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+The Project Gutenberg EBook of Anomalies and Curiosities of Medicine, by 
+George M. Gould and Walter Lytle Pyle
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Anomalies and Curiosities of Medicine
+
+Author: George M. Gould
+        Walter Lytle Pyle
+
+Posting Date: August 3, 2008 [EBook #747]
+Release Date: December, 1996
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK ANOMALIES, CURIOSITIES OF MEDICINE ***
+
+
+
+
+Produced by Charles Keller.  HTML version by Al Haines.
+
+
+
+
+
+
+
+
+
+ANOMALIES and CURIOSITIES of MEDICINE
+
+Being an encyclopedic collection of rare and extraordinary cases, and
+of the most striking instances of abnormality in all branches of
+medicine and surgery, derived from an exhaustive research of medical
+literature from its origin to the present day, abstracted, classified,
+annotated, and indexed.
+
+by GEORGE M. GOULD, A.M., M.D. and WALTER L. PYLE, A.M., M.D.
+
+
+
+PREFATORY AND INTRODUCTORY.
+
+----
+
+Since the time when man's mind first busied itself with subjects beyond
+his own self-preservation and the satisfaction of his bodily appetites,
+the anomalous and curious have been of exceptional and persistent
+fascination to him; and especially is this true of the construction and
+functions of the human body.  Possibly, indeed, it was the anomalous
+that was largely instrumental in arousing in the savage the attention,
+thought, and investigation that were finally to develop into the body
+of organized truth which we now call Science. As by the aid of
+collected experience and careful inference we to-day endeavor to pass
+our vision into the dim twilight whence has emerged our civilization,
+we find abundant hint and even evidence of this truth. To the highest
+type of philosophic minds it is the usual and the ordinary that demand
+investigation and explanation. But even to such, no less than to the
+most naive-minded, the strange and exceptional is of absorbing
+interest, and it is often through the extraordinary that the
+philosopher gets the most searching glimpses into the heart of the
+mystery of the ordinary. Truly it has been said, facts are stranger
+than fiction. In monstrosities and dermoid cysts, for example, we seem
+to catch forbidden sight of the secret work-room of Nature, and drag
+out into the light the evidences of her clumsiness, and proofs of her
+lapses of skill,--evidences and proofs, moreover, that tell us much of
+the methods and means used by the vital artisan of Life,--the loom, and
+even the silent weaver at work upon the mysterious garment of
+corporeality.
+
+"La premiere chose qui s'offre a l' Homme quand il se regarde, c'est
+son corps," says Pascal, and looking at the matter more closely we find
+that it was the strange and mysterious things of his body that occupied
+man's earliest as well as much of his later attention. In the
+beginning, the organs and functions of generation, the mysteries of
+sex, not the routine of digestion or of locomotion, stimulated his
+curiosity, and in them he recognized, as it were, an unseen hand
+reaching down into the world of matter and the workings of bodily
+organization, and reining them to impersonal service and far-off ends.
+All ethnologists and students of primitive religion well know the role
+that has been played in primitive society by the genetic instincts.
+Among the older naturalists, such as Pliny and Aristotle, and even in
+the older historians, whose scope included natural as well as civil and
+political history, the atypic and bizarre, and especially the
+aberrations of form or function of the generative organs, caught the
+eye most quickly. Judging from the records of early writers, when
+Medicine began to struggle toward self-consciousness, it was again the
+same order of facts that was singled out by the attention. The very
+names applied by the early anatomists to many structures so widely
+separated from the organs of generation as were those of the brain,
+give testimony of the state of mind that led to and dominated the
+practice of dissection.
+
+In the literature of the past centuries the predominance of the
+interest in the curious is exemplified in the almost ludicrously
+monotonous iteration of titles, in which the conspicuous words are
+curiosa, rara, monstruosa, memorabilia, prodigiosa, selecta, exotica,
+miraculi, lusibus naturae, occultis naturae, etc., etc.  Even when
+medical science became more strict, it was largely the curious and rare
+that were thought worthy of chronicling, and not the establishment or
+illustration of the common, or of general principles. With all his
+sovereign sound sense, Ambrose Pare has loaded his book with references
+to impossibly strange, and even mythologic cases.
+
+In our day the taste seems to be insatiable, and hardly any medical
+journal is without its rare or "unique" case, or one noteworthy chiefly
+by reason of its anomalous features. A curious case is invariably
+reported, and the insertion of such a report is generally productive of
+correspondence and discussion with the object of finding a parallel for
+it.
+
+In view of all this it seems itself a curious fact that there has never
+been any systematic gathering of medical curiosities. It would have
+been most natural that numerous encyclopedias should spring into
+existence in response to such a persistently dominant interest. The
+forelying volume appears to be the first thorough attempt to classify
+and epitomize the literature of this nature.  It has been our purpose
+to briefly summarize and to arrange in order the records of the most
+curious, bizarre, and abnormal cases that are found in medical
+literature of all ages and all languages--a thaumatographia medica. It
+will be readily seen that such a collection must have a function far
+beyond the satisfaction of mere curiosity, even if that be stigmatized
+with the word "idle." If, as we believe, reference may here be found to
+all such cases in the literature of Medicine (including Anatomy,
+Physiology, Surgery, Obstetrics, etc.) as show the most extreme and
+exceptional departures from the ordinary, it follows that the future
+clinician and investigator must have use for a handbook that decides
+whether his own strange case has already been paralleled or excelled.
+He will thus be aided in determining the truth of his statements and
+the accuracy of his diagnoses.  Moreover, to know extremes gives
+directly some knowledge of means, and by implication and inference it
+frequently does more.  Remarkable injuries illustrate to what extent
+tissues and organs may be damaged without resultant death, and thus the
+surgeon is encouraged to proceed to his operation with greater
+confidence and more definite knowledge as to the issue. If a mad cow
+may blindly play the part of a successful obstetrician with her horns,
+certainly a skilled surgeon may hazard entering the womb with his
+knife. If large portions of an organ,--the lung, a kidney, parts of the
+liver, or the brain itself,--may be lost by accident, and the patient
+still live, the physician is taught the lesson of nil desperandum, and
+that if possible to arrest disease of these organs before their total
+destruction, the prognosis and treatment thereby acquire new and more
+hopeful phases.
+
+Directly or indirectly many similar examples have also clear
+medicolegal bearings or suggestions; in fact, it must be acknowledged
+that much of the importance of medical jurisprudence lies in a thorough
+comprehension of the anomalous and rare cases in Medicine. Expert
+medical testimony has its chief value in showing the possibilities of
+the occurrence of alleged extreme cases, and extraordinary deviations
+from the natural. Every expert witness should be able to maintain his
+argument by a full citation of parallels to any remarkable theory or
+hypothesis advanced by his clients; and it is only by an exhaustive
+knowledge of extremes and anomalies that an authority on medical
+jurisprudence can hope to substantiate his testimony beyond question.
+In every poisoning case he is closely questioned as to the largest dose
+of the drug in question that has been taken with impunity, and the
+smallest dose that has killed, and he is expected to have the cases of
+reported idiosyncrasies and tolerance at his immediate command. A widow
+with a child of ten months' gestation may be saved the loss of
+reputation by mention of the authentic cases in which pregnancy has
+exceeded nine months' duration; the proof of the viability of a seven
+months' child may alter the disposition of an estate; the proof of
+death by a blow on the epigastrium without external marks of violence
+may convict a murderer; and so it is with many other cases of a
+medicolegal nature.
+
+It is noteworthy that in old-time medical literature--sadly and
+unjustly neglected in our rage for the new--should so often be found
+parallels of our most wonderful and peculiar modern cases.  We wish,
+also, to enter a mild protest against the modern egotism that would set
+aside with a sneer as myth and fancy the testimonies and reports of
+philosophers and physicians, only because they lived hundreds of years
+ago. We are keenly appreciative of the power exercised by the
+myth-making faculty in the past, but as applied to early physicians, we
+suggest that the suspicion may easily be too active. When Pare, for
+example, pictures a monster, we may distrust his art, his artist, or
+his engraver, and make all due allowance for his primitive knowledge of
+teratology, coupled with the exaggerations and inventions of the
+wonder-lover; but when he describes in his own writing what he or his
+confreres have seen on the battle-field or in the dissecting room, we
+think, within moderate limits, we owe him credence. For the rest, we
+doubt not that the modern reporter is, to be mild, quite as much of a
+myth-maker as his elder brother, especially if we find modern instances
+that are essentially like the older cases reported in reputable
+journals or books, and by men presumably honest. In our collection we
+have endeavored, so far as possible, to cite similar cases from the
+older and from the more recent literature.
+
+This connection suggests the question of credibility in general.  It
+need hardly be said that the lay-journalist and newspaper reporter have
+usually been ignored by us, simply because experience and investigation
+have many times proved that a scientific fact, by presentation in most
+lay-journals, becomes in some mysterious manner, ipso facto, a
+scientific caricature (or worse!), and if it is so with facts, what
+must be the effect upon reports based upon no fact whatsoever? It is
+manifestly impossible for us to guarantee the credibility of chronicles
+given. If we have been reasonably certain of unreliability, we may not
+even have mentioned the marvelous statement. Obviously, we could do no
+more with apparently credible cases, reported by reputable medical men,
+than to cite author and source and leave the matter there, where our
+responsibility must end.
+
+But where our proper responsibility seemed likely never to end was in
+carrying out the enormous labor requisite for a reasonable certainty
+that we had omitted no searching that might lead to undiscovered facts,
+ancient or modern. Choice in selection is always, of course, an affair
+de gustibus, and especially when, like the present, there is
+considerable embarrassment of riches, coupled with the purpose of
+compressing our results in one handy volume. In brief, it may be said
+that several years of exhaustive research have been spent by us in the
+great medical libraries of the United States and Europe in collecting
+the material herewith presented. If, despite of this, omissions and
+errors are to be found, we shall be grateful to have them pointed out.
+It must be remembered that limits of space have forbidden satisfactory
+discussion of the cases, and the prime object of the whole work has
+been to carefully collect and group the anomalies and curiosities, and
+allow the reader to form his own conclusions and make his own
+deductions.
+
+As the entire labor in the preparation of the forelying volume, from
+the inception of the idea to the completion of the index, has been
+exclusively the personal work of the authors, it is with full
+confidence of the authenticity of the reports quoted that the material
+is presented.
+
+Complete references are given to those facts that are comparatively
+unknown or unique, or that are worthy of particular interest or further
+investigation. To prevent unnecessary loading of the book with
+foot-notes, in those instances in which there are a number of cases of
+the same nature, and a description has not been thought necessary, mere
+citation being sufficient, references are but briefly given or omitted
+altogether. For the same reason a bibliographic index has been added at
+the end of the text. This contains the most important sources of
+information used, and each journal or book therein has its own number,
+which is used in its stead all through the book (thus, 476 signifies
+The Lancet, London; 597, the New York Medical Journal; etc.).  These
+bibliographic numbers begin at 100.
+
+Notwithstanding that every effort has been made to conveniently and
+satisfactorily group the thousands of cases contained in the book (a
+labor of no small proportions in itself), a complete general index is a
+practical necessity for the full success of what is essentially a
+reference-volume, and consequently one has been added, in which may be
+found not only the subjects under consideration and numerous
+cross-references, but also the names of the authors of the most
+important reports. A table of contents follows this preface.
+
+We assume the responsibility for innovations in orthography, certain
+abbreviations, and the occasional substitution of figures for large
+numerals, fractions, and decimals, made necessary by limited space, and
+in some cases to more lucidly show tables and statistics. From the
+variety of the reports, uniformity of nomenclature and numeration is
+almost impossible.
+
+As we contemplate constantly increasing our data, we shall be glad to
+receive information of any unpublished anomalous or curious cases,
+either of the past or in the future.
+
+For many courtesies most generously extended in aiding our
+research-work we wish, among others, to acknowledge our especial
+gratitude and indebtedness to the officers and assistants of the
+Surgeon-General's Library at Washington, D.C., the Library of the Royal
+College of Surgeons of London, the Library of the British Museum, the
+Library of the British Medical Association, the Bibliotheque de Faculte
+de Medecine de Paris, the Bibliotheque Nationale, and the Library of
+the College of Physicians of Philadelphia.
+
+                                  GEORGE M. GOULD.
+PHILADELPHIA, October, 1896.      WALTER L. PYLE.
+
+
+
+TABLE OF CONTENTS.
+
+CHAPTER                                                   PAGES
+
+I. GENETIC ANOMALIES . . . . . . . . . . . . . . . . .    17-49
+
+II. PRENATAL ANOMALIES . . . . . . . . . . . . . . . .   50-112
+
+III. OBSTETRIC ANOMALIES . . . . . . . . . . . . . . .  113-143
+
+IV. PROLIFICITY  . . . . . . . . . . . . . . . . . . .  144-160
+
+V. MAJOR TERATA  . . . . . . . . . . . . . . . . . . .  161-212
+
+VI. MINOR TERATA . . . . . . . . . . . . . . . . . . .  213-323
+
+VII. ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT . . .  324-364
+
+VIII. LONGEVITY  . . . . . . . . . . . . . . . . . . .  365-382
+
+IX. PHYSIOLOGIC AND FUNCTIONAL ANOMALIES . . . . . . .  383-526
+
+X. SURGICAL ANOMALIES OF THE HEAD AND NECK . . . . . .  527-587
+
+XI. SURGICAL ANOMALIES OF THE EXTREMITIES  . . . . . .  588-605
+
+XII. SURGICAL ANOMALIES OF THE THORAX AND ABDOMEN  . .  606-666
+
+XIII. SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM .  667-696
+
+XIV. MISCELLANEOUS SURGICAL ANOMALIES  . . . . . . . .  697-758
+
+XV. ANOMALOUS TYPES AND INSTANCES OF DISEASE . . . . .  759-822
+
+XVI. ANOMALOUS SKIN-DISEASES . . . . . . . . . . . . .  823-851
+
+XVII. ANOMALOUS NERVOUS AND MENTAL DISEASES  . . . . .  852-890
+
+XVIII. HISTORIC EPIDEMICS  . . . . . . . . . . . . . .  891-914
+
+
+
+
+ANOMALIES AND CURIOSITIES OF MEDICINE.
+
+
+
+CHAPTER I.
+
+GENETIC ANOMALIES.
+
+Menstruation has always been of interest, not only to the student of
+medicine, but to the lay-observer as well. In olden times there were
+many opinions concerning its causation, all of which, until the era of
+physiologic investigation, were of superstitious derivation. Believing
+menstruation to be the natural means of exit of the feminine bodily
+impurities, the ancients always thought a menstruating woman was to be
+shunned; her very presence was deleterious to the whole animal economy,
+as, for instance, among the older writers we find that Pliny remarks:
+"On the approach of a woman in this state, must will become sour, seeds
+which are touched by her become sterile, grass withers away, garden
+plants are parched up, and the fruit will fall from the tree beneath
+which she sits." He also says that the menstruating women in Cappadocia
+were perambulated about the fields to preserve the vegetation from
+worms and caterpillars. According to Flemming, menstrual blood was
+believed to be so powerful that the mere touch of a menstruating woman
+would render vines and all kinds of fruit-trees sterile. Among the
+indigenous Australians, menstrual superstition was so intense that one
+of the native blacks, who discovered his wife lying on his blanket
+during her menstrual period, killed her, and died of terror himself in
+a fortnight. Hence, Australian women during this season are forbidden
+to touch anything that men use. Aristotle said that the very look of a
+menstruating woman would take the polish out of a mirror, and the next
+person looking in it would be bewitched.  Frommann mentions a man who
+said he saw a tree in Goa which withered because a catamenial napkin
+was hung on it. Bourke remarks that the dread felt by the American
+Indians in this respect corresponds with the particulars recited by
+Pliny. Squaws at the time of menstrual purgation are obliged to seclude
+themselves, and in most instances to occupy isolated lodges, and in all
+tribes are forbidden to prepare food for anyone save themselves. It was
+believed that, were a menstruating woman to step astride a rifle, a
+bow, or a lance, the weapon would have no utility. Medicine men are in
+the habit of making a "protective" clause whenever they concoct a
+"medicine," which is to the effect that the "medicine" will be
+effective provided that no woman in this condition is allowed to
+approach the tent of the official in charge.
+
+Empiricism had doubtless taught the ancient husbands the dangers of
+sexual intercourse during this period, and the after-results of many
+such connections were looked upon as manifestations of the
+contagiousness of the evil excretions issuing at this period.  Hence at
+one time menstruation was held in much awe and abhorrence.
+
+On the other hand, in some of the eastern countries menstruation was
+regarded as sacred, and the first menstrual discharge was considered so
+valuable that premenstrual marriages were inaugurated in order that the
+first ovum might not be wasted, but fertilized, because it was supposed
+to be the purest and best for the purpose. Such customs are extant at
+the present day in some parts of India, despite the efforts of the
+British Government to suppress them, and descriptions of
+child-marriages and their evil results have often been given by
+missionaries.
+
+As the advances of physiology enlightened the mind as to the true
+nature of the menstrual period, and the age of superstition gradually
+disappeared, the intense interest in menstruation vanished, and now,
+rather than being held in fear and awe, the physicians of to-day
+constantly see the results of copulation during this period. The
+uncontrollable desire of the husband and the mercenary aims of the
+prostitute furnish examples of modern disregard.
+
+The anomalies of menstruation must naturally have attracted much
+attention, and we find medical literature of all times replete with
+examples. While some are simply examples of vicarious or compensatory
+menstruation, and were so explained even by the older writers, there
+are many that are physiologic curiosities of considerable interest.
+Lheritier furnishes the oft-quoted history of the case of a young girl
+who suffered from suppression of menses, which, instead of flowing
+through the natural channels, issued periodically from vesicles on the
+leg for a period of six months, when the seat of the discharge changed
+to an eruption on the left arm, and continued in this location for one
+year; then the discharge shifted to a sore on the thumb, and at the end
+of another six months again changed, the next location being on the
+upper eyelid; here it continued for a period of two years.  Brierre de
+Boismont and Meisner describe a case apparently identical with the
+foregoing, though not quoting the source.
+
+Haller, in a collection of physiologic curiosities covering a period of
+a century and a half, cites 18 instances of menstruation from the skin.
+Parrot has also mentioned several cases of this nature. Chambers speaks
+of bloody sweat occurring periodically in a woman of twenty-seven; the
+intervals, however, were occasionally but a week or a fortnight, and
+the exudation was not confined to any one locality. Van Swieten quotes
+the history of a case of suppression of the menstrual function in which
+there were convulsive contractions of the body, followed by paralysis
+of the right arm. Later on, the patient received a blow on the left eye
+causing amaurosis; swelling of this organ followed, and one month later
+blood issued from it, and subsequently blood oozed from the skin of the
+nose, and ran in jets from the skin of the fingers and from the nails.
+
+D'Andrade cites an account of a healthy Parsee lady, eighteen years of
+age, who menstruated regularly from thirteen to fifteen and a half
+years; the catamenia then became irregular and she suffered occasional
+hemorrhages from the gums and nose, together with attacks of
+hematemesis. The menstruation returned, but she never became pregnant,
+and, later, blood issued from the healthy skin of the left breast and
+right forearm, recurring every month or two, and finally additional
+dermal hemorrhage developed on the forehead. Microscopic examination of
+the exuded blood showed usual constituents present. There are two
+somewhat similar cases spoken of in French literature. The first was
+that of a young lady, who, after ten years' suppression of the
+menstrual discharge, exhibited the flow from a vesicular eruption on
+the finger. The other case was quite peculiar, the woman being a
+prostitute, who menstruated from time to time through spots, the size
+of a five-franc piece, developing on the breasts, buttocks, back,
+axilla, and epigastrium. Barham records a case similar to the
+foregoing, in which the menstruation assumed the character of periodic
+purpura. Duchesne mentions an instance of complete amenorrhea, in which
+the ordinary flow was replaced by periodic sweats.
+
+Parrot speaks of a woman who, when seven months old, suffered from
+strumous ulcers, which left cicatrices on the right hand, from whence,
+at the age of six years, issued a sanguineous discharge with associate
+convulsions. One day, while in violent grief, she shed bloody tears.
+She menstruated at the age of eleven, and was temporarily improved in
+her condition; but after any strong emotion the hemorrhages returned.
+The subsidence of the bleeding followed her first pregnancy, but
+subsequently on one occasion, when the menses were a few days in
+arrears, she exhibited a blood-like exudation from the forehead,
+eyelids, and scalp. As in the case under D'Andrade's observation, the
+exudation was found by microscopic examination to consist of the true
+constituents of blood. An additional element of complication in this
+case was the occurrence of occasional attacks of hematemesis.
+
+Menstruation from the Breasts.--Being in close sympathy with the
+generative function, we would naturally expect to find the female
+mammae involved in cases of anomalous menstruation, and the truth of
+this supposition is substantiated in the abundance of such cases on
+record. Schenck reports instances of menstruation from the nipple; and
+Richter, de Fontechia, Laurentius, Marcellus Donatus, Amatus Lusitanus,
+and Bierling are some of the older writers who have observed this
+anomaly. Pare says the wife of Pierre de Feure, an iron merchant,
+living at Chasteaudun, menstruated such quantities from the breasts
+each month that several serviettes were necessary to receive the
+discharge.  Cazenave details the history of a case in which the mammary
+menstruation was associated with a similar exudation from the face, and
+Wolff saw an example associated with hemorrhage from the fauces. In the
+Lancet (1840-1841) is an instance of monthly discharge from beneath the
+left mamma. Finley also writes of an example of mammary hemorrhage
+simulating menstruation. Barnes saw a case in St. George's Hospital,
+London, 1876, in which the young girl menstruated vicariously from the
+nipple and stomach. In a London discussion there was mentioned the case
+of a healthy woman of fifty who never was pregnant, and whose
+menstruation had ceased two years previously, but who for twelve months
+had menstruated regularly from the nipples, the hemorrhage being so
+profuse as to require constant change of napkins. The mammae were large
+and painful, and the accompanying symptoms were those of ordinary
+menstruation. Boulger mentions an instance of periodic menstrual
+discharge from beneath the left mamma. Jacobson speaks of habitual
+menstruation by both breasts. Rouxeau describes amenorrhea in a girl of
+seventeen, who menstruated from the breast; and Teufard reports a case
+in which there was reestablishment of menstruation by the mammae at the
+age of fifty-six. Baker details in full the description of a case of
+vicarious menstruation from an ulcer on the right mamma of a woman of
+twenty. At the time he was called to see her she was suffering with
+what was called "green-sickness." The girl had never menstruated
+regularly or freely. The right mamma was quite well developed, flaccid,
+the nipple prominent, and the superficial veins larger and more
+tortuous than usual. The patient stated that the right mamma had always
+been larger than the left. The areola was large and well marked, and
+1/4 inch from its outer edge, immediately under the nipple, there was
+an ulcer with slightly elevated edges measuring about 1 1/4 inches
+across the base, and having an opening in its center 1/4 inch in
+diameter, covered with a thin scab. By removing the scab and making
+pressure at the base of the ulcer, drops of thick, mucopurulent matter
+were made to exude. This discharge, however, was not offensive to the
+smell. On March 17, 1846, the breast became much enlarged and
+congested, as portrayed in Plate 1. The ulcer was much inflamed and
+painful, the veins corded and deep colored, and there was a free
+discharge of sanguineous yellowish matter. When the girl's general
+health improved and menstruation became more natural, the vicarious
+discharge diminished in proportion, and the ulcer healed shortly
+afterward. Every month this breast had enlarged, the ulcer became
+inflamed and discharged vicariously, continuing in this manner for a
+few days, with all the accompanying menstrual symptoms, and then dried
+up gradually. It was stated that the ulcer was the result of the girl's
+stooping over some bushes to take an egg from a hen's nest, when the
+point of a palmetto stuck in her breast and broke off. The ulcer
+subsequently formed, and ultimately discharged a piece of palmetto.
+This happened just at the time of the beginning of the menstrual epoch.
+The accompanying figures, Plate 1, show the breast in the ordinary
+state and at the time of the anomalous discharge.
+
+Hancock relates an instance of menstruation from the left breast in a
+large, otherwise healthy, Englishwoman of thirty-one, who one and a
+half years after the birth of the youngest child (now ten years old)
+commenced to have a discharge of fluid from the left breast three days
+before the time of the regular period. As the fluid escaped from the
+nipple it became changed in character, passing from a whitish to a
+bloody and to a yellowish color respectively, and suddenly terminating
+at the beginning of the real flow from the uterus, to reappear again at
+the breast at the close of the flow, and then lasting two or three days
+longer.  Some pain of a lancinating type occurred in the breast at this
+time. The patient first discovered her peculiar condition by a stain of
+blood upon the night-gown on awakening in the morning, and this she
+traced to the breast. From an examination it appeared that a neglected
+lacerated cervix during the birth of the last child had given rise to
+endometritis, and for a year the patient had suffered from severe
+menorrhagia, for which she was subsequently treated. At this time the
+menses became scanty, and then supervened the discharge of bloody fluid
+from the left breast, as heretofore mentioned. The right breast
+remained always entirely passive. A remarkable feature of the case was
+that some escape of fluid occurred from the left breast during coitus.
+As a possible means of throwing light on this subject it may be added
+that the patient was unusually vigorous, and during the nursing of her
+two children she had more than the ordinary amount of milk
+(galactorrhea), which poured from the breast constantly. Since this
+time the breasts had been quite normal, except for the tendency
+manifested in the left one under the conditions given.
+
+Cases of menstruation through the eyes are frequently mentioned by the
+older writers. Bellini, Hellwig, and Dodonaeus all speak of
+menstruation from the eye. Jonston quotes an example of ocular
+menstruation in a young Saxon girl, and Bartholinus an instance
+associated with bloody discharge of the foot. Guepin has an example in
+a case of a girl of eighteen, who commenced to menstruate when three
+years old. The menstruation was tolerably regular, occurring every
+thirty-two or thirty-three days, and lasting from one to six days. At
+the cessation of the menstrual flow, she generally had a supplementary
+epistaxis, and on one occasion, when this was omitted, she suffered a
+sudden effusion into the anterior chamber of the eye. The discharge had
+only lasted two hours on this occasion. He also relates an example of
+hemorrhage into the vitreous humor in a case of amenorrhea.
+Conjunctival hemorrhage has been noticed as a manifestation of
+vicarious menstruation by several American observers. Liebreich found
+examples of retinal hemorrhage in suppressed menstruation, and Sir
+James Paget says that he has seen a young girl at Moorfields who had a
+small effusion of blood into the anterior chamber of the eye at the
+menstrual period, which became absorbed during the intervals of
+menstruation. Blair relates the history of a case of vicarious
+menstruation attended with conjunctivitis and opacity of the cornea.
+Law speaks of a plethoric woman of thirty who bled freely from the
+eyes, though menstruating regularly.
+
+Relative to menstruation from the ear, Spindler, Paullini, and Alibert
+furnish examples. In Paullini's case the discharge is spoken of as very
+foul, which makes it quite possible that this was a case of middle-ear
+disease associated with some menstrual disturbance, and not one of true
+vicarious menstruation.  Alibert's case was consequent upon suppression
+of the menses. Law cites an instance in a woman of twenty-three, in
+whom the menstrual discharge was suspended several months. She
+experienced fulness of the head and bleeding (largely from the ears),
+which subsequently occurred periodically, being preceded by much
+throbbing; but the patient finally made a good recovery. Barnes,
+Stepanoff, and Field adduce examples of this anomaly. Jouilleton
+relates an instance of menstruation from the right ear for five years,
+following a miscarriage.
+
+Hemorrhage from the mouth of a vicarious nature has been frequently
+observed associated with menstrual disorders. The Ephemerides,
+Meibomius, and Rhodius mention instances. The case of Meibomius was
+that of an infant, and the case mentioned by Rhodius was associated
+with hemorrhages from the lungs, umbilicus, thigh, and tooth-cavity.
+Allport reports the history of a case in which there was recession of
+the gingival margins and alveolar processes, the consequence of
+amenorrhea. Caso has an instance of menstruation from the gums, and
+there is on record the description of a woman, aged thirty-two, who had
+bleeding from the throat preceding menstruation; later the menstruation
+ceased to be regular, and four years previously, after an unfortunate
+and violent connection, the menses ceased, and the woman soon developed
+hemorrhoids and hemoptysis. Henry speaks of a woman who menstruated
+from the mouth; at the necropsy 207 stones were found in the
+gall-bladder. Krishaber speaks of a case of lingual menstruation at the
+epoch of menstruation.
+
+Descriptions of menstruation from the extremities are quite numerous.
+Pechlin offers an example from the foot; Boerhaave from the skin of the
+hand; Ephemerides from the knee; Albertus from the foot; Zacutus
+Lusitanus from the left thumb; Bartholinus a curious instance from the
+hand; and the Ephemerides another during pregnancy from the ankle.
+
+Post speaks of a very peculiar case of edema of the arm alternating
+with the menstrual discharge. Sennert writes of menstruation from the
+groin associated with hemorrhage from the umbilicus and gums. Moses
+offers an example of hemorrhage from the umbilicus, doubtless
+vicarious. Verduc details the history of two cases from the top of the
+head, and Kerokring cites three similar instances, one of which was
+associated with hemorrhage from the hand.
+
+A peculiar mode is vicarious menstrual hemorrhage through old ulcers,
+wounds, or cicatrices, and many examples are on record, a few of which
+will be described. Calder gives an excellent account of menstruation at
+an ankle-ulcer, and Brincken says he has seen periodical bleeding from
+the cicatrix of a leprous ulcer. In the Lancet is an account of a case
+in the Vienna Hospital of simulated stigmata; the scar opened each
+month and a menstrual flow proceeded therefrom; but by placing a
+plaster-of-Paris bandage about the wound, sealing it so that tampering
+with the wound could be easily detected, healing soon ensued, and the
+imposture was thus exposed. Such would likely be the result of the
+investigation of most cases of "bleeding wounds" which are exhibited to
+the ignorant and superstitious for religious purposes.
+
+Hogg publishes a report describing a young lady who injured her leg
+with the broken steel of her crinoline. The wound healed nicely, but
+always burst out afresh the day preceding the regular period. Forster
+speaks of a menstrual ulcer of the face, and Moses two of the head.
+White, quoted by Barnes, cites an instance of vicarious hemorrhage from
+five deep fissures of the lips in a girl of fourteen; the hemorrhage
+was periodical and could not be checked. At the advent of each
+menstrual period the lips became much congested, and the
+recently-healed menstrual scars burst open anew.
+
+Knaggs relates an interesting account of a sequel to an operation for
+ovarian disease. Following the operation, there was a regular, painless
+menstruation every month, at which time the lower part of the wound
+re-opened, and blood issued forth during the three days of the
+catamenia. McGraw illustrates vicarious menstruation by an example, the
+discharge issuing from an ovariotomy-scar, and Hooper cites an instance
+in which the vicarious function was performed by a sloughing ulcer.
+Buchanan and Simpson describe "amenorrheal ulcers." Dupuytren speaks of
+denudation of the skin from a burn, with the subsequent development of
+vicarious catamenia from the seat of the injury.
+
+There are cases on record in which the menstruation occurs by the
+rectum or the urinary tract. Barbee illustrates this by a case in which
+cholera morbus occurred monthly in lieu of the regular menstrual
+discharge. Barrett speaks of a case of vicarious menstruation by the
+rectum. Astbury says he has seen a case of menstruation by the
+hemorrhoidal vessels, and instances of relief from plethora by
+vicarious menstruation in this manner are quite common. Rosenbladt
+cites an instance of menstruation by the bladder, and Salmuth speaks of
+a pregnant woman who had her monthly flow by the urinary tract. Ford
+illustrates this anomaly by the case of a woman of thirty-two, who
+began normal menstruation at fourteen; for quite a period she had
+vicarious menstruation from the urinary tract, which ceased after the
+birth of her last child. The coexistence of a floating kidney in this
+case may have been responsible for this hemorrhage, and in reading
+reports of so-called menstruation due consideration must be given to
+the existence of any other than menstrual derangement before we can
+accept the cases as true vicarious hemorrhage.  Tarnier cites an
+instance of a girl without a uterus, in whom menstruation proceeded
+from the vagina. Zacutus Lusitanus relates the history of a case of
+uterine occlusion, with the flow from the lips of the cervix. There is
+mentioned an instance of menstruation from the labia.
+
+The occurrence of menstruation after removal of the uterus or ovaries
+is frequently reported. Storer, Clay, Tait, and the British and Foreign
+Medico-Chirurgical Review report cases in which menstruation took place
+with neither uterus nor ovary.  Doubtless many authentic instances like
+the preceding could be found to-day. Menstruation after hysterectomy
+and ovariotomy has been attributed to the incomplete removal of the
+organs in question, yet upon postmortem examination of some cases no
+vestige of the functional organs in question has been found.
+
+Hematemesis is a means of anomalous menstruation, and several instances
+are recorded. Marcellus Donatus and Benivenius exemplify this with
+cases. Instances of vicarious and compensatory epistaxis and hemoptysis
+are so common that any examples would be superfluous. There is recorded
+an inexplicable case of menstruation from the region of the sternum,
+and among the curious anomalies of menstruation must be mentioned that
+reported by Parvin seen in a woman, who, at the menstrual epoch,
+suffered hemoptysis and oozing of blood from the lips and tongue.
+Occasionally there was a substitution of a great swelling of the
+tongue, rendering mastication and articulation very difficult for four
+or five days. Parvin gives portraits showing the venous congestion and
+discoloration of the lips.
+
+Instances of migratory menstruation, the flow moving periodically from
+the ordinary passage to the breasts and mammae, are found in the older
+writers. Salmuth speaks of a woman on whose hands appeared spots
+immediately before the establishment of the menses. Cases of
+semimonthly menstruation and many similar anomalies of periodicity are
+spoken of.
+
+The Ephemerides contains an instance of the simulation of menstruation
+after death, and Testa speaks of menstruation lasting through a long
+sleep. Instances of black menstruation are to be found, described in
+full, in the Ephemerides, by Paullini and by Schurig, and in some of
+the later works; it is possible that an excess of iron, administered
+for some menstrual disorder, may cause such an alteration in the color
+of the menstrual fluid.
+
+Suppression of menstruation is brought about in many peculiar ways, and
+sometimes by the slightest of causes, some authentic instances being so
+strange as to seem mythical. Through the Ephemerides we constantly read
+of such causes as contact with a corpse, the sight of a serpent or
+mouse, the sight of monsters, etc. Lightning stroke and curious
+neuroses have been reported as causes. Many of the older books on
+obstetric subjects are full of such instances, and modern illustrations
+are constantly reported.
+
+Menstruation in Man.--Periodic discharges of blood in man, constituting
+what is called "male menstruation," have been frequently noticed and
+are particularly interesting when the discharge is from the penis or
+urethra, furnishing a striking analogy to the female function of
+menstruation. The older authors quoted several such instances, and
+Mehliss says that in the ancient days certain writers remarked that
+catamenial lustration from the penis was inflicted on the Jews as a
+divine punishment.  Bartholinus mentions a case in a youth; the
+Ephemerides several instances; Zacutus Lusitanus, Salmuth, Hngedorn,
+Fabricius Hildanus, Vesalius, Mead, and Acta Eruditorum all mention
+instances. Forel saw menstruation in a man. Gloninger tells of a man of
+thirty-six, who, since the age of seventeen years and five months, had
+had lunar manifestations of menstruation. Each attack was accompanied
+by pains in the back and hypogastric region, febrile disturbance, and a
+sanguineous discharge from the urethra, which resembled in color,
+consistency, etc., the menstrual flux. King relates that while
+attending a course of medical lectures at the University of Louisiana
+he formed the acquaintance of a young student who possessed the normal
+male generative organs, but in whom the simulated function of
+menstruation was periodically performed. The cause was inexplicable,
+and the unfortunate victim was the subject of deep chagrin, and was
+afflicted with melancholia. He had menstruated for three years in this
+manner: a fluid exuded from the sebaceous glands of the deep fossa
+behind the corona glandis; this fluid was of the same appearance as the
+menstrual flux. The quantity was from one to two ounces, and the
+discharge lasted from three to six days. At this time the student was
+twenty-two years of age, of a lymphatic temperament, not particularly
+lustful, and was never the victim of any venereal disease. The author
+gives no account of the after-life of this man, his whereabouts being,
+unfortunately, unknown or omitted.
+
+Vicarious Menstruation in the Male.--This simulation of menstruation by
+the male assumes a vicarious nature as well as in the female. Van
+Swieten, quoting from Benivenius, relates a case of a man who once a
+month sweated great quantities of blood from his right flank. Pinel
+mentions a case of a captain in the army (M. Regis), who was wounded by
+a bullet in the body and who afterward had a monthly discharge from the
+urethra. Pinel calls attention particularly to the analogy in this case
+by mentioning that if the captain were exposed to fatigue, privation,
+cold, etc., he exhibited the ordinary symptoms of amenorrhea or
+suppression. Fournier speaks of a man over thirty years old, who had
+been the subject of a menstrual evacuation since puberty, or shortly
+after his first sexual intercourse. He would experience pains of the
+premenstrual type, about twenty-four hours before the appearance of the
+flow, which subsided when the menstruation began. He was of an
+intensely voluptuous nature, and constantly gave himself up to sexual
+excesses. The flow was abundant on the first day, diminished on the
+second, and ceased on the third.  Halliburton, Jouilleton, and Rayman
+also record male menstruation.
+
+Cases of menstruation during pregnancy and lactation are not rare. It
+is not uncommon to find pregnancy, lactation, and menstruation
+coexisting. No careful obstetrician will deny pregnancy solely on the
+regular occurrence of the menstrual periods, any more than he would
+make the diagnosis of pregnancy from the fact of the suppression of
+menses. Blake reports an instance of catamenia and mammary secretion
+during pregnancy.  Denaux de Breyne mentions a similar case. The child
+was born by a face-presentation. De Saint-Moulin cites an instance of
+the persistence of menstruation during pregnancy in a woman of
+twenty-four, who had never been regular; the child was born at term.
+Gelly speaks of a case in which menstruation continued until the third
+month of pregnancy, when abortion occurred. Post, in describing the
+birth of a two-pound child, mentions that menstruation had persisted
+during the mother's pregnancy. Rousset reports a peculiar case in which
+menstruation appeared during the last four months of pregnancy.
+
+There are some cases on record of child-bearing after the menopause,
+as, for instance, that of Pearson, of a woman who had given birth to
+nine children up to September, 1836; after this the menses appeared
+only slightly until July, 1838, when they ceased entirely. A year and a
+half after this she was delivered of her tenth child. Other cases,
+somewhat similar, will be found under the discussion of late conception.
+
+Precocious menstruation is seen from birth to nine or ten years.  Of
+course, menstruation before the third or fourth year is extremely rare,
+most of the cases reported before this age being merely accidental
+sanguineous discharges from the genitals, not regularly periodical, and
+not true catamenia. However, there are many authentic cases of
+infantile menstruation on record, which were generally associated with
+precocious development in other parts as well. Billard says that the
+source of infantile menstruation is the lining membrane of the uterus;
+but Camerer explains it as due to ligature of the umbilical cord before
+the circulation in the pulmonary vessels is thoroughly established.  In
+the consideration of this subject, we must bear in mind the influence
+of climate and locality on the time of the appearance of menstruation.
+In the southern countries, girls arrive at maturity at an earlier age
+than their sisters of the north.  Medical reports from India show early
+puberty of the females of that country. Campbell remarks that girls
+attain the age of puberty at twelve in Siam, while, on the contrary,
+some observers report the fact that menstruation does not appear in the
+Esquimaux women until the age of twenty-three, and then is very scanty,
+and is only present in the summer months.
+
+Cases of menstruation commencing within a few days after birth and
+exhibiting periodical recurrence are spoken of by Penada, Neues
+Hannoverisehes Magazin, Drummond, Buxtorf, Arnold, The Lancet, and the
+British Medical Journal.
+
+Cecil relates an instance of menstruation on the sixth day, continuing
+for five days, in which six or eight drams of blood were lost. Peeples
+cites an instance in Texas in an infant at the age of five days, which
+was associated with a remarkable development of the genital organs and
+breasts. Van Swieten offers an example at the first month; the British
+Medical Journal at the second month; Conarmond at the third month.
+Ysabel, a young slave girl belonging to Don Carlos Pedro of Havana,
+began to menstruate soon after birth, and at the first year was regular
+in this function. At birth her mamma were well developed and her
+axillae were slightly covered with hair. At the age of thirty-two
+months she was three feet ten inches tall, and her genitals and mammae
+resembled those of a girl of thirteen. Her voice was grave and
+sonorous; her moral inclinations were not known. Deever records an
+instance of a child two years and seven months old who, with the
+exception of three months only, had menstruated regularly since the
+fourth month. Harle speaks of a child, the youngest of three girls, who
+had a bloody discharge at the age of five months which lasted three
+days and recurred every month until the child was weaned at the tenth
+month. At the eleventh month it returned and continued periodically
+until death, occasioned by diarrhea at the fourteenth month. The
+necropsy showed a uterus 1 5/8 inches long, the lips of which were
+congested; the left ovary was twice the size of the right, but
+displayed nothing strikingly abnormal.  Baillot and the British Medical
+Journal cite instances of menstruation at the fourth month. A case is
+on record of an infant who menstruated at the age of six months, and
+whose menses returned on the twenty-eighth day exactly. Clark, Wall,
+and the Lancet give descriptions of cases at the ninth month. Naegele
+has seen a case at the eighteenth month, and Schmidt and Colly in the
+second year. Another case is that of a child, nineteen months old,
+whose breasts and external genitals were fully developed, although the
+child had shown no sexual desire, and did not exceed other children of
+the same age in intellectual development. This prodigy was
+symmetrically formed and of pleasant appearance.  Warner speaks of
+Sophie Gantz, of Jewish parentage, born in Cincinnati, July 27, 1865,
+whose menses began at the twenty-third month and had continued
+regularly up to the time of reporting. At the age of three years and
+six months she was 38 inches tall, 38 pounds in weight, and her girth
+at the hip was 33 1/2 inches. The pelvis was broad and well shaped, and
+measured 10 1/2 inches from the anterior surface of the spinous process
+of one ilium to that of the other, being a little more than the
+standard pelvis of Churchill, and, in consequence of this pelvic
+development, her legs were bowed. The mammae and labia had all the
+appearance of established puberty, and the pubes and axillae were
+covered with hair. She was lady-like and maidenly in her demeanor,
+without unnatural constraint or effrontery. A case somewhat similar,
+though the patient had the appearance of a little old woman, was a
+child of three whose breasts were as well developed as in a girl of
+twenty, and whose sexual organs resembled those of a girl at puberty.
+She had menstruated regularly since the age of two years. Woodruff
+describes a child who began to menstruate at two years of age and
+continued regularly thereafter. At the age of six years she was still
+menstruating, and exhibited beginning signs of puberty. She was 118 cm.
+tall, her breasts were developed, and she had hair on the mons veneris.
+Van der Veer mentions an infant who began menstruating at the early age
+of four months and had continued regularly for over two years. She had
+the features and development of a child ten or twelve years old. The
+external labia and the vulva in all its parts were well formed, and the
+mons veneris was covered with a full growth of hair. Sir Astley Cooper,
+Mandelshof, the Ephemerides, Rause, Geoffroy-Saint-Hilaire, and several
+others a report instances of menstruation occurring at three years of
+age. Le Beau describes an infant prodigy who was born with the mammae
+well formed and as much hair on the mons veneris as a girl of thirteen
+or fourteen.  She menstruated at three and continued to do so
+regularly, the flow lasting four days and being copious. At the age of
+four years and five months she was 42 1/2 inches tall; her features
+were regular, the complexion rosy, the hair chestnut, the eyes
+blue-gray, her mamma the size of a large orange, and indications that
+she would be able to bear children at the age of eight.  Prideaux cites
+a case at five, and Gaugirau Casals, a doctor of Agde, has seen a girl
+of six years who suffered abdominal colic, hemorrhage from the nose,
+migraine, and neuralgia, all periodically, which, with the association
+of pruritus of the genitals and engorged mammae, led him to suspect
+amenorrhea. He ordered baths, and shortly the menstruation appeared and
+became regular thereafter. Brierre de Boismont records cases of
+catamenia at five, seven, and eight years; and Skene mentions a girl
+who menstruated at ten years and five months. She was in the lowest
+grade of society, living with a drunken father in a tenement house, and
+was of wretched physical constitution, quite ignorant, and of low moral
+character, as evinced by her specific vaginitis. Occurring from nine
+years to the ordinary time of puberty, many cases are recorded.
+
+Instances of protracted menstruation are, as a rule, reliable, the
+individuals themselves being cognizant of the nature of true
+menstruation, and themselves furnishing the requisite information as to
+the nature and periodicity of the discharge in question.  Such cases
+range even past the century-mark. Many elaborate statistics on this
+subject have been gathered by men of ability.  Dr. Meyer of Berlin
+quotes the following:--
+
+  28  at 50 years of age,
+   3  at 57 years of age,
+  18  "  51   "   "   "
+   3  "  58   "   "   "
+  18  "  52   "   "   "
+   1  "  59   "   "   "
+  11  "  53   "   "   "
+   4  "  60   "   "   "
+  13  "  54   "   "   "
+   4  "  62   "   "   "
+   5  "  55   "   "   "
+   3  "  63   "   "   "
+   4  "  56   "   "   "
+
+These statistics were from examination of 6000 cases of menstruating
+women. The last seven were found to be in women in the highest class of
+society.
+
+Mehliss has made the following collection of statistics of a somewhat
+similar nature--
+
+                      Late Dentition.   Late          Late
+                      Male.  Female.   Lactation.  Menstruation.
+  Between 40 and 50    0         4        0            0
+          " 50 " 60    1         4        2            1
+          " 60 " 70    3         2        1            0
+          " 70 " 80    3         2        0            7
+          " 80 " 90    6         2        0            0
+         " 90 " 100    1         1        0            1
+    Above 100 .....    6         1        0            1
+                      --        --       --           --
+                      20        16       3           10
+
+These statistics seem to have been made with the idea of illustrating
+the marvelous rather than to give the usual prolongation of these
+functions. It hardly seems possible that ordinary investigation would
+show no cases of menstruation between sixty and seventy, and seven
+cases between seventy and eighty; however, in searching literature for
+such a collection, we must bear in mind that the more extraordinary the
+instance, the more likely it is that it would be spoken of, as the
+natural tendency of medical men is to overlook the important ordinary
+and report the nonimportant extraordinary. Dewees mentions an example
+of menstruation at sixty-five, and others at fifty-four and fifty-five
+years. Motte speaks of a case at sixty-one; Ryan and others, at
+fifty-five, sixty, and sixty-five; Parry, from sixty-six to seventy
+seven; Desormeux, from sixty to seventy-five; Semple, at seventy and
+eighty seven; Higgins, at seventy-six; Whitehead, at seventy-seven;
+Bernstein, at seventy-eight; Beyrat, at eighty-seven; Haller, at one
+hundred; and highest of all is Blancardi's case, in which menstruation
+was present at one hundred and six years. In the London Medical and
+Surgical Journal, 1831, are reported cases at eighty and ninety-five
+years. In Good's System of Nosology there are instances occurring at
+seventy-one, eighty, and ninety years.  There was a woman in Italy
+whose menstrual function continued from twenty-four to ninety years.
+Emmet cites an instance of menstruation at seventy, and Brierre de
+Boismont one of a woman who menstruated regularly from her
+twenty-fourth year to the time of her death at ninety-two.
+
+Strasberger of Beeskow describes a woman who ceased menstruating at
+forty-two, who remained in good health up to eighty, suffering slight
+attacks of rheumatism only, and at this late age was seized with
+abdominal pains, followed by menstruation, which continued for three
+years; the woman died the next year. This late menstruation had all the
+sensible characters of the early one. Kennard mentions a negress, aged
+ninety-one, who menstruated at fourteen, ceased at forty-nine, and at
+eighty-two commenced again, and was regular for four years, but had had
+no return since. On the return of her menstruation, believing that her
+procreative powers were returning, she married a vigorous negro of
+thirty-five and experienced little difficulty in satisfying his
+desires. Du Peyrou de Cheyssiole and Bonhoure speak of an aged peasant
+woman, past ninety-one years of age, who menstruated regularly.
+
+Petersen describes a woman of seventy-nine, who on March 26th was
+seized with uterine pains lasting a few days and terminating with
+hemorrhagic discharge. On April 23d she was seized again, and a
+discharge commenced on the 25th, continuing four days. Up to the time
+of the report, one year after, this menstruation had been regular.
+There is an instance on record of a female who menstruated every three
+months during the period from her fiftieth to her seventy-fourth year,
+the discharge, however, being very slight. Thomas cites an instance of
+a woman of sixty-nine who had had no menstruation since her forty-ninth
+year, but who commenced again the year he saw her. Her mother and
+sister were similarly affected at the age of sixty, in the first case
+attributable to grief over the death of a son, in the second ascribed
+to fright. It seemed to be a peculiar family idiosyncrasy. Velasquez of
+Tarentum says that the Abbess of Monvicaro at the very advanced age of
+one hundred had a recurrence of catamenia after a severe illness, and
+subsequently a new set of teeth and a new growth of hair.
+
+Late Establishment of Menstruation.--In some cases menstruation never
+appears until late in life, presenting the same phenomena as normal
+menstruation. Perfect relates the history of a woman who had been
+married many years, and whose menstruation did not appear until her
+forty-seventh year. She was a widow at the time, and had never been
+pregnant. Up to the time of her death, which was occasioned by a
+convulsive colic, in her fifty-seventh year, she had the usual
+prodromes of menstruation followed by the usual discharge. Rodsewitch
+speaks of a widow of a peasant who menstruated for the first time at
+the age of thirty-six. Her first coitus took place at the age of
+fifteen, before any signs of menstruation had appeared, and from this
+time all through her married life she was either pregnant or suckling.
+Her husband died when thirty-six years old, and ever since the
+catamenial flow had shown itself with great regularity. She had borne
+twins in her second, fourth, and eighth confinement, and altogether had
+16 children. Holdefrund in 1836 mentions a case in which menstruation
+did not commence until the seventieth year, and Hoyer mentions one
+delayed to the seventy-sixth year. Marx of Krakau speaks of a woman,
+aged forty-eight, who had never menstruated; until forty-two years old
+she had felt no symptoms, but at this time pain began, and at
+forty-eight regular menstruation ensued. At the time of report, four
+years after, she was free from pain and amenorrhea, and her flow was
+regular, though scant. She had been married since she was twenty-eight
+years of age. A somewhat similar case is mentioned by Gregory of a
+mother of 7 children who had never had her menstrual flow.  There are
+two instances of delayed menstruation quoted: the first, a woman of
+thirty, well formed, healthy, of good social position, and with all the
+signs of puberty except menstruation, which had never appeared; the
+second, a married woman of forty-two, who throughout a healthy
+connubial life had never menstruated. An instance is known to the
+authors of a woman of forty who has never menstruated, though she is of
+exceptional vigor and development. She has been married many years
+without pregnancy.
+
+The medical literature relative to precocious impregnation is full of
+marvelous instances. Individually, many of the cases would be beyond
+credibility, but when instance after instance is reported by reliable
+authorities we must accept the possibility of their occurrence, even if
+we doubt the statements of some of the authorities. No less a medical
+celebrity than the illustrious Sir Astley Cooper remarks that on one
+occasion he saw a girl in Scotland, seven years old, whose pelvis was
+so fully developed that he was sure she could easily give birth to a
+child; and Warner's case of the Jewish girl three and a half years old,
+with a pelvis of normal width, more than substantiates this
+supposition. Similar examples of precocious pelvic and sexual
+development are on record in abundance, and nearly every medical man of
+experience has seen cases of infantile masturbation.
+
+The ordinary period of female maturity is astonishingly late when
+compared with the lower animals of the same size, particularly when
+viewed with cases of animal precocity on record. Berthold speaks of a
+kid fourteen days old which was impregnated by an adult goat, and at
+the usual period of gestation bore a kid, which was mature but weak, to
+which it gave milk in abundance, and both the mother and kid grew up
+strong. Compared with the above, child-bearing by women of eight is not
+extraordinary.
+
+The earliest case of conception that has come to the authors' notice is
+a quotation in one of the last century books from von Mandelslo of
+impregnation at six; but a careful search in the British Museum failed
+to confirm this statement, and, for the present, we must accept the
+statement as hearsay and without authority available for
+reference-purposes.
+
+Molitor gives an instance of precocious pregnancy in a child of eight.
+It was probably the same case spoken of by Lefebvre and reported to the
+Belgium Academy: A girl, born in Luxemborg, well developed sexually,
+having hair on the pubis at birth, who menstruated at four, and at the
+age of eight was impregnated by a cousin of thirty-seven, who was
+sentenced to five years' imprisonment for seduction. The pregnancy
+terminated by the expulsion of a mole containing a well-characterized
+human embryo.  Schmidt's case in 1779 was in a child who had
+menstruated at two, and bore a dead fetus when she was but eight years
+and ten months old. She had all the appearance and development of a
+girl of seventeen. Kussmaul gives an example of conception at eight.
+Dodd speaks of a child who menstruated early and continued up to the
+time of impregnation. She was a hard worker and did all her mother's
+washing. Her labor pains did not continue over six hours, from first to
+the last. The child was a large one, weighing 7 pounds, and afterward
+died in convulsions. The infant's left foot had but 3 toes. The young
+mother at the time of delivery was only nine years and eight months
+old, and consequently must have been impregnated before the age of
+nine.  Meyer gives an astonishing instance of birth in a Swiss girl at
+nine. Carn describes a case of a child who menstruated at two, became
+pregnant at eight, and lived to an advanced age. Ruttel reports
+conception in a girl of nine, and as far north as St.  Petersburg a
+girl has become a mother before nine years. The Journal de Scavans,
+1684, contains the report of the case of a boy, who survived, being
+born to a mother of nine years.
+
+Beck has reported an instance of delivery in a girl a little over ten
+years of age. There are instances of fecundity at nine years recorded
+by Ephemerides, Wolffius, Savonarola, and others.  Gleaves reports from
+Wytheville, Va., the history of what he calls the case of the youngest
+mother in Virginia--Annie H.--who was born in Bland County, July 15,
+1885, and, on September 10, 1895, was delivered of a well-formed child
+weighing 5 pounds. The girl had not the development of a woman,
+although she had menstruated regularly since her fifth year. The labor
+was short and uneventful, and, two hours afterward, the child-mother
+wanted to arise and dress and would have done so had she been
+permitted.  There were no developments of the mammae nor secretion of
+milk.  The baby was nourished through its short existence (as it only
+lived a week) by its grandmother, who had a child only a few months
+old. The parents of this child were prosperous, intelligent, and worthy
+people, and there was no doubt of the child's age. "Annie is now well
+and plays about with the other children as if nothing had happened."
+Harris refers to a Kentucky woman, a mother at ten years, one in
+Massachusetts a mother at ten years, eight months, and seventeen days,
+and one in Philadelphia at eleven years and three months. The first
+case was one of infantile precocity, the other belonging to a much
+later period, the menstrual function having been established but a few
+months prior to conception. All these girls had well-developed pelves,
+large mammae, and the general marks of womanhood, and bore living
+children. It has been remarked of 3 very markedly precocious cases of
+pregnancy that one was the daughter of very humble parents, one born in
+an almshouse, and the other raised by her mother in a house of
+prostitution. The only significance of this statement is the greater
+amount of vice and opportunity for precocious sexual intercourse to
+which they were exposed; doubtless similar cases under more favorable
+conditions would never be recognized as such.
+
+The instance in the Journal decavans is reiterated in 1775, which is
+but such a repetition as is found all through medical literature--"new
+friends with old faces," as it were. Haller observed a case of
+impregnation in a girl of nine, who had menstruated several years, and
+others who had become pregnant at nine, ten, and twelve years
+respectively. Rowlett, whose case is mentioned by Harris, saw a child
+who had menstruated the first year and regularly thereafter, and gave
+birth to a child weighing 7 3/4 pounds when she was only ten years and
+thirteen days old.  At the time of delivery she measured 4 feet 7
+inches in height and weighed 100 pounds. Curtis, who is also quoted by
+Harris, relates the history of Elizabeth Drayton, who became pregnant
+before she was ten, and was delivered of a full-grown, living male
+child weighing 8 pounds. She had menstruated once or twice before
+conception, was fairly healthy during gestation, and had a rather
+lingering but natural labor. To complete the story, the father of this
+child was a boy of fifteen. One of the faculty of Montpellier has
+reported an instance at New Orleans of a young girl of eleven, who
+became impregnated by a youth who was not yet sixteen. Maygrier says
+that he knew a girl of twelve, living in the Faubourg Saint-Germain,
+who was confined.
+
+Harris relates the particulars of the case of a white girl who began to
+menstruate at eleven years and four months, and who gave birth to an
+over-sized male child on January 21, 1872, when she was twelve years
+and nine months old. She had an abundance of milk and nursed the child;
+the labor was of about eighteen hours' duration, and laceration was
+avoided. He also speaks of a mulatto girl, born in 1848, who began to
+menstruate at eleven years and nine months, and gave birth to a female
+child before she reached thirteen, and bore a second child when
+fourteen years and seven months old. The child's father was a white boy
+of seventeen.
+
+The following are some Indian statistics: 1 pregnancy at ten, 6 at
+eleven, 2 at eighteen, 1 at nineteen. Chevers speaks of a mother at ten
+and others at eleven and twelve; and Green, at Dacca, performed
+craniotomy upon the fetus of a girl of twelve.  Wilson gives an account
+of a girl thirteen years old, who gave birth to a full-grown female
+child after three hours' labor. She made a speedy convalescence, but
+the child died four weeks afterward from bad nursing. The lad who
+acknowledged paternity was nineteen years old. King reports a
+well-verified case of confinement in a girl of eleven. Both the mother
+and child did well.
+
+Robertson of Manchester describes a girl, working in a cotton factory,
+who was a mother at twelve; de La Motte mentions pregnancy before
+twelve; Kilpatrick in a negress, at eleven years and six months; Fox,
+at twelve; Hall, at twelve; Kinney, at twelve years, ten months, and
+sixteen days; Herrick, at thirteen years and nine months; Murillo, at
+thirteen years; Philippart, at fourteen years; Stallcup, at eleven
+years and nine months; Stoakley, at thirteen years; Walker, at the age
+of twelve years and eight months; another case, at twelve years and six
+months; and Williams, at eleven.
+
+An editorial article in the Indian Medical Gazette of Sept., 1890,
+says:--
+
+"The appearance of menstruation is held by the great majority of
+natives of India to be evidence and proof of marriageability, but among
+the Hindu community it is considered disgraceful that a girl should
+remain unmarried until this function is established.  The consequence
+is that girls are married at the age of nine or ten years, but it is
+understood or professed that the consummation of the marriage is
+delayed until after the first menstrual period. There is, however, too
+much reason to believe that the earlier ceremony is very frequently,
+perhaps commonly, taken to warrant resort to sexual intercourse before
+the menstrual flux has occurred: it may be accepted as true that
+premenstrual copulation is largely practised under the cover of
+marriage in this country.
+
+"From this practice it results that girls become mothers at the
+earliest possible period of their lives. A native medical witness
+testified that in about 20 per cent of marriages children were born by
+wives of from twelve to thirteen years of age. Cases of death caused by
+the first act of sexual intercourse are by no means rare. They are
+naturally concealed, but ever and anon they come to light. Dr. Chevers
+mentioned some 14 cases of this sort in the last edition of his
+'Handbook of Medical Jurisprudence for India,' and Dr. Harvey found 5
+in the medicolegal returns submitted by the Civil Surgeons of the
+Bengal Presidency during the years 1870-71-72.
+
+"Reform must come from conviction and effort, as in every other case,
+but meantime the strong arm of the law should be put forth for the
+protection of female children from the degradation and hurt entailed by
+premature sexual intercourse. This can easily be done by raising the
+age of punishable intercourse, which is now fixed at the absurd limit
+of ten years. Menstruation very seldom appears in native girls before
+the completed age of twelve years, and if the 'age of consent' were
+raised to that limit, it would not interfere with the prejudices and
+customs which insist on marriage before menstruation."
+
+In 1816 some girls were admitted to the Paris Maternite as young as
+thirteen, and during the Revolution several at eleven, and even
+younger. Smith speaks of a legal case in which a girl, eleven years
+old, being safely delivered of a living child, charged her uncle with
+rape. Allen speaks of a girl who became pregnant at twelve years and
+nine months, and was delivered of a healthy, 9-pound boy before the
+physician's arrival; the placenta came away afterward, and the mother
+made a speedy recovery. She was thought to have had "dropsy of the
+abdomen," as the parents had lost a girl of about the same age who was
+tapped for ascites.  The father of the child was a boy only fourteen
+years of age.
+
+Marvelous to relate, there are on record several cases of twins being
+born to a child mother. Kay reports a case of twins in a girl of
+thirteen; Montgomery, at fourteen; and Meigs reports the case of a
+young girl, of Spanish blood, at Maracaibo, who gave birth to a child
+before she was twelve and to twins before reaching fourteen years.
+
+In the older works, the following authors have reported cases of
+pregnancy before the appearance of menstruation: Ballonius, Vogel,
+Morgagni, the anatomist of the kidney, Schenck, Bartholinus, Bierling,
+Zacchias, Charleton, Mauriceau, Ephemerides, and Fabricius Hildanus.
+
+In some cases this precocity seems to be hereditary, being transmitted
+from mother to daughter, bringing about an almost incredible state of
+affairs, in which a girl is a grandmother about the ordinary age of
+maternity. Kay says that he had reported to him, on "pretty good"
+authority, an instance of a Damascus Jewess who became a grandmother at
+twenty-one years. In France they record a young grandmother of
+twenty-eight. Ketchum speaks of a negress, aged thirteen, who gave
+birth to a well-developed child which began to menstruate at ten years
+and nine months and at thirteen became pregnant; hence the negress was
+a grandmother at twenty-five years and nine months. She had a second
+child before she was sixteen, who began to menstruate at seven years
+and six months, thus proving the inheritance of this precocity, and
+leaving us at sea to figure what degree of grandmother she may be if
+she lives to an advanced age. Another interesting case of this nature
+is that of Mrs. C., born 1854, married in 1867, and who had a daughter
+ten months after. This daughter married in 1882, and in March, 1883,
+gave birth to a 9-pound boy. The youthful grandmother, not twenty-nine,
+was present at the birth. This case was remarkable, as the children
+were both legitimate.
+
+Fecundity in the old seems to have attracted fully as much attention
+among the older observers as precocity. Pliny speaks of Cornelia, of
+the family of Serpios, who bore a son at sixty, who was named Volusius
+Saturnius; and Marsa, a physician of Venice, was deceived in a
+pregnancy in a woman of sixty, his diagnosis being "dropsy." Tarenta
+records the history of the case of a woman who menstruated and bore
+children when past the age of sixty. Among the older reports are those
+of Blanchard of a woman who bore a child at sixty years; Fielitz, one
+at sixty; Ephemerides, one at sixty-two; Rush, one at sixty; Bernstein,
+one at sixty years; Schoepfer, at seventy years; and, almost beyond
+belief, Debes cites an instance as taking place at the very advanced
+age of one hundred and three. Wallace speaks of a woman in the Isle of
+Orkney bearing children when past the age of sixty. We would naturally
+expect to find the age of child-bearing prolonged in the northern
+countries where the age of maturity is later. Capuron cites an example
+of child-birth in a woman of sixty; Haller, cases at fifty-eight,
+sixty-three, and seventy; Dewees, at sixty-one; and Thibaut de
+Chauvalon, in a woman of Martinique aged ninety years. There was a
+woman delivered in Germany, in 1723, at the age of fifty-five; one at
+fifty-one in Kentucky; and one in Russia at fifty. Depasse speaks of a
+woman of fifty-nine years and five months old who was delivered of a
+healthy male child, which she suckled, weaning it on her sixtieth
+birthday. She had been a widow for twenty years, and had ceased to
+menstruate nearly ten years before. In St. Peter's Church, in East
+Oxford, is a monument bearing an inscription recording the death in
+child-birth of a woman sixty-two years old. Cachot relates the case of
+a woman of fifty-three, who was delivered of a living child by means of
+the forceps, and a year after bore a second child without instrumental
+interference. She had no milk in her breasts at the time and no signs
+of secretion. This aged mother had been married at fifty-two, five
+years after the cessation of her menstruation, and her husband was a
+young man, only twenty-four years old.
+
+Kennedy reports a delivery at sixty-two years, and the Cincinnati
+Enquirer, January, 1863, says: "Dr. W. McCarthy was in attendance on a
+lady of sixty-nine years, on Thursday night last, who gave birth to a
+fine boy. The father of the child is seventy-four years old, and the
+mother and child are doing well." Quite recently there died in Great
+Britain a Mrs. Henry of Gortree at the age of one hundred and twelve,
+leaving a daughter of nine years.
+
+Mayham saw a woman seventy-three years old who recovered after delivery
+of a child. A most peculiar case is that of a widow, seventy years old,
+a native of Garches. She had been in the habit of indulging freely in
+wine, and, during the last six months, to decided excess. After an
+unusually prolonged libation she found herself unable to walk home; she
+sat down by the roadside waiting until she could proceed, and was so
+found by a young man who knew her and who proposed helping her home. By
+the time her house was reached night was well advanced, and she invited
+him to stop over night; finding her more than affable, he stopped at
+her house over four nights, and the result of his visits was an ensuing
+pregnancy for Madame.
+
+Multiple births in the aged have been reported from authentic sources.
+The Lancet quotes a rather fabulous account of a lady over sixty-two
+years of age who gave birth to triplets, making her total number of
+children 13. Montgomery, Colomb, and Knehel, each, have recorded the
+birth of twins in women beyond the usual age of the menopause, and
+there is a case recorded of a woman of fifty-two who was delivered of
+twins.
+
+Impregnation without completion of the copulative act by reason of some
+malformation, such as occlusion of the vagina or uterus, fibrous and
+unruptured hymen, etc., has been a subject of discussion in the works
+of medical jurisprudence of all ages; and cases of conception without
+entrance of the penis are found in abundance throughout medical
+literature, and may have an important medicolegal bearing. There is
+little doubt of the possibility of spermatozoa deposited on the
+genitalia making progress to the seat of fertilization, as their power
+of motility and tenacity of life have been well demonstrated. Percy
+reports an instance in which semen was found issuing from the os uteri
+eight and one-half days after the last intercourse; and a microscopic
+examination of this semen revealed the presence of living as well as
+dead spermatozoa. We have occasional instances of impregnation by
+rectal coitus, the semen finding its way into an occluded vaginal canal
+by a fistulous communication.
+
+Guillemeau, the surgeon of the French king, tells of a girl of
+eighteen, who was brought before the French officials in Paris, in
+1607, on the citation of her husband of her inability to allow him
+completion of the marital function. He alleged that he had made several
+unsuccessful attempts to enter her, and in doing so had caused
+paraphimosis. On examination by the surgeons she was found to have a
+dense membrane, of a fibrous nature, entirely occluding the vagina,
+which they incised. Immediately afterward the woman exhibited morning
+sickness and the usual signs of pregnancy, and was delivered in four
+months of a full-term child, the results of an impregnation occasioned
+by one of the unsuccessful attempts at entrance. Such instances are
+numerous in the older literature, and a mere citation of a few is
+considered sufficient here. Zacchias, Amand, Fabricius Hildanus, Graaf,
+the discoverer of the follicles that bear his name, Borellus, Blegny,
+Blanchard, Diemerbroeck, Duddell, Mauriceau, a Reyes, Riolan, Harvey,
+the discoverer of the circulation of the blood, Wolfius, Walther,
+Rongier, Ruysch, Forestus, Ephemerides, and Schurig all mention cases
+of conception with intact hymen, and in which there was no entrance of
+the penis. Tolberg has an example of hymen integrum after the birth of
+a fetus five months old, and there is recorded a case of tubal
+pregnancy in which the hymen was intact.
+
+Gilbert gives an account of a case of pregnancy in an unmarried woman,
+who successfully resisted an attempt at criminal connection and yet
+became impregnated and gave birth to a perfectly formed female child.
+The hymen was not ruptured, and the impregnation could not have
+preceded the birth more than thirty-six weeks. Unfortunately, this poor
+woman was infected with gonorrhea after the attempted assault. Simmons
+of St. Louis gives a curious peculiarity of conception, in which there
+was complete closure of the vagina, subsequent conception, and delivery
+at term. He made the patient's acquaintance from her application to him
+in regard to a malcondition of her sexual apparatus, causing much
+domestic infelicity.
+
+Lawson speaks of a woman of thirty-five, who had been married ten
+months, and whose husband could never effect an entrance; yet she
+became pregnant and had a normal labor, despite the fact that, in
+addition to a tough and unruptured hymen, she had an occluding vaginal
+cyst. Hickinbotham of Birmingham reports the history of two cases of
+labor at term in females whose hymens were immensely thickened. H. Grey
+Edwards has seen a case of imperforate hymen which had to be torn
+through in labor; yet one single act of copulation, even with this
+obstacle to entrance, sufficed to impregnate. Champion speaks of a
+woman who became pregnant although her hymen was intact. She had been
+in the habit of having coitus by the urethra, and all through her
+pregnancy continued this practice.
+
+Houghton speaks of a girl of twenty-five into whose vagina it was
+impossible to pass the tip of the first finger on account of the dense
+cicatricial membrane in the orifice, but who gave birth, with
+comparative ease, to a child at full term, the only interference
+necessary being a few slight incisions to permit the passage of the
+head. Tweedie saw an Irish girl of twenty-three, with an imperforate os
+uteri, who had menstruated only scantily since fourteen and not since
+her marriage. She became pregnant and went to term, and required some
+operative interference. He incised at the point of usual location of
+the os, and one of his incisions was followed by the flow of liquor
+amnii, and the head fell upon the artificial opening, the diameter of
+which proved to be one and a half or two inches; the birth then
+progressed promptly, the child being born alive.
+
+Guerard notes an instance in which the opening barely admitted a hair;
+yet the patient reached the third month of pregnancy, at which time she
+induced abortion in a manner that could not be ascertained. Roe gives a
+case of conception in an imperforate uterus, and Duncan relates the
+history of a case of pregnancy in an unruptured hymen, characterized by
+an extraordinary ascent of the uterus. Among many, the following modern
+observers have also reported instances of pregnancy with hymen
+integrum: Braun, 3 cases; Francis, Horton, Oakman, Brill, 2 cases;
+Burgess, Haig, Hay, and Smith.
+
+Instances in which the presence of an unruptured hymen has complicated
+or retarded actual labor are quite common, and until the membrane is
+ruptured by external means the labor is often effectually obstructed.
+Among others reporting cases of this nature are Beale, Carey, Davis,
+Emond Fetherston, Leisenring, Mackinlay, Martinelli, Palmer, Rousseau,
+Ware, and Yale.
+
+There are many cases of stricture or complete occlusion of the vagina,
+congenital or acquired from cicatricial contraction, obstructing
+delivery, and in some the impregnation seems more marvelous than cases
+in which the obstruction is only a thin membranous hymen. Often the
+obstruction is so dense as to require a large bistoury to divide it,
+and even that is not always sufficient, and the Cesarean operation only
+can terminate the obstructed delivery; we cannot surmise how conception
+could have been possible. Staples records a case of pregnancy and
+parturition with congenital stricture of the vagina. Maisonneuve
+mentions the successful practice of a Cesarean operation in a case of
+congenital occlusion of the vagina forming a complete obstruction to
+delivery. Verdile records an instance of imperforate vagina in which
+rectovaginal wall was divided and the delivery effected through the
+rectum and anus. Lombard mentions an observation of complete occlusion
+of the vagina in a woman, the mother of 4 living children and pregnant
+for the fifth time.  Thus, almost incredible to relate, it is possible
+for a woman to become a mother of a living child and yet preserve all
+the vaginal evidences of virginity. Cole describes a woman of
+twenty-four who was delivered without the rupture of the hymen, and
+Meek remarks on a similar case. We can readily see that, in a case like
+that of Verdile, in which rectal delivery is effected, the hymen could
+be left intact and the product of conception be born alive.
+
+A natural sequence to the subject of impregnation without entrance is
+that of artificial impregnation. From being a matter of wonder and
+hearsay, it has been demonstrated as a practical and useful method in
+those cases in which, by reason of some unfortunate anatomic
+malformation on either the male or the female side, the marriage is
+unfruitful. There are many cases constantly occurring in which the
+birth of an heir is a most desirable thing in a person's life. The
+historic instance of Queen Mary of England, whose anxiety and efforts
+to bear a child were the subject of public comment and prayers, is but
+an example of a fact that is occurring every day, and doubtless some of
+these cases could be righted by the pursuance of some of the methods
+suggested.
+
+There have been rumors from the beginning of the century of women being
+impregnated in a bath, from contact with cloths containing semen, etc.,
+and some authorities in medical jurisprudence have accepted the
+possibility of such an occurrence. It is not in the province of this
+work to speculate on what may be, but to give authoritative facts, from
+which the reader may draw his own deductions. Fertilization of plants
+has been thought to have been known in the oldest times, and there are
+some who believe that the library at Alexandria must have contained
+some information relative to it. The first authentic account that we
+have of artificial impregnation is that of Schwammerdam, who in 1680
+attempted it without success by the fecundation of the eggs of fish.
+Roesel, his scholar, made an attempt in 1690, but also failed; and to
+Jacobi, in 1700, belongs the honor of success. In 1780, Abbe
+Spallanzani, following up the success of Jacobi, artificially
+impregnated a bitch, who brought forth in sixty-two days 3 puppies, all
+resembling the male. The illustrious John Hunter advised a man
+afflicted with hypospadias to impregnate his wife by vaginal injections
+of semen in water with an ordinary syringe, and, in spite of the
+simplicity of this method, the attempt was followed by a successful
+issue. Since this time, Nicholas of Nancy and Lesueur have practised
+the simple vaginal method; while Gigon, d'Angouleme (14 cases), Girault
+(10 cases), Marion Sims, Thomas, Salmon, Pajot, Gallard, Courty,
+Roubaud, Dehaut, and others have used the more modern uterine method
+with success.
+
+A dog-breeder, by syringing the uterus of a bitch, has succeeded in
+impregnating her. Those who are desirous of full information on this
+subject, as regards the modus operandi, etc., are referred to Girault;
+this author reports in full several examples. One case was that of a
+woman, aged twenty-five, afflicted with blenorrhea, who, chagrined at
+not having issue, made repeated forcible injections of semen in water
+for two months, and finally succeeded in impregnating herself, and was
+delivered of a living child. Another case was that of a female, aged
+twenty-three, who had an extra long vaginal canal, probably accounting
+for the absence of pregnancy. She made injections of semen, and was
+finally delivered of a child. He also reports the case of a
+distinguished musician who, by reason of hypospadias, had never
+impregnated his wife, and had resorted to injections of semen with a
+favorable result. This latter case seems hardly warranted when we
+consider that men afflicted with hypospadias and epispadias have become
+fathers. Percy gives the instance of a gentleman whom he had known for
+some time, whose urethra terminated a little below the frenum, as in
+other persons, but whose glans bulged quite prominently beyond it,
+rendering urination in the forward direction impossible. Despite the
+fact that this man could not perform the ejaculatory function, he was
+the father of three children, two of them inheriting his penile
+formation.
+
+The fundamental condition of fecundity being the union of a
+spermatozoid and an ovum, the object of artificial impregnation is to
+further this union by introducing semen directly to the fundus of the
+uterus. The operation is quite simple and as follows: The husband,
+having been found perfectly healthy, is directed to cohabit with his
+wife, using a condom. The semen ejaculated is sucked up by an
+intrauterine syringe which has been properly disinfected and kept warm.
+The os uteri is now exposed and wiped off with some cotton which has
+been dipped in an antiseptic fluid; introduced to the fundus of the
+uterus, and some drops of the fluid slowly expressed into the uterus.
+The woman is then kept in bed on her back. This operation is best
+carried out immediately before or immediately after the menstrual
+epoch, and if not successful at the first attempt should be repeated
+for several months. At the present day artificial impregnation in
+pisciculture is extensively used with great success.
+
+{footnote} The following extraordinary incident of accidental
+impregnation, quoted from the American Medical Weekly by the Lancet, is
+given in brief, not because it bears any semblance of possibility, but
+as a curious example from the realms of imagination in medicine.
+
+L. G. Capers of Vicksburg, Miss., relates an incident during the late
+Civil War, as follows: A matron and her two daughters, aged fifteen and
+seventeen years, filled with the enthusiasm of patriotism, stood ready
+to minister to the wounds of their countrymen in their fine residence
+near the scene of the battle of R----, May 12, 1863, between a portion
+of Grant's army and some Confederates. During the fray a gallant and
+noble young friend of the narrator staggered and fell to the earth; at
+the same time a piercing cry was heard in the house near by.
+Examination of the wounded soldier showed that a bullet had passed
+through the scrotum and carried away the left testicle.  The same
+bullet had apparently penetrated the left side of the abdomen of the
+elder young lady, midway between the umbilicus and the anterior
+superior spinous process of the ilium, and had become lost in the
+abdomen. This daughter suffered an attack of peritonitis, but recovered
+in two months under the treatment administered.
+
+Marvelous to relate, just two hundred and seventy-eight days after the
+reception of the minie-ball, she was delivered of a fine boy, weighing
+8 pounds, to the surprise of herself and the mortification of her
+parents and friends. The hymen was intact, and the young mother
+strenuously insisted on her virginity and innocence. About three weeks
+after this remarkable birth Dr. Capers was called to see the infant,
+and the grandmother insisted that there was something wrong with the
+child's genitals.  Examination showed a rough, swollen, and sensitive
+scrotum, containing some hard substance. He operated, and extracted a
+smashed and battered minie-ball. The doctor, after some meditation,
+theorized in this manner: He concluded that this was the same ball that
+had carried away the testicle of his young friend, that had penetrated
+the ovary of the young lady, and, with some spermatozoa upon it, had
+impregnated her. With this conviction he approached the young man and
+told him the circumstances; the soldier appeared skeptical at first,
+but consented to visit the young mother; a friendship ensued which soon
+ripened into a happy marriage, and the pair had three children, none
+resembling, in the same degree as the first, the heroic pater familias.
+
+
+Interesting as are all the anomalies of conception, none are more so
+than those of unconscious impregnation; and some well-authenticated
+cases can be mentioned. Instances of violation in sleep, with
+subsequent pregnancy as a result, have been reported in the last
+century by Valentini, Genselius, and Schurig. Reports by modern
+authorities seem to be quite scarce, though there are several cases on
+record of rape during anesthesia, followed by impregnation. Capuron
+relates a curious instance of a woman who was raped during lethargy,
+and who subsequently became pregnant, though her condition was not
+ascertained until the fourth month, the peculiar abdominal sensation
+exciting suspicion of the true nature of the case, which had previously
+been thought impossible.
+
+There is a record of a case of a young girl of great moral purity who
+became pregnant without the slightest knowledge of the source;
+although, it might be remarked, such cases must be taken "cum grano
+salis." Cases of conception without the slightest sexual desire or
+pleasure, either from fright, as in rape, or naturally deficient
+constitution, have been recorded; as well as conception during
+intoxication and in a hypnotic trance, which latter has recently
+assumed a much mooted legal aspect. As far back as 1680, Duverney
+speaks of conception without the slightest sense of desire or pleasure
+on the part of the female.
+
+Conception with Deficient Organs.--Having spoken of conception with
+some obstructive interference, conception with some natural or acquired
+deficiency of the functional, organic, or genital apparatus must be
+considered. It is a well-known fact that women exhibiting rudimentary
+development of the uterus or vagina are still liable to become
+pregnant, and many such cases have been recorded; but the most peculiar
+cases are those in which pregnancy has appeared after removal of some
+of the sexual apparatus.
+
+Pregnancy going to term with a successful delivery frequently follows
+the performance of ovariotomy with astonishing rapidity.  Olier cites
+an instance of ovariotomy with a pregnancy of twins three months
+afterward, and accouchement at term of two well-developed boys.
+Polaillon speaks of a pregnancy consecutive to ovariotomy, the
+accouchement being normal at term. Crouch reports a case of successful
+parturition in a patient who had previously undergone ovariotomy by a
+large incision. Parsons mentions a case of twin pregnancy two years
+after ovariotomy attended with abnormal development of one of the
+children. Cutter speaks of a case in which a woman bore a child one
+year after the performance of ovariotomy, and Pippingskold of two cases
+of pregnancy after ovariotomy in which the stump as well as the
+remaining ovary were cauterized. Brown relates a similar instance with
+successful delivery. Bixby, Harding, Walker (1878-9), and Mears all
+report cases, and others are not at all rare. In the cases following
+shortly after operation, it has been suggested that they may be
+explained by the long retention of the ova in the uterus, deposited
+them prior to operation. In the presence of such facts one can but
+wonder if artificial fecundation of an ovum derived from another woman
+may ever be brought about in the uterus of a sterile woman!
+
+Conception Soon After a Preceding Pregnancy.--Conception sometimes
+follows birth (or abortion) with astonishing rapidity, and some women
+seem for a period of their lives either always pregnant or with infants
+at their breasts. This prolificity is often alluded to, and is not
+confined to the lower classes, as often stated, but is common even
+among the nobility. Illustrative of this, we have examples in some of
+the reigning families in Europe to-day. A peculiar instance is given by
+Sparkman in which a woman conceived just forty hours after abortion.
+Rice mentions the case of a woman who was confined with her first
+child, a boy, on July 31, 1870, and was again delivered of another
+child on June 4, 1871. She had become pregnant twenty-eight days after
+delivery. He also mentions another case of a Mrs. C., who, at the age
+of twenty-three, gave birth to a child on September 13, 1880, and bore
+a second child on July 2, 1881. She must have become pregnant
+twenty-one days after the delivery of her first child.
+
+Superfetation has been known for many centuries; the Romans had laws
+prescribing the laws of succession in such cases, and many medical
+writers have mentioned it. Hippocrates and Aristotle wrote of it, the
+former at some length. Pliny speaks of a slave who bore two infants,
+one resembling the master, the other a man with whom she had
+intercourse, and cites the case as one of superfetation. Schenck
+relates instances, and Zacchias, Velchius, and Sinibaldus mention
+eases. Pare seemed to be well conversant with the possibility as well
+as the actuality of superfetation; and Harvey reports that a certain
+maid, gotten with child by her master, in order to hide her knavery
+came to London in September, where she lay in by stealth, and being
+recovered, returned home.  In December of the same year she was
+unexpectedly delivered of another child, a product of superfetation,
+which proclaimed the crime that she had so cunningly concealed before.
+
+Marcellus Donatus, Goret, Schacher, and Mauriceau mention
+superfetation. In the Academie des Sciences, at Paris, in 1702, there
+was mentioned the case of a woman who was delivered of a boy; in the
+placenta was discovered a sort of bladder which was found to contain a
+female fetus of the age of from four to five months; and in 1729,
+before the same society, there was an instance in which two fetuses
+were born a day apart, one aged forty days and the other at full term.
+From the description, it does not seem possible that either of these
+were blighted twin pregnancies. Ruysch gives an account of a surgeon's
+wife at Amsterdam, in 1686, who was delivered of a strong child which
+survived, and, six hours after, of a small embryo, the funis of which
+was full of hydatids and the placenta as large and thick as one of
+three months. Ruysch accompanies his description with an illustrative
+figure. At Lyons, in 1782, Benoite Franquet was unexpectedly delivered
+of a child seven months old; three weeks later she experienced symptoms
+indicative of the existence of another fetus, and after five months and
+sixteen days she was delivered of a remarkably strong and healthy child.
+
+Baudeloque speaks of a case of superfetation observed by Desgranges in
+Lyons in 1780. After the birth of the first infant the lochia failed to
+flow, no milk appeared in the breasts, and the belly remained large. In
+about three weeks after the accouchement she had connection with her
+husband, and in a few days felt fetal movements. A second child was
+born at term, sixty-eight days after the first; and in 1782 both
+children were living. A woman of Arles was delivered on November 11,
+1796, of a child at term; she had connection with her husband four days
+after; the lochia stopped, and the milk did not flow after this
+intercourse. About one and a half months after this she felt quickening
+again, and naturally supposed that she had become impregnated by the
+first intercourse after confinement; but five months after the first
+accouchement she was delivered of another child at term, the result of
+a superfetation. Milk in abundance made its appearance, and she was
+amply able to nourish both children from the breasts. Lachausse speaks
+of a woman of thirty who bore one child on April 30, 1748, and another
+on September 16th in the same year. Her breasts were full enough to
+nourish both of the children. It might be remarked in comment on this
+case that, according to a French authority, the woman died in 1755, and
+on dissection was found to have had a double uterus.
+
+A peculiar instance of superfetation was reported by Langmore in which
+there was an abortion of a fetus between the third and fourth months,
+apparently dead some time, and thirteen hours later a second fetus; an
+ovum of about four weeks and of perfect formation was found adherent
+near the fundus. Tyler Smith mentions a lady pregnant for the first
+time who miscarried at five months and some time afterward discharged a
+small clot containing a perfectly fresh and healthy ovum of about four
+weeks' formation. There was no sign of a double uterus, and the patient
+menstruated regularly during pregnancy, being unwell three weeks before
+the abortion. Harley and Tanner speak of a woman of thirty-eight who
+never had borne twins, and who aborted a fetus of four months'
+gestation; serious hemorrhage accompanied the removal of the placenta,
+and on placing the hand in the uterine cavity an embryo of five or six
+weeks was found inclosed in a sac and floating in clear liquor amnii.
+The patient was the mother of nine children, the youngest of which was
+three years old.
+
+Young speaks of a woman who three months previously had aborted a three
+months' fetus, but a tumor still remained in the abdomen, the
+auscultation of which gave evidence of a fetal heart-beat.  Vaginal
+examination revealed a dilatation of the os uteri of at least one inch
+and a fetal head pressing out; subsequently a living fetus of about six
+months of age was delivered. Severe hemorrhage complicated the case,
+but was controlled, and convalescence speedily ensued. Huse cites an
+instance of a mother bearing a boy on November 4, 1834, and a girl on
+August 3, 1835.  At birth the boy looked premature, about seven months
+old, which being the case, the girl must have been either a
+superfetation or a seven months' child also. Van Bibber of Baltimore
+says he met a young lady who was born five months after her sister, and
+who was still living.
+
+The most curious and convincing examples of superfetation are those in
+which children of different colors, either twins or near the same age,
+are born to the same woman,--similar to that exemplified in the case of
+the mare who was covered first by a stallion and a quarter of an hour
+later by an ass, and gave birth at one parturition to a horse and a
+mule. Parsons speaks of a case at Charleston, S.C., in 1714, of a white
+woman who gave birth to twins, one a mulatto and the other white. She
+confessed that after her husband left her a negro servant came to her
+and forced her to comply with his wishes by threatening her life.
+Smellie mentions the case of a black woman who had twins, one child
+black and the other almost white. She confessed having had intercourse
+with a white overseer immediately after her husband left her bed.
+Dewees reports a similar case. Newlin of Nashville speaks of a negress
+who bore twins, one distinctly black with the typical African features,
+while the other was a pretty mulatto exhibiting the distinct characters
+of the Caucasian race. Both the parents were perfect types of the black
+African negro. The mother, on being questioned, frankly acknowledged
+that shortly after being with her husband she had lain a night with a
+white man. In this case each child had its own distinct cord and
+placenta.
+
+Archer gives facts illustrating and observations showing: "that a white
+woman, by intercourse with a white man and negro, may conceive twins,
+one of which shall be white and the other a mulatto; and that, vice
+versa, a black woman, by intercourse with a negro and a white man, may
+conceive twins, one of which shall be a negro and the other a mulatto."
+Wight narrates that he was called to see a woman, the wife of an East
+Indian laborer on the Isle of Trinidad, who had been delivered of a
+fetus 6 inches long, about four months old, and having a cord of about
+18 inches in length. He removed the placenta, and in about half an hour
+the woman was delivered of a full-term white female child. The first
+child was dark, like the mother and father, and the mother denied any
+possibility of its being a white man's child; but this was only natural
+on her part, as East Indian husbands are so intensely jealous that they
+would even kill an unfaithful wife.  Both the mother and the mysterious
+white baby are doing well.  Bouillon speaks of a negress in Guadeloupe
+who bore twins, one a negro and the other a mulatto. She had sexual
+congress with both a negro and a white man.
+
+Delmas, a surgeon of Rouen, tells of a woman of thirty-six who was
+delivered in the hospital of his city on February 26, 1806, of two
+children, one black and the other a mulatto. She had been pregnant
+eight months, and had had intercourse with a negro twice about her
+fourth month of pregnancy, though living with the white man who first
+impregnated her. Two placentae were expelled some time after the twins,
+and showed a membranous junction. The children died shortly after birth.
+
+Pregnancy often takes place in a unicorn or bicorn uterus, leading to
+similar anomalous conditions. Galle, Hoffman, Massen, and Sanger give
+interesting accounts of this occurrence, and Ross relates an instance
+of triple pregnancy in a double uterus.  Cleveland describes a
+discharge of an anomalous deciduous membrane during pregnancy which was
+probably from the unimpregnated half of a double uterus.
+
+
+
+CHAPTER II.
+
+PRENATAL ANOMALIES.
+
+Extrauterine Pregnancy.--In the consideration of prenatal anomalies,
+the first to be discussed will be those of extrauterine pregnancy. This
+abnormalism has been known almost as long as there has been any real
+knowledge of obstetrics. In the writings of Albucasis, during the
+eleventh century, extrauterine pregnancy is discussed, and later the
+works of N. Polinus and Cordseus, about the sixteenth century, speak of
+it; in the case of Cordseus the fetus was converted into a lithopedion
+and carried in the abdomen twenty-eight years. Horstius in the
+sixteenth century relates the history of a woman who conceived for the
+third time in March, 1547, and in 1563 the remains of the fetus were
+still in the abdomen.
+
+Israel Spach, in an extensive gynecologic work published in 1557,
+figures a lithopedion drawn in situ in the case of a woman with her
+belly laid open. He dedicated to this calcified fetus, which he
+regarded as a reversion, the following curious epigram, in allusion to
+the classical myth that after the flood the world was repopulated by
+the two survivors, Deucalion and Pyrrha, who walked over the earth and
+cast stones behind them, which, on striking the ground, became people.
+Roughly translated from the Latin, this epigram read as follows:
+"Deucalion cast stones behind him and thus fashioned our tender race
+from the hard marble. How comes it that nowadays, by a reversal of
+things, the tender body of a little babe has limbs nearer akin to
+stone?" Many of the older writers mention this form of fetation as a
+curiosity, but offer no explanation as to its cause. Mauriceau and de
+Graaf discuss in full extrauterine pregnancy, and Salmuth, Hannseus,
+and Bartholinus describe it. From the beginning of the eighteenth
+century this subject always demanded the attention and interest of
+medical observers. In more modern times, Campbell and
+Geoffroy-Saint-Hilaire, who named it "Grossesse Pathologique," have
+carefully defined and classified the forms, and to-day every text-book
+on obstetrics gives a scientific discussion and classification of the
+different forms of extrauterine pregnancy.
+
+The site of the conception is generally the wall of the uterus, the
+Fallopian tube, or the ovary, although there are instances of pregnancy
+in the vagina, as for example when there is scirrhus of the uterus; and
+again, cases supposed to be only extrauterine have been instances
+simply of double uterus, with single or concurrent pregnancy. Ross
+speaks of a woman of thirty-three who had been married fourteen years,
+had borne six children, and who on July 16, 1870, miscarried with twins
+of about five months' development. After a week she declared that she
+was still pregnant with another child, but as the physician had placed
+his hand in the uterine cavity after the abortion, he knew the fetus
+must be elsewhere or that no pregnancy existed. We can readily see how
+this condition might lead to a diagnosis of extrauterine pregnancy, but
+as the patient insisted on a thorough examination, the doctor found by
+the stethoscope the presence of a beating fetal heart, and by vaginal
+examination a double uterus. On introducing a sound into the new
+aperture he discovered that it opened into another cavity; but as the
+woman was pregnant in this, he proceeded no further. On October 31st
+she was delivered of a female child of full growth. She had menstruated
+from this bipartite uterus three times during the period between the
+miscarriage of the twins and the birth of the child. Both the mother
+and child did well.
+
+In most cases there is rupture of the fetal sac into the abdominal
+cavity or the uterus, and the fetus is ejected into this location, from
+thence to be removed or carried therein many years; but there are
+instances in which the conception has been found in situ, as depicted
+in Figure 2. A sturdy woman of thirty was executed on January 16, 1735,
+for the murder of her child. It was ascertained that she had passed her
+catamenia about the first of the month, and thereafter had sexual
+intercourse with one of her fellow-prisoners. On dissection both
+Fallopian tubes were found distended, and the left ovary, which bore
+signs of conception, was twice as large as the right. Campbell quotes
+another such case in a woman of thirty-eight who for twenty years had
+practised her vocation as a Cyprian, and who unexpectedly conceived. At
+the third month of pregnancy a hard extrauterine tumor was found, which
+was gradually increasing in size and extending to the left side of the
+hypogastrium, the associate symptoms of pregnancy, sense of pressure,
+pain, tormina, and dysuria, being unusually severe. There was
+subsequently at attack of inflammatory fever, followed by tumefaction
+of the abdomen, convulsions, and death on the ninth day. The fetus had
+been contained in the peritoneal coat of the ovary until the fourth
+month, when one of the feet passed through the cyst and caused the
+fatal result. Signs of acute peritonitis were seen postmortem, the
+abdominal cavity was full of blood, and the ovary much lacerated.
+
+The termination of extrauterine pregnancy varies; in some cases the
+fetus is extracted by operation after rupture; in others the fetus has
+been delivered alive by abdominal section; it may be partially
+absorbed, or carried many years in the abdomen; or it may ulcerate
+through the confining walls, enter the bowels or bladder, and the
+remnants of the fetal body be discharged.
+
+The curious cases mentioned by older writers, and called abortion by
+the mouth, etc., are doubtless, in many instances, remnants of
+extrauterine pregnancies or dermoid cysts. Maroldus speaks in full of
+such cases; Bartholinus, Salmuth, and a Reyes speak of women vomiting
+remnants of fetuses. In Germany, in the seventeenth century, there
+lived a woman who on three different occasions is said to have vomited
+a fetus. The last miscarriage in this manner was of eight months'
+growth and was accompanied by its placenta. The older observers thought
+this woman must have had two orifices to her womb, one of which had
+some connection with the stomach, as they had records of the dissection
+of a female in whom was found a conformation similar to this.
+
+Discharge of the fetal bones or even the whole of an extrauterine fetus
+by the rectum is not uncommon. There are two early cases mentioned in
+which the bones of a fetus were discharged at stool, causing intense
+pain. Armstrong describes an anomalous case of pregnancy in a
+syphilitic patient who discharged fetal bones by the rectum. Bubendorf
+reports the spontaneous elimination of a fetal skeleton by the rectum
+after five years of retention, with recovery of the patient. Butcher
+speaks of delivery through the rectum at the fourth month, with
+recovery. Depaul mentions a similar expulsion after a pregnancy of
+about two months and a half. Jackson reports the dissection of an
+extrauterine sac which communicated freely with the large intestine.
+Peck has an example of spontaneous delivery of an extrauterine fetus by
+the rectum, with recovery of the mother. Skippon, in the early part of
+the last century, reports the discharge of the bones of a fetus through
+an "imposthume" in the groin. Other cases of anal discharge of the
+product of extrauterine conception are recorded by Winthrop, Woodbury,
+Tuttle, Atkinson, Browne, Weinlechner, Gibson, Littre, Magruder,
+Gilland, and many others. De Brun du Bois-Noir speaks of the expulsion
+of extrauterine remains by the anus after seven years, and Heyerdahl
+after thirteen years.  Benham mentions the discharge of a fetus by the
+rectum; there was a stricture of the rectum associated with syphilitic
+patches, necessitating the performance of colotomy.
+
+Bartholinus and Rosseus speak of fetal bones being discharged from the
+urinary passages. Ebersbach, in the Ephemerides of 1717, describes a
+necropsy in which a human fetus was found contained in the bladder. In
+1878 White reported an instance of the discharge of fetal remains
+through the bladder.
+
+Discharge of the Fetus through the Abdominal Walls.--Margaret Parry of
+Berkshire in 1668 voided the bones of a fetus through the flesh above
+the os pubis, and in 1684 she was alive and well, having had healthy
+children afterward. Brodie reports the history of a case in a negress
+who voided a fetus from an abscess at the navel about the seventeenth
+month of conception. Modern instances of the discharge of the
+extrauterine fetus from the walls of the abdomen are frequently
+reported. Algora speaks of an abdominal pregnancy in which there was
+spontaneous perforation of the anterior abdominal parietes, followed by
+death. Bouzal cites an extraordinary case of ectopic gestation in which
+there was natural expulsion of the fetus through abdominal walls, with
+subsequent intestinal strangulation. An artificial anus was established
+and the mother recovered. Brodie, Dunglison, Erich, Rodbard, Fox, and
+Wilson are among others reporting the expulsion of remnants of ectopic
+pregnancies through the abdominal parietes. Campbell quotes the case of
+a Polish woman, aged thirty-five, the mother of nine children, most of
+whom were stillborn, who conceived for the tenth time, the gestation
+being normal up to the lying-in period. She had pains followed by
+extraordinary effusion and some blood into the vagina. After various
+protracted complaints the abdominal tumor became painful and inflamed
+in the umbilical region. A breach in the walls soon formed, giving exit
+to purulent matter and all the bones of a fetus. During this process
+the patient received no medical treatment, and frequently no assistance
+in dressing the opening.  She recovered, but had an artificial anus all
+her life. Sarah McKinna was married at sixteen and menstruated for the
+first time a month thereafter. Ten months after marriage she showed
+signs of pregnancy and was delivered at full term of a living child;
+the second child was born ten months after the first, and the second
+month after the second birth she again showed signs of pregnancy.  At
+the close of nine months these symptoms, with the exception of the
+suppression of menses, subsided, and in this state she continued for
+six years. During the first four years she felt discomfort in the
+region of the umbilicus. About the seventh year she suffered
+tumefaction of the abdomen and thought she had conceived again. The
+abscess burst and an elbow of the fetus protruded from the wound. A
+butcher enlarged the wound and, fixing his finger under the jaw of the
+fetus, extracted the head.  On looking into the abdomen he perceived a
+black object, whereupon he introduced his hand and extracted piecemeal
+an entire fetal skeleton and some decomposed animal-matter. The abdomen
+was bound up, and in six weeks the woman was enabled to superintend her
+domestic affairs; excepting a ventral hernia she had no bad
+after-results. Kimura, quoted by Whitney, speaks of a case of
+extrauterine pregnancy in a Japanese woman of forty-one similar to the
+foregoing, in which an arm protruded through the abdominal wall above
+the umbilicus and the remains of a fetus were removed through the
+aperture. The accompanying illustration shows the appearance of the arm
+in situ before extraction of the fetus and the location of the wound.
+
+Bodinier and Lusk report instances of the delivery of an extrauterine
+fetus by the vagina; and Mathieson relates the history of the delivery
+of a living ectopic child by the vagina, with recovery of the mother.
+Gordon speaks of a curious case in a negress, six months pregnant, in
+which an extrauterine fetus passed down from the posterior culdesac and
+occluded the uterus.  It was removed through the vagina, and two days
+later labor-pains set in, and in two hours she was delivered of a
+uterine child.  The placenta was left behind and drainage established
+through the vagina, and the woman made complete recovery.
+
+Combined Intrauterine and Extrauterine Gestation.--Many
+well-authenticated cases of combined pregnancy, in which one of the
+products of conception was intrauterine and the other of extrauterine
+gestation, have been recorded. Clark and Ramsbotham report instances of
+double conception, one fetus being born alive in the ordinary manner
+and the other located extrauterine.  Chasser speaks of a case in which
+there was concurrent pregnancy in both the uterus and the Fallopian
+tube. Smith cites an instance of a woman of twenty-three who became
+pregnant in August, 1870. In the following December she passed fetal
+bones from the rectum, and a month later gave birth to an intrauterine
+fetus of six months' growth. McGee mentions the case of a woman of
+twenty-eight who became pregnant in July, 1872, and on October 20th and
+21st passed several fetal bones by the rectum, and about four months
+later expelled some from the uterus. From this time she rapidly
+recovered her strength and health. Devergie quotes an instance of a
+woman of thirty who had several children, but who died suddenly, and
+being pregnant was opened. In the right iliac fossa was found a male
+child weighing 5 pounds and 5 ounces, 8 1/2 inches long, and of about
+five months' growth. The uterus also contained a male fetus of about
+three months' gestation.  Figure 4 shows combined intrauterine and
+extrauterine gestation.  Hodgen speaks of a woman of twenty-seven, who
+was regular until November, 1872; early in January, 1873, she had an
+attack of pain with peritonitis, shortly after which what was
+apparently an extrauterine pregnancy gradually diminished. On August
+17, 1873, after a labor of eight hours, she gave birth to a healthy
+fetus.  The hand in the uterus detected a tumor to the left, which wag
+reduced to about one-fourth the former size. In April, 1874, the woman
+still suffered pain and tenderness in the tumor. Hodgen believed this
+to have been originally a tubal pregnancy, which burst, causing much
+hemorrhage and the death of the fetus, together with a limited
+peritonitis. Beach has seen a twin compound pregnancy in which after
+connection there was a miscarriage in six weeks, and four years after
+delivery of an extrauterine fetus through the abdominal walls. Cooke
+cites an example of intrauterine and extrauterine pregnancy progressing
+simultaneously to full period of gestation, with resultant death.
+Rosset reports the case of a woman of twenty-seven, who menstruated
+last in November, 1878, and on August 5, 1879, was delivered of a
+well-developed dead female child weighing seven pounds. The uterine
+contractions were feeble, and the attached placenta was removed only
+with difficulty; there was considerable hemorrhage. The hemorrhage
+continued to occur at intervals of two weeks, and an extrauterine tumor
+remained. Two weeks later septicemia supervened and life was despaired
+of. On the 15th of October a portion of a fetus of five months' growth
+in an advanced stage of decomposition protruded from the vulva. After
+the escape of this putrid mass her health returned, and in four months
+she was again robust and healthy. Whinery speaks of a young woman who
+at the time of her second child-birth observed a tumor in the abdomen
+on her right side and felt motion in it. In about a month she was with
+severe pain which continued a week and then ceased. Health soon
+improved, and the woman afterward gave birth to a third child;
+subsequently she noticed that the tumor had enlarged since the first
+birth, and she had a recurrence of pain and a slight hemorrhage every
+three weeks, and distinctly felt motion in the tumor. This continued
+for eighteen months, when, after a most violent attack of pain, all
+movement ceased, and, as she expressed it, she knew the moment the
+child died. The tumor lost its natural consistence and felt flabby and
+dead. An incision was made through the linea alba, and the knife came
+in contact with a hard, gritty substance, three or four lines thick.
+The escape of several quarts of dark brown fluid followed the incision,
+and the operation had to be discontinued on account of the ensuing
+syncope. About six weeks afterward a bone presented at the orifice,
+which the woman extracted, and this was soon followed by a mass of
+bones, hair, and putrid matter. The discharge was small, and gradually
+grew less in quantity and offensiveness, soon ceasing altogether, and
+the wound closed. By December health was good and the menses had
+returned.
+
+Ahlfeld, Ambrosioni, Galabin, Packard, Thiernesse, Maxson, de
+Belamizaran, Dibot, and Chabert are among others recording the
+phenomenon of coexisting extrauterine and intrauterine pregnancy.
+Argles mentions simultaneous extrauterine fetation and superfetation.
+
+Sanger mentions a triple ectopic gestation, in which there was twin
+pregnancy in the wall of the uterus and a third ovum at the fimbriated
+end of the right tube. Careful examination showed this to be a case of
+intramural twin pregnancy at the point of entrance of the tube and the
+uterus, while at the abdominal end of the same tube there was another
+ovum,--the whole being an example of triple unilateral ectopic
+gestation.
+
+The instances of delivery of an extrauterine fetus, with viability of
+the child, from the abdomen of the mother would attract attention from
+their rarity alone, but when coupled with associations of additional
+interest they surely deserve a place in a work of this nature. Osiander
+speaks of an abdominal fetus being taken out alive, and there is a
+similar case on record in the early part of this century. The London
+Medical and Physical Journal, in one of its early numbers, contained an
+account of an abdominal fetus penetrating the walls of the bladder and
+being extracted from the walls of the hypogastrium; but Sennertus gives
+a case which far eclipses this, both mother and fetus surviving.  He
+says that in this case the woman, while pregnant, received a blow on
+the lower part of her body, in consequence of which a small tumor
+appeared shortly after the accident. It so happened in this case that
+the peritoneum was extremely dilatable, and the uterus, with the child
+inside, made its way into the peritoneal sac. In his presence an
+incision was made and the fetus taken out alive. Jessop gives an
+example of extrauterine gestation in a woman of twenty-six, who had
+previously had normal delivery. In this case an incision was made and a
+fetus of about eight months' growth was found lying loose in the
+abdominal cavity in the midst of the intestines. Both the mother and
+child were saved. This is a very rare result. Campbell, in his
+celebrated monograph, in a total of 51 operations had only seen
+recorded the accounts of two children saved, and one of these was too
+marvelous to believe.  Lawson Tait reports a case in which he saved the
+child, but lost the mother on the fourth day. Parvin describes a case
+in which death occurred on the third day. Browne quotes Parry as saying
+that there is one twin pregnancy in 23 extrauterine conceptions.  He
+gives 24 cases of twin conception, one of which was uterine, the other
+extrauterine, and says that of 7 in the third month, with no operation,
+the mother died in 5. Of 6 cases of from four and a half to seven
+months' duration, 2 lived, and in 1 case at the fifth month there was
+an intrauterine fetus delivered which lived. Of 11 such cases at nine
+months, 6 mothers lived and 6 intrauterine fetuses lived. In 6 of these
+cases no operation was performed. In one case the mother died, but both
+the uterine and the extrauterine conceptions lived. In another the
+mother and intrauterine fetus died, and the extrauterine fetus lived.
+Wilson a gives an instance of a woman delivered of a healthy female
+child at eight months which lived. The after-birth came away without
+assistance, but the woman still presented every appearance of having
+another child within her, although examination by the vagina revealed
+none. Wilson called Chatard in consultation, and from the fetal
+heart-sounds and other symptoms they decided that there was another
+pregnancy wholly extrauterine. They allowed the case to go twenty-three
+days, until pains similar to those of labor occurred, and then decided
+on celiotomy. The operation was almost bloodless, and a living child
+weighing eight pounds was extracted. Unfortunately, the mother
+succumbed after ninety hours, and in a month the intrauterine child
+died from inanition, but the child of extrauterine gestation thrived.
+Sales gives the case of a negress of twenty-two, who said that she had
+been "tricked by a negro," and had a large snake in the abdomen, and
+could distinctly feel its movements. She stoutly denied any
+intercourse. It was decided to open the abdominal cyst; the incision
+was followed by a gush of blood and a placenta came into view, which
+was extracted with a living child. To the astonishment of the operators
+the uterus was distended, and it was decided to open it, when another
+living child was seen and extracted. The cyst and the uterus were
+cleansed of all clots and the wound closed. The mother died of
+septicemia, but the children both lived and were doing well six weeks
+after the operation. A curious case was seen in 1814 of a woman who at
+her fifth gestation suffered abdominal uneasiness at the third month,
+and this became intolerable at the ninth month.  The head of the fetus
+could be felt through the abdomen; an incision was made through the
+parietes; a fully developed female child was delivered, but,
+unfortunately, the mother died of septic infection.
+
+The British Medical Journal quotes: "Pinard (Bull. de l'Acad. de Med.,
+August 6, 1895) records the following, which he describes as an ideal
+case. The patient was aged thirty-six, had had no illness, and had been
+regular from the age of fourteen till July, 1894. During August of that
+year she had nausea and vomiting; on the 22d and 23d she lost a fluid,
+which was just pink. The symptoms continued during September, on the
+22d and 23d of which month there was a similar loss. In October she was
+kept in bed for two days by abdominal pain, which reappeared in
+November, and was then associated with pain in micturition and
+defecation. From that time till February 26, 1895, when she came under
+Pinard's care, she was attended by several doctors, each of whom
+adopted a different diagnosis and treatment. One of them, thinking she
+had a fibroid, made her take in all about an ounce of savin powder,
+which did not, however, produce any ill effect. When admitted she
+looked ill and pinched. The left thigh and leg were painful and
+edematous. The abdomen looked like that of the sixth month of
+pregnancy. The abdominal wall was tense, smooth, and without lineae
+albicantes. Palpation revealed a cystic immobile tumor, extending 2
+inches above the umbilicus and apparently fixed by deep adhesions. The
+fetal parts could only be made out with difficulty by deep palpation,
+but the heart-sounds were easily heard to the right of and below the
+umbilicus. By the right side of this tumor one could feel a small one,
+the size of a Tangerine orange, which hardened and softened under
+examination. When contracted the groove between it and the large tumor
+became evident. Vaginal examination showed that the cervix, which was
+slightly deflected forward and to the right and softened, as in uterine
+gestation, was continuous with the smaller tumor.  Cephalic
+ballottement was obtained in the large tumor. No sound was passed into
+the uterus for fear of setting up reflex action; the diagnosis of
+extrauterine gestation at about six and a half months with a living
+child was established without requiring to be clinched by proving the
+uterus empty. The patient was kept absolutely at rest in bed and the
+edema of the left leg cured by position. On April 30th the fundus of
+the tumor was 35 cm. above the symphysis and the uterus 11 1/2 cm.; the
+cervix was soft as that of a primipara at term. Operation, May 2d:
+Uterus found empty, cavity 14 1/2 cm. long. Median incision in
+abdominal wall; cyst walls exposed; seen to be very slight and filled
+with enormous vessels, some greater than the little finger. On seizing
+the wall one of these vessels burst, and the hemorrhage was only
+rendered greater on attempting to secure it, so great was the
+friability of the walls. The cyst was therefore rapidly opened and the
+child extracted by the foot. Hemorrhage was restrained first by
+pressure of the hands, then by pressure-forceps and ligatures. The
+walls of the cyst were sewn to the margins of the abdominal wound, the
+edge of the placenta being included in the suture. A wound was thus
+formed 10 cm. in diameter, with the placenta for its base; it was
+filled with iodoform and salicylic gauze. The operation lasted an hour,
+and the child, a boy weighing 5 1/2 pounds, after a brief period of
+respiratory difficulties, was perfectly vigorous. There was at first a
+slight facial asymmetry and a depression on the left upper jaw caused
+by the point of the left shoulder, against which it had been pressed in
+the cyst; these soon disappeared, and on the nineteenth day the boy
+weighed 12 pounds. The maternal wound was not dressed till May 13th,
+when it was washed with biniodid, 1:4000. The placenta came away
+piecemeal between May 25th and June 2d. The wound healed up, and the
+patient got up on the forty-third day, having suckled her infant from
+the first day after its birth."
+
+Quite recently Werder has investigated the question of the ultimate
+fate of ectopic children delivered alive. He has been able to obtain
+the record of 40 cases. Of these, 18 died within a week after birth; 5
+within a month; 1 died at six months of bronchopneumonia; 1 at seven
+months of diarrhea; 2 at eleven months, 1 from croup; 1 at eighteen
+months from cholera infantum--making a total of 26 deaths and leaving
+14 children to be accounted for. Of these, 5 were reported as living
+and well after operation, with no subsequent report; 1 was strong and
+healthy after three weeks, but there has been no report since; 1 was
+well at six months, then was lost sight of; 1 was well at the Last
+report; 2 live and are well at one year; 2 are living and well at two
+years; 1 (Beisone's case) is well at seven years; and 1 (Tait's case)
+is well at fourteen and one-half years. The list given on pages 60 and
+61 has been quoted by Hirst and Dorland. It contains data relative to
+17 cases in which abdominal section has been successfully performed for
+advanced ectopic gestation with living children.
+
+Long Retention of Extrauterine Pregnancy.--The time of the retention of
+an extrauterine gestation is sometimes remarkable, and it is no
+uncommon occurrence for several pregnancies to successfully ensue
+during such retention. The Ephemerides contains examples of
+extrauterine pregnancy remaining in the abdomen forty-six years;
+Hannaeus mentioned an instance remaining ten years, the mother being
+pregnant in the meantime; Primperosius speaks of a similar instance; de
+Blegny, one of twenty-five years in the abdomen; Birch, a case of
+eighteen years in the abdomen, the woman bearing in the meantime;
+Bayle, one of twenty-six years, and the Ephemerides, another. In a
+woman of forty-six, the labor pains intervened without expulsion of the
+fetus. Impregnation ensued twice afterward, each followed by the birth
+of a living child. The woman lived to be ninety-four, and was persuaded
+that the fetus was still in the abdomen, and directed a postmortem
+examination to be made after her decease, which was done, and a large
+cyst containing an ossified fetus was discovered in the left side of
+the cavity. In 1716 a woman of Joigny when thirty years old, having
+been married four years, became pregnant, and three months later felt
+movements and found milk in her breasts. At the ninth month she had
+labor-pains, but the fetus failed to present; the pains ceased, but
+recurred in a month, still with a negative result. She fell into a most
+sickly condition and remained so for eighteen months, when the pains
+returned again, but soon ceased. Menstruation ceased and the milk in
+her breasts remained for thirty years. She died at sixty-one of
+peripneumonia, and on postmortem examination a tumor was found
+occupying part of the hypogastric and umbilical regions. It weighed
+eight pounds and consisted of a male fetus of full term with six teeth;
+it had no odor and its sac contained no liquid.  The bones seemed
+better developed than ordinarily; the skin was thick, callous, and
+yellowish The chorion, amnion, and placenta were ossified and the cord
+dried up. Walther mentions the case of an infant which remained almost
+petrified in the belly of its mother for twenty-three years. No trace
+of the placenta, cord, or enveloping membrane could be found.
+
+Cordier publishes a paper on ectopic gestation, with particular
+reference to tubal pregnancy, and mentions that when there is rupture
+between the broad ligaments hemorrhage is greatly limited by the
+resistance of the surrounding structures, death rarely resulting from
+the primary rupture in this location. Cordier gives an instance in
+which he successfully removed a full-grown child, the result of an
+ectopic gestation which had ruptured intraligamentally and had been
+retained nearly two years.
+
+Lospichlerus gives an account of a mother carrying twins, extrauterine,
+for six years. Mounsey of Riga, physician to the army of the Czarina,
+sent to the Royal Society in 1748 the bones of a fetus that had been
+extracted from one of the fallopian tubes after a lodgment of thirteen
+years. Starkey Middleton read the report of a case of a child which had
+been taken out of the abdomen, having lain there nearly sixteen years,
+during which time the mother had borne four children. It was argued at
+this time that boys were conceived on the right side and girls on the
+left, and in commenting on this Middleton remarks that in this case the
+woman had three boys and one girl after the right fallopian tube had
+lost its function. Chester cites the instance of a fetus being retained
+fifty-two years, the mother not dying until her eightieth year.
+Margaret Mathew carried a child weighing eight pounds in her abdomen
+for twenty-six years, and which after death was extracted. Aubrey
+speaks of a woman aged seventy years unconsciously carrying an
+extrauterine fetus for many years, which was only discovered
+postmortem. She had ceased to menstruate at forty and had borne a child
+at twenty-seven.  Watkins speaks of a fetus being retained forty-three
+years; James, others for twenty-five, thirty, forty-six, and fifty
+years; Murfee, fifty-five years; Cunningham, forty years; Johnson,
+forty-four years; Josephi, fifteen years (in the urinary bladder);
+Craddock, twenty-two years, and da Costa Simoes, twenty-six years.
+
+Long Retention of Uterine Pregnancy.--Cases of long retained
+intrauterine pregnancies are on record and deserve as much
+consideration as those that were extrauterine. Albosius speaks of a
+mother carrying a child in an ossified condition in the uterus for
+twenty-eight years. Cheselden speaks of a case in which a child was
+carried many years in the uterus, being converted into a clay-like
+substance, but preserving form and outline. Caldwell mentions the case
+of a woman who carried an ossified fetus in her uterus for sixty years.
+Camerer describes the retention of a fetus in the uterus for forty-six
+years; Stengel, one for ten years, and Storer and Buzzell, for
+twenty-two months. Hannaeus, in 1686, issued a paper on such a case
+under the title, "Mater, Infantis Mortui Vivum Sepulchrum," which may
+be found in French translation.
+
+Buchner speaks of a fetus being retained in the uterus for six years,
+and Horstius relates a similar case. Schmidt's Jahrbucher contain the
+report of a woman of forty-nine, who had borne two children. While
+threshing corn she felt violent pain like that of labor, and after an
+illness suffered a constant fetid discharge from the vagina for eleven
+years, fetal bones being discharged with occasional pain. This poor
+creature worked along for eleven years, at the end of which time she
+was forced to bed, and died of symptoms of purulent peritonitis. At the
+necropsy the uterus was found adherent to the anterior wall of the
+abdomen and containing remnants of a putrid fetus with its numerous
+bones.  There is an instance recorded of the death of a fetus occurring
+near term, its retention and subsequent discharge being through a
+spontaneous opening in the abdominal wall one or two months after.
+
+Meigs cites the case of a woman who dated her pregnancy from March,
+1848, and which proceeded normally for nine months, but no labor
+supervened at this time and the menses reappeared. In March, 1849, she
+passed a few fetal bones by the rectum, and in May, 1855, she died. At
+the necropsy the uterus was found to contain the remains of a fully
+developed fetus, minus the portions discharged through a fistulous
+connection between the uterine cavity and the rectum. In this case
+there had been retention of a fully developed fetus for nine years. Cox
+describes the case of a woman who was pregnant seven months, and who
+was seized with convulsions; the supposed labor-pains passed off, and
+after death the fetus was found in the womb, having lain there for five
+years. She had an early return of the menses, and these recurred
+regularly for four years. Dewees quotes two cases, in one of which the
+child was carried twenty months in the uterus; in the other, the mother
+was still living two years and five months after fecundation. Another
+case was in a woman of sixty, who had conceived at twenty-six, and
+whose fetus was found, partly ossified, in the uterus after death.
+
+There are many narratives of the long continuation of fetal movements,
+and during recent years, in the Southern States, there was quite a
+prevalence of this kind of imposters. Many instances of the exhibition
+of fetal movements in the bellies of old negro women have been noticed
+by the lay journals, but investigation proves them to have been nothing
+more than an exceptional control over the abdominal muscles, with the
+ability to simulate at will the supposed fetal jerks. One old woman
+went so far as to show the fetus dancing to the music of a banjo with
+rhythmical movements. Such imposters flourished best in the regions
+given to "voodooism." We can readily believe how easy the deception
+might be when we recall the exact simulation of the fetal movements in
+instances of pseudocyesis.
+
+The extraordinary diversity of reports concerning the duration of
+pregnancy has made this a much mooted question. Many opinions relative
+to the longest and shortest period of pregnancy, associated with
+viability of the issue, have been expressed by authors on medical
+jurisprudence. There is perhaps no information more unsatisfactory or
+uncertain. Mistakes are so easily made in the date of the occurrence of
+pregnancy, or in the date of conception, that in the remarkable cases
+we can hardly accept the propositions as worthy evidence unless
+associated with other and more convincing facts, such as the appearance
+and stage of development of the fetus, or circumstances making
+conception impossible before or after the time mentioned, etc. It will
+be our endeavor to cite the more seemingly reliable instances of the
+anomalies of the time or duration of pregnancy reported in reputable
+periodicals or books.
+
+Short Pregnancies.--Hasenet speaks of the possibility of a living birth
+at four months; Capuron relates the instance of Fortunio Liceti, who
+was said to have been born at the end of four and a half months and
+lived to complete his twenty-fourth year. In the case of the Marechal
+de Richelieu, the Parliament of Paris decreed that an infant of five
+months possessed that capability of living the ordinary period of
+existence, i.e., the "viabilite," which the law of France requires for
+the establishment of inheritance. In his seventh book Pliny gives
+examples of men who were born out of time. Jonston gives instances of
+births at five, six, seven, and eight months. Bonnar quotes 5 living
+births before the one hundred and fiftieth day; 1 of one hundred and
+twenty-five days; 1 of one hundred and twenty days; 1 of one hundred
+and thirty-three days, surviving to twenty-one months; and 1 of one
+hundred and thirty-five days' pregnancy surviving to eighty years.
+Maisonneuve describes a case in which abortion took place at four and a
+half months; he found the fetus in its membranes two hours after
+delivery, and, on laying the membranes open, saw that it was living. He
+applied warmth, and partly succeeded in restoring it; for a few minutes
+respiratory movements were performed regularly, but it died in six
+hours. Taylor quotes Carter concerning the case of a fetus of five
+months which cried directly after it was born, and in the half hour it
+lived it tried frequently to breathe. He also quotes Davies, mentioning
+an instance of a fetus of five months, which lived twelve hours,
+weighing 2 pounds, and measuring 12 inches, and which cried vigorously.
+The pupillary membrane was entire, the testes had not descended, and
+the head was well covered with hair. Usher speaks of a woman who in
+1876 was delivered of 2 male children on the one hundred and
+thirty-ninth day; both lived for an hour; the first weighed 10 ounces 6
+drams and measured 9 3/4 inches; the other 10 ounces 7 drams, with the
+same length as the first. Routh speaks of a Mrs. F----, aged
+thirty-eight, who had borne 9 children and had had 3 miscarriages, the
+last conception terminating as such. Her husband was away, and returned
+October 9, 1869. She did not again see her husband until the 3d or 4th
+of January. The date of quickening was not observed, and the child was
+born June 8, 1870. During gestation she was much frightened by a rat.
+The child was weak, the testes undescended, and it lived but eighteen
+days, dying of symptoms of atrophy. The parents were poor, of excellent
+character, and although, according to the evidence, this pregnancy
+lasted but twenty-two weeks and two days, there was absolutely no
+reason to suspect infidelity.
+
+Ruttel speaks of a child of five months who lived twenty-four hours;
+and he saw male twins born at the sixth month weighing 3 pounds each
+who were alive and healthy a year after. Barker cites the case of a
+female child born on the one hundred and fifty-eighth day that weighed
+1 pound and was 11 inches long. It had rudimentary nails, very little
+hair on the head, its eyelids were closed, and the skin much shriveled;
+it did not suckle properly, and did not walk until nineteen months old.
+Three and a half years after, the child was healthy and thriving, but
+weighed only 29 1/2 pounds. At the time of birth it was wrapped up in a
+box and placed before the fire. Brouzet speaks of living births of from
+five to six months' pregnancy, and Kopp speaks of a six months' child
+which lived four days. The Ephemerides contains accounts of living
+premature births.
+
+Newinton describes a pregnancy of five months terminating with the
+birth of twins, one of whom lived twenty minutes and the other fifteen.
+The first was 11 1/2 inches long, and weighed 1 pound 3 1/2 ounces, and
+the other was 11 inches long, and weighed 1 pound. There is a recent
+instance of premature birth following a pregnancy of between five and a
+half and six months, the infant weighing 955 grams. One month after
+birth, through the good offices of the wet-nurse and M. Villemin, who
+attended the child and who invented a "couveuse" for the occasion, it
+measured 38 cm. long.
+
+Moore is accredited with the trustworthy report of the case of a woman
+who bore a child at the end of the fifth month weighing 1 1/2 pounds
+and measuring 9 inches. It was first nourished by dropping liquid food
+into its mouth; and at the age of fifteen months it was healthy and
+weighed 18 pounds. Eikam saw a case of abortion at the fifth month in
+which the fetus was 6 inches in length and weighed about 8 ounces. The
+head was sufficiently developed and the cranial bones considerably
+advanced in ossification. He tied the cord and placed the fetus in warm
+water. It drew up its feet and arms and turned its head from one side
+to the other, opening its mouth and trying to breathe. It continued in
+this wise for an hour, the action of the heart being visible ten
+minutes after the movements ceased. From its imperfectly developed
+genitals it was supposed to have been a female. Professor J. Muller, to
+whom it was shown, said that it was not more than four months old, and
+this coincided with the mother's calculation.
+
+Villemin before the Societe Obstetricale et Gynecologique reported the
+case of a two-year-old child, born in the sixth month of pregnancy.
+That the child had not had six months of intrauterine life he could
+vouch, the statement being borne out by the last menstrual period of
+the mother, the date of the first fetal movements, the child's weight,
+which was 30 1/2 ounces, and its appearance. Budin had had this infant
+under observation from the beginning and corroborated Villemin's
+statements. He had examined infants of six or seven months that had
+cried and lived a few days, and had found the alveolar cavities filled
+with epithelial cells, the lung sinking when placed in a vessel of
+water. Charpentier reported a case of premature birth in his practice,
+the child being not more than six and a half months and weighing 33 1/2
+ounces. So sure was he that it would not live that he placed it in a
+basin while he attended to the mother.  After this had been done, the
+child being still alive, he wrapped it in cotton and was surprised next
+day to find it alive. It was then placed in a small, well-heated room
+and fed with a spoon on human milk; on the twelfth day it could take
+the breast, since which time it thrived and grew.
+
+There is a case on record of a child viable at six months and twenty
+days. The mother had a miscarriage at the beginning of 1877, after
+which menstruation became regular, appearing last from July 3 to 9,
+1877. On January 28, 1878, she gave birth to a male infant, which was
+wrapped in wadding and kept at an artificial temperature. Being unable
+to suckle, it was fed first on diluted cow's milk. It was so small at
+birth that the father passed his ring over the foot almost to the knee.
+On the thirteenth day it weighed 1250 grams, and at the end of a week
+it was taking the breast. In December, 1879, it had 16 teeth, weighed
+10 kilograms, walked with agility, could pronounce some words, and was
+especially intelligent. Capuron relates an instance of a child born
+after a pregnancy of six and a half months and in excellent health at
+two years, and another living at ten years of the same age at birth.
+Tait speaks of a living female child, born on the one hundred and
+seventy-ninth day, with no nails on its fingers or toes, no hair, the
+extremities imperfectly developed, and the skin florid and thin. It was
+too feeble to grasp its mother's nipple, and was fed for three weeks by
+milk from the breast through a quill. At forty days it weighed 3 pounds
+and measured 13 inches. Before the expiration of three months it died
+of measles. Dodd describes a case in which the catamenia were on the
+24th of June, 1838, and continued a week; the woman bore twins on
+January 11, 1839, one of which survived, the other dying a few minutes
+after birth. She was never irregular, prompt to the hour, and this
+fact, coupled with the diminutive size of the children, seemed to
+verify the duration of the pregnancy. In 1825, Baber of Buxur, India,
+spoke of a child born at six and a half months, who at the age of fifty
+days weighed 1 pound and 13 ounces and was 14 inches long. The longest
+circumference of the head was 10 inches and the shortest 9.1 inches.
+The child suckled freely and readily. In Spaeth's clinic there was a
+viable infant at six and a half months weighing 900 grams. Spaeth says
+that he has known a child of six months to surpass in eventual
+development its brothers born at full term.
+
+In some cases there seems to be a peculiarity in women which manifests
+itself by regular premature births. La Motte, van Swieten, and Fordere
+mention females who always brought forth their conceptions at the
+seventh month.
+
+The incubator seems destined to be the future means of preserving these
+premature births. Several successful cases have been noticed, and by
+means of an incubator Tarnier succeeded in raising infants which at the
+age of six months were above the average. A full description of the
+incubator may be found. The modified Auvard incubator is easily made;
+the accompanying illustrations (Figs. 5, 6, and 7) explain its
+mechanism. Several improved incubators have been described in recent
+years, but the Auvard appears to be the most satisfactory.
+
+The question of retardation of labor, like that of premature birth, is
+open to much discussion, and authorities differ as to the limit of
+protraction with viability. Aulus Gellius says that, after a long
+conversation with the physicians and wise men, the Emperor Adrian
+decided in a case before him, that of a woman of chaste manners and
+irreproachable character, the child born eleven months after her
+husband's death was legitimate. Under the Roman law the Decenviri
+established that a woman may bear a viable child at the tenth month of
+pregnancy. Paulus Zacchias, physician to Pope Innocent X, declared that
+birth may be retarded to the tenth month, and sometimes to a longer
+period. A case was decided in the Supreme Court of Friesland, a
+province in the northern part of the Netherlands, October, 1634, in
+which a child born three hundred and thirty-three days after the death
+of the husband was pronounced legitimate. The Parliament of Paris was
+gallant enough to come to the rescue of a widow and save her reputation
+by declaring that a child born after a fourteen months' gestation was
+legitimate. Bartholinus speaks of an unmarried woman of Leipzig who was
+delivered after a pregnancy of sixteen months. The civil code of France
+provides that three hundred days shall constitute the longest period of
+the legitimacy of an infant; the Scottish law, three hundred days; and
+the Prussian law, three hundred and one days.
+
+There are numerous cases recorded by the older writers. Amman has one
+of twelve months' duration; Enguin, one of twelve months'; Buchner, a
+case of twelve months'; Benedictus, one of fourteen months'; de Blegny,
+one of nineteen months'; Marteau, Osiander, and others of forty-two and
+forty-four weeks'; and Stark's Archives, one of forty-five weeks',
+living, and also another case of forty-four weeks'. An incredible case
+is recorded of an infant which lived after a three years' gestation.
+Instances of twelve months' duration are also recorded. Jonston quotes
+Paschal in relating an instance of birth after pregnancy of
+twenty-three months; Aventium, one after two years; and Mercurialis, a
+birth after a four years' gestation--which is, of course, beyond belief.
+
+Thormeau writes from Tours, 1580, of a case of gestation prolonged to
+the twenty-third month, and Santorini, at Venice, in 1721, describes a
+similar case, the child reaching adult life.  Elvert records a case of
+late pregnancy, and Henschel one of forty-six weeks, but the fetus was
+dead. Schneider cites an instance of three hundred and eight days'
+duration. Campbell says that Simpson had cases of three hundred and
+nineteen, three hundred and thirty-two, and three hundred and
+thirty-six days'; Meigs had one of four hundred and twenty. James Reid,
+in a table of 500 mature births, gives 14 as being from three hundred
+and two to three hundred and fifteen days'.
+
+Not so long ago a jury rendered a verdict of guilty of fornication and
+bastardy when it was alleged that the child was born three hundred and
+seventeen days after intercourse. Taylor relates a case of pregnancy in
+which the wife of a laborer went to America three hundred and
+twenty-two days before the birth.  Jaffe describes an instance of the
+prolongation of pregnancy for three hundred and sixty-five days, in
+which the developments and measurements corresponded to the length of
+protraction. Bryan speaks of a woman of twenty-five who became pregnant
+on February 10, 1876, and on June 17th felt motion. On July 28th she
+was threatened with miscarriage, and by his advice the woman weaned the
+child at the breast. She expected to be confined the middle of
+November, 1876, but the expected event did not occur until April 26,
+1877, nine months after the quickening and four hundred and forty days
+from the time of conception. The boy was active and weighed nine
+pounds. The author cites Meigs' case, and also one of Atlee's, at three
+hundred and fifty-six days.
+
+Talcott, Superintendent of the State Homeopathic Asylum for the Insane,
+explained the pregnancy of an inmate who had been confined for four
+years in this institution as one of protracted labor. He said that many
+such cases have been reported, and that something less than two years
+before he had charge of a case in which the child was born. He made the
+report to the New York Senate Commission on Asylums for the Insane as
+one of three years' protraction. Tidd speaks of a woman who was
+delivered of a male child at term, and again in ten months delivered of
+a well-developed male child weighing 7 1/4 pounds; he relates the
+history of another case, in Clifton, W. Va., of a woman expecting
+confinement on June 1st going over to September 16th, the fetus being
+in the uterus over twelve months, and nine months after quickening was
+felt.
+
+Two extraordinary cases are mentioned, one in a woman of thirty-five,
+who expected to be confined April 24, 1883. In May she had a few
+labor-pains that passed away, and during the next six months she
+remained about as large as usual, and was several times thought to be
+in the early stages of labor. In September the os dilated until the
+first and second fingers could be passed directly to the head. This
+condition lasted about a month, but passed away. At times during the
+last nine months of pregnancy she was almost unable to endure the
+movements of the child.  Finally, on the morning of November 6th, after
+a pregnancy of four hundred and seventy-six days, she was delivered of
+a male child weighing 13 pounds. Both the mother and child did well
+despite the use of chloroform and forceps. The other case was one
+lasting sixteen months and twenty days.
+
+In a rather loose argument, Carey reckons a case of three hundred and
+fifty days. Menzie gives an instance in a woman aged twenty-eight, the
+mother of one child, in whom a gestation was prolonged to the
+seventeenth month. The pregnancy was complicated by carcinoma of the
+uterus. Ballard describes the case of a girl of sixteen years and six
+months, whose pregnancy, the result of a single intercourse, lasted
+three hundred and sixty days. Her labor was short and easy for a
+primipara, and the child was of the average size. Mackenzie cites the
+instance of a woman aged thirty-two, a primipara, who had been married
+ten years and who always had been regular in menstruation. The menses
+ceased on April 28, 1888, and she felt the child for the first time in
+September. She had false pains in January, 1889, and labor did not
+begin until March 8th, lasting sixty-six hours. If all these statements
+are correct, the probable duration of this pregnancy was eleven months
+and ten days.
+
+Lundie relates an example of protracted gestation of eleven months, in
+which an anencephalous fetus was born; and Martin of Birmingham
+describes a similar case of ten and a half months' duration.
+Raux-Tripier has seen protraction to the thirteenth month. Enguin
+reports an observation of an accouchement of twins after a pregnancy
+that had been prolonged for eleven months.  Resnikoff mentions a
+pregnancy of eleven months' duration in an anemic secundipara. The case
+had been under his observation from the beginning of pregnancy; the
+patient would not submit to artificial termination at term, which he
+advised. After a painful labor of twenty-four hours a macerated and
+decomposed child was born, together with a closely-adherent placenta.
+Tarnier reports an instance of partus serotinus in which the product of
+conception was carried in the uterus forty days after term. The fetus
+was macerated but not putrid, and the placenta had undergone fatty
+degeneration. At a recent meeting of the Chicago Gynecological Society,
+Dr. F. A. Stahl reported the case of a German-Bohemian woman in which
+the fifth pregnancy terminated three hundred and two days after the
+last menstruation. Twenty days before there had occurred pains similar
+to those of labor, but they gradually ceased. The sacral promontory was
+exaggerated, and the anteroposterior pelvic diameter of the inlet in
+consequence diminished. The fetus was large and occupied the first
+position. Version was with difficulty effected and the passage of the
+after-coming head through the superior strait required expression and
+traction, during which the child died.  The mother suffered a deep
+laceration of the perineum involving an inch of the wall of the rectum.
+
+Among others reporting instances of protracted pregnancy are Collins,
+eleven months; Desbrest, eighteen months; Henderson, fifteen months;
+Jefferies, three hundred and fifty-eight days, and De la Vergne gives
+the history of a woman who carried an infant in her womb for
+twenty-nine months; this case may possibly belong under the head of
+fetus long retained in the uterus.
+
+Unconscious Pregnancy.--There are numerous instances of women who have
+had experience in pregnancy unconsciously going almost to the moment of
+delivery, yet experiencing none of the usual accompanying symptoms of
+this condition. Crowell speaks of a woman of good social position who
+had been married seven years, and who had made extensive preparations
+for a long journey, when she was seized with a "bilious colic," and, to
+her dismay and surprise, a child was born before the arrival of the
+doctor summoned on account of her sudden colic and her inability to
+retain her water. A peculiar feature of this case was the fact that
+mental disturbance set in immediately afterward, and the mother became
+morbid and had to be removed to an asylum, but recovered in a few
+months. Tanner saw a woman of forty-two who had been suffering with
+abdominal pains. She had been married three years and had never been
+pregnant. Her catamenia were very scant, but this was attributed to her
+change of life. She had conceived, had gone to the full term of
+gestation, and was in labor ten hours without any suspicion of
+pregnancy. She was successfully delivered of a girl, which occasioned
+much rejoicing in the household.
+
+Tasker of Kendall's Mills, Me., reports the case of a young married
+woman calling him for bilious colic. He found the stomach slightly
+distended and questioned her about the possibility of pregnancy. Both
+she and her husband informed him that such could not be the case, as
+her courses had been regular and her waist not enlarged, as she had
+worn a certain corset all the time.  There were no signs of quickening,
+no change in the breasts, and, in fact, none of the usual signs of
+pregnancy present. He gave her an opiate, and to her surprise, in about
+six hours she was the mother of a boy weighing five pounds. Both the
+mother and child made a good recovery. Duke cites the instance of a
+woman who supposed that she was not pregnant up to the night of her
+miscarriage. She had menstruated and was suckling a child sixteen
+months old. During the night she was attacked with pains resembling
+those of labor and a fetus slipped into the vagina without any
+hemorrhage; the placenta came away directly afterward. In this peculiar
+case the woman was menstruating regularly, suckling a child, and at the
+same time was unconsciously pregnant.
+
+Isham speaks of a case of unconscious pregnancy in which extremely
+small twins were delivered at the eighth month. Fox cites an instance
+of a woman who had borne eight children, and yet unconscious of
+pregnancy. Merriman speaks of a woman forty years of age who had not
+borne a child for nine years, but who suddenly gave birth to a stout,
+healthy boy without being cognizant of pregnancy. Dayral tells of a
+woman who carried a child all through pregnancy, unconscious of her
+condition, and who was greatly surprised at its birth. Among the French
+observers speaking of pregnancy remaining unrecognized by the mother
+until the period of accouchement, Lozes and Rhades record peculiar
+cases; and Mouronval relates an instance in which a woman who had borne
+three children completely ignored the presence of pregnancy until the
+pains of labor were felt.  Fleishman and Munzenthaler also record
+examples of unconscious pregnancy.
+
+Pseudocyesis.--On the other hand, instances of pregnancy with imaginary
+symptoms and preparations for birth are sometimes noticed, and many
+cases are on record. In fact, nearly every text-book on obstetrics
+gives some space to the subject of pseudocyesis. Suppression of the
+menses, enlargement of the abdomen, engorgement of the breasts,
+together with the symptoms produced by the imagination, such as nausea,
+spasmodic contraction of the abdomen, etc., are for the most part the
+origin of the cases of pseudocyesis. Of course, many of the cases are
+not examples of true pseudocyesis, with its interesting phenomena, but
+instances of malingering for mercenary or other purposes, and some are
+calculated to deceive the most expert obstetricians by their tricks.
+Weir Mitchell delineates an interesting case of pseudocyesis as
+follows: "A woman, young, or else, it may be, at or past the
+climacteric, eagerly desires a child or is horribly afraid of becoming
+pregnant. The menses become slight in amount, irregular, and at last
+cease or not.  Meanwhile the abdomen and breasts enlarge, owing to a
+rapid taking on of fat, and this is far less visible elsewhere. There
+comes with this excess of fat the most profound conviction of the fact
+of pregnancy. By and by the child is felt, the physician takes it for
+granted, and this goes on until the great diagnostician, Time, corrects
+the delusion. Then the fat disappears with remarkable speed, and the
+reign of this singular simulation is at an end." In the same article,
+Dr. Mitchell cites the two following cases under his personal
+observation: "I was consulted by a lady in regard to a woman of thirty
+years of age, a nurse in whom she was interested. This person had been
+married some three years to a very old man possessed of a considerable
+estate. He died, leaving his wife her legal share and the rest to
+distant cousins, unless the wife had a child. For two months before he
+died the woman, who was very anemic, ceased to menstruate. She became
+sure that she was pregnant, and thereupon took on flesh at a rate and
+in a way which seemed to justify her belief. Her breasts and abdomen
+were the chief seats of this overgrowth. The menses did not return, her
+pallor increased; the child was felt, and every preparation made for
+delivery. At the eighth month a physician made an examination and
+assured her of the absence of pregnancy. A second medical opinion
+confirmed the first, and the tenth month found her of immense size and
+still positive as to her condition. At the twelfth month her menstrual
+flow returned, and she became sure it was the early sign of labor. When
+it passed over she became convinced of her error, and at once dropped
+weight at the rate of half a pound a day despite every effort to limit
+the rate of this remarkable loss. At the end of two months she had
+parted with fifty pounds and was, on the whole, less anemic. At this
+stage I was consulted by letter, as the woman had become exceedingly
+hysteric. This briefly stated case, which occurred many years ago, is a
+fair illustration of my thesis.
+
+"Another instance I saw when in general practice. A lady who had
+several children and suffered much in her pregnancies passed five years
+without becoming impregnated. Then she missed a period, and had, as
+usual, vomiting. She made some wild efforts to end her supposed
+pregnancy, and failing, acquiesced in her fate. The menses returned at
+the ninth month and were presumed to mean labor. Meanwhile she vomited,
+up to the eighth month, and ate little. Nevertheless, she took on fat
+so as to make the abdomen and breasts immense and to excite unusual
+attention. No physician examined her until the supposed labor began,
+when, of course, the truth came out. She was pleased not to have
+another child, and in her case, as in all the others known to me, the
+fat lessened as soon as the mind was satisfied as to the non-existence
+of pregnancy. As I now recall the facts, this woman was not more than
+two months in getting rid of the excess of adipose tissue.  Dr. Hirst
+tells me he has met with cases of women taking on fat with cessation of
+the menses, and in which there was also a steady belief in the
+existence of pregnancy. He has not so followed up these cases as to
+know if in them the fat fell away with speed when once the patient was
+assured that no child existed within her."
+
+Hirst, in an article on the difficulties in the diagnosis of pregnancy,
+gives several excellent photographs showing the close resemblance
+between several pathologic conditions and the normal distention of the
+abdomen in pregnancy. A woman who had several children fell sick with a
+chest-affection, followed by an edema.  For fifteen months she was
+confined to her bed, and had never had connection with her husband
+during that time. Her menses ceased; her mammae became engorged and
+discharged a serous lactescent fluid; her belly enlarged, and both she
+and her physician felt fetal movements in her abdomen. As in her
+previous pregnancies, she suffered nausea. Naturally, a suspicion as to
+her virtue came into her husband's mind, but when he considered that
+she had never left her bed for fifteen months he thought the pregnancy
+impossible. Still the wife insisted that she was pregnant and was
+confirmed in the belief by a midwife. The belly continued to increase,
+and about eleven months after the cessation of the menses she had the
+pains of labor. Three doctors and an accoucheur were present, and when
+they claimed that the fetal head presented the husband gave up in
+despair; but the supposed fetus was born shortly after, and proved to
+be only a mass of hydatids, with not the sign of a true pregnancy.
+Girard of Lyons speaks of a female who had been pregnant several times,
+but again experienced the signs of pregnancy. Her mammae were engorged
+with a lactescent fluid, and she felt belly-movements like those of a
+child; but during all this time she had regular menstruation. Her
+abdomen progressively increased in size, and between the tenth and
+eleventh months she suffered what she thought to be labor-pains. These
+false pains ceased upon taking a bath, and with the disappearance of
+the other signs was dissipated the fallacious idea of pregnancy.
+
+There is mentioned an instance of medicolegal interest of a young girl
+who showed all the signs of pregnancy and confessed to her parents that
+she had had commerce with a man. The parents immediately prosecuted the
+seducer by strenuous legal methods, but when her ninth month came, and
+after the use of six baths, all the signs of pregnancy vanished. Harvey
+cites several instances of pseudocyesis, and says we must not rashly
+determine of the the inordinate birth before the seventh or after the
+eleventh month. In 1646 a woman, after having laughed heartily at the
+jests of an ill-bred, covetous clown, was seized with various movements
+and motions in her belly like those of a child, and these continued for
+over a month, when the courses appeared again and the movements ceased.
+The woman was certain that she was pregnant.
+
+The most noteworthy historic case of pseudocyesis is that of Queen Mary
+of England, or "Bloody Mary," as she was called. To insure the
+succession of a Catholic heir, she was most desirous of having a son by
+her consort, Philip, and she constantly prayed and wished for
+pregnancy.  Finally her menses stopped; the breasts began to enlarge
+and became discolored around the nipples. She had morning-sickness of a
+violent nature and her abdomen enlarged. On consultation with the
+ladies of her court, her opinion of pregnancy was strongly confirmed.
+Her favorite amusement then was to make baby-clothes and count on her
+fingers the months of pregnancy. When the end of the ninth month
+approached, the people were awakened one night by the joyous peals of
+the bells of London announcing the new heir.  An ambassador had been
+sent to tell the Pope that Mary could feel the new life within her, and
+the people rushed to St. Paul's Cathedral to listen to the venerable
+Archbishop of Canterbury describe the baby-prince and give thanks for
+his deliverance. The spurious labor pains passed away, and after being
+assured that no real pregnancy existed in her case, Mary went into
+violent hysterics, and Philip, disgusted with the whole affair,
+deserted her; then commenced the persecution of the Protestants, which
+blighted the reign.
+
+Putnam cites the case of a healthy brunet, aged forty, the mother of
+three children. She had abrupt vertical abdominal movements, so strong
+as to cause her to plunge and sway from side to side.  Her breasts were
+enlarged, the areolae dark, and the uterus contained an elastic tumor,
+heavy and rolling under the hand. Her abdomen progressively enlarged to
+the regular size of matured gestation; but the extrauterine pregnancy,
+which was supposed to have existed, was not seen at the autopsy,
+nothing more than an enlarged liver being found. The movement was due
+to spasmodic movements of the abdominal muscles, the causes being
+unknown.  Madden gives the history of a primipara of twenty-eight,
+married one year, to whom he was called. On entering the room he was
+greeted by the midwife, who said she expected the child about 8 P.M.
+The woman was lying in the usual obstetric position, on the left side,
+groaning, crying loudly, and pulling hard at a strap fastened to the
+bed-post. She had a partial cessation of menses, and had complained of
+tumultuous movements of the child and overflow of milk from the
+breasts. Examination showed the cervix low down, the os small and
+circular, and no signs of pregnancy in the uterus. The abdomen was
+distended with tympanites and the rectum much dilated with accumulated
+feces. Dr. Madden left her, telling her that she was not pregnant, and
+when she reappeared at his office in a few days, he reassured her of
+the nonexistence of pregnancy; she became very indignant, triumphantly
+squeezed lactescent fluid from her breasts, and, insisting that she
+could feel fetal movements, left to seek a more sympathetic accoucheur.
+Underhill, in the words of Hamilton, describes a woman as "having
+acquired the most accurate description of the breeding symptoms, and
+with wonderful facility imagined that she had felt every one of them."
+He found the woman on a bed complaining of great labor-pains, biting a
+handkerchief, and pulling on a cloth attached to her bed. The finger on
+the abdomen or vulva elicited symptoms of great sensitiveness. He told
+her she was not pregnant, and the next day she was sitting up, though
+the discharge continued, but the simulated throes of labor, which she
+had so graphically pictured, had ceased.
+
+Haultain gives three examples of pseudocyesis, the first with no
+apparent cause, the second due to carcinoma of the uterus, while in the
+third there was a small fibroid in the anterior wall of the uterus.
+Some cases are of purely nervous origin, associated with a purely
+muscular distention of the abdomen. Clay reported a case due to
+ascites. Cases of pseudocyesis in women convicted of murder are not
+uncommon, though most of them are imposters hoping for an extra lease
+of life.
+
+Croon speaks of a child seven years old on whom he performed ovariotomy
+for a round-celled sarcoma. She had been well up to May, but since then
+she had several times been raped by a boy, in consequence of which she
+had constant uterine hemorrhage. Shortly after the first coitus her
+abdomen began to enlarge, the breasts to develop, and the areolae to
+darken. In seven months the abdomen presented the signs of pregnancy,
+but the cervix was soft and patulous; the sound entered three inches
+and was followed by some hemorrhage. The child was well developed, the
+mons was covered with hair, and all the associate symptoms tended to
+increase the deception.
+
+Sympathetic Male Nausea of Pregnancy.--Associated with pregnancy there
+are often present morning-nausea and vomiting as prominent and reliable
+symptoms. Vomiting is often so excessive as to be provocative of most
+serious issue and even warranting the induction of abortion. This fact
+is well known and has been thoroughly discussed, but with it is
+associated an interesting point, the occasional association of the same
+symptoms sympathetically in the husband. The belief has long been a
+superstition in parts of Great Britain, descending to America, and even
+exists at the present day. Sir Francis Bacon has written on this
+subject, the substance of his argument being that certain loving
+husbands so sympathize with their pregnant wives that they suffer
+morning-sickness in their own person. No less an authority than S. Weir
+Mitchell called attention to the interesting subject of sympathetic
+vomiting in the husband in his lectures on nervous maladies some years
+ago. He also quotes the following case associated with pseudocyesis:--
+
+"A woman had given birth to two female children. Some years passed and
+her desire for a boy was ungratified. Then she missed her flow once,
+and had thrice after this, as always took place with her when pregnant,
+a very small but regular loss. At the second month morning-vomiting
+came on as usual with her.  Meanwhile she became very fat, and as the
+growth was largely, in fact excessively, abdominal, she became easily
+sure of her condition. She was not my patient, but her husband
+consulted me as to his own morning-sickness, which came on with the
+first occurrence of this sign in his wife, as had been the case twice
+before in her former pregnancies. I advised him to leave home, and this
+proved effectual. I learned later that the woman continued to gain
+flesh and be sick every morning until the seventh month. Then
+menstruation returned, an examination was made, and when sure that
+there was no possibility of her being pregnant she began to lose flesh,
+and within a few months regained her usual size."
+
+Hamill reports an instance of morning-sickness in a husband two weeks
+after the appearance of menstruation in the wife for the last time. He
+had daily attacks, and it was not until the failure of the next menses
+that the woman had any other sign of pregnancy than her husband's
+nausea. His nausea continued for two months, and was the same as that
+which he had suffered during his wife's former pregnancies, although
+not until both he and his wife became aware of the existence of
+pregnancy. The Lancet describes a case in which the husband's nausea
+and vomiting, as well as that of the wife, began and ended
+simultaneously. Judkins cites an instance of a man who was sick in the
+morning while his wife was carrying a child. This occurred during every
+pregnancy, and the man related that his own father was similarly
+affected while his mother was in the early months of pregnancy with
+him, showing an hereditary predisposition.
+
+The perverted appetites and peculiar longings of pregnant women furnish
+curious matter for discussion. From the earliest times there are many
+such records. Borellus cites an instance, and there are many others, of
+pregnant women eating excrement with apparent relish. Tulpius, Sennert,
+Langius, van Swieten, a Castro, and several others report depraved
+appetites. Several writers have seen avidity for human flesh in such
+females.  Fournier knew a woman with an appetite for the blood of her
+husband. She gently cut him while he lay asleep by her side and sucked
+blood from the wounds--a modern "Succubus." Pare mentions the perverted
+appetites of pregnant women, and says that they have been known to eat
+plaster, ashes, dirt, charcoal, flour, salt, spices, to drink pure
+vinegar, and to indulge in all forms of debauchery. Plot gives the case
+of a woman who would gnaw and eat all the linen off her bed. Hufeland's
+Journal records the history of a case of a woman of thirty-two, who had
+been married ten years, who acquired a strong taste for charcoal, and
+was ravenous for it. It seemed to cheer her and to cure a supposed
+dyspepsia. She devoured enormous quantities, preferring hard-wood
+charcoal. Bruyesinus speaks of a woman who had a most perverted
+appetite for her own milk, and constantly drained her breasts;
+Krafft-Ebing cites a similar case. Another case is that of a pregnant
+woman who had a desire for hot and pungent articles of food, and who in
+a short time devoured a pound of pepper.  Scheidemantel cites a case in
+which the perverted appetite, originating in pregnancy, became
+permanent, but this is not the experience of most observers. The
+pregnant wife of a farmer in Hassfort-on-the-Main ate the excrement of
+her husband.
+
+Many instances could be quoted, some in which extreme cases of
+polydipsia and bulimia developed; these can be readily attributed to
+the increased call for liquids and food. Other cases of diverse new
+emotions can be recalled, such as lasciviousness, dirty habits,
+perverted thoughts, and, on the other hand, extreme piety, chastity,
+and purity of the mind. Some of the best-natured women are when
+pregnant extremely cross and irritable and many perversions of
+disposition are commonly noticed in pregnancy.  There is often a
+longing for a particular kind of food or dish for which no noticeable
+desire had been displayed before.
+
+Maternal Impressions.--Another curious fact associated with pregnancy
+is the apparent influence of the emotions of the mother on the child in
+utero. Every one knows of the popular explanation of many birth-marks,
+their supposed resemblance to some animal or object seen by the mother
+during pregnancy, etc. The truth of maternal impressions, however,
+seems to be more firmly established by facts of a substantial nature.
+There is a natural desire to explain any abnormality or anomaly of the
+child as due to some incident during the period of the mother's
+pregnancy, and the truth is often distorted and the imagination heavily
+drawn upon to furnish the satisfactory explanation. It is the customary
+speech of the dime-museum lecturer to attribute the existence of some
+"freak" to an episode in the mother's pregnancy. The poor
+"Elephant-man" firmly believed his peculiarity was due to the fact that
+his mother while carrying him in utero was knocked down at the circus
+by an elephant. In some countries the exhibition of monstrosities is
+forbidden because of the supposed danger of maternal impression. The
+celebrated "Siamese Twins" for this reason were forbidden to exhibit
+themselves for quite a period in France.
+
+We shall cite only a few of the most interesting cases from medical
+literature. Hippocrates saved the honor of a princess, accused of
+adultery with a negro because she bore a black child, by citing it as a
+case of maternal impression, the husband of the princess having placed
+in her room a painting of a negro, to the view of which she was
+subjected during the whole of her pregnancy. Then, again, in the
+treatise "De Superfoetatione" there occurs the following distinct
+statement: "If a pregnant woman has a longing to eat earth or coals,
+and eats of them, the infant which is born carries on its head the mark
+of these things." This statement, however, occurs in a work which is
+not mentioned by any of the ancient authorities, and is rejected by
+practically all the modern ones; according to Ballantyne, there is,
+therefore, no absolute proof that Hippocrates was a believer in one of
+the most popular and long-persisting beliefs concerning fetal
+deformities.
+
+In the explanation of heredity, Hippocrates states "that the body of
+the male as well as that of the female furnishes the semen.  That which
+is weak (unhealthy) is derived from weak (unhealthy) parts, that which
+is strong (healthy) from strong (healthy) parts, and the fetus will
+correspond to the quality of the semen.  If the semen of one part come
+in greater quantity from the male than from the female, this part will
+resemble more closely the father; if, however, it comes more from the
+female, the part will rather resemble the mother. If it be true that
+the semen comes from both parents, then it is impossible for the whole
+body to resemble either the mother or the father, or neither the one
+nor the other in anything, but necessarily the child will resemble both
+the one and the other in something. The child will most resemble the
+one who contributes most to the formation of the parts." Such was the
+Hippocratic theory of generation and heredity, and it was ingeniously
+used to explain the hereditary nature of certain diseases and
+malformations. For instance, in speaking of the sacred disease
+(epilepsy), Hippocrates says: "Its origin is hereditary, like that of
+other diseases; for if a phlegmatic person be born of a phlegmatic, and
+a bilious of a bilious, and a phthisical of a phthisical, and one
+having spleen disease of another having disease of the spleen, what is
+to hinder it from happening that where the father and mother were
+subject to this disease certain of their offspring should be so
+affected also? As the semen comes from all parts of the body, healthy
+particles will come from healthy parts, and unhealthy from unhealthy
+parts."
+
+According to Pare, Damascene saw a girl with long hair like a bear,
+whose mother had constantly before her a picture of the hairy St. John.
+Pare also appends an illustration showing the supposed resemblance to a
+bear. Jonston quotes a case of Heliodorus; it was an Ethiopian, who by
+the effect of the imagination produced a white child. Pare describes
+this case more fully: "Heliodorus says that Persina, Queen of Ethiopia,
+being impregnated by Hydustes, also an Ethiopian, bore a daughter with
+a white skin, and the anomaly was ascribed to the admiration that a
+picture of Andromeda excited in Persina throughout the whole of the
+pregnancy." Van Helmont cites the case of a tailor's wife at Mechlin,
+who during a conflict outside her house, on seeing a soldier lose his
+hand at her door, gave birth to a daughter with one hand, the other
+hand being a bleeding stump; he also speaks of the case of the wife of
+a merchant at Antwerp, who after seeing a soldier's arm shot off at the
+siege of Ostend gave birth to a daughter with one arm. Plot speaks of a
+child bearing the figure of a mouse; when pregnant, the mother had been
+much frightened by one of these animals. Gassendus describes a fetus
+with the traces of a wound in the same location as one received by the
+mother. The Lancet speaks of several cases--one of a child with a face
+resembling a dog whose mother had been bitten; one of a child with one
+eye blue and the other black, whose mother during confinement had seen
+a person so marked; of an infant with fins as upper and lower
+extremities, the mother having seen such a monster; and another, a
+child born with its feet covered with scalds and burns, whose mother
+had been badly frightened by fireworks and a descending rocket. There
+is the history of a woman who while pregnant at seven months with her
+fifth child was bitten on the right calf by a dog. Ten weeks after, she
+bore a child with three marks corresponding in size and appearance to
+those caused by the dog's teeth on her leg. Kerr reports the case of a
+woman in her seventh month whose daughter fell on a cooking stove,
+shocking the mother, who suspected fatal burns. The woman was delivered
+two months later of an infant blistered about the mouth and extremities
+in a manner similar to the burns of her sister. This infant died on the
+third day, but another was born fourteen months later with the same
+blisters. Inflammation set in and nearly all the fingers and toes
+sloughed of. In a subsequent confinement, long after the mental
+agitation, a healthy unmarked infant was born.
+
+Hunt describes a case which has since become almost classic of a woman
+fatally burned, when pregnant eight months, by her clothes catching
+fire at the kitchen grate. The day after the burns labor began and was
+terminated by the birth of a well-formed dead female child, apparently
+blistered and burned in extent and in places corresponding almost
+exactly to the locations of the mother's injuries. The mother died on
+the fourth day.
+
+Webb reports the history of a negress who during a convulsion while
+pregnant fell into a fire, burning the whole front of the abdomen, the
+front and inside of the thighs to the knees, the external genitals, and
+the left arm. Artificial delivery was deemed necessary, and a dead
+child, seemingly burned much like its mother, except less intensely,
+was delivered. There was also one large blister near the inner canthus
+of the eye and some large blisters about the neck and throat which the
+mother did not show. There was no history of syphilis nor of any
+eruptive fever in the mother, who died on the tenth day with tetanus.
+
+Graham describes a woman of thirty-five, the mother of seven children,
+who while pregnant was feeding some rabbits, when one of the animals
+jumped at her with its eyes "glaring" upon her, causing a sudden
+fright. Her child was born hydrocephalic. Its mouth and face were small
+and rabbit-shaped. Instead of a nose, it had a fleshy growth 3/4 inch
+long by 1/4 inch broad, directed upward at an angle of 45 degrees. The
+space between this and the mouth was occupied by a body resembling an
+adult eye. Within this were two small, imperfect eyes which moved
+freely while life lasted (ten minutes). The child's integument was
+covered with dark, downy, short hair. The woman recovered and afterward
+bore two normal children.
+
+Parvin mentions an instance of the influence of maternal impression in
+the causation of a large, vivid, red mark or splotch on the face: "When
+the mother was in Ireland she was badly frightened by a fire in which
+some cattle were burned.  Again, during the early months of her
+pregnancy she was frightened by seeing another woman suddenly light the
+fire with kerosene, and at that time became firmly impressed with the
+idea that her child would be marked." Parvin also pictures the
+"turtle-man," an individual with deformed extremities, who might be
+classed as an ectromelus, perhaps as a phocomelus, or seal-like
+monster. According to the story, when the mother was a few weeks
+pregnant her husband, a coarse, rough fisherman, fond of rude jokes,
+put a large live turtle in the cupboard. In the twilight the wife went
+to the cupboard and the huge turtle fell out, greatly startling her by
+its hideous appearance as it fell suddenly to the floor and began to
+move vigorously.
+
+Copeland mentions a curious case in which a woman was attacked by a
+rattlesnake when in her sixth month of pregnancy, and gave birth to a
+child whose arm exhibited the shape and action of a snake, and
+involuntarily went through snake-like movements. The face and mouth
+also markedly resembled the head of a snake.
+
+The teeth were situated like a serpent's fangs. The mere mention of a
+snake filled the child (a man of twenty-nine) with great horror and
+rage, "particularly in the snake season." Beale gives the history of a
+case of a child born with its left eye blackened as by a blow, whose
+mother was struck in a corresponding portion of the face eight hours
+before confinement. There is on record an account of a young man of
+twenty-one suffering from congenital deformities attributed to the fact
+that his mother was frightened by a guinea-pig having been thrust into
+her face during pregnancy. He also had congenital deformity of the
+right auricle.  At the autopsy, all the skin, tissues, muscles, and
+bones were found involved. Owen speaks of a woman who was greatly
+excited ten months previously by a prurient curiosity to see what
+appearance the genitals of her brother presented after he had submitted
+to amputation of the penis on account of carcinoma. The whole penis had
+been removed. The woman stated that from the time she had thus
+satisfied herself, her mind was unceasingly engaged in reflecting and
+sympathizing on the forlorn condition of her brother. While in this
+mental state she gave birth to a son whose penis was entirely absent,
+but who was otherwise well and likely to live. The other portions of
+the genitals were perfect and well developed. The appearance of the
+nephew and the uncle was identical. A most peculiar case is stated by
+Clerc as occurring in the experience of Kuss of Strasburg. A woman had
+a negro paramour in America with whom she had had sexual intercourse
+several times. She was put in a convent on the Continent, where she
+stayed two years. On leaving the convent she married a white man, and
+nine months after she gave birth to a dark-skinned child. The
+supposition was that during her abode in the convent and the nine
+months subsequently she had the image of her black paramour constantly
+before her. Loin speaks of a woman who was greatly impressed by the
+actions of a clown at a circus, and who brought into the world a child
+that resembled the fantastic features of the clown in a most striking
+manner.
+
+Mackay describes five cases in which fright produced distinct marks on
+the fetus. There is a case mentioned in which a pregnant woman was
+informed that an intimate friend had been thrown from his horse; the
+immediate cause of death was fracture of the skull, produced by the
+corner of a dray against which the rider was thrown. The mother was
+profoundly impressed by the circumstance, which was minutely described
+to her by an eye-witness. Her child at birth presented a red and
+sensitive area upon the scalp corresponding in location with the fatal
+injury in the rider. The child is now an adult woman, and this area
+upon the scalp remains red and sensitive to pressure, and is almost
+devoid of hair. Mastin of Mobile, Alabama, reports a curious instance
+of maternal impression. During the sixth month of the pregnancy of the
+mother her husband was shot, the ball passing out through the left
+breast. The woman was naturally much shocked, and remarked to Dr.
+Mastin: "Doctor, my baby will be ruined, for when I saw the wound I put
+my hands over my face, and got it covered with blood, and I know my
+baby will have a bloody face." The child came to term without a bloody
+face. It had, however, a well-defined spot on the left breast just
+below the site of exit of the ball from its father's chest. The spot
+was about the size of a silver half-dollar, and had elevated edges of a
+bright red color, and was quite visible at the distance of one hundred
+feet. The authors have had personal communication with Dr. Mastin in
+regard to this case, which he considers the most positive evidence of a
+case of maternal impression that he has ever met.
+
+Paternal Impressions.--Strange as are the foregoing cases, those of
+paternal impression eclipse them. Several are on record, but none are
+of sufficient authenticity to warrant much discussion on the subject.
+Those below are given to illustrate the method of report. Stahl, quoted
+by Steinan, 1843, speaks of the case of a child, the father being a
+soldier who lost an eye in the war. The child was born with one of its
+eyes dried up in the orbit, in this respect presenting an appearance
+like that of the father.  Schneider says a man whose wife was expecting
+confinement dreamt that his oldest son stood beside his bedside with
+his genitals much mutilated and bleeding. He awoke in a great state of
+agitation, and a few days later the wife was delivered of a child with
+exstrophy of the bladder. Hoare recites the curious story of a man who
+vowed that if his next child was a daughter he would never speak to it.
+The child proved to be a son, and during the whole of the father's life
+nothing could induce the son to speak to his father, nor, in fact, to
+any other male person, but after the father's death he talked fluently
+to both men and women.  Clark reports the birth of a child whose father
+had a stiff knee-joint, and the child's knee was stiff and bent in
+exactly the same position as that of its father.
+
+Telegony.--The influence of the paternal seed on the physical and
+mental constitution of the child is well known. To designate this
+condition, Telegony is the word that was coined by Weismann in his "Das
+Keimplasma," and he defines it as "Infection of the Germ," and, at
+another time, as "Those doubtful instances in which the offspring is
+said to resemble, not the father, but an early mate of the
+mother,"--or, in other words, the alleged influence of a previous sire
+on the progeny produced by a subsequent one from the same mother. In a
+systematic discussion of telegony before the Royal Medical Society,
+Edinburgh, on March 1, 1895, Brunton Blaikie, as a means of making the
+definition of telegony plainer by practical example, prefaced his
+remarks by citing the classic example which first drew the attention of
+the modern scientific world to this phenomenon. The facts of this case
+were communicated in a letter from the Earl of Morton to the President
+of the Royal Society in 1821, and were as follows: In the year 1816
+Lord Morton put a male quagga to a young chestnut mare of 7/8 Arabian
+blood, which had never before been bred from.  The result was a female
+hybrid which resembled both parents. He now sold the mare to Sir Gore
+Ousley, who two years after she bore the hybrid put her to a black
+Arabian horse. During the two following years she had two foals which
+Lord Morton thus describes: "They have the character of the Arabian
+breed as decidedly as can be expected when 15/16 of the blood are
+Arabian, and they are fine specimens of the breed; but both in their
+color and in the hair of their manes they have a striking resemblance
+to the quagga. Their color is bay, marked more or less like the quagga
+in a darker tint. Both are distinguished by the dark line along the
+ridge of the back, the dark stripes across the forehand, and the dark
+bars across the back part of the legs." The President of the Royal
+Society saw the foals and verified Lord Morton's statement.
+
+"Herbert Spencer, in the Contemporary Review for May, 1893, gives
+several cases communicated to him by his friend Mr. Fookes, whom
+Spencer says is often appointed judge of animals at agricultural shows.
+After giving various examples he goes on to say: 'A friend of mine near
+this had a valuable Dachshund bitch, which most unfortunately had a
+litter by a stray sheep-dog. The next year the owner sent her on a
+visit to a pure Dachshund dog, but the produce took quite as much of
+the first father as the second, and the next year he sent her to
+another Dachshund, with the same result. Another case: A friend of mine
+in Devizes had a litter of puppies unsought for, by a setter from a
+favorite pointer bitch, and after this she never bred any true
+pointers, no matter what the paternity was.'
+
+"Lord Polwarth, whose very fine breed of Border Leicesters is famed
+throughout Britain, and whose knowledge on the subject of breeding is
+great, says that 'In sheep we always consider that if a ewe breeds to a
+Shrop ram, she is never safe to breed pure Leicesters from, as dun or
+colored legs are apt to come even when the sire is a pure Leicester.
+This has been proved in various instances, but is not invariable.'"
+
+Hon. Henry Scott says: "Dog-breeders know this theory well; and if a
+pure-bred bitch happens to breed to a dog of another breed, she is of
+little use for breeding pure-bred puppies afterward.  Animals which
+produce large litters and go a short time pregnant show this throwing
+back to previous sires far more distinctly than others--I fancy dogs
+and pigs most of all, and probably horses least. The influence of
+previous sires may be carried into the second generation or further, as
+I have a cat now which appears to be half Persian (long hair). His dam
+has very long hair and every appearance of being a half Persian,
+whereas neither have really any Persian blood, as far as I know, but
+the grand-dam (a very smooth-haired cat) had several litters by a
+half-Persian tom-cat, and all her produce since have showed the
+influence retained. The Persian tom-cat died many years ago, and was
+the only one in the district, so, although I cannot be absolutely
+positive, still I think this case is really as stated."
+
+Breeders of Bedlington terriers wish to breed dogs with as powerful
+jaws as possible. In order to accomplish this they put the Bedlington
+terrier bitch first to a bull-terrier dog, and get a mongrel litter
+which they destroy. They now put the bitch to a Bedlington terrier dog
+and get a litter of puppies which are practically pure, but have much
+stronger jaws than they would otherwise have had, and also show much of
+the gameness of the bull-terrier, thus proving that physiologic as well
+as anatomic characters may be transmitted in this way.
+
+After citing the foregoing examples, Blaikie directs his attention to
+man, and makes the following interesting remarks:--
+
+"We might expect from the foregoing account of telegony amongst animals
+that whenever a black woman had a child to a white man, and then
+married a black man, her subsequent children would not be entirely
+black. Dr. Robert Balfour of Surinam in 1851 wrote to Harvey that he
+was continually noticing amongst the colored population of Surinam
+'that if a negress had a child or children by a white, and afterward
+fruitful intercourse with a negro, the latter offspring had generally a
+lighter color than the parents.' But, as far as I know, this is the
+only instance of this observation on record. Herbert Spencer has shown
+that when a pure-bred animal breeds with an animal of a mixed breed,
+the offspring resembles much more closely the parent of pure blood, and
+this may explain why the circumstance recorded by Balfour has been so
+seldom noted. For a negro, who is of very pure blood, will naturally
+have a stronger influence on the subsequent progeny than an
+Anglo-Saxon, who comes of a mixed stock. If this be the correct
+explanation, we should expect that when a white woman married first a
+black man, and then a white, the children by the white husband would be
+dark colored. Unfortunately for the proof of telegony, it is very rare
+that a white woman does marry a black man, and then have a white as
+second husband; nevertheless, we have a fair number of recorded
+instances of dark-colored children being born in the above way of white
+parents.
+
+"Dr. Harvey mentions a case in which 'a young woman, residing in
+Edinburgh, and born of white (Scottish) parents, but whose mother, some
+time previous to her marriage, had a natural (mulatto) child by a negro
+man-servant in Edinburgh, exhibits distinct traces of the negro. Dr.
+Simpson--afterward Sir James Simpson--whose patient the young woman at
+one time was, has had no recent opportunities of satisfying himself as
+to the precise extent to which the negro character prevails in her
+features; but he recollects being struck with the resemblance, and
+noticed particularly that the hair had the qualities characteristic of
+the negro.' Herbert Spencer got a letter from a 'distinguished
+correspondent' in the United States, who said that children by white
+parents had been 'repeatedly' observed to show traces of black blood
+when the women had had previous connection with (i.e., a child by) a
+negro. Dr. Youmans of New York interviewed several medical professors,
+who said the above was 'generally accepted as a fact.' Prof. Austin
+Flint, in 'A Text-book of Human Physiology,' mentioned this fact, and
+when asked about it said: 'He had never heard the statement questioned.'
+
+"But it is not only in relation to color that we find telegony to have
+been noticed in the human subject. Dr. Middleton Michel gives a most
+interesting case in the American Journal of the Medical Sciences for
+1868: 'A black woman, mother of several negro children, none of whom
+were deformed in any particular, had illicit intercourse with a white
+man, by whom she became pregnant. During gestation she manifested great
+uneasiness of mind, lest the birth of a mulatto offspring should
+disclose her conduct.... It so happened that her negro husband
+possessed a sixth digit on each hand, but there was no peculiarity of
+any kind in the white man, yet when the mulatto child was born it
+actually presented the deformity of a supernumerary finger.' Taruffi,
+the celebrated Italian teratologist, in speaking of the subject, says:
+'Our knowledge of this strange fact is by no means recent for Fienus,
+in 1608, said that most of the children born in adultery have a greater
+resemblance to the legal than to the real father'--an observation that
+was confirmed by the philosopher Vanini and by the naturalist
+Ambrosini. From these observations comes the proverb: 'Filium ex
+adultera excusare matrem a culpa.' Osiander has noted telegony in
+relation to moral qualities of children by a second marriage. Harvey
+said that it has long been known that the children by a second husband
+resemble the first husband in features mind, and disposition. He then
+gave a case in which this resemblance was very well marked.  Orton,
+Burdach (Traite de Physiologie), and Dr. William Sedgwick have all
+remarked on this physical resemblance; and Dr. Metcalfe, in a
+dissertation delivered before this society in 1855, observed that in
+the cases of widows remarrying the children of the second marriage
+frequently resemble the first husband.
+
+"An observation probably having some bearing on this subject was made
+by Count de Stuzeleci (Harvey, loc. cit.). He noticed that when an
+aboriginal female had had a child by a European, she lost the power of
+conception by a male of her own race, but could produce children by a
+white man. He believed this to be the case with many aboriginal races;
+but it has been disproved, or at all events proved to be by no means a
+universal law, in every case except that of the aborigines of Australia
+and New Zealand. Dr. William Sedgwick thought it probable that the
+unfruitfulness of prostitutes might in some degree be due to the same
+cause as that of the Australian aborigines who have had children by
+white men.
+
+"It would seem as though the Israelites had had some knowledge of
+telegony, for in Deuteronomy we find that when a man died leaving no
+issue, his wife was commanded to marry her husband's brother, in order
+that he might 'raise up seed to his brother.'"
+
+We must omit the thorough inquiry into this subject that is offered by
+Mr. Blaikie. The explanations put forward have always been on one of
+three main lines:--
+
+(1) The imagination-theory, or, to quote Harvey: "Due to mental causes
+so operating either on the mind of the female and so acting on her
+reproductive powers, or on the mind of the male parent, and so
+influencing the qualities of his semen, as to modify the nutrition and
+development of the offspring."
+
+(2) Due to a local influence on the reproductive organs of the mother.
+
+(3) Due to a general influence through the fetus on the mother.
+
+Antenatal Pathology.--We have next to deal with the diseases,
+accidents, and operations that affect the pregnant uterus and its
+contents; these are rich in anomalies and facts of curious interest,
+and have been recognized from the earliest times. In the various works
+usually grouped together under the general designation of "Hippocratic"
+are to be found the earliest opinions upon the subject of antenatal
+pathology which the medical literature of Greece has handed down to
+modern times.  That there were medical writers before the time of
+Hippocrates cannot be doubted, and that the works ascribed to the
+"Father of Medicine" were immediately followed by those of other
+physicians, is likewise not to be questioned; but whilst nearly all the
+writings prior to and after Hippocrates have been long lost to the
+world, most of those that were written by the Coan physician and his
+followers have been almost miraculously preserved. As Littre puts it,
+"Les ecrits hippocratiques demeurent isoles au milieu des debris de
+l'antique litterature medicale."--(Ballantyne.)
+
+The first to be considered is the transmission of contagious disease to
+the fetus in utero. The first disease to attract attention was
+small-pox. Devilliers, Blot, and Depaul all speak of congenital
+small-pox, the child born dead and showing evidences of the typical
+small-pox pustulation, with a history of the mother having been
+infected during pregnancy. Watson reports two cases in which a child in
+utero had small-pox. In the first case the mother was infected in
+pregnancy; the other was nursing a patient when seven months pregnant;
+she did not take the disease, although she had been infected many
+months before.  Mauriceau delivered a woman of a healthy child at full
+term after she had recovered from a severe attack of this disease
+during the fifth month of gestation. Mauriceau supposed the child to be
+immune after the delivery. Vidal reported to the French Academy of
+Medicine, May, 1871, the case of a woman who gave birth to a living
+child of about six and one-half months' maturation, which died some
+hours after birth covered with the pustules of seven or eight days'
+eruption. The pustules on the fetus were well umbilicated and typical,
+and could have been nothing but those of small-pox; besides, this
+disease was raging in the neighborhood at the time. The mother had
+never been infected before, and never was subsequently. Both parents
+were robust and neither of them had ever had syphilis. About the time
+of conception, the early part of December, 1870, the father had
+suffered from the semiconfluent type, but the mother, who had been
+vaccinated when a girl, had never been stricken either during or after
+her husband's sickness. Quirke relates a peculiar instance of a child
+born at midnight, whose mother was covered with the eruption eight
+hours after delivery. The child was healthy and showed no signs of the
+contagion, and was vaccinated at once. Although it remained with its
+mother all through the sickness, it continued well, with the exception
+of the ninth day, when a slight fever due to its vaccination appeared.
+The mother made a good recovery, and the author remarks that had the
+child been born a short time later, it would most likely have been
+infected.
+
+Ayer reports an instance of congenital variola in twins.  Chantreuil
+speaks of a woman pregnant with twins who aborted at five and a half
+months. One of the fetuses showed distinct signs of congenital variola,
+although the mother and other fetus were free from any symptoms of the
+disease. In 1853 Charcot reported the birth of a premature fetus
+presenting numerous variolous pustules together with ulcerations of the
+derm and mucous membranes and stomach, although the mother had
+convalesced of the disease some time before. Mitchell describes a case
+of small-pox occurring three days after birth, the mother not having
+had the disease since childhood. Shertzer relates an instance of
+confluent small-pox in the eighth month of pregnancy. The child was
+born with the disease, and both mother and babe recovered.  Among many
+others offering evidence of variola in utero are Degner, Derham, John
+Hunter, Blot, Bulkley, Welch, Wright, Digk, Forbes, Marinus, and
+Bouteiller.
+
+Varicella, Measles, Pneumonia, and even Malaria are reported as having
+been transmitted to the child in utero. Hubbard attended a woman on
+March 17, 1878, in her seventh accouchement. The child showed the rash
+of varicella twenty-four hours after birth, and passed through the
+regular coarse of chicken-pox of ten days' duration. The mother had no
+signs of the disease, but the children all about her were infected.
+Ordinarily the period of incubation is from three to four days, with a
+premonitory fever of from twenty-four to seventy-two hours' duration,
+when the rash appears; this case must therefore have been infected in
+utero.  Lomer of Hamburg tells of the case of a woman, twenty-two
+years, unmarried, pregnant, who had measles in the eighth month, and
+who gave birth to an infant with measles. The mother was attacked with
+pneumonia on the fifth day of her puerperium, but recovered; the child
+died in four weeks of intestinal catarrh. Gautier found measles
+transmitted from the mother to the fetus in 6 out of 11 cases, there
+being 2 maternal deaths in the 11 cases.
+
+Netter has observed the case of transmission of pneumonia from a mother
+to a fetus, and has seen two cases in which the blood from the uterine
+vessels of patients with pneumonia contained the pneumococcus. Wallick
+collected a number of cases of pneumonia occurring during pregnancy,
+showing a fetal mortality of 80 per cent.
+
+Felkin relates two instances of fetal malaria in which the infection
+was probably transmitted by the male parent. In one case the father
+near term suffered severely from malaria; the mother had never had a
+chill. The violent fetal movements induced labor, and the spleen was so
+large as to retard it. After birth the child had seven malarial
+paroxysms but recovered, the splenic tumor disappearing.
+
+The modes of infection of the fetus by syphilis, and the infection of
+the mother, have been well discussed, and need no mention here.
+
+There has been much discussion on the effects on the fetus in utero of
+medicine administered to the pregnant mother, and the opinions as to
+the reliability of this medication are so varied that we are in doubt
+as to a satisfactory conclusion. The effects of drugs administered and
+eliminated by the mammary glands and transmitted to the child at the
+breast are well known, and have been witnessed by nearly every
+physician, and, as in cases of strong metallic purges, etc., need no
+other than the actual test.  However, scientific experiments as to the
+efficacy of fetal therapeutics have been made from time to time with
+varying results.
+
+Gusserow of Strasbourg tested for iodin, chloroform, and salicylic acid
+in the blood and secretions of the fetus after maternal administration
+just before death. In 14 cases in which iodin had been administered, he
+examined the fetal urine of 11 cases; in 5, iodin was present, and in
+the others, absent. He made some similar experiments on the lower
+animals. Benicke reports having given salicylic acid just before birth
+in 25 cases, and in each case finding it in the urine of the child
+shortly after birth.
+
+At a discussion held in New York some years ago as to the real effect
+on the fetus of giving narcotics to the mother, Dr. Gaillard Thomas was
+almost alone in advocating that the effect was quite visible. Fordyce
+Barker was strongly on the negative side. Henning and Ahlfeld, two
+German observers, vouch for the opinion of Thomas, and Thornburn states
+that he has witnessed the effect of nux vomica and strychnin on the
+fetus shortly after birth. Over fifty years ago, in a memoir on
+"Placental Phthisis," Sir James Y. Simpson advanced a new idea in the
+recommendation of potassium chlorate during the latter stages of
+pregnancy. The efficacy of this suggestion is known, and whether, as
+Simpson said, it acts by supplying extra oxygen to the blood, or
+whether the salt itself is conveyed to the fetus, has never been
+definitely settled.
+
+McClintock, who has been a close observer on this subject, reports some
+interesting cases. In his first case he tried a mixture of iron
+perchlorid and potassium chlorate three times a day on a woman who had
+borne three dead children, with a most successful result. His second
+case failed, but in a third he was successful by the same medication
+with a woman who had before borne a dead child. In a fourth case of
+unsuccessful pregnancy for three consecutive births he was successful.
+His fifth case was extraordinary: It was that of a woman in her tenth
+pregnancy, who, with one exception, had always borne a dead child at
+the seventh or eighth month. The one exception lived a few hours only.
+Under this treatment he was successful in carrying the woman safely
+past her time for miscarriage, and had every indication for a normal
+birth at the time of report. Thornburn believes that the administration
+of a tonic like strychnin is of benefit to a fetus which, by its feeble
+heart-beats and movements, is thought to be unhealthy. Porak has
+recently investigated the passage of substances foreign to the organism
+through the placenta, and offers an excellent paper on this subject,
+which is quoted in brief in a contemporary number of Teratologia.
+
+In this important paper, Porak, after giving some historical notes,
+describes a long series of experiments performed on the guinea-pig in
+order to investigate the passage of arsenic, copper, lead, mercury,
+phosphorus, alizarin, atropin, and eserin through the placenta. The
+placenta shows a real affinity for some toxic substances; in it
+accumulate copper and mercury, but not lead, and it is therefore
+through it that the poison reaches the fetus; in addition to its
+pulmonary, intestinal, and renal functions, it fixes glycogen and acts
+as an accumulator of poisons, and so resembles in its action the liver;
+therefore the organs of the fetus possess only a potential activity.
+The storing up of poisons in the placenta is not so general as the
+accumulation of them in the liver of the mother. It may be asked if the
+placenta does not form a barrier to the passage of poisons into the
+circulation of the fetus; this would seem to be demonstrated by
+mercury, which was always found in the placenta and never in the fetal
+organs. In poisoning by lead and copper the accumulation of the poison
+in the fetal tissues is greater than in the maternal, perhaps from
+differences in assimilation and disassimilation or from greater
+diffusion. Whilst it is not an impermeable barrier to the passage of
+poisons, the placenta offers a varying degree of obstruction: it allows
+copper and lead to pass easily, arsenic with greater difficulty. The
+accumulation of toxic substances in the fetus does not follow the same
+law as in the adult. They diffuse more widely in the fetus. In the
+adult the liver is the chief accumulatory organ. Arsenic, which in the
+mother elects to accumulate in the liver, is in the fetus stored up in
+the skin; copper accumulates in the fetal liver, central nervous
+system, and sometimes in the skin; lead which is found specially in the
+maternal liver, but also in the skin, has been observed in the skin,
+liver, nervous centers, and elsewhere in the fetus. The frequent
+presence of poisons in the fetal skin demonstrates its physiologic
+importance. It has probably not a very marked influence on its health.
+On the contrary, accumulation in the placenta and nerve centers
+explains the pathogenesis of abortion and the birth of dead fetuses
+("mortinatatite") Copper and lead did not cause abortion, but mercury
+did so in two out of six cases. Arsenic is a powerful abortive agent in
+the guinea-pig, probably on account of placental hemorrhages. An
+important deduction is that whilst the placenta is frequently and
+seriously affected in syphilis, it is also the special seat for the
+accumulation of mercury. May this not explain its therapeutic action in
+this disease? The marked accumulation of lead in the central nervous
+system of the fetus explains the frequency and serious character of
+saturnine encephalopathic lesions. The presence of arsenic in the fetal
+skin alone gives an explanation of the therapeutic results of the
+administration of this substance in skin diseases.
+
+Intrauterine amputations are of interest to the medical man,
+particularly those cases in which the accident has happened in early
+pregnancy and the child is born with a very satisfactory and clean
+stump. Montgomery, in an excellent paper, advances the theory, which is
+very plausible, that intrauterine amputations are caused by contraction
+of bands or membranes of organized lymph encircling the limb and
+producing amputation by the same process of disjunctive atrophy that
+the surgeons induce by ligature. Weinlechner speaks of a case in which
+a man devoid of all four extremities was exhibited before the Vienna
+Medical Society. The amputations were congenital, and on the right side
+there was a very small stump of the upper arm remaining, admitting the
+attachment of an artificial apparatus. He was twenty-seven years old,
+and able to write, to thread a needle, pour water out of a bottle, etc.
+Cook speaks of a female child born of Indian parents, the fourth birth
+of a mother twenty-six years old. The child weighed 5 1/2 pounds; the
+circumference of the head was 14 inches and that of the trunk 13
+inches. The upper extremities consisted of perfect shoulder joints, but
+only 1/4 of each humerus was present. Both sides showed evidences of
+amputation, the cicatrix on the right side being 1 inch long and on the
+left 1/4 inch long. The right lower limb was merely a fleshy corpuscle
+3/4 inch wide and 1/4 inch long; to the posterior edge was attached a
+body resembling the little toe of a newly-born infant. On the left side
+the limb was represented by a fleshy corpuscle 1 inch long and 1/4 inch
+in circumference, resembling the great toe of an infant. There was no
+history of shock or injury to the mother. The child presented by the
+breech, and by the absence of limbs caused much difficulty in
+diagnosis.  The three stages of labor were one and one-half hours,
+forty-five minutes, and five minutes, respectively. The accompanying
+illustration shows the appearance of the limbs at the time of report.
+
+Figure 10 represents a negro boy, the victim of intrauterine
+amputation, who learned to utilize his toes for many purposes.  The
+illustration shows his mode of holding his pen.
+
+There is an instance reported in which a child at full term was born
+with an amputated arm, and at the age of seventeen the stump was
+scarcely if at all smaller than the other. Blake speaks of a case of
+congenital amputation of both the upper extremities.  Gillilam a
+mentions a case that shows the deleterious influence of even the weight
+of a fetal limb resting on a cord or band. His case was that of a
+fetus, the product of a miscarriage of traumatic origin; the soft
+tissues were almost cut through and the bone denuded by the limb
+resting on one of the two umbilical cords, not encircling it, but in a
+sling. The cord was deeply imbedded in the tissues.
+
+The coilings of the cord are not limited to compression about the
+extremities alone, but may even decapitate the head by being firmly
+wrapped several times about the neck. According to Ballantyne, there is
+in the treatise De Octimestri Partu, by Hippocrates, a reference to
+coiling of the umbilical cord round the neck of the fetus. This coiling
+was, indeed, regarded as one of the dangers of the eighth month, and
+even the mode of its production is described. It is said that if the
+cord he extended along one side of the uterus, and the fetus lie more
+to the other side, then when the culbute is performed the funis must
+necessarily form a loop round the neck or chest of the infant. If it
+remain in this position, it is further stated, the mother will suffer
+later and the fetus will either perish or be born with difficulty. If
+the Hippocratic writers knew that this coiling is sometimes quite
+innocuous, they did not in any place state the fact.
+
+The accompanying illustrations show the different ways in which the
+funis may be coiled, the coils sometimes being as many as 8.
+
+Bizzen mentions an instance in which from strangulation the head of a
+fetus was in a state of putrefaction, the funis being twice tightly
+bound around the neck. Cleveland, Cuthbert, and Germain report
+analogous instances. Matthyssens observed the twisting of the funis
+about the arm and neck of a fetus the body of which was markedly
+wasted. There was complete absence of amniotic fluid during labor.
+Blumenthal presented to the New York Pathological Society an ovum
+within which the fetus was under going intrauterine decapitation.
+Buchanan describes a case illustrative of the etiology of spontaneous
+amputation of limbs in utero Nebinger reports a case of abortion,
+showing commencing amputation of the left thigh from being encircled by
+the funis.  The death of the fetus was probably due to compression of
+the cord. Owen mentions an instance in which the left arm and hand of a
+fetus were found in a state of putrescence from strangulation, the
+funis being tightly bound around at the upper part. Simpson published
+an article on spontaneous amputation of the forearm and rudimentary
+regeneration of the hand in the fetus. Among other contributors to this
+subject are Avery, Boncour, Brown, Ware, Wrangell, Young, Nettekoven,
+Martin, Macan, Leopold, Hecker, Gunther, and Friedinger.
+
+Wygodzky finds that the greatest number of coils of the umbilical cord
+ever found to encircle a fetus are 7 (Baudelocque), 8 (Crede), and 9
+(Muller and Gray). His own case was observed this year in Wilna. The
+patient was a primipara aged twenty. The last period was seen on May
+10, 1894. On February 19th the fetal movements suddenly ceased. On the
+20th pains set in about two weeks before term. At noon turbid liquor
+amnii escaped. At 2 P.M., on examination, Wygodzky defined a dead fetus
+in left occipito-anterior presentation, very high in the inlet. The os
+was nearly completely dilated, the pains strong. By 4 P.M. the head was
+hardly engaged in the pelvic cavity. At 7 P.M. it neared the outlet at
+the height of each pain, but retracted immediately afterward. After 10
+P.M. the pains grew weak. At midnight Wygodzky delivered the dead child
+by expression. Not till then was the cause of delay clear. The funis
+was very tense and coiled 7 times round the neck and once round the
+left shoulder; there was also a distinct knot. It measured over 65
+inches in length.  The fetus was a male, slightly macerated. It weighed
+over 5 pounds, and was easily delivered entire after division and
+unwinding of the funis. No marks remained on the neck. The placenta
+followed ten minutes later and, so far as naked-eye experience
+indicated, seemed healthy.
+
+Intrauterine fractures are occasionally seen, but are generally the
+results of traumatism or of some extraordinary muscular efforts on the
+part of the mother. A blow on the abdomen or a fall may cause them. The
+most interesting cases are those in which the fractures are multiple
+and the causes unknown.  Spontaneous fetal fractures have been
+discussed thoroughly, and the reader is referred to any responsible
+text-book for the theories of causation. Atkinson, De Luna, and Keller
+report intrauterine fractures of the clavicle. Filippi contributes an
+extensive paper on the medicolegal aspect of a case of intrauterine
+fracture of the os cranium. Braun of Vienna reports a case of
+intrauterine fracture of the humerus and femur.  Rodrigue describes a
+case of fracture and dislocation of the humerus of a fetus in utero.
+Gaultier reports an instance of fracture of both femora intrauterine.
+Stanley, Vanderveer, and Young cite instances of intrauterine fracture
+of the thigh; in the case of Stanley the fracture occurred during the
+last week of gestation, and there was rapid union of the fragments
+during lactation. Danyau, Proudfoot, and Smith mention intrauterine
+fracture of the tibia; in Proudfoot's case there was congenital talipes
+talus.
+
+Dolbeau describes an instance in which multiple fractures were found in
+a fetus, some of which were evidently postpartum, while others were
+assuredly antepartum. Hirschfeld describes a fetus showing congenital
+multiple fractures. Gross speaks of a wonderful case of Chaupier in
+which no less than 113 fractures were discovered in a child at birth.
+It survived twenty-four hours, and at the postmortem examination it was
+found that some were already solid, some uniting, whilst others were
+recent. It often happens that the intrauterine fracture is well united
+at birth. There seems to be a peculiar predisposition of the bones to
+fracture in the cases in which the fractures are multiple and the cause
+is not apparent.
+
+The results to the fetus of injuries to the pregnant mother are most
+diversified. In some instances the marvelous escape of any serious
+consequences of one or both is almost incredible, while in others the
+slightest injury is fatal. Guillemont cites the instance of a woman who
+was killed by a stroke of lightning, but whose fetus was saved; while
+Fabricius Hildanus describes a case in which there was perforation of
+the head, fracture of the skull, and a wound of the groin, due to
+sudden starting and agony of terror of the mother. Here there was not
+the slightest history of any external violence.
+
+It is a well-known fact that injuries to the pregnant mother show
+visible effects on the person of the fetus. The older writers kept a
+careful record of the anomalous and extraordinary injuries of this
+character and of their effects. Brendelius tells us of hemorrhage from
+the mouth and nose of the fetus occasioned by the fall of the mother;
+Buchner mentions a case of fracture of the cranium from fright of the
+mother; Reuther describes a contusion of the os sacrum and abdomen in
+the mother from a fall, with fracture of the arm and leg of the fetus
+from the same cause; Sachse speaks of a fractured tibia in a fetus,
+caused by a fall of the mother; Slevogt relates an instance of rupture
+of the abdomen of a fetus by a fall of the mother; the Ephemerides
+contains accounts of injuries to the fetus of this nature, and among
+others mentions a stake as having been thrust into a fetus in utero;
+Verduc offers several examples, one a dislocation of the fetal foot
+from a maternal fall; Plocquet gives an instance of fractured femur;
+Walther describes a case of dislocation of the vertebrae from a fall;
+and there is also a case of a fractured fetal vertebra from a maternal
+fall. There is recorded a fetal scalp injury, together with clotted
+blood in the hair, after a fall of the mother: Autenrieth describes a
+wound of the pregnant uterus, which had no fatal issue, and there is
+also another similar case on record.
+
+The modern records are much more interesting and wonderful on this
+subject than the older ones. Richardson speaks of a woman falling down
+a few weeks before her delivery. Her pelvis was roomy and the birth was
+easy; but the infant was found to have extensive wounds on the back,
+reaching from the 3d dorsal vertebra across the scapula, along the back
+of the humerus, to within a short distance of the elbow. Part of these
+wounds were cicatrized and part still granulating, which shows that the
+process of reparation is as active in utero as elsewhere.
+
+Injuries about the genitalia would naturally be expected to exercise
+some active influence on the uterine contents; but there are many
+instances reported in which the escape of injury is marvelous. Gibb
+speaks of a woman, about eight months pregnant, who fell across a
+chair, lacerating her genitals and causing an escape of liquor amnii.
+There was regeneration of this fluid and delivery beyond term. The
+labor was tedious and took place two and a half months after the
+accident. The mother and the female child did well. Purcell reports
+death in a pregnant woman from contused wound of the vulva. Morland
+relates an instance of a woman in the fifth month of her second
+pregnancy, who fell on the roof of a woodshed by slipping from one of
+the steps by which she ascended to the roof, in the act of hanging out
+some clothes to dry. She suffered a wound on the internal surface of
+the left nympha 1 1/2 inch long and 1/2 inch deep. She had lost about
+three quarts of blood, and had applied ashes to the vagina to stop the
+bleeding. She made a recovery by the twelfth day, and the fetal sounds
+were plainly audible. Cullingworth speaks of a woman who, during a
+quarrel with her husband, was pushed away and fell between two chairs,
+knocking one of them over, and causing a trivial wound one inch long in
+the vagina, close to the entrance.  She screamed, there was a gush of
+blood, and she soon died. The uterus contained a fetus three or four
+months old, with the membranes intact, the maternal death being due to
+the varicosity of the pregnant pudenda, the slight injury being
+sufficient to produce fatal hemorrhage. Carhart describes the case of a
+pregnant woman, who, while in the stooping position, milking a cow, was
+impaled through the vagina by another cow. The child was born seven
+days later, with its skull crushed by the cow's horn.  The horn had
+entered the vagina, carrying the clothing with it.
+
+There are some marvelous cases of recovery and noninterference with
+pregnancy after injuries from horns of cattle. Corey speaks of a woman
+of thirty-five, three months pregnant, weighing 135 pounds, who was
+horned by a cow through the abdominal parietes near the hypogastric
+region; she was lifted into the air, carried, and tossed on the ground
+by the infuriated animal. There was a wound consisting of a ragged rent
+from above the os pubis, extending obliquely to the left and upward,
+through which protruded the great omentum, the descending and
+transverse colon, most of the small intestines, as well as the pyloric
+extremity of the stomach. The great omentum was mangled and comminuted,
+and bore two lacerations of two inches each. The intestines and stomach
+were not injured, but there was considerable extravasation of blood
+into the abdominal cavity. The intestines were cleansed and an
+unsuccessful attempt was made to replace them. The intestines remained
+outside of the body for two hours, and the great omentum was carefully
+spread out over the chest to prevent interference with the efforts to
+return the intestines.  The patient remained conscious and calm
+throughout; finally deep anesthesia was produced by ether and
+chloroform, three and a half hours after the accident, and in twenty
+minutes the intestines were all replaced in the abdominal cavity. The
+edges were pared, sutured, and the wound dressed. The woman was placed
+in bed, on the right side, and morphin was administered. The sutures
+were removed on the ninth day, and the wound had healed except at the
+point of penetration. The woman was discharged twenty days after, and,
+incredible to relate, was delivered of a well-developed, full-term
+child just two hundred and two days from the time of the accident. Both
+the mother and child did well.
+
+Luce speaks of a pregnant woman who was horned in the lower part of the
+abdomen by a cow, and had a subsequent protrusion of the intestines
+through the wound. After some minor complications, the wound healed
+fourteen weeks after the accident, and the woman was confined in
+natural labor of a healthy, vigorous child. In this case no blood was
+found on the cow's horn, and the clothing was not torn, so that the
+wound must have been made by the side of the horn striking the greatly
+distended abdomen.
+
+Richard, quoted also by Tiffany, speaks of a woman, twenty-two, who
+fell in a dark cellar with some empty bottles in her hand, suffering a
+wound in the abdomen 2 inches above the navel on the left side 8 cm.
+long. Through this wound a mass of intestines, the size of a man's
+head, protruded. Both the mother and the child made a good
+convalescence. Harris cites the instance of a woman of thirty, a
+multipara, six months pregnant, who was gored by a cow; her intestines
+and omentum protruded through the rip and the uterus was bruised. There
+was rapid recovery and delivery at term. Wetmore of Illinois saw a
+woman who in the summer of 1860, when about six months pregnant, was
+gored by a cow, and the large intestine and the omentum protruded
+through the wound.  Three hours after the injury she was found swathed
+in rags wet with a compound solution of whiskey and camphor, with a
+decoction of tobacco. The intestines were cold to the touch and dirty,
+but were washed and replaced. The abdomen was sewed up with a darning
+needle and black linen thread; the woman recovered and bore a healthy
+child at the full maturity of her gestation. Crowdace speaks of a
+female pauper, six months pregnant, who was attacked by a buffalo, and
+suffered a wound about 1 1/2 inch long and 1/2 inch wide just above the
+umbilicus. Through this small opening 19 inches of intestine protruded.
+The woman recovered, and the fetal heart-beats could be readily
+auscultated.
+
+Major accidents in pregnant women are often followed by the happiest
+results. There seems to be no limit to what the pregnant uterus can
+successfully endure. Tiffany, who has collected some statistics on this
+subject, as well as on operations successfully performed during
+pregnancy, which will be considered later, quotes the account of a
+woman of twenty-seven, eight months pregnant, who was almost buried
+under a clay wall. She received terrible wounds about the head, 32
+sutures being used in this location alone. Subsequently she was
+confined, easily bore a perfectly normal female child, and both did
+well. Sibois describes the case of a woman weighing 190 pounds, who
+fell on her head from the top of a wall from 10 to 12 feet high. For
+several hours she exhibited symptoms of fracture of the base of the
+skull, and the case was so diagnosed; fourteen hours after the accident
+she was perfectly conscious and suffered terrible pain about the head,
+neck, and shoulders. Two days later an ovum of about twenty days was
+expelled, and seven months after she was delivered of a healthy boy
+weighing 10 1/2 pounds. She had therefore lost after the accident
+one-half of a double conception.
+
+Verrier has collected the results of traumatism during pregnancy, and
+summarizes 61 cases. Prowzowsky cites the instance of a patient in the
+eighth month of her first pregnancy who was wounded by many pieces of
+lead pipe fired from a gun but a few feet distant. Neither the patient
+nor the child suffered materially from the accident, and gestation
+proceeded; the child died on the fourth day after birth without
+apparent cause. Milner records an instance of remarkable tolerance of
+injury in a pregnant woman. During her six months of pregnancy the
+patient was accidentally shot through the abdominal cavity and lower
+part of the thorax. The missile penetrated the central tendon of the
+diaphragm and lodged in the lung. The injury was limited by localized
+pneumonia and peritonitis, and the wound was drained through the lung
+by free expectoration. Recovery ensued, the patient giving birth to a
+healthy child sixteen weeks later.  Belin mentions a stab-wound in a
+pregnant woman from which a considerable portion of the epiploon
+protruded. Sloughing ensued, but the patient made a good recovery,
+gestation not being interrupted. Fancon describes the case of a woman
+who had an injury to the knee requiring drainage. She was attacked by
+erysipelas, which spread over the whole body with the exception of the
+head and neck; yet her pregnancy was uninterrupted and recovery ensued.
+Fancon also speaks of a girl of nineteen, frightened by her lover, who
+threatened to stab her, who jumped from a second-story window. For
+three days after the fall she had a slight bloody flow from the vulva.
+Although she was six months pregnant there was no interruption of the
+normal course of gestation.
+
+Bancroft speaks of a woman who, being mistaken for a burglar, was shot
+by her husband with a 44-caliber bullet. The missile entered the second
+and third ribs an inch from the sternum, passed through the right lung,
+and escaped at the inferior angle of the scapula, about three inches
+below the spine; after leaving her body it went through a pine door.
+She suffered much hemorrhage and shock, but made a fair recovery at the
+end of four weeks, though pregnant with her first child at the seventh
+month. At full term she was delivered by foot-presentation of a healthy
+boy. The mother at the time of report was healthy and free from cough,
+and was nursing her babe, which was strong and bright.
+
+All the cases do not have as happy an issue as most of the foregoing
+ones, though in some the results are not so bad as might be expected. A
+German female, thirty-six, while in the sixth month of pregnancy, fell
+and struck her abdomen on a tub.  She was delivered of a normal living
+child, with the exception that the helix of the left ear was pushed
+anteriorly, and had, in its middle, a deep incision, which also
+traversed the antihelix and the tragus, and continued over the cheek
+toward the nose, where it terminated. The external auditory meatus was
+obliterated. Gurlt speaks of a woman, seven months pregnant, who fell
+from the top of a ladder, subsequently losing some blood and water from
+the vagina. She had also persistent pains in the belly, but there was
+no deterioration of general health. At her confinement, which was
+normal, a strong boy was born, wanting the arm below the middle, at
+which point a white bone protruded. The wound healed and the separated
+arm came away after birth.  Wainwright relates the instance of a woman
+of forty, who when six months pregnant was run over by railway cars.
+After a double amputation of the legs she miscarried and made a good
+recovery.  Neugebauer reported the history of a case of a woman who,
+while near her term of pregnancy, committed suicide by jumping from a
+window. She ruptured her uterus, and a dead child with a fracture of
+the parietal bone was found in the abdominal cavity. Staples speaks of
+a Swede of twenty-eight, of Minnesota, who was accidentally shot by a
+young man riding by her side in a wagon.  The ball entered the abdomen
+two inches above the crest of the right ilium, a little to the rear of
+the anterior superior spinous process, and took a downward and forward
+course. A little shock was felt but no serious symptoms followed. In
+forty hours there was delivery of a dead child with a bullet in its
+abdomen.  Labor was normal and the internal recovery complete. Von
+Chelius, quoting the younger Naegele, gives a remarkable instance of a
+young peasant of thirty-five, the mother of four children, pregnant
+with the fifth child, who was struck on the belly violently by a blow
+from a wagon pole. She was thrown down, and felt a tearing pain which
+caused her to faint. It was found that the womb had been ruptured and
+the child killed, for in several days it was delivered in a putrid
+mass, partly through the natural passage and partly through an abscess
+opening in the abdominal wall. The woman made a good recovery. A
+curious accident of pregnancy is that of a woman of thirty-eight,
+advanced eight months in her ninth pregnancy, who after eating a hearty
+meal was seized by a violent pain in the region of the stomach and soon
+afterward with convulsions, supposed to have been puerperal. She died
+in a few hours, and at the autopsy it was found that labor had not
+begun, but that the pregnancy had caused a laceration of the spleen,
+from which had escaped four or five pints of blood. Edge speaks of a
+case of chorea in pregnancy in a woman of twenty-seven, not
+interrupting pregnancy or retarding safe delivery. This had continued
+for four pregnancies, but in the fourth abortion took place.
+
+Buzzard had a case of nervous tremor in a woman, following a fall at
+her fourth month of pregnancy, who at term gave birth to a male child
+that was idiotic. Beatty relates a curious accident to a fetus in
+utero. The woman was in her first confinement and was delivered of a
+small but healthy and strong boy. There was a small puncture in the
+abdominal parietes, through which the whole of the intestines protruded
+and were constricted. The opening was so small that he had to enlarge
+it with a bistoury to replace the bowel, which was dark and congested;
+he sutured the wound with silver wire, but the child subsequently died.
+
+Tiffany of Baltimore has collected excellent statistics of operations
+during pregnancy; and Mann of Buffalo has done the same work, limiting
+himself to operations on the pelvic organs, where interference is
+supposed to have been particularly contraindicated in pregnancy. Mann,
+after giving his individual cases, makes the following summary and
+conclusions:--
+
+(1) Pregnancy is not a general bar to operations, as has been supposed.
+
+(2) Union of the denuded surfaces is the rule, and the cicatricial
+tissue, formed during the earlier months of pregnancy, is strong enough
+to resist the shock of labor at term.
+
+(3) Operations on the vulva are of little danger to mother or child.
+
+(4) Operations on the vagina are liable to cause severe hemorrhage, but
+otherwise are not dangerous.
+
+(5) Venereal vegetations or warts are best treated by removal.
+
+(6) Applications of silver nitrate or astringents may be safely made to
+the vagina. For such application, phenol or iodin should not be used,
+pure or in strong solution.
+
+(7) Operations on the bladder or urethra are not dangerous or liable to
+be followed by abortion.
+
+(8) Operations for vesicovaginal fistulae should not be done, as they
+are dangerous, and are liable to be followed by much hemorrhage and
+abortion.
+
+(9) Plastic operations may be done in the earlier months of pregnancy
+with fair prospects of a safe and successful issue.
+
+(10) Small polypi may be treated by torsion or astringents. If cut,
+there is likely to be a subsequent abortion.
+
+(11) Large polypi removed toward the close of pregnancy will cause
+hemorrhage.
+
+(12) Carcinoma of the cervix should be removed at once.
+
+A few of the examples on record of operations during pregnancy of
+special interest, will be given below. Polaillon speaks of a double
+ovariotomy on a woman pregnant at three months, with the subsequent
+birth of a living child at term. Gordon reports five successful
+ovariotomies during pregnancy, in Lebedeff's clinic.  Of these cases, 1
+aborted on the fifth day, 2 on the fifteenth, and the other 2 continued
+uninterrupted. He collected 204 cases with a mortality of only 3 per
+cent; 22 per cent aborted, and 69.4 per cent were delivered at full
+term. Kreutzman reports two cases in which ovarian tumors were
+successfully removed from pregnant subjects without the interruption of
+gestation. One of these women, a secundipara, had gone two weeks over
+time, and had a large ovarian cyst, the pedicle of which had become
+twisted, the fluid in the cyst being sanguineous. May describes an
+ovariotomy performed during pregnancy at Tottenham Hospital. The woman,
+aged twenty-two, was pale, diminutive in size, and showed an enormous
+abdomen, which measured 50 inches in circumference at the umbilicus and
+27 inches from the ensiform cartilage to the pubes. At the operation,
+36 pints of brown fluid were drawn off.  Delivery took place twelve
+hours after the operation, the mother recovering, but the child was
+lost. Galabin had a case of ovariotomy performed on a woman in the
+sixth month of pregnancy without interruption of pregnancy; Potter had
+a case of double ovariotomy with safe delivery at term; and Storry had
+a similar case. Jacobson cites a case of vaginal lithotomy in a patient
+six and a half months pregnant, with normal delivery at full term.
+Tiffany quotes Keelan's description of a woman of thirty-five, in the
+eighth month of pregnancy, from whom he removed a stone weighing 12 1/2
+ounces and measuring 2 by 2 1/2 inches, with subsequent recovery and
+continuation of pregnancy. Rydygier mentions a case of obstruction of
+the intestine during the sixth month of gestation, showing symptoms of
+strangulation for seven days, in which he performed abdominal section.
+Recovery of the woman without abortion ensued. The Revue de Chirurgien
+1887, contains an account of a woman who suffered internal
+strangulation, on whom celiotomy was performed; she recovered in
+twenty-five days, and did not miscarry, which shows that severe injury
+to the intestine with operative interference does not necessarily
+interrupt pregnancy. Gilmore, without inducing abortion, extirpated the
+kidney of a negress, aged thirty-three, for severe and constant pain.
+Tiffany removed the kidney of a woman of twenty-seven, five months
+pregnant, without interruption of this or subsequent pregnancies. The
+child was living. He says that Fancon cites instances of operation
+without abortion.
+
+Lovort describes an enucleation of the eye in the second month of
+pregnancy. Pilcher cites the instance of a woman of fifty-eight, eight
+months in her fourth pregnancy, whose breast and axilla he removed
+without interruption of pregnancy. Robson, Polaillon, and Coen report
+similar instances.
+
+Rein speaks of the removal of an enormous echinococcus cyst of the
+omentum without interruption of pregnancy. Robson reports a
+multi-locular cyst of the ovary with extensive adhesions of the uterus,
+removed at the tenth week of pregnancy and ovariotomy performed without
+any interruption of the ordinary course of labor. Russell cites the
+instance of a woman who was successfully tapped at the sixth month of
+pregnancy.
+
+McLean speaks of a successful amputation during pregnancy; Napper, one
+of the arm; Nicod, one of the arm; Russell, an amputation through the
+shoulder joint for an injury during pregnancy, with delivery and
+recovery; and Vesey speaks of amputation for compound fracture of the
+arm, labor following ten hours afterward with recovery. Keen reports
+the successful performance of a hip-joint amputation for malignant
+disease of the femur during pregnancy. The patient, who was five months
+advanced in gestation, recovered without aborting.
+
+Robson reports a case of strangulated hernia in the third month of
+pregnancy with stercoraceous vomiting. He performed herniotomy in the
+femoral region, and there was a safe delivery at full term. In the
+second month of pregnancy he also rotated an ovarian tumor causing
+acute symptoms and afterward performed ovariotomy without interfering
+with pregnancy. Mann quotes Munde in speaking of an instance of removal
+of elephantiasis of the vulva without interrupting pregnancy, and says
+that there are many cases of the removal of venereal warts without any
+interference with gestation. Campbell of Georgia operated inadvertently
+at the second and third month in two cases of vesicovaginal fistula in
+pregnant women. The first case showed no interruption of pregnancy, but
+in the second case the woman nearly died and the fistula remained
+unhealed. Engelmann operated on a large rectovaginal fistula in the
+sixth month of pregnancy without any interruption of pregnancy, which
+is far from the general result.  Cazin and Rey both produced abortion
+by forcible dilatation of the anus for fissure, but Gayet used both the
+fingers and a speculum in a case at five months and the woman went to
+term. By cystotomy Reamy removed a double hair-pin from a woman
+pregnant six and a half months, without interruption, and according to
+Mann again, McClintock extracted stones from the bladder by the urethra
+in the fourth month of pregnancy, and Phillips did the same in the
+seventh month. Hendenberg and Packard report the removal of a tumor
+weighing 8 3/4 pounds from a pregnant uterus without interrupting
+gestation.
+
+The following extract from the University Medical Magazine of
+Philadelphia illustrates the after-effects of abdominal hysteropasy on
+subsequent pregnancies:--
+
+"Fraipont (Annales de la Societe Medico-Chirurgicale de Liege, 1894)
+reports four cases where pregnancy and labor were practically normal,
+though the uterus of each patient had been fixed to the abdominal
+walls. In two of the cases the hysteropexy had been performed over five
+years before the pregnancy occurred, and, although the bands of
+adhesion between the fundus and the parietes must have become very
+tough after so long a period, no special difficulty was encountered. In
+two of the cases the forceps was used, but not on account of uterine
+inertia; the fetal head was voluminous, and in one of the two cases
+internal rotation was delayed. The placenta was always expelled easily,
+and no serious postpartum hemorrhage occurred. Fraipont observed the
+progress of pregnancy in several of these cases. The uterus does not
+increase specially in its posterior part, but quite uniformly, so that,
+as might be expected, the fundus gradually detaches itself from the
+abdominal wall. Even if the adhesions were not broken down they would
+of necessity be so stretched as to be useless for their original
+purpose after delivery. Bands of adhesion could not share in the
+process of involution. As, however, the uterus undergoes perfect
+involution, it is restored to its original condition before the onset
+of the disease which rendered hysteropexy necessary."
+
+The coexistence of an extensive tumor of the uterus with pregnancy does
+not necessarily mean that the product of conception will be blighted.
+Brochin speaks of a case in which pregnancy was complicated with
+fibroma of the uterus, the accouchement being natural at term. Byrne
+mentions a case of pregnancy complicated with a large uterine fibroid.
+Delivery was effected at full term, and although there was considerable
+hemorrhage the mother recovered. Ingleby describes a case of fibrous
+tumor of the uterus terminating fatally, but not until three weeks
+after delivery. Lusk mentions a case of pregnancy with fibrocystic
+tumor of the uterus occluding the cervix. At the appearance of symptoms
+of eclampsia version was performed and delivery effected, followed by
+postpartum hemorrhage. The mother died from peritonitis and collapse,
+but the stillborn child was resuscitated. Roberts reports a case of
+pregnancy associated with a large fibrocellular polypus of the uterus.
+A living child was delivered at the seventh month, ecrasement was
+performed, and the mother recovered.
+
+Von Quast speaks of a fibromyoma removed five days after labor.  Gervis
+reports the removal of a large polypus of the uterus on the fifth day
+after confinement. Davis describes the spontaneous expulsion of a large
+polypus two days after the delivery of a fine, healthy, male child.
+Deason mentions a case of anomalous tumor of the uterus during
+pregnancy which was expelled after the birth of the child; and Daly
+also speaks of a tumor expelled from the uterus after delivery. Cathell
+speaks of a case of pregnancy complicated with both uterine fibroids
+and measles. Other cases of a similar nature to the foregoing are too
+numerous to mention.  Figure 13, taken from Spiegelberg, shows a large
+fibroid blocking the pelvis of a pregnant woman.
+
+There are several peculiar accidents and anomalies not previously
+mentioned which deserve a place here, viz., those of the membranes
+surrounding the fetus. Brown speaks of protrusion of the membranes from
+the vulva several weeks before confinement.  Davies relates an instance
+in which there was a copious watery discharge during pregnancy not
+followed by labor. There is a case mentioned in which an accident and
+an inopportune dose of ergot at the fifth month of pregnancy were
+followed by rupture of the amniotic sac, and subsequently a constant
+flow of watery fluid continued for the remaining three months of
+pregnancy. The fetus died at the time, and was born in an advanced
+state of putrefaction, by version, three months after the accident. The
+mother died five months after of carcinoma of the uterus.  Montgomery
+reports the instance of a woman who menstruated last on May 22, 1850,
+and quickened on September 26th, and continued well until the 11th of
+November. At this time, as she was retiring, she became conscious that
+there was a watery discharge from the vagina, which proved to be liquor
+amnii. Her health was good. The discharge continued, her size
+increased, and the motions of the child continued active. On the 18th
+of January a full-sized eight months' child was born. It had an
+incessant, wailing, low cry, always of evil augury in new-born infants.
+The child died shortly after. The daily discharge was about 5 ounces,
+and had lasted sixty-eight days, making 21 pints in all. The same
+accident of rupture of the membranes long before labor happened to the
+patient's mother.
+
+Bardt speaks of labor twenty-three days after the flow of the waters;
+and Cobleigh one of seventeen days; Bradley relates the history of a
+case of rupture of the membranes six weeks before delivery. Rains cites
+an instance in which gestation continued three months after rupture of
+the membranes, the labor-pains lasting thirty-six hours. Griffiths
+speaks of rupture of the amniotic sac at about the sixth month of
+pregnancy with no untoward interruption of the completion of gestation
+and with delivery of a living child. There is another observation of an
+accouchement terminating successfully twenty-three days after the loss
+of the amniotic fluid. Campbell mentions delivery of a living child
+twelve days after rupture of the membranes. Chesney relates the history
+of a double collection of waters. Wood reports a case in which there
+was expulsion of a bag of waters before the rupture of the membranes.
+Bailly, Chestnut, Bjering, Cowger, Duncan, and others also record
+premature rupture of the membranes without interruption of pregnancy.
+
+Harris gives an instance of the membranes being expelled from the
+uterus a few days before delivery at the full term. Chatard, Jr.,
+mentions extrusion of the fetal membranes at the seventh month of
+pregnancy while the patient was taking a long afternoon walk, their
+subsequent retraction, and normal labor at term. Thurston tells of a
+case in which Nature had apparently effected the separation of the
+placenta without alarming hemorrhage, the ease being one of placenta
+praevia, terminating favorably by natural processes. Playfair speaks of
+the detachment of the uterine decidua without the interruption of
+pregnancy.
+
+Guerrant gives a unique example of normal birth at full term in which
+the placenta was found in the vagina, but not a vestige of the
+membranes was noticed. The patient had experienced nothing unusual
+until within three months of expected confinement, since which time
+there had been a daily loss of water from the uterus.  She recovered
+and was doing her work. There was no possibility that this was a case
+of retained secundines.
+
+Anomalies of the Umbilical Cord.--Absence of the membranes has its
+counterpart in the deficiency of the umbilical cord, so frequently
+noticed in old reports. The Ephemerides, Osiander, Stark's Archives,
+Thiebault, van der Wiel, Chatton, and Schurig all speak of it, and it
+has been noticed since. Danthez speaks of the development of a fetus in
+spite of the absence of an umbilical cord. Stute reports an observation
+of total absence of the umbilical cord, with placental insertion near
+the cervix of the uterus.
+
+There is mentioned a bifid funis. The Ephemerides and van der Wiel
+speak of a duplex funis. Nolde reports a cord 38 inches long; and
+Werner cites the instance of a funis 51 inches long.  There are modern
+instances in which the funis has been bifid or duplex, and there is
+also a case reported in which there were two cords in a twin pregnancy,
+each of them measuring five feet in length. The Lancet gives the
+account of a most peculiar pregnancy consisting of a placenta alone,
+the fetus wanting. What this "placenta" was will always be a matter of
+conjecture.
+
+Occasionally death of the fetus is caused by the formation of knots in
+the cord, shutting off the fetal circulation; Gery, Grieve, Mastin,
+Passot, Piogey, Woets, and others report instances of this nature.
+Newman reports a curious case of twins, in which the cord of one child
+was encircled by a knot on the cord of the other. Among others, Latimer
+and Motte report instances of the accidental tying of the bowel with
+the funis, causing an artificial anus.
+
+The diverse causes of abortion are too numerous to attempt giving them
+all, but some are so curious and anomalous that they deserve mention.
+Epidemics of abortion are spoken of by Fickius, Fischer, and the
+Ephemerides. Exposure to cold is spoken of as a cause, and the same is
+alluded to by the Ephemerides; while another case is given as due to
+exposure white nude. There are several cases among the older writers in
+which odors are said to have produced abortion, but as analogues are
+not to be found in modern literature, unless the odor is very poisonous
+or pungent, we can give them but little credence. The Ephemerides gives
+the odor of urine as provocative of abortion; Sulzberger, Meyer, and
+Albertus all mention odors; and Vesti gives as a plausible cause the
+odor of carbonic vapor. The Ephemerides mentions singultus as a cause
+of abortion. Mauriceau, Pelargus, and Valentini mention coughing.
+Hippocrates mentions the case of a woman who induced abortion by
+calling excessively loud to some one. Fabrieius Hildanus speaks of
+abortion following a kick in the region of the coccyx.  Gullmannus
+speaks of an abortion which he attributes to the woman's constant
+neglect to answer the calls of nature, the rectum being at all times in
+a state of irritation from her negligence. Hawley mentions abortion at
+the fourth or fifth month due to the absorption of spirits of
+turpentine. Solingen speaks of abortion produced by sneezing. Osiander
+cites an instance in which a woman suddenly arose, and in doing so
+jolted herself so severely that she produced abortion. Hippocrates
+speaks of extreme hunger as a cause of abortion. Treuner speaks of
+great anger and wrath in a woman disturbing her to the extent of
+producing abortion.
+
+The causes that are observed every day, such tight lacing, excessive
+venery, fright, and emotions, are too well known to be discussed here.
+
+There has been reported a recent case of abortion following a
+viper-bite, and analogues may be found in the writings of Severinus and
+Oedman, who mention viper-bites as the cause; but there are so many
+associate conditions accompanying a snake-bite, such as fright,
+treatment, etc., any one of which could be a cause in itself, that this
+is by no means a reliable explanation.  Information from India an this
+subject would be quite valuable.
+
+The Ephemerides speak of bloodless abortion, and there have been modern
+instances in which the hemorrhage has been hardly noticeable.
+
+Abortion in a twin pregnancy does not necessarily mean the abortion or
+death of both the products of conception. Chapman speaks of the case of
+the expulsion of a blighted fetus at the seventh month, the living
+child remaining to the full term, and being safely delivered, the
+placenta following. Crisp says of a case of labor that the head of the
+child was obstructed by a round body, the nature of which he was for
+some time unable to determine. He managed to push the obstructing body
+up and delivered a living, full-term child; this was soon followed by a
+blighted fetus, which was 11 inches long, weighed 12 ounces, with a
+placenta attached weighing 6 1/2 ounces. It is quite common for a
+blighted fetus to be retained and expelled at term with a living child,
+its twin.
+
+Bacon speaks of twin pregnancy, with the death of one fetus at the
+fourth month and the other delivered at term. Beall reports the
+conception of twins, with one fetus expelled and the other retained;
+Beauchamp cites a similar instance. Bothwell describes a twin labor at
+term, in which one child was living and the other dead at the fifth
+month and macerated. Belt reports an analogous case. Jameson gives the
+history of an extraordinary case of twins in which one (dead) child was
+retained in the womb for forty-nine weeks, the other having been born
+alive at the expiration of nine months. Hamilton describes a case of
+twins in which one fetus died from the effects of an injury between the
+fourth and fifth months and the second arrived at full period. Moore
+cites an instance in which one of the fetuses perished about the third
+month, but was not expelled until the seventh, and the other was
+carried to full term. Wilson speaks of a secondary or blighted fetus of
+the third month with fatty degeneration of the membranes retained and
+expelled with its living twin at the eighth month of uterogestation.
+
+There was a case at Riga in 1839 of a robust girl who conceived in
+February, and in consequence her menses ceased. In June she aborted,
+but, to her dismay, soon afterward the symptoms of advanced pregnancy
+appeared, and in November a full-grown child, doubtless the result of
+the same impregnation as the fetus, was expelled at the fourth month.
+In 1860 Schuh reported an instance before the Vienna Faculty of
+Medicine in which a fetus was discharged at the third month of
+pregnancy and the other twin retained until full term. The abortion was
+attended with much metrorrhagia, and ten weeks afterward the movements
+of the other child could be plainly felt and pregnancy continued its
+course uninterrupted. Bates mentions a twin pregnancy in which an
+abortion took place at the second month and was followed by a natural
+birth at full term. Hawkins gives a case of miscarriage, followed by a
+natural birth at full term; and Newnham cites a similar instance in
+which there was a miscarriage at the seventh month and a birth at full
+term.
+
+Worms in the Uterus.--Haines speaks of a most curious case--that of a
+woman who had had a miscarriage three days previous; she suffered
+intense pain and a fetid discharge. A number of maggots were seen in
+the vagina, and the next day a mass about the size of an orange came
+away from the uterus, riddled with holes, and which contained a number
+of dead maggots, killed by the carbolic acid injection given soon after
+the miscarriage. The fact seems inexplicable, but after their expulsion
+the symptoms immediately ameliorated. This case recalls a somewhat
+similar one given by the older writers, in which a fetus was eaten by a
+worm.  Analogous are those cases spoken of by Bidel of lumbricoides
+found in the uterus; by Hole, in which maggots were found in the vagina
+and uterus; and Simpson, in which the abortion was caused by worms in
+the womb--if the associate symptoms were trustworthy.
+
+We can find fabulous parallels to all of these in some of the older
+writings. Pare mentions Lycosthenes' account of a woman in Cracovia in
+1494 who bore a dead child which had attached to its back a live
+serpent, which had gnawed it to death. He gives an illustration showing
+the serpent in situ. He also quotes the case of a woman who conceived
+by a mariner, and who, after nine months, was delivered by a midwife of
+a shapeless mass, followed by an animal with a long neck, blazing eyes,
+and clawed feet.  Ballantyne says that in the writings of Hippocrates
+there is in the work on "Diseases", which is not usually regarded as
+genuine, a some what curious statement with regard to worms in the
+fetus.  It is affirmed that flat worms develop in the unborn infant,
+and the reason given is that the feces are expelled so soon after birth
+that there would not be sufficient time during extrauterine life for
+the formation of creatures of such a size. The same remark applies to
+round worms. The proof of these statements is to be found in the fact
+that many infants expel both these varieties of parasites with the
+first stool. It is difficult to know what to make of these opinions;
+for, with the exception of certain cases in some of the seventeenth and
+eighteenth century writers, there are no records in medicine of the
+occurrence of vermes in the infant at birth. It is possible that other
+things, such as dried pieces of mucus, may have been erroneously
+regarded as worms.
+
+
+
+CHAPTER III.
+
+OBSTETRIC ANOMALIES.
+
+General Considerations.--In discussing obstetric anomalies we shall
+first consider those strange instances in which stages of parturition
+are unconscious and for some curious reason the pains of labor absent.
+Some women are anatomically constituted in a manner favorable to
+child-birth, and pass through the experience in a comparatively easy
+manner; but to the great majority the throes of labor are anticipated
+with extreme dread, particularly by the victims of the present fashion
+of tight lacing.
+
+It seems strange that a physiologic process like parturition should be
+attended by so much pain and difficulty. Savages in their primitive and
+natural state seem to have difficulty in many cases, and even animals
+are not free from it. We read of the ancient wild Irish women breaking
+the pubic bones of their female children shortly after birth, and by
+some means preventing union subsequently, in order that these might
+have less trouble in child-birth--as it were, a modified and early form
+of symphysiotomy. In consequence of this custom the females of this
+race, to quote an old English authority, had a "waddling, lamish
+gesture in their going." These old writers said that for the same
+reason the women in some parts of Italy broke the coccyxes of their
+female children. This report is very likely not veracious, because this
+bone spontaneously repairs itself so quickly and easily. Rodet and
+Engelmunn, in their most extensive and interesting papers on the modes
+of accouchement among the primitive peoples, substantiate the fear,
+pain, and difficulty with which labor is attended, even in the lowest
+grades of society.
+
+In view of the usual occurrence of pain and difficulty with labor, it
+seems natural that exceptions to the general rule should in all ages
+have attracted the attention of medical men, and that literature should
+be replete with such instances.  Pechlin and Muas record instances of
+painless births. The Ephemerides records a birth as having occurred
+during asphyxia, and also one during an epileptic attack. Storok also
+speaks of birth during unconsciousness in an epileptic attack; and Haen
+and others describe cases occurring during the coma attending
+apoplectic attacks. King reports the histories of two married women,
+fond mothers and anticipating the event, who gave birth to children,
+apparently unconsciously. In the first case, the appearance of the
+woman verified the assertion; in the second, a transient suspension of
+the menstrual influence accounted for it.  After some months epilepsy
+developed in this case. Crawford speaks of a Mrs. D., who gave birth to
+twins in her first confinement at full term, and who two years after
+aborted at three months. In December, 1868, a year after the abortion,
+she was delivered of a healthy, living fetus of about five or six
+months' growth in the following manner: While at stool, she discovered
+something of a shining, bluish appearance protruding through the
+external labia, but she also found that when she lay down the tumor
+disappeared. This tumor proved to be the child, which had been expelled
+from the uterus four days before, with the waters and membranes intact,
+but which had not been recognized; it had passed through the os without
+pain or symptoms, and had remained alive in the vagina over four days,
+from whence it was delivered, presenting by the foot.
+
+The state of intoxication seems by record of several cases to render
+birth painless and unconscious, as well as serving as a means of
+anesthesia in the preanesthetic days.
+
+The feasibility of practising hypnotism in child-birth has been
+discussed, and Fanton reports 12 cases of parturition under the
+hypnotic influence. He says that none of the subjects suffered any pain
+or were aware of the birth, and offers the suggestion that to
+facilitate the state of hypnosis it should be commenced before strong
+uterine contractions have occurred.
+
+Instances of parturition or delivery during sleep, lethargies, trances,
+and similar conditions are by no means uncommon. Heister speaks of
+birth during a convulsive somnolence, and Osiander of a case during
+sleep. Montgomery relates the case of a lady, the mother of several
+children, who on one occasion was unconsciously delivered in sleep.
+Case relates the instance of a French woman residing in the town of
+Hopedale, who, though near confinement, attributed her symptoms to
+over-fatigue on the previous day. When summoned, the doctor found that
+she had severe lumbar pains, and that the os was dilated to the size of
+a half-dollar. At ten o'clock he suggested that everyone retire, and
+directed that if anything of import occurred he should be called. About
+4 A.M. the husband of the girl, in great fright, summoned the
+physician, saying: "Monsieur le Medecin, il y a quelque chose entre les
+jambes de ma femme," and, to Dr. Case's surprise, he found the head of
+a child wholly expelled during a profound sleep of the mother. In
+twenty minutes the secundines followed. The patient, who was only
+twenty years old, said that she had dreamt that something was the
+matter with her, and awoke with a fright, at which instant, most
+probably, the head was expelled. She was afterward confined with the
+usual labor-pains.
+
+Palfrey speaks of a woman, pregnant at term, who fell into a sleep
+about eleven o'clock, and dreamed that she was in great pain and in
+labor, and that sometime after a fine child was crawling over the bed.
+After sleeping for about four hours she awoke and noticed a discharge
+from the vagina. Her husband started for a light, but before he
+obtained it a child was born by a head-presentation. In a few minutes
+the labor-pains returned and the feet of a second child presented, and
+the child was expelled in three pains, followed in ten minutes by the
+placenta.  Here is an authentic case in which labor progressed to the
+second stage during sleep.
+
+Weill describes the case of a woman of twenty-three who gave birth to a
+robust boy on the 16th of June, 1877, and suckled him eleven months.
+This birth lasted one hour. She became pregnant again and was delivered
+under the following circumstances: She had been walking on the evening
+of September 5th and returned home about eleven o'clock to sleep. About
+3 A.M. she awoke, feeling the necessity of passing urine. She arose and
+seated herself for the purpose. She at once uttered a cry and called
+her husband, telling him that a child was born and entreating him to
+send for a physician. Weill saw the woman in about ten minutes and she
+was in the same position, so he ordered her to be carried to bed. On
+examining the urinal he found a female child weighing 10 pounds. He
+tied the cord and cared for the child. The woman exhibited little
+hemorrhage and made a complete recovery. She had apparently slept
+soundly through the uterine contractions until the final strong pain,
+which awoke her, and which she imagined was a call for urination.
+
+Samelson says that in 1844 he was sent for in Zabelsdorf, some 30 miles
+from Berlin, to attend Hannah Rhode in a case of labor. She had passed
+easily through eight parturitions. At about ten o'clock in the morning,
+after a partially unconscious night, there was a sudden gush of blood
+and water from the vagina; she screamed and lapsed into an unconscious
+condition. At 10.35 the face presented, soon followed by the body,
+after which came a great flow of blood, welling out in several waves.
+The child was a male middle-sized, and was some little time in making
+himself heard. Only by degrees did the woman's consciousness return.
+She felt weary and inclined to sleep, but soon after she awoke and was
+much surprised to know what had happened. She had seven or eight pains
+in all. Schultze speaks of a woman who, arriving at the period for
+delivery, went into an extraordinary state of somnolence, and in this
+condition on the third day bore a living male child.
+
+Berthier in 1859 observed a case of melancholia with delirium which
+continued through pregnancy. The woman was apparently unconscious of
+her condition and was delivered without pain.  Cripps mentions a case
+in which there was absence of pain in parturition. Depaul mentions a
+woman who fell in a public street and was delivered of a living child
+during a syncope which lasted four hours. Epley reports painless labor
+in a patient with paraplegia. Fahnestock speaks of the case of a woman
+who was delivered of a son while in a state of artificial somnambulism,
+without pain to herself or injury to the child. Among others mentioning
+painless or unconscious labor are Behrens (during profound sleep),
+Eger, Tempel, Panis, Agnoia, Blanckmeister, Whitehill, Gillette,
+Mattei, Murray, Lemoine, and Moglichkeit.
+
+Rapid Parturition Without Usual Symptoms.--Births unattended by
+symptoms that are the usual precursors of labor often lead to speedy
+deliveries in awkward places. According to Willoughby, in Darby,
+February 9, 1667, a poor fool, Mary Baker, while wandering in an open,
+windy, and cold place, was delivered by the sole assistance of Nature,
+Eve's midwife, and freed of her afterbirth.  The poor idiot had leaned
+against a wall, and dropped the child on the cold boards, where it lay
+for more than a quarter of an hour with its funis separated from the
+placenta. She was only discovered by the cries of the infant. In
+"Carpenter's Physiology" is described a remarkable case of instinct in
+an idiotic girl in Paris, who had been seduced by some miscreant; the
+girl had gnawed the funis in two, in the same manner as is practised by
+the lower animals. From her mental imbecility it can hardly be imagined
+that she had any idea of the object of this separation, and it must
+have been instinct that impelled her to do it. Sermon says the wife of
+Thomas James was delivered of a lusty child while in a wood by herself.
+She put the child in an apron with some oak leaves, marched stoutly to
+her husband's uncle's house a half mile distant, and after two hours'
+rest went on her journey one mile farther to her own house; despite all
+her exertions she returned the next day to thank her uncle for the two
+hours' accommodation. There is related the history of a case of a woman
+who was delivered of a child on a mountain during a hurricane, who took
+off her gown and wrapped the child up in it, together with the
+afterbirth, and walked two miles to her cottage, the funis being
+unruptured.
+
+Harvey relates a case, which he learned from the President of Munster,
+Ireland, of a woman with child who followed her husband, a soldier in
+the army, in daily march. They were forced to a halt by reason of a
+river, and the woman, feeling the pains of labor approaching, retired
+to a thicket, and there alone brought forth twins. She carried them to
+the river, washed them herself, did them up in a cloth, tied them to
+her back, and that very day marched, barefooted, 12 miles with the
+soldiers, and was none the worse for her experience. The next day the
+Deputy of Ireland and the President of Munster, affected by the story,
+to repeat the words of Harvey, "did both vouchsafe to be godfathers of
+the infants."
+
+Willoughby relates the account of a woman who, having a cramp while in
+bed with her sister, went to an outhouse, as if to stool, and was there
+delivered of a child. She quickly returned to bed, her going and her
+return not being noticed by her sleeping sister. She buried the child,
+"and afterward confessed her wickedness, and was executed in the
+Stafford Gaol, March 31, 1670." A similar instance is related by the
+same author of a servant in Darby in 1647. Nobody suspected her, and
+when delivered she was lying in the same room with her mistress. She
+arose without awakening anyone, and took the recently delivered child
+to a remote place, and hid it at the bottom of a feather tub, covering
+it with feathers; she returned without any suspicion on the part of her
+mistress. It so happened that it was the habit of the Darby soldiers to
+peep in at night where they saw a light, to ascertain if everything was
+all right, and they thus discovered her secret doings, which led to her
+trial at the next sessions at Darby.
+
+Wagner relates the history of a case of great medicolegal interest. An
+unmarried servant, who was pregnant, persisted in denying it, and took
+every pains to conceal it. She slept in a room with two other maids,
+and, on examination, she stated that on the night in question she got
+up toward morning, thinking to relieve her bowels. For this purpose she
+secured a wooden tub in the room, and as she was sitting down the child
+passed rapidly into the empty vessel. It was only then that she became
+aware of the nature of her pains. She did not examine the child
+closely, but was certain it neither moved nor cried. The funis was no
+doubt torn, and she made an attempt to tie it. Regarding the event as a
+miscarriage, she took up the tub with its contents and carried it to a
+sand pit about 30 paces distant, and threw the child in a hole in the
+sand that she found already made. She covered it up with sand and
+packed it firmly so that the dogs could not get it. She returned to her
+bedroom, first calling up the man-servant at the stable. She awakened
+her fellow-servants, and feeling tired sat down on a stool. Seeing the
+blood on the floor, they asked her if she had made way with the child.
+She said: "Do you take me for an old sow?" But, having their suspicions
+aroused, they traced the blood spots to the sand pit.  Fetching a
+spade, they dug up the child, which was about one foot below the
+surface. On the access of air, following the removal of the sand and
+turf, the child began to cry, and was immediately taken up and carried
+to its mother, who washed it and laid it on her bed and soon gave it
+the breast. The child was healthy with the exception of a club-foot,
+and must have been under ground at least fifteen minutes and no air
+could have reached it. It seems likely that the child was born
+asphyxiated and was buried in this state, and only began to assume
+independent vitality when for the second time exposed to the air. This
+curious case was verified to English correspondents by Dr. Wagner, and
+is of unquestionable authority; it became the subject of a thorough
+criminal investigation in Germany.
+
+During the funeral procession of Marshal MacMahon in Paris an enormous
+crowd was assembled to see the cortege pass, and in this crowd was a
+woman almost at the time of delivery; the jostling which she received
+in her endeavors to obtain a place of vantage was sufficient to excite
+contraction, and, in an upright position, she gave birth to a fetus,
+which fell at her feet. The crowd pushed back and made way for the
+ambulance officials, and mother and child were carried off, the mother
+apparently experiencing little embarrassment. Quoted by Taylor,
+Anderson speaks of a woman accused of child murder, who walked a
+distance of 28 miles on a single day with her two-days-old child on her
+back.
+
+There is also a case of a female servant named Jane May, who was
+frequently charged by her mistress with pregnancy but persistently
+denied it. On October 26th she was sent to market with some poultry.
+Returning home, she asked the boy who drove her to stop and allow her
+to get out. She went into a recess in a hedge. In five minutes she was
+seen to leave the hedge and follow the cart, walking home, a distance
+of a mile and a half. The following day she went to work as usual, and
+would not have been found out had not a boy, hearing feeble cries from
+the recess of the hedge, summoned a passer-by, but too late to save the
+child.  At her trial she said she did not see her babe breathe nor cry,
+and she thought by the sudden birth that it must have been a still-born
+child.
+
+Shortt says that one day, while crossing the esplanade at Villaire,
+between seven and eight o'clock in the morning, he perceived three
+Hindoo women with large baskets of cakes of "bratties" on their heads,
+coming from a village about four miles distant. Suddenly one of the
+women stood still for a minute, stooped, and to his surprise dropped a
+fully developed male child to the ground. One of her companions ran
+into the town, about 100 yards distant, for a knife to divide the cord.
+A few of the female passers-by formed a screen about the mother with
+their clothes, and the cord was divided. The after-birth came away, and
+the woman was removed to the town. It was afterward discovered that she
+was the mother of two children, was twenty-eight years old, had not the
+slightest sign of approaching labor, and was not aware of parturition
+until she actually felt the child between her thighs.
+
+Smith of Madras, in 1862, says he was hastily summoned to see an
+English lady who had borne a child without the slightest warning.  He
+found the child, which had been born ten minutes, lying close to the
+mother's body, with the funis uncut. The native female maid, at the
+lady's orders, had left the child untouched, lifting the bed-clothes to
+give it air. The lady said that she arose at 5.30 feeling well, and
+during the forenoon had walked down a long flight of steps across a
+walk to a small summer-house within the enclosure of her grounds.
+Feeling a little tired, she had lain down on her bed, and soon
+experienced a slight discomfort, and was under the impression that
+something solid and warm was lying in contact with her person. She
+directed the servant to look below the bed-clothes, and then a female
+child was discovered.  Her other labors had extended over six hours,
+and were preceded by all the signs distinctive of childbirth, which
+fact attaches additional interest to the case. The ultimate fate of the
+child is not mentioned. Smith quotes Wilson, who said he was called to
+see a woman who was delivered without pain while walking about the
+house. He found the child on the floor with its umbilical cord torn
+across.
+
+Langston mentions the case of a woman, twenty-three, who, between 4 and
+5 A.M., felt griping pains in the abdomen. Knowing her condition she
+suspected labor, and determined to go to a friend's house where she
+could be confined in safety. She had a distance of about 600 yards to
+go, and when she was about half way she was delivered in an upright
+position of a child, which fell on the pavement and ruptured its funis
+in the fall. Shortly after, the placenta was expelled, and she
+proceeded on her journey, carrying the child in her arms. At 5.50 the
+physician saw the woman in bed, looking well and free from pain, but
+complaining of being cold. The child, which was her first, was healthy,
+well nourished, and normal, with the exception of a slight ecchymosis
+of the parietal bone on the left side. The funis was lacerated
+transversely four inches from the umbilicus. Both mother and child
+progressed favorably. Doubtless the intense cold had so contracted the
+blood-vessels as to prevent fatal hemorrhage to mother and child. This
+case has a legal bearing in the supposition that the child had been
+killed in the fall.
+
+There is reported the case of a woman in Wales, who, while walking with
+her husband, was suddenly seized with pains, and would have been
+delivered by the wayside but for the timely help of Madame Patti, the
+celebrated diva, who was driving by, and who took the woman in her
+carriage to her palatial residence close by. It was to be christened in
+a few days with an appropriate name in remembrance of the occasion.
+Coleman met an instance in a married woman, who without the slightest
+warning was delivered of a child while standing near a window in her
+bedroom. The child fell to the floor and ruptured the cord about one
+inch from the umbilicus, but with speedy attention the happiest results
+were attained. Twitchell has an example in the case of a young woman of
+seventeen, who was suddenly delivered of a child while ironing some
+clothes. The cord in this case was also ruptured, but the child
+sustained no injury. Taylor quotes the description of a child who died
+from an injury to the head caused by dropping from the mother at an
+unexpected time, while she was in the erect position; he also speaks of
+a parallel case on record.
+
+Unusual Places of Birth.--Besides those mentioned, the other awkward
+positions in which a child may be born are so numerous and diversified
+that mention of only a few can be made here.  Colton tells of a
+painless labor in an Irish girl of twenty-three, who felt a desire to
+urinate, and while seated on the chamber dropped a child. She never
+felt a labor-pain, and twelve days afterward rode 20 miles over a rough
+road to go to her baby's funeral. Leonhard describes the case of a
+mother of thirty-seven, who had borne six children alive, who was
+pregnant for the tenth time, and who had miscalculated her pregnancy.
+During pregnancy she had an attack of small-pox and suffered all
+through pregnancy with constipation. She had taken a laxative, and when
+returning to bed from stool was surprised to find herself attached to
+the stool by a band. The child in the vessel began to cry and was
+separated from the woman, who returned to bed and suddenly died
+one-half hour later. The mother was entirely unconscious of the
+delivery. Westphal mentions a delivery in a water-closet.
+
+Brown speaks of a woman of twenty-six who had a call of nature while in
+bed, and while sitting up she gave birth to a fine, full-grown child,
+which, falling on the floor, ruptured the funis. She took her child,
+lay down with it for some time, and feeling easier, hailed a cab, drove
+to a hospital with the child in her arms, and wanted to walk upstairs.
+She was put to bed and delivered of the placenta, there being but
+little hemorrhage from the cord; both she and her child made speedy
+recoveries. Thebault reports an instance of delivery in the erect
+position, with rupture of the funis at the placenta. There was recently
+a rumor, probably a newspaper fabrication, that a woman while at stool
+in a railway car gave birth to a child which was found alive on the
+track afterward.
+
+There is a curious instance on record in which a child was born in a
+hip-bath and narrowly escaped drowning. The mother was a European woman
+aged forty, who had borne two children, the last nine years before. She
+was supposed to have dropsy of the abdomen, and among other treatments
+was the use of a speculum and caustic applications for inflammation of
+the womb. The escape of watery fluid for two days was considered
+evidence of the rupture of an ovarian cyst. At the end of two days,
+severe pains set in, and a warm hip-bath and an opiate were ordered.
+While in the bath she bore a fully-matured, living, male child, to the
+great surprise of herself and her friends. The child might have been
+drowned had not assistance been close at hand.
+
+Birth by the Rectum.--In some cases in which there is some obstacle to
+the delivery of a child by the natural passages, the efforts of nature
+to expel the product of conception lead to an anomalous exit. There are
+some details of births by the rectum mentioned in the last century by
+Reta and others. Payne cites the instance of a woman of thirty-three,
+in labor thirty-six hours, in whom there was a congenital absence of
+the vaginal orifice.  The finger, gliding along the perineum, arrived
+at a distended anus, just inside of which was felt a fetal head. He
+anesthetized the patient and delivered the child with forceps, and
+without perineal rupture. There was little hemorrhage, and the placenta
+was removed with slight difficulty. Five months later, Payne found an
+unaltered condition of the perineum and vicinity; there was absence of
+the vaginal orifice, and, on introducing the finger along the anterior
+wall of the rectum, a fistula was found, communicating with the vagina;
+above this point the arrangement and the situation of the parts were
+normal. The woman had given birth to three still-born children, and
+always menstruated easily. Coitus always seemed satisfactory, and no
+suspicion existed in the patient's mind, and had never been suggested
+to her, of her abnormality.
+
+Harrison saw a fetus delivered by the anus after rupture of the uterus;
+the membranes came away by the same route. In this case the neck of the
+uterus was cartilaginous and firmly adherent to the adjacent parts. In
+seven days after the accouchement the woman had completely regained her
+health. Vallisneri reports the instance of a woman who possessed two
+uteruses, one communicating with the vagina, the other with the rectum.
+She had permitted rectal copulation and had become impregnated in this
+manner.  Louis, the celebrated French surgeon, created a furore by a
+pamphlet entitled "De partium externarum generationi inservientium in
+mulieribus naturali vitiosa et morbosa dispositione, etc.," for which
+he was punished by the Sorbonne, but absolved by the Pope. He described
+a young lady who had no vaginal opening, but who regularly menstruated
+by the rectum. She allowed her lover to have connection with her in the
+only possible way, by the rectum, which, however, sufficed for
+impregnation, and at term she bore by the rectum a well-formed child.
+Hunter speaks of a case of pregnancy in a woman with a double vagina,
+who was delivered at the seventh month by the rectum. Mekeln and
+Andrews give instances of parturition through the anus. Morisani
+describes a case of extrauterine pregnancy with tubal rupture and
+discharge into the culdesac, in which there was delivery by the rectum.
+After an attack of severe abdominal pain, followed by hemorrhage, the
+woman experienced an urgent desire to empty the rectum. The fetal
+movements ceased, and a recurrence of these symptoms led the patient to
+go to stool, at which she passed blood and a seromucoid fluid. She
+attempted manually to remove the offending substances from the rectum,
+and in consequence grasped the leg of a fetus. She was removed to a
+hospital, where a fetus nine inches long was removed from the rectum.
+The rectal opening gradually cicatrized, the sac became obliterated,
+and the woman left the hospital well.
+
+Birth Through Perineal Perforation.--Occasionally there is perineal
+perforation during labor, with birth of the child through the opening.
+Brown mentions a case of rupture of the perineum with birth of a child
+between the vaginal opening and the anus. Cassidy reports a case of
+child-birth through the perineum. A successful operation was performed
+fifteen days after the accident. Dupuytren speaks of the passage of an
+infant through a central opening of the perineum. Capuron, Gravis, and
+Lebrun all report accouchement through a perineal perforation, without
+alteration in the sphincter ani or the fourchet. In his "Diseases of
+Women" Simpson speaks of a fistula left by the passage of an infant
+through the perineum. Wilson, Toloshinoff, Stolz, Argles, Demarquay,
+Harley, Hernu, Martyn, Lamb, Morere, Pollock, and others record the
+birth of children through perineal perforations.
+
+Birth Through the Abdominal Wall.--Hollerius gives a very peculiar
+instance in which the abdominal walls gave way from the pressure
+exerted by the fetus, and the uterus ruptured, allowing the child to be
+extracted by the hand from the umbilicus; the mother made a speedy
+recovery. In such cases delivery is usually by means of operative
+interference (which will be spoken of later), but rarely, as here,
+spontaneously. Farquharson and Ill both mention rupture of the
+abdominal parietes during labor.
+
+There have been cases reported in which the recto-vaginal septum has
+been ruptured, as well as the perineum and the sphincter ani, giving
+all the appearance of a birth by the anus.
+
+There is an account of a female who had a tumor projecting between the
+vagina and rectum, which was incised through the intestine, and proved
+to be a dead child. Saviard reported what he considered a rather unique
+case, in which the uterus was ruptured by external violence, the fetus
+being thrown forward into the abdomen and afterward extracted from an
+umbilical abscess.
+
+Birth of the Fetus Enclosed in the Membranes.--Harvey says that an
+infant can rest in its membranes several hours after birth without loss
+of life. Schurig eventrated a pregnant bitch and her puppies lived in
+their membranes half an hour. Wrisberg cites three observations of
+infants born closed in their membranes; one lived seven minutes; the
+other two nine minutes; all breathed when the membranes were cut and
+air admitted. Willoughby recorded the history of a case which attracted
+much comment at the time.  It was the birth of twins enclosed in their
+secundines. The sac was opened and, together with the afterbirth, was
+laid over some hot coals; there was, however, a happy issue, the
+children recovering and living. Since Willoughby's time several cases
+of similar interest have been noticed, one in a woman of forty, who had
+been married sixteen years, and who had had several pregnancies in her
+early married life and a recent abortion. Her last pregnancy lasted
+about twenty-eight or twenty-nine weeks, and terminated, after a short
+labor, by the expulsion of the ovum entire. The membranes had not been
+ruptured, and still enclosed the fetus and the liquor amnii. On
+breaking them, the fetus was seen floating on the waters, alive, and,
+though very diminutive, was perfectly formed. It continued to live, and
+a day afterward took the breast and began to cry feebly. At six weeks
+it weighed 2 pounds 2 ounces, and at ten months, 12 pounds, but was
+still very weak and ill-nourished. Evans has an instance of a fetus
+expelled enveloped in its membranes entire and unruptured. The
+membranes were opaque and preternaturally thickened, and were opened
+with a pair of scissors; strenuous efforts were made to save the child,
+but to no purpose. The mother, after a short convalescence, made a good
+recovery. Forman reports an instance of unruptured membranes at birth,
+the delivery following a single pain, in a woman of twenty-two,
+pregnant for a second time.  Woodson speaks of a case of twins, one of
+which was born enveloped in its secundines.
+
+Van Bibber was called in great haste to see a patient in labor.  He
+reached the house in about fifteen minutes, and was told by the
+midwife, a woman of experience, that she had summoned him because of
+the expulsion from the womb of something the like of which she had
+never seen before. She thought it must have been some variety of false
+conception, and had wrapped it up in some flannel. It proved to be a
+fetus enclosed in its sac, with the placenta, all having been expelled
+together and intact. He told the nurse to rupture the membranes, and
+the child, which had been in the unruptured sac for over twenty
+minutes, began to cry. The infant lived for over a month, but
+eventually died of bronchitis.
+
+Cowger reports labor at the end of the seventh month without rupture of
+the fetal sac. Macknus and Rootes speak of expulsion of the entire ovum
+at the full period of gestation. Roe mentions a case of parturition
+with unruptured membrane. Slusser describes the delivery of a
+full-grown fetus without rupture of the membrane.
+
+"Dry Births."--The reverse of the foregoing are those cases in which,
+by reason of the deficiency of the waters, the birth is dry. Numerous
+causes can be stated for such occurrences, and the reader is referred
+elsewhere for them, the subject being an old one. The Ephemerides
+speaks of it, and Rudolph discusses its occurrence exhaustively and
+tells of the difficulties of such a labor. Burrall mentions a case of
+labor without apparent liquor amnii, delivery being effected by the
+forceps. Strong records an unusual obstetric case in which there was
+prolongation of the pregnancy, with a large child, and entire absence
+of liquor amnii. The case was also complicated with interstitial and
+subserous fibroids and a contracted pelvis, combined with a posterior
+position of the occiput and nonrotation of the head.  Lente mentions a
+case of labor without liquor amnii; and Townsend records delivery
+without any sanguineous discharge. Cosentino mentions a case of the
+absence of liquor amnii associated with a fetal monstrosity.
+
+Delivery After Death of the Mother.--Curious indeed are those anomalous
+cases in which the delivery is effected spontaneously after the death
+of the mother, or when, by manipulation, the child is saved after the
+maternal decease. Wegelin gives the account of a birth in which version
+was performed after death and the child successfully delivered.
+Bartholinus, Wolff, Schenck, Horstius, Hagendorn, Fabricius Hildanus,
+Valerius, Rolfinck, Cornarius, Boener, and other older writers cite
+cases of this kind. Pinard gives a most wonderful case. The patient was
+a woman of thirty-eight who had experienced five previous normal
+labors.  On October 27th she fancied she had labor pains and went to
+the Lariboisiere Maternite, where, after a careful examination, three
+fetal poles were elicited, and she was told, to her surprise, of the
+probability of triplets. At 6 P.M., November 13th, the pains of labor
+commenced. Three hours later she was having great dyspnea with each
+pain. This soon assumed a fatal aspect and the midwife attempted to
+resuscitate the patient by artificial respiration, but failed in her
+efforts, and then she turned her attention to the fetuses, and, one by
+one, she extracted them in the short space of five minutes; the last
+one was born twelve minutes after the mother's death. They all lived
+(the first two being females), and they weighed from 4 1/4 to 6 1/2
+pounds.
+
+Considerable attention has been directed to the advisability of
+accelerated and forced labor in the dying, in order that the child may
+be saved. Belluzzi has presented several papers on this subject.
+Csurgay of Budapest mentions saving the child by forced labor in the
+death agonies of the mother. Devilliers considers this question from
+both the obstetric and medicolegal points of view. Hyneaux mentions
+forcible accouchement practised on both the dead and the dying.
+Rogowicz advocates artificial delivery by the natural channel in place
+of Cesarian section in cases of pending or recent death, and Thevenot
+discussed this question at length at the International Medico-Legal
+Congress in 1878. Duer presented the question of postmortem delivery in
+this country.
+
+Kelly reports the history of a woman of forty who died in her eighth
+pregnancy, and who was delivered of a female child by version and
+artificial means. Artificial respiration was successfully practised on
+the child, although fifteen minutes had elapsed from the death of the
+mother to its extraction. Driver relates the history of a woman of
+thirty-five, who died in the eighth month of gestation, and who was
+delivered postmortem by the vagina, manual means only being used. The
+operator was about to perform Cesarean section when he heard the noise
+of the membranes rupturing. Thornton reports the extraction of a living
+child by version after the death of the mother. Aveling has compiled
+extensive statistics on all varieties of postmortem deliveries,
+collecting 44 cases of spontaneous expulsion of the fetus after death
+of the mother.
+
+Aveling states that in 1820 the Council of Cologne sanctioned the
+placing of a gag in the mouth of a dead pregnant woman, thereby hoping
+to prevent suffocation of the infant, and there are numerous such laws
+on record, although most of them pertain to the performance of Cesarean
+section immediately after death.
+
+Reiss records the death of a woman who was hastily buried while her
+husband was away, and on his return he ordered exhumation of her body,
+and on opening the coffin a child's cry was heard. The infant had
+evidently been born postmortem. It lived long afterward under the name
+of "Fils de la terre." Willoughby mentions the curious instance in
+which rumbling was heard from the coffin of a woman during her hasty
+burial. One of her neighbors returned to the grave, applied her ear to
+the ground, and was sure she heard a sighing noise. A soldier with her
+affirmed her tale, and together they went to a clergyman and a justice,
+begging that the grave be opened. When the coffin was opened it was
+found that a child had been born, which had descended to her knees. In
+Derbyshire, to this day, may be seen on the parish register: "April ye
+20, 1650, was buried Emme, the wife of Thomas Toplace, who was found
+delivered of a child after she had lain two hours in the grave."
+
+Johannes Matthaeus relates the case of a buried woman, and that some
+time afterward a noise was heard in the tomb. The coffin was
+immediately opened, and a living female child rolled to the feet of the
+corpse. Hagendorn mentions the birth of a living child some hours after
+the death of the mother. Dethardingius mentions a healthy child born
+one-half hour after the mother's death. In the Gentleman's Magazine
+there is a record of an instance, in 1759, in which a midwife, after
+the death of a woman whom she had failed to deliver, imagined that she
+saw a movement under the shroud and found a child between its mother's
+legs. It died soon after. Valerius Maximus says that while the body of
+the mother of Gorgia Epirotas was being carried to the grave, a loud
+noise was heard to come from the coffin and on examination a live child
+was found between the thighs,--whence arose the proverb: "Gorgiam prius
+ad funus elatum, quam natum fuisse."
+
+Other cases of postmortem delivery are less successful, the delivery
+being delayed too late for the child to be viable. The first of
+Aveling's cases was that of a pregnant woman who was hanged by a
+Spanish Inquisitor in 1551 While still hanging, four hours later, two
+children were said to have dropped from her womb. The second case was
+of a woman of Madrid, who after death was shut in a sepulcher. Some
+months after, when the tomb was opened, a dead infant was found by the
+side of the corpse.  Rolfinkius tells of a woman who died during
+parturition, and her body being placed in a cellar, five days later a
+dead boy and girl were found on the bier. Bartholinus is accredited
+with the following: Three midwives failing to deliver a woman, she
+died, and forty-eight hours after death her abdomen swelled to such an
+extent as to burst her grave-clothes, and a male child, dead, was seen
+issuing from the vagina. Bonet tells of a woman, who died in Brussels
+in 1633, who, undelivered, expired in convulsions on Thursday. On
+Friday abdominal movements in the corpse were seen, and on Sunday a
+dead child was found hanging between the thighs.  According to Aveling,
+Herman of Berne reports the instance of a young lady whose body was far
+advanced in putrefaction, from which was expelled an unbroken ovum
+containing twins. Even the placenta showed signs of decomposition.
+Naumann relates the birth of a child on the second day after the death
+of the mother.  Richter of Weissenfels, in 1861, reported the case of a
+woman who died in convulsions, and sixty hours after death an eight
+months' fetus came away. Stapedius writes to a friend of a fetus being
+found dead between the thighs of a woman who expired suddenly of an
+acute disease. Schenk mentions that of a woman, dying at 5 P.M., a
+child having two front teeth was born at 3 A.M.  Veslingius tells of a
+woman dying of epilepsy on June 6, 1630, from whose body, two days
+later, issued a child. Wolfius relates the case of a woman dying in
+labor in 1677. Abdominal movements being seen six hours after death,
+Cesarean section was suggested, but its performance was delayed, and
+eighteen hours after a child was spontaneously born. Hoyer of Mulhausen
+tells of a child with its mouth open and tongue protruding, which was
+born while the mother was on the way to the grave. Bedford of Sydney,
+according to Aveling, relates the story of a case in which malpractice
+was suspected on a woman of thirty-seven, who died while pregnant with
+her seventh child. The body was exhumed, and a transverse rupture of
+the womb six inches long above the cervix was found, and the body of a
+dead male child lay between the thighs. In 1862, Lanigan tells of a
+woman who was laid out for funeral obsequies, and on removal of the
+covers for burial a child was found in bed with her. Swayne is credited
+with the description of the death of a woman whom a midwife failed to
+deliver. Desiring an inquest, the coroner had the body exhumed, when,
+on opening the coffin, a well-developed male infant was found parallel
+to and lying on the lower limbs, the cord and placenta being entirely
+unattached from the mother.
+
+Some time after her decease Harvey found between the thighs of a dead
+woman a dead infant which had been expelled postmortem.  Mayer relates
+the history of a case of a woman of forty-five who felt the movement of
+her child for the fourth time in the middle of November. In the
+following March she had hemoptysis, and serious symptoms of
+inflammation in the right lung following, led to her apparent death on
+the 31st of the month. For two days previous to her death she had
+failed to perceive the fetal movements. She was kept on her back in a
+room, covered up and undisturbed, for thirty-six hours, the members of
+the family occasionally visiting her to sprinkle holy water on her
+face.  There was no remembrance of cadaveric distortion of the features
+or any odor. When the undertakers were drawing the shroud on they
+noticed a half-round, bright-red, smooth-looking body between the
+genitals which they mistook for a prolapsed uterus. Early on April 2d,
+a few hours before interment, the men thought to examine the swelling
+they had seen the day before. A second look showed it to be a dead
+female child, now lying between the thighs and connected with the
+mother by the umbilical cord. The interment was stopped, and Mayer was
+called to examine the body, but with negative results, though the signs
+of death were not plainly visible for a woman dead fifty-eight hours.
+By its development the body of the fetus confirmed the mother's account
+of a pregnancy of twenty-one weeks. Mayer satisfies himself at least
+that the mother was in a trance at the time of delivery and died soon
+afterward.
+
+Moritz gives the instance of a woman dying in pregnancy, undelivered,
+who happened to be disinterred several days after burial. The body was
+in an advanced state of decomposition, and a fetus was found in the
+coffin. It was supposed that the pressure of gas in the mother's body
+had forced the fetus from the uterus.  Ostmann speaks of a woman
+married five months, who was suddenly seized with rigors, headache, and
+vomiting. For a week she continued to do her daily work, and in
+addition was ill-treated by her husband. She died suddenly without
+having any abdominal pain or any symptoms indicative of abortion. The
+body was examined twenty-four hours after death and was seen to be
+dark, discolored, and the abdomen distended. There was no sanguineous
+discharge from the genitals, but at the time of raising the body to
+place it in the coffin, a fetus, with the umbilical cord, escaped from
+the vagina. There seemed to have been a rapid putrefaction in this
+ease, generating enough pressure of gas to expel the fetus as well as
+the uterus from the body. This at least is the view taken by Hoffman
+and others in the solution of these strange cases.
+
+Antepartum Crying of the Child.--There are on record fabulous cases of
+children crying in the uterus during pregnancy, and all sorts of
+unbelievable stories have been constructed from these reported
+occurrences. Quite possible, however, and worthy of belief are the
+cases in which the child has been heard to cry during the progress of
+parturition--that is, during delivery.  Jonston speaks of infants
+crying in the womb, and attempts a scientific explanation of the fact.
+He also quotes the following lines in reference to this subject:--
+
+"Mirandum foetus nlaterna clausus in alvo Dicitur insuetos ore dedisse
+sonos.  Causa subest; doluit se angusta sede telleri Et cupiit magnae
+cernere moliis opus.  Aut quia quaerendi studio vis fessa parentum
+Aucupii aptas innuit esse manus."
+
+The Ephemerides gives examples of the child hiccoughing in the uterus.
+Cases of crying before delivery, some in the vagina, some just before
+the complete expulsion of the head from the os uteri, are very numerous
+in the older writers; and it is quite possible that on auscultation of
+the pregnant abdomen fetal sounds may have been exaggerated into cries.
+Bartholinus, Borellus, Boyle, Buchner, Paullini, Mezger, Riolanus,
+Lentillus, Marcellus Donatus, and Wolff all speak of children crying
+before delivery; and Mazinus relates the instance of a puppy whose
+feeble cries could be heard before expulsion from the bitch. Osiander
+fully discusses the subject of infants crying during parturition.
+
+McLean describes a case in which he positively states that a child
+cried lustily in utero during application of the forceps.  He compared
+the sound as though from a voice in the cellar. This child was in the
+uterus, not in the vagina, and continued the crying during the whole of
+the five minutes occupied by delivery.
+
+Cesarean Section.--Although the legendary history of Cesarean section
+is quite copious, it is very seldom that we find authentic records in
+the writings of the older medical observers.  The works of Hippocrates,
+Aretxeus, Galen, Celsus, and Aetius contain nothing relative to records
+of successful Cesarean sections. However, Pliny says that Scipio
+Africanus was the first and Manlius the second of the Romans who owed
+their lives to the operation of Cesarean section; in his seventh book
+he says that Julius Caesar was born in this way, the fact giving origin
+to his name. Others deny this and say that his name came from the thick
+head of hair which he possessed. It is a frequent subject in old Roman
+sculpture, and there are many delineations of the birth of Bacchus by
+Cesarean section from the corpse of Semele. Greek mythology tells us of
+the birth of Bacchus in the following manner: After Zeus burnt the
+house of Semele, daughter of Cadmus, he sent Hermes in great haste with
+directions to take from the burnt body of the mother the fruit of seven
+months. This child, as we know, was Bacchus. Aesculapius, according to
+the legend of the Romans, had been excised from the belly of his dead
+mother, Corinis, who was already on the funeral pile, by his
+benefactor, Apollo; and from this legend all products of Cesarean
+sections were regarded as sacred to Apollo, and were thought to have
+been endowed with sagacity and bravery.
+
+Old records tell us that one of the kings of Navarre was delivered in
+this way, and we also have records of the birth of the celebrated Doge,
+Andreas Doria, by this method. Jane Seymour was supposed to have been
+delivered of Edward VI by Cesarean section, the father, after the
+consultation of the physicians was announced to him, replying: "Save
+the child by all means, for I shall be able to get mothers enough."
+Robert II of Scotland was supposed to have been delivered in this way
+after the death of his mother, Margery Bruce, who was killed by being
+thrown from a horse. Shakespere's immortal citation of Macduff, "who
+was from his mother's womb untimely ripped," must have been such a
+case, possibly crudely done, perchance by cattle-horn. Pope Gregory XIV
+was said to have been taken from his mother's belly after her death.
+The Philosophical Transactions, in the last century contain accounts of
+Cesarean section performed by an ignorant butcher and also by a
+midwife; and there are many records of the celebrated case performed by
+Jacob Nufer, a cattle gelder, at the beginning of the sixteenth century.
+
+By the advent of antisepsis and the improvements of Porro and others,
+Cesarean section has come to be a quite frequent event, and a record of
+the successful cases would hardly be considered a matter of
+extraordinary interest, and would be out of the province of this work,
+but a citation of anomalous cases will be given. Baldwin reports a case
+of Cesarean section on a typical rachitic dwarf of twenty-four, who
+weighed 100 pounds and was only 47 1/2 inches tall. It was the ninth
+American case, according to the calculation of Harris, only the third
+successful one, and the first successful one in Ohio. The woman had a
+uniformly contracted pelvis whose anteroposterior diameter was about 1
+1/4 inches. The hygienic surroundings for the operation were not of the
+best, as the woman lived in a cellar. Tait's method of performing the
+operation was determined upon and successfully performed. Convalescence
+was prompt, and in three weeks the case was dismissed. The child was a
+female of 7 1/2 pounds which inherited the deformities of its mother.
+It thrived for nine and a half months, when it died of angina Ludovici.
+Figure 15 represents the mother and child.
+
+Harris gives an account of an operation upon a rachitic dwarf who was
+impregnated by a large man, a baby weighing 14 pounds and measuring 20
+inches being delivered by the knife. St. Braun gives the account of a
+Porro-Cesarean operation in the case of a rachitic dwarf 3 feet 10
+inches tall, in which both the mother and child recovered. Munde speaks
+of twins being delivered by Cesarean section. Franklin gives the
+instance of a woman delivered at full term of a living child by this
+means, in whom was also found a dead fetus. It lay behind the stump of
+the amputated cervix, in the culdesac of Douglas. The patient died of
+hemorrhage.
+
+Croston reports a case of Cesarean section on a primipara of
+twenty-four at full term, with the delivery of a double female monster
+weighing 12 1/2 pounds. This monster consisted of two females of about
+the same size, united from the sternal notch to the navel, having one
+cord and one placenta. It was stillborn.  The diagnosis was made before
+operation by vaginal examination.  In a communication to Croston,
+Harris remarked that this was the first successful Cesarean section for
+double monstrous conception in America, and added that in 1881 Collins
+and Leidy performed the same operation without success.
+
+Instances of repeated Cesarean section were quite numerous, and the
+pride of the operators noteworthy, before the uterus was removed at the
+first operation, as is now generally done. Bacque reports two sections
+in the same woman, and Bertrandi speaks of a case in which the
+operation was successfully executed many times in the same woman.
+Rosenberg reports three cases repeated successfully by Leopold of
+Dresden. Skutsch reports a case in which it was twice performed on a
+woman with a rachitic pelvis, and who the second time was pregnant with
+twins; the children and mother recovered. Zweifel cites an instance in
+which two Cesarean sections were performed on a patient, both of the
+children delivered being in vigorous health. Stolz relates a similar
+case.  Beck gives an account of a Cesarean operation twice on the same
+woman; in the first the child perished, but in the second it survived.
+Merinar cites an instance of a woman thrice opened.  Parravini gives a
+similar instance. Charlton gives an account of the performance carried
+out successfully four times in the same woman; Chisholm mentions a case
+in which it was twice performed.  Michaelis of Kiel gives an instance
+in which he performed the same operation on a woman four times, with
+successful issues to both mother and children, despite the presence of
+peritonitis the last time. He had operated in 1826, 1830, 1832, and
+1836. Coe and Gueniot both mention cases in which Cesarean section had
+been twice performed with successful terminations as regards both
+mothers and children. Rosenberg tabulates a number of similar cases
+from medical literature.
+
+Cases of Cesarean section by the patient herself are most curious, but
+may be readily believed if there is any truth in the reports of the
+operation being done in savage tribes. Felkin gives an account of a
+successful case performed in his presence, with preservation of the
+lives of both mother and child, by a native African in Kahura, Uganda
+Country. The young girl was operated on in the crudest manner, the
+hemorrhage being checked by a hot iron. The sutures were made by means
+of seven thin, hot iron spikes, resembling acupressure-needles, closing
+the peritoneum and skin. The wound healed in eleven days, and the
+mother made a complete recovery. Thomas Cowley describes the case of a
+negro woman who, being unable to bear the pains of labor any longer,
+took a sharp knife and made a deep incision in her belly--deep enough
+to wound the buttocks of her child, and extracted the child, placenta
+and all. A negro horse-doctor was called, who sewed the wound up in a
+manner similar to the way dead bodies are closed at the present time.
+
+Barker gives the instance of a woman who, on being abused by her
+husband after a previous tedious labor, resolved to free herself of the
+child, and slyly made an incision five inches long on the left side of
+the abdomen with a weaver's knife. When Barker arrived the patient was
+literally drenched with blood and to all appearance dead. He extracted
+a dead child from the abdomen and bandaged the mother, who lived only
+forty hours. In his discourses on Tropical Diseases Moseley speaks of a
+young negress in Jamaica who opened her uterus and extracted therefrom
+a child which lived six days; the woman recovered. Barker relates
+another case in Rensselaer County, N.Y., in which the incision was made
+with the razor, the woman likewise recovering. There is an interesting
+account of a poor woman at Prischtina, near the Servian frontier, who,
+suffering greatly from the pains of labor, resolved to open her abdomen
+and uterus. She summoned a neighbor to sew up the incision after she
+had extracted the child, and at the time of report, several months
+later, both the mother and child were doing well.
+
+Madigan cites the case of a woman of thirty-four, in her seventh
+confinement, who, while temporarily insane, laid open her abdomen with
+a razor, incised the uterus, and brought out a male child.  The
+abdominal wound was five inches long, and extended from one inch above
+the umbilicus straight downward. There was little or no bleeding and
+the uterus was firmly contracted. She did not see a physician for three
+hours. The child was found dead and, with the placenta, was lying by
+her side. The neighbors were so frightened by the awful sight that they
+ran away, or possibly the child might have been saved by ligature of
+the funis. Not until the arrival of the clergyman was anything done,
+and death ultimately ensued.
+
+A most wonderful case of endurance of pain and heroism was one
+occurring in Italy, which attracted much European comment at the time.
+A young woman, illegitimately pregnant, at full term, on March 28th, at
+dawn, opened her own abdomen on the left side with a common knife such
+as is generally used in kitchens. The wound measured five inches, and
+was directed obliquely outward and downward. She opened the uterus in
+the same direction, and endeavored to extract the fetus. To expedite
+the extraction, she drew out an arm and amputated it, and finding the
+extraction still difficult, she cut off the head and completely emptied
+the womb, including the placenta. She bound a tight bandage around her
+body and hid the fetus in a straw mattress. She then dressed herself
+and attended to her domestic duties. She afterward mounted a cart and
+went into the city of Viterbo, where she showed her sister a cloth
+bathed in blood as menstrual proof that she was not pregnant. On
+returning home, having walked five hours, she was seized with an attack
+of vomiting and fainted. The parents called Drs. Serpieri and Baliva,
+who relate the case.  Thirteen hours had elapsed from the infliction of
+the wound, through which the bulk of the intestines had been protruding
+for the past six hours. The abdomen was irrigated, the toilet made, and
+after the eighteenth day the process of healing was well progressed,
+and the woman made a recovery after her plucky efforts to hide her
+shame.
+
+Cases like the foregoing excite no more interest than those on record
+in which an abdominal section has been accidental, as, for instance, by
+cattle-horns, and the fetus born through the wound.  Zuboldie speaks of
+a case in which a fetus was born from the wound made by a bull's horn
+in the mother's abdomen. Deneux describes a case in which the wound
+made by the horn was not sufficiently large to permit the child's
+escape, but it was subsequently brought through the opening. Pigne
+speaks of a woman of thirty-eight, who in the eighth month of her sixth
+pregnancy was gored by a bull, the horn effecting a transverse wound 27
+inches long, running from one anterior spine to the other. The woman
+was found cold and insensible and with an imperceptible pulse. The
+small intestines were lying between the thighs and covered with
+coagulated blood. In the process of cleansing, a male child was
+expelled spontaneously through a rent in the uterus. The woman was
+treated with the usual precautions and was conscious at midday. In a
+month she was up. She lived twenty years without any inconvenience
+except that due to a slight hernia on the left side. The child died at
+the end of a fortnight.
+
+In a very exhaustive article Harris of Philadelphia has collected
+nearly all the remaining cases on record, and brief extracts from some
+of them will be given below. In Zaandam, Holland, 1647, a farmer's wife
+was tossed by a furious bull. Her abdomen was ripped open, and the
+child and membranes escaped. The child suffered no injuries except a
+bruised upper lip and lived nine months. The mother died within forty
+hours of her injuries.  Figure 19 taken from an engraving dated 1647,
+represents an accouchement by a mad bull, possibly the same case. In
+Dillenberg, Germany, in 1779, a multipara was gored by an ox at her
+sixth month of pregnancy; the horn entered the right epigastric region,
+three inches from the linea alba, and perforated the uterus. The right
+arm of the fetus protruded; the wound was enlarged and the fetus and
+placenta delivered. Thatcher speaks of a woman who was gored by a cow
+in King's Park, and both mother and child were safely delivered and
+survived.
+
+In the Parish of Zecoytia, Spain, in 1785, Marie Gratien was gored by
+an ox in the superior portion of her epigastrium, making a wound eight
+inches long which wounded the uterus in the same direction. Dr. Antonio
+di Zubeldia and Don Martin Monaco were called to take charge of the
+case. While they were preparing to effect delivery by the vagina, the
+woman, in an attack of singultus, ruptured the line of laceration and
+expelled the fetus, dead. On the twenty-first day the patient was doing
+well.  The wound closed at the end of the sixteenth week. The woman
+subsequently enjoyed excellent health and, although she had a small
+ventral hernia, bore and nursed two children.
+
+Marsh cites the instance of a woman of forty-two, the mother of eight
+children, who when eight months pregnant was horned by a cow. Her
+clothes were not torn, but she felt that the child had slipped out, and
+she caught it in her dress. She was seen by some neighbors twelve yards
+from the place of accident, and was assisted to her house. The bowels
+protruded and the child was separated from the funis. A physician saw
+the woman three-quarters of an hour afterward and found her pulseless
+and thoroughly exhausted. There was considerable but not excessive loss
+of blood, and several feet of intestine protruded through the wound.
+The womb was partially inverted through the wound, and the placenta was
+still attached to the inverted portion. The wound in the uterus was
+Y-shaped. The mother died in one and a half hours from the reception of
+her injuries, but the child was uninjured.
+
+Scott mentions the instance of a woman thirty-four years old who was
+gored by an infuriated ox while in the ninth month of her eighth
+pregnancy. The horn entered at the anterior superior spinous process of
+the ilium, involving the parietes and the uterus. The child was
+extruded through the wound about half an hour after the occurrence of
+the accident. The cord was cut and the child survived and thrived,
+though the mother soon died.  Stalpart tells the almost incredible
+story of a soldier's wife who went to obtain water from a stream and
+was cut in two by a cannonball while stooping over. A passing soldier
+observed something to move in the water, which, on investigation, he
+found to be a living child in its membranes. It was christened by order
+of one Cordua and lived for some time after.
+
+Postmortem Cesarean Section.--The possibility of delivering a child by
+Cesarean section after the death of the mother has been known for a
+long time to the students of medicine. In the olden times there were
+laws making compulsory the opening of the dead bodies of pregnant women
+shortly after death. Numa Pompilius established the first law, which
+was called "les regia," and in later times there were many such
+ordinances. A full description of these laws is on record. Life was
+believed possible after a gestation of six months or over, and, as
+stated, some famous men were supposed to have been born in this manner.
+Francois de Civile, who on great occasions signed himself "trois fois
+enterre et trois fois par le grace de Dieu ressucite," saw the light of
+the world by a happy Cesarean operation on his exhumed mother.
+Fabricius Hildanus and Boarton report similar instances. Bourton cites
+among others the case of an infant who was found living twelve hours
+after the death of his mother. Dufour and Mauriceau are two older
+French medical writers who discuss this subject.  Flajani speaks of a
+case in which a child was delivered at the death of its mother, and
+some of the older Italian writers discuss the advisability of the
+operation in the moribund state before death actually ensues. Heister
+writes of the delivery of the child after the death of the mother by
+opening the abdomen and uterus.
+
+Harris relates several interesting examples. In Peru in 1794 a Sambi
+woman was killed by lightning, and the next day the abdomen was opened
+by official command and a living child was extracted.  The Princess von
+Swartzenberg, who was burned to death at a ball in Paris in 1810, was
+said to have had a living child removed from her body the next day.
+Like all similar instances, this was proved to be false, as her body
+was burned beyond the possibility of recognition, and, besides, she was
+only four months pregnant.  Harris mentions another case of a young
+woman who threw herself from the Pont Neuf into the Seine. Her body was
+recovered, and a surgeon who was present seized a knife from a butcher
+standing by and extracted a living child in the presence of the curious
+spectators. Campbell discusses this subject most thoroughly, though he
+advances no new opinions upon it.
+
+Duer tabulates the successful results of a number of cases of Cesarean
+section after death as follows:--
+
+  Children extracted
+  between 1 and 5 minutes after death of the mother, 21
+  "   "   10 and 15   "    "    "   "    "    "      13
+  "   "   15 and 30   "    "    "   "    "    "       2
+  "   "   1 hour      "    "    "   "    "    "       2
+  "   "   2 hours     "    "    "   "    "    "       2
+
+Garezky of St. Petersburg collected reports of 379 cases of Cesarean
+section after death with the following results: 308 were extracted
+dead; 37 showed signs of life; 34 were born alive. Of the 34, only 5
+lived for any length of time. He concludes that if extracted within
+five or six minutes after death, they may be born alive; if from six to
+ten minutes, they may still be born alive, though asphyxiated; if from
+ten to twenty-six minutes, they will be highly asphyxiated. In a great
+number of these cases the infant was asphyxiated or dead in one minute.
+Of course, if the death is sudden, as by apoplexy, accident, or
+suicide, the child's chances are better. These statistics seem
+conscientious and reliable, and we are safe in taking them as
+indicative of the usual result, which discountenances the old reports
+of death as taking place some time before extraction.
+
+Peuch is credited with statistics showing that in 453 operations 101
+children gave signs of life, but only 45 survived.
+
+During the Commune of Paris, Tarnier, one night at the Maternite, was
+called to an inmate who, while lying in bed near the end of pregnancy,
+had been killed by a ball which fractured the base of the skull and
+entered the brain. He removed the child by Cesarean section and it
+lived for several days. In another case a pregnant woman fell from a
+window for a distance of more than 30 feet, instant death resulting;
+thirty minutes at least after the death of the mother an infant was
+removed, which, after some difficulty, was resuscitated and lived for
+thirteen years.  Tarnier states that delivery may take place
+three-quarters of an hour or even an hour after the death of the
+mother, and he also quotes an extraordinary case by Hubert of a
+successful Cesarean operation two hours after the mother's death; the
+woman, who was eight months pregnant, was instantly killed while
+crossing a railroad track.
+
+
+Hoffman records the case of a successful Cesarean section done ten
+minutes after death. The patient was a woman of thirty-six, in her
+eighth month of pregnancy, who was suddenly seized with eclampsia,
+which terminated fatally in ten hours. Ten minutes after her last
+respiration the Cesarean section was performed and a living male child
+delivered. This infant was nourished with the aid of a spoon, but it
+died in twenty-five hours in consequence of its premature birth and
+enfeebled vitality.
+
+Green speaks of a woman, nine months pregnant, who was run over by a
+heavily laden stage-coach in the streets of Southwark. She died in
+about twenty minutes, and in about twenty minutes more a living child
+was extracted from her by Cesarean section. There was a similar case in
+the Hopital St. Louis, in Paris, in 1829; but in this case the child
+was born alive five minutes after death. Squire tells of a case in
+which the mother died of dilatation of the aorta, and in from twenty to
+thirty minutes the child was saved. In comment on this case Aveling is
+quoted as saying that he believed it possible to save a child one hour
+after the death of the mother. No less an authority than Playfair
+speaks of a case in which a child was born half an hour after the death
+of the mother. Beckman relates the history of a woman who died suddenly
+in convulsions. The incision was made about five minutes after death,
+and a male child about four pounds in weight was extracted. The child
+exhibited feeble heart-contractions and was despaired of. Happily,
+after numerous and persistent means of resuscitation, applied for about
+two and a half hours, regular respirations were established and the
+child eventually recovered.  Walter reports a successful instance of
+removal of the child after the death of the mother from apoplexy.
+
+Cleveland gives an account of a woman of forty-seven which is of
+special interest. The mother had become impregnated five months after
+the cessation of menstruation, and a uterine sound had been used in
+ignorance of the impregnation at this late period. The mother died, and
+one hour later a living child was extracted by Cesarean section. There
+are two other recent cases recorded of extraction after an hour had
+expired from the death. One is cited by Veronden in which the
+extraction was two hours after death, a living child resulting, and the
+other by Blatner in which one hour had elapsed after death, when the
+child was taken out alive.
+
+Cases of rupture of the uterus during pregnancy from the pressure of
+the contents and delivery of the fetus by some unnatural passage are
+found in profusion through medical literature, and seem to have been of
+special interest to the older observers.  Benivenius saw a case in
+which the uterus ruptured and the intestines protruded from the vulva.
+An instance similar to the one recorded by Benivenius is also found in
+the last century in Germany. Bouillon and Desbois, two French
+physicians of the last century, both record examples of the uterus
+rupturing in the last stages of pregnancy and the mother recovering.
+Schreiber gives an instance of rupture of the uterus occasioned by the
+presence of a 13-pound fetus, and there is recorded the account of a
+rupture caused by a 20-pound fetus that made its way into the abdomen.
+We find old accounts of cases of rupture of the uterus with birth by
+the umbilicus and the recovery of the woman. Vespre describes a case in
+which the uterus was ruptured by the feet of the fetus.
+
+Farquharson has an account of a singular case in midwifery in which
+abdomen ruptured from the pressure of the fetus; and quite recently
+Geoghegan illustrates the possibilities of uterine pressure in
+pregnancy by a postmortem examination after a fatal parturition, in
+which the stomach was found pushed through the diaphragm and lying
+under the left clavicle. Heywood Smith narrates the particulars of a
+case of premature labor at seven months in which rupture of the uterus
+occurred and, notwithstanding the fact that the case was complicated by
+placenta praevia, the patient recovered.
+
+Rupture of the uterus and recovery does not necessarily prevent
+subsequent successful pregnancy and delivery by the natural channels.
+Whinery relates an instance of a ruptured uterus in a healthy Irish
+woman of thirty-seven from whom a dead child was extracted by abdominal
+section and who was safely delivered of a healthy female child about
+one year afterward. Analogous to this case is that of Lawrence, who
+details the instance of a woman who had been delivered five times of
+dead children; she had a very narrow pelvis and labor was always
+induced at the eighth month to assure delivery. In her sixth pregnancy
+she had miscalculated her time, and, in consequence, her uterus
+ruptured in an unexpected parturition, but she recovered and had
+several subsequent pregnancies.
+
+Occasionally there is a spontaneous rupture of the vagina during the
+process of parturition, the uterus remaining intact.  Wiltshire reports
+such a case in a woman who had a most prominent sacrum; the laceration
+was transverse and quite extensive, but the woman made a good recovery.
+Schauta pictures an exostosis on the promontory of the sacrum.
+Blenkinsop cites an instance in which the labor was neither protracted
+nor abnormally severe, yet the rupture of the vagina took place with
+the escape of the child into the abdomen of the mother, and was from
+thence extracted by Cesarean section. A peculiarity of this case was
+the easy expulsion from the uterus, no instrumental or other manual
+interference being attempted and the uterus remaining perfectly intact.
+
+In some cases there is extensive sloughing of the genitals after
+parturition with recovery far beyond expectation. Gooch mentions a case
+in which the whole vagina sloughed, yet to his surprise the patient
+recovered. Aetius and Benivenius speak of recovery in such cases after
+loss of the whole uterus. Cazenave of Bordeaux relates a most marvelous
+case in which a primipara suffered in labor from an impacted head. She
+was twenty-five, of very diminutive stature, and was in labor a long
+time. After labor, sloughing of the parts commenced and progressed to
+such an extent that in one month there were no traces of the labia,
+nymphae, vagina, perineum, or anus. There was simply a large opening
+extending from the meatus urinarius to the coccyx. The rectovaginal
+septum, the lower portion of the rectum, and the neck of the bladder
+were obliterated. The woman survived, although she always experienced
+great difficulty in urination and in entirely emptying the rectum. A
+similar instance is reported in a woman of thirty who was thirty-six
+hours in labor. The fundus of the uterus descended into the vagina and
+the whole uterine apparatus was removed. The lower part of the rectum
+depended between the labia; in the presence of the physician the nurse
+drew this out and it separated at the sphincter ani. On examining the
+parts a single opening was seen, as in the preceding case, from the
+pubes to the coccyx. Some time afterward the end of the intestine
+descended several inches and hung loosely on the concave surface of the
+rectum. A sponge was introduced to support the rectum and prevent
+access of air. The destruction of the parts was so complete and the
+opening so large as to bring into view the whole inner surface of the
+pelvis, in spite of which, after prolonged suppuration, the wound
+cicatrized from behind forward and health returned, except as regards
+the inconvenience of feces and urine. Milk-secretion appeared late and
+lasted two months without influencing the other functions.
+
+There are cases in which, through the ignorance of the midwife or the
+physician, prolapsed pelvic organs are mistaken for afterbirth and
+extracted. There have been instances in which the whole uterus and its
+appendages, not being recognized, have been dragged out. Walters cites
+the instance of a woman of twenty-two, who was in her third
+confinement. The midwife in attendance, finding the afterbirth did not
+come away, pulled at the funis, which broke at its attachment. She then
+introduced her hand and tore away what proved to be the whole of the
+uterus, with the right ovary and fallopian tube, a portion of the round
+ligament, and the left tube and ovarian ligament attached to it. A
+large quantity of omentum protruded from the vulva and upper part of
+the vagina, and an enormous rent was left. Walters saw the woman
+twenty-one hours afterward, and ligated and severed the protruding
+omentum. On the twenty-eighth day, after a marvelous recovery, she was
+able to drive to the Royal Berkshire Hospital, a distance of five
+miles. At the time of report, two years and six months after the
+mutilation, she was in perfect health.  Walters looked into the
+statistics of such cases and found 36 accidental removals of the uterus
+in the puerperium with 14 recoveries. All but three of these were
+without a doubt attended by previous inversion of the uterus.
+
+A medical man was tried for manslaughter in 1878 because he made a
+similar mistake. He had delivered a woman by means of the forceps, and,
+after delivery, brought away what he thought a tumor. This "tumor"
+consisted of the uterus, with the placenta attached to the fundus, the
+funis, a portion of the lateral ligament, containing one ovary and
+about three inches of vagina.  The uterus was not inverted. A horrible
+case, with similar results, happened in France, and was reported by
+Tardieu. A brutal peasant, whose wife was pregnant, dragged out a fetus
+of seven months, together with the uterus and the whole intestinal
+canal, from within 50 cm. of the pylorus to within 8 cm. of the
+ileocecal valve. The woman was seen three-quarters of an hour after the
+intestines had been found in the yard (where the brute had thrown
+them), still alive and reproaching her murderer.  Hoffman cites an
+instance in which a midwife, in her anxiety to extract the afterbirth,
+made traction on the cord, brought out the uterus, ovaries, and tubes,
+and tore the vulva and perineum as far as the anus.
+
+Woodson tells the story of a negress who was four months pregnant, and
+who, on being seized with severe uterine pains in a bath, succeeded in
+seizing the fetus and dragging it out, but inverting the uterus in the
+operation. There is a case recorded of a girl of eighteen, near her
+labor, who, being driven from her house by her father, took refuge in a
+neighboring house, and soon felt the pains of child-birth. The
+accoucheur was summoned, pronounced them false pains, and went away. On
+his return he found the girl dying, with her uterus completely inverted
+and hanging between her legs. This unfortunate maiden had been
+delivered while standing upright, with her elbows on the back of a
+chair. The child suddenly escaped, bringing with it the uterus, but as
+the funis ruptured the child fell to the floor. Wagner pictures partial
+prolapse of the womb in labor.
+
+It would too much extend this chapter to include the many accidents
+incident to labor, and only a few of especial interest will be given.
+Cases like rupture of an aneurysm during labor, extensive hemorrhage,
+the entrance of air into the uterine veins and sinuses, and common
+lacerations will be omitted, together with complicated births like
+those of double monsters, etc., but there are several other cases that
+deserve mention. Eldridge gives an instance of separation of the
+symphysis pubis during labor,--a natural symphysiotomy. A separation of
+3/4 inch could be discerned at the symphysis, and in addition the
+sacroiliac synchondrosis was also quite movable. The woman had not been
+able to walk in the latter part of her pregnancy. The child weighed 10
+1/2 pounds and had a large head in a remarkably advanced stage of
+ossification, with the fontanelles nearly closed. Delivery was
+effected, though during the passage of the head the pubes separated to
+such an extent that Eldridge placed two fingers between them. The
+mother recovered, and had perfect union and normal locomotion.
+
+Sanders reports a case of the separation of the pubic bones in labor.
+Studley mentions a case of fracture of the pelvis during instrumental
+delivery. Humphreys cites a most curious instance.  The patient, it
+appears, had a large exostosis on the body of the pubes which, during
+parturition, was forced through the walls of the uterus and bladder,
+resulting in death. Kilian reports four cases of death from perforation
+of the uterus in this manner.  Schauta pictures such an exostosis.
+
+Chandler relates an instance in which there was laceration of the liver
+during parturition; and Hubbard records a case of rupture of the spleen
+after labor.
+
+Symphysiotomy is an operation consisting of division of the pubic
+symphysis in order to facilitate delivery in narrow pelves. This
+operation has undergone a most remarkable revival during the past two
+years. It originated in a suggestion by Pineau in his work on surgery
+in 1598, and in 1665 was first performed by La Courvee upon a dead body
+in order to save the child, and afterward by Plenk, in 1766, for the
+same purpose. In 1777 Sigault first proposed the operation on the
+living, and Ferrara was the one to carry out, practically, the
+proposition,--although Sigault is generally considered to be the first
+symphysiotormist, and the procedure is very generally known as the
+"Sigaultean operation." From Ferrara's time to 1858, when the operation
+had practically died out, it had been performed 85 times, with a
+recorded mortality of 33 per cent. In 1866 the Italians, under the
+leadership of Morisani of Naples, revived the operation, and in twenty
+years had performed it 70 times with a mortality of 24 per cent. Owing
+to rigid antiseptic technic, the last 38 of these operations (1886 to
+1891) showed a mortality of only 50 per cent, while the
+infant-mortality was only 10 2/3 per cent. The modern history of this
+operation is quite interesting, and is very completely reviewed by
+Hirst and Dorland.
+
+In November, 1893, Hirst reported 212 operations since 1887, with a
+maternal mortality of 12.73 per cent and a fetal mortality of 28 per
+cent. In his later statistics Morisani gives 55 cases with 2 maternal
+deaths and 1 infantile death, while Zweifel reports 14 cases from the
+Leipzig clinic with no maternal death and 2 fetal deaths, 1 from
+asphyxia and 1 from pneumonia, two days after birth. All the modern
+statistics are correspondingly encouraging.
+
+Irwin reports a case in which the firm attachment of the fetal head to
+the uterine parietes rendered delivery without artificial aid
+impossible, and it was necessary to perform craniotomy. The right
+temporal region of the child adhered to the internal surface of the
+neck of the uterus, being connected by membranes.  The woman was
+forty-four years old, and the child was her fourth.
+
+Delay in the Birth of the Second Twin.--In twin pregnancies there is
+sometimes a delay of many days in the birth of a second child, even to
+such an extent as to give suspicion of superfetation.  Pignot speaks of
+one twin two months before the other. De Bosch speaks of a delay of
+seventeen days; and there were 2 cases on record in France in the last
+century, one of which was delayed ten days, and the other showed an
+interval of seven weeks between the delivery of the twins. There is an
+old case on record in which there was an interval of six weeks between
+deliveries; Jansen gives an account of three births in ten months;
+Pinart mentions a case with an interval of ten days; Thilenius, one of
+thirteen days; and Ephemerides, one of one week. Wildberg describes a
+case in which one twin was born two months after the other, and there
+was no secretion of milk until after the second birth. A full
+description of Wildberg's case is given in another journal in brief, as
+follows: A woman, eighteen months married, was in labor in the eighth
+month of pregnancy. She gave birth to a child, which, though not fully
+matured, lived. There was no milk-secretion in her breasts, and she
+could distinctly feel the movements of another child; her abdomen
+increased in size. After two months she had another labor, and a fully
+developed and strong child was born, much heavier than the first. On
+the third day after, the breasts became enlarged, and she experienced
+considerable fever. It was noticeable in this case that a placenta was
+discharged a quarter of an hour after the first birth. Irvine relates
+an instance of thirty-two days' delay; and Pfau one of seven days'.
+
+Carson cites the instance of a noblewoman of forty, the mother of four
+children, who was taken ill about two weeks before confinement was
+expected, and was easily delivered of a male child, which seemed well
+formed, with perfect nails, but weakly.  After the birth the mother
+never became healthy or natural in appearance. She was supposed to be
+dying of dropsy, but after forty-four days the mystery was cleared by
+the birth of a fine, well-grown, and healthy daughter. Both mother and
+child did well.
+
+Addison describes the case of a woman who was delivered of a healthy
+male child, and everything was well until the evening of the fourth
+day, when intense labor-pains set in, and well-formed twins about the
+size of a pigeon's egg were born. In this strange case, possibly an
+example of superfetation, the patient made a good recovery and the
+first child lived. A similar case is reported by Lumby in which a woman
+was delivered on January 18th, by a midwife, of a full-grown and
+healthy female child. On the third day she came down-stairs and resumed
+her ordinary duties, which she continued until February 4th (seventeen
+days after). At this time she was delivered of twins, a boy and a girl,
+healthy and well-developed. The placenta was of the consistency of
+jelly and had to be scooped away with the hand. The mother and children
+did well. This woman was the mother of ten children besides the product
+of this conception, and at the latter occurrence had entire absence of
+pains and a very easy parturition.
+
+Pincott had a case with an interval of seven weeks between the births;
+Vale 1 of two months; Bush 1 of seventeen days; and Burke 1 with an
+interval of two months. Douglas cites an instance of twins being born
+four days apart. Bessems of Antwerp, in 1866, mentions a woman with a
+bicornate uterus who bore two twins at fifty-four days' interval.
+
+
+
+CHAPTER IV.
+
+PROLIFICITY.
+
+General Historic Observations.--Prolificity is a much discussed
+subject, for besides its medical and general interest it is of
+importance in social as well as in political economy. Superfluous
+population was a question that came to consciousness early; Aristotle
+spoke of legislation to prevent the increase of population and the
+physical and mental deterioration of the race,--he believed in a
+population fixed as regards numbers,--and later Lycurgus transformed
+these precepts into a terrible law.  Strabonius reports that the
+inhabitants of Cathea brought their infants at the age of two months
+before a magistrate for inspection. The strong and promising were
+preserved and the weak destroyed. The founders of the Roman Empire
+followed a similar usage. With great indignation Seneca, Ovid, and
+Juvenal reproved this barbarity of the Romans. With the domination of
+Christianity this custom gradually diminished, and Constantine stopped
+it altogether, ordering succor to the people too poor to rear their own
+children. The old Celts were so jealous of their vigor that they placed
+their babes on a shield in the river, and regarded those that the waves
+respected as legitimate and worthy to become members of their clans. In
+many of the Oriental countries, where the population is often very
+excessive and poverty great, the girl babies of the lower classes were
+destroyed. At one time the crocodiles, held sacred in the Nile, were
+given the surplus infants. By destroying the females the breeding
+necessarily diminished, and the number of the weaker and dependent
+classes became less. In other countries persons having children beyond
+their ability to support were privileged to sell them to citizens, who
+contracted to raise them on condition that they became their slaves.
+
+General Law, and the Influence of War.--In the increase of the world's
+population, although circumstances may for the time alter it, a general
+average of prolificity has, in the long run, been maintained. In the
+history of every nation artificial circumstances, such as fashion, war,
+poverty, etc., at some period have temporarily lowered the average of
+prolificity; but a further search finds another period, under opposite
+circumstances, which will more than compensate for it. The effect of a
+long-continued war or wars on generation and prolificity has never been
+given proper consideration. In such times marriages become much less
+frequent; the husbands are separated from their wives for long periods;
+many women are left widows; the females become in excess of the males;
+the excitement of the times overtops the desire for sexual intercourse,
+or, if there is the same desire, the unprolific prostitute furnishes
+the satisfaction; and such facts as these, coupled with many similar
+ones, soon produce an astonishing effect upon the comparative
+birth-rate and death-rate of the country. The resources of a country,
+so far as concerns population, become less as the period of
+peace-disturbance is prolonged. Mayo-Smith quotes von Mayr in the
+following example of the influence of the war of 1870-71 on the
+birth-rate in Bavaria,--the figures for births are thrown back nine
+months, so as to show the time of conception: Before the war under
+normal conception the number of births was about 16,000 per month.
+During the war it sank to about 2000 per month.  Immediately on the
+cessation of hostilities it arose to its former number, while the
+actual return of the troops brought an increase of 2000 per month. The
+maximum was reached in March, 1872, when it was 18,450. The war of 1866
+seems to have passed over Germany without any great influence, the
+birth-rate in 1865 being 39.2; in 1866, 39.4; in 1867, 38.3; in 1868,
+38.4. On the other hand, while the birth-rate in 1870 was 40.1, in 1871
+it was only 35.9; in 1872 it recovered to 41.1, and remained above 41
+down to 1878. Von Mayr believes the war had a depressing influence upon
+the rate apart from the mere absence of the men, as shown in the fact
+that immediately upon the cessation of hostilities it recovered in
+Bavaria, although it was several months before the return of the troops.
+
+Mayo-Smith, in remarking on the influence of war on the marriage-rate,
+says that in 1866 the Prussian rate fell from 18.2 to 15.6, while the
+Austrian rate fell from 15.5 to 13.0. In the war of 1870-71 the
+Prussian rate fell from 17.9 in 1869 to 14.9 in 1870 and 15.9 in 1871;
+but in the two years after peace was made it rose to 20.6 and 20.2, the
+highest rates ever recorded.  In France the rate fell from 16.5 to 12.1
+and 14.4, and then rose to 19.5 and 17.7, the highest rates ever
+recorded in France.
+
+Influence of Rural and Urban Life.--Rural districts are always very
+prolific, and when we hear the wails of writers on "Social Economy,"
+bemoaning the small birth-rates of their large cities, we need have no
+fear for urban extinction, as emigration from the country by many
+ambitious sons and daughters, to avail themselves of the superior
+advantages that the city offers, will not only keep up but to a certain
+point increase the population, until the reaction of overcrowding,
+following the self-regulating law of compensation, starts a return
+emigration.
+
+The effect of climate and race on prolificity, though much spoken of,
+is not so great a factor as supposed. The inhabitants of Great Britain
+are surpassed by none in the point of prolificity; yet their location
+is quite northern. The Swedes have always been noted for their
+fecundity. Olaf Rudbeck says that from 8 to 12 was the usual family
+number, and some ran as high as 25 or 30.  According to Lord Kames, in
+Iceland before the plague (about 1710) families of from 15 to 20 were
+quite common. The old settlers in cold North America were always
+blessed with large families, and Quebec is still noted for its
+prolificity. There is little difference in this respect among nations,
+woman being limited about the same everywhere, and the general average
+of the range of the productive function remaining nearly identical in
+all nations. Of course, exception must be made as to the extremes of
+north or south.
+
+Ancient and Modern Prolificity.--Nor is there much difference between
+ancient and modern times. We read in the writings of Aristotle, Pliny,
+and Albucasis of the wonderful fertility of the women of Egypt, Arabia,
+and other warm countries, from 3 to 6 children often being born at once
+and living to maturity; but from the wonder and surprise shown in the
+narration of these facts, they were doubtless exceptions, of which
+parallels may be found in the present day. The ancient Greek and Roman
+families were no larger than those of to-day, and were smaller in the
+zenith of Roman affluence, and continued small until the period of
+decadence.
+
+Legal Encouragement of Prolificity.--In Quebec Province, Canada,
+according to a Montreal authority, 100 acres of land are allotted to
+the father who has a dozen children by legitimate marriage.  The same
+journal states that, stimulated by the premium offered, families of 20
+or more are not rare, the results of patriotic efforts. In 1895, 1742
+"chefs de famille" made their claim according to the conditions of the
+law, and one, Paul Bellanger, of the River du Loup, claimed 300 acres
+as his premium, based on the fact that he was the father of 36
+children. Another claimant, Monsieur Thioret de Sainte Genevieve, had
+been presented by his wife, a woman not yet thirty years old, with 17
+children. She had triplets twice in the space of five years and twins
+thrice in the mean time. It is a matter of conjecture what the effect
+would be of such a premium in countries with a lowering birth-rate, and
+a French medical journal, quoting the foregoing, regretfully wishes for
+some countrymen at home like their brothers in Quebec.
+
+Old Explanations of Prolificity.--The old explanation of the causation
+of the remarkable exceptions to the rules of prolificity was similar to
+that advanced by Empedocles, who says that the greater the quantity of
+semen, the greater the number of children at birth. Pare, later, uses a
+similar reason to explain the causation of monstrosities, grouping them
+into two classes, those due to deficiency of semen, such as the
+acephalous type, and those due to excess, such as the double monsters.
+Hippocrates, in his work on the "Nature of the Infant," tells us that
+twins are the result of a single coitus, and we are also informed that
+each infant has a chorion; so that both kinds of plural gestation
+(monochorionic and dichorionic) were known to the ancients. In this
+treatise it is further stated that the twins may be male or female, or
+both males or both females; the male is formed when the semen is thick
+and strong.
+
+The greatest number of children at a single birth that it is possible
+for a woman to have has never been definitely determined. Aristotle
+gives it as his opinion that one woman can bring forth no more than 5
+children at a single birth, and discredits reports of multiplicity
+above this number; while Pliny, who is not held to be so trustworthy,
+positively states that there were authentic records of as many as 12 at
+a birth.  Throughout the ages in which superstitious distortion of
+facts and unquestioning credulity was unchecked, all sorts of
+incredible accounts of prolificity are found. Martin Cromerus, a Polish
+historian, quoted by Pare, who has done some good work in statistical
+research on this subject, says a that Margaret, of a noble and ancient
+family near Cracovia, the wife of Count Virboslaus, brought forth 36
+living children on January 20, 1296.
+
+The celebrated case of Countess Margaret, daughter of Florent IV, Earl
+of Holland, and spouse of Count Hermann of Henneberg, was supposed to
+have occurred just before this, on Good Friday, 1278.  She was at this
+time forty-two years of age, and at one birth brought forth 365
+infants, 182 males, 182 females, and 1 hermaphrodite. They were all
+baptized in two large brazen dishes by the Bishop of Treras, the males
+being called John, the females Elizabeth. During the last century the
+basins were still on exhibition in the village church of Losdun, and
+most of the visitors to Hague went out to see them, as they were
+reckoned one of the curiosities of Holland. The affliction was ascribed
+to the curse of a poor woman who, holding twins in her arms, approached
+the Countess for aid. She was not only denied alms, but was insulted by
+being told that her twins were by different fathers, whereupon the poor
+woman prayed God to send the Countess as many children as there were
+days in the year. There is room for much speculation as to what this
+case really was. There is a possibility that it was simply a case of
+hydatidiform or multiple molar pregnancy, elaborated by an exhaustive
+imagination and superstitious awe. As late as 1799 there was a woman of
+a town of Andalusia who was reported to have been delivered of 16 male
+infants, 7 of which were alive two months later.
+
+Mayo-Smith remarks that the proportion of multiple births is not more
+than 1 per cent of the total number of parturitions. The latest
+statistics, by Westergaard, give the following averages to number of
+cases of 100 births in which there were 2 or more at a birth:--
+
+  Sweden,      1.45
+  Germany,     1.24
+  Bavaria,     1.38
+  Denmark,     1.34
+  Holland,     1.30
+  Prussia,     1.26
+  Scotland,    1.22
+  Norway,      1.32
+  Saxony,      1.20
+  Italy,       1.21
+  Austria,     1.17
+  Switzerland, 1.16
+  France,      0.99
+  Belgium,     0.97
+  Spain,       0.85
+
+
+In Prussia, from 1826 to 1880, there were 85 cases of quadruplets and 3
+cases of 5 at a birth.
+
+The most extensive statistics in regard to multiple births are those of
+Veit, who reviews 13,000,000 births in Prussia.  According to his
+deductions, twins occur once in 88 births; triplets, once in 7910; and
+quadruplets, once in 371,126. Recent statistics supplied by the Boards
+of Health of New York and Philadelphia place the frequency of twin
+births in these cities at 1 in every 120 births, while in Bohemia twins
+occur once in about 60 births, a proportion just twice as great. Of
+150,000 twin pregnancies studied by Veit, in one-third both children
+were boys; in slightly less than one-third both were girls; in the
+remaining third both sexes were represented.
+
+Authentic records of 5 and 6 at a birth are extremely rare and
+infinitesimal in proportion. The reputed births in excess of 6 must be
+looked on with suspicion, and, in fact, in the great majority of
+reports are apochryphal.
+
+The examples of multiple births of a single pregnancy will be taken up
+under their respective numbers, several examples of each being given,
+together with the authorities. Many twin and triplet brothers have
+figured prominently in history, and, in fact, they seem especially
+favored. The instance of the Horatii and the Curatii, and their famous
+battle, on which hung the fate of Rome and Alba, is familiar to every
+one, their strength and wisdom being legendary with the Romans.
+
+Twins and triplets, being quite common, will not be considered here,
+although there are 2 cases of interest of the latter that deserve
+citation. Sperling reports 2 instances of triplets; in the first there
+was 1 placenta and chorion, 2 amnions, and the sex was the same; in the
+second case, in which the sexes were different, there were 3 placentas,
+3 chorions, and 3 amnions.  What significance this may have is only a
+matter of conjecture.  Petty describes a case of triplets in which one
+child was born alive, the other 2 having lost their vitality three
+months before. Mirabeau has recently found that triple births are most
+common (1 to 6500) in multiparous women between thirty and thirty-four
+years of age. Heredity seems to be a factor, and duplex uteruses
+predispose to multiple births. Ross reports an instance of double
+uterus with triple pregnancy.
+
+Quadruplets are supposed to occur once in about every 400,000 births.
+There are 72 instances recorded in the Index Catalogue of the Surgeon
+General's Library, U. S. A., up to the time of compilation, not
+including the subsequent cases in the Index Medicus. At the Hotel-Dieu,
+in Paris, in 108,000 births, covering a period of sixty years, mostly
+in the last century, there was only one case of quadruplets. The
+following extract of an account of the birth of quadruplets is given by
+Dr. De Leon of Ingersoll, Texas:--
+
+"I was called to see Mrs. E. T. Page, January 10, 1890, about 4 o'clock
+A.M.; found her in labor and at full time, although she assured me that
+her 'time' was six weeks ahead. At 8 o'clock A.M.  I delivered her of a
+girl baby; I found there were triplets, and so informed her. At 11 A.M.
+I delivered her of the second girl, after having rectified
+presentation, which was singular, face, hands, and feet all presented;
+I placed in proper position and practised 'version.' This child was
+'still-born,' and after considerable effort by artificial respiration
+it breathed and came around 'all right.' The third girl was born at
+11.40 A.M.  This was the smallest one of the four. In attempting to
+take away the placenta, to my astonishment I found the feet of another
+child. At 1 P.M. this one was born; the head of this child got firmly
+impacted at the lower strait, and it was with a great deal of
+difficulty and much patient effort that it was finally disengaged; it
+was blocked by a mass of placenta and cords. The first child had its
+own placenta; the second and third had their placenta; the fourth had
+also a placenta. They weighed at birth in the aggregate 19 1/2 pounds
+without clothing; the first weighed 6 pounds; the second 5 pounds; the
+third 4 1/2 pounds; the fourth 4 pounds. Mrs. Page is a blonde, about
+thirty-six years old, and has given birth to 14 children, twins three
+times before this, one pair by her first husband. She has been married
+to Page three years, and has had 8 children in that time. I have waited
+on her each time. Page is an Englishman, small, with dark hair, age
+about twenty-six, and weighs about 115 pounds. They are in St. Joseph,
+Mo., now, having contracted with Mr. Uffner of New York to travel and
+exhibit themselves in Denver, St. Joseph, Omaha, and Nebraska City,
+then on to Boston, Mass., where they will spend the summer."
+
+There is a report from Canada of the birth of 4 living children at one
+time. The mother, a woman of thirty-eight, of small stature, weighing
+100 pounds, had 4 living children of the ages of twelve, ten, eight,
+and seven years, respectively. She had aborted at the second month, and
+at full term was delivered of 2 males, weighing, respectively, 4 pounds
+9 1/4 ounces and 4 pounds 3 ounces; and of 2 females, weighing 4 pounds
+3 ounces and 3 pounds 13 3/4 ounces, respectively. There was but one
+placenta, and no more exhaustion or hemorrhage than at a single birth.
+The father weighed 169 pounds, was forty-one years old, and was 5 feet
+5 inches tall, healthy and robust. The Journal of St.  Petersburg, a
+newspaper of the highest standard, stated that at the end of July,
+1871, a Jewish woman residing in Courland gave birth to 4 girls, and
+again, in May, 1872, bore 2 boys and a girl; the mother and the 7
+children, born within a period of ten months, were doing well at the
+time of the report. In the village of Iwokina, on May 26, 1854, the
+wife of a peasant bore 4 children at a birth, all surviving. Bousquet
+speaks of a primiparous mother, aged twenty-four, giving birth to 4
+living infants, 3 by the breech and 1 by the vertex, apparently all in
+one bag of membranes. They were nourished by the help of 3 wet-nurses.
+Bedford speaks of 4 children at a birth, averaging 5 pounds each, and
+all nursing the mother.
+
+Quintuplets are quite rare, and the Index Catalogue of the Surgeon
+General's Library, U. S. A., gives only 19 cases, reports of a few of
+which will be given here, together with others not given in the
+Catalogue, and from less scientific though reliable sources. In the
+year 1731 there was one case of quintuplets in Upper Saxony and another
+near Prague, Bohemia. In both of these cases the children were all
+christened and had all lived to maturity. Garthshore speaks of a
+healthy woman, Margaret Waddington, giving birth to 5 girls, 2 of which
+lived; the 2 that lived weighed at birth 8 pounds 12 ounces and 9
+pounds, respectively. He discusses the idea that woman was meant to
+bear more than one child at a birth, using as his argument the
+existence of the double nipple and mamma, to which might be added the
+not infrequent occurrence of polymazia.
+
+In March, 1736, in a dairy cellar in the Strand, London, a poor woman
+gave birth to 3 boys and 9 girls. In the same journal was reported the
+birth at Wells, Somersetshire, in 1739, of 4 boys and a girl, all of
+whom were christened and were healthy. Pare in 1549 gives several
+instances of 5 children at a birth, and Pliny reports that in the
+peninsula of Greece there was a woman who gave birth to quintuplets on
+four different occasions. Petritus, a Greek physician, speaks of the
+birth of quintuplets at the seventh month. Two males and one female
+were born dead, being attached to the same placenta; the others were
+united to a common placenta and lived three days. Chambon mentions an
+instance of 5 at a birth. Not far from Berne, Switzerland, the wife of
+John Gelinger, a preacher in the Lordship of Berne, brought forth
+twins, and within a year after she brought forth quintuplets, 3 sons
+and 2 daughters. There is a similar instance reported in 1827 of a
+woman of twenty-seven who, having been delivered of twins two years
+before, was brought to bed with 5 children, 3 boys and 2 girls. Their
+length was from 15 1/2 to 16 1/2 inches.  Although regularly formed,
+they did not seem to have reached maturity. The mother was much
+exhausted, but recovered. The children appeared old-looking, had
+tremulous voices, and slept continually; during sleep their
+temperatures seemed very low.
+
+Kennedy showed before the Dublin Pathological Society 5 fetuses with
+the involucra, the product of an abortion at the third month. At Naples
+in 1839 Giuseppa Califani gave birth to 5 children; and about the same
+time Paddock reported the birth in Franklin County, Pa., of
+quintuplets. The Lancet relates an account of the birth of quintuplets,
+2 boys and 3 girls, by the wife of a peasant on March 1, 1854. Moffitt
+records the birth at Monticello, Ill., of quintuplets. The woman was
+thirty-five years of age; examination showed a breech presentation; the
+second child was born by a foot-presentation, as was the third, but the
+last was by a head-presentation. The combined weight was something over
+19 pounds, and of the 5, 3 were still-born, and the other 2 died soon
+after birth. The Elgin Courant (Scotland), 1858, speaks of a woman
+named Elspet Gordon, at Rothes, giving birth to 3 males and 2 females.
+Although they were six months' births, the boys all lived until the
+following morning. The girls were still-born. One of the boys had two
+front teeth when born.  Dr. Dawson of Rothes is the obstetrician
+mentioned in this case.
+
+The following recent instance is given with full details to illustrate
+the difficulties attending the births of quintuplets.  Stoker has
+reported the case of a healthy woman, thirty-five years old, 5 feet 1
+inch high, and of slight build, whom he delivered of 5 fetuses in the
+seventh month of pregnancy, none of the children surviving. The
+patient's mother had on two occasions given birth to twins. The woman
+herself had been married for six years and had borne 4 children at full
+term, having no difficulty in labor. When she came under observation
+she computed that she had been pregnant for six months, and had had her
+attention attracted to the unusually large size of her abdomen. She
+complained of fixed pain in the left side of the abdomen on which side
+she thought she was larger. Pains set in with regularity and the labor
+lasted eight and three-quarter hours. After the rupture of the
+membranes the first child presented by the shoulder.  Version was
+readily performed; the child was dead (recently).  Examination after
+the birth of the first child disclosed the existence of more than one
+remaining fetus. The membranes protruded and became tense with each
+contraction. The presentation was a transverse one. In this case also
+there was little difficulty in effecting internal version. The child
+lived a couple of hours. The third fetus was also enclosed in a
+separate sac, which had to be ruptured. The child presented by the
+breech and was delivered naturally, and lived for an hour. In the
+fourth case the membranes had likewise to be ruptured, and alarming
+hemorrhage ensued. Version was at once practised, but the chin became
+locked with that of the remaining fetus. There was some difficulty and
+considerable delay in freeing the children, though the extent of
+locking was not at any time formidable. The child was dead (recently).
+The fifth fetus presented by the head and was delivered naturally. It
+lived for half an hour. The placenta was delivered about five minutes
+after the birth of the last child, and consisted of two portions united
+by a narrow isthmus. One, the smaller, had two cords attached centrally
+and close together; the other, and larger, had two cords attached in a
+similar way and one where it was joined to the isthmus. The organ
+appeared to be perfectly healthy. The cord of the fourth child was so
+short that it had to be ligated in the vagina. The children were all
+females and of about the same size, making a total weight of 8 pounds.
+The mother rallied quickly and got on well.
+
+Trustworthy records of sextuplets are, of course, extremely scarce.
+There are few catalogued at Washington, and but two authentic cases are
+on record in the United States. On December 30, 1831, a woman in Dropin
+was delivered of 6 daughters, all living, and only a little smaller
+than usual in size. The mother was not quite twenty years old, but was
+of strong constitution.  The 6 lived long enough to be baptized, but
+died the evening of their births. There was a case a of sextuplets in
+Italy in 1844.  In Maine, June 27, 1847, a woman was delivered of 6
+children, 2 surviving and, together with the mother, doing well. In
+1885 there was reported the birth of sextuplets in Lorca, Spain, of
+which only one survived. At Dallas, Texas, in 1888, Mrs. George Hirsh
+of Navarro County gave birth to 6 children, the mother and the children
+all doing well. There were 4 boys and 2 girls, and they were all
+perfect, well formed, but rather small.
+
+Valsalli gives an instance which is quoted by the Medical News without
+giving the authority. Valsalli's account, which differs slightly from
+the account in the Medical News, is briefly as follows: While straining
+at stool on the one hundred and fifteenth day of pregnancy the
+membranes ruptured and a foot prolapsed, no pain having been felt
+before the accident. A fetus was delivered by the midwife. Valsalli was
+summoned and found the woman with an enormously distended abdomen,
+within which were felt numerous fetal parts; but no fetal heart-sounds
+or movements were noticed. The cervix was only slightly dilated, and,
+as no pains were felt, it was agreed to wait. On the next day the
+membranes were ruptured and 4 more fetuses were delivered.  Traction on
+the umbilical cord started hemorrhage, to check which the physician
+placed his hand in the uterine cavity. In this most arduous position he
+remained four hours until assistance from Lugano came. Then, in the
+presence of the three visiting physicians, a sixth amniotic sac was
+delivered with its fetus.  The woman had a normal convalescence, and in
+the following year gave birth to healthy, living twins. The News says
+the children all moved vigorously at birth; there were 4 males and 2
+females, and for the 6 there was only one placenta The mother,
+according to the same authority, was thirty-six years of age, and was
+in her second pregnancy.
+
+Multiple Births over Six.--When we pass sextuplets the records of
+multiple births are of the greatest rarity and in modern records there
+are almost none. There are several cases mentioned by the older writers
+whose statements are generally worthy of credence, which, however
+incredible, are of sufficient interest at least to find a place in this
+chapter. Albucasis affirms that he knew of the birth of seven children
+at one time; and d'Alechampius reports that Bonaventura, the slave of
+one Savelli, a gentleman of Siena, gave birth to 7 children, 4 of whom
+were baptized. At the Parish of San Ildefonso, Valladolid, Julianna,
+wife of Benito Quesada, gave birth to 3 children in one day, and during
+the following night to 4 more. Sigebert, in his Chronicles, says that
+the mother of the King of Lombardy had borne 7 children at a birth.
+Borellus says that in 1650 the lady of the then present Lord Darre gave
+birth to eight perfect children at one parturition and that it was the
+unusual event of the country.
+
+Mrs. Timothy Bradlee of Trumbull County, Ohio, in 1872 is reported to
+have given birth to 8 children at one time. They were healthy and
+living, but quite small. The mother was married six years previously
+and then weighed 273 pounds. She had given birth to 2 pairs of twins,
+and, with these 3 boys and 5 girls, she had borne 12 children in six
+years. She herself was a triplet and her father and her mother were of
+twin births and one of her grandmothers was the mother of 5 pairs of
+twins. This case was most celebrated and was much quoted, several
+British journals extracting it.
+
+Watering of Maregnac speaks of the simultaneous birth of 8 children at
+one time. When several months pregnant the woman was seized with
+colicky pains and thought them a call of nature. She went into a
+vineyard to answer it, and there, to her great astonishment, gave birth
+to 8 fetuses. Watering found them enclosed in a sac, and thought they
+probably had died from mutual pressure during growth. The mother made a
+good recovery.
+
+In 1755 Seignette of Dijon reports the simultaneous birth of nine
+children. Franciscus Picus Mirandulae, quoted by Pare, says that one
+Dorothea, an Italian, bore 20 children at 2 confinements, the first
+time bearing 9 and the second time eleven. He gives a picture of this
+marvel of prolificity, in which her belly is represented as hanging
+down to her knees, and supported by a girdle from the neck. In the
+Annals, History, and Guide to Leeds and York, according to Walford,
+there is mention of Ann Birch, who in 1781 was delivered of 10
+children. One daughter, the sole survivor of the 10, married a market
+gardener named Platt, who was well known in Leeds. Jonston quotes
+Baytraff as saying that he knew of a case in which 9 children were born
+simultaneously; and also says that the Countess of Altdorf gave birth
+to twelve at one birth. Albucasis mentions a case of fifteen
+well-formed children at a birth. According to Le Brun, Gilles de
+Trazegines, who accompanied Saint Louis to Palestine, and who was made
+Constable of France, was one of thirteen infants at a simultaneous
+accouchement. The Marquise, his mother, was impregnated by her husband
+before his departure, and during his absence had 13 living children.
+She was suspected by the native people and thought to be an adulteress,
+and some of the children were supposed to be the result of
+superfetation. They condemned them all to be drowned, but the Marquis
+appeared upon the scene about this time and, moved by compassion,
+acknowledged all 13.  They grew up and thrived, and took the name of
+Trazegines, meaning, in the old language, 13 drowned, although many
+commentaries say that "gines" was supposed to mean in the twelfth
+century "nes," or, in full, the interpretation would be "13 born."
+
+Cases in which there is a repetition of multiple births are quite
+numerous, and sometimes so often repeated as to produce a family the
+size of which is almost incredible. Aristotle is credited with saying
+that he knew the history of a woman who had quintuplets four times.
+Pliny's case of quintuplets four times repeated has been mentioned; and
+Pare, who may be believed when he quotes from his own experience, says
+that the wife of the last Lord de Maldemeure, who lived in the Parish
+of Seaux, was a marvel of prolificity. Within a year after her marriage
+she gave birth to twins; in the next year to triplets; in the third
+year to quadruplets; in the fourth year to quintuplets, and in the
+fifth year bore sextuplets; in this last labor she died. The then
+present Lord de Maldemeure, he says, was one of the final sextuplets.
+This case attracted great notice at the time, as the family was quite
+noble and very well known. Seaux, their home, was near Chambellay.
+Picus Mirandulae gathered from the ancient Egyptian inscriptions that
+the women of Egypt brought forth sometimes 8 children at a birth, and
+that one woman bore 30 children in 4 confinements. He also cites, from
+the history of a certain Bishop of Necomus, that a woman named Antonia,
+in the Territory of Mutina, Italy, now called Modena, had brought forth
+40 sons before she was forty years of age, and that she had had 3 and 4
+at a birth. At the auction of the San Donato collection of pictures a
+portrait of Dianora Frescobaldi, by one of the Bronzinos in the
+sixteenth century, sold for about $3000. At the bottom of this portrait
+was an inscription stating that she was the mother of 52 children. This
+remarkable woman never had less than 3 at a birth, and tradition gives
+her as many as 6.
+
+Merriman quotes a case of a woman, a shopkeeper named Blunet, who had
+21 children in 7 successive births. They were all born alive, and 12
+still survived and were healthy. As though to settle the question as to
+whom should be given the credit in this case, the father or the mother,
+the father experimented upon a female servant, who, notwithstanding her
+youth and delicateness, gave birth to 3 male children that lived three
+weeks. According to despatches from Lafayette, Indiana, investigation
+following the murder, on December 22, 1895, of Hester Curtis, an aged
+woman of that city, developed the rather remarkable fact that she had
+been the mother of 25 children, including 7 pairs of twins.
+
+According to a French authority the wife of a medical man at
+Fuentemajor, in Spain, forty-three years of age, was delivered of
+triplets 13 times. Puech read a paper before the French Academy in
+which he reports 1262 twin births in Nimes from 1790 to 1875, and
+states that of the whole number in 48 cases the twins were duplicated,
+and in 2 cases thrice repeated, and in one case 4 times repeated.
+
+Warren gives an instance of a lady, Mrs. M----, thirty-two years of
+age, married at fourteen, who, after the death of her first child, bore
+twins, one living a month and the other six weeks.  Later she again
+bore twins, both of whom died. She then miscarried with triplets, and
+afterward gave birth to 12 living children, as follows: July 24, 1858,
+1 child; June 30, 1859, 2 children; March 24, 1860, 2 children; March
+1, 1861, 3 children; February 13, 1862, 4 children; making a total of
+21 children in eighteen years, with remarkable prolificity in the later
+pregnancies. She was never confined to her bed more than three days,
+and the children were all healthy.
+
+A woman in Schlossberg, Germany, gave birth to twins; after a year, to
+triplets, and again, in another year, to 3 fairly strong boys. In the
+State Papers, Domestic Series, Charles I, according to Walford, appears
+an extract from a letter from George Garrard to Viscount Conway, which
+is as follows: "Sir John Melton, who entertained you at York, hath
+buried his wife, Curran's daughter.  Within twelve months she brought
+him 4 sons and a daughter, 2 sons last summer, and at this birth 2 more
+and a daughter, all alive." Swan mentions a woman who gave birth to 6
+children in seventeen months in 2 triple pregnancies. The first
+terminated prematurely, 2 children dying at once, the other in five
+weeks.  The second was uneventful, the 3 children living at the time of
+the report. Rockwell gives the report of a case of a woman of
+twenty-eight, herself a twin, who gave birth to twins in January, 1879.
+They died after a few weeks, and in March, 1880, she again bore twins,
+one living three and the other nine weeks. On March 12, 1881, she gave
+birth to triplets. The first child, a male, weighed 7 pounds; the
+second, a female, 6 1/4 pounds; the third, a male, 5 1/2 pounds. The
+third child lived twenty days, the other two died of cholera infantum
+at the sixth month, attributable to the bottle-feeding. Banerjee gives
+the history of a case of a woman of thirty being delivered of her
+fourth pair of twins. Her mother was dead, but she had 3 sisters
+living, of one of which she was a twin, and the other 2 were twins. One
+of her sisters had 2 twin terms, 1 child surviving; like her own
+children, all were females. A second sister had a twin term, both
+males, 1 surviving. The other sister aborted female twins after a fall
+in the eighth month of pregnancy. The name of the patient was Mussamat
+Somni, and she was the wife of a respectable Indian carpenter.
+
+There are recorded the most wonderful accounts of prolificity, in
+which, by repeated multiple births, a woman is said to have borne
+children almost beyond belief. A Naples correspondent to a Paris
+Journal gives the following: "About 2 or 3 stations beyond Pompeii, in
+the City of Nocera, lives Maddalena Granata, aged forty-seven, who was
+married at twenty-eight, and has given birth to 52 living and dead
+children, 49 being males. Dr. de Sanctis, of Nocera, states that she
+has had triplets 15 times."
+
+Peasant Kirilow was presented to the Empress of Russia in 1853, at the
+age of seventy years. He had been twice married, and his first wife had
+presented him with 57 children, the fruits of 21 pregnancies. She had
+quadruplets four times, triplets seven times, and twins thrice. By his
+second wife he had 15 children, twins six times, and triplets once.
+This man, accordingly, was the father of 72 children, and, to magnify
+the wonder, all the children were alive at the time of presentation.
+Herman, in some Russian statistics, relates the instance of Fedor
+Vassilet, a peasant of the Moscow Jurisdiction, who in 1872, at the age
+of seventy-five years, was the father of 87 children. He had been twice
+married; his first wife bore him 69 children in 27 accouchements,
+having twins sixteen times, triplets seven times, and quadruplets four
+times, but never a single birth. His second wife bore him 18 children
+in 8 accouchements. In 1872, 83 of the 87 children were living. The
+author says this case is beyond all question, as the Imperial Academy
+of St. Petersburg, as well as the French Academy, have substantial
+proof of it. The family are still living in Russia, and are the object
+of governmental favors. The following fact is interesting from the
+point of exaggeration, if for nothing else: "The New York Medical
+Journal is accredited with publishing the following extract from the
+history of a journey to Saragossa, Barcelona, and Valencia, in the year
+1585, by Philip II of Spain. The book was written by Henrique Cock, who
+accompanied Philip as his private secretary.  On page 248 the following
+statements are to be found: At the age of eleven years, Margarita
+Goncalez, whose father was a Biscayian, and whose mother was French,
+was married to her first husband, who was forty years old. By him she
+had 78 boys and 7 girls. He died thirteen years after the marriage,
+and, after having remained a widow two years, the woman married again.
+By her second husband, Thomas Gchoa, she had 66 boys and 7 girls.
+These children were all born in Valencia, between the fifteenth and
+thirty-fifth year of the mother's age, and at the time when the account
+was written she was thirty-five years old and pregnant again. Of the
+children, 47 by the first husband and 52 by the second were baptized;
+the other births were still or premature. There were 33 confinements in
+all."
+
+Extreme Prolificity by Single Births.--The number of children a woman
+may bring forth is therefore not to be accurately stated; there seems
+to be almost no limit to it, and even when we exclude those cases in
+which remarkable multiplicity at each birth augments the number, there
+are still some almost incredible cases on record. The statistics of the
+St. Pancras Royal Dispensary, 1853, estimated the number of children
+one woman may bear as from 25 to 69. Eisenmenger relates the history of
+a case of a woman in the last century bearing 51 children, and there is
+another case in which a woman bore 44 children, all boys. Atkinson
+speaks of a lady married at sixteen, dying when she was sixty-four, who
+had borne 39 children, all at single births, by one husband, whom she
+survived. The children, 32 daughters and 7 sons, all attained their
+majority. There was a case of a woman in America who in twenty-six
+years gave birth to 22 children, all at single births.  Thoresby in his
+"History of Leeds," 1715, mentions three remarkable cases--one the wife
+of Dr. Phineas Hudson, Chancellor of York, as having died in her
+thirty-ninth year of her twenty-fourth child; another of Mrs. Joseph
+Cooper, as dying of her twenty-sixth child, and, lastly, of Mrs.
+William Greenhill, of a village in Hertford, England, who gave birth to
+39 children during her life. Brand, a writer of great repute, in his
+"History of Newcastle," quoted by Walford, mentions as a well attested
+fact the wife of a Scotch weaver who bore 62 children by one husband,
+all of whom lived to be baptized.
+
+A curious epitaph is to be seen at Conway, Carnarvonshire--
+
+"Here lieth the body of Nicholas Hookes, of Conway, gentleman, who was
+one-and-fortieth child of his father, William Hookes, Esq., by Alice,
+his wife, and the father of 27 children. He died 20th of March, 1637."
+
+On November 21, 1768, Mrs. Shury, the wife of a cooper, in Vine Street,
+Westminster, was delivered of 2 boys, making 26 by the same husband.
+She had previously been confined with twins during the year.
+
+It would be the task of a mathematician to figure the possibilities of
+paternity in a man of extra long life who had married several prolific
+women during his prolonged period of virility. A man by the name of
+Pearsons of Lexton, Nottingham, at the time of the report had been
+married 4 times. By his first 3 wives he had 39 children and by his
+last 14, making a total of 53. He was 6 feet tall and lived to his
+ninety-sixth year. We have already mentioned the two Russian cases in
+which the paternity was 72 and 87 children respectively, and in "Notes
+and Queries," June 21, 1856, there is an account of David Wilson of
+Madison, Ind., who had died a few years previously at the age of one
+hundred and seven. He had been 5 times married and was the father of 47
+children, 35 of whom were living at the time of his death.
+
+On a tomb in Ely, Cambridgeshire, there is an inscription saying that
+Richard Worster, buried there, died on May 11, 1856, the tomb being in
+memory of his 22 sons and 5 daughters.
+
+Artaxerxes was supposed to have had 106 children; Conrad, Duke of
+Moscow, 80; and in the polygamous countries the number seems
+incredible. Herotinus was said to have had 600; and Jonston also quotes
+instances of 225 and even of 650 in the Eastern countries.
+
+Recently there have been published accounts of the alleged experiments
+of Luigi Erba, an Italian gentleman of Perugia, whose results have been
+announced. About forty years of age and being quite wealthy, this
+bizarre philanthropist visited various quarters of the world, securing
+women of different races; having secured a number sufficient for his
+purposes, he retired with them to Polynesia, where he is accredited
+with maintaining a unique establishment with his household of females.
+In 1896, just seven years after the experiment commenced, the reports
+say he is the father of 370 children.
+
+The following is a report from Raleigh, N.C., on July 28, 1893, to the
+New York Evening Post:--
+
+"The fecundity of the negro race has been the subject of much comment
+and discussion. A case has come to light in this State that is one of
+the most remarkable on record. Moses Williams, a negro farmer, lives in
+the eastern section of this State. He is sixty-five years old (as
+nearly as he can make out), but does not appear to be over fifty. He
+has been married twice, and by the two wives has had born to him 45
+children. By the first wife he had 23 children, 20 of whom were girls
+and 3 were boys. By the second wife he had 22 children--20 girls and 2
+boys. He also has about 50 grand-children. The case is well
+authenticated."
+
+We also quote the following, accredited to the "Annals of Hygiene:"--
+
+"Were it not part of the records of the Berks County courts, we could
+hardly credit the history of John Heffner, who was accidentally killed
+some years ago at the age of sixty-nine. He was married first in 1840.
+In eight years his wife bore him 17 children. The first and second
+years of their marriage she gave birth to twins. For four successive
+years afterward she gave birth to triplets. In the seventh year she
+gave birth to one child and died soon afterward. Heffner engaged a
+young woman to look after his large brood of babies, and three months
+later she became the second Mrs. Heffner. She presented her husband
+with 2 children in the first two years of her wedded life. Five years
+later she had added 10 more to the family, having twins 5 times.  Then
+for three years she added but 1 a year. At the time of the death of the
+second wife 12 of the 32 children had died. The 20 that were left did
+not appear to be any obstacle to a young widow with one child
+consenting to become the third wife of the jolly little man, for he was
+known as one of the happiest and most genial of men, although it kept
+him toiling like a slave to keep a score of mouths in bread. The third
+Mrs. Heffner became the mother of 9 children in ten years, and the
+contentment and happiness of the couple were proverbial. One day, in
+the fall of 1885, the father of the 41 children was crossing a railroad
+track and was run down by a locomotive and instantly killed. His widow
+and 24 of the 42 children are still living."
+
+Many Marriages.--In this connection it seems appropriate to mention a
+few examples of multimarriages on record, to give an idea of the
+possibilities of the extent of paternity. St. Jerome mentions a widow
+who married her twenty-second husband, who in his time had taken to
+himself 20 loving spouses. A gentleman living in Bordeaux in 1772 had
+been married 16 times.  DeLongueville, a Frenchman, lived to be one
+hundred and ten years old, and had been joined in matrimony to 10
+wives, his last wife bearing him a son in his one hundred and first
+year.
+
+Possible Descendants.--When we indulge ourselves as to the possible
+number of living descendants one person may have, we soon get
+extraordinary figures. The Madrid Estafette states that a gentleman,
+Senor Lucas Nequeiras Saez, who emigrated to America seventy years
+previously, recently returned to Spain in his own steamer, and brought
+with him his whole family, consisting of 197 persons. He had been
+thrice married, and by his first wife had 11 children at 7 births; by
+his second wife, 19 at 13 births, and by his third wife, 7 at 6 births.
+The youngest of the 37 was thirteen years old and the eldest seventy.
+This latter one had a son aged forty-seven and 16 children besides. He
+had 34 granddaughters, 45 grandsons, 45 great granddaughters, 39 great
+grandsons, all living. Senor Saez himself was ninety-three years old
+and in excellent health.
+
+At Litchfield, Conn., there is said to be the following inscription:--
+
+"Here lies the body of Mrs. Mary, wife of Dr. John Bull, Esq. She died
+November 4, 1778, aetat. ninety, having had 13 children, 101
+grandchildren, 274 great grandchildren, and 22 great-great
+grandchildren, a total of 410; surviving, 336."
+
+In Esher Church there is an inscription, scarcely legible, which
+records the death of the mother of Mrs. Mary Morton on April 18, 1634,
+and saying that she was the wonder of her sex and age, for she lived to
+see nearly 400 issued from her loins.
+
+The following is a communication to "Notes and Queries," March 21,
+1891: "Mrs. Mary Honeywood was daughter and one of the coheiresses of
+Robert Waters, Esq., of Lenham, in Kent. She was born in 1527; married
+in February, 1543, at sixteen years of age, to her only husband, Robert
+Honeywood, Esq., of Charing, in Kent.  She died in the ninety-third
+year of her age, in May, 1620. She had 16 children of her own body, 7
+sons and 9 daughters, of whom one had no issue, 3 died young--the
+youngest was slain at Newport battle, June 20, 1600. Her grandchildren,
+in the second generation, were 114; in the third, 228, and in the
+fourth, 9; so that she could almost say the same as the distich doth of
+one of the Dalburg family of Basil: 'Rise up, daughter and go to thy
+daughter, for thy daughter's daughter hath a daughter.'
+
+"In Markshal Church, in Essex, on Mrs. Honeywood's tomb is the
+following inscription: 'Here lieth the body of Mary Waters, the
+daughter and coheir of Robert Waters, of Lenham, in Kent, wife of
+Robert Honeywood, of Charing, in Kent, her only husband, who had at her
+decease, lawfully descended from her, 367 children, 16 of her own body,
+114 grandchildren, 228 in the third generation, and 9 in the fourth.
+She lived a most pious life and died at Markshal, in the ninety-third
+year of her age and the forty-fourth of her widowhood, May 11, 1620.'
+(From 'Curiosities for the Ingenious,' 1826.)            S. S. R."
+
+Animal prolificity though not finding a place in this work, presents
+some wonderful anomalies.
+
+In illustration we may note the following: In the Illustrated London
+News, May 11, 1895, is a portrait of "Lady Millard," a fine St. Bernard
+bitch, the property of Mr. Thorp of Northwold, with her litter of 21
+puppies, born on February 9, 1896, their sire being a magnificent
+dog--"Young York." There is quoted an incredible account of a cow, the
+property of J. N. Sawyer of Ohio, which gave birth to 56 calves, one of
+which was fully matured and lived, the others being about the size of
+kittens; these died, together with the mother. There was a cow in
+France, in 1871, delivered of 5 calves.
+
+
+
+CHAPTER V.
+
+MAJOR TERATA.
+
+Monstrosities have attracted notice from the earliest time, and many of
+the ancient philosophers made references to them. In mythology we read
+of Centaurs, impossible beings who had the body and extremities of a
+beast; the Cyclops, possessed of one enormous eye; or their parallels
+in Egyptian myths, the men with pectoral eyes,--the creatures "whose
+heads do beneath their shoulders grow;" and the Fauns, those sylvan
+deities whose lower extremities bore resemblance to those of a goat.
+Monsters possessed of two or more heads or double bodies are found in
+the legends and fairy tales of every nation. Hippocrates, his
+precursors, Empedocles and Democritus, and Pliny, Aristotle, and Galen,
+have all described monsters, although in extravagant and ridiculous
+language.
+
+Ballantyne remarks that the occasional occurrence of double monsters
+was a fact known to the Hippocratic school, and is indicated by a
+passage in De morbis muliebribus, in which it is said that labor is
+gravely interfered with when the infant is dead or apoplectic or
+double. There is also a reference to monochorionic twins (which are by
+modern teratologists regarded as monstrosities) in the treatise De
+Superfoetatione, in which it is stated that "a woman, pregnant with
+twins, gives birth to them both at the same time, just as she has
+conceived them; the two infants are in a single chorion."
+
+Ancient Explanations of Monstrosities.--From the time of Galen to the
+sixteenth century many incredible reports of monsters are seen in
+medical literature, but without a semblance of scientific truth. There
+has been little improvement in the mode of explanation of monstrous
+births until the present century, while in the Middle Ages the
+superstitions were more ludicrous and observers more ignorant than
+before the time of Galen. In his able article on the teratologic
+records of Chaldea, Ballantyne makes the following trite statements:
+"Credulity and superstition have never been the peculiar possession of
+the lower types of civilization only, and the special beliefs that have
+gathered round the occurrence of teratologic phenomena have been common
+to the cultured Greek and Roman of the past, the ignorant peasant of
+modern times, and the savage tribes of all ages. Classical writings,
+the literature of the Middle Ages, and the popular beliefs of the
+present day all contain views concerning teratologic subjects which so
+closely resemble those of the Chaldean magi as to be indistinguishable
+from them. Indeed, such works as those of Obsequens, Lycosthenes,
+Licetus, and Ambroise Pare only repeat, but with less accuracy of
+description and with greater freedom of imagination, the beliefs of
+ancient Babylon.  Even at the present time the most impossible cases of
+so-called 'maternal impressions' are widely scattered through medical
+literature; and it is not very long since I received a letter from a
+distinguished member of the profession asking me whether, in my
+opinion, I thought it possible for a woman to give birth to a dog. Of
+course, I do not at all mean to infer that teratology has not made
+immense advances within recent times, nor do I suggest that on such
+subjects the knowledge of the magi can be compared with that of the
+average medical student of the present; but what I wish to emphasize is
+that, in the literature of ancient Babylonia, there are indications of
+an acquaintance with structural defects and malformations of the human
+body which will compare favorably with even the writings of the
+sixteenth century of the Christian era."
+
+Many reasons were given for the existence of monsters, and in the
+Middle Ages these were as faulty as the descriptions themselves.  They
+were interpreted as divinations, and were cited as forebodings and
+examples of wrath, or even as glorifications of the Almighty. The
+semi-human creatures were invented or imagined, and cited as the
+results of bestiality and allied forms of sexual perversion prevalent
+in those times. We find minute descriptions and portraits of these
+impossible results of wicked practices in many of the older medical
+books. According to Pare there was born in 1493, as the result of
+illicit intercourse between a woman and a dog, a creature resembling in
+its upper extremities its mother, while its lower extremities were the
+exact counterpart of its canine father. This particular case was
+believed by Bateman and others to be a precursor to the murders and
+wickedness that followed in the time of Pope Alexander I. Volateranus,
+Cardani, and many others cite instances of this kind. Lycosthenes says
+that in the year 1110, in the bourg of Liege, there was found a
+creature with the head, visage, hands, and feet of a man, and the rest
+of the body like that of a pig. Pare quotes this case and gives an
+illustration. Rhodiginus mentions a shepherd of Cybare by the name of
+Cratain, who had connection with a female goat and impregnated her, so
+that she brought forth a beast with a head resembling that of the
+father, but with the lower extremities of a goat. He says that the
+likeness to the father was so marked that the head-goat of the herd
+recognized it, and accordingly slew the goatherd who had sinned so
+unnaturally.
+
+In the year 1547, at Cracovia, a very strange monster was born, which
+lived three days. It had a head shaped like that of a man; a nose long
+and hooked like an elephant's trunk; the hands and feet looking like
+the web-foot of a goose; and a tail with a hook on it. It was supposed
+to be a male, and was looked upon as a result of sodomy. Rueff says
+that the procreation of human beings and beasts is brought about--
+
+(1) By the natural appetite;
+
+(2) By the provocation of nature by delight;
+
+(3) By the attractive virtue of the matrix, which in beasts and women
+is alike.
+
+Plutarch, in his "Lesser Parallels," says that Aristonymus Ephesius,
+son of Demonstratus, being tired of women, had carnal knowledge with an
+ass, which in the process of time brought forth a very beautiful child,
+who became the maid Onoscelin. He also speaks of the origin of the
+maiden Hippona, or as he calls her, Hippo, as being from the connection
+of a man with a mare.  Aristotle mentions this in his paradoxes, and we
+know that the patron of horses was Hippona. In Helvetia was reported
+the existence of a colt (whose mother had been covered by a bull) that
+was half horse and half bull. One of the kings of France was supposed
+to have been presented with a colt with the hinder part of a hart, and
+which could outrun any horse in the kingdom. Its mother had been
+covered by a hart.
+
+Writing in 1557, Lycosthenes reports the mythical birth of a serpent by
+a woman. It is quite possible that some known and classified type of
+monstrosity was indicated here in vague terms.  In 1726 Mary Toft, of
+Godalming, in Surrey, England, achieved considerable notoriety
+throughout Surrey, and even over all England, by her extensively
+circulated statements that she bore rabbits. Even at so late a day as
+this the credulity of the people was so great that many persons
+believed in her. The woman was closely watched, and being detected in
+her maneuvers confessed her fraud. To show the extent of discussion
+this case called forth, there are no less than nine pamphlets and books
+in the Surgeon-General's library at Washington devoted exclusively to
+this case of pretended rabbit-breeding. Hamilton in 1848, and Hard in
+1884, both report the births in this country of fetal monstrosities
+with heads which showed marked resemblance to those of dogs. Doubtless
+many of the older cases of the supposed results of bestiality, if seen
+to-day, could be readily classified among some of our known forms of
+monsters. Modern investigation has shown us the sterile results of the
+connections between man and beast or between beasts of different
+species, and we can only wonder at the simple credulity and the
+imaginative minds of our ancestors. At one period certain phenomena of
+nature, such as an eclipse or comet, were thought to exercise their
+influence on monstrous births. Rueff mentions that in Sicily there
+happened a great eclipse of the sun, and that women immediately began
+to bring forth deformed and double-headed children.
+
+Before ending these preliminary remarks, there might be mentioned the
+marine monsters, such as mermaids, sea-serpents, and the like, which
+from time to time have been reported; even at the present day there are
+people who devoutly believe that they have seen horrible and impossible
+demons in the sea. Pare describes and pictures a monster, at Rome, on
+November 3, 1520, with the upper portion of a child apparently about
+five or six years old, and the lower part and ears of a fish-like
+animal. He also pictures a sea-devil in the same chapter, together with
+other gruesome examples of the power of imagination.
+
+Early Teratology.--Besides such cases as the foregoing, we find the
+medieval writers report likely instances of terata, as, for instance,
+Rhodiginus, who speaks of a monster in Italy with two heads and two
+bodies; Lycosthenes saw a double monster, both components of which
+slept at the same time; he also says this creature took its food and
+drink simultaneously in its two mouths. Even Saint Augustine says that
+he knew of a child born in the Orient who, from the belly up, was in
+all parts double.
+
+The first evidences of a step toward classification and definite
+reasoning in regard to the causation of monstrosities were evinced by
+Ambroise Pare in the sixteenth century, and though his ideas are crude
+and some of his phenomena impossible, yet many of his facts and
+arguments are worthy of consideration. Pare attributed the cause of
+anomalies of excess to an excessive quantity of semen, and anomalies of
+default to deficiency of the same fluid. He has collected many
+instances of double terata from reliable sources, but has interspersed
+his collection with accounts of some hideous and impossible creatures,
+such as are illustrated in the accompanying figure, which shows a
+creature that was born shortly after a battle of Louis XII, in 1512; it
+had the wings, crest, and lower extremity of a bird and a human head
+and trunk; besides, it was an hermaphrodite, and had an extra eye in
+the knee. Another illustration represents a monstrous head found in an
+egg, said to have been sent for examination to King Charles at Metz in
+1569. It represented the face and visage of a man, with small living
+serpents taking the place of beard and hair. So credulous were people
+at this time that even a man so well informed as Pare believed in the
+possibility of these last two, or at least represented them as facts.
+At this time were also reported double hermaphroditic terata, seemingly
+without latter-day analogues. Rhodiginus speaks of a two-headed monster
+born in Ferrari, Italy, in 1540, well formed, and with two sets of
+genitals, one male and the other female. Pare gives a picture of twins,
+born near Heidelberg in 1486, which had double bodies joined back to
+back; one of the twins had the aspect of a female and the other of a
+male, though both had two sets of genitals.
+
+Scientific Teratology.--About the first half of the eighteenth century
+what might be called the positive period of teratology begins.
+Following the advent of this era come Mery, Duverney, Winslow, Lemery,
+and Littre. In their works true and concise descriptions are given and
+violent attacks are made against the ancient beliefs and prejudices.
+From the beginning of the second half of the last century to the
+present time may be termed the scientific epoch of teratology. We can
+almost with a certainty start this era with the names of Haller,
+Morgagni, Geoffroy-Saint-Hilaire, and Meckel, who adduced the
+explanations asked for by Harvey and Wolff. From the appearance of the
+treatise by Geoffroy-Saint-Hilaire, teratology has made enormous
+strides, and is to-day well on the road to becoming a science.  Hand in
+hand with embryology it has been the subject of much investigation in
+this century, and to enumerate the workers of the present day who have
+helped to bring about scientific progress would be a task of many
+pages. Even in the artificial production of monsters much has been
+done, and a glance at the work of Dareste well repays the trouble.
+Essays on teratogenesis, with reference to batrachians, have been
+offered by Lombardini; and by Lereboullet and Knoch with reference to
+fishes. Foll and Warynski have reported their success in obtaining
+visceral inversion, and even this branch of the subject promises to
+become scientific.
+
+Terata are seen in the lower animals and always excite interest.  Pare
+gives the history of a sheep with three heads, born in 1577; the
+central head was larger than the other two, as shown in the
+accompanying illustration. Many of the Museums of Natural History
+contain evidences of animal terata. At Hallae is a two-headed mouse;
+the Conant Museum in Maine contains the skeleton of an adult sheep with
+two heads; there was an account of a two-headed pigeon published in
+France in 1734; Leidy found a two-headed snake in a field near
+Philadelphia; Geoffroy Saint-Hilaire and Conant both found similar
+creatures, and there is one in the Museum at Harvard; Wyman saw a
+living double-headed snake in the Jardin des Plantes in Paris in 1853,
+and many parallel instances are on record.
+
+Classification.--We shall attempt no scientific discussion of the
+causation or embryologic derivation of the monster, contenting
+ourselves with simple history and description, adding any associate
+facts of interest that may be suggested. For further information, the
+reader is referred to the authors cited or to any of the standard
+treatises on teratology.
+
+Many classifications of terata have been offered, and each possesses
+some advantage. The modern reader is referred to the modification of
+the grouping of Geoffroy-Saint-Hilaire given by Hirst and Piersol, or
+those of Blanc and Guinard. For convenience, we have adopted the
+following classification, which will include only those monsters that
+have LIVED AFTER BIRTH, and who have attracted general notice or
+attained some fame in their time, as attested by accounts in
+contemporary literature.
+
+CLASS 1.--Union of several fetuses.  CLASS 2.--Union of two distinct
+fetuses by a connecting band.  CLASS 3.--Union of two distinct fetuses
+by an osseous junction of the cranial bones.  CLASS 4.--Union of two
+distinct fetuses in which one or more parts are eliminated by the
+junction.  CLASS 5.--Fusion of two fetuses by a bony union of the
+ischii. CLASS 6.--Fusion of two fetuses below the umbilicus into a
+common lower extremity.  CLASS 7.--Bicephalic monsters.  CLASS
+8.--Parasitic monsters.  CLASS 9.--Monsters with a single body and
+double lower extremities.  CLASS 10.--Diphallic terata. CLASS
+11.--Fetus in fetu, and dermoid cysts.  CLASS 12.--Hermaphrodites.
+
+CLASS I.--Triple Monsters.--Haller and Meckel were of the opinion that
+no cases of triple monsters worthy of credence are on record, and since
+their time this has been the popular opinion.  Surely none have ever
+lived. Licetus describes a human monster with two feet and seven heads
+and as many arms. Bartholinus speaks of a three-headed monster who
+after birth gave vent to horrible cries and expired. Borellus speaks of
+a three-headed dog, a veritable Cerberus. Blasius published an essay on
+triple monsters in 1677. Bordenave is quoted as mentioning a human
+monster formed of three fetuses, but his description proves clearly
+that it was only the union of two. Probably the best example of this
+anomaly that we have was described by Galvagni at Cattania in 1834.
+This monster had two necks, on one of which was a single head normal in
+dimensions. On the other neck were two heads, as seen in the
+accompanying illustration.  Geoffroy-Saint-Hilaire mentions several
+cases, and Martin de Pedro publishes a description of a case in Madrid
+in 1879. There are also on record some cases of triple monster by
+inclusion which will be spoken of later. Instances in the lower animals
+have been seen, the three-headed sheep of Pare, already spoken of,
+being one.
+
+CLASS II.--Double Monsters.--A curious mode of junction, probably the
+most interesting, as it admits of longer life in these monstrosities,
+is that of a simple cartilaginous band extending between two absolutely
+distinct and different individuals. The band is generally in the
+sternal region. In 1752 there was described a remarkable monstrosity
+which consisted of conjoined twins, a perfect and an imperfect child,
+connected at their ensiform cartilages by a band 4 inches in
+circumference. The Hindoo sisters, described by Dr. Andrew Berry, lived
+to be seven years old; they stood face to face, with their chests 6 1/2
+inches and their pubes 8 1/2 inches apart. Mitchell describes the
+full-grown female twins, born at Newport, Ky., called the Newport
+twins. The woman who gave birth to them became impregnated, it is said,
+immediately after seeing the famous Siamese twins, and the products of
+this pregnancy took the conformation of those celebrated exhibitionists.
+
+Perhaps the best known of all double monsters were the Siamese twins.
+They were exhibited all over the globe and had the additional benefit
+and advertisement of a much mooted discussion as to the advisability of
+their severance, in which opinions of the leading medical men of all
+nations were advanced. The literature on these famous brothers is
+simply stupendous. The amount of material in the Surgeon General's
+library at Washington would surprise an investigator. A curious volume
+in this library is a book containing clippings, advertisements, and
+divers portraits of the twins. It will be impossible to speak at all
+fully on this subject, but a short history and running review of their
+lives will be given: Eng and Chang were born in Siam about May, 1811.
+Their father was of Chinese extraction and had gone to Siam and there
+married a woman whose father was also a Chinaman.  Hence, for the most
+part, they were of Chinese blood, which probably accounted for their
+dark color and Chinese features.  Their mother was about thirty-five
+years old at the time of their birth and had borne 4 female children
+prior to Chang and Eng. She afterward had twins several times, having
+eventually 14 children in all. She gave no history of special
+significance of the pregnancy, although she averred that the head of
+one and the feet of the other were born at the same time. The twins
+were both feeble at birth, and Eng continued delicate, while Chang
+thrived.  It was only with difficulty that their lives were saved, as
+Chowpahyi, the reigning king, had a superstition that such freaks of
+nature always presaged evil to the country. They were really discovered
+by Robert Hunter, a British merchant at Bangkok, who in 1824 saw them
+boating and stripped to the waist. He prevailed on the parents and King
+Chowpahyi to allow them to go away for exhibition. They were first
+taken out of the country by a certain Captain Coffin. The first
+scientific description of them was given by Professor J. C. Warren, who
+examined them in Boston, at the Harvard University, in 1829. At that
+time Eng was 5 feet 2 inches and Chang 5 feet 1 1/2 inches in height.
+They presented all the characteristics of Chinamen and wore long black
+queues coiled thrice around their heads, as shown by the accompanying
+illustration. After an eight-weeks' tour over the Eastern States they
+went to London, arriving at that port November 20, 1829.  Their tour in
+France was forbidden on the same grounds as the objection to the
+exhibition of Ritta-Christina, namely, the possibility of causing the
+production of monsters by maternal impressions in pregnant women. After
+their European tour they returned to the United States and settled down
+as farmers in North Carolina, adopting the name of Bunker. When
+forty-four years of age they married two sisters, English women,
+twenty-six and twenty-eight years of age, respectively. Domestic
+infelicity soon compelled them to keep the wives at different houses,
+and they alternated weeks in visiting each wife. Chang had six children
+and Eng five, all healthy and strong. In 1869 they made another trip to
+Europe, ostensibly to consult the most celebrated surgeons of Great
+Britain and France on the advisability of being separated. It was
+stated that a feeling of antagonistic hatred after a quarrel prompted
+them to seek "surgical separation," but the real cause was most likely
+to replenish their depleted exchequer by renewed exhibition and
+advertisement.
+
+A most pathetic characteristic of these illustrious brothers was the
+affection and forbearance they showed for each other until shortly
+before their death. They bore each other's trials and petty maladies
+with the greatest sympathy, and in this manner rendered their lives far
+more agreeable than a casual observer would suppose possible. They both
+became Christians and members or attendants of the Baptist Church.
+
+Figure 31 is a representation of the Siamese twins in old age. On each
+side of them is a son. The original photograph is in the Mutter Museum,
+College of Physicians, Philadelphia.
+
+The feasibility of the operation of separating them was discussed by
+many of the leading men of America, and Thompson, Fergusson, Syme, Sir
+J. Y. Simpson, Nelaton, and many others in Europe, with various reports
+and opinions after examination. These opinions can be seen in full in
+nearly any large medical library. At this time they had diseased and
+atheromatous arteries, and Chang, who was quite intemperate, had marked
+spinal curvature, and shortly afterward became hemiplegic. They were
+both partially blind in their two anterior eyes, possibly from looking
+outward and obliquely. The point of junction was about the
+sterno-siphoid angle, a cartilaginous band extending from sternum to
+sternum. In 1869 Simpson measured this band and made the distance on
+the superior aspect from sternum to sternum 4 1/2 inches, though it is
+most likely that during the early period of exhibition it was not over
+3 inches. The illustration shows very well the position of the joining
+band.
+
+The twins died on January 17, 1874, and a committee of surgeons from
+the College of Physicians of Philadelphia, consisting of Doctors
+Andrews, Allen, and Pancoast, went to North Carolina to perform an
+autopsy on the body, and, if possible, to secure it.  They made a long
+and most interesting report on the results of their trip to the
+College. The arteries, as was anticipated, were found to have undergone
+calcareous degeneration. There was an hepatic connection through the
+band, and also some interlacing diaphragmatic fibers therein. There was
+slight vascular intercommunication of the livers and independence of
+the two peritoneal cavities and the intestines. The band itself was
+chiefly a coalescence of the xyphoid cartilages, surrounded by areolar
+tissue and skin.
+
+The "Orissa sisters," or Radica-Doddica, shown in Europe in 1893, were
+similar to the Siamese twins in conformation. They were born in Orissa,
+India, September, 1889, and were the result of the sixth pregnancy, the
+other five being normal. They were healthy girls, four years of age,
+and apparently perfect in every respect, except that, from the ensiform
+cartilage to the umbilicus, they were united by a band 4 inches long
+and 2 inches wide. The children when facing each other could draw their
+chests three or four inches apart, and the band was so flexible that
+they could sit on either side of the body. Up to the date mentioned it
+was not known whether the connecting band contained viscera. A portrait
+of these twins was shown at the World's Fair in Chicago.
+
+In the village of Arasoor, district of Bhavany, there was reported a
+monstrosity in the form of two female children, one 34 inches and the
+other 33 3/4 inches high, connected by the sternum. They were said to
+have had small-pox and to have recovered. They seemed to have had
+individual nervous systems, as when one was pinched the other did not
+feel it, and while one slept the other was awake. There must have been
+some vascular connection, as medicine given to one affected both.
+
+Fig. 36 shows a mode of cartilaginous junction by which each component
+of a double monster may be virtually independent.
+
+Operations on Conjoined Twins.--Swingler speaks of two girls joined at
+the xiphoid cartilage and the umbilicus, the band of union being 1 1/2
+inches thick, and running below the middle of it was the umbilical
+cord, common to both. They first ligated the cord, which fell off in
+nine days, and then separated the twins with the bistoury. They each
+made early recovery and lived.
+
+In the Ephemerides of 1690 Konig gives a description of two Swiss
+sisters born in 1689 and united belly to belly, who were separated by
+means of a ligature and the operation afterward completed by an
+instrument. The constricting band was formed by a coalition of the
+xiphoid cartilages and the umbilical vessels, surrounded by areolar
+tissue and covered with skin. Le Beau says that under the Roman reign,
+A. D. 945, two male children were brought from Armenia to
+Constantinople for exhibition. They were well formed in every respect
+and united by their abdomens. After they had been for some time an
+object of great curiosity, they were removed by governmental order,
+being considered a presage of evil. They returned, however, at the
+commencement of the reign of Constantine VII, when one of them took
+sick and died. The surgeons undertook to preserve the other by
+separating him from the corpse of his brother, but he died on the third
+day after the operation.
+
+In 1866 Boehm gives an account of Guzenhausen's case of twins who were
+united sternum to sternum. An operation for separation was performed
+without accident, but one of the children, already very feeble, died
+three days after; the other survived. The last attempt at an operation
+like this was in 1881, when Biaudet and Buginon attempted to separate
+conjoined sisters (Marie-Adele) born in Switzerland on June 26th.
+Unhappily, they were very feeble and life was despaired of when the
+operation was performed, on October 29th. Adele died six hours
+afterward, and Marie died of peritonitis on the next day.
+
+CLASS III.--Those monsters joined by a fusion of some of the cranial
+bones are sometimes called craniopagi. A very ancient observation of
+this kind is cited by Geoffroy-Saint-Hilaire.  These two girls were
+born in 1495, and lived to be ten years old.  They were normal in every
+respect, except that they were joined at the forehead, causing them to
+stand face to face and belly to belly. When one walked forward, the
+other was compelled to walk backward; their noses almost touched, and
+their eyes were directed laterally. At the death of one an attempt to
+separate the other from the cadaver was made, but it was unsuccessful,
+the second soon dying; the operation necessitated opening the cranium
+and parting the meninges. Bateman said that in 1501 there was living an
+instance of double female twins, joined at the forehead. This case was
+said to have been caused in the following manner: Two women, one of
+whom was pregnant with the twins at the time, were engaged in an
+earnest conversation, when a third, coming up behind them, knocked
+their heads together with a sharp blow. Bateman describes the death of
+one of the twins and its excision from the other, who died
+subsequently, evidently of septic infection. There is a possibility
+that this is merely a duplication of the account of the preceding case
+with a slight anachronism as to the time of death.
+
+At a foundling hospital in St. Petersburg there were born two living
+girls, in good health, joined by the heads. They were so united that
+the nose of one, if prolonged, would strike the ear of the other; they
+had perfectly independent existences, but their vascular systems had
+evident connection.
+
+Through extra mobility of their necks they could really lie in a
+straight line, one sleeping on the side and the other on the back.
+There is a report a of two girls joined at their vertices, who survived
+their birth. With the exception of this junction they were well formed
+and independent in existence. There was no communication of the cranial
+cavities, but simply fusion of the cranial bones covered by superficial
+fascia and skin. Daubenton has seen a case of union at the occiput, but
+further details are not quoted.
+
+CLASS IV.--The next class to be considered is that in which the
+individuals are separate and well formed, except that the point of
+fusion is a common part, eliminating their individual components in
+this location. The pygopagous twins belong in this section. According
+to Bateman, twins were born in 1493 at Rome joined back to back, and
+survived their birth. The same authority speaks of a female child who
+was born with "2 bellies, 4 arms, 4 legs, 2 heads, and 2 sets of
+privates, and was exhibited throughout Italy for gain's sake." The
+"Biddenden Maids" were born in Biddenden, Kent, in 1100. Their names
+were Mary and Eliza Chulkhurst, and their parents were fairly
+well-to-do people. They were supposed to have been united at the hips
+and the shoulders, and lived until 1134. At the death of one it was
+proposed to separate them, but the remaining sister refused, saying,
+"As we came together, we will also go together," and, after about six
+hours of this Mezentian existence, they died. They bequeathed to the
+church-wardens of the parish and their successors land to the extent of
+20 acres, at the present time bringing a rental of about $155.00
+annually, with the instructions that the money was to be spent in the
+distribution of cakes (bearing the impression of their images, to be
+given away on each Easter Sunday to all strangers in Biddenden) and
+also 270 quartern loaves, with cheese in proportion, to all the poor in
+said parish. Ballantyne has accompanied his description of these
+sisters by illustrations, one of which shows the cake. Heaton gives a
+very good description of these maids; and a writer in "Notes and
+Queries" of March 27, 1875, gives the following information relative to
+the bequest:--
+
+"On Easter Monday, at Biddenden, near Staplehurst, Kent, there is a
+distribution, according to ancient custom, of 'Biddenden Maids' cakes,'
+with bread and cheese, the cost of which is defrayed from the proceeds
+of some 20 acres of land, now yielding L35 per annum. and known as the
+'Bread and Cheese Lands.' About the year 1100 there lived Eliza and
+Mary Chulkhurst, who were joined together after the manner of the
+Siamese twins, and who lived for thirty-four years, one dying, and then
+being followed by her sister within six hours. They left by their will
+the lands above alluded to and their memory is perpetuated by
+imprinting on the cakes their effigies 'in their habit as they lived.'
+The cakes, which are simple flour and water, are four inches long by
+two inches wide, and are much sought after as curiosities. These, which
+are given away, are distributed at the discretion of the
+church-wardens, and are nearly 300 in number. The bread and cheese
+amounts to 540 quartern loaves and 470 pounds of cheese.  The
+distribution is made on land belonging to the charity, known as the Old
+Poorhouse. Formerly it used to take place in the Church, immediately
+after the service in the afternoon, but in consequence of the unseemly
+disturbance which used to ensue the practice was discontinued. The
+Church used to be filled with a congregation whose conduct was
+occasionally so reprehensible that sometimes the church-wardens had to
+use their wands for other purposes than symbols of office. The
+impressions of the maids 'on the cakes are of a primitive character,
+and are made by boxwood dies cut in 1814. They bear the date 1100, when
+Eliza and Mary Chulkhurst are supposed to have been born, and also
+their age at death, thirty-four years."
+
+Ballantyne has summed up about all there is to be said on this national
+monstrosity, and his discussion of the case from its historic as well
+as teratologic standpoint is so excellent that his conclusions will be
+quoted--
+
+"It may be urged that the date fixed for the birth of the Biddenden
+Maids is so remote as to throw grave doubt upon the reality of the
+occurrence. The year 1100 was, it will be remembered, that in which
+William Rufus was found dead in the New Forest, 'with the arrow either
+of a hunter or an assassin in his breast.' According to the Anglo-Saxon
+Chronicle, several 'prodigies' preceded the death of this profligate
+and extravagant monarch. Thus it is recorded that 'at Pentecost blood
+was observed gushing from the earth at a certain town of Berkshire,
+even as many asserted who declared that they had seen it. And after
+this, on the morning after Lammas Day, King William was shot.' Now, it
+is just possible that the birth of the Biddenden Maids may have
+occurred later, but have been antedated by the popular tradition to the
+year above mentioned. For such a birth would, in the opinion of the
+times, be regarded undoubtedly as a most evident prodigy or omen of
+evil. Still, even admitting that the date 1100 must be allowed to
+stand, its remoteness from the present time is not a convincing
+argument against a belief in the real occurrence of the phenomenon; for
+of the dicephalic Scottish brothers, who lived in 1490, we have
+credible historic evidence.  Further, Lycosthenes, in his "Chronicon
+Prodigiorum atque Ostentorum", published in 1557, states, upon what
+authority I know not, that in the year 1112 joined twins resembling the
+Biddenden phenomenon in all points save in sex were born in England.
+The passage is as follows: 'In Anglia natus est puer geminus a clune ad
+superiores partes ita divisus, ut duo haberet capita, duo corpora
+integra ad renes cum suis brachiis, qui baptizatus triduo supervixit.'
+It is just possible that in some way or other this case has been
+confounded with the story of Biddenden; at any rate, the occurrence of
+such a statement in Lycosthenes' work is of more than passing interest.
+Had there been no bequest of land in connection with the case of the
+Kentish Maids, the whole affair would probably soon have been forgotten.
+
+"There is, however, one real difficulty in accepting the story handed
+down to us as authentic,--the nature of the teratologic phenomenon
+itself. All the records agree in stating that the Maids were joined
+together at the shoulders and hips, and the impression on the cakes and
+the pictures on the 'broadsides' show this peculiar mode of union, and
+represent the bodies as quite separate in the space between the
+above-named points. The Maids are shown with four feet and two arms,
+the right and left respectively, whilst the other arms (left and right)
+are fused together at the shoulder according to one illustration, and a
+little above the elbow according to another. Now, although it is not
+safe to say that such an anomaly is impossible, I do not know of any
+case of this peculiar mode of union; but it may be that, as Prof. A. R.
+Simpson has suggested, the Maids had four separate arms, and were in
+the habit of going about with their contiguous arms round each other's
+necks, and that this gave rise to the notion that these limbs were
+united. If this be so, then the teratologic difficulty is removed, for
+the case becomes perfectly comparable with the well-known but rare type
+of double terata known as the pygopagous twins, which is placed by
+Taruffi with that of the ischiopagous twins in the group dicephalus
+lecanopagus. Similar instances, which are well known to students of
+teratology, are the Hungarian sisters (Helen and Judith), the North
+Carolina twins (Millie and Christine), and the Bohemian twins (Rosalie
+and Josepha Blazek). The interspace between the thoraces may, however,
+have simply been the addition of the first artist who portrayed the
+Maids (from imagination?); then it may be surmised that they were
+ectopagous twins.
+
+"Pygopagous twins are fetuses united together in the region of the
+nates and having each its own pelvis. In the recorded cases the union
+has been usually between the sacra and coccyges, and has been either
+osseous or (more rarely) ligamentous. Sometimes the point of junction
+was the middle line posteriorly, at other times it was rather a
+posterolateral union; and it is probable that in the Biddenden Maids it
+was of the latter kind; and it is likely, from the proposal made to
+separate the sisters after the death of one, that it was ligamentous in
+nature.
+
+"If it be granted that the Biddenden Maids were pygopagous twins, a
+study of the histories of other recorded cases of this monstrosity
+serves to demonstrate many common characters. Thus, of the 8 cases
+which Taruffi has collected, in 7 the twins were female; and if to
+these we add the sisters Rosalie and Josepha Blazek and the Maids, we
+have 10 cases, of which 9 were girls.  Again, several of the pygopagous
+twins, of whom there are scientific records, survived birth and lived
+for a number of years, and thus resembled the Biddenden terata. Helen
+and Judith, for instance, were twenty-three years old at death; and the
+North Carolina twins, although born in 1851, are still alive. There is,
+therefore, nothing inherently improbable in the statement that the
+Biddenden Maids lived for thirty-four years. With regard also to the
+truth of the record that the one Maid survived her sister for six
+hours, there is confirmatory evidence from scientifically observed
+instances, for Joly and Peyrat (Bull. de l'Acad. Med., iii., pp. 51 and
+383, 1874) state that in the case seen by them the one infant lived ten
+hours after the death of the other. It is impossible to make any
+statement with regard to the internal structure of the Maids or to the
+characters of their genital organs, for there is absolutely no
+information forthcoming upon these points. It may simply be said, in
+conclusion, that the phenomenon of Biddenden is interesting not only on
+account of the curious bequest which arose out of it, but also because
+it was an instance of a very rare teratologic type, occurring at a very
+early period in our national history."
+
+Possibly the most famous example of twins of this type were Helen and
+Judith, the Hungarian sisters, born in 1701 at Szony, in Hungary. They
+were the objects of great curiosity, and were shown successively in
+Holland, Germany, Italy, France, England, and Poland. At the age of
+nine they were placed in a convent, where they died almost
+simultaneously in their twenty-second year.  During their travels all
+over Europe they were examined by many prominent physiologists,
+psychologists, and naturalists; Pope and several minor poets have
+celebrated their existence in verse; Buffon speaks of them in his
+"Natural History," and all the works on teratology for a century or
+more have mentioned them. A description of them can be best given by a
+quaint translation by Fisher of the Latin lines composed by a Hungarian
+physician and inscribed on a bronze statuette of them:--
+
+Two sisters wonderful to behold, who have thus grown as one, That
+naught their bodies can divide, no power beneath the sun.  The town of
+Szoenii gave them birth, hard by far-famed Komorn, Which noble fort may
+all the arts of Turkish sultans scorn.  Lucina, woman's gentle friend,
+did Helen first receive; And Judith, when three hours had passed, her
+mother's womb did leave.  One urine passage serves for both;--one anus,
+so they tell; The other parts their numbers keep, and serve their
+owners well.  Their parents poor did send them forth, the world to
+travel through, That this great wonder of the age should not be hid
+from view.  The inner parts concealed do lie hid from our eyes, alas!
+But all the body here you view erect in solid brass.
+
+
+They were joined back to back in the lumbar region, and had all their
+parts separate except the anus between the right thigh of Helen and the
+left of Judith and a single vulva. Helen was the larger, better
+looking, the more active, and the more intelligent. Judith at the age
+of six became hemiplegic, and afterward was rather delicate and
+depressed. They menstruated at sixteen and continued with regularity,
+although one began before the other. They had a mutual affection, and
+did all in their power to alleviate the circumstances of their sad
+position.  Judith died of cerebral and pulmonary affections, and Helen,
+who previously enjoyed good health, soon after her sister's first
+indisposition suddenly sank into a state of collapse, although
+preserving her mental faculties, and expired almost immediately after
+her sister. They had measles and small-pox simultaneously, but were
+affected in different degree by the maladies. The emotions,
+inclinations, and appetites were not simultaneous.  Eccardus, in a very
+interesting paper, discusses the physical, moral, and religious
+questions in reference to these wonderful sisters, such as the
+advisability of separation, the admissibility of matrimony, and,
+finally, whether on the last day they would rise as joined in life, or
+separated.
+
+There is an account of two united females, similar in conjunction to
+the "Hungarian sisters," who were born in Italy in 1700. They were
+killed at the age of four months by an attempt of a surgeon to separate
+them.
+
+In 1856 there was reported to have been born in Texas, twins after the
+manner of Helen and Judith, united back to back, who lived and attained
+some age. They were said to have been of different natures and
+dispositions, and inclined to quarrel very often.
+
+Pancoast gives an extensive report of Millie-Christine, who had been
+extensively exhibited in Europe and the United States. They were born
+of slave parents in Columbus County, N.C., July 11, 1851; the mother,
+who had borne 8 children before, was a stout negress of thirty-two,
+with a large pelvis. The presentation was first by the stomach and
+afterward by the breech. These twins were united at the sacra by a
+cartilaginous or possibly osseous union. They were exhibited in Paris
+in 1873, and provoked as much discussion there as in the United States.
+Physically, Millie was the weaker, but had the stronger will and the
+dominating spirit.  They menstruated regularly from the age of
+thirteen. One from long habit yielded instinctively to the other's
+movements, thus preserving the necessary harmony. They ate separately,
+had distinct thoughts, and carried on distinct conversations at the
+same time. They experienced hunger and thirst generally simultaneously,
+and defecated and urinated nearly at the same times. One, in tranquil
+sleep, would be wakened by a call of nature of the other. Common
+sensibility was experienced near the location of union. They were
+intelligent and agreeable and of pleasant appearance, although slightly
+under size; they sang duets with pleasant voices and accompanied
+themselves with a guitar; they walked, ran, and danced with apparent
+ease and grace. Christine could bend over and lift Millie up by the
+bond of union.
+
+A recent example of the pygopagus type was Rosa-Josepha Blazek, born in
+Skerychov, in Bohemia, January 20, 1878. These twins had a broad bony
+union in the lower part of the lumbar region, the pelvis being
+obviously completely fused. They had a common urethral and anal
+aperture, but a double vaginal orifice, with a very apparent septum.
+The sensation was distinct in each, except where the pelves joined.
+They were exhibited in Paris in 1891, being then on an exhibition tour
+around the world. Rosa was the stronger, and when she walked or ran
+forward she drew her sister with her, who must naturally have reversed
+her steps. They had independent thoughts and separate minds; one could
+sleep while the other was awake. Many of their appetites were
+different, one preferring beer, the other wine; one relished salad, the
+other detested it, etc. Thirst and hunger were not simultaneous.
+Baudoin describes their anatomic construction, their mode of life, and
+their mannerisms and tastes in a quite recent article.  Fig. 42 is a
+reproduction of an early photograph of the twins, and Fig. 43
+represents a recent photograph of these "Bohemian twins," as they are
+now called.
+
+The latest record we have of this type of monstrosity is that given by
+Tynberg to the County Medical Society of New York, May 27, 1895. The
+mother was present with the remarkable twins in her arms, crying at the
+top of their voices. These two children were born at midnight on April
+15th. Tynberg remarked that he believed them to be distinct and
+separate children, and not dependent on a common arterial system; he
+also expressed his intention of separating them, but did not believe
+the operation could be performed with safety before another year.
+Jacobi describes in full Tynberg's instance of pygopagus. He says the
+confinement was easy; the head of one was born first, soon followed by
+the feet and the rest of the twins. The placenta was single and the
+cord consisted of two branches. The twins were united below the third
+sacral vertebrae in such a manner that they could lie alongside of each
+other. They were females, and had two vaginae, two urethrae four labia
+minora, and two labia majora, one anus, but a double rectum divided by
+a septum. They micturated independently but defecated simultaneously.
+They virtually lived separate lives, as one might be asleep while the
+other cried, etc.
+
+CLASS V.--While instances of ischiopagi are quite numerous, few have
+attained any age, and, necessarily, little notoriety. Pare speaks of
+twins united at the pelves, who were born in Paris July 20, 1570. They
+were baptized, and named Louis and Louise. Their parents were well
+known in the rue des Gravelliers. According to Bateman, and also Rueff,
+in the year 1552 there were born, not far from Oxford, female twins,
+who, from the description given, were doubtless of the ischiopagus
+type. They seldom wept, and one was of a cheerful disposition, while
+the other was heavy and drowsy, sleeping continually. They only lived a
+short time, one expiring a day before the other. Licetus speaks of Mrs.
+John Waterman, a resident of Fishertown, near Salisbury, England, who
+gave birth to a double female monster on October 26, 1664, which
+evidently from the description was joined by the ischii. It did not
+nurse, but took food by both the mouths; all its actions were done in
+concert; it was possessed of one set of genitourinary organs; it only
+lived a short while. Many people in the region flocked to see the
+wonderful child, whom Licetus called "Monstrum Anglicum." It is said
+that at the same accouchement the birth of this monster was followed by
+the birth of a well-formed female child, who survived.
+Geoffroy-Saint-Hilaire quotes a description of twins who were born in
+France on October 7, 1838, symmetrically formed and united at their
+ischii. One was christened Marie-Louise, and the other
+Hortense-Honorine. Their avaricious parents took the children to Paris
+for exhibition, the exposures of which soon sacrificed their lives. In
+the year 1841 there was born in the island of Ceylon, of native
+parents, a monstrous child that was soon brought to Columbo, where it
+lived only two months. It had two heads and seemed to have duplication
+in all its parts except the anus and male generative organs.
+Montgomery speaks of a double child born in County Roscommon, Ireland,
+on the 24th of July, 1827. It had two heads, two chests with arms
+complete, two abdominal and pelvic cavities united end to end, and four
+legs, placed two on either side. It had only one anus, which was
+situated between the thighs. One of the twins was dark haired and was
+baptized Mary, while the other was a blonde and was named Catherine.
+These twins felt and acted independently of each other; they each in
+succession sucked from the breast or took milk from the spoon, and used
+their limbs vigorously. One vomited without affecting the other, but
+the feces were discharged through a common opening.
+
+Goodell speaks of Minna and Minnie Finley, who were born in Ohio and
+examined by him. They were fused together in a common longitudinal
+axis, having one pelvis, two heads, four legs, and four arms. One was
+weak and puny and the other robust and active; it is probable that they
+had but one rectum and one bladder.  Goodell accompanies his
+description by the mention of several analogous cases. Ellis speaks of
+female twins, born in Millville, Tenn., and exhibited in New York in
+1868, who were joined at the pelves in a longitudinal axis. Between the
+limbs on either side were to be seen well-developed female genitals,
+and the sisters had been known to urinate from both sides, beginning
+and ending at the same time.
+
+Huff details a description of the "Jones twins," born on June 24, 1889,
+in Tipton County, Indiana, whose spinal columns were in apposition at
+the lower end. The labor, of less than two hours' duration, was
+completed before the arrival of the physician.  Lying on their mother's
+back, they could both nurse at the same time. Both sets of genitals and
+ani were on the same side of the line of union, but occupied normal
+positions with reference to the legs on either side. Their weight at
+birth was 12 pounds and their length 22 inches. Their mother was a
+medium-sized brunette of 19, and had one previous child then living at
+the age of two; their father was a finely formed man 5 feet 10 inches
+in height.  The twins differed in complexion and color of the eyes and
+hair.  They were publicly exhibited for some time, and died February 19
+and 20, 1891, at St. John's Hotel, Buffalo, N.Y. Figure 45 shows their
+appearance several months after birth.
+
+CLASS VI.--In our sixth class, the first record we have is from the
+Commentaries of Sigbert, which contains a description of a monstrosity
+born in the reign of the Emperor Theodosius, who had two heads, two
+chests with four arms attached, but a single lower extremity. The
+emotions, affections, and appetites were different. One head might be
+crying while the other laughed, or one feeding while the other was
+sleeping. At times they quarreled and occasionally came to blows. This
+monster is said to have lived two years, one part dying four days
+before the other, which evinced symptoms of decay like its inseparable
+neighbor.
+
+Roger of Wendover says that in Lesser Brittany and Normandy, in 1062,
+there was seen a female monster, consisting of two women joined about
+the umbilicus and fused into a single lower extremity. They took their
+food by two mouths but expelled it at a single orifice. At one time,
+one of the women laughed, feasted, and talked, while the other wept,
+fasted, and kept a religious silence. The account relates how one of
+them died, and the survivor bore her dead sister about for three years
+before she was overcome by the oppression and stench of the cadaver.
+Batemen describes the birth of a boy in 1529, who had two heads, four
+ears, four arms, but only two thighs and two legs. Buchanan speaks at
+length of the famous "Scottish Brothers," who were the cynosure of the
+eyes of the Court of James III of Scotland. This monster consisted of
+two men, ordinary in appearance in the superior extremities, whose
+trunks fused into a single lower extremity. The King took diligent care
+of their education, and they became proficient in music, languages, and
+other court accomplishments. Between them they would carry on animated
+conversations, sometimes merging into curious debates, followed by
+blows. Above the point of union they had no synchronous sensations,
+while below, sensation was common to both. This monster lived
+twenty-eight years, surviving the royal patron, who died June, 1488.
+One of the brothers died some days before the other, and the survivor,
+after carrying about his dead brother, succumbed to "infection from
+putrescence." There was reported to have been born in Switzerland a
+double headed male monster, who in 1538, at the age of thirty, was
+possessed of a beard on each face, the two bodies fused at the
+umbilicus into a single lower extremity. These two twins resembled one
+another in contour and countenance. They were so joined that at rest
+they looked upon one another. They had a single wife, with whom they
+were said to have lived in harmony. In the Gentleman's Magazine about
+one hundred and fifty years since there was given the portrait and
+description of a double woman, who was exhibited all over the large
+cities of Europe. Little can be ascertained anatomically of her
+construction, with the exception that it was stated that she had two
+heads, two necks, four arms, two legs, one pelvis, and one set of
+pelvic organs.
+
+The most celebrated monster of this type was Ritta-Christina, who was
+born in Sassari, in Sardinia, March 23, 1829. These twins were the
+result of the ninth confinement of their mother, a woman of thirty-two.
+Their superior extremities were double, but they joined in a common
+trunk at a point a little below the mammae.  Below this point they had
+a common trunk and single lower extremities. The right one, christened
+Ritta, was feeble and of a sad and melancholy countenance; the left,
+Christina, was vigorous and of a gay and happy aspect. They suckled at
+different times, and sensations in the upper extremities were distinct.
+They expelled urine and feces simultaneously, and had the indications
+in common. Their parents, who were very poor, brought them to Paris for
+the purpose of public exhibition, which at first was accomplished
+clandestinely, but finally interdicted by the public authorities, who
+feared that it would open a door for psychologic discussion and
+speculation. This failure of the parents to secure public patronage
+increased their poverty and hastened the death of the children by
+unavoidable exposure in a cold room. The nervous system of the twins
+had little in common except in the line of union, the anus, and the
+sexual organs, and Christina was in good health all through Ritta's
+sickness; when Ritta died, her sister, who was suckling at the mother's
+breast, suddenly relaxed hold and expired with a sigh. At the
+postmortem, which was secured with some difficulty on account of the
+authorities ordering the bodies to be burned, the pericardium was found
+single, covering both hearts. The digestive organs were double and
+separate as far as the lower third of the ilium, and the cecum was on
+the left side and single, in common with the lower bowel. The livers
+were fused and the uterus was double. The vertebral columns, which were
+entirely separate above, were joined below by a rudimentary os
+innorminatum. There was a junction between the manubrium of each. Sir
+Astley Cooper saw a monster in Paris in 1792 which, by his description,
+must have been very similar to Ritta-Christina.
+
+The Tocci brothers were born in 1877 in the province of Turin, Italy.
+They each had a well-formed head, perfect arms, and a perfect thorax to
+the sixth rib; they had a common abdomen, a single anus, two legs, two
+sacra, two vertebral columns, one penis, but three buttocks, the
+central one containing a rudimentary anus. The right boy was christened
+Giovanni-Batista, and the left Giacomo. Each individual had power over
+the corresponding leg on his side, but not over the other one.  Walking
+was therefore impossible. All their sensations and emotions were
+distinctly individual and independent. At the time of the report, in
+1882, they were in good health and showed every indication of attaining
+adult age. Figure 48 represents these twins as they were exhibited
+several years ago in Germany.
+
+McCallum saw two female children in Montreal in 1878 named Marie-Rosa
+Drouin. They formed a right angle with their single trunk, which
+commenced at the lower part of the thorax of each.  They had a single
+genital fissure and the external organs of generation of a female. A
+little over three inches from the anus was a rudimentary limb with a
+movable articulation; it measured five inches in length and tapered to
+a fine point, being furnished with a distinct nail, and it contracted
+strongly to irritation. Marie, the left child, was of fair complexion
+and more strongly developed than Rosa. The sensations of hunger and
+thirst were not experienced at the same time, and one might be asleep
+while the other was crying. The pulsations and the respiratory
+movements were not synchronous. They were the products of the second
+gestation of a mother aged twenty-six, whose abdomen was of such
+preternatural size during pregnancy that she was ashamed to appear in
+public. The order of birth was as follows: one head and body, the lower
+extremity, and the second body and head.
+
+CLASS VII.--There are many instances of bicephalic monsters on record.
+Pare mentions and gives an illustration of a female apparently single
+in conformation, with the exception of having two heads and two necks.
+The Ephemerides, Haller, Schenck, and Archenholz cite examples, and
+there is an old account of a double-headed child, each of whose heads
+were baptized, one called Martha and the other Mary. One was of a gay
+and the other a sad visage, and both heads received nourishment; they
+only lived a couple of days. There is another similar record of a
+Milanese girl who had two heads, but was in all other respects single,
+with the exception that after death she was found to have had two
+stomachs. Besse mentions a Bavarian woman of twenty-six with two heads,
+one of which was comely and the other extremely ugly; Batemen quotes
+what is apparently the same case--a woman in Bavaria in 1541 with two
+heads, one of which was deformed, who begged from door to door, and who
+by reason of the influence of pregnant women was given her expenses to
+leave the country.
+
+A more common occurrence of this type is that in which there is fusion
+of the two heads. Moreau speaks of a monster in Spain which was shown
+from town to town. Its heads were fused; it had two mouths and two
+noses; in each face an eye well conformed and placed above the nose;
+there was a third eye in the middle of the forehead common to both
+heads; the third eye was of primitive development and had two pupils.
+Each face was well formed and had its own chin. Buffon mentions a cat,
+the exact analogue of Moreau's case. Sutton speaks of a photograph sent
+to Sir James Paget in 1856 by William Budd of Bristol. This portrays a
+living child with a supernumerary head, which had mouth, nose, eyes,
+and a brain of its own. The eyelids were abortive, and as there was no
+orbital cavity the eyes stood out in the form of naked globes on the
+forehead. When born, the corneas of both heads were transparent, but
+then became opaque from exposure. The brain of the supernumerary head
+was quite visible from without, and was covered by a membrane beginning
+to slough. On the right side of the head was a rudimentary external
+ear. The nurse said that when the child sucked some milk regurgitated
+through the supernumerary mouth. The great physiologic interest in this
+case lies in the fact that every movement and every act of the natural
+face was simultaneously repeated by the supernumerary face in a
+perfectly consensual manner, i.e., when the natural mouth sucked, the
+second mouth sucked; when the natural face cried, yawned, or sneezed,
+the second face did likewise; and the eyes of the two heads moved in
+unison. The fate of the child is not known.
+
+Home speaks of a child born in Bengal with a most peculiar fusion of
+the head. The ordinary head was nearly perfect and of usual volume, but
+fused with its vertex and reversed was a supernumerary head. Each head
+had its own separate vessels and brain, and each an individual
+sensibility, but if one had milk first the other had an abundance of
+saliva in its mouth. It narrowly escaped being burned to death at
+birth, as the midwife, greatly frightened by the monstrous appearance,
+threw it into the fire to destroy it, from whence it was rescued,
+although badly burned, the vicious conformation of the accessory head
+being possibly due to the accident. At the age of four it was bitten by
+a venomous serpent and, as a result, died. Its skull is in the
+possession of the Royal College of Surgeons in London.
+
+The following well-known story of Edward Mordake, though taken from lay
+sources, is of sufficient notoriety and interest to be mentioned here:--
+
+"One of the weirdest as well as most melancholy stories of human
+deformity is that of Edward Mordake, said to have been heir to one of
+the noblest peerages in England. He never claimed the title, however,
+and committed suicide in his twenty-third year.  He lived in complete
+seclusion, refusing the visits even of the members of his own family.
+He was a young man of fine attainments, a profound scholar, and a
+musician of rare ability.  His figure was remarkable for its grace, and
+his face--that is to say, his natural face--was that of an Antinous.
+But upon the back of his head was another face, that of a beautiful
+girl, 'lovely as a dream, hideous as a devil.' The female face was a
+mere mask, 'occupying only a small portion of the posterior part of the
+skull, yet exhibiting every sign of intelligence, of a malignant sort,
+however.' It would be seen to smile and sneer while Mordake was
+weeping. The eyes would follow the movements of the spectator, and the
+lips would 'gibber without ceasing.' No voice was audible, but Mordake
+avers that he was kept from his rest at night by the hateful whispers
+of his 'devil twin,' as he called it, 'which never sleeps, but talks to
+me forever of such things as they only speak of in hell. No imagination
+can conceive the dreadful temptations it sets before me. For some
+unforgiven wickedness of my forefathers I am knit to this fiend--for a
+fiend it surely is. I beg and beseech you to crush it out of human
+semblance, even if I die for it.' Such were the words of the hapless
+Mordake to Manvers and Treadwell, his physicians. In spite of careful
+watching he managed to procure poison, whereof he died, leaving a
+letter requesting that the 'demon face' might be destroyed before his
+burial, 'lest it continues its dreadful whisperings in my grave.' At
+his own request he was interred in a waste place, without stone or
+legend to mark his grave."
+
+A most curious case was that of a Fellah woman who was delivered at
+Alexandria of a bicephalic monster of apparently eight months'
+pregnancy. This creature, which was born dead, had one head white and
+the other black the change of color commencing at the neck of the black
+head. The bizarre head was of negro conformation and fully developed,
+and the colored skin was found to be due to the existence of pigment
+similar to that found in the black race. The husband of the woman had a
+light brown skin, like an ordinary Fellah man, and it was ascertained
+that there were some negro laborers in port during the woman's
+pregnancy; but no definite information as to her relations with them
+could be established, and whether this was a case of maternal
+impression or superfetation can only be a matter of conjecture.
+
+Fantastic monsters, such as acephalon, paracephalon, cyclops,
+pseudencephalon, and the janiceps, prosopthoracopagus, disprosopus,
+etc., although full of interest, will not be discussed here, as none
+are ever viable for any length of time, and the declared intention of
+this chapter is to include only those beings who have lived.
+
+CLASS VIII.--The next class includes the parasitic terata, monsters
+that consist of one perfect body, complete in every respect, but from
+the neighborhood of whose umbilicus depends some important portion of a
+second body. Pare, Benivenius, and Columbus describe adults with
+acephalous monsters attached to them. Schenck mentions 13 cases, 3 of
+which were observed by him.  Aldrovandus shows 3 illustrations under
+the name of "monstrum bicorpum monocephalon." Bustorf speaks of a case
+in which the nates and lower extremities of one body proceeded out of
+the abdomen of the other, which was otherwise perfect. Reichel and
+Anderson mention a living parasitic monster, the inferior trunk of one
+body proceeding from the pectoral region of the other.
+
+Pare says that there was a man in Paris in 1530, quite forty years of
+age, who carried about a parasite without a head, which hung pendant
+from his belly. This individual was exhibited and drew great crowds.
+Pare appends an illustration, which is, perhaps, one of the most
+familiar in all teratology. He also gives a portrait of a man who had a
+parasitic head proceeding from his epigastrium, and who was born in
+Germany the same year that peace was made with the Swiss by King
+Francis. This creature lived to manhood and both heads were utilized in
+alimentation.  Bartholinus details a history of an individual named
+Lazarus-Joannes Baptista Colloredo, born in Genoa in 1617, who
+exhibited himself all over Europe. From his epigastrium hung an
+imperfectly developed twin that had one thigh, hands, body, arms, and a
+well-formed head covered with hair, which in the normal position hung
+lowest. There were signs of independent existence in the parasite,
+movements of respiration, etc., but its eyes were closed, and, although
+saliva constantly dribbled from its open mouth, nothing was ever
+ingested. The genitals were imperfect and the arms ended in badly
+formed hands. Bartholinus examined this monster at twenty-two, and has
+given the best report, although while in Scotland in 1642 he was again
+examined, and accredited with being married and the father of several
+children who were fully and admirably developed. Moreau quotes a case
+of an infant similar in conformation to the foregoing monster, who was
+born in Switzerland in 1764, and whose supernumerary parts were
+amputated by means of a ligature.  Winslow reported before the Academie
+Royale des Sciences the history of a girl of twelve who died at the
+Hotel-Dieu in 1733.  She was of ordinary height and of fair
+conformation, with the exception that hanging from the left flank was
+the inferior half of another girl of diminutive proportions. The
+supernumerary body was immovable, and hung so heavily that it was said
+to be supported by the hands or by a sling. Urine and feces were
+evacuated at intervals from the parasite, and received into a diaper
+constantly worn for this purpose. Sensibility in the two was common, an
+impression applied to the parasite being felt by the girl. Winslow
+gives an interesting report of the dissection of this monster, and
+mentions that he had seen an Italian child of eight who had a small
+head proceeding from under the cartilage of the third left rib.
+Sensibility was common, pinching the ear of the parasitic head causing
+the child with the perfect head to cry. Each of the two heads received
+baptism, one being named John and the other Matthew. A curious question
+arose in the instance of the girl, as to whether the extreme unction
+should be administered to the acephalous fetus as well as to the child.
+
+In 1742, during the Ambassadorship of the Marquis de l'Hopital at
+Naples, he saw in that city an aged man, well conformed, with the
+exception that, like the little girl of Winslow, he had the inferior
+extremities of a male child growing from his epigastric region. Haller
+and Meckel have also observed cases like this.  Bordat described before
+the Royal Institute of France, August, 1826, a Chinaman, twenty-one
+years of age, who had an acephalous fetus attached to the surface of
+his breast (possibly "A-ke").
+
+Dickinson describes a wonderful child five years old, who, by an
+extraordinary freak of nature, was an amalgamation of two children.
+From the body of an otherwise perfectly formed child was a
+supernumerary head protruding from a broad base attached to the lower
+lumbar and sacral region. This cephalic mass was covered with hair
+about four or five inches long, and showed the rudiments of an eye,
+nose, mouth, and chin. This child was on exhibition when Dickinson saw
+it. Montare and Reyes were commissioned by the Academy of Medicine of
+Havana to examine and report on a monstrous girl of seven months,
+living in Cuba. The girl was healthy and well developed, and from the
+middle line of her body between the xiphoid cartilage and the
+umbilicus, attached by a soft pedicle, was an accessory individual,
+irregular, of ovoid shape, the smaller end, representing the head,
+being upward. The parasite measured a little over 1 foot in length, 9
+inches about the head, and 7 3/4 inches around the neck. The cranial
+bones were distinctly felt, and the top of the head was covered by a
+circlet of hair. There were two rudimentary eyebrows; the left eye was
+represented by a minute perforation encircled with hair; the right eye
+was traced by one end of a mucous groove which ran down to another
+transverse groove representing the mouth; the right third of this
+latter groove showed a primitive tongue and a triangular tooth, which
+appeared at the fifth month. There was a soft, imperforate nose, and
+the elements of the vertebral column could be distinguished beneath the
+skin; there were no legs; apparently no vascular sounds; there was
+separate sensation, as the parasite could be pinched without attracting
+the perfect infant's notice. The mouth of the parasite constantly
+dribbled saliva, but showed no indication of receiving aliment.
+
+Louise L., known as "La dame a quatre jambes," was born in 1869, and
+had attached to her pelvis another rudimentary pelvis and two atrophied
+legs of a parasite, weighing 8 kilos. The attachment was effected by
+means of a pedicle 33 cm. in diameter, having a bony basis, and being
+fixed without a joint. The attachment almost obliterated the vulva and
+the perineum was displaced far backward. At the insertion of the
+parasite were two rudimentary mammae, one larger than the other. No
+genitalia were seen on the parasite and it exhibited no active
+movements, the joints of both limbs being ankylosed. The woman could
+localize sensations in the parasite except those of the feet. She had
+been married five years, and bore, in the space of three years, two
+well-formed daughters.
+
+Quite recently there was exhibited in the museums of the United States
+an individual bearing the name "Laloo," who was born in Oudh, India,
+and was the second of four children. At the time of examination he was
+about nineteen years of age. The upper portion of a parasite was firmly
+attached to the lower right side of the sternum of the individual by a
+bony pedicle, and lower by a fleshy pedicle, and apparently contained
+intestines. The anus of the parasite was imperforate; a well-developed
+penis was found, but no testicles; there was a luxuriant growth of hair
+on the pubes. The penis of the parasite was said to show signs of
+erection at times, and urine passed through it without the knowledge of
+the boy. Perspiration and elevation of temperature seemed to occur
+simultaneously in both. To pander to the morbid curiosity of the
+curious, the "Dime Museum" managers at one time shrewdly clothed the
+parasite in female attire, calling the two brother and sister; but
+there is no doubt that all the traces of sex were of the male type. An
+analogous case was that of "A-Ke," a Chinaman, who was exhibited in
+London early in the century, and of whom and his parasite anatomic
+models are seen in our museums.  Figure 58 represents an epignathus, a
+peculiar type parasitic monster, in which the parasite is united to the
+inferior maxillary bone of the autosite.
+
+CLASS IX.--Of "Lusus naturae" none is more curious than that of
+duplication of the lower extremities. Pare says that on January 9,
+1529, there was living in Germany a male infant having four legs and
+four arms. In Paris, at the Academie des Sciences, on September 6,
+1830, there was presented by Madame Hen, a midwife, a living male child
+with four legs, the anus being nearly below the middle of the third
+buttock; and the scrotum between the two left thighs, the testicles not
+yet descended. There was a well-formed and single pelvis, and the
+supernumerary legs were immovable. Aldrovandus mentions several similar
+instances, and gives the figure of one born in Rome; he also describes
+several quadruped birds. Bardsley speaks of a male child with one head,
+four arms, four legs, and double generative organs. He gives a portrait
+of the child when it was a little over a year old.  Heschl published in
+Vienna in 1878 a description of a girl of seventeen, who instead of
+having a duplication of the superior body, as in "Millie-Christine, the
+two-headed nightingale," had double parts below the second lumbar
+vertebra. Her head and upper body resembled a comely, delicate girl of
+twelve.
+
+Wells a describes Mrs. B., aged twenty, still alive and healthy.  The
+duplication in this case begins just above the waist, the spinal column
+dividing at the third lumbar vertebra, below this point everything
+being double. Micturition and defecation occur at different times, but
+menstruation occurs simultaneously. She was married at nineteen, and
+became pregnant a year later on the left side, but abortion was induced
+at the fourth month on account of persistent nausea and the expectation
+of impossible delivery. Whaley, in speaking of this case, said Mrs. B.
+utilized her outside legs for walking; he also remarks that when he
+informed her that she was pregnant on the left side she replied, "I
+think you are mistaken; if it had been on my right side I would come
+nearer believing it;"--and after further questioning he found, from the
+patient's observation, that her right genitals were almost invariably
+used for coitus. Bechlinger of Para, Brazil, describes a woman of
+twenty-five, a native of Martinique, whose father was French and mother
+a quadroon, who had a modified duplication of the lower body. There was
+a third leg attached to a continuation of the processus coceygeus of
+the sacrum, and in addition to well developed mammae regularly
+situated, there were two rudimentary ones close together above the
+pubes. There were two vaginae and two well-developed vulvae, both
+having equally developed sensations. The sexual appetite was markedly
+developed, and coitus was practised in both vaginae. A somewhat similar
+case, possibly the same, is that of Blanche Dumas, born in 1860.  She
+had a very broad pelvis, two imperfectly developed legs, and a
+supernumerary limb attached to the symphysis, without a joint, but with
+slight passive movement. There was a duplication of bowel, bladder, and
+genitalia. At the junction of the rudimentary limb with the body, in
+front, were two rudimentary mammary glands, each containing a nipple.
+
+Other instances of supernumerary limbs will be found in Chapter VI.
+
+CLASS X.--The instances of diphallic terata, by their intense interest
+to the natural bent of the curious mind, have always elicited much
+discussion. To many of these cases have been attributed exaggerated
+function, notwithstanding the fact that modern observation almost
+invariably shows that the virile power diminishes in exact proportion
+to the extent of duplication.  Taylor quotes a description of a
+monster, exhibited in London, with two distinct penises, but with only
+one distinct testicle on either side. He could exercise the function of
+either organ.
+
+Schenck, Schurig, Bartholinus, Loder, and Ollsner report instances of
+diphallic terata; the latter case a was in a soldier of Charles VI,
+twenty-two years old, who applied to the surgeon for a bubonic
+affection, and who declared that he passed urine from the orifice of
+the left glans and also said that he was incapable of true coitus.
+Valentini mentions an instance in a boy of four, in which the two
+penises were superimposed. Bucchettoni speaks of a man with two penises
+placed side by side. There was an anonymous case described of a man of
+ninety-three with a penis which was for more than half its length
+divided into two distinct members, the right being somewhat larger than
+the left. From the middle of the penis up to the symphysis only the
+lower wall of the urethra was split. Jenisch describes a diphallic
+infant, the offspring of a woman of twenty-five who had been married
+five years. Her first child was a well-formed female, and the second,
+the infant in question, cried much during the night, and several times
+vomited dark-green matter. In lieu of one penis there were two,
+situated near each other, the right one of natural size and the left
+larger, but not furnished with a prepuce. Each penis had its own
+urethra, from which dribbled urine and some meconium.  There was a
+duplication of each scrotum, but only one testicle in each, and several
+other minor malformations.
+
+Gore, reported by Velpeau, has seen an infant of eight and one-half
+months with two penises and three lower extremities. The penises were 4
+cm. apart and the scrotum divided, containing one testicle in each
+side. Each penis was provided with a urethra, urine being discharged
+from both simultaneously. In a similar case, spoken of by
+Geoffroy-Saint-Hilaire, the two organs were also separate, but urine
+and semen escaped sometimes from one, sometimes from both.
+
+The most celebrated of all the diphallic terata was Jean Baptista dos
+Santos, who when but six months old was spoken of by Acton.  His father
+and mother were healthy and had two well-formed children. He was easily
+born after an uneventful pregnancy. He was good-looking, well
+proportioned, and had two distinct penises, each as large as that of a
+child of six months.  Urination proceeded simultaneously from both
+penises; he had also two scrotums. Behind and between the legs there
+was another limb, or rather two, united throughout their length. It was
+connected to the pubis by a short stem 1/2 inch long and as large as
+the little finger, consisting of separate bones and cartilages. There
+was a patella in the supernumerary limb on the anal aspect, and a joint
+freely movable. This compound limb had no power of motion, but was
+endowed with sensibility. A journal in London, after quoting Acton's
+description, said that the child had been exhibited in Paris, and that
+the surgeons advised operation.  Fisher, to whom we are indebted for an
+exhaustive work in Teratology, received a report from Havana in July,
+1865, which detailed a description of Santos at twenty-two years of
+age, and said that he was possessed of extraordinary animal passion,
+the sight of a female alone being sufficient to excite him. He was said
+to use both penises, after finishing with one continuing with the
+other; but this account of him does not agree with later descriptions,
+in which no excessive sexual ability had been noticed. Hart describes
+the adult Santos in full, and accompanies his article with an
+illustration. At this time he was said to have developed double
+genitals, and possibly a double bladder communicating by an imperfect
+septum. At adulthood the anus was three inches anterior to the os
+coceygeus. In the sitting or lying posture the supernumerary limb
+rested on the front of the inner surface of the lower third of his left
+thigh. He was in the habit of wearing this limb in a sling, or bound
+firmly to the right thigh, to prevent its unseemly dangling when erect.
+The perineum proper was absent, the entire space between the anus and
+the posterior edge of the scrotum being occupied by the pedicle.
+Santos' mental and physical functions were developed above normal, and
+he impressed everybody with his accomplishments.
+Geoffroy-Saint-Hilaire records an instance in which the conformation
+was similar to that of Santos. There was a third lower extremity
+consisting of two limbs fused into one with a single foot containing
+ten distinct digits. He calls the case one of arrested twin development.
+
+Van Buren and Keyes describe a case in a man of forty-two, of good,
+healthy appearance. The two distinct penises of normal size were
+apparently well formed and were placed side by side, each attached at
+its root to the symphysis. Their covering of skin was common as far as
+the base of the glans; at this point they seemed distinct and perfect,
+but the meatus of the left was imperforate.  The right meatus was
+normal, and through it most of the urine passed, though some always
+dribbled through an opening in the perineum at a point where the root
+of the scrotum should have been. On lifting the double-barreled penis
+this opening could be seen and was of sufficient size to admit the
+finger. On the right side of the aperture was an elongated and rounded
+prominence similar in outline to a labium majus. This prominence
+contained a testicle normal in shape and sensibility, but slightly
+undersized, and surrounded, as was evident from its mobility, by a
+tunica vaginalis. The left testicle lay on the tendon of the adductor
+longus in the left groin; it was not fully developed, but the patient
+had sexual desires, erections, and emissions.  Both penises became
+erect simultaneously, the right more vigorously. The left leg was
+shorter than the right and congenitally smaller; the mammae were of
+normal dimensions.
+
+Sangalli speaks of a man of thirty-five who had a supernumerary penis,
+furnished with a prepuce and capable of erection. At the apex of the
+glans opened a canal about 12 cm. long, through which escaped monthly a
+serous fluid. Smith mentions a man who had two penises and two
+bladders, on one of which lithotomy was performed. According to
+Ballantyne, Taruffi, the scholarly observer of terata, mentions a child
+of forty-two months and height of 80 cm. who had two penises, each
+furnished with a urethra and well-formed scrotal sacs which were
+inserted in a fold of the groin. There were two testicles felt in the
+right scrotum and one in the left. Fecal evacuations escaped through
+two anal orifices. There is also another case mentioned similar to the
+foregoing in a man of forty; but here there was an osseous projection
+in the middle line behind the bladder. This patient said that erection
+was simultaneous in both penises, and that he had not married because
+of his chagrin over his deformity. Cole speaks of a child with two
+well-developed male organs, one to the left and the other to the right
+of the median line, and about 1/4 or 1/2 inch apart at birth. The
+urethra bifurcated in the perineal region and sent a branch to each
+penis, and urine passed from each meatus. The scrotum was divided into
+three compartments by two raphes, and each compartment contained a
+testicle. The anus at birth was imperforate, but the child was
+successfully operated on, and at its sixtieth day weighed 17 pounds.
+
+Lange says that an infant was brought to Karg for relief of anal
+atresia when fourteen days old. It was found to possess duplicate
+penises, which communicated each to its distinct half of the bladder as
+defined by a median fold. The scrotum was divided into three portions
+by two raphes, and each lateral compartment contained a fully formed
+testicle. This child died because of its anal malformation, which we
+notice is a frequent associate of malformations or duplicity of the
+penis. There is an example in an infant described in which there were
+two penises, each about 1/2 inch long, and a divided scrotal sac 21
+inches long. Englisch speaks of a German of forty who possessed a
+double penis of the bifid type.
+
+Ballantyne and his associates define diphallic terata as individuals
+provided with two more or less well-formed and more or less separate
+penises, who may show also other malformations of the adjoining parts
+and organs (e.g., septate bladder), but who are not possessed of more
+than two lower limbs. This definition excludes, therefore, the cases in
+which in addition to a double penis there is a supernumerary lower
+extremity--such a case, for example, as that of Jean Baptista dos
+Santos, so frequently described by teratologists. It also excludes the
+more evident double terata, and, of course, the cases of duplication of
+the female genital organs (double clitoris, vulva, vagina, and uterus).
+Although Schurig, Meckel, Himly, Taruffi, and others give bibliographic
+lists of diphallic terata, even in them erroneous references are
+common, and there is evidence to show that many cases have been
+duplicated under different names.  Ballantyne and Skirving have
+consulted all the older original references available and eliminated
+duplications of reports and, adhering to their original definition,
+have collected and described individually 20 cases; they offer the
+following conclusions:--
+
+1. Diphallus, or duplication of the penis in an otherwise apparently
+single individual, is a very rare anomaly, records of only 20 cases
+having been found in a fairly exhaustive search through teratologic
+literature. As a distinct and well-authenticated type it has only quite
+recently been recognized by teratologists.
+
+2. It does not of itself interfere with intrauterine or extrauterine
+life; but the associated anomalies (e.g., atresia ani) may be sources
+of danger. If not noticed at birth, it is not usually discovered till
+adult life, and even then the discovery is commonly accidental.
+
+3. With regard to the functions of the pelvic viscera, urine may be
+passed by both penises, by one only, or by neither. In the last
+instance it finds exit by an aperture in the perineum. There is reason
+to believe that semen may be passed in the same way; but in most of the
+recorded cases there has been sterility, if not inability to perform
+the sexual act.
+
+4. All the degrees of duplication have been met with, from a fissure of
+the glans penis to the presence of two distinct penises inserted at
+some distance from each other in the inguinal regions.
+
+5. The two penises are usually somewhat defective as regards prepuce,
+urethra, etc.; they may lie side by side, or more rarely may be
+situated anteroposteriorly; they may be equal in size, or less commonly
+one is distinctly larger than the other; and one or both may be
+perforate or imperforate.
+
+6. The scrotum may be normal or split; the testicles, commonly two in
+number, may be normal or atrophic, descended or undescended; the
+prostate may be normal or imperfectly developed, as may also the vasa
+deferentia and vesiculae seminales.
+
+7. The commonly associated defects are: More or less completely septate
+bladder, atresia ani, or more rarely double anus, double urethra,
+increased breadth of the bony pelvis with defect of the symphysis
+pubis, and possibly duplication of the lower end of the spine, and
+hernia of some of the abdominal contents into a perineal pouch. Much
+more rarely, duplication of the heart, lungs, stomach, and kidneys has
+been noted, and the lower limbs may be shorter than normal.
+
+CLASS XI.--Cases of fetus in fetu, those strange instances in which one
+might almost say that a man may be pregnant with his brother or sister,
+or in which an infant may carry its twin without the fact being
+apparent, will next be discussed. The older cases were cited as being
+only a repetition of the process by which Eve was born of Adam. Figure
+63 represents an old engraving showing the birth of Eve. Bartholinus,
+the Ephemerides, Otto, Paullini, Schurig, and Plot speak of instances
+of fetus in fetu. Ruysch describes a tumor contained in the abdomen of
+a man which was composed of hair, molar teeth, and other evidences of a
+fetus. Huxham reported to the Royal Society in 1748 the history of a
+child which was born with a tumor near the anus larger than the whole
+body of the child; this tumor contained rudiments of an embryo. Young
+speaks of a fetus which lay encysted between the laminae of the
+transverse mesocolon, and Highmore published a report of a fetus in a
+cyst communicating with the duodenum.  Dupuytren gives an example in a
+boy of thirteen, in whom was found a fetus. Gaetano-Nocito, cited by
+Philipeaux, has the history of a taken with a great pain in the right
+hypochondrium, and from which issued subsequently fetal bones and a
+mass of macerated embryo. His mother had had several double
+pregnancies, and from the length of the respective tibiae one of the
+fetuses seemed to be of two months' and the other of three months'
+intrauterine life. The man died five years after the abscess had burst
+spontaneously.
+
+Brodie speaks of a case in which fetal remains were taken from the
+abdomen of a girl of two and one-half years. Gaither describes a child
+of two years and nine months, supposed to be affected with ascites, who
+died three hours after the physician's arrival. In its abdomen was
+found a fetus weighing almost two pounds and connected to the child by
+a cord resembling an umbilical cord. This child was healthy for about
+nine months, and had a precocious longing for ardent spirits, and drank
+freely an hour before its death.
+
+Blundell says that he knew "a boy who was literally and without evasion
+with child, for the fetus was contained in a sac communicating with the
+abdomen and was connected to the side of the cyst by a short umbilical
+cord; nor did the fetus make its appearance until the boy was eight or
+ten years old, when after much enlargement of pregnancy and subsequent
+flooding the boy died." The fetus, removed after death, on the whole
+not very imperfectly formed, was of the size of about six or seven
+months' gestation. Bury cites an account of a child that had a second
+imperfectly developed fetus in its face and scalp. There was a boy by
+the name of Bissieu who from the earliest age had a pain in one of his
+left ribs; this rib was larger than the rest and seemed to have a tumor
+under it. He died of phthisis at fourteen, and after death there was
+found in a pocket lying against the transverse colon and communicating
+with it all the evidences of a fetus.
+
+At the Hopital de la Charite in Paris, Velpeau startled an audience of
+500 students and many physicians by saying that he expected to find a
+rudimentary fetus in a scrotal tumor placed in his hands for operation.
+His diagnosis proved correct, and brought him resounding praise, and
+all wondered as to his reasons for expecting a fetal tumor. It appears
+that he had read with care a report by Fatti of an operation on the
+scrotum of a child which had increased in size as the child grew, and
+was found to contain the ribs, the vertebral column, the lower
+extremities as far as the knees, and the two orbits of a fetus; and
+also an account of a similar operation performed by Wendt of Breslau on
+a Silesian boy of seven. The left testicle in this case was so swollen
+that it hung almost to the knee, and the fetal remains removed weighed
+seven ounces.
+
+Sulikowski relates an instance of congenital fetation in the umbilicus
+of a girl of fourteen, who recovered after the removal of the anomaly.
+Aretaeos described to the members of the medical fraternity in Athens
+the case of a woman of twenty-two, who bore two children after a seven
+months' pregnancy. One was very rudimentary and only 21 inches long,
+and the other had an enormous head resembling a case of hydrocephalus.
+On opening the head of the second fetus, another, three inches long,
+was found in the medulla oblongata, and in the cranial cavity with it
+were two additional fetuses, neither of which was perfectly formed.
+
+Broca speaks of a fetal cyst being passed in the urine of a man of
+sixty-one; the cyst contained remnants of hair, bone, and cartilage.
+Atlee submits quite a remarkable case of congenital ventral gestation,
+the subject being a girl of six, who recovered after the discharge of
+the fetal mass from the abdomen. McIntyre speaks of a child of eleven,
+playing about and feeling well, but whose abdomen progressively
+increased in size 1 1/2 inches each day. After ten days there was a
+large fluctuating mass on the right side; the abdomen was opened and
+the mass enucleated; it was found to contain a fetal mass weighing
+nearly five pounds, and in addition ten pounds of fluid were removed.
+The child made an early recovery. Rogers mentions a fetus that was
+found in a man's bladder. Bouchacourt reports the successful
+extirpation of the remains of a fetus from the rectum of a child of
+six. Miner describes a successful excision of a congenital gestation.
+
+Modern literature is full of examples, and nearly every one of the
+foregoing instances could be paralleled from other sources.  Rodriguez
+is quoted as reporting that in July, 1891, several newspapers in the
+city of Mexico published, under the head of "A Man-mother," a wonderful
+story, accompanied by wood-cuts, of a young man from whose body a great
+surgeon had extracted a "perfectly developed fetus." One of these
+wood-cuts represented a tumor at the back of a man opened and
+containing a crying baby.  In commenting upon this, after reviewing
+several similar cases of endocymian monsters that came under his
+observation in Mexico, Rodriguez tells what the case which had been so
+grossly exaggerated by the lay journals really was: An Indian boy, aged
+twenty-two, presented a tumor in the sacrococcygeal region measuring 53
+cm. in circumference at the base, having a vertical diameter of 17 cm.
+and a transverse diameter of 13 cm. It had no pedicle and was fixed,
+showing unequal consistency. At birth this tumor was about the size of
+a pigeon's egg. A diagnosis of dermoid cyst was made and two operations
+were performed on the boy, death following the second. The skeleton
+showed interesting conditions; the rectum and pelvic organs were
+natural, and the contents of the cyst verified the diagnosis.
+
+Quite similar to the cases of fetus in fetu are the instances of
+dermoid cysts. For many years they have been a mystery to
+physiologists, and their origin now is little more than hypothetic. At
+one time the fact of finding such a formation in the ovary of an
+unmarried woman was presumptive evidence that she was unchaste; but
+this idea was dissipated as soon as examples were reported in children,
+and to-day we have a well-defined difference between congenital and
+extrauterine pregnancy. Dermoid cysts of the ovary may consist only of
+a wall of connective tissue lined with epidermis and containing
+distinctly epidermic scales which, however, may be rolled up in firm
+masses of a more or less soapy consistency; this variety is called by
+Orth epidermoid cyst; or, according to Warren, a form of cyst made up
+of skin containing small and ill-defined papillae, but rich in hair
+follicles and sebaceous glands. Even the erector pili muscle and the
+sudoriparous gland are often found. The hair is partly free and rolled
+up into thick balls or is still attached to the walls. A large mass of
+sebaceous material is also found in these cysts. Thomson reports a case
+of dermoid cyst of the bladder containing hair, which cyst he removed.
+It was a pedunculated growth, and it was undoubtedly vesical and not
+expelled from some ovarian source through the urinary passage, as
+sometimes occurs.
+
+The simpler forms of the ordinary dermoid cysts contain bone and teeth.
+The complicated teratoma of this class may contain, in addition to the
+previously mentioned structures, cartilage and glands, mucous and
+serous membrane, muscle, nerves, and cerebral substance, portions of
+eyes, fingers with nails, mammae, etc.  Figure 64 represents a cyst
+containing long red hair that was removed from a blonde woman aged
+forty-four years who had given birth to six children. Cullingworth
+reports the history of a woman in whom both ovaries were apparently
+involved by dermoids, who had given birth to 12 children and had three
+miscarriages--the last, three months before the removal of the growths.
+The accompanying illustration, taken from Baldy, pictures a dermoid
+cyst of the complicated variety laid open and exposing the contents in
+situ. Mears of Philadelphia reports a case of ovarian cyst removed from
+a girl of six and a half by Bradford of Kentucky in 1875. From this age
+on to adult life many similar cases are recorded. Nearly every medical
+museum has preserved specimens of dermoid cysts, and almost all
+physicians are well acquainted with their occurrence. The curious
+formations and contents and the bizarre shapes are of great variety.
+Graves mentions a dermoid cyst containing the left side of a human
+face, an eye, a molar tooth, and various bones. Dermoid cysts are found
+also in regions of the body quite remote from the ovary. The so-called
+"orbital wens" are true inclusion of the skin of a congenital origin,
+as are the nasal dermoids and some of the cysts of the neck.
+
+Weil reported the case of a man of twenty-two years who was born with
+what was supposed to be a spina bifida in the lower sacral region.
+According to Senn, the swelling never caused any pain or inconvenience
+until it inflamed, when it opened spontaneously and suppurated,
+discharging a large quantity of offensive pus, hair, and sebaceous
+material, thus proving it to have been a dermoid.  The cyst was freely
+incised, and there were found numerous openings of sweat glands, from
+which drops of perspiration escaped when the patient was sweating.
+
+Dermoid cysts of the thorax are rare. Bramann reported a case in which
+a dermoid cyst of small size was situated over the sternum at the
+junction of the manubrium with the gladiolus, and a similar cyst in the
+neck near the left cornu of the hyoid bone.  Chitten removed a dermoid
+from the sternum of a female of thirty-nine, the cyst containing 11
+ounces of atheromatous material. In the Museum of St. Bartholomew's
+Hospital in London there is a congenital tumor which was removed from
+the anterior mediastinum of a woman of twenty one, and contained
+portions of skin, fat, sebaceous material, and two pieces of bone
+similar to the superior maxilla, and in which several teeth were found.
+Dermoids are found in the palate and pharynx, and open dermoids of the
+conjunctiva are classified by Sutton with the moles.  According to
+Senn, Barker collected sixteen dermoid tumors of the tongue. Bryk
+successfully removed a tumor of this nature the size of a fist.
+Wellington Gray removed an enormous lingual dermoid from the mouth of a
+negro. It contained 40 ounces of atheromatous material. Dermoids of the
+rectum are reported. Duyse reports the history of a case of labor
+during which a rectal dermoid was expelled. The dermoid contained a
+cerebral vesicle, a rudimentary eye, a canine and a molar tooth, and a
+piece of bone. There is little doubt that many cases of fetus in fetu
+reported were really dermoids of the scrotum.
+
+Ward reports the successful removal of a dermoid cyst weighing 30
+pounds from a woman of thirty-two, the mother of two children aged ten
+and twelve, respectively. The report is briefly as follows: "The
+patient has always been in good health until within the last year,
+during which time she has lost flesh and strength quite rapidly, and
+when brought to my hospital by her physician, Dr. James of
+Williamsburg, Kansas, was quite weak, although able to walk about the
+house. A tumor had been growing for a number of years, but its growth
+was so gradual that the patient had not considered her condition
+critical until quite recently. The tumor was diagnosed to be cystoma of
+the left ovary. Upon opening the sac with the trocar we were confronted
+by complications entirely unlooked for, and its use had to be abandoned
+entirely because the thick contents of the cyst would not flow freely,
+and the presence of sebaceous matter blocked the instrument. As much of
+the fluid as possible was removed, and the abdominal incision was
+enlarged to allow of the removal of the large tumor. An ovarian
+hematoma the size of a large orange was removed from the right side. We
+washed the intestines quite as one would wash linen, since some of the
+contents of the cyst had escaped into the abdominal cavity. The abdomen
+was closed without drainage, and the patient placed in bed without
+experiencing the least shock.  Her recovery was rapid and uneventful.
+She returned to her home in four weeks after the operation.
+
+"The unusual feature in this case was the nature of the contents of the
+sac. There was a large quantity of long straight hair growing from the
+cyst wall and an equal amount of loose hair in short pieces floating
+through the tumor-contents, a portion of which formed nuclei for what
+were called 'moth-balls,' of which there were about 1 1/2 gallons.
+These balls, or marbles, varied from the size of moth-balls, as
+manufactured and sold by druggists, to that of small walnuts. They
+seemed to be composed of sebaceous matter, and were evidently formed
+around the short hairs by the motion of the fluid produced by walking
+or riding.  There was some tissue resembling true skin attached to the
+inner wall of the sac."
+
+There are several cases of multiple dermoid cysts on record, and they
+may occur all over the body. Jamieson reports a case in which there
+were 250, and in Maclaren's case there were 132.  According to Crocker,
+Hebra and Rayer also each had a case. In a case of Sangster, reported
+by Politzer, although most of the dermoids, as usual, were like
+fibroma-nodules and therefore the color of normal skin, those over the
+mastoid processes and clavicle were lemon-yellow, and were generally
+thought to be xanthoma until they were excised, and Politzer found they
+were typical dermoid cysts with the usual contents of degenerated
+epithelium and hair.
+
+Hermaphroditism.--Some writers claim that Adam was the first
+hermaphrodite and support this by Scriptural evidence. We find in some
+of the ancient poets traces of an Egyptian legend in which the goddess
+of the moon was considered to be both male and female. From mythology
+we learn that Hermaphroditus was the son of Hermes, or Mercury, and
+Venus Aphrodite, and had the powers both of a father and mother. In
+speaking of the foregoing Ausonius writes, "Cujus erat facies in qua
+paterque materque cognosci possint, nomen traxit ab illis." Ovid and
+Virgil both refer to legendary hermaphrodites, and the knowledge of
+their existence was prevalent in the olden times. The ancients
+considered the birth of hermaphrodites bad omens, and the Athenians
+threw them into the sea, the Romans, into the Tiber.  Livy speaks of an
+hermaphrodite being put to death in Umbria, and another in Etruria.
+Cicero, Aristotle, Strabonius, and Pliny all speak concerning this
+subject. Martial and Tertullian noticed this anomaly among the Romans.
+Aetius and Paulus Aegineta speak of females in Egypt with prolonged
+clitorides which made them appear like hermaphrodites. Throughout the
+Middle Ages we frequently find accounts, naturally exaggerated, of
+double-sexed creatures. Harvey, Bartholinus, Paullini, Schenck, Wolff,
+Wrisberg, Zacchias, Marcellus Donatus, Haller, Hufeland, de Graff, and
+many others discuss hermaphroditism. Many classifications have been
+given, as, e.g., real and apparent; masculine, feminine, or neuter;
+horizontal and vertical; unilateral and bilateral, etc. The anomaly in
+most cases consists of a malformation of the external genitalia. A
+prolonged clitoris, prolapsed ovaries, grossness of figure, and hirsute
+appearance have been accountable for many supposed instances of
+hermaphrodites. On the other hand, a cleft scrotum, an ill-developed
+penis, perhaps hypospadias or epispadias, rotundity of the mammae, and
+feminine contour have also provoked accounts of similar instances. Some
+cases have been proved by dissection to have been true hermaphrodites,
+portions or even entire genitalia of both sexes having been found.
+
+Numerous accounts, many mythical, but always interesting, are given of
+these curious persons. They have been accredited with having performed
+the functions of both father and mother, notwithstanding the statements
+of some of the best authorities that they are always sterile.
+Observation has shown that the sexual appetite diminishes in proportion
+to the imperfections in the genitalia, and certainly many of these
+persons are sexually indifferent.
+
+We give descriptions of a few of the most famous or interesting
+instances of hermaphroditism. Pare speaks of a woman who, besides a
+vulva, from which she menstruated, had a penis, but without prepuce or
+signs of erectility. Haller alludes to several cases in which prolonged
+clitorides have been the cause of the anomaly.  In commenting on this
+form of hermaphroditism Albucasiusus describes a necessary operation
+for the removal of the clitoris.
+
+Columbus relates the history of an Ethiopian woman who was evidently a
+spurious female hermaphrodite. The poor wretch entreated him to cut off
+her penis, an enlarged clitoris, which she said was an intolerable
+hindrance to her in coitus. De Graff and Riolan describe similar cases.
+There is an old record of a similar creature, supposing herself to be a
+male, who took a wife, but previously having had connection with a man,
+the outcome of which was pregnancy, was shortly after marriage
+delivered of a daughter. There is an account of a person in Germany
+who, for the first thirty years of life, was regarded as feminine, and
+being of loose morals became a mother. At a certain period she began to
+feel a change in her sexual inclinations; she married and became the
+father of a family. This is doubtless a distortion of the facts of the
+case of Catherine or Charles Hoffman, born in 1824, and who was
+considered a female until the age of forty. At puberty she had the
+instincts of a woman, and cohabitated with a male lover for twenty
+years. Her breasts were well formed and she menstruated at nineteen. At
+the age of forty-six her sexual desires changed, and she attempted
+coitus as a man, with such evident satisfaction that she married a
+woman soon afterward. Fitch speaks of a house-servant with masculine
+features and movements, aged twenty-eight, and 5 feet and 9 inches
+tall, who was arrested by the police for violating the laws governing
+prostitution. On examination, well-developed male and female organs of
+generation were found. The labia majora were normal and flattened on
+the anterior surface. The labia minora and hymen were absent. The
+vagina was spacious and the woman had a profuse leukorrhea. She stated
+that several years previously she gave birth to a normal child. In
+place of a clitoris she had a penis which, in erection, measured 5 1/4
+inches long and 3 5/8 inches in circumference. The glans penis and the
+urethra were perfectly formed. The scrotum contained two testicles,
+each about an inch long; the mons veneris was sparsely covered with
+straight, black hair. She claimed functional ability with both sets of
+genitalia, and said she experienced equal sexual gratification with
+either. Semen issued from the penis, and every three weeks she had
+scanty menstruation, which lasted but two days.
+
+Beclard showed Marie-Madeline Lefort, nineteen years of age, 1 1/2
+meters in height. Her mammae were well developed, her nipples erectile
+and surrounded by a brown areola, from which issued several hairs. Her
+feet were small, her pelvis large, and her thighs like those of a
+woman. Projecting from the vulva was a body looking like a penis 7 cm.
+long and slightly erectile at times; it was imperforate and had a
+mobile prepuce. She had a vulva with two well-shaped labia as shown by
+the accompanying illustration. She menstruated slightly and had an
+opening at the root of the clitoris. The parotid region showed signs of
+a beard and she had hair on her upper lip. On August 20, 1864, a person
+came into the Hotel-Dieu, asking treatment for chronic pleurisy.  He
+said his age was sixty-five, and he pursued the calling of a
+mountebank, but remarked that in early life he had been taken for a
+woman. He had menstruated at eight and had been examined by doctors at
+sixteen. The menstruation continued until 1848, and at its cessation he
+experienced the feelings of a male. At this time he presented the
+venerable appearance of a long-bearded old man.  At the autopsy, about
+two months later, all the essentials of a female were delineated. A
+Fallopian tube, ovaries, uterus, and round ligaments were found, and a
+drawing in cross-section of the parts was made. There is no doubt but
+that this individual was Marie-Madeline Lefort in age.
+
+
+Worbe speaks of a person who was supposed to be feminine for twenty-two
+years. At the age of sixteen she loved a farmer's son, but the union
+was delayed for some reason, and three years later her grace faded and
+she became masculine in her looks and tastes.  It was only after
+lengthy discussion, in which the court took part, that it was
+definitely settled that this person was a male.
+
+Adelaide Preville, who was married as a female, and as such lived the
+last ten years of her life in France, was found on dissection at the
+Hotel-Dieu to be a man. A man was spoken of in both France and Germany
+a who passed for many years as a female. He had a cleft scrotum and
+hypospadias, which caused the deception.  Sleeping with another servant
+for three years, he constantly had sexual congress with her during this
+period, and finally impregnated her. It was supposed in this case that
+the posterior wall of the vagina supplied the deficiency of the lower
+boundary of the urethra, forming a complete channel for the semen to
+proceed through. Long ago in Scotland a servant was condemned to death
+by burial alive for impregnating his master's daughter while in the
+guise and habit of a woman. He had always been considered a woman. We
+have heard of a recent trustworthy account of a pregnancy and delivery
+in a girl who had been impregnated by a bed-fellow who on examination
+proved to be a male pseudohermaphrodite.
+
+Fournier speaks of an individual in Lisbon in 1807 who was in the
+highest degree graceful, the voice feminine, the mammae well developed,
+The female genitalia were normal except the labia majora, which were
+rather diminutive. The thighs and the pelvis.  were not so wide as
+those of a woman. There was some beard on the chin, but it was worn
+close. the male genitalia were of the size and appearance of a male
+adult and were covered with the usual hair. This person had been twice
+pregnant and aborted at the third and fifth month. During coitus the
+penis became erect, etc.
+
+Schrell describes a case in which, independent of the true penis and
+testicles, which were well formed, there existed a small vulva
+furnished with labia and nymphae, communicating with a rudimentary
+uterus provided with round ligaments and imperfectly developed ovaries.
+Schrell remarks that in this case we must notice that the female
+genitalia were imperfectly developed, and adds that perfect
+hermaphroditism is a physical impossibility without great alterations
+of the natural connections of the bones and other parts of the pelvis.
+Cooper describes a woman with an enormous development of the clitoris,
+an imperforate uterus, and absence of vagina; at first sight of the
+parts they appeared to be those of a man.
+
+In 1859 Hugier succeeded in restoring a vagina to a young girl of
+twenty who had an hypertrophied clitoris and no signs of a vagina. The
+accompanying illustrations show the conformation of the parts before
+operation with all the appearance of ill-developed male genitalia, and
+the appearance afterward with restitution of the vaginal opening.
+
+Virchow in 1872, Boddaert in 1875, and Marchand in 1883 report cases of
+duplication of the genitalia, and call their cases true hermaphrodites
+from an anatomic standpoint. There is a specimen in St. Bartholomew's
+Hospital in London from a man of forty-four, who died of cerebral
+hemorrhage. He was well formed and had a beard and a full-sized penis.
+He was married, and it was stated that his wife had two children. The
+bladder and the internal organs of generation were those of a man in
+whom neither testis had descended into the scrotum, and in whom the
+uterus masculinus and vagina were developed to an unusual degree. The
+uterus, nearly as large as in the adult female, lay between the bladder
+and rectum, and was enclosed between two layers of peritoneum, to
+which, on either side of the uterus, were attached the testes.  There
+was also shown in London the pelvic organs from a case of complex or
+vertical hermaphroditism occurring in a child of nine months who died
+from the effects of an operation for the radical cure of a right
+inguinal hernia. The external organs were those of a male with
+undescended testes. The bladder was normal and its neck was surrounded
+by a prostate gland. Projecting backward were a vagina, uterus, and
+broad ligaments, round ligaments, and Fallopian tubes, with the testes
+in the position of the ovaries.  There were no seminal vesicles. The
+child died eleven days after the operation. The family history states
+that the mother had had 14 children and eight miscarriages. Seven of
+the children were dead and showed no abnormalities. The fifth and sixth
+children were boys and had the same sexual arrangement.
+
+Barnes, Chalmers, Sippel, and Litten describe cases of spurious
+hermaphroditism due to elongation of the clitoris. In Litten's case a
+the clitoris was 3 1/2 inches long, and there was hydrocele of the
+processus vaginalis on both sides, making tumors in the labium on one
+side and the inguinal canal on the other, which had been diagnosed as
+testicles and again as ovaries. There was associate cystic ovarian
+disease. Plate 4 is taken from a case of false external bilateral
+hermaphroditism. Phillips mentions four cases of spurious
+hermaphroditism in one family, and recently Pozzi tells of a family of
+nine individuals in whom this anomaly was observed. The first was alive
+and had four children; the second was christened a female but was
+probably a male; the third, fourth, and fifth were normal but died
+young; the sixth daughter was choreic and feeble-minded, aged
+twenty-nine, and had one illegitimate child; the seventh, a boy, was
+healthy and married; the eighth was christened a female, but when
+seventeen was declared by the Faculty to be a male; the ninth was
+christened a female, but at eighteen the genitals were found to be
+those of a male, though the mammae were well developed.
+
+O'Neill speaks of a case in which the clitoris was five inches long and
+one inch thick, having a groove in its inferior surface reaching down
+to an oblique opening in the perineum. The scrotum contained two hard
+bodies thought to be testicles, and the general appearance was that of
+hypospadias. Postmortem a complete set of female genitalia was found,
+although the ovaries were very small. The right round ligament was
+exceedingly thick and reached down to the bottom of the false scrotum,
+where it was firmly attached. The hard bodies proved to be on one side
+an irreducible omental hernia, probably congenital, and on the other a
+hardened mass having no glandular structure. The patient was an adult.
+As we have seen, there seems to be a law of evolution in
+hermaphroditism which prevents perfection. If one set of genitalia are
+extraordinarily developed, the other set are correspondingly atrophied.
+In the case of extreme development of the clitoris and approximation to
+the male type we must expect to find imperfectly developed uterus or
+ovaries. This would answer for one of the causes of sterility in these
+cases.
+
+There is a type of hermaphroditism in which the sex cannot be
+definitely declared, and sometimes dissection does not definitely
+indicate the predominating sex. Such cases are classed under the head
+of neuter hermaphrodites, possibly an analogy of the "genus epicoenum"
+of Quintilian. Marie Dorothee, of the age of twenty-three, was examined
+and declared a girl by Hufeland and Mursina, while Stark, Raschig, and
+Martens maintained that she was a boy. This formidable array of talent
+on both sides provoked much discussion in contemporary publications,
+and the case attracted much notice. Marc saw her in 1803, at which time
+she carried contradicting certificates as to her sex. He found an
+imperforate penis, and on the inferior face near the root an opening
+for the passage of urine. No traces of nymphae, vagina, testicles, nor
+beard were seen. The stature was small, the form debilitated, and the
+voice effeminate. Marc came to the conclusion that it was impossible
+for any man to determine either one sex or the other. Everard Home
+dissected a dog with apparent external organs of the female, but
+discovered that neither sex was sufficiently pronounced to admit of
+classification. Home also saw at the Royal Marine Hospital at Plymouth,
+in 1779, a marine who some days after admission was reported to be a
+girl. On examination Home found him to possess a weak voice, soft skin,
+voluminous breasts, little beard, and the thighs and legs of a woman.
+There was fat on the pubis, the penis was short and small and incapable
+of erection, the testicles of fetal size; he had no venereal desires
+whatever, and as regards sex was virtually neuter.
+
+The legal aspect of hermaphroditism has always been much discussed.
+Many interesting questions arise, and extraordinary complications
+naturally occur. In Rome a hermaphrodite could be a witness to a
+testament, the exclusive privilege of a man, and the sex was settled by
+the predominance. If the male aspect and traits together with the
+generative organs of man were most pronounced, then the individual
+could call himself a man.  "Hermaphroditus an ad testamentum adhiberi
+possit qualitas sesus incalescentis ostendit."
+
+There is a peculiar case on record in which the question of legal male
+inheritance was not settled until the individual had lived as a female
+for fifty-one years. This person was married when twenty-one, but
+finding coitus impossible, separated after ten years, and though
+dressing as a female had coitus with other women. She finally lived
+with her brother, with whom she eventually came to blows. She
+prosecuted him for assault, and the brother in return charged her with
+seducing his wife. Examination ensued, and at this ripe age she was
+declared to be a male.
+
+The literature on hermaphroditism is so extensive that it is impossible
+to select a proper representation of the interesting cases in this
+limited space, and the reader is referred to the modern French works on
+this subject, in which the material is exhaustive and the discussion
+thoroughly scientific.
+
+
+
+CHAPTER VI.
+
+MINOR TERATA.
+
+Ancient Ideas Relative to Minor Terata.--The ancients viewed with great
+interest the minor structural anomalies of man, and held them to be
+divine signs or warnings in much the same manner as they considered
+more pronounced monstrosities. In a most interesting and instructive
+article, Ballantyne quotes Ragozin in saying that the
+Chaldeo-Babylonians, in addition to their other numerous subdivisions
+of divination, drew presages and omens for good or evil from the
+appearance of the liver, bowels, and viscera of animals offered for
+sacrifice and opened for inspection, and from the natural defects or
+monstrosities of babies or the young of animals. Ballantyne names this
+latter subdivision of divination fetomancy or teratoscopy, and thus
+renders a special chapter as to omens derived from monstrous births,
+given by Lenormant:--
+
+"The prognostics which the Chaldeans claimed to draw from monstrous
+births in man and the animals are worthy of forming a class by
+themselves, insomuch the more as it is the part of their divinatory
+science with which, up to the present time, we are best acquainted. The
+development that their astrology had given to 'genethliaque,' or the
+art of horoscopes of births, had led them early to attribute great
+importance to all the teratologic facts which were there produced. They
+claimed that an experience of 470,000 years of observations, all
+concordant, fully justified their system, and that in nothing was the
+influence of the stars marked in a more indubitable manner than in the
+fatal law which determined the destiny of each individual according to
+the state of the sky at the moment when he came into the world. Cicero,
+by the very terms which he uses to refute the Chaldeans, shows that the
+result of these ideas was to consider all infirmities and monstrosities
+that new-born infants exhibited as the inevitable and irremediable
+consequence of the action of these astral positions. This being
+granted, the observation of similar monstrosities gave, as it were, a
+reflection of the state of the sky; on which depended all terrestrial
+things; consequently, one might read in them the future with as much
+certainty as in the stars themselves. For this reason the greatest
+possible importance was attached to the teratologic auguries which
+occupy so much space in the fragments of the great treatise on
+terrestrial presages which have up to the present time been published."
+
+The rendering into English of the account of 62 teratologic cases in
+the human subject with the prophetic meanings attached to them by
+Chaldean diviners, after the translation of Opport, is given as follows
+by Ballantyne, some of the words being untranslatable:--
+
+"When a woman gives birth to an infant--
+
+(1) that has the ears of a lion, there will be a powerful king in the
+country;
+
+(2) that wants the right ear, the days of the master (king) will be
+prolonged (reach old age);
+
+(3) that wants both ears, there will be mourning in the country, and
+the country will be lessened (diminished);
+
+(4) whose right ear is small, the house of the man (in whose house the
+birth took place) will be destroyed;
+
+(5) whose ears are both small, the house of the man will be built of
+bricks;
+
+(6) whose right ear is mudissu tehaat (monstrous), there will be an
+androgyne in the house of the new-born
+
+(7) whose ears are both mudissu (deformed), the country will perish and
+the enemy rejoice;
+
+(8) whose right ear is round, there will be an androgyne in the house
+of the new-born;
+
+(9) whose right ear has a wound below, and tur re ut of the man, the
+house will be estroyed;
+
+(10) that has two ears on the right side and none on the left, the gods
+will bring about a stable reign, the country will flourish, and it will
+be a land of repose;
+
+(11) whose ears are both closed, sa a au;
+
+(12) that has a bird's beak, the country will be peaceful;
+
+(13) that has no mouth, the mistress of the house will die;
+
+(14) that has no right nostril, the people of the world will be injured;
+
+(15) whose nostrils are absent, the country will be in affliction, and
+the house of the man will be ruined;
+
+(16) whose jaws are absent, the days of the master (king) will be
+prolonged, but the house (where the infant is born) will be ruined.
+
+When a woman gives birth to an infant--
+
+(17) that has no lower jaw, mut ta at mat, the name will not be effaced;
+
+(20) that has no nose, affliction will seize upon the country, and the
+master of the house will die;
+
+(21) that has neither nose nor virile member (penis), the army of the
+king will be strong, peace will be in the land, the men of the king
+will be sheltered from evil influences, and Lilit (a female demon)
+shall not have power over them;
+
+(22) whose upper lip overrides the lower, the people of the world will
+rejoice (or good augury for the troops);
+
+(23) that has no lips, affliction will seize upon the land, and the
+house of the man will be destroyed;
+
+(24) whose tongue is kuri aat, the man will be spared (?);
+
+(25) that has no right hand, the country will be convulsed by an
+earthquake;
+
+(26) that has no fingers, the town will have no births, the bar shall
+be lost;
+
+(27) that has no fingers on the right side, the master (king) will not
+pardon his adversary (or shall be humiliated by his enemies);
+
+(28) that has six fingers on the right side, the man will take the
+lukunu of the house;
+
+(29) that has six very small toes on both feet, he shall not go to the
+lukunu;
+
+(30) that has six toes on each foot, the people of the world will be
+injured (calamity to the troops);
+
+(31) that has the heart open and that has no skin, the country will
+suffer from calamities;
+
+(32) that has no penis, the master of the house will be enriched by the
+harvest of his field;
+
+(33) that wants the penis and the umbilicus, there will be ill-will in
+the house, the woman (wife) will have an overbearing eye (be haughty);
+but the male descent of the palace will be more extended.
+
+When a woman gives birth to an infant--
+
+(34) that has no well-marked sex, calamity and affliction will seize
+upon the land; the master of the house shall have no happiness;
+
+(35) whose anus is closed, the country will suffer from want of
+nourishment;
+
+(36) whose right testicle (?) is absent, the country of the master
+(king) will perish;
+
+(37) whose right foot is absent, his house will be ruined and there
+will be abundance in that of the neighbor;
+
+(38) that has no feet, the canals of the country will be cut
+(intercepted) and the house ruined;
+
+(39) that has the right foot in the form of a fish's tail, the booty of
+the country of the humble will not be imas sa bir;
+
+(40) whose hands and feet are like four fishes' tails (fins), the
+master (king) shall perish (?) and his country shall be consumed;
+
+(41) whose feet are moved by his great hunger, the house of the su su
+shall be destroyed;
+
+(42) whose foot hangs to the tendons of the body, there will be great
+prosperity in the land;
+
+(43) that has three feet, two in their normal position (attached to the
+body) and the third between them, there will be great prosperity in the
+land;
+
+(44) whose legs are male and female, there will be rebellion;
+
+(45) that wants the right heel, the country of the master (king) will
+be destroyed.
+
+When a woman gives birth to an infant--
+
+(46) that has many white hairs on the head, the days of the king will
+be prolonged;
+
+(47) that has much ipga on the head, the master of the house will die,
+the house will be destroyed;
+
+(48) that has much pinde on the head, joy shall go to meet the house
+(that has a head on the head, the good augury shall enter at its aspect
+into the house);
+
+(49) that has the head full of hali, there will be ill-will toward him
+and the master (king) of the town shall die;
+
+(50) that has the head full of siksi the king will repudiate his
+masters;
+
+(51) that has some pieces of flesh (skin) hanging on the head, there
+shall be ill-will;
+
+(52) that has some branches (?) (excrescences) of flesh (skin) hanging
+on the head, there shall be ill-will, the house will perish;
+
+(53) that has some formed fingers (horns?) on the head, the days of the
+king will be less and the years lengthened (in the duration of his old
+age);
+
+(54) that has some kali on the head, there will be a king of the land;
+
+(55) that has a ---- of a bird on the head, the master of the house
+shall not prosper;
+
+(56) that has some teeth already through (cut), the days of the king
+will arrive at old age, the country will show itself powerful over
+(against) strange (feeble) lands, but the house where the infant is
+born will be ruined;
+
+(57) that has the beard come out, there will be abundant rains;
+
+(58) that has some birta on the head, the country will be strengthened
+(reinforced);
+
+(59) that has on the head the mouth of an old man and that foams
+(slabbers), there will be great prosperity in the land, the god Bin
+will give a magnificent harvest (inundate the land with fertility), and
+abundance shall be in the land;
+
+(60) that has on one side of the head a thickened ear, the first-born
+of the men shall live a long time (?);
+
+(61) that has on the head two long and thick ears, there will be
+tranquility and the pacification of litigation (contests);
+
+(62) that has the figure in horn (like a horn?)..."
+
+As ancient and as obscure as are these records, Ballantyne has
+carefully gone over each, and gives the following lucid explanatory
+comments:--
+
+"What 'ears like a lion' (No. 1) may have been it is difficult to
+determine; but doubtless the direction and shape of the auricles were
+so altered as to give them an animal appearance, and possibly the
+deformity was that called 'orechio ad ansa' by Lombroso. The absence of
+one or both ears (Nos. 2 and 3) has been noted in recent times by
+Virchow (Archiv fur path. Anat. xxx., p.  221), Gradenigo (Taruffi's
+'Storia della Teratologia,' vi., p.  552), and others. Generally some
+cartilaginous remnant is found, but on this point the Chaldean record
+is silent. Variations in the size of the ears (Nos. 4 and 5) are well
+known at the present time, and have been discussed at length by Binder
+(Archiv fur Psychiatrie und Nervenkrankheiten, xx., 1887) and others.
+The exact malformation indicated in Nos. 6 and 7 is, of course, not to
+be determined, although further researches in Assyriology may clear up
+this point. The 'round ear' (No. 8) is one of Binder's types, and that
+with a 'wound below' (No. 9) probably refers to a case of fistula auris
+congenita (Toynbee, 'Diseases of the Ear,' 1860). The instance of an
+infant born with two ears on the right side (No. 10) was doubtless one
+of cervical auricle or preauricular appendage, whilst closure of the
+external auditory meatus (No. 11) is a well-known deformity.
+
+"The next thirteen cases (Nos. 12-24) were instances of anomalies of
+the mouth and nose. The 'bird's beak' (No. 12) may have been a markedly
+aquiline nose; No. 13 was a case of astoma; and Nos. 14 and 15 were
+instances of stenosis or atresia of the anterior nares. Fetuses with
+absence of the maxillae (Nos. 16 and 17) are in modern terminology
+called agnathous. Deformities like that existing in Nos. 20 and 21 have
+been observed in paracephalic and cyclopic fetuses. The coincident
+absence of nose and penis (No.  21) is interesting, especially when
+taken in conjunction with the popular belief that the size of the
+former organ varies with that of the latter. Enlargement of the upper
+lip (No. 22), called epimacrochelia by Taruffi, and absence of the lips
+(No. 23), known now under the name of brachychelia, have been not
+unfrequently noticed in recent times. The next six cases (Nos.  25-30)
+were instances of malformations of the upper limb: Nos.  25, 26. and 27
+were probably instances of the so-called spontaneous or intrauterine
+amputation; and Nos. 28, 29, and 30 were examples of the comparatively
+common deformity known as polydactyly. No. 31 was probably a case of
+ectopia cordis.
+
+"Then follow five instances of genital abnormalities (Nos.  32-36),
+consisting of absence of the penis (epispadias?), absence of penis and
+umbilicus (epispadias and exomphalos?), hermaphroditism, imperforate
+anus, and nondescent of one testicle. The nine following cases (Nos.
+37-45) were anomalies of the lower limbs: Nos. 37, 38, and 42 may have
+been spontaneous amputations; Nos. 39 and 40 were doubtless instances
+of webbed toes (syndactyly), and the deformity indicated in No. 45 was
+presumably talipes equinus. The infant born with three feet (No.  43)
+was possibly a case of parasitic monstrosity, several of which have
+been reported in recent teratologic literature; but what is meant by
+the statement concerning 'male and female legs' it is not easy to
+determine.
+
+"Certain of the ten following prodigies (Nos. 46-55) cannot in the
+present state of our knowledge be identified. The presence of
+congenital patches of white or gray hair on the scalp, as recorded in
+No. 46, is not an unknown occurrence at the present time; but what the
+Chaldeans meant by ipga, pinde, hali riksi, and kali on the head of the
+new-born infant it is impossible to tell. The guess may be hazarded
+that cephalhematoma, hydrocephalus, meningocele, nevi, or an excessive
+amount of vernix caseosa were the conditions indicated, but a wider
+acquaintance with the meaning of the cuneiform characters is necessary
+before any certain identification is possible. The 'pieces of skin
+hanging from the head' (No. 51) may have been fragments of the
+membranes; but there is nothing in the accompanying prediction to help
+us to trace the origin of the popular belief in the good luck following
+the baby born with a caul. If No. 53 was a case of congenital horns on
+the head, it must be regarded as a unique example, unless, indeed, a
+form of fetal ichthyosis be indicated.
+
+"The remaining observations (No. 56-62) refer to cases of congenital
+teeth (No. 56) to deformity of the ears (Nos. 60 and 61), and a horn
+(No. 62)."
+
+
+From these early times almost to the present day similar significance
+has been attached to minor structural anomalies. In the following pages
+the individual anomalies will be discussed separately and the most
+interesting examples of each will be cited. It is manifestly evident
+that the object of this chapter is to mention the most striking
+instances of abnormism and to give accompanying descriptions of
+associate points of interest, rather than to offer a scientific
+exposition of teratology, for which the reader is referred elsewhere.
+
+Congenital defect of the epidermis and true skin is a rarity in
+pathology. Pastorello speaks of a child which lived for two and a half
+hours whose hands and feet were entirely destitute of epidermis; the
+true skin of those parts looked like that of a dead and already
+putrefying child. Hanks cites the history of a case of antepartum
+desquamation of the skin in a living fetus.  Hochstetter describes a
+full-term, living male fetus with cutaneous defect on both sides of the
+abdomen a little above the umbilicus. The placenta and membranes were
+normal, a fact indicating that the defect was not due to amniotic
+adhesions; the child had a club-foot on the left side. The mother had a
+fall three weeks before labor.
+
+Abnormal Elasticity of the Skin.--In some instances the skin is affixed
+so loosely to the underlying tissues and is possessed of so great
+elasticity that it can be stretched almost to the same extent as India
+rubber. There have been individuals who could take the skin of the
+forehead and pull it down over the nose, or raise the skin of the neck
+over the mouth. They also occasionally have an associate muscular
+development in the subcutaneous tissues similar to the panniculus
+adiposus of quadrupeds, giving them preternatural motile power over the
+skin. The man recently exhibited under the title of the "Elastic-Skin
+Man" was an example of this anomaly. The first of this class of
+exhibitionists was seen in Buda-Pesth some years since and possessed
+great elasticity in the skin of his whole body; even his nose could be
+stretched. Figure 70 represents a photograph of an exhibitionist named
+Felix Wehrle, who besides having the power to stretch his skin could
+readily bend his fingers backward and forward. The photograph was taken
+in January, 1888.
+
+In these congenital cases there is loose attachment of the skin without
+hypertrophy, to which the term dermatolysis is restricted by Crocker.
+Job van Meekren, the celebrated Dutch physician of the seventeenth
+century, states that in 1657 a Spaniard, Georgius Albes, is reported to
+have been able to draw the skin of the left pectoral region to the left
+ear, or the skin under the face over the chin to the vertex. The skin
+over the knee could be extended half a yard, and when it retracted to
+its normal position it was not in folds. Seiffert examined a case of
+this nature in a young man of nineteen, and, contrary to Kopp's
+supposition, found that in some skin from over the left second rib the
+elastic fibers were quite normal, but there was transformation of the
+connective tissue of the dermis into an unformed tissue like a myxoma,
+with total disappearance of the connective-tissue bundles. Laxity of
+the skin after distention is often seen in multipara, both in the
+breasts and in the abdominal walls, and also from obesity, but in all
+such cases the skin falls in folds, and does not have a normal
+appearance like that of the true "elastic-skin man."
+
+Occasionally abnormal development of the scalp is noticed.  McDowall of
+twenty-two. On each side of the median line of the head there were five
+deep furrows, more curved and shorter as the distance from the median
+line increased. In the illustration the hair in the furrows is left
+longer than that on the rest of the head. The patient was distinctly
+microcephalic and the right side of the body was markedly wasted. The
+folds were due to hypertrophy of the muscles and scalp, and the same
+sort of furrowing is noticed when a dog "pricks his ears." This case
+may possibly be considered as an example of reversion to inferior
+types. Cowan records two cases of the foregoing nature in idiots.  The
+first case was a paralytic idiot of thirty-nine, whose cranial
+development was small in proportion to the size of the face and body;
+the cranium was oxycephalic; the scalp was lax and redundant and the
+hair thin; there were 13 furrows, five on each side running
+anteroposteriorly, and three in the occipital region running
+transversely. The occipitofrontalis muscle had no action on them. The
+second case was that of an idiot of forty-four of a more degraded type
+than the previous one. The cranium was round and bullet-shaped and the
+hair generally thick. The scalp was not so lax as in the other case,
+but the furrows were more crooked.  By tickling the scalp over the back
+of the neck the two median furrows involuntarily deepened.
+
+Impervious Skin.--There have been individuals who claimed that their
+skin was impervious to ordinary puncture, and from time to time these
+individuals have appeared in some of the larger medical clinics of the
+world for inspection. According to a recent number of the London
+Graphic, there is in Berlin a Singhalese who baffles all investigations
+by physicians by the impenetrability of his skin. The bronzed
+Easterner, a Hercules in shape, claims to have found an elixir which
+will render the human skin impervious to any metal point or sharpened
+edge of a knife or dagger, and calls himself the "Man with Iron Skin."
+He is now exhibiting himself, and his greatest feat is to pass with his
+entire body through a hoop the inside of which is hardly big enough to
+admit his body and is closely set with sharp knife-points, daggers,
+nails, and similar things. Through this hoop he squeezes his body with
+absolute impunity. The physicians do not agree as to his immunity, and
+some of them think that Rhannin, which is his name, is a fakir who has
+by long practice succeeded in hardening himself against the impressions
+of metal upon his skin. The professors of the Berlin clinic, however,
+considered it worth while to lecture about the man's skin, pronouncing
+it an inexplicable matter. This individual performed at the London
+Alhambra in the latter part of 1895. Besides climbing with bare feet a
+ladder whose rungs were sharp-edged swords, and lying on a bed of nail
+points with four men seated upon him, he curled himself up in a barrel,
+through whose inner edges nails projected, and was rolled about the
+stage at a rapid rate. Emerging from thence uninjured, he gracefully
+bows himself off the stage.
+
+Some individuals claim immunity from burns and show many interesting
+feats in handling fire. As they are nothing but skilful "fire jugglers"
+they deserve no mention here. The immunity of the participants in the
+savage fire ceremonies will be discussed in Chapter IX.
+
+Albinism is characterized by the absolute or relative absence of
+pigment of the skin, due to an arrest, insufficiency, or retardation of
+this pigment. Following Trelat and Guinard, we may divide albinism into
+two classes,--general and partial.
+
+As to the etiology of albinism, there is no known cause of the complete
+form. Heredity plays no part in the number of cases investigated by the
+authors. D'Aube, by his observations on white rabbits, believes that
+the influence of consanguinity is a marked factor in the production of
+albinism; there are, however, many instances of heredity in this
+anomaly on record, and this idea is possibly in harmony with the
+majority of observers.  Geoffroy-Saint-Hilaire has noted that albinism
+can also be a consequence of a pathologic condition having its origin
+in adverse surroundings, the circumstances of the parents, such as the
+want of exercise, nourishment, light, etc.
+
+Lesser knew a family in which six out of seven were albinos, and in
+some tropical countries, such as Loango, Lower Guinea, it is said to be
+endemic. It is exceptional for the parents to be affected; but in a
+case of Schlegel, quoted by Crocker, the grandfather was an albino, and
+Marey describes the case of the Cape May albinos, in which the mother
+and father were "fair emblems of the African race," and of their
+children three were black and three were white, born in the following
+order: two consecutive black boys, two consecutive white girls, one
+black girl, one white boy. Sym of Edinburgh relates the history of a
+family of seven children, who were alternately white and black.  All
+but the seventh were living and in good health and mentally without
+defect. The parents and other relatives were dark. Figure 73 portrays
+an albino family by the name of Cavalier who exhibited in Minneapolis
+in 1887.
+
+Examples of the total absence of pigment occur in all races, but
+particularly is it interesting when seen in negroes who are found
+absolutely white but preserving all the characteristics of their race,
+as, for instance, the kinky, woolly hair, flattened nose, thick lips,
+etc. Rene Claille, in his "Voyage a Tombouctou," says that he saw a
+white infant, the offspring of a negro and negress.  Its hair was
+white, its eyes blue, and its lashes flaxen. Its pupils were of a
+reddish color, and its physiognomy that of a Mandingo. He says such
+cases are not at all uncommon; they are really negro albinos. Thomas
+Jefferson, in his "History of Virginia," has an excellent description
+of these negroes, with their tremulous and weak eyes; he remarks that
+they freckle easily. Buffon speaks of Ethiops with white twins, and
+says that albinos are quite common in Africa, being generally of
+delicate constitution, twinkling eyes, and of a low degree of
+intelligence; they are despised and ill-treated by the other negroes.
+Prichard, quoted by Sedgwick, speaks of a case of atavic transmission
+of albinism through the male line of the negro race.  The grandfather
+and the grandchild were albinos, the father being black. There is a
+case of a brother and sister who were albinos, the parents being of
+ordinary color but the grandfather an albino. Coinde, quoted by
+Sedgwick, speaks of a man who, by two different wives, had three albino
+children.
+
+A description of the ordinary type of albino would be as follows: The
+skin and hair are deprived of pigment; the eyebrows and eyelashes are
+of a brilliant white or are yellowish; the iris and the choroid are
+nearly or entirely deprived of coloring material, and in looking at the
+eye we see a roseate zone and the ordinary pink pupil; from absence of
+pigment they necessarily keep their eyes three-quarters closed, being
+photophobic to a high degree.  They are amblyopic, and this is due
+partially to a high degree of ametropia (caused by crushing of the
+eyeball in the endeavor to shut out light) and from retinal exhaustion
+and nystagmus. Many authors have claimed that they have little
+intelligence, but this opinion is not true. Ordinarily the reproductive
+functions are normal, and if we exclude the results of the union of two
+albinos we may say that these individuals are fecund.
+
+Partial albinism is seen. The parts most often affected are the
+genitals, the hair, the face, the top of the trunk, the nipple, the
+back of the hands and fingers. Folker reports the history of a case of
+an albino girl having pink eyes and red hair, the rest of the family
+having pink eyes and white hair. Partial albinism, necessarily
+congenital, presenting a piebald appearance, must not be confounded
+with leukoderma, which is rarely seen in the young and which will be
+described later.
+
+Albinism is found in the lower animals, and is exemplified ordinarily
+by rats, mice, crows, robins, etc. In the Zoologic Garden at Baltimore
+two years ago was a pair of pure albino opossums. The white elephant is
+celebrated in the religious history of Oriental nations, and is an
+object of veneration and worship in Siam. White monkeys and white
+roosters are also worshiped. In the Natural History Museum in London
+there are stuffed examples of albinism and melanism in the lower
+animals.
+
+Melanism is an anomaly, the exact contrary of the preceding. It is
+characterized by the presence in the tissues and skin of an excessive
+amount of pigment. True total melanism is unknown in man, in whom is
+only observed partial melanism, characterized simply by a pronounced
+coloration of part of the integument.
+
+Some curious instances have been related of an infant with a
+two-colored face, and of others with one side of the face white and the
+other black; whether they were cases of partial albinism or partial
+melanism cannot be ascertained from the descriptions.
+
+Such epidermic anomalies as ichthyosis, scleroderma, and molluscum
+simplex, sometimes appearing shortly after birth, but generally seen
+later in life, will be spoken of in the chapter on Anomalous Skin
+Diseases.
+
+Human horns are anomalous outgrowths from the skin and are far more
+frequent than ordinarily supposed. Nearly all the older writers cite
+examples. Aldrovandus, Amatus Lusitanus, Boerhaave, Dupre, Schenck,
+Riverius, Vallisneri, and many others mention horns on the head. In the
+ancient times horns were symbolic of wisdom and power. Michael Angelo
+in his famous sculpture of Moses has given the patriarch a pair of
+horns. Rhodius observed a Benedictine monk who had a pair of horns and
+who was addicted to rumination. Fabricius saw a man with horns on his
+head, whose son ruminated; the son considered that by virtue of his
+ruminating characteristics his father had transmitted to him the
+peculiar anomaly of the family. Fabricius Hildanus saw a patient with
+horns all over the body and another with horns on the forehead.
+Gastaher speaks of a horn from the left temple; Zacutus Lusitanus saw a
+horn from the heel; Wroe, one of considerable length from the scapula;
+Cosnard, one from the bregma; the Ephemerides, from the foot; Borellus,
+from the face and foot, and Ash, horns all over the body. Home, Cooper,
+and Treves have collected examples of horns, and there is one 11 inches
+long and 2 1/2 in circumference in a London museum. Lozes collected
+reports of 71 cases of horns,--37 in females, 31 in males, and three in
+infants. Of this number, 15 were on the head, eight on the face, 18 on
+the lower extremities, eight on the trunk, and three on the glans
+penis. Wilson collected reports of 90 cases,--44 females, 39 males, the
+sex not being mentioned in the remainder. Of these 48 were on the head,
+four on the face, four on the nose, 11 on the thigh, three on the leg
+and foot, six on the back, five on the glans penis, and nine on the
+trunk. Lebert's collection numbered 109 cases of cutaneous horns. The
+greater frequency among females is admitted by all authors. Old age is
+a predisposing cause. Several patients over seventy have been seen and
+one of ninety-seven.
+
+Instances of cutaneous horns, when seen and reported by the laity, give
+rise to most amusing exaggerations and descriptions.  The following
+account is given in New South Wales, obviously embellished with
+apocryphal details by some facetious journalist: The child, five weeks
+old, was born with hair two inches long all over the body; his features
+were fiendish and his eyes shone like beads beneath his shaggy brows.
+He had a tail 18 inches long, horns from the skull, a full set of
+teeth, and claw-like hands; he snapped like a dog and crawled on all
+fours, and refused the natural sustenance of a normal child. The mother
+almost became an imbecile after the birth of the monster. The country
+people about Bomballa considered this devil-child a punishment for a
+rebuff that the mother gave to a Jewish peddler selling
+Crucifixion-pictures. Vexed by his persistence, she said she would
+sooner have a devil in her house than his picture.
+
+Lamprey has made a minute examination of the much-spoken-of "Horned Men
+of Africa." He found that this anomaly was caused by a congenital
+malformation and remarkable development of the infraorbital ridge of
+the maxillary bone. He described several cases, and through an
+interpreter found that they were congenital, followed no history of
+traumatism, caused little inconvenience, and were unassociated with
+disturbance of the sense of smell. He also learned that the deformity
+was quite rare in the Cape Coast region, and received no information
+tending to prove the conjecture that the tribes in West Africa used
+artificial means to produce the anomaly, although such custom is
+prevalent among many aborigines.
+
+Probably the most remarkable case of a horn was that of Paul Rodrigues,
+a Mexican porter, who, from the upper and lateral part of his head, had
+a horn 14 inches in circumference and divided into three shafts, which
+he concealed by constantly wearing a peculiarly shaped red cap. There
+is in Paris a wax model of a horn, eight or nine inches in length,
+removed from an old woman by the celebrated Souberbielle. Figure 75 is
+from a wax model supposed to have been taken from life, showing an
+enormous grayish-black horn proceeding from the forehead. Warren
+mentions a case under the care of Dubois, in a woman from whose
+forehead grew a horn six inches in diameter and six inches in height.
+It was hard at the summit and had a fetid odor. In 1696 there was an
+old woman in France who constantly shed long horns from her forehead,
+one of which was presented to the King. Bartholinus mentions a horn 12
+inches long. Voigte cites the case of an old woman who had a horn
+branching into three portions, coming from her forehead. Sands speaks
+of a woman who had a horn 6 3/4 inches long, growing from her head.
+There is an account of the extirpation of a horn nearly ten inches in
+length from the forehead of a woman of eighty-two. Bejau describes a
+woman of forty from whom he excised an excrescence resembling a ram's
+horn, growing from the left parietal region. It curved forward and
+nearly reached the corresponding tuberosity. It was eight cm.  long,
+two cm. broad at the base, and 1 1/2 cm. at the apex, and was quite
+mobile. It began to grow at the age of eleven and had constantly
+increased. Vidal presented before the Academie de Medecine in 1886 a
+twisted horn from the head of a woman. This excrescence was ten inches
+long, and at the time of presentation reproduction of it was taking
+place in the woman. Figure 76 shows a case of ichthyosis cornea
+pictured in the Lancet, 1850.
+
+There was a woman of seventy-five, living near York, who had a horny
+growth from the face which she broke off and which began to reproduce,
+the illustration representing the growth during twelve months. Lall
+mentions a horn from the cheek; Gregory reports one that measured 7 1/2
+inches long that was removed from the temple of a woman in Edinburgh;
+Chariere of Barnstaple saw a horn that measured seven inches growing
+from the nape of a woman's neck; Kameya Iwa speaks of a dermal horn of
+the auricle; Saxton of New York has excised several horns from the
+tympanic membrane of the ear; Noyes speaks of one from the eyelid;
+Bigelow mentions one from the chin; Minot speaks of a horn from the
+lower lip, and Doran of one from the neck.
+
+Gould cites the instance of a horn growing from an epitheliomatous
+penis. The patient was fifty-two years of age and the victim of
+congenital phimosis. He was circumcised four years previously, and
+shortly after the wound healed there appeared a small wart, followed by
+a horn about the size of a marble. Jewett speaks of a penile horn 3 1/2
+inches long and 3 3/4 inches in diameter; Pick mentions one 2 1/2
+inches long. There is an account of a Russian peasant boy who had a
+horn on his penis from his earliest childhood. Johnson mentions a case
+of a horn from the scrotum, which was of sebaceous origin and was
+subsequently supplanted by an epithelioma.
+
+Ash reported the case of a girl named Annie Jackson, living in
+Waterford, Ireland, who had horny excrescences from her joints, arms,
+axillae, nipples, ears, and forehead. Locke speaks of a boy at the
+Hopital de la Charite in Paris, who had horny excrescences four inches
+long and 11 inches in circumference growing from his fingers and toes.
+
+Wagstaffe presents a horn which grew from the middle of the leg six
+inches below the knee in a woman of eighty. It was a flattened spiral
+of more than two turns, and during forty years' growth had reached the
+length of 14.3 inches. Its height was 3.8 inches, its skin-attachment
+1.5 inches in diameter, and it ended in a blunt extremity of 0.5 inch
+in diameter. Stephens mentions a dermal horn on the buttocks at the
+seat of a carcinomatous cicatrix. Harris and Domonceau speak of horns
+from the leg.  Cruveilhier saw a Mexican Indian who had a horn four
+inches long and eight inches in circumference growing from the left
+lumbar region. It had been sawed off twice by the patient's son and was
+finally extirpated by Faget. The length of the pieces was 12 inches.
+Bellamy saw a horn on the clitoris about the size of a tiger's claw in
+a its origin from beneath the preputium clitoridis.
+
+Horns are generally solitary but cases of multiple formation are known
+Lewin and Heller record a syphilitic case with eight cutaneous horns on
+the palms and soles. A female patient of Manzuroff had as many as 185
+horns.
+
+Pancoast reports the case of a man whose nose, cheeks, forehead, and
+lips were covered with horny growths, which had apparently undergone
+epitheliomatous degeneration. The patient was a sea-captain of
+seventy-eight, and had been exposed to the winds all his life. He had
+suffered three attacks of erysipelas from prolonged exposure. When he
+consulted Pancoast the horns had nearly all fallen off and were brought
+to the physician for inspection; and the photograph was taken after the
+patient had tied the horns in situ on his face.
+
+Anomalies of the Hair.--Congenital alopecia is quite rare, and it is
+seldom that we see instances of individuals who have been totally
+destitute of hair from birth. Danz knew of two adult sons of a Jewish
+family who never had hair or teeth. Sedgwick quotes the case of a man
+of fifty-eight who ever since birth was totally devoid of hair and in
+whom sensible perspiration and tears were absent. A cousin on his
+mother's side, born a year before him, had precisely the same
+peculiarity. Buffon says that the Turks and some other people practised
+depilatory customs by the aid of ointments and pomades, principally
+about the genitals. Atkinson exhibited in Philadelphia a man of forty
+who never had any distinct growth of hair since birth, was edentulous,
+and destitute of the sense of smell and almost of that of taste. He had
+no apparent perspiration, and when working actively he was obliged to
+wet his clothes in order to moderate the heat of his body. He could
+sleep in wet clothes in a damp cellar without catching cold. There was
+some hair in the axillae and on the pubes, but only the slightest down
+on the scalp, and even that was absent on the skin. His maternal
+grandmother and uncle were similarly affected; he was the youngest of
+21 children, had never been sick, and though not able to chew food in
+the ordinary manner, he had never suffered from dyspepsia in any form.
+He was married and had eight children. Of these, two girls lacked a
+number of teeth, but had the ordinary quantity of hair. Hill speaks of
+an aboriginal man in Queensland who was entirely devoid of hair on the
+head, face, and every part of the body. He had a sister, since dead,
+who was similarly hairless. Hill mentions the accounts given of another
+black tribe, about 500 miles west of Brisbane, that contained hairless
+members. This is very strange, as the Australian aboriginals are a very
+hairy race of people.
+
+Hutchinson mentions a boy of three and a half in whom there was
+congenital absence of hair and an atrophic condition of the skin and
+appendages. His mother was bald from the age of six, after alopecia
+areata. Schede reports two cases of congenitally bald children of a
+peasant woman (a boy of thirteen and a girl of six months). They had
+both been born quite bald, and had remained so.  In addition there were
+neither eyebrows nor eyelashes and nowhere a trace of lanugo. The
+children were otherwise healthy and well formed. The parents and
+brothers were healthy and possessed a full growth of hair. Thurman
+reports a case of a man of fifty-eight, who was almost devoid of hair
+all his life and possessed only four teeth. His skin was very delicate
+and there was absence of sensible perspiration and tears. The skin was
+peculiar in thinness, softness, and absence of pigmentation. The hair
+on the crown of the head and back was very fine, short, and soft, and
+not more in quantity than that of an infant of three months. There was
+a similar peculiarity in his cousin-german.  Williams mentions the case
+of a young lady of fifteen with scarcely any hair on the eyebrows or
+head and no eyelashes. She was edentulous and had never sensibly
+perspired. She improved under tonic treatment.
+
+Rayer quotes the case of Beauvais, who was a patient in the Hopital de
+la Charite in 1827. The skin of this man's cranium was apparently
+completely naked, although in examining it narrowly it was found to be
+beset with a quantity of very white and silky hair, similar to the down
+that covers the scalp of infants; here and there on the temples there
+were a few black specks, occasioned by the stumps of several hairs
+which the patient had shaved off. The eyebrows were merely indicated by
+a few fine and very short hairs; the free edges of the eyelids were
+without cilia, but the bulb of each of these was indicated by a small,
+whitish point. The beard was so thin and weak that Beauvais clipped it
+off only every three weeks. A few straggling hairs were observed on the
+breast and pubic region, as in young people on the approach of puberty.
+There was scarcely any under the axillae. It was rather more abundant
+on the inner parts of the legs. The voice was like that of a full-grown
+and well-constituted man. Beauvais was of an amorous disposition and
+had had syphilis twice. His mother and both sisters had good heads of
+hair, but his father presented the same defects as Beauvais.
+
+Instances are on record of women devoid of hair about the genital
+region. Riolan says that he examined the body of a female libertine who
+was totally hairless from the umbilical region down.
+
+Congenital alopecia is seen in animals. There is a species of dog, a
+native of China but now bred in Mexico and in the United States, which
+is distinguished for its congenital alopecia. The same fact has been
+observed occasionally in horses, cattle, and dogs. Heusner has seen a
+pigeon destitute of feathers, and which engendered a female which in
+her turn transmitted the same characteristic to two of her young.
+
+Sexualism and Hair Growth.--The growth or development of the hair may
+be accelerated by the state of the organs of generation. This is
+peculiarly noticeable in the pubic hairs and the beard, and is fully
+exemplified in the section on precocious development (Chapter VII);
+however, Moreau de la Sarthe showed a child to the Medical Faculty of
+Paris in whom precocious development of the testicles had influenced
+that of the hair to such a degree that, at the age of six, the chest of
+this boy was as thickly set with hair as is usually seen in adults. It
+is well known that eunuchs often lose a great part of their beards, and
+after removal of the ovaries women are seen to develop an extra
+quantity of hair.  Gerberon tells of an infant with a beard, and
+Paullini and the Ephemerides mention similar instances.
+
+Bearded women are not at all infrequent. Hippocrates mentions a female
+who grew a beard shortly after menstruation had ceased. It is a
+well-recognized fact that after the menopause women become more
+hirsute, the same being the case after removal of any of the functional
+generative apparatus. Vicat saw a virgin who had a beard, and Joch
+speaks of "foeminis barbati." Leblond says that certain women of
+Ethiopia and South America have beards and little or no menstruation.
+He also says that sterility and excessive chastity are causes of female
+beards, and cites the case of Schott of a young widow who secluded
+herself in a cloister, and soon had a beard.
+
+Barbara Urster, who lived in the 16th century, had a beard to her
+girdle. The most celebrated "bearded woman" was Rosine-Marguerite
+Muller, who died in a hospital in Dresden in 1732, with a thick beard
+and heavy mustache. Julia Pastrana had her face covered with thick hair
+and had a full beard and mustache. She exhibited defective dentition in
+both jaws, and the teeth present were arranged in an irregular fashion.
+She had pronounced prognathism, which gave her a simian appearance.
+Ecker examined in 1876 a woman who died at Fribourg, whose face
+contained a full beard and a luxuriant mustache.
+
+Harris reports several cases of bearded women, inmates of the Coton
+Hill Lunatic Asylum. One of the patients was eighty-three years of age
+and had been insane forty-four years following a puerperal period. She
+would not permit the hair on her face to be cut, and the curly white
+hairs had attained a length of from eight to ten inches on the chin,
+while on the upper lip the hairs were scarcely an inch. This patient
+was quite womanly in all her sentiments. The second case was a woman of
+thirty-six, insane from emotional melancholia. She had tufts of thick,
+curly hair on the chin two inches long, light yellowish in color, and a
+few straggling hairs on the upper lip. The third case was that of a
+woman of sixty-four, who exhibited a strong passion for the male sex.
+Her menstruation had been regular until the menopause. She plaited her
+beard, and it was seven or eight inches long on the chin and one inch
+on the lip. This woman had extremely hairy legs. Another case was that
+of a woman of sixty-two, who, though bald, developed a beard before the
+climacteric. Her structural proportions were feminine in character, and
+it is said that her mother, who was sane, had a beard also. A curious
+case was that of a woman of twenty-three (Mrs. Viola M.), who from the
+age of three had a considerable quantity of hair on the side of the
+cheek which eventually became a full beard. She was quite feminine was
+free from excessive hair elsewhere, her nose and forehead being
+singularly bare. Her voice was very sweet; she was married at seventeen
+and a half, having two normal children, and nursed each for one month.
+"The bearded woman" of every circus side-show is an evidence of the
+curious interest in which these women are held. The accompanying
+illustration is a representation of a "bearded woman" born in Bracken
+County, Ky. Her beard measured 15 inches in length.
+
+There is a class of anomalies in which there is an exaggerated
+development of hair. We would naturally expect to find the primitive
+peoples, who are not provided with artificial protection against the
+wind, supplied with an extra quantity of hair or having a hairy coat
+like animals; but this is sometimes found among civilized people. This
+abnormal presence of hair on the human body has been known for many
+years; the description of Esau in the Bible is an early instance.
+Aldrovandus says that in the sixteenth century there came to the Canary
+Islands a family consisting of a father, son, and two daughters, who
+were covered all over their bodies by long hair, and their portrait,
+certainly reproduced from life, resembles the modern instances of "dog
+men."
+
+In 1883 there was shown in England and France, afterward in America, a
+girl of seven named "Krao," a native of Indo-China.  The whole body of
+this child was covered with black hair. Her face was of the prognathic
+type, and this, with her extraordinary prehensile powers of feet and
+lips, gave her the title of "Darwin's missing link." In 1875 there was
+exhibited in Paris, under the name of "l'homme-chien" Adrien Jeftichew,
+a Russian peasant of fifty-five, whose face, head, back, and limbs were
+covered with a brown hairy coat looking like wool and several
+centimeters long. The other parts of the body were also covered with
+hair, but less abundantly. This individual had a son of three,
+Theodore, who was hairy like himself.
+
+A family living in Burmah (Shive-Maon, whose history is told by
+Crawford and Yule), consisting of a father, a daughter, and a
+granddaughter, were nearly covered with hair. Figure 84 represents a
+somewhat similar family who were exhibited in this country.
+
+Teresa Gambardella, a young girl of twelve, mentioned by Lombroso, was
+covered all over the body, with the exception of the hands and feet, by
+thick, bushy hair. This hypertrichosis was exemplified in this country
+only a few months since by a person who went the rounds of the dime
+museums under the euphonious name of "Jo-Jo, the dog-face boy." His
+face was truly that of a skye-terrier.
+
+Sometimes the hairy anomalies are but instances of naevus pilosus. The
+Indian ourang-outang woman examined at the office of the Lancet was an
+example of this kind. Hebra, Hildebrandt, Jablokoff, and Klein describe
+similar cases. Many of the older "wild men" were individuals bearing
+extensive hairy moles.
+
+Rayer remarks that he has seen a young man of sixteen who exhibited
+himself to the public under the name of a new species of wild man whose
+breast and back were covered with light brown hair of considerable
+length.
+
+The surface upon which it grew was of a brownish hue, different from
+the color of the surrounding integument. Almost the whole of the right
+arm was covered in the same manner. On the lower extremity several
+tufts of hair were observed implanted upon brown spots from seven to
+eight lines in diameter symmetrically disposed upon both legs. The hair
+was brown, of the same color as that of the head. Bichat informs us
+that he saw at Paris an unfortunate man who from his birth was
+afflicted with a hairy covering of his face like that of a wild boar,
+and he adds that the stories which were current among the vulgar of
+individuals with a boar's head, wolf's head, etc., undoubtedly referred
+to cases in which the face was covered to a greater or less degree with
+hair. Villerme saw a child of six at Poitiers in 1808 whose body,
+except the feet and hands, was covered with a great number of prominent
+brown spots of different dimensions, beset with hair shorter and not so
+strong as that of a boar, but bearing a certain resemblance to the
+bristles of that animal. These spots occupied about one-fifth of the
+surface of this child's skin.  Campaignac in the early part of this
+century exhibited a case in which there was a large tuft of long black
+hair growing from the shoulder. Dufour has detailed a case of a young
+man of twenty whose sacral region contained a tuft of hair as long and
+black, thick and pliant, as that of the head, and, particularly
+remarkable in this case, the skin from which it grew was as fine and
+white as the integument of the rest of the body. There was a woman
+exhibited recently, under the advertisement of "the lady with a mane,"
+who had growing from the center of her back between the shoulders a
+veritable mane of long, black hair, which doubtless proceeded from a
+form of naevus.
+
+Duyse reports a case of extensive hypertrichosis of the back in a girl
+aged nine years; her teeth were normal; there was pigmentation of the
+back and numerous pigmentary nevi on the face. Below each scapula there
+were tumors of the nature of fibroma molluscum. In addition to hairy
+nevi on the other parts of the body there was localized ichthyosis.
+
+Ziemssen figures an interesting case of naevus pilosus resembling
+"bathing tights". There were also present several benign tumors
+(fibroma molluscum) and numerous smaller nevi over the body.  Schulz
+first observed the patient in 1878. This individual's name was Blake,
+and he stated that he was born with a large naevus spreading over the
+upper parts of the thighs and lower parts of the trunk, like
+bathing-tights, and resembling the pelt of an animal. The same was true
+of the small hairy parts and the larger and smaller tumors.
+Subsequently the altered portions of the skin had gradually become
+somewhat larger. The skin of the large hairy naevus, as well as that of
+the smaller ones, was stated by Schulz to have been in the main
+thickened, in part uneven, verrucose, from very light to intensely dark
+brown in color; the consistency of the larger mammiform and smaller
+tumors soft, doughy, and elastic. The case was really one of large
+congenital naevus pilosus and fibroma molluscum combined.
+
+A Peruvian boy was shown at the Westminster Aquarium with a dark, hairy
+mole situated in the lower part of the trunk and on the thighs in the
+position of bathing tights. Nevins Hyde records two similar cases with
+dermatolytic growths. A sister of the Peruvian boy referred to had a
+still larger growth, extending from the nucha all over the back. Both
+she and her brother had hundreds of smaller hairy growths of all sizes
+scattered irregularly over the face, trunk, and limbs. According to
+Crocker, a still more extraordinary case, with extensive dermatolytic
+growths all over the back and nevi of all sizes elsewhere, is described
+and engraved in "Lavater's Physiognomy," 1848. Baker describes an
+operation in which a large mole occupying half the forehead was removed
+by the knife.
+
+In some instances the hair and beard is of an enormous length.  Erasmus
+Wilson of London saw a female of thirty-eight, whose hair measured 1.65
+meters long. Leonard of Philadelphia speaks of a man in the interior of
+this country whose beard trailed on the ground when he stood upright,
+and measured 2.24 meters long. Not long ago there appeared the famous
+so-called "Seven Sutherland Sisters," whose hair touched the ground,
+and with whom nearly every one is familiar through a hair tonic which
+they extensively advertised. In Nature, January 9, 1892, is an account
+of a Percheron horse whose mane measured 13 feet and whose tail
+measured almost ten feet, probably the greatest example of excessive
+mane development on record. Figure 88 represents Miss Owens, an
+exhibitionist, whose hair measured eight feet three inches. In Leslie's
+Weekly, January 2, 1896, there is a portrait of an old negress named
+Nancy Garrison whose woolly hair was equally as long.
+
+The Ephemerides contains the account of a woman who had hair from the
+mons veneris which hung to the knees; it was affected with plica
+polonica, as was also the other hair of the body.
+
+Rayer saw a Piedmontese of twenty-eight, with an athletic build, who
+had but little beard or hair on the trunk, but whose scalp was covered
+with a most extraordinary crop. It was extremely fine and silky, was
+artificially frizzled, dark brown in color, and formed a mass nearly
+five feet in circumference.
+
+Certain pathologic conditions may give rise to accidental growths of
+hair. Boyer was accustomed to quote in his lectures the case of a man
+who, having an inflamed tumor in the thigh, perceived this part
+becoming covered in a short time with numerous long hairs. Rayer speaks
+of several instances of this kind. In one the part affected by a
+blister in a child of two became covered with hair. Another instance
+was that of a student of medicine, who after bathing in the sea for a
+length of time, and exposing himself to the hot sun, became affected
+with coppery patches, from which there sprang a growth of hair.
+Bricheteau, quoted by the same authority, speaks of a woman of
+twenty-four, having white skin and hair of deep black, who after a long
+illness occasioned by an affection analogous to marasmus became
+covered, especially on the back, breast, and abdomen, with a multitude
+of small elevations similar to those which appear on exposure to cold.
+These little elevations became brownish at the end of a few days, and
+short, fair, silky hair was observed on the summit of each, which grew
+so rapidly that the whole surface of the body with the exception of the
+hands and face became velvety. The hair thus evolved was afterward
+thrown out spontaneously and was not afterward reproduced.
+
+Anomalies of the Color of the Hair.--New-born infants sometimes have
+tufts of hair on their heads which are perfectly white in color.
+Schenck speaks of a young man whose beard from its first appearance
+grew white. Young men from eighteen to twenty occasionally become gray;
+and according to Rayer, paroxysms of rage, unexpected and unwelcome
+news, diseases of the scalp such as favus, wounds of the head, habitual
+headache, over-indulgence of the sexual appetite, mercurial courses too
+frequently repeated, too great anxiety, etc., have been known to blanch
+the hair prematurely.
+
+The well-accepted fact of the sudden changing of the color of the hair
+from violent emotions or other causes has always excited great
+interest, and many ingenious explanations have been devised to account
+for it. There is a record in the time of Charles V of a young man who
+was committed to prison in 1546 for seducing his girl companion, and
+while there was in great fear and grief, expecting a death-sentence
+from the Emperor the next day. When brought before his judge, his face
+was wan and pale and his hair and beard gray, the change having taken
+place in the night. His beard was filthy with drivel, and the Emperor,
+moved by his pitiful condition, pardoned him. There was a clergyman of
+Nottingham whose daughter at the age of thirteen experienced a change
+from jet-blackness of the hair to white in a single night, but this was
+confined to a spot on the back of the head 1 1/2 inches in length. Her
+hair soon became striped, and in seven years was totally white. The
+same article speaks of a girl in Bedfordshire, Maria Seeley, aged
+eight, whose face was swarthy, and whose hair was long and dark on one
+side and light and short on the other. One side of her body was also
+brown, while the other side was light and fair. She was seen by the
+faculty in London, but no cause could be established.
+
+Voigtel mentions the occurrence of canities almost suddenly.  Bichat
+had a personal acquaintance whose hair became almost entirely gray in
+consequence of some distressing news that reached him. Cassan records a
+similar case. According to Rayer, a woman by the name of Perat,
+summoned before the Chamber of Peers to give evidence in the trial of
+the assassin Louvel, was so much affected that her hair became entirely
+white in a single night Byron makes mention of this peculiar anomaly in
+the opening stanzas of the "Prisoner of Chillon:"--
+
+"My hair is gray, but not with years, Nor grew it white In a single
+night.  As men's have grown from sudden fears."
+
+The commentators say that Byron had reference to Ludovico Sforza and
+others. The fact of the change is asserted of Marie Antoinette, the
+wife of Louis XVI, though in not quite so short a period, grief and not
+fear being the cause. Ziemssen cites Landois' case of a compositor of
+thirty-four who was admitted to a hospital July 9th with symptoms of
+delirium tremens; until improvement began to set in (July 13th) he was
+continually tormented by terrifying pictures of the imagination. In the
+night preceding the day last mentioned the hair of the head and beard
+of the patient, formerly blond, became gray. Accurate examination by
+Landois showed the pigment contents of the hair to be unchanged, and
+led him to believe that the white color was solely due to the excessive
+development of air-bubbles in the hair shaft. Popular belief brings the
+premature and especially the sudden whitening into connection with
+depressing mental emotions.  We might quote the German
+expression--"Sich graue Haare etwas wachsen lassen" ("To worry one's
+self gray"). Brown-Sequard observed on several occasions in his own
+dark beard hairs which had turned white in a night and which he
+epileptoid. He closes his brief communication on the subject with the
+belief that it is quite possible for black hair to turn white in one
+night or even in a less time, although Hebra and Kaposi discredit
+sudden canities (Duhring). Raymond and Vulpian observed a lady of
+neurotic type whose hair during a severe paroxysm of neuralgia
+following a mental strain changed color in five hours over the entire
+scalp except on the back and sides; most of the hair changed from black
+to red, but some to quite white, and in two days all the red hair
+became white and a quantity fell off. The patient recovered her general
+health, but with almost total loss of hair, only a few red, white, and
+black hairs remaining on the occipital and temporal regions. Crocker
+cites the case of a Spanish cock which was nearly killed by some pigs.
+The morning after the adventure the feathers of the head had become
+completely white, and about half of those on the back of the neck were
+also changed.
+
+Dewees reports a case of puerperal convulsions in a patient under his
+care which was attended with sudden canities. From 10 A.M. to 4 P.M. 50
+ounces of blood were taken. Between the time of Dr. Dewees' visits, not
+more than an hour, the hair anterior to the coronal suture turned
+white. The next day it was less light, and in four or five days was
+nearly its natural color. He also mentions two cases of sudden
+blanching from fright.
+
+Fowler mentions the case of a healthy girl of sixteen who found one
+morning while combing her hair, which was black, that a strip the whole
+length of the back hair was white, starting from a surface about two
+inches square around the occipital protuberance. Two weeks later she
+had patches of ephelis over the whole body.
+
+Prentiss, in Science, October 3, 1890, has collected numerous instances
+of sudden canities, several of which will be given:--
+
+"In the Canada Journal of Medical Science, 1882, p. 113, is reported a
+case of sudden canities due to business-worry. The microscope showed a
+great many air-vesicles both in the medullary substance and between the
+medullary and cortical substance.
+
+"In the Boston Medical and Surgical Journal, 1851, is reported a case
+of a man thirty years old, whose hair 'was scared' white in a day by a
+grizzly bear. He was sick in a mining camp, was left alone, and fell
+asleep. On waking he found a grizzly bear standing over him.
+
+"A second case is that of a man of twenty-three years who was gambling
+in California. He placed his entire savings of $1100 on the turn of a
+card. He was under tremendous nervous excitement while the cards were
+being dealt. The next day his hair was perfectly white.
+
+"In the same article is the statement that the jet-black hair of the
+Pacific Islanders does not turn gray gradually, but when it does turn
+it is sudden, usually the result of fright or sudden emotions."
+
+D'Alben, quoted by Fournier, describes a young man of twenty-four, an
+officer in the regiment of Touraine in 1781, who spent the night in
+carnal dissipation with a mulatto, after which he had violent spasms,
+rendering flexion of the body impossible.  His beard and hair on the
+right side of the body was found as white as snow, the left side being
+unchanged. He appeared before the Faculte de Montpelier, and though
+cured of his nervous symptoms his hair was still white, and no
+suggestion of relief was offered him.
+
+Louis of Bavaria, who died in 1294, on learning of the innocence of his
+wife, whom he had put to death on a suspicion of her infidelity, had a
+change of color in his hair, which became white almost immediately.
+Vauvilliers, the celebrated Hellenist, became white-haired almost
+immediately after a terrible dream, and Brizard, the comedian,
+experienced the same change after a narrow escape from drowning in the
+Rhone. The beard and the hair of the Duke of Brunswick whitened in
+twenty-four hours after hearing that his father had been mortally
+wounded at the battle of Auerstadt.
+
+De Schweinitz speaks of a well-formed and healthy brunette of eighteen
+in whom the middle portion of the cilia of the right upper eyelid and a
+number of the hairs of the lower lid turned white in a week. Both eyes
+were myopic, but no other cause could be assigned. Another similar case
+is cited by Hirshberg, and the authors have seen similar cases.
+Thornton of Margate records the case of a lady in whom the hair of the
+left eyebrow and eyelashes began to turn white after a fortnight of
+sudden grief, and within a week all the hair of these regions was quite
+white and remained so. No other part was affected nor was there any
+other symptom.  After a traumatic ophthalmitis of the left and
+sympathetic inflammation of the right eye in a boy of nine, Schenck
+observed that a group of cilia of the right upper lid and nearly all
+the lashes of the upper lid of the left eye, which had been enucleated,
+turned silvery-white in a short time. Ludwig has known the eyelashes to
+become white after small-pox.  Communications are also on record of
+local decolorization of the eyebrows and lashes in neuralgias of
+isolated branches of the trigeminus, especially of the supraorbital
+nerve.
+
+Temporary and Partial Canities.--Of special interest are those cases in
+which whiteness of the hair is only temporary. Thus, Compagne mentions
+a case in which the black hair of a woman of thirty-six began to fade
+on the twenty-third day of a malignant fever, and on the sixth day
+following was perfectly white, but on the seventh day the hairs became
+darker again, and on the fourteenth day after the change they had
+become as black as they were originally. Wilson records a case in which
+the hair lost its color in winter and regained it in summer. Sir John
+Forbes, according to Crocker, had gray hair for a long time, then
+suddenly it all turned white, and after remaining so for a year it
+returned to its original gray.
+
+Grayness of the hair is sometimes only partial. According to Crocker an
+adult whose hair was generally brown had a tuft of white hair over the
+temple, and several like cases are on record.  Lorry tells us that
+grayness of one side only is sometimes occasioned by severe headache.
+Hagedorn has known the beard to be black in one place and white in
+another. Brandis mentions the hair becoming white on one side of the
+face while it continued of its former color on the other. Rayer quotes
+cases of canities of the whole of one side of the body.
+
+Richelot observed white mottling of hair in a girl sick with chlorosis.
+The whitening extended from the roots to a distance of two inches. The
+probable cause was a temporary alteration of the pigment-forming
+function. When the chlorosis was cured the natural color returned.
+Paullini and Riedlin, as well as the Ephemerides, speak of different
+colored hair in the same head, and it is not at all rare to see
+individuals with an anomalously colored patch of hair on the head. The
+members of the ancient house of Rohan were said to possess a tuft of
+white hair on the front of their heads.
+
+Michelson of Konigsberg describes a curious case in a barrister of
+twenty-three affected with partial canities. In the family of both
+parents there was stated to be congenital premature canities, and some
+white hairs had been observed even in childhood. In the fifteenth year,
+after a grave attack of scarlet fever, the hair to a great extent fell
+out. The succeeding growth of hair was stated to have been throughout
+lighter in tissue and color and fissured at the points. Soon after
+bunches of white hair appeared on the occiput, and in the succeeding
+years small patches of decolored hairs were observed also on the
+anterior and lateral portions of the scalp. In the spring of 1880 the
+patient exhibited signs of infiltration of the apex of the right lung,
+and afterward a violent headache came on. At the time of the report the
+patient presented the appearance shown in Figure 89.  The complexion
+was delicate throughout, the eyelashes and eyelids dark brown, the
+moustache and whiskers blond, and in the latter were a few groups of
+white hair. The white patches were chiefly on the left side of the
+head. The hairs growing on them were unpigmented, but otherwise normal.
+The patient stated that his head never sweated. He was stout and
+exhibited no signs of internal disease, except at the apex of the right
+lung.
+
+Anomalous Color Changes of the Hair.--The hair is liable to undergo
+certain changes of color connected with some modification of that part
+of the bulb secreting its coloring-matter. Alibert, quoted by Rayer,
+gives us a report of the case of a young lady who, after a severe fever
+which followed a very difficult labor, lost a fine head of hair during
+a discharge of viscid fluid, which inundated the head in every part. He
+tells us, further, that the hair grew again of a deep black color after
+the recovery of the patient. The same writer tells of the case of James
+B--, born with brown hair, who, having lost it all during the course of
+a sickness, had it replaced with a crop of the brightest red.  White
+and gray hair has also, under peculiar circumstances, been replaced by
+hair of the same color as the individual had in youth. We are even
+assured by Bruley that in 1798 the white hair of a woman sixty years of
+age changed to black a few days before her death. The bulbs in this
+case were found of great size, and appeared gorged with a substance
+from which the hair derived its color. The white hairs that remained,
+on the contrary, grew from shriveled bulbs much smaller than those
+producing the black. This patient died of phthisis.
+
+A very singular case, published early in the century, was that of a
+woman whose hair, naturally fair, assumed a tawny red color as often as
+she was affected with a certain fever, and returned to its natural hue
+as soon as the symptoms abated. Villerme alludes to the case of a young
+lady, sixteen years of age, who had never suffered except from trifling
+headaches, and who, in the winter of 1817, perceived that the hair
+began to fall out from several parts of her head, so that before six
+months were over she became entirely bald. In the beginning of January,
+1819, her head became covered with a kind of black wool over those
+places that were first denuded, and light brown hair began to develop
+from the rest of the scalp. Some of this fell out again when it had
+grown from three to four inches; the rest changed color at different
+distances from its end and grew of a chestnut color from the roots. The
+hair, half black, half chestnut, had a very singular appearance.
+
+Alibert and Beigel relate cases of women with blond hair which all came
+off after a severe fever (typhus in one case), and when it grew again
+it was quite black. Alibert also saw a young man who lost his brown
+hair after an illness, and after restoration it became red. According
+to Crocker, in an idiotic girl of epileptic type (in an asylum at
+Edinburgh), with alternating phases of stupidity and excitement, the
+hair in the stupid phase was blond and in the excited condition red.
+The change of color took place in the course of two or three days,
+beginning first at the free ends, and remaining of the same tint for
+seven or eight days. The pale hairs had more air-spaces than the darker
+ones.  There was much structural change in the brain and spinal cord.
+Smyly of Dublin reported a case of suppurative disease of the temporal
+bone, in which the hair changed from a mouse-color to a reddish-brown;
+and Squire records a congenital case in a deaf mute, in whom the hair
+on the left side was in light patches of true auburn and dark patches
+of dark brown like a tortoise-shell cap; on the other side the hair was
+a dark brown. Crocker mentions the changes which have occurred in rare
+instances after death from dark brown to red.
+
+Chemic colorations of various tints occur. Blue hair is seen in workers
+in cobalt mines and indigo works; green hair in copper smelters; deep
+red-brown hair in handlers of crude anilin; and the hair is dyed a
+purplish-brown whenever chrysarobin applications used on a scalp come
+in contact with an alkali, as when washed with soap. Among such cases
+in older literature Blanchard and Marcellus Donatus speak of green
+hair; Rosse saw two instances of the same, for one of which he could
+find no cause; the other patient worked in a brass foundry.
+
+Many curious causes are given for alopecia. Gilibert and Merlet mention
+sexual excess; Marcellus Donatus gives fear; the Ephemerides speaks of
+baldness from fright; and Leo Africanus, in his description of Barbary,
+describes endemic baldness. Neyronis makes the following observation: A
+man of seventy-three, convalescent from a fever, one morning, about six
+months after recovery perceived that he had lost all his hair, even his
+eyelashes, eyebrows, nostril-hairs, etc. Although his health continued
+good, the hair was never renewed.
+
+The principal anomalies of the nails observed are absence, hypertrophy,
+and displacement of these organs. Some persons are born with
+finger-nails and toe-nails either very rudimentary or entirely absent;
+in others they are of great length and thickness. The Chinese nobility
+allow their finger-nails to grow to a great length and spend much time
+in the care of these nails.  Some savage tribes have long and thick
+nails resembling the claws of beasts, and use them in the same way as
+the lower animals.  There is a description of a person with
+finger-nails that resembled the horns of a goat.
+
+Neuhof, in his books on Tartary and China, says that many Chinamen have
+two nails on the little toe, and other instances of double nails have
+been reported.
+
+The nails may be reversed or arise from anomalous positions.
+Bartholinus speaks of nails from the inner side of the digits; in
+another case, in which the fingers were wanting, he found the nails
+implanted on the stumps. Tulpius says he knew of a case in which nails
+came from the articulations of three digits; and many other curious
+arrangements of nails are to be found.
+
+Rouhuot sent a description and drawing of some monstrous nails to the
+Academie des Sciences de Paris. The largest of these was the left great
+toe-nail, which, from its extremity to its root, measured 4 3/4 inches;
+the laminae of which it consisted were placed one over the other, like
+the tiles on a roof, only reversed. This nail and several of the others
+were of unequal thickness and were variously curved, probably on
+account of the pressure of the shoe or the neighboring digits. Rayer
+mentions two nails sent to him by Bricheteau, physician of the Hopital
+Necker, belonging to an old woman who had lived in the Salpetriere.
+They were very thick and spirally twisted, like the horns of a ram.
+Saviard informs us that he saw a patient at the Hotel Dieu who had a
+horn like that of a ram, instead of a nail, on each great toe, the
+extremities of which were turned to the metatarsus and overlapped the
+whole of the other toes of each foot. The skeleton of Simore, preserved
+in Paris, is remarkable for the ankylosis of all the articulations and
+the considerable size of all the nails. The fingers and toes, spread
+out and ankylosed, ended in nails of great length and nearly of equal
+thickness. A woman by the name of Melin, living in the last century in
+Paris, was surnamed "the woman with nails;" according to the
+description given by Saillant in 1776 she presented another and not
+less curious instance of the excessive growth of the nails.
+
+Musaeus gives an account of the nails of a girl of twenty, which grew
+to such a size that some of those of the fingers were five inches in
+length. They were composed of several layers, whitish interiorly,
+reddish-gray on the exterior, and full of black points. These nails
+fell off at the end of four months and were succeeded by others. There
+were also horny laminae on the knees and shoulders and elbows which
+bore a resemblance to nails, or rather talons. They were sensitive only
+at the point of insertion into the skin. Various other parts of the
+body, particularly the backs of the hands, presented these horny
+productions. One of them was four inches in length. This horny growth
+appeared after small-pox. Ash, in the Philosophical Transactions,
+records a somewhat similar case in a girl of twelve.
+
+Anomalies of the Teeth.--Pliny, Colombus, van Swieten, Haller,
+Marcellus Donatus, Baudelocque, Soemmering, and Gardien all cite
+instances in which children have come into the world with several teeth
+already erupted. Haller has collected 19 cases of children born with
+teeth. Polydorus Virgilus describes an infant who was born with six
+teeth. Some celebrated men are supposed to have been born with teeth;
+Louis XIV was accredited with having two teeth at birth. Bigot, a
+physician and philosopher of the sixteenth century; Boyd, the poet;
+Valerian, Richard III, as well as some of the ancient Greeks and
+Romans, were reputed to have had this anomaly. The significance of the
+natal eruption of teeth is not always that of vigor, as many of the
+subjects succumb early in life. There were two cases typical of fetal
+dentition shown before the Academie de Medecine de Paris. One of the
+subjects had two middle incisors in the lower jaw and the other had one
+tooth well through. Levison saw a female born with two central incisors
+in the lower jaw.
+
+Thomas mentions a case of antenatal development of nine teeth.  Puech,
+Mattei, Dumas, Belluzi, and others report the eruption of teeth in the
+newborn. In Dumas' case the teeth had to be extracted on account of
+ulceration of the tongue. Instances of triple dentition late in life
+are quite numerous, many occurring after a hundred years. Mentzelius
+speaks of a man of one hundred and ten who had nine new teeth. Lord
+Bacon cites the case of a Countess Desmond, who when over a century old
+had two new teeth; Hufeland saw an instance of dentition at one hundred
+and sixteen; Nitzsch speaks of one at one hundred, and the Ephemerides
+contain an account of a triple dentition at one hundred and twenty.
+There is an account of a country laborer who lost all his teeth by the
+time he arrived at his sixtieth year of age, but about a half year
+afterward a new set made their appearance. Bisset mentions an account
+of an old woman who acquired twelve molar teeth at the age of
+ninety-eight. Carre notes a case of dental eruption in an individual of
+eighty-five. Mazzoti speaks of a third dentition, and Ysabeau writes of
+dentition of a molar at the age of ninety-two. There is a record of a
+physician of the name of Slave who retained all his second teeth until
+the age of eighty, when they fell out; after five years another set
+appeared, which he retained until his death at one hundred. In the same
+report there is mentioned an old Scotchman who died at one hundred and
+ten, whose teeth were renewed at an advanced age after he had lost his
+second teeth. One of the older journals speaks of dentition at seventy,
+eighty-four, ninety, and one hundred and fourteen. The Philosophical
+Transactions of London contain accounts of dentition at seventy-five
+and eighty-one. Bassett tells of an old woman who had twelve molar
+teeth at the age of eighty-eight. In France there is recorded dentition
+at eighty-five and an account of an old man of seventy-three who had
+six new teeth. Von Helmont relates an instance of triple dentition at
+the same age. There is recorded in Germany an account of a woman of
+ninety who had dentition at forty-seven and sixty-seven, each time a
+new set of teeth appearing; Hunter and Petrequin have observed similar
+cases. Carter describes an example of third dentition. Lison makes a
+curious observation of a sixth dentition.
+
+Edentulousness.--We have already noticed the association of congenital
+alopecia with edentulousness, but, strange to say, Magitot has remarked
+that "l'homme-chien," was the subject of defective dentition. Borellus
+found atrophy of all the dental follicles in a woman of sixty who never
+had possessed any teeth.  Fanton-Touvet saw a boy of nine who had never
+had teeth, and Fox a woman who had but four in both jaws; Tomes cites
+several similar instances. Hutchinson speaks of a child who was
+perfectly edentulous as to temporary teeth, but who had the permanent
+teeth duly and fully erupted. Guilford describes a man of forty-eight,
+who was edentulous from birth, who also totally lacked the sense of
+smell, and was almost without the sense of taste; the surface of his
+body was covered with fine hairs and he had never had visible
+perspiration. This is probably the same case quoted in the foregoing
+paragraph in regard to the anomalies of hair. Otto, quoted by Sedgwick,
+speaks of two brothers who were both totally edentulous. It might be
+interesting in this connection to note that Oudet found in a fetus at
+term all the dental follicles in a process of suppuration, leaving no
+doubt that, if the fetus had been born viable, it would have been
+edentulous. Giraldes mentions the absence of teeth in an infant of
+sixteen months.  Bronzet describes a child of twelve, with only half
+its teeth, in whom the alveolar borders receded as in age. Baumes
+remarks that he had seen a man who never had any teeth.
+
+The anomalies of excessive dentition are of several varieties, those of
+simple supernumerary teeth, double or triple rows, and those in
+anomalous positions. Ibbetson saw a child with five incisors in the
+inferior maxillary bone, and Fanton-Touvet describes a young lady who
+possessed five large incisors of the first dentition in the superior
+maxilla. Rayer notes a case of dentition of four canines, which first
+made their appearance after pain for eight days in the jaws and
+associated with convulsions. In an Ethiopian Soemmering has seen one
+molar too many on each side and in each jaw. Ploucquet and Tesmer have
+seen five incisors and Fanchard six. Many persons have the
+supernumerary teeth parallel with their neighbors, anteriorly or
+posteriorly. Costa reports a case in which there were five canine teeth
+in the upper jaw, two placed laterally on either side, and one on the
+right side behind the other two. The patient was twenty-six years of
+age, well formed and in good health.
+
+In some cases there is fusion of the teeth. Pliny, Bartholinus, and
+Melanthon pretend to have seen the union of all the teeth, making a
+continuous mass. In the "Musee de l'ecole dentaire de Paris" there are
+several milk-teeth, both of the superior and inferior maxilla, which
+are fused together. Bloch cites a case in which there were two rows of
+teeth in the superior maxilla.  Hellwig has observed three rows of
+teeth, and the Ephemerides contain an account of a similar anomaly.
+
+Extraoral Dentition.--Probably the most curious anomaly of teeth is
+that in which they are found in other than normal positions.  Albinus
+speaks of teeth in the nose and orbit; Borellus, in the palate;
+Fabricius Hildanus, under the tongue; Schenck, from the palate; and
+there are many similar modern records. Heister in 1743 wrote a
+dissertation on extraoral teeth. The following is a recent quotation:--
+
+"In the Norsk Magazin fur Laegevidenskaben, January, 1895, it is
+reported that Dr. Dave, at a meeting of the Medical Society in
+Christiania, showed a tooth removed from the nose of a woman aged
+fifty-three. The patient had consulted him for ear-trouble, and the
+tooth was found accidentally during the routine examination.  It was
+easily removed, having been situated in a small depression at the
+junction of the floor and external wall of the nasal cavity, 22 mm.
+from the external nares. This patient had all her teeth; they were
+placed somewhat far from each other. The tooth resembled a milk canine;
+the end of the imperfect root was covered with a fold of mucous
+membrane, with stratified epithelium. The speaker suggested that part
+of the mucous membrane of the mouth with its tooth-germ had become
+impacted between the superior and premaxillary bones and thus cut off
+from the cavity of the mouth. Another speaker criticised this fetal
+dislocation and believed it to be due to an inversion--a development in
+the wrong direction--by which the tooth had grown upward into the nose.
+The same speaker also pointed out that the stratified epithelium of the
+mucous membrane did not prove a connection with the cavity of the
+mouth, as it is known that cylindric epithelium-cells after irritative
+processes are replaced by flat ones."
+
+Delpech saw a young man in 1829 who had an opening in the palatine
+vault occasioned by the extraction of a tooth. This opening
+communicated with the nasal fossa by a fracture of the palatine and
+maxillary bones; the employment of an obturator was necessary. It is
+not rare to see teeth, generally canine, make their eruption from the
+vault of the palate; and these teeth are not generally supernumerary,
+but examples of vice and deviation of position. Fanton-Touvet, however,
+gives an example of a supernumerary tooth implanted in the palatine
+arch. Branch a describes a little negro boy who had two large teeth in
+the nose; his dentition was otherwise normal, but a portion of the nose
+was destroyed by ulceration. Roy describes a Hindoo lad of fourteen who
+had a tooth in the nose, supposed to have been a tumor. It was of the
+canine type, and was covered with enamel to the junction with the root,
+which was deeply imbedded in the side and upper part of the antrum. The
+boy had a perfect set of permanent teeth and no deformity, swelling, or
+cystic formation of the jaw.  This was clearly a case of
+extrafollicular development and eruption of the tooth in an anomalous
+position, the peculiarity being that while in other similar cases the
+crown of the tooth shows itself at the floor of the nasal cavity from
+below upward, in this instance the dental follicle was transposed, the
+eruption being from above downward. Hall cites an instance in which the
+right upper canine of a girl erupted in the nose. The subject showed
+marked evidence of hereditary syphilis. Carver describes a child who
+had a tooth growing from the lower right eyelid. The number of
+deciduous teeth was perfect; although this tooth was canine it had a
+somewhat bulbulous fang.
+
+Of anomalies of the head the first to be considered will be the
+anencephalous monsters who, strange to say, have been known to survive
+birth. Clericus cites an example of life for five days in a child
+without a cerebrum. Heysham records the birth of a child without a
+cerebrum and remarks that it was kept alive for six days. There was a
+child born alive in Italy in 1831 without a brain or a cerebellum--in
+fact, no cranial cavity--and yet it lived eleven hours. A somewhat
+similar case is recorded in the last century. In the Philosophical
+Transactions there is mentioned a child virtually born without a head
+who lived four days; and Le Duc records a case of a child born without
+brain, cerebellum, or medulla oblongata, and who lived half an hour.
+Brunet describes an anencephalous boy born at term who survived his
+birth. Saviard delivered an anencephalous child at term which died in
+thirty-six hours. Lawrence mentions a child with brain and cranium
+deficient that lived five days. Putnam speaks of a female
+nosencephalous monster that lived twenty-nine hours.  Angell and Elsner
+in March, 1895, reported a case of anencephaly, or rather
+pseudencephaly, associated with double divergent strabismus and limbs
+in a state of constant spastic contraction.  The infant lived eight
+days. Geoffroy-Saint-Hilaire cites an example of anencephaly which
+lived a quarter of an hour. Fauvel mentioned one that lived two hours,
+and Sue describes a similar instance in which life persisted for seven
+hours and distinct motions were noticed. Malacarne saw life in one for
+twelve hours, and Mery has given a description of a child born without
+brain that lived almost a full day and took nourishment. In the
+Hotel-Dieu in Paris in 1812 Serres saw a monster of this type which
+lived three days, and was fed on milk and sugared water, as no nurse
+could be found who was willing to suckle it.
+
+Fraser mentions a brother and sister, aged twenty and thirty,
+respectively, who from birth had exhibited signs of defective
+development of the cerebellum. They lacked power of coordination and
+walked with a drunken, staggering gait; they could not touch the nose
+with the finger when their eyes were shut, etc. The parents of these
+unfortunate persons were perfectly healthy, as were the rest of their
+family. Cruveilhier cites a case of a girl of eleven who had absolutely
+no cerebellum, with the same symptoms which are characteristic in such
+cases. There is also recorded the history of a man who was deficient in
+the corpus callosum; at the age of sixty-two, though of feeble
+intelligence, he presented no signs of nervous disorder. Claude Bernard
+made an autopsy on a woman who had no trace of olfactory lobes, and
+after a minute inquiry into her life he found that her sense of smell
+had been good despite her deficiency.
+
+Buhring relates the history of a case somewhat analogous to viability
+of anencephalous monsters. It was a bicephalous child that lived
+thirty-two hours after he had ligated one of its heads.
+
+{footnote} The argument that the brain is not the sole organ of the
+mind is in a measure substantiated by a wonderful case of a decapitated
+rooster, reported from Michigan. A stroke of the knife bad severed the
+larynx and removed the whole mass of the cerebrum, leaving the inner
+aspect and base of the skull exposed.  The cerebrum was partly removed;
+the external auditory meatus was preserved. Immediately after the
+decapitation the rooster was left to its supposed death struggles, but
+it ran headless to the barn, where it was secured and subsequently fed
+by pushing corn down its esophagus, and allowing water to trickle into
+this tube from the spout of an oil-can. The phenomena exhibited by the
+rooster were quite interesting. It made all the motions of pecking,
+strutted about, flapped its wings, attempted to crow, but, of course,
+without making any sound. It exhibited no signs of incoordination, but
+did not seem to hear. A ludicrous exhibition was the absurd, sidelong
+pas seul made toward the hens.
+
+
+Ward mentions an instance of congenital absence of the corpora
+callosum. Paget and Henry mention cases in which the corpora callosum,
+the fornix, and septum lucidum were imperfectly formed.  Maunoir
+reports congenital malformation of the brain, consisting of almost
+complete absence of the occipital lobe. The patient died at the
+twenty-eighth month. Combettes reports the case of a girl who died at
+the age of eleven who had complete absence of the cerebellum in
+addition to other minor structural defects; this was probably the case
+mentioned by Cruveilhier.
+
+Diminution in volume of the head is called microcephaly. Probably the
+most remarkable case on record is that mentioned by Lombroso.  The
+individual was called "l'homme-oiseau," or the human bird, and his
+cranial capacity was only 390 c.c. Lombroso speaks of another
+individual called "l'homme-lapin," or man-rabbit, whose cranium was
+only slightly larger than that of the other, measuring 490 mm. in
+circumference. Castelli alludes to endemic microcephaly among some of
+the peoples of Asia. We also find it in the Caribbean Islands, and from
+the skulls and portraits of the ancient Aztecs we are led to believe
+that they were also microcephalic.
+
+Two creatures of celebrity were Maximo and Bartola, who for twenty-five
+years have been shown in America and in Europe under the name of the
+"Aztecs" or the "Aztec children". They were male and female and very
+short, with heads resembling closely the bas-reliefs on the ancient
+Aztec temples of Mexico. Their facial angle was about 45 degrees, and
+they had jutting lips and little or no chin. They wore their hair in an
+enormous bunch to magnify the deformity. These curiosities were born in
+Central America and were possibly half Indian and Negro. They were
+little better than idiots in point of intelligence.
+
+Figure 92 represents a microcephalic youth known as the "Mexican wild
+boy," who was shown with the Wallace circus.
+
+Virchow exhibited a girl of fourteen whose face was no larger than that
+of a new-born child, and whose head was scarcely as large as a man's
+fist. Magitot reported a case of a microcephalic woman of thirty who
+weighed 70 pounds.
+
+Hippocrates and Strabonius both speak of head-binding as a custom
+inducing artificial microcephaly, and some tribes of North American
+Indians still retain this custom.
+
+As a rule, microcephaly is attended with associate idiocy and arrested
+development of the rest of the body. Ossification of the fontanelles in
+a mature infant would necessarily prevent full development of the
+brain. Osiander and others have noticed this anomaly. There are cases
+on record in which the fontanelles have remained open until adulthood.
+
+Augmentation of the volume of the head is called macrocephaly, and
+there are a number of curious examples related. Benvenuti describes an
+individual, otherwise well formed, whose head began to enlarge at
+seven. At twenty-seven it measured over 37 inches in circumference and
+the man's face was 15 inches in height; no other portion of his body
+increased abnormally; his voice was normal and he was very intelligent.
+He died of apoplexy at the age of thirty.
+
+Fournier speaks of a cranium in the cabinet of the Natural History
+Museum of Marseilles of a man by the name of Borghini, who died in
+1616. At the time he was described he was fifty years old, four feet in
+height; his head measured three feet in circumference and one foot in
+height. There was a proverb in Marseilles, "Apas mai de sen que
+Borghini," meaning in the local dialect, "Thou hast no more wit than
+Borghini." This man, whose fame became known all over France, was not
+able, as he grew older, to maintain the weight of his head, but carried
+a cushion on each shoulder to prop it up. Fournier also quotes the
+history of a man who died in the same city in 1807 at the age of
+sixty-seven. His head was enormous, and he never lay on a bed for
+thirty years, passing his nights in a chair, generally reading or
+writing. He only ate once in twenty-four or thirty hours, never warmed
+himself, and never used warm water. His knowledge was said to have been
+great and encyclopedic, and he pretended never to have heard the
+proverb of Borghini. There is related the account of a Moor, who was
+seen in Tunis early in this century, thirty-one years of age, of middle
+height, with a head so prodigious in dimensions that crowds flocked
+after him in the streets. His nose was quite long, and his mouth so
+large that he could eat a melon as others would an apple. He was an
+imbecile.  William Thomas Andrews was a dwarf seventeen years old,
+whose head measured in circumference 35 inches; from one external
+auditory meatus to another, 27 1/4 inches; from the chin over the
+cranial summit to the suboccipital protuberance, 37 1/2 inches; the
+distance from the chin to the pubes was 20 inches; and from the pubes
+to the soles of the feet, 16; he was a monorchid. James Cardinal, who
+died in Guy's Hospital in 1825, and who was so celebrated for the size
+of his head, only measured 32 1/2 inches in head-circumference.
+
+The largest healthy brains on record, that is, of men of prominence,
+are those of Cuvier, weighing 64 1/3 ounces; of Daniel Webster,
+weighing 63 3/4 ounces (the circumference of whose head was 23 3/4
+inches); of Abercrombie, weighing 63 ounces, and of Spurzheim, weighing
+55 1/16 ounces. Byron and Cromwell had abnormally heavy brains, showing
+marked evidence of disease.
+
+A curious instance in this connection is that quoted by Pigne, who
+gives an account of a double brain found in an infant. Keen reports
+finding a fornix which, instead of being solid from side to side,
+consisted of two lateral halves with a triangular space between them.
+
+When the augmentation of the volume of the cranium is caused by an
+abundant quantity of serous fluid the anomaly is known as hydrocephaly.
+In this condition there is usually no change in the size of the
+brain-structure itself, but often the cranial bones are rent far
+asunder. Minot speaks of a hydrocephalic infant whose head measured 27
+1/2 inches in circumference; Bright describes one whose head measured
+32 inches; and Klein, one 43 inches. Figure 93 represents a child of
+six whose head circumference was 36 inches. Figure 94 shows a
+hydrocephalic adult who was exhibited through this country.
+
+There is a record of a curious monster born of healthy half-caste
+African parents. The deformity was caused by a deficiency of osseous
+material of the bones of the head. There was considerable arrest of
+development of the parietal, temporal, and superior maxillary bones, in
+consequence of which a very small amount of the cerebral substance
+could be protected by the membranous expansion of the cranial centers.
+The inferior maxilla and the frontal bone were both perfect; the ears
+were well developed and the tongue strong and active; the nostrils were
+imperforate and there was no roof to the mouth nor floor to the nares.
+The eyes were curiously free from eyelashes, eyelids, or brows. The
+cornea threatened to slough. There was double harelip on the left side;
+the second and third fingers of both hands were webbed for their whole
+length; the right foot wanted the distal phalanx of the great toe and
+the left foot was clubbed and drawn inward. The child swallowed when
+fed from a spoon, appeared to hear, but exhibited no sense of light. It
+died shortly after the accompanying sketch was made.
+
+Occasionally a deficiency in the osseous material of the cranium or an
+abnormal dilatation of the fontanelles gives rise to a hernia of the
+meninges, which, if accompanied by cerebrospinal fluid in any quantity,
+causes a large and peculiarly shaped tumor called meningocele. If there
+is a protrusion of brain-substance itself, a condition known as hernia
+cerebri results.
+
+Complete absence of the inferior maxilla is much rarer in man than in
+animals. Nicolas and Prenant have described a curious case of this
+anomaly in a sheep. Gurlt has named subjects presenting the total or
+partial absence of the inferior maxilla, agnathes or hemiagnathes.
+Simple atrophy of the inferior maxilla has been seen in man as well as
+in the lower animals, but is much less frequent than atrophy of the
+superior maxilla. Langenbeck reports the case of a young man who had
+the inferior maxilla so atrophied that in infancy it was impossible for
+him to take milk from the breast. He had also almost complete
+immobility of the jaws. Boullard reports a deformity of the visage,
+resulting in a deficiency of the condyles of the lower jaw. Maurice
+made an observation on a vice of conformation of the lower jaw which
+rendered lactation impossible, probably causing the death of the infant
+on this account. Tomes gives a description of a lower jaw the
+development of the left ramus of which had been arrested.  Canton
+mentions arrest of development of the left perpendicular ramus of the
+lower jaw combined with malformation of the external ear.
+
+Exaggerated prominence of the maxillaries is called prognathism; that
+of the superior maxilla is seen in the North American Indians. Inferior
+prognathism is observed in man as well as in animals. The bull-dog, for
+example, displays this, but in this instance the deformity is really
+superior brachygnathism, the superior maxilla being arrested in
+development.
+
+Congenital absence of the nose is a very rare anomaly.  Maisonneuve has
+seen an example in an individual in which, in place of the nasal
+appendix, there was a plane surface perforated by two small openings a
+little less than one mm. in diameter and three mm. apart.
+
+Exaggeration in volume of the nose is quite frequent. Ballonius speaks
+of a nose six times larger than ordinary. Viewing the Roman
+celebrities, we find that Numa, to whom was given the surname
+Pompilius, had a nose which measured six inches.  Plutarch, Lyourgus,
+and Solon had a similar enlargement, as had all the kings of Italy
+except Tarquin the Superb.
+
+Early in the last century a man, Thomas Wedders (or Wadhouse), with a
+nose 7 1/2 inches long, was exhibited throughout Yorkshire. This man
+expired as he had lived, in a condition of mind best described as the
+most abject idiocy. The accompanying illustration is taken from a
+reproduction of an old print and is supposed to be a true likeness of
+this unfortunate individual.
+
+There are curious pathologic formations about the nose which increase
+its volume so enormously as to interfere with respiration and even with
+alimentation; but these will be spoken of in another chapter.
+
+There have been some celebrities whose noses were undersized. The Duc
+de Guise, the Dauphin d'Auvergne, and William of Orange, celebrated in
+the romances of chivalry, had extremely short noses.
+
+There are a few recorded cases of congenital division of the nose.
+Bartholinus, Borellus, and the Ephemerides speak of duplex noses.
+Thomas of Tours has observed congenital fissure of the nose. Rikere
+reports the case of an infant of three weeks who possessed a
+supernumerary nose on the right nasal bone near the inner canthus of
+the eye. It was pear-shaped, with its base down, and was the size of
+the natural nose of an infant of that age, and air passed through it.
+Hubbell, Ronaldson, and Luscha speak of congenital occlusion of the
+posterior nares. Smith and Jarvis record cases of congenital occlusion
+of the anterior nares.
+
+Anomalies in size of the mouth are not uncommon. Fournier quotes the
+history of a man who had a mouth so large that when he opened it all
+his back teeth could be seen. There is a history of a boy of seventeen
+who had a preternaturally-sized mouth, the transverse diameter being 6
+1/2 inches. The mother claimed that the boy was born with his foot in
+his mouth and to this fact attributed his deformity. The negro races
+are noted for their large mouths and thick lips. A negro called "Black
+Diamond," recently exhibited in Philadelphia, could put both his fists
+in his mouth.
+
+Morgan reports two cases of congenital macrostoma accompanied by
+malformation of the auricles and by auricular appendages. Van Duyse
+mentions congenital macrostoma with preauricular tumors and a dermoid
+of the eye. Macrostoma is sometimes produced by lateral fissures. In
+other cases this malformation is unilateral and the fissure ascends, in
+which instance the fissure may be accompanied by a fistula of the duct
+of Stensen. Sometimes there is associated with these anomalies curious
+terminations of the salivary ducts, either through the cheek by means
+of a fistula or on the anterior part of the neck.
+
+Microstoma.--There are a few cases on record in which the mouth has
+been so small or ill-defined as not to admit of alimentation.  Molliere
+knew an individual of forty whose mouth was the exact size of a
+ten-centime piece.
+
+Buchnerus records a case of congenital atresia of the mouth.  Cayley,
+Smith, Sourrouille, and Stankiewiez of Warsaw discuss atresia of the
+mouth. Cancrum oris, scarlet fever, burns, scurvy, etc., are occasional
+causes that have been mentioned, the atresia in these instances taking
+place at any time of life.
+
+Anomalies of the Lips.--The aboriginal tribes are particularly noted
+for their large and thick lips, some of which people consider enormous
+lips signs of adornment. Elephantiasis or other pathologic hypertrophy
+of the labial tissues can produce revolting deformity, such as is seen
+in Figure 100, representing an individual who was exhibited several
+years ago in Philadelphia. We have in English the expression, "pulling
+a long lip." Its origin is said to date back to a semimythical hero of
+King Arthur's time, who, "when sad at heart and melancholic," would let
+one of his lips drop below his waist, while he turned the other up like
+a cap on his head.
+
+Blot records a case of monstrous congenital hypertrophy of the superior
+lip in an infant of eight months. Buck successfully treated by surgical
+operations a case of congenital hypertrophy of the under lip, and
+Detmold mentions a similar result in a young lady with hypertrophy of
+the lip and lower part of the nose. Murray reports an undescribed
+malformation of the lower lip occurring in one family.
+
+Hare-lip may be unilateral or double, and may or may not include the
+palatine arch. In the worst cases it extends in fissures on both sides
+to the orbit. In other cases the minimum degree of this deformity is
+seen.
+
+Congenital absence of the tongue does not necessarily make speech,
+taste, or deglutition impossible. Jussieu cites the case of a girl who
+was born without a tongue but who spoke very distinctly. Berdot
+describes a case in which the tongue was deficient, without apparent
+disturbance of any of the functions.  Riolan mentions speech after loss
+of the tongue from small-pox.
+
+Boddington gives an account of Margaret Cutting, who spoke readily and
+intelligibly, although she had lost her tongue.  Saulquin has an
+observation of a girl without a tongue who spoke, sang, and swallowed
+normally. Aurran, Bartholinus, Louis, Parsons, Tulpius, and others
+mention speech without the presence of a tongue.
+
+Philib reports a case in which mutism, almost simulating that of one
+congenitally deaf, was due to congenital adhesions of the tongue to the
+floor of the buccal cavity. Speech was established after removal of the
+abnormal adhesion. Routier speaks of ankylosis of the tongue of
+seventeen years' duration.
+
+Jurist records such abnormal mobility of the tongue that the patient
+was able to project the tongue into the nasopharynx.  Wherry and
+Winslow record similar instances.
+
+There have been individuals with bifid tongues, after the normal type
+of serpents and saurians, and others who possessed a supernumerary
+tongue. Rev. Henry Wharton, Chaplain to Archbishop Sancroft, in his
+journal, written in the seventeenth century, says that he was born with
+two tongues and passed through life so, one, however, gradually
+atrophying. In the polyclinic of Schnitzer in Vienna in 1892 Hajek
+observed in a lad of twelve an accessory tongue 2.4 cm. in length and
+eight mm. in breadth, forming a tumor at the base of the normal tongue.
+It was removed by scissors, and on histologic examination proved to be
+a true tongue with the typical tissues and constituents. Borellus,
+Ephemerides, Eschenbach, Mortimer, Penada, and Schenck speak of double
+tongues, and Avicenna and Schenck have seen fissured tongues. Dolaeus
+records an instance of double tongue in a paper entitled "De puella
+bilingui," and Beaudry and Brothers speak of cleft tongue. Braine
+records a case in which there was a large hypertrophied fold of
+membrane coming from each side of the upper lip.
+
+In some cases there is marked augmentation of the volume of the tongue.
+Fournier has seen a juggler with a tongue so long that he could extrude
+it six inches from his mouth. He also refers to a woman in Berlin with
+a long tongue, but it was thinner than that of a cat. When she laughed
+it hung over her teeth like a curtain, and was always extremely cold to
+the touch. In the same article there is a description of a man with a
+very long neck who could touch his tongue to his chest without
+reclining his head.  Congenital and acquired hypertrophy of the tongue
+will be discussed later.
+
+Amatus Lusitanus and Portal refer to the presence of hair on the
+tongue, and later there was an account of a medical student who
+complained of dyspepsia and a sticky sensation in the mouth. On
+examination a considerable growth of hair was found on the surface of
+the tongue. The hairs would be detached in vomiting but would grow
+again, and when he was last seen they were one inch long. Such are
+possibly nevoid in formation.
+
+The ordinary anomalies of the palate are the fissures, unilateral,
+bilateral, median, etc.: they are generally associated with hare-lip.
+The median fissure commencing between the middle incisors is quite rare.
+
+Many curious forms of obturator or artificial palate are employed to
+remedy congenital defects. Sercombe mentions a case in which
+destruction of the entire palate was successfully relieved by
+mechanical means. In some instances among the lower classes these
+obturators are simple pieces of wood, so fashioned as to fit into the
+palatine cleft, and not infrequently the obturator has been swallowed,
+causing obstruction of the air-passages or occluding the esophagus.
+
+Abnormalism of the Uvula.--Examples of double uvula are found in the
+older writers, and Hagendorn speaks of a man who was born without a
+uvula. The Ephemerides and Salmuth describe uvulae so defective as to
+be hardly noticeable. Bolster, Delius, Hodges, Mackenzie of Baltimore,
+Orr, Riedel, Schufeldt, and Tidyman are among observers reporting
+bifurcated and double uvula, and they are quite common. Ogle records
+instances of congenital absence of the uvula.
+
+Anomalies of the Epiglottis.--Morgagni mentions a man without an
+epiglottis who ate and spoke without difficulty. He thought the
+arytenoids were so strongly developed that they replaced the functions
+of the missing organ. Enos of Brooklyn in 1854 reported absence of the
+epiglottis without interference with deglutition.  Manifold speaks of a
+case of bifurcated epiglottis. Debloisi records an instance of
+congenital web of the vocal bands.  Mackenzie removed a congenital
+papillomatous web which had united the vocal cords until the age of
+twenty-three, thus establishing the voice. Poore also recorded a case
+of congenital web in the larynx. Elsberg and Scheff mention occlusion
+of the rima glottidis by a membrane.
+
+Instances of duplication of the epiglottis attended with a species of
+double voice possess great interest. French described a man of thirty,
+by occupation a singer and contortionist, who became possessed of an
+extra voice when he was sixteen. In high and falsetto tones he could
+run the scale from A to F in an upper and lower range. The compass of
+the low voice was so small that he could not reach the high notes of
+any song with it, and in singing he only used it to break in on the
+falsetto and produce a sensation. He was supposed to possess a double
+epiglottis.
+
+Roe describes a young lady who could whistle at will with the lower
+part of her throat and without the aid of her lips.  Laryngeal
+examination showed that the fundamental tones were produced by
+vibrations of the edges of the vocal cords, and the modifications were
+effected by a minute adjustment of the ventricular bands, which
+regulated the laryngeal opening above the cord, and pressing firmly
+down closed the ventricle and acted as a damper preventing the
+vibrations of the cords except in their middle third. Morgan in the
+same journal mentions the case of a boy of nineteen, who seemed to be
+affected with laryngeal catarrh, and who exhibited distinct
+diphthongia. He was seen to have two glottic orifices with associate
+bands. The treatment was directed to the catarrh and consequent paresis
+of the posterior bands, and he soon lost his evidences of double voice.
+
+{footnote} The following is a description of the laryngeal formation of
+a singer who has recently acquired considerable notice by her ability
+to sing notes of the highest tones and to display the greatest compass
+of voice. It is extracted from a Cleveland, Ohio, newspaper: "She has
+unusual development of the larynx, which enables her to throw into
+vibration and with different degrees of rapidity the entire length of
+the vocal cords or only a part thereof. But of greatest interest is her
+remarkable control over the muscles which regulate the division and
+modification of the resonant cavities, the laryngeal, pharyngeal, oral,
+and nasal, and upon this depends the quality of her voice. The uvula is
+bifurcated, and the two divisions sometimes act independently. The
+epiglottis during the production of the highest notes rises upward and
+backward against the posterior pharyngeal wall in such a way as almost
+entirely to separate the pharyngeal cavities, at the same time that it
+gives an unusual conformation to those resonant chambers."
+
+
+Complete absence of the eyes is a very rare anomaly. Wordsworth
+describes a baby of seven weeks, otherwise well formed and healthy,
+which had congenital absence of both eyes. The parents of this child
+were in every respect healthy. There are some cases of monstrosities
+with closed, adherent eyelids and absence of eyes. Holmes reports a
+case of congenital absence of both eyes, the child otherwise being
+strong and perfect. The child died of cholera infantum. He also reports
+a case very similar in a female child of American parents. In a girl of
+eight, of German parents, he reports deficiency of the external walls
+of each orbit, in addition to great deformity of the side of the head.
+He also gives an instance of congenital paralysis of the levator
+palpebrae muscles in a child whose vision was perfect and who was
+otherwise perfect. Holmes also reports a case of enormous congenital
+exophthalmos, in which the right eye protruded from the orbit and was
+no longer covered by the cornea. Kinney has an account of a child born
+without eyeballs. The delivery was normal, and there was no history of
+any maternal impression; the child was otherwise healthy and well
+formed.
+
+Landes reports the case of an infant in which both eyes were absent.
+There were six fingers on each hand and six toes on each foot. The
+child lived a few weeks. In some instances of supposed absence of the
+eyeball the eye is present but diminutive and in the posterior portion
+of the orbit. There are instances of a single orbit with no eyes and
+also a single orbit containing two eyes. Again we may have two orbits
+with an absence of eyes but the presence of the lacrimal glands, or the
+eyes may be present or very imperfectly developed. Mackenzie mentions
+cases in which the orbit was more or less completely wanting and a mass
+of cellular tissue in each eye.
+
+Cases of living cyclopia, or individuals with one eye in the center of
+the forehead after the manner of the mythical Cyclops, are quite rare.
+Vallentini in 1884 reports a case of a male cyclopic infant which lived
+for seventy-three hours. There were median fissures of the upper lip,
+preauricular appendages, oral deformity, and absence of the olfactory
+proboscis The fetus was therefore a cyclops arrhynchus, or
+cyclocephalus. Blok describes a new-born infant which lived for six or
+seven hours, having but one eye and an extremely small mouth.
+
+The "Four-eyed Man of Cricklade" was a celebrated English monstrosity
+of whom little reliable information is obtainable. He was visited by W.
+Drury, who is accredited with reporting the following--
+
+"'So wondrous a thing, such a lusus naturae, such a scorn and spite of
+nature I have never seen. It was a dreadful and shocking sight.' This
+unfortunate had four eyes placed in pairs, 'one eye above the other and
+all four of a dull brown, encircled with red, the pupils enormously
+large.' The vision in each organ appeared to be perfect. 'He could shut
+any particular eye, the other three remaining open, or, indeed, as many
+as he chose, each several eye seeming to be controlled by his will and
+acting independently of the remainder. He could also revolve each eye
+separately in its orbit, looking backward with one and forward with
+another, upward with one and downward with another simultaneously.' He
+was of a savage, malignant disposition, delighting in ugly tricks,
+teasing children, torturing helpless animals, uttering profane and
+blasphemous words, and acting altogether like the monster, mental and
+physical, that he was. 'He could play the fiddle, though in a silly
+sort, having his notes on the left side, while closing the right pair
+of eyes. He also sang, but in a rough, screeching voice not to be
+listened to without disgust.'"
+
+There is a recent report of a child born in Paris with its eyes in the
+top of its head. The infant seemed to be doing well and crowds of
+people have flocked to see it. Recent reports speak of a child born in
+Portland, Oregon, which had a median rudimentary eye between two normal
+eyes. Fournier describes an infant born with perfectly formed eyes, but
+with adherent eyelids and closed ocular aperture. Forlenze has seen the
+pupils adherent to the conjunctiva, and by dissection has given sight
+to the subject.
+
+Dubois cites an instance of supernumerary eyelid. At the external angle
+of the eyelid was a fold of conjunctiva which extended 0.5 cm. in front
+of the conjunctiva, to which it did not adhere, therefore constituting
+a fourth eyelid. Fano presents a similar case in a child of four
+months, in whom no other anomaly, either of organs or of vision, was
+observed. On the right side, in front of the external half of the
+sclerotic, was observed a semilunar fold with the concavity inward, and
+which projected much more when the lower lid was depressed. When the
+eyelid rolled inward the fold rolled with the globe, but never reached
+so far as the circumference of the cornea and did not interfere with
+vision.
+
+Total absence of both irides has been seen in a man of eighteen.  Dixon
+reports a case of total aniridia with excellent sight in a woman of
+thirty-seven. In Guy's Hospital there was seen a case of complete
+congenital absence of the iris. Hentzschel speaks of a man with
+congenital absence of the iris who had five children, three of whom
+exhibited the same anomaly while the others were normal. Benson,
+Burnett, Demaux, Lawson, Morison, Reuling, Samelson, and others also
+report congenital deficiency of the irides in both eyes.
+
+Jeaffreson describes a female of thirty, living in India, who was
+affected with complete ossification of the iris. It was immovable and
+quite beautiful when seen through the transparent cornea; the sight was
+only slightly impaired. No cause was traceable.
+
+Multiple Pupils.--More than one pupil in the eye has often been
+noticed, and as many as six have been seen. They may be congenital or
+due to some pathologic disturbance after birth.  Marcellus Donatus
+speaks of two pupils in one eye. Beer, Fritsche, and Heuermann are
+among the older writers who have noticed supernumerary pupils. Higgens
+in 1885 described a boy whose right iris was perforated by four
+pupils,--one above, one to the inner side, one below, and a fourth to
+the outer side. The first three were slit-shaped; the fourth was the
+largest and had the appearance as of the separation of the iris from
+its insertion. There were two pupils in the left eye, both to the outer
+side of the iris, one being slit-like and the other resembling the
+fourth pupil in the right eye. All six pupils commenced at the
+periphery, extended inward, and were of different sizes. The fundus
+could be clearly seen through all of the pupils, and there was no
+posterior staphyloma nor any choroidal changes. There was a rather high
+degree of myopia. This peculiarity was evidently congenital, and no
+traces of a central pupil nor marks of a past iritis could be found.
+Clinical Sketches a contains quite an extensive article on and several
+illustrations of congenital anomalies of the iris.
+
+Double crystalline lenses are sometimes seen. Fritsch and Valisneri
+have seen this anomaly and there are modern references to it.
+Wordsworth presented to the Medical Society of London six members of
+one family, all of whom had congenital displacement of the crystalline
+lens outward and upward. The family consisted of a woman of fifty, two
+sons, thirty-five and thirty-seven, and three grandchildren--a girl of
+ten and boys of five and seven.  The irides were tremulous.
+
+Clark reports a case of congenital dislocation of both crystalline
+lenses. The lenses moved freely through the pupil into the anterior
+chambers. The condition remained unchanged for four years, when
+glaucoma supervened.
+
+Differences in Color of the Two Eyes.--It is not uncommon to see people
+with different colored eyes. Anastasius I had one black eye and the
+other blue, from whence he derived his name "Dicore," by which this
+Emperor of the Orient was generally known. Two distinct colors have
+been seen in an iris. Berry gives a colored illustration of such a case.
+
+The varieties of strabismus are so common that they will be passed
+without mention. Kuhn presents an exhaustive analysis of 73 cases of
+congenital defects of the movements of the eyes, considered clinically
+and didactically. Some or all of the muscles may be absent or two or
+more may be amalgamated, with anomalies of insertion, false, double, or
+degenerated, etc.
+
+The influence of heredity in the causation of congenital defects of the
+eye is strikingly illustrated by De Beck. In three generations twelve
+members of one family had either coloboma iridis or irideremia. He
+performed two operations for the cure of cataract in two brothers. The
+operations were attended with difficulty in all four eyes and followed
+by cyclitis. The result was good in one eye of each patient, the eye
+most recently blind.  Posey had a case of coloboma in the macular
+region in a patient who had a supernumerary tooth. He believes the
+defects were inherited, as the patient's mother also had a
+supernumerary tooth.
+
+Nunnely reports cases of congenital malformation in three children of
+one family. The globes of two of them (a boy and a girl) were smaller
+than natural, and in the boy in addition were flattened by the action
+of the recti muscles and were soft; the sclera were very vascular and
+the cornea, conical, the irides dull, thin, and tremulous; the pupils
+were not in the axis of vision, but were to the nasal side. The elder
+sister had the same congenital condition, but to a lesser degree. The
+other boy in the family had a total absence of irides, but he could see
+fairly well with the left eye.
+
+Anomalies of the Ears.--Bilateral absence of the external ears is quite
+rare, although there is a species of sheep, native of China, called the
+"Yungti," in which this anomaly is constant.  Bartholinus, Lycosthenes,
+Pare, Schenck, and Oberteuffer have remarked on deficient external
+ears. Guys, the celebrated Marseilles litterateur of the eighteenth
+century, was born with only one ear. Chantreuil mentions obliteration
+of the external auditory canal in the new-born. Bannofont reports a
+case of congenital imperforation of the left auditory canal existing
+near the tympanic membrane with total deafness in that ear. Lloyd
+described a fetus showing absence of the external auditory meatus on
+both sides. Munro reports a case of congenital absence of the external
+auditory meatus of the right ear; and Richardson speaks of congenital
+malformation of the external auditory apparatus of the right side.
+There is an instance of absence of the auditory canal with but partial
+loss of hearing. Mussey reports several cases of congenitally deficient
+or absent aural appendages. One case was that in which there was
+congenital absence of the external auditory meatus of both ears without
+much impairment of hearing. In neither ear of N. W. Goddard, aged
+twenty-seven, of Vermont, reported in 1834, was there a vestige of an
+opening or passage in the external ear, and not even an indentation.
+The Eustachian tube was closed. The integuments of the face and scalp
+were capable of receiving acoustic impressions and of transmitting them
+to the organs of hearing. The authors know of a student of a prominent
+New York University who is congenitally deficient in external ears, yet
+his hearing is acute. He hides his deformity by wearing his hair long
+and combed over his ears.
+
+The knowledge of anomalous auricles is lost in antiquity. Figure 103
+represents the head of an aegipan in the British Museum showing a
+supernumerary auricle. As a rule, supernumerary auricles are
+preauricular appendages. Warner, in a report of the examination of
+50,000 children, quoted by Ballantyne, describes 33 with supernumerary
+auricles, represented by sessile or pedunculated outgrowths in front of
+the tragus. They are more commonly unilateral, always congenital, and
+can be easily removed, giving rise to no unpleasant symptoms. They have
+a soft and elastic consistency, and are usually composed of a hyaline
+or reticular cartilaginous axis covered with connective or adipose
+tissue and skin bearing fine hairs; sometimes both cartilage and fat
+are absent. They are often associated with some form of defective
+audition--harelip, ocular disturbance, club-feet, congenital hernia,
+etc. These supernumerary members vary from one to five in number and
+are sometimes hereditary. Reverdin describes a man having a
+supernumerary nipple on the right side of his chest, of whose five
+children three had preauricular appendages. Figure 104 represents a
+girl with a supernumerary auricle in the neck, described in the Lancet,
+1888. A little girl under Birkett's care in Guy's Hospital more than
+answered to Macbeth's requisition, "Had I three ears I'd hear thee!"
+since she possessed two superfluous ones at the sides of the neck,
+somewhat lower than the angle of the jaw, which were well developed as
+to their external contour and made up of fibrocartilage. There is
+mentioned the case of a boy of six months on the left side of whose
+neck, over the middle anterior border of the sternocleidomastoid
+muscle, was a nipple-like projection 1/2 inch in length; a rod of
+cartilage was prolonged into it from a thin plate, which was freely
+movable in the subcutaneous tissue, forming a striking analogue to an
+auricle.  Moxhay cites the instance of a mother who was frightened by
+the sight of a boy with hideous contractions in the neck, and who gave
+birth to a child with two perfect ears and three rudimentary auricles
+on the right side, and on the left side two rudimentary auricles.
+
+In some people there is an excessive development of the auricular
+muscles, enabling them to move their ears in a manner similar to that
+of the lower animals. Of the celebrated instances the Abbe de Marolles,
+says Vigneul-Marville, bears witness in his "Memoires" that the Regent
+Crassot could easily move his ears.  Saint Augustine mentions this
+anomaly.
+
+Double tympanitic membrane is spoken of by Loeseke. There is sometimes
+natural perforation of the tympanum in an otherwise perfect ear, which
+explains how some people can blow tobacco-smoke from the ear. Fournier
+has seen several Spaniards and Germans who could perform this feat, and
+knew one man who could smoke a whole cigar without losing any smoke,
+since he made it leave either by his mouth, his ears, or in both ways.
+Fournier in the same article mentions that he has seen a woman with
+ears over four inches long.
+
+Strange to say, there have been reports of cases in which the ossicles
+were deficient without causing any imperfection of hearing. Caldani
+mentions a case with the incus and malleus deficient, and Scarpa and
+Torreau quote instances of deficient ossicles. Thomka in 1895 reported
+a case of supernumerary tympanic ossicle, the nature of which was
+unknown, although it was neither an inflammatory product nor a remnant
+of Meckel's cartilage.
+
+Absence of the Limbs.--Those persons born without limbs are either the
+subjects of intrauterine amputation or of embryonic malformation.
+Probably the most celebrated of this class was Marc Cazotte, otherwise
+known as "Pepin," who died in Paris in the last century at the age of
+sixty-two of a chronic intestinal disorder. He had no arms, legs, or
+scrotum, but from very jutting shoulders on each side were well-formed
+hands. His abdomen ended in a flattened buttock with badly-formed feet
+attached. He was exhibited before the public and was celebrated for his
+dexterity.  He performed nearly all the necessary actions, exhibited
+skilfulness in all his movements, and was credited with the ability of
+coitus. He was quite intellectual, being able to write in several
+languages. His skeleton is preserved in the Musee Dupuytren. Flachsland
+speaks of a woman who three times had borne children without arms and
+legs. Hastings describes a living child born without any traces of arms
+or legs. Garlick has seen a child with neither upper nor lower
+extremities. In place of them were short stumps three or four inches
+long, closely resembling the ordinary stumps after amputation. The
+head, chest, body, and male genitals were well formed, and the child
+survived. Hutchinson reports the history of a child born without
+extremities, probably the result of intrauterine amputation. The flaps
+were healed at the deltoid insertion and just below the groin. Pare
+says he saw in Paris a man without arms, who by means of his head and
+neck could crack a whip or hold an axe. He ate by means of his feet,
+dealt and played cards, and threw dice with the same members,
+exhibiting such dexterity that finally his companions refused to play
+with him. He was proved to be a thief and a murderer and was finally
+hanged at Gueldres. Pare also relates having seen a woman in Paris who
+sewed, embroidered, and did other things with her feet. Jansen speaks
+of a man in Spain, born without arms, who could use his feet as well as
+most people use their arms. Schenck and Lotichius give descriptions of
+armless people.
+
+Hulke describes a child of four whose upper limbs were absent, a small
+dimple only being in their place. He had free movement of the shoulders
+in every direction and could grasp objects between his cheeks and his
+acromian process; the prehensile power of the toes was well developed,
+as he could pick up a coin thrown to him. A monster of the same
+conformation was the celebrated painter, Ducornet, who was born at
+Lille on the 10th of January, 1806. He was completely deprived of arms,
+but the rest of the body was well formed with the exception of the
+feet, of which the second toe was faulty. The deformity of the feet,
+however, had the happiest result, as the space between the great toe
+and its neighbor was much larger than ordinary and the toes much more
+mobile. He became so skilful in his adopted profession that he finally
+painted a picture eleven feet in height (representing Mary Magdalene at
+the feet of Christ after the resurrection), which was purchased by the
+Government and given to the city of Lille. Broca describes James
+Leedgwood, who was deprived of his arms and had only one leg. He
+exhibited great dexterity with his single foot, wrote, discharged a
+pistol, etc.; he was said to have been able to pick up a sewing-needle
+on a slippery surface with his eyes blindfolded. Capitan described to
+the Societe d'anthropologie de Paris a young man without arms, who was
+said to play a violin and cornet with his feet. He was able to take a
+kerchief from his pocket and to blow his nose; he could make a
+cigarette, light it, and put it in his mouth, play cards, drink from a
+glass, and eat with a fork by the aid of his dexterous toes. There was
+a creature exhibited some time since in the principal cities of France,
+who was called the "l'homme tronc." He was totally deprived of all his
+members. Curran describes a Hindoo, a prostitute of forty, with
+congenital absence of both upper extremities. A slight fleshy
+protuberance depended from the cicatrix of the humerus and
+shoulder-joint of the left side, and until the age of ten there was one
+on the right side. She performed many tricks with her toes. Caldani
+speaks of a monster without arms, Davis mentions one, and Smith
+describes a boy of four with his upper limbs entirely absent. Breschet
+has seen a child of nine with only portions of the upper arms and
+deformity of lower extremities and pelvis. Pare says that he saw in
+Paris in 1573, at the gate of St. Andrew des Arts, a boy of nine, a
+native of a small village near Guise, who had no legs and whose left
+foot was represented by a fleshy body hanging from the trunk; he had
+but two fingers hanging on his right hand, and had between his legs
+what resembled a virile penis. Pare attributes this anomaly to a
+default in the quantity of semen.
+
+The figure and skeleton of Harvey Leach, called "Hervio Nono," is in
+the museum of the University College in London. The pelvis was
+comparatively weak, the femurs hardly to be recognized, and the right
+tibia and foot defective; the left foot was better developed, although
+far from being in due proportion to the trunk above. He was one of the
+most remarkable gymnasts of his day, and notwithstanding the distortion
+of his lower limbs had marvelous power and agility in them. As an
+arena-horseman, either standing or sitting, he was scarcely excelled.
+He walked and even ran quite well, and his power of leaping, partly
+with his feet and partly with his hands, was unusual. His lower limbs
+were so short that, erect, he touched the floor with his fingers, but
+he earned his livelihood as much with his lower as with his upper
+limbs. In his skeleton his left lower limb, between the hip and heel,
+measured 16 inches, while the right, between the same points, measured
+nine inches. Hare mentions a boy of five and a half whose head and
+trunk were the same as in any other child of like age. He was 22 1/2
+inches high, had no spinal curvature, but was absolutely devoid of
+lower extremities. The right arm was two inches long and the left 2
+1/4. Each contained the head and a small adjoining portion of the
+humerus. The legs were represented by masses of cellular tissue and fat
+covered by skin which projected about an inch. He was intelligent, had
+a good memory, and exhibited considerable activity. He seemed to have
+had more than usual mobility and power of flexion of the lower lumbar
+region. When on his back he was unable to rise up, but resting on the
+lower part of the pelvis he was able to maintain himself erect. He
+usually picked up objects with his teeth, and could hold a coin in the
+axilla as he rolled from place to place. His rolling was accomplished
+by a peculiar twisting of the thorax and bending of the pelvis. There
+was no history of maternal impression during pregnancy, no injury, and
+no hereditary disposition to anomalous members. Figure 112 represents a
+boy with congenital deficiency of the lower extremities who was
+exhibited a few years ago in Philadelphia. In Figure 113, which
+represents a similar case in a girl whose photograph is deposited in
+the Mutter Museum of the College of Physicians, Philadelphia, we see
+how cleverly the congenital defect may be remedied by mechanical
+contrivance. With her crutches and artificial legs this girl was said
+to have moved about easily.
+
+Parvin describes a "turtle-man" as an ectromelian, almost entering the
+class of phocomelians or seal-like monsters; the former term signifies
+abortive or imperfect formation of the members. The hands and feet were
+normally developed, but the arms, forearms, and legs are much shortened.
+
+The "turtle-woman" of Demerara was so called because her mother when
+pregnant was frightened by a turtle, and also from the child's fancied
+resemblance to a turtle. The femur was six inches long, the woman had a
+foot of six bones, four being toes, viz., the first and second
+phalanges of the first and second toes. She had an acetabulum, capsule,
+and ligamentum teres, but no tibia or fibula; she also had a defective
+right forearm. She was never the victim of rachitis or like disease,
+but died of syphilis in the Colonial Hospital. In her twenty-second
+year she was delivered of a full-grown child free of deformity.
+
+There was a woman living in Bavaria, under the observation of Buhl, who
+had congenital absence of both femurs and both fibulas.  Almost all the
+muscles of the thigh existed, and the main attachment to the pelvis was
+by a large capsular articulation.  Charpentier gives the portrait of a
+woman in whom there was a uniform diminution in the size of the limbs.
+Debout portrays a young man with almost complete absence of the thigh
+and leg, from whose right hip there depended a foot. Accrell describes
+a peasant of twenty-six, born without a hip, thigh, or leg on the right
+side. The external genital organs were in their usual place, but there
+was only one testicle in the scrotum. The man was virile. The rectum
+instead of opening outward and underneath was deflected to the right.
+
+Supernumerary Limbs.--Haller reports several cases of supernumerary
+extremities. Plancus speaks of an infant with a complete third leg, and
+Dumeril cites a similar instance.  Geoffroy-Saint-Hilaire presented to
+the Academie des Sciences in 1830 a child with four legs and feet who
+was in good health.  Amman saw a girl with a large thigh attached to
+her nates. Below the thigh was a single leg made by the fusion of two
+legs. No patella was found and the knee was anchylosed. One of the feet
+of the supernumerary limb had six toes, while the other, which was
+merely an outgrowth, had two toes on it.
+
+According to Jules Guerin, the child named Gustav Evrard was born with
+a thigh ending in two legs and two imperfect feet depending from the
+left nates.
+
+Tucker describes a baby born in the Sloane Maternity in New York,
+October 1, 1894, who had a third leg hanging from a bony and fleshy
+union attached to the dorsal spine. The supernumerary leg was well
+formed and had a left foot attached to it. Larkin and Jones mention the
+removal of a meningocele and a supernumerary limb from an infant of
+four months. This limb contained three fingers only, one of which did
+not have a bony skeleton.
+
+Pare says that on the day the Venetians and the Genevois made peace a
+monster was born in Italy which had four legs of equal proportions, and
+besides had two supernumerary arms from the elbows of the normal limbs.
+This creature lived and was baptized.
+
+Anomalies of the Feet.--Hatte has seen a woman who bore a child that
+had three feet. Bull gives a description of a female infant with the
+left foot double or cloven. There was only one heel, but the anterior
+portion consisted of an anterior and a posterior part. The anterior
+foot presented a great toe and four smaller ones, but deformed like an
+example of talipes equinovarus.  Continuous with the outer edge of the
+anterior part and curving beneath it was a posterior part, looking not
+unlike a second foot, containing six well-formed toes situated directly
+beneath the other five. The eleven toes were all perfect and none of
+them were webbed.
+
+There is a class of monsters called "Sirens" on account of their
+resemblance to the fabulous creatures of mythology of that name.  Under
+the influence of compression exercised in the uterus during the early
+period of gestation fusion of the inferior extremities is effected. The
+accompanying illustration shows the appearance of these monsters, which
+are thought to resemble the enchantresses celebrated by Homer.
+
+Anomalies of the Hand.--Blumenbach speaks of an officer who, having
+lost his right hand, was subsequently presented by his wife with
+infants of both sexes showing the same deformity.  Murray cites the
+instance of a woman of thirty-eight, well developed, healthy, and the
+mother of normal children, who had a double hand. The left arm was
+abnormal, the flexion of the elbow imperfect, and the forearm
+terminated in a double hand with only rudimentary thumbs. In working as
+a charwoman she leaned on the back of the flexed carpus. The double
+hand could grasp firmly, though the maximum power was not so great as
+that of the right hand. Sensation was equally acute in all three of the
+hands. The middle and ring fingers of the supernumerary hand were
+webbed as far as the proximal joints, and the movements of this hand
+were stiff and imperfect. No single finger of the two hands could be
+extended while the other seven were flexed. Giraldes saw an infant in
+1864 with somewhat the same deformity, but in which the disposition of
+the muscles and tendons permitted the ordinary movements.
+
+Absence of Digits.--Maygrier describes a woman of twenty-four who
+instead of having a hand on each arm had only one finger, and each foot
+had but two toes. She was delivered of two female children in 1827 and
+one in 1829, each having exactly the same deformities. Her mother was
+perfectly formed, but the father had but one toe on his foot and one
+finger on his left hand.
+
+Kohler gives photographs of quite a remarkable case of suppression and
+deformity of the digits of both the fingers and toes.
+
+Figure 123 shows a man who was recently exhibited in Philadelphia. He
+had but two fingers on each hand and two toes on each foot, and
+resembles Kohler's case in the anomalous digital conformation.
+
+Figure 124 represents an exhibitionist with congenital suppression of
+four digits on each hand.
+
+Tubby has seen a boy of three in whom the first, second, and third toes
+of each foot were suppressed, the great toe and the little toe being so
+overgrown that they could be opposed. In this family for four
+generations 15 individuals out of 22 presented this defect of the lower
+extremity. The patient's brothers and a sister had exactly the same
+deformity, which has been called "lobster-claw foot."
+
+Falla of Jedburgh speaks of an infant who was born without forearms or
+hands; at the elbow there was a single finger attached by a thin string
+of tissue. This was the sixth child, and it presented no other
+deformity. Falla also says that instances of intrauterine digital
+amputation are occasionally seen.
+
+According to Annandale, supernumerary digits may be classified as
+follows:--
+
+(1) A deficient organ, loosely attached by a narrow pedicle to the hand
+or foot (or to another digit).
+
+(2) A more or less developed organ, free at its extremity, and
+articulating with the head or sides of a metacarpal, metatarsal, or
+phalangeal bone.
+
+(3) A fully developed separate digit.
+
+(4) A digit intimately united along its whole length with another
+digit, and having either an additional metacarpal or metatarsal bone of
+its own, or articulating with the head of one which is common to it and
+another digit.
+
+Superstitions relative to supernumerary fingers have long been
+prevalent. In the days of the ancient Chaldeans it was for those of
+royal birth especially that divinations relative to extra digits were
+cast. Among the ancients we also occasionally see illustrations
+emblematic of wisdom in an individual with many fingers, or rather
+double hands, on each arm.
+
+Hutchinson, in his comments on a short-limbed, polydactylous dwarf
+which was dissected by Ruysch, the celebrated Amsterdam anatomist,
+writes as follows.--
+
+"This quaint figure is copied from Theodore Kerckring's 'Spicilegium
+Anatomicum,' published in Amsterdam in 1670. The description states
+that the body was that of an infant found drowned in the river on
+October 16, 1668. It was dissected by the renowned Ruysch. A detailed
+description of the skeleton is given.  My reason for now reproducing
+the plate is that it offers an important item of evidence in reference
+to the development of short-limbed dwarfs. Although we must not place
+too much reliance on the accuracy of the draughtsman, since he has
+figured some superfluous lumbar vertebrae, yet there can be no doubt
+that the limbs are much too short for the trunk and head. This remark
+especially applies to the lower limbs and pelvis. These are exactly
+like those of the Norwich dwarf and of the skeleton in the Heidelberg
+Museum which I described in a recent number of the 'Archives.' The
+point of extreme interest in the present case is that this dwarfing of
+the limbs is associated with polydactylism.  Both the hands have seven
+digits. The right foot has eight and the left nine. The conditions are
+not exactly symmetrical, since in some instances a metacarpal or
+metatarsal bone is wanting; or, to put it otherwise, two are welded
+together. It will be seen that the upper extremities are so short that
+the tips of the digits will only just touch the iliac crests.
+
+"This occurrence of short limbs with polydactylism seems to prove
+conclusively that the condition may be due to a modification of
+development of a totally different nature from rickets. It is probable
+that the infant was not at full term. Among the points which the author
+has noticed in his description are that the fontanelle was double its
+usual size; that the orbits were somewhat deformed; that the two halves
+of the lower jaw were already united; and that the ribs were short and
+badly formed. He also, of course, draws attention to the shortness of
+the limbs, the stoutness of the long bones, and the supernumerary
+digits. I find no statement that the skeleton was deposited in any
+museum, but it is very possible that it is still in existence in
+Amsterdam, and if so it is very desirable that it should be more
+exactly described."
+
+In Figure 126, A represents division of thumb after Guyot-Daubes, shows
+a typical case of supernumerary fingers, and C pictures Morand's case
+of duplication of several toes.
+
+Forster gives a sketch of a hand with nine fingers and a foot with nine
+toes. Voight records an instance of 13 fingers on each hand and 12 toes
+on each foot. Saviard saw an infant at the Hotel-Dieu in Paris in 1687
+which had 40 digits, ten on each member. Annandale relates the history
+of a woman who had six fingers and two thumbs on each hand, and another
+who had eight toes on one foot.
+
+Meckel tells of a case in which a man had 12 fingers and 12 toes, all
+well formed, and whose children and grandchildren inherited the
+deformity. Mason has seen nine toes on the left foot. There is recorded
+the account of a child who had 12 toes and six fingers on each hand,
+one fractured. Braid describes talipes varus in a child of a few months
+who had ten toes. There is also on record a collection of cases of from
+seven to ten fingers on each hand and from seven to ten toes on each
+foot. Scherer gives an illustration of a female infant, otherwise
+normally formed, with seven fingers on each hand, all united and
+bearing claw-like nails. On each foot there was a double halux and five
+other digits, some of which were webbed.
+
+The influence of heredity on this anomaly is well demonstrated.
+Reaumur was one of the first to prove this, as shown by the Kelleia
+family of Malta, and there have been many corroboratory instances
+reported; it is shown to last for three, four, and even five
+generations; intermarriage with normal persons finally eradicates it.
+
+It is particularly in places where consanguineous marriages are
+prevalent that supernumerary digits persist in a family. The family of
+Foldi in the tribe of Hyabites living in Arabia are very numerous and
+confine their marriages to their tribe. They all have 24 digits, and
+infants born with the normal number are sacrificed as being the
+offspring of adultery. The inhabitants of the village of Eycaux in
+France, at the end of the last century, had nearly all supernumerary
+digits either on the hands or feet.  Being isolated in an inaccessible
+and mountainous region, they had for many years intermarried and thus
+perpetuated the anomaly.  Communication being opened, they emigrated or
+married strangers and the sexdigitism vanished. Maupertuis recalls the
+history of a family living in Berlin whose members had 24 digits for
+many generations. One of them being presented with a normal infant
+refused to acknowledge it. There is an instance in the Western United
+States in which supernumerary digits have lasted through five
+generations. Cameron speaks of two children in the same family who were
+polydactylic, though not having the same number of supernumerary
+fingers.
+
+Smith and Norwell report the case of a boy of fifteen both of whose
+hands showed webbing of the middle and ring fingers and accessory
+nodules of bone between the metacarpals, and six toes on each foot. The
+boy's father showed similar malformations, and in five generations 21
+out of 28 individuals were thus malformed, ten females and 11 males.
+The deformity was especially transmitted in the female line.
+
+Instances of supernumerary thumbs are cited by Panaroli, Ephemerides,
+Munconys, as well as in numerous journals since.  This anomaly is not
+confined to man alone; apes, dogs, and other lower animals possess it.
+Bucephalus, the celebrated horse of Alexander, and the horse of Caesar
+were said to have been cloven-hoofed.
+
+Hypertrophy of the digits is the result of many different processes,
+and true hypertrophy or gigantism must be differentiated from
+acromegaly, elephantiasis, leontiasis, and arthritis deformans, for
+which distinction the reader is referred to an article by Park. Park
+also calls attention to the difference between acquired gigantism,
+particularly of the finger and toes, and another condition of
+congenital gigantism, in which either after or before birth there is a
+relatively disproportionate, sometimes enormous, overgrowth of perhaps
+one finger or two, perhaps of a limited portion of a hand or foot, or
+possibly of a part of one of the limbs. The best collection of this
+kind of specimens is in the College of Surgeons in London.
+
+Curling quotes a most peculiar instance of hypertrophy of the fingers
+in a sickly girl. The middle and ring fingers of the right hand were of
+unusual size, the middle finger measuring 5 1/2 inches in length four
+inches in circumference. On the left hand the thumb and middle fingers
+were hypertrophied and the index finger was as long as the middle one
+of the right hand. The middle finger had a lateral curvature outward,
+due to a displacement of the extensor tendon. This affection resembled
+acromegaly. Curling cites similar cases, one in a Spanish gentleman,
+Governor of Luzon, in the Philippine Islands, in 1850, who had an
+extraordinary middle finger, which he concealed by carrying it in the
+breast of his coat.
+
+Hutchinson exhibited a photograph showing the absence of the radius and
+thumb, with shortening of the forearm. Conditions more or less
+approaching this had occurred in several members of the same family. In
+some they were associated with defects of development in the lower
+extremities also.
+
+The varieties of club-foot--talipes varus, valgus, equinus,
+equino-varus, etc.--are so well known that they will be passed with
+mention only of a few persons who have been noted for their activity
+despite their deformity. Tyrtee, Parini, Byron, and Scott are among the
+poets who were club-footed; some writers say that Shakespeare suffered
+in a slight degree from this deformity.  Agesilas, Genserie, Robert II,
+Duke of Normandy, Henry II, Emperor of the West, Otto II, Duke of
+Brunswick, Charles II, King of Naples, and Tamerlane were victims of
+deformed feet. Mlle.  Valliere, the mistress of Louis XIV, was supposed
+to have both club-foot and hip-disease. Genu valgum and genu varum are
+ordinary deformities and quite common in all classes.
+
+Transpositions of the character of the vertebrae are sometimes seen. In
+man the lumbar vertebrae have sometimes assumed the character of the
+sacral vertebrae, the sacral vertebrae presenting the aspect of lumbar
+vertebrae, etc. It is quite common to see the first lumbar vertebra
+presenting certain characteristics of the dorsal.
+
+Numerical anomalies of the vertebrae are quite common, generally in the
+lumbar and dorsal regions, being quite rare in the cervical, although
+there have been instances of six or eight cervical vertebrae. In the
+lower animals the vertebrae are prolonged into a tail, which, however,
+is sometimes absent, particularly when hereditary influence exists. It
+has been noticed in the class of dogs whose tails are habitually
+amputated to improve their appearance that the tail gradually decreases
+in length. Some breeders deny this fact.
+
+Human Tails.--The prolongation of the coccyx sometimes takes the shape
+of a caudal extremity in man. Broca and others claim that the sacrum
+and the coccyx represent the normal tail of man, but examples are not
+infrequent in which there has been a fleshy or bony tail appended to
+the coccygeal region. Traditions of tailed men are old and widespread,
+and tailed races were supposed to reside in almost every country. There
+was at one time an ancient belief that all Cornishmen had tails, and
+certain men of Kent were said to have been afflicted with tails in
+retribution for their insults to Thomas a Becket. Struys, a Dutch
+traveler in Formosa in the seventeenth century, describes a wild man
+caught and tied for execution who had a tail more than a foot long,
+which was covered with red hair like that of a cow.
+
+The Niam Niams of Central Africa are reported to have tails smooth and
+hairy and from two to ten inches long. Hubsch of Constantinople remarks
+that both men and women of this tribe have tails. Carpus, or
+Berengarius Carpensis, as he is called, in one of his Commentaries said
+that there were some people in Hibernia with long tails, but whether
+they were fleshy or cartilaginous could not be known, as the people
+could not be approached.  Certain supposed tailed races which have been
+described by sea-captains and voyagers are really only examples of
+people who wear artificial appendages about the waists, such as
+palm-leaves and hair. A certain Wesleyan missionary, George Brown, in
+1876 spoke of a formal breeding of a tailed race in Kali, off the coast
+of New Britain. Tailless children were slain at once, as they would be
+exposed to public ridicule. The tailed men of Borneo are people
+afflicted with hereditary malformation analogous to sexdigitism. A
+tailed race of princes have ruled Rajoopootana, and are fond of their
+ancestral mark. There are fabulous stories told of canoes in the East
+Indies which have holes in their benches made for the tails of the
+rowers. At one time in the East the presence of tails was taken as a
+sign of brute force.
+
+There was reported from Caracas the discovery of a tribe of Indians in
+Paraguay who were provided with tails. The narrative reads somewhat
+after this manner: One day a number of workmen belonging to Tacura Tuyn
+while engaged in cutting grass had their mules attacked by some
+Guayacuyan Indians. The workmen pursued the Indians but only succeeded
+in capturing a boy of eight. He was taken to the house of Senor
+Francisco Galeochoa at Posedas, and was there discovered to have a tail
+ten inches long. On interrogation the boy stated that he had a brother
+who had a tail as long as his own, and that all the tribe had tails.
+
+Aetius, Bartholinus, Falk, Harvey, Kolping, Hesse, Paulinus, Strauss,
+and Wolff give descriptions of tails. Blanchard says he saw a tail
+fully a span in length: and there is a description in 1690 of a man by
+the name of Emanuel Konig, a son of a doctor of laws who had a tail
+half a span long, which grew directly downward from the coccyx and was
+coiled on the perineum, causing much discomfort. Jacob describes a
+pouch of skin resembling a tail which hung from the tip of the coccyx
+to the length of six inches. It was removed and was found to be thicker
+than the thumb, consisted of distinctly jointed portions with synovial
+capsules. Gosselin saw at his clinic a caudal appendix in an infant
+which measured about ten cm. Lissner says that in 1872 he assisted in
+the delivery of a young girl who had a tail consisting of a coccyx
+prolonged and covered with skin, and in 1884 he saw the same girl, at
+this time the tail measuring nearly 13 cm.
+
+Virchow received for examination a tail three inches long amputated
+from a boy of eight weeks. Ornstein, chief physician of the Greek army,
+describes a Greek of twenty-six who had a hairless, conical tail, free
+only at the tip, two inches long and containing three vertebrae. He
+also remarks that other instances have been observed in recruits. Thirk
+of Broussa in 1820 described the tail of a Kurd of twenty-two which
+contained four vertebrae. Belinovski gives an account of a hip-joint
+amputation and extirpation of a fatty caudal extremity, the only one he
+had ever observed.
+
+Before the Berlin Anthropological Society there were presented two
+adult male Papuans, in good health and spirits, who had been brought
+from New Guinea; their coccygeal bones projected 1 1/2 inches. Oliver
+Wendell Holmes in the Atlantic Monthly, June, 1890, says that he saw in
+London a photograph of a boy with a considerable tail. The "Moi Boy"
+was a lad of twelve, who was found in Cochin China, with a tail a foot
+long which was simply a mass of flesh. Miller tells of a West Point
+student who had an elongation of the coccyx, forming a protuberance
+which bulged very visibly under the skin. Exercise at the riding school
+always gave him great distress, and the protuberance would often chafe
+until the skin was broken, the blood trickling into his boots.
+
+Bartels presents a very complete article in which he describes 21
+persons born with tails, most of the tails being merely fleshy
+protuberances. Darwin speaks of a person with a fleshy tail and refers
+to a French article on human tails.
+
+Science contains a description of a negro child born near Louisville,
+eight weeks old, with a pedunculated tail 2 1/2 inches long, with a
+base 1 1/4 inches in circumference. The tail resembled in shape a pig's
+tail and had grown 1/4 inch since birth. It showed no signs of
+cartilage or bone, and had its origin from a point slightly to the left
+of the median line and about an inch above the end of the spinal column.
+
+Dickinson recently reported the birth of a child with a tail. It was a
+well-developed female between 5 1/2 and six pounds in weight. The
+coccyx was covered with the skin on both the anterior and posterior
+surfaces. It thus formed a tail of the size of the nail of the little
+finger, with a length of nearly 3/16 inch on the inner surface and 3/8
+inch on the rear surface. This little tip could be raised from the body
+and it slowly sank back.
+
+In addition to the familiar caudal projection of the human fetus,
+Dickinson mentions a group of other vestigial remains of a former state
+of things. Briefly these are:--
+
+(1) The plica semilunaris as a vestige of the nictitating membrane of
+certain birds.
+
+(2) The pointed ear, or the turned-down tip of the ears of many men.
+
+(3) The atrophied muscles, such as those that move the ear, that are
+well developed in certain people, or that shift the scalp, resembling
+the action of a horse in ridding itself of flies.
+
+(4) The supracondyloid foremen of the humerus.
+
+(5) The vermiform appendix.
+
+(6) The location and direction of the hair on the trunk and limbs.
+
+(7) The dwindling wisdom-teeth.
+
+(8) The feet of the fetus strongly deflected inward, as in the apes,
+and persisting in the early months of life, together with great
+mobility and a distinct projection of the great toe at an angle from
+the side of the foot.
+
+(9) The remarkable grasping power of the hand at birth and for a few
+weeks thereafter, that permits young babies to suspend their whole
+weight on a cane for a period varying from half a minute to two minutes.
+
+Horrocks ascribes to these anal tags a pathologic importance. He claims
+that they may be productive of fistula in ano, superficial ulcerations,
+fecal concretions, fissure in ano, and that they may hypertrophy and
+set up tenesmus and other troubles. The presence of human tails has
+given rise to discussion between friends and opponents of the Darwinian
+theory. By some it is considered a reversion to the lower species,
+while others deny this and claim it to be simply a pathologic appendix.
+
+Anomalies of the Spinal Canal and Contents.--When there is a default in
+the spinal column, the vice of conformation is called spina bifida.
+This is of two classes: first, a simple opening in the vertebral canal,
+and, second, a large cleft sufficient to allow the egress of spinal
+membranes and substance. Figure 130 represents a large congenital
+sacral tumor.
+
+Achard speaks of partial duplication of the central canal of the spinal
+cord. De Cecco reports a singular case of duplication of the lumbar
+segment of the spinal cord. Wagner speaks of duplication of a portion
+of the spinal cord.
+
+Foot records a case of amyelia, or absence of the spinal cord, in a
+fetus with hernia cerebri and complete fissure of the spinal column.
+Nicoll and Arnold describe an anencephalous fetus with absence of
+spinal marrow; and Smith also records the birth of an amyelitic fetus.
+
+In some persons there are exaggerated curvatures of the spine.  The
+first of these curvatures is called kyphosis, in which the curvature is
+posterior; second, lordosis, in which the curvature is anterior; third,
+scoliosis, in which it is lateral, to the right or left.
+
+Kyphosis is the most common of the deviations in man and is most often
+found in the dorsal region, although it may be in the lumbar region.
+Congenital kyphosis is very rare in man, is generally seen in monsters,
+and when it does exist is usually accompanied by lordosis or spine
+bifida. We sometimes observe a condition of anterior curvature of the
+lumbar and sacral regions, which might be taken for a congenital
+lordosis, but this is really a deformity produced after birth by the
+physiologic weight of the body. Figure 131 represents a case of
+lordosis caused by paralysis of the spinal muscles.
+
+Analogous to this is what the accoucheurs call spondylolisthesis.
+Scoliosis may be a cervicodorsal, dorsolumbar, or lumbosacral curve,
+and the inclination of the vertebral column may be to the right or
+left. The pathologists divide scoliosis into a myopathic variety, in
+which the trouble is a physiologic antagonism of the muscles; or
+osteopathic, ordinarily associated with rachitis, which latter variety
+is generally accountable for congenital scoliosis. In some cases the
+diameter of the chest is shortened to an almost incredible degree, but
+may yet be compatible with life. Glover speaks of an extraordinary
+deformity of the chest with lateral curvature of the spine, in which
+the diameter from the pit of the stomach to the spinal integument was
+only 5 1/2 inches.
+
+Supernumerary ribs are not at all uncommon in man, nearly every medical
+museum having some examples. Cervical ribs are not rare.  Gordon
+describes a young man of seventeen in whom there was a pair of
+supernumerary ribs attached to the cervical vertebrae.  Bernhardt
+mentions an instance in which cervical ribs caused motor and sensory
+disturbances. Dumerin of Lyons showed an infant of eight days which had
+an arrested development of the 2d, 3d, 4th, and 5th ribs. Cases of
+deficient ribs are occasionally met.  Wistar in 1818 gives an account
+of a person in whom one side of the thorax was at rest while the other
+performed the movements of breathing in the usual manner.
+
+In some cases we see fissure of the sternum, caused either by deficient
+union or absence of one of its constituent parts. In the most
+exaggerated cases these fissures permit the exit of the heart, and as a
+general rule ectopies of the heart are thus caused. Pavy has given a
+most remarkable case of sternal fissure in a young man of twenty-five,
+a native of Hamburg. He exhibited himself in one medical clinic after
+another all over Europe, and was always viewed with the greatest
+interest. In the median line, corresponding to the absence of sternum,
+was a longitudinal groove bounded on either side by a continuous hard
+ridge which articulated with the costal cartilages. The skin passed
+naturally over the chest from one side to another, but was raised at
+one part of the groove by a pulsatile swelling which occupied the
+position of the right auricle. The clavicle and the two margins of the
+sternum had no connections whatever, and below the groove was a hard
+substance corresponding to the ensiform cartilage, which, however, was
+very elastic, and allowed the patient, under the influence of the
+pectoral muscles, when the upper extremity was fixed, to open the
+groove to nearly the extent of three inches, which was more than twice
+its natural width. By approximating his arms he made the ends of his
+clavicles overlap.  When he coughed, the right lung suddenly protruded
+from the chest through the groove and ascended a considerable distance
+above the clavicle into the neck. Between the clavicles another
+pulsatile swelling was easily felt but hardly seen, which was doubtless
+the arch of the aorta, as by putting the fingers on it one could feel a
+double shock, synchronous with distention and recoil of a vessel or
+opening and closing of the semilunar valves.
+
+Madden pictures (Figs. 134 and 135) a Swede of forty with congenital
+absence of osseous structure in the middle line of the sternum, leaving
+a fissure 5 3/8 X 1 3/16 X 2 inches, the longest diameter being
+vertical. Madden also mentions several analogous instances on record.
+Groux's case was in a person of forty-five, and the fissure had the
+vertical length of four inches. Hodgen of St. Louis reports a case in
+which there was exstrophy of the heart through the fissure. Slocum
+reports the occurrence of a sternal fissure 3 X 1 1/2 inches in an
+Irishman of twenty-five.  Madden also cites the case of Abbott in an
+adult negress and a mother. Obermeier mentions several cases. Gibson
+and Malet describe a presternal fissure uncovering the base of the
+heart.  Ziemssen, Wrany, and Williams also record congenital fissures
+of the sternum.
+
+Thomson has collected 86 cases of thoracic defects and summarizes his
+paper by saying that the structures deficient are generally the hair in
+the mammary and axillary regions, the subcutaneous fat over the
+muscles, nipples, and breasts, the pectorals and adjacent muscles, the
+costal cartilages and anterior ends of ribs, the hand and forearm; he
+also adds that there may be a hernia of the lung, not hereditary, but
+probably due to the pressure of the arm against the chest. De Marque
+gives a curious instance in which the chin and chest were congenitally
+fastened together. Muirhead cites an instance in which a firm, broad
+strip of cartilage resembling sternomastoid extended from below the
+left ear to the left upper corner of the sternum, being entirely
+separate from the jaw.
+
+Some preliminary knowledge of embryology is essential to understand the
+formation of branchial fissures, and we refer the reader to any of the
+standard works on embryology for this information. Dzondi was one of
+the first to recognize and classify congenital fistulas of the neck.
+The proper classification is into lateral and median fissures. In a
+case studied by Fevrier the exploration of a lateral pharyngeal fistula
+produced by the introduction of the sound violent reflex phenomena,
+such as pallor of the face and irregular, violent beating of the heart.
+The rarest of the lateral class is the preauricular fissure, which has
+been observed by Fevrier, Le Dentu, Marchand, Peyrot, and Routier.
+
+The median congenital fissures of the neck are probably caused by
+defective union of the branchial arches, although Arndt thinks that he
+sees in these median fistulas a persistence of the hypobranchial furrow
+which exists normally in the amphioxus. They are less frequent than the
+preceding variety.
+
+The most typical form of malformation of the esophagus is imperforation
+or obliteration. Van Cuyck of Brussels in 1824 delivered a child which
+died on the third day from malnutrition.  Postmortem it was found that
+the inferior extremity of the esophagus to the extent of about two
+inches was converted into a ligamentous cord. Porro describes a case of
+congenital obliteration of the esophagus which ended in a cecal pouch
+about one inch below the inferior portion of the glottidean aperture
+and from this point to the stomach only measured an inch; there was
+also tracheal communication. The child was noticed to take to the
+breast with avidity, but after a little suckling it would cough, become
+livid, and reject most of the milk through the nose, in this way almost
+suffocating at each paroxysm; it died on the third day.
+
+In some cases the esophagus is divided, one portion opening into the
+bronchial or other thoracic organs. Brentano describes an infant dying
+ten days after birth whose esophagus was divided into two portions, one
+terminating in a culdesac, the other opening into the bronchi; the left
+kidney was also displaced downward. Blasius describes an anomalous case
+of duplication of the esophagus. Grashuys, and subsequently Vicq
+d'Azir, saw a dilatation of the esophagus resembling the crop of a bird.
+
+Anomalies of the Lungs.--Carper describes a fetus of thirty-seven weeks
+in whose thorax he found a very voluminous thymus gland but no lungs.
+These organs were simply represented by two little oval bodies having
+no lobes, with the color of the tissue of the liver. The heart had only
+one cavity but all the other organs were perfectly formed. This case
+seems to be unique. Tichomiroff records the case of a woman of
+twenty-four who died of pneumonia in whom the left lung was entirely
+missing. No traces of a left bronchus existed. The subject was very
+poorly developed physically. Tichomiroff finds four other cases in
+literature, in all of which the left lung was absent. Theremin and
+Tyson record cases of the absence of the left lung.
+
+Supplementary pulmonary lobes are occasionally seen in man and are
+taken by some authorities to be examples of retrogressive anomalies
+tending to prove that the derivation of the human race is from the
+quadrupeds which show analogous pulmonary malformation. Eckley reports
+an instance of supernumerary lobe of the right lung in close connection
+with the vena azygos major.  Collins mentions a similar case. Bonnet
+and Edwards speak of instances of four lobes in the right lung. Testut
+and Marcondes report a description of a lung with six lobes.
+
+Anomalies of the Diaphragm.--Diemerbroeck is said to have dissected a
+human subject in whom the diaphragm and mediastinum were apparently
+missing, but such cases must be very rare, although we frequently find
+marked deficiency of this organ.  Bouchand reports an instance of
+absence of the right half of the diaphragm in an infant born at term.
+Lawrence mentions congenital deficiency of the muscular fibers of the
+left half of the diaphragm with displacement of the stomach. The
+patient died of double pneumonia. Carruthers, McClintock, Polaillon,
+and van Geison also record instances of congenital deficiency of part
+of the diaphragm. Recently Dittel reported unilateral defect in the
+diaphragm of an infant that died soon after birth. The stomach, small
+intestines, and part of the large omentum lay in the left pleural
+cavity; both the phrenic nerves were normal. Many similar cases of
+diaphragmatic hernia have been observed. In such cases the opening may
+be large enough to allow a great part of the visceral constituents to
+pass into the thorax, sometimes seriously interfering with respiration
+and circulation by the pressure which ensues. Alderson reports a fatal
+case of diaphragmatic hernia with symptoms of pneumothorax. The
+stomach, spleen, omentum, and transverse colon were found lying in the
+left pleura. Berchon mentions double perforation of the diaphragm with
+hernia of the epiploon. The most extensive paper on this subject was
+contributed by Bodwitch, who, besides reporting an instance in the
+Massachusetts General Hospital, gives a numerical analysis of all the
+cases of this affection found recorded in the writings of medical
+authors between the years 1610 and 1846.  Hillier speaks of an instance
+of congenital diaphragmatic hernia in which nearly all the small
+intestines and two-thirds of the large passed into the right side of
+the thorax. Macnab reports an instance in which three years after the
+cure of empyema the whole stomach constituted the hernia. Recently Joly
+described congenital hernia of the stomach in a man of thirty-seven,
+who died from collapse following lymphangitis, persistent vomiting, and
+diarrhea. At the postmortem there was found a defect in the diaphragm
+on the left side, permitting herniation of the stomach and first part
+of the duodenum into the left pleural cavity.  There was no history of
+traumatism to account for strangulation.  Longworth cites an instance
+of inversion of the diaphragm in a human subject. Bartholinus mentions
+coalition of the diaphragm and liver; and similar cases are spoken of
+by Morgagni and the Ephemerides. Hoffman describes diaphragmatic
+junction with the lung.
+
+Anomalies of the Stomach.--The Ephemerides contains the account of a
+dissection in which the stomach was found wanting, and also speaks of
+two instances of duplex stomach. Bartholinus, Heister, Hufeland,
+Morgagni, Riolan, and Sandifort cite examples of duplex stomach. Bonet
+speaks of a case of vomiting which was caused by a double stomach.
+Struthers reports two cases in which there were two cavities to the
+stomach. Struthers also mentions that Morgagni, Home, Monro, Palmer,
+Larry, Blasius, Hufeland, and Walther also record instances in which
+there was contraction in the middle of the stomach, accounting for
+their instances of duplex stomach. Musser reports an instance of
+hour-glass contraction of the stomach. Hart dissected the stomach of a
+woman of thirty which resembled the stomach of a predaceous bird, with
+patches of tendon on its surface. The right extremity instead of
+continuously contracting ended in a culdesac one-half as large as the
+greater end of the stomach. The duodenum proceeded from the depression
+marking the lesser arch of the organ midway between the cardiac orifice
+and the right extremity. Crooks speaks of a case in which the stomach
+of an infant terminated in a culdesac.
+
+Hernia of the stomach is not uncommon, especially in diaphragmatic or
+umbilical deficiency. There are many cases on record, some terminating
+fatally from strangulation or exposure to traumatism. Paterson reports
+a case of congenital hernia of the stomach into the left portion of the
+thoracic cavity. It was covered with fat and occupied the whole left
+half of the thoracic cavity. The spleen, pancreas, and transverse colon
+were also superior to the diaphragm. Death was caused by a well-defined
+round perforation at the cardiac curvature the size of a sixpence.
+
+Anomalies of the Intestines.--The Ephemerides contains the account of
+an example of double cecum, and Alexander speaks of a double colon, and
+there are other cases of duplication of the bowel recorded. There is an
+instance of coalition of the jejunum with the liver, and Treuner
+parallels this case. Aubery, Charrier Poelman, and others speak of
+congenital division of the intestinal canal. Congenital occlusion is
+quite frequently reported.
+
+Dilatation of the colon frequently occurs as a transient affection, and
+by its action in pushing up the diaphragm may so seriously interfere
+with the action of the heart and lungs as to occasionally cause
+heart-failure. Fenwick has mentioned an instance of this nature.
+According to Osler there is a chronic form of dilatation of the colon
+in which the gut may reach an enormous size. The coats may be
+hypertrophied without evidence of any special organic change in the
+mucosa. The most remarkable instance has been reported by Formad. The
+patient, known as the "balloon-man," aged twenty-three at the time of
+his death, had had a distended abdomen from infancy. Postmortem the
+colon was found as large as that of an ox, the circumference ranging
+from 15 to 30 inches. The weight of the contents was 47 pounds. Cases
+are not uncommon in children. Osler reports three well-marked cases
+under his care. Chapman mentions a case in which the liver was
+displaced by dilatation of the sigmoid flexure. Mya reports two cases
+of congenital dilatation and hypertrophy of the colon (megacolon
+congenito). Hirsohsprung, Genersich, Faralli, Walker, and Griffiths all
+record similar instances, and in all these cases the clinical features
+were obstinate constipation and marked meteorismus.
+
+Imperforate Anus.--Cases in which the anus is imperforate or the rectum
+ends in a blind pouch are occasionally seen. In some instances the
+rectum is entirely absent, the colon being the termination of the
+intestinal tract. There are cases on record in which the rectum
+communicated with the anus solely by a fibromuscular cord. Anorectal
+atresia is the ordinary imperforation of the anus, in which the rectum
+terminates in the middle of the sacral cavity. The rectum may be
+deficient from the superior third of the sacrum, and in this position
+is quite inaccessible for operation.
+
+A compensatory coalition of the bowel with the bladder or urethra is
+sometimes present, and in these cases the feces are voided by the
+urinary passages. Huxham mentions the fusion of the rectum and colon
+with the bladder, and similar instances are reported by Dumas and
+Baillie. Zacutus Lusitanus describes an infant with an imperforate
+membrane over its anus who voided feces through the urethra for three
+months. After puncture of the membrane, the discharge came through the
+natural passage and the child lived; Morgagni mentions a somewhat
+similar case in a little girl living in Bologna, and other modern
+instances have been reported. The rectum may terminate in the vagina.
+Masters has seen a child who lived nine days in whom the sigmoid
+flexure of the colon terminated in the fundus of the bladder. Guinard
+pictures a case in which there was communication between the rectum and
+the bladder. In Figure 140 a represents the rectum; b the bladder; c
+the point of communication; g shows the cellular tissue of the scrotum.
+
+There is a description of a girl of fourteen, otherwise well
+constituted and healthy, who had neither external genital organs nor
+anus. There was a plain dermal covering over the genital and anal
+region. She ate regularly, but every three days she experienced pain in
+the umbilicus and much intestinal irritation, followed by severe
+vomiting of stercoraceous matter; the pains then ceased and she
+cleansed her mouth with aromatic washes, remaining well until the
+following third day. Some of the urine was evacuated by the mammae. The
+examiners displayed much desire to see her after puberty to note the
+disposition of the menstrual flow, but no further observation of her
+case can be found.
+
+Fournier narrates that he was called by three students, who had been
+trying to deliver a woman for five days. He found a well-constituted
+woman of twenty-two in horrible agony, who they said had not had a
+passage of the bowels for eight days, so he prescribed an enema. The
+student who was directed to give the enema found to his surprise that
+there was no anus, but by putting his finger in the vagina he could
+discern the floating end of the rectum, which was full of feces. There
+was an opening in this suspended rectum about the size of an
+undistended anus.  Lavage was practiced by a cannula introduced through
+the opening, and a great number of cherry stones agglutinated with
+feces followed the water, and labor was soon terminated. The woman
+afterward confessed that she was perfectly aware of her deformity, but
+was ashamed to disclose it before. There was an analogue of this case
+found by Mercurialis in a child of a Jew called Teutonicus.
+
+Gerster reports a rare form of imperforate anus, with malposition of
+the left ureter, obliteration of the ostia of both ureters, with
+consequent hydronephrosis of a confluent kidney. There was a minute
+opening into the bladder, which allowed the passage of meconium through
+the urethra. Burge mentions the case of what he calls "sexless child,"
+in which there was an imperforate anus and no pubic arch; the ureters
+discharged upon a tumor the size of a teacup extending from the
+umbilicus to the pubes. A postmortem examination confirmed the
+diagnosis of sexless child.
+
+The Liver.--The Ephemerides, Frankenau, von Home, Molinetti, Schenok,
+and others speak of deficient or absent liver. Zacutus Lusitanus says
+that he once found a mass of flesh in place of the liver. Lieutaud is
+quoted as describing a postmortem examination of an adult who had died
+of hydropsy, in whom the liver and spleen were entirely missing. The
+portal vein discharged immediately into the vena cava; this case is
+probably unique, as no authentic parallel could be found.
+
+Laget reports an instance of supernumerary lobe in the liver. Van Buren
+describes a supernumerary liver. Sometimes there is rotation, real or
+apparent, caused by transposition of the characteristics of the liver.
+Handy mentions such a case.  Kirmisson reports a singular anomaly of
+the liver which he calls double displacement by interversion and
+rotation on the vertical axis. Actual displacements of the liver as
+well as what is known as wandering liver are not uncommon. The
+operation for floating liver will be spoken of later.
+
+Hawkins reports a case of congenital obliteration of the ductus
+communis choledochus in a male infant which died at the age of four and
+a half months. Jaundice appeared on the eighth day and lasted through
+the short life. The hepatic and cystic ducts were pervious and the
+hepatic duct obliterated. There were signs of hepatic cirrhosis and in
+addition an inguinal hernia.
+
+The Gall-Bladder.--Harle mentions the case of a man of fifty, in whom
+he could find no gall-bladder; Patterson has seen a similar instance in
+a men of twenty-five. Purser describes a double gall-bladder.
+
+The spleen has been found deficient or wanting by Lebby, Ramsay, and
+others, but more frequently it is seen doubled. Cabrolius, Morgagni,
+and others have found two spleens in one subject; Cheselden and
+Fallopius report three; Fantoni mentions four found in one subject;
+Guy-Patin has seen five, none as large as the ordinary organ;
+Hollerius, Kerckringius, and others have remarked on multiple spleens.
+There is a possibility that in some of the cases of multiple spleens
+reported the organ is really single but divided into several lobes.
+Albrecht mentions a case shown at a meeting of the Vienna Medical
+Society of a very large number of spleens found in the mesogastrium,
+peritoneum, on the mesentery and transverse mesocolon, in Douglas'
+pouch, etc. There was a spleen "the size of a walnut" in the usual
+position, with the splenic artery and vein in their normal position.
+Every one of these spleens had a capsule, was covered by peritoneum,
+and exhibited the histologic appearance of splenic tissue. According to
+the review of this article, Toldt explains the case by assuming that
+other parts of the celomic epithelium, besides that of the
+mesogastrium, are capable of forming splenic tissue.  Jameson reports a
+case of double spleen and kidneys. Bainbrigge mentions a case of
+supernumerary spleen causing death from the patient being placed in the
+supine position in consequence of fracture of the thigh. Peevor
+mentions an instance of second spleen. Beclard and Guy-Patin have seen
+the spleen congenitally misplaced on the right side and the liver on
+the left; Borellus and Bartholinus with others have observed
+misplacement of the spleen.
+
+The Pancreas.--Lieutaud has seen the pancreas missing and speaks of a
+double pancreatic duct that he found in a man who died from starvation;
+Bonet speaks of a case similar to this last.
+
+There are several cases of complete transposition of the viscera on
+record. This bizarre anomaly was probably observed first in 1650 by
+Riolanus, but the most celebrated case was that of Morand in 1660, and
+Mery described the instance later which was the subject of the
+following quatrain:--
+
+"La nature, peu sage et sans douse en debauche Placa le foie au cote
+gauche, Et de meme, vice versa Le coeur a le droite placa."
+
+Young cites an example in a woman of eighty-five who died at
+Hammersmith, London. She was found dead in bed, and in a postmortem
+examination, ordered to discover if possible the cause of death, there
+was seen complete transposition of the viscera.  The heart lay with its
+base toward the left, its apex toward the right, reaching the lower
+border of the 4th rib, under the right mamma. The vena cava was on the
+left side and passed into the pulmonary cavity of the heart, which was
+also on the left side, the aorta and systemic ventricle being on the
+right. The left splenic vein was lying on the superior vena cava, the
+liver under the left ribs, and the spleen on the right side underneath
+the heart. The esophagus was on the right of the aorta, and the
+location of the two ends of the stomach was reversed; the sigmoid
+flexure was on the right side. Davis describes a similar instance in a
+man.
+
+Herrick mentions transposition of viscera in a man of twenty-five.
+Barbieux cites a case of transposition of viscera in a man who was
+wounded in a duel. The liver was to the left and the spleen and heart
+to the right etc. Albers, Baron, Beclard, Boyer, Bull, Mackensie,
+Hutchinson, Hunt, Murray, Dareste, Curran, Duchesne, Musser, Sabatier,
+Shrady, Vulpian, Wilson, and Wehn are among others reporting instances
+of transposition and inversion of the viscera.
+
+Congenital extroversion or eventration is the result of some congenital
+deficiency in the abdominal wall; instances are not uncommon, and some
+patients live as long as do cases of umbilical hernia proper. Ramsey
+speaks of entire want of development of the abdominal parietes.
+Robertson, Rizzoli, Tait, Hamilton, Brodie, Denis, Dickie, Goyrand, and
+many others mention extroversion of viscera from parietal defects. The
+different forms of hernia will be considered in another chapter.
+
+There seem to be no authentic cases of complete absence of the kidney
+except in the lowest grades of monstrosities. Becker, Blasius, Rhodius,
+Baillie, Portal, Sandifort, Meckel, Schenck, and Stoll are among the
+older writers who have observed the absence of one kidney. In a recent
+paper Ballowitz has collected 213 cases, from which the following
+extract has been made by the British Medical Journal:--
+
+"Ballowitz (Virchow's Archiv, August 5, 1895) has collected as far as
+possible all the recorded cases of congenital absence of one kidney.
+Excluding cases of fused kidney and of partial atrophy of one kidney,
+he finds 213 cases of complete absence of one kidney, upon which he
+bases the following conclusions: Such deficiency occurs almost twice as
+often in males as in females, a fact, however, which may be partly
+accounted for by the greater frequency of necropsies on males. As to
+age, 23 occurred in the fetus or newly born, most having some other
+congenital deformity, especially imperforate anus; the rest were about
+evenly distributed up to seventy years of age, after which only seven
+cases occurred. Taking all cases together, the deficiency is more
+common on the left than on the right side; but while in males the left
+kidney is far more commonly absent than the right, in females the two
+sides show the defect equally. The renal vessels were generally absent,
+as also the ureter, on the abnormal side (the latter in all except 15
+cases); the suprarenal was missing in 31 cases. The solitary kidney was
+almost always normal in shape and position, but much enlarged.
+Microscopically the enlargement would seem to be due rather to
+hyperplasia than to hypertrophy. The bladder, except for absence of the
+opening of one ureter, was generally normal. In a large number of cases
+there were associated deformities of the organs of generation,
+especially of the female organs, and these were almost invariably on
+the side of the renal defect; they affected the conducting portion much
+more than the glandular portion--that is, uterus, vagina, and Fallopian
+tubes in the female, and vas deferens or vesiculae seminales in the
+male, rather than the ovaries or testicles. Finally, he points out the
+practical bearing of the subject--for example, the probability of
+calculus causing sudden suppression of urine in such cases--and also
+the danger of surgical interference, and suggests the possibility of
+diagnosing the condition by ascertaining the absence of the opening of
+one ureter in the bladder by means of the cystoscope, and also the
+likelihood of its occurring where any abnormality of the genital organs
+is found, especially if this be unilateral."
+
+Green reports the case of a female child in which the right kidney and
+right Fallopian tube and ovary were absent without any rudimentary
+structures in their place. Guiteras and Riesman have noted the absence
+of the right kidney, right ureter, and right adrenal in an old woman
+who had died of chronic nephritis. The left kidney although cirrhotic
+was very much enlarged.
+
+Tompsett describes a necropsy made on a coolie child of nearly twelve
+months, in which it was seen that in the place of a kidney there were
+two left organs connected at the apices by a prolongation of the
+cortical substance of each; the child had died of neglected malarial
+fever. Sandifort speaks of a case of double kidneys and double ureters,
+and cases of supernumerary kidney are not uncommon, generally being
+segmentation of one of the normal kidneys. Rayer has seen three kidneys
+united and formed like a horseshoe. We are quite familiar with the
+ordinary "horseshoe kidney," in which two normal kidneys are connected.
+
+There are several forms of displacement of the kidneys, the most common
+being the "floating kidney," which is sometimes successfully removed or
+fixed; Rayer has made an extensive study of this anomaly.
+
+The kidney may be displaced to the pelvis, and Guinard quotes an
+instance in which the left kidney was situated in the pelvis, to the
+left of the rectum and back of the bladder. The ureter of the left side
+was very short. The left renal artery came from the bifurcation of the
+aorta and the primitive iliacs. The right kidney was situated normally,
+and received from the aorta two arteries, whose volume did not surpass
+the two arteries supplying the left suprarenal capsule, which was in
+its ordinary place.  Displacements of the kidney anteriorly are very
+rare.
+
+The ureters have been found multiple; Griffon reports the history of a
+male subject in whom the ureter on the left side was double throughout
+its whole length; there were two vesical orifices on the left side one
+above the other; and Morestin, in the same journal, mentions ureters
+double on both sides in a female subject. Molinetti speaks of six
+ureters in one person. Littre in 1705 described a case of coalition of
+the ureters. Allen describes an elongated kidney with two ureters.
+Coeyne mentions duplication of the ureters on both sides. Lediberder
+reports a case in which the ureter had double origin. Tyson cites an
+instance of four ureters in an infant. Penrose mentions the absence of
+the upper two-thirds of the left ureter, with a small cystic kidney,
+and there are parallel cases on record.
+
+The ureters sometimes have anomalous terminations either in the rectum,
+vagina, or directly in the urethra. This latter disposition is realized
+normally in a number of animals and causes the incessant flow of urine,
+resulting in a serious inconvenience. Flajani speaks of the termination
+of the ureters in the pelvis; Nebel has seen them appear just beneath
+the umbilicus; and Lieutaud describes a man who died at thirty-five,
+from another cause, whose ureters, as large as intestines, terminated
+in the urethral canal, causing him to urinate frequently; the bladder
+was absent. In the early part of this century there was a young girl
+examined in New York whose ureters emptied into a reddish carnosity on
+the mons veneris. The urine dribbled continuously, and if the child
+cried or made any exertion it came in jets. The genital organs
+participated but little in the deformity, and with the exception that
+the umbilicus was low and the anus more anterior than natural, the
+child was well formed and its health good. Colzi reports a case in
+which the left ureter opened externally at the left side of the hymen a
+little below the normal meatus urinarius. There is a case described of
+a man who evidently suffered from a patent urachus, as the urine passed
+in jets as if controlled by a sphincter from his umbilicus. Littre
+mentions a patent urachus in a boy of eighteen. Congenital dilatation
+of the ureters is occasionally seen in the new-born. Shattuck describes
+a male fetus showing reptilian characters in the sexual ducts. There
+was ectopia vesicae and prolapse of the intestine at the umbilicus; the
+right kidney was elongated; the right vas deferens opened into the
+ureter. There was persistence in a separate condition of the two
+Mullerian ducts which opened externally inferiorly, and there were two
+ducts near the openings which represented anal pouches. Both testicles
+were in the abdomen. Ord describes a man in whom one of the Mullerian
+ducts was persistent.
+
+Anomalies of the Bladder.--Blanchard, Blasius, Haller, Nebel, and
+Rhodius mention cases in which the bladder has been found absent and we
+have already mentioned some cases, but the instances in which the
+bladder has been duplex are much more frequent.  Bourienne,
+Oberteuffer, Ruysch, Bartholinus, Morgagni, and Franck speak of vesical
+duplication. There is a description of a man who had two bladders, each
+receiving a ureter. Bussiere describes a triple bladder, and Scibelli
+of Naples mentions an instance in a subject who died at fifty-seven
+with symptoms of retention of urine. In the illustration, B represents
+the normal bladder, A and C the supplementary bladders, with D and E
+their respective points of entrance into B. As will be noticed, the
+ureters terminate in the supplementary bladders. Fantoni and Malgetti
+cite instances of quintuple bladders.
+
+The Ephemerides speaks of a case of coalition of the bladder with the
+os pubis and another case of coalition with the omentum.  Prochaska
+mentions vesical fusion with the uterus, and we have already described
+union with the rectum and intestine.
+
+Exstrophy of the bladder is not rare, and is often associated with
+hypospadias, epispadias, and other malformations of the genitourinary
+tract. It consists of a deficiency of the abdominal wall in the
+hypogastric region, in which is seen the denuded bladder. It is
+remedied by many different and ingenious plastic operations.
+
+In an occasional instance in which there is occlusion at the umbilicus
+and again at the neck of the bladder this organ becomes so distended as
+to produce a most curious deformity in the fetus.  Figure 143 shows
+such a case.
+
+The Heart.--Absence of the heart has never been recorded in human
+beings except in the case of monsters, as, for example, the
+omphalosites, although there was a case reported and firmly believed by
+the ancient authors,--a Roman soldier in whom Telasius said he could
+discover no vestige of a heart.
+
+The absence of one ventricle has been recorded. Schenck has seen the
+left ventricle deficient, and the Ephemerides, Behr, and Kerckring
+speak of a single ventricle only in the heart. Riolan mentions a heart
+in which both ventricles were absent. Jurgens reported in Berlin,
+February 1, 1882, an autopsy on a child who had lived some days after
+birth, in which the left ventricle of the heart was found completely
+absent. Playfair showed the heart of a child which had lived nine
+months in which one ventricle was absent. In King's College Hospital in
+London there is a heart of a boy of thirteen in which the cavities
+consist of a single ventricle and a single auricle.
+
+Duplication of the heart, notwithstanding the number of cases reported,
+has been admitted with the greatest reserve by Geoffroy-Saint-Hilaire
+and by a number of authors. Among the celebrated anatomists who
+describe duplex heart are Littre, Meckel, Collomb, Panum, Behr,
+Paullini, Rhodins, Winslow, and Zacutus Lusitanus.
+
+The Ephemerides cites an instance of triple heart, and Johnston has
+seen a triple heart in a goose.
+
+The phenomenon of "blue-disease," or congenital cyanosis, is due to the
+patency of the foremen ovale, which, instead of closing at birth,
+persists sometimes to adult life.
+
+Perhaps the most unique collection of congenital malformations of the
+heart from persons who have reached the age of puberty was to be seen
+in London in 1895. In this collection there was an adult heart in which
+the foremen ovale remained open until the age of thirty-seven; there
+were but two pulmonary valves; there was another heart showing a large
+patent foramen ovale from a man of forty-six; and there was a septum
+ventriculorum of an adult heart from a woman of sixty-three, who died
+of carcinoma of the breast, in which the foremen ovale was still open
+and would admit the fore-finger. This woman had shown no symptoms of
+the malformation. There were also hearts in which the interventricular
+septum was deficient, the ductus arteriosus patent, or some valvular
+malformation present. All these persons had reached puberty.
+
+Displacements of the heart are quite numerous. Deschamps of Laval made
+an autopsy on an old soldier which justified the expression, "He had a
+heart in his belly." This organ was found in the left lumbar region; it
+had, with its vessels, traversed an anomalous opening in the diaphragm.
+Franck observed in the Hospital of Colmar a woman with the heart in the
+epigastric region. Ramel and Vetter speak of the heart under the
+diaphragm.
+
+Inversion of the heart is quite frequent, and we often find reports of
+cases of this anomaly. Fournier describes a soldier of thirty years, of
+middle height, well proportioned and healthy, who was killed in a duel
+by receiving a wound in the abdomen; postmortem, the heart was found in
+the position of the right lung; the two lungs were joined and occupied
+the left chest.
+
+The anomalies of the vascular system are so numerous that we shall
+dismiss them with a slight mention. Malacarne in Torino in 1784
+described a double aorta, and Hommelius mentions an analogous case. The
+following case is quite an interesting anatomic anomaly: A woman since
+infancy had difficulty in swallowing, which was augmented at the epoch
+of menstruation and after exercise; bleeding relieved her momentarily,
+but the difficulty always returned. At last deglutition became
+impossible and the patient died of malnutrition. A necropsy revealed
+the presence of the subclavicular artery passing between the tracheal
+artery and the esophagus, compressing this latter tube and opposing the
+passage of food.
+
+Anomalies of the Breasts.--The first of the anomalies of the generative
+apparatus to be discussed, although not distinctly belonging under this
+head, will be those of the mammae.
+
+Amazia, or complete absence of the breast, is seldom seen.  Pilcher
+describes an individual who passed for a female, but who was really a
+male, in whom the breasts were absolutely wanting.  Foerster, Froriep,
+and Ried cite instances associated with thoracic malformation. Greenhow
+reports a case in which the mammae were absent, although there were
+depressed rudimentary nipples and areolae. There were no ovaries and
+the uterus was congenitally imperfect.
+
+There was a negress spoken of in 1842 in whom the right breast was
+missing, and there are cases of but one breast, mentioned by King,
+Paull, and others. Scanzoni has observed absence of the left mamma with
+absence of the left ovary.
+
+Micromazia is not so rare, and is generally seen in females with
+associate genital troubles. Excessive development of the mammae,
+generally being a pathologic phenomenon, will be mentioned in another
+chapter. However, among some of the indigenous negroes the female
+breasts are naturally very large and pendulous. This is well shown in
+Figure 144, which represents a woman of the Bushman tribe nursing an
+infant. The breasts are sufficiently pendulous and loose to be easily
+thrown over the shoulder.
+
+Polymazia is of much more frequent occurrence than is supposed.  Julia,
+the mother of Alexander Severus, was surnamed "Mammea" because she had
+supernumerary breasts. Anne Boleyn, the unfortunate wife of Henry VIII
+of England, was reputed to have had six toes, six fingers, and three
+breasts. Lynceus says that in his time there existed a Roman woman with
+four mammae, very beautiful in contour, arranged in two lines,
+regularly, one above the other, and all giving milk in abundance.
+Rubens has pictured a woman with four breasts; the painting may be seen
+in the Louvre in Paris.
+
+There was a young and wealthy heiress who addressed herself to the
+ancient faculty at Tubingen, asking, as she displayed four mammary,
+whether, should she marry, she would have three or four children at a
+birth. This was a belief with which some of her elder matron friends
+had inspired her, and which she held as a hindrance to marriage.
+
+Leichtenstern, who has collected 70 cases of polymazia in females and
+22 in males, thinks that accessory breasts or nipples are due to
+atavism, and that our most remote inferiorly organized ancestors had
+many breasts, but that by constantly bearing but one child, from being
+polymastic, females have gradually become bimastic. Some of the older
+philosophers contended that by the presence of two breasts woman was
+originally intended to bear two children.
+
+Hirst says: "Supernumerary breasts and nipples are more common than is
+generally supposed. Bruce found 60 instances in 3956 persons examined
+(1.56 per cent). Leichtenstern places the frequency at one in 500. Both
+observers declare that men present the anomaly about twice as
+frequently as women. It is impossible to account for the accessory
+glands on the theory of reversion, as they occur with no regularity in
+situation, but may develop at odd places on the body. The most frequent
+position is on the pectoral surface below the true mammae and somewhat
+nearer the middle line, but an accessory gland has been observed on the
+left shoulder over the prominence of the deltoid, on the abdominal
+surface below the costal cartilages, above the umbilicus, in the
+axilla, in the groin, on the dorsal surface, on the labium majus, and
+on the outer aspect of the left thigh. Ahlfeld explains the presence of
+mammae on odd parts of the body by the theory that portions of the
+embryonal material entering into the composition of the mammary gland
+are carried to and implanted upon any portion of the exterior of the
+body by means of the amnion."
+
+Possibly the greatest number of accessory mammae reported is that of
+Neugebauer in 1886, who found ten in one person. Peuch in 1876
+collected 77 cases, and since then Hamy, Quinqusud, Whiteford,
+Engstrom, and Mitchell Bruce have collected cases. Polymazia must have
+been known in the olden times, and we still have before us the old
+images of Diana, in which this goddess is portrayed with numerous
+breasts, indicating her ability to look after the growing child. Figure
+145 shows an ancient Oriental statue of Artemisia or Diana now at
+Naples.
+
+Bartholinus has observed a Danish woman with three mammae, two
+ordinarily formed and a third forming a triangle with the others and
+resembling the breasts of a fat man. In the village of Phullendorf in
+Germany early in this century there was an old woman who sought alms
+from place to place, exhibiting to the curious four symmetrical
+breasts, arranged parallel. She was extremely ugly, and when on all
+fours, with her breasts pendulous, she resembled a beast. The authors
+have seen a man with six distinct nipples, arranged as regularly as
+those of a bitch or sow. The two lower were quite small. This man's
+body was covered with heavy, long hair, making him a very conspicuous
+object when seen naked during bathing. The hair was absent for a space
+of nearly an inch about the nipples. Borellus speaks of a woman with
+three mammae, two as ordinarily, the third to the left side, which gave
+milk, but not the same quantity as the others.  Gardiner describes a
+mulatto woman who had four mammae, two of which were near the axillae,
+about four inches in circumference, with proportionate sized nipples.
+She became a mother at fourteen, and gave milk from all her breasts. In
+his "Dictionnaire Philosophique" Voltaire gives the history of a woman
+with four well-formed and symmetrically arranged breasts; she also
+exhibited an excrescence, covered with a nap-like hair, looking like a
+cow-tail. Percy thought the excrescence a prolongation of the coccyx,
+and said that similar instances were seen in savage men of Borneo.
+
+Percy says that among some prisoners taken in Austria was found a woman
+of Valachia, near Roumania, exceedingly fatigued, and suffering
+intensely from the cold. It was January, and the ground was covered
+with three feet of snow. She had been exposed with her two infants, who
+had been born twenty days, to this freezing temperature, and died on
+the next day. An examination of her body revealed five mammae, of which
+four projected as ordinarily, while the fifth was about the size of
+that of a girl at puberty.
+
+They all had an intense dark ring about them; the fifth was situated
+about five inches above the umbilicus. Percy injected the subject and
+dissected and described the mammary blood-supply.  Hirst mentions a
+negress of nineteen who had nine mammae, all told, and as many nipples.
+The two normal glands were very large.  Two accessory glands and
+nipples below them were small and did not excrete milk. All the other
+glands and nipples gave milk in large quantities. There were five
+nipples on the left and four on the right side. The patient's mother
+had an accessory mamma on the abdomen that secreted milk during the
+period of lactation.
+
+Charpentier has observed in his clinic a woman with two supplementary
+axillary mammae with nipples. They gave milk as the ordinary mammae.
+Robert saw a woman who nourished an infant by a mamma on the thigh.
+Until the time of pregnancy this mamma was taken for an ordinary nevus,
+but with pregnancy it began to develop and acquired the size of a
+citron. Figure 147 is from an old wood-cut showing a child suckling at
+a supernumerary mamma on its mother's thigh while its brother is at the
+natural breast.  Jenner speaks of a breast on the outer side of the
+thigh four inches below the great trochanter. Hare describes a woman of
+thirty-seven who secreted normal milk from her axillae. Lee mentions a
+woman of thirty-five with four mammae and four nipples; she suckled
+with the pectoral and not the axillary breasts. McGillicudy describes a
+pair of rudimentary abdominal mammae, and there is another similar case
+recorded. Hartung mentions a woman of thirty who while suckling had a
+mamma on the left labium majus. It was excised, and microscopic
+examination showed its structure to be that of a rudimentary nipple and
+mammary gland. Leichtenstern cites a case of a mamma on the left
+shoulder nearly under the insertion of the deltoid, and Klob speaks of
+an acromial accessory mamma situated on the shoulder over the greatest
+prominence of the deltoid. Hall reports the case of a functionally
+active supernumerary mamma over the costal cartilage of the 8th rib.
+Jussieu speaks of a woman who had three breasts, one of which was
+situated on the groin and with which she occasionally suckled; her
+mother had three breasts, but they were all situated on the chest.
+Saunois details an account of a female who had two supernumerary
+breasts on the back. Bartholinus (quoted by Meckel) and Manget also
+mention mammae on the back, but Geoffroy-Saint-Hilaire questions their
+existence. Martin gives a very clear illustration of a woman with a
+supernumerary breast below the natural organ. Sneddon, who has
+collected quite a number of cases of polymazia, quotes the case of a
+woman who had two swellings in each axilla in which gland-structure was
+made out, but with no external openings, and which had no anatomic
+connection with the mammary glands proper. Shortly after birth they
+varied in size and proportion, as the breasts were full or empty, and
+in five weeks all traces of them were lost.  Her only married sister
+had similar enlargements at her third confinement.
+
+Polymazia sometimes seems to be hereditary. Robert saw a daughter whose
+mother was polymastic, and Woodman saw a mother and eldest daughter who
+each had three nipples. Lousier mentions a woman wanting a mamma who
+transmitted this vice of conformation to her daughter. Handyside says
+he knew two brothers in both of whom breasts were wanting.
+
+Supernumerary nipples alone are also seen, as many as five having been
+found on the same breast. Neugebauer reports eight supernumerary
+nipples in one case. Hollerus has seen a woman who had two nipples on
+the same breast which gave milk with the same regularity and the same
+abundance as the single nipple. The Ephemerides contains a description
+of a triple nipple. Barth describes "mamma erratica" on the face in
+front of the right ear which enlarged during menstruation.
+
+Cases of deficiency of the nipples have been reported by the
+Ephemerides, Lentilius, Severinus, and Werckardus.
+
+Cases of functional male mammae will be discussed in Chapter IX.
+
+Complete absence of the hymen is very rare, if we may accept the
+statements of Devilliers, Tardieu, and Brouardel, as they have never
+seen an example in the numerous young girls they have examined from a
+medico-legal point of view.
+
+Duplication or biperforation of the hymen is also a very rare anomaly
+of this membrane. In this instance the hymen generally presents two
+lateral orifices, more or less irregular and separated by a membranous
+band, which gives the appearance of duplicity. Roze reported from
+Strasburg in 1866 a case of this kind, and Delens has observed two
+examples of biperforate hymen, which show very well that this
+disposition of the membrane is due to a vice of conformation. The first
+was in a girl of eleven, in which the membrane was of the usual size
+and thickness, but was duplicated on either side. In her sister of nine
+the hymen was normally conformed. The second case was in a girl under
+treatment by Cornil in 1876 for vaginitis. Her brother had accused a
+young man of eighteen of having violated her, and on examination the
+hymen showed a biperforate conformation; there were two oval orifices,
+their greatest diameter being in the vertical plane; the openings were
+situated on each side of the median line, about five mm. apart; the
+dividing band did not appear to be cicatricial, but presented the same
+roseate coloration as the rest of the hymen. Since this report quite a
+number of cases have been recorded.
+
+The different varieties of the hymen will be left to the works on
+obstetrics. As has already been observed, labor is frequently seriously
+complicated by a persistent and tough hymen.
+
+Deficient vulva may be caused by the persistence of a thick hymen, by
+congenital occlusion, or by absolute absence in vulvar structure.
+Bartholinus, Borellus, Ephemerides, Julius, Vallisneri, and Baux are
+among the older writers who mention this anomaly, but as it is
+generally associated with congenital occlusion, or complete absence of
+the vagina, the two will be considered together.
+
+Complete absence of the vagina is quite rare. Baux a reports a case of
+a girl of fourteen in whom "there was no trace of fundament or of
+genital organs." Oberteuffer speaks of a case of absent vagina. Vicq
+d'Azir is accredited with having seen two females who, not having a
+vagina, copulated all through life by the urethra, and Fournier sagely
+remarks that the extra large urethra may have been a special
+dispensation of nature. Bosquet describes a young girl of twenty with a
+triple vice of conformation--an obliterated vulva, closure of the
+vagina, and absence of the uterus. Menstrual hemorrhage took place from
+the gums. Clarke has studied a similar case which was authenticated by
+an autopsy.
+
+O'Ferral of Dublin, Gooch, Davies, Boyd, Tyler Smith, Hancock, Coste,
+Klayskens, Debrou, Braid, Watson, and others are quoted by Churchill as
+having mentioned the absence of the vagina. Amussat observed a German
+girl who did not have a trace of a vagina and who menstruated
+regularly. Griffith describes a specimen in the Museum of St.
+Bartholomew's Hospital, London, in which the ovaries lay on the surface
+of the pelvic peritoneum and there was neither uterus nor vagina; the
+pelvis had some of the characteristics of the male type. Matthews
+Duncan has observed a somewhat similar case, the vagina not measuring
+more than an inch in length. Ferguson describes a prostitute of
+eighteen who had never menstruated. The labia were found well
+developed, but there was no vagina, uterus, or ovaries. Coitus had been
+through the urethra, which was considerably distended, though not
+causing incontinence of urine. Hulke reports a case of congenital
+atresia of the vagina in a brunette of twenty, menstruation occurring
+through the urethra. He also mentions the instance of congenital
+atresia of the vagina with hernia of both ovaries into the left groin
+in a servant of twenty, and the case of an imperforate vagina in a girl
+of nineteen with an undeveloped uterus.
+
+Brodhurst reports an instance of absence of the vagina and uterus in a
+girl of sixteen who at four years of age showed signs of approaching
+puberty. At this early age the mons was covered with hair, and at ten
+the clitoris was three inches long and two inches in circumference. The
+mammae were well developed. The labia descended laterally and expanded
+into folds, resembling the scrotum.
+
+Azema reports an instance of complete absence of the vagina and
+impermeability and probable absence of the col uterinus. The
+deficiencies were remedied by operation. Berard mentions a similar
+deformity and operation in a girl of eighteen. Gooding cites an
+instance of absent vagina in a married woman, the uterus discharging
+the functions. Gosselin reports a case in which a voluminous tumor was
+formed by the retained menstrual fluid in a woman without a vagina. An
+artificial vagina was created, but the patient died from extravasation
+of blood into the peritoneal cavity. Carter, Polaillon, Martin, Curtis,
+Worthington, Hall, Hicks, Moliere, Patry, Dolbeau, Desormeaux, and
+Gratigny also record instances of absence of the vagina.
+
+There are some cases reported in extramedical literature which might be
+cited. Bussy Rabutin in his Memoires in 1639 speaks of an instance. The
+celebrated Madame Recamier was called by the younger Dumas an
+involuntary virgin; and in this connection could be cited the malicious
+and piquant sonnet--
+
+Chateaubriand et Madame Recamier.
+
+  "Juliette et Rene s'aimaient d'amour si tendre
+  Que Dien, sans les punir, a pu leur pardonner:
+  Il n'avait pas voulu que l'une put donner
+  Ce que l'autre ne pouvait prendre."
+
+Duplex vagina has been observed by Bartholinus, Malacarne, Asch,
+Meckel, Osiander, Purcell, and other older writers. In more modern
+times reports of this anomaly are quite frequent. Hunter reports a case
+of labor at the seventh month in a woman with a double vagina, and
+delivery through the rectum. Atthill and Watts speak of double vagina
+with single uterus.
+
+Robb of Johns Hopkins Hospital reports a case of double vagina in a
+patient of twenty suffering from dyspareunia. The vaginal orifice was
+contracted; the urethra was dilated and had evidently been used for
+coitus. A membrane divided the vagina into two canals, the cervix lying
+in the right half; the septum was also divided. Both the thumbs of the
+patient were so short that their tips could scarcely meet those of the
+little fingers. Double vagina is also reported by Anway, Moulton,
+Freeman, Frazer, Haynes, Lemaistre, Boardman, Dickson, Dunoyer, and
+Rossignol.  This anomaly is usually associated with bipartite or double
+uterus. Wilcox mentions a primipara, three months pregnant, with a
+double vagina and a bicornate uterus, who was safely delivered of
+several children. Haller and Borellus have seen double vagina, double
+uterus, and double ovarian supply; in the latter case there was also a
+double vulva. Sanger speaks of a supernumerary vagina connecting with
+the other vagina by a fistulous opening, and remarks that this was not
+a case of patent Gartner's duct.
+
+Cullingworth cites two cases in which there were transverse septa of
+the vagina. Stone reports five cases of transverse septa of the vagina.
+Three of the patients were young women who had never borne children or
+suffered injury. Pregnancy existed in each case. In the first the
+septum was about two inches from the introitus, and contained an
+opening about 1/2 inch in diameter which admitted the tip of the
+finger. The membrane was elastic and thin and showed no signs of
+inflammation. Menstruation had always been regular up to the time of
+pregnancy. The second was a duplicate of the first, excepting that a
+few bands extended from the cervix to the membranous septum. In the
+third the lumen of the vagina, about two inches from the introitus, was
+distinctly narrowed by a ridge of tissue. There was uterine
+displacement and some endocervicitis, but no history of injury or
+operation and no tendency to contraction. The two remaining cases
+occurred in patients seen by Dr. J. F. Scott. In one the septum was
+about 1 3/4 inches from the entrance to the vagina and contained an
+orifice large enough to admit a uterine probe. During labor the septum
+resisted the advance of the head for several hours, until it was slit
+in several directions. In the other, menstruation had always been
+irregular, intermissions being followed by a profuse flow of black and
+tarry blood, which lasted sometimes for fifteen days and was
+accompanied by severe pain. The septum was 1 1/2 inches from the
+vaginal orifice and contained an opening which admitted a uterine
+sound. It was very dense and tight and fully 1/8 inch in thickness.
+
+Mordie reported a case of congenital deficiency of the rectovaginal
+septum which was successfully remedied by operation.
+
+Anomalous Openings of the Vagina.--The vagina occasionally opens
+abnormally into the rectum, into the bladder, the urethra, or upon the
+abdominal parietes. Rossi reports from a hospital in Turin the case of
+a Piedmontese girl in whom there was an enormous tumor corresponding to
+the opening of the vaginal orifice; no traces of a vagina could be
+found. The tumor was incised and proved to be a living infant. The
+husband of the woman said that he had coitus without difficulty by the
+rectum, and examination showed that the vagina opened into the rectum,
+by which means impregnation had been accomplished. Bonnain and Payne
+have observed analogous cases of this abnormality of the vaginal
+opening and subsequent accouchement by the anus. Payne's case was of a
+woman of thirty-five, well formed, who had been in labor thirty-six
+hours, when the physician examined and looked in vain for a vaginal
+opening; the finger, gliding along the perineum, came in contact with
+the distended anus, in which was recognized the head of the fetus. The
+woman from prolongation of labor was in a complete state of
+prostration, which caused uterine inertia.  Payne anesthetized the
+patient, applied the forceps, and extracted the fetus without further
+accident. The vulva of this woman five months afterward displayed all
+the characteristics of virginity, the vagina opened into the rectum,
+and menstruation had always been regular. This woman, as well as her
+husband, averred that they had no suspicion of the anomaly and that
+coitus (by the anus) had always been satisfactory.
+
+Opening of the vagina upon the parietes, of which Le Fort has collected
+a number of cases, has never been observed in connection with a viable
+fetus.
+
+Absence of the labia majora has been observed, especially by Pozzi, to
+the exclusion of all other anomalies. It is the rule in exstrophy of
+the bladder.
+
+Absence of the nymphae has also been observed, particularly by Auvard
+and by Perchaux, and is generally associated with imperfect development
+of the clitoris. Constantinedes reports absence of the external organs
+of generation, probably also of the uterus and its appendages, in a
+young lady. Van Haartman, LeFort, Magee, and Ogle cite cases of absence
+of the external female organs. Riolan in the early part of the
+seventeenth century reported a case of defective nymphae; Neubauer in
+1774 offers a contrast to this case in an instance of triple nymphae.
+
+The nymphae are sometimes enormously enlarged by hypertrophy, by
+varicocele, or by elephantiasis, of which latter type Rigal de Gaillac
+has observed a most curious case. There is also a variety of
+enlargement of the clitoris which seems to be constant in some races;
+it may be a natural hypertrophy, or perhaps produced by artificial
+manipulation.
+
+The peculiar conditions under which the Chinese women are obliged to
+live, particularly their mode of sitting, is said to have the effect of
+causing unusual development of the mons veneris and the labia majora.
+On the other hand, some of the lower African races have been
+distinguished by the deficiency in development of the labia majora,
+mons veneris, and genital hair. In this respect they present an
+approximation to the genitals of the anthropoid apes, among whom the
+orang-outang alone shows any tendency to formation of the labia majora.
+
+The labial appendages of the Hottentot female have been celebrated for
+many years. Blumenbach and others of the earlier travelers found that
+the apron-like appearance of the genitals of the Hottentot women was
+due to abnormal hypertrophy of the labia and nymphae. According to John
+Knott, the French traveler, Le Vaillant, said that the more coquettish
+among the Hottentot girls are excited by extreme vanity to practice
+artificial elongation of the nympha and labia. They are said to pull
+and rub these parts, and even to stretch them by hanging weights to
+them. Some of them are said to spend several hours a day at this
+process, which is considered one of the important parts of the toilet
+of the Hottentot belle, this malformation being an attraction for the
+male members of the race. Merensky says that in Basutoland the elder
+women begin to practice labial manipulation on their female children
+shortly after infancy, and Adams has found this custom to prevail in
+Dahomey; he says that the King's seraglio includes 3000 members, the
+elect of his female subjects, all of whom have labia up to the standard
+of recognized length. Cameron found an analogous practice among the
+women of the shores of Lake Tanganyika. The females of this nation
+manipulated the skin of the lower part of the abdomens of the female
+children from infancy, and at puberty these women exhibit a cutaneous
+curtain over the genitals which reaches half-way down the thighs.
+
+A corresponding development of the preputian clitorides, attaining the
+length of 18 mm. or even more, has been observed among the females of
+Bechuanaland. The greatest elongation measured by Barrow was five
+inches, but it is quite probable that it was not possible for him to
+examine the longest, as the females so gifted generally occupied very
+high social positions.
+
+Morgagni describes a supernumerary left nympha, and Petit is accredited
+with seeing a case which exhibited neither nymphae, clitoris, nor
+urinary meatus. Mauriceau performed nymphotomy on a woman whose nymphae
+were so long as to render coitus difficult.  Morand quotes a case of
+congenital malformation of the nymphae, to which he attributed
+impotency.
+
+There is sometimes coalition of the labia and nymphae, which may be so
+firm and extensive as to obliterate the vulva. Debout has reported a
+case of absence of the vulva in a woman of twenty upon whom he
+operated, which was the result of the fusion of the labia minora, and
+this with an enlarged clitoris gave the external appearance of an
+hermaphrodite.
+
+The absence of the clitoris coincides with epispadias in the male, and
+in atrophy of the vulva it is common to find the clitoris rudimentary;
+but a more frequent anomaly is hypertrophy of the clitoris.
+
+Among the older authorities quoting instances of enlarged clitorides
+are Bartholinus, Schenck, Hellwig, Rhodius, Riolanus, and Zacchias.
+Albucasis describes an operation for enlarged clitoris, Chabert ligated
+one, and Riedlin gives an instance of an enlarged clitoris, in which
+there appeared a tumor synchronous with the menstrual epoch.
+
+We learn from the classics that there were certain females inhabiting
+the borders of the Aegean Sea who had a sentimental attachment for one
+another which was called "Lesbian love," and which carried them to the
+highest degree of frenzy. The immortal effusions of Sappho contain
+references to this passion. The solution of this peculiar ardor is
+found in the fact that some of the females had enlarged clitorides,
+strong voices, robust figures, and imitated men. Their manner was
+imperative and authoritative to their sex, who worshiped them with
+perverted devotion. We find in Martial mention of this perverted love,
+and in the time of the dissolute Greeks and Romans ridiculous
+jealousies for unfaithfulness between these women prevailed.  Aetius
+said that the Egyptians practiced amputation of the clitoris, so that
+enlargement of this organ must have been a common vice of conformation
+along the Nile. It was also said that the Egyptian women practiced
+circumcision on their females at the age of seven or eight, the time
+chosen being when the Nile was in flood. Bertherand cites examples of
+enlarged clitorides in Arab women; Bruce testifies to this circumstance
+in Abyssinia, and Mungo Park has observed it in the Mandingos and the
+Ibbos.
+
+Sonnini says that the women of Egypt had a natural excrescence, fleshy
+in consistency, quite thick and pendulous, coming from the skin of the
+mons veneris. Sonnini says that in a girl of eight he saw one of these
+caruncles which was 1/2 inch long, and another on a woman of twenty
+which was four inches long, and remarks that they seem peculiar only to
+women of distinct Egyptian origin.
+
+Duhouset says that in circumcision the Egyptian women not only remove a
+great part of the body of the clitoris with the prepuce, but also
+adjacent portions of the nymphae; Gallieni found a similar operation
+customary on the upper banks of the Niger.
+
+Otto at Breslau in 1824 reports seeing a negress with a clitoris 4 1/2
+inches long and 1 1/2 inches in the transverse diameter; it projected
+from the vulva and when supine formed a complete covering for the
+vaginal orifice. The clitoris may at times become so large as to
+prevent coitus, and in France has constituted a legitimate cause for
+divorce. This organ is very sensitive, and it is said that in cases of
+supposed catalepsy a woman cannot bear titillation of the clitoris
+without some visible movement.
+
+Columbus cites an example of a clitoris as long as a little finger;
+Haller mentions one which measured seven inches, and there is a record
+of an enlarged clitoris which resembled the neck of a goose and which
+was 12 inches long. Bainbridge reports a case of enlarged clitoris in a
+woman of thirty-two who was confined with her first child. This organ
+was five inches in length and of about the diameter of a quiescent
+penis. Figure 149 shows a well-marked case of hypertrophy of the
+clitoris. Rogers describes a woman of twenty-five in a reduced state of
+health with an enormous clitoris and warts about the anus; there were
+also manifestations of tuberculosis. On questioning her, it was found
+that she had formerly masturbated; later she had sexual intercourse
+several times with a young man, but after his death she commenced
+self-abuse again, which brought on the present enlargement. The
+clitoris was ligated and came away without leaving disfigurement.
+Cassano and Pedretti of Naples reported an instance of monstrous
+clitoris in 1860 before the Academy of Medicine.
+
+In some cases ossification of the clitoris is observed Fournier speaks
+of a public woman in Venice who had an osseous clitoris; it was said
+that men having connection with her invariably suffered great pain,
+followed by inflammation of the penis.
+
+There are a few instances recorded of bifid clitoris, and Arnaud cites
+the history of a woman who had a double clitoris. Secretain speaks of a
+clitoris which was in a permanent state of erection.
+
+Complete absence of the ovaries is seldom seen, but there are instances
+in which one of the ovaries is missing. Hunter, Vidal, and Chaussier
+report in full cases of the absence of the ovaries, and Thudicum has
+collected 21 cases of this nature. Morgagni, Pears, and Cripps have
+published observations in which both ovaries were said to have been
+absent. Cripps speaks of a young girl of eighteen who had an infantile
+uterus and no ovaries; she neither menstruated nor had any signs of
+puberty. Lauth cites the case of a woman whose ovaries and uterus were
+rudimentary, and who exhibited none of the principal physiologic
+characteristics of her sex; on the other hand, Ruband describes a woman
+with only rudimentary ovaries who was very passionate and quite
+feminine in her aspect.
+
+At one time the existence of genuine supernumerary ovaries was
+vigorously disputed, and the older records contain no instances, but
+since the researches of Beigel, Puech, Thudicum, Winckler, de Sinety,
+and Paladino the presence of multiple ovaries is an incontestable fact.
+It was originally thought that supernumerary ovaries as well as
+supernumerary kidneys were simply segmentations of the normal organs
+and connected to them by portions of the proper substance; now,
+however, by the recent reports we are warranted in admitting these
+anomalous structures as distinct organs. It has even been suggested
+that it is the persistence of these ovaries that causes the
+menstruation of which we sometimes hear as taking place after
+ovariotomy. Sippel records an instance of third ovary; Mangiagalli has
+found a supernumerary ovary in the body of a still-born child, situated
+to the inner side of the normal organ. Winckel discovered a large
+supernumerary ovary connected to the uterus by its own ovarian
+ligament. Klebs found two ovaries on one side, both consisting of true
+ovarian tissue, and connected by a band 3/5 inch long.
+
+Doran divides supernumerary ovaries into three classes:--
+
+(1) The ovarium succentauriatum of Beigel.
+
+(2) Those cases in which two masses of ovarian tissue are separated by
+ligamentous bands.
+
+(3) Entirely separate organs, as in Winckel's case.
+
+Prolapsus or displacement of the ovaries into the culdesac of Douglas,
+the vaginal wall, or into the rectum can be readily ascertained by the
+resulting sense of nausea, particularly in defecation or in coitus.
+Munde, Barnes, Lentz, Madden, and Heywood Smith report instances, and
+Cloquet describes an instance of inguinal hernia of the ovary in which
+the uterus as well as the Fallopian tube were found in the inguinal
+canal. Debierre mentions that Puech has gathered 88 instances of
+inguinal hernia of the ovary and 14 of the crural type, and also adds
+that Otte cites the only instance in which crural ovarian hernia has
+been found on both sides. Such a condition with other associate
+malformations of the genitalia might easily be mistaken for an instance
+of hermaphroditic testicles.
+
+The Fallopian tubes are rarely absent on either side, although Blasius
+reports an instance of deficient oviducts. Blot reports a case of
+atrophy, or rather rudimentary state of one of the ovaries, with
+absence of the tube on that side, in a woman of forty.
+
+Doran has an instance of multiple Fallopian tubes, and Richard, in
+1861, says several varieties are noticed. These tubes are often found
+fused or adherent to the ovary or to the uterus; but Fabricius
+describes the symphysis of the Fallopian tube with the rectum.
+
+Absence of the uterus is frequently reported. Lieutaud and Richerand
+are each said to have dissected female subjects in whom neither the
+uterus nor its annexed organs were found. Many authors are accredited
+with mentioning instances of defective or deficient uteri, among them
+Bosquet, Boyer, Walther, Le Fort, Calori, Pozzi, Munde, and Strauch.
+Balade has reported a curious absence of the uterus and vagina in a
+girl of eighteen. Azem, Bastien, Bibb, Bovel, Warren, Ward, and many
+others report similar instances, and in several cases all the adnexa as
+well as the uterus and vagina were absent, and even the kidney and
+bladder malformed.
+
+Phillips speaks of two sisters, both married, with congenital absence
+of the uterus. In his masterly article on "Heredity," Sedgwick quotes
+an instance of total absence of the uterus in three out of five
+daughters of the same family; two of the three were twice married.
+
+Double uterus is so frequently reported that an enumeration of the
+cases would occupy several pages. Bicorn, bipartite, duplex, and double
+uteruses are so called according to the extent of the duplication. The
+varieties range all the way from slight increase to two distinct
+uteruses, with separate appendages and two vaginae. Meckel, Boehmer,
+and Callisen are among the older writers who have observed double
+uterus with associate double vagina. Figure 150 represents a transverse
+section of a bipartite uterus with a double vagina. The so-called
+uterus didelphus is really a duplex uterus, or a veritable double
+uterus, each segment having the appearance of a complete unicorn uterus
+more or less joined to its neighbor. Vallisneri relates the history of
+a woman who was poisoned by cantharides who had two uteruses, one
+opening into the vagina, the other into the rectum. Morand,
+Bartholinus, Tiedemann, Ollivier, Blundell, and many others relate
+instances of double uterus in which impregnation had occurred, the
+fetus being retained until the full term.
+
+Purcell of Dublin says that in the summer of 1773 he opened the body of
+a woman who died in the ninth month of pregnancy. He found a uterus of
+ordinary size and form as is usual at this period of gestation, which
+contained a full-grown fetus, but only one ovary attached to a single
+Fallopian tube. On the left side he found a second uterus,
+unimpregnated and of usual size, to which another ovary and tube were
+attached. Both of these uteruses were distinct and almost entirely
+separate.
+
+Pregnancy with Double Uterus.--Hollander describes the following
+anomaly of the uterus which he encountered during the performance of a
+celiotomy:--
+
+"There were found two uteruses, the posterior one being a normal organ
+with its adnexa; connected with this uterus was another one, anterior
+to it. The two uteruses had a common cervix; the anterior of the two
+organs had no adnexa, though there were lateral peritoneal ligaments;
+it had become pregnant." Hollander explains the anomaly by stating that
+probably the Mullerian ducts or one of them had grown excessively,
+leading to a folding off of a portion which developed into the anterior
+uterus.
+
+Other cases of double uterus with pregnancy are mentioned on page 49.
+
+When there is simultaneous pregnancy in each portion of a double uterus
+a complication of circumstances arises. Debierre quotes an instance of
+a woman who bore one child on July 16, 1870, and another on October
+31st of the same year, and both at full term.  She had only had three
+menstrual periods between the confinements. The question as to whether
+a case like this would be one of superfetation in a normal uterus, or
+whether the uterus was double, would immediately arise. There would
+also be the possibility that one of the children was of protracted
+gestation or that the other was of premature birth. Article 312 of the
+Civil Code of France accords a minimum of one hundred and eighty and a
+maximum of three hundred days for the gestation of a viable child. (See
+Protracted Gestation.)
+
+Voight is accredited with having seen a triple uterus, and there are
+several older parallels on record. Thilow mentions a uterus which was
+divided into three small portions.
+
+Of the different anomalous positions of the uterus, most of which are
+acquired, the only one that will be mentioned is that of complete
+prolapse of the uterus. In this instance the organ may hang entirely
+out of the body and even forbid locomotion.
+
+Of 19 cases of hernia of the uterus quoted by Debierre 13 have been
+observed in the inguinal region, five on the right and seven on the
+left side. In the case of Roux in 1891 the hernia existed on both
+sides. The uterus has been found twice only in crural hernia and three
+times in umbilical hernia. There is one case recorded, according to
+Debierre, in which the uterus was one of the constituents of an
+obturator hernia. Sometimes its appendages are found with it. Doring,
+Ledesma, Rektorzick, and Scazoni have found the uterus in the sac of an
+inguinal hernia; Leotaud, Murray, and Hagner in an umbilical hernia.
+The accompanying illustration represents a hernia of the gravid womb
+through the linea alba.
+
+Absence of the penis is an extremely rare anomaly, although it has been
+noted by Schenck, Borellus, Bouteiller, Nelaton, and others. Fortunatus
+Fidelis and Revolat describe a newly born child with absence of
+external genitals, with spina bifida and umbilical hernia. Nelaton
+describes a child of two entirely without a penis, but both testicles
+were found in the scrotum; the boy urinated by the rectum. Ashby and
+Wright mention complete absence of the penis, the urethra opening at
+the margin of the anus outside the external sphincter; the scrotum and
+testicles were well developed. Murphy gives the description of a
+well-formed infant apparently without a penis; the child passed urine
+through an opening in the lower part of the abdomen just above the
+ordinary location of the penis; the scrotum was present. Incisions were
+made into a small swelling just below the urinary opening in the
+abdomen which brought into view the penis, the glans being normal but
+the body very small. The treatment consisted of pressing out the glans
+daily until the wound healed; the penis receded spontaneously. It is
+stated that the organ would doubtless be equal to any requirements
+demanded of it.  Demarquay quotes a somewhat similar case in an infant,
+but it had no urinary opening until after operation.
+
+Among the older writers speaking of deficient or absent penis are
+Bartholinus, Bauhinus, Cattierus, the Ephemerides, Frank, Panaroli, van
+der Wiel, and others. Renauldin describes a man with a small penis and
+enormous mammae. Goschler, quoted by Jacobson, speaks of a
+well-developed man of twenty-two, with abundant hair on his chin and
+suprapubic region and the scrotum apparently perfect, with median
+rapine; a careful search failed to show any trace of a penis; on the
+anterior wall of the rectum four lines above the anus was an orifice
+which gave vent to urine; the right testicle and cord were normal, but
+there was an acute orchitis in the left. Starting from just in front of
+the anal orifice was a fold of skin 1 1/2 inches long and 3/4 inch high
+continuous with the rapine, which seemed to be formed of erectile
+tissue and which swelled under excitement, the enlargement lasting
+several minutes with usually an emission from the rectum. It was
+possible to pass a sound through the opening in the rectum to the
+bladder through a urethra 1 1/2 inches wide; the patient had control of
+the bladder and urinated from every three to five hours.
+
+Many instances of rudimentary development of the penis have been
+recorded, most of them complicated with cryptorchism or other
+abnormality of the sexual organs. In other instances the organ is
+present, but the infantile type is present all through life; sometimes
+the subjects are weak in intellect and in a condition similar to
+cretinism. Kaufmann quotes a case in a weakly boy of twelve whose penis
+was but 3/4 inch long, about as thick as a goose-quill, and feeling as
+limp as a mere tube of skin; the corpora cavernosa were not entirely
+absent, but ran only from the ischium to the junction of the fixed
+portion of the penis, suddenly terminating at this point. Nothing
+indicative of a prostate could be found. The testicles were at the
+entrance of the inguinal canal and the glans was only slightly
+developed.
+
+Binet speaks of a man of fifty-three whose external genitalia were of
+the size of those of a boy of nine. The penis was of about the size of
+the little finger, and contained on each side testicles not larger than
+a pea. There was no hair on the pubes or the face, giving the man the
+aspect of an old woman. The prostate was almost exterminated and the
+seminal vesicles were very primitive in conformation. Wilson was
+consulted by a gentleman of twenty-six as to his ability to perform the
+marital function. In size his penis and testicles hardly exceeded those
+of a boy of eight. He had never felt desire for sexual intercourse
+until he became acquainted with his intended wife, since when he had
+erections and nocturnal emissions. The patient married and became the
+father of a family; those parts which at twenty-six were so much
+smaller than usual had increased at twenty-eight to normal adult size.
+There are three cases on record in the older literature of penises
+extremely primitive in development. They are quoted by the Ephemerides,
+Plater, Schenck, and Zacchias. The result in these cases was impotency.
+
+In the Army and Medical Museum at Washington are two injected specimens
+of the male organ divested of skin. From the meatus to the pubis they
+measure 6 1/2 and 5 1/2 inches; from the extremity to the termination
+of either crus 9 3/4 and 8 3/4 inches, and the circumferences are 4 3/4
+and 4 1/4 inches. Between these two we can strike an average of the
+size of the normal penis.
+
+In some instances the penis is so large as to forbid coitus and even
+inconvenience its possessor, measuring as much as ten or even more
+inches in length. Extraordinary cases of large penis are reported by
+Albinus (who mentions it as a cause for sterility), Bartholinus,
+Fabricius Hildanus, Paullini, Peyer, Plater, Schurig, Sinibaldus, and
+Zacchias. Several cases of enormous penises in the new-born have been
+observed by Wolff and others.
+
+The penis palme, or suture de la verge of the French, is the name given
+to those examples of single cutaneous envelope for both the testicles
+and penis; the penis is adherent to the scrotum by its inferior face;
+the glans only is free and erection is impossible.  Chretien cites an
+instance in a man of twenty-five, and Schrumpf of Wesserling describes
+an example of this rare anomaly. The penis and testes were inclosed in
+a common sac, a slight projection not over 1/4 inch long being seen
+from the upper part of this curious scrotum. When the child was a year
+old a plastic operation was performed on this anomalous member with a
+very satisfactory result. Petit describes an instance in which the
+penis was slightly fused with the scrotum.
+
+There are many varieties of torsion of the penis. The glans itself may
+be inclined laterally, the curvature may be total, or there may be a
+veritable rotation, bringing the inferior face above and the superior
+face below. Gay describes a child with epispadias whose penis had
+undergone such torsion on its axis that its inferior surface looked
+upward to the left, and the child passed urine toward the left
+shoulder. Follin mentions a similar instance in a boy of twelve with
+complete epispadias, and Verneuil and Guerlin also record cases, both
+complicated with associate maldevelopment. Caddy mentions a youth of
+eighteen who had congenital torsion of the penis with out hypospadias
+or epispadias. There was a complete half-turn to the left, so that the
+slit-like urinary meatus was reversed and the frenum was above. Among
+the older writers who describe incurvation or torsion of the penis are
+Arantius, the Ephemerides, Haenel, Petit, Schurig, Tulpius, and
+Zacchias.
+
+Zacutus Lusitans speaks of torsion of the penis from freezing.
+Paullini mentions a case the result of masturbation, and Hunter speaks
+of torsion of the penis associated with arthritis.
+
+Ossification of the Penis.--MacClellann speaks of a man of fifty-two
+whose penis was curved and distorted in such a manner that urine could
+not be passed without pain and coitus was impossible. A bony mass was
+discovered in the septum between the corpora cavernosa; this was
+dissected out with much hemorrhage and the upward curvature was
+removed, but there resulted a slight inclination in the opposite
+direction. The formation of bone and cartilage in the penis is quite
+rare. Velpeau, Kauffmann, Lenhoseck, and Duploy are quoted by Jacobson
+as having seen this anomaly. There is an excellent preparation in
+Vienna figured by Demarquay, but no description is given. The
+Ephemerides and Paullini describe osseous penises.
+
+The complete absence of the frenum and prepuce has been observed in
+animals but is very rare in man. The incomplete or irregular
+development is more frequent, but most common is excessive development
+of the prepuce, constituting phimosis, when there is abnormal adherence
+with the glans. Instances of phimosis, being quite common, will be
+passed without special mention. Deficient or absent prepuce has been
+observed by Blasius, Marcellus Donatus, and Gilibert. Partial
+deficiency is described by Petit Severinus, and others.
+
+There may be imperforation or congenital occlusion of some portion of
+the urethra, causing enormous accumulation of urine in the bladder, but
+fortunately there is generally in such cases some anomalous opening of
+the urethra giving vent to the excretions. Tulpius mentions a case of
+deficient urethra. In the Ephemerides there is an account of a man who
+had a constant flow of semen from an abnormal opening in the abdomen.
+La Peyroma describes a case of impotence due to ejaculation of the
+spermatic ducts into the bladder instead of into the urethra, but
+remarks that there was a cicatrix of a wound of the neighboring parts.
+There are a number of instances in which the urethra has terminated in
+the rectum. Congenital dilatation of the urethral canal is very rare,
+and generally accompanied by other malformation.
+
+Duplication of the urethra or the existence of two permeable canals is
+not accepted by all the authors, some of whom contend that one of the
+canals either terminates in a culdesac or is not separate in itself.
+Verneuil has published an article clearly exposing a number of cases,
+showing that it is possible for the urethra to have two or more canals
+which are distinct and have separate functions. Fabricius Hildanus
+speaks of a double aperture to the urethra; Marcellus Donatus describes
+duplicity of the urethra, one of the apertures being in the testicle;
+and there is another case on record in which there was a urethral
+aperture in the groin. A case of double urethra in a man of twenty-five
+living in Styria who was under treatment for gonorrhea is described,
+the supernumerary urethra opening above the natural one and receiving a
+sound to the depth of 17 cm.  There was purulent gonorrhea in both
+urethrae. Vesalius has an account of a double urethral aperture, one of
+which was supposed to give spermatic fluid and the other urine.
+Borellus, Testa, and Cruveilhier have reported similar instances.
+Instances of double penis have been discussed under the head of
+diphallic terata, page 194.
+
+Hypospadias and epispadias are names given to malformations of the
+urethra in which the wall of the canal is deficient either above or
+below. These anomalies are particularly interesting, as they are nearly
+always found in male hermaphrodites, the fissure giving the appearance
+of a vulva, as the scrotum is sometimes included, and even the perineum
+may be fissured in continuity with the other parts, thus exaggerating
+the deception. There seems to be an element of heredity in this
+malformation, and this allegation is exemplified by Sedgwick, who
+quotes a case from Heuremann in which a family of females had for
+generations given birth to males with hypospadias. Belloc mentions a
+man whose urethra terminated at the base of the frenum who had four
+sons with the same deformity. Picardat mentions a father and son, both
+of whom had double urethral orifices, one above the other, from one of
+which issued urine and from the other semen--a fact that shows the
+possibility of inheritance of this malformation.  Patients in whom the
+urethra opens at the root of the penis, the meatus being imperforate,
+are not necessarily impotent; as, for instance, Fournier knew of a man
+whose urethra opened posteriorly who was the father of four children.
+Fournier supposed that the semen ejaculated vigorously and followed the
+fissure on the back of the penis to the uterus, the membrane of the
+vagina supplanting the deficient wall of the urethra. The penis was
+short, but about as thick as ordinary.
+
+Gray mentions a curious case in a man afflicted with hypospadias who,
+suffering with delusions, was confined in the insane asylum at Utica.
+When he determined to get married, fully appreciating his physical
+defect, he resolved to imitate nature, and being of a very ingenious
+turn of mind, he busied himself with the construction of an artificial
+penis. While so engaged he had seized every opportunity to study the
+conformation of this organ, and finally prepared a body formed of
+cotton, six inches in length, and shaped like a penis, minus a prepuce.
+He sheathed it in pig's gut and gave it a slight vermilion hue. To the
+touch it felt elastic, and its shape was maintained by a piece of
+gutta-percha tubing, around which the cotton was firmly wound. It was
+fastened to the waist-band by means of straps, a central and an upper
+one being so arranged that the penis could be thrown into an erect
+position and so maintained. He had constructed a flesh-colored covering
+which completely concealed the straps.  With this artificial member he
+was enabled to deceive his wife for fifteen months, and was only
+discovered when; she undressed him while he was in a state of
+intoxication. To further the deception he had told his wife immediately
+after their marriage that it was quite indecent for a husband to
+undress in the presence of his wife, and therefore she had always
+retired first and turned out the light. Partly from fear that his
+virile power would be questioned and partly from ignorance, the
+duration of actual coitus would approach an hour. When the discovery
+was made, his wife hid the instrument with which he had perpetrated a
+most successful fraud upon her, and the patient subsequently attempted
+coitus by contact with unsuccessful results, although both parties had
+incomplete orgasms. Shortly afterward evidences of mental derangement
+appeared and the man became the subject of exalted delusions. His wife,
+at the time of report, had filed application for divorce. Haslam
+reports a case in which loss of the penis was compensated for by the
+use of an ivory succedaneum.  Parallel instances of this kind have been
+recorded by Ammann and Jonston.
+
+Entire absence of the male sexual apparatus is extremely rare, but
+Blondin and Velpeau have reported cases.
+
+Complete absence of the testicles, or anorchism, is a comparatively
+rare anomaly, and it is very difficult to distinguish between anorchism
+and arrest of development, or simple atrophy, which is much more
+common. Fisher of Boston describes the case of a man of forty-five, who
+died of pneumonia.  From the age of puberty to twenty-five, and even to
+the day of death, his voice had never changed and his manners were
+decidedly effeminate. He always sang soprano in concert with females.
+After the age of twenty-five, however, his voice became more grave and
+he could not accompany females with such ease. He had no beard, had
+never shaved, and had never exhibited amorous propensities or desire
+for female society. When about twenty-one he became associated with a
+gay company of men and was addicted to the cup, but would never visit
+houses of ill-fame. On dissection no trace of testicles could be found;
+the scrotum was soft and flabby. The cerebellum was the exact size of
+that of a female child.
+
+Individuals with one testicle are called monorchids, and may be divided
+into three varieties:--
+
+(1) A solitary testicle divided in the middle by a deep fissure, the
+two lobes being each provided with a spermatic cord on the same side as
+the lobe.
+
+(2) Testicles of the same origin, but with coalescence more general.
+
+(3) A single testicle and two cords.
+
+Gruber of St. Petersburg held a postmortem on a man in January, 1867,
+in whom the right half of the scrotum, the right testicle, epididymis,
+and the scrotal and inguinal parts of the right vas deferens were
+absent. Gruber examined the literature for thirty years up to the time
+of his report, and found 30 recorded postmortem examinations in which
+there was absence of the testicle, and in eight of these both testicles
+were missing. As a rule, natural eunuchs have feeble bodies, are
+mentally dull, and live only a short time. The penis is ordinarily
+defective and there is sometimes another associate malformation. They
+are not always disinclined toward the opposite sex.
+
+Polyorchids are persons who have more than two testicles. For a long
+time the abnormality was not believed to exist, and some of the
+observers denied the proof by postmortem examination of any of the
+cases so diagnosed, but there is at present no doubt of the
+fact,--three, four, and five testicles having been found at autopsies.
+Russell, one of the older writers on the testicle, mentions a monk who
+was a triorchid, and was so salacious that his indomitable passion
+prevented him from keeping his vows of chastity. The amorous
+propensities and generative faculties of polyorchids have always been
+supposed greater than ordinary.  Russell reports another case of a man
+with a similar peculiarity, who was prescribed a concubine as a
+reasonable allowance to a man thus endowed.
+
+Morgagni and Meckel say that they never discovered a third testicle in
+dissections of reputed triorchids, and though Haller has collected
+records of a great number of triorchids, he has never been able to
+verify the presence of the third testicle on dissection. Some authors,
+including Haller, have demonstrated heredity in examples of
+polyorchism. There is an old instance in which two testicles, one above
+the other, were found on the right side and one on the left. Macann
+describes a recruit of twenty, whose scrotum seemed to be much larger
+on the right than on the left side, although it was not pendulous. On
+dissection a right and left testicle were found in their normal
+positions, but situated on the right side between the groin and the
+normal testicle was a supernumerary organ, not in contact, and having a
+separate and short cord. Prankard also describes a man with three
+testicles. Three cases of triorchidism were found in recruits in the
+British Army. Lane reports a supernumerary testis found in the right
+half of the scrotum of a boy of fifteen. In a necropsy held on a man
+killed in battle, Hohlberg discovered three fully developed testicles,
+two on the right side placed one above the other. The London Medical
+Record of 1884 quotes Jdanoff of St.  Petersburg in mentioning a
+soldier of twenty-one who had a supernumerary testicle erroneously
+diagnosed as inguinal hernia.  Quoted by the same reference, Bulatoff
+mentions a soldier who had a third testicle, which diagnosis was
+confirmed by several of his confreres. They recommended dismissal of
+the man from the service, as the third testicle, usually resting in
+some portion of the inguinal canal, caused extra exposure to traumatic
+influence.
+
+Venette gives an instance of four testicles, and Scharff, in the
+Ephemerides, mentions five; Blasius mentions more than three testicles,
+and, without citing proof, Buffon admits the possibility of such
+occurrence and adds that such men are generally more vigorous.
+
+Russell mentions four, five, and even six testicles in one individual;
+all were not verified on dissection. He cites an instance of six
+testicles four of which were of usual size and two smaller than
+ordinary.
+
+Baillie, the Ephemerides, and Schurig mention fusion of the testicles,
+or synorchidism, somewhat after the manner of the normal disposition of
+the batrachians and also the kangaroos, in the former of which the
+fusion is abdominal and in the latter scrotal. Kerckring has a
+description of an individual in whom the scrotum was absent.
+
+In those cases in which the testicles are still in the abdominal cavity
+the individuals are termed cryptorchids. Johnson has collected the
+results of postmortem examinations of 89 supposed cryptorchids. In
+eight of this number no testicles were found postmortem, the number
+found in the abdomen was uncertain, but in 18 instances both testicles
+were found in the inguinal canal, and in eight only one was found in
+the inguinal canal, the other not appearing. The number in which the
+semen was examined microscopically was 16, and in three spermatozoa
+were found in the semen; one case was dubious, spermatozoa being found
+two weeks afterward on a boy's shirt. The number having children was
+ten. In one case a monorchid generated a cryptorchid child. Some of the
+cryptorchids were effeminate, although others were manly with good
+evidences of a beard. The morbid, hypochondriac, the voluptuous, and
+the imbecile all found a place in Johnson's statistics; and although
+there are evidences of the possession of the generative function,
+still, we are compelled to say that the chances are against fecundity
+of human cryptorchids. In this connection might be quoted the curious
+case mentioned by Geoffroy-Saint-Hilaire, of a soldier who was hung for
+rape. It was alleged that no traces of testicles were found externally
+or internally yet semen containing spermatozoa was found in the seminal
+vesicles. Spermatozoa have been found days and weeks after castration,
+and the individuals during this period were capable of impregnation,
+but in these cases the reservoirs were not empty, although the spring
+had ceased to flow. Beigel, in Virchow's Archives, mentions a
+cryptorchid of twenty-two who had nocturnal emissions containing
+spermatozoa and who indulged in sexual congress. Partridge describes a
+man of twenty-four who, notwithstanding his condition, gave evidences
+of virile seminal flow.
+
+In some cases there is anomalous position of the testicle. Hough
+mentions an instance in which, from the great pain and sudden
+appearance, a small tumor lying against the right pubic bone was
+supposed to be a strangulated hernia. There were two well-developed
+testicles in the scrotum, and the hernia proved to be a third. McElmail
+describes a soldier of twenty-nine, who two or three months before
+examination felt a pricking and slight burning pain near the internal
+aperture of the internal inguinal canal, succeeded by a swelling until
+the tumor passed into the scrotum. It was found in the upper part of
+the scrotum above the original testicle, but not in contact, and was
+about half the size of the normal testicle; its cord and epididymis
+could be distinctly felt and caused the same sensation as pressure on
+the other testicle did.
+
+Marshall mentions a boy of sixteen in whom the right half of the
+scrotum was empty, although the left was of normal size and contained a
+testicle. On close examination another testicle was found in the
+perineum; the boy said that while running he fell down, four years
+before, and on getting up suffered great pain in the groin, and this
+pain recurred after exertion. This testicle was removed successfully to
+the scrotum. Horsley collected 20 instances of operators who made a
+similar attempt, Annandale being the first one; his success was likely
+due to antisepsis, as previously the testicles had always sloughed.
+There is a record of a dog remarkable for its salacity who had two
+testicles in the scrotum and one in the abdomen; some of the older
+authors often indulged in playful humor on this subject.
+
+Brown describes a child with a swelling in the perineum both painful
+and elastic to the touch. The child cried if pressure was applied to
+the tumor and there was every evidence that the tumor was a testicle.
+Hutcheson, quoted by Russell, has given a curious case in an English
+seaman who, as was the custom at that time, was impressed into service
+by H.M.S. Druid in 1807 from a trading ship off the coast of Africa.
+The man said he had been examined by dozens of ship-surgeons, but was
+invariably rejected on account of rupture in both groins. The scrotum
+was found to be an empty bag, and close examination showed that the
+testicles occupied the seats of the supposed rupture. As soon as the
+discovery was made the man became unnerved and agitated, and on
+re-examining the parts the testicles were found in the scrotum.  When
+he found that there was no chance for escape he acknowledged that he
+was an impostor and gave an exhibition in which, with incredible
+facility, he pulled both testes up from the bottom of the scrotum to
+the external abdominal ring. At the word of command he could pull up
+one testicle, then another, and let them drop simultaneously; he
+performed other like feats so rapidly that the movements could not be
+distinguished.
+
+In this connection Russell speaks of a man whose testicle was elevated
+every time the east wind blew, which caused him a sense of languor and
+relaxation; the same author describes a man whose testicles ascended
+into the inguinal canal every time he was in the company of women.
+
+Inversion of the testicle is of several varieties and quite rare, it
+has been recognized by Sir Astley Cooper, Boyer, Maisonneuve, Royet,
+and other writers.
+
+The anomalies of the vas deferens and seminal vesicles are of little
+interest and will be passed with mention of the case of Weber, who
+found the seminal vesicles double; a similar conformation has been seen
+in hermaphrodites.
+
+
+
+CHAPTER VII.
+
+ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.
+
+Giants.--The fables of mythology contain accounts of horrible monsters,
+terrible in ferocity, whose mission was the destruction of the life of
+the individuals unfortunate enough to come into their domains. The
+ogres known as the Cyclops, and the fierce anthropophages, called
+Lestrygons, of Sicily, who were neighbors of the Cyclops, are pictured
+in detail in the "Odyssey" of Homer.  Nearly all the nations of the
+earth have their fairy tales or superstitions of monstrous beings
+inhabiting some forest, mountain, or cave; and pages have been written
+in the heroic poems of all languages describing battles between these
+monsters and men with superhuman courage, in which the giant finally
+succumbs.
+
+The word giant is derived indirectly from the old English word "geant,"
+which in its turn came from the French of the conquering Normans. It is
+of Greek derivation, "gigas", or the Latin, "gigas." The Hebrew
+parallel is "nophel," or plural, "nephilim."
+
+Ancient Giants.--We are told in the Bible a that the bedstead of Og,
+King of Basham, was 9 cubits long, which in English measure is 16 1/2
+feet. Goliath of Gath, who was slain by David, stood 6 cubits and a
+span tall--about 11 feet. The body of Orestes, according to the Greeks,
+was 11 1/2 feet long. The mythical Titans, 45 in number, were a race of
+Giants who warred against the Gods, and their descendants were the
+Gigantes. The height attributed to these creatures was fabulous, and
+they were supposed to heap up mountains to scale the sky and to help
+them to wage their battles. Hercules, a man of incredible strength, but
+who is said to have been not over 7 feet high, was dispatched against
+the Gigantes.
+
+Pliny describes Gabbaras, who was brought to Rome by Claudius Caesar
+from Arabia and was between 9 and 10 feet in height, and adds that the
+remains of Posio and Secundilla, found in the reign of Augustus Caesar
+in the Sallustian Gardens, of which they were supposed to be the
+guardians, measured 10 feet 3 inches each. In common with Augustine,
+Pliny believed that the stature of man has degenerated, but from the
+remains of the ancients so far discovered it would appear that the
+modern stature is about the same as the ancient. The beautiful
+alabaster sarcophagus discovered near Thebes in 1817 and now in Sir
+John Soane's Museum in Lincoln's Inn Fields in London measures 9 feet 4
+inches long.  This unique example, the finest extant, is well worth
+inspection by visitors in London.
+
+Herodotus says the shoes of Perseus measured an equivalent of about 3
+feet, English standard. Josephus tells of Eleazar, a Jew, among the
+hostages sent by the King of Persia to Rome, who was nearly 11 feet
+high. Saxo, the grammarian, mentions a giant 13 1/2 feet high and says
+he had 12 companions who were double his height. Ferragus, the monster
+supposed to have been slain by Roland, the nephew of Charlemagne, was
+said to have been nearly 11 feet high. It was said that there was a
+giant living in the twelfth century under the rule of King Eugene II of
+Scotland who was 11 1/2 feet high.
+
+There are fabulous stories told of the Emperor Maximilian. Some
+accounts say that he was between 8 1/2 and 9 feet high, and used his
+wife's bracelet for a finger-ring, and that he ate 40 pounds of flesh a
+day and drank six gallons of wine. He was also accredited with being a
+great runner, and in his earlier days was said to have conquered
+single-handed eight soldiers. The Emperors Charlemagne and Jovianus
+were also accredited with great height and strength.
+
+In the olden times there were extraordinary stories of the giants who
+lived in Patagonia. Some say that Magellan gave the name to this
+country because its inhabitants measured 5 cubits. The naturalist
+Turner says that on the river Plata near the Brazilian coast he saw
+naked savages 12 feet high; and in his description of America, Thevenot
+confirms this by saying that on the coast of Africa he saw on a boat
+the skeleton of an American giant who had died in 1559, and who was 11
+feet 5 inches in height. He claims to have measured the bones himself.
+He says that the bones of the leg measured 3 feet 4 inches, and the
+skull was 3 feet and 1 inch, just about the size of the skull of
+Borghini, who, however, was only of ordinary height. In his account of
+a voyage to the Straits of Magellan, Jacob Lemaire says that on
+December 17, 1615, he found at Port Desire several graves covered with
+stones, and beneath the stones were skeletons of men which measured
+between 10 and 11 feet. The ancient idea of the Spaniards was that the
+men of Patagonia were so tall that the Spanish soldiers could pass
+under their arms held out straight; yet we know that the Patagonians
+exhibit no exaggeration of height--in fact, some of the inhabitants
+about Terra del Fuego are rather diminutive.  This superstition of the
+voyagers was not limited to America; there were accounts of men in the
+neighborhood of the Peak of Teneriffe who had 80 teeth in their head
+and bodies 15 feet in height.
+
+Discoveries of "Giants' Bones."--Riolan, the celebrated anatomist, says
+that there was to be seen at one time in the suburbs of Saint Germain
+the tomb of the giant Isoret, who was reputed to be 20 feet tall; and
+that in 1509, in digging ditches at Rouen, near the Dominicans, they
+found a stone tomb containing a monstrous skeleton, the skull of which
+would hold a bushel of corn; the shin-bone measured about 4 feet,
+which, taken as a guide, would make his height over 17 feet. On the
+tomb was a copper plate which said that the tomb contained the remains
+of "the noble and puissant lord, the Chevalier Ricon de Vallemont."
+Plater, the famous physician, declares that he saw at Lucerne the true
+human bones of a subject that must have been at least 19 feet high.
+
+Valence in Dauphine boasted of possessing the bones of the giant
+Bucart, the tyrant of the Vivarias, who was slain by his vassal, Count
+de Cabillon. The Dominicans had the shin-bone and part of the
+knee-articulation, which, substantiated by the frescoes and
+inscriptions in their possession, showed him to be 22 1/2 feet high.
+They claimed to have an os frontis in the medical school of Leyden
+measuring 9.1 X 12.2 X .5 inches, which they deduce must have belonged
+to a man 11 or 12 feet high.
+
+It is said that while digging in France in 1613 there was disinterred
+the body of a giant bearing the title "Theutobochus Rex," and that the
+skeleton measured 25 feet long, 10 feet across the shoulders, and 5
+feet from breast to back. The shin-bone was about 4 feet long, and the
+teeth as large as those of oxen. This is likely another version of the
+finding of the remains of Bucart.
+
+Near Mezarino in Sicily in 1516 there was found the skeleton of a giant
+whose height was at least 30 feet; his head was the size of a hogshead,
+and each tooth weighed 5 ounces; and in 1548 and in 1550 there were
+others found of the height of 30 feet. The Athenians found near their
+city skeletons measuring 34 and 36 feet in height. In Bohemia in 758 it
+is recorded that there was found a human skeleton 26 feet tall, and the
+leg-bones are still kept in a medieval castle in that country. In
+September, 1691, there was the skull of a giant found in Macedonia
+which held 210 pounds of corn.
+
+General Opinions.--All the accounts of giants originating in the
+finding of monstrous bones must of course be discredited, as the
+remains were likely those of some animal. Comparative anatomy has only
+lately obtained a hold in the public mind, and in the Middle Ages
+little was known of it. The pretended giants' remains have been those
+of mastodons, elephants, and other animals. From Suetonius we learn
+that Augustus Caesar pleased himself by adorning his palaces with
+so-called giants' bones of incredible size, preferring these to
+pictures or images. From their enormous size we must believe they were
+mastodon bones, as no contemporary animals show such measurements.
+Bartholinus describes a large tooth for many years exhibited as the
+canine of a giant which proved to be nothing but a tooth of a
+spermaceti whale (Cetus dentatus), quite a common fish. Hand described
+an alleged giant's skeleton shown in London early in the eighteenth
+century, and which was composed of the bones of the fore-fin of a small
+whale or of a porpoise.
+
+The celebrated Sir Hans Sloane, who treated this subject very
+learnedly, arrived at the conclusion that while in most instances the
+bones found were those of mastodons, elephants, whales, etc., in some
+instances accounts were given by connoisseurs who could not readily be
+deceived. However, modern scientists will be loath to believe that any
+men ever existed who measured over 9 feet; in fact, such cases with
+authentic references are extremely rare Quetelet considers that the
+tallest man whose stature is authentically recorded was the "Scottish
+Giant" of Frederick the Great's regiment of giants. This person was not
+quite 8 feet 3 inches tall. Buffon, ordinarily a reliable authority,
+comes to a loose conclusion that there is no doubt that men have lived
+who were 10, 12, and even 15 feet tall; but modern statisticians cannot
+accept this deduction from the references offered.
+
+From the original estimation of the height of Adam (Henrion once
+calculated that Adam's height was 123 feet and that of Eve 118) we
+gradually come to 10 feet, which seemed to be about the favorite height
+for giants in the Middle Ages. Approaching this century, we still have
+stories of men from 9 to 10 feet high, but no authentic cases. It was
+only in the latter part of the last century that we began to have
+absolutely authentic heights of giants, and to-day the men showing
+through the country as measuring 8 feet generally exaggerate their
+height several inches, and exact measurement would show that but few
+men commonly called giants are over 7 1/2 feet or weigh over 350
+pounds. Dana says that the number of giants figuring as public
+characters since 1700 is not more than 100, and of these about 20 were
+advertised to be over 8 feet. If we confine ourselves to those
+accurately and scientifically measured the list is surprisingly small.
+Topinard measured the tallest man in the Austrian army and found that
+he was 8 feet 4 1/2 inches. The giant Winckelmeyer measured 8 feet 6
+inches in height. Ranke measured Marianne Wehde, who was born in
+Germany in the present century, and found that she measured 8 feet 4
+1/4 inches when only sixteen and a half years old.
+
+In giants, as a rule, the great stature is due to excessive growth of
+the lower extremities, the size of the head and that of the trunk being
+nearly the same as those of a man or boy of the same age. On the other
+hand, in a natural dwarf the proportions are fairly uniform, the head,
+however, being always larger in proportion to the body, just as we find
+in infants. Indeed, the proportions of "General Tom Thumb" were those
+of an ordinary infant of from thirteen to fifteen months old.
+
+Figure 156 shows a portrait of two well-known exhibitionists of about
+the same age, and illustrates the possible extremes of anomalies in
+stature.
+
+Recently, the association of acromegaly with gigantism has been
+noticed, and in these instances there seems to be an acquired uniform
+enlargement of all the bones of the body. Brissaud and Meige describe
+the case of a male of forty-seven who presented nothing unusual before
+the age of sixteen, when he began to grow larger, until, having reached
+his majority, he measured 7 feet 2 inches in height and weighed about
+340 pounds. He remained well and very strong until the age of
+thirty-seven, when he overlifted, and following this he developed an
+extreme deformity of the spine and trunk, the latter "telescoping into
+itself" until the nipples were on a level with the anterior superior
+spines of the ilium. For two years he suffered with debility, fatigue,
+bronchitis, night-sweats, headache, and great thirst.  Mentally he was
+dull; the bones of the face and extremities showed the hypertrophies
+characteristic of acromegaly, the soft parts not being involved. The
+circumference of the trunk at the nipples was 62 inches, and over the
+most prominent portion of the kyphosis and pigeon-breast, 74 inches.
+The authors agree with Dana and others that there is an intimate
+relation between acromegaly and gigantism, but they go further and
+compare both to the growth of the body. They call attention to the
+striking resemblance to acromegaly of the disproportionate growth of
+the boy at adolescence, which corresponds so well to Marie's terse
+description of this disease: "The disease manifests itself by
+preference in the bones of the extremities and in the extremities of
+the bones," and conclude with this rather striking and aphoristic
+proposition: "Acromegaly is gigantism of the adult; gigantism is
+acromegaly of adolescence."
+
+The many theories of the cause of gigantism will not be discussed here,
+the reader being referred to volumes exclusively devoted to this
+subject.
+
+Celebrated Giants.--Mention of some of the most famous giants will be
+made, together with any associate points of interest.
+
+Becanus, physician to Charles V, says that he saw a youth 9 feet high
+and a man and a woman almost 10 feet. Ainsworth says that in 1553 the
+Tower of London was guarded by three brothers claiming direct descent
+from Henry VIII, and surnamed Og, Gog, and Magog, all of whom were over
+8 feet in height. In his "Chronicles of Holland" in 1557 Hadrianus
+Barlandus said that in the time of John, Earl of Holland, the giant
+Nicholas was so large that men could stand under his arms, and his shoe
+held 3 ordinary feet.  Among the yeoman of the guard of John Frederick,
+Duke of Hanover, there was one Christopher Munster, 8 1/2 feet high,
+who died in 1676 in his forty-fifth year. The giant porter of the Duke
+of Wurtemberg was 7 1/2 feet high. "Big Sam," the porter at Carleton
+Palace, when George IV was Prince of Wales, was 8 feet high. The porter
+of Queen Elizabeth, of whom there is a picture in Hampton Court,
+painted by Zucchero, was 7 1/2 feet high; and Walter Parson, porter to
+James I, was about the same height. William Evans, who served Charles
+I, was nearly 8 feet; he carried a dwarf in his pocket.
+
+In the seventeenth century, in order to gratify the Empress of Austria,
+Guy-Patin made a congress of all the giants and dwarfs in the Germanic
+Empire. A peculiarity of this congress was that the giants complained
+to the authorities that the dwarfs teased them in such a manner as to
+make their lives miserable.
+
+Plater speaks of a girl in Basle, Switzerland, five years old, whose
+body was as large as that of a full-grown woman and who weighed when a
+year old as much as a bushel of wheat. He also mentions a man living in
+1613, 9 feet high, whose hand was 1 foot 6 inches long. Peter van den
+Broecke speaks of a Congo negro in 1640 who was 8 feet high. Daniel,
+the porter of Cromwell, was 7 feet 6 inches high; he became a lunatic.
+
+Frazier speaks of Chilian giants 9 feet tall. There is a chronicle
+which says one of the Kings of Norway was 8 feet high.  Merula says
+that in 1538 he saw in France a Flemish man over 9 feet. Keysler
+mentions seeing Hans Brau in Tyrol in 1550, and says that he was nearly
+12 feet high.
+
+Jonston mentions a lad in Holland who was 8 feet tall. Pasumot mentions
+a giant of 8 feet.
+
+Edmund Mallone was said to have measured 7 feet 7 inches.  Wierski, a
+Polander, presented to Maximilian II, was 8 feet high.  At the age of
+thirty-two there died in 1798 a clerk of the Bank of England who was
+said to have been nearly 7 1/2 feet high. The Daily Advertiser for
+February 23, 1745, says that there was a young colossus exhibited
+opposite the Mansion House in London who was 7 feet high, although but
+fifteen years old. In the same paper on January 31, 1753, is an account
+of MacGrath, whose skeleton is still preserved in Dublin. In the reign
+of George I, during the time of the Bartholomew Fair at Smithfield,
+there was exhibited an English man seventeen years old who was 8 feet
+tall.
+
+Nicephorus tells of Antonius of Syria, in the reign of Theodosius, who
+died at the age of twenty-five with a height of 7 feet 7 inches.
+Artacaecas, in great favor with Xerxes, was the tallest Persian and
+measured 7 feet. John Middleton, born in 1752 at Hale, Lancashire,
+humorously called the "Child of Hale," and whose portrait is in
+Brasenose College, Oxford, measured 9 feet 3 inches tall. In his
+"History of Ripton," in Devonshire, 1854, Bigsby gives an account of a
+discovery in 1687 of a skeleton 9 feet long. In 1712 in a village in
+Holland there died a fisherman named Gerrit Bastiaansen who was 8 feet
+high and weighed 500 pounds. During Queen Anne's reign there was shown
+in London and other parts of England a most peculiar anomaly--a German
+giantess without hands or feet who threaded a needle, cut gloves, etc.
+About 1821 there was issued an engraving of Miss Angelina Melius,
+nineteen years of age and 7 feet high, attended by her page, Senor Don
+Santiago de los Santos, from the Island of Manilla, thirty-live years
+old and 2 feet 2 inches high. "The Annual Register" records the death
+of Peter Tuchan at Posen on June 18, 1825, of dropsy of the chest. He
+was twenty-nine years old and 8 feet 7 inches in height; he began to
+grow at the age of seven.  This monster had no beard; his voice was
+soft; he was a moderate eater. There was a giant exhibited in St.
+Petersburg, June, 1829, 8 feet 8 inches in height, who was very thin
+and emaciated.
+
+Dr. Adam Clarke, who died in 1832, measured a man 8 feet 6 inches tall.
+Frank Buckland, in his "Curiosities of Natural History," says that
+Brice, the French giant, was 7 feet 7 inches. Early in 1837 there was
+exhibited at Parma a young man formerly in the service of the King of
+the Netherlands who was 8 feet 10 inches high and weighed 401 pounds.
+Robert Hale, the "Norfolk Giant," who died in Yarmouth in 1843 at the
+age of forty-three, was 7 feet 6 inches high and weighed 452 pounds.
+The skeleton of Cornelius McGrath, now preserved in the Trinity College
+Museum, Dublin, is a striking example of gigantism. At sixteen years he
+measured 7 feet 10 inches.
+
+O'Brien or Byrne, the Irish giant, was supposed to be 8 feet 4 inches
+in height at the time of his death in 1783 at the age of twenty-two.
+The story of his connection with the illustrious John Hunter is quite
+interesting. Hunter had vowed that he would have the skeleton of
+O'Brien, and O'Brien was equally averse to being boiled in the
+distinguished scientist's kettle. The giant was tormented all his life
+by the constant assertions of Hunter and by his persistence in locating
+him. Finally, when, following the usual early decline of his class of
+anomalies, O'Brien came to his death-bed, he bribed some fishermen to
+take his body after his death to the middle of the Irish Channel and
+sink it with leaden weights. Hunter, it is alleged, was informed of
+this and overbribed the prospective undertakers and thus secured the
+body.  It has been estimated that it cost Hunter nearly 500 pounds
+sterling to gain possession of the skeleton of the "Irish Giant." The
+kettle in which the body was boiled, together with some interesting
+literature relative to the circumstances, are preserved in the Museum
+of the Royal College of Surgeons in London, and were exhibited at the
+meeting of the British Medical Association in 1895 with other Hunterian
+relics. The skeleton, which is now one of the features of the Museum,
+is reported to measure 92 3/4 inches in height, and is mounted
+alongside that of Caroline Crachami, the Sicilian dwarf, who was
+exhibited as an Italian princess in London in 1824. She did not grow
+after birth and died at the age of nine.
+
+Patrick Cotter, the successor of O'Brien, and who for awhile exhibited
+under this name, claiming that he was a lineal descendant of the famous
+Irish King, Brian Boru, who he declared was 9 feet in height, was born
+in 1761, and died in 1806 at the age of forty-five. His shoe was 17
+inches long, and he was 8 feet 4 inches tall at his death.
+
+In the Museum of Madame Tussaud in London there is a wax figure of
+Loushkin, said to be the tallest man of his time. It measures 8 feet 5
+inches, and is dressed in the military uniform of a drum-major of the
+Imperial Preobrajensky Regiment of Guards. To magnify his height there
+is a figure of the celebrated dwarf, "General Tom Thumb," in the palm
+of his hand. Figure 158 represents a well-known American giant, Ben
+Hicks who was called "the Denver Steeple."
+
+Buffon refers to a Swedish giantess who he affirms was 8 feet 6 inches
+tall. Chang, the "Chinese Giant," whose smiling face is familiar to
+nearly all the modern world, was said to be 8 feet tall. In 1865, at
+the age of nineteen, he measured 7 feet 8 inches. At Hawick, Scotland,
+in 1870, there was an Irishman 7 feet 8 inches in height, 52 inches
+around the chest, and who weighed 22 stone. Figure 159 shows an
+American giantess known as "Leah, the Giantess." At the age of nineteen
+she was 7 feet 2 inches tall and weighed 165 pounds.
+
+On June 17, 1871, there were married at Saint-Martins-in-the-Field in
+London Captain Martin Van Buren Bates of Kentucky and Miss Anna Swann
+of Nova Scotia, two celebrated exhibitionists, both of whom were over 7
+feet. Captain Bates, familiarly known as the "Kentucky Giant," years
+ago was a familiar figure in many Northern cities, where he exhibited
+himself in company with his wife, the combined height of the two being
+greater than that of any couple known to history. Captain Bates was
+born in Whitesburg, Letcher County, Ky., on November 9, 1845. He
+enlisted in the Southern army in 1861, and though only sixteen years
+old was admitted to the service because of his size. At the close of
+the war Captain Bates had attained his great height of 7 feet 2 1/2
+inches. His body was well proportioned and his weight increased until
+it reached 450 pounds. He traveled as a curiosity from 1866 to 1880,
+being connected with various amusement organizations. He visited nearly
+all the large cities and towns in the United States, Canada, Great
+Britain, France, Spain, Germany, Switzerland, Austria, and Russia.
+While in England in 1871 the Captain met Miss Anna H.  Swann, known as
+the "Nova Scotia Giantess," who was two years the junior of her giant
+lover. Miss Swann was justly proud of her height, 7 feet 5 1/2 inches.
+The two were married soon afterward.  Their combined height of 14 feet
+8 inches marked them as the tallest married couple known to mankind.
+
+Captain Bates' parents were of medium size. His father, a native of
+Virginia, was 5 feet 10 inches high and weighed 160 pounds.  His mother
+was 5 feet 3 inches tall and weighed 125 pounds. The height of the
+father of Mrs. Anna Swann Bates was 6 feet and her mother was 5 feet
+and 2 inches high, weighing but 100 pounds.
+
+A recent newspaper dispatch says: "Captain M. V. Bates, whose
+remarkable height at one time attracted the attention of the world, has
+recently retired from his conspicuous position and lives in comparative
+obscurity on his farm in Guilford, Medina County, O., half a mile east
+of Seville."
+
+In 1845 there was shown in Paris Joachim Eleiceigui, the Spanish giant,
+who weighed 195 kilograms (429 pounds) and whose hands were 42 cm. (16
+1/2 inches) long and of great beauty. In 1882 at the Alhambra in London
+there was a giantess by the name of Miss Marian, called the "Queen of
+the Amazons," aged eighteen years, who measured 2.45 meters (96 1/2
+inches). William Campbell, a Scotchman, died at Newcastle in May 1878.
+He was so large that the window of the room in which the deceased lay
+and the brick-work to the level of the floor had to be taken out, in
+order that the coffin might be lowered with block and tackle three
+stories to the ground. On January 27, 1887, a Greek, although a Turkish
+subject, recently died of phthisis in Simferopol. He was 7 feet 8
+inches in height and slept on three beds laid close together.
+
+Giants of History.--A number of persons of great height, particularly
+sovereigns and warriors, are well-known characters of history, viz.,
+William of Scotland, Edward III, Godefroy of Bouillon, Philip the Long,
+Fairfax, Moncey, Mortier, Kleber; there are others celebrated in modern
+times. Rochester, the favorite of Charles II; Pothier, the jurist;
+Bank, the English naturalist; Gall, Billat-Savarin, Benjamin Constant,
+the painter David, Bellart, the geographer Delamarche, and Care, the
+founder of the Gentleman's Magazine, were all men of extraordinary
+stature.
+
+Dwarfs.--The word "dwarf" is of Saxon origin (dwerg, dweorg) and
+corresponds to the "pumilio" or "nanus" of the Romans. The Greeks
+believed in the pygmy people of Thrace and Pliny speaks of the
+Spithamiens. In the "Iliad" Homer writes of the pygmies and Juvenal
+also describes them; but the fantasies of these poets have given these
+creatures such diminutive stature that they have deprived the
+traditions of credence. Herodotus relates that in the deserts of Lybia
+there were people of extreme shortness of stature. The Bible mentions
+that no dwarf can officiate at the altar. Aristotle and Philostratus
+speak of pygmy people descended from Pygmaeus, son of Dorus. In the
+seventeenth century van Helmont supposed that there were pygmies in the
+Canary Islands, and Abyssinia, Brazil, and Japan in the older times
+were repeatedly said to contain pygmy races. Relics of what must have
+been a pygmy race have been found in the Hebrides, and in this country
+in Kentucky and Tennessee.
+
+Dr. Schweinfurth, the distinguished African traveler, confirms the
+statements of Homer, Herodotus, and Aristotle that there was a race of
+pygmies near the source of the Nile. Schweinfurth says that they live
+south of the country occupied by the Niam-Niam, and that their stature
+varies from 4 feet to 4 feet 10 inches.  These people are called the
+Akkas, and wonderful tales are told of their agility and cunning,
+characteristics that seem to compensate for their small stature.
+
+In 1860 Paul DuChaillu speaks of the existence of an African people
+called the Obongos, inhabiting the country of the Ashangos, a little to
+the south of the equator, who were about 1.4 meters in height. There
+have been people found in the Esquimaux region of very diminutive
+stature. Battel discovered another pygmy people near the Obongo who are
+called the Dongos.  Kolle describes the Kenkobs, who are but 3 to 4
+feet high, and another tribe called the Reebas, who vary from 3 to 5
+feet in height. The Portuguese speak of a race of dwarfs whom they call
+the Bakka-bakka, and of the Yogas, who inhabit territory as far as the
+Loango. Nubia has a tribe of dwarfs called the Sukus, but little is
+known of them. Throughout India there are stories of dwarf tribes
+descended from the monkey-God, or Hoonuman of the mythologic poems.
+
+In the works of Humboldt and Burgoa there is allusion to the tradition
+of a race of pygmies in the unexplored region of Chiapas near the
+Isthmus of Tehuantepec in Central America. There is an expedition of
+anthropologists now on the way to discover this people. Professor Starr
+of Chicago on his return from this region reported many colonies of
+undersized people, but did not discover any pygmy tribes answering to
+the older legendary descriptions. Figure 160 represents two dwarf
+Cottas measuring 3 feet 6 inches in height.
+
+The African pygmies who were sent to the King of Italy and shown in
+Rome resembled the pygmy travelers of Akka that Schweinfurth saw at the
+court of King Munza at Monbuttu. These two pygmies at Rome were found
+in Central Africa and were respectively about ten and fifteen years
+old. They spoke a dialect of their own and different from any known
+African tongue; they were partly understood by an Egyptian sergeant, a
+native of Soudan, who accompanied them as the sole survivor of the
+escort with which their donor, Miani, penetrated Monbuttu. Miani, like
+Livingstone, lost his life in African travel. These dwarfs had grown
+rapidly in recent years and at the time of report, measured 1.15 and
+1.02 meters. In 1874 they were under the care of the Royal Geographical
+Society of Italy. They were intelligent in their manner, but resented
+being lionized too much, and were prone to scratch ladies who attempted
+to kiss them.
+
+The "Aztec Children" in 1851, at the ages of seven and six years,
+another pair of alleged indigenous pygmies, measured 33 3/4 and 29 1/2
+inches in height and weighed 20 3/4 and 17 pounds respectively. The
+circumference of their heads did not equal that of an ordinary infant
+at birth.
+
+It is known that at one time the ancients artificially produced dwarfs
+by giving them an insufficient alimentation when very young. They soon
+became rachitic from their deprivation of lime-salts and a great number
+perished, but those who survived were very highly prized by the Roman
+Emperors for their grotesque appearance. There were various recipes for
+dwarfing children. One of the most efficient in the olden times was
+said to have been anointing the backbone with the grease of bats,
+moles, dormice, and such animals; it was also said that puppies were
+dwarfed by frequently washing the feet and backbone, as the consequent
+drying and hardening of the parts were alleged to hinder their
+extension. To-day the growth of boys intended to be jockeys is kept
+down by excessive sweating.
+
+Ancient Popularity of Dwarfs.--At one time a dwarf was a necessary
+appendage of every noble family. The Roman Emperors all had their
+dwarfs. Julia, the niece of Augustus, had a couple of dwarfs, Conopas
+and Andromeda, each of whom was 2 feet 4 inches in height. It was the
+fashion at one time to have dwarfs noted for their wit and wisdom.
+Philos of Cos, tutor of Ptolemy Philadelphus, was a dwarf, as were
+Carachus, the friend of Saladin; Alypius of Alexandria, who was only 2
+feet high; Lucinus Calvus, who was only 3 feet high, and aesop, the
+famous Greek fabulist. Later in the Middle Ages and even to the last
+century dwarfs were seen at every Court. Lady Montagu describes the
+dwarfs at the Viennese Court as "devils bedaubed with diamonds." They
+had succeeded the Court Jester and exercised some parts of this ancient
+office. At this time the English ladies kept monkeys for their
+amusement. The Court dwarfs were allowed unlimited freedom of speech,
+and in order to get at truths other men were afraid to utter one of the
+Kings of Denmark made one of his dwarfs Prime Minister.
+
+Charles IX in 1572 had nine dwarfs, of which four had been given to him
+by King Sigismund-Augustus of Poland and three by Maximilian II of
+Germany. Catherine de Medicis had three couples of dwarfs at one time,
+and in 1579 she had still five pygmies, named Merlin, Mandricart,
+Pelavine, Rodomont, and Majoski.  Probably the last dwarf in the Court
+of France was Balthazar Simon, who died in 1662.
+
+Sometimes many dwarfs were present at great and noble gatherings.  In
+Rome in 1566 the Cardinal Vitelli gave a sumptuous banquet at which the
+table-attendants were 34 dwarfs. Peter the Great of Russia had a
+passion for dwarfs, and in 1710 gave a great celebration in honor of
+the marriage of his favorite, Valakoff, with the dwarf of the Princess
+Prescovie Theodorovna. There were 72 dwarfs of both sexes present to
+form the bridal party.  Subsequently, on account of dangerous and
+difficult labor, such marriages were forbidden in Russia.
+
+In England and in Spain the nobles had the portraits of their dwarfs
+painted by the celebrated artists of the day. Velasquez has represented
+Don Antonio el Ingles, a dwarf of fine appearance, with a large dog,
+probably to bring out the dwarf's inferior height. This artist also
+painted a great number of other dwarfs at the Court of Spain, and in
+one of his paintings he portrays the Infanta Marguerite accompanied by
+her male and female dwarfs. Reproductions of these portraits have been
+given by Garnier. In the pictures of Raphael, Paul Veronese, and
+Dominiquin, and in the "Triumph of Caesar" by Mantegna, representations
+of dwarfs are found, as well as in other earlier pictures representing
+Court events. At the present time only Russia and Turkey seem to have
+popular sympathy for dwarfs, and this in a limited degree.
+
+Intellectual Dwarfs.--It must be remarked, however, that many of the
+dwarfs before the public have been men of extraordinary-intelligence,
+possibly augmented by comparison. In a postmortem discussed at a
+meeting of the Natural History Society at Bonn in 1868 it was
+demonstrated by Schaufhausen that in a dwarf subject the brain weighed
+1/19 of the body, in contradistinction to the average proportion of
+adults, from 1 to 30 to 1 to 44. The subject was a dwarf of sixty-one
+who died in Coblentz, and was said to have grown after his thirtieth
+year.  His height was 2 feet 10 inches and his weight 45 pounds. The
+circumference of the head was 520 mm. and the brain weighed 1183.33 gm.
+and was well convoluted. This case was one of simple arrest of
+development, affecting all the organs of the body; he was not virile.
+He was a child of large parents; had two brothers and a sister of
+ordinary size and two brothers dwarfs, one 6 inches higher and the
+other his size.
+
+Several personages famous in history have been dwarfs. Attila, the
+historian Procopius, Gregory of Tours, Pepin le Bref, Charles III, King
+of Naples, and Albert the Grand were dwarfs. About the middle of the
+seventeenth century the French episcopacy possessed among its members a
+dwarf renowned for his intelligence. This diminutive man, called
+Godeau, made such a success in literature that by the grace of
+Richelieu he was named the Archbishop of Grasse. He died in 1672. The
+Dutch painter Doos, the English painter Gibson (who was about 3 feet in
+height and the father of nine infants by a wife of about the same
+height), Prince Eugene, and the Spanish Admiral Gravina were dwarfs.
+Fleury and Garry, the actors.
+
+Hay, a member of Parliament from Sussex in the last century;
+Hussein-Pasha, celebrated for his reforms under Selim III; the Danish
+antiquarian and voyager, Arendt, and Baron Denon were men far below the
+average size Varro says that there were two gentlemen of Rome who from
+their decorations must have belonged to an Equestrian Order, and who
+were but 2 Roman cubits (about 3 feet) high. Pliny also speaks of them
+as preserved in their coffins.
+
+It may be remarked that perhaps certain women are predisposed to give
+birth to dwarfs. Borwilaski had a brother and a sister who were dwarfs.
+In the middle of the seventeenth century a woman brought forth four
+dwarfs, and in the eighteenth century a dwarf named Hopkins had a
+sister as small as he was. Therese Souvray, the dwarf fiancee of Bebe,
+had a dwarf sister 41 inches high.  Virey has examined a German dwarf
+of eight who was only 18 inches tall, i.e., about the length of a
+newly-born infant. The parents were of ordinary size, but had another
+child who was also a dwarf.
+
+There are two species of dwarfs, the first coming into the world under
+normal conditions, but who in their infancy become afflicted with a
+sudden arrest of development provoked by some malady; the second are
+born very small, develop little, and are really dwarfs from their
+birth; as a rule they are well conformed, robust, and intelligent.
+These two species can be distinguished by an important characteristic.
+The rachitic dwarfs of the first class are incapable of perpetuating
+their species, while those of the second category have proved more than
+once their virility. A certain number of dwarfs have married with women
+of normal height and have had several children, though this is not, it
+is true, an indisputable proof of their generative faculties; but we
+have instances in which dwarfs have married dwarfs and had a family
+sometimes quite numerous. Robert Skinner (25 inches) and Judith (26
+inches), his wife, had 14 infants, well formed, robust, and of normal
+height.
+
+Celebrated Dwarfs.--Instances of some of the most celebrated dwarfs
+will be cited with a short descriptive mention of points of interest in
+their lives:--
+
+Vladislas Cubitas, who was King of Poland in 1305, was a dwarf, and was
+noted for his intelligence, courage, and as a good soldier. Geoffrey
+Hudson, the most celebrated English dwarf, was born at Oakham in
+England in 1619. At the age of eight, when not much over a foot high,
+he was presented to Henriette Marie, wife of Charles I, in a pie; he
+afterward became her favorite. Until he was thirty he was said to be
+not more than 18 inches high, when he suddenly increased to about 45
+inches. In his youth he fought several duels, one with a turkey cock,
+which is celebrated in the verse of Davenant. He became a popular and
+graceful courtier, and proved his bravery and allegiance to his
+sovereign by assuming command of a royalist company and doing good
+service therein. Both in moral and physical capacities he showed his
+superiority. At one time he was sent to France to secure a midwife for
+the Queen, who was a Frenchwoman. He afterward challenged a gentleman
+by the name of Croft to fight a duel, and would accept only deadly
+weapons; he shot his adversary in the chest; the quarrel grew out of
+his resentment of ridicule of his diminutive size. He was accused of
+participation in the Papist Plot and imprisoned by his political
+enemies in the Gate House at Westminster, where he died in 1682 at the
+advanced age of sixty-three. In Scott's "Peveril of the Peak" Hudson
+figures prominently. This author seemed fond of dwarfs.
+
+About the same epoch Charles I had a page in his court named Richard
+Gibson, who was remarkable for his diminutive size and his ability as a
+miniature painter. This little artist espoused another of his class,
+Anne Shepherd, a dwarf of Queen Henriette Marie, about his size (45
+inches). Mistress Gibson bore nine children, five of whom arrived at
+adult age and were of ordinary proportions. She died at the age of
+eighty; her husband afterward became the drawing master of Princesses
+Mary and Anne, daughters of James II; he died July 23, 1690, aged
+seventy-five years.
+
+In 1730 there was born of poor fisher parents at Jelst a child named
+Wybrand Lokes. He became a very skilful jeweler, and though he was of
+diminutive stature he married a woman of medium height, by whom he had
+several children. He was one of the smallest men ever exhibited,
+measuring but 25 1/2 inches in height. To support his family better, he
+abandoned his trade and with great success exhibited himself throughout
+Holland and England. After having amassed a great fortune he returned
+to his country, where he died in 1800, aged seventy. He was very
+intelligent, and proved his power of paternity, especially by one son,
+who at twenty-three was 5 feet 3 inches tall, and robust.
+
+Another celebrated dwarf was Nicolas Ferry, otherwise known as Bebe. He
+was born at Plaine in the Vosges in 1741; he was but 22 cm. (8 1/2
+inches) long, weighed 14 ounces at birth, and was carried on a plate to
+the church for baptism. At five Bebe was presented to King Stanislas of
+Poland. At fifteen he measured 29 inches. He was of good constitution,
+but was almost an idiot; for example, he did not recognize his mother
+after fifteen days' separation. He was quite lax in his morals, and
+exhibited no evidences of good nature except his lively attachment for
+his royal master, who was himself a detestable character. He died at
+twenty-two in a very decrepit condition, and his skeleton is preserved
+in the Museum of Natural History in Paris. Shortly before his death
+Bebe became engaged to a female dwarf named Therese Souvray, who at one
+time was exhibited in Paris at the Theatre Conti, together with an
+older sister. Therese lived to be seventy-three, and both she and her
+sister measured only 30 inches in height. She died in 1819.
+
+Aldrovandus gives a picture of a famous dwarf of the Duc de Crequi who
+was only 30 inches tall, though perfectly formed; he also speaks of
+some dwarfs who were not over 2 feet high.
+
+There was a Polish gentleman named Joseph Borwilaski, born in 1739 who
+was famed all over Europe. He became quite a scholar, speaking French
+and German fairly well. In 1860, at the age of twenty-two, and 28
+inches in height, he married a woman of ordinary stature, who bore him
+two infants well conformed. He was exhibited in many countries, and
+finally settled at Durham, England, where he died in 1837 at the almost
+incredible age of ninety-eight, and is buried by the side of the
+Falstaffian Stephen Kemble. Mary Jones of Shropshire, a dwarf 32 inches
+tall and much deformed, died in 1773 at the age of one hundred. These
+two instances are striking examples of great age in dwarfs and are
+therefore of much interest. Borwilaski's parents were tall in stature
+and three of his brothers were small; three of the other children
+measured 5 feet 6 inches. Diderot has written a history of this family.
+
+Richeborg, a dwarf only 23 inches in height, died in Paris in 1858 aged
+ninety years. In childhood he had been a servant in the House of
+Orleans and afterward became their pensioner. During the Revolution he
+passed in and out of Paris as an infant in a nurse's arms, thus
+carrying dispatches memorized which might have proved dangerous to
+carry in any other manner.
+
+At St. Philip's, Birmingham, there is the following inscription on a
+tomb: "In memory of Mannetta Stocker, who quitted this life on the 4th
+day of May, 1819, at the age of thirty-nine years, the smallest woman
+in the kingdom, and one of the most accomplished." She was born in
+Krauma, in the north of Austria, under normal conditions. Her growth
+stopped at the age of four, when she was 33 inches tall. She was shown
+in many villages and cities over Europe and Great Britain; she was very
+gay, played well on the piano, and had divers other accomplishments.
+
+In 1742 there was shown in London a dwarf by the name of Robert
+Skinner, .63 meters in height, and his wife, Judith, who was a little
+larger. Their exhibition was a great success and they amassed a small
+fortune; during twenty-three years they had 14 robust and well-formed
+children. Judith died in 1763, and Robert grieved so much after her
+that he himself expired two years later.
+
+Figure 161 shows a female dwarf with her husband and child, all of whom
+were exhibited some years since in the Eastern United States. The
+likeness of the child to the mother is already noticeable.
+
+Buffon speaks of dwarfs 24, 21, and 18 inches high, and mentions one
+individual, aged thirty-seven, only 16 inches tall, whom he considers
+the smallest person on record. Virey in 1818 speaks of an English child
+of eight or nine who was but 18 inches tall. It had the intelligence of
+a child of three or four; its dentition was delayed until it was two
+years old and it did not walk until four. The parents of this child
+were of ordinary stature.
+
+At the "Cosmorama" in Regent Street in 1848 there was a Dutch boy of
+ten exhibited. He was said to be the son of an apothecary and at the
+time of his birth weighed nine pounds. He continued to grow for six
+months and at the expiration of that time weighed 12 pounds; since
+then, however, he had only increased four pounds.  The arrest of
+development seemed to be connected with hydrocephalus; although the
+head was no larger than that of a child of two, the anterior fontanelle
+was widely open, indicating that there was pressure within. He was
+strong and muscular; grave and sedate in his manner; cheerful and
+affectionate; his manners were polite and engaging; he was expert in
+many kinds of handicraft; he possessed an ardent desire for knowledge
+and aptitude for education.
+
+Rawdon described a boy of five and a half, at the Liverpool Infirmary
+for Children, who weighed 10 1/2 pounds and whose height was 28 or 29
+inches. He uttered no articulate sound, but evidently possessed the
+sense of hearing. His eyes were large and well formed, but he was
+apparently blind. He suckled, cut his teeth normally, but had tonic
+contractions of the spine and was an apparent idiot.
+
+Hardie mentions a girl of sixteen and a half whose height was 40 inches
+and weight 35 1/2 pounds, including her clothes. During intrauterine
+life her mother had good health and both her parents had always been
+healthy. She seemed to stop growing at her fourth year. Her intellect
+was on a par with the rest of her body.  Sometimes she would talk and
+again she would preserve rigid silence for a long time. She had a
+shuffling walk with a tendency to move on her toes. Her temporary teeth
+were shed in the usual manner and had been replaced by canines and
+right first molar and incisors on the right side. There was no
+indication of puberty except a slight development of the hips. She was
+almost totally imbecile, but could tell her letters and spell short
+words. The circumference of the head was 19 inches, and Ross pointed
+out that the tendon-reflexes were well marked, as well as the
+ankle-clonus; he diagnosed the case as one of parencephalus.  Figure
+162 represents a most curious case of a dwarf named Carrie Akers, who,
+though only 34 inches tall, weighed 309 pounds.
+
+In recent years several dwarfs have commanded the popular attention,
+but none so much as "General Tom Thumb," the celebrated dwarf of
+Barnum's Circus. Charles Stratton, surnamed "Tom Thumb," was born at
+Bridgeport, Conn., on January 11, 1832; he was above the normal weight
+of the new-born. He ceased growing at about five months, when his
+height was less than 21 inches.  Barnum, hearing of this phenomenon in
+his city, engaged him, and he was shown all over the world under his
+assumed name. He was presented to Queen Victoria in 1844, and in the
+following year he was received by the Royal Family in France. His
+success was wonderful, and even the most conservative journals
+described and commented on him. He gave concerts, in which he sang in a
+nasal voice; but his "drawing feat" was embracing the women who visited
+him. It is said that in England alone he kissed a million females; he
+prided himself on his success in this function, although his features
+were anything but inviting. After he had received numerous presents and
+had amassed a large fortune he returned to America in 1864, bringing
+with him three other dwarfs, the "Sisters Warren" and "Commodore Nutt."
+He married one of the Warrens, and by her had one child, Minnie, who
+died some months after birth of cerebral congestion. In 1883 Tom Thumb
+and his wife, Lavinia, were still living, but after that they dropped
+from public view and have since died.
+
+In 1895 the wife of a dwarf named Morris gave birth to twins at
+Blaenavon, North Wales. Morris is only 35 inches in height and his wife
+is even smaller. They were married at Bartholmey Church and have since
+been traveling through England under the name of "General and Mrs.
+Small," being the smallest married couple in the world. At the latest
+reports the mother and her twins were doing well.
+
+The Rossow Brothers have been recently exhibited to the public.  These
+brothers, Franz and Carl, are twenty and eighteen years respectively.
+Franz is the eldest of 16 children and is said to weigh 24 pounds and
+measure 21 inches in height; Carl is said to weigh less than his
+brother but is 29 inches tall. They give a clever gymnastic exhibition
+and are apparently intelligent. They advertise that they were examined
+and still remain under the surveillance of the Faculty of Gottingen.
+
+Next to the success of "Tom Thumb" probably no like attraction has been
+so celebrated as the "Lilliputians," whose antics and wit so many
+Americans have in late years enjoyed. They were a troupe of singers and
+comedians composed entirely of dwarfs; they exhibited much talent in
+all their performances, which were given for several years and quite
+recently in all the large cities of the United States. They showed
+themselves to be worthy rivals for honors in the class of
+entertainments known as burlesques. As near as could be ascertained,
+partly from the fact that they all spoke German fluently and originally
+gave their performance entirely in German, they were collected from the
+German and Austrian Empires.
+
+The "Princess Topaze" was born near Paris in 1879. According to a
+recent report she is perfectly formed and is intelligent and vivacious.
+She is 23 1/2 inches tall and weighs 14 pounds. Her parents were of
+normal stature.
+
+Not long since the papers recorded the death of Lucia Zarete, a Mexican
+girl, whose exact proportions were never definitely known; but there is
+no doubt that she was the smallest midget ever exhibited In this
+country. Her exhibitor made a fortune with her and her salary was among
+the highest paid to modern "freaks."
+
+Miss H. Moritz, an American dwarf, at the age of twenty weighed 36
+pounds and was only 22 inches tall.
+
+Precocious development is characterized by a hasty growth of the
+subject, who at an early period of life attains the dimensions of an
+adult. In some of these instances the anomaly is associated with
+precocious puberty, and after acquiring the adult growth at an early
+age there is an apparent cessation of the development.  In adult life
+the individual shows no distinguishing characters.
+
+The first to be considered will be those cases, sometimes called
+"man-boys," characterized by early puberty and extraordinary
+development in infancy. Histories of remarkable children have been
+transmitted from the time of Vespasian. We read in the "Natural
+History" of Pliny that in Salamis, Euthimedes had a son who grew to 3
+Roman cubits (4 1/2 feet) in three years; he was said to have little
+wit, a dull mind, and a slow and heavy gait; his voice was manly, and
+he died at three of general debility.  Phlegon says that Craterus, the
+brother of King Antigonus, was an infant, a young man, a mature man, an
+old man, and married and begot children all in the space of seven
+years. It is said that King Louis II of Hungary was born so long before
+his time that he had no skin; in his second year he was crowned, in his
+tenth year he succeeded, in his fourteenth year he had a complete
+beard, in his fifteenth he was married, in his eighteenth he had gray
+hair, and in his twentieth he died. Rhodiginus speaks of a boy who when
+he was ten years impregnated a female. In 1741 there was a boy born at
+Willingham, near Cambridge, who had the external marks of puberty at
+twelve months, and at the time of his death at five years he had the
+appearance of an old man. He was called "prodigium Willinghamense." The
+Ephemerides and some of the older journals record instances of penile
+erection immediately after birth.
+
+It was said that Philip Howarth, who was born at Quebec Mews, Portman
+Square, London, February 21, 1806, lost his infantile rotundity of form
+and feature after the completion of his first year and became pale and
+extremely ugly, appearing like a growing boy. His penis and testes
+increased in size, his voice altered, and hair grew on the pubes. At
+the age of three he was 3 feet 4 1/2 inches tall and weighed 51 1/4
+pounds. The length of his penis when erect was 4 1/2 inches and the
+circumference 4 inches; his thigh-measure was 13 1/2 inches, his
+waist-measure 24 inches, and his biceps 7 inches. He was reported to be
+clever, very strong, and muscular. An old chronicle says that in
+Wisnang Parish, village of Tellurge, near Tygure, in Lordship Kiburge,
+there was born on the 26th of May, 1548, a boy called Henry Walker, who
+at five years was of the height of a boy of fourteen and possessed the
+genitals of a man. He carried burdens, did men's work, and in every way
+assisted his parents, who were of usual size.
+
+There is a case cited by the older authors of a child born in the Jura
+region who at the age of four gave proof of his virility, at seven had
+a beard and the height of a man. The same journal also speaks of a boy
+of six, 1.62 meters tall, who was perfectly proportioned and had
+extraordinary strength. His beard and general appearance, together with
+the marks of puberty, gave him the appearance of a man of thirty.
+
+In 1806 Dupuytren presented to the Medical Society in Paris a child 3
+1/2 feet high, weighing 57 pounds, who had attained puberty.
+
+There are on record six modern cases of early puberty in boys, one of
+whom died at five with the signs of premature senility; at one year he
+had shown signs of enlargement of the sexual organs.  There was another
+who at three was 3 feet 6 3/4 inches high, weighed 50 pounds, and had
+seminal discharges. One of the cases was a child who at birth resembled
+an ordinary infant of five months. From four to fifteen months his
+penis enlarged, until at the age of three it measured when erect 3
+inches. At this age he was 3 feet 7 inches high and weighed 64 pounds.
+The last case mentioned was an infant who experienced a change of voice
+at twelve months and showed hair on the pubes. At three years he was 3
+feet 4 1/2 inches tall and weighed 51 1/4 pounds. Smith, in Brewster's
+Journal, 1829, records the case of a boy who at the age of four was
+well developed; at the age of six he was 4 feet 2 inches tall and
+weighed 74 pounds; his lower extremities were extremely short
+proportionally and his genitals were as well developed as those of an
+adult. He had a short, dark moustache but no hair on his chin, although
+his pubic hair was thick, black, and curly. Ruelle describes a child of
+three and a quarter years who was as strong and muscular as one at
+eight. He had full-sized male organs and long black hair on the pubes.
+Under excitement he discharged semen four or five times a day; he had a
+deep male voice, and dark, short hair on the cheek and upper lip.
+
+Stone gives an account of a boy of four who looked like a child of ten
+and exhibited the sexual organs of a man with a luxuriant growth of
+hair on the pubes. This child was said to have been of great beauty and
+a miniature model of an athlete. His height was 4 feet 1/4 inch and
+weight 70 pounds; the penis when semiflaccid was 4 1/4 inches long; he
+was intelligent and lively, and his back was covered with the acne of
+puberty. A peculiar fact as regards this case was the statement of the
+father that he himself had had sexual indulgence at eight. Stone
+parallels this case by several others that he has collected from
+medical literature.  Breschet in 1821 reported the case of a boy born
+October 20, 1817, who at three years and one month was 3 feet 6 3/4
+inches tall; his penis when flaccid measured 4 inches and when erect 5
+1/4 inches, but the testicles were not developed in proportion.  Lopez
+describes a mulatto boy of three years ten and a half months whose
+height was 4 feet 1/2 inch and weight 82 pounds; he measured about the
+chest 27 1/2 inches and about the waist 27 inches; his penis at rest
+was 4 inches long and had a circumference of 3 1/2 inches, although the
+testes were not descended. He had evidences of a beard and his axillae
+were very hairy; it is said he could with ease lift a man weighing 140
+pounds. His body was covered with acne simplex and had a strong
+spermatic odor, but it was not known whether he had any venereal
+appetite.
+
+Johnson mentions a boy of seven with severe gonorrhea complicated with
+buboes which he had contracted from a servant girl with whom he slept.
+At the Hopital des Enfans Malades children at the breast have been
+observed to masturbate. Fournier and others assert having seen
+infantile masturbators, and cite a case of a girl of four who was
+habitually addicted to masturbation from her infancy but was not
+detected until her fourth year; she died shortly afterward in a
+frightful state of marasmus. Vogel alludes to a girl of three in whom
+repeated attacks of epilepsy occurred after six months' onanism. Van
+Bambeke mentions three children from ten to twenty months old, two of
+them females, who masturbated.
+
+Bidwell describes a boy of five years and two months who during the
+year previous had erections and seminal emissions. His voice had
+changed and he had a downy moustache on his upper lip and hair on the
+pubes; his height was 4 feet 3 1/2 inches and his weight was 82 1/2
+pounds. His penis and testicles were as well developed as those of a
+boy of seventeen or eighteen, but from his facial aspect one would take
+him to be thirteen. He avoided the company of women and would not let
+his sisters nurse him when he was sick.
+
+Pryor speaks of a boy of three and a half who masturbated and who at
+five and a half had a penis of adult size, hair on the pubes, and was
+known to have had seminal emissions. Woods describes a boy of six years
+and seven months who had the appearance of a youth of eighteen. He was
+4 feet 9 inches tall and was quite muscular. He first exhibited signs
+of precocious growth at the beginning of his second year and when three
+years old he had hair on the pubes. There is an instance in which a boy
+of thirteen had intercourse with a young woman at least a dozen times
+and succeeded in impregnating her. The same journal mentions an
+instance in which a boy of fourteen succeeded in impregnating a girl of
+the same age. Chevers speaks of a young boy in India who was sentenced
+to one year's imprisonment for raping a girl of three.
+
+Douglass describes a boy of four years and three months who was 3 feet
+10 1/2 inches tall and weighed 54 pounds; his features were large and
+coarse, and his penis and testes were of the size of those of an adult.
+He was unusually dull, mentally, quite obstinate, and self-willed. It
+is said that he masturbated on all opportunities and had vigorous
+erections, although no spermatozoa were found in the semen issued. He
+showed no fondness for the opposite sex. The history of this rapid
+growth says that he was not unlike other children until the third year,
+when after wading in a small stream several hours he was taken with a
+violent chill, after which his voice began to change and his sexual
+organs to develop.
+
+Blanc quotes the case described by Cozanet in 1875 of Louis Beran, who
+was born on September 29, 1869, at Saint-Gervais, of normal size. At
+the age of six months his dimensions and weight increased in an
+extraordinary fashion. At the age of six years he was 1.28 meters high
+(4 feet 2 1/3 inches) and weighed 80 pounds.  His puberty was
+completely manifested in every way; he eschewed the society of children
+and helped his parents in their labors.  Campbell showed a lad of
+fourteen who had been under his observation for ten years. When fifteen
+months old this prodigy had hair on his pubes and his external genitals
+were abnormally larger end at the age of two years they were fully
+developed and had not materially changed in the following years. At
+times he manifested great sexual excitement. Between four and seven
+years he had seminal discharges, but it was not determined whether the
+semen contained spermatozoa. He had the muscular development of a man
+of twenty-five. He had shaved several years. The boy's education was
+defective from his failure to attend school.
+
+The accompanying illustration represents a boy of five years and three
+months of age whose height at this time was 4 feet and his physical
+development far beyond that usual at this age, his external genitals
+resembling those of a man of twenty. His upper lip was covered by a
+mustache, and the hirsute growth elsewhere was similarly precocious.
+
+The inscription on the tombstone of James Weir in the Parish of
+Carluke, Scotland, says that when only thirteen months old he measured
+3 feet 4 inches in height and weighed 5 stone. He was pronounced by the
+faculty of Edinburgh and Glasgow to be the most extraordinary child of
+his age. Linnaeus saw a boy at the Amsterdam Fair who at the age of
+three weighed 98 pounds. In Paris, about 1822, there was shown an
+infant Hercules of seven who was more remarkable for obesity than
+general development. He was 3 feet 4 inches high, 4 feet 5 inches in
+circumference, and weighed 220 pounds. He had prominent eyebrows, black
+eyes, and his complexion resembled that of a fat cook in the heat.
+Borellus details a description of a giant child. There is quoted from
+Boston a the report of a boy of fifteen months weighing 92 pounds who
+died at Coney Island. He was said to have been of phenomenal size from
+infancy and was exhibited in several museums during his life.
+
+Desbois of Paris mentions an extraordinary instance of rapid growth in
+a boy of eleven who grew 6 inches in fifteen days.
+
+Large and Small New-born Infants.--There are many accounts of new-born
+infants who were characterized by their diminutive size.  On page 66 we
+have mentioned Usher's instance of twins born at the one hundred and
+thirty-ninth day weighing each less than 11 ounces; Barker's case of a
+female child at the one hundred and fifty-eighth day weighing 1 pound;
+Newinton's case of twins at the fifth month, one weighing 1 pound and
+the other 1 pound 3 1/2 ounces; and on page 67 is an account of Eikam's
+five-months' child, weighing 8 ounces. Of full-term children Sir
+Everard Home, in his Croonian Oration in 1824, speaks of one borne by a
+woman who was traveling with the baggage of the Duke of Wellington's
+army. At her fourth month of pregnancy this woman was attacked and
+bitten by a monkey, but she went to term, and a living child was
+delivered which weighed but a pound and was between 7 and 8 inches
+long. It was brought to England and died at the age of nine, when 22
+inches high. Baker mentions a child fifty days' old that weighed 1
+pound 13 ounces and was 14 inches long. Mursick describes a living
+child who at birth weighed but 1 3/4 pounds.  In June, 1896, a baby
+weighing 1 3/4 pounds was born at the Samaritan Hospital, Philadelphia.
+
+Scott has recorded the birth of a child weighing 2 1/2 pounds, and
+another 3 1/4 pounds. In the Chicago Inter-Ocean there is a letter
+dated June 20, 1874, which says that Mrs. J. B. McCrum of Kalamazoo,
+Michigan, gave birth to a boy and girl that could be held in the palm
+of the hand of the nurse. Their aggregate weight was 3 pounds 4 ounces,
+one weighing 1 pound 8 ounces, the other 1 pound 12 ounces. They were
+less than 8 inches long and perfectly formed; they were not only alive
+but extremely vivacious.
+
+There is an account of female twins born in 1858 before term. One
+weighed 22 1/2 ounces, and over its arm, forearm, and hand one could
+easily pass a wedding-ring. The other weighed 24 ounces.  They both
+lived to adult life; the larger married and was the mother of two
+children, which she bore easily. The other did not marry, and although
+not a dwarf, was under-sized; she had her catamenia every third week.
+Post describes a 2-pound child.
+
+On the other hand, there have been infants characterized by their
+enormous size at birth. Among the older writers, Cranz describes an
+infant which at birth weighed 23 pounds; Fern mentions a fetus of 18
+pounds; and Mittehauser speaks of a new-born child weighing 24 pounds.
+Von Siebold in his "Lucina" has recorded a fetus which weighed 22 1/2
+pounds. It is worthy of comment that so great is the rarity of these
+instances that in 3600 cases, in the Rotunda Hospital, Dublin, only one
+child reached 11 pounds.
+
+There was a child born in Sussex in 1869 which weighed 13 1/2 pounds
+and measured 26 1/2 inches. Warren delivered a woman in Derbyshire of
+male twins, one weighing 17 pounds 8 ounces and the other 18 pounds.
+The placenta weighed 4 pounds, and there was an ordinary pailful of
+liquor amnii. Both the twins were muscular and well formed; the parents
+were of ordinary stature, and at last reports the mother was rapidly
+convalescing. Burgess mentions an 18-pound new-born child; end Meadows
+has seen a similar instance. Eddowes speaks of the birth of a child at
+Crewe, a male, which weighed 20 pounds 2 ounces and was 23 inches long.
+It was 14 1/2 inches about the chest, symmetrically developed, and
+likely to live. The mother, who was a schoolmistress of thirty-three,
+had borne two previous children, both of large size. In this instance
+the gestation had not been prolonged, the delivery was spontaneous, and
+there was no laceration of the parts.
+
+Chubb says that on Christmas Day, 1852, there was a child delivered
+weighing 21 pounds. The labor was not severe and the other children of
+the family were exceptionally large. Dickinson describes a woman, a
+tertipara, who had a most difficult labor and bore an extremely large
+child. She had been thirty-six hours in parturition, and by
+evisceration and craniotomy was delivered of a child weighing 16
+pounds. Her first child weighed 9 pounds, her second 20, and her third,
+the one described, cost her her life soon after delivery.
+
+There is a history of a Swedish woman in Boston who was delivered by
+the forceps of her first child, which weighed 19 3/4 pounds and which
+was 25 3/4 inches long. The circumference of the head was 16 3/4
+inches, of the neck 9 3/4, and of the thigh 10 3/4 inches.
+
+Rice speaks of a child weighing 20 1/4 pounds at birth. Johnston
+describes a male infant who was born on November 26, 1848, weighing 20
+pounds, and Smith another of the same weight. Baldwin quotes the case
+of a woman who after having three miscarriages at last had a child that
+weighed 23 pounds. In the delivery there was extensive laceration of
+the anterior wall of the vagina; the cervix and perineum, together with
+an inch of the rectum, were completely destroyed.
+
+Beach describes a birth of a young giant weighing 23 3/4 pounds.  Its
+mother was Mrs. Bates, formerly Anna Swann, the giantess who married
+Captain Bates. Labor was rather slow, but she was successfully
+delivered of a healthy child weighing 23 3/4 pounds and 30 inches long.
+The secundines weighed ten pounds and there were nine quarts of
+amniotic fluid.
+
+There is a recent record of a Cesarian section performed on a woman of
+forty in her twelfth pregnancy and one month beyond term. The fetus,
+which was almost exsanguinated by amputation, weighed 22 1/2 pounds.
+Bumm speaks of the birth of a premature male infant weighing 4320 gm.
+(9 1/2 pounds) and measuring 54 cm.  long. Artificial labor had been
+induced at the thirty-fifth week in the hope of delivering a living
+child, the three preceding infants having all been still-born on
+account of their large size. Although the mother's pelvis was wide, the
+disposition to bear huge infants was so great as to render the woman
+virtually barren.
+
+Congenital asymmetry and hemihypertrophy of the body are most peculiar
+anomalies and must not be confounded with acromegaly or myxedema, in
+both of which there is similar lack of symmetric development. There
+seems to be no satisfactory clue to the causation of these
+abnormalisms. Most frequently the left side is the least developed, and
+there is a decided difference in the size of the extremities.
+
+Finlayson reports a case of a child affected with congenital unilateral
+hypertrophy associated with patches of cutaneous congestion. Logan
+mentions hypertrophy in the right half of the body in a child of four,
+first noticed shortly after birth; Langlet also speaks of a case of
+congenital hypertrophy of the right side. Broca and Trelat were among
+the first observers to discuss this anomaly.
+
+Tilanus of Munich in 1893 reported a case of hemihypertrophy in a girl
+of ten. The whole right half of the body was much smaller and better
+developed than the left, resulting in a limping gait.  The electric
+reaction and the reflexes showed no abnormality. The asymmetry was
+first observed when the child was three. Mobius and Demme report
+similar cases.
+
+Adams reports an unusual case of hemihypertrophy in a boy of ten.
+There was nothing noteworthy in the family history, and the patient had
+suffered from none of the diseases of childhood.  Deformity was
+noticeable at birth, but not to such a degree relatively as at a later
+period. The increased growth affected the entire right half of the
+body, including the face, but was most noticeable in the leg, thigh,
+and buttock. Numerous telangiectatic spots were scattered irregularly
+over the body, but most thickly on the right side, especially on the
+outer surface of the leg. The accompanying illustration represents the
+child's appearance at the time of report.
+
+Jacobson reports the history of a female child of three years with
+nearly universal giant growth (Riesenwuchs). At first this case was
+erroneously diagnosed as acromegaly. The hypertrophy affected the face,
+the genitals, the left side of the trunk, and all the limbs.
+
+Milne records a case of hemihypertrophy in a female child of one year.
+The only deviation from uniform excess of size of the right side was
+shown in the forefinger and thumb, which were of the same size as on
+the other hand; and the left side showed no overgrowth in any of its
+members except a little enlargement of the second toe. While
+hypertrophy of one side is the usual description of such cases, the
+author suggests that there may be a condition of defect upon the other
+side, and he is inclined to think that in this case the limb, hand, and
+foot of the left side seemed rather below the average of the child's
+age. In this case, as in others previously reported, there were
+numerous telangiectatic spots of congestion scattered irregularly over
+the body. Milne also reported later to the Sheffield Medico-Chirurgical
+Society an instance of unilateral hypertrophy in a female child of
+nineteen months. The right side was involved and the anomaly was
+believed to be due to a deficiency of growth of the left side as well
+as over-development of the right. There were six teeth on the right
+side and one on the left.
+
+Obesity.--The abnormality of the adipose system, causing in consequence
+an augmentation of the natural volume of the subject, should be
+described with other anomalies of size and stature.  Obesity may be
+partial, as seen in the mammae or in the abdomen of both women and men,
+or it may be general; and it is of general obesity that we shall
+chiefly deal. Lipomata, being distinctly pathologic formations, will be
+left for another chapter.
+
+The cases of obesity in infancy and childhood are of considerable
+interest, and we sometimes see cases that have been termed examples of
+"congenital corpulency." Figure 167 represents a baby of thirteen
+months that weighed 75 pounds. Figure 168 shows another example of
+infantile obesity, known as "Baby Chambers." Elliotson describes a
+female infant not a year old which weighed 60 pounds. There is an
+instance on record of a girl of four who weighed 256 pounds Tulpius
+mentions a girl of five who weighed 150 pounds and had the strength of
+a man. He says that the acquisition of fat did not commence until some
+time after birth.  Ebstein reports an instance given to him by Fisher
+of Moscow of a child in Pomerania who at the age of six weighed 137
+pounds and was 46 inches tall; her girth was 46 inches and the
+circumference of her head was 24 inches. She was the offspring of
+ordinary-sized parents, and lived in narrow and sometimes needy
+circumstances. The child was intelligent and had an animated expression
+of countenance.
+
+Bartholinus mentions a girl of eleven who weighed over 200 pounds.
+There is an instance recorded of a young girl in Russia who weighed
+nearly 200 pounds when but twelve. Wulf, quoted by Ebstein, describes a
+child which died at birth weighing 295 ounces. It was well proportioned
+and looked like a child three months old, except that it had an
+enormous development of fatty tissue. The parents were not excessively
+large, and the mother stated that she had had children before of the
+same proportions.  Grisolles mentions a child who was so fat at twelve
+months that there was constant danger of suffocation; but, marvelous to
+relate, it lost all its obesity when two and a half, and later was
+remarkable for its slender figure. Figure 169 shows a girl born in
+Carbon County, Pa., who weighed 201 pounds when nine years old.
+McNaughton describes Susanna Tripp, who at six years of age weighed 203
+pounds and was 3 feet 6 inches tall and measured 4 feet 2 inches around
+the waist. Her younger sister, Deborah, weighed 119 pounds; neither of
+the two weighed over 7 pounds at birth and both began to grow at the
+fourth month. On October, 1788, there died at an inn in the city of
+York the surprising "Worcestershire Girl" at the age of five. She had
+an exceedingly beautiful face and was quite active. She was 4 feet in
+height and larger around the breast and waist; her thigh measured 18
+inches and she weighed nearly 200 pounds. In February, 1814, Mr. S.
+Pauton was married to the only daughter of Thomas Allanty of Yorkshire;
+although she was but thirteen she was 13 stone weight (182 pounds). At
+seven years she had weighed 7 stone (98 pounds). Williams mentions
+several instances of fat children. The first was a German girl who at
+birth weighed 13 pounds; at six months, 42 pounds; at four years, 150
+pounds; and at twenty years, 450 pounds. Isaac Butterfield, born near
+Leeds in 1781, weighed 100 pounds in 1782 and was 3 feet 13 inches
+tall. There was a child named Everitt, exhibited in London in 1780, who
+at eleven months was 3 feet 9 inches tall and measured around the loins
+over 3 feet. William Abernethy at the age of thirteen weighed 22 stone
+(308 pounds) and measured 57 inches around the waist. He was 5 feet 6
+inches tall. There was a girl of ten who was 1.45 meters (4 feet 9
+inches) high and weighed 175 pounds. Her manners were infantile and her
+intellectual development was much retarded. She spoke with difficulty
+in a deep voice; she had a most voracious appetite.
+
+At a meeting of the Physical Society of Vienna on December 4, 1894,
+there was shown a girl of five and a half who weighed 250 pounds. She
+was just shedding her first teeth; owing to the excess of fat on her
+short limbs she toddled like an infant.  There was no tendency to
+obesity in her family. Up to the eleventh month she was nursed by her
+mother, and subsequently fed on cabbage, milk, and vegetable soup. This
+child, who was of Russian descent, was said never to perspire.
+
+Cameron describes a child who at birth weighed 14 pounds, at twelve
+months she weighed 69 pounds, and at seventeen months 98 pounds. She
+was not weaned until two years old and she then commenced to walk. The
+parents were not remarkably large. There is an instance of a boy of
+thirteen and a half who weighed 214 pounds. Kaestner speaks of a child
+of four who weighed 82 pounds, and Benzenberg noted a child of the same
+age who weighed 137.  Hildman, quoted by Picat, speaks of an infant
+three years and ten months old who had a girth of 30 inches. Hillairet
+knew of a child of five which weighed 125 pounds. Botta cites several
+instances of preternaturally stout children. One child died at the age
+of three weighing 90 pounds, another at the age of five weighed 100
+pounds, and a third at the age of two weighed 75 pounds.
+
+Figure 170 represents Miss "Millie Josephine" of Chicago, a recent
+exhibitionist, who at the reputed age of thirteen was 5 feet 6 inches
+tall and weighed 422 pounds.
+
+General Remarks.--It has been chiefly in Great Britain and in Holland
+that the most remarkable instances of obesity have been seen,
+especially in the former country colossal weights have been recorded.
+In some countries corpulency has been considered an adornment of the
+female sex. Hesse-Wartegg refers to the Jewesses of Tunis, who when
+scarcely ten years old are subjected to systematic treatment by
+confinement in narrow, dark rooms, where they are fed on farinaceous
+foods and the flesh of young puppies until they are almost a shapeless
+mass of fat. According to Ebstein, the Moorish women reach with
+astonishing rapidity the desired embonpoint on a diet of dates and a
+peculiar kind of meal.
+
+In some nations and families obesity is hereditary, and generations
+come and go without a change in the ordinary conformation of the
+representatives. In other people slenderness is equally persistent, and
+efforts to overcome this peculiarity of nature are without avail.
+
+Treatment of Obesity.--Many persons, the most famous of whom was
+Banting, have advanced theories to reduce corpulency and to improve
+slenderness; but they have been uniformly unreliable, and the whole
+subject of stature-development presents an almost unexplored field for
+investigation. Recently, Leichtenstein, observing in a case of myxedema
+treated with the thyroid gland that the subcutaneous fat disappeared
+with the continuance of the treatment, was led to adopt this treatment
+for obesity itself and reports striking results. The diet of the
+patient remained the same, and as the appetite was not diminished by
+the treatment the loss of weight was evidently due to other causes than
+altered alimentation. He holds that the observations in myxedema, in
+obesity, and psoriasis warrant the belief that the thyroid gland
+eliminates a material having a regulating influence upon the
+constitution of the panniculus adiposus and upon the nutrition of the
+skin in general. There were 25 patients in all; in 22 the effect was
+entirely satisfactory, the loss of weight amounting to as much as 9.5
+kilos (21 pounds). Of the three cases in which the result was not
+satisfactory, one had nephritis with severe Graves' disease, and the
+third psoriasis. Charrin has used the injections of thyroid extract
+with decided benefit. So soon as the administration of the remedy was
+stopped the loss of weight ceased, but with the renewal of the remedy
+the loss of weight again ensued to a certain point, beyond which the
+extract seemed powerless to act. Ewald also reports good results from
+this treatment of obesity.
+
+Remarkable Instances of Obesity.--From time immemorial fat men and
+women have been the object of curiosity and the number who have
+exhibited themselves is incalculable. Nearly every circus and dime
+museum has its example, and some of the most famous have in this way
+been able to accumulate fortunes.
+
+Athenaeus has written quite a long discourse on persons of note who in
+the olden times were distinguished for their obesity. He quotes a
+description of Denys, the tyrant of Heraclea, who was so enormous that
+he was in constant danger of suffocation; most of the time he was in a
+stupor or asleep, a peculiarity of very fat people. His doctors had
+needles put in the back of his chairs to keep him from falling asleep
+when sitting up and thus incurring the danger of suffocation. In the
+same work Athenaeus speaks of several sovereigns noted for their
+obesity; among others he says that Ptolemy VII, son of Alexander, was
+so fat that, according to Posidonius, when he walked he had to be
+supported on both sides.  Nevertheless, when he was excited at a
+repast, he would mount the highest couch and execute with agility his
+accustomed dance.
+
+According to old chronicles the cavaliers at Rome who grew fat were
+condemned to lose their horses and were placed in retirement. During
+the Middle Ages, according to Guillaume in his "Vie de Suger," obesity
+was considered a grace of God.
+
+Among the prominent people in the olden time noted for their embonpoint
+were Agesilas, the orator Licinius Calvus, who several times opposed
+Cicero, the actor Lucius, and others. Among men of more modern times we
+can mention William the Conqueror; Charles le Gros; Louis le Gros;
+Humbert II, Count of Maurienne; Henry I, King of Navarre; Henry III,
+Count of Champagne; Conan III, Duke of Brittany; Sancho I, King of
+Leon; Alphonse II, King of Portugal; the Italian poet Bruni, who died
+in 1635; Vivonne, a general under Louis XIV; the celebrated German
+botanist Dillenius; Haller; Frederick I, King of Wurtemberg, and Louis
+XVIII.
+
+Probably the most famous of all the fat men was Daniel Lambert, born
+March 13, 1770, in the parish of Saint Margaret, Leicester.  He did not
+differ from other youths until fourteen. He started to learn the trade
+of a die-sinker and engraver in Birmingham. At about nineteen he began
+to believe he would be very heavy and developed great strength. He
+could lift 500 pounds with ease and could kick seven feet high while
+standing on one leg. In 1793 he weighed 448 pounds; at this time he
+became sensitive as to his appearance. In June, 1809, he weighed 52
+stone 11 pounds (739 pounds), and measured over 3 yards around the body
+and over 1 yard around the leg. He had many visitors, and it is said
+that once, when the dwarf Borwilaski came to see him, he asked the
+little man how much cloth he needed for a suit. When told about 3/4 of
+a yard, he replied that one of his sleeves would be ample.  Another
+famous fat man was Edward Bright, sometimes called "the fat man of
+Essex." He weighed 616 pounds. In the same journal that records
+Bright's weight is an account of a man exhibited in Holland who weighed
+503 pounds.
+
+Wadd, a physician, himself an enormous man, wrote a treatise on obesity
+and used his own portrait for a frontispiece. He speaks of Doctor
+Beddoes, who was so uncomfortably fat that a lady of Clifton called him
+a "walking feather bed." He mentions Doctor Stafford, who was so
+enormous that this epitaph was ascribed to him:--
+
+"Take heed, O good traveler! and do not tread hard, For here lies Dr.
+Stafford, in all this churchyard."
+
+Wadd has gathered some instances, a few of which will be cited.  At
+Staunton, January 2, 1816, there died Samuel Sugars, Gent., who weighed
+with a single wood coffin 50 stone (700 pounds).  Jacob Powell died in
+1764, weighing 660 pounds. It took 16 men to carry him to his grave.
+Mr. Baker of Worcester, supposed to be larger than Bright, was interred
+in a coffin that was larger than an ordinary hearse. In 1797 there was
+buried Philip Hayes, a professor of music, who was as heavy as Bright
+(616 pounds).
+
+Mr. Spooner, an eminent farmer of Warwickshire, who died in 1775, aged
+fifty-seven, weighed 569 pounds and measured over 4 feet across the
+shoulders. The two brothers Stoneclift of Halifax, Yorkshire, together
+weighed 980 pounds.
+
+Keysler in his travels speaks of a corpulent Englishman who in passing
+through Savoy had to use 12 chairmen; he says that the man weighed 550
+pounds. It is recorded on the tombstone of James Parsons, a fat man of
+Teddington, who died March 7, 1743, that he had often eaten a whole
+shoulder of mutton and a peck of hasty pudding. Keysler mentions a
+young Englishman living in Lincoln who was accustomed to eat 18 pounds
+of meat daily. He died in 1724 at the age of twenty-eight, weighing 530
+pounds. In 1815 there died in Trenaw, in Cornwall, a person known as
+"Giant Chillcot." He measured at the breast 6 feet 9 inches and weighed
+460 pounds. One of his stockings held 6 gallons of wheat. In 1822 there
+was reported to be a Cambridge student who could not go out in the
+daytime without exciting astonishment. The fat of his legs overhung his
+shoes like the fat in the legs of Lambert and Bright. Dr. Short
+mentions a lady who died of corpulency in her twenty-fifth year
+weighing over 50 stone (700 pounds). Catesby speaks of a man who
+weighed 500 pounds, and Coe mentions another who weighed 584 pounds.
+Fabricius and Godart speak of obesity so excessive as to cause death.
+There is a case reported from the French of a person who weighed 800
+pounds. Smetius speaks of George Fredericus, an office-holder in
+Brandenburgh, who weighed 427 pounds.
+
+Dupuytren gives the history of Marie Francoise-Clay, who attained such
+celebrity for her obesity. She was born in poverty, reached puberty at
+thirteen, and married at twenty-five, at which age she was already the
+stoutest woman of her neighborhood notwithstanding her infirmity. She
+followed her husband, who was an old-clothes dealer, afoot from town to
+town. She bore six children, in whom nothing extraordinary was noticed.
+The last one was born when she was thirty-five years old. Neither the
+births, her travels, nor her poverty, which sometimes forced her to beg
+at church doors, arrested the progress of the obesity. At the age of
+forty she was 5 feet 1 inch high and one inch greater about the waist.
+Her head was small and her neck was entirely obliterated. Her breasts
+were over a yard in circumference and hung as low as the umbilicus. Her
+arms were elevated and kept from her body by the fat in her axillae.
+Her belly was enormous and was augmented by six pregnancies. Her thighs
+and haunches were in proportion to her general contour. At forty she
+ceased to menstruate and soon became afflicted with organic heart
+diseases.
+
+Fournier quotes an instance of a woman in Paris who at twenty-four, the
+time of her death, weighed 486 pounds. Not being able to mount any
+conveyance or carriage in the city, she walked from place to place,
+finding difficulty not in progression, but in keeping her equilibrium.
+Roger Byrne, who lived in Rosenalis, Queen's County, Ireland, died of
+excessive fatness at the age of fifty-four, weighing 52 stone. Percy
+and Laurent speak of a young German of twenty who weighed 450 pounds.
+At birth he weighed 13 pounds, at six months 42, and at four years 150
+pounds. He was 5 feet 5 inches tall and the same in circumference.
+William Campbell, the landlord of the Duke of Wellington in
+Newcastle-on-Tyne, was 6 feet 4 inches tall and weighed 728 pounds. He
+measured 96 inches around the shoulders, 85 inches around the waist,
+and 35 inches around the calf. He was born at Glasgow in 1856, and was
+not quite twenty-two when last measured.  To illustrate the rate of
+augmentation, he weighed 4 stone at nine months and at ten years 18
+stone. He was one of a family of seven children. His appetite was not
+more than the average, and he was moderate as regards the use of
+liquors, but a great smoker Notwithstanding his corpulency, he was
+intelligent and affable.
+
+Miss Conley, a member of an American traveling circus, who weighed 479
+pounds, was smothered in bed by rolling over on her face; she was
+unable to turn on her back without assistance.
+
+There was a girl who died at Plaisance near Paris in 1890 who weighed
+470 pounds or more. In 1889 an impresario undertook to exhibit her; but
+eight men could not move her from her room, and as she could not pass
+through the door the idea was abandoned.
+
+There was a colored woman who died near Baltimore who weighed 850
+pounds, exceeding the great Daniel Lambert by 120 pounds. The journal
+reporting this case quotes the Medical Record as saying that there was
+a man in North Carolina, who was born in 1798, who was 7 feet 8 inches
+tall and weighed over 1000 pounds, probably the largest man that ever
+lived. Hutchison says that he Saw in the Infirmary at Kensington, under
+Porter's care, a remarkable example of obesity. The woman was only just
+able to walk about and presented a close resemblance to Daniel Lambert.
+Obesity forced her to leave her occupation. The accumulation of fat on
+the abdomen, back, and thighs was enormous.
+
+According to a recent number of La Liberte, a young woman of
+Pennsylvania, although only sixteen years old, weighs 450 pounds.  Her
+waist measures 61 inches in circumference and her neck 22 inches. The
+same paper says that on one of the quays of Paris may be seen a
+wine-shop keeper with whom this Pennsylvania girl could not compare. It
+is said that this curiosity of the Notre-Dame quarter uses three large
+chairs while sitting behind her specially constructed bar. There is
+another Paris report of a man living in Switzerland who weighs more
+than 40 stone (560 pounds) and eats five times as much as an ordinary
+person. When traveling he finds the greatest difficulty in entering an
+ordinary railway carriage, and as a rule contents himself in the
+luggage van.  Figure 171 represents an extremely fat woman with a
+well-developed beard. To end this list of obese individuals, we mention
+an old gentleman living in San Francisco who, having previously been
+thin, gained 14 pounds in his seventieth year and 14 pounds each of
+seven succeeding years.
+
+Simulation of Obesity.--General dropsy, elephantiasis, lipomata,
+myxedema, and various other affections in which there is a hypertrophic
+change of the connective tissues may be mistaken for general obesity;
+on the other hand, a fatty, pendulous abdomen may simulate the
+appearances of pregnancy or even of ovarian cyst.
+
+Dercum of Philadelphia has described a variety of obesity which he has
+called "adiposis dolorosa," in which there is an enormous growth of
+fat, sometimes limited, sometimes spread all over the body, this
+condition differing from that of general lipomatosis in its rarity, in
+the mental symptoms, in the headache, and the generally painful
+condition complained of. In some of the cases examined by Dercum he
+found that the thyroid was indurated and infiltrated by calcareous
+deposits. The disease is not myxedema because there is no peculiar
+physiognomy, no spade-like hands nor infiltrated skin, no alteration of
+the speech, etc. Dercum considers it a connective-tissue dystrophy--a
+fatty metamorphosis of various stages, possibly a neuritis. The first
+of Dercum's cases was a widow of Irish birth, who died both alcoholic
+and syphilitic. When forty-eight or forty-nine her arms began to
+enlarge. In June, 1887, the enlargement affected the shoulders, arms,
+back, and sides of the chest. The parts affected were elastic, and
+there was no pitting. In some places the fat was lobulated, in others
+it appeared as though filled with bundles of worms. The skin was not
+thickened and the muscles were not involved. In the right arm there was
+unendurable pain to the touch, and this was present in a lesser degree
+in the left arm.  Cutaneous sensibility was lessened. On June 13th a
+chill was followed by herpes over the left arm and chest, and later on
+the back and on the front of the chest. The temperature was normal.
+The second case was a married Englishwoman of sixty-four. The enlarged
+tissue was very unevenly distributed, and sensibility was the same as
+in the previous case. At the woman's death she weighed 300 pounds, and
+the fat over the abdomen was three inches thick. The third case was a
+German woman in whom were seen soft, fat-like masses in various
+situations over either biceps, over the outer and posterior aspect of
+either arm, and two large masses over the belly; there was excessive
+prominence of the mons veneris. At the autopsy the heart weighed 8 1/2
+ounces, and the fat below the umbilicus was seven inches thick.
+
+Abnormal Leanness.--In contrast to the fat men are the so-called
+"living skeletons," or men who have attained notice by reason of
+absence of the normal adipose tissue. The semimythical poet Philotus
+was so thin that it was said that he fastened lead on his shoes to
+prevent his being blown away,--a condition the opposite of that of
+Dionysius of Heraclea, who, after choking to death from his fat, could
+hardly be moved to his grave.
+
+In March, 1754, there died in Glamorganshire of mere old age and
+gradual decay a little Welshman, Hopkin Hopkins, aged seventeen years.
+He had been recently exhibited in London as a natural curiosity; he had
+never weighed over 17 pounds, and for the last three years of his life
+never more than 12 pounds. His parents still had six children left, all
+of whom were normal and healthy except a girl of twelve, who only
+weighed 18 pounds and bore marks of old age.
+
+There was a "living skeleton" brought to England in 1825 by the name of
+Claude Seurat. He was born in 1798 and was in his twenty-seventh year.
+He usually ate in the course of a day a penny roll and drank a small
+quantity of wine. His skeleton was plainly visible, over which the skin
+was stretched tightly. The distance from the chest to the spine was
+less than 3 inches, and internally this distance was less. The
+pulsations of the heart were plainly visible. He was in good health and
+slept well. His voice was very weak and shrill. The circumference of
+this man's biceps was only 4 inches. The artist Cruikshank has made
+several drawings of Seurat.
+
+Calvin Edson was another living skeleton. In 1813 he was in the army at
+the battle of Plattsburg, and had lain down in the cold and become
+benumbed. At this time he weighed 125 pounds and was twenty-five years
+old. In 1830 he weighed but 60 pounds, though 5 feet 4 inches tall. He
+was in perfect health and could chop a cord of wood without fatigue; he
+was the father of four children.
+
+Salter speaks of a man in 1873 who was thirty-two years of age and only
+weighed 49 pounds. He was 4 feet 6 inches tall: his forehead measured
+in circumference 20 1/2 inches and his chest 27 inches. His genitals,
+both internal and external, were defectively developed. Figure 175
+represents the well-known Ohio "living skeleton," J. W. Coffey, who has
+been exhibited all over the Continent. His good health and appetite
+were proverbial among his acquaintances.
+
+In some instances the so-called "living skeletons" are merely cases of
+extreme muscular atrophy. As a prominent example of this class the
+exhibitionist, Rosa Lee Plemons at the age of eighteen weighed only 27
+pounds. Figure 177 shows another case of extraordinary atrophic
+condition of all the tissues of the body associated with
+nondevelopment. These persons are always sickly and exhibit all the
+symptoms of progressive muscular atrophy, and cannot therefore be
+classed with the true examples of thinness, in which the health is but
+slightly affected or possibly perfect health is enjoyed.
+
+
+
+CHAPTER VIII.
+
+LONGEVITY.
+
+Scope of the Present Article.--The limits of space in this work render
+impossible a scientific discussion upon the most interesting subject of
+longevity, and the reader is referred to some of the modern works
+devoted exclusively to this subject. In reviewing the examples of
+extreme age found in the human race it will be our object to lay before
+the reader the most remarkable instances of longevity that have been
+authentically recorded, to cite the source of the information, when
+possible to give explanatory details, and to report any relative points
+of value and interest. Throughout the article occasional facts will be
+given to show in what degree character, habit, and temperament
+influence longevity, and in what state of mind and body and under what
+circumstances man has obtained the highest age.
+
+General Opinions.--There have been many learned authorities who
+invariably discredit all accounts of extraordinary age, and contend
+that there has never been an instance of a man living beyond the
+century mark whose age has been substantiated by satisfactory proof.
+Such extremists as Sir G. Cornewall Lewis and Thoms contend that since
+the Christian era no person of royal or noble line mentioned in history
+whose birth was authentically recorded at its occurrence has reached
+one hundred years. They have taken the worst station in life in which
+to find longevity as their field of observation. Longevity is always
+most common in the middle and lower classes, in which we cannot expect
+to find the records preserved with historical correctness.
+
+The Testimony of Statistics.--Walford in his wonderful "Encyclopedia of
+Insurance" says that in England the "Royal Exchange" for a period of
+one hundred and thirty-five years had insured no life which survived
+ninety-six. The "London Assurance" for the same period had no clients
+who lived over ninety, and the "Equitable" had only one at ninety-six.
+In an English Tontine there was in 1693 a person who died at one
+hundred; and in Perth there lived a nominee at one hundred and
+twenty-two and another at one hundred and seven. On the other hand, a
+writer in the Strand Magazine points out that an insurance investigator
+some years ago gathered a list of 225 centenarians of almost every
+social rank and many nationalities, but the majority of them Britons or
+Russians.
+
+In reviewing Walford's statistics we must remember that it has only
+been in recent years that the middle and lower classes of people have
+taken insurance on their lives. Formerly only the wealthy and those
+exposed to early demise were in the habit of insuring.
+
+Dr. Ogle of the English Registrar-General's Department gives tables of
+expectancy that show that 82 males and 225 females out of 1,000,000 are
+alive at one hundred years. The figures are based on the death-rates of
+the years 1871-80.
+
+The researches of Hardy in the thirteenth, fourteenth, fifteenth, and
+sixteenth centuries are said to indicate that three-score-and-ten was
+considered old age; yet many old tombstones and monuments contain
+inscriptions recording age far beyond this, and even the pages of
+ordinary biographies disprove the alleged results of Hardy's research.
+
+In all statistical work of an individual type the histories of the
+lower classes are almost excluded; in the olden times only the lives
+and movements of the most prominent are thought worthy of record. The
+reliable parish register is too often monopolized by the gentry,
+inferior births not being thought worth recording.
+
+Many eminent scientists say that the natural term of the life of an
+animal is five times the period needed for its development.  Taking
+twenty-one as the time of maturity in man, the natural term of human
+life would be one hundred and five. Sir Richard Owen fixes it at one
+hundred and three and a few months.
+
+Censuses of Centenarians.--Dr. Farr, the celebrated English
+Registrar-General, is credited with saying that out of every 1,000,000
+people in England only 223 live to be one hundred years old, making an
+average of one to 4484. French says that during a period of ten years,
+from 1881 to 1890, in Massachusetts, there were 203 deaths of persons
+past the age of one hundred, making an average, with a population of
+394,484, of one in 1928. Of French's centenarians 165 were between one
+hundred and one hundred and five; 35 were between one hundred and five
+and one hundred and ten; five were between one hundred and ten and one
+hundred and fifteen; and one was one hundred and eighteen. Of the 203,
+153 were females and 50 males. There are 508 people in Iowa who are
+more than ninety years of age. There are 21 who are more than one
+hundred years old. One person is one hundred and fifteen years old, two
+are one hundred and fourteen, and the remaining 18 are from one hundred
+to one hundred and seven.
+
+In the British Medical Journal for 1886 there is an account of a report
+of centenarians. Fifty-two cases were analyzed. One who doubts the
+possibility of a man reaching one hundred would find this report of
+interest.
+
+The Paris correspondent to the London Telegraph is accredited with the
+following:--
+
+"A census of centenarians has been taken in France, and the results,
+which have been published, show that there are now alive in this
+country 213 persons who are over one hundred years old.  Of these 147
+are women, the alleged stronger sex being thus only able to show 66
+specimens who are managing to still "husband out life's taper" after
+the lapse of a century. The preponderance of centenarians of the
+supposed weaker sex has led to the revival of some amusing theories
+tending to explain this phenomenon. One cause of the longevity of women
+is stated to be, for instance, their propensity to talk much and to
+gossip, perpetual prattle being highly conducive, it is said, to the
+active circulation of the blood, while the body remains unfatigued and
+undamaged. More serious theorists or statisticians, while commenting on
+the subject of the relative longevity of the sexes, attribute the
+supremacy of woman in the matter to the well-known cause, namely, that
+in general she leads a more calm and unimpassioned existence than a
+man, whose life is so often one of toil, trouble, and excitement.
+Setting aside these theories, however, the census of French
+centenarians is not devoid of interest in some of its details. At
+Rocroi an old soldier who fought under the First Napoleon in Russia
+passed the century limit last year. A wearer of the St. Helena medal--a
+distinction awarded to survivors of the Napoleonic campaigns, and who
+lives at Grand Fayt, also in the Nord--is one hundred and three years
+old, and has been for the last sixty-eight years a sort of rural
+policeman in his native commune. It is a rather remarkable fact in
+connection with the examples of longevity cited that in almost every
+instance the centenarian is a person in the humblest rank of life.
+According to the compilers of these records, France can claim the honor
+of having possessed the oldest woman of modern times. This venerable
+dame, having attained one hundred and fifty years, died peacefully in a
+hamlet in the Haute Garonne, where she had spent her prolonged
+existence, subsisting during the closing decade of her life on goat's
+milk and cheese. The woman preserved all her mental faculties to the
+last, but her body became attenuated to an extraordinary degree, and
+her skin was like parchment."
+
+In the last ten years the St. James' Gazette has kept track of 378
+centenarians, of whom 143 were men and 235 were women. A writer to the
+Strand Magazine tells of 14 centenarians living in Great Britain within
+the last half-dozen years.
+
+It may be interesting to review the statistics of Haller, who has
+collected the greatest number of instances of extreme longevity.  He
+found:--
+
+ 1000 persons who lived from 100 to 110
+   15 persons who lived from 130 to 140
+   60   "      "    "    "   110 to 120
+    6   "      "    "    "   140 to 150
+   29   "      "    "    "   120 to 130
+    1 person   "    "    "       to 169
+
+Effect of Class-Influences, Occupation, etc.--Unfortunately for the
+sake of authenticity, all the instances of extreme age in this country
+have been from persons in the lower walks of life or from obscure parts
+of the country, where little else than hearsay could be procured to
+verify them. It must also be said that it is only among people of this
+class that we can expect to find parallels of the instances of extreme
+longevity of former times.  The inhabitants of the higher stations of
+life, the population of thickly settled communities, are living in an
+age and under conditions almost incompatible with longevity. In fact,
+the strain of nervous energy made necessary by the changed conditions
+of business and mode of living really predisposes to premature decay.
+
+Those who object to the reliability of reports of postcentenarianism
+seem to lose sight of these facts, and because absolute proof and
+parallel cannot be obtained they deny the possibility without giving
+the subject full thought and reason.  As tending to substantiate the
+multitude of instances are the opinions of such authorities as
+Hufeland, Buffon, Haller, and Flourens. Walter Savage Landor on being
+told that a man in Russia was living at one hundred and thirty-two
+replied that he was possibly older, as people when they get on in years
+are prone to remain silent as to the number of their years--a statement
+that can hardly be denied. One of the strongest disbelievers in extreme
+age almost disproved in his own life the statement that there were no
+centenarians.
+
+It is commonly believed that in the earliest periods of the world's
+history the lives of the inhabitants were more youthful and perfect;
+that these primitive men had gigantic size, incredible strength, and
+most astonishing duration of life. It is to this tendency that we are
+indebted for the origin of many romantic tales. Some have not hesitated
+to ascribe to our forefather Adam the height of 900 yards and the age
+of almost a thousand years; but according to Hufeland acute theologians
+have shown that the chronology of the early ages was not the same as
+that used in the present day. According to this same authority Hensler
+has proved that the year at the time of Abraham consisted of but three
+months, that it was afterward extended to eight, and finally in the
+time of Joseph to twelve. Certain Eastern nations, it is said, still
+reckon but three months to the year; this substantiates the opinion of
+Hensler, and, as Hufeland says, it would be inexplicable why the life
+of man should be shortened nearly one-half immediately after the flood.
+
+Accepting these conclusions as correct, the highest recorded age, that
+of Methuselah, nine hundred years, will be reduced to about two
+hundred, an age that can hardly be called impossible in the face of
+such an abundance of reports, to which some men of comparatively modern
+times have approached, and which such substantial authorities as
+Buffon, Hufeland, and Flourens believed possible.
+
+Alchemy and the "Elixir of Life."--The desire for long life and the
+acquisition of wealth have indirectly been the stimulus to medical and
+physical investigation, eventually evolving science as we have it now.
+The fundamental principles of nearly every branch of modern science
+were the gradual metamorphoses of the investigations of the old
+searchers after the "philosopher's stone" and "elixir of life." The
+long hours of study and experiment in the chase for this
+will-o'-the-wisp were of vast benefit to the coming generations; and to
+these deluded philosophers of the Middle Ages, and even of ancient
+times, we are doubtless indebted for much in this age of advancement.
+
+With a credulous people to work upon, many of the claimants of the
+discovery of the coveted secret of eternal life must be held as rank
+impostors claiming ridiculous ages for themselves. In the twelfth
+century Artephius claimed that by the means of his discovery he had
+attained one thousand and twenty-five years.  Shortly after him came
+Alan de Lisle of Flanders with a reputed fabulous age. In 1244 Albertus
+Magnus announced himself as the discoverer. In 1655 the celebrated
+Doctor Dee appeared on the scene and had victims by the score. Then
+came the Rosicrucians.  Count Saint-Germain claimed the secret of the
+"philosopher's stone" and declared to the Court of Louis XV that he was
+two thousand years old, and a precursor of the mythical "Wandering
+Jew," who has been immortalized in prose and rhyme and in whose
+existence a great mass of the people recently believed. The last of the
+charlatans who claimed possession of the secret of perpetual life was
+Joseph Balsamo, who called himself "Count of Cagliostro." He was born
+in Italy in 1743 and acquired a world-wide reputation for his alleged
+occult powers and acquisition of the "philosopher's stone." He died in
+1795, and since then no one has generally inspired the superstitious
+with credence in this well-worn myth. The ill-fated Ponce de Leon when
+he discovered Florida, in spite of his superior education, announced
+his firm belief in the land of the "Fountain of Perpetual Youth," in
+the pursuit of which he had risked his fortune and life.
+
+We wish to emphasize that we by no means assume the responsibility of
+the authenticity of the cases to be quoted, but expressing belief in
+their possibility, we shall mention some of the extraordinary instances
+of longevity derived from an exhaustive research of the literature of
+all times. This venerable gallery of Nestors will include those of all
+periods and nations, but as the modern references are more available
+greater attention will be given to them.
+
+Turning first to the history of the earlier nations, we deduce from
+Jewish history that Abraham lived to one hundred and seventy-five;
+Isaac, likewise a tranquil, peaceful man, to one hundred and eighty;
+Jacob, who was crafty and cunning, to one hundred and forty-seven;
+Ishmael, a warrior, to one hundred and thirty-seven; and Joseph, to one
+hundred and ten. Moses, a man of extraordinary vigor, which, however,
+he exposed to great cares and fatigues, attained the advanced age of
+one hundred and twenty; and the warlike and ever-active Joshua lived to
+one hundred and ten. Lejoucourt gives the following striking parallels:
+John Glower lived to one hundred and seventy-two, and Abraham to one
+hundred and seventy-five; Susan, the wife of Gower, lived to one
+hundred and sixty-four, and Sarah, the wife of Abraham, to one hundred
+and twenty-seven. The eldest son of the Gower couple was one hundred
+and fifteen when last seen, and Isaac, the son of Abraham and Sarah,
+lived to one hundred and eighty.
+
+However replete with fables may be the history of the Kings of Egypt,
+none attained a remarkable age, and the record of the common people is
+incomplete or unavailable.
+
+If we judge from the accounts of Lucian we must form a high idea of the
+great age of the Seres, or ancient Chinese. Lucian ascribes this
+longevity to their habit of drinking excessive quantities of water.
+
+Among the Greeks we find several instances of great age in men of
+prominence. Hippocrates divided life into seven periods, living himself
+beyond the century mark. Aristotle made three divisions,--the growing
+period, the stationary period, and the period of decline. Solon made
+ten divisions of life, and Varro made five. Ovid ingeniously compares
+life to the four seasons.  Epimenides of Crete is said to have lived
+one hundred and fifty-seven years, the last fifty-seven of which he
+slept in a cavern at night. Gorgias, a teacher, lived to one hundred
+and eight; Democritus, a naturalist, attained one hundred and nine;
+Zeno, the founder of the Stoics, lived to one hundred; and Diogenes,
+the frugal and slovenly, reached ninety years. Despite his life of
+exposure, Hippocrates lived to one hundred and nine; and Galen, the
+prince of physicians after him, who was naturally of a feeble
+constitution, lived past eighty, and few of the followers of his system
+of medicine, which stood for thirteen centuries, surpassed him in point
+of age.
+
+Among the Romans, Orbilis, Corvinus, Fabius, and Cato, the enemy of the
+physicians, approximated the century mark.
+
+A valuable collection relative to the duration of life in the time of
+the Emperor Vespasian has been preserved for us by Pliny from the
+records of a census, a perfectly reliable and creditable source. In 76
+A. D. there were living in that part of Italy which lies between the
+Apennines and the Po 124 persons who had attained the age of one
+hundred and upward. There were 54 of one hundred; 57 of one hundred and
+ten; 2 of one hundred and twenty-five; 4 of one hundred and thirty; 4
+of from one hundred and thirty-five to one hundred and thirty-seven,
+and 3 of one hundred and forty. In Placentia there was a man of one
+hundred and thirty and at Faventia a woman of one hundred and
+thirty-two.  According to Hufeland, the bills of mortality of Ulpian
+agree in the most striking manner with those of our great modern cities.
+
+Among hermits and ecclesiastics, as would be the natural inference from
+their regular lives, many instances of longevity are recorded. John was
+supposed to be ninety-three; Paul the hermit was one hundred and
+thirteen; Saint Anthony lived to one hundred and five; James the hermit
+to one hundred and four; Saint Epithanius lived to one hundred and
+fifteen; Simeon Stylites to one hundred and twelve; Saint Mungo was
+accredited with one hundred and eighty-five years (Spottiswood), and
+Saint David attained one hundred and forty-six. Saint Polycarpe
+suffered martyrdom at over one hundred, and Simon Cleophas was Bishop
+of Jerusalem at one hundred and twenty.
+
+Brahmin priests of India are known to attain incredible age, and one of
+the secrets of the adepts of the Buddhist faith is doubtless the
+knowledge of the best means of attaining very old age. Unless cut off
+by violence or accident the priests invariably become venerable
+patriarchs.
+
+Influence of Mental Culture.--Men of thought have at all times been
+distinguished for their age. Among the venerable sages are Appolonius
+of Tyana, a follower of Pythagoras, who lived to over one hundred;
+Xenophilus, also a Pythagorean, was one hundred and six; Demonax, a
+Stoic, lived past one hundred; Isocrates was ninety-eight, and Solon,
+Sophocles, Pindar, Anacreon, and Xenophon were octogenarians.
+
+In more modern times we find men of science and literature who have
+attained advanced age. Kant, Buffon, Goethe, Fontenelle, and Newton
+were all over eighty. Michael Angelo and Titian lived to eighty-nine
+and ninety-nine respectively. Harvey, the discoverer of the
+circulation; Hans Sloane, the celebrated president of the Royal Society
+in London; Plater, the Swiss physician; Duverney, the anatomist, as
+well as his confrere, Tenon, lived to be octogenarians. Many men have
+displayed activity when past four score. Brougham at eighty-two and
+Lyndhurst at eighty-eight could pour forth words of eloquence and
+sagacity for hours at a time.  Landor wrote his "Imaginary
+Conversations" when eighty-five, and Somerville his "Molecular Science"
+at eighty-eight; Isaac Walton was active with his pen at ninety;
+Hahnemann married at eighty and was working at ninety-one.
+
+J. B. Bailey has published a biography of "Modern Methusalehs," which
+includes histories of the lives of Cornaro, Titian, Pletho, Herschell,
+Montefiore, Routh, and others. Chevreul, the centenarian chemist, has
+only lately died. Gladstone, Bismarck, and von Moltke exemplify vigor
+in age In the Senate of the United States, Senators Edmunds, Sherman,
+Hoar, Morrill, and other elderly statesmen display as much vigor as
+their youthful colleagues. Instances of vigor in age could be cited in
+every profession and these few examples are only mentioned as typical.
+At a recent meeting of the Society of English Naturalists, Lord Kelvin
+announced that during the last year 26 members had died at an average
+age of seventy-six and a half years; one reached the age of ninety-nine
+years, another ninety-seven, a third ninety-five, etc.
+
+In commenting on the perfect compatibility of activity with longevity,
+the National Popular Review says:--
+
+"Great men usually carry their full mental vigor and activity into old
+age. M. Chevreul, M. De Lesseps, Gladstone, and Bismarck are evidences
+of this anthropologic fact. Pius IX, although living in tempestuous
+times, reached a great age in full possession of all his faculties, and
+the dramatist Crebillon composed his last dramatic piece at
+ninety-four, while Michael Angelo was still painting his great canvases
+at ninety-eight, and Titian at ninety still worked with all the vigor
+of his earlier years. The Austrian General Melas was still in the
+saddle and active at eighty-nine, and would have probably won Marengo
+but for the inopportune arrival of Desaix. The Venetian Doge Henry
+Dandolo, born at the beginning of the eleventh century, who lost his
+eyesight when a young man, was nevertheless subsequently raised to the
+highest office in the republic, managed successfully to conduct various
+wars, and at the advanced age of eighty-three, in alliance with the
+French, besieged and captured Constantinople. Fontenelle was as
+gay-spirited at ninety-eight as in his fortieth year, and the
+philosopher Newton worked away at his tasks at the age of eighty-three
+with the same ardor that animated his middle age. Cornaro was as happy
+at ninety as at fifty, and in far better health at the age of
+ninety-five than he had enjoyed at thirty.
+
+"These cases all tend to show the value and benefits to be derived from
+an actively cultivated brain in making a long life one of comfort and
+of usefulness to its owner. The brain and spirits need never grow old,
+even if our bodies will insist on getting rickety and in falling by the
+wayside. But an abstemious life will drag even the old body along to
+centenarian limits in a tolerable state of preservation and usefulness.
+The foregoing list can be lengthened out with an indefinite number of
+names, but it is sufficiently long to show what good spirits and an
+active brain will do to lighten up the weight of old age. When we
+contemplate the Doge Dandolo at eighty-three animating his troops from
+the deck of his galley, and the brave old blind King of Bohemia falling
+in the thickest of the fray at Crecy, it would seem as it there was no
+excuse for either physical, mental, or moral decrepitude short of the
+age of four score and ten."
+
+Emperors and Kings, in short, the great ones of the earth, pay the
+penalty of their power by associate worriment and care. In ancient
+history we can only find a few rulers who attained four score, and this
+is equally the case in modern times. In the whole catalogue of the
+Roman and German Emperors, reckoning from Augustus to William I, only
+six have attained eighty years.  Gordian, Valerian, Anastasius, and
+Justinian were octogenarians, Tiberius was eighty-eight at his death,
+and Augustus Caesar was eighty-six. Frederick the Great, in spite of
+his turbulent life, attained a rare age for a king, seventy-six.
+William I seems to be the only other exception.
+
+Of 300 Popes who may be counted, no more than five attained the age of
+eighty. Their mode of life, though conducive to longevity in the minor
+offices of the Church, seems to be overbalanced by the cares of the
+Pontificate.
+
+Personal Habits.--According to Hufeland and other authorities on
+longevity, sobriety, regular habits, labor in the open air, exercise
+short of fatigue, calmness of mind, moderate intellectual power, and a
+family life are among the chief aids to longevity. For this reason we
+find the extraordinary instances of longevity among those people who
+amidst bodily labor and in the open air lead a simple life, agreeable
+to nature. Such are farmers, gardeners, hunters, soldiers, and sailors.
+In these situations man may still maintain the age of one hundred and
+fifty or even one hundred and sixty.
+
+Possibly the most celebrated case of longevity on record is that of
+Henry Jenkins. This remarkable old man was born in Yorkshire in 1501
+and died in 1670, aged one hundred and sixty-nine. He remembered the
+battle of Flodden Field in 1513, at which time he was twelve years old.
+It was proved from the registers of the Chancery and other courts that
+he had appeared in evidence one hundred and forty years before his
+death and had had an oath administered to him. In the office of the
+King's Remembrancer is a record of a deposition in which he appears as
+a witness at one hundred and fifty-seven. When above one hundred he was
+able to swim a rapid stream.
+
+Thomas Parr (or Parre), among Englishmen known as "old Parr," was a
+poor farmer's servant, born in 1483. He remained single until eighty.
+His first wife lived thirty-two years, and eight years after her death,
+at the age of one hundred and twenty, he married again. Until his one
+hundred and thirtieth year he performed his ordinary duties, and at
+this age was even accustomed to thresh.  He was visited by Thomas, Earl
+of Arundel and Surrey, and was persuaded to visit the King in London.
+His intelligence and venerable demeanor impressed every one, and crowds
+thronged to see him and pay him homage. The journey to London, together
+with the excitement and change of mode of living, undoubtedly hastened
+his death, which occurred in less than a year. He was one hundred and
+fifty-two years and nine months old, and had lived under nine Kings of
+England. Harvey examined his body and at the necropsy his internal
+organs were found in a most perfect state. His cartilages were not even
+ossified, as is the case generally with the very aged. The slightest
+cause of death could not be discovered, and the general impression was
+that he died from being over-fed and too-well treated in London. His
+great-grandson was said to have died in this century in Cork at the age
+of one hundred and three. Parr is celebrated by a monument reared to
+his memory in Westminster Abbey.
+
+The author of the Dutch dictionary entitled "Het algemen historish
+Vanderbok" says that there was a peasant in Hungary named Jean Korin
+who was one hundred and seventy-two and his wife was one hundred and
+sixty-four; they had lived together one hundred and forty-eight years,
+and had a son at the time of their death who was one hundred and
+sixteen.
+
+Setrasch Czarten, or, as he is called by Baily, Petratsh Zartan, was
+also born in Hungary at a village four miles from Teneswaer in 1537. He
+lived for one hundred and eighty years in one village and died at the
+age of one hundred and eighty-seven, or, as another authority has it,
+one hundred and eighty-five. A few days before his death he had walked
+a mile to wait at the post-office for the arrival of travelers and to
+ask for succor, which, on account of his remarkable age, was rarely
+refused him. He had lost nearly all his teeth and his beard and hair
+were white. He was accustomed to eat a little cake the Hungarians call
+kalatschen, with which he drank milk. After each repast he took a glass
+of eau-de-vie. His son was living at ninety-seven and his descendants
+to the fifth generation embellished his old age.  Shortly before his
+death Count Wallis had his portrait painted.  Comparing his age with
+that of others, we find that he was five years older than the Patriarch
+Isaac, ten more than Abraham, thirty-seven more than Nahor, sixteen
+more than Henry Jenkins, and thirty-three more than "old Parr."
+
+Sundry Instances of Great Age.--In a churchyard near Cardiff,
+Glamorganshire, is the following inscription: "Here lieth the body of
+William Edwards, of Cacreg, who departed this life 24th February, Anno
+Domini 1668, anno aetatis suae one hundred and sixty-eight."
+
+Jonas Warren of Balydole died in 1787 aged one hundred and sixty-seven.
+He was called the "father of the fishermen" in his vicinity, as he had
+followed the trade for ninety-five years.
+
+The Journal de Madrid, 1775, contains the account of a South American
+negress living in Spanish possessions who was one hundred and
+seventy-four years of age. The description is written by a witness, who
+declares that she told of events which confirmed her age. This is
+possibly the oft-quoted case that was described in the London
+Chronicle, October 5, 1780, Louisa Truxo, who died in South America at
+the age of one hundred and seventy-five.
+
+Huteland speaks of Joseph Surrington, who died near Bergen, Norway, at
+the age of one hundred and sixty. Marvelous to relate, he had one
+living son of one hundred and three and another of nine. There has been
+recently reported from Vera Cruz, Mexico, in the town of Teluca, where
+the registers are carefully and efficiently kept, the death of a man
+one hundred and ninety-two years old--almost a modern version of
+Methuselah. Buffon describes a man who lived to be one hundred and
+sixty-five.  Martin mentions a man of one hundred and eighty. There was
+a Polish peasant who reached one hundred and fifty-seven and had
+constantly labored up to his one hundred and forty-fifth year, always
+clad lightly, even in cold weather. Voigt admits the extreme age of one
+hundred and sixty.
+
+There was a woman living in Moscow in 1848 who was said to be one
+hundred and sixty-eight; she had been married five times and was one
+hundred and twenty-one at her last wedding. D'Azara records the age of
+one hundred and eighty, and Roequefort speaks of two cases at one
+hundred and fifty.
+
+There are stories of an Englishman who lived in the sixteenth century
+to be two hundred and seven, and there is a parallel case cited.
+
+Van Owen tabulates 331 cases of deaths between 110 and 120, 91 between
+120 and 130, 37 between 130 and 140, 11 at 150, and 17 beyond this age.
+While not vouching for the authenticity in each case, he has always
+given the sources of information.
+
+Quite celebrated in English history by Raleigh and Bacon was the
+venerable Countess Desmond, who appeared at Court in 1614, being one
+hundred and forty years old and in full possession of all her powers,
+mental and physical. There are several portraits of her at this
+advanced age still to be seen. Lord Bacon also mentions a man named
+Marcus Appenius, living in Rimini, who was registered by a Vespasian
+tax-collector as being one hundred and fifty.
+
+There are records of Russians who have lived to one hundred and
+twenty-five, one hundred and thirty, one hundred and thirty-five, one
+hundred and forty-five, and one hundred and fifty. Nemnich speaks of
+Thomas Newman living in Bridlington at one hundred and fifty-three
+years. Nemnich is confirmed in his account of Thomas Newman by his
+tombstone in Yorkshire, dated 1542.
+
+In the chancel of the Honington Church, Wiltshire, is a black marble
+monument to the memory of G. Stanley, gent., who died in 1719, aged one
+hundred and fifty-one.
+
+There was a Dane named Draakenburg, born in 1623, who until his
+ninety-first year served as a seaman in the royal navy, and had spent
+fifteen years of his life in Turkey as a slave in the greatest misery.
+He was married at one hundred and ten to a woman of sixty, but outlived
+her a long time, in his one hundred and thirtieth year he again fell in
+love with a young country girl, who, as may well be supposed, rejected
+him. He died in 1772 in his one hundred and forty-sixth year. Jean
+Effingham died in Cornwall in 1757 in his one hundred and forty-fourth
+year. He was born in the reign of James I and was a soldier at the
+battle of Hochstadt; he never drank strong liquors and rarely ate meat;
+eight days before his death he walked three miles.
+
+Bridget Devine, the well-known inhabitant of Olean Street, Manchester
+died at the age of one hundred and forty-seven in 1845. On the register
+of the Cheshire Parish is a record of the death of Thomas Hough of
+Frodsam in 1591 at the age of one hundred and forty-one.
+
+Peter Garden of Auchterless died in 1775 at the age of one hundred and
+thirty-one. He had seen and talked with Henry Jenkins about the battle
+of Flodden Field, at which the latter was present when a boy of twelve.
+It seems almost incredible that a man could say that he had heard the
+story of an event which had happened two hundred and sixty-three years
+before related by the lips of an eye-witness to that event;
+nevertheless, in this case it was true. A remarkable instance of
+longevity in one family has recently been published in the St. Thomas's
+Hospital Gazette.  Mrs. B., born in 1630 (five years after the
+accession of Charles I), died March 13, 1732. She was tended in her
+last illness by her great-granddaughter, Miss Jane C., born 1718, died
+1807, and Miss Sarah C., born 1725, died 1811. A great-niece of one of
+these two ladies, Mrs. W., who remembers one of them, was born in 1803,
+and is at the present time alive and well. It will be seen from the
+above facts that there are three lives only to bridge over the long
+period between 1630 and 1896, and that there is at present living a
+lady who personally knew Miss C., who had nursed a relative born in
+1630. The last lady of this remarkable trio is hale and hearty, and has
+just successfully undergone an operation for cataract. Similar to the
+case of the centenarian who had seen Henry Jenkins was that of James
+Horrocks, who was born in 1744 and died in 1844. His father was born in
+1657, one year before the death of the Protector, and had issue in
+early life. He married again at eighty-four to a woman of twenty-six,
+of which marriage James was the offspring in 1744. In 1844 this man
+could with verity say that he had a brother born during the reign of
+Charles II, and that his father was a citizen of the Commonwealth.
+
+Among the Mission Indians of Southern California there are reported
+instances of longevity ranging from one hundred and twenty to one
+hundred and forty. Lieutenant Gibbons found in a village in Peru one
+hundred inhabitants who were past the century mark, and another
+credible explorer in the same territory records a case of longevity of
+one hundred and forty. This man was very temperate and always ate his
+food cold, partaking of meat only in the middle of the day. In the year
+of 1840 in the town of Banos, Ecuador, died "Old Morales," a carpenter,
+vigorous to his last days. He was an elderly man and steward of the
+Jesuits when they were expelled from their property near this location
+in 1767. In the year 1838 there was a witness in a judicial trial in
+South America who was born on the night of the great earthquake which
+destroyed the town of Ambato in 1698. How much longer this man who was
+cradled by an earthquake lived is not as yet reported. In the State of
+Vera Cruz, Mexico, as late as 1893 a man died at the age of one hundred
+and thirty-seven. The census of 1864 for the town of Pilaguin, Ecuador,
+lying 11,000 feet above the level of the sea and consisting of about
+2000 inhabitants, gives 100 above seventy, 30 above ninety, five above
+one hundred, and one at one hundred and fifteen years.
+
+Francis Auge died in Maryland in 1767 at the age of one hundred and
+thirty-four. He remembered the execution of Charles I and had a son
+born to him after he was one hundred.
+
+There are several other instances in which men have displayed
+generative ability in old age. John Gilley, who died in Augusta, Maine,
+in 1813, was born in Ireland in 1690. He came to this country at the
+age of sixty, and continued in single blessedness until seventy-five,
+when he married a girl of eighteen, by whom he had eight children. His
+wife survived him and stated that he was virile until his one hundred
+and twentieth year. Baron Baravicino de Capelis died at Meran in 1770
+at the age of one hundred and four, being the oldest man in Tyrol. His
+usual food was eggs, and he rarely tasted meat. He habitually drank tea
+and a well-sweetened cordial of his own recipe. He was married four
+times during his life, taking his fourth wife when he was eighty-four.
+By her he had seven children and at his death she was pregnant with the
+eighth child.
+
+Pliny mentions cases of men begetting sons when past the age of eighty
+and Plot speaks of John Best of the parish of Horton, who when one
+hundred and four married a woman of fifty-six and begat a son. There
+are also records of a man in Stockholm of one hundred who had several
+children by a wife of thirty.
+
+On August 7, 1776, Mary, the wife of Joseph Yates, at Lizard Common not
+far from London, was buried at the age of one hundred and twenty-seven.
+She had walked to London in 1666, and was hearty and strong at one
+hundred and twenty, and had married a third husband at ninety-two.
+
+A case without parallel, of long survival of a deaf mute, is found in
+Mrs. Gray of Northfleet, Kent, who died in 1770, one hundred and
+twenty-one years old. She was noted for her cheerful disposition, and
+apparently enjoyed life in spite of her infirmity, which lasted one
+hundred and twenty-one years.
+
+Macklin the actor was born in 1697 and died in 1797. Several years
+before his death he played "Shylock," displaying great vigor in the
+first act, but in the second his memory failed him, and with much grace
+and solemnity he advanced to the foot-lights and apologized for his
+inability to continue. It is worthy of remark that several instances of
+longevity in Roman actresses have been recorded. One Luceja, who came
+on the stage very young, performed a whole century, and even made her
+public appearance in her one hundred and twelfth year. Copiola was said
+to have danced before Augustus when past ninety.
+
+Influence of Stimulants, etc.--There have been men who have attributed
+their long lives to their excesses in stimulants.  Thomas Wishart of
+Annandale, Dumfries, died in 1760 at one hundred and twenty-four. He
+had chewed tobacco one hundred and seventeen years, contracting the
+habit when a child; his father gave it to him to allay hunger while
+shepherding in the mountains. John de la Somet of Virginia died in 1766
+aged one hundred and thirty. He was a great smoker, and according to
+Eaton the habit agreed with his constitution, and was not improbably
+the cause of his long health and longevity. William Riddell, who died
+at one hundred and sixteen carefully avoided water all his life and had
+a love for brandy.
+
+Possession of Faculties.--Eglebert Hoff was a lad driving a team in
+Norway when the news was brought that Charles I was beheaded.  He died
+in Fishkill, N.Y., in 1764 at the age of one hundred and twenty-eight.
+He never used spectacles, read fluently, and his memory and senses were
+retained until his death, which was due to an accident. Nicolas
+Petours, curate of the parish of Baleene and afterward canon of the
+Cathedral of Constance, died at the age of one hundred and
+thirty-seven; he was always a healthy, vigorous man, and celebrated
+mass five days before his death. Mr. Evans of Spital Street,
+Spitalfields, London, died in 1780 aged one hundred and thirty-nine,
+having full possession of his mental faculties. Of interest to
+Americans is the case of David Kinnison, who, when one hundred and
+eleven, related to Lossing the historian the tale of the Boston Tea
+Party, of which he had been a member. He died in good mental condition
+at the age of one hundred and fifteen. Anthony Senish, a farmer of the
+village of Limoges, died in 1770 in his one hundred and eleventh year.
+He labored until two weeks before his death, had still his hair, and
+his sight had not failed him. His usual food was chestnuts and Turkish
+corn; he had never been bled or used any medicine. Not very long ago
+there was alive in Tacony, near Philadelphia, a shoemaker named R. Glen
+in his one hundred and fourteenth year.  He had seen King William III,
+and all his faculties were perfectly retained; he enjoyed good health,
+walking weekly to Philadelphia to church. His third wife was but thirty
+years old.
+
+Longevity in Ireland.--Lord Bacon said that at one time there was not a
+village in all Ireland in which there was not a man living upward of
+eighty. In Dunsford, a small village, there were living at one time 80
+persons above the age of four score. Colonel Thomas Winslow was
+supposed to have died in Ireland on August 26, 1766, aged one hundred
+and forty-six. There was a man by the name of Butler who died at
+Kilkenny in 1769 aged one hundred and thirty-three. He rode after the
+hounds while yet a centenarian.  Mrs. Eckelston, a widow in
+Phillipstown, Kings County, Ireland, died in 1690 at one hundred and
+forty-three.
+
+There are a number of instances in which there is extraordinary
+renovation of the senses or even of the body in old age,--a new period
+of life, as it were, is begun. A remarkable instance is an old
+magistrate known to Hufeland, who lived at Rechingen and who died in
+1791 aged one hundred and twenty. In 1787, long after he had lost all
+his teeth, eight new ones appeared, and at the end of six months they
+again dropped out, but their place was supplied by other new ones, and
+Nature, unwearied, continued this process until his death. All these
+teeth he had acquired and lost without pain, the whole number amounting
+to 150. Alice, a slave born in Philadelphia, and living in 1802 at the
+age of one hundred and sixteen, remembered William Penn and Thomas
+Story.  Her faculties were well preserved, but she partially lost her
+eyesight at ninety-six, which, strange to say, returned in part at one
+hundred and two. There was a woman by the name of Helen Gray who died
+in her one hundred and fifth year, and who but a few years before her
+death had acquired a new set of teeth.
+
+In Wilson's "Healthy Skin" are mentioned several instances of very old
+persons in whom the natural color of the hair returned after they had
+been gray for years. One of them was John Weeks, whose hair became
+brown again at one hundred and fourteen. Sir John Sinclair a mentions a
+similar case in a Scotchman who lived to one hundred and ten. Susan
+Edmonds when in her ninety-fifth year recovered her black hair, but
+previously to her death at one hundred and five again became gray.
+There was a Dr. Slave who at the age of eighty had a renewal of rich
+brown hair, which he maintained until his death at one hundred. There
+was a man in Vienna, aged one hundred and five, who had black hair long
+after his hair had first become white This man is mentioned as a
+parallel to Dr. Slave. Similar examples are mentioned in Chapter VI.
+
+It is a remarkable fact that many persons who have reached an old age
+have lived on the smallest diet and the most frugal fare.  Many of the
+instances of longevity were in people of Scotch origin who subsisted
+all their lives on porridges. Saint Anthony is said to have maintained
+life to one hundred and five on twelve ounces of bread daily. In 1792
+in the Duchy of Holstein there was an industrious laborer named Stender
+who died at one hundred and three, his food for the most part of his
+life having been oatmeal and buttermilk. Throughout his life he had
+been particularly free from thirst, drinking little water and no
+spirits.
+
+Heredity.--There are some very interesting instances of successive
+longevity. Lister speaks of a son and a father, from a village called
+Dent, who were witnesses before a jury at York in 1664. The son was
+above one hundred and the father above one hundred and forty. John
+Moore died in 1805 aged one hundred and seven. His father died at one
+hundred and five and his grandfather at one hundred and fifteen, making
+a total of three hundred and twenty-seven years for the three
+generations.  Recently, Wynter mentions four sisters,--of one hundred,
+one hundred and three, one hundred and five, and one hundred and seven
+years respectively. On the register of Bremhill 1696, is the following
+remarkable entry: "Buried, September 29th, Edith Goldie, Grace Young,
+and Elizabeth Wiltshire, their united ages making three hundred." As
+late as 1886 in the district of Campinos there was a strong active man
+named Joseph Joachim de Prado, of good family, who was one hundred and
+seven years old.  His mother died by accident at one hundred and
+twelve, and his maternal grandmother died at one hundred and twenty-two.
+
+Longevity in Active Military Service.--One of the most remarkable
+proofs that under fickle fortune, constant danger, and the most
+destructive influences the life of man may be long preserved is
+exemplified in the case of an old soldier named Mittelstedt, who died
+in Prussia in 1792, aged one hundred and twelve. He was born at Fissalm
+in June, 1681. He entered the army, served under three Kings, Frederick
+I, Frederick William I, and Frederick II, and did active service in the
+Seven Years' War, in which his horse was shot under him and he was
+taken prisoner by the Russians. In his sixty-eight years of army
+service he participated in 17 general engagements, braved numerous
+dangers, and was wounded many times. After his turbulent life he
+married, and at last in 1790, in his one hundred and tenth year, he
+took a third wife.  Until shortly before his death he walked every
+month to the pension office, a distance of two miles from his house.
+
+Longevity in Physicians.--It may be of interest to the members of our
+profession to learn of some instances of longevity among confreres. Dr.
+R. Baynes of Rockland, Maine, has been mentioned in the list of "grand
+old men" in medicine; following in the footsteps of Hippocrates and
+Galen, he was practicing at ninety-nine. He lives on Graham's diet,
+which is a form of vegetarianism; he does not eat potatoes, but does
+eat fruit. His drink is almost entirely water, milk, and chocolate, and
+he condemns the use of tea, coffee, liquors, and tobacco. He has almost
+a perfect set of natural teeth and his sight is excellent.  Like most
+men who live to a great age, Dr. Baynes has a "fad," to which he
+attributes a chief part in prolonging his life. This is the avoidance
+of beds, and except when away from home he has not slept on a bed or
+even on a mattress for over fifty years. He has an iron reclining
+chair, over which he spreads a few blankets and rugs.
+
+The British Medical Journal speaks of Dr. Boisy of Havre, who is one
+hundred and three. It is said he goes his rounds every day, his
+practice being chiefly among the poor. At one time he practiced in
+India. He has taken alcoholic beverages and smoked tobacco since his
+youth, although in moderation. His father, it is added, died at the age
+of one hundred and eight. Mr. William R. Salmon, living near Cowbridge,
+Glamorganshire, recently celebrated his one hundred and sixth birthday.
+Mr. Salmon was born at Wickham Market in 1790, and became a member of
+the Royal College of Surgeons in 1809, the year in which Gladstone was
+born. He died April 11, 1896. In reference to this wonderful old
+physician the Journal of the American Medical Association, 1896, page
+995, says--
+
+"William Reynold Salmon, M.R.C.S., of Penllyn Court, Cowbridge,
+Glamorganshire, South Wales, completed his one hundred and sixth year
+on March 16th, and died on the 11th of the present month--at the time
+of his death the oldest known individual of indisputably authenticated
+age, the oldest physician, the oldest member of the Royal College of
+Surgeons, England, and the oldest Freemason in the world. His age does
+not rest upon tradition or repute. He was the son of a successful and
+esteemed practicing physician of Market Wickham, Suffolk, England, and
+there is in the possession of his two surviving relatives, who cared
+for his household for many years, his mother's diary, in which is
+inscribed in the handwriting of a lady of the eighteenth century, under
+the date, Tuesday, March 16, 1790, a prayer of thankfulness to God that
+she had passed her 'tryall,' and that a son was born, who she hoped
+'would prosper, be a support to his parents, and make virtue his chief
+pursuit.' The Royal College of Surgeons verified this record many years
+ago, and it was subsequently again authenticated by the authorities of
+the Freemasons, who thereupon enshrined his portrait in their gallery
+as the oldest living Freemason. The Salmon family moved to Cowbridge in
+1796, so that the doctor had lived exactly a century in the lovely and
+poetic Vale of Glamorgan, in the very heart of which Penllyn Court is
+situated. Here on his one hundred and sixth birthday--a man of over
+middle height, with still long, flowing hair, Druidical beard and
+mustache, and bushy eyebrows--Dr. Salmon was visited by one who
+writes:--
+
+"'Seen a few days ago, the Patriarch of Penllyn Court was hale and
+hearty. He eats well and sleeps well and was feeling better than he had
+felt for the last five years. On that day he rose at noon, dined at
+six, and retired at nine. Drank two glasses of port with his dinner,
+but did not smoke. He abandoned his favorite weed at the age of ninety,
+and had to discontinue his drives over his beautiful estate in his one
+hundredth year. One day is much the same as another, for he gives his
+two relatives little trouble in attending upon his wants. Dr. Salmon
+has not discovered the elixir of life, for the shadows of life's
+evening are stealing slowly over him. He cannot move about, his hearing
+is dulled, and the light is almost shut out from the "windows of his
+soul." Let us think of this remarkable man waiting for death
+uncomplainingly in his old-fashioned mansion, surrounded by the
+beautiful foliage and the broad expanse of green fields that he loved
+so much to roam when a younger man, in that sylvan Sleepy Hollow in the
+Vale of Glamorgan.'
+
+"Eight weeks later he, who in youth had been 'the youngest surgeon in
+the army, died, the oldest physician in the world."
+
+Dr. William Hotchkiss, said to have reached the age of one hundred and
+forty years, died in St. Louis April 1, 1895. He went to St. Louis
+forty years ago, and has always been known as the "color doctor." In
+his peculiar practice of medicine he termed his patients members of his
+"circles," and claimed to treat them by a magnetic process. Dr. A. J.
+Buck says that his Masonic record has been traced back one hundred
+years, showing conclusively that he was one hundred and twenty-one
+years old. A letter received from his old home in Virginia, over a year
+ago, says that he was born there in 1755.
+
+It is comforting to the members of our profession, in which the average
+of life is usually so low, to be able to point out exceptions. It has
+been aptly said of physicians in general: "Aliis inserviendo
+consumuntur; aliis medendo moriuntur," or "In serving others they are
+consumed; in healing others they are destroyed."
+
+Recent Instances of Longevity.--There was a man who died in Spain at
+the advanced age of one hundred and fifty-one, which is the most
+extraordinary instance from that country. It is reported that quite
+recently a Chinese centenarian passed the examination for the highest
+place in the Academy of Mandarins. Chevreul, born in 1786, at Angers,
+has only recently died after an active life in chemical investigation.
+Sir Moses Montefiore is a recent example of an active centenarian.
+
+In the New York Herald of April 21, 1895, is a description and a
+portrait of Noah Raby of the Piscataway Poor Farm of New Jersey, to
+whom was ascribed one hundred and twenty-three years. He was discharged
+from active duty on the "Brandywine," U.S.N., eighty-three years ago.
+He relates having heard George Washington speak at Washington and at
+Portsmouth while his ship was in those places. The same journal also
+says that at Wichita, Kansas, there appeared at a municipal election an
+old negress named Mrs. Harriet McMurray, who gave her age as one
+hundred and fifteen.  She had been a slave, and asserted that once on a
+visit to Alexandria with her master she had seen General Washington.
+From the Indian Medical Record we learn that Lieutenant Nicholas Lavin
+of the Grand Armee died several years ago at the age of one hundred and
+twenty-five, leaving a daughter of seventy-eight. He was born in Paris
+in 1768, served as a hussar in several campaigns, and was taken a
+prisoner during the retreat from Moscow. After his liberation he
+married and made his residence in Saratoff.
+
+
+
+CHAPTER IX.
+
+PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.
+
+In considering the anomalies of the secretions, it must be remembered
+that the ingestion of certain kinds of food and the administration of
+peculiar drugs in medicine have a marked influence in coloring
+secretions. Probably the most interesting of all these anomalies is the
+class in which, by a compensatory process, metastasis of the secretions
+is noticed.
+
+Colored Saliva.--Among the older writers the Ephemerides contains an
+account of blue saliva; Huxham speaks of green saliva; Marcellus
+Donatus of yellow, and Peterman relates the history of a case of yellow
+saliva. Dickinson describes a woman of sixty whose saliva was blue;
+besides this nothing was definitely the matter with her. It seemed
+however, that the color was due to some chemic-pencil poisoning rather
+than to a pathologic process.  A piece of this aniline pencil was
+caught in the false teeth.  Paget cites an instance of blue saliva due
+to staining the tongue in the same manner. Most cases of anomalous
+coloring of this kind can be subsequently traced to artificial
+substances unconsciously introduced. Crocker mentions a woman who on
+washing her hands constantly found that the water was stained blue, but
+this was subsequently traced to the accidental introduction of an
+orchid leaf. In another instance there was a woman whose linen was at
+every change stained brown; this, however, was found to be due to a
+hair-wash that she was in the habit of using.
+
+Among the older writers who have mentioned abnormal modes of exit of
+the urine is Baux, who mentions urine from the nipples; Paullini and
+the Ephemerides describe instances of urination from the eyes.
+Blancard, the Ephemerides, Sorbalt, and Vallisneri speak of urination
+by the mouth. Arnold relates the history of a case of dysuria in which
+urine was discharged from the nose, breasts, ears, and umbilicus; the
+woman was twenty-seven years old, and the dysuria was caused by a
+prolapsed uterus. There was an instance of anomalous discharge of urine
+from the body reported in Philadelphia many years ago which led to
+animated discussion. A case of dysuria in which the patient discharged
+urine from the stomach was reported early in this century from Germany.
+The patient could feel the accumulation of urine by burning pain in the
+epigastrium. Suddenly the pain would move to the soles of the feet, she
+would become nauseated, and large quantities of urine would soon be
+vomited. There was reported the case of an hysterical female who had
+convulsions and mania, alternating with anuria of a peculiar nature and
+lasting seven days. There was not a drop of urine passed during this
+time, but there were discharges through the mouth of alkaline waters
+with a strong ammoniacal odor.
+
+Senter reports in a young woman a singular case of ischuria which
+continued for more than three years; during this time if her urine was
+not drawn off with the catheter she frequently voided it by vomiting;
+for the last twenty months she passed much gravel by the catheter; when
+the use of the instrument was omitted or unsuccessfully applied the
+vomitus contained gravel. Carlisle mentions a case in which there was
+vomiting of a fluid containing urea and having the sensible properties
+of urine. Curious to relate, a cure was effected after ligature of the
+superior thyroid arteries and sloughing of the thyroid gland. Vomiting
+of urine is also mentioned by Coley, Domine, Liron, Malago, Zeviani,
+and Yeats. Marsden reports a case in which, following secondary papular
+syphilis and profuse spontaneous ptyalism, there was vicarious
+secretion of the urinary constituents from the skin.
+
+Instances of the anomalous exit of urine caused by congenital
+malformation or fistulous connections are mentioned in another chapter.
+Black urine is generally caused by the ingestion of pigmented food or
+drugs, such as carbolic acid and the anilines.  Amatus Lusitanus,
+Bartholinus, and the Ephemerides speak of black urine after eating
+grapes or damson plums. The Ephemerides speaks of black urine being a
+precursor of death, but Piso, Rhodius, and Schenck say it is anomalous
+and seldom a sign of death. White urine, commonly known as chyluria, is
+frequently seen, and sometimes results from purulent cystitis. Though
+containing sediment, the urine looks as if full of milk. A case of this
+kind was seen in 1895 at the Jefferson Medical College Hospital,
+Philadelphia, in which the chyluria was due to a communication between
+the bladder and the thoracic duct.
+
+Ackerman has spoken of metastasis of the tears, and Dixon gives an
+instance in which crying was not attended by the visible shedding of
+tears. Salomon reports a case of congenital deficiency of tears.
+Blood-stained tears were frequently mentioned by the older writers.
+Recently Cross has written an article on this subject, and its analogy
+is seen in the next chapter under hemorrhages from the eyes through the
+lacrimal duct.
+
+The Semen.--The older writers spoke of metastasis of the seminal flow,
+the issue being by the skin (perspiration) and other routes. This was
+especially supposed to be the case in satyriasis, in which the
+preternatural exit was due to superabundance of semen, which could be
+recognized by its odor.  There is no doubt that some people have a
+distinct seminal odor, a fact that will be considered in the section on
+"Human Odors."
+
+The Ephemerides, Schurig, and Hoffman report instances of what they
+call fetid semen (possibly a complication of urethral disease). Paaw
+speaks of black semen in a negro, and the Ephemerides and Schurig
+mention instances of dark semen. Blancard records an instance of
+preternatural exit of semen by the bowel.  Heers mentions a similar
+case caused by urethral fistula. Ingham mentions the escape of semen
+through the testicle by means of a fistula. Demarquay is the authority
+on bloody semen.
+
+Andouard mentions an instance of blue bile in a woman, blue flakes
+being found in her vomit. There was no trace of copper to be found in
+this case. Andouard says that the older physicians frequently spoke of
+this occurrence.
+
+Rhodius speaks of the sweat being sweet after eating honey; the
+Ephemerides and Paullini also mention it. Chromidrosis, or colored
+sweat, is an interesting anomaly exemplified in numerous reports. Black
+sweat has been mentioned by Bartholinus, who remarked that the
+secretion resembled ink; in other cases Galeazzi and Zacutus Lusitanus
+said the perspiration resembled sooty water. Phosphorescent sweat has
+been recorded. Paullini and the Ephemerides mention perspiration which
+was of a leek-green color, and Borellus has observed deep green
+perspiration. Marcard mentions green perspiration of the feet, possibly
+due to stains from colored foot-gear. The Ephemerides and Paullini
+speak of violet perspiration, and Bartholinus has described
+perspiration which in taste resembled wine.
+
+Sir Benjamin Brodie has communicated the history of a case of a young
+girl of fifteen on whose face was a black secretion. On attempting to
+remove it by washing, much pain was caused. The quantity removed by
+soap and water at one time was sufficient to make four basins of water
+as black as if with India ink. It seemed to be physiologically
+analogous to melanosis. The cessation of the secretion on the forehead
+was followed by the ejection of a similar substance from the bowel,
+stomach, and kidney. The secretion was more abundant during the night,
+and at one time in its course an erysipelas-eruption made its
+appearance. A complete cure ultimately followed.
+
+Purdon describes an Irish married woman of forty, the subject of
+rheumatic fever, who occasionally had a blue serous discharge or
+perspiration that literally flowed from her legs and body, and
+accompanied by a miliary eruption. It was on the posterior portions,
+and twelve hours previous was usually preceded by a moldy smell and a
+prickly sensation. On the abdomen and the back of the neck there was a
+yellowish secretion. In place of catamenia there was a discharge
+reddish-green in color. The patient denied having taken any coloring
+matter or chemicals to influence the color of her perspiration, and no
+remedy relieved her cardiac or rheumatic symptoms.
+
+The first English case of chromidrosis, or colored sweat, was published
+by Yonge of Plymouth in 1709. In this affection the colored sweating
+appears symmetrically in various parts of the body, the parts commonly
+affected being the cheeks, forehead, side of the nose, whole face,
+chest, abdomen, backs of the hands, finger-tips, and the flexors,
+flexures at the axillae, groins, and popliteal spaces. Although the
+color is generally black, nearly every color has been recorded. Colcott
+Fox reported a genuine case, and Crocker speaks of a case at Shadwell
+in a woman of forty-seven of naturally dark complexion. The bowels were
+habitually sluggish, going three or four days at least without action,
+and latterly the woman had suffered from articular pains.  The
+discolored sweat came out gradually, beginning at the sides of the
+face, then spreading to the cheeks and forehead. When seen, the upper
+half of the forehead, the temporal regions, and the skin between the
+ear and malar eminence were of a blackish-brown color, with slight
+hyperemia of the adjacent parts; the woman said the color had been
+almost black, but she had cleaned her face some. There was evidently
+much fat in the secretion; there was also seborrhea of the scalp.
+Washing with soap and water had very little effect upon it; but it was
+removed with ether, the skin still looking darker and redder than
+normal.  After a week's treatment with saline purgatives the
+discoloration was much less, but the patient still had articular pains,
+for which alkalies were prescribed; she did not again attend. Crocker
+also quotes the case of a girl of twenty, originally under Mackay of
+Brighton. Her affection had lasted a year and was limited to the left
+cheek and eyebrow. Six months before the patch appeared she had a
+superficial burn which did not leave a distinct scar, but the surface
+was slightly granular. The deposit was distinctly fatty, evidently
+seborrheic and of a sepia-tint. The girl suffered from obstinate
+constipation, the bowels acting only once a week. The left side flushed
+more than the right In connection with this case may be mentioned one
+by White of Harvard, a case of unilateral yellow chromidrosis in a man.
+Demons gives the history of a case of yellow sweat in a patient with
+three intestinal calculi.
+
+Wilson says that cases of green, yellow, and blue perspiration have
+been seen, and Hebra, Rayer, and Fuchs mention instances.  Conradi
+records a case of blue perspiration on one-half the scrotum. Chojnowski
+records a case in which the perspiration resembled milk.
+
+Hyperidrosis occurs as a symptom in many nervous diseases, organic and
+functional, and its presence is often difficult of explanation. The
+following are recent examples: Kustermann reports a case of acute
+myelitis in which there was profuse perspiration above the level of the
+girdle-sensation and none at all below. Sharkey reports a case of tumor
+of the pons varolii and left crus cerebri, in which for months there
+was excessive generalized perspiration; it finally disappeared without
+treatment. Hutchinson describes the case of a woman of sixty-four who
+for four years had been troubled by excessive sweating on the right
+side of the face and scalp. At times she was also troubled by an
+excessive flow of saliva, but she could not say if it was unilateral.
+There was great irritation of the right side of the tongue, and for two
+years taste was totally abolished. It was normal at the time of
+examination. The author offered no explanation of this case, but the
+patient gave a decidedly neurotic history, and the symptoms seem to
+point with some degree of probability to hysteria. Pope reports a
+peculiar case in which there were daily attacks of neuralgia preceded
+by sweating confined to a bald spot on the head. Rockwell reports a
+case of unilateral hyperidrosis in a feeble old man which he thought
+due to organic affection of the cervical sympathetic.
+
+Dupont has published an account of a curious case of chronic general
+hyperidrosis or profuse sweating which lasted upward of six years. The
+woman thus affected became pregnant during this time and was happily
+delivered of an infant, which she nursed herself. According to Dupont,
+this hyperidrosis was independent of any other affection, and after
+having been combated fruitlessly by various remedies, yielded at last
+to fluid extract of aconitin.
+
+Myrtle relates the case of a man of seventy-seven, who, after some
+flying pains and fever, began to sweat profusely and continued to do so
+until he died from exhaustion at the end of three months from the onset
+of the sweating. Richardson records another case of the same kind.
+Crocker quotes the case of a tailor of sixty-five in whom hyperidrosis
+had existed for thirty-five years. It was usually confined to the hands
+and feet, but when worst affected the whole body. It was absent as long
+as he preserved the horizontal posture, but came on directly when he
+rose; it was always increased in the summer months. At the height of
+the attack the man lost appetite and spirit, had a pricking sensation,
+and sometimes minute red papules appeared all over the hand. He had
+tried almost every variety of treatment, but sulphur did the most good,
+as it had kept the disease under for twelve months. Latterly, even that
+failed.
+
+Bachman reports the history of a case of hyperidrosis cured by
+hypnotism.
+
+Unilateral and localized sweating accompanies some forms of nervous
+disturbance. Mickle has discussed unilateral sweating in the general
+paralysis of the insane. Ramskill reports a case of sweating on one
+side of the face in a patient who was subject to epileptic convulsions.
+Takacs describes a case of unilateral sweating with proportionate
+nervous prostration. Bartholow and Bryan report unilateral sweating of
+the head. Cason speaks of unilateral sweating of the head, face, and
+neck. Elliotson mentions sweat from the left half of the body and the
+left extremities only. Lewis reports a case of unilateral perspiration
+with an excess of temperature of 3.5 degrees F. in the axilla of the
+perspiring side. Mills, White, Dow, and Duncan also cite instances of
+unilateral perspiration. Boquis describes a case of unilateral
+perspiration of the skin of the head and face, and instances of
+complete unilateral perspiration have been frequently recorded by the
+older writers,--Tebure, Marcellus Donatus, Paullini, and Hartmann
+discussing it. Hyperidrosis confined to the hands and feet is quite
+common.
+
+Instances of bloody sweat and "stigmata" have been known through the
+ages and are most interesting anomalies. In the olden times there were
+people who represented that in their own persons they realized at
+certain periods the agonies of Gethsemane, as portrayed in medieval
+art, e.g., by pictures of Christ wearing the crown of thorns in
+Pilate's judgment hall. Some of these instances were, perhaps, of the
+nature of compensatory hemorrhage, substituting the menses or periodic
+hemorrhoids, hemoptysis, epistaxis, etc., or possibly purpura. Extreme
+religious frenzy or deep emotions might have been the indirect cause of
+a number of these bleeding zealots. There are instances on record in
+which fear and other similar emotions have caused a sweating of blood,
+the expression "sweating blood" being not uncommon.
+
+Among the older writers, Ballonius, Marcolini, and Riedlin mention
+bloody sweat. The Ephemerides speaks of it in front of the
+hypochondrium. Paullini observed a sailor of thirty, who, falling
+speechless and faint during a storm on the deck of his ship, sweated a
+red perspiration from his entire body and which stained his clothes. He
+also mentions bloody sweat following coitus. Aristotle speaks of bloody
+sweat, and Pellison describes a scar which periodically opened and
+sweated blood. There were many cases like this, the scars being usually
+in the location of Christ's wounds.
+
+De Thou mentions an Italian officer who in 1552, during the war between
+Henry II of France and Emperor Charles V, was threatened with public
+execution; he became so agitated that he sweated blood from every
+portion of the body. A young Florentine about to be put to death by an
+order of Pope Sixtus V was so overcome with grief that he shed bloody
+tears and sweated blood. The Ephemerides contains many instances of
+bloody tears and sweat occasioned by extreme fear, more especially fear
+of death.  Mezeray mentions that the detestable Charles IX of France,
+being under constant agitation and emotion, sank under a disorder which
+was accompanied by an exudation of blood from every pore of his body.
+This was taken as an attempt of nature to cure by bleeding according to
+the theory of the venesectionists. Fabricius Hildanus mentions a child
+who, as a rule, never drank anything but water, but once, contrary to
+her habit, drank freely of white wine, and this was soon followed by
+hemorrhage from the gums, nose, and skin.
+
+There is a case also related of a woman of forty-five who had lost her
+only son. One day she fancied she beheld him beseeching her to release
+his soul from purgatory by prayers and fasting every Friday. The
+following Friday, which was in the month of August, and for five
+succeeding Fridays she had a profuse bloody perspiration, the disorder
+disappearing on Friday, March 8th, of the following year. Pooley says
+that Maldonato, in his "Commentaries of Four Gospels," mentions a
+healthy and robust man who on hearing of his sentence of death sweated
+blood, and Zacchias noted a similar phenomenon in a young man condemned
+to the flames. Allusion may also be made to St. Luke, who said of
+Christ that in agony He prayed more earnestly, "and His sweat was, as
+it were, great drops of blood falling down to the ground."
+
+Pooley quotes the case of a young woman of indolent habit who in a
+religious fanatical trance sweated blood. The stigmatists were often
+imposters who artificially opened their scars, and set the example for
+the really peculiar cases of bloody sweat, which among ignorant people
+was considered evidence of sympathy with the agony of the Cross.
+
+Probably the best studied case on record is that of Louise Lateau of
+Bois d'Haine, which, according to Gray, occurred in 1869 in a village
+of Belgium when the girl was at the age of twenty-three; her previous
+life had offered nothing remarkable. The account is as follows: "One
+Friday Louise Lateau noticed that blood was flowing from one side of
+her chest, and this recurred every Friday. On each Thursday morning an
+oval surface about one inch in length on the back of each hand became
+pink in color and smooth, whilst a similar oval surface on the palm of
+each hand became of the same hue, and on the upper surface of each foot
+a pinkish-white square appeared. Examined under a magnifying glass, the
+epidermis appeared at first without solution of continuity and
+delicate. About noon on Thursday a vesicle formed on the pink surfaces
+containing clear serum. In the night between Thursday and Friday,
+usually between midnight and one o'clock, the flow of blood began, the
+vesicle first rupturing. The amount of blood lost during the so called
+stigmata varied, and some observers estimated it at about one and
+three-quarter pints. The blood itself was of a reddish color, inclining
+to violet, about the hue therefore, of capillary blood, coagulating in
+the usual way, and the white and red corpuscles being normal in
+character and relative proportion. The flow ceased on Saturdays. During
+the flow of the blood the patient was in a rapt, ecstatic condition.
+The facial expression was one of absorption and far-off contemplation,
+changing often to melancholy, terror, to an attitude of prayer or
+contrition. The patient herself stated that at the beginning of the
+ecstasy she imagined herself surrounded by a brilliant light; figures
+then passed before her, and the successive scenes of the crucifixion
+were panoramically progressive. She saw Christ in person--His clothing,
+His wounds, His crown of thorns, His cross--as well as the Apostles,
+the holy women, and the assembled Jews. During the ecstasy the
+circulation of the skin and heart was regular, although at times a
+sudden flash or pallor overspread the face, according with the play of
+the expression. From midday of Thursdays, when she took a frugal meal,
+until eight o'clock on Saturday mornings the girl took no nourishment,
+not even water, because it was said that she did not feel the want of
+it and could not retain anything upon her stomach. During this time the
+ordinary secretions were suspended."
+
+Fournier mentions a statesman of forty-five who, following great
+Cabinet labors during several years and after some worriment, found
+that the day after indulging in sexual indiscretions he would be in a
+febrile condition, with pains in the thighs, groins, legs, and penis.
+The veins of these parts became engorged, and subsequently blood oozed
+from them, the flow lasting several days. The penis was the part most
+affected. He was under observation for twenty months and presented the
+same phenomena periodically, except that during the last few months
+they were diminished in every respect. Fournier also mentions a curious
+case of diapedesis in a woman injured by a cow. The animal struck her
+in the epigastric region, she fell unconscious, and soon after vomited
+great quantities of blood, and continued with convulsive efforts of
+expulsion to eject blood periodically from every eight to fifteen days,
+losing possibly a pound at each paroxysm. There was no alteration of
+her menses. A physician gave her astringents, which partly suppressed
+the vomiting, but the hemorrhage changed to the skin, and every day she
+sweated blood from the chest, back of the thighs, feet, and the
+extremities of the fingers. When the blood ceased to flow from her skin
+she lost her appetite, became oppressed, and was confined to her bed
+for some days. Itching always preceded the appearance of a new flow.
+There was no dermal change that could be noticed.
+
+Fullerton mentions a girl of thirteen who had occasional oozing of
+blood from her brow, face, and the skin under the eyes.  Sometimes a
+pound of clots was found about her face and pillow.  The blood first
+appeared in a single clot, and, strange to say, lumps of fleshy
+substance and minute pieces of bone were discharged all day. This
+latter discharge became more infrequent, the bone being replaced by
+cartilaginous substance. There was no pain, discoloration, swelling, or
+soreness, and after this strange anomaly disappeared menstruation
+regularly commenced. Van Swieten mentions a young lady who from her
+twelfth year at her menstrual periods had hemorrhages from pustules in
+the skin, the pustules disappearing in the interval.
+
+Schmidt's Jahrbucher for 1836 gives an account of a woman who had
+diseased ovaries and a rectovesicovaginal fistula, and though sometimes
+catamenia appeared at the proper place it was generally arrested and
+hemorrhage appeared on the face. Chambers mentions a woman of
+twenty-seven who suffered from bloody sweat after the manner of the
+stigmatists, and Petrone mentions a young man of healthy antecedents,
+the sweat from whose axillae and pubes was red and very pungent.
+Petrone believes it was due to a chromogenic micrococcus, and relieved
+the patient by the use of a five per cent solution of caustic potash.
+Chloroform, ether, and phenol had been tried without success. Hebra
+mentions a young man in whom the blood spurted from the hand in a
+spiral jet corresponding to the direction of the duct of the
+sweat-gland.  Wilson refers to five cases of bloody sweat.
+
+There is a record of a patient who once or twice a day was attacked
+with swelling of the scrotum, which at length acquired a deep red color
+and a stony hardness, at which time the blood would spring from a
+hundred points and flow in the finest streams until the scrotum was
+again empty.
+
+Hill describes a boy of four who during the sweating stage of malaria
+sweated blood from the head and neck. Two months later the
+skin-hemorrhages ceased and the boy died, vomiting blood and with
+bloody stools.
+
+Postmortem sweating is described in the Ephemerides and reported by
+Hasenest and Schneider. Bartholinus speaks of bloody sweat in a cadaver.
+
+In considering the anomalies of lactation we shall first discuss those
+of color and then the extraordinary places of secretion.  Black milk is
+spoken of by the Ephemerides and Paullini. Red milk has been observed
+by Cramer and Viger. Green milk has been observed by Lanzonius,
+Riverius, and Paullini. The Ephemerides also contains an account of
+green milk. Yellow milk has been mentioned in the Ephemerides and its
+cause ascribed to eating rhubarb.
+
+It is a well-known fact that some cathartics administered to nursing
+mothers are taken from the breast by their infants, who,
+notwithstanding its indirect mode of administration, exhibit the
+effects of the original drug. The same is the case with some poisons,
+and instances of lead-poisoning and arsenic-poisoning have been seen in
+children who have obtained the toxic substance in the mother's milk.
+There is one singular case on record in which a child has been poisoned
+from the milk of its mother after she had been bitten by a serpent.
+
+Paullini and the Ephemerides give instances of milk appearing in the
+perspiration, and there are numerous varieties of milk-metastasis
+recorded Dolaeus and Nuck mention the appearance of milk in the saliva.
+Autenreith mentions metastasis of milk through an abdominal abscess to
+the thigh, and Balthazaar also mentions excretion of milk from the
+thigh. Bourdon mentions milk from the thigh, labia, and vulva. Klein
+speaks of the metastasis of the milk to the lochia. Gardane speaks of
+metastasis to the lungs, and there is another case on record in which
+this phenomenon caused asphyxia. Schenck describes excretion of milk
+from the bladder and uterus. Jaeger in 1770 at Tubingen describes the
+metastasis of milk to the umbilicus, Haen to the back, and Schurig to a
+wound in the foot. Knackstedt has seen an abscess of the thigh which
+contained eight pounds of milk. Hauser gives the history of a case in
+which the kidneys secreted milk vicariously.
+
+There is the history of a woman who suffered from metastasis of milk to
+the stomach, and who, with convulsive action of the chest and abdomen,
+vomited it daily. A peculiar instance of milk in a tumor is that of a
+Mrs. Reed, who, when pregnant with twins, developed an abdominal tumor
+from which 25 pounds of milk was drawn off.
+
+There is a French report of secretion of milk in the scrotum of a man
+of twenty-one. The scrotum was tumefied, and to the touch gave the
+sensation of a human breast, and the parts were pigmented similar to an
+engorged breast. Analysis showed the secretion to have been true human
+milk.
+
+Cases of lactation in the new-born are not infrequent.  Bartholinus,
+Baricelli, Muraltus, Deusingius, Rhodius, Schenck, and Schurig mention
+instances of it. Cardanus describes an infant of one month whose
+breasts were swollen and gave milk copiously.  Battersby cites a
+description of a male child three weeks old whose breasts were full of
+a fluid, analysis proving it to have been human milk; Darby, in the
+same journal, mentions a child of eight days whose breasts were so
+engorged that the nurse had to milk it. Faye gives an interesting paper
+in which he has collected many instances of milk in the breasts of the
+new-born.  Jonston details a description of lactation in an infant.
+Variot mentions milk-secretion in the new-born and says that it
+generally takes place from the eighth to the fifteenth day and not in
+the first week. He also adds that probably mammary abscesses in the
+new-born could be avoided if the milk were squeezed out of the breasts
+in the first days. Variot says that out of 32 children of both sexes,
+aged from six to nine months, all but six showed the presence of milk
+in the breasts. Gibb mentions copious milk-secretion in an infant, and
+Sworder and Menard have seen young babes with abundant milk-secretion.
+
+Precocious Lactation.--Bochut says that he saw a child whose breasts
+were large and completely developed, offering a striking contrast to
+the slight development of the thorax. They were as large as a stout
+man's fist, pear-shaped, with a rosy areola, in the center of which was
+a nipple. These precocious breasts increased in size at the beginning
+of the menstrual epoch (which was also present) and remained enlarged
+while the menses lasted.  The vulva was covered with thick hair and the
+external genitalia were well developed. The child was reticent, and
+with a doll was inclined to play the role of mother.
+
+Baudelocque mentions a girl of eight who suckled her brother with her
+extraordinarily developed breasts. In 1783 this child milked her
+breasts in the presence of the Royal Academy at Paris. Belloc spoke of
+a similar case. There is another of a young negress who was able to
+nourish an infant; and among the older writers we read accounts of
+young virgins who induced lactation by applying infants to their
+breasts. Bartholinus, Benedictus, Hippocrates, Lentilius, Salmuth, and
+Schenck mention lactation in virgins.
+
+De la Coide describes a case in which lactation was present, though
+menstruation had always been deficient. Dix, at the Derby Infirmary,
+has observed two females in whom there was continued lactation,
+although they had never been pregnant. The first was a chaste female of
+twenty-five, who for two years had abundant and spontaneous discharge
+of milk that wetted the linen; and the other was in a prostitute of
+twenty, who had never been pregnant, but who had, nevertheless, for
+several months an abundant secretion of healthy milk. Zoologists know
+that a nonpregnant bitch may secrete milk in abundance. Delafond and de
+Sinnety have cited instances.
+
+Lactation in the aged has been frequently noticed. Amatus Lusitanus and
+Schenck have observed lactation in old women; in recent years Dunglison
+has collected some instances. Semple relates the history of an elderly
+woman who took charge of an infant the mother of which had died of
+puerperal infection. As a means of soothing the child she allowed it to
+take the nipple, and, strange to say, in thirty-six hours milk appeared
+in her breasts, and soon she had a flow as copious as she had ever had
+in her early married life. The child thrived on this production of a
+sympathetic and spontaneous lactation. Sir Hans Sloane mentions a lady
+of sixty-eight who though not having borne a child for twenty years,
+nursed her grandchildren one after another.
+
+Montegre describes a woman in the Department of Charente who bore two
+male children in 1810. Not having enough milk for both, and being too
+poor to secure the assistance of a midwife, in her desperation she
+sought an old woman named Laverge, a widow of sixty-five, whose husband
+had been dead twenty-nine years. This old woman gave the breast to one
+of the children, and in a few days an abundant flow of milk was
+present. For twenty-two months she nursed the infant, and it thrived as
+well as its brother, who was nursed by their common mother--in fact, it
+was even the stronger of the two.
+
+Dargan tells of a case of remarkable rejuvenated lactation in a woman
+of sixty, who, in play, placed the child to her breast, and to her
+surprise after three weeks' nursing of this kind there appeared an
+abundant supply of milk, even exceeding in amount that of the young
+mother.
+
+Blanchard mentions milk in the breasts of a woman of sixty, and Krane
+cites a similar instance. In the Philosophical Transactions there is an
+instance of a woman of sixty-eight having abundant lactation.
+
+Warren, Boring, Buzzi, Stack, Durston, Egan, Scalzi, Fitzpatrick, and
+Gillespie mention rejuvenation and renewed lactation in aged women.
+Ford has collected several cases in which lactation was artificially
+induced by women who, though for some time not having been pregnant
+themselves, nursed for others.
+
+Prolonged lactation and galactorrhea may extend through several
+pregnancies. Green reports the case of a woman of forty-seven, the
+mother of four children, who after each weaning had so much milk
+constantly in her breasts that it had to be drawn until the next birth.
+At the time of report the milk was still secreting in abundance. A
+similar and oft-quoted case was that of Gomez Pamo, who described a
+woman in whom lactation seemed indefinitely prolonged; she married at
+sixteen, two years after the establishment of menstruation. She became
+pregnant shortly after marriage, and after delivery had continued
+lactation for a year without any sign of returning menstruation. Again
+becoming pregnant, she weaned her first child and nursed the other
+without delay or complication. This occurrence took place fourteen
+times.  She nursed all 14 of her children up to the time that she found
+herself pregnant again, and during the pregnancies after the first the
+flow of milk never entirely ceased; always after the birth of an infant
+she was able to nurse it. The milk was of good quality and always
+abundant, and during the period between her first pregnancy to seven
+years after the birth of her last child the menses had never
+reappeared. She weaned her last child five years before the time of
+report, and since then the milk had still persisted in spite of all
+treatment. It was sometimes so abundant as to necessitate drawing it
+from the breast to relieve painful tension.
+
+Kennedy describes a woman of eighty-one who persistently menstruated
+through lactation, and for forty-seven years had uninterruptedly nursed
+many children, some of which were not her own. Three years of this time
+she was a widow. At the last reports she had a moderate but regular
+secretion of milk in her eighty-first year.
+
+In regard to profuse lacteal flow, Remy is quoted as having seen a
+young woman in Japan from whom was taken 12 1/2 pints of milk each day,
+which is possibly one of the most extreme instance of continued
+galactorrhea on record.
+
+Galen refers to gynecomastia or gynecomazia; Aristotle says he has seen
+men with mammae a which were as well developed as those of a woman, and
+Paulus aegineta recognized the fact in the ancient Greeks. Subsequently
+Albucasis discusses it in his writings. Bartholinus, Behr, Benedictus,
+Borellus, Bonet, the Ephemerides, Marcellus Donatus, Schenck, Vesalius,
+Schacher, Martineau, and Buffon all discuss the anomalous presence of
+milk in the male breast. Puech says that this condition is found in one
+out of 13,000 conscripts.
+
+To Bedor, a marine surgeon, we owe the first scientific exposition of
+this subject, and a little later Villeneuve published his article in
+the French dictionary. Since then many observations have been made on
+this subject, and quite recently Laurent has published a most
+exhaustive treatise upon it.
+
+Robert describes an old man who suckled a child, and Meyer discusses
+the case of a castrated man who was said to suckle children. It is said
+that a Bishop of Cork, who gave one-half crown to an old Frenchman of
+seventy, was rewarded by an exhibition of his breasts, which were
+larger than the Bishop had ever seen in a woman. Petrequin speaks of a
+male breast 18 inches long which he amputated, and Laurent gives the
+photograph of a man whose breasts measured 30 cm. in circumference at
+the base, and hung like those of a nursing woman.
+
+In some instances whole families with supernumerary breasts are seen.
+Handyside gives two instances of quadruple breasts in brothers.
+Blanchard speaks of a father who had a supernumerary nipple on each
+breast and his seven sons had the same deformities; it was not noticed
+in the daughters. The youngest son transmitted this anomaly to his four
+sons. Petrequin describes a man with three mammae, two on the left
+side, the third being beneath the others. He had three sons with
+accessory mammae on the right side and two daughters with the same
+anomaly on the left side. Savitzky reports a case of gynecomazia in a
+peasant of twenty-one whose father, elder brother, and a cousin were
+similarly endowed. The patient's breasts were 33 cm. in circumference
+and 15 cm. from the nipple to the base of the gland; they resembled
+normal female mammae in all respects. The penis and the other genitalia
+were normal, but the man had a female voice and absence of facial hair.
+There was an abundance of subcutaneous fat and a rather broad pelvis.
+
+Wiltshire said that he knew a gynecomast in the person of a
+distinguished naturalist who since the age of puberty observed activity
+in his breasts, accompanied with secretion of milky fluid which lasted
+for a period of six weeks and occurred every spring. This authority
+also mentions that the French call husbands who have well-developed
+mammae "la couvade;" the Germans call male supernumerary breasts
+"bauchwarze," or ventral nipples.  Hutchinson describes several cases
+of gynecomazia, in which the external genital organs decreased in
+proportion to the size of the breast and the manners became effeminate.
+Cameron, quoted by Snedden, speaks of a fellow-student who had a
+supernumerary nipple, and also says he saw a case in a little boy who
+had an extra pair of nipples much wider than the ordinary ones.
+Ansiaux, surgeon of Liege, saw a conscript of thirteen whose left mamma
+was well developed like that of a woman, and whose nipple was
+surrounded by a large areola. He said that this breast had always been
+larger than the other, but since puberty had grown greatly; the genital
+organs were well formed. Morgan examined a seaman of twenty-one,
+admitted to the Royal Naval Hospital at Hong Kong, whose right mamma,
+in size and conformation, had the appearance of the well developed
+breast of a full-grown woman. It was lobulated and had a large,
+brown-colored areola; the nipple, however, was of the same size as that
+on the left breast. The man stated that he first observed the breast to
+enlarge at sixteen and a half years; since that time it had steadily
+increased, but there was no milk at any time from the nipple; the
+external genital organs were well and fully developed. He complained of
+no pain or uneasiness except when in drilling aloft his breast came in
+contact with the ropes.
+
+Gruger of St. Petersburg divides gynecomazia into three classes:--
+
+(1) That in which the male generative organs are normal;
+
+(2) In which they are deformed;
+
+(3) In which the anomaly is spurious, the breast being a mass of fat or
+a new growth.
+
+The same journal quotes an instance (possibly Morgan's case) in a young
+man of twenty-one with a deep voice, excellent health, and genitals
+well developed, and who cohabited with his wife regularly. When sixteen
+his right breast began to enlarge, a fact that he attributed to the
+pressure of a rope. Glandular substance could be distinctly felt, but
+there was no milk-secretion. The left breast was normal. Schuchardt has
+collected 272 cases of gynecomazia.
+
+Instances of Men Suckling Infants.--These instances of gynecomazia are
+particularly interesting when the individuals display ability to suckle
+infants. Hunter refers to a man of fifty who shared equally with his
+wife the suckling of their children. There is an instance of a sailor
+who, having lost his wife, took his son to his own breast to quiet him,
+and after three or four days was able to nourish him. Humboldt
+describes a South American peasant of thirty-two who, when his wife
+fell sick immediately after delivery, sustained the child with his own
+milk, which came soon after the application to the breast; for five
+months the child took no other nourishment. In Franklin's "Voyages to
+the Polar Seas" he quotes the instance of an old Chippewa who, on
+losing his wife in childbirth, had put his infant to his breast and
+earnestly prayed that milk might flow; he was fortunate enough to
+eventually produce enough milk to rear the child. The left breast, with
+which he nursed, afterward retained its unusual size. According to
+Mehliss some missionaries in Brazil in the sixteenth century asserted
+that there was a whole Indian nation whose women had small and withered
+breasts, and whose children owed their nourishment entirely to the
+males.  Hall exhibited to his class in Baltimore a negro of fifty-five
+who had suckled all his mistress' family. Dunglison reports this case
+in 1837, and says that the mammae projected seven inches from the
+chest, and that the external genital organs were well developed.
+Paullini and Schenck cite cases of men suckling infants, and Blumenbach
+has described a male-goat which, on account of the engorgement of the
+mammae, it was necessary to milk every other day of the year.
+
+Ford mentions the case of a captain who in order to soothe a child's
+cries put it to his breast, and who subsequently developed a full
+supply of milk. He also quotes an instance of a man suckling his own
+children, and mentions a negro boy of fourteen who secreted milk in one
+breast. Hornor and Pulido y Fernandez also mention similar instances of
+gynecomazia.
+
+Human Odors.--Curious as it may seem, each individual as well as each
+species is in life enveloped with an odor peculiarly its own, due to
+its exhaled breath, its excretions, and principally to its insensible
+perspiration. The faculty of recognizing an odor in different
+individuals, although more developed in savage tribes, is by no means
+unknown in civilized society. Fournier quotes the instance of a young
+man who, like a dog, could smell the enemy by scent, and who by smell
+alone recognized his own wife from other persons.
+
+Fournier also mentions a French woman, an inhabitant of Naples, who had
+an extreme supersensitiveness of smell. The slightest odor was to her
+intolerable; sometimes she could not tolerate the presence of certain
+individuals. She could tell in a numerous circle which women were
+menstruating. This woman could not sleep in a bed which any one else
+had made, and for this reason discharged her maid, preparing her own
+toilet and her sleeping apartments. Cadet de Gassieourt witnessed this
+peculiar instance, and in consultation with several of the physicians
+of Paris attributed this excessive sensitiveness to the climate. There
+is a tale told of a Hungarian monk who affirmed that he was able to
+decide the chastity of females by the sense of smell alone. It is well
+known that some savage tribes with their large, open nostrils not only
+recognize their enemies but also track game the same as hounds.
+
+Individual Odors.--Many individuals are said to have exhaled
+particularly strong odors, and history is full of such instances.  We
+are told by Plutarch that Alexander the Great exhaled an odor similar
+to that of violet flowers, and his undergarments always smelled of this
+natural perfume. It is said that Cujas offered a particular analogy to
+this. On the contrary, there are certain persons spoken of who exhaled
+a sulphurous odor. Martial said that Thais was an example of the class
+of people whose odor was insupportable. Schmidt has inserted in the
+Ephemerides an account of a journeyman saddler, twenty-three years of
+age, of rather robust constitution, whose hands exhaled a smell of
+sulphur so powerful and penetrating as to rapidly fill any room in
+which he happened to be. Rayer was once consulted by a valet-de-chambre
+who could never keep a place in consequence of the odor he left behind
+him in the rooms in which he worked.
+
+Hammond is quoted with saying that when the blessed Venturni of
+Bergamons officiated at the altar people struggled to come near him in
+order to enjoy the odor he exhaled. It was said that St.  Francis de
+Paul, after he had subjected himself to frequent disciplinary
+inflictions, including a fast of thirty-eight to forty days, exhaled a
+most sensible and delicious odor. Hammond attributes the peculiar odors
+of the saints of earlier days to neglect of washing and, in a measure,
+to affections of the nervous system. It may be added that these odors
+were augmented by aromatics, incense, etc., artificially applied. In
+more modern times Malherbe and Haller were said to diffuse from their
+bodies the agreeable odor of musk. These "human flowers," to use
+Goethe's expression, are more highly perfumed in Southern latitudes.
+
+Modifying Causes.--According to Brieude, sex, age, climate, habits,
+ailments, the passions, the emotions, and the occupations modify the
+difference in the humors exhaled, resulting in necessarily different
+odors. Nursing infants have a peculiar sourish smell, caused by the
+butyric acid of the milk, while bottle-fed children smell like strong
+butter. After being weaned the odors of the babies become less decided.
+Boys when they reach puberty exhibit peculiar odors which are similar
+to those of animals when in heat. These odors are leading symptoms of
+what Borden calls "seminal fever" and are more strongly marked in those
+of a voluptuous nature. They are said to be caused by the absorption of
+spermatic fluid into the circulation and its subsequent elimination by
+the skin. This peculiar circumstance, however, is not seen in girls, in
+whom menstruation is sometimes to be distinguished by an odor somewhat
+similar to that of leather. Old age produces an odor similar to that of
+dry leaves, and there have been persons who declared that they could
+tell approximately the age of individuals by the sense of smell.
+
+Certain tribes and races of people have characteristic odors.  Negroes
+have a rank ammoniacal odor, unmitigated by cleanliness; according to
+Pruner-Bey it is due to a volatile oil set free by the sebaceous
+follicles. The Esquimaux and Greenlanders have the odors of their
+greasy and oily foods, and it is said that the Cossacks, who live much
+with their horses, and who are principally vegetarians, will leave the
+atmosphere charged with odors several hours after their passage in
+numbers through a neighborhood. The lower race of Chinamen are
+distinguished by a peculiar musty odor, which may be noticed in the
+laundry shops of this country. Some people, such as the low grade of
+Indians, have odors, not distinctive, and solely due to the filth of
+their persons. Food and drink, as have been mentioned, markedly
+influence the odor of an individual, and those perpetually addicted to
+a special diet or drink have a particular odor.
+
+Odor after Coitus.--Preismann in 1877 makes the statement that for six
+hours after coitus there is a peculiar odor noticeable in the breath,
+owing to a peculiar secretion of the buccal glands.  He says that this
+odor is most perceptible in men of about thirty-five, and can be
+discerned at a distance of from four to six feet. He also adds that
+this fact would be of great medicolegal value in the early arrest of
+those charged with rape.  In this connection the analogy of the breath
+immediately after coitus to the odor of chloroform has been mentioned.
+The same article states that after coitus naturally foul breath becomes
+sweet.
+
+The emotions are said to have a decided influence on the odor of an
+individual. Gambrini, quoted by Monin, mentions a young man,
+unfortunate in love and violently jealous, whose whole body exhaled a
+sickening, pernicious, and fetid odor. Orteschi met a young lady who,
+without any possibility of fraud, exhaled the strong odor of vanilla
+from the commissures of her fingers.
+
+Rayer speaks of a woman under his care at the Hopital de la Charite
+affected with chronic peritonitis, who some time before her death
+exhaled a very decided odor of musk. The smell had been noticed several
+days, but was thought to be due to a bag of musk put purposely into the
+bed to overpower other bad smells. The woman, however, gave full
+assurance that she had no kind of perfume about her and that her
+clothes had been frequently changed. The odor of musk in this case was
+very perceptible on the arms and other portions of the body, but did
+not become more powerful by friction. After continuing for about eight
+days it grew fainter and nearly vanished before the patient's death.
+Speranza relates a similar case.
+
+Complexion.--Pare states that persons of red hair and freckled
+complexion have a noxious exhalation; the odor of prussic acid is said
+to come from dark individuals, while blondes exhale a secretion
+resembling musk. Fat persons frequently have an oleaginous smell.
+
+The disorders of the nervous system are said to be associated with
+peculiar odors. Fevre says the odor of the sweat of lunatics resembles
+that of yellow deer or mice, and Knight remarks that the absence of
+this symptom would enable him to tell whether insanity was feigned or
+not. Burrows declares that in the absence of further evidence he would
+not hesitate to pronounce a person insane if he could perceive certain
+associate odors. Sir William Gull and others are credited with
+asserting that they could detect syphilis by smell. Weir Mitchell has
+observed that in lesions of nerves the corresponding cutaneous area
+exhaled the odor of stagnant water. Hammond refers to three cases under
+his notice in which specific odors were the results of affections of
+the nervous system. One of these cases was a young woman of hysterical
+tendencies who exhaled the odor of violets, which pervaded her
+apartments. This odor was given off the left half of the chest only and
+could be obtained concentrated by collecting the perspiration on a
+handkerchief, heating it with four ounces of spirit, and distilling the
+remaining mixture. The administration of the salicylate of soda
+modified in degree this violaceous odor. Hammond also speaks of a young
+lady subject to chorea whose insensible perspiration had an odor of
+pineapples; a hypochondriac gentleman under his care smelled of
+violets. In this connection he mentions a young woman who, when
+suffering from intense sick headache, exhaled an odor resembling that
+of Limburger cheese.
+
+Barbier met a case of disordered innervation in a captain of infantry,
+the upper half of whose body was subject to such offensive perspiration
+that despite all treatment he had to finally resign his commission.
+
+In lethargy and catalepsy the perspiration very often has a cadaverous
+odor, which has probably occasionally led to a mistaken diagnosis of
+death. Schaper and de Meara speak of persons having a cadaveric odor
+during their entire life.
+
+Various ingesta readily give evidence of themselves by their influence
+upon the breath. It has been remarked that the breath of individuals
+who have recently performed a prolonged necropsy smells for some hours
+of the odor of the cadaver. Such things as copaiba, cubebs, sandalwood,
+alcohol, coffee, etc., have their recognizable fragrance. There is an
+instance of a young woman taking Fowler's solution who had periodic
+offensive axillary sweats that ceased when the medicine was
+discontinued.
+
+Henry of Navarre was a victim of bromidrosis; proximity to him was
+insufferable to his courtiers and mistresses, who said that his odor
+was like that of carrion. Tallemant says that when his wife, Marie de
+Medicis, approached the bridal night with him she perfumed her
+apartments and her person with the essences of the flowers of her
+country in order that she might be spared the disgusting odor of her
+spouse. Some persons are afflicted with an excessive perspiration of
+the feet which often takes a disgusting odor. The inguinoscrotal and
+inguinovulvar perspirations have an aromatic odor like that of the
+genitals of either sex.
+
+During menstruation, hyperidrosis of the axillae diffuses an aromatic
+odor similar to that of acids or chloroform, and in suppression of
+menses, according to the Ephemerides, the odor is as of hops.
+
+Odors of Disease.--The various diseases have their own peculiar odors.
+The "hospital odor," so well known, is essentially variable in
+character and chiefly due to an aggregation of cutaneous exhalations.
+The wards containing women and children are perfumed with butyric acid,
+while those containing men are influenced by the presence of alkalies
+like ammonia.
+
+Gout, icterus, and even cholera (Drasch and Porker) have their own
+odors. Older observers, confirmed by Doppner, say that all the
+plague-patients at Vetlianka diffused an odor of honey. In diabetes
+there is a marked odor of apples. The sweat in dysentery unmistakably
+bears the odor of the dejecta. Behier calls the odor of typhoid that of
+the blood, and Berard says that it attracts flies even before death.
+Typhus has a mouse-like odor, and the following diseases have at
+different times been described as having peculiar odors,--measles, the
+smell of freshly plucked feathers; scarlatina, of bread hot from the
+oven; eczema and impetigo, the smell of mold; and rupia, a decidedly
+offensive odor.
+
+The hair has peculiar odors, differing in individuals. The hair of the
+Chinese is known to have the odor of musk, which cannot be washed away
+by the strongest of chemicals. Often the distinctive odor of a female
+is really due to the odor of great masses of hair. It is said that
+wig-makers simply by the sense of smell can tell whether hair has been
+cut from the living head or from combings, as hair loses its odor when
+it falls out. In the paroxysms of hysteroepilepsy the hair sometimes
+has a specific odor of ozone. Taenia favosa gives to the scalp an odor
+resembling that of cat's urine.
+
+Sexual Influence of Odors.--In this connection it may be mentioned that
+there is a peculiar form of sexual perversion, called by Binet
+"fetichism," in which the subject displays a perverted taste for the
+odors of handkerchiefs, shoes, underclothing, and other articles of
+raiment worn by the opposite sex. Binet maintains that these articles
+play the part of the "fetich" in early theology. It is said that the
+favors given by the ladies to the knights in the Middle Ages were not
+only tokens of remembrance and appreciation, but sexual excitants as
+well. In his remarkable "Osphresiologie," Cloquet calls attention to
+the sexual pleasure excited by the odors of flowers, and tells how
+Richelieu excited his sexual functions by living in an atmosphere
+loaded with these perfumes. In the Orient the harems are perfumed with
+intense extracts and flowers, in accordance with the strong belief in
+the aphrodisiac effect of odors.
+
+Krafft-Ebing quotes several interesting cases in which the connection
+between the olfactory and sexual functions is strikingly verified.
+
+"The case of Henry III shows that contact with a person's perspiration
+may be the exciting cause of passionate love. At the betrothal feast of
+the King of Navarre and Margaret of Valois he accidentally dried his
+face with a garment of Maria of Cleves which was moist with her
+perspiration. Although she was the bride of the Prince of Conde, Henry
+immediately conceived such a passion for her that he could not resist
+it, and, as history shows, made her very unhappy. An analogous instance
+is related of Henry IV, whose passion for the beautiful Gabrielle is
+said to have originated at the instant when, at a ball, he wiped his
+brow with her handkerchief."
+
+Krafft-Ebing also says that "one learns from reading the work of Ploss
+('Das Weib') that attempts to attract a person of the opposite sex by
+means of the perspiration may be discerned in many forms in popular
+psychology. In reference to this a custom is remarkable which holds
+among the natives of the Philippine Islands when they become engaged.
+When it becomes necessary for the engaged pair to separate they
+exchange articles of wearing apparel, by means of which each becomes
+assured of faithfulness.  These objects are carefully preserved,
+covered with kisses, and smelled."
+
+The love of perfumes by libertines and prostitutes, as well as sensual
+women of the higher classes, is quite marked. Heschl reported a case of
+a man of forty-five in whom absence of the olfactory sense was
+associated with imperfect development of the genitals; it is also well
+known that olfactory hallucinations are frequently associated with
+psychoses of an erotic type.
+
+Garnier has recently collected a number of observations of fetichism,
+in which he mentions individuals who have taken sexual satisfaction
+from the odors of shoes, night-dresses, bonnets, drawers, menstrual
+napkins, and other objects of the female toilet. He also mentions
+creatures who have gloated over the odors of the blood and excretions
+from the bodies of women, and gives instances of fetichism of persons
+who have been arrested in the streets of Paris for clipping the long
+hair from young girls.  There are also on record instances of
+homosexual fetichism, a type of disgusting inversion of the sexual
+instinct, which, however, it is not in the province of this work to
+discuss.
+
+Among animals the influence of the olfactory perceptions on the sexual
+sense is unmistakable. According to Krafft Ebing, Althaus shows that
+animals of opposite sexes are drawn to each other by means of olfactory
+perceptions, and that almost all animals at the time of rutting emit a
+very strong odor from their genitals.  It is said that the dog is
+attracted in this way to the bitch several miles away. An experiment by
+Schiff is confirmatory. He extirpated the olfactory nerves of puppies,
+and found that as they grew the male was unable to distinguish the
+female. Certain animals, such as the musk-ox, civet-cat, and beaver,
+possess glands on their sexual organs that secrete materials having a
+very strong odor. Musk, a substance possessing the most penetrating
+odor and used in therapeutics, is obtained from the preputial follicles
+of the musk-deer of Thibet; and castor, a substance less penetrating,
+is obtained from the preputial sacs of the beaver. Virgin moths
+(Bombyx) carried in boxes in the pockets of entomologists will on wide
+commons cause the appearance of males of the same species.
+
+Bulimia is excessive morbid hunger, also called canine appetite.  While
+sometimes present in healthy people, it is most often seen in idiots
+and the insane, and is a symptom of diabetes mellitus.  Mortimer
+mentions a boy of twelve who, while laboring under this affliction, in
+six days devoured food to the extent of 384 pounds and two ounces. He
+constantly vomited, but his craving for food was so insatiable that if
+not satisfied he would devour the flesh off his own bones. Martyn,
+Professor of Botany at Cambridge in the early part of the last century,
+tells of a boy ten years old whose appetite was enormous. He consumed
+in one week 373 pounds of food and drink. His urine and stools were
+voided in normal quantities, the excess being vomited. A pig was fed on
+what he vomited, and was sold in the market. The boy continued in this
+condition for a year, and at last reports was fast failing.  Burroughs
+mentions a laborer at Stanton, near Bury, who ate an ordinary leg of
+veal at a meal, and fed at this extravagant rate for many days
+together. He would eat thistles and other similar herbs greedily. At
+times he would void worms as large as the shank of a clay-pipe, and
+then for a short period the bulimia would disappear.
+
+Johnston mentions a case of bulimia in a man who devoured large
+quantities of raw flesh. There is an instance on record of a case of
+canine appetite in which nearly 400 pounds of solid and fluid elements
+were taken into the body in six days and again ejected.  A recovery was
+effected by giving very concentrated food, frequently repeated in small
+quantities. Mason mentions a woman in St. Bartholomew's Hospital in
+London in the early part of this century who was wretched unless she
+was always eating. Each day she consumed three quartern-loaves, three
+pounds of beef-steak, in addition to large quantities of vegetables,
+meal, etc., and water. Smith describes a boy of fourteen who ate
+continuously fifteen hours out of the twenty-four, and who had eight
+bowel movements each day. One year previous his weight was 105 pounds,
+but when last seen he weighed 284 pounds and was increasing a half
+pound daily. Despite his continuous eating, this boy constantly
+complained of hunger.
+
+Polydipsia is an abnormal thirst; it may be seen in persons otherwise
+normal, or it may be associated with diseases--such as diabetes
+mellitus or diabetes insipidus. Mackenzie quotes a case from Trousseau,
+in which an individual afflicted with diabetes insipidus passed 32
+liters of urine daily and drank enormous quantities of water. This
+patient subjected himself to severe regimen for eight months,--although
+one day, in his agonies, he seized the chamber-pot and drank its
+contents at once. Mackenzie also mentions an infant of three who had
+polydipsia from birth and drank daily nearly two pailfuls of water. At
+the age of twenty-two she married a cobbler, unaware of her propensity,
+who found that his earnings did not suffice to keep her in water alone,
+and he was compelled to melt ice and snow for her. She drank four
+pailfuls a day, the price being 12 sous; water in the community was
+scarce and had to be bought. This woman bore 11 children. At the age of
+forty she appeared before a scientific commission and drank in their
+presence 14 quarts of water in ten hours and passed ten quarts of
+almost colorless urine. Dickinson mentions that he has had patients in
+his own practice who drank their own urine. Mackenzie also quotes
+Trousseau's history of a man who drank a liter of strong French brandy
+in two hours, and habitually drank the same quantity daily. He stated
+that he was free from the effects of alcohol; on several occasions on a
+wager he took 20 liters of wine, gaining his wager without visibly
+affecting his nervous system.
+
+There is an instance of a man of fifty-eight who could not live through
+the night without a pail of water, although his health was otherwise
+good. Atkinson in 1856 reported a young man who in childhood was a
+dirt-eater, though at that time complaining of nothing but excessive
+thirst. He was active, industrious, enjoyed good health, and was not
+addicted to alcoholics. His daily ration of water was from eight to
+twelve gallons. He always placed a tub of water by his bed at night,
+but this sometimes proved insufficient. He had frequently driven hogs
+from mudholes to slake his thirst with the water. He married in 1829
+and moved into Western Tennessee, and in 1854 he was still drinking the
+accustomed amount; and at this time he had grown-up children.  Ware
+mentions a young man of twenty who drank six gallons of water daily. He
+was tormented with thirst, and if he abstained he became weak, sick,
+and dizzy. Throughout a long life he continued his habit, sometimes
+drinking a gallon at one draught; he never used spirits. There are
+three cases of polydipsia reported from London in 1792.
+
+Field describes a boy with bilious remittent fever who would drink
+until his stomach was completely distended and then call for more.
+Emesis was followed by cries for more water. Becoming frantic, he would
+jump from his bed and struggle for the water bucket; failing in this,
+he ran to the kitchen and drank soapsuds, dish-water, and any other
+liquid he could find. He had swallowed a mass of mackerel which he had
+not properly masticated, a fact proved later by ejection of the whole
+mass.  There is a case on record a in which there was intolerable
+thirst after retiring, lasting for a year. There was apparently no
+polydipsia during the daytime.
+
+The amount of water drunk by glass-blowers in a day is almost
+incredible. McElroy has made observations in the glass-factories in his
+neighborhood, and estimates that in the nine working hours of each day
+a glass-blower drinks from 50 to 60 pints of water.  In addition to
+this many are addicted to the use of beer and spirits after working
+hours and at lunch-time. The excreta and urine never seem to be
+perceptibly increased. When not working these men do not drink more
+than three or four pints of water.  Occasionally a man becomes what is
+termed "blown-up with water;" that is, the perspiration ceases, the man
+becomes utterly helpless, has to be carried out, and is disabled until
+the sweating process is restored by vigorously applied friction.  There
+is little deleterious change noticed in these men; in fact, they are
+rarely invalids.
+
+Hydroadipsia is a lack of thirst or absence of the normal desire for
+water. In some of these cases there is a central lesion which accounts
+for the symptoms. McElroy, among other cases, speaks of one in a
+patient who was continually dull and listless, eating little, and
+complaining of much pain after the least food. This, too, will be
+mentioned under abstinence.
+
+Perverted appetites are of great variety and present many interesting
+as well as disgusting examples of anomalies. In some cases the tastes
+of people differ so that an article considered by one race as
+disgusting would be held as a delicacy by another class. The ancients
+used asafetida as a seasoning, and what we have called "stercus
+diaboli," the Asiatics have named the "food of the gods." The
+inhabitants of Greenland drink the oil of the whale with as much
+avidity as we would a delicate wine, and they eat blubber the mere
+smell of which nauseates an European. In some nations of the lower
+grade, insects, worms, serpents, etc., are considered edible. The
+inhabitants of the interior of Africa are said to relish the flesh of
+serpents and eat grubs and worms.  The very earliest accounts of the
+Indians of Florida and Texas show that "for food, they dug roots, and
+that they ate spiders, ants' eggs, worms, lizards, salamanders, snakes,
+earth, wood, the dung of deer, and many other things." Gomara, in his
+"Historia de les Indias," says this loathsome diet was particular to
+one tribe, the Yagusces of Florida. It is said that a Russian peasant
+prefers a rotten egg to a fresh one; and there are persons who prefer
+game partly spoiled.
+
+Bourke recalls that the drinking of human urine has often been a
+religious rite, and describes the urine-dance of the Zunis of New
+Mexico, in which the participants drink freely of their urine; he draws
+an analogy to the Feast of the Fools, a religious custom of Pagan
+origin which did not disappear in Europe until the time of the
+Reformation. It is still a practice in some parts of the United States
+to give children fresh urine for certain diseases.  It is said that the
+ordure of the Grand Lama of Thibet was at one time so venerated that it
+was collected and worn as amulets.
+
+The disgusting habit of eating human excrement is mentioned by Schurig,
+who gives numerous examples in epileptics, maniacs, chlorotic young
+women, pregnant women, children who have soiled their beds and,
+dreading detection, have swallowed their ejecta, and finally among men
+and women with abnormal appetites. The Indians of North America
+consider a broth made from the dung of the hare and caribou a dainty
+dish, and according to Abbe Domenech, as a means of imparting a flavor,
+the bands near Lake Superior mix their rice with the excrement of
+rabbits. De Bry mentions that the negroes of Guinea ate filthy,
+stinking elephant-meat and buffalo-flesh infested with thousands of
+maggots, and says that they ravenously devoured dogs' guts raw.
+Spencer, in his "Descriptive Sociology," describes a "Snake savage" of
+Australia who devoured the contents of entrails of an animal. Some
+authors have said that within the last century the Hottentots devoured
+the flesh and the entrails of wild beasts, uncleansed of their filth
+and excrement, and whether sound or rotten. In a personal letter to
+Captain Bourke, the Reverend J.  Owen Dorsey reports that while among
+the Ponkas he saw a woman and child devour the entrails of a beef with
+their contents.  Bourke also cites instances in which human ordure was
+eaten by East Indian fanatics. Numerous authorities are quoted by
+Bourke to prove the alleged use of ordure in food by the ancient
+Israelites. Pages of such reference are to be found in the works on
+Scatology, and for further reference the reader is referred to books on
+this subject, of which prominent in English literature is that of
+Bourke.
+
+Probably the most revolting of all the perverted tastes is that for
+human flesh. This is called anthropophagy or cannibalism, and is a
+time-honored custom among some of the tribes of Africa. This custom is
+often practised more in the spirit of vengeance than of real desire for
+food. Prisoners of war were killed and eaten, sometimes cooked, and
+among some tribes raw. In their religious frenzy the Aztecs ate the
+remains of the human beings who were sacrificed to their idols. At
+other times cannibalism has been a necessity. In a famine in Egypt, as
+pictured by the Arab Abdullatif, the putrefying debris of animals, as
+well as their excrement, was used as food, and finally the human dead
+were used; then infants were killed and devoured, so great was the
+distress. In many sieges, shipwrecks, etc., cannibalism has been
+practiced as a last resort for sustaining life. When supplies have
+given out several Arctic explorers have had to resort to eating the
+bodies of their comrades. In the famous Wiertz Museum in Brussels is a
+painting by this eccentric artist in which he has graphically portrayed
+a woman driven to insanity by hunger, who has actually destroyed her
+child with a view to cannibalism.  At the siege of Rochelle it is
+related that, urged by starvation, a father and mother dug up the
+scarcely cold body of their daughter and ate it. At the siege of Paris
+by Henry IV the cemeteries furnished food for the starving. One mother
+in imitation of what occurred at the siege of Jerusalem roasted the
+limbs of her dead child and died of grief under this revolting
+nourishment.
+
+St. Jerome states that he saw Scotchmen in the Roman armies in Gaul
+whose regular diet was human flesh, and who had "double teeth all
+around."
+
+Cannibalism, according to a prominent New York journal, has been
+recently made a special study by the Bureau of Ethnology at Washington,
+D.C. Data on the subject have been gathered from all parts of the
+world, which are particularly interesting in view of discoveries
+pointing to the conclusion that this horrible practice is far more
+widespread than was imagined. Stanley claims that 30,000,000 cannibals
+dwell in the basin of the Congo to-day--people who relish human flesh
+above all other meat.  Perah, the most peculiar form of cannibalism, is
+found in certain mountainous districts of northeast Burmah, where there
+are tribes that follow a life in all important respects like that of
+wild beasts. These people eat the congealed blood of their enemies.
+The blood is poured into bamboo reeds, and in the course of time, being
+corked up, it hardens. The filled reeds are hung under the roofs of the
+huts, and when a person desires to treat his friends very hospitably
+the reeds are broken and the contents devoured.
+
+"The black natives of Australia are all professed cannibals. Dr. Carl
+Lumholtz, a Norwegian scientist, spent many months in studying them in
+the wilds of the interior. He was alone among these savages, who are
+extremely treacherous. Wearing no clothing whatever, and living in
+nearly every respect as monkeys do, they know no such thing as
+gratitude, and have no feeling that can be properly termed human. Only
+fear of the traveler's weapons prevented them from slaying him, and
+more than once he had a narrow escape. One of the first of them whom he
+employed looked more like a brute than a man. 'When he talked,' says
+the doctor, 'he rubbed his belly with complacency, as if the sight of
+me made his mouth water.' This individual was regarded with much
+respect by his fellows because of his success in procuring human flesh
+to eat. These aborigines say that the white man's flesh is salt and
+occasions nausea. A Chinaman they consider as good for eating as a
+black man, his food being chiefly vegetable.
+
+"The most horrible development of cannibalism among the Australian
+blacks is the eating of defunct relatives. When a person dies there
+follows an elaborate ceremony, which terminates with the lowering of
+the corpse into the grave. In the grave is a man not related to the
+deceased, who proceeds to cut off the fat adhering to the muscles of
+the face, thighs, arms, and stomach, and passes it around to be
+swallowed by some of the near relatives. All those who have eaten of
+the cadaver have a black ring of charcoal powder and fat drawn around
+the mouth. The order in which the mourners partake of their dead
+relatives is duly prescribed. The mother eats of her children and the
+children of their mother. A man eats of his sister's husband and of his
+brother's wife. Mothers' brothers, mothers' sisters, sisters' children,
+mothers' parents, and daughters' children are also eaten by those to
+whom the deceased person stands in such relation. But the father does
+not eat of his children, nor the children of their sire.
+
+"The New Zealanders, up to very recent times, were probably the most
+anthropophagous race that ever existed. As many as 1000 prisoners have
+been slaughtered by them at one time after a successful battle, the
+bodies being baked in ovens underground.  If the individual consumed
+had been a redoubtable enemy they dried his head as a trophy and made
+flutes of his thigh bones.
+
+"Among the Monbuttos of Africa human fat is commonly employed for a
+variety of purposes. The explorer Schweinfurth speaks of writing out in
+the evenings his memoranda respecting these people by the light of a
+little oil-lamp contrived by himself, which was supplied with some
+questionable-looking grease furnished by the natives. The smell of this
+grease, he says, could not fail to arouse one's worst suspicions
+against the negroes. According to his account the Monbuttos are the
+most confirmed cannibals in Africa. Surrounded as they are by a number
+of peoples who are blacker than themselves, and who, being inferior to
+them in culture, are held in contempt, they carry on expeditions of war
+and plunder which result in the acquisition of a booty especially
+coveted by them--namely, human flesh. The bodies of all foes who fall
+in battle are distributed on the field among the victors, and are
+prepared by drying for transportation. The savages drive their
+prisoners before them, and these are reserved for killing at a later
+time. During Schweinfurth's residence at the Court of Munza it was
+generally understood that nearly every day a little child was
+sacrificed to supply a meal for the ogre potentate. For centuries past
+the slave trade in the Congo Basin has been conducted largely for the
+purpose of furnishing human flesh to consumers. Slaves are sold and
+bought in great numbers for market, and are fattened for slaughter.
+
+"The Mundurucus of the Upper Amazon, who are exceedingly ferocious,
+have been accused of cannibalism. It is they who preserve human heads
+in such a remarkable way. When one of their warriors has killed an
+enemy he cuts off the head with his bamboo knife, removes the brain,
+soaks the head in a vegetable oil, takes out bones of the skull, and
+dries the remaining parts by putting hot pebbles inside of it. At the
+same time care is taken to preserve all the features and the hair
+intact. By repeating the process with the hot pebbles many times the
+head finally becomes shrunken to that of a small doll, though still
+retaining its human aspect, so that the effect produced is very weird
+and uncanny. Lastly, the head is decorated with brilliant feathers, and
+the lips are fastened together with a string, by which the head is
+suspended from the rafters of the council-house."
+
+Ancient Customs.--According to Herodotus the ancient Lydians and Medes,
+and according to Plato the islanders in the Atlantic, cemented
+friendship by drinking human blood. Tacitus speaks of Asian princes
+swearing allegiance with their own blood, which they drank. Juvenal
+says that the Scythians drank the blood of their enemies to quench
+their thirst.
+
+Occasionally a religious ceremony has given sanction to cannibalism. It
+is said that in the Island of Chios there was a rite by way of
+sacrifice to Dionysius in which a man was torn limb from limb, and
+Faber tells us that the Cretans had an annual festival in which they
+tore a living bull with their teeth.  Spencer quotes that among the
+Bacchic orgies of many of the tribes of North America, at the
+inauguration of one of the Clallum chiefs on the northwest coast of
+British America, the chief seized a small dog and began to devour it
+alive, and also bit the shoulders of bystanders. In speaking of these
+ceremonies, Boas, quoted by Bourke, says that members of the tribes
+practicing Hamatsa ceremonies show remarkable scars produced by biting,
+and at certain festivals ritualistic cannibalism is practiced, it being
+the duty of the Hamatsa to bite portions of flesh out of the arms,
+legs, or breast of a man.
+
+Another cause of cannibalism, and the one which deserves discussion
+here, is genuine perversion or depravity of the appetite for human
+flesh among civilized persons,--the desire sometimes being so strong as
+to lead to actual murder. Several examples of this anomaly are on
+record. Gruner of Jena speaks of a man by the name of Goldschmidt, in
+the environs of Weimar, who developed a depraved appetite for human
+flesh. He was married at twenty-seven, and for twenty-eight years
+exercised his calling as a cow-herd. Nothing extraordinary was noticed
+in him, except his rudeness of manner and his choleric and gross
+disposition. In 1771, at the age of fifty-five, he met a young traveler
+in the woods, and accused him of frightening his cows; a discussion
+arose, and subsequently a quarrel, in which Goldschmidt killed his
+antagonist by a blow with a stick which he used. To avoid detection he
+dragged the body to the bushes, cut it up, and took it home in
+sections. He then washed, boiled, and ate each piece.  Subsequently, he
+developed a further taste for human flesh, and was finally detected in
+eating a child which he had enticed into his house and killed. He
+acknowledged his appetite before his trial.
+
+Hector Boetius says that a Scotch brigand and his wife and children
+were condemned to death on proof that they killed and ate their
+prisoners. The extreme youth of one of the girls excused her from
+capital punishment; but at twelve years she was found guilty of the
+same crime as her father and suffered capital punishment. This child
+had been brought up in good surroundings, yet her inherited appetite
+developed. Gall tells of an individual who, instigated by an
+irresistible desire to eat human flesh, assassinated many persons; and
+his daughter, though educated away from him, yielded to the same
+graving.
+
+At Bicetre there was an individual who had a horribly depraved appetite
+for decaying human flesh. He would haunt the graveyards and eat the
+putrefying remains of the recently buried, preferring the intestines.
+Having regaled himself in a midnight prowl, he would fill his pockets
+for future use. When interrogated on the subject of his depravity he
+said it had existed since childhood.  He acknowledged the greatest
+desire to devour children he would meet playing; but he did not possess
+the courage to kill them.
+
+Prochaska quotes the case of a woman of Milan who attracted children to
+her home in order that she might slay, salt, and eat them. About 1600,
+there is the record of a boy named Jean Granier, who had repeatedly
+killed and devoured several young children before he was discovered.
+Rodericus a Castro tells of a pregnant woman who so strongly desired to
+eat the shoulder of a baker that she killed him, salted his body, and
+devoured it at intervals.
+
+There is a record of a woman who in July, 1817, was discovered in
+cooking an amputated leg of her little child. Gorget in 1827 reported
+the celebrated case of Leger the vine dresser, who at the age of
+twenty-four wandered about a forest for eight days during an attack of
+depression. Coming across a girl of twelve, he violated her, and then
+mutilated her genitals, and tore out her heart, eating of it, and
+drinking the blood. He finally confessed his crime with calm
+indifference. After Leger's execution Esquirol found morbid adhesions
+between the brain and the cerebral membranes. Mascha relates a similar
+instance in a man of fifty-five who violated and killed a young girl,
+eating of her genitals and mammae. At the trial he begged for
+execution, saying that the inner impulse that led him to his crime
+constantly persecuted him.
+
+A modern example of lust-murder and anthropophagy is that of Menesclou,
+who was examined by Brouardel, Motet, and others, and declared to be
+mentally sound; he was convicted. This miscreant was arrested with the
+forearm of a missing child in his pocket, and in his stove were found
+the head and entrails in a half-burnt condition. Parts of the body were
+found in the water-closet, but the genitals were missing; he was
+executed, although he made no confession, saying the deed was an
+accident. Morbid changes were found in his brain. Krafft-Ebing cites
+the case of Alton, a clerk in England, who lured a child into a
+thicket, and after a time returned to his office, where he made an
+entry in his note-book: "Killed to-day a young girl; it was fine and
+hot." The child was missed, searched for, and found cut into pieces.
+Many parts, and among them the genitals, could not be found. Alton did
+not show the slightest trace of emotion, and gave no explanation of the
+motive or circumstances of his horrible deed; he was executed.
+
+D'Amador tells of persons who went into slaughter-houses and
+waste-places to dispute with wolves for the most revolting carrion. It
+is also mentioned that patients in hospitals have been detected in
+drinking the blood of patients after venesections, and in other
+instances frequenting dead-houses and sucking the blood of the recently
+deceased. Du Saulle quotes the case of a chlorotic girl of fourteen who
+eagerly drank human blood. She preferred that flowing fresh from a
+recent wound.
+
+Further Examples of Depraved Appetites.--Bijoux speaks of a porter or
+garcon at the Jardin des Plantes in Paris who was a prodigious glutton.
+He had eaten the body of a lion that had died of disease at the
+menagerie. He ate with avidity the most disgusting things to satiate
+his depraved appetite. He showed further signs of a perverted mind by
+classifying the animals of the menagerie according to the form of their
+excrement, of which he had a collection. He died of indigestion
+following a meal of eight pounds of hot bread.
+
+Percy saw the famous Tarrare, who died at Versailles, at about
+twenty-six years of age. At seventeen he weighed 100 pounds. He ate a
+quarter of beef in twenty-four hours. He was fond of the most revolting
+things. He particularly relished the flesh of serpents and would
+quickly devour the largest. In the presence of Lorenze he seized a live
+cat with his teeth, eventrated it, sucked its blood, and ate it,
+leaving the bare skeleton only. In about thirty minutes he rejected the
+hairs in the manner of birds of prey and carnivorous animals. He also
+ate dogs in the same manner. On one occasion it was said that he
+swallowed a living eel without chewing it; but he had first bitten off
+its head. He ate almost instantly a dinner that had been prepared for
+15 vigorous workmen and drank the accompanying water and took their
+aggregate allowance of salt at the same time. After this meal his
+abdomen was so swollen that it resembled a balloon. He was seen by
+Courville, a surgeon-major in a military hospital, where he had
+swallowed a wooden box wrapped in plain white paper. This he passed the
+next day with the paper intact. The General-in-chief had seen him
+devour thirty pounds of raw liver and lungs. Nothing seemed to diminish
+his appetite. He waited around butcher-shops to eat what was discarded
+for the dogs. He drank the bleedings of the hospital and ate the dead
+from the dead-houses. He was suspected of eating a child of fourteen
+months, but no proof could be produced of this. He was of middle height
+and was always heated and sweating. He died of a purulent diarrhea, all
+his intestines and peritoneum being in a suppurating condition.
+
+Fulton mentions a girl of six who exhibited a marked taste for feeding
+on slugs, beetles, cockroaches, spiders, and repulsive insects. This
+child had been carefully brought up and was one of 13 children, none of
+whom displayed any similar depravity of appetite. The child was of good
+disposition and slightly below the normal mental standard for her age.
+At the age of fourteen her appetite became normal.
+
+In the older writings many curious instances of abnormal appetite are
+seen. Borellus speaks of individuals swallowing stones, horns,
+serpents, and toads. Plater mentions snail-eating and eel-eating, two
+customs still extant. Rhodius is accredited with seeing persons who
+swallowed spiders and scorpions. Jonston says that Avicenna, Rufus, and
+Gentilis relate instances of young girls who acquired a taste for
+poisonous animals and substances, who could ingest them with impunity.
+Colonia Agrippina was supposed to have eaten spiders with impunity. Van
+Woensel is said to have seen persons who devoured live eels.
+
+The habit of dirt eating or clay-eating, called pica, is well
+authenticated in many countries. The Ephemerides contains mention of
+it; Hunter speaks of the blacks who eat potters' clay; Bartholinus
+describes dirt-eating as does also a Castro. Properly speaking,
+dirt-eating should be called geophagism; it is common in the Antilles
+and South America, among the low classes, and is seen in the negroes
+and poorest classes of some portions of the Southern United States. It
+has also been reported from Java, China, Japan, and is said to have
+been seen in Spain and Portugal. Peat-eating or bog-eating is still
+seen in some parts of Ireland.
+
+There were a number of people in the sixteenth and seventeenth
+centuries who had formed the habit of eating small pebbles after each
+meal. They formed the habit from seeing birds swallowing gravel after
+eating. A number of such cases are on record.
+
+There is on record the account of a man living in Wurtemberg who with
+much voracity had eaten a suckling pig, and sometimes devoured an
+entire sheep. He swallowed dirt, clay, pebbles, and glass, and was
+addicted to intoxication by brandy. He lived sixty years in this manner
+and then he became abstemious; he died at seventy-nine. His omentum was
+very lean, but the liver covered all his abdominal viscera. His stomach
+was very large and thick, but the intestines were very narrow.
+
+Ely had a patient who was addicted to chalk-eating; this ha said
+invariably relieved his gastric irritation. In the twenty-five years of
+the habit he had used over 1/2 ton of chalk; but notwithstanding this
+he always enjoyed good health. The Ephemerides contains a similar
+instance, and Verzascha mentions a lime-eater. Adams mentions a child
+of three who had an instinctive desire to eat mortar. This baby was
+rickety and had carious teeth. It would pick its preferred diet out of
+the wall, and if prevented would cry loudly. When deprived of the
+mortar it would vomit its food until this substance was given to it
+again.  At the time of report part of the routine duties of the sisters
+of this boy was to supply him with mortar containing a little sand.
+Lime-water was substituted, but he insisted so vigorously on the solid
+form of food that it had to be replaced in his diet.  He suffered from
+small-pox; on waking up in the night with a fever, he always cried for
+a piece of mortar. The quantity consumed in twenty-four hours was about
+1/2 teacupful. The child had never been weaned.
+
+Arsenic Eaters.--It has been frequently stated that the peasants of
+Styria are in the habit of taking from two to five grains of arsenious
+acid daily for the purpose of improving the health, avoiding infection,
+and raising the whole tone of the body. It is a well-substantiated fact
+that the quantities taken habitually are quite sufficient to produce
+immediate death ordinarily. But the same might be easily said of those
+addicted to opium and chloral, a subject that will be considered later.
+Perverted appetites during pregnancy have been discussed on pages 80
+and 81.
+
+Glass-eaters, penknife-swallowers, and sword-swallowers, being
+exhibitionists and jugglers, and not individuals with perverted
+appetites, will be considered in Chapter XII.
+
+Fasting.--The length of time which a person can live with complete
+abstinence from food is quite variable. Hippocrates admits the
+possibility of fasting more than six days without a fatal issue; but
+Pliny and others allow a much longer time, and both the ancient and
+modern literature of medicine are replete with examples of abstinence
+to almost incredible lengths of time.  Formerly, and particularly in
+the Middle Ages when religious frenzy was at its highest pitch,
+prolonged abstinence was prompted by a desire to do penance and to gain
+the approbation of Heaven.
+
+In many religions fasting has become a part of worship or religions
+ceremony, and from the earliest times certain sects have carried this
+custom to extremes. It is well known that some of the priests and
+anchorites of the East now subsist on the minimum amount of food, and
+from the earliest times before the advent of Christianity we find
+instances of prolonged fasting associated with religious worship. The
+Assyrians, the Hebrews, the Egyptians, and other Eastern nations, and
+also the Greeks and Romans, as well as feasting days, had their times
+of fasting, and some of these were quite prolonged.
+
+At the present day religious fervor accounts for but few of our
+remarkable instances of abstinence, most of them being due to some form
+of nervous disorder, varying from hysteria and melancholia to absolute
+insanity. The ability seen in the Middle Ages to live on the Holy
+Sacrament and to resist starvation may possibly have its analogy in
+some of the fasting girls of the present day. In the older times these
+persons were said to have been nourished by angels or devils; but
+according to Hammond many cases both of diabolical abstinence from food
+and of holy fasting exhibited manifest signs of hysteric symptoms.
+Hammond, in his exhaustive treatise on the subject of "Fasting Girls,"
+also remarks that some of the chronicles detail the exact symptoms of
+hysteria and without hesitation ascribe them to a devilish agency. For
+instance, he speaks of a young girl in the valley of Calepino who had
+all her limbs twisted and contracted and had a sensation in her
+esophagus as if a ball was sometimes rising in her throat or falling
+into the stomach--a rather lay description of the characteristic
+hysteric "lump in the throat," a frequent sign of nervous abstinence.
+
+Abstinence, or rather anorexia, is naturally associated with numerous
+diseases, particularly of the febrile type; but in all of these the
+patient is maintained by the use of nutrient enemata or by other means,
+and the abstinence is never complete.
+
+A peculiar type of anorexia is that striking and remarkable digestive
+disturbance of hysteria which Sir William Gull has called anorexia
+nervosa. In this malady there is such annihilation of the appetite that
+in some cases it seems impossible ever to eat again. Out of it grows an
+antagonism to food which results at last, and in its worst forms, in
+spasm on the approach of food, and this in its turn gives rise to some
+of those remarkable cases of survival for long periods without food.
+As this goes on there may be an extreme degree of muscular
+restlessness, so that the patients wander about until exhausted.
+According to Osler, who reports a fatal case in a girl who, at her
+death, only weighed 49 pounds, nothing more pitiable is to be seen in
+medical practice than an advanced case of this malady.  The emaciation
+and exhaustion are extreme, and the patient is as miserable as one with
+carcinoma of the esophagus, food either not being taken at all or only
+upon urgent compulsion.
+
+Gull mentions a girl of fourteen, of healthy, plump appearance, who in
+the beginning of February, 1887, without apparent cause evinced a great
+repugnance to food and soon afterward declined to take anything but a
+half cup of tea or coffee. Gull saw her in April, when she was much
+emaciated; she persisted in walking through the streets, where she was
+the object of remark of passers-by. At this time her height was five
+feet four inches, her weight 63 pounds, her temperature 97 degrees F.,
+her pulse 46, and her respiration from 12 to 14. She had a persistent
+wish to be moving all the time, despite her emaciation and the
+exhaustion of the nutritive functions.
+
+There is another class of abstainers from food exemplified in the
+exhibitionists who either for notoriety or for wages demonstrate their
+ability to forego eating, and sometimes drinking, for long periods.
+Some have been clever frauds, who by means of artifices have carried on
+skilful deceptions; others have been really interesting physiologic
+anomalies.
+
+Older Instances.--Democritus in 323 B.C. is said to have lived forty
+days by simply smelling honey and hot bread. Hippocrates remarks that
+most of those who endeavored to abstain five days died within that
+period, and even if they were prevailed upon to eat and drink before
+the termination of their fast they still perished. There is a
+possibility that some of these cases of Hippocrates were instances of
+pyloric carcinoma or of stenosis of the pylorus. In the older writings
+there are instances reported in which the period of abstinence has
+varied from a short time to endurance beyond the bounds of credulity.
+Hufeland mentions total abstinence from food for seventeen days, and
+there is a contemporary case of abstinence for forty days in a maniac
+who subsisted solely on water and tobacco. Bolsot speaks of abstinence
+for fourteen months, and Consbruch mentions a girl who fasted eighteen
+months. Muller mentions an old man of forty-five who lived six weeks on
+cold water. There is an instance of a person living in a cave
+twenty-four days without food or drink, and another of a man who
+survived five weeks' burial under ruins.  Ramazzini speaks of fasting
+sixty-six days; Willian, sixty days (resulting in death); von Wocher,
+thirty-seven days (associated with tetanus); Lantana, sixty days;
+Hobbes, forty days; Marcardier, six months; Cruikshank, two months; the
+Ephemerides, thirteen months; Gerard, sixty-nine days (resulting in
+death); and in 1722 there was recorded an instance of abstinence
+lasting twenty-five months.
+
+Desbarreaux-Bernard says that Guillaume Granie died in the prison of
+Toulouse in 1831, after a voluntary suicidal abstinence of sixty-three
+days.
+
+Haller cites a number of examples of long abstinence, but most
+extraordinary was that of a girl of Confolens, described by Citois of
+Poitiers, who published a history of the case in the beginning of the
+seventeenth century. This girl is said to have passed three entire
+years, from eleven to fourteen, without taking any kind of aliment. In
+the "Harleian Miscellanies" is a copy of a paper humbly offered to the
+Royal Society by John Reynolds, containing a discourse upon prodigious
+abstinence, occasioned by the twelve months' fasting of a woman named
+Martha Taylor, a damsel of Derbyshire. Plot gives a great variety of
+curious anecdotes of prolonged abstinence. Ames refers to "the true and
+admirable history of the maiden of Confolens," mentioned by Haller. In
+the Annual Register, vol. i., is an account of three persons who were
+buried five weeks in the snow; and in the same journal, in 1762, is the
+history of a girl who is said to have subsisted nearly four years on
+water. In 1684 four miners were buried in a coal-pit in Horstel, a half
+mile from Liege, Belgium, and lived twenty-four days without food,
+eventually making good recoveries. An analysis of the water used during
+their confinement showed an almost total absence of organic matter and
+only a slight residue of calcium salts.
+
+Joanna Crippen lay six days in the snow without nutriment, being
+overcome by the cold while on the way to her house; she recovered
+despite her exposure. Somis, physician to the King of Sardinia, gives
+an account of three women of Piedmont, Italy, who were saved from the
+ruins of a stable where they had been buried by an avalanche of snow,
+March 19, 1765. thirty-seven days before.  Thirty houses and 22
+inhabitants were buried in this catastrophe, and these three women,
+together with a child of two, were sheltered in a stable over which the
+snow lodged 42 feet deep.  They were in a manger 20 inches broad and
+upheld by a strong arch. Their enforced position was with their backs
+to the wall and their knees to their faces. One woman had 15 chestnuts,
+and, fortunately, there were two goats near by, and within reach some
+hay, sufficient to feed them for a short time. By milking one of the
+goats which had a kid, they obtained about two pints daily, upon which
+they subsisted for a time. They quenched their thirst with melted snow
+liquefied by the heat of their hands. Their sufferings were greatly
+increased by the filth, extreme cold, and their uncomfortable
+positions; their clothes had rotted. When they were taken out their
+eyes were unable to endure the light and their stomachs at first
+rejected all food.
+
+While returning from Cambridge, February 2, 1799, Elizabeth Woodcock
+dismounted from her horse, which ran away, leaving her in a violent
+snowstorm. She was soon overwhelmed by an enormous drift six feet high.
+The sensation of hunger ceased after the first day and that of thirst
+predominated, which she quenched by sucking snow. She was discovered on
+the 10th of February, and although suffering from extensive gangrene of
+the toes, she recovered. Hamilton says that at a barracks near Oppido,
+celebrated for its earthquakes, there were rescued two girls, one
+sixteen and the other eleven; the former had remained under the ruins
+without food for eleven days. This poor creature had counted the days
+by a light coming through a small opening. The other girl remained six
+days under the ruin in a confined and distressing posture, her hands
+pressing her cheek until they had almost made a hole in it. Two persons
+were buried under earthquake ruins at Messina for twenty-three and
+twenty-two days each.
+
+Thomas Creaser gives the history of Joseph Lockier of Bath, who, while
+going through a woods between 6 and 7 P.M., on the 18th of August, was
+struck insensible by a violent thunderbolt. His senses gradually
+returned and he felt excessively cold. His clothes were wet, and his
+feet so swollen that the power of the lower extremities was totally
+gone and that of the arms was much impaired. For a long time he was
+unable to articulate or to summon assistance. Early in September he
+heard some persons in the wood and, having managed to summon them in a
+feeble voice, told them his story. They declared him to be an impostor
+and left him. On the evening of the same day his late master came to
+his assistance and removed him to Swan Inn. He affirmed that during his
+exposure in the woods he had nothing to eat; though distressing at
+first, hunger soon subsided and yielded to thirst, which he appeased by
+chewing grass having beads of water thereon.  He slept during the
+warmth of the day, but the cold kept him awake at night. During his
+sleep he dreamt of eating and drinking. On November 17, 1806, several
+surgeons of Bath made an affidavit, in which they stated that this man
+was admitted to the Bath City Dispensary on September 15th, almost a
+month after his reputed stroke, in an extremely emaciated condition,
+with his legs and thighs shriveled as well as motionless. There were
+several livid spots on his legs and one toe was gangrenous. After some
+time they amputated the toe. The power in the lower extremities soon
+returned.
+
+In relating his travels in the Levant, Hasselquist mentions 1000
+Abyssinians who became destitute of provisions while en route to Cairo,
+and who lived two months on gum arabic alone, arriving at their
+destination without any unusual sickness or mortality. Dr. Franklin
+lived on bread and water for a fortnight, at the rate of ten pounds per
+week, and maintained himself stout and healthy.  Sir John Pringle knew
+a lady of ninety who lived on pure fat meat. Glower of Chelmsford had a
+patient who lived ten years on a pint of tea daily, only now or then
+chewing a half dozen raisins or almonds, but not swallowing them. Once
+in long intervals she took a little bread.
+
+Brassavolus describes a younger daughter of Frederick King of Naples
+who lived entirely without meat, and could not endure even the taste of
+it, as often as she put any in her mouth she fell fainting. The monks
+of Monte Santo (Mount Athos) never touched animal food, but lived on
+vegetables, olives, end cheese. In 1806 one of them at the age of one
+hundred and twenty was healthy.
+
+Sometimes in the older writings we find records of incredible
+abstinence. Jonston speaks of a man in 1460 who, after an unfortunate
+matrimonial experience, lived alone for fifteen years, taking neither
+food nor drink. Petrus Aponensis cites the instance of a girl fasting
+for eight years. According to Jonston, Hermolus lived forty years on
+air alone. This same author has also collected cases of abstinence
+lasting eleven, twenty-two, and thirty years and cites Aristotle as an
+authority in substantiating his instances of fasting girls.
+
+Wadd, the celebrated authority on corpulence, quotes Pennant in
+mentioning a woman in Rosshire who lived one and three-quarters years
+without meat or drink. Granger had under observation a woman by the
+name of Ann Moore, fifty-eight years of age, who fasted for two years.
+Fabricius Hildanus relates of Apollonia Schreiera that she lived three
+years without meat or drink. He also tells of Eva Flegen, who began to
+fast in 1596, and from that time on for sixteen years, lived without
+meat or drink.  According to the Rev. Thos. Steill, Janet Young fasted
+sixteen years and partially prolonged her abstinence for fifty years.
+The Edinburgh Medical and Surgical Journal, which contains a mention of
+the foregoing case, also describes the case of Janet Macleod, who
+fasted for four years, showing no signs of emaciation.  Benjamin Rush
+speaks of a case mentioned in a letter to St.  George Tucker, from J.
+A. Stuart, of a man who, after receiving no benefit from a year's
+treatment for hemiplegia, resolved to starve himself to death. He
+totally abstained from food for sixty days, living on water and chewing
+apples, but spitting out the pulp; at the expiration of this time he
+died. Eccles relates the history of a beautiful young woman of sixteen,
+who upon the death of a most indulgent father refused food for
+thirty-four days, and soon afterward for fifty-four days, losing all
+her senses but that of touch.
+
+There is an account of a French adventurer, the Chevalier de
+Saint-Lubin, who had a loathing for food and abstained from every kind
+of meat and drink for fifty-eight days. Saint-Sauver, at that time
+Lieutenant of the Bastille, put a close watch on this man and certified
+to the verity of the fast. The European Magazine in 1783 contained an
+account of the Calabria earthquake, at which time a girl of eighteen
+was buried under ruins for six days. The edge of a barrel fell on her
+ankle and partly separated it, the dust and mortar effectually stopping
+the hemorrhage. The foot dropped off and the wound healed without
+medical assistance, the girl making a complete recovery. There is an
+account taken from a document in the Vatican of a man living in 1306,
+in the reign of Pope Clement V, who fasted for two years. McNaughton
+mentions Rubin Kelsey, a medical student afflicted with melancholia,
+who voluntarily fasted for fifty-three days, drinking copiously and
+greedily of water. For the first six weeks he walked about, and was
+strong to the day of his death.
+
+Hammond has proved many of the reports of "fasting girls" to have been
+untrustworthy. The case of Miss Faucher of Brooklyn, who was supposed
+to have taken no food for fourteen years, was fraudulent. He says that
+Ann Moore was fed by her daughter in several ways; when washing her
+mother's face she used towels wet with gravy, milk, or strong
+arrow-root meal. She also conveyed food to her mother by means of
+kisses. One of the "fasting girls," Margaret Weiss, although only ten
+years old, had such powers of deception that after being watched by the
+priest of the parish, Dr. Bucoldianus, she was considered free from
+juggling, and, to everybody's astonishment, she grew, walked, and
+talked like other children of her age, still maintaining that she used
+neither food nor drink. In several other cases reported all attempts to
+discover imposture failed. As we approach more modern times the
+detection is more frequent. Sarah Jacobs, the Welsh fasting girl who
+attained such celebrity among the laity, was taken to Guy's Hospital on
+December 9, 1869, and after being watched by eight experienced nurses
+for eight days she died of starvation. A postmortem examination of Anna
+Garbero of Racconis, in Piedmont, who died on May 19, 1828, after
+having endured a supposed fast of two years, eight months, and eleven
+days, revealed remarkable intestinal changes. The serous membranes were
+all callous and thickened, and the canal of the sigmoid flexure was
+totally obliterated. The mucous membranes were all soft and friable,
+and presented the appearance of incipient gangrene.
+
+Modern Cases.--Turning now to modern literature, we have cases of
+marvelous abstinence well substantiated by authoritative evidence.
+Dickson describes a man of sixty-two, suffering from monomania, who
+refused food for four months, but made a successful recovery.
+Richardson mentions a case, happening in 1848, of a man of thirty-three
+who voluntarily fasted for fifty-five days. His reason for fasting,
+which it was impossible to combat, was that he had no gastric juice and
+that it was utterly useless for him to take any nutrition, as he had no
+means of digesting it. He lived on water until the day of his death.
+Richardson gives an interesting account of the changes noticed at the
+necropsy. There is an account of a religious mendicant of the Jain
+caste who as a means of penance fasted for ninety-one days.  The
+previous year he had fasted eighty-six days. He had spent his life in
+strict asceticism, and during his fasting he was always engrossed in
+prayer.
+
+Collins describes a maiden lady of eighty, always a moderate eater, who
+was attacked by bronchitis, during which she took food as usual. Two
+days after her recovery, without any known cause, she refused all food
+and continued to do so for thirty-three days, when she died. She was
+delirious throughout this fast and slept daily seven or eight hours. As
+a rule, she drank about a wineglassful of water each day and her urine
+was scanty and almost of the consistency of her feces. There is a
+remarkable case of a girl of seventeen who, suffering with typhoid
+fever associated with engorgement of the abdomen and suppression of the
+functions of assimilation, fasted for four months without visible
+diminution in weight. Pierce reports the history of a woman of
+twenty-six who fasted for three months and made an excellent recovery.
+
+Grant describes the "Market Harborough fasting-girl," a maiden of
+nineteen, who abstained from food from April, 1874, until December,
+1877, although continually using morphia. Throughout her fast she had
+periodic convulsions, and voided no urine or feces for twelve months
+before her death. There was a middle-aged woman in England in 1860 who
+for two years lived on opium, gin, and water. Her chief symptoms were
+almost daily sickness and epileptic fits three times a week. She was
+absolutely constipated, and at her death her abdomen was so distended
+as to present the appearance of ascites. After death, the distention of
+the abdomen was found to be due to a coating of fat, four inches thick,
+in the parietes. There was no obstruction to the intestinal canal and
+no fecal or other accumulation within it.  Christina Marshall, a girl
+of fourteen, went fifteen and one-half months without taking solid
+nourishment. She slept very little, seldom spoke, but occasionally
+asked the time of day. She took sweets and water, with beef tea at
+intervals, and occasionally a small piece of orange. She died April 18,
+1882, after having been confined to her bed for a long while.
+
+King, a surgeon, U.S.A., gives an account of the deprivation of a squad
+of cavalry numbering 40. While scouting for Indians on the plains they
+went for eighty-six hours without water; when relieved their mouths and
+throats were so dry that even brown sugar would not dissolve on their
+tongues. Many were delirious, and all had drawn fresh blood from their
+horses. Despite repeated vomiting, some drank their own urine. They
+were nearly all suffering from overpowering dyspnea, two were dead, and
+two were missing. The suffering was increased by the acrid atmosphere
+of the dry plains; the slightest exercise in this climate provoked a
+thirst. MacLoughlin, the surgeon in charge of the S.S. City of Chester,
+speaks of a young stowaway found by the stevedores in an insensible
+condition after a voyage of eleven days. The man was brought on deck
+and revived sufficiently to be sent to St.  Vincent's Hospital, N.Y.,
+about one and one-half hours after discovery, in an extremely
+emaciated, cold, and nearly pulseless condition. He gave his name as
+John Donnelly, aged twenty, of Dumbarton, Scotland. On the whole voyage
+he had nothing to eat or drink. He had found some salt, of which he ate
+two handfuls, and he had in his pocket a small flask, empty. Into this
+flask he voided his urine, and afterward drank it. Until the second day
+he was intensely hungry, but after that time was consumed by a burning
+thirst; he shouted four or five hours every day, hoping that he might
+be heard. After this he became insensible and remembered nothing until
+he awakened in the hospital where, under careful treatment, he finally
+recovered.
+
+Fodere mentions some workmen who were buried alive fourteen days in a
+cold, damp cavern under a ruin, and yet all lived. There is a modern
+instance of a person being buried thirty-two days beneath snow, without
+food. The Lancet notes that a pig fell off Dover Cliff and was picked
+up alive one hundred and sixty days after, having been partially
+imbedded in debris. It was so surrounded by the chalk of the cliff that
+little motion was possible, and warmth was secured by the enclosing
+material. This animal had therefore lived on its own fat during the
+entire period.
+
+Among the modern exhibitionists may be mentioned Merlatti, the fasting
+Italian, and Succi, both of whom fasted in Paris; Alexander Jacques,
+who fasted fifty days; and the American, Dr. Tanner, who achieved great
+notoriety by a fast of forty days, during which time he exhibited
+progressive emaciation. Merlatti, who fasted in Paris in 1886, lost 22
+pounds in a month; during his fast of fifty days he drank only pure
+filtered water. Prior to the fast his farewell meal consisted of a
+whole fat goose, including the bones, two pounds of roast beef,
+vegetables for two, and a plate of walnuts, the latter eaten whole.
+Alexander Jacques fasted fifty days and Succi fasted forty days.
+Jacques lost 28 pounds and 4 ounces (from 142 pounds, 8 ounces to 114
+pounds, 4 ounces), while Succi's loss was 34 pounds and 3 ounces.
+Succi diminished in height from 65 3/4 to 64 1/2 inches, while Jacques
+increased from 64 1/2 to 65 1/2 inches. Jacques smoked cigarettes
+incessantly, using 700 in the fifty days, although, by professional
+advice, he stopped the habit on the forty-second day. Three or four
+times a day he took a powder made of herbs to which he naturally
+attributed his power of prolonging life without food. Succi remained in
+a room in which he kept the temperature at a very high point. In
+speaking of Succi's latest feat a recent report says: "It has come to
+light in his latest attempt to go for fifty days without food that he
+privately regaled himself on soup, beefsteak, chocolate, and eggs. It
+was also discovered that one of the 'committee,' who were supposed to
+watch and see that the experiment was conducted in a bona fide manner,
+'stood in' with the faster and helped him deceive the others. The
+result of the Vienna experiment is bound to cast suspicion on all
+previous fasting accomplishments of Signor Succi, if not upon those of
+his predecessors."
+
+Although all these modern fasters have been accused of being jugglers
+and deceivers, throughout their fasts they showed constant decrease in
+weight, and inspection by visitors was welcomed at all times. They
+invariably invited medical attention, and some were under the closest
+surveillance; although we may not implicitly believe that the fasts
+were in every respect bona fide, yet we must acknowledge that these men
+displayed great endurance in their apparent indifference for food, the
+deprivation of which in a normal individual for one day only causes
+intense suffering.
+
+Anomalies of Temperature.--In reviewing the reports of the highest
+recorded temperatures of the human body, it must be remembered that no
+matter how good the evidence or how authentic the reference there is
+always chance for malingering. It is possible to send the index of an
+ordinary thermometer up to the top in ten or fifteen seconds by rubbing
+it between the slightly moistened thumb and the finger, exerting
+considerable pressure at the time. There are several other means of
+artificially producing enormous temperatures with little risk of
+detection, and as the sensitiveness of the thermometer becomes greater
+the easier is the deception.
+
+Mackenzie reports the temperature-range of a woman of forty-two who
+suffered with erysipelatous inflammation of a stump of the leg.
+Throughout a somewhat protracted illness, lasting from February 20 to
+April 22, 1879, the temperature many times registered between 108
+degrees and 111 degrees F. About a year later she was again troubled
+with the stump, and this time the temperature reached as high as 114
+degrees. Although under the circumstances, as any rational physician
+would, Mackenzie suspected fraud, he could not detect any method of
+deception.  Finally the woman confessed that she had produced the
+temperature artificially by means of hot-water bottles, poultices, etc.
+
+MacNab records a case of rheumatic fever in which the temperature was
+111.4 degrees F. as indicated by two thermometers, one in the axilla
+and the other in the groin. This high degree of temperature was
+maintained after death. Before the Clinical Society of London, Teale
+reported a case in which, at different times, there were recorded
+temperatures from 110 degrees to 120 degrees F. in the mouth, rectum,
+and axilla. According to a comment in the Lancet, there was no way that
+the patient could have artificially produced this temperature, and
+during convalescence the thermometer used registered normal as well as
+subnormal temperatures. Caesar speaks of a girl of fifteen with enteric
+fever, whose temperature, on two occasions 110 degrees F., reached the
+limit of the mercury in the thermometer.
+
+There have been instances mentioned in which, in order to escape
+duties, prisoners have artificially produced high temperatures, and the
+same has occasionally been observed among conscripts in the army or
+navy. There is an account of a habit of prisoners of introducing
+tobacco into the rectum, thereby reducing the pulse to an alarming
+degree and insuring their exemption from labor. In the Adelaide
+Hospital in Dublin there was a case in which the temperature in the
+vagina and groin registered from 120 degrees to 130 degrees, and one
+day it reached 130.8 degrees F.; the patient recovered. Ormerod
+mentions a nervous and hysteric woman of thirty-two, a sufferer with
+acute rheumatism, whose temperature rose to 115.8 degrees F. She
+insisted on leaving the hospital when her temperature was still 104
+degrees.
+
+Wunderlich mentions a case of tetanus in which the temperature rose to
+46.40 degrees C. (115.5 degrees F.), and before death it was as high as
+44.75 degrees C. Obernier mentions 108 degrees F.  in typhoid fever.
+Kartulus speaks of a child of five, with typhoid fever, who at
+different times had temperatures of 107 degrees, 108 degrees, and 108.2
+degrees F.; it finally recovered.  He also quotes a case of pyemia in a
+boy of seven, whose temperature rose to 107.6 degrees F. He also speaks
+of Wunderlich's case of remittent fever, in which the temperature
+reached 107.8 degrees F. Wilson Fox, in mentioning a case of rheumatic
+fever, says the temperature reached 110 degrees F.
+
+Philipson gives an account of a female servant of twenty-three who
+suffered from a neurosis which influenced the vasomotor nervous system,
+and caused hysteria associated with abnormal temperatures. On the
+evening of July 9th her temperature was 112 degrees F.; on the 16th, it
+was 111 degrees; on the 18th, 112 degrees; on the 24th, 117 degrees
+(axilla); on the 28th, in the left axilla it was 117 degrees, in the
+right axilla, 114 degrees, and in the mouth, 112 degrees; on the 29th,
+it was 115 degrees in the right axilla, 110 degrees in the left axilla,
+and 116 degrees in the mouth The patient was discharged the following
+September.  Steel of Manchester speaks of a hysteric female of twenty,
+whose temperature was 116.4 degrees. Mahomed mentions a hysteric woman
+of twenty-two at Guy's Hospital, London, with phthisis of the left
+lung, associated with marked hectic fevers. Having registered the limit
+of the ordinary thermometers, the physicians procured one with a scale
+reaching to 130 degrees F. She objected to using the large
+thermometers, saying they were "horse thermometers." On October 15,
+1879, however, they succeeded in obtaining a temperature of 128 degrees
+F. with the large thermometer. In March of the following year she died,
+and the necropsy revealed nothing indicative of a cause for these
+enormous temperatures. She was suspected of fraud, and was closely
+watched in Guy's Hospital, but never, in the slightest way, was she
+detected in using artificial means to elevate the temperature record.
+
+In cases of insolation it is not at all unusual to see a patient whose
+temperature cannot be registered by an ordinary thermometer. Any one
+who has been resident at a hospital in which heat-cases are received in
+the summer will substantiate this. At the Emergency Hospital in
+Washington, during recent years, several cases have been brought in
+which the temperatures were above the ordinary registering point of the
+hospital thermometers, and one of the most extraordinary cases
+recovered.
+
+At a meeting of the Association of American Physicians in 1895, Jacobi
+of New York reported a case of hyperthermy reaching 148 degrees F. This
+instance occurred in a profoundly hysteric fireman, who suffered a
+rather severe injury as the result of a fall between the revolving rods
+of some machinery, and was rendered unconscious for four days.
+Thereafter he complained of various pains, bloody expectoration, and
+had convulsions at varying intervals, with loss of consciousness, rapid
+respiration, unaccelerated pulse, and excessively high temperature, the
+last on one occasion reaching the height of 148 degrees F. The
+temperature was taken carefully in the presence of a number of persons,
+and all possible precautions were observed to prevent deception. The
+thermometer was variously placed in the mouth, anus, axilla, popliteal
+space, groin, urethra, and different instruments were from time to time
+employed. The behavior of the patient was much influenced by attention
+and by suggestion. For a period of five days the temperature averaged
+continuously between 120 degrees and 125 degrees F.
+
+In the discussion of the foregoing case, Welch of Baltimore referred to
+a case that had been reported in which it was said that the temperature
+reached as high as 171 degrees F. These extraordinary elevations of
+temperature, he said, appear physically impossible when they are long
+continued, as they are fatal to the life of the animal cell.
+
+In the same connection Shattuck of Boston added that he had observed a
+temperature of 117 degrees F.; every precaution had been taken to
+prevent fraud or deception. The patient was a hysteric young woman.
+
+Jacobi closed the discussion by insisting that his observations had
+been made with the greatest care and precautions and under many
+different circumstances. He had at first viewed the case with
+skepticism, but he could not doubt the results of his observation. He
+added, that although we cannot explain anomalies of this kind, this
+constitutes no reason why we should deny their occurrence.
+
+Duffy records one of the lowest temperatures on record in a negress of
+thirty-five who, after an abortion, showed only 84 degrees F. in the
+mouth and axillae. She died the next day.
+
+The amount of external heat that a human being can endure is sometimes
+remarkable, and the range of temperature compatible with life is none
+the less extraordinary. The Esquimaux and the inhabitants of the
+extreme north at times endure a temperature of--60 degrees F., while
+some of the people living in equatorial regions are apparently healthy
+at a temperature as high as 130 degrees F., and work in the sun, where
+the temperature is far higher. In the engine-rooms of some steamers
+plying in tropical waters temperatures as high as 150 degrees F. have
+been registered, yet the engineers and the stokers become habituated to
+this heat and labor in it without apparent suffering. In Turkish baths,
+by progressively exposing themselves to graduated temperatures, persons
+have been able to endure a heat considerably above the boiling point,
+though having to protect their persons from the furniture and floors
+and walls of the rooms. The hot air in these rooms is intensely dry,
+provoking profuse perspiration. Sir Joseph Banks remained some time in
+a room the temperature of which was 211 degrees F., and his own
+temperature never mounted above normal.
+
+There have been exhibitionists who claimed particular ability to endure
+intense heats without any visible disadvantage. These men are generally
+styled "human salamanders," and must not be confounded with the
+"fire-eaters," who, as a rule, are simply jugglers. Martinez, the
+so-called "French Salamander," was born in Havana. As a baker he had
+exposed himself from boyhood to very high temperatures, and he
+subsequently gave public exhibitions of his extraordinary ability to
+endure heat. He remained in an oven erected in the middle of the
+Gardens of Tivoli for fourteen minutes when the temperature in the oven
+was 338 degrees F. His pulse on entering was 76 and on coming out 130.
+He often duplicated this feat before vast assemblages, though hardly
+ever attaining the same degree of temperature, the thermometer
+generally varying from 250 degrees F. upward. Chamouni was the
+celebrated "Russian Salamander," assuming the title of "The
+Incombustible." His great feat was to enter an oven with a raw leg of
+mutton, not retiring until the meat was well baked. This person
+eventually lost his life in the performance of this feat; his ashes
+were conveyed to his native town, where a monument was erected over
+them. Since the time of these two contemporaneous salamanders there
+have been many others, but probably none have attained the same
+notoriety.
+
+In this connection Tillet speaks of some servant girls to a baker who
+for fifteen minutes supported a temperature of 270 degrees F.; for ten
+minutes, 279 degrees F.; and for several minutes, 364 degrees F., thus
+surpassing Martinez. In the Glasgow Medical Journal, 1859, there is an
+account of a baker's daughter who remained twelve minutes in an oven at
+274 degrees F. Chantrey, the sculptor, and his workman are said to have
+entered with impunity a furnace of over 320 degrees F.
+
+In some of the savage ceremonies of fire worship the degree of heat
+endured by the participants is really remarkable, and even if the rites
+are performed by skilful juggling, nevertheless, the ability to endure
+intense heat is worthy of comment. A recent report says:--
+
+"The most remarkable ceremonial of fire worship that survives in this
+country is practiced by the Navajos. They believe in purification by
+fire, and to this end they literally wash themselves in it. The feats
+they perform with it far exceed the most wonderful acts of fire-eating
+and fire-handling accomplished by civilized jugglers. In preparation
+for the festival a gigantic heap of dry wood is gathered from the
+desert. At the appointed moment the great pile of inflammable brush is
+lighted and in a few moments the whole of it is ablaze. Storms of
+sparks fly 100 feet or more into the air, and ashes fall about like a
+shower of snow. The ceremony always takes place at night and the effect
+of it is both weird and impressive.
+
+"Just when the fire is raging at its hottest a whistle is heard from
+the outer darkness and a dozen warriors, lithe and lean, dressed simply
+in narrow white breech-cloths and moccasins and daubed with white earth
+so as to look like so many living statues, come bounding through the
+entrance to the corral that incloses the flaming heap. Yelping like
+wolves, they move slowly toward the fire, bearing aloft slender wands
+tipped with balls of eagle-down. Rushing around the fire, always to the
+left, they begin thrusting their wands toward the fire, trying to burn
+off the down from the tips. Owing to the intensity of the heat this is
+difficult to accomplish. One warrior dashes wildly toward the fire and
+retreats; another lies as close to the ground as a frightened lizard,
+endeavoring to wriggle himself up to the fire; others seek to catch on
+their wands the sparks that fly in the air. At last one by one they all
+succeed in burning the downy balls from the wands. The test of
+endurance is very severe, the heat of the fire being so great.
+
+"The remarkable feats, however, are performed in connection with
+another dance that follows. This is heralded by a tremendous blowing of
+horns. The noise grows louder and louder until suddenly ten or more men
+run into the corral, each of them carrying two thick bundles of
+shredded cedar bark.
+
+"Four times they run around the fire waving the bundles, which are then
+lighted. Now begins a wild race around the fire, the rapid running
+causing the brands to throw out long streamers of flames over the hands
+and arms of the dancers. The latter apply the brands to their own nude
+bodies and to the bodies of their comrades in front. A warrior will
+seize the flaming mass as if it were a sponge, and, keeping close to
+the man he is pursuing, will rub his back with it as if bathing him.
+The sufferer in turn catches up with the man in front of him and bathes
+him in flame.  From time to time the dancers sponge their own backs
+with the flaming brands. When a brand is so far consumed that it can no
+longer be held it is dropped and the dancers disappear from the corral.
+The spectators pick up the flaming bunches thus dropped and bathe their
+own hands in the fire.
+
+"No satisfactory explanation seems to be obtainable as to the means by
+which the dancers in this extraordinary performance are able to escape
+injury. Apparently they do not suffer from any burns. Doubtless some
+protection is afforded by the earth that is applied to their bodies."
+
+Spontaneous combustion of the human body, although doubted by the
+medical men of this day, has for many years been the subject of much
+discussion; only a few years ago, among the writers on this subject,
+there were as many credulous as there were skeptics.  There is,
+however, no reliable evidence to support the belief in the spontaneous
+combustion of the body. A few apochryphal cases only have been
+recorded. The opinion that the tissues of drunkards might be so
+saturated with alcohol as to render the body combustible is disproved
+by the simple experiment of placing flesh in spirits for a long time
+and then trying to burn it.  Liebig and others found that flesh soaked
+in alcohol would burn only until the alcohol was consumed. That various
+substances ignite spontaneously is explained by chemic phenomena, the
+conditions of which do not exist in the human frame. Watkins in
+speaking of the inflammability of the human body remarks that on one
+occasion he tried to consume the body of a pirate given to him by a U.
+S. Marshal. He built a rousing fire and piled wood on all night, and
+had not got the body consumed by the forenoon of the following day.
+Quite a feasible reason for supposed spontaneous human combustion is to
+be found in several cases quoted by Taylor, in which persons falling
+asleep, possibly near a fire, have been accidentally ignited, and
+becoming first stupefied by the smoke, and then suffocated, have been
+burned to charcoal without awaking. Drunkenness or great exhaustion may
+also explain certain cases. In substantiation of the possibility of
+Taylor's instances several prominent physiologists have remarked that
+persons have endured severe burns during sleep and have never wakened.
+There is an account of a man who lay down on the top of a lime kiln,
+which was fired during his sleep, and one leg was burned entirely off
+without awaking the man, a fact explained by the very slow and gradual
+increase of temperature.
+
+The theories advanced by the advocates of spontaneous human combustion
+are very ingenious and deserve mention here. An old authority has said:
+"Our blood is of such a nature, as also our lymph and bile: all of
+which, when dried by art, flame like spirit of wine at the approach of
+the least fire and burn away to ashes." Lord Bacon mentions spontaneous
+combustion, and Marcellus Donatus says that in the time of Godefroy of
+Bouillon there were people of a certain locality who supposed
+themselves to have been burning of an invisible fire in their entrails,
+and he adds that some cut off a hand or a foot when the burning began,
+that it should go no further. What may have been the malady with which
+these people suffered must be a matter of conjecture.
+
+Overton, in a paper on this subject, remarks that in the "Memoirs of
+the Royal Society of Paris," 1751, there is related an account of a
+butcher who, opening a diseased beef, was burned by a flame which
+issued from the maw of the animal; there was first an explosion which
+rose to a height of five feet and continued to blaze several minutes
+with a highly offensive odor. Morton saw a flame emanate from beneath
+the skin of a hog at the instant of making an incision through it.
+Ruysch, the famous Dutch physician, remarks that he introduced a hollow
+bougie into a woman's stomach he had just opened, and he observed a
+vapor issuing from the mouth of the tube, and this lit on contact with
+the atmosphere. This is probably an exaggeration of the properties of
+the hydrogen sulphid found in the stomach. There is an account of a man
+of forty-three, a gross feeder, who was particularly fond of fats and a
+victim of psoriasis palmaria, who on going to bed one night, after
+extinguishing the light in the room, was surprised to find himself
+enveloped in a phosphorescent halo; this continued for several days and
+recurred after further indiscretions in diet. It is well known that
+there are insects and other creatures of the lower animal kingdom which
+possess the peculiar quality of phosphorescence.
+
+There are numerous cases of spontaneous combustion of the human body
+reported by the older writers. Bartholinus mentions an instance after
+the person had drunk too much wine. Fouquet mentions a person ignited
+by lightning. Schrader speaks of a person from whose mouth and fauces
+after a debauch issued fire.  Schurig tells of flames issuing from the
+vulva, and Moscati records the same occurrence in parturition,
+Sinibaldust, Borellus, and Bierling have also written on this subject,
+and the Ephemerides contains a number of instances.
+
+In 1763 Bianchini, Prebendary of Verona, published an account of the
+death of Countess Cornelia Bandi of Cesena, who in her sixty-second
+year was consumed by a fire kindled in her own body.  In explanation
+Bianchini said that the fire was caused in the entrails by the inflamed
+effluvia of the blood, by the juices and fermentation in the stomach,
+and, lastly, by fiery evaporations which exhaled from the spirits of
+wine, brandy, etc. In the Gentleman's Magazine, 1763, there is recorded
+an account of three noblemen who, in emulation, drank great quantities
+of strong liquor, and two of them died scorched and suffocated by a
+flame forcing itself from the stomach. There is an account of a poor
+woman in Paris in the last century who drank plentifully of spirits,
+for three years taking virtually nothing else. Her body became so
+combustible that one night while lying on a straw couch she was
+spontaneously burned to ashes and smoke. The evident cause of this
+combustion is too plain to be commented on. In the Lancet, 1845, there
+are two cases reported in which shortly before death luminous breath
+has been seen to issue from the mouth.
+
+There is an instance reported of a professor of mathematics of
+thirty-five years of age and temperate, who, feeling a pain in his left
+leg, discovered a pale flame about the size of a ten-cent piece issuing
+therefrom. As recent as March, 1850, in a Court of Assizes in Darmstadt
+during the trial of John Stauff, accused of the murder of the Countess
+Goerlitz, the counsel for the defense advanced the theory of
+spontaneous human combustion, and such eminent doctors as von Siebold,
+Graff, von Liebig, and other prominent members of the Hessian medical
+fraternity were called to comment on its possibility; principally on
+their testimony a conviction and life-imprisonment was secured. In 1870
+there was a woman of thirty-seven, addicted to alcoholic liquors, who
+was found in her room with her viscera and part of her limbs consumed
+by fire, but the hair and clothes intact. According to Walford, in the
+Scientific American for 1870, there was a case reported by Flowers of
+Louisiana of a man a hard drinker, who was sitting by a fire surrounded
+by his Christmas guests, when suddenly flames of a bluish tint burst
+from his mouth and nostrils and he was soon a corpse. Flowers states
+that the body remained extremely warm for a much longer period than
+usual.
+
+Statistics.--From an examination of 28 cases of spontaneous combustion,
+Jacobs makes the following summary:--
+
+(1) It has always occurred in the human living body.
+
+(2) The subjects were generally old persons.
+
+(3) It was noticed more frequently in women than in men.
+
+(4) All the persons were alone at the time of occurrence.
+
+(5) They all led an idle life.
+
+(6) They were all corpulent or intemperate.
+
+(7) Most frequently at the time of occurrence there was a light and
+some ignitible substance in the room.
+
+(8) The combustion was rapid and was finished in from one to seven
+hours.
+
+(9) The room where the combustion took place was generally filled with
+a thick vapor and the walls covered with a thick, carbonaceous
+substance.
+
+(10) The trunk was usually the part most frequently destroyed; some
+part of the head and extremities remained.
+
+(11) With but two exceptions, the combustion occurred in winter and in
+the northern regions.
+
+Magnetic, Phosphorescent, and Electric Anomalies.--There have been
+certain persons who have appeared before the public under such names as
+the "human magnet," the "electric lady," etc. There is no doubt that
+some persons are supercharged with magnetism and electricity. For
+instance, it is quite possible for many persons by drawing a rubber
+comb through the hair to produce a crackling noise, and even produce
+sparks in the dark. Some exhibitionists have been genuine curiosities
+of this sort, while others by skilfully arranged electric apparatus are
+enabled to perform their feats. A curious case was reported in this
+country many years ago, which apparently emanates from an authoritative
+source. On the 25th of January, 1837, a certain lady became suddenly
+and unconsciously charged with electricity. Her newly acquired power
+was first exhibited when passing her hand over the face of her brother;
+to the astonishment of both, vivid electric sparks passed from the ends
+of each finger. This power continued with augmented force from the 25th
+of January to the last of February, but finally became extinct about
+the middle of May of the same year.
+
+Schneider mentions a strong, healthy, dark-haired Capuchin monk, the
+removal of whose head-dress always induced a number of shining,
+crackling sparks from his hair or scalp. Bartholinus observed a similar
+peculiarity in Gonzaga, Duke of Mantua. In another case luminous sparks
+were given out whenever the patient passed urine. Marsh relates two
+cases of phthisis in which the heads of the patients were surrounded by
+phosphorescent lights.  Kaster mentions an instance in which light was
+seen in the perspiration and on the body linen after violent exertion.
+After exertion Jurine, Guyton, and Driessen observed luminous urine
+passed by healthy persons, and Nasse mentions the same phenomenon in a
+phthisical patient. Percy and Stokes have observed phosphorescence in a
+carcinomatous ulcer.
+
+There is a description of a Zulu boy exhibited in Edinburgh in 1882
+whose body was so charged with electricity that he could impart a shock
+to any of his patrons. He was about six-and-a-half years of age,
+bright, happy, and spoke English thoroughly well.  From infancy he had
+been distinguished for this faculty, variable with the state of the
+atmosphere. As a rule, the act of shaking hands was generally attended
+by a quivering sensation like that produced by an electric current, and
+contact with his tongue gave a still sharper shock.
+
+Sir Charles Bell has made extensive investigation of the subject of
+human magnetism and is probably the best authority on the subject, but
+many celebrated scientists have studied it thoroughly. In the Pittsburg
+Medical Review there is a description of a girl of three and a half, a
+blonde, and extremely womanly for her age, who possessed a wonderful
+magnetic power. Metal spoons would adhere to her finger-tips, nose, or
+chin. The child, however, could not pick up a steel needle, an article
+generally very sensitive to the magnet; nor would a penny stick to any
+portion of her body.
+
+Only recently there was exhibited through this country a woman named
+Annie May Abbott, who styled herself the "Georgia Electric Lady." This
+person gave exhibitions of wonderful magnetic power, and invited the
+inspection and discussion of medical men. Besides her chief
+accomplishment she possessed wonderful strength and was a skilled
+equilibrist. By placing her hands on the sides of a chair upon which a
+heavy man was seated, she would raise it without apparent effort. She
+defied the strongest person in the audience to take from her hand a
+stick which she had once grasped. Recent reports say that Miss Abbott
+is amusing herself now with the strong men of China and Japan. The
+Japanese wrestlers, whose physical strength is celebrated the world
+over, were unable to raise Miss Abbott from the floor, while with the
+tips of her fingers she neutralized their most strenuous efforts to
+lift even light objects, such as a cane, from a table. The
+possibilities, in this advanced era of electric mechanism, make fraud
+and deception so easy that it is extremely difficult to pronounce on
+the genuineness of any of the modern exhibitions of human electricity.
+
+The Effects of Cold.--Gmelin, the famous scientist and investigator of
+this subject, says that man has lived where the temperature falls as
+low as -157 degrees F. Habit is a marked factor in this endurance. In
+Russia men and women work with their breasts and arms uncovered in a
+temperature many degrees below zero and without attention to the fact.
+In the most rigorous winter the inhabitants of the Alps work with bare
+breasts and the children sport about in the snow. Wrapping himself in
+his pelisse the Russian sleeps in the snow. This influence of habit is
+seen in the inability of intruders in northern lands to endure the
+cold, which has no effect on the indigenous people. On their way to
+besiege a Norwegian stronghold in 1719, 7000 Swedes perished in the
+snows and cold of their neighboring country. On the retreat from Prague
+in 1742, the French army, under the rigorous sky of Bohemia, lost 4000
+men in ten days. It is needless to speak of the thousands lost in
+Napoleon's campaign in Russia in 1812.
+
+Pinel has remarked that the insane are less liable to the effects of
+cold than their normal fellows, and mentions the escape of a naked
+maniac, who, without any visible after-effect, in January, even, when
+the temperature was -4 degrees F., ran into the snow and gleefully
+rubbed his body with ice. In the French journals in 1814 there is the
+record of the rescue of a naked crazy woman who was found in the
+Pyrenees, and who had apparently suffered none of the ordinary effects
+of cold.
+
+Psychologic Effects of Cold.--Lambert says that the mind acts more
+quickly in cold weather, and that there has been a notion advanced that
+the emotion of hatred is much stronger in cold weather, a theory
+exemplified by the assassination of Paul of Russia, the execution of
+Charles of England, and that of Louis of France. Emotions, such as
+love, bravery, patriotism, etc., together with diverse forms of
+excitement, seem to augment the ability of the human body to endure
+cold.
+
+Cold seems to have little effect on the generative function. In both
+Sweden, Norway, and other Northern countries the families are as large,
+if not larger, than in other countries. Cold undoubtedly imparts vigor,
+and, according to DeThou, Henry III lost his effeminacy and love of
+pleasure in winter and reacquired a spirit of progress and reformation.
+Zimmerman has remarked that in a rigorous winter the lubberly Hollander
+is like the gayest Frenchman. Cold increases appetite, and Plutarch
+says Brutus experienced intense bulimia while in the mountains, barely
+escaping perishing. With full rations the Greek soldiers under Xenophon
+suffered intense hunger as they traversed the snow-clad mountains of
+Armenia.
+
+Beaupre remarks that those who have the misfortune to be buried under
+the snow perish less quickly than those who are exposed to the open
+air, his observations having been made during the retreat of the French
+army from Moscow. In Russia it is curious to see fish frozen stiff,
+which, after transportation for great distances, return to life when
+plunged into cold water.
+
+Sudden death from cold baths and cold drinks has been known for many
+centuries. Mauriceau mentions death from cold baptism on the head, and
+Graseccus, Scaliger, Rush, Schenck, and Velschius mention deaths from
+cold drinks. Aventii, Fabricius Hildanus, the Ephemerides, and Curry
+relate instances of a fatal issue following the ingestion of cold water
+by an individual in a superheated condition. Cridland describes a case
+of sudden insensibility following the drinking of a cold fluid. It is
+said that Alexander the Great narrowly escaped death from a
+constrictive spasm, due to the fact that while in a copious sweat he
+plunged into the river Cydnus. Tissot gives an instance of a man dying
+at a fountain after a long draught on a hot day.  Hippocrates mentions
+a similar fact, and there are many modern instances.
+
+The ordinary effects of cold on the skin locally and the system
+generally will not be mentioned here, except to add the remark of
+Captain Wood that in Greenland, among his party, could be seen
+ulcerations, blisters, and other painful lesions of the skin. In
+Siberia the Russian soldiers cover their noses and ears with greased
+paper to protect them against the cold. The Laplanders and Samoiedes,
+to avoid the dermal lesions caused by cold (possibly augmented by the
+friction of the wind and beating of snow), anoint their skins with
+rancid fish oil, and are able to endure temperatures as low as -40
+degrees F. In the retreat of the 10,000 Xenophon ordered all his
+soldiers to grease the parts exposed to the air.
+
+Effects of Working in Compressed Air.--According to a writer in
+Cassier's Magazine, the highest working pressures recorded have been
+close to 50 pounds per square inch, but with extreme care in the
+selection of men, and corresponding care on the part of the men, it is
+very probable that this limit may be considerably exceeded. Under
+average conditions the top limit may be placed at about 45 pounds, the
+time of working, according to conditions, varying from four to six
+hours per shift. In the cases in which higher pressures might be used,
+the shifts for the men should be restricted to two of two hours each,
+separated by a considerable interval. As an example of heavy pressure
+work under favorable conditions as to ventilation, without very bad
+effects on the men, Messrs. Sooysmith & Company had an experience with
+a work on which men were engaged in six-hour shifts, separated into two
+parts by half-hour intervals for lunch. This work was excavation in
+open, seamy rock, carried on for several weeks under about 45 pounds
+pressure. The character of the material through which the caisson is
+being sunk or upon which it may be resting at any time bears quite
+largely upon the ability of the men to stand the pressure necessary to
+hold back the water at that point. If the material be so porous as to
+permit a considerable leakage of air through it, there will naturally
+result a continuous change of air in the working chamber, and a
+corresponding relief of the men from the deleterious effects which are
+nearly always produced by over-used air.
+
+From Strasburg in 1861 Bucuoy reports that during the building of a
+bridge at Kehl laborers had to work in compressed air, and it was found
+that the respirations lost their regularity; there were sometimes
+intense pains in the ears, which after a while ceased.  It required a
+great effort to speak at 2 1/2 atmospheres, and it was impossible to
+whistle. Perspiration was very profuse. Those who had to work a long
+time lost their appetites, became emaciated, and congestion of the lung
+and brain was observed. The movements of the limbs were easier than in
+normal air, though afterward muscular and rheumatic pains were often
+observed.
+
+The peculiar and extraordinary development of the remaining special
+senses when one of the number is lost has always been a matter of great
+interest. Deaf people have always been remarkable for their acuteness
+of vision, touch, and smell. Blind persons, again, almost invariably
+have the sense of hearing, touch, and what might be called the senses
+of location and temperature exquisitely developed. This substitution of
+the senses is but; an example of the great law of compensation which we
+find throughout nature.
+
+Jonston quotes a case in the seventeenth century of a blind man who, it
+is said, could tell black from white by touch alone; several other
+instances are mentioned in a chapter entitled "De compensatione naturae
+monstris facta." It must, however, be held impossible that blind people
+can thus distinguish colors in any proper sense of the words. Different
+colored yarns, for example, may have other differences of texture,
+etc., that would be manifest to the sense of touch. We know of one case
+in which the different colors were accurately distinguished by a blind
+girl, but only when located in customary and definite positions. Le Cat
+speaks of a blind organist, a native of Holland, who still played the
+organ as well as ever. He could distinguish money by touch, and it is
+also said that he made himself familiar with colors. He was fond of
+playing cards, but became such a dangerous opponent, because in
+shuffling he could tell what cards and hands had been dealt, that he
+was never allowed to handle any but his own cards.
+
+It is not only in those who are congenitally deficient in any of the
+senses that the remarkable examples of compensation are seen, but
+sometimes late in life these are developed. The celebrated sculptor,
+Daniel de Volterre, became blind after he had obtained fame, and
+notwithstanding the deprivation of his chief sense he could, by touch
+alone, make a statue in clay after a model. Le Cat also mentions a
+woman, perfectly deaf, who without any instruction had learned to
+comprehend anything said to her by the movements of the lips alone. It
+was not necessary to articulate any sound, but only to give the labial
+movements. When tried in a foreign language she was at a loss to
+understand a single word.
+
+Since the establishment of the modern high standard of blind asylums
+and deaf-and-dumb institutions, where so many ingenious methods have
+been developed and are practiced in the education of their inmates,
+feats which were formerly considered marvelous are within the reach of
+all those under tuition To-day, those born deaf-mutes are taught to
+speak and to understand by the movements of the lips alone, and the
+blind read, become expert workmen, musicians, and even draughtsmen. D.
+D. Wood of Philadelphia, although one of the finest organists in the
+country, has been totally blind for years. It is said that he acquires
+new compositions with almost as great facility as one not afflicted
+with his infirmity. "Blind Tom," a semi-idiot and blind negro achieved
+world-wide notoriety by his skill upon the piano.
+
+In some extraordinary cases in which both sight and hearing, and
+sometimes even taste and smell, are wanting, the individuals in a most
+wonderful way have developed the sense of touch to such a degree that
+it almost replaces the absent senses. The extent of this compensation
+is most beautifully illustrated in the cases of Laura Bridgman and
+Helen Keller. No better examples could be found of the compensatory
+ability of differentiated organs to replace absent or disabled ones.
+
+Laura Dewey Bridgman was born December 21, 1829, at Hanover, N.H.  Her
+parents were farmers and healthy people. They were of average height,
+regular habits, slender build, and of rather nervous dispositions.
+Laura inherited the physical characteristics of her mother. In her
+infancy she was subject to convulsions, but at twenty months had
+improved, and at this time had learned to speak several words. At the
+age of two years, in common with two of the other children of the
+family, she had an attack of severe scarlet fever. Her sisters died,
+and she only recovered after both eyes and ears had suppurated; taste
+and smell were also markedly impaired. Sight in the left eye was
+entirely abolished, but she had some sensation for large, bright
+objects in the right eye up to her eighth year; after that time she
+became totally blind.  After her recovery it was two years before she
+could sit up all day, and not until she was five years old had she
+entirely regained her strength. Hearing being lost, she naturally never
+developed any speech; however, she was taught to sew, knit, braid, and
+perform several other minor household duties. In 1837 Dr. S. W. Howe,
+the Director of the Massachusetts Asylum for the Blind, took Laura in
+charge, and with her commenced the ordinary deaf-mute education. At
+this time she was seven years and ten months old. Two years later she
+had made such wonderful progress and shown such ability to learn that,
+notwithstanding her infirmities, she surpassed any of the pupils of her
+class. Her advancement was particularly noticed immediately after her
+realization that an idea could be expressed by a succession of raised
+letters. In fact, so rapid was her progress, that it was deemed
+advisable by the authorities to hold her back. By her peculiar
+sensibility to vibration she could distinguish the difference between a
+whole and a half note in music, and she struck the notes on the piano
+quite correctly. During the first years of her education she could not
+smell at all, but later she could locate the kitchen by this sense.
+Taste had developed to such an extent that at this time she could
+distinguish the different degrees of acidity. The sense of touch,
+however, was exceedingly delicate and acute. As to her moral habits,
+cleanliness was the most marked. The slightest dirt or rent in her
+clothes caused her much embarrassment and shame, and her sense of
+order, neatness, and propriety was remarkable. She seemed quite at home
+and enjoyed the society of her own sex, but was uncomfortable and
+distant in the society of males. She quickly comprehended the
+intellectual capacity of those with whom she was associated, and soon
+showed an affiliation for the more intelligent of her friends. She was
+quite jealous of any extra attention shown to her fellow scholars,
+possibly arising from the fact that she had always been a favorite. She
+cried only from grief, and partially ameliorated bodily pain by jumping
+and by other excessive muscular movements. Like most mutes, she
+articulated a number of noises,--50 or more, all monosyllabic; she
+laughed heartily, and was quite noisy in her play. At this time it was
+thought that she had been heard to utter the words doctor, pin, ship,
+and others. She attached great importance to orientation, and seemed
+quite ill at ease in finding her way about when not absolutely sure of
+directions. She was always timid in the presence of animals, and by no
+persuasion could she be induced to caress a domestic animal. In common
+with most maidens, at sixteen she became more sedate, reserved and
+thoughtful; at twenty she had finished her education. In 1878 she was
+seen by G. Stanley Hall, who found that she located the approach and
+departure of people through sensation in her feet, and seemed to have
+substituted the cutaneous sense of vibration for that of hearing. At
+this time she could distinguish the odors of various fragrant flowers
+and had greater susceptibility to taste, particularly to sweet and
+salty substances. She had written a journal for ten years, and had also
+composed three autobiographic sketches, was the authoress of several
+poems, and some remarkably clever letters. She died at the Perkins
+Institute, May 24, 1889, after a life of sixty years, burdened with
+infirmities such as few ever endure, and which, by her superior
+development of the remnants of the original senses left her, she had
+overcome in a degree nothing less than marvelous.  According to a
+well-known observer, in speaking of her mental development, although
+she was eccentric she was not defective.  She necessarily lacked
+certain data of thought, but even this feet was not very marked, and
+was almost counterbalanced by her exceptional power of using what
+remained.
+
+In the present day there is a girl as remarkable as Laura Bridgman, and
+who bids fair to attain even greater fame by her superior development.
+This girl, Helen Keller, is both deaf and blind; she has been seen in
+all the principal cities of the United States, has been examined by
+thousands of persons, and is famous for her victories over infirmities.
+On account of her wonderful power of comprehension special efforts have
+been made to educate Helen Keller, and for this reason her mind is far
+more finely developed than in most girls of her age. It is true that
+she has the advantage over Laura Bridgman in having the senses of taste
+and smell, both of which she has developed to a most marvelous degree
+of acuteness. It is said that by odor alone she is always conscious of
+the presence of another person, no matter how noiseless his entrance
+into the room in which she may be. She cannot be persuaded to take food
+which she dislikes, and is never deceived in the taste. It is, however,
+by the means of what might be called "touch-sight" that the most
+miraculous of her feats are performed. By placing her hands on the face
+of a visitor she is able to detect shades of emotion which the normal
+human eye fails to distinguish, or, in the words of one of her lay
+observers, "her sense of touch is developed to such an exquisite extent
+as to form a better eye for her than are yours or mine for us; and what
+is more, she forms judgments of character by this sight." According to
+a recent report of a conversation with one of the principals of the
+school in which her education is being completed, it is said that since
+the girl has been under his care he has been teaching her to sing with
+great success. Placing the fingers of her hands on the throat of a
+singer, she is able to follow notes covering two octaves with her own
+voice, and sings synchronously with her instructor. The only difference
+between her voice and that of a normal person is in its resonant
+qualities. So acute has this sense become, that by placing her hand
+upon the frame of a piano she can distinguish two notes not more than
+half a tone apart. Helen is expected to enter the preparatory school
+for Radcliffe College in the fall of 1896.
+
+At a meeting of the American Association to Promote the Teaching of
+Speech to the Deaf, in Philadelphia, July, 1896, this child appeared,
+and in a well-chosen and distinct speech told the interesting story of
+her own progress. Miss Sarah Fuller, principal of the Horace Mann
+School for the Deaf, Boston, is credited with the history of Helen
+Keller, as follows:--
+
+"Helen Keller's home is in Tuscumbia, Ala. At the age of nineteen
+months she became deaf, dumb, and blind after convulsions lasting three
+days. Up to the age of seven years she had received no instruction. Her
+parents engaged Miss Sullivan of the Perkins Institute for the Blind,
+South Boston, to go to Alabama as her teacher. She was familiar with
+methods of teaching the blind, but knew nothing about instructing deaf
+children. Miss Sullivan called upon Miss Fuller for some instruction on
+the subject. Miss Fuller was at that time experimenting with two little
+deaf girls to make them speak as hearing children do, and called Miss
+Sullivan's attention to it. Miss Sullivan left for her charge, and from
+time to time made reports to Dr. Anagnos the principal of the Perkins
+School, which mentioned the remarkable mind which she found this little
+Alabama child possessed. The following year Miss Sullivan brought the
+child, then eight years old, to Boston, and Mrs. Keller came with her.
+They visited Miss Fuller's school.  Miss Sullivan had taught the child
+the manual alphabet, and she had obtained much information by means of
+it. Miss Fuller noticed how quickly she appreciated the ideas given to
+her in that way.
+
+"It is interesting to note that before any attempt had been made to
+teach the child to speak or there had been any thought of it, her own
+quickness of thought had suggested it to her as she talked by hand
+alphabet to Miss Fuller. Her mother, however, did not approve Miss
+Fuller's suggestion that an attempt should be made to teach her speech.
+She remained at the Perkins School, under Miss Sullivan's charge,
+another year, when the matter was brought up again, this time by little
+Helen herself, who said she must speak. Miss Sullivan brought her to
+Miss Fuller's school one day and she received her first lesson, of
+about two hours' length.
+
+"The child's hand was first passed over Miss Fuller's face, mouth, and
+neck, then into her mouth, touching the tongue, teeth, lips, and hard
+palate, to give her an idea of the organs of speech. Miss Fuller then
+arranged her mouth, tongue, and teeth for the sound of i as in it. She
+took the child's finger and placed it upon the windpipe so that she
+might feel the vibration there, put her finger between her teeth to
+show her how wide apart they were, and one finger in the mouth to feel
+the tongue, and then sounded the vowel. The child grasped the idea at
+once.  Her fingers flew to her own mouth and throat, and she produced
+the sound so nearly accurate that it sounded like an echo. Next the
+sound of ah was made by dropping the jaw a little and letting the child
+feel that the tongue was soft and lying in the bed of the jaw with the
+teeth more widely separated. She in the same way arranged her own, but
+was not so successful as at first, but soon produced the sound
+perfectly."
+
+"Eleven such lessons were given, at intervals of three or four days,
+until she had acquired all the elements of speech, Miss Sullivan in the
+meantime practicing with the child on the lessons received. The first
+word spoken was arm, which was at once associated with her arm; this
+gave her great delight. She soon learned to pronounce words by herself,
+combining the elements she had learned, and used them to communicate
+her simple wants. The first connected language she used was a
+description she gave Miss Fuller of a visit she had made to Dr. Oliver
+Wendell Holmes, in all over 200 words. They were, all but two or three,
+pronounced correctly. She now, six years afterward, converses quite
+fluently with people who know nothing of the manual alphabet by placing
+a couple of fingers on the speaker's lips, her countenance showing
+great intentness and brightening as she catches the meaning.  Anybody
+can understand her answers."
+
+In a beautiful eulogy of Helen Keller in a recent number of Harper's
+Magazine, Charles Dudley Warner expresses the opinion that she is the
+purest-minded girl of her age in the world.
+
+Edith Thomas, a little inmate of the Perkins Institute for the Blind,
+at South Boston, is not only deaf and dumb but also blind.  She was a
+fellow-pupil with Helen Keller, and in a measure duplicated the rapid
+progress of her former playmate. In commenting on progress in learning
+to talk the Boston Herald says: "And as the teacher said the word
+'Kitty' once or twice she placed the finger-tips of one hand upon the
+teacher's lips and with the other hand clasped tightly the teacher's
+throat; then, guided by the muscular action of the throat and the
+position of the teeth, tongue, and lips, as interpreted by that
+marvelous and delicate touch of hers, she said the word 'Kitty' over
+and over again distinctly in a very pretty way. She can be called dumb
+no longer, and before the summer vacation comes she will have mastered
+quite a number of words, and such is her intelligence and patience, in
+spite of the loss of three senses, she may yet speak quite readily.
+
+"Her history is very interesting. She was born in Maplewood, and up to
+the time of contracting diphtheria and scarlet fever, which occurred
+when she was four years old, had been a very healthy child of more than
+ordinary quickness and ability. She had attained a greater command of
+language than most children of her age. What a contrast between these
+'other days,' as she calls them, and the days which followed, when
+hearing and sight were completely gone, and gradually the senses of
+speech and smell went, too! After the varied instruction of the blind
+school the little girl had advanced so far as to make the rest of her
+study comparatively easy. The extent of her vocabulary is not
+definitely known, but it numbers at least 700 words. Reading, which was
+once an irksome task, has become a pleasure to her. Her ideas of
+locality and the independence of movement are remarkable, and her
+industry and patience are more noticeable from day to day. She has
+great ability, and is in every respect a very wonderful child."
+
+According to recent reports, in the vicinity of Rothesay, on the Clyde,
+there resides a lady totally deaf and dumb, who, in point of
+intelligence, scholarship, and skill in various ways, far excels many
+who have all their faculties. Having been educated partly in Paris, she
+is a good French scholar, and her general composition is really
+wonderful. She has a shorthand system of her own, and when writing
+letters, etc., she uses a peculiar machine, somewhat of the nature of a
+typewriter.
+
+Among the deaf persons who have acquired fame in literature and the
+arts have been Dibil Alkoffay, an Arabian poet of the eighth century;
+the tactician, Folard; the German poet, Engelshall; Le Sage; La
+Condamine, who composed an epigram on his own infirmity; and Beethoven,
+the famous musician. Fernandez, a Spanish painter of the sixteenth
+century, was a deaf-mute.
+
+All the world pities the blind, but despite their infirmities many have
+achieved the highest glory in every profession. Since Homer there have
+been numerous blind poets. Milton lost none of his poetic power after
+he had become blind. The Argovienne, Louise Egloff, and Daniel Leopold,
+who died in 1753, were blind from infancy. Blacklock, Avisse, Koslov,
+and La Mott-Houdart are among other blind poets. Asconius Pedianus, a
+grammarian of the first century; Didyme, the celebrated doctor of
+Alexandria; the Florentine, Bandolini, so well versed in Latin poetry;
+the celebrated Italian grammarian, Pontanus; the German, Griesinger,
+who spoke seven languages; the philologist, Grassi, who died in 1831,
+and many others have become blind at an age more or less advanced in
+their working lives.
+
+Probably the most remarkable of the blind scientists was the
+Englishman, Saunderson, who in 1683, in his first year, was deprived of
+sight after an attack of small-pox. In spite of his complete blindness
+he assiduously studied the sciences, and graduated with honor at the
+University of Cambridge in mathematics and optics. His sense of touch
+was remarkable. He had a collection of old Roman medals, all of which,
+without mistake, he could distinguish by their impressions. He also
+seemed to have the ability to judge distance, and was said to have
+known how far he had walked, and by the velocity he could even tell the
+distance traversed in a vehicle. Among other blind mathematicians was
+the Dutchman, Borghes (died in 1652); the French astronomer, the Count
+de Pagan, who died in 1655; Galileo; the astronomer, Cassini, and
+Berard, who became blind at twenty-three years, and was for a long time
+Professor of Mathematics at the College of Briancon.
+
+In the seventeenth century the sculptor, Jean Gonnelli, born in
+Tuscany, became blind at twenty years; but in spite of his infirmity he
+afterward executed what were regarded as his masterpieces. It is said
+that he modeled a portrait of Pope Urban VIII, using as a guide his
+hand, passed from time to time over the features. Lomazzo, the Italian
+painter of the eighteenth century, is said to have continued his work
+after becoming blind.
+
+Several men distinguished for their bravery and ability in the art of
+war have been blind. Jean de Troczow, most commonly known by the name
+of Ziska, in 1420 lost his one remaining eye, and was afterward known
+as the "old blind dog," but, nevertheless, led his troops to many
+victories. Froissart beautifully describes the glorious death of the
+blind King of Bohemia at the battle of Crecy in 1346. Louis III, King
+of Provence; Boleslas III, Duke of Bohemia; Magnus IV, King of Norway,
+and Bela II, King of Hungary, were blind. Nathaniel Price, a librarian
+of Norwich in the last century, lost his sight in a voyage to America,
+which, however, did not interfere in any degree with his duties, for
+his books were in as good condition and their location as directly
+under his knowledge, during his blindness as they were in his earlier
+days. At the present day in New York there is a blind billiard expert
+who occasionally gives exhibitions of his prowess.
+
+Feats of Memory.--From time to time there have been individuals,
+principally children, who gave wonderful exhibitions of memory, some
+for dates, others for names, and some for rapid mental calculation.
+Before the Anthropological Society in 1880 Broca exhibited a lad of
+eleven, a Piedmontese, named Jacques Inaudi.  This boy, with a trick
+monkey, had been found earning his livelihood by begging and by solving
+mentally in a few minutes the most difficult problems in arithmetic. A
+gentleman residing in Marseilles had seen him while soliciting alms
+perform most astonishing feats of memory, and brought him to Paris. In
+the presence of the Society Broca gave him verbally a task in
+multiplication, composed of some trillions to be multiplied by
+billions. In the presence of all the members he accomplished his task
+in less than ten minutes, and without the aid of pencil and paper,
+solving the whole problem mentally. Although not looking intelligent,
+and not being able to read or write, he perhaps could surpass any one
+in the world in his particular feat. It was stated that he proceeded
+from left to right in his calculations, instead of from right to left
+in the usual manner. In his personal appearance the only thing
+indicative of his wonderful abilities was his high forehead.
+
+An infant prodigy named Oscar Moore was exhibited to the physicians of
+Chicago at the Central Music Hall in 1888, and excited considerable
+comment at the time. The child was born of mulatto parents at Waco,
+Texas, on August 19, 1885, and when only thirteen months old manifested
+remarkable mental ability and precocity. S. V. Clevenger, a physician
+of Chicago, has described the child as follows:--
+
+"Oscar was born blind and, as frequently occurs in such cases, the
+touch-sense compensatingly developed extraordinarily. It was observed
+that after touching a person once or twice with his stubby baby
+fingers, he could thereafter unfailingly recognize and call by name the
+one whose hand he again felt. The optic sense is the only one
+defective, for tests reveal that his hearing, taste, and smell are
+acute, and the tactile development surpasses in refinement. But his
+memory is the most remarkable peculiarity, for when his sister conned
+her lessons at home, baby Oscar, less than two years old, would recite
+all he heard her read. Unlike some idiot savants, in which category he
+is not to be included, who repeat parrot-like what they have once
+heard, baby Oscar seems to digest what he hears, and requires at least
+more than one repetition of what he is trying to remember, after which
+he possesses the information imparted and is able to yield it at once
+when questioned. It is not necessary for him to commence at the
+beginning, as the possessors of some notable memories were compelled to
+do, but he skips about to any required part of his repertoire.
+
+"He sings a number of songs and counts in different languages, but it
+is not supposable that he understands every word he utters. If,
+however, his understanding develops as it promises to do, he will
+become a decided polyglot. He has mastered an appalling array of
+statistics, such as the areas in square miles of hundreds of countries,
+the population of the world's principal cities, the birthdays of all
+the Presidents, the names of all the cities of the United States of
+over 10,000 inhabitants, and a lot of mathematical data. He is greatly
+attracted by music, and this leads to the expectation that when more
+mature he may rival Blind Tom.
+
+"In disposition he is very amiable, but rather grave beyond his years.
+He shows great affection for his father, and is as playful and as happy
+as the ordinary child. He sleeps soundly, has a good childish appetite,
+and appears to be in perfect health. His motions are quick but not
+nervous, and are as well coordinated as in a child of ten. In fact, he
+impresses one as having the intelligence of a much older child than
+three years (now five years), but his height, dentition, and general
+appearance indicate the truthfulness of the age assigned. An evidence
+of his symmetrical mental development appears in his extreme
+inquisitiveness. He wants to understand the meaning of what he is
+taught, and some kind of an explanation must be given him for what he
+learns. Were his memory alone abnormally great and other faculties
+defective, this would hardly be the case; but if so, it cannot at
+present be determined.
+
+"His complexion is yellow, with African features, flat nose, thick lips
+but not prognathous, superciliary ridges undeveloped, causing the
+forehead to protrude a little. His head measures 19 inches in
+circumference, on a line with the upper ear-tips, the forehead being
+much narrower than the occipitoparietal portion, which is noticeably
+very wide. The occiput protrudes backward, causing a forward sweep of
+the back of the neck. From the nose-root to the nucha over the head he
+measures 13 1/2 inches, and between upper ear-tips across and over the
+head 11 inches, which is so close to the eight-and ten-inch standard
+that he may be called mesocephalic. The bulging in the vicinity of the
+parietal region accords remarkably with speculations upon the location
+of the auditory memory in that region, such as those in the American
+Naturalist, July, 1888, and the fact that injury of that part of the
+brain may cause loss of memory of the meaning of words. It may be that
+the premature death of the mother's children has some significance in
+connection with Oscar's phenomenal development. There is certainly a
+hypernutrition of the parietal brain with atrophy of the optic tract,
+both of which conditions could arise from abnormal vascular causes, or
+the extra growth of the auditory memory region may have deprived of
+nutrition, by pressure, the adjacent optic centers in the occipital
+brain. The otherwise normal motion of the eyes indicates the nystagmus
+to be functional.
+
+"Sudden exaltation of the memory is often the consequence of grave
+brain disease, and in children this symptom is most frequent.
+Pritchard, Rush, and other writers upon mental disorders record
+interesting instances of remarkable memory-increase before death,
+mainly in adults, and during fever and insanity. In simple mania the
+memory is often very acute.  Romberg tells of a young girl who lost her
+sight after an attack of small-pox, but acquired an extraordinary
+memory. He calls attention to the fact that the scrofulous and rachitic
+diatheses in childhood are sometimes accompanied by this disorder.
+Winslow notes that in the incipient state of the brain disease of early
+life connected with fevers, disturbed conditions of the cerebral
+circulation and vessels, and in affections of advanced life, there is
+often witnessed a remarkable exaltation of the memory, which may herald
+death by apoplexy.
+
+"Not only has the institution of intelligence in idiots dated from
+falls upon the head, but extra mentality has been conferred by such an
+event Pritchard tells of three idiot brothers, one of whom, after a
+severe head injury, brightened up and became a barrister, while his
+brothers remained idiotic. 'Father Mabillon,' says Winslow, 'is said to
+have been an idiot until twenty-six years of age, when he fractured his
+skull against a stone staircase. He was trepanned. After recovering,
+his intellect fully developed itself in a mind endowed with a lively
+imagination, an amazing memory, and a zeal for study rarely equaled.'
+Such instances can be accounted for by the brain having previously been
+poorly nourished by a defective blood supply, which defect was remedied
+by the increased circulation afforded by the head-injury.
+
+"It is a commonly known fact that activity of the brain is attended
+with a greater head-circulation than when the mind is dull, within
+certain limits. Anomalous development of the brain through
+blood-vessels, affording an extra nutritive supply to the mental
+apparatus, can readily be conceived as occurring before birth, just as
+aberrant nutrition elsewhere produces giants from parents of ordinary
+size.
+
+"There is but one sense-defect in the child Oscar, his
+eyesight-absence, and that is atoned for by his hearing and
+touch-acuteness, as it generally is in the blind. Spitzka and others
+demonstrate that in such cases other parts of the brain enlarge to
+compensate for the atrophic portion which is connected with the
+functionless nerves. This, considered with his apparently perfect,
+mental and physical health, leaves no reason to suppose that Oscar's
+extravagant memory depends upon disease any more than we can suspect
+all giants of being sickly, though the anomaly is doubtless due to
+pathologic conditions. Of course, there is no predicting what may
+develop later in his life, but in any event science will be benefited.
+
+"It is a popular idea that great vigor of memory is often associated
+with low-grade intelligence, and cases such as Blind Tom and other
+'idiot savants,' who could repeat the contents of a newspaper after a
+single reading, justify the supposition.  Fearon, on 'Mental Vigor,'
+tells of a man who could remember the day that every person had been
+buried in the parish for thirty-five years, and could repeat with
+unvarying accuracy the name and age of the deceased and the mourners at
+the funeral. But he was a complete fool. Out of the line of burials he
+had not one idea, could not give an intelligible reply to a single
+question, nor be trusted even to feed himself. While memory-development
+is thus apparent in some otherwise defective intellects, it has
+probably as often or oftener been observed to occur in connection with
+full or great intelligence. Edmund Burke, Clarendon, John Locke,
+Archbishop Tillotson, and Dr. Johnson were all distinguished for having
+great strength of memory. Sir W.  Hamilton observed that Grotius,
+Pascal, Leibnitz, and Euler were not less celebrated for their
+intelligence than for their memory.  Ben Jonson could repeat all that
+he had written and whole books he had read. Themistocles could call by
+name the 20,000 citizens of Athens. Cyrus is said to have known the
+name of every soldier in his army. Hortensius, a great Roman orator,
+and Seneca had also great memories. Niebuhr, the Danish historian, was
+remarkable for his acuteness of memory. Sir James Mackintosh, Dugald
+Stewart, and Dr. Gregory had similar reputations.
+
+"Nor does great mental endowment entail physical enfeeblement; for,
+with temperance, literary men have reached extreme old age, as in the
+cases of Klopstock, Goethe, Chaucer, and the average age attained by
+all the signers of the American Declaration of Independence was
+sixty-four years, many of them being highly gifted men intellectually.
+Thus, in the case of the phenomenal Oscar it cannot be predicted that
+he will not develop, as he now promises to do, equal and extraordinary
+powers of mind, even though it would be rare in one of his racial
+descent, and in the face of the fact that precocity gives no assurance
+of adult brightness, for it can be urged that John Stuart Mill read
+Greek when four years of age.
+
+"The child is strumous, however, and may die young. His exhibitors, who
+are coining him into money, should seek the best medical care for him
+and avoid surcharging his memory with rubbish. Proper cultivation of
+his special senses, especially the tactile, by competent teachers, will
+give Oscar the best chance of developing intellectually and acquiring
+an education in the proper sense of the word."
+
+By long custom many men of letters have developed wonderful feats of
+memory; and among illiterate persons, by means of points of
+association, the power of memory has been little short of marvelous. At
+a large hotel in Saratoga there was at one time a negro whose duty was
+to take charge of the hats and coats of the guests as they entered the
+dining-room and return to each his hat after the meal. It was said
+that, without checks or the assistance of the owners, he invariably
+returned the right articles to the right persons on request, and no
+matter how large the crowd, his limit of memory never seemed to be
+reached. Many persons have seen expert players at draughts and chess
+who, blindfolded, could carry on numerous games with many competitors
+and win most of the matches. To realize what a wonderful feat of memory
+this performance is, one need only see the absolute exhaustion of one
+of these men after a match. In whist, some experts have been able to
+detail the succession of the play of the cards so many hands back that
+their competitors had long since forgotten it.
+
+There is reported to be in Johnson County, Missouri, a mathematical
+wonder by the name of Rube Fields. At the present day he is between
+forty and fifty years of age, and his external appearance indicates
+poverty as well as indifference. His temperament is most sluggish; he
+rarely speaks unless spoken to, and his replies are erratic.
+
+The boyhood of this strange character was that of an overgrown country
+lout with boorish manners and silly mind. He did not and would not go
+to school, and he asserts now that if he had done so he "would have
+become as big a fool as other people." A shiftless fellow, left to his
+own devices, he performed some wonderful feats, and among the many
+stories connected with this period of his life is one which describes
+how he actually ate up a good-sized patch of sugar cane, simply because
+he found it good to his taste.
+
+Yet from this clouded, illiterate mind a wonderful mathematical gift
+shines. Just when he began to assert his powers is not known; but his
+feats have been remembered for twenty years by his neighbors. A report
+says:--
+
+"Give Rube Fields the distance by rail between any two points, and the
+dimensions of a car-wheel, and almost as soon as the statement has left
+your lips he will tell you the number of revolutions the wheel will
+make in traveling over the track. Call four or five or any number of
+columns of figures down a page, and when you have reached the bottom he
+will announce the sum. Given the number of yards or pounds of articles
+and the price, and at once he will return the total cost--and this he
+will do all day long, without apparent effort or fatigue.
+
+"A gentleman relates an instance of Fields' knowledge of figures.
+After having called several columns of figures for addition, he went
+back to the first column, saying that it was wrong, and repeating it,
+purposely miscalling the next to the last figure.  At once Fields threw
+up his hand, exclaiming: 'You didn't call it that way before.'
+
+"Fields' answers come quick and sharp, seemingly by intuition.
+Calculations which would require hours to perform are made in less time
+than it takes to state the question. The size of the computations seems
+to offer no bar to their rapid solution, and answers in which long
+lines of figures are reeled off come with perfect ease. In watching the
+effort put forth in reaching an answer, there would seem to be some
+process going on in the mind, and an incoherent mumbling is often
+indulged in, but it is highly probable that Fields does not himself
+know how he derives his answers. Certain it is that he is unable to
+explain the process, nor has any one ever been able to draw from him
+anything concerning it. Almost the only thing he knows about the power
+is that he possesses it, and, while he is not altogether averse to
+receiving money for his work, he has steadily refused to allow himself
+to be exhibited." In reviewing the peculiar endowment of Fields, the
+Chicago Record says:--
+
+"How this feat is performed is as much a mystery as the process by
+which he solves a problem in arithmetic. He answers no questions. Rapid
+mathematicians, men of study, who by intense application and short
+methods have become expert, have sought to probe these two mysteries,
+but without results. Indeed, the man's intelligence is of so low an
+order as to prevent him from aiding those who seek to know. With age,
+too, he grows more surly. Of what vast value this 'gift' might be to
+the world of science, if coupled with average intelligence, is readily
+imagined. That it will ever be understood is unlikely. As it is, the
+power staggers belief and makes modern psychology, with its study of
+brain-cells, stand aghast. As to poor Fields himself, he excites only
+sympathy. Homeless, unkempt, and uncouth, traveling aimlessly on a
+journey which he does not understand, he hugs to his heart a marvelous
+power, which he declares to be a gift from God. To his weak mind it
+lifts him above his fellow-men, and yet it is as useless to the world
+as a diamond in a dead man's hand."
+
+Wolf-Children.--It is interesting to know to what degree a human being
+will resemble a beast when deprived of the association with man. We
+seem to get some insight to this question in the investigation of so
+called cases of "wolf-children."
+
+Saxo Grammaticus speaks of a bear that kidnapped a child and kept it a
+long time in his den. The tale of the Roman she-wolf is well known, and
+may have been something more than a myth, as there have been several
+apparently authentic cases reported in which a child has been rescued
+from its associations with a wolf who had stolen it some time
+previously. Most of the stories of wolf-children come from India.
+According to Oswald in Ball's "Jungle Life in India," there is the
+following curious account of two children in the Orphanage of Sekandra,
+near Agra, who had been discovered among wolves: "A trooper sent by a
+native Governor of Chandaur to demand payment of some revenue was
+passing along the bank of the river about noon when he saw a large
+female wolf leave her den, followed by three whelps and a little boy.
+The boy went on all-fours, and when the trooper tried to catch him he
+ran as fast as the whelps, and kept up with the old one. They all
+entered the den, but were dug out by the people and the boy was
+secured. He struggled hard to rush into every hole or gully they came
+near. When he saw a grown-up person he became alarmed, but tried to fly
+at children and bite them. He rejected cooked meat with disgust, but
+delighted in raw flesh and bones, putting them under his paws like a
+dog." The other case occurred at Chupra, in the Presidency of Bengal.
+In March, 1843, a Hindoo mother went out to help her husband in the
+field, and while she was cutting rice her little boy was carried off by
+a wolf. About a year afterward a wolf, followed by several cubs and a
+strange, ape-like creature, was seen about ten miles from Chupra. After
+a lively chase the nondescript was caught and recognized (by the mark
+of a burn on his knee) as the Hindoo boy that had disappeared in the
+rice-field. This boy would not eat anything but raw flesh, and could
+never be taught to speak, but expressed his emotions in an inarticulate
+mutter. His elbows and the pans of his knees had become horny from
+going on all-fours with his foster mother. In the winter of 1850 this
+boy made several attempts to regain his freedom, and in the following
+spring he escaped for good and disappeared in the jungle-forest of
+Bhangapore.
+
+The Zoologist for March, 1888, reproduced a remarkable pamphlet printed
+at Plymouth in 1852, which had been epitomized in the Lancet. This
+interesting paper gives an account of wolves nurturing small children
+in their dens. Six cases are given of boys who have been rescued from
+the maternal care of wolves. In one instance the lad was traced from
+the moment of his being carried off by a lurking wolf while his parents
+were working in the field, to the time when, after having been
+recovered by his mother six years later, he escaped from her into the
+jungle. In all these cases certain marked features reappear. In the
+first, the boy was very inoffensive, except when teased, and then he
+growled surlily. He would eat anything thrown to him, but preferred
+meat, which he devoured with canine voracity. He drank a pitcher of
+buttermilk at one gulp, and could not be induced to wear clothing even
+in the coldest weather. He showed the greatest fondness for bones, and
+gnawed them contentedly, after the manner of his adopted parents. This
+child had coarse features, a repulsive countenance, was filthy in his
+habits, and could not articulate a word.
+
+In another case the child was kidnapped at three and recovered at nine.
+He muttered, but could not articulate. As in the other case, he could
+not be enticed to wear clothes. From constantly being on all-fours the
+front of this child's knees and his elbows had become hardened. In the
+third case the father identified a son who had been carried away at the
+age of six, and was found four years afterward. The intellectual
+deterioration was not so marked. The boy understood signs, and his
+hearing was exceedingly acute; when directed by movements of the hands
+to assist the cultivators in turning out cattle, he readily
+comprehended what was asked of him; yet this lad, whose vulpine career
+was so short, could neither talk nor utter any decidedly articulate
+sound.
+
+The author of the pamphlet expressed some surprise that there was no
+case on record in which a grown man had been found in such association.
+This curious collection of cases of wolf-children is attributed to
+Colonel Sleeman, a well-known officer, who is known to have been
+greatly interested in the subject, and who for a long time resided in
+the forests of India. A copy, now a rarity, is in the South Kensington
+Museum.
+
+An interesting case of a wolf-child was reported many years ago in
+Chambers' Journal. In the Etwah district, near the banks of the river
+Jumna, a boy was captured from the wolves. After a time this child was
+restored to his parents, who, however, "found him very difficult to
+manage, for he was most fractious and troublesome--in fact, just a
+caged wild beast. Often during the night for hours together he would
+give vent to most unearthly yells and moans, destroying the rest and
+irritating the tempers of his neighbors and generally making night
+hideous. On one occasion his people chained him by the waist to a tree
+on the outskirts of the village. Then a rather curious incident
+occurred. It was a bright moonlight night, and two wolf cubs
+(undoubtedly those in whose companionship he had been captured),
+attracted by his cries while on the prowl, came to him, and were
+distinctly seen to gambol around him with as much familiarity and
+affection as if they considered him quite one of themselves. They only
+left him on the approach of morning, when movement and stir again arose
+in the village. This boy did not survive long. He never spoke, nor did
+a single ray of human intelligence ever shed its refining light over
+his debased features."
+
+Recently a writer in the Badmington Magazine, in speaking of the
+authenticity of wolf-children, says:--
+
+"A jemidar told me that when he was a lad he remembered going, with
+others, to see a wolf-child which had been netted. Some time after
+this, while staying at an up-country place called Shaporeooundie, in
+East Bengal, it was my fortune to meet an Anglo-Indian gentleman who
+had been in the Indian civil service for upward of thirty years, and
+had traveled about during most of that time; from him I learned all I
+wanted to know of wolf-children, for he not only knew of several cases,
+but had actually seen and examined, near Agra, a child which had been
+recovered from the wolves. The story of Romulus and Remus, which all
+schoolboys and the vast majority of grown people regard as a myth,
+appears in a different light when one studies the question of
+wolf-children, and ascertains how it comes to pass that boys are found
+living on the very best terms with such treacherous and rapacious
+animals as wolves, sleeping with them in their dens, sharing the raw
+flesh of deer and kids which the she-wolf provides, and, in fact,
+leading in all essentials the actual life of a wolf.
+
+"A young she-wolf has a litter of cubs, and after a time her instinct
+tells her that they will require fresh food. She steals out at night in
+quest of prey. Soon she espies a weak place in the fence (generally
+constructed of thatching grass and bamboos) which encloses the
+compound, or 'unguah,' of a poor villager. She enters, doubtless, in
+the hope of securing a kid; and while prowling about inside looks into
+a hut where a woman and infant are soundly sleeping. In a moment she
+has pounced on the child, and is out of reach before its cries can
+attract the villagers.  Arriving safely at her den under the rocks, she
+drops the little one among her cubs. At this critical time the fate of
+the child hangs in the balance. Either it will be immediately torn to
+pieces and devoured, or in a most wonderful way remain in the cave
+unharmed. In the event of escape, the fact may be accounted for in
+several ways. Perhaps the cubs are already gorged when the child is
+thrown before them, or are being supplied with solid food before their
+carnivorous instinct is awakened, so they amuse themselves by simply
+licking the sleek, oily body (Hindoo mothers daily rub their boy babies
+with some native vegetable oil) of the infant, and thus it lies in the
+nest, by degrees getting the odor of the wolf cubs, after which the
+mother wolf will not molest it.  In a little time the infant begins to
+feel the pangs of hunger, and hearing the cubs sucking, soon follows
+their example. Now the adoption is complete, all fear of harm to the
+child from wolves has gone, and the foster-mother will guard and
+protect it as though it were of her own flesh and blood.
+
+"The mode of progression of these children is on all fours--not, as a
+rule, on the hands and feet, but on the knees and elbows.  The reason
+the knees are used is to be accounted for by the fact that, owing to
+the great length of the human leg and thigh in proportion to the length
+of the arm, the knee would naturally be brought to the ground, and the
+instep and top of the toes would be used instead of the sole and heel
+of the almost inflexible foot. Why the elbow should be employed instead
+of the hand is less easy to understand, but probably it is better
+suited to give support to the head and fore-part of the body.
+
+"Some of these poor waifs have been recovered after spending ten or
+more years in the fellowship of wolves, and, though wild and savage at
+first, have in time become tractable in some degree.  They are rarely
+seen to stand upright, unless to look around, and they gnaw bones in
+the manner of a dog, holding one end between the forearms and hands,
+while snarling and snapping at everybody who approaches too near. The
+wolf-child has little except his outward form to show that it is a
+human being with a soul. It is a fearful and terrible thing, and hard
+to understand, that the mere fact of a child's complete isolation from
+its own kind should bring it to such a state of absolute degradation.
+Of course, they speak no language, though some, in time, have learned
+to make known their wants by signs. When first taken they fear the
+approach of adults, and, if possible, will slink out of sight; but
+should a child of their own size, or smaller, come near, they will
+growl, and even snap and bite at it. On the other hand, the close
+proximity of "pariah" dogs or jackals is unresented, in some cases
+welcomed; for I have heard of them sharing their food with these
+animals, and even petting and fondling them. They have in time been
+brought to a cooked-meat diet, but would always prefer raw flesh. Some
+have been kept alive after being reclaimed for as long as two years,
+but for some reason or other they all sicken and die, generally long
+before that time. One would think, however, that, having undoubtedly
+robust constitutions, they might be saved if treated in a scientific
+manner and properly managed."
+
+Rudyard Kipling, possibly inspired by accounts of these wolf-children
+in India, has ingeniously constructed an interesting series of fabulous
+stories of a child who was brought up by the beasts of the jungles and
+taught their habits and their mode of communication. The ingenious way
+in which the author has woven the facts together and interspersed them
+with his intimate knowledge of animal-life commends his "Jungle-Book"
+as a legitimate source of recreation to the scientific observer.
+
+Among observers mentioned in the "Index Catalogue" who have studied
+this subject are Giglioli, Mitra, and Ornstein.
+
+The artificial manufacture of "wild men" or "wild boys" in the Chinese
+Empire is shown by recent reports. Macgowan says the traders kidnap a
+boy and skin him alive bit by bit, transplanting on the denuded
+surfaces the hide of a bear or dog. This process is most tedious and is
+by no means complete when the hide is completely transplanted, as the
+subject must be rendered mute by destruction of the vocal cords, made
+to use all fours in walking, and submitted to such degradation as to
+completely blight all reason. It is said that the process is so severe
+that only one in five survive. A "wild boy" exhibited in Kiangse had
+the entire skin of a dog substituted and walked on all fours. It was
+found that he had been kidnapped. His proprietor was decapitated on the
+spot. Macgowan says that parasitic monsters are manufactured in China
+by a similar process of transplantation. He adds that the deprivation
+of light for several years renders the child a great curiosity, if in
+conjunction its growth is dwarfed by means of food and drugs, and its
+vocal apparatus destroyed. A certain priest subjected a kidnapped boy
+to this treatment and exhibited him as a sacred deity. Macgowan
+mentions that the child looked like wax, as though continually fed on
+lardaceous substances. He squatted with his palms together and was a
+driveling idiot. The monk was discovered and escaped, but his temple
+was razed.
+
+Equilibrists.--Many individuals have cultivated their senses so acutely
+that by the eye and particularly by touch they are able to perform
+almost incredible feats of maintaining equilibrium under the most
+difficult circumstances Professional rope-walkers have been known in
+all times. The Greeks had a particular passion for equilibrists, and
+called them "neurobates," "oribates," and "staenobates." Blondin would
+have been one of the latter. Antique medals showing equilibrists making
+the ascent of an inclined cord have been found. The Romans had walkers
+both of the slack-rope and tight-rope Many of the Fathers of the Church
+have pronounced against the dangers of these exercises. Among others,
+St. John Chrysostom speaks of men who execute movements on inclined
+ropes at unheard-of heights. In the ruins of Herculaneum there is still
+visible a picture representing an equilibrist executing several
+different exercises, especially one in which he dances on a rope to the
+tune of a double flute, played by himself. The Romans particularly
+liked to witness ascensions on inclined ropes, and sometimes these were
+attached to the summits of high hills, and while mounting them the
+acrobats performed different pantomimes.  It is said that under Charles
+VI a Genoese acrobat, on the occasion of the arrival of the Queen of
+France, carried in each hand an illuminated torch while descending a
+rope stretched from the summit of the towers of Notre Dame to a house
+on the Pont au Change. According to Guyot-Daubes, a similar performance
+was seen in London in 1547. In this instance the rope was attached to
+the highest pinnacle of St. Paul's Cathedral. Under Louis XII an
+acrobat named Georges Menustre, during a passage of the King through
+Macon, executed several performances on a rope stretched from the grand
+tower of the Chateau and the clock of the Jacobins, at a height of 156
+feet. A similar performance was given at Milan before the French
+Ambassadors, and at Venice under the Doges and the Senate on each St.
+Mark's Day, rope-walkers performed at high altitudes. In 1649 a man
+attempted to traverse the Seine on a rope placed between the Tour de
+Nesles and the Tour du Grand-Prevost. The performance, however, was
+interrupted by the fall of the mountebank into the Seine. At subsequent
+fairs in France other acrobats have appeared. At the commencement of
+this century there was a person named Madame Saqui who astonished the
+public with her nimbleness and extraordinary skill in rope walking. Her
+specialty was military maneuvers. On a cord 20 meters from the ground
+she executed all sorts of military pantomimes without assistance,
+shooting off pistols, rockets, and various colored fires. Napoleon
+awarded her the title of the first acrobat of France. She gave a
+performance as late as 1861 at the Hippodrome of Paris.
+
+In 1814 there was a woman called "La Malaga," who, in the presence of
+the allied sovereigns at Versailles, made an ascension on a rope 200
+feet above the Swiss Lake.
+
+In the present generation probably the most famous of all the
+equilibrists was Blondin. This person, whose real name was Emile
+Gravelet, acquired a universal reputation; about 1860 he traversed the
+Niagara Falls on a cable at an elevation of nearly 200 feet. Blondin
+introduced many novelties in his performances.  Sometimes he would
+carry a man over on his shoulders; again he would eat a meal while on
+his wire; cook and eat an omelet, using a table and ordinary cooking
+utensils, all of which he kept balanced. In France Blondin was almost
+the patron saint of the rope-walkers; and at the present day the
+performers imitate his feats, but never with the same grace and
+perfection.
+
+In 1882 an acrobat bearing the natural name of Arsens Blondin traversed
+one river after another in France on a wire stretched at high
+altitudes. With the aid of a balancing-rod he walked the rope
+blindfolded; with baskets on his feet; sometimes he wheeled persons
+over in a wheelbarrow. He was a man of about thirty, short, but
+wonderfully muscled and extremely supple.
+
+It is said that a negro equilibrist named Malcom several times
+traversed the Meuse at Sedan on a wire at about a height of 100 feet.
+Once while attempting this feat, with his hands and feet shackled with
+iron chains, allowing little movement, the support on one side fell,
+after the cable had parted, and landed on the spectators, killing a
+young girl and wounding many others. Malcom was precipitated into the
+river, but with wonderful presence of mind and remarkable strength he
+broke his bands and swam to the shore, none the worse for his high
+fall; he immediately helped in attention to his wounded spectators. A
+close inspection of all the exhibitionists of this class will show that
+they are of superior physique and calm courage. They only acquire their
+ability after long gymnastic exercise, as well as actual practice on
+the rope. Most of these persons used means of balancing themselves,
+generally a long and heavy pole; but some used nothing but their
+outstretched arms. In 1895, at the Royal Aquarium in London, there was
+an individual who slowly mounted a long wire reaching to the top of
+this huge structure, and, after having made the ascent, without the aid
+of any means of balancing but his arms, slid the whole length of the
+wire, landing with enormous velocity into an outstretched net.
+
+The equilibrists mentioned thus far have invariably used a tightly
+stretched rope or wire; but there are a number of persons who perform
+feats, of course not of such magnitude, on a slack wire, in which they
+have to defy not only the force of gravity, but the to-and-fro motion
+of the cable as well. It is particularly with the Oriental performers
+that we see this exhibition. Some use open parasols, which, with their
+Chinese or Japanese costumes, render the performance more picturesque;
+while others seem to do equally well without such adjuncts. There have
+been performers of this class who play with sharp daggers while
+maintaining themselves on thin and swinging wires.
+
+Another class of equilibrists are those who maintain the upright
+position resting on their heads with their feet in the air. At the
+Hippodrome in Paris some years since there was a man who remained in
+this position seven minutes and ate a meal during the interval. There
+were two clowns at the Cirque Franconi who duplicated this feat, and
+the program called their dinner "Un dejouner en tete-a-tete." Some
+other persons perform wonderful feats of a similar nature on an
+oscillating trapeze, and many similar performances have been witnessed
+by the spectators of our large circuses.
+
+The "human pyramids" are interesting, combining, as they do, wonderful
+power of maintaining equilibrium with agility and strength. The
+rapidity with which they are formed and are tumbled to pieces is
+marvelous they sometimes include as many as 16 persons men, women, and
+children.
+
+The exhibitions given by the class of persons commonly designated as
+"jugglers" exemplify the perfect control that by continual practice one
+may obtain over his various senses and muscles. The most wonderful
+feats of dexterity are thus reduced into mere automatic movements.
+Either standing, sitting, mounted on a horse, or even on a wire, they
+are able to keep three four, five, and even six balls in continual
+motion in the air. They use articles of the greatest difference in
+specific gravity in the same manner. A juggler called "Kara," appearing
+in London and Paris in the summer of 1895, juggled with an open
+umbrella, an eye-glass, and a traveling satchel, and received each
+after its course in the air with unerring precision. Another man called
+"Paul Cinquevalli," well known in this country, does not hesitate to
+juggle with lighted lamps or pointed knives. The tricks of the clowns
+with their traditional pointed felt hats are well known.  Recently
+there appeared in Philadelphia a man who received six such hats on his
+head, one on top of the other, thrown by his partner from the rear of
+the first balcony of the theater. Others will place a number of rings
+on their fingers, and with a swift and dexterous movement toss them all
+in the air, catching them again all on one finger. Without resorting to
+the fabulous method of Columbus, they balance eggs on a table, and in
+extraordinary ways defy all the powers of gravity.
+
+In India and China we see the most marvelous of the knife-jugglers.
+
+With unerring skill they keep in motion many pointed knives, always
+receiving them at their fall by the handles. They throw their
+implements with such precision that one often sees men, who, placing
+their partner against a soft board, will stand at some distance and so
+pen him in with daggers that he cannot move until some are withdrawn,
+marking a silhouette of his form on the board,--yet never once does one
+as much as graze the skin. With these same people the foot-jugglers are
+most common. These persons, both made and female, will with their feet
+juggle substances and articles that it requires several assistants to
+raise.
+
+A curious trick is given by Rousselet in his magnificent work entitled
+"L'Inde des Rajahs," and quoted by Guyot-Daubes. It is called in India
+the "dance of the eggs." The dancer, dressed in a rather short skirt,
+places on her head a large wheel made of light wood, and at regular
+intervals having hanging from it pieces of thread, at the ends of which
+are running knots kept open by beads of glass. She then brings forth a
+basket of eggs, and passes them around for inspection to assure her
+spectators of their genuineness. The monotonous music commences and the
+dancer sets the wheel on her head in rapid motion; then, taking an egg,
+with a quick movement she puts it on one of the running knots and
+increases the velocity of the revolution of the wheel by gyrations
+until the centrifugal force makes each cord stand out in an almost
+horizontal line with the circumference of the wheel.  Then one after
+another she places the eggs on the knots of the cord, until all are
+flying about her head in an almost horizontal position. At this moment
+the dance begins, and it is almost impossible to distinguish the
+features of the dancer. She continues her dance, apparently indifferent
+to the revolving eggs. At the velocity with which they revolve the
+slightest false movement would cause them to knock against one another
+and surely break. Finally, with the same lightning-like movements, she
+removes them one by one, certainly the most delicate part of the trick,
+until they are all safely laid away in the basket from which they came,
+and then she suddenly brings the wheel to a stop; after this wonderful
+performance, lasting possibly thirty minutes, she bows herself out.
+
+A unique Japanese feat is to tear pieces of paper into the form of
+butterflies and launch them into the air about a vase full of flowers;
+then with a fan to keep them in motion, making them light on the
+flowers, fly away, and return, after the manner of several living
+butterflies, without allowing one to fall to the ground.
+
+Marksmen.--It would be an incomplete paper on the acute development of
+the senses that did not pay tribute to the men who exhibit marvelous
+skill with firearms. In the old frontier days in the Territories, the
+woodsmen far eclipsed Tell with his bow or Robin Hood's famed band by
+their unerring aim with their rifles. It is only lately that there
+disappeared in this country the last of many woodsmen, who, though
+standing many paces away and without the aid of the improved sights of
+modern guns, could by means of a rifle-ball, with marvelous precision,
+drive a nail "home" that had been placed partly in a board. The experts
+who shoot at glass balls rarely miss, and when we consider the number
+used each year, the proportion of inaccurate shots is surprisingly
+small. Ira Paine, Doctor Carver, and others have been seen in their
+marvelous performances by many people of the present generation. The
+records made by many of the competitors of the modern army-shooting
+matches are none the less wonderful, exemplifying as they do the degree
+of precision that the eye may attain and the control which may be
+developed over the nerves and muscles. The authors know of a countryman
+who successfully hunted squirrels and small game by means of pebbles
+thrown with his hand.
+
+Physiologic wonders are to be found in all our modern sports and games.
+In billiards, base-ball, cricket, tennis, etc., there are experts who
+are really physiologic curiosities. In the trades and arts we see
+development of the special senses that is little less than marvelous.
+It is said that there are workmen in Krupp's gun factory in Germany who
+have such control over the enormous trip hammers that they can place a
+watch under one and let the hammer fall, stopping it with unerring
+precision just on the crystal. An expert tool juggler in one of the
+great English needle factories, in a recent test of skill, performed
+one of the most delicate mechanical feats imaginable. He took a common
+sewing needle of medium size (length 1 5/8 inches) and drilled a hole
+through its entire length from eye to point--the opening being just
+large enough to admit the passage of a very fine hair. Another workman
+in a watch-factory of the United States drilled a hole through a hair
+of his beard and ran a fiber of silk through it.
+
+Ventriloquists, or "two-voiced men," are interesting anomalies of the
+present day; it is common to see a person who possesses the power of
+speaking with a voice apparently from the epigastrium.  Some acquire
+this faculty, while with others it is due to a natural resonance,
+formed, according to Dupont, in the space between the third and fourth
+ribs and their cartilaginous union and the middle of the first portion
+of the sternum. Examination of many of these cases proves that the
+vibration is greatest here. It is certain that ventriloquists have
+existed for many centuries. It is quite possible that some of the old
+Pagan oracles were simply the deceptions of priests by means of
+ventriloquism.
+
+Dupont, Surgeon-in-chief of the French Army about a century since,
+examined minutely an individual professing to be a ventriloquist. With
+a stuffed fox on his lap near his epigastrium, he imitated a
+conversation with the fox. By lying on his belly, and calling to some
+one supposed to be below the surface of the ground, he would imitate an
+answer seeming to come from the depths of the earth. With his belly on
+the ground he not only made the illusion more complete, but in this way
+he smothered "the epigastric voice."
+
+He was always noticed to place the inanimate objects with which he held
+conversations near his umbilicus.
+
+Ventriloquists must not be confounded with persons who by means of
+skilful mechanisms, creatures with movable fauces, etc., imitate
+ventriloquism. The latter class are in no sense of the word true
+ventriloquists, but simulate the anomaly by quickly changing the tones
+of their voice in rapid succession, and thus seem to make their puppets
+talk in many different voices. After having acquired the ability to
+suddenly change the tone of their voice, they practice imitations of
+the voices of the aged, of children, dialects, and feminine tones, and,
+with a set of mechanical puppets, are ready to appear as
+ventriloquists. By contraction of the pharyngeal and laryngeal muscles
+they also imitate tones from a distance. Some give their performance
+with little labial movement, but close inspection of the ordinary
+performer of this class shows visible movements of his lips. The true
+ventriloquist pretends only to speak from the belly and needs no
+mechanical assistance.
+
+The wonderful powers of mimicry displayed by expert ventriloquists are
+marvelous; they not only imitate individuals and animals, but do not
+hesitate to imitate a conglomeration of familiar sounds and noises in
+such a manner as to deceive their listeners into believing that they
+hear the discussions of an assemblage of people. The following
+description of an imitation of a domestic riot by a Chinese
+ventriloquist is given by the author of "The Chinaman at Home" and well
+illustrates the extent of their abilities: "The ventriloquist was
+seated behind a screen, where there were only a chair, a table, a fan,
+and a ruler. With this ruler he rapped on the table to enforce silence,
+and when everybody had ceased speaking there was suddenly heard the
+barking of a dog. Then we heard the movements of a woman. She had been
+waked by the dog and was shaking her husband. We were just expecting to
+hear the man and wife talking together when a child began to cry. To
+pacify it the mother gave it food; we could hear it drinking and crying
+at the same time. The mother spoke to it soothingly and then rose to
+change its clothes.  Meanwhile another child had wakened and was
+beginning to make a noise. The father scolded it, while the baby
+continued crying.  By-and-by the whole family went back to bed and fell
+asleep. The patter of a mouse was heard. It climbed up some vase and
+upset it. We heard the clatter of the vase as it fell. The woman
+coughed in her sleep. Then cries of "Fire! fire!" were heard. The mouse
+had upset the lamp; the bed curtains were on fire. The husband and wife
+waked up, shouted, and screamed, the children cried, people came
+running and shouting. Children cried, dogs barked, squibs and crackers
+exploded. The fire brigade came racing up. Water was pumped up in
+torrents and hissed in the flames. The representation was so true to
+life that every one rose to his feet and was starting away when a
+second blow of the ruler on the table commanded silence. We rushed
+behind the screen, but there was nothing there except the
+ventriloquist, his table, his chair, and his ruler."
+
+Athletic Feats.--The ancients called athletes those who were noted for
+their extraordinary agility, force, and endurance. The history of
+athletics is not foreign to that of medicine, but, on the contrary, the
+two are in many ways intimately blended. The instances of feats of
+agility and endurance are in every sense of the word examples of
+physiologic and functional anomalies, and have in all times excited the
+interest and investigation of capable physicians.
+
+The Greeks were famous for their love of athletic pastimes; and
+classical study serves powerfully to strengthen the belief that no
+institution exercised greater influence than the public contests of
+Greece in molding national character and producing that admirable type
+of personal and intellectual beauty that we see reflected in her art
+and literature. These contests were held at four national festivals,
+the Olympian, the Pythian, the Nemean, and the Isthmean games. On these
+occasions every one stopped labor, truce was declared between the
+States, and the whole country paid tribute to the contestants for the
+highly-prized laurels of these games. Perhaps the enthusiasm shown in
+athletics and interest in physical development among the Greeks has
+never been equaled by any other people. Herodotus and all the Greek
+writers to Plutarch have elaborated on the glories of the Greek
+athlete, and tell us of the honors rendered to the victors by the
+spectators and the vanquished, dwelling with complacency on the fact
+that in accepting the laurel they cared for nothing but honor. The
+Romans in "ludi publici," as they called their games, were from first
+to last only spectators; but in Greece every eligible person was an
+active participant. In the regimen of diet and training the physicians
+from the time of Hippocrates, and even before, have been the
+originators and professional advisers of the athlete. The change in the
+manner of living of athletes, if we can judge from the writings of
+Hippocrates, was anterior to his time; for in Book V of the "Epidemics"
+we read of Bias, who, "suapte nature vorax, in choleram-morbum incidit
+ex carnium esu, praecipueque suillarum crudarum, etc."
+
+From the time of the well-known fable of the hero who, by practicing
+daily from his birth, was able to lift a full-grown bull, thus
+gradually accustoming himself to the increased weight, physiologists
+and scientists have collaborated with the athlete in evolving the
+present ideas and system of training. In his aphorisms Hippocrates
+bears witness to the dangers of over-exercise and superabundant
+training, and Galen is particularly averse to an art which so
+preternaturally develops the constitution and nature of man; many
+subsequent medical authorities believed that excessive development of
+the human frame was necessarily followed by a compensatory shortening
+of life.
+
+The foot-race was the oldest of the Greek institutions, and in the
+first of the Olympiads the "dromos," a course of about 200 yards, was
+the only contest; but gradually the "dialos," in which the course was
+double that of the dromos, was introduced, and, finally, tests of
+endurance as well as speed were instituted in the long-distance races
+and the contests of racing in heavy armor, which were so highly
+commended by Plato as preparation for the arduous duties of a soldier.
+Among the Greeks we read of Lasthenes the Theban, who vanquished a
+horse in the course; of Polymnestor, who chased and caught a hare; and
+Philonides, the courier of Alexander the Great, who in nine hours
+traversed the distance between the Greek cities Sicyone and Elis, a
+distance of over 150 miles. We read of the famous soldier of Marathon,
+who ran to announce the victory to the Magistrates of Athens and fell
+dead at their feet. In the Olympian games at Athens in 1896 this
+distance (about 26 miles) was traversed in less than three hours.
+
+It is said of Euchidas, who carried the fire necessary for the
+sacrifices which were to replace those which the Persians had spoiled,
+that he ran a thousand stadia (about 125 miles) and fell dead at the
+end of his mission. The Roman historians have also recited the
+extraordinary feats of the couriers of their times.  Pliny speaks of an
+athlete who ran 235 kilometers (almost 150 miles) without once
+stopping. He also mentions a child who ran almost half this distance.
+
+In the Middle Ages the Turks had couriers of almost supernatural
+agility and endurance. It is said that the distance some of them would
+traverse in twenty-four hours was 120 miles, and that it was common for
+them to make the round trip from Constantinople to Adrianople, a
+distance of 80 leagues, in two days. They were dressed very lightly,
+and by constant usage the soles of their feet were transformed into a
+leathery consistency. In the last century in the houses of the rich
+there were couriers who preceded the carriages and were known as
+"Basques," who could run for a very long time without apparent fatigue.
+In France there is a common proverb, "Courir comme un Basque." Rabelais
+says: "Grand-Gousier depeche le Basque son laquais pour querir
+Gargantua en toute hate."
+
+In the olden times the English nobility maintained running footmen who,
+living under special regimen and training, were enabled to traverse
+unusual distances without apparent fatigue.  There is an anecdote of a
+nobleman living in a castle not far from Edinburgh, who one evening
+charged his courier to carry a letter to that city. The next morning
+when he arose he found this valet sleeping in his antechamber. The
+nobleman waxed wroth, but the courier gave him a response to the
+letter. He had traveled 70 miles during the night. It is said that one
+of the noblemen under Charles II in preparing for a great dinner
+perceived that one of the indispensable pieces of his service was
+missing. His courier was dispatched in great haste to another house in
+his domain, 15 miles distant, and returned in two hours with the
+necessary article, having traversed a distance of over 30 miles. It is
+also said that a courier carrying a letter to a London physician
+returned with the potion prescribed within twenty-four hours, having
+traversed 148 miles. There is little doubt of the ability of these
+couriers to tire out any horse. The couriers who accompany the
+diligences in Spain often fatigue the animals who draw the vehicles.
+
+At the present time in this country the Indians furnish examples of
+marvelous feats of running. The Tauri-Mauri Indians, who live in the
+heart of the Sierra Madre Mountains, are probably the most wonderful
+long-distance runners in the world. Their name in the language of the
+mountain Mexicans means foot-runners; and there is little doubt that
+they perform athletic feats which equal the best in the days of the
+Olympian games. They are possibly the remnants of the wonderful runners
+among the Indian tribes in the beginning of this century. There is an
+account of one of the Tauri-Mauri who was mail carrier between
+Guarichic and San Jose de los Cruces, a distance of 50 miles of as
+rough, mountainous road as ever tried a mountaineer's lungs and limbs.
+Bareheaded and barelegged, with almost no clothing, this man made this
+trip each day, and, carrying on his back a mail-pouch weighing 40
+pounds, moved gracefully and easily over his path, from time to time
+increasing his speed as though practicing, and then again more slowly
+to smoke a cigarette. The Tauri-Mauri are long-limbed and slender,
+giving the impression of being above the average height. There is
+scarcely any flesh on their puny arms, but their legs are as muscular
+as those of a greyhound. In short running they have the genuine
+professional stride, something rarely seen in other Indian racers. In
+traversing long distances they leap and bound like deer.
+
+"Deerfoot," the famous Indian long-distance runner, died on the
+Cattaraugus Reservation in January, 1896. His proper name was Louis
+Bennett, the name "Deerfoot" having been given to him for his prowess
+in running. He was born on the reservation in 1828.  In 1861 he went to
+England, where he defeated the English champion runners. In April,
+1863, he ran 11 miles in London in fifty-six minutes fifty-two seconds,
+and 12 miles in one hour two minutes and two and one-half seconds, both
+of which have stood as world's records ever since.
+
+In Japan, at the present day, the popular method of conveyance, both in
+cities and in rural districts, is the two-wheeled vehicle, looking like
+a baby-carriage, known to foreigners as the jinrickisha, and to the
+natives as the kuruma. In the city of Tokio there is estimated to be
+38,000 of these little carriages in use. They are drawn by coolies, of
+whose endurance remarkable stories are told. These men wear light
+cotton breeches and a blue cotton jacket bearing the license number,
+and the indispensable umbrella hat. In the course of a journey in hot
+weather the jinrickisha man will gradually remove most of his raiment
+and stuff it into the carriage. In the rural sections he is covered
+with only two strips of cloth, one wrapped about his head and the other
+about his loins. It is said that when the roadway is good, these "human
+horses" prefer to travel bare-footed; when working in the mud they wrap
+a piece of straw about each big toe, to prevent slipping and to give
+them a firmer grip. For any of these men a five-mile spurt on a good
+road without a breathing spell is a small affair. A pair of them will
+roll a jinrickisha along a country road at the rate of four miles an
+hour, and they will do this eight hours a day. The general average of
+the distance traversed in a day is 25 miles. Cockerill, who has
+recently described these men, says that the majority of them die early.
+The terrible physical strain brings on hypertrophy and valvular
+diseases of the heart, and many of them suffer from hernia.
+Occasionally one sees a veteran jinrickisha man, and it is interesting
+to note how tenderly he is helped by his confreres.  They give him
+preference as regards wages, help push his vehicle up heavy grades, and
+show him all manner of consideration.
+
+Figure 180 represents two Japanese porters and their usual load, which
+is much more difficult to transport than a jinrickisha carriage. In
+other Eastern countries, palanquins and other means of conveyance are
+still borne on the shoulders of couriers, and it is not so long since
+our ancestors made their calls in Sedan-chairs borne by sturdy porters.
+
+Some of the letter-carriers of India make a daily journey of 30 miles.
+They carry in one hand a stick, at the extremity of which is a ring
+containing several little plates of iron, which, agitated during the
+course, produce a loud noise designed to keep off ferocious beasts and
+serpents. In the other hand they carry a wet cloth, with which they
+frequently refresh themselves by wiping the countenance. It is said
+that a regular Hindustanee carrier, with a weight of 80 pounds on his
+shoulder,--carried, of course, in two divisions, hung on his neck by a
+yoke,--will, if properly paid, lope along over 100 miles in twenty-four
+hours--a feat which would exhaust any but the best trained runners.
+
+The "go-as-you-please" pedestrians, whose powers during the past years
+have been exhibited in this country and in England, have given us
+marvelous examples of endurance, over 600 miles having been
+accomplished in a six-days' contest. Hazael, the professional
+pedestrian, has run over 450 miles in ninety-nine hours, and Albert has
+traveled over 500 miles in one hundred and ten hours. Rowell, Hughes,
+and Fitzgerald have astonishingly high records for long-distance
+running, comparing favorably with the older, and presumably mythical,
+feats of this nature. In California, C. A. Harriman of Truckee in
+April, 1883, walked twenty-six hours without once resting, traversing
+122 miles.
+
+For the purpose of comparison we give the best modern records for
+running:--
+
+100 Yards.--9 3/5 seconds, made by Edward Donavan, at Natick, Mass.,
+September 2, 1895.
+
+220 Yards.--21 3/5 seconds, made by Harry Jewett, at Montreal,
+September 24, 1892.
+
+Quarter-Mile.--47 3/4 seconds, made by W. Baker, at Boston, Mass., July
+1, 1886.
+
+Half-Mile.--1 minute 53 2/3 seconds, made by C. J. Kirkpatrick, at
+Manhattan Field, New York, September 21, 1895.
+
+1 Mile.--4 minutes 12 3/4 seconds, made by W. G. George, at London,
+England, August 23, 1886.
+
+5 Miles.--24 minutes 40 seconds, made by J. White, in England, May 11,
+1863.
+
+10 Miles.--51 minutes 6 3/5 seconds, made by William Cummings, at
+London, England, September 18,1895.
+
+25 Miles.--2 hours 33 minutes 44 seconds, made by G. A. Dunning, at
+London, England, December 26, 1881.
+
+50 Miles.--5 hours 55 minutes 4 1/2 seconds, made by George Cartwright,
+at London, England, February 21, 1887.
+
+75 Miles.--8 hours 48 minutes 30 seconds, made by George Littlewood, at
+London, England, November 24, 1884.
+
+100 Miles.--13 hours 26 minutes 30 seconds, made by Charles Rowell at
+New York, February 27, 1882.
+
+In instances of long-distance traversing, rapidity is only a secondary
+consideration, the remarkable fact being in the endurance of fatigue
+and the continuity of the exercise. William Gale walked 1500 miles in a
+thousand consecutive hours, and then walked 60 miles every twenty-four
+hours for six weeks on the Lillie Bridge cinder path. He was five feet
+five inches tall, forty-nine years of age, and weighed 121 pounds, and
+was but little developed muscularly. He was in good health during his
+feat; his diet for the twenty-four hours was 16 pounds of meat, five or
+six eggs, some cocoa, two quarts of milk, a quart of tea, and
+occasionally a glass of bitter ale, but never wine nor spirits. Strange
+to say, he suffered from constipation, and took daily a compound
+rhubarb pill. He was examined at the end of his feat by Gant. His pulse
+was 75, strong, regular, and his heart was normal. His temperature was
+97.25 degrees F., and his hands and feet warm; respirations were deep
+and averaged 15 a minute.  He suffered from frontal headache and was
+drowsy. During the six weeks he had lost only seven pounds, and his
+appetite maintained its normal state.
+
+Zeuner of Cincinnati refers to John Snyder of Dunkirk, whose
+walking-feats were marvelous. He was not an impostor. During
+forty-eight hours he was watched by the students of the Ohio Medical
+College, who stated that he walked constantly; he assured them that it
+did not rest him to sit down, but made him uncomfortable. The
+celebrated Weston walked 5000 miles in one hundred days, but Snyder was
+said to have traveled 25,000 miles in five hundred days and was
+apparently no more tired than when he began.
+
+Recently there was a person who pushed a wheelbarrow from San Francisco
+to New York in one hundred and eighteen days. In 1809 the celebrated
+Captain Barclay wagered that he could walk 1000 miles in one thousand
+consecutive hours, and gained his bet with some hours to spare. In 1834
+Ernest Mensen astonished all Europe by his pedestrian exploits. He was
+a Norwegian sailor, who wagered that he could walk from Paris to Moscow
+in fifteen days.  On June 25, 1834, at ten o'clock A.M., he entered the
+Kremlin, after having traversed 2500 kilometers (1550 miles) in
+fourteen days and eighteen hours. His performances all over Europe were
+so marvelous as to be almost incredible. In 1836, in the service of the
+East India Company, he was dispatched from Calcutta to Constantinople,
+across Central Asia. He traversed the distance in fifty-nine days,
+accomplishing 9000 kilometers (5580 miles) in one-third less time than
+the most rapid caravan. He died while attempting to discover the source
+of the Nile, having reached the village of Syang.
+
+A most marvelous feat of endurance is recorded in England in the first
+part of this century. It is said that on a wager Sir Andrew Leith Hay
+and Lord Kennedy walked two days and a night under pouring rain, over
+the Grampian range of mountains, wading all one day in a bog. The
+distance traversed was from a village called Banchory on the river Dee
+to Inverness. This feat was accomplished without any previous
+preparation, both men starting shortly after the time of the wager.
+
+Riders.--The feats of endurance accomplished by the couriers who ride
+great distances with many changes of horses are noteworthy.  According
+to a contemporary medical journal there is, in the Friend of India, an
+account of the Thibetan couriers who ride for three weeks with
+intervals of only half an hour to eat and change horses. It is the duty
+of the officials at the Dak bungalows to see that the courier makes no
+delay, and even if dying he is tied to his horse and sent to the next
+station. The celebrated English huntsman, "Squire" Osbaldistone, on a
+wager rode 200 miles in seven hours ten minutes and four seconds. He
+used 28 horses; and as one hour twenty-two minutes and fifty-six
+seconds were allowed for stoppages, the whole time, changes and all,
+occupied in accomplishing this wonderful feat was eight hours and
+forty-two minutes. The race was ridden at the Newmarket Houghton
+Meeting over a four-mile course. It is said that a Captain Horne of the
+Madras Horse Artillery rode 200 miles on Arab horses in less than ten
+hours along the road between Madras and Bangalore. When we consider the
+slower speed of the Arab horses and the roads and climate of India,
+this performance equals the 200 miles in the shorter time about an
+English race track and on thoroughbreds. It is said that this wonderful
+horseman lost his life in riding a horse named "Jumping Jenny" 100
+miles a day for eight days. The heat was excessive, and although the
+horse was none the worse for the performance, the Captain died from the
+exposure he encountered. There is a record of a Mr. Bacon of the Bombay
+Civil Service, who rode one camel from Bombay to Allygur (perhaps 800
+miles) in eight days.
+
+As regards the physiology of the runners and walkers, it is quite
+interesting to follow the effects of training on the respiration,
+whereby in a measure is explained the ability of these persons to
+maintain their respiratory function, although excessively exercising. A
+curious discussion, persisted in since antiquity, is as to the supposed
+influence of the spleen on the ability of couriers. For ages runners
+have believed that the spleen was a hindrance to their vocation, and
+that its reduction was followed by greater agility on the course. With
+some, this opinion is perpetuated to the present day. In France there
+is a proverb, "Courir comme un derate." To reduce the size of the
+spleen, the Greek athletes used certain beverages, the composition of
+which was not generally known; the Romans had a similar belief and
+habit Pliny speaks of a plant called equisetum, a decoction of which
+taken for three days after a fast of twenty-four hours would effect
+absorption of the spleen. The modern pharmacopeia does not possess any
+substance having a similar virtue, although quinin has been noticed to
+diminish the size of the spleen when engorged in malarial fevers.
+Strictly speaking, however, the facts are not analogous. Hippocrates
+advises a moxa of mushrooms applied over the spleen for melting or
+dissolving it. Godefroy Moebius is said to have seen in the village of
+Halberstadt a courier whose spleen had been cauterized after incision;
+and about the same epoch (seventeenth century) some men pretended to be
+able to successfully extirpate the spleen for those who desired to be
+couriers. This operation we know to be one of the most delicate in
+modern surgery, and as we are progressing with our physiologic
+knowledge of the spleen we see nothing to justify the old theory in
+regard to its relations to agility and coursing.
+
+Swimming.--The instances of endurance that we see in the aquatic sports
+are equally as remarkable as those that we find among the runners and
+walkers. In the ancient days the Greeks, living on their various
+islands and being in a mild climate, were celebrated for their prowess
+as swimmers. Socrates relates the feats of swimming among the
+inhabitants of Delos. The journeys of Leander across the Hellespont are
+well celebrated in verse and prose, but this feat has been easily
+accomplished many times since, and is hardly to be classed as
+extraordinary. Herodotus says that the Macedonians were skilful
+swimmers; and all the savage tribes about the borders of waterways are
+found possessed of remarkable dexterity and endurance in swimming.
+
+In 1875 the celebrated Captain Webb swam from Dover to Calais. On
+landing he felt extremely cold, but his body was as warm as when he
+started. He was exhausted and very sleepy, falling in deep slumber on
+his way to the hotel. On getting into bed his temperature was 98
+degrees F. and his pulse normal. In five hours he was feverish, his
+temperature rising to 101 degrees F. During the passage he was blinded
+from the salt water in his eyes and the spray beating against his face.
+He strongly denied the newspaper reports that he was delirious, and
+after a good rest was apparently none the worse for the task. In 1876
+he again traversed this passage with the happiest issue. In 1883 he was
+engaged by speculators to swim the rapids at Niagara, and in attempting
+this was overcome by the powerful currents, and his body was not
+recovered for some days after. The passage from Dover to Calais has
+been duplicated.
+
+In 1877 Cavill, another Englishman, swam from Cape Griz-Nez to South
+Forland in less than thirteen hours. In 1880 Webb swam and floated at
+Scarborough for seventy-four consecutive hours--of course, having no
+current to contend with and no point to reach.  This was merely a feat
+of staying in the water. In London in 1881, Beckwith, swimming ten
+hours a day over a 32-lap course for six days, traversed 94 miles.
+Since the time of Captain Webb, who was the pioneer of modern
+long-distance swimming, many men have attempted and some have
+duplicated his feats; but these foolhardy performances have in late
+years been diminishing, and many of the older feats are forbidden by
+law.
+
+Jumpers and acrobatic tumblers have been popular from the earliest
+time. By the aid of springing boards and weights in their hands, the
+old jumpers covered great distances. Phayllus of Croton is accredited
+with jumping the incredible distance of 55 feet, and we have the
+authority of Eustache and Tzetzes that this jump is genuine. In the
+writings of many Greek and Roman historians are chronicled jumps of
+about 50 feet by the athletes; if they are true, the modern jumpers
+have greatly degenerated. A jump of over 20 feet to-day is considered
+very clever, the record being 29 feet seven inches with weights, and 23
+feet eight inches without weights, although much greater distances have
+been jumped with the aid of apparatus, but never an approximation to 50
+feet.  The most surprising of all these athletes are the tumblers, who
+turn somersaults over several animals arranged in a row. Such feats are
+not only the most amusing sights of a modern circus, but also the most
+interesting as well. The agility of these men is marvelous, and the
+force with which they throw themselves in the air apparently enables
+them to defy gravity. In London, Paris, or New York one may see these
+wonderful tumblers and marvel at the capabilities of human physical
+development.
+
+In September, 1895, M. F. Sweeney, an American amateur, at Manhattan
+Field in New York jumped six feet 5 5/8 inches high in the running high
+jump without weights. With weights, J. H.  Fitzpatrick at Oak Island,
+Mass., jumped six feet six inches high. The record for the running high
+kick is nine feet eight inches, a marvelous performance, made by C. C.
+Lee at New Haven, Conn., March 19, 1887.
+
+Extraordinary physical development and strength has been a grand means
+of natural selection in the human species. As Guyot-Daubes remarks, in
+prehistoric times, when our ancestors had to battle against hunger,
+savage beasts, and their neighbors, and when the struggle for existence
+was so extremely hard, the strong man alone resisted and the weak
+succumbed. This natural selection has been perpetuated almost to our
+day; during the long succession of centuries, the chief or the master
+was selected on account of his being the strongest, or the most valiant
+in the combat.  Originally, the cavaliers, the members of the nobility,
+were those who were noted for their courage and strength, and to them
+were given the lands of the vanquished. Even in times other than those
+of war, disputes of succession were settled by jousts and tourneys.
+This fact is seen in the present day among the lower animals, who in
+their natural state live in tribes; the leader is usually the
+strongest, the wisest, and the most courageous.
+
+The strong men of all times have excited the admiration of their
+fellows and have always been objects of popular interest. The Bible
+celebrates the exploits of Samson of the tribe of Dan.  During his
+youth he, single handed, strangled a lion; with the jaw-bone of an ass
+he is said to have killed 1000 Philistines and put the rest to flight.
+At another time during the night he transported from the village of
+Gaza enormous burdens and placed them on the top of a mountain.
+Betrayed by Delilah, he was delivered into the hands of his enemies and
+employed in the most servile labors. When old and blind he was attached
+to the columns of an edifice to serve as an object of public ridicule;
+with a violent effort he overturned the columns, destroying himself and
+3000 Philistines.
+
+In the Greek mythology we find a great number of heroes, celebrated for
+their feats of strength and endurance. Many of them have received the
+name of Hercules; but the most common of these is the hero who was
+supposed to be the son of Jupiter and Alemena. He was endowed with
+prodigious strength by his father, and was pursued with unrelenting
+hatred by Juno. In his infancy he killed with his hands the serpents
+which were sent to devour him. The legends about him are innumerable.
+He was said to have been armed with a massive club, which only he was
+able to carry.  The most famous of his feats were the twelve labors,
+with which all readers of mythology are familiar. Hercules,
+personified, meant to the Greeks physical force as well as strength,
+generosity, and bravery, and was equivalent to the Assyrian Hercules.
+The Gauls had a Hercules-Pantopage, who, in addition to the ordinary
+qualities attributed to Hercules, had an enormous appetite.
+
+As late as the sixteenth century, and in a most amusing and picturesque
+manner, Rabelais has given us the history of Gargantua, and even to
+this day, in some regions, there are groups of stones which are
+believed by ignorant people to have been thrown about by Gargantua in
+his play. In their citations the older authors often speak of battles,
+and in epic ballads of heroes with marvelous strength. In the army of
+Charlemagne, after Camerarius, and quoted by Guyot-Daubes (who has made
+an extensive collection of the literature on this subject and to whom
+the authors are indebted for much information), there was found a giant
+named Oenother, a native of a village in Suabia, who performed
+marvelous feats of strength. In his history of Bavaria Aventin speaks
+of this monster. To Roland, the nephew of Charlemagne, the legends
+attributed prodigious strength; and, dying in the valley of
+Roncesveaux, he broke his good sword "Durandal" by striking it against
+a rock, making a breach, which is stilled called the "Breche de
+Roland." Three years before his death, on his return from Palestine,
+Christopher, Duke of Bavaria, was said to have lifted to his shoulders
+a stone which weighed more than 340 pounds. Louis de Boufflers,
+surnamed the "Robust," who lived in 1534, was noted for his strength
+and agility. When he placed his feet together, one against the other,
+he could find no one able to disturb them. He could easily bend and
+break a horseshoe with his hands, and could seize an ox by the tail and
+drag it against its will. More than once he was said to have carried a
+horse on his shoulders. According to Guyot-Daubes there was, in the
+last century, a Major Barsaba who could seize the limb of a horse and
+fracture its bone. There was a tale of his lifting an iron anvil, in a
+blacksmith's forge, and placing it under his coat.
+
+To the Emperor Maximilian I was ascribed enormous strength; even in his
+youth, when but a simple patriot, he vanquished, at the games given by
+Severus, 16 of the most vigorous wrestlers, and accomplished this feat
+without stopping for breath. It is said that this feat was the origin
+of his fortune. Among other celebrated persons in history endowed with
+uncommon strength were Edmund "Ironsides," King of England; the Caliph
+Mostasem-Billah; Baudouin, "Bras-de-Fer," Count of Flanders; William
+IV, called by the French "Fier-a-Bras," Duke of Aquitaine; Christopher,
+son of Albert the Pious, Duke of Bavaria; Godefroy of Bouillon; the
+Emperor Charles IV; Scanderbeg; Leonardo da Vinci; Marshal Saxe; and
+the recently deceased Czar of Russia, Alexander III.
+
+Turning now to the authentic modern Hercules, we have a man by the name
+of Eckeberg, born in Anhalt, and who traveled under the name of
+"Samson." He was exhibited in London, and performed remarkable feats of
+strength. He was observed by the celebrated Desaguliers (a pupil of
+Newton) in the commencement of the last century, who at that time was
+interested in the physiologic experiments of strength and agility.
+Desaguliers believed that the feats of this new Samson were more due to
+agility than strength. One day, accompanied by two of his confreres,
+although a man of ordinary strength, he duplicated some of Samson's
+feats, and followed his performance by a communication to the Royal
+Society. One of his tricks was to resist the strength of five or six
+men or of two horses. Desaguliers claimed that this was entirely due to
+the position taken. This person would lift a man by one foot, and bear
+a heavy weight on his chest when resting with his head and two feet on
+two chairs. By supporting himself with his arms he could lift a piece
+of cannon attached to his feet.
+
+A little later Desaguliers studied an individual in London named Thomas
+Topham, who used no ruse in his feats and was not the skilful
+equilibrist that the German Samson was, his performances being merely
+the results of abnormal physical force. He was about thirty years old,
+five feet ten inches in height and well proportioned, and his muscles
+well developed, the strong ligaments showing under the skin. He ignored
+entirely the art of appearing supernaturally strong, and some of his
+feats were rendered difficult by disadvantageous positions. In the feat
+of the German--resisting the force of several men or horses--Topham
+exhibited no knowledge of the principles of physics, like that of his
+predecessor, but, seated on the ground and putting his feet against two
+stirrups, he was able to resist the traction of a single horse; when he
+attempted the same feat against two horses he was severely strained and
+wounded about the knees. According to Desaguliers, if Topham had taken
+the advantageous positions of the German Samson, he could have resisted
+not only two, but four horses. On another occasion, with the aid of a
+bridle passed about his neck, he lifted three hogsheads full of water,
+weighing 1386 pounds. If he had utilized the force of his limbs and his
+loins, like the German, he would have been able to perform far more
+difficult feats. With his teeth he could lift and maintain in a
+horizontal position a table over six feet long, at the extremity of
+which he would put some weight. Two of the feet of the table he rested
+on his knees. He broke a cord five cm. in diameter, one part of which
+was attached to a post and the other to a strap passed under his
+shoulder. He was able to carry in his hands a rolling-pin weighing 800
+pounds, about twice the weight a strong man is considered able to lift.
+
+Tom Johnson was another strong man who lived in London in the last
+century, but he was not an exhibitionist, like his predecessors. He was
+a porter on the banks of the Thames, his duty being to carry sacks of
+wheat and corn from the wharves to the warehouses. It was said that
+when one of his comrades was ill, and could not provide support for his
+wife and children, Johnson assumed double duty, carrying twice the
+load. He could seize a sack of wheat, and with it execute the movements
+of a club-swinger, and with as great facility. He became quite a
+celebrated boxer, and, besides his strength, he soon demonstrated his
+powers of endurance, never seeming fatigued after a lively bout. The
+porters of Paris were accustomed to lift and carry on their shoulders
+bags of flour weighing 159 kilograms (350 pounds) and to mount stairs
+with them. Johnson, on hearing this, duplicated the feat with three
+sacks, and on one occasion attempted to carry four, and resisted this
+load some little time.  These four sacks weighed 1400 pounds.
+
+Some years since there was a female Hercules who would get on her hands
+and knees under a carriage containing six people, and, forming an arch
+with her body, she would lift it off the ground, an attendant turning
+the wheels while in the air to prove that they were clear from the
+ground.
+
+Guyot-Daubes considers that one of the most remarkable of all the men
+noted for their strength was a butcher living in the mountains of
+Margeride, known as Lapiada (the extraordinary).  This man, whose
+strength was legendary in the neighboring country, one day seized a mad
+bull that had escaped from his stall and held him by the horns until
+his attendants could bind him. For amusement he would lie on his belly
+and allow several men to get on his back; with this human load he would
+rise to the erect position. One of Lapiada's great feats was to get
+under a cart loaded with hay and, forming an arch with his body, raise
+it from the ground, then little by little he would mount to his
+haunches, still holding the cart and hay. Lapiada terminated his
+Herculean existence in attempting a mighty effort. Having charged
+himself alone with the task of placing a heavy tree-trunk in a cart, he
+seized it, his muscles stiffened, but the blood gushed from his mouth
+and nostrils, and he fell, overcome at last. The end of Lapiada
+presents an analogue to that of the celebrated athlete, Polydamas, who
+was equally the victim of too great confidence in his muscular force,
+and who died crushed by the force that he hoped to maintain. Figures
+181 and 183 portray the muscular development of an individual noted for
+his feats of strength, and who exhibited not long since.
+
+In recent years we have had Sebastian Miller, whose specialty was
+wrestling and stone-breaking; Samson, a recent English exhibitionist,
+Louis Cyr, and Sandow, who, in addition to his remarkable strength and
+control over his muscles, is a very clever gymnast. Sandow gives an
+excellent exposition of the so-called "checkerboard" arrangement of the
+muscular fibers of the lower thoracic and abdominal regions, and in a
+brilliant light demonstrates his extraordinary power over his muscles,
+contracting muscles ordinarily involuntary in time with music, a feat
+really more remarkable than his exhibition of strength.  Figures 182
+and 184 show the beautiful muscular development of this remarkable man.
+
+Joseph Pospischilli, a convict recently imprisoned in the Austrian
+fortress of Olen, surprised the whole Empire by his wonderful feats of
+strength. One of his tricks was to add a fifth leg to a common table
+(placing the useless addition in the exact center) and then balance it
+with his teeth while two full-grown gipsies danced on it, the music
+being furnished by a violinist seated in the middle of the
+well-balanced platform. One day when the prison in which this Hercules
+was confined was undergoing repairs, he picked up a large carpenter's
+bench with his teeth and held it balanced aloft for nearly a minute.
+Since being released from the Olen prison, Pospischilli and his cousin,
+another local "strong man" named Martenstine, have formed a combination
+and are now starring Southern Europe, performing all kinds of startling
+feats of strength. Among other things they have had a 30-foot bridge
+made of strong timbers, which is used in one of their great muscle
+acts. This bridge has two living piers--Pospischilli acting as one and
+Martenstine the other.  Besides supporting this monstrous structure
+(weight, 1866 pounds) upon their shoulders, these freaks of superhuman
+strength allow a team of horses and a wagon loaded with a ton of
+cobble-stones to be driven across it.
+
+It is said that Selig Whitman, known as "Ajax," a New York policeman,
+has lifted 2000 pounds with his hands and has maintained 450 pounds
+with his teeth. This man is five feet 8 1/2 inches tall and weighs 162
+pounds. His chest measurement is 40 inches, the biceps 17 inches, that
+of his neck 16 1/2 inches, the forearm 11, the wrist 9 1/2, the thigh
+23, and the calf 17.
+
+One of the strongest of the "strong women" is Madame Elise, a
+Frenchwoman, who performs with her husband. Her greatest feat is the
+lifting of eight men weighing altogether about 1700 pounds.  At her
+performances she supports across her shoulders a 700-pound dumb-bell,
+on each side of which a person is suspended.
+
+Miss Darnett, the "singing strong lady," extends herself upon her hands
+and feet, face uppermost, while a stout platform, with a semicircular
+groove for her neck, is fixed upon her chest, abdomen, and thighs by
+means of a waist-belt which passes through brass receivers on the under
+side of the board. An ordinary upright piano is then placed on the
+platform by four men; a performer mounts the platform and plays while
+the "strong lady" sings a love song while supporting possibly half a
+ton.
+
+Strength of the Jaws.--There are some persons who exhibit extraordinary
+power of the jaw. In the curious experiments of Regnard and Blanchard
+at the Sorbonne, it was found that a crocodile weighing about 120
+pounds exerted a force between its jaws at a point corresponding to the
+insertion of the masseter muscles of 1540 pounds; a dog of 44 pounds
+exerted a similar force of 363 pounds.
+
+It is quite possible that in animals like the tiger and lion the force
+would equal 1700 or 1800 pounds. The anthropoid apes can easily break a
+cocoanut with their teeth, and Guyot-Daubes thinks that possibly a
+gorilla has a jaw-force of 200 pounds. A human adult is said to exert a
+force of from 45 to 65 pounds between his teeth, and some individuals
+exceed this average as much as 100 pounds. In Buffon's experiments he
+once found a Frenchman who could exert a force of 534 pounds with his
+jaws.
+
+In several American circuses there have been seen women who hold
+themselves by a strap between their teeth while they are being hauled
+up to a trapeze some distance from the ground. A young mulatto girl by
+the name of "Miss Kerra" exhibited in the Winter Circus in Paris;
+suspended from a trapeze, she supported a man at the end of a strap
+held between her teeth, and even permitted herself to be turned round
+and round.
+
+She also held a cannon in her teeth while it was fired. This feat has
+been done by several others. According to Guyot-Daubes, at Epernay in
+1882, while a man named Bucholtz, called "the human cannon," was
+performing this feat, the cannon, which was over a yard long and
+weighed nearly 200 pounds, burst and wounded several of the spectators.
+
+There was another Hercules in Paris, who with his teeth lifted and held
+a heavy cask of water on which was seated a man and varying weights,
+according to the size of his audience, at the same time keeping his
+hands occupied with other weights. Figure 185 represents a well-known
+modern exhibitionist lifting with his teeth a cask on which are seated
+four men. The celebrated Mlle.  Gauthier, an actress of the
+Comedie-Francais, had marvelous power of her hands, bending coins,
+rolling up silver plate, and performing divers other feats. Major
+Barsaba had enormous powers of hand and fingers. He could roll a silver
+plate into the shape of a goblet. Being challenged by a Gascon, he
+seized the hand of his unsuspecting adversary in the ordinary manner of
+salutation and crushed all the bones of the fingers, thus rendering
+unnecessary any further trial of strength.
+
+It is said that Marshal Saxe once visited a blacksmith ostensibly to
+have his horse shod, and seeing no shoe ready he took a bar of iron,
+and with his hands fashioned it into a horseshoe. There are Japanese
+dentists who extract teeth with their wonderfully developed fingers.
+There are stories of a man living in the village of Cantal who received
+the sobriquet of "La Coupia" (The Brutal). He would exercise his
+function as a butcher by strangling with his fingers the calves and
+sheep, instead of killing them in the ordinary manner. It is said that
+one day, by placing his hands on the shoulders of the strong man of a
+local fair, he made him faint by the pressure exerted by his fingers.
+
+Manual strangulation is a well-known crime and is quite popular in some
+countries. The Thugs of India sometimes murdered their victims in this
+way. Often such force is exerted by the murderer's fingers as to
+completely fracture the cricoid cartilage.
+
+In viewing the feats of strength of the exhibitionist we must bear in
+consideration the numerous frauds perpetrated. A man of extraordinary
+strength sometimes finds peculiar stone, so stratified that he is able
+to break it with the force he can exert by a blow from the hand alone,
+although a man of ordinary strength would try in vain. In most of these
+instances, if one were to take a piece of the exhibitionist's stone, he
+would find that a slight tap of the hammer would break it. Again, there
+are many instances in which the stone has been found already separated
+and fixed quite firmly together, placing it out of the power of an
+ordinary man to break, but which the exhibitionist finds within his
+ability. This has been the solution of the feats of many of the
+individuals who invite persons to send them marked stones to use at
+their performances. By skilfully arranging stout twine on the hands, it
+is surprising how easily it is broken, and there are many devices and
+tricks to deceive the public, all of which are more or less used by
+"strong men."
+
+The recent officially recorded feats of strength that stand unequaled
+in the last decade are as follows:--
+
+Weight-lifting.--Hands alone 1571 1/4 pounds, done by C. G.  Jefferson,
+an amateur, at Clinton, Mass December 10, 1890; with harness, 3239
+pounds, by W B. Curtis, at New York December 20 1868; Louis Cyr, at
+Berthierville, Can., October 1, 1888, pushed up 3536 pounds of pig-iron
+with his back, arms, and legs.
+
+Dumb-bells.--H. Pennock, in New York, 1870, put up a 10-pound dumb-bell
+8431 times in four hours thirty-four minutes; by using both hands to
+raise it to the shoulder, and then using one hand alone, R. A. Pennell,
+in New York, January 31, 1874, managed to put up a bell weighing 201
+pounds 5 ounces; and Eugene Sandow, at London, February 11, 1891,
+surpassed this feat with a 250-pound bell.
+
+Throwing 16-pound hammer.--J. S. Mitchell, at Travers Island, N.  Y.,
+October 8, 1892, made a record-throw of 145 feet 3/4 inch.
+
+Putting 16-pound Shot.--George R. Gray, at Chicago, September 16, 1893,
+made the record of 47 feet.
+
+Throwing 50-pound Weight.--J. S. Mitchell, at New York, September 22,
+1894, made the distance record of 35 feet 10 inches; and at Chicago,
+September 16, 1893, made the height record of 15 feet 4 1/2 inches.
+
+The class of people commonly known as contortionists by the laxity of
+their muscles and ligaments are able to dislocate or preternaturally
+bend their joints. In entertainments of an arena type and even in what
+are now called "variety performances" are to be seen individuals of
+this class. These persons can completely straddle two chairs, and do
+what they call "the split;" they can place their foot about their neck
+while maintaining the upright position; they can bend almost double at
+the waist in such a manner that the back of the head will touch the
+calves, while the legs are perpendicular with the ground; they can
+bring the popliteal region over their shoulders and in this position
+walk on their hands; they can put themselves in a narrow barrel; eat
+with a fork attached to a heel while standing on their hands, and
+perform divers other remarkable and almost incredible feats. Their
+performances are genuine, and they are real physiologic curiosities.
+Plate 6 represents two well-known contortionists in their favorite
+feats.
+
+Wentworth, the oldest living contortionist, is about seventy years of
+age, but seems to have lost none of his earlier sinuosity. His chief
+feat is to stow himself away in a box 23 X 29 X 16 inches. When inside,
+six dozen wooden bottles of the same size and shape as those which
+ordinarily contain English soda water are carefully stowed away, packed
+in with him, and the lid slammed down. He bestows upon this act the
+curious and suggestive name of "Packanatomicalization."
+
+Another class of individuals are those who can either partially or
+completely dislocate the major articulations of the body. Many persons
+exhibit this capacity in their fingers. Persons vulgarly called "double
+jointed" are quite common.
+
+Charles Warren, an American contortionist, has been examined by several
+medical men of prominence and descriptions of him have appeared from
+time to time in prominent medical journals. When he was but a child he
+was constantly tumbling down, due to the heads of the femurs slipping
+from the acetabula, but reduction was always easy. When eight years old
+he joined a company of acrobats and strolling performers, and was
+called by the euphonious title of "the Yankee dish-rag." His muscular
+system was well-developed, and, like Sandow, he could make muscles act
+in concert or separately.
+
+He could throw into energetic single action the biceps, the supinator
+longus, the radial extensors, the platysma myoides, and many other
+muscles. When he "strings," as he called it, the sartorius, that ribbon
+muscle shows itself as a tight cord, extending from the front of the
+iliac spine to the inner side of the knee. Another trick was to leave
+flaccid that part of the serratus magnus which is attached to the
+inferior angle of the scapula whilst he roused energetic contraction in
+the rhomboids.  He could displace his muscles so that the lower angles
+of the scapulae projected and presented the appearance historically
+attributed to luxation of the scapula.
+
+Warren was well informed on surgical landmarks and had evidently been a
+close student of Sir Astley Cooper's classical illustrations of
+dislocations. He was able so to contract his abdominal muscles that the
+aorta could be distinctly felt with the fingers. In this feat nearly
+all the abdominal contents were crowded beneath the diaphragm. On the
+other hand, he could produce a phantom abdominal tumor by driving the
+coils of the intestine within a peculiar grasp of the rectus and
+oblique muscles. The "growth" was rounded, dull on percussion, and
+looked as if an exploratory incision or puncture would be advisable for
+diagnosis.
+
+By extraordinary muscular power and extreme laxity of his ligaments, he
+simulated all the dislocations about the hip joint.  Sometimes he
+produced actual dislocation, but usually he said he could so distort
+his muscles as to imitate in the closest degree the dislocations. He
+could imitate the various forms of talipes, in such a way as to deceive
+an expert. He dislocated nearly every joint in the body with great
+facility. It was said that he could contract at will both pillars of
+the fauces. He could contract his chest to 34 inches and expand it to
+41 inches.
+
+Warren weighed 150 pounds, was a total abstainer, and was the father of
+two children, both of whom could readily dislocate their hips.
+
+In France in 1886 there was shown a man who was called "l'homme
+protee," or protean man. He had an exceptional power over his muscles.
+Even those muscles ordinarily involuntary he could exercise at will. He
+could produce such rigidity of stature that a blow by a hammer on his
+body fell as though on a block of stone. By his power over his
+abdominal muscles he could give himself different shapes, from the
+portly alderman to the lean and haggard student, and he was even
+accredited with assuming the shape of a "living skeleton." Quatrefages,
+the celebrated French scientist, examined him, and said that he could
+shut off the blood from the right side and then from the left side of
+the body, which feat he ascribed to unilateral muscular action.
+
+In 1893 there appeared in Washington, giving exhibitions at the
+colleges there and at the Emergency Hospital, a man named Fitzgerald,
+claiming to reside in Harrisburg, Pa., who made his living by
+exhibiting at medical colleges over the country. He simulated all the
+dislocations, claiming that they were complete, using manual force to
+produce and reduce them. He exhibited a thorough knowledge of the
+pathology of dislocations and of the anatomy of the articulations. He
+produced the different forms of talipes, as well as all the major
+hip-dislocations. When interrogated as to the cause of his enormous
+saphenous veins, which stood out like huge twisted cords under the skin
+and were associated with venous varicosity on the leg, he said he
+presumed they were caused by his constantly compressing the saphenous
+vein at the hip in giving his exhibitions, which in some large cities
+were repeated several times a day.
+
+Endurance of Pain.--The question of the endurance of pain is,
+necessarily, one of comparison. There is little doubt that in the lower
+classes the sensation of pain is felt in a much less degree than in
+those of a highly intellectual and nervous temperament.  If we
+eliminate the element of fear, which always predominates in the lower
+classes, the result of general hospital observation will show this
+distinction. There are many circumstances which have a marked influence
+on pain. Patriotism, enthusiasm, and general excitement, together with
+pride and natural obstinacy, prove the power of the mind over the body.
+The tortures endured by prisoners of war, religious martyrs and
+victims, exemplify the power of a strong will excited by deep emotion
+over the sensation of pain. The flagellants, persons who expiated their
+sins by voluntarily flaying themselves to the point of exhaustion, are
+modern examples of persons who in religious enthusiasm inflict pain on
+themselves. In the ancient times in India the frenzied zealots
+struggled for positions from which they could throw themselves under
+the car of the Juggernaut, and their intense emotions turned the pains
+of their wounds into a pleasure.  According to the reports of her
+Majesty's surgeons, there are at the present time in India native
+Brahmins who hang themselves on sharp hooks placed in the flesh between
+the scapulae, and remain in this position without the least visible
+show of pain. In a similar manner they pierce the lips and cheeks with
+long pins and bore the tongue with a hot iron. From a reliable source
+the authors have an account of a man in Northern India who as a means
+of self-inflicted penance held his arm aloft for the greater part of
+each day, bending the fingers tightly on the palms. After a
+considerable time the nails had grown or been forced through the palms
+of the hands, making their exit on the dorsal surfaces.  There are many
+savage rites and ceremonies calling for the severe infliction of pain
+on the participants which have been described from time to time by
+travelers. The Aztecs willingly sacrificed even their lives in the
+worship of their Sun-god.
+
+By means of singing and dancing the Aissaoui, in the Algerian town of
+Constantine, throw themselves into an ecstatic state in which their
+bodies seem to be insensible even to severe wounds.  Hellwald says they
+run sharp-pointed irons into their heads, eyes, necks, and breasts
+without apparent pain or injury to themselves. Some observers claim
+they are rendered insensible to pain by self-induced hypnotism.
+
+An account by Carpenter of the Algerian Aissaoui contained the
+following lucid description of the performances of these people:--
+
+"The center of the court was given up to the Aissaoui. These were 12
+hollow-checked men, some old and some young, who sat cross-legged in an
+irregular semicircle on the floor. Six of them had immense flat drums
+or tambours, which they presently began to beat noisily. In front of
+them a charcoal fire burned in a brazier, and into it one of them from
+time to time threw bits of some sort of incense, which gradually filled
+the place with a thin smoke and a mildly pungent odor.
+
+"For a long time--it seemed a long time--this went on with nothing to
+break the silence but the rhythmical beat of the drums. Gradually,
+however, this had become quicker, and now grew wild and almost
+deafening, and the men began a monotonous chant which soon was
+increased to shouting. Suddenly one of the men threw himself with a
+howl to the ground, when he was seized by another, who stripped him of
+part of his garments and led him in front of the fire. Here, while the
+pounding of the drums and the shouts of the men became more and more
+frantic, he stood swaying his body backward and forward, almost
+touching the ground in his fearful contortions, and wagging his head
+until it seemed as if he must dislocate it from his shoulders. All at
+once he drew from the fire a red-hot bar of iron, and with a yell of
+horror, which sent a shiver down one's back, held it up before his
+eyes. More violently than ever he swayed his body and wagged his head,
+until he had worked himself up to a climax of excitement, when he
+passed the glowing iron several times over the palm of each hand and
+then licked it repeatedly with his tongue. He next took a burning coal
+from the fire, and, placing it between his teeth, fanned it by his
+breath into a white heat. He ended his part of the performance by
+treading on red-hot coals scattered on the floor after which he resumed
+his place with the rest. Then the next performer with a yell as before,
+suddenly sprang to his feet and began again the same frantic
+contortions, in the midst of which he snatched from the fire an iron
+rod with a ball on one end, and after winding one of his eyelids around
+it until the eyeball was completely exposed, he thrust its point in
+behind the eye, which was forced far out on his cheek. It was held
+there for a moment when it was withdrawn, the eye released, and then
+rubbed vigorously a few times with the balled end of the rod.
+
+"The drums all the time had been beaten lustily, and the men had kept
+up their chant, which still went unceasingly on. Again a man sprang to
+his feet and went through the same horrid motions. This time the
+performer took from the fire a sharp nail and, with a piece of the
+sandy limestone common to this region, proceeded with a series of
+blood-curdling howls to hammer it down into the top of his head, where
+it presently stuck upright, while he tottered dizzily around until it
+was pulled out with apparent effort and with a hollow snap by one of
+the other men.
+
+"The performance had now fairly begun, and, with short intervals and
+always in the same manner, the frenzied contortions first, another ate
+up a glass lamp-chimney, which he first broke in pieces in his hands
+and then crunched loudly with his teeth. He then produced from a tin
+box a live scorpion, which ran across the floor with tail erect, and
+was then allowed to attach itself to the back of his hand and his face,
+and was finally taken into his mouth, where it hung suspended from the
+inside of his cheek and was finally chewed and swallowed. A sword was
+next produced, and after the usual preliminaries it was drawn by the
+same man who had just given the scorpion such unusual opportunities
+several times back and forth across his throat and neck, apparently
+deeply imbedded in the flesh. Not content with this, he bared his body
+at his waist, and while one man held the sword, edge upward, by the
+hilt and another by the point, about which a turban had been wrapped,
+he first stood upon it with his bare feet and then balanced himself
+across it on his naked stomach, while still another of the performers
+stood upon his back, whither he had sprung without any attempt to
+mollify the violence of the action. With more yells and genuflections,
+another now drew from the fire several iron skewers, some of which he
+thrust into the inner side of his cheeks and others into his throat at
+the larynx, where they were left for a while to hang.
+
+"The last of the actors in this singular entertainment was a stout man
+with a careworn face, who apparently regarded his share as a melancholy
+duty which he was bound to perform, and the last part of it, I have no
+doubt, was particularly painful. He first took a handful of hay, and,
+having bared the whole upper part of his body, lighted the wisp at the
+brazier and then passed the blazing mass across his chest and body and
+over his arms and face. This was but a preliminary, and presently he
+began to sway backward and forward until one grew dazed with watching
+him. The drums grew noisier and noisier and the chant louder and
+wilder.  The man himself had become maudlin, his tongue hung from his
+mouth, and now and then he ejaculated a sound like the inarticulate cry
+of an animal. He could only totter to the fire, out of which he
+snatched the balled instrument already described, which he thereupon
+thrust with a vicious stab into the pit of his stomach, where it was
+left to hang. A moment after he pulled it out again, and, picking up
+the piece of stone used before, he drove it with a series of resounding
+blows into a new place, where it hung, drawing the skin downward with
+its weight, until a companion pulled it out and the man fell in a heap
+on the floor."
+
+To-day it is only through the intervention of the United States troops
+that some of the barbarous ceremonies of the North American Indians are
+suppressed. The episode of the "Ghost-dance" is fresh in every mind.
+Instances of self-mutilation, although illustrating this subject, will
+be discussed at length in Chapter XIV.
+
+Malingerers often endure without flinching the most arduous tests.
+Supraorbital pressure is generally of little avail, and pinching,
+pricking, and even incision are useless with these hospital impostors.
+It is reported that in the City Hospital of St. Louis a negro submitted
+to the ammonia-test, inhaling this vapor for several hours without
+showing any signs of sensibility, and made his escape the moment his
+guard was absent. A contemporary journal says:--
+
+"The obstinacy of resolute impostors seems, indeed, capable of
+emulating the torture-proof perseverance of religious enthusiasts and
+such martyrs of patriotism as Mueius Scaevola or Grand Master Ruediger
+of the Teutonic Knights, who refused to reveal the hiding place of his
+companion even when his captors belabored him with red-hot irons.
+
+"One Basil Rohatzek, suspected of fraudulent enlistment
+(bounty-jumping, as our volunteers called it), pretended to have been
+thrown by his horse and to have been permanently disabled by a
+paralysis of the lower extremities. He dragged himself along in a
+pitiful manner, and his knees looked somewhat bruised, but he was known
+to have boasted his ability to procure his discharge somehow or other.
+One of his tent mates had also seen him fling himself violently and
+repeatedly on his knees (to procure those questionable bruises), and on
+the whole there seemed little doubt that the fellow was shamming. All
+the surgeons who had examined him concurred in that view, and the case
+was finally referred to his commanding officer, General Colloredo. The
+impostor was carried to a field hospital in a little Bohemian border
+town and watched for a couple of weeks, during which he had been twice
+seen moving his feet in his sleep. Still, the witnesses were not
+prepared to swear that those changes of position might not have been
+effected by a movement of the whole body. The suspect stuck to his
+assertion, and Colloredo, in a fit of irritation, finally summoned a
+surgeon, who actually placed the feet of the professed paralytic in
+"aqua fortis," but even this rigorous method availed the cruel surgeon
+nothing, and he was compelled to advise dismissal from the service.
+
+"The martyrdom of Rohatzek, however, was a mere trifle compared with
+the ordeal by which the tribunal of Paris tried in vain to extort a
+confession of the would-be regicide, Damiens. Robert Damiens, a native
+of Arras, had been exiled as an habitual criminal, and returning in
+disguise made an attempt upon the life of Louis XV, January 5, 1757.
+His dagger pierced the mantle of the King, but merely grazed his neck.
+Damiens, who had stumbled, was instantly seized and dragged to prison,
+where a convocation of expert torturers exhausted their ingenuity in
+the attempt to extort a confession implicating the Jesuits, a
+conspiracy of Huguenots, etc. But Damiens refused to speak. He could
+have pleaded his inability to name accomplices who did not exist, but
+he stuck to his resolution of absolute silence. They singed off his
+skin by shreds, they wrenched out his teeth and finger-joints, they
+dragged him about at the end of a rope hitched to a team of stout
+horses, they sprinkled him from head to foot with acids and seething
+oil, but Damiens never uttered a sound till his dying groan announced
+the conclusion of the tragedy."
+
+The apparent indifference to the pain of a major operation is sometimes
+marvelous, and there are many interesting instances on record. When at
+the battle of Dresden in 1813 Moreau, seated beside the Emperor
+Alexander, had both limbs shattered by a French cannon-ball, he did not
+utter a groan, but asked for a cigar and smoked leisurely while a
+surgeon amputated one of his members. In a short time his medical
+attendants expressed the danger and questionability of saving his other
+limb, and consulted him. In the calmest way the heroic General
+instructed them to amputate it, again remaining unmoved throughout the
+operation.
+
+Crompton records a case in which during an amputation of the leg not a
+sound escaped from the patient's lips, and in three weeks, when it was
+found necessary to amputate the other leg, the patient endured the
+operation without an anesthetic, making no show of pain, and only
+remarking that he thought the saw did not cut well. Crompton quotes
+another case, in which the patient held a candle with one hand while
+the operator amputated his other arm at the shoulder-joint. Several
+instances of self-performed major operations are mentioned in Chapter
+XIV.
+
+Supersensitiveness to Pain.--Quite opposite to the foregoing instances
+are those cases in which such influences as expectation, naturally
+inherited nervousness, and genuine supersensitiveness make the
+slightest pain almost unendurable. In many of these instances the state
+of the mind and occasionally the time of day have a marked influence.
+Men noted for their sagacity and courage have been prostrated by fear
+of pain. Sir Robert Peel, a man of acknowledged superior physical and
+intellectual power, could not even bear the touch of Brodie's finger to
+his fractured clavicle. The authors know of an instance of a pugilist
+who had elicited admiration by his ability to stand punishment and his
+indomitable courage in his combats, but who fainted from the puncture
+of a small boil on his neck.
+
+The relation of pain to shock has been noticed by many writers.  Before
+the days of anesthesia, such cases as the following, reported by Sir
+Astley Cooper, seem to have been not unusual: A brewer's servant, a man
+of middle age and robust frame, suffered much agony for several days
+from a thecal abscess, occasioned by a splinter of wood beneath the
+thumb. A few seconds after the matter was discharged by an incision,
+the man raised himself by a convulsive effort from his bed and
+instantly expired.
+
+It is a well-known fact that powerful nerve-irritation, such as
+produces shock, is painless, and this accounts for the fact that wounds
+received during battle are not painful.
+
+Leyden of Berlin showed to his class at the Charite Hospital a number
+of hysteric women with a morbid desire for operation without an
+anesthetic. Such persons do not seem to experience pain, and, on the
+contrary, appear to have genuine pleasure in pain. In illustration,
+Leyden showed a young lady who during a hysteric paroxysm had suffered
+a serious fracture of the jaw, injuring the facial artery, and
+necessitating quite an extensive operation. The facial and carotid
+arteries had to be ligated and part of the inferior maxilla removed,
+but the patient insisted upon having the operations performed without
+an anesthetic, and afterward informed the operator that she had
+experienced great pleasure throughout the whole procedure.
+
+Pain as a Means of Sexual Enjoyment.--There is a form of sexual
+perversion in which the pervert takes delight in being subjected to
+degrading, humiliating, and cruel acts on the part of his or her
+associate. It was named masochism from Sacher-Masoch, an Austrian
+novelist, whose works describe this form of perversion.  The victims
+are said to experience peculiar pleasure at the sight of a rival who
+has obtained the favor of their mistress, and will even receive blows
+and lashes from the rival with a voluptuous mixture of pain and
+pleasure. Masochism corresponds to the passivism of Stefanowski, and is
+the opposite of sadism, in which the pleasure is derived from
+inflicting pain on the object of affection. Krafft-Ebing cites several
+instances of masochism.
+
+Although the enjoyment and frenzy of flagellation are well known, its
+pleasures are not derived from the pain but by the undoubted
+stimulation offered to the sexual centers by the castigation. The
+delight of the heroines of flagellation, Maria Magdalena of Pazzi and
+Elizabeth of Genton, in being whipped on the naked loins, and thus
+calling up sensual and lascivious fancies, clearly shows the
+significance of flagellation as a sexual excitant. It is said that when
+Elizabeth of Genton was being whipped she believed herself united with
+her ideal and would cry out in the loudest tones of the joys of love.
+
+There is undoubtedly a sympathetic communication between the ramifying
+nerves of the skin of the loins and the lower portion of the spinal
+cord which contains the sexual centers. Recently, in cases of
+dysmenorrhea, amenorrhea dysmenorrhagia, and like sexual disorders,
+massage or gentle flagellation of the parts contiguous with the
+genitalia and pelvic viscera has been recommended. Taxil is the
+authority for the statement that just before the sexual act rakes
+sometimes have themselves flagellated or pricked until the blood flows
+in order to stimulate their diminished sexual power. Rhodiginus,
+Bartholinus, and other older physicians mention individuals in whom
+severe castigation was a prerequisite of copulation. As a ritual custom
+flagellation is preserved to the present day by some sects.
+
+Before leaving the subject of flagellation it should be stated that
+among the serious after-results of this practice as a disciplinary
+means, fatal emphysema, severe hemorrhage, and shock have been noticed.
+There are many cases of death from corporal punishment by flogging.
+Ballingal records the death of a soldier from flogging; Davidson has
+reported a similar case, and there is a death from the same cause cited
+in the Edinburgh Medical and Surgical Journal for 1846.
+
+Idiosyncrasy is a peculiarity of constitution whereby an individual is
+affected by external agents in a different manner from others. Begin
+defines idiosyncrasy as the predominance of an organ, of a viscus, or a
+system of organs. This definition does not entirely grasp the subject.
+An idiosyncrasy is something inherent in the organization of the
+individual, of which we only see the manifestation when proper causes
+are set in action. We do not attempt to explain the susceptibility of
+certain persons to certain foods and certain exposures. We know that
+such is the fact. According to Begin's idea, there is scarcely any
+separation between idiosyncrasy and temperament, whereas from what
+would appear to be sound reasoning, based on the physiology of the
+subject, a very material difference exists.
+
+Idiosyncrasies may be congenital, hereditary, or acquired, and, if
+acquired, may be only temporary. Some, purely of mental origin, are
+often readily cured. One individual may synchronously possess an
+idiosyncrasy of the digestive, circulatory, and nervous systems.
+Striking examples of transitory or temporary idiosyncrasies are seen in
+pregnant women.
+
+There are certain so-called antipathies that in reality are
+idiosyncrasies, and which are due to peculiarities of the ideal and
+emotional centers. The organ of sense in question and the center that
+takes cognizance of the image brought to it are in no way disordered.
+In some cases the antipathy or the idiosyncrasy develops to such an
+extent as to be in itself a species of monomania. The fear-maladies, or
+"phobias," as they are called, are examples of this class, and,
+belonging properly under temporary mental derangements, the same as
+hallucinations or delusions, will be spoken of in another chapter.
+
+Possibly the most satisfactory divisions under which to group the
+material on this subject collected from literature are into examples of
+idiosyncrasies in which, although the effect is a mystery, the sense is
+perceptible and the cause distinctly defined and known, and those in
+which sensibility is latent. The former class includes all the peculiar
+antipathies which are brought about through the special senses, while
+the latter groups all those strange instances in which, without the
+slightest antipathy on the part of the subject, a certain food or drug,
+after ingestion, produces an untoward effect.
+
+The first examples of idiosyncrasies to be noticed will be those
+manifested through the sense of smell. On the authority of Spigelius,
+whose name still survives in the nomenclature of the anatomy of the
+liver, Mackeuzie quotes an extraordinary case in a Roman Cardinal,
+Oliver Caraffa, who could not endure the smell of a rose. This is
+confirmed from personal observation by another writer, Pierius, who
+adds that the Cardinal was obliged every year to shut himself up during
+the rose season, and guards were stationed at the gates of his palace
+to stop any visitors who might be wearing the dreadful flower. It is,
+of course, possible that in this case the rose may not have caused the
+disturbance, and as it is distinctly stated that it was the smell to
+which the Cardinal objected, we may fairly conclude that what annoyed
+him was simply a manifestation of rose-fever excited by the pollen.
+There is also an instance of a noble Venetian who was always confined
+to his palace during the rose season. However, in this connection Sir
+Kenelm Digby relates that so obnoxious was a rose to Lady Heneage, that
+she blistered her cheek while accidentally lying on one while she
+slept. Ledelius records the description of a woman who fainted before a
+red rose, although she was accustomed to wear white ones in her hair.
+Cremer describes a Bishop who died of the smell of a rose from what
+might be called "aromatic pain."
+
+The organ of smell is in intimate relation with the brain and the
+organs of taste and sight; and its action may thus disturb that of the
+esophagus, the stomach, the diaphragm, the intestines, the organs of
+generation, etc. Odorous substances have occasioned syncope, stupor,
+nausea, vomiting, and sometimes death. It is said that the Hindoos, and
+some classes who eat nothing but vegetables, are intensely nauseated by
+the odors of European tables, and for this reason they are incapable of
+serving as dining-room servants.
+
+Fabricius Hildanus mentions a person who fainted from the odor of
+vinegar. The Ephemerides contains an instance of a soldier who fell
+insensible from the odor of a peony. Wagner knew a man who was made ill
+by the odor of bouillon of crabs. The odors of blood, meat, and fat are
+repugnant to herbivorous animals. It is a well-known fact that horses
+detest the odor of blood.
+
+Schneider, the father of rhinology, mentions a woman in whom the odor
+of orange-flowers produced syncope. Odier has known a woman who was
+affected with aphonia whenever exposed to the odor of musk, but who
+immediately recovered after taking a cold bath.  Dejean has mentioned a
+man who could not tolerate an atmosphere of cherries. Highmore knew a
+man in whom the slightest smell of musk caused headache followed by
+epistaxis. Lanzonius gives an account of a valiant soldier who could
+neither bear the sight nor smell of an ordinary pink. There is an
+instance on record in which the odor coming from a walnut tree excited
+epilepsy. It is said that one of the secretaries of Francis I was
+forced to stop his nostrils with bread if apples were on the table. He
+would faint if one was held near his nose Schenck says that the noble
+family of Fystates in Aquitaine had a similar peculiarity--an innate
+hatred of apples. Bruyerinus knew a girl of sixteen who could not bear
+the smell of bread, the slightest particle of which she would detect by
+its odor. She lived almost entirely on milk. Bierling mentions an
+antipathy to the smell of musk, and there is a case on record in which
+it caused convulsions.  Boerhaave bears witness that the odor of cheese
+caused nasal hemorrhage. Whytt mentions an instance in which tobacco
+became repugnant to a woman each time she conceived, but after delivery
+this aversion changed to almost an appetite for tobacco fumes.
+Panaroli mentions an instance of sickness caused by the smell of
+sassafras, and there is also a record of a person who fell helpless at
+the smell of cinnamon. Wagner had a patient who detested the odor of
+citron. Ignorant of this repugnance, he prescribed a potion in which
+there was water of balm-mint, of an odor resembling citron. As soon as
+the patient took the first dose he became greatly agitated and much
+nauseated, and this did not cease until Wagner repressed the balm-mint.
+There is reported the case of a young woman, rather robust, otherwise
+normal, who always experienced a desire to go to stool after being
+subjected to any nasal irritation sufficient to excite sneezing.
+
+It has already been remarked that individuals and animals have their
+special odors, certain of which are very agreeable to some people and
+extremely unpleasant to others. Many persons are not able to endure the
+emanations from cats, rats, mice, etc., and the mere fact of one of
+these animals being in their vicinity is enough to provoke distressing
+symptoms. Mlle. Contat, the celebrated French actress, was not able to
+endure the odor of a hare. Stanislaus, King of Poland and Duke of
+Lorraine, found it impossible to tolerate the smell of a cat. The
+Ephemerides mentions the odor of a little garden-frog as causing
+epilepsy. Ab Heers mentions a similar anomaly, fainting caused by the
+smell of eels. Habit had rendered Haller insensible to the odor of
+putrefying cadavers, but according to Zimmerman the odor of the
+perspiration of old people, not perceptible to others, was intolerable
+to him at a distance of ten or twelve paces. He also had an extreme
+aversion for cheese. According to Dejan, Gaubius knew a man who was
+unable to remain in a room with women, having a great repugnance to the
+female odor. Strange as it may seem, some individuals are incapable of
+appreciating certain odors.  Blumenbach mentions an Englishman whose
+sense of smell was otherwise very acute, but he was unable to perceive
+the perfume of the mignonette.
+
+The impressions which come to us through the sense of hearing cause
+sensations agreeable or disagreeable, but even in this sense we see
+marked examples of idiosyncrasies and antipathies to various sounds and
+tones. In some individuals the sensations in one ear differ from those
+of the other. Everard Home has cited several examples, and Heidmann of
+Vienna has treated two musicians, one of whom always perceived in the
+affected ear, during damp weather, tones an octave lower than in the
+other ear.  The other musician perceived tones an octave higher in the
+affected ear. Cheyne is quoted as mentioning a case in which, when the
+subject heard the noise of a drum, blood jetted from the veins with
+considerable force. Sauvages has seen a young man in whom intense
+headache and febrile paroxysm were only relieved by the noise from a
+beaten drum. Esparron has mentioned an infant in whom an ataxic fever
+was established by the noise of this instrument. Ephemerides contains
+an account of a young man who became nervous and had the sense of
+suffocation when he heard the noise made by sweeping. Zimmerman speaks
+of a young girl who had convulsions when she heard the rustling of
+oiled silk. Boyle, the father of chemistry, could not conquer an
+aversion he had to the sound of water running through pipes. A
+gentleman of the Court of the Emperor Ferdinand suffered epistaxis when
+he heard a cat mew.  La Mothe Le Vayer could not endure the sounds of
+musical instruments, although he experienced pleasurable sensations
+when he heard a clap of thunder. It is said that a chaplain in England
+always had a sensation of cold at the top of his head when he read the
+53d chapter of Isaiah and certain verses of the Kings.  There was an
+unhappy wight who could not hear his own name pronounced without being
+thrown into convulsions. Marguerite of Valois, sister of Francis I,
+could never utter the words "mort" or "petite verole," such a horrible
+aversion had she to death and small-pox. According to Campani, the
+Chevalier Alcantara could never say "lana," or words pertaining to
+woolen clothing.  Hippocrates says that a certain Nicanor had the
+greatest horror of the sound of the flute at night, although it
+delighted him in the daytime. Rousseau reports a Gascon in whom
+incontinence of urine was produced by the sound of a bagpipe. Frisch,
+Managetta, and Rousse speak of a man in whom the same effect was
+produced by the sound of a hurdy-gurdy. Even Shakespeare alludes to the
+effects of the sound of bagpipes. Tissot mentions a case in which music
+caused epileptic convulsions, and Forestus mentions a beggar who had
+convulsions at the sound of a wooden trumpet similar to those used by
+children in play. Rousseau mentions music as causing convulsive
+laughter in a woman. Bayle mentions a woman who fainted at the sound of
+a bell. Paullini cites an instance of vomiting caused by music, and
+Marcellus Donatus mentions swooning from the same cause. Many people
+are unable to bear the noise caused by the grating of a pencil on a
+slate, the filing of a saw, the squeak of a wheel turning about an
+axle, the rubbing of pieces of paper together, and certain similar
+sounds.  Some persons find the tones of music very disagreeable, and
+some animals, particularly dogs, are unable to endure it. In Albinus
+the younger the slightest perceptible tones were sufficient to produce
+an inexplicable anxiety. There was a certain woman of fifty who was
+fond of the music of the clarionet and flute, but was not able to
+listen to the sound of a bell or tambourine.  Frank knew a man who ran
+out of church at the beginning of the sounds of an organ, not being
+able to tolerate them. Pope could not imagine music producing any
+pleasure. The harmonica has been noticed to produce fainting in
+females. Fischer says that music provokes sexual frenzy in elephants.
+Gutfeldt speaks of a peculiar idiosyncrasy of sleep produced by hearing
+music. Delisle mentions a young person who during a whole year passed
+pieces of ascarides and tenia, during which time he could not endure
+music.
+
+Autenreith mentions the vibrations of a loud noise tickling the fauces
+to such an extent as to provoke vomiting. There are some emotional
+people who are particularly susceptible to certain expressions. The
+widow of Jean Calas always fell in a faint when she heard the words of
+the death-decree sounded on the street.  There was a Hanoverian officer
+in the Indian war against Typoo-Saib, a good and brave soldier, who
+would feel sick if he heard the word "tiger" pronounced. It was said
+that he had experienced the ravages of this beast.
+
+The therapeutic value of music has long been known. For ages warriors
+have been led to battle to the sounds of martial strains. David charmed
+away Saul's evil spirit with his harp.  Horace in his 32d Ode Book 1,
+concludes his address to the lyre:--
+
+       "O laborum
+  Dulce lenimen mihicumque calve,
+  Rite vocanti;"
+
+Or, as Kiessling of Berlin interprets:--
+
+       "O laborum,
+  Dulce lenimen medieumque, salve,
+  Rite vocanti."
+
+--"O, of our troubles the sweet, the healing sedative, etc."
+
+Homer, Plutarch, Theophrastus, and Galen say that music cures
+rheumatism, the pests, and stings of reptiles, etc. Diemerbroeck,
+Bonet, Baglivi, Kercher, and Desault mention the efficacy of melody in
+phthisis, gout, hydrophobia, the bites of venomous reptiles, etc. There
+is a case in the Lancet of a patient in convulsions who was cured in
+the paroxysm by hearing the tones of music. Before the French Academy
+of Sciences in 1708, and again in 1718, there was an instance of a
+dancing-master stricken with violent fever and in a condition of
+delirium, who recovered his senses and health on hearing melodious
+music. There is little doubt of the therapeutic value of music, but
+particularly do we find its value in instances of neuroses. The
+inspiration offered by music is well-known, and it is doubtless a
+stimulant to the intellectual work. Bacon, Milton, Warburton, and
+Alfieri needed music to stimulate them in their labors, and it is said
+that Bourdaloue always played an air on the violin before preparing to
+write.
+
+According to the American Medico-Surgical Bulletin, "Professor
+Tarchanoff of Saint Petersburg has been investigating the influence of
+music upon man and other animals. The subject is by no means a new one.
+In recent times Dagiel and Fere have investigated the effect of music
+upon the respirations, the pulse, and the muscular system in man.
+Professor Tarchanoff made use of the ergograph of Mosso, and found that
+if the fingers were completely fatigued, either by voluntary efforts or
+by electric excitation, to the point of being incapable of making any
+mark except a straight line on the registering cylinder, music had the
+power of making the fatigue disappear, and the finger placed in the
+ergograph again commenced to mark lines of different heights, according
+to the amount of excitation. It was also found that music of a sad and
+lugubrious character had the opposite effect, and could check or
+entirely inhibit the contractions. Professor Tarchanoff does not
+profess to give any positive explanation of these facts, but he
+inclines to the view that 'the voluntary muscles, being furnished with
+excitomotor and depressant fibers, act in relation to the music
+similarly to the heart--that is to say, that joyful music resounds
+along the excitomotor fibers, and sad music along the depressant or
+inhibitory fibers.' Experiments on dogs showed that music was capable
+of increasing the elimination of carbonic acid by 16.7 per cent, and of
+increasing the consumption of oxygen by 20.1 per cent. It was also
+found that music increased the functional activity of the skin.
+Professor Tarchanoff claims as the result of these experiments that
+music may fairly be regarded as a serious therapeutic agent, and that
+it exercises a genuine and considerable influence over the functions of
+the body. Facts of this kind are in no way surprising, and are chiefly
+of interest as presenting some physiologic basis for phenomena that are
+sufficiently obvious.  The influence of the war-chant upon the warrior
+is known even to savage tribes. We are accustomed to regard this
+influence simply as an ordinary case of psychic stimuli producing
+physiologic effects.
+
+"Professor Tarchanoff evidently prefers to regard the phenomena as
+being all upon the same plane, namely, that of physiology; and until we
+know the difference between mind and body, and the principles of their
+interaction, it is obviously impossible to controvert this view
+successfully. From the immediately practical point of view we should
+not ignore the possible value of music in some states of disease. In
+melancholia and hysteria it is probably capable of being used with
+benefit, and it is worth bearing in mind in dealing with insomnia.
+Classical scholars will not forget that the singing of birds was tried
+as a remedy to overcome the insomnia of Maecenas. Music is certainly a
+good antidote to the pernicious habit of introspection and
+self-analysis, which is often a curse both of the hysteric and of the
+highly cultured. It would seem obviously preferable to have recourse to
+music of a lively and cheerful character."
+
+Idiosyncrasies of the visual organs are generally quite rare. It is
+well-known that among some of the lower animals, e.g., the
+turkey-cocks, buffaloes, and elephants, the color red is unendurable.
+Buchner and Tissot mention a young boy who had a paroxysm if he viewed
+anything red. Certain individuals become nauseated when they look for a
+long time on irregular lines or curves, as, for examples, in
+caricatures. Many of the older examples of idiosyncrasies of color are
+nothing more than instances of color-blindness, which in those times
+was unrecognized. Prochaska knew a woman who in her youth became
+unconscious at the sight of beet-root, although in her later years she
+managed to conquer this antipathy, but was never able to eat the
+vegetable in question. One of the most remarkable forms of idiosyncrasy
+on record is that of a student who was deprived of his senses by the
+very sight of an old woman. On one occasion he was carried out from a
+party in a dying state, caused, presumably, by the abhorred aspect of
+the chaperons The Count of Caylus was always horror-stricken at the
+sight of a Capuchin friar. He cured himself by a wooden image dressed
+in the costume of this order placed in his room and constantly before
+his view. It is common to see persons who faint at the sight of blood.
+Analogous are the individuals who feel nausea in an hospital ward.
+
+All Robert Boyle's philosophy could not make him endure the sight of a
+spider, although he had no such aversion to toads, venomous snakes,
+etc. Pare mentions a man who fainted at the sight of an eel, and
+another who had convulsions at the sight of a carp.  There is a record
+of a young lady in France who fainted on seeing a boiled lobster.
+Millingen cites the case of a man who fell into convulsions whenever he
+saw a spider. A waxen one was made, which equally terrified him. When
+he recovered, his error was pointed out to him, and the wax figure was
+placed in his hand without causing dread, and henceforth the living
+insect no longer disturbed him. Amatus Lusitanus relates the case of a
+monk who fainted when he beheld a rose, and never quitted his cell when
+that flower was in bloom. Scaliger, the great scholar, who had been a
+soldier a considerable portion of his life, confesses that he could not
+look on a water-cress without shuddering, and remarks: "I, who despise
+not only iron, but even thunderbolts, who in two sieges (in one of
+which I commanded) was the only one who did not complain of the food as
+unfit and horrible to eat, am seized with such a shuddering horror at
+the sight of a water-cress that I am forced to go away." One of his
+children was in the same plight as regards the inoffensive vegetable,
+cabbage.  Scaliger also speaks of one of his kinsmen who fainted at the
+sight of a lily. Vaughheim, a great huntsman of Hanover, would faint at
+the sight of a roasted pig. Some individuals have been disgusted at the
+sight of eggs. There is an account of a sensible man who was terrified
+at the sight of a hedgehog, and for two years was tormented by a
+sensation as though one was gnawing at his bowels. According to Boyle,
+Lord Barrymore, a veteran warrior and a person of strong mind, swooned
+at the sight of tansy. The Duke d'Epernon swooned on beholding a
+leveret, although a hare did not produce the same effect. Schenck tells
+of a man who swooned at the sight of pork. The Ephemerides contains an
+account of a person who lost his voice at the sight of a crab, and also
+cites cases of antipathy to partridges, a white hen, to a serpent, and
+to a toad. Lehman speaks of an antipathy to horses; and in his
+observations Lyser has noticed aversion to the color purple. It is a
+strange fact that the three greatest generals of recent years,
+Wellington, Napoleon, and Roberts, could never tolerate the sight of a
+cat, and Henry III of France could not bear this animal in his room. We
+learn of a Dane of herculean frame who had a horror of cats. He was
+asked to a supper at which, by way of a practical joke, a live cat was
+put on the table in a covered dish. The man began to sweat and shudder
+without knowing why, and when the cat was shown he killed his host in a
+paroxysm of terror. Another man could not even see the hated form even
+in a picture without breaking into a cold sweat and feeling a sense of
+oppression about the heart. Quercetanus and Smetius mention fainting at
+the sight of cats. Marshal d'Abret was supposed to be in violent fear
+of a pig.
+
+As to idiosyncrasies of the sense of touch, it is well known that some
+people cannot handle velvet or touch the velvety skin of a peach
+without having disagreeable and chilly sensations come over them.
+Prochaska knew a man who vomited the moment he touched a peach, and
+many people, otherwise very fond of this fruit, are unable to touch it.
+The Ephemerides speaks of a peculiar idiosyncrasy of skin in the axilla
+of a certain person, which if tickled would provoke vomiting. It is
+occasionally stated in the older writings that some persons have an
+idiosyncrasy as regards the phases of the sun and moon. Baillou speaks
+of a woman who fell unconscious at sunset and did not recover till it
+reappeared on the horizon. The celebrated Chancellor Bacon, according
+to Mead, was very delicate, and was accustomed to fall into a state of
+great feebleness at every moon-set without any other imaginable cause.
+He never recovered from his swooning until the moon reappeared.
+
+Nothing is more common than the idiosyncrasy which certain people
+display for certain foods. The trite proverb, "What is one man's meat
+is another man's poison," is a genuine truth, and is exemplified by
+hundreds of instances. Many people are unable to eat fish without
+subsequent disagreeable symptoms. Prominent among the causes of
+urticaria are oysters, crabs, and other shell fish, strawberries,
+raspberries, and other fruits. The abundance of literature on this
+subject makes an exhaustive collection of data impossible, and only a
+few of the prominent and striking instances can be reported.
+
+Amatus Lusitanus speaks of vomiting and diarrhea occurring each time a
+certain Spaniard ate meat. Haller knew a person who was purged
+violently by syrup of roses. The son of one of the friends of Wagner
+would vomit immediately after the ingestion of any substance containing
+honey. Bayle has mentioned a person so susceptible to honey that by a
+plaster of this substance placed upon the skin this untoward effect was
+produced. Whytt knew a woman who was made sick by the slightest bit of
+nutmeg. Tissot observed vomiting in one of his friends after the
+ingestion of the slightest amount of sugar. Ritte mentions a similar
+instance.  Roose has seen vomiting produced in a woman by the slightest
+dose of distilled water of linden. There is also mentioned a person in
+whom orange-flower water produced the same effect. Dejean cites a case
+in which honey taken internally or applied externally acted like
+poison. It is said that the celebrated Haen would always have
+convulsions after eating half a dozen strawberries. Earle and Halifax
+attended a child for kidney-irritation produced by strawberries, and
+this was the invariable result of the ingestion of this fruit. The
+authors personally know of a family the male members of which for
+several generations could not eat strawberries without symptoms of
+poisoning. The female members were exempt from the idiosyncrasy. A
+little boy of this family was killed by eating a single berry. Whytt
+mentions a woman of delicate constitution and great sensibility of the
+digestive tract in whom foods difficult of digestion provoked spasms,
+which were often followed by syncopes. Bayle describes a man who
+vomited violently after taking coffee. Wagner mentions a person in whom
+a most insignificant dose of manna had the same effect.  Preslin speaks
+of a woman who invariably had a hemorrhage after swallowing a small
+quantity of vinegar. According to Zimmerman, some people are unable to
+wash their faces on account of untoward symptoms. According to Ganbius,
+the juice of a citron applied to the skin of one of his acquaintances
+produced violent rigors.
+
+Brasavolus says that Julia, wife of Frederick, King of Naples, had such
+an aversion to meat that she could not carry it to her mouth without
+fainting. The anatomist Gavard was not able to eat apples without
+convulsions and vomiting. It is said that Erasmus was made ill by the
+ingestion of fish; but this same philosopher, who was cured of a malady
+by laughter, expressed his appreciation by an elegy on the folly. There
+is a record of a person who could not eat almonds without a scarlet
+rash immediately appearing upon the face. Marcellus Donatus knew a
+young man who could not eat an egg without his lips swelling and purple
+spots appearing on his face. Smetius mentions a person in whom the
+ingestion of fried eggs was often followed by syncope. Brunton has seen
+a case of violent vomiting and purging after the slightest bit of egg.
+On one occasion this person was induced to eat a small morsel of cake
+on the statement that it contained no egg, and, although fully
+believing the words of his host, he subsequently developed prominent
+symptoms, due to the trace of egg that was really in the cake. A letter
+from a distinguished litterateur to Sir Morell Mackenzie gives a
+striking example of the idiosyncrasy to eggs transmitted through four
+generations. Being from such a reliable source, it has been deemed
+advisable to quote the account in full: "My daughter tells me that you
+are interested in the ill-effects which the eating of eggs has upon
+her, upon me, and upon my father before us. I believe my grandfather,
+as well as my father, could not eat eggs with impunity. As to my father
+himself, he is nearly eighty years old; he has not touched an egg since
+he was a young man; he can, therefore, give no precise or reliable
+account of the symptoms the eating of eggs produce in him. But it was
+not the mere 'stomach-ache' that ensued, but much more immediate and
+alarming disturbances. As for me, the peculiarity was discovered when I
+was a spoon-fed child. On several occasions it was noticed (that is my
+mother's account) that I felt ill without apparent cause; afterward it
+was recollected that a small part of a yolk of an egg had been given to
+me. Eclaircissement came immediately after taking a single spoonful of
+egg. I fell into such an alarming state that the doctor was sent for.
+The effect seems to have been just the same that it produces upon my
+daughter now,--something that suggested brain-congestion and
+convulsions. From time to time, as a boy and a young man, I have eaten
+an egg by way of trying it again, but always with the same result--a
+feeling that I had been poisoned; and yet all the while I liked eggs.
+Then I never touched them for years. Later I tried again, and I find
+the ill-effects are gradually wearing off. With my daughter it is
+different; she, I think, becomes more susceptible as time goes on, and
+the effect upon her is more violent than in my case at any time.
+Sometimes an egg has been put with coffee unknown to her, and she has
+been seen immediately afterward with her face alarmingly changed--eyes
+swollen and wild, the face crimson, the look of apoplexy. This is her
+own account: 'An egg in any form causes within a few minutes great
+uneasiness and restlessness, the throat becomes contracted and painful,
+the face crimson, and the veins swollen. These symptoms have been so
+severe as to suggest that serious consequences might follow.' To this I
+may add that in her experience and my own, the newer the egg, the worse
+the consequences."
+
+Hutchinson speaks of a Member of Parliament who had an idiosyncrasy as
+regards parsley. After the ingestion of this herb in food he always had
+alarming attacks of sickness and pain in the abdomen, attended by
+swelling of the tongue and lips and lividity of the face. This same man
+could not take the smallest quantity of honey, and certain kinds of
+fruit always poisoned him. There was a collection of instances of
+idiosyncrasy in the British Medical Journal, 1859, which will be
+briefly given in the following lines: One patient could not eat rice in
+any shape without extreme distress. From the description given of his
+symptoms, spasmodic asthma seemed to be the cause of his discomfort. On
+one occasion when at a dinner-party he felt the symptoms of
+rice-poisoning come on, and, although he had partaken of no dish
+ostensibly containing rice, was, as usual, obliged to retire from the
+table. Upon investigation it appeared that some white soup with which
+he had commenced his meal had been thickened with ground rice. As in
+the preceding case there was another gentleman who could not eat rice
+without a sense of suffocation. On one occasion he took lunch with a
+friend in chambers, partaking only of simple bread and cheese and
+bottled beer. On being seized with the usual symptoms of rice-poisoning
+he informed his friend of his peculiarity of constitution, and the
+symptoms were explained by the fact that a few grains of rice had been
+put into each bottle of beer for the purpose of exciting a secondary
+fermentation. The same author speaks of a gentleman under treatment for
+stricture who could not eat figs without experiencing the most
+unpleasant formication of the palate and fauces. The fine dust from
+split peas caused the same sensation, accompanied with running at the
+nose; it was found that the father of the patient suffered from
+hay-fever in certain seasons.  He also says a certain young lady after
+eating eggs suffered from swelling of the tongue and throat,
+accompanied by "alarming illness," and there is recorded in the same
+paragraph a history of another young girl in whom the ingestion of
+honey, and especially honey-comb, produced swelling of the tongue,
+frothing of the mouth, and blueness of the fingers. The authors know of
+a gentleman in whom sneezing is provoked on the ingestion of chocolate
+in any form. There was another instance--in a member of the medical
+profession--who suffered from urticaria after eating veal. Veal has the
+reputation of being particularly indigestible, and the foregoing
+instance of the production of urticaria from its use is doubtless not
+an uncommon one.
+
+Overton cites a striking case of constitutional peculiarity or
+idiosyncrasy in which wheat flour in any form, the staff of life, an
+article hourly prayed for by all Christian nations as the first and
+most indispensable of earthly blessings, proved to one unfortunate
+individual a prompt and dreadful poison. The patient's name was David
+Waller, and he was born in Pittsylvania County, Va., about the year
+1780. He was the eighth child of his parents, and, together with all
+his brothers and sisters, was stout and healthy. At the time of
+observation Waller was about fifty years of age. He had dark hair, gray
+eyes, dark complexion, was of bilious and irascible temperament, well
+formed, muscular and strong, and in all respects healthy as any man,
+with the single exception of his peculiar idiosyncrasy. He had been the
+subject of but few diseases, although he was attacked by the epidemic
+of 1816. From the history of his parents and an inquiry into the health
+of his ancestry, nothing could be found which could establish the fact
+of heredity in his peculiar disposition.  Despite every advantage of
+stature, constitution, and heredity, David Waller was through life,
+from his cradle to his grave, the victim of what is possibly a unique
+idiosyncrasy of constitution.  In his own words he declared: "Of two
+equal quantities of tartar and wheat flour, not more than a dose of the
+former, he would rather swallow the tartar than the wheat flour." If he
+ate flour in any form or however combined, in the smallest quantity, in
+two minutes or less he would have painful itching over the whole body,
+accompanied by severe colic and tormina in the bowels, great sickness
+in the stomach, and continued vomiting, which he declared was ten times
+as distressing as the symptoms caused by the ingestion of tartar
+emetic. In about ten minutes after eating the flour the itching would
+be greatly intensified, especially about the head, face, and eyes, but
+tormenting all parts of the body, and not to be appeased. These
+symptoms continued for two days with intolerable violence, and only
+declined on the third day and ceased on the tenth. In the
+convalescence, the lungs were affected, he coughed, and in
+expectoration raised great quantities of phlegm, and really resembled a
+phthisical patient.  At this time he was confined to his room with
+great weakness, similar to that of a person recovering from an
+asthmatic attack.  The mere smell of wheat produced distressing
+symptoms in a minor degree, and for this reason he could not, without
+suffering, go into a mill or house where the smallest quantity of wheat
+flour was kept. His condition was the same from the earliest times, and
+he was laid out for dead when an infant at the breast, after being fed
+with "pap" thickened with wheat flour. Overton remarks that a case of
+constitutional peculiarity so little in harmony with the condition of
+other men could not be received upon vague or feeble evidence, and it
+is therefore stated that Waller was known to the society in which he
+lived as an honest and truthful man. One of his female neighbors, not
+believing in his infirmity, but considering it only a whim, put a small
+quantity of flour in the soup which she gave him to eat at her table,
+stating that it contained no flour, and as a consequence of the
+deception he was bed-ridden for ten days with his usual symptoms. It
+was also stated that Waller was never subjected to militia duty because
+it was found on full examination of his infirmity that he could not
+live upon the rations of a soldier, into which wheat flour enters as a
+necessary ingredient. In explanation of this strange departure from the
+condition of other men, Waller himself gave a reason which was deemed
+equivalent in value to any of the others offered. It was as follows:
+His father being a man in humble circumstances in life, at the time of
+his birth had no wheat with which to make flour, although his mother
+during gestation "longed" for wheat-bread. The father, being a kind
+husband and responsive to the duty imposed by the condition of his
+wife, procured from one of his opulent neighbors a bag of wheat and
+sent it to the mill to be ground. The mother was given much uneasiness
+by an unexpected delay at the mill, and by the time the flour arrived
+her strong appetite for wheat-bread had in a great degree subsided.
+Notwithstanding this, she caused some flour to be immediately baked
+into bread and ate it, but not so freely as she had expected The bread
+thus taken caused intense vomiting and made her violently and painfully
+ill, after which for a considerable time she loathed bread. These facts
+have been ascribed as the cause of the lamentable infirmity under which
+the man labored, as no other peculiarity or impression in her gestation
+was noticed. In addition it may be stated that for the purpose of
+avoiding the smell of flour Waller was in the habit of carrying camphor
+in his pocket and using snuff, for if he did not smell the flour,
+however much might be near him, it was as harmless to him as to other
+men.
+
+The authors know of a case in which the eating of any raw fruit would
+produce in a lady symptoms of asthma; cooked fruit had no such effect.
+
+Food-Superstitions.--The superstitious abhorrence and antipathy to
+various articles of food that have been prevalent from time to time in
+the history of the human race are of considerable interest and well
+deserve some mention here. A writer in a prominent journal has studied
+this subject with the following result:--
+
+"From the days of Adam and Eve to the present time there has been not
+only forbidden fruit, but forbidden meats and vegetables. For one
+reason or another people have resolutely refused to eat any and all
+kinds of flesh, fish, fowl, fruits, and plants. Thus, the apple, the
+pear, the strawberry, the quince, the bean, the onion, the leek, the
+asparagus, the woodpecker, the pigeon, the goose, the deer, the bear,
+the turtle, and the eel--these, to name only a few eatables, have been
+avoided as if unwholesome or positively injurious to health and
+digestion.
+
+"As we all know, the Jews have long had an hereditary antipathy to
+pork. On the other hand, swine's flesh was highly esteemed by the
+ancient Greeks and Romans. This fact is revealed by the many references
+to pig as a dainty bit of food. At the great festival held annually in
+honor of Demeter, roast pig was the piece de resistance in the bill of
+fare, because the pig was the sacred animal of Demeter. Aristophanes in
+'The Frogs' makes one of the characters hint that some of the others
+'smell of roast pig.' These people undoubtedly had been at the festival
+(known as the Thesmophoria) and had eaten freely of roast pig, Those
+who took part in another Greek mystery or festival (known as the
+Eleusinia) abstained from certain food, and above all from beans.
+
+"Again, as we all know, mice are esteemed in China and in some parts of
+India. But the ancient Egyptians, Greeks, and Jews abhorred mice and
+would not touch mouse-meat. Rats and field-mice were sacred in Old
+Egypt, and were not to be eaten on this account. So, too, in some parts
+of Greece, the mouse was the sacred animal of Apollo, and mice were fed
+in his temples. The chosen people were forbidden to eat 'the weasel,
+and the mouse, and the tortoise after his kind.' These came under the
+designation of unclean animals, which were to be avoided.
+
+"But people have abstained from eating kinds of flesh which could not
+be called unclean. For example, the people of Thebes, as Herodotus
+tells us, abstained from sheep. Then, the ancients used to abstain from
+certain vegetables. In his 'Roman Questions' Plutarch asks: 'Why do the
+Latins abstain strictly from the flesh of the woodpecker?' In order to
+answer Plutarch's question correctly it is necessary to have some idea
+of the peculiar custom and belief called 'totemism.' There is a stage
+of society in which people claim descent from and kinship with beasts,
+birds, vegetables, and other objects. This object, which is a 'totem,'
+or family mark, they religiously abstain from eating.  The members of
+the tribe are divided into clans or stocks, each of which takes the
+name of some animal, plant, or object, as the bear, the buffalo, the
+woodpecker, the asparagus, and so forth.  No member of the bear family
+would dare to eat bear-meat, but he has no objection to eating buffalo
+steak. Even the marriage law is based on this belief, and no man whose
+family name is Wolf may marry a woman whose family name is also Wolf.
+
+"In a general way it may be said that almost all our food prohibitions
+spring from the extraordinary custom generally called totemism. Mr.
+Swan, who was missionary for many years in the Congo Free State, thus
+describes the custom: 'If I were to ask the Yeke people why they do not
+eat zebra flesh, they would reply, 'Chijila,' i.e., 'It is a thing to
+which we have an antipathy;' or better, 'It is one of the things which
+our fathers taught us not to eat.' So it seems the word 'Bashilang'
+means 'the people who have an antipathy to the leopard;' the
+'Bashilamba,' 'those who have an antipathy to the dog,' and the
+'Bashilanzefu,' 'those who have an antipathy to the elephant.' In other
+words, the members of these stocks refuse to eat their totems, the
+zebra, the leopard, or the elephant, from which they take their names.
+
+"The survival of antipathy to certain foods was found among people as
+highly civilized as the Egyptians, the Greeks, and the Romans. Quite a
+list of animals whose flesh was forbidden might be drawn up. For
+example, in Old Egypt the sheep could not be eaten in Thebes, nor the
+goat in Mendes, nor the cat in Bubastis, nor the crocodile at Ombos,
+nor the rat, which was sacred to Ra, the sun-god. However, the people
+of one place had no scruples about eating the forbidden food of another
+place. And this often led to religious disputes.
+
+"Among the vegetables avoided as food by the Egyptians may be mentioned
+the onion, the garlic, and the leek. Lucian says that the inhabitants
+of Pelusium adored the onion. According to Pliny the Egyptians relished
+the leek and the onion. Juvenal exclaims: 'Surely a very religious
+nation, and a blessed place, where every garden is overrun with gods!'
+The survivals of totemism among the ancient Greeks are very
+interesting. Families named after animals and plants were not uncommon.
+One Athenian gens, the Ioxidae, had for its ancestral plant the
+asparagus. One Roman gens, the Piceni, took a woodpecker for its totem,
+and every member of this family refused, of course, to eat the flesh of
+the woodpecker. In the same way as the nations of the Congo Free State,
+the Latins had an antipathy to certain kinds of food. However, an
+animal or plant forbidden in one place was eaten without any
+compunction in another place. 'These local rites in Roman times,' says
+Mr. Lang, 'caused civil brawls, for the customs of one town naturally
+seemed blasphemous to neighbors with a different sacred animal.  Thus
+when the people of dog-town were feeding on the fish called
+oxyrrhyncus, the citizens of the town which revered the oxyrrhyncus
+began to eat dogs. Hence arose a riot.' The antipathy of the Jews to
+pork has given rise to quite different explanations. The custom is
+probably a relic of totemistic belief. That the unclean
+animals--animals not to be eaten--such as the pig, the mouse, and the
+weasel, were originally totems of the children of Israel, Professor
+Robertson Smith believes is shown by various passages in the Old
+Testament.
+
+"When animals and plants ceased to be held sacred they were endowed
+with sundry magical or mystic properties. The apple has been supposed
+to possess peculiar virtues, especially in the way of health. 'The
+relation of the apple to health,' says Mr. Conway, 'is traceable to
+Arabia. Sometimes it is regarded as a bane. In Hessia it is said an
+apple must not be eaten on New Year's Day, as it will produce an
+abscess. But generally it is curative. In Pomerania it is eaten on
+Easter morning against fevers; in Westphalia (mixed with saffron)
+against jaundice; while in Silesia an apple is scraped from top to
+stalk to cure diarrhea, and upward to cure costiveness.' According to
+an old English fancy, if any one who is suffering from a wound in the
+head should eat strawberries it will lead to fatal results. In the
+South of England the folk say that the devil puts his cloven foot upon
+the blackberries on Michaelmas Day, and hence none should be gathered
+or eaten after that day. On the other hand, in Scotland the peasants
+say that the devil throws his cloak over the blackberries and makes
+them unwholesome after that day, while in Ireland he is said to stamp
+on the berries. Even that humble plant, the cabbage, has been invested
+with some mystery. It was said that the fairies were fond of its
+leaves, and rode to their midnight dances on cabbage-stalks. The German
+women used to say that 'Babies come out of the cabbage-heads.' The
+Irish peasant ties a cabbage-leaf around the neck for sore throat.
+According to Gerarde, the Spartans ate watercress with their bread,
+firmly believing that it increased their wit and wisdom. The old
+proverb is, 'Eat cress to learn more wit.'
+
+"There is another phase to food-superstitions, and that is the theory
+that the qualities of the eaten pass into the eater. Mr. Tylor refers
+to the habit of the Dyak young men in abstaining from deer-meat lest it
+should make them timid, while the warriors of some South American
+tribes eat the meat of tigers, stags, and boars for courage and speed.
+He mentions the story of an English gentleman at Shanghai who at the
+time of the Taeping attack met his Chinese servant carrying home the
+heart of a rebel, which he intended to eat to make him brave. There is
+a certain amount of truth in the theory that the quality of food does
+affect the mind and body. Buckle in his 'History of Civilization' took
+this view, and tried to prove that the character of a people depends on
+their diet."
+
+Idiosyncrasies to Drugs.--In the absorption and the assimilation of
+drugs idiosyncrasies are often noted; in fact, they are so common that
+we can almost say that no one drug acts in the same degree or manner on
+different individuals. In some instances the untoward action assumes
+such a serious aspect as to render extreme caution necessary in the
+administration of the most inert substances. A medicine ordinarily so
+bland as cod-liver oil may give rise to disagreeable eruptions.
+Christison speaks of a boy ten years old who was said to have been
+killed by the ingestion of two ounces of Epsom salts without inducing
+purgation; yet this common purge is universally used without the
+slightest fear or caution. On the other hand, the extreme tolerance
+exhibited by certain individuals to certain drugs offers a new phase of
+this subject. There are well-authenticated cases on record in which
+death has been caused in children by the ingestion of a small fraction
+of a grain of opium. While exhibiting especial tolerance from peculiar
+disposition and long habit, Thomas De Quincey, the celebrated English
+litterateur, makes a statement in his "Confessions" that with impunity
+he took as much as 320 grains of opium a day, and was accustomed at one
+period of his life to call every day for "a glass of laudanum negus,
+warm, and without sugar," to use his own expression, after the manner a
+toper would call for a "hot-Scotch."
+
+The individuality noted in the assimilation and the ingestion of drugs
+is functional as well as anatomic. Numerous cases have been seen by all
+physicians. The severe toxic symptoms from a whiff of cocain-spray, the
+acute distress from the tenth of a grain of morphin, the gastric crises
+and profuse urticarial eruptions following a single dose of
+quinin,--all are proofs of it. The "personal equation" is one of the
+most important factors in therapeutics, reminding us of the old rule,
+"Treat the patient, not the disease."
+
+The idiosyncrasy may be either temporary or permanent, and there are
+many conditions that influence it. The time and place of
+administration; the degree of pathologic lesion in the subject; the
+difference in the physiologic capability of individual organs of
+similar nature in the same body; the degree of human vitality
+influencing absorption and resistance; the peculiar epochs of life; the
+element of habituation, and the grade and strength of the drug,
+influencing its virtue,--all have an important bearing on untoward
+action and tolerance of poisons.
+
+It is not in the province of this work to discuss at length the
+explanations offered for these individual idiosyncrasies. Many authors
+have done so, and Lewin has devoted a whole volume to this subject, of
+which, fortunately, an English translation has been made by Mulheron,
+and to these the interested reader is referred for further information.
+In the following lines examples of idiosyncrasy to the most common
+remedial substances will be cited, taking the drugs up alphabetically.
+
+Acids.--Ordinarily speaking, the effect of boric acid in medicinal
+doses on the human system is nil, an exceptionally large quantity
+causing diuresis. Binswanger, according to Lewin, took eight gm. in two
+doses within an hour, which was followed by nausea, vomiting, and a
+feeling of pressure and fulness of the stomach which continued several
+hours. Molodenkow mentions two fatal cases from the external employment
+of boric acid as an antiseptic. In one case the pleural cavity was
+washed out with a five per cent solution of boric acid and was followed
+by distressing symptoms, vomiting, weak pulse, erythema, and death on
+the third day. In the second case, in a youth of sixteen, death
+occurred after washing out a deep abscess of the nates with the same
+solution. The autopsy revealed no change or signs indicative of the
+cause of death. Hogner mentions two instances of death from the
+employment of 2 1/2 per cent solution of boric acid in washing out a
+dilated stomach The symptoms were quite similar to those mentioned by
+Molodenkow.
+
+In recent years the medical profession has become well aware that in
+its application to wounds it is possible for carbolic acid or phenol to
+exercise exceedingly deleterious and even fatal consequences. In the
+earlier days of antisepsis, when operators and patients were exposed
+for some time to an atmosphere saturated with carbolic spray, toxic
+symptoms were occasionally noticed. Von Langenbeck spoke of severe
+carbolic-acid intoxication in a boy in whom carbolic paste had been
+used in the treatment of abscesses. The same author reports two
+instances of death following the employment of dry carbolized dressings
+after slight operations. Kohler mentions the death of a man suffering
+from scabies who had applied externally a solution containing about a
+half ounce of phenol. Rose spoke of gangrene of the finger after the
+application of carbolized cotton to a wound thereon. In some cases
+phenol acts with a rapidity equal to any poison. Taylor speaks of a man
+who fell unconscious ten seconds after an ounce of phenol had been
+ingested, and in three minutes was dead. There is recorded an account
+of a man of sixty-four who was killed by a solution containing slightly
+over a dram of phenol. A half ounce has frequently caused death;
+smaller quantities have been followed by distressing symptoms, such as
+intoxication (which Olshausen has noticed to follow irrigation of the
+uterus), delirium, singultus, nausea, rigors, cephalalgia, tinnitus
+aurium, and anasarca. Hind mentions recovery after the ingestion of
+nearly six ounces of crude phenol of 14 per cent strength. There was a
+case at the Liverpool Northern Hospital in which recovery took place
+after the ingestion with suicidal intent of four ounces of crude
+carbolic acid. Quoted by Lewin, Busch accurately describes a case which
+may be mentioned as characteristic of the symptoms of carbolism. A boy,
+suffering from abscess under the trochanter, was operated on for its
+relief. During the few minutes occupied by the operation he was kept
+under a two per cent carbolic spray, and the wound was afterward
+dressed with carbolic gauze. The day following the operation he was
+seized with vomiting, which was attributed to the chloroform used as an
+anesthetic. On the following morning the bandages were removed under
+the carbolic spray; during the day there was nausea, in the evening
+there was collapse, and carbolic acid was detected in the urine. The
+pulse became small and frequent and the temperature sank to 35.5
+degrees C. The frequent vomiting made it impossible to administer
+remedies by the stomach, and, in spite of hypodermic injections and
+external application of analeptics, the boy died fifty hours after
+operation.
+
+Recovery has followed the ingestion of an ounce of officinal
+hydrochloric acid. Black mentions a man of thirty-nine who recovered
+after swallowing 1 1/2 ounces of commercial hydrochloric acid. Johnson
+reports a case of poisoning from a dram of hydrochloric acid.
+Tracheotomy was performed, but death resulted.
+
+Burman mentions recovery after the ingestion of a dram of dilute
+hydrocyanic acid of Scheele's strength (2.4 am. of the acid). In this
+instance insensibility did not ensue until two minutes after taking the
+poison, the retarded digestion being the means of saving life.
+
+Quoting Taafe, in 1862 Taylor speaks of the case of a man who swallowed
+the greater part of a solution containing an ounce of potassium cyanid.
+In a few minutes the man was found insensible in the street, breathing
+stertorously, and in ten minutes after the ingestion of the drug the
+stomach-pump was applied. In two hours vomiting began, and thereafter
+recovery was rapid.
+
+Mitscherlich speaks of erosion of the gums and tongue with hemorrhage
+at the slightest provocation, following the long administration of
+dilute nitric acid. This was possibly due to the local action.
+
+According to Taylor, the smallest quantity of oxalic acid causing death
+is one dram. Ellis describes a woman of fifty who swallowed an ounce of
+oxalic acid in beer. In thirty minutes she complained of a burning pain
+in the stomach and was rolling about in agony.  Chalk and water was
+immediately given to her and she recovered.  Woodman reports recovery
+after taking 1/2 ounce of oxalic acid.
+
+Salicylic acid in medicinal doses frequently causes untoward symptoms,
+such as dizziness, transient delirium, diminution of vision, headache,
+and profuse perspiration; petechial eruptions and intense gastric
+symptoms have also been noticed.
+
+Sulphuric acid causes death from its corrosive action, and when taken
+in excessive quantities it produces great gastric disturbance; however,
+there are persons addicted to taking oil of vitriol without any
+apparent untoward effect. There is mentioned a boot-maker who
+constantly took 1/2 ounce of the strong acid in a tumbler of water,
+saying that it relieved his dyspepsia and kept his bowels open.
+
+Antimony.--It is recorded that 3/4 grain of tartar emetic has caused
+death in a child and two grains in an adult. Falot reports three cases
+in which after small doses of tartar emetic there occurred vomiting,
+delirium, spasms, and such depression of vitality that only the
+energetic use of stimulants saved life.  Beau mentions death following
+the administration of two doses of 1 1/2 gr. of tartar emetic.
+Preparations of antimony in an ointment applied locally have caused
+necrosis, particularly of the cranium, and Hebra has long since
+denounced the use of tartar emetic ointment in affections of the scalp.
+Carpenter mentions recovery after ingestion of two drams of tartar
+emetic. Behrends describes a case of catalepsy with mania, in which a
+dose of 40 gr. of tartar emetic was tolerated, and Morgagni speaks of a
+man who swallowed two drams, immediately vomited, and recovered.
+Instances like the last, in which an excessive amount of a poison by
+its sudden emetic action induces vomiting before there is absorption of
+a sufficient quantity to cause death, are sometimes noticed. McCreery
+mentions a case of accidental poisoning with half an ounce of tartar
+emetic successfully treated with green tea and tannin. Mason reports
+recovery after taking 80 gr. of tartar emetic.
+
+Arsenic.--The sources of arsenical poisoning are so curious as to
+deserve mention. Confectionery, wall-paper, dyes, and the like are
+examples. In other cases we note money-counting, the colored candles of
+a Christmas tree, paper collars, ball-wreaths of artificial flowers,
+ball-dresses made of green tarlatan, playing cards, hat-lining, and
+fly-papers.
+
+Bazin has reported a case in which erythematous pustules appeared after
+the exhibition during fifteen days of the 5/6 gr. of arsenic. Macnal
+speaks of an eruption similar to that of measles in a patient to whom
+he had given but three drops of Fowler's solution for the short period
+of three days. Pareira says that in a gouty patient for whom he
+prescribed 1/6 gr. of potassium arseniate daily, on the third day there
+appeared a bright red eruption of the face, neck, upper part of the
+trunk and flexor surfaces of the joints, and an edematous condition of
+the eyelids. The symptoms were preceded by restlessness, headache, and
+heat of the skin, and subsided gradually after the second or third day,
+desquamation continuing for nearly two months. After they had subsided
+entirely, the exhibition of arsenic again aroused them, and this time
+they were accompanied by salivation.  Charcot and other French authors
+have noticed the frequent occurrence of suspension of the sexual
+instinct during the administration of Fowler's solution. Jackson speaks
+of recovery after the ingestion of two ounces of arsenic by the early
+employment of an emetic. Walsh reports a case in which 600 gr. of
+arsenic were taken without injury. The remarkable tolerance of arsenic
+eaters is well known. Taylor asserts that the smallest lethal dose of
+arsenic has been two gr., but Tardieu mentions an instance in which ten
+cgm. (1 1/2 gr.) has caused death.  Mackenzie speaks of a man who
+swallowed a large quantity of arsenic in lumps, and received no
+treatment for sixteen hours, but recovered. It is added that from two
+masses passed by the anus 105 gr. of arsenic were obtained.
+
+In speaking of the tolerance of belladonna, in 1859 Fuller mentioned a
+child of fourteen who in eighteen days took 37 grains of atropin; a
+child of ten who took seven grains of extract of belladonna daily, or
+more than two ounces in twenty-six days; and a man who took 64 grains
+of the extract of belladonna daily, and from whose urine enough atropin
+was extracted to kill two white mice and to narcotize two others. Bader
+has observed grave symptoms following the employment of a vaginal
+suppository containing three grains of the extract of belladonna. The
+dermal manifestations, such as urticaria and eruptions resembling the
+exanthem of scarlatina, are too well known to need mention here.  An
+enema containing 80 grains of belladonna root has been followed in five
+hours by death, and Taylor has mentioned recovery after the ingestion
+of three drams of belladonna. In 1864 Chambers reported to the Lancet
+the recovery of a child of four years who took a solution containing
+1/2 grain of the alkaloid. In some cases the idiosyncrasy to belladonna
+is so marked that violent symptoms follow the application of the
+ordinary belladonna plaster. Maddox describes a ease of poisoning in a
+music teacher by the belladonna plaster of a reputable maker. She had
+obscure eye-symptoms, and her color-sensations were abnormal. Locomotor
+equilibration was also affected. Golden mentions two cases in which the
+application of belladonna ointment to the breasts caused suppression of
+the secretion of milk. Goodwin relates the history of a case in which
+an infant was poisoned by a belladonna plaster applied to its mother's
+breast and died within twenty-four hours after the first application of
+the plaster. In 1881 Betancourt spoke of an instance of inherited
+susceptibility to belladonna, in which the external application of the
+ointment produced all the symptoms of belladonna poisoning. Cooper
+mentions the symptoms of poisoning following the application of extract
+of belladonna to the scrotum. Davison reports poisoning by the
+application of belladonna liniment. Jenner and Lyman also record
+belladonna poisoning from external applications.
+
+Rosenthal reports a rare case of poisoning in a child eighteen months
+old who had swallowed about a teaspoonful of benzin.  Fifteen minutes
+later the child became unconscious. The stomach-contents, which were
+promptly removed, contained flakes of bloody mucus. At the end of an
+hour the radial pulse was scarcely perceptible, respiration was
+somewhat increased in frequency and accompanied with a rasping sound.
+The breath smelt of benzin. The child lay in quiet narcosis,
+occasionally throwing itself about as if in pain. The pulse gradually
+improved, profuse perspiration occurred, and normal sleep intervened.
+Six hours after the poisoning the child was still stupefied. The urine
+was free from albumin and sugar, and the next morning the little one
+had perfectly recovered.
+
+There is an instance mentioned of a robust youth of twenty who by a
+mistake took a half ounce of cantharides. He was almost immediately
+seized with violent heat in the throat and stomach, pain in the head,
+and intense burning on urination. These symptoms progressively
+increased, were followed by intense sickness and almost continual
+vomiting. In the evening he passed great quantities of blood from the
+urethra with excessive pain in the urinary tract. On the third day all
+the symptoms were less violent and the vomiting had ceased. Recovery
+was complete on the fifteenth day.
+
+Digitalis has been frequently observed to produce dizziness, fainting,
+disturbances of vision, vomiting, diarrhea, weakness of the pulse, and
+depression of temperature. These phenomena, however, are generally
+noticed after continued administration in repeated doses, the result
+being doubtless due to cumulative action caused by abnormally slow
+elimination by the kidneys.  Traube observed the presence of
+skin-affection after the use of digitalis in a case of pericarditis.
+Tardieu has seen a fluid-dram of the tincture of digitalis cause
+alarming symptoms in a young woman who was pregnant. He also quotes
+cases of death on the tenth day from ingestion of 20 grains of the
+extract, and on the fifth day from 21 grams of the infusion. Kohuhorn
+mentions a death from what might be called chronic digitalis poisoning.
+
+There is a deleterious practice of some of the Irish peasantry
+connected with their belief in fairies, which consists of giving a
+cachetic or rachitic child large doses of a preparation of fox-glove
+(Irish--luss-more, or great herb), to drive out or kill the fairy in
+the child. It was supposed to kill an unhallowed child and cure a
+hallowed one. In the Hebrides, likewise, there were many cases of
+similar poisoning.
+
+Epidemics of ergotism have been recorded from time to time since the
+days of Galen, and were due to poverty, wretchedness, and famine,
+resulting in the feeding upon ergotized bread. According to Wood,
+gangrenous ergotism, or "Ignis Sacer" of the Middle Ages, killed 40,000
+persons in Southwestern France in 922 A. D., and in 1128-29, in Paris
+alone, 14,000 persons perished from this malady. It is described as
+commencing with itchings and formications in the feet, severe pain in
+the back, contractions in the muscles, nausea, giddiness, apathy, with
+abortion in pregnant women, in suckling women drying of milk, and in
+maidens with amenorrhea. After some time, deep, heavy aching in the
+limbs, intense feeling of coldness, with real coldness of the surfaces,
+profound apathy, and a sense of utter weariness develop; then a dark
+spot appears on the nose or one of the extremities, all sensibility is
+lost in the affected part, the skin assumes a livid red hue, and
+adynamic symptoms in severe cases deepen as the gangrene spreads, until
+finally death ensues.  Very generally the appetite and digestion are
+preserved to the last, and not rarely there is a most ferocious hunger.
+Wood also mentions a species of ergotism characterized by epileptic
+paroxysms, which he calls "spasmodic ergotism." Prentiss mentions a
+brunette of forty-two, under the influence of ergot, who exhibited a
+peculiar depression of spirits with hysteric phenomena, although
+deriving much benefit from the administration of the drug from the
+hemorrhage caused by uterine fibroids. After taking ergot for three
+days she felt like crying all the time, became irritable, and stayed in
+bed, being all day in tears. The natural disposition of the patient was
+entirely opposed to these manifestations, as she was even-tempered and
+exceptionally pleasant.
+
+In addition to the instance of the fatal ingestion of a dose of Epsom
+salts already quoted, Lang mentions a woman of thirty-five who took
+four ounces of this purge. She experienced burning pain in the stomach
+and bowels, together with a sense of asphyxiation.  There was no
+purging or vomiting, but she became paralyzed and entered a state of
+coma, dying fifteen minutes after ingestion.
+
+Iodin Preparations.--The eruptions following the administration of
+small doses of potassium iodid are frequently noticed, and at the same
+time large quantities of albumin have been seen in the urine. Potassium
+iodid, although generally spoken of as a poisonous drug, by gradually
+increasing the dose can be given in such enormous quantities as to be
+almost beyond the bounds of credence, several drams being given at a
+dose. On the other hand, eight grains have produced alarming symptoms.
+In the extensive use of iodoform as a dressing instances of untoward
+effects, and even fatal ones, have been noticed, the majority of them
+being due to careless and injudicious application. In a French journal
+there is mentioned the history of a man of twenty-five, suspected of
+urethral ulceration, who submitted to the local application of one gram
+of iodoform. Deep narcosis and anesthesia were induced, and two hours
+after awakening his breath smelled strongly of iodoform. There are two
+similar instances recorded in England.
+
+Pope mentions two fatal cases of lead-poisoning from diachylon plaster,
+self-administered for the purpose of producing abortion.  Lead
+water-pipes, the use of cosmetics and hair-dyes, coloring matter in
+confectionery and in pastry, habitual biting of silk threads,
+imperfectly burnt pottery, and cooking bread with painted wood have
+been mentioned as causes of chronic lead-poisoning.
+
+Mercury.--Armstrong mentions recovery after ingestion of 1 1/2 drams of
+corrosive sublimate, and Lodge speaks of recovery after a dose
+containing 100 grains of the salt. It is said that a man swallowed 80
+grains of mercuric chlorid in whiskey and water, and vomited violently
+about ten minutes afterward. A mixture of albumin and milk was given to
+him, and in about twenty-five minutes a bolus of gold-leaf and reduced
+iron; in eight days he perfectly recovered. Severe and even fatal
+poisoning may result from the external application of mercury. Meeres
+mentions a case in which a solution (two grains to the fluid-ounce)
+applied to the head of a child of nine for the relief of tinea
+tonsurans caused diarrhea, profuse salivation, marked prostration, and
+finally death. Washing out the vagina with a solution of corrosive
+sublimate, 1:2000, has caused severe and even fatal poisoning. Bonet
+mentions death after the inunction of a mercurial ointment, and
+instances of distressing salivation from such medication are quite
+common. There are various dermal affections which sometimes follow the
+exhibition of mercury and assume an erythematous type. The
+susceptibility of some persons to calomel, the slightest dose causing
+profuse salivation and painful oral symptoms, is so common that few
+physicians administer mercury to their patients without some knowledge
+of their susceptibility to this drug. Blundel relates a curious case
+occurring in the times when mercury was given in great quantities, in
+which to relieve obstinate constipation a half ounce of crude mercury
+was administered and repeated in twelve hours. Scores of globules of
+mercury soon appeared over a vesicated surface, the result of a
+previous blister applied to the epigastric region. Blundel, not
+satisfied with the actuality of the phenomena, submitted his case to
+Dr. Lister, who, after careful examination, pronounced the globules
+metallic.
+
+Oils.--Mauvezin tells of the ingestion of three drams of croton oil by
+a child of six, followed by vomiting and rapid recovery.  There was no
+diarrhea in this case. Wood quotes Cowan in mentioning the case of a
+child of four, who in two days recovered from a teaspoonful of croton
+oil taken on a full stomach. Adams saw recovery in an adult after
+ingestion of the same amount.  There is recorded an instance of a woman
+who took about an ounce, and, emesis being produced three-quarters of
+an hour afterward by mustard, she finally recovered. There is a record
+in which so small a dose as three minims is supposed to have killed a
+child of thirteen months. According to Wood, Giacomini mentions a case
+in which 24 grains of the drug proved fatal in as many hours.
+
+Castor oil is usually considered a harmless drug, but the castor bean,
+from which it is derived, contains a poisonous acrid principle, three
+such beans having sufficed to produce death in a man. Doubtless some of
+the instances in which castor oil has produced symptoms similar to
+cholera are the results of the administration of contaminated oil.
+
+The untoward effects of opium and its derivatives are quite numerous
+Gaubius treated an old woman in whom, after three days, a single grain
+of opium produced a general desquamation of the epidermis; this
+peculiarity was not accidental, as it was verified on several other
+occasions. Hargens speaks of a woman in whom the slightest bit of opium
+in any form produced considerable salivation. Gastric disturbances are
+quite common, severe vomiting being produced by minimum doses; not
+infrequently, intense mental confusion, vertigo, and headache, lasting
+hours and even days, sometimes referable to the frontal region and
+sometimes to the occipital, are seen in certain nervous individuals
+after a dose of from 1/4 to 5/6 gr. of opium. These symptoms were
+familiar to the ancient physicians, and, according to Lewin, Tralles
+reports an observation with reference to this in a man, and says
+regarding it in rather unclassical Latin: "... per multos dies
+ponderosissimum caput circumgestasse." Convulsions are said to be
+observed after medicinal doses of opium. Albers states that twitching
+in the tendons tremors of the hands, and even paralysis, have been
+noticed after the ingestion of opium in even ordinary doses. The
+"pruritus opii," so familiar to physicians, is spoken of in the older
+writings. Dioscorides, Paulus Aegineta, and nearly all the writers of
+the last century describe this symptom as an annoying and unbearable
+affection. In some instances the ingestion of opium provokes an
+eruption in the form of small, isolated red spots, which, in their
+general character, resemble roseola. Rieken remarks that when these
+spots spread over all the body they present a scarlatiniform
+appearance, and he adds that even the mucous membranes of the mouth and
+throat may be attacked with erethematous inflammation.  Behrend
+observed an opium exanthem, which was attended by intolerable itching,
+after the exhibition of a quarter of a grain. It was seen on the chest,
+on the inner surfaces of the arms, on the flexor surfaces of the
+forearms and wrists, on the thighs, and posterior and inner surfaces of
+the legs, terminating at the ankles in a stripe-like discoloration
+about the breadth of three fingers. It consisted of closely disposed
+papules of the size of a pin-head, and several days after the
+disappearance of the eruption a fine, bran-like desquamation of the
+epidermis ensued. Brand has also seen an eruption on the trunk and
+flexor surfaces, accompanied with fever, from the ingestion of opium.
+Billroth mentions the case of a lady in whom appeared a feeling of
+anxiety, nausea, and vomiting after ingestion of a small fraction of a
+grain of opium; she would rather endure her intense pain than suffer
+the untoward action of the drug. According to Lewin, Brochin reported a
+case in which the idiosyncrasy to morphin was so great that 1/25 of a
+grain of the drug administered hypodermically caused irregularity of
+the respiration, suspension of the heart-beat, and profound narcosis.
+According to the same authority, Wernich has called attention to
+paresthesia of the sense of taste after the employment of morphin,
+which, according to his observation, is particularly prone to supervene
+in patients who are much reduced and in persons otherwise healthy who
+have suffered from prolonged inanition. These effects are probably due
+to a central excitation of a similar nature to that produced by
+santonin. Persons thus attacked complain, shortly after the injection,
+of an intensely sour or bitter taste, which for the most part ceases
+after elimination of the morphin. Von Graefe and Sommerfrodt speak of a
+spasm of accommodation occurring after ingestion of medicinal doses of
+morphin. There are several cases on record in which death has been
+produced in an adult by the use of 1/2 to 1/6 grain of morphin.
+According to Wood, the maximum doses from which recovery has occurred
+without emesis are 55 grains of solid opium, and six ounces of
+laudanum. According to the same authority, in 1854 there was a case in
+which a babe one day old was killed by one minim of laudanum, and in
+another case a few drops of paregoric proved fatal to a child of nine
+months.  Doubtful instances of death from opium are given, one in an
+adult female after 30 grains of Dover's powder given in divided doses,
+and another after a dose of 1/4 grain of morphin. Yavorski cites a
+rather remarkable instance of morphin-poisoning with recovery: a female
+took 30 grains of acetate of morphin, and as it did not act quickly
+enough she took an additional dose of 1/2 ounce of laudanum. After this
+she slept a few hours, and awoke complaining of being ill. Yavorski saw
+her about an hour later, and by producing emesis, and giving coffee,
+atropin, and tincture of musk, he saved her life. Pyle describes a
+pugilist of twenty-two who, in a fit of despondency after a debauch (in
+which he had taken repeated doses of morphin sulphate), took with
+suicidal intent three teaspoonfuls of morphin; after rigorous treatment
+he revived and was discharged on the next day perfectly well.
+Potassium permanganate was used in this case. Chaffee speaks of
+recovery after the ingestion of 18 grains of morphin without vomiting.
+
+In chronic opium eating the amount of this drug which can be ingested
+with safety assumes astounding proportions. In his "Confessions" De
+Quincey remarks: "Strange as it may sound, I had a little before this
+time descended suddenly and without considerable effort from 320 grains
+of opium (8000 drops of laudanum) per day to 40 grains, or 1/8 part.
+Instantaneously, and as if by magic, the cloud of profoundest
+melancholy which rested on my brain, like some black vapors that I have
+seen roll away from the summits of the mountains, drew off in one
+day,--passed off with its murky banners as simultaneously as a ship
+that has been stranded and is floated off by a spring-tide--
+
+     'That moveth altogether if it move at all.'
+
+Now, then, I was again happy; I took only a thousand drops of Laudanum
+per day, and what was that? A latter spring had come to close up the
+season of youth; my brain performed its functions as healthily as ever
+before; I read Kant again, and again I understood him, or fancied that
+I did." There have been many authors who, in condemning De Quincey for
+unjustly throwing about the opium habit a halo of literary beauty which
+has tempted many to destruction, absolutely deny the truth of his
+statements. No one has any stable reason on which to found denial of De
+Quincey's statements as to the magnitude of the doses he was able to
+take; and his frankness and truthfulness is equal to that of any of his
+detractors. William Rosse Cobbe, in a volume entitled "Dr. Judas, or
+Portrayal of the Opium Habit," gives with great frankness of confession
+and considerable purity of diction a record of his own experiences with
+the drug. One entire chapter of Mr. Cobb's book and several portions of
+other chapters are devoted to showing that De Quincey was wrong in some
+of his statements, but notwithstanding his criticism of De Quincey, Mr.
+Cobbe seems to have experienced the same adventures in his dreams,
+showing, after all, that De Quincey knew the effects of opium even if
+he seemed to idealize it. According to Mr. Cobbe, there are in the
+United States upward of two millions of victims of enslaving drugs
+entirely exclusive of alcohol. Cobbe mentions several instances in
+which De Quincey's dose of 320 grains of opium daily has been
+surpassed. One man, a resident of Southern Illinois, consumed 1072
+grains a day; another in the same State contented himself with 1685
+grains daily; and still another is given whose daily consumption
+amounted to 2345 grains per day. In all cases of laudanum-takers it is
+probable that analysis of the commercial laudanum taken would show the
+amount of opium to be greatly below that of the official proportion,
+and little faith can be put in the records of large amounts of opium
+taken when the deduction has been made from the laudanum used. Dealers
+soon begin to know opium victims, and find them ready dupes for
+adulteration. According to Lewin, Samter mentions a case of
+morphin-habit which was continued for three years, during which, in a
+period of about three, hundred and twenty-three days, upward of 2 1/2
+ounces of morphin was taken daily. According to the same authority,
+Eder reports still larger doses. In the case observed by him the
+patient took laudanum for six years in increasing doses up to one ounce
+per day; for eighteen months, pure opium, commencing with 15 grains and
+increasing to 2 1/4 drams daily; and for eighteen months morphin, in
+commencing quantities of six grains, which were later increased to 40
+grains a day. When deprived of their accustomed dose of morphin the
+sufferings which these patients experience are terrific, and they
+pursue all sorts of deceptions to enable them to get their enslaving
+drug.  Patients have been known to conceal tubes in their mouths, and
+even swallow them, and the authors know of a fatal instance in which a
+tube of hypodermic tablets of the drug was found concealed in the
+rectum.
+
+The administration of such an inert substance as the infusion of
+orange-peel has been sufficient to invariably produce nervous
+excitement in a patient afflicted with carcinoma.
+
+Sonnenschein refers to a case of an infant of five weeks who died from
+the effects of one phosphorous match head containing only 1/100 grain
+of phosphorus. There are certain people who by reason of a special
+susceptibility cannot tolerate phosphorus, and the exhibition of it
+causes in them nausea, oppression, and a feeling of pain in the
+epigastric region, tormina and tenesmus, accompanied with diarrhea, and
+in rare cases jaundice, sometimes lasting several months. In such
+persons 1/30 grain is capable of causing the foregoing symptoms. In
+1882 a man was admitted to Guy's Hospital, London, after he had taken
+half of a sixpenny pot of phosphorous paste in whiskey, and was
+subsequently discharged completely recovered.
+
+A peculiar feature of phosphorus-poisoning is necrosis of the jaw. This
+affection was first noticed in 1838, soon after the introduction of the
+manufacture of phosphorous matches. In late years, owing to the
+introduction of precautions in their manufacture, the disease has
+become much less common. The tipping of the match sticks is
+accomplished by dipping their ends in a warm solution of a composition
+of phosphorus, chlorate of potassium, with particles of ground flint to
+assist friction, some coloring agent, and Irish glue. From the contents
+of the dipping-pans fumes constantly arise into the faces of the
+workmen and dippers, and in cutting the sticks and packing the matches
+the hands are constantly in contact with phosphorus. The region chiefly
+affected in this poisoning is the jaw-bone, but the inflammation may
+spread to the adjoining bones and involve the vomer, the zygoma, the
+body of the spheroid bone, and the basilar process of the occipital
+bone. It is supposed that conditions in which the periosteum is exposed
+are favorable to the progress of the disease, and, according to Hirt,
+workmen with diseased teeth are affected three times as readily as
+those with healthy teeth, and are therefore carefully excluded from
+some of the factories in America.
+
+Prentiss of Washington, D.C., in 1881 reported a remarkable case of
+pilocarpin idiosyncrasy in a blonde of twenty-five. He was consulted by
+the patient for constipation. Later on symptoms of cystitis developed,
+and an ultimate diagnosis of pyelitis of the right kidney was made.
+Uremic symptoms were avoided by the constant use of pilocarpin. Between
+December 16, 1880, and February 22, 1881, the patient had 22 sweats
+from pilocarpin. The action usually lasted from two to six hours, and
+quite a large dose was at length necessary. The idiosyncrasy noted was
+found in the hair, which at first was quite light, afterward
+chestnut-brown, and May 1, 1881, almost pure black. The growth of the
+hair became more vigorous and thicker than formerly, and as its color
+darkened it became coarser in proportion. In March, 1889, Prentiss saw
+his patient, and at that time her hair was dark brown, having returned
+to that color from black. Prentiss also reported the following case a
+as adding another to the evidence that jaborandi will produce the
+effect mentioned under favorable circumstances: Mrs. L., aged
+seventy-two years, was suffering from Bright's disease (contracted
+kidney). Her hair and eyebrows had been snow-white for twenty years.
+She suffered greatly from itching of the skin, due to the uremia of the
+kidney-disease; the skin was harsh and dry. For this symptom fluid
+extract of jaborandi was prescribed with the effect of relieving the
+itching. It was taken in doses of 20 or 30 drops several times a day,
+from October, 1886, to February, 1888.  During the fall of 1887 it was
+noticed by the nurse that the eyebrows were growing darker, and that
+the hair of the head was darker in patches. These patches and the
+eyebrows continued to become darker, until at the time of her death
+they were quite black, the black tufts on the head presenting a very
+curious appearance among the silver-white hairs surrounding them.
+
+Quinin being such a universally used drug, numerous instances of
+idiosyncrasy and intolerance have been recorded. Chevalier mentions
+that through contact of the drug workmen in the manufacture of quinin
+are liable to an affection of the skin which manifests itself in a
+vesicular, papular, or pustular eruption on different parts of the
+body. Vepan mentions a lady who took 1 1/2 grains and afterward 2 1/2
+grains of quinin for neuralgia, and two days afterward her body was
+covered with purpuric spots, which disappeared in the course of nine
+days but reappeared after the administration of the drug was resumed.
+Lewin says that in this case the severity of the eruption was in
+accordance with the size of the dose, and during its existence there
+was bleeding at the gums; he adds that Gouchet also noticed an eruption
+of this kind in a lady who after taking quinin expectorated blood. The
+petechiae were profusely spread over the entire body, and they
+disappeared after the suspension of the drug. Dauboeuf, Garraway,
+Hemming, Skinner, and Cobner mention roseola and scarlatiniform
+erythema after minute doses of quinin.  In nearly all these cases the
+accompanying symptoms were different. Heusinger speaks of a lady who,
+after taking 1/2 grain of quinin, experienced headache, nausea, intense
+burning, and edema, together with nodular erythema on the eyelids,
+cheeks, and portion of the forehead. At another time 1 1/2 grains of
+the drug gave rise to herpetic vesicles on the cheeks, followed by
+branny desquamation on elimination of the drug. In other patients
+intense itching is experienced after the ingestion of quinin.  Peters
+cites an instance of a woman of sixty-five who, after taking one grain
+of quinin, invariably exhibited after an hour a temperature of from 104
+degrees to 105 degrees F., accelerated pulse, rigors, slight delirium,
+thirst, and all the appearances of ill-defined fever, which would pass
+off in from twelve to twenty-four hours. Peters witnessed this
+idiosyncrasy several times and believed it to be permanent. The most
+unpleasant of the untoward symptoms of quinin exhibition are the
+disturbances of the organs of special sense. Photophobia, and even
+transient amblyopia, have been observed to follow small doses. In the
+examination of cases of the untoward effects of quinin upon the eye,
+Knapp of New York found the power of sight diminished in various
+degrees, and rarely amaurosis and immobility of the pupils. According
+to Lewin, the perceptions of color and light are always diminished, and
+although the disorder may last for some time the prognosis is
+favorable. The varieties of the disturbances of the functions of the
+ear range from tinnitus aurium to congestion causing complete deafness.
+The gastro-intestinal and genito-urinary tracts are especially disposed
+to untoward action by quinin. There is a case recorded in which, after
+the slightest dose of quinin, tingling and burning at the meatus
+urinarius were experienced. According to Lewin, there is mentioned in
+the case reported by Gauchet a symptom quite unique in the literature
+of quinin, viz., hemoptysis. Simon de Ronchard first noted the
+occurrence of several cases of hemoptysis following the administration
+of doses of eight grains daily. In the persons thus attacked the lungs
+and heart were healthy. Hemoptysis promptly ceased with the suspension
+of the drug. When it was renewed, blood again appeared in the sputa.
+Taussig mentions a curious mistake, in which an ounce of quinin
+sulphate was administered to a patient at one dose; the only symptoms
+noticed were a stuporous condition and complete deafness. No antidote
+was given, and the patient perfectly recovered in a week. In malarious
+countries, and particularly in the malarial fevers of the late war,
+enormous quantities of quinin were frequently given. In fact, at the
+present day in some parts of the South quinin is constantly kept on the
+table as a prophylactic constituent of the diet.
+
+Skinner noticed the occurrence of a scarlatiniform eruption in a woman
+after the dose of 1/165 grain of strychnin, which, however, disappeared
+with the discontinuance of the drug. There was a man in London in 1865
+who died in twenty minute's after the ingestion of 1/2 grain of
+strychnin. Wood speaks of a case in which the administration of 1/100
+grain killed a child three and one-half months old. Gray speaks of a
+man who took 22 grains and was not seen for about an hour. He had
+vomited some of it immediately after taking the dose, and was
+successfully treated with chloral hydrate. A curious case is mentioned
+in which three mustard plasters, one on the throat, one on the back of
+the neck, and another on the left shoulder of a woman, produced
+symptoms similar to strychnin poisoning. They remained in position for
+about thirty minutes, and about thirty hours afterward a painful
+stinging sensation commenced in the back of the neck, followed by
+violent twitching of the muscles of the face, arms, and legs, which
+continued in regular succession through the whole of the night, but
+after twelve hours yielded to hot fomentations of poppy-heads applied
+to the back of the neck. It could not be ascertained whether any
+medicine containing strychnin had been taken, but surely, from the
+symptoms, such must have been the case.
+
+Tobacco.--O'Neill a gives the history of a farmer's wife, aged forty,
+who wounded her leg against a sewing-machine, and by lay advice applied
+a handful of chopped wet tobacco to it, from which procedure, strange
+to say, serious nicotin-poisoning ensued. The pupils were dilated,
+there were dimness of vision, confusion of thought, and extreme
+prostration. The pulse was scarcely apparent, the skin was white and
+wet with clammy perspiration.  Happily, strychnin was given in time to
+effect recovery, and without early medical assistance she would
+undoubtedly have succumbed. There are several similar cases on record.
+
+Although not immediately related to the subject of idiosyncrasy, the
+following case may be mentioned here: Ramadge speaks of a young
+Frenchman, suffering from an obstinate case of gonorrhea, who was said
+to have been completely cured by living in a newly painted house in
+which he inhaled the odors or vapors of turpentine.
+
+White speaks of a case of exanthematous eruption similar to that of
+ivy-poison in mother and child, which was apparently caused by playing
+with and burning the toy called "Pharaoh's serpent egg."
+
+The idiosyncrasies noticed in some persons during coitus are quite
+interesting. The Ephemerides mentions a person in whom coitus
+habitually caused vomiting, and another in whom excessive sexual
+indulgence provoked singultus. Sometimes exaggerated tremors or
+convulsions, particularly at the moment of orgasm, are noticed. Females
+especially are subject to this phenomenon, and it is seen sometimes in
+birds.
+
+Winn reports the case of a man who, when prompted to indulge in sexual
+intercourse, was immediately prior to the act seized with a fit of
+sneezing. Even the thought of sexual pleasure with a female was
+sufficient to provoke this peculiar idiosyncrasy.
+
+Sullivan mentions a bride of four weeks, who called at the doctor's
+office, saying that in coitus her partner had no difficulty until the
+point of culmination or orgasm, when he was seized with complete
+numbness and lost all pleasurable sensation in the penis. The numbness
+was followed by a sensation of pain, which was intensified on the
+slightest motion, and which was at times so excruciating as to forbid
+separation for upward of an hour, or until the penis had become
+flaccid. The woman asked for advice for her unfortunate husband's
+relief, and the case was reported as a means of obtaining suggestions
+from the physicians over the country. In response, one theory was
+advanced that this man had been in the habit of masturbating and had a
+stricture of the membranous portion of the urethra, associated with an
+ulcer of the prostate involving the ejaculatory ducts, or an
+inflammatory condition of all the tissues compressed by the ejaculatory
+muscles.
+
+Hendrichsen quotes a case in which a spasmodic contraction of the
+levator ani occurred during coitus, and the penis could not be
+withdrawn while this condition lasted; and in support of this
+circumstance Hendrichsen mentions that Marion Sims, Beigel, and Budin
+describe spasmodic contractions of the levator and, constricting the
+vagina; he also cites an instance under his personal observation in
+which this spasm was excited by both vaginal and rectal examination,
+although on the following day no such condition could be produced. In
+this connection, among the older writers, Borellus gives the history of
+a man who before coitus rubbed his virile member with musk, and,
+similar to the connection of a dog and bitch, was held fast in his
+wife's vagina; it was only after the injection of great quantities of
+water to soften the parts that separation was obtained.  Diemerbroeck
+confirms this singular property of musk by an analogous observation, in
+which the ludicrous method of throwing cold water on the persons was
+practised. Schurig also relates the history of a similar instance.
+
+Among the peculiar effects of coitus is its deteriorating effect on the
+healing process of wounds. Boerhaave, Pare, and Fabricius Hildanus all
+speak of this untoward effect of venery, and in modern times Poncet has
+made observations at a hospital in Lyons which prove that during the
+process of healing wounds are unduly and harmfully influenced by
+coitus, and cites confirmatory instances. Poncet also remarks that he
+found on nine occasions, by placing a thermometer in the rectum, that
+the temperature was about 1 degrees F. lower just before than after
+coitus, and that during the act the temperature gradually rose above
+normal.
+
+There are many associate conditions which, under the exciting influence
+of coitus, provoke harmful effects and even a fatal issue. Deguise
+mentions a man who had coitus 18 times in ten hours with most
+disastrous effects. Cabrolius speaks of a man who took a potion of
+aphrodisiac properties, in which, among other things, he put an
+enormous dose of cantharides. The anticipation of the effect of his
+dose, that is, the mental influence, in addition to the actual
+therapeutic effect, greatly distressed and excited him. Almost beyond
+belief, it is said that he approached his wife eighty-seven times
+during the night, spilling much sperm on the sleeping-bed. Cabrolius
+was called to see this man in the morning, and found him in a most
+exhausted condition, but still having the supposed consecutive
+ejaculations. Exhaustion progressed rapidly, and death soon terminated
+this erotic crisis.  Lawson is accredited with saying that among the
+Marquesan tribe he knew of a woman who during a single night had
+intercourse with 103 men.
+
+Among the older writers there are instances reported in which erection
+and ejaculation took place without the slightest pleasurable sensation.
+Claudius exemplifies this fact in his report of a Venetian merchant who
+had vigorous erections and ejaculations of thick and abundant semen
+without either tingling or pleasure.
+
+Attila, King of the Huns, and one of the most celebrated leaders of the
+German hosts which overran the Roman Empire in its decline, and whose
+enormous army and name inspired such terror that he was called the
+"Scourge of God," was supposed to have died in coitus. Apoplexy,
+organic heart disorders, aneurysms, and other like disorders are in
+such cases generally the direct cause of death, coitus causing the
+death indirectly by the excitement and exertion accompanying the act.
+
+Bartholinus, Benedictus, Borellus, Pliny, Morgagni, Plater, a Castro,
+Forestus, Marcellus Donatus, Schurig, Sinibaldus, Schenck, the
+Ephemerides, and many others mention death during coitus; the older
+writers in some cases attributed the fatal issue to excessive sexual
+indulgence, not considering the possibility of the associate direct
+cause, which most likely would have been found in case of a necropsy.
+
+Suspended Animation.--Various opinions have been expressed as to the
+length of time compatible with life during which a person can stay
+under water. Recoveries from drowning furnish interesting examples of
+the suspension of animation for a protracted period, but are hardly
+ever reliable, as the subject at short intervals almost invariably
+rises to the surface of the water, allowing occasional respiration.
+Taylor mentions a child of two who recovered after ten minutes'
+submersion; in another case a man recovered after fourteen minutes'
+submersion. There is a case reported in this country of a woman who was
+said to have been submerged twenty minutes. Guerard quotes a case
+happening in 1774, in which there was submersion for an hour with
+subsequent recovery; but there hardly seems sufficient evidence of this.
+
+Green mentions submersion for fifteen minutes; Douglass, for fourteen
+minutes; Laub, for fifteen minutes; Povall gives a description of three
+persons who recovered after a submersion of twenty-five minutes. There
+is a case in French literature, apparently well authenticated, in which
+submersion for six minutes was followed by subsequent recovery.
+
+There have been individuals who gave exhibitions of prolonged
+submersion in large glass aquariums, placed in full view of the
+audience. Taylor remarks that the person known some years ago in London
+as "Lurline" could stay under water for three minutes.  There have been
+several exhibitionists of this sort. Some of the more enterprising seat
+themselves on an artificial coral, and surrounded by fishes of divers
+hues complacently eat a meal while thus submerged. It is said that
+quite recently in Detroit there was a performer who accomplished the
+feat of remaining under water four minutes and eight seconds in full
+view of the audience. Miss Lurline swam about in her aquarium, which
+was brilliantly illuminated, ate, reclined, and appeared to be taking a
+short nap during her short immersion. In Paris, some years since, there
+was exhibited a creature called "l'homme-poisson," who performed feats
+similar to Lurline, including the smoking of a cigarette held entirely
+in his mouth. In all these exhibitions all sorts of artificial means
+are used to make the submersion appear long. Great ceremony, music, and
+the counting of the seconds in a loud voice from the stage, all tend to
+make the time appear much longer than it really is. However, James
+Finney in London, April 7, 1886, stayed under water four minutes,
+twenty-nine and one-fourth seconds, and one of his feats was to pick up
+70 or 80 gold-plated half-pennies with his mouth, his hands being
+securely tied behind his back, and never emerging from his tank until
+his feat was fully accomplished. In company with his sister he played a
+game of "nap" under water, using porcelain cards and turning them to
+the view of the audience.  "Professor Enochs" recently stayed under
+water at Lowell, Mass., for four minutes, forty-six and one-fifth
+seconds. The best previous record was four minutes, thirty-five
+seconds, made by "Professor Beaumont" at Melbourne on December 16, 1893.
+
+For the most satisfactory examples of prolonged submersion we must look
+to the divers, particularly the natives who trade in coral, and the
+pearl fishers. Diving is an ancient custom, and even legendary exploits
+of this nature are recorded. Homer compares the fall of Hector's
+chariot to the action of a diver; and specially trained men were
+employed at the Siege of Syracuse, their mission being to laboriously
+scuttle the enemy's vessels.  Many of the old historians mention
+diving, and Herodotus speaks of a diver by the name of Scyllias who was
+engaged by Xerxes to recover some articles of value which had been sunk
+on some Persian vessels in a tempest. Egyptian divers are mentioned by
+Plutarch, who says that Anthony was deceived by Cleopatra in a fishing
+contest by securing expert divers to place the fish upon the hooks.
+There was a historical or rather legendary character by the name of
+Didion, who was noted for his exploits in the river Meuse. He had the
+ability to stay under water a considerable length of time, and even to
+catch fish while submerged.
+
+There was a famous diver in Sicily at the end of the fifteenth century
+whose feats are recorded in the writings of Alexander ab Alexandro,
+Pontanus, and Father Kircher, the Jesuit savant. This man's name was
+Nicolas, born of poor parents at Catania. From his infancy he showed an
+extraordinary power of diving and swimming, and from his compatriots
+soon acquired various names indicative of his capacity. He became very
+well known throughout Sicily, and for his patron had Frederick, King of
+Naples. In the present day, the sponge-fishers and pearl-fishers in the
+West Indies, the Mediterranean, the Indian Seas, and the Gulf of Mexico
+invite the attention of those interested in the anomalies of suspended
+animation. There are many marvelous tales of their ability to remain
+under water for long periods. It is probable that none remain submerged
+over two minutes, but, what is more remarkable, they are supposed to
+dive to extraordinary depths, some as much as 150 to 200 feet.
+Ordinarily they remain under water from a minute to one and a half
+minutes. Remaining longer, the face becomes congested, the eyes
+injected; the sputum bloody, due to rupture of some of the minute
+vessels in the lung. It is said by those who have observed them
+carefully that few of these divers live to an advanced age. Many of
+them suffer apoplectic attacks, and some of them become blind from
+congestion of the ocular vessels. The Syrian divers are supposed to
+carry weights of considerable size in their hands in order to
+facilitate the depth and duration of submersion. It is also said that
+the divers of Oceanica use heavy stones. According to Guyot-Daubes, in
+the Philippine Isles the native pearl-fishers teach their children to
+dive to the depth of 25 meters. The Tahitians, who excited the
+admiration of Cook, are noted for their extraordinary diving.  Speaking
+of the inhabitants of the island of Fakaraya, near Tahiti, de la
+Quesnerie says that the pearl-fishers do not hesitate to dive to the
+depth even of 100 feet after their coveted prizes. On the Ceylon coast
+the mother-of-pearl fishers are under the direction of the English
+Government, which limits the duration and the practice of this
+occupation. These divers are generally Cingalese, who practice the
+exercise from infancy.  As many as 500 small boats can be seen about
+the field of operation, each equipped with divers. A single diver makes
+about ten voyages under the water, and then rests in the bottom of the
+boat, when his comrade takes his place. Among other native divers are
+the Arabs of Algeria and some of the inhabitants of the Mexican coast.
+
+It might be well to mention here the divers who work by means of
+apparatus. The ancients had knowledge of contrivances whereby they
+could stay under water some time. Aristotle speaks of an instrument by
+which divers could rest under water in communication with the air, and
+compares it with the trunk of an elephant wading a stream deeper than
+his height. In the presence of Charles V diving bells were used by the
+Greeks in 1540. In 1660 some of the cannon of the sunken ships of the
+Spanish Armada were raised by divers in diving bells. Since then
+various improvements in submarine armor have been made, gradually
+evolving into the present perfected diving apparatus of to-day, by
+which men work in the holds of vessels sunk in from 120 to 200 feet of
+water. The enormous pressure of the water at these great depths makes
+it necessary to have suits strong enough to resist it. Lambert, a
+celebrated English diver, recovered L90,000 in specie from the steamer
+Alphonso XII, a Spanish mail boat belonging to the Lopez line, which
+sank off Point Gando, Grand Canary, in 26 1/2 fathoms of water. For
+nearly six months the salvage party, despatched by the underwriters in
+May, 1885, persevered in the operations; two divers lost their lives,
+the golden bait being in the treasure-room beneath the three decks, but
+Lambert finished the task successfully.
+
+Deep-sea divers only acquire proficiency after long training. It is
+said that as a rule divers are indisposed to taking apprentices, as
+they are afraid of their vocation being crowded and their present ample
+remuneration diminished. At present there are several schools. At
+Chatham, England, there is a school of submarine mining, in which men
+are trained to lay torpedoes and complete harbor defense. Most of these
+divers can work six hours at a time in from 35 to 50 feet of water.
+Divers for the Royal Navy are trained at Sheerness. When sufficiently
+trained to work at the depth of 150 feet seamen-divers are fully
+qualified, and are drafted to the various ships. They are connected
+with an air-pump in charge of trustworthy men; they signal for their
+tools and material, as well as air, by means of a special line for this
+purpose. At some distance below the water the extraordinary weight of
+the suits cannot be felt, and the divers work as well in armor as in
+ordinary laboring clothes. One famous diver says that the only
+unpleasant experience he ever had in his career as a diver, not
+excepting the occasion of his first dive, was a drumming in the ears,
+as a consequence of which, after remaining under water at a certain
+work for nine hours, he completely lost the use of one ear for three
+months, during which time he suffered agony with the earache. These men
+exhibit absolute indifference to the dangers attached to their calling,
+and some have been known to sleep many fathoms beneath the surface.
+Both by means of their signal lines and by writing on a slate they keep
+their associates informed of the progress of their work.
+
+Suspension of the Pulse.--In some cases the pulse is not apparent for
+many days before actual death, and there have been instances in which,
+although the pulse ceased for an extended period, the patient made an
+ultimate recovery. In reviewing the older literature we find that
+Ballonius mentions an instance in which the pulse was not apparent for
+fourteen days before complete asphyxia. Ramazzini describes a case of
+cessation of the pulse four days before death. Schenck details the
+history of a case in which the pulse ceased for three days and asphyxia
+was almost total, but the patient eventually recovered. There is a
+noteworthy observation, in which there was cessation of the pulse for
+nine days without a fatal issue.
+
+Some persons seem to have a preternatural control over their
+circulatory system, apparently enabling them to produce suspension of
+cardiac movement at will. Cheyne speaks of a Colonel Townshend who
+appeared to possess the power of dying, as it were, at will,--that is,
+so suspending the heart's action that no pulsation could be detected.
+After lying in this state of lifelessness for a short period, life
+would become slowly established without any consciousness or volition
+on the man's part. The longest period in which he remained in this
+death-like condition was about thirty minutes. A postmortem examination
+of this person was awaited with great interest; but after his death
+nothing was found to explain the power he possessed over his heart.
+
+Saint Augustin knew of a priest named Rutilut who had the power of
+voluntarily simulating death. Both the pulsation and respiration was
+apparently abolished when he was in his lifeless condition. Burning and
+pricking left visible effects on the skin after his recovery, but had
+no apparent effect on his lethargy.  Chaille reports an instance of
+voluntary suspension of the pulse.
+
+Relative to hibernation, it is well-known that mice, snakes, and some
+reptiles, as well as bees, sometimes seem to entirely suspend animation
+for an extended period, and especially in the cold weather. In Russia
+fish are transported frozen stiff, but return to life after being
+plunged into cold water. A curious tale is told by Harley, from Sir
+John Lubbock, of a snail brought from Egypt and thought to be dead. It
+was placed on a card and put in position on a shelf in the British
+Museum in March, 1845.  In March, 1850 after having been gummed to a
+label for five years, it was noticed to have an apparent growth on its
+mouth and was taken out and placed in water, when it soon showed signs
+of life and ate cabbage leaves offered to it. It has been said, we
+think with credible evidence, that cereal seeds found in the tombs with
+mummies have grown when planted, and Harley quotes an instance of a
+gentleman who took some berries, possibly the remnants of Pharaoh's
+daughter's last meal, coming as they did from her mummified stomach
+after lying dormant in an Egyptian tomb many centuries, and planted
+them in his garden, where they soon grew, and he shortly had a bush as
+flourishing as any of those emanating from fresh seeds.
+
+Human hibernation is an extremely rare anomaly. Only the fakirs of
+India seem to have developed this power, and even the gifted ones there
+are seldom seen. Many theories have been advanced to explain this
+ability of the fakirs, and many persons have discredited all the
+stories relative to their powers; on the other hand, all who have
+witnessed their exhibitions are convinced of their genuineness.
+Furthermore, these persons are extremely scarce and are indifferent to
+money; none has been enticed out of his own country to give
+exhibitions. When one dies in a community, his place is never
+filled--proving that he had no accomplices who knew any fraudulent
+secret practices, otherwise the accomplice would soon step out to take
+his place. These men have undoubtedly some extraordinary mode of
+sending themselves into a long trance, during which the functions of
+life are almost entirely suspended. We can readily believe in their
+ability to fast during their periods of burial, as we have already
+related authentic instances of fasting for a great length of time,
+during which the individual exercised his normal functions.
+
+To the fakir, who neither visibly breathes nor shows circulatory
+movements, and who never moves from his place of confinement, fasting
+should be comparatively easy, when we consider the number of men whose
+minds were actively at work during their fasts, and who also exercised
+much physical power.
+
+Harley says that the fakirs begin their performances by taking a large
+dose of the powerfully stupefying "bang," thus becoming narcotized. In
+this state they are lowered into a cool, quiet tomb, which still
+further favors the prolongation of the artificially induced vital
+lethargy; in this condition they rest for from six to eight weeks. When
+resurrected they are only by degrees restored to life, and present a
+wan, haggard, debilitated, and wasted appearance. Braid is credited, on
+the authority of Sir Claude Wade, with stating that a fakir was buried
+in an unconscious state at Lahore in 1837, and when dug up, six weeks
+later, he presented all the appearances of a dead person. The legs and
+arms were shrunken and stiff, and the head reclined on the shoulder in
+a manner frequently seen in a corpse.  There was no pulsation of the
+heart or arteries of the arm or temple--in fact, no really visible
+signs of life. By degrees this person was restored to life. Every
+precaution had been taken in this case to prevent the possibility of
+fraud, and during the period of interment the grave was guarded night
+and day by soldiers of the regiment stationed at Lahore.
+
+Honigberger, a German physician in the employ of Runjeet Singh, has an
+account of a fakir of Punjaub who allowed himself to be buried in a
+well-secured vault for such a long time that grain sown in the soil
+above the vault sprouted into leaf before he was exhumed. Honigberger
+affirms that the time of burial was over 40 days, and that on being
+submitted to certain processes the man recovered and lived many years
+after. Sir Henry Lawrence verified the foregoing statements. The chest
+in which the fakir was buried was sealed with the Runjeet stamp on it,
+and when the man was brought up he was cold and apparently lifeless.
+Honigberger also states that this man, whose name was Haridas, was four
+months in a grave in the mountains; to prove the absolute suspension of
+animation, the chin was shaved before burial, and at exhumation this
+part was as smooth as on the day of interment. This latter statement
+naturally calls forth comment when we consider the instances that are
+on record of the growth of beard and hair after death.
+
+There is another account of a person of the same class who had the
+power of suspending animation, and who would not allow his coffin to
+touch the earth for fear of worms and insects, from which he is said to
+have suffered at a previous burial.
+
+It has been stated that the fakirs are either eunuchs or
+hermaphrodites, social outcasts, having nothing in common with the
+women or men of their neighborhood; but Honigberger mentions one who
+disproved this ridiculous theory by eloping to the mountains with his
+neighbor's wife.
+
+Instances of recovery after asphyxia from hanging are to be found,
+particularly among the older references of a time when hanging was more
+common than it is to-day. Bartholinus, Blegny, Camerarius, Morgagni,
+Pechlin, Schenck, Stoll, and Wepfer all mention recovery after hanging.
+Forestus describes a case in which a man was rescued by provoking
+vomiting with vinegar, pepper, and mustard seed. There is a case on
+record in which a person was saved after hanging nineteen minutes.
+There was a case of a man brought into the Hopital Saint-Louis
+asphyxiated by strangulation, having been hung for some time. His
+rectal temperature was only 93.3 degrees F., but six hours after it
+rose to 101.6 degrees F., and he subsequently recovered. Taylor cites
+the instance of a stout woman of forty-four who recovered from hanging.
+When the woman was found by her husband she was hanging from the top of
+a door, having been driven to suicide on account of his abuse and
+intemperance. When first seen by Taylor she was comatose, her mouth was
+surrounded by white froth, and the swollen tongue protruded from it.
+Her face was bloated, her lips of a darkened hue, and her neck of a
+brown parchment-color. About the level of the larynx, the epidermis was
+distinctly abraded, indicating where the rope had been. The conjunctiva
+was insensible and there was no contractile response of the pupil to
+the light of a candle. The reflexes of the soles of the feet were
+tested, but were quite in abeyance. There was no respiratory movement
+and only slight cardiac pulsation. After vigorous measures the woman
+ultimately recovered. Recovery is quite rare when the asphyxiation has
+gone so far, the patients generally succumbing shortly after being cut
+down or on the following day.  Chevers mentions a most curious case, in
+which cerebral congestion from the asphyxiation of strangling was
+accidentally relieved by an additional cut across the throat. The
+patient was a man who was set upon by a band of Thugs in India, who,
+pursuant to their usual custom, strangled him and his fellow-traveler.
+Not being satisfied that he was quite dead, one of the band returned
+and made several gashes across his throat. This latter action
+effectually relieved the congestion caused by the strangulation and
+undoubtedly saved his life, while his unmutilated companion was found
+dead. After the wounds in his throat had healed this victim of the
+Thugs gave such a good description of the murderous band that their
+apprehension and execution soon followed.
+
+Premature Burial.--In some instances simulation of death has been so
+exact that it has led to premature interment. There are many such cases
+on record, and it is a popular superstition of the laity that all the
+gruesome tales are true of persons buried alive and returning to life,
+only to find themselves hopelessly lost in a narrow coffin many feet
+below the surface of the earth.  Among the lower classes the dread of
+being buried before life is extinct is quite generally felt, and for
+generations the medical profession have been denounced for their
+inability to discover an infallible sign of death. Most of the
+instances on record, and particularly those from lay journals, are
+vivid exaggerations, drawn from possibly such a trivial sign as a
+corpse found with the fist tightly clenched or the face distorted,
+which are the inspiration of the horrible details of the dying
+struggles of the person in the coffin. In the works of Fontenelle there
+are 46 cases recorded of the premature interment of the living, in
+which apparent has been mistaken for real death. None of these cases,
+however, are sufficiently authentic to be reliable. Moreover, in all
+modern methods of burial, even if life were not extinct, there could be
+no possibility of consciousness or of struggling.  Absolute
+asphyxiation would soon follow the closing of the coffin lid.
+
+We must admit, however, that the mistake has been made, particularly in
+instances of catalepsy or trance, and during epidemics of malignant
+fevers or plagues, in which there is an absolute necessity of hasty
+burial for the prevention of contagion. In a few instances on the
+battle-field sudden syncope, or apparent death, has possibly led to
+premature interment; but in the present day this is surely a very rare
+occurrence. There is also a danger of mistake from cases of
+asphyxiation, drowning, and similar sudden suspensions of the vital
+functions.
+
+It is said that in the eighty-fourth Olympiad, Empedocles restored to
+life a woman who was about to be buried, and that this circumstance
+induced the Greeks, for the future protection of the supposed dead, to
+establish laws which enacted that no person should be interred until
+the sixth or seventh day. But even this extension of time did not give
+satisfaction, and we read that when Hephestion, at whose funeral
+obsequies Alexander the Great was present, was to be buried his funeral
+was delayed until the tenth day. There is also a legend that when
+Acilius Aviola fell a victim to disease he was burned alive, and
+although he cried out, it was too late to save him, as the fire had
+become so widespread before life returned.
+
+While returning to his country house Asclepiades, a physician
+denominated the "God of Physic," and said to have been a descendant of
+aesculapius, saw during the time of Pompey the Great a crowd of
+mourners about to start a fire on a funeral pile. It is said that by
+his superior knowledge he perceived indications of life in the corpse
+and ordered the pile destroyed, subsequently restoring the supposed
+deceased to life. These examples and several others of a similar nature
+induced the Romans to delay their funeral rites, and laws were enacted
+to prevent haste in burning, as well as in interment. It was not until
+the eighth day that the final rites were performed, the days
+immediately subsequent to death having their own special ceremonies.
+The Turks were also fearful of premature interment and subjected the
+defunct to every test; among others, one was to examine the
+contractility of the sphincter and, which shows their keen observation
+of a well-known modern medical fact.
+
+According to the Memoirs of Amelot de la Houssaye, Cardinal Espinola,
+Prime Minister to Philip II, put his hand to the embalmer's knife with
+which he was about to be opened; It is said that Vesalius, sometimes
+called the "Father of Anatomy," having been sent for to perform an
+autopsy on a woman subject to hysteric convulsions, and who was
+supposed to be dead, on making the first incision perceived by her
+motion and cries that she was still alive. This circumstance, becoming
+known, rendered him so odious that he had to leave the community in
+which he practiced, and it is believed that he never entirely recovered
+from the shock it gave him. The Abbe Prevost, so well known by his
+works and the singularities of his life, was seized by apoplexy in the
+Forest of Chantilly on October 23, 1763. His body was carried to the
+nearest village, and the officers of justice proceeded to open it, when
+a cry he sent forth frightened all the assistants and convinced the
+surgeon in charge that the Abbe was not dead; but it was too late to
+save him, as he had already received a mortal wound.
+
+Massien speaks of a woman living in Cologne in 1571 who was interred
+living, but was not awakened from her lethargy until a grave-digger
+opened her grave to steal a valuable ring which she wore. This instance
+has been cited in nearly every language.  There is another more recent
+instance, coming from Poitiers, of the wife of a goldsmith named
+Mernache who was buried with all her jewels. During the night a beggar
+attempted to steal her jewelry, and made such exertion in extracting
+one ring that the woman recovered and was saved. After this
+resurrection she is said to have had several children. This case is
+also often quoted. Zacchias mentions an instance which, from all
+appearances, is authentic. It was that of a young man, pest-stricken
+and thought to be dead, who was placed with the other dead for burial.
+He exhibited signs of life, and was taken back to the pest-hospital.
+Two days later he entered a lethargic condition simulating death, and
+was again on his way to the sepulcher, when he once more recovered.
+
+It is said that when the body of William, Earl of Pembroke, who died
+April 10, 1630, was opened to be embalmed, the hand raised when the
+first incision was made. There is a story of an occurrence which
+happened on a return voyage from India. The wife of one of the
+passengers, an officer in the army, to all appearances died. They were
+about to resort to sea-burial, when, through the interposition of the
+husband, who was anxious to take her home, the ship-carpenters started
+to construct a coffin suitable for a long voyage, a process which took
+several days, during which time she lay in her berth, swathed in robes
+and ready for interment. When the coffin was at last ready the husband
+went to take his last farewell, and removed the wedding-ring, which was
+quite tightly on her finger. In the effort to do this she was aroused,
+recovered, and arrived in England perfectly well.
+
+It is said that when a daughter of Henry Laurens, the first President
+of the American Congress, died of small-pox, she was laid out as dead,
+and the windows of the room were opened for ventilation. While left
+alone in this manner she recovered. This circumstance so impressed her
+illustrious father that he left explicit directions that in case of his
+death he should be burned. The same journal also contains the case of a
+maid-servant who recovered thrice on her way to the grave, and who,
+when really dead, was kept a preposterous length of time before burial.
+
+The literature on this subject is very exhaustive, volumes having been
+written on the uncertainty of the signs of death, with hundreds of
+examples cited illustrative of the danger of premature interment. The
+foregoing instances have been given as indicative of the general style
+of narration; for further information the reader is referred to the
+plethora of material on this subject.
+
+Postmortem Anomalies.--Among the older writers startling movements of a
+corpse have given rise to much discussion, and possibly often led to
+suspicion of premature burial. Bartholinus describes motion in a
+cadaver. Barlow says that movements were noticed after death in the
+victims of Asiatic cholera. The bodies were cold and expressions were
+death-like, but there were movements simulating natural life. The most
+common was flexion of the right leg, which would also be drawn up
+toward the body and resting on the left leg. In some cases the hand was
+moved, and in one or two instances a substance was grasped as if by
+reflex action. Some observers have stated that reflex movements of the
+face were quite noticeable. These movements continued sometimes for
+upward of an hour, occurring mostly in muscular subjects who died very
+suddenly, and in whom the muscular irritability or nervous stimulus or
+both had not become exhausted at the moment of dissolution. Richardson
+doubts the existence of postmortem movements of respiration.
+
+Snow is accredited with having seen a girl in Soho who, dying of
+scarlet fever, turned dark at the moment of death, but in a few hours
+presented such a life-line appearance and color as to almost denote the
+return of life. The center of the cheeks became colored in a natural
+fashion, and the rest of the body resumed the natural flesh color. The
+parents refused to believe that death had ensued. Richardson remarks
+that he had seen two similar cases, and states that he believes the
+change is due to oxidation of the blood surcharged with carbon dioxid.
+The moist tissues suffuse carbonized blood, and there occurs an osmotic
+interchange between the carbon dioxid and the oxygen of the air
+resulting in an oxygenation of the blood, and modification of the color
+from dark venous to arterial red.
+
+A peculiar postmortem anomaly is erection of the penis. The Ephemerides
+and Morgagni discuss postmortem erection, and Guyon mentions that on
+one occasion he saw 14 negroes hanged, and states that at the moment of
+suspension erection of the penis occurred in each; in nine of these
+blacks traces of this erectile state were perceived an hour after death.
+
+Cadaveric perspiration has been observed and described by several
+authors, and Paullini has stated that he has seen tears flow from the
+eyes of a corpse.
+
+The retardation of putrefaction of the body after death sometimes
+presents interesting changes. Petrifaction or mummification of the body
+are quite well known, and not being in the province of this work, will
+be referred to collateral books on this subject; but sometimes an
+unaccountable preservation takes place. In a tomb recently opened at
+Canterbury Cathedral, a for the purpose of discovering what
+Archbishop's body it contained, the corpse was of an extremely
+offensive and sickening odor, unmistakably that of putrefaction. The
+body was that of Hubert Walter, who died in 1204 A.D., and the
+decomposition had been retarded, and was actually still in progress,
+several hundred years after burial.
+
+Retardation of the putrefactive process has been noticed in bodies some
+years under water. Konig of Hermannstadt mentions a man who, forty
+years previous to the time of report, had fallen under the waters of
+Echoschacht, and who was found in a complete state of preservation.
+
+Postmortem Growth of Hair and Nails.--The hair and beard may grow after
+death, and even change color. Bartholinus recalls a case of a man who
+had short, black hair and beard at the time of interment, but who, some
+time after death, was found to possess long and yellowish hair.
+Aristotle discusses postmortem growth of the hair, and Garmanus cites
+an instance in which the beard and hair were cut several times from the
+cadaver. We occasionally see evidences of this in the dissecting-rooms.
+Caldwell mentions a body buried four years, the hair from which
+protruded at the points where the joints of the coffin had given away.
+The hair of the head measured 18 inches, that of the beard eight
+inches, and that on the breast from four to six inches. Rosse of
+Washington mentions an instance in which after burial the hair turned
+from dark brown to red, and also cites a case in a Washington cemetery
+of a girl, twelve or thirteen years old, who when exhumed was found to
+have a new growth of hair all over her body. The Ephemerides contains
+an account of hair suddenly turning gray after death.
+
+Nails sometimes grow several inches after death, and there is on record
+the account of an idiot who had an idiosyncrasy for long nails, and
+after death the nails were found to have grown to such an extent that
+they curled up under the palms and soles.
+
+The untoward effects of the emotions on the vital functions are quite
+well exemplified in medical literature. There is an abundance of cases
+reported in which joy, fear, pride, and grief have produced a fatal
+issue. In history we have the old story of the Lacedemonian woman who
+for some time had believed her son was dead, and who from the sudden
+joy occasioned by seeing him alive, herself fell lifeless. There is a
+similar instance in Roman history. Aristotle, Pliny, Livy, Cicero, and
+others cite instances of death from sudden or excessive joy. Fouquet
+died of excessive joy on being released from prison. A niece of the
+celebrated Leibnitz immediately fell dead on seeing a casket of gold
+left to her by her deceased uncle.
+
+Galen mentions death from joy, and in comment upon it he says that the
+emotion of joy is much more dangerous than that of anger. In discussing
+this subject, Haller says that the blood is probably sent with such
+violence to the brain as to cause apoplexy. There is one case on record
+in which after a death from sudden joy the pericardium was found full
+of blood. The Ephemerides, Marcellus Donatus, Martini, and Struthius
+all mention death from joy.
+
+Death from violent laughter has been recorded, but in this instance it
+is very probable that death was not due to the emotion itself, but to
+the extreme convulsion and exertion used in the laughter. The
+Ephemerides mentions a death from laughter, and also describes the
+death of a pregnant woman from violent mirth. Roy, Swinger, and
+Camerarius have recorded instances of death from laughter. Strange as
+it may seem, Saint-Foix says that the Moravian brothers, a sect of
+Anabaptists having great horror of bloodshed, executed their condemned
+brethren by tickling them to death.
+
+Powerfully depressing emotions, which are called by Kant "asthenic,"
+such as great and sudden sorrow, grief, or fright, have a pronounced
+effect on the vital functions, at times even causing death. Throughout
+literature and history we have examples of this anomaly. In
+Shakespeare's "Pericles," Thaisa, the daughter to Simonides and wife of
+Pericles, frightened when pregnant by a threatened shipwreck, dies in
+premature childbirth.
+
+In Scott's "Guy Mannering," Mrs. Bertram, on suddenly learning of the
+death of her little boy, is thrown into premature labor, followed by
+death. Various theories are advanced in explanation of this anomaly. A
+very plausible one is, that the cardiac palsy is caused by energetic
+and persistent excitement of the inhibitory cardiac nerves. Strand is
+accredited with saying that agony of the mind produces rupture of the
+heart. It is quite common to hear the expression, "Died of a broken
+heart;" and, strange to say, in some cases postmortem examination has
+proved the actual truth of the saying. Bartholinus, Fabricius Hildanus,
+Pliny, Rhodius, Schenck, Marcellus Donatus, Riedlin, and Garengeot
+speak of death from fright and fear, and the Ephemerides describes a
+death the direct cause of which was intense shame. Deleau, a celebrated
+doctor of Paris, while embracing his favorite daughter, who was in the
+last throes of consumption, was so overcome by intense grief that he
+fell over her corpse and died, and both were buried together.
+
+The fear of child-birth has been frequently cited as a cause of death
+McClintock quotes a case from Travers of a young lady, happily married;
+who entertained a fear of death in child-birth; although she had been
+safely delivered, she suddenly and without apparent cause died in six
+hours. Every region of the body was examined with minutest care by an
+eminent physician, but no signs indicative of the cause of death were
+found. Mordret cites a similar instance of death from fear of labor.
+Morgagni mentions a woman who died from the disappointment of bearing a
+girl baby when she was extremely desirous of a boy.
+
+The following case, quoted from Lauder Brunton, shows the extent of
+shock which may be produced by fear: Many years ago a janitor of a
+college had rendered himself obnoxious to the students, and they
+determined to punish him. Accordingly they prepared a block and an axe,
+which they conveyed to a lonely place, and having appropriately dressed
+themselves, some of them prepared to act as judges, and sent others of
+their company to bring him before them. He first affected to treat the
+whole affair as a joke, but was solemnly assured by the students that
+they meant it in real earnest. He was told to prepare for immediate
+death. The trembling janitor looked all around in the vain hope of
+seeing some indication that nothing was really meant, but stern looks
+met him everywhere. He was blindfolded, and made to kneel before the
+block. The executioner's axe was raised, but, instead of the sharp
+edge, a wet towel was brought sharply down on the back of the neck. The
+bandage was now removed from the culprit's eyes, but to the horror and
+astonishment of the students they found that he was dead. Such a case
+may be due to heart-failure from fear or excitement.
+
+It is not uncommon that death ensues from the shock alone following
+blows that cause no visible injury, but administered to vital parts.
+This is particularly true of blows about the external genital region,
+or epigastrium, where the solar plexus is an active factor in
+inhibition. Ivanhoff of Bulgaria in 1886 speaks of a man of forty-five
+who was dealt a blow on the testicle in a violent street fight, and
+staggering, he fell insensible. Despite vigorous medical efforts he
+never regained consciousness and died in forty-five minutes. Postmortem
+examination revealed everything normal, and death must have been caused
+by syncope following violent pain. Watkins cites an instance occurring
+in South Africa. A native shearing sheep for a farmer provoked his
+master's ire by calling him by some nickname.  While the man was in a
+squatting posture the farmer struck him in the epigastrium. He followed
+this up by a kick in the side and a blow on the head, neither of which,
+however, was as severe as the first blow. The man fell unconscious and
+died. At the autopsy there were no signs indicative of death, which
+must have been due to the shock following the blow on the epigastrium.
+
+As illustrative of the sensitiveness of the epigastric region, Vincent
+relates the following case: "A man received a blow by a stick upon the
+epigastrium. He had an anxious expression and suffered from oppression.
+Irregular heart-action and shivering were symptoms that gradually
+disappeared during the day. In the evening his appetite returned and he
+felt well; during the night he died without a struggle, and at the
+autopsy there was absolutely nothing abnormal to be found." Blows upon
+the neck often produce sudden collapse. Prize-fighters are well aware
+of the effects of a blow on the jugular vein. Maschka, quoted by
+Warren, reports the case of a boy of twelve, who was struck on the
+anterior portion of the larynx by a stone. He fell lifeless to the
+ground, and at autopsy no local lesion was found nor any lesion
+elsewhere. The sudden death may be attributed in this case partly to
+shock and partly to cerebral anemia.
+
+Soldiers have been seen to drop lifeless on the battle-field without
+apparent injury or organic derangement; in the olden times this death
+was attributed to fear and fright, and later was supposed to be caused
+by what is called "the wind of a cannon-ball." Tolifree has written an
+article on this cause of sudden death and others have discussed it. By
+some it is maintained that the momentum acquired by a cannon-ball
+generates enough force in the neighboring air to prostrate a person in
+the immediate vicinity of its path of flight.
+
+
+
+CHAPTER X.
+
+SURGICAL ANOMALIES OF THE HEAD AND NECK.
+
+Injuries of such a delicate organ as the eye, in which the slightest
+accident can produce such disastrous consequences, naturally elicit the
+interest of all. Examples of exophthalmos, or protrusion of the eye
+from the orbit from bizarre causes, are of particular interest. Among
+the older writers we find Ficker and the Ephemerides giving instances
+of exophthalmos from vomiting. Fabricius Hildanus mentions a similar
+instance.  Salmuth, Verduc, and others mention extrusion of the eyeball
+from the socket, due to excessive coughing. Ab Heers and Sennert
+mention instances in which after replacement the sight was uninjured.
+Tyler relates the case of a man who, after arising in the morning, blew
+his nose violently, and to his horror his left eye extruded from the
+orbit. With the assistance of his wife it was immediately replaced and
+a bandage placed over it. When Tyler saw him the upper lid was slightly
+swollen and discolored, but there was no hemorrhage.
+
+Hutchinson describes extrusion of the eyeball from the orbit caused by
+a thrust with a stick. There was paraphymotic strangulation of the
+globe, entirely preventing replacement and necessitating excision.
+Reyssie speaks of a patient who, during a fire, was struck in the right
+eye by a stream of water from a hose, violently thrusting the eye
+backward. Contracting under the double influence of shock and cold, the
+surrounding tissues forced the eyeball from the orbit, and an hour
+later Reyssie saw the patient with the eye hanging by the optic nerve
+and muscles.  Its reduction was easy, and after some minor treatment
+vision was perfectly restored in the injured organ. Thirty months after
+the accident the patient had perfect vision, and the eye had never in
+the slightest way discommoded him.
+
+Bodkin mentions the case of a woman of sixty who fell on the key in a
+door and completely avulsed her eye. In von Graefe's Archiv there is a
+record of a man of seventy-five who suffered complete avulsion of the
+eye by a cart-wheel passing over his head.  Verhaeghe records complete
+avulsion of the eye caused by a man falling against the ring of a
+sharp-worn key. Hamill describes the case of a young girl whose
+conjunctiva was pierced by one of the rests of an ordinary gas-bracket.
+Being hooked at one of its extremities the iron became entangled in
+either the inferior oblique or external rectus muscles, and completely
+avulsed the eyeball upon the cheek. The real damage could not be
+estimated, as the patient never returned after the muscle was clipped
+off close to its conjunctival insertion. Calhoun mentions an instance
+of a little Esquimaux dog whose head was seized between the jaws of a
+large Newfoundland with such force as to press the left eyeball from
+the socket. The ball rested on the cheek, held by the taut optic nerve;
+the cornea was opaque. The ball was carefully and gently replaced, and
+sight soon returned to the eye.
+
+In former days there was an old-fashioned manner of fighting called
+"gouging." In this brutal contest the combatant was successful who
+could, with his thumb, press his opponent's eyeball out. Strange to
+say, little serious or permanently bad results followed such inhuman
+treatment of the eye. Von Langenbeck of Berlin mentions an instance of
+fracture of the superior maxilla, in which the eyeball was so much
+displaced as to lodge in the antrum of Highmore. Von Becker of
+Heidelberg reports the history of a case in which a blow from the horn
+of a cow dislocated the eye so far back in the orbit as to present the
+appearance of enucleation. The conjunctiva hid the organ from view, but
+when it was pulled aside the eyeball was exposed, and in its remote
+position still possessed the power of vision. In some cases in which
+exophthalmos has been seemingly spontaneous, extreme laxity of the lids
+may serve as an explanation. There is an instance on record in which a
+Polish dew appeared in a Continental hospital, saying that while
+turning in bed, without any apparent cause, his eyeball was completely
+extruded. There have been people who prided themselves on their ability
+to produce partial exophthalmos.
+
+Rupture of the Eyeball.--Jessop mentions the case of a child of eight
+who suffered a blow on the eye from a fall against a bedpost, followed
+by compound rupture of the organ. The wound in the sclerotic was three
+or four lines in length, and the rent in the conjunctiva was so large
+that it required three sutures. The chief interest in this case was the
+rapid and complete recovery of vision.
+
+Adler reports a case of fracture of the superior maxillary in which the
+dislocated bone-fragment of the lower orbital border, through pressure
+on the inferior maxillary and counter pressure on the skull, caused
+rupture of the conjunctiva of the left eye.
+
+Serious Sequelae of Orbital Injuries.--In some instances injuries
+primarily to the orbit either by extension or implication of the
+cerebral contents provoke the most serious issues. Pointed instruments
+thrust into the orbital cavity may by this route reach the brain. There
+is a record of death caused by a wound of a cavernous sinus through the
+orbit by the stem of a tobacco-pipe. Bower saw a woman at the
+Gloucester Infirmary who had been stabbed in the eye by the end of an
+umbrella. There was profuse hemorrhage from the nostrils and left eye,
+but no signs indicative of its origin. Death shortly ensued, and at the
+necropsy a fracture through the roof of the orbit was revealed, the
+umbrella point having completely severed the optic nerve and divided
+the ophthalmic artery. The internal carotid artery was wounded in
+one-half of its circumference at its bend, just before it passes up
+between the anterior clinoid process and the optic nerve. The cavernous
+sinus was also opened. In this rare injury, although there was a
+considerable quantity of clotted blood at the base of the brain, there
+was no wound to the eyeball nor to the brain itself.
+
+Pepper records a case in which a knife was thrust through the
+spheroidal fissure, wounding a large meningeal vein, causing death from
+intracranial hemorrhage. Nelaton describes an instance in which the
+point of an umbrella wounded the cavernous sinus and internal carotid
+artery of the opposite side, causing the formation of an arteriovenous
+aneurysm which ultimately burst, and death ensued. Polaillon saw a boy
+of eighteen who was found in a state of coma. It was stated that an
+umbrella stick had been thrust up through the roof of the orbit and had
+been withdrawn with much difficulty. The anterior lobe of the brain was
+evidently much wounded; an incision was made in the forehead and a
+portion of the frontal bone chiseled away entrance being thus effected,
+the aura was incised, and some blood and cerebrospinal fluid escaped.
+Five splinters were removed and a portion of the damaged
+brain-substance, and a small artery was tied with catgut.  The debris
+of the eyeball was enucleated and a drain was placed in the frontal
+wound, coming out through the orbit. The patient soon regained
+consciousness and experienced no bad symptoms afterward. The drains
+were gradually withdrawn, the process of healing advanced rapidly, and
+recovery soon ensued.
+
+Annandale mentions an instance in which a knitting-needle penetrated
+the brain through the orbit. Hewett speaks of perforation of the roof
+of the orbit and injury to the brain by a lead-pencil.
+
+Gunshot Injuries of the Orbit.--Barkan recites the case in which a
+leaden ball 32/100 inch in diameter was thrown from a sling into the
+left orbital cavity, penetrating between the eyeball and osseous wall
+of the orbit without rupturing the tunics of the eye or breaking the
+bony wall of the cavity. It remained lodged two weeks without causing
+any pain or symptoms, and subsequently worked itself forward, contained
+in a perfect conjunctival sac, in which it was freely movable.
+
+Buchanan recites the case of a private in the army who was shot at a
+distance of three feet away, the ball entering the inner canthus of the
+right eye and lodging under the skin of the opposite side. The eye was
+not lost, and opacity of the lower part of the cornea alone resulted.
+Cold water and purging constituted the treatment.
+
+It is said a that an old soldier of one of Napoleon's armies had a
+musket-ball removed from his left orbit after twenty-four years'
+lodgment. He was struck in the orbit by a musket-ball, but as at the
+same time a companion fell dead at his side he inferred that the bullet
+rebounded from his orbit and killed his comrade.  For twenty-four years
+he had suffered from cephalalgia and pains and partial exophthalmos of
+the left eye. After removal of the ball the eye partially atrophied.
+
+Warren reports a case of a man of thirty-five whose eyeball was
+destroyed by the explosion of a gun, the breech-pin flying off and
+penetrating the head. The orbit was crushed; fourteen months afterward
+the man complained of soreness on the hard palate, and the whole
+breech-pin, with screw attached, was extracted. The removal of the pin
+was followed by fissure of the hard palate, which, however, was
+relieved by operation. The following is an extract of a report by
+Wenyon of Fatshan, South China:--
+
+"Tang Shan, Chinese farmer, thirty-one years of age, was injured in the
+face by the bursting of a shot-gun. After being for upward of two
+months under the treatment of native practitioners, he came to me on
+December 4, 1891. I observed a cicatrix on the right side of his nose,
+and above this a sinus, still unhealed, the orifice of which involved
+the inner canthus of the right eye, and extended downward and inward
+for about a centimeter. The sight of the right eye was entirely lost,
+and the anterior surface of the globe was so uniformly red that the
+cornea could hardly be distinguished from the surrounding conjunctiva.
+There was no perceptible enlargement or protrusion of the eyeball, and
+it did not appear to have sustained any mechanical injury or loss of
+tissue. The ophthalmia and keratitis were possibly caused by the
+irritating substances applied to the wound by the Chinese doctors. The
+sinus on the side of the nose gave exit to a continuous discharge of
+slightly putrid pus, and the patient complained of continuous headache
+and occasional dizziness, which interfered with his work. The pain was
+referred to the right frontal and temporal regions, and the skin on
+this part of the head had a slight blush, but there was no superficial
+tenderness.  The patient had been told by his native doctors, and he
+believed it himself, that there was no foreign body in the wound; but
+on probing it I easily recognized the lower edge of a hard metallic
+substance at a depth of about one inch posteriorly from the orifice of
+the sinus. Being unable to obtain any reliable information as to the
+probable size or shape of the object, I cautiously made several
+attempts to remove it through a slightly enlarged opening, but without
+success. I therefore continued the incision along the side of the nose
+to the nostril, thus laying open the right nasal cavity; then, seizing
+the foreign body with a pair of strong forceps, I with difficulty
+removed the complete breech-pin of a Chinese gun. Its size and shape
+are accurately represented by the accompanying drawing. The breech-pin
+measures a little over three inches in length, and weighs 21 ounces, or
+75.6 grams. It had evidently lain at the back of the orbit, inclined
+upward and slightly backward from its point of entrance, at an angle of
+about 45 degrees. On its removal the headache was at once relieved and
+did not return. In ten days the wound was perfectly healed and the
+patient went back to his work. A somewhat similar case, but which
+terminated fatally, is recorded in the American Journal of the Medical
+Sciences of July, 1882."
+
+The extent of permanent injury done by foreign bodies in the orbit is
+variable. In some instances the most extensive wound is followed by the
+happiest result, while in others vision is entirely destroyed by a
+minor injury.
+
+Carter reports a case in which a hat-peg 3 3/10 inches long and about
+1/4 inch in diameter (upon one end of which was a knob nearly 1/2 inch
+in diameter) was impacted in the orbit for from ten to twenty days, and
+during this time the patient was not aware of the fact. Recovery
+followed its extraction, the vision and movements of the eye being
+unimpaired.
+
+According to the Philosophical Transactions a laborer thrust a long
+lath with great violence into the inner canthus of the left eye of his
+fellow workman, Edward Roberts. The lath broke off short, leaving a
+piece two inches long, 1/2 inch wide, and 1/4 inch thick, in situ.
+Roberts rode about a mile to the surgery of Mr. Justinian Morse, who
+extracted it with much difficulty; recovery followed, together with
+restoration of the sight and muscular action. The lath was supposed to
+have passed behind the eyeball. Collette speaks of an instance in which
+186 pieces of glass were extracted from the left orbit, the whole mass
+weighing 186 Belgian grains. They were blown in by a gust of wind that
+broke a pane of glass; after extraction no affection of the brain or
+eye occurred. Watson speaks of a case in which a chip of steel 3/8 inch
+long was imbedded in cellular tissue of the orbit for four days, and
+was removed without injury to the eye. Wordsworth reports a case in
+which a foreign body was deeply imbedded in the orbit for six weeks,
+and was removed with subsequent recovery.  Chisholm has seen a case in
+which for five weeks a fly was imbedded in the culdesac between the
+lower lid and the eyeball.
+
+Foreign bodies are sometimes contained in the eyeball for many years.
+There is an instance on record in which a wooden splinter, five mm.
+long and two mm. broad, remained in the eye forty-seven years. It was
+extracted, with the lens in which it was lodged, to relieve pain and
+other distressing symptoms. Snell reports a case in which a piece of
+steel was imbedded and encapsulated in the ciliary process twenty-nine
+years without producing sympathetic irritation of its fellow, but
+causing such pain as to warrant enucleation of this eye. Gunning speaks
+of a piece of thorn 5/8 inch long, imbedded in the left eyeball of an
+old man for six years, causing total loss of vision; he adds that,
+after its removal, some improvement was noticed.
+
+Williams mentions a stone-cutter whose left eye was put out by a piece
+of stone. Shortly after this his right eye was wounded by a knife,
+causing traumatic cataract, which was extracted by Sir William Wilde,
+giving the man good sight for twelve years, after which iritis attacked
+the right eye and produced a false membrane over the pupil so that the
+man could not work. It was in this condition that he consulted
+Williams, fourteen years after the loss of the left eye. The eye was
+atrophied, and on examination a piece of stone was seen projecting from
+it directly between the lids. The visible portion was 1/4 inch long,
+and the end in the shrunken eye was evidently longer than the end
+protruding. The sclera was incised, and, after fourteen years' duration
+in the eye, the stone was removed.
+
+Taylor reports the removal of a piece of bone which had remained
+quiescent in the eye for fourteen years; after the removal of the eye
+the bone was found adherent to the inner tunics. It resembled the lens
+in size and shape. Williams mentions continual tolerance of foreign
+bodies in the eyeball for fifteen and twenty-two years; and Chisholm
+reports the lodgment of a fragment of metal in the iris for
+twenty-three years. Liebreich extracted a piece of steel from the
+interior of the eye where it had been lodged twenty-two years. Barkar
+speaks of a piece of steel which penetrated through the cornea and
+lens, and which, five months later, was successfully removed by the
+extraction of the cataractous lens. Critchett gives an instance of a
+foreign body being loose in the anterior chamber for sixteen years.
+Rider speaks of the lodgment of a fragment of a copper percussion cap
+in the left eye, back of the inner ciliary margin of the iris, for
+thirty-five years; and Bartholinus mentions a thorn in the canthus for
+thirty years. Jacob reports a case in which a chip of iron remained in
+the eyeball twenty-eight years without giving indications for removal.
+It was clearly visible, protruding into the anterior surface of the
+iris, and although it was rusted by its long lodgment, sight in the eye
+was fairly good, and there was no sign of irritation.
+
+Snell gives an instance in which a piece of steel was imbedded close to
+the optic disc with retention of sight. It was plainly visible by the
+opthalmoscope eighteen months after the accident, when as yet no
+diminution of sight was apparent. Smyly speaks of a portion of a
+tobacco pipe which was successfully removed from the anterior chamber
+by an incision through the cornea. Clark mentions a case in which
+molten lead in the eye caused no permanent injury; and there are
+several cases mentioned in confirmation of the statement that the eye
+seems to be remarkably free from disastrous effects after this injury.
+
+Williamson mentions eyelashes in the anterior chamber of the eye, the
+result of a stab wound of this organ.
+
+Contusion of the eyeball may cause dislocation of the lens into the
+anterior chamber, and several instances have been recorded.  We regret
+our inability to give the reference or authority for a report that we
+have seen, stating that by one kick of a horse the lenses of both eyes
+of a man were synchronously knocked through the eyeballs by the calkins
+of the horseshoe. Oliver mentions extraction of a lens by a thrust of a
+cow's horn.
+
+Lowe speaks of rupture of the anterior capsule of the lens from violent
+sneezing, with subsequent absorption of the lenticular substance and
+restoration of vision. Trioen mentions a curious case of expulsion of
+the crystalline lens from the eye in ophthalmia, through the formation
+of a corneal fissure. The authors have personal knowledge of a case of
+spontaneous extrusion of the lens through a corneal ulcer, in a case of
+ophthalmia of the new-born.
+
+Injury of the Eyeball by Birds.--There are several instances in which
+birds have pierced the eyeball with their bills, completely destroying
+vision. Not long since a prominent taxidermist winged a crane, picked
+it up, and started to examine it, when it made one thrust with its bill
+and totally destroyed his eyeball. In another instance a man was going
+from the railroad station to his hotel in a gale of wind, when, as he
+turned the corner of the street, an English sparrow was blown into his
+face. Its bill penetrated his eyeball and completely ruined his sight.
+There are several instances on record in which game fowls have
+destroyed the eyes of their owners. In one case a game cock almost
+completed the enucleation of the eye of his handler by striking him
+with his gaff while preparing in a cock-pit.
+
+Moorehead explains a rare accident to an eye as follows:--
+
+"Mr. S. B. A., while attending to his bees, was stung by one upon the
+right upper eyelid near its center. An employee, who was assisting in
+the work, immediately discovered the sting driven in the lid and
+cautiously extracted it, stating that he made sufficient traction to
+lift the lid well away from the globe. In a few hours the lid became
+much swollen, but the pain experienced at first had disappeared. Before
+retiring for the night he began gentle massage of the lid, stroking it
+horizontally with his finger. The edematous condition was by this means
+much reduced in a short time. While thus engaged in stroking the lid he
+suddenly experienced intense pain in the eye as if it had been pierced
+by a sharp instrument. The suffering was very severe, and he passed a
+wretched night, constantly feeling 'something in his eye.'
+
+"The next morning, the trouble continuing, he came to me for relief.
+Upon examination of the lid, no opening could be made out where the
+sting had penetrated, and a minute inspection of the conjunctival
+surface with a good glass failed to reveal any foreign substance.
+Cleansing the lid thoroughly, and carefully inspecting with a lens
+under strong light, a minute dark point was made out about the center
+of the lid. Feeling that this might be the point of the sting, I had
+recourse to several expedients for its removal, but without success.
+Finally, with a fine knife, I succeeded in cutting down by the side of
+the body and tilting it out. Examination with a 1/5 inch objective
+confirmed my opinion that it was the point of the bee-sting.
+
+"The barbed formation of the point explains how, under the stroking
+with the finger, it was forced through the dense tarsal cartilage and
+against the cornea of the eye."
+
+There is a story told in La Medecine Moderne of a seamstress of Berlin
+who was in the habit of allowing her dog to lick her face.  She was
+attacked with a severe inflammation of the right eye, which had to be
+enucleated, and was found full of tenia echinococcus, evidently derived
+from the dog's tongue.
+
+Gabb mentions a case of epistaxis in which the blood welled up through
+the lacrimal ducts and suffused into the eye so that it was constantly
+necessary to wipe the lower eyelid, and the discharge ceased only when
+the nose stopped bleeding. A brief editorial note on epistaxis through
+the eyes, referring to a case in the Medical News of November 30, 1895,
+provoked further reports from numerous correspondents. Among others,
+the following:--
+
+"Dr. T. L. Wilson of Bellwood, Pa., relates the case of an old lady of
+seventy-eight whom he found with the blood gushing from the nostrils.
+After plugging the nares thoroughly with absorbent cotton dusted with
+tannic acid he was surprised to see the blood ooze out around the
+eyelids and trickle down the cheeks. This oozing continued for the
+greater part of an hour, being controlled by applications of ice to
+both sides of the nose."
+
+"Dr. F. L. Donlon of New York City reports the case of a married woman,
+about fifty years old, in whom epistaxis set in suddenly at 11 P.M.,
+and had continued for several hours, when the anterior nares were
+plugged. In a short time the woman complained that she could scarcely
+see, owing to the welling up of blood in the eyes and trickling down
+her face. The bleeding only ceased when the posterior nares also were
+plugged."
+
+"Dr. T. G. Wright of Plainville, Conn., narrates the case of a young
+man whom he found in the night, bleeding profusely, and having already
+lost a large amount of blood. Shortly after plugging both anterior and
+posterior nares the blood found its way through the lacrimal ducts to
+the eyes and trickled down the cheeks."
+
+"Dr. Charles W. Crumb cites the case of a man, sixty-five years old,
+with chronic nephritis, in whom a slight bruise of the nose was
+followed by epistaxis lasting twenty-four hours. When the nares were
+plugged blood escaped freely from the eyes. A cone-shaped bit of
+sponge, saturated with ferrous sulphate, was passed into each anterior
+naris, and another piece of sponge, similarly medicated, into either
+posterior naris. The patient had been taking various preparations of
+potassium, and it was thought that his blood contained a deficiency of
+fibrin. Upon removal of the nasal plugs a catarrhal inflammation
+developed which lasted a long time and was attended with considerable
+purulent discharge."
+
+Late Restoration of Sight.--There are some marvelous cases on record in
+which, after many years of blindness, the surgeon has been able, by
+operation, to restore the sight. McKeown gives the history of a blind
+fiddler of sixty-three, who, when one and a half years old, had lost
+the sight of both eyes after an attack of small-pox. Iridectomy was
+performed, and after over sixty years of total blindness his sight was
+restored; color-perception was good. Berncastle mentions a case of
+extraction of double cataract and double iridectomy for occluded
+pupils, which, after thirty years of blindness, resulted in the
+recovery of good sight. The patient was a blind beggar of Sydney.
+
+To those interested in this subject, Jauffret has a most interesting
+description of a man by the name of Garin, who was born blind, who
+talked at eight or nine months, showed great intelligence, and who was
+educated at a blind asylum. At the age of twenty-four he entered the
+hospital of Forlenze, to be operated upon by that famous oculist. Garin
+had never seen, but could distinguish night or darkness by one eye
+only, and recognized orange and red when placed close to that eye. He
+could tell at once the sex and age of a person approximately by the
+voice and tread, and formed his conclusions more rapidly in regard to
+females than males. Forlenze diagnosed cataract, and, in the presence
+of a distinguished gathering, operated with the happiest result. The
+description that follows, which is quoted by Fournier and is readily
+accessible to any one, is well worth reading, as it contains an account
+of the first sensations of light, objects, distance, etc., and minor
+analogous thoughts, of an educated and matured mind experiencing its
+first sensations of sight.
+
+Hansell and Clark say that the perplexities of learning to see after
+twenty-six years of blindness from congenital disease, as described by
+a patient of Franke, remind one of the experience of Shelley's
+Frankenstein. Franke's patient was successfully operated on for
+congenital double cataract, at twenty-six years of age. The author
+describes the difficulties the patient had of recognizing by means of
+vision the objects he had hitherto known through his other senses, and
+his slowness in learning to estimate distances and the comparative size
+of objects.
+
+Sight is popularly supposed to be occasionally restored without the aid
+of art, after long years of blindness. Benjamin Rush saw a man of
+forty-five who, twelve years before, became blind without ascertainable
+cause, and recovered his sight equally without reason. St. Clair
+mentions Marshal Vivian, who at the age of one hundred regained sight
+that for nearly forty years had gradually been failing almost to
+blindness, and preserved this new sight to the time of his death.
+
+There are many superstitions prevalent among uneducated people as to
+"second sight," recovery of vision, etc., which render their reports of
+such things untrustworthy. The real explanations of such cases are too
+varied for discussion here.
+
+Nyctalopia etymologically means night blindness, but the general usage,
+making the term mean night-vision, is so strongly intrenched that it is
+useless and confusing to attempt any reinstatement of the old
+significance. The condition in which one sees better by night,
+relatively speaking, than by day is due to some lesion of the macular
+region, rendering it blind. At night the pupil dilates more than in the
+day-time, and hence vision with the extramacular or peripheral portions
+of the retina is correspondingly better. It is, therefore, a symptom of
+serious retinal disease. All night-prowling animals have widely
+dilatable pupils, and in addition to this they have in the retina a
+special organ called the tapetum lucidum, the function of which is to
+reflect to a focus in front of them the relatively few rays of light
+that enter the widely-dilated pupil and thus enable them the better to
+see their way. Hence the luminous appearance of the eyes of such
+animals in the dark.
+
+Hemeralopia (etymologically day-blindness, but by common usage meaning
+day-vision or night-blindness) is a symptom of a peculiar degenerative
+disease of the retina, called retinitis pigmentosa.  It also occurs in
+some cases of extreme denutrition, numerous cases having been reported
+among those who make the prolonged fasts customary in the Russian
+church. In retinitis pigmentosa the peripheral or extramacular portions
+of the retina are subject to a pigmentary degeneration that renders
+them insensitive to light, and patients so afflicted are consequently
+incapable of seeing at night as well as others. They stumble and run
+against objects easily seen by the normal eye.
+
+Snow-blindness occurs from prolonged exposure of the eyes to snow upon
+which the sun is shining. Some years ago, some seventy laborers, who
+were clearing away snow-drifts in the Caucasus, were seized, and thirty
+of them could not find their way home, so great was the photophobia,
+conjunctivitis, and lacrimation.  Graddy reports six cases, and many
+others are constantly occurring.
+
+Other forms of retinal injury from too great or too prolonged exposure
+to light are "moon-blindness," due to sleeping with the eyes exposed to
+bright moonlight, and that due to lightning--a case, e.g., being
+reported by Knies. Silex also reports such a case and reviews the
+reported cases, 25 in number, in ten of which cataract ensued. In the
+Annual of the Universal Medical Sciences, 1888, there is a report of
+seven cases of retinal injury with central scotoma, amblyopia, etc., in
+Japanese medical students, caused by observation of the sun in eclipse.
+
+In discussing the question of electric-light injuries of the eyes Gould
+reviews the literature of the subject and epitomizes the cases reported
+up to that time. They numbered 23. No patient was seriously or
+permanently injured, and none was in a person who used the electric
+light in a proper manner as an illuminant. All were in scientific
+investigators or workmen about the light, who approached it too closely
+or gazed at it too long and without the colored protecting spectacles
+now found necessary by such workers.
+
+Injuries to the Ear.--The folly of the practice of boxing children's
+ears, and the possible disastrous results subsequent to this
+punishment, are well exemplified throughout medical literature. Stewart
+quotes four cases of rupture of the tympanum from boxing the ears, and
+there is an instance of a boy of eight, who was boxed on the ear at
+school, in whom subsequent brain-disease developed early, and death
+followed. Roosa of New York mentions the loss of hearing following a
+kiss on the ear.
+
+Dalby, in a paper citing many different causes of rupture of the
+tympanic membrane, mentions the following: A blow in sparring; violent
+sneezing; blowing the nose; forcible dilatation of the Eustachian
+canal; a thorn or twig of a tree accidentally thrust into the head;
+picking the ear with a toothpick. In time of battle soldiers sometimes
+have their tympanums ruptured by the concussion caused by the firing of
+cannon. Dalby mentions an instance of an officer who was discharged for
+deafness acquired in this manner during the Crimean War. He was
+standing beside a mortar which, unexpectedly to him, was fired, causing
+rupture of the tympanic membrane, followed by hemorrhage from the ear.
+Similar cases were reported in the recent naval engagements between the
+Chinese and Japanese. Wilson reports two cases of rupture of the
+membrane tympani caused by diving. Roosa divides the causes into
+traumatic, hemorrhagic, and inflammatory, and primary lesions of the
+labyrinth, exemplifying each by numerous instances. Under traumatic
+causes he mentions severe falls, blows about the head or face, constant
+listening to a telegraphic instrument, cannonading, and finally eight
+cases of boiler-makers' deafness. Roosa cites a curious case of sudden
+and profound deafness in a young man in perfect health, while calling
+upon the parents of his lady-love to ask her hand in marriage.  Strange
+to say that after he had had a favorable reply he gradually recovered
+his hearing! In the same paper there is an instance of a case of
+deafness due to the sudden cessation of perspiration, and an instance
+of tinnitus due to the excessive use of tobacco; Roosa also mentions a
+case of deafness due to excessive mental employment.
+
+Perforation of the Tympanum.--Kealy relates an instance in which a pin
+was introduced into the left ear to relieve an intolerable itching. It
+perforated the tympanum, and before the expiration of twenty-four hours
+was coughed up from the throat with a small quantity of blood. The pin
+was bent at an angle of about 120 degrees. Another similar case was
+that of a girl of twenty-two who, while pricking her ear with a
+hair-pin, was jerked or struck on the arm by a child, and the pin
+forced into the ear; great pain and deafness followed, together with
+the loss of taste on the same side of the tongue; after treatment both
+of the disturbed senses were restored. A man of twenty was pricked in
+the ear by a needle entering the meatus. He uttered a cry, fell
+senseless, and so continued until the fourth day when he died.  The
+whole auditory meatus was destroyed by suppuration. Gamgee tells of a
+constable who was stabbed in the left ear, severing the middle
+meningeal artery, death ensuing. In this instance, after digital
+compression, ligature of the common carotid was practiced as a last
+resort. There is an account of a provision-dealer's agent who fell
+asleep at a public house at Tottenham. In sport an attendant tickled
+his ear with a wooden article used as a pipe light. A quick,
+unconscious movement forced the wooden point through the tympanum,
+causing cerebral inflammation and subsequent death. There is a record
+of death, in a child of nine, caused by the passage of a
+knitting-needle into the auditory meatus.
+
+Kauffmann reports a case of what he calls objective tinnitus aurium, in
+which the noise originating in the patient's ears was distinctly
+audible by others. The patient was a boy of fourteen, who had fallen on
+the back of his head and had remained unconscious for nearly two weeks.
+The noises were bilateral, but more distinct on the left than on the
+right side. The sounds were described as crackling, and seemed to
+depend on movements of the arch of the palate. Kauffmann expresses the
+opinion that the noises were due to clonic spasm of the tensor velum
+palati, and states that under appropriate treatment the tinnitus
+gradually subsided.
+
+The introduction of foreign bodies in the ear is usually accidental,
+although in children we often find it as a result of sport or
+curiosity. There is an instance on record of a man who was accustomed
+to catch flies and put them in his ear, deriving from them a
+pleasurable sensation from the tickling which ensued.  There have been
+cases in which children, and even adults, have held grasshoppers,
+crickets, or lady-birds to their ears in order to more attentively
+listen to the noise, and while in this position the insects have
+escaped and penetrated the auditory canal. Insects often enter the ears
+of persons reposing in the fields with the ear to the ground. Fabricius
+Hildanus speaks of a cricket penetrating the ear during sleep. Calhoun
+mentions an instance of disease of the ear which he found was due to
+the presence of several living maggots in the interior of the ear.  The
+patient had been sleeping in a horse stall in which were found maggots
+similar to those extracted from his ear. An analogous instance was seen
+in a negro in the Emergency Hospital, Washington, D.C., in the summer
+of 1894; and many others are recorded. The insects are frequently
+removed only after a prolonged lodgment.
+
+D'Aguanno gives an account of two instances of living larvae of the
+musca sarcophaga in the ears of children. In one of the cases the
+larvae entered the drum-cavity through a rupture in the tympanic
+membrane. In both cases the maggots were removed by forceps. Haug has
+observed a tic (ixodes ricinus) in the ear of a lad of seventeen. The
+creature was killed by a mercuric-chlorid solution, and removed with a
+probe.
+
+There is a common superstition that centipedes have the faculty of
+entering the ear and penetrating the brain, causing death. The authors
+have knowledge of an instance in which three small centipedes were
+taken from the ear of a policeman after remaining there three days;
+during this time they caused excruciating pain, but there was no
+permanent injury. The Ephemerides contains instances in which, while
+yet living, worms, crickets, ants, and beetles have all been taken from
+the ear. In one case the entrance of a cricket in the auditory canal
+was the cause of death. Martin gives an instance in which larvae were
+deposited in the ear. Stalpart van der Wiel relates an instance of the
+lodgment of a living spider in the ear.
+
+Far more common than insects are inanimate objects as foreign bodies in
+the ear, and numerous examples are to be found in literature. Fabricius
+Hildanus tells of a glass ball introduced into the auditory canal of a
+girl of ten, followed by headache, numbness on the left side, and after
+four or five years epileptic seizures, and atrophy of the arm. He
+extracted it and the symptoms immediately ceased. Sabatier speaks of an
+abscess of the brain caused by a ball of paper in the ear; and it is
+quite common for persons in the habit of using a tampon of cotton in
+the meatus to mistake the deep entrance of this substance for
+functional derangement, and many cases of temporary deafness are simply
+due to forgetfulness of the cause. A strange case is reported in a girl
+of fourteen, who lost her tympanum from a profuse otorrhea, and who
+substituted an artificial tympanum which was, in its turn, lost by deep
+penetration, causing augmentation of the symptoms, of the cause of
+which the patient herself seemed unaware. Sometimes artificial otoliths
+are produced by the insufflation of various powders which become
+agglutinated, and are veritable foreign bodies. Holman tells of a
+negro, aged thirty-five, whose wife poured molten pewter in his ear
+while asleep. It was removed, but total deafness was the result.
+
+Alley mentions a New Orleans wharf laborer, in whose ear was poured
+some molten lead; seventeen months afterward the lead was still
+occupying the external auditory meatus. It is quite remarkable that the
+lead should have remained such a length of time without causing
+meningeal inflammation. There was deafness and palsy of that side of
+the face. A fungous growth occupied the external portion of the ear;
+the man suffered pain and discharge from the ear, and had also great
+difficulty in closing his right eyelid. Morrison mentions an alcoholic
+patient of forty who, on June 6, 1833, had nitric acid poured in her
+right ear. There were no headache, febrile symptoms, stupor, or
+vertigo. Debility alone was present. Two weeks after the injury
+paralysis began on the right side, and six weeks from the injury the
+patient died. This case is interesting from the novel mode of death,
+the perfect paralysis of the arm, paralysis agitans of the body
+(occurring as hemorrhage from the ear came on, and subsiding with it),
+and extensive caries of the petrous bone, without sensation of pain or
+any indicative symptoms.
+
+There is an instance in a young girl in which a piece of pencil
+remained in the right ear for seven years. Haug speaks of two beads
+lying in the auditory canal for twenty-eight years without causing any
+harm.
+
+A boy of six introduced a carob-nut kernel into each ear. On the next
+day incompetent persons attempted to extract the kernel from the left
+side, but only caused pain and hemorrhage. The nut issued spontaneously
+from the right side. In the afternoon the auditory canal was found
+excoriated and red, and deep in the meatus the kernel was found,
+covered with blood. The patient had been so excited and pained by the
+bungling attempts at extraction that the employment of instruments was
+impossible; prolonged employment of injections was substituted.
+Discharge from the ear commenced, intense fever and delirium ensued,
+and the patient had to be chloroformed to facilitate the operation of
+extraction. The nut, when taken out, was found to have a consistency
+much larger than originally, caused by the agglutination of wax and
+blood.  Unfortunately the symptoms of meningitis increased; three days
+after the operation coma followed, and on the next day death ensued. In
+75 cases collected by Mayer, and cited by Poulet (whose work on
+"Foreign Bodies" is the most extensive in existence), death as a
+consequence of meningitis was found in three.
+
+Fleury de Clermont mentions a woman of twenty-five who consulted him
+for removal of a pin which was in her right ear. Vain attempts by some
+of her lay-friends to extract the pin had only made matters worse. The
+pin was directed transversely, and its middle part touched the membrane
+tympanum. The mere touching of the pin caused the woman intense pain;
+even after etherization it was necessary to construct a special
+instrument to extract it.  She suffered intense cephalalgia and other
+signs of meningitis; despite vigorous treatment she lost consciousness
+and died shortly after the operation.
+
+Winterbotham reports an instance in which a cherry-stone was removed
+from the meatus auditorius after lodgment of upward of sixty years.
+Marchal de Calvi mentions intermittent deafness for forty years, caused
+by the lodgment of a small foreign body in the auditory canal. There is
+an instance in which a carious molar tooth has been tolerated in the
+same location for forty years.
+
+Albucasius, Fabricius Hildanus, Pare, and others, have mentioned the
+fact that seeds and beans have been frequently seen to increase in
+volume while lodged in the auditory canal. Tulpius speaks of an infant,
+playing with his comrades, who put a cherry-seed in his ear which he
+was not able to extract. The seed increased in volume to such an extent
+that it was only by surgical interference that it could be extracted,
+and then such serious consequences followed that death resulted. Albers
+reports an instance in which a pin introduced into the ear issued from
+the pharynx.
+
+Confusion of diagnosis is occasionally noticed in terrified or hysteric
+persons. Lowenberg was called to see a child of five who had introduced
+a button into his left ear. When he saw the child it complained of all
+the pain in the right ear, and he naturally examined this ear first but
+found nothing to indicate the presence of a foreign body. He examined
+the ear supposed to be healthy and there found the button lying against
+the tympanum.  This was explained by the fact that the child was so
+pained and terrified by the previous explorations of the affected ear
+that rather than undergo them again he presented the well ear for
+examination. In the British Medical Journal for 1877 is an account of
+an unjustified exploration of an ear for a foreign body by an
+incompetent physician, who spent a half hour in exploration and
+manipulation, and whose efforts resulted in the extraction of several
+pieces of bone. The child died in one and a half hours afterward from
+extreme hemorrhage, and the medical bungler was compelled to appear
+before a coroner's jury in explanation of his ignorance.
+
+In the external ear of a child Tansley observed a diamond which he
+removed under chloroform. The mother of the child had pushed the body
+further inward in her endeavors to remove it and had wounded the canal.
+Schmiegelow reports a foreign body forced into the drum-cavity,
+followed by rough extraction, great irritation, tetanus, and death; and
+there are on record several cases of fatal meningitis, induced by rough
+endeavors to extract a body from the external ear.
+
+In the Therapeutic Gazette, August 15, 1896, there is a translation of
+the report of a case by Voss, in which a child of five pushed a dry pea
+in his ear. Four doctors spent several days endeavoring to extract it,
+but only succeeded in pushing it in further. It was removed by
+operation on the fifth day, but suppuration of the tympanic cavity
+caused death on the ninth day.
+
+Barclay reports a rare case of ensnared aural foreign body in a lady,
+aged about forty years, who, while "picking" her left ear with a
+so-called "invisible hair-pin" several hours before the consultation,
+had heard a sudden "twang" in the ear, as if the hair-pin had broken.
+And so, indeed, it had; for on the instant she had attempted to jerk it
+quickly from the ear the sharp extremity of the inner portion of its
+lower prong sprang away from its fellow, penetrated the soft tissues of
+the floor of the external auditory canal, and remained imbedded there,
+the separated end of this prong only coming away in her grasp. Every
+attempt on her part to remove the hair-pin by traction on its
+projecting prong--she durst not force it INWARD for fear of wounding
+the drumhead--had served but to bury the point of the broken prong more
+deeply into the flesh of the canal, thereby increasing her suffering.
+Advised by her family physician not to delay, she forthwith sought
+advice and aid. On examination, it was found that the lower prong of
+the "invisible hair-pin" had broken at the outer end of its wavy
+portion, and seemed firmly imbedded in the floor of the auditory canal,
+now quite inflamed, at a point about one-third of its depth from the
+outlet of the canal. The loop or turn of the hair-pin was about 1/2
+inch from the flaccid portion of the drumhead, and, together with the
+unbroken prong, it lay closely against the roof of the canal.
+Projecting from the meatus there was enough of this prong to be easily
+grasped between one's thumb and finger. Removal of the hair-pin was
+effected by first inserting within the meatus a Gruber speculum,
+encircling the unbroken projecting prong, and then raising the end of
+the broken one with a long-shanked aural hook, when the hair-pin was
+readily withdrawn. The wound of the canal-floor promptly healed.
+
+In the severest forms of scalp-injuries, such as avulsion of the scalp
+from the entangling of the hair in machinery, skin-grafting or
+replantation is of particular value. Ashhurst reports a case which he
+considers the severest case of scalp-wound that he had ever seen,
+followed by recovery. The patient was a girl of fifteen, an operative
+in a cotton-mill, who was caught by her hair between two rollers which
+were revolving in opposite directions; her scalp being thus, as it
+were, squeezed off from her head, forming a large horseshoe flap. The
+linear extent of the wound was 14 inches, the distance between the two
+extremities being but four inches. This large flap was thrown backward,
+like the lid of a box, the skull being denuded of its pericranium for
+the space of 2 1/2 by one inch in extent. The anterior temporal artery
+was divided and bled profusely, and when admitted to the hospital the
+patient was extremely depressed by shock and hemorrhage. A ligature was
+applied to the bleeding vessel, and after it had been gently but
+carefully cleansed the flap was replaced and held in place with gauze
+and collodion dressing. A large compress soaked in warm olive oil was
+then placed over the scalp, covered with oiled silk and with a
+recurrent bandage. A considerable portion of the wound healed by
+adhesions, and the patient was discharged, cured, in fifty-four days.
+No exfoliation of bone occurred. Reverdin, a relative of the discoverer
+of transplantation of skin, reported the case of a girl of twenty-one
+whose entire scalp was detached by her hair being caught in machinery,
+leaving a wound measuring 35 cm. from the root of the nose to the nape
+of the neck, 28 cm. from one ear to the other, and 57 cm. in
+circumference. Grafts from the rabbit and dog failed, and the skin from
+the amputated stump of a boy was employed, and the patient was able to
+leave the hospital in seven months. Cowley speaks of a girl of fourteen
+whose hair was caught in the revolving shaft of a steam-engine, which
+resulted in the tearing off of her whole scalp. A triangular portion of
+the skin was hanging over her face, the apex of the triangle containing
+short hair, from which the long hair had been detached. Both ears were
+hanging down the neck, having been detached above. The right pinna was
+entire, and the upper half of the left pinna had disappeared. The whole
+of the head and back of the neck was denuded of skin. One of the
+temporal arteries was ligated, and the scalp cleansed and reapplied.
+The hanging ears and the skin of the forehead were successfully
+restored to their proper position. The patient had no bad symptoms and
+little pain, and the shock was slight. Where the periosteum had
+sloughed the bone was granulating, and at the time of the report
+skin-grafting was shortly to be tried.
+
+Schaeffer has presented quite an extensive article on scalp-injuries in
+which grafting and transplantation has been used, and besides reporting
+his own he mentions several other cases. One was that of a young lady
+of twenty-four. While at work under a revolving shaft in a laundry the
+wind blew her hair and it was caught in the shaft. The entire skull was
+laid bare from the margin of the eyelids to the neck. The nasal bones
+were uncovered and broken, exposing the superior nasal meatus. The skin
+of the eyelids was removed from within three mm. of their edges. The
+lower margin of the wound was traceable from the lower portion of the
+left external process of the frontal bone, downward and backward below
+the left ear (which was entirely removed), thence across the neck, five
+cm. below the superior curved line of the occipital bone, and forward
+through the lower one-third of the right auricle to the right external
+angular process of the frontal bone and margin of the right upper
+eyelid, across the lid, nose, and left eyelid, to the point of
+commencement. Every vessel and nerve supplying the scalp was destroyed,
+and the pericranium was torn off in three places, one of the denuded
+spots measuring five by seven cm. and another five by six cm. The neck
+flap of the wound fell away from the muscular structures beneath it,
+exposing the trapezius muscle almost one-half the distance to the
+shoulder blade. The right ear was torn across in its lower third, and
+hung by the side of the neck by a piece of skin less than five mm.
+wide. The exposed surface of the wound measured 40 cm. from before
+back, and 34 cm. in width near the temporal portion. The cranial
+sutures were distinctly seen in several places, and only a few muscular
+fibers of the temporal were left on each side. Hemorrhage was profuse
+from the temporal, occipital, and posterior auricular arteries, which
+were tied. The patient was seen three-quarters of an hour after the
+injury, and the mangled scalp was thoroughly washed in warm carbolized
+water, and stitched back in position, after the hair was cut from the
+outer surface. Six weeks after the injury suppuration was still free,
+and skin-grafting was commenced. In all, 4800 grafts were used, the
+patient supplying at different times 1800 small grafts. Her own skin
+invariably did better than foreign grafts. In ten months she had almost
+completely recovered, and sight and hearing had returned. Figure 191
+shows the extent of the injury, and the ultimate results of the
+treatment.
+
+Schaeffer also reports the case of a woman working in a button factory
+at Union City, Conn., in 1871, who placed her head under a swiftly
+turning shaft to pick up a button, when her hair caught in the shaft,
+taking off her scalp from the nape of the neck to the eyebrows. The
+scalp was cleansed by her physician, Dr. Bartlett, and placed on her
+head about two hours after the accident, but it did not stay in
+position. Then the head was covered twice by skin-grafts, but each time
+the grafts were lost; but the third time a successful grafting was
+performed and she was enabled to work after a period of two years. The
+same authority also quotes Wilson and Way of Bristol, Conn., in an
+account of a complete avulsion of the scalp, together with tearing of
+the eyelid and ear. The result of the skin-grafting was not given.
+Powell of Chicago gives an account of a girl of nineteen who lost her
+scalp while working in the Elgin Watch Factory at Elgin, Illinois. The
+wound extended across the forehead above the eyebrows, but the ears
+were untouched.  Skin-grafting was tried in this case but with no
+result, and the woman afterward lost an eye by exposure, from
+retraction of the eyelid.
+
+In some cases extensive wounds of the scalp heal without artificial aid
+by simply cicatrizing over. Gross mentions such a case in a young lady,
+who, in 1869, lost her scalp in a factory.  There is reported an
+account of a conductor on the Union Pacific Railroad, who, near
+Cheyenne, in 1869, was scalped by Sioux Indians. He suffered an
+elliptic wound, ten by eight cm., a portion of the outer table of the
+cranium being removed, yet the wound healed over.
+
+Cerebral Injuries.--The recent advances in brain-surgery have, in a
+measure, diminished the interest and wonder of some of the older
+instances of major injuries of the cerebral contents with unimportant
+after-results, and in reviewing the older cases we must remember that
+the recoveries were made under the most unfavorable conditions, and
+without the slightest knowledge of all important asepsis and antisepsis.
+
+Penetration or even complete transfixion of the brain is not always
+attended with serious symptoms. Dubrisay is accredited with the
+description of a man of forty-four, who, with suicidal intent, drove a
+dagger ten cm. long and one cm. wide into his brain. He had
+deliberately held the dagger in his left hand, and with a mallet in his
+right hand struck the steel several blows.  When seen two hours later
+he claimed that he experienced no pain, and the dagger was sticking out
+of his head. For half an hour efforts at extraction were made, but with
+no avail. He was placed on the ground and held by two persons while
+traction was made with carpenter's pliers. This failing, he was taken
+to a coppersmith's, where he was fastened by rings to the ground, and
+strong pinchers were placed over the dagger and attached to a chain
+which was fastened to a cylinder revolved by steam force.  At the
+second turn of the cylinder the dagger came out. During all the efforts
+at extraction the patient remained perfectly cool and complained of no
+pain. A few drops of blood escaped from the wound after the removal of
+the dagger, and in a few minutes the man walked to a hospital where he
+remained a few days without fever or pain. The wound healed, and he
+soon returned to work. By experiments on the cadaver Dubrisay found
+that the difficulty in extraction was due to rust on the steel, and by
+the serrated edges of the wound in the bone.
+
+Warren describes a case of epilepsy of seven months' standing, from
+depression of the skull caused by a red hot poker thrown at the
+subject's head. Striking the frontal bone just above the orbit, it
+entered three inches into the cerebral substance.  Kesteven reports the
+history of a boy of thirteen who, while holding a fork in his hand,
+fell from the top of a load of straw.  One of the prongs entered the
+head one inch behind and on a line with the lobe of the left ear and
+passed upward and slightly backward to almost its entire length. With
+some difficulty it was withdrawn by a fellow workman; the point was
+bent on itself to the extent of two inches. The patient lived nine
+days. Abel and Colman have reported a case of puncture of the brain
+with loss of memory, of which the following extract is an epitome: "A
+railway-fireman, thirty-six years old, while carrying an oil-feeder in
+his hand, slipped and fell forward, the spout of the can being driven
+forcibly into his face. There was transitory loss of consciousness,
+followed by twitching and jerking movements of the limbs, most marked
+on the left side, the legs being drawn up and the body bent forward.
+There was no hemorrhage from mouth, nose, or ears. The metallic spout
+of the oil-can was firmly fixed in the base of the skull, and was only
+removed from the grasp of the bone by firm traction with forceps. It
+had passed upward and toward the middle line, with its concavity
+directed from the middle line. Its end was firmly plugged by bone from
+the base of the skull. No hemorrhage followed its removal.  The wound
+was cleansed and a simple iodoform-dressing applied.  The violent
+jerking movements were replaced by a few occasional twitchings. It was
+now found that the left side of the face and the left arm were
+paralyzed, with inability to close the left eye completely. The man
+became drowsy and confused, and was unable to give replies to any but
+the simplest questions. The temperature rose to 102 degrees; the pupils
+became contracted, the right in a greater degree than the left; both
+reacted to light. The left leg began to lose power. There was complete
+anesthesia of the right eyebrow and of both eyelids and of the right
+cheek for an uncertain distance below the lower eyelid. The conjunctiva
+of the right eye became congested, and a small ulcer formed on the
+right cornea, which healed without much trouble. In the course of a few
+days power began to return, first in the left leg and afterward, though
+to a much less extent, in the left arm. For two weeks there was
+drowsiness, and the man slept considerably. He was apathetic, and for
+many days passed urine in bed. He could not recognize his wife or old
+comrades, and had also difficulty in recognizing common objects and
+their uses. The most remarkable feature was the loss of all memory of
+his life for twenty years before the accident. As time went on, the
+period included in this loss of memory was reduced to five years
+preceding the accident.  The hemiplegia persisted, although the man was
+able to get about.  Sensibility was lost to all forms of stimuli in the
+right upper eyelid, forehead, and anterior part of the scalp,
+corresponding with the distribution of the supraorbital and nasal
+nerves. The cornea was completely anesthetic, and the right cheek, an
+inch and a half external to the angle of the nose, presented a small
+patch of anesthesia. There was undue emotional mobility, the patient
+laughing or crying on slight provocation. The condition of
+mind-blindness remained. It is believed that the spout of the oil-can
+must have passed under the zygoma to the base of the skull, perforating
+the great wing of the spheroid bone and penetrating the centrum ovale,
+injuring the anterior fibers of the motor tract in the internal capsule
+near the genu."
+
+Figures 192 and 193 show the outline and probable course of the spout.
+
+Beaumont reports the history of an injury in a man of forty-five, who,
+standing but 12 yards away, was struck in the orbit by a rocket, which
+penetrated through the spheroidal fissure into the middle and posterior
+lobes of the left hemisphere. He did not fall at the time he was
+struck, and fifteen minutes after the stick was removed he arose
+without help and walked away.  Apparently no extensive cerebral lesion
+had been caused, and the man suffered no subsequent cerebral symptoms
+except, three years afterward, impairment of memory.
+
+There is an account given by Chelius of an extraordinary wound caused
+by a ramrod. The rod was accidentally discharged while being employed
+in loading, and struck a person a few paces away.  It entered the head
+near the root of the zygomatic arch, about a finger's breadth from the
+outer corner of the right eye, passed through the head, emerging at the
+posterior superior angle of the parietal bone, a finger's breadth from
+the sagittal suture, and about the same distance above the superior
+angle of the occipital bone. The wounded man attempted to pull the
+ramrod out, but all his efforts were ineffectual. After the tolerance
+of this foreign body for some time, one of his companions managed to
+extract it, and when it was brought out it was as straight as the day
+it left the maker's shop. Little blood was lost, and the wound healed
+rapidly and completely; in spite of this major injury the patient
+recovered.
+
+Carpenter reports the curious case of an insane man who deliberately
+bored holes through his skull, and at different times, at a point above
+the ear, he inserted into his brain five pieces of No. 20 broom wire
+from 2 1/16 to 6 3/4 inches in length, a fourpenny nail 2 1/4 inches
+long, and a needle 1 5/8 inches long. Despite these desperate attempts
+at suicide he lived several months, finally accomplishing his purpose
+by taking an overdose of morphin. MacQueen has given the history of a
+man of thirty-five, who drove one three-inch nail into his forehead,
+another close to his occiput, and a third into his vertex an inch in
+front and 1/4 inch to the left of the middle line. He had used a hammer
+to effect complete penetration, hoping that death would result from his
+injuries. He failed in this, as about five weeks later he was
+discharged from the Princess Alice Hospital at Eastbourne, perfectly
+recovered. There is a record of a man by the name of Bulkley who was
+found, by a police officer in Philadelphia, staggering along the
+streets, and was taken to the inebriate ward of the Blockley Hospital,
+where he subsequently sank and died, after having been transferred from
+ward to ward, his symptoms appearing inexplicable. A postmortem
+examination revealed the fact that an ordinary knife-blade had been
+driven into his brain on the right side, just above the ear, and was
+completely hidden by the skin. It had evidently become loosened from
+the handle when the patient was stabbed, and had remained in the brain
+several days. No clue to the assailant was found.
+
+Thudicum mentions the case of a man who walked from Strafford to
+Newcastle, and from Newcastle to London, where he died, and in his
+brain was found the breech-pin of a gun. Neiman describes a severe
+gunshot wound of the frontal region, in which the iron breech-block of
+an old-fashioned muzzle-loading gun was driven into the substance of
+the brain, requiring great force for its extraction. The patient, a
+young man of twenty-eight, was unconscious but a short time, and
+happily made a good recovery. A few pieces of bone came away, and the
+wound healed with only a slight depression of the forehead. Wilson
+speaks of a child who fell on an upright copper paper-file, which
+penetrated the right side of the occipital bone, below the external
+orifice of the ear, and entered the brain for more than three inches;
+and yet the child made a speedy recovery.
+
+Baron Larrey knew of a man whose head was completely transfixed by a
+ramrod, which extended from the middle of the forehead to the left side
+of the nape of the neck; despite this serious injury the man lived two
+days.
+
+Jewett records the case of an Irish drayman who, without treatment,
+worked for forty-seven days after receiving a penetrating wound of the
+skull 1/4 inch in diameter and four inches deep. Recovery ensued in
+spite of the delay in treatment.
+
+Gunshot Injuries.--Swain mentions a patient who stood before a looking
+glass, and, turning his head far around to the left, fired a pistol
+shot into his brain behind the right ear. The bullet passed into his
+mouth, and he spat it out. Some bleeding occurred from both the
+internal and external wounds; the man soon began to suffer with a
+troublesome cough, with bloody expectoration; his tongue was coated and
+drawn to the right; he became slightly deaf in his right ear and
+dragged his left leg in walking. These symptoms, together with those of
+congestion of the lung, continued for about a week, when he died,
+apparently from his pulmonary trouble.
+
+Ford quotes the case of a lad of fifteen who was shot in the head, 3/4
+inch anterior to the summit of the right ear, the ball escaping through
+the left os frontis, 1 1/4 inch above the center of the brow. Recovery
+ensued, with a cicatrix on the forehead, through which the pulsations
+of the brain could be distinctly seen. The senses were not at all
+deteriorated.
+
+Richardson tells of a soldier who was struck by a Minie ball on the
+left temporal bone; the missile passed out through the left frontal
+bone 1/2 inch to the left of the middle of the forehead.  He was only
+stunned, and twenty-four hours later his intellect was undisturbed.
+There was no operation; free suppuration with discharges of fragments
+of skull and broken-down substance ensued for four weeks, when the
+wounds closed kindly, and recovery followed.
+
+Angle records the case of a cowboy who was shot by a comrade in
+mistake. The ball entered the skull beneath the left mastoid process
+and passed out of the right eye. The man recovered.
+
+Rice describes the case of a boy of fourteen who was shot in the head,
+the ball directly traversing the brain substance, some of which
+protruded from the wound. The boy recovered. The ball entered one inch
+above and in front of the right ear and made its exit through the
+lambdoidal suture posteriorly.
+
+Hall of Denver, Col., in an interesting study of gunshot wounds of the
+brain, writes as follows:--
+
+"It is in regard to injuries involving the brain that the question of
+the production of immediate unconsciousness assumes the greatest
+interest. We may state broadly that if the medulla or the great centers
+at the base of the brain are wounded by a bullet, instant
+unconsciousness must result; with any other wounds involving the
+brain-substance it will, with very great probability, result. But there
+is a very broad area of uncertainty. Many instances have been recorded
+in which the entrance of a small bullet into the anterior part of the
+brain has not prevented the firing of a second shot on the part of the
+suicide. Personally, I have not observed such a case, however.  But,
+aside from the injuries by the smallest missiles in the anterior parts
+of the brain, we may speak with almost absolute certainty with regard
+to the production of unconsciousness, for the jar to the brain from the
+blow of the bullet upon the skull would produce such a result even if
+the damage to the brain were not sufficient to do so.
+
+"Many injuries to the brain from bullets of moderate size and low
+velocity do not cause more than a temporary loss of consciousness, and
+the subjects are seen by the surgeon, after the lapse of half an hour
+or more, apparently sound of mind.  These are the cases in which the
+ball has lost its momentum in passing through the skull, and has
+consequently done little damage to the brain-substance, excepting to
+make a passage for itself for a short distance into the brain. It is
+apparently well established that, in the case of the rifle-bullet of
+high velocity, and especially if fired from the modern military weapons
+using nitro-powders, and giving an enormous initial velocity to the
+bullet, the transmission of the force from the displaced particles of
+brain (and this rule applies to any other of the soft organs as well)
+to the adjacent parts is such as to disorganize much of the tissue
+surrounding the original track of the missile. Under these
+circumstances a much slighter wound would be necessary to produce
+unconsciousness or death than in the case of a bullet of low velocity,
+especially if it were light in weight. Thus I have recorded elsewhere
+an instance of instant death in a grizzly bear, an animal certainly as
+tenacious of life as any we have, from a mere furrow, less than a
+quarter of an inch in depth, through the cortex of the brain, without
+injury of the skull excepting the removal of the bone necessary for the
+production of this furrow. The jar to the brain from a bullet of great
+velocity, as in this case, was alone sufficient to injure the organ
+irreparably. In a similar manner I have known a deer to be killed by
+the impact of a heavy rifle-ball against one horn, although there was
+no evidence of fracture of the skull. On the other hand, game animals
+often escape after such injuries not directly involving the brain,
+although temporarily rendered unconscious, as I have observed in
+several instances, the diagnosis undoubtedly being concussion of the
+brain.
+
+"Slight injury to the brain, and especially if it be unilateral, then,
+may not produce unconsciousness. It is not very uncommon for a missile
+from a heavy weapon to strike the skull, and be deflected without the
+production of such a state. Near the town in which I formerly
+practiced, the town-marshal shot at a negro, who resisted arrest, at a
+distance of only a few feet, with a 44-caliber revolver, striking the
+culprit on the side of the head.  The wound showed that the ball struck
+the skull and plowed along under the scalp for several inches before
+emerging, but it did not even knock the negro down, and no
+unconsciousness followed later. I once examined an express-messenger
+who had been shot in the occipital region by a weapon of similar size,
+while seated at his desk in the car. The blow was a very glancing one
+and did not produce unconsciousness, and probably, as in the case of
+the negro, because it did not strike with sufficient directness."
+
+Head Injuries with Loss of Cerebral Substance.--The brain and its
+membranes may be severely wounded, portions of the cranium or cerebral
+substance destroyed or lost, and yet recovery ensue.  Possibly the most
+noted injury of this class was that reported by Harlow and commonly
+known as "Bigelow's Case" or the "American Crow-bar Case." Phineas P.
+Gage, aged twenty-five, a foreman on the Rutland and Burlington
+Railroad, was employed September 13, 1847, in charging a hole with
+powder preparatory to blasting. A premature explosion drove a
+tamping-iron, three feet seven inches long, 1 1/4 inches in diameter,
+weighing 13 1/4 pounds, completely through the man's head. The iron was
+round and comparatively smooth; the pointed end entered first. The iron
+struck against the left side of the face, immediately anterior to the
+inferior maxillary and passed under the zygomatic arch, fracturing
+portions of the spheroid bone and the floor of the left orbit; it then
+passed through the left anterior lobe of the cerebrum, and, in the
+median line, made its exit at the junction of the coronal and sagittal
+sutures, lacerating the longitudinal sinus, fracturing the parietal and
+frontal bones, and breaking up considerable of the brain; the globe of
+the left eye protruded nearly one-half of its diameter. The patient was
+thrown backward and gave a few convulsive movements of the extremities.
+He was taken to a hotel 3/4 mile distant, and during the transportation
+seemed slightly dazed, but not at all unconscious. Upon arriving at the
+hotel he dismounted from the conveyance, and without assistance walked
+up a long flight of stairs to the hall where his wound was to be
+dressed. Harlow saw him at about six o'clock in the evening, and from
+his condition could hardly credit the story of his injury, although his
+person and his bed were drenched with blood. His scalp was shaved, the
+coagula and debris removed, and among other portions of bone was a
+piece of the anterior superior angle of each parietal bone and a
+semicircular piece of the frontal bone, leaving an opening 3 1/2 inches
+in diameter. At 10 P.M. on the day of the injury Gage was perfectly
+rational and asked about his work and after his friends. After a while
+delirium set in for a few days, and on the eleventh day he lost the
+vision in the left eye. His convalescence was rapid and uneventful. It
+was said that he discharged pieces of bone and cerebral substance from
+his mouth for a few days. The iron when found was smeared with blood
+and cerebral substance.
+
+As was most natural such a wonderful case of cerebral injury attracted
+much notice. Not only was the case remarkable in the apparent innocuous
+loss of cerebral substance, but in the singular chance which exempted
+the brain from either concussion or compression, and subsequent
+inflammation. Professor Bigelow examined the patient in January, 1850,
+and made a most excellent report of the case, and it is due to his
+efforts that the case attained world-wide notoriety. Bigelow found the
+patient quite recovered in his faculties of body and mind, except that
+he had lost the sight of the injured eye. He exhibited a linear
+cicatrix one inch long near the angle of the ramus of the left lower
+jaw.  His left eyelid was involuntarily closed and he had no power to
+overcome his ptosis. Upon the head, well covered by the hair, was a
+large unequal depression and elevation. In order to ascertain how far
+it might be possible for a bar of the size causing the injury to
+traverse the skull in the track assigned to it, Bigelow procured a
+common skull in which the zygomatic arches were barely visible from
+above, and having entered a drill near the left angle of the inferior
+maxilla, he passed it obliquely upward to the median line of the
+cranium just in front of the junction of the sagittal and coronal
+sutures. This aperture was then enlarged until it allowed the passage
+of the bar in question, and the loss of substance strikingly
+corresponded with the lesion said to have been received by the patient.
+From the coronoid process of the inferior maxilla there was removed a
+fragment measuring about 3/4 inch in length. This fragment, in the
+patient's case, might have been fractured and subsequently reunited.
+The iron bar, together with a cast of the patient's head, was placed in
+the Museum of the Massachusetts Medical College.
+
+Bigelow appends an engraving to his paper. In the illustration the
+parts are as follows:--
+
+(1) Lateral view of a prepared cranium representing the iron bar
+traversing its cavity.
+
+(2) Front view of same.
+
+(3) Plan of the base seen from within. In these three figures the optic
+foramina are seen to be intact and are occupied by small white rods.
+
+(4) Cast taken from the shaved head of the patient representing the
+appearance of the fracture in 1850, the anterior fragment being
+considerably elevated in the profile view.
+
+(5) The iron bar with length and diameter in proportion to the size of
+the other figures.
+
+Heaton reports a case in which, by an explosion, a tamping-iron was
+driven through the chin of a man into the cerebrum. Although there was
+loss of brain-substance, the man recovered with his mental faculties
+unimpaired. A second case was that of a man who, during an explosion,
+was wounded in the skull. There was visible a triangular depression,
+from which, possibly, an ounce of brain-substance issued. This man also
+recovered.
+
+Jewett mentions a case in which an injury somewhat similar to that in
+Bigelow's case was produced by a gas-pipe.
+
+Among older writers, speaking of loss of brain-substance with
+subsequent recovery, Brasavolus saw as much brain evacuated as would
+fill an egg shell; the patient afterward had an impediment of speech
+and grew stupid. Franciscus Arcaeus gives the narrative of a workman
+who was struck on the head by a stone weighing 24 pounds falling from a
+height. The skull was fractured; fragments of bone were driven into the
+brain. For three days the patient was unconscious and almost lifeless.
+After the eighth day a cranial abscess spontaneously opened, from the
+sinciput to the occiput, and a large quantity of "corruption" was
+evacuated.  Speech returned soon after, the eyes opened, and in twenty
+days the man could distinguish objects. In four months recovery was
+entire. Bontius relates a singular accident to a sailor, whose head was
+crushed between a ship and a small boat; the greater part of the
+occipital bone was taken away in fragments, the injury extending almost
+to the foremen magnum. Bontius asserts that the patient was perfectly
+cured by another surgeon and himself. Galen mentions an injury to a
+youth in Smyrna, in whom the brain was so seriously wounded that the
+anterior ventricles were opened; and vet the patient recovered.
+Glandorp mentions a case of fracture of the skull out of which his
+father took large portions of brain and some fragments of bone. He adds
+that the man was afterward paralyzed an the opposite side and became
+singularly irritable. In his "Chirurgical Observations," Job van
+Meek'ren tells the story of a Russian nobleman who lost part of his
+skull, and a dog's skull was supplied in its place. The bigoted divines
+of the country excommunicated the man, and would not annul his sentence
+until he submitted to have the bit of foreign bone removed.
+
+Mendenhall reports the history of an injury to a laborer nineteen years
+old. While sitting on a log a few feet from a comrade who was chopping
+wood, the axe glanced and, slipping from the woodman's grasp, struck
+him just above the ear, burying the "bit" of the axe in his skull. Two
+hours afterward he was seen almost pulseless, and his clothing drenched
+with blood which was still oozing from the wound with mixed
+brain-substance and fragments of bone. The cut was horizontal on a
+level with the orbit, 5 1/2 inches long externally, and, owing to the
+convex shape of the axe, a little less internally. Small spicules of
+bone were removed, and a cloth was placed on the battered skull to
+receive the discharges for the inspection of the surgeon, who on his
+arrival saw at least two tablespoonfuls of cerebral substance on this
+cloth. Contrary to all expectation this man recovered, but, strangely,
+he had a marked and peculiar change of voice, and this was permanent.
+From the time of the reception of the injury his whole mental and moral
+nature had undergone a pronounced change.  Before the injury, the
+patient was considered a quiet, unassuming, and stupid boy, but
+universally regarded as honest.  Afterward he became noisy,
+self-asserting, sharp, and seemingly devoid of moral sense or honesty.
+These new traits developed immediately, and more strikingly so soon as
+convalescence was established.
+
+Bergtold quotes a case reported in 1857 of extreme injury to the
+cranium and its contents. While sleeping on the deck of a canal boat, a
+man at Highspire was seriously injured by striking his head against a
+bridge. When seen by the surgeon his hair was matted and his clothes
+saturated with blood. There was a terrible gap in the scalp from the
+superciliary ridge to the occipital bone, and, though full of clots,
+the wound was still oozing. In a cloth on a bench opposite were rolled
+up a portion of the malar bone, some fragments of the os frontis, one
+entire right parietal bone, detached from its fellow along the sagittel
+suture, and from the occipital along the lambdoidal suture, perhaps
+taking with it some of the occipital bone together with some of the
+squamous portion of the temporal bone. This bone was as clean of soft
+parts as if it had been removed from a dead subject with a scalpel and
+saw. No sight of the membranes or of the substance of the brain was
+obtained. The piece of cranium removed was 6 3/4 inches in the
+longitudinal diameter, and 5 3/4 inches in the short oval diameter. The
+dressing occupied an hour, at the end of which the patient arose to his
+feet and changed his clothes as though nothing had happened. Twenty-six
+years after the accident there was slight unsteadiness of gait, and
+gradual paralysis of the left leg and arm and the opposite side of the
+face, but otherwise the man was in good condition. In place of the
+parietal bone the head presented a marked deficiency as though a slice
+of the skull were cut out. The depressed area measured five by six
+inches. In 1887 the man left the hospital in Buffalo with the paralysis
+improved, but his mental equilibrium could be easily disturbed. He
+became hysteric and sobbed when scolded.
+
+Buchanan mentions the history of a case in a woman of twenty-one, who,
+while working in a mill, was struck by a bolt. Her skull was fractured
+and driven into the brain comminuted. Hanging from the wound was a bit
+of brain-substance, the size of a finger, composed of convolution as
+well as white matter. The wound healed, there was no hernia, and at the
+time of report the girl was conscious of no disturbance, not even a
+headache. There was nothing indicative of the reception of the injury
+except a scar near the edge of the hair on the upper part of the right
+side of the forehead. Steele, in a school-boy of eight, mentions a case
+of very severe injury to the bones of the face and head, with escape of
+cerebral substance, and recovery. The injury was caused by falling into
+machinery.
+
+There was a seaman aboard of the U.S.S. "Constellation," who fell
+through a hatchway from the masthead, landing on the vertex of the
+head. There was copious bleeding from the ears, 50 to 60 fluid-ounces
+of blood oozing in a few hours, mingled with small fragments of
+brain-tissue. The next day the discharge became watery, and in it were
+found small pieces of true brain-substance. In five weeks the man
+returned to duty complaining only of giddiness and of a "stuffed-up"
+head. In 1846 there is a record of a man of forty who fell from a
+scaffold, erected at a height of 20 feet, striking on his head. He was
+at first stunned, but on admission to the hospital recovered
+consciousness. A small wound was found over the right eyebrow,
+protruding from which was a portion of brain-substance. There was
+slight hemorrhage from the right nostril, and some pain in the head,
+but the pulse and respiration were undisturbed. On the following day a
+fragment of the cerebral substance, about the size of a hazel-nut,
+together with some brood-clots, escaped from the right nostril. In this
+case the inner wall of the frontal sinus was broken, affording exit for
+the lacerated brain.
+
+Cooke and Laycock mention a case of intracranial injury with extensive
+destruction of brain-substance around the Rolandic area; there was
+recovery but with loss of the so called muscular sense. The patient, a
+workman of twenty-nine, while cutting down a gum-tree, was struck by a
+branch as thick as a man's arm, which fell from 100 feet overhead,
+inflicting a compound comminuted fracture of the cranium. The right eye
+was contused but the pupils equal; the vertex-wound was full of
+brain-substance and pieces of bone, ten of which were removed, leaving
+an oval opening four by three inches. The base of the skull was
+fractured behind the orbits; a fissure 1/4 inch wide was discernible,
+and the right frontal bone could be easily moved. The lacerated and
+contused brain-substance was removed. Consciousness returned six days
+after the operation. The accompanying illustrations (Figs.  196 and
+197) show the extent of the injury. The lower half of the ascending
+frontal convolution, the greater half of the sigmoid gyrus, the
+posterior third of the lower and middle frontal convolutions, the base
+and posterior end of the upper convolution, and the base of the
+corresponding portion of the falciform lobe were involved. The sensory
+and motor functions of the arm were retained in a relative degree.
+There was power of simple movements, but complex movements were
+awkward. The tactile localization was almost lost.
+
+Morton mentions a patient of forty-seven, who was injured in a railroad
+accident near Phoenixville, Pa.; there was a compound comminuted
+fracture of the skull involving the left temporal, spheroid, and
+superior maxillary bones. The side of the head and the ear were
+considerably lacerated; several teeth were broken, and besides this
+there was injury to the aura and cerebral substance. There was profound
+coma for ten days and paralysis of the 1st, 2d, 3d, 4th, 6th, and 7th
+cranial nerves, particularly affecting the left side of the face. There
+was scarcely enough blood-supply left to the orbit to maintain life in
+the globe. The man primarily recovered, but ninety-one days from the
+injury he died of cerebral abscess.
+
+There is the record of a curious brain-injury in a man of twenty-two,
+who was struck on the skull by a circular saw. The saw cut directly
+down into the brain, severing the superior longitudinal sinus, besides
+tearing a branch of the meningeal artery. The wound was filled with
+sawdust left by the saw while it was tearing through the parts. After
+ordinary treatment the man recovered.
+
+Bird reports a compound comminuted fracture of the left temporal
+region, with loss of bone, together with six drams of brain-substance,
+which, however, was followed by recovery. Tagert gives an instance of
+compound depressed fracture of the skull, with loss of brain-substance,
+in which recovery was effected without operative interference. Ballou,
+Bartlett, Buckner, Capon, Carmichael, Corban, Maunder and many others,
+cite instances of cranial fracture and loss of brain-substance, with
+subsequent recovery. Halsted reports the history of a boy of seventeen,
+who, while out fowling, had the breech-pin of a shot-gun blown out, the
+sharp point striking the forehead in the frontal suture, crushing the
+os frontis, destroying 1 3/4 inches of the longitudinal sinus, and
+causing severe hemorrhage from both the longitudinal and frontal
+sinuses. The pin was pulled out by the boy, who washed his own face,
+and lay down; he soon became semi-comatose, in which condition he
+remained for some days; but, after operation, he made complete recovery.
+
+Loss of Brain-substance from Cerebral Tumor.--Koser is accredited with
+reporting results of a postmortem held on a young man of twenty who
+suffered from a cerebral tumor of considerable duration. It was stated
+that, although there was a cavity in the brain at least five inches in
+length, the patient, almost up to the time of death, was possessed of
+the senses of touch, taste, hearing, and smell, showed considerable
+control over his locomotor muscles, and could talk. In fact, he was
+practically discommoded in no other way than by loss of vision, caused
+by pressure on the optic centers. It was also stated that the retention
+of memory was remarkable, and, up to within two weeks of his death, the
+patient was able to memorize poems. The amount of involvement
+discovered postmortem in cases similar to the preceding is astonishing.
+At a recent pathologic display in London several remarkable specimens
+were shown.
+
+Extensive Fractures of the Skull. Jennings mentions an instance of
+extensive fracture of the skull, 14 pieces of the cranium being found.
+The patient lived five weeks and two days after the injury, the
+immediate cause of death being edema of the lungs.  His language was
+incoherent and full of oaths. Belloste, in his "Hospital Surgeon,"
+states that he had under has care a most dreadful case of a girl of
+eleven or twelve years, who received 18 or 19 cutlass wounds of the
+head, each so violent as to chip out pieces of bone; but,
+notwithstanding her severe injuries, she made recovery. At the
+Emergency Hospital in Washington, D.C., there was received a negress
+with at least six gaping wounds of the head, in some cases denuding the
+periosteum and cutting the cranium. During a debauch the night before
+she had been engaged in a quarrel with a negro with whom she lived, and
+was struck by him several times on the head with an axe. She lay all
+night unconscious, and was discovered the next morning with her hair
+and clothes and the floor on which she lay drenched with blood.  The
+ambulance was summoned to take her to the morgue, but on the arrival of
+the police it was seen that feeble signs of life still existed. On
+admission to the hospital she was semi-comatose, almost pulseless,
+cold, and exhibiting all the signs of extreme hemorrhage and shock. Her
+head was cleaned up, but her condition would not permit of any other
+treatment than a corrosive-sublimate compress and a bandage of
+Scultetus. She was taken to the hospital ward, where warmth and
+stimulants were applied, after which she completely reacted. She
+progressed so well that it was not deemed advisable to remove the
+head-bandage until the fourth day, when it was seen that the wounds had
+almost entirely healed and suppuration was virtually absent. The
+patient rapidly and completely recovered, and her neighbors, on her
+return home, could hardly believe that she was the same woman whom, a
+few days before, they were preparing to take to the morgue.
+
+A serious injury, which is not at all infrequent, is that caused by
+diving into shallow water, or into a bath from which water has been
+withdrawn. Curran mentions a British officer in India who, being
+overheated, stopped at a station bath in which the previous night he
+had had a plunge, and without examining, took a violent "header" into
+the tank, confidently expecting to strike from eight to ten feet of
+water. He dashed his head against the concrete bottom 12 feet below
+(the water two hours previously having been withdrawn) and crushed his
+brain and skull into an indistinguishable mass.
+
+There are many cases on record in which an injury, particularly a
+gunshot wound of the skull, though showing no external wound, has
+caused death by producing a fracture of the internal table of the
+cranium. Pare gives details of the case of a nobleman whose head was
+guarded by a helmet and who was struck by a ball, leaving no external
+sign of injury, but it was subsequently found that there was an
+internal fracture of the cranium. Tulpius and Scultetus are among the
+older writers reporting somewhat similar instances, and there are
+several analogous cases reported as having occurred during the War of
+the Rebellion. Boling reports a case in which the internal table was
+splintered to a much greater extent than the external.
+
+Fracture of the base of the skull is ordinarily spoken of as a fatal
+injury, reported instances of recovery being extremely rare, but
+Battle, in a paper on this subject, has collected numerous statistics
+of nonfatal fracture of the base of the brain, viz.:--
+
+                                        Male. Female.
+  Anterior fossa, . . . . . . . . . . .    16    5
+  Middle fossa, . . . . . . . . . . . .    50    6
+  Posterior fossa,. . . . . . . . . . .    10    1
+  Middle and anterior fossae, . . . . .    15    5
+  Middle and posterior fossae,. . . . .     4    1
+  Anterior, middle, and posterior fossae,   1    0
+                                        ------ ------
+                                           96    18  Total, 114.
+
+In a paper on nonmortal fractures of the base of the skull, Lidell
+gives an account of 135 cases. MacCormac reports a case of a boy of
+nine who was run over by a carriage drawn by a pair of horses. He
+suffered fracture of the base of the skull, of the bones of the face,
+and of the left ulna, and although suppuration at the points of
+fracture ensued, followed by an optic neuritis, an ultimate recovery
+was effected. Ball, an Irish surgeon, has collected several instances
+in which the base of the skull has been driven in and the condyle of
+the jaw impacted in the opening by force transmitted through the lower
+maxilla.
+
+The tolerance of foreign bodies in the brain is most marvelous.  In the
+ancient chronicles of Koenigsberg there is recorded the history of a
+man who for fourteen years carried in his head a piece of iron as large
+as his finger. After its long lodgment, during which the subject was
+little discommoded, it finally came out by the palatine arch. There is
+also an old record of a ball lodging near the sella turcica for over a
+year, the patient dying suddenly of an entirely different accident.
+Fabricius Hildanus relates the history of an injury, in which, without
+causing any uncomfortable symptoms, a ball rested between the skull and
+dura for six months.
+
+Amatus Lusitanus speaks of a drunken courtesan who was wounded in a
+fray with a long, sharp-pointed knife which was driven into the head.
+No apparent injury resulted, and death from fever took place eight
+years after the reception of the injury. On opening the head a large
+piece of knife was found between the skull and dura. It is said that
+Benedictus mentions a Greek who was wounded, at the siege of Colchis,
+in the right temple by a dart and taken captive by the Turks; he lived
+for twenty years in slavery, the wound having completely healed.
+Obtaining his liberty, he came to Sidon, and five years after, as he
+was washing his face, he was seized by a violent fit of sneezing, and
+discharged from one of his nostrils a piece of the dart having an iron
+point of considerable length.
+
+In about 1884 there died in the Vienna Hospital a bookbinder of
+forty-five, who had always passed as an intelligent man, but who had at
+irregular intervals suffered from epileptic convulsions.  An iron nail
+covered with rust was discovered in his brain; from the history of his
+life and from the appearances of the nail it had evidently been lodged
+in the cerebrum since childhood.
+
+Slee mentions a case in which, after the death of a man from septic
+peritonitis following a bullet-wound of the intestines, he found
+postmortem a knife-blade 5/16 inch in width projecting into the brain
+to the depth of one inch. The blade was ensheathed in a strong fibrous
+capsule 1/2 inch thick, and the adjacent brain-structure was apparently
+normal. The blade was black and corroded, and had evidently passed
+between the sutures during boyhood as there was no depression or
+displacement of the cranial bones. The weapon had broken off just on a
+level with the skull, and had remained in situ until the time of death
+without causing any indicative symptoms. Slee does not state the man's
+age, but remarks that he was a married man and a father at the time of
+his death, and had enjoyed the best of health up to the time he was
+shot in the abdomen. Callaghan, quoted in Erichsen's "Surgery," remarks
+that he knew of an officer who lived seven years with a portion of a
+gun-breech weighing three ounces lodged in his brain.
+
+Lawson mentions the impaction of a portion of a breech of a gun in the
+forehead of a man for twelve years, with subsequent removal and
+recovery. Waldon speaks of a similar case in which a fragment of the
+breech weighing three ounces penetrated the cranium, and was lodged in
+the brain for two months previous to the death of the patient.
+
+Huppert tells of the lodgment of a slate-pencil three inches long in
+the brain during lifetime, death ultimately being caused by a slight
+head-injury. Larry mentions a person who for some time carried a six
+ounce ball in the brain and ultimately recovered.  Peter removed a
+musket-ball from the frontal sinus after six years' lodgment, with
+successful issue. Mastin has given an instance in which the blade of a
+pen-knife remained in the brain six months, recovery following its
+removal. Camden reports a case in which a ball received in a gunshot
+wound of the brain remained in situ for thirteen years; Cronyn mentions
+a similar case in which a bullet rested in the brain for eight years.
+Doyle successfully removed an ounce Minie ball from the brain after a
+fifteen years' lodgment.
+
+Pipe-stems, wires, shot, and other foreign bodies, are from time to
+time recorded as remaining in the brain for some time. Wharton has
+compiled elaborate statistics on this subject, commenting on 316 cases
+in which foreign bodies were lodged in the brain, and furnishing all
+the necessary information to persons interested in this subject.
+
+Injuries of the nose, with marked deformity, are in a measure combated
+by devices invented for restoring the missing portions of the injured
+member. Taliacotius, the distinguished Italian surgeon of the sixteenth
+century, devised an operation which now bears his name, and consists in
+fashioning a nose from the fleshy tissues of the arm. The arm is
+approximated to the head and held in this position by an apparatus or
+system of bandages for about ten days, at which time it is supposed
+that it can be severed, and further trimming and paring of the nose is
+then practiced. A column is subsequently made from the upper lip. In
+the olden days there was a timorous legend representing Taliacotius
+making noses for his patients from the gluteal regions of other
+persons, which statement, needless to say, is not founded on fact.
+Various modifications and improvements on the a Talicotian method have
+been made; but in recent years the Indian method, introduced by Carpue
+into England in 1816, is generally preferred. Syme of Edinburgh, Wood,
+and Ollier have devised methods of restoring the nose, which bear their
+names.
+
+Ohmann-Dumesnil reports a case of rhinophyma in a man of seventy-two,
+an alcoholic, who was originally affected with acne rosacea, on whom he
+performed a most successful operation for restoration. The accompanying
+illustration shows the original deformity--a growth weighing two
+pounds--and also pictures the appearance shortly after the operation.
+This case is illustrative of the possibilities of plastic surgery in
+the hands of a skilful and ingenious operator.
+
+About 1892 Dr. J. P. Parker then of Kansas City, Mo., restored the
+missing bridge of a patient's nose by laying the sunken part open in
+two long flaps, denuding the distal extremity of the little finger of
+the patient's right hand of nail, flesh, tendons, etc., and binding it
+into the wound of the nose until firm union had taken place. The finger
+was then amputated at the second joint and the plastic operation
+completed, with a result pleasing both to patient and operator.
+
+There is a case quoted of a young man who, when first seen by his
+medical attendant, had all the soft parts of the nose gone, except
+one-third of the left ala and a thin flap of the septum which was lying
+on the upper lip. The missing member was ferreted out and cleansed, and
+after an hour's separation sutured on. The nostrils were daily syringed
+with a corrosive sublimate solution, and on the tenth day the dressing
+was removed; the nose was found active and well, with the single
+exception of a triangular notch on the right side, which was too
+greatly bruised by the violence of the blow to recover. When we
+consider the varicosity of this organ we can readily believe the
+possibility of the foregoing facts, and there is little doubt that more
+precaution in suturing severed portions of the nose would render the
+operation of nose making a very rare one.
+
+Maxwell mentions a curious case of attempted suicide in which the ball,
+passing through the palatine process of the superior maxillary bone,
+crushing the vomer to the extent of its own diameter, fell back through
+the right nostril into the pharynx, was swallowed, and discharged from
+the anus.
+
+Deformities of the nose causing enormous development, or the condition
+called "double-nose" by Bartholinus, Borellus, Bidault, and others, are
+ordinarily results of a pathologic development of the sebaceous glands.
+In some cases tumors develop from the root of the nose, forming what
+appears to be a second nose. In other cases monstrous vegetations
+divide the nose into many tumors. In the early portion of this century
+much was heard about a man who was a daily habitue of the Palais-Royal
+Gardens. His nose was divided into unequally sized tumors, covering
+nearly his entire face. Similar instances have been observed in recent
+years. Hey mentions a case in which the tumor extended to the lower
+part of the under lip, which compressed the patient's mouth and
+nostrils to such an extent that while sleeping, in order to insure
+sufficient respiration, he had to insert a tin-tube into one of his
+nostrils. Imbert de Lannes is quoted as operating on a former Mayor of
+Angouleme. This gentleman's nose was divided into five lobes by
+sarcomatous tumors weighing two pounds, occupying the external surface
+of the face, adherent to the buccinator muscles to which they extended,
+and covering the chin. In the upright position the tumors sealed the
+nostrils and mouth, and the man had to bend his head before and after
+respiration. In eating, this unfortunate: person had to lift his tumors
+away from his mouth, and during sleep the monstrous growths were
+supported in a sling attached to his night cap. He presented such a
+hideous aspect that he was virtually ostracized from society The growth
+had been in progress for twelve years, but during twenty-two months'
+confinement in Revolutionary prisons the enlargement had been very
+rapid. Fournier says that the most beautiful result followed the
+operation which was considered quite hazardous.
+
+Foreign bodies in the nose present phenomena as interesting as wounds
+of this organ. Among the living objects which have been found in the
+nose may be mentioned flies, maggots, worms, leeches, centipedes, and
+even lizards. Zacutus Lusitanus tells of a person who died in two days
+from the effects of a leech which was inadvertently introduced into the
+nasal fossa, and there is a somewhat similar case of a military
+pharmacist, a member of the French army in Spain, who drank some water
+from a pitcher and exhibited, about a half hour afterward, a persistent
+hemorrhage from the nose. Emaciation progressively continued, although
+his appetite was normal. Three doctors, called in consultation,
+prescribed bleeding, which, however, proved of no avail. Three weeks
+afterward he carried in his nostril a tampon of lint, wet with an
+astringent solution, and, on the next day, on blowing his nose, there
+fell from the right nostril a body which he recognized as a leech.
+Healey gives the history of four cases in which medicinal leeches were
+removed from the mouth and posterior nares of persons who had, for some
+days previously, been drinking turbid water. Sinclair mentions the
+removal of a leech from the posterior nares.
+
+In some regions, more particularly tropical ones, there are certain
+flies that crawl into the nostrils of the inhabitants and deposit eggs,
+in the cavities. The larvae develop and multiply with great rapidity,
+and sometimes gain admission into the frontal sinus, causing intense
+cephalalgia, and even death.
+
+Dempster reports an instance of the lodgment of numerous live maggots
+within the cavity of the nose, causing sloughing of the palate and
+other complications. Nicholson mentions a case of ulceration and
+abscess of the nostrils and face from which maggots were discharged.
+Jarvis gives the history of a strange and repeated hemorrhage from the
+nose and adjacent parts that was found to be due to maggots from the
+ova of a fly, which had been deposited in the nose while the patient
+was asleep. Tomlinson gives a case in which maggots traversed the
+Eustachian tube, some being picked out of the nostrils, while others
+were coughed up.  Packard records the accidental entrance of a
+centipede into the nostril. There is an account of a native who was
+admitted to the Madras General Hospital, saying that a small lizard had
+crawled up his nose. The urine of these animals is very irritating,
+blistering any surface it touches. Despite vigorous treatment the
+patient died in consequence of the entrance of this little creature.
+
+There have been instances among the older writers in which a pea has
+remained in the nose for such a length of time as to present evidences
+of sprouting. The Ephemerides renders an instance of this kind, and
+Breschet cites the history of a young boy, who, in 1718, introduced a
+pea into his nostril; in three days it had swollen to such an extent as
+to fill the whole passage. It could not be extracted by an instrument,
+so tobacco snuff was used, which excited sneezing, and the pea was
+ejected.
+
+Vidal and the Ephemerides report several instances of tolerance of
+foreign bodies in the nasal cavities for from twenty to twenty-five
+years. Wiesman, in 1893, reported a rhinolith, which was composed of a
+cherry-stone enveloped in chalk, that had been removed after a sojourn
+of sixty years, with intense ozena as a consequence of its lodgment.
+Waring mentions the case of a housemaid who carried a rhinolith, with a
+cherry-stone for a nucleus, which had been introduced twenty-seven
+years before, and which for twenty-five years had caused no symptoms.
+Grove describes a necrosed inferior turbinated bone, to which was
+attached a coffee-grain which had been retained in the nostril for
+twenty years., Hickman gives an instance of a steel ring which for
+thirteen and a half years had been impacted in the nasopharyngeal fossa
+of a child. It was detected by the rhinoscope and was removed. Parker
+speaks of a gunbreech bolt which was removed from the nose after five
+years' lodgment. Major mentions the removal of a foreign body from the
+nose seven years after its introduction.
+
+Howard removed a large thimble from the posterior nares, although it
+had remained in its position for some time undetected. Eve reports a
+case in which a thimble was impacted in the right posterior nares.
+Gazdar speaks, of a case of persistent neuralgia of one-half of the
+face, caused by a foreign body in the nose.  The obstruction was
+removed after seven years' lodgment and the neuralgia disappeared.
+Molinier has an observation on the extraction of a fragment of a
+knife-blade which had rested four years in the nasal fossae, where the
+blade had broken off during a quarrel.
+
+A peculiar habit, sometimes seen in nervous individuals, is that of
+"swallowing the tongue." Cohen claims that in some cases of supposed
+laryngeal spasm the tongue is swallowed, occluding the larynx, and
+sometimes with fatal consequences. There are possibly a half score of
+cases recorded, but this anomaly is very rare, and Major is possibly
+the only one who has to a certainty demonstrated the fact by a
+laryngoscopic examination. By the laryngoscope he was enabled to
+observe a paroxysm in a woman, in which the tongue retracted and
+impinged on the epiglottis, but quickly recovered its position. Pettit
+mentions suffocation from "tongue swallowing," both with and without
+section of the frenum.  Schobinger cites a similar instance, due to
+loosening of the frenum.
+
+Analogous to the foregoing phenomenon is the habit of "tongue sucking."
+Morris mentions a young lady of fifteen who spontaneously dislocated
+her jaw, owing indirectly to this habit.  Morris says that from infancy
+the patient was addicted to this habit, which was so audible as to be
+heard in all parts of the room. The continued action of the pterygoid
+muscles had so preternaturally loosened the ligaments and muscular
+structures supporting the joint as to render them unable to resist the
+violent action of "tongue sucking" even during sleep.
+
+Injuries to the Tongue.--Hobbs describes a man of twenty-three who,
+while working, had a habit of protruding his tongue. One day he was hit
+under the chin by the chain of a crane on a pier, his upper teeth
+inflicting a wound two inches deep, three inches from the tip, and
+dividing the entire structure of the tongue except the arteries. The
+edges of the wound were brought into apposition by sutures, and after
+the removal of the latter perfect union and complete restoration of the
+sensation of taste ensued. Franck mentions regeneration of a severed
+tongue; and Van Wy has seen union of almost entirely severed parts of
+the tongue. De Fuisseaux reports reunion of the tongue by suture after
+almost complete transverse division.
+
+There is an account of a German soldier who, May 2, 1813, was wounded
+at the battle of Gross-Gorschen by a musket ball which penetrated the
+left cheek, carrying away the last four molars of the upper jaw and
+passing through the tongue, making exit on the left side, and forcing
+out several teeth of the left lower jaw.  To his surprise, thirty years
+afterward, one of the teeth was removed from an abscess of the tongue.
+Baker speaks of a boy of thirteen who was shot at three yards distance.
+The bullet knocked out two teeth and passed through the tongue,
+although it produced no wound of the pharynx, and was passed from the
+anus on the sixth day. Stevenson mentions a case of an organist who
+fell forward when stooping with a pipe in his mouth, driving its stem
+into the roof of the pharynx. He complained of a sore throat for
+several days, and, after explanation, Stevenson removed from the soft
+palate a piece of clay pipe nearly 1 1/4 inches long.  Herbert tells of
+a case resembling carcinoma of the tongue, which was really due to the
+lodgment of a piece of tooth in that organ.
+
+Articulation Without the Tongue.--Total or partial destruction of the
+tongue does not necessarily make articulation impossible.  Banon
+mentions a man who had nothing in his mouth representing a tongue. When
+he was young, he was attacked by an ulceration destroying every vestige
+of this member. The epiglottis, larynx, and pharynx, in fact the
+surrounding structures were normal, and articulation, which was at
+first lost, became fairly distinct, and deglutition was never
+interfered with. Pare gives a description of a man whose tongue was
+completely severed, in consequence of which he lost speech for three
+years, but was afterward able to make himself understood by an
+ingenious bit of mechanism. He inserted under the stump of the tongue a
+small piece of wood, in a most marvelous way replacing the missing
+member. Articulation with the absence of some constituent of the vocal
+apparatus has been spoken of on page 254.
+
+Hypertrophy of the Tongue.--It sometimes happens that the tongue is so
+large that it is rendered not only useless but a decided hindrance to
+the performance of the ordinary functions into which it always enters.
+Ehrlich, Ficker, Klein, Rodforffer, and the Ephemerides, all record
+instances in which a large tongue was removed either by ligation or
+amputation. Von Siebold records an instance in which death was caused
+by the ligature of an abnormally sized tongue. There is a modern record
+of three cases of enormous tongues, the result of simple hypertrophy.
+In one case the tongue measured 6 1/4 inches from the angle of the
+mouth about the sides and tip to the opposite angle, necessitating
+amputation of the protruding portion.
+
+Carnochan reports a case in which hypertrophy of the tongue was reduced
+to nearly the normal size by first tying the external carotid, and six
+weeks later the common carotid artery. Chalk mentions partial
+dislocation of the lower jaw from an enlarged tongue. Lyford speaks of
+enlargement of the tongue causing death.
+
+The above conditions are known as macroglossia, which is a congenital
+hypertrophy of the tongue analogous to elephantiasis.  It is of slow
+growth, and as the organ enlarges it interferes with deglutition and
+speech. It may protrude over the chin and reach even as far down as the
+sternum.
+
+The great enlargement may cause deformities of the teeth and lower jaw,
+and even present itself as an enormous tumor in the neck. The
+protruding tongue itself may ulcerate, possibly bleed, and there is
+constant dribbling of saliva. The disease is probably due to congenital
+defect aggravated by frequent attacks of glossitis, and the treatment
+consists in the removal of the protruding portions by the knife,
+ligation, the cautery, or ecraseur.
+
+Living Fish in the Pharynx.--Probably the most interesting cases of
+foreign bodies are those in which living fish enter the pharynx and
+esophagus. Chevers has collected five cases in which death was caused
+by living fish entering the mouth and occluding the air-passages. He
+has mentioned a case in which a large catfish jumped into the mouth of
+a Madras bheestie. An operation on the esophagus was immediately
+commenced, but abandoned, and an attempt made to push the fish down
+with a probang, which was, in a measure, successful. However, the
+patient gave a convulsive struggle, and, to all appearances, died. The
+trachea was immediately opened, and respiration was restored. During
+the course of the night the man vomited up pieces of fish bone softened
+by decomposition. In 1863 White mentions that the foregoing accident is
+not uncommon among the natives of India, who are in the habit of
+swimming with their mouths open in tanks abounding with fish. There is
+a case in which a fisherman, having both hands engaged in drawing a
+net, and seeing a sole-fish about eight inches long trying to escape
+through the meshes of the net, seized it with his teeth. A sudden
+convulsive effort of the fish enabled it to enter the fisherman's
+throat, and he was asphyxiated before his boat reached the shore. After
+death the fish was found in the cardiac end of the stomach. There is
+another case of a man named Durand, who held a mullet between his teeth
+while rebaiting his hook. The fish, in the convulsive struggles of
+death, slipped down the throat, and because of the arrangement of its
+scales it could be pushed down but not up; asphyxiation, however,
+ensued. Stewart has extensively described the case of a native
+"Puckally" of Ceylon who was the victim of the most distressing
+symptoms from the impaction of a living fish in his throat. The native
+had caught the fish, and in order to extract it placed its head between
+his teeth, holding the body with the left hand and the hook with the
+right. He had hardly extracted the hook, when the fish pricked his palm
+with his long and sharp dorsal fin, causing him suddenly to release his
+grasp on the fish and voluntarily open his mouth at the same time. The
+fish quickly bolted into his mouth, and, although he grasped the tail
+with his right hand, and squeezed his pharynx with his left, besides
+coughing violently, the fish found its way into the esophagus. Further
+attempts at extraction were dangerous and quite likely to fail; his
+symptoms were distressing, he could not hold his head erect without the
+most agonizing pain and he was almost prostrated from fright and
+asphyxia; it was thought advisable to push the fish into the stomach,
+and after an impaction of sixteen hours the symptoms were relieved. The
+fish in this instance was the Anabas scandens or "walking perch" of
+Ceylon, which derives its name from its power of locomotion on land and
+its ability to live out of water for some time. It is from four to five
+inches long and has a dorsal fin as sharp as a knife and directed
+toward the tail, and pectoral fins following the same direction; these
+would admit of entrance, but would interfere with extraction. MacLauren
+reports the history of a young man who, after catching a fish, placed
+it between his teeth. The fish, three inches long, by a sudden
+movement, entered the pharynx. Immediately ensued suffocation, nausea,
+vomiting, together with the expectoration of blood and mucus. There was
+emphysema of the face, neck, and chest. The fish could be easily felt
+impacted in the tissues, but, after swallowing much water and vinegar,
+together with other efforts at extraction, the fins were
+loosened--about twenty-four hours after the accident. By this time the
+emphysema had extended to the scrotum. There was much expectoration of
+muco-purulent fluid, and on the third day complete aphonia, but the
+symptoms gradually disappeared, and recovery was complete in eight
+days. Dantra is accredited with describing asphyxiation, accompanied by
+great agony, in a man who, while swimming, had partially swallowed a
+live fish. The fish was about three inches in length and one in
+breadth, and was found lying on the dorsum of his tongue and, together
+with numerous clots of blood, filled his mouth. Futile attempts to
+extract the fish by forceps were made. Examination showed that the fish
+had firmly grasped the patient's uvula, which it was induced to
+relinquish when its head was seized by the forceps and pressed from
+side to side. After this it was easily extracted and lived for some
+time. There was little hemorrhage after the removal of the offending
+object, and the blood had evidently come from the injuries to the sides
+of the mouth, caused by the fins.  The uvula was bitten, not torn.
+There is an interesting account of a native of India, who, while
+fishing in a stream, caught a flat eel-like fish from fifteen to
+sixteen inches long. After the fashion of his fellows he attempted to
+kill the eel by biting off its head; in the attempt the fish slipped
+into his gullet, and owing to its sharp fins could not be withdrawn.
+The man died one hour later in the greatest agony; so firmly was the
+eel impacted that even after death it could not be extracted, and the
+man was buried with it protruding from his mouth.
+
+A Leech in the Pharynx.--Granger, a surgeon in Her Majesty's Indian
+Service, writes:--"Several days ago I received a note from the
+political sirdar, asking me if I would see a man who said he had a
+leech in his throat which he was unable to get rid of. I was somewhat
+sceptical, and thought that possibly the man might be laboring under a
+delusion. On going outside the fort to see the case, I found an old
+Pathan graybeard waiting for me. On seeing me, he at once spat out a
+large quantity of dark, half-clotted blood to assure me of the serious
+nature of his complaint. His history--mostly made out with the aid of
+interpreters--was that eleven days ago he was drinking from a
+rain-water tank and felt something stick in his throat, which he could
+not reject. He felt this thing moving, and it caused difficulty in
+swallowing, and occasionally vomiting. On the following day he began to
+spit up blood, and this continued until he saw me. He stated that he
+once vomited blood, and that he frequently felt that he was going to
+choke.
+
+"On examining his throat, a large clot of blood was found to be
+adherent to the posterior wall of the pharynx. On removing this clot of
+blood, no signs of the presence of a leech could be detected. However,
+on account of the symptoms complained of by the patient I introduced a
+polypus forceps into the lower part of the pharynx and toward the
+esophagus, where a body, distinctly moving, was felt. This body I
+seized with the forceps, and with considerable force managed to remove
+it. It was a leech between 2 1/2 and three inches in length, and with a
+body of the size of a Lee-Metford bullet. No doubt during the eleven
+days it had remained in the man's throat the leech had increased in
+size.  Nevertheless it must have been an animal of considerable size
+when the man attempted to swallow it. I send this case as a typical
+example of the carelessness of natives of the class from which we
+enlist our Sepoys, as to the nature of the water they drink. This man
+had drunk the pea-soup like water of a tank dug in the side of the
+hill, rather than go a few hundred yards to a spring where the water is
+perfectly clear and pure. Though I have not met with another case of
+leeches being taken with drinking water, I am assured that such cases
+are occasionally met with about Agra and other towns in the North-West
+Provinces. This great carelessness as to the purity or impurity of
+their drinking water shows the difficulty medical officers must
+experience in their endeavors to prevent the Sepoys of a regiment from
+drinking water from condemned or doubtful sources during a cholera or
+typhoid epidemic."
+
+Foreign Bodies in the Pharynx and Esophagus.--Aylesbury mentions a boy
+who swallowed a fish-hook while eating gooseberries. He tried to pull
+it up, but it was firmly fastened, and a surgeon was called. By
+ingeniously passing a leaden bullet along the line, the weight of the
+lead loosened the hook, and both bullet and hook were easily drawn up.
+Babbit and Battle report an ingenious method of removing a piece of
+meat occluding the esophagus--the application of trypsin. Henry speaks
+of a German officer who accidentally swallowed a piece of beer bottle,
+3/8 x 1/8 inch, which subsequently penetrated the esophagus, and in its
+course irritated the recurrent laryngeal and vagi, giving rise to the
+most serious phlegmonous inflammation and distressing respiratory
+symptoms. A peculiar case is that of the man who died after a fire at
+the Eddystone Lighthouse. He was endeavoring to extinguish the flames
+which were at a considerable distance above his head, and was looking
+up with his mouth open, when the lead of a melting lantern dropped down
+in such quantities as not only to cover his face and enter his mouth,
+but run over his clothes.  The esophagus and tunica in the lower part
+of the stomach were burned, and a great piece of lead, weighing over 7
+1/2 ounces, was taken from the stomach after death.
+
+Evans relates the history of a girl of twenty-one who swallowed four
+artificial teeth, together with their gold plate; two years and eight
+days afterward she ejected them after a violent attack of retching.
+Gauthier speaks of a young girl who, while eating soup, swallowed a
+fragment of bone. For a long time she had symptoms simulating phthisis,
+but fourteen years afterward the bone was dislodged, and, although the
+young woman was considered in the last stages of phthisis, she
+completely recovered in six weeks. Gastellier has reported the case of
+a young man of sixteen who swallowed a crown piece, which became lodged
+in the middle portion of the esophagus and could not be removed. For
+ten months the piece of money remained in this position, during which
+the young man was never without acute pain and often had convulsions.
+He vomited material, sometimes alimentary, sometimes mucus, pus, or
+blood, and went into the last stage of marasmus. At last, after this
+long-continued suffering, following a strong convulsion and syncope,
+the coin descended to the stomach, and the young man expectorated great
+quantities of pus. After thirty-five years, the coin had not been
+passed by the rectum.
+
+Instances of migration of foreign bodies from the esophagus are
+repeatedly recorded. There is an instance of a needle which was
+swallowed and lodged in the esophagus, but twenty-one months afterward
+was extracted by an incision at a point behind the right ear. Kerckring
+speaks of a girl who swallowed a needle which was ultimately extracted
+from the muscles of her neck.  Poulet remarks that Vigla has collected
+the most interesting of these cases of migration of foreign bodies.
+Hevin mentions several cases of grains of wheat abstracted from
+abscesses of the thoracic parietes, from thirteen to fifteen days after
+ingestion.  Bonnet and Helmontius have reported similar facts.
+Volgnarius has seen a grain of wheat make its exit from the axilla, and
+Polisius mentions an abscess of the back from which was extracted a
+grain of wheat three months after ingestion. Bally reports a somewhat
+similar instance, in which, three months after ingestion, during an
+attack of peripneumonia, a foreign body was extracted from an abscess
+of the thorax, between the 2d and 3d ribs. Ambrose found a needle
+encysted in the heart of a negress. She distinctly stated that she had
+swallowed it at a time calculated to have been nine years before her
+death. Planque speaks of a small bone perforating the esophagus and
+extracted through the skin.
+
+Abscess or ulceration, consequent upon periesophagitis, caused by the
+lodgment of foreign bodies in the esophagus, often leads to the most
+serious results. There is an instance of a soldier who swallowed a bone
+while eating soup, who died on the thirty-first day from the rupture
+internally of an esophageal abscess.  Grellois has reported the history
+of a case of a child twenty-two months old, who suffered for some time
+with impaction of a small bone in the esophagus. Less than three months
+afterward the patient died with all the symptoms of marasmus, due to
+difficult deglutition, and at the autopsy an abscess was seen in the
+posterior wall of the pharynx, opposite the 3d cervical vertebra;
+extensive caries was also noticed in the bodies of the 2d, 3d, and 4th
+cervical vertebrae. Guattani mentions a curious instance in which a man
+playing with a chestnut threw it in the air, catching it in his mouth.
+The chestnut became lodged in the throat and caused death on the
+nineteenth day. At the autopsy it was found that an abscess
+communicating with the trachea had been formed in the pharynx and
+esophagus.
+
+A peculiarly fatal accident in this connection is that in which a
+foreign body in the esophagus ulcerates, and penetrates one of the
+neighboring major vessels. Colles mentions a man of fifty-six who,
+while eating, perceived a sensation as of a rent in the chest. The pain
+was augmented during deglutition, and almost immediately afterward he
+commenced to expectorate great quantities of blood. On the following
+day he vomited a bone about an inch long and died on the same day. At
+the autopsy it was found that there was a rent in the posterior wall of
+the esophagus, about 1/2 inch long, and a corresponding wound of the
+aorta. There was blood in the pleura, pericardium, stomach, and
+intestines. There is one case in which a man of forty-seven suddenly
+died, after vomiting blood, and at the autopsy it was demonstrated that
+a needle had perforated the posterior wall of the esophagus and wounded
+the aorta. Poulet has collected 31 cases in which ulceration caused by
+foreign bodies in the esophagus has resulted in perforation of the
+walls of some of the neighboring vessels. The order of frequency was as
+follows: aorta, 17; carotids, four; vena cava, two; and one case each
+of perforation of the inferior thyroid artery, right coronary vein,
+demi-azygos vein, the right subclavicular artery (abnormal), and the
+esophageal artery. In three of the cases collected there was no autopsy
+and the vessel affected was not known.
+
+In a child of three years that had swallowed a half-penny, Atkins
+reports rupture of the innominate artery. No symptoms developed, but
+six weeks later, the child had an attack of ulcerative stomatitis, from
+which it seemed to be recovering nicely, when suddenly it ejected two
+ounces of bright red blood in clots, and became collapsed out of
+proportion to the loss of blood. Under treatment, it rallied somewhat,
+but soon afterward it ejected four ounces more of blood and died in a
+few minutes. At the autopsy 3/4 pint of blood was found in the stomach,
+and a perforation was discovered on the right side of the esophagus,
+leading into a cavity, in which a blackened half-penny was found.  A
+probe passed along the aorta into the innominate protruded into the
+same cavity about the bifurcation of the vessel.
+
+Denonvilliers has described a perforation of the esophagus and aorta by
+a five-franc piece. A preserved preparation of this case, showing the
+coin in situ, is in the Musee Dupuytren.  Blaxland relates the instance
+of a woman of forty-five who swallowed a fish bone, was seized with
+violent hematemesis, and died in eight hours. The necropsy revealed a
+penetration of the aorta through the thoracic portion of the esophagus.
+There is also in the Musee Dupuytren a preparation described by
+Bousquet, in which the aorta and the esophagus were perforated by a
+very irregular piece of bone. Mackenzie mentions an instance of death
+from perforation of the aorta by a fish-bone.
+
+In some cases penetration of the esophagus allows the further
+penetration of some neighboring membrane or organ in the same manner as
+the foregoing cases. Dudley mentions a case in which fatal hemorrhage
+was caused by penetration of the esophagus and lung by a chicken-bone.
+Buist speaks of a patient who swallowed two artificial teeth. On the
+following day there was pain in the epigastrium, and by the fourth day
+the pain extended to the vertebrae, with vomiting, delirium, and death
+on the fifth day.  At the autopsy it was found that a foreign body,
+seven cm. long had perforated the pericardium, causing a suppurative
+pericarditis. Dagron reports a unique instance of death by purulent
+infection arising from perforation of the esophagus by a pin. The
+patient was a man of forty-two, and, some six weeks before he presented
+himself for treatment, before swallowing had experienced a severe pain
+low down in the neck. Five days before admission he had had a severe
+chill, followed by sweating and delirium. He died of a supraclavicular
+abscess on the fifth day; a black steel pin was found against the
+esophagus and trachea.
+
+In connection with foreign bodies in the esophagus, it might be
+interesting to remark that Ashhurst has collected 129 cases of
+esophagotomy for the removal of foreign bodies, resulting in 95
+recoveries and 34 deaths. Gaudolphe collected 142 cases with 110
+recoveries.
+
+Injuries of the neck are usually inflicted with suicidal intent or in
+battle. Cornelius Nepos says that while fighting against the
+Lacedemonians, Epaminondas was sensible of having received a mortal
+wound, and apprehending that the lance was stopping a wound in an
+important vessel, remarked that he would die when it was withdrawn.
+When he was told that the Boeotians had conquered, exclaiming "I die
+unconquered," he drew out the lance and perished. Petrus de Largenta
+speaks of a man with an arrow in one of his carotids, who was but
+slightly affected before its extraction, but who died immediately after
+the removal of the arrow. Among the remarkable recoveries from injuries
+of the neck is that mentioned by Boerhaave, of a young man who lived
+nine or ten days after receiving a sword-thrust through the neck
+between the 4th and 5th vertebrae, dividing the vertebral artery.
+Benedictus, Bonacursius, and Monroe, all mention recovery after cases
+of cut-throat in which the esophagus as well as the trachea was
+wounded, and food protruded from the external cut. Warren relates the
+history of a case in which the vertebral artery was wounded by the
+discharge of a pistol loaded with pebbles. The hemorrhage was checked
+by compression and packing, and after the discharge of a pebble and a
+piece of bone from the wound, the man was seen a month afterward in
+perfect health. Corson of Norristown, Pa., has reported the case of a
+quarryman who was stabbed in the neck with a shoemaker's knife,
+severing the left carotid one inch below its division. He was seen
+thirty minutes later in an apparently lifeless condition, but efforts
+at resuscitation were successfully made. The hemorrhage ceased
+spontaneously, and at the time of report, the man presented the
+symptoms of one who had had his carotid ligated (facial atrophy on one
+side, no pulse, etc.). Baron Larrey mentions a case of gunshot wound in
+which the carotid artery was open at its division into internal and
+external branches, and says that the wound was plugged by an
+artilleryman until ligation, and in this primitive manner the patient
+was saved. Sale reports the case of a girl of nineteen, who fell on a
+china bowl that she had shattered, and wounded both the right common
+carotid artery and internal jugular vein. There was profuse and
+continuous hemorrhage for a time, and subsequently a false aneurysm
+developed, which ruptured in about three months, giving rise to
+enormous momentary hemorrhage; notwithstanding the severity of the
+injury and the extent of the hemorrhage, complete recovery ensued. Amos
+relates the instance of a woman named Mary Green who, after complete
+division of all the vessels of the neck, walked 23 yards and climbed
+over an ordinary bar-gate nearly four feet high.
+
+Cholmeley reports the instance of a Captain of the First Madras
+Fusileers, who was wounded at Pegu by a musket-ball penetrating his
+neck. The common carotid was divided and for five minutes there was
+profuse hemorrhage which, however, strange to say, spontaneously
+ceased. The patient died in thirty-eight hours, supposedly from spinal
+concussion or shock.
+
+Relative to ligature of the common carotid artery, Ashhurst mentions
+the fact that the artery has been ligated in 228 instances, with 94
+recoveries. Ellis mentions ligature of both carotids in four and a half
+days, as a treatment for a gunshot wound, with subsequent recovery.
+Lewtas reports a case of ligation of the innominate and carotid
+arteries for traumatic aneurysm (likely a hematoma due to a gunshot
+injury of the subclavian artery). The patient was in profound collapse,
+but steadily reacted and was discharged cured on the forty-fifth day,
+with no perceptible pulse at the wrist and only a feeble beat in the
+pulmonary artery.
+
+Garengeot, Wirth, Fine, and Evers, all mention perforating wounds of
+the trachea and esophagus with recoveries. Van Swieten and Hiester
+mention cases in which part of the trachea was carried away by a ball,
+with recovery. Monro, Tulpius, Bartholinus, and Pare report severance
+of the trachea with the absence of oral breathing, in which the divided
+portions were sutured, with successful results. In his "Theatro
+Naturae," Bodinus says that William, Prince of Orange, lost the sense
+of taste after receiving a wound of the larynx; according to an old
+authority, a French soldier became mute after a similar accident.
+Davies-Colley mentions a boy of eighteen who fell on a stick about the
+thickness of the index finger, transfixing his neck from right to left;
+he walked to a doctor's house, 250 yards away, with the stick in situ.
+In about two weeks he was discharged completely well. During treatment
+he had no hemorrhage of any importance, and his voice was not affected,
+but for a while he had slight dysphagia.
+
+Barker gives a full account of a barber who was admitted to a hospital
+two and a half hours after cutting his throat. He had a deep wound
+running transversely across the neck, from one angle of the jaw to the
+other, cutting open the floor of the mouth and extending from the inner
+border of the sternocleido-mastoid to the other, leaving the large
+vessels of the neck untouched. The razor had passed through the
+glosso-epiglottidean fold, a tip of the epiglottis, and through the
+pharynx down to the spinal column. There was little hemorrhage, but the
+man could neither swallow nor speak. The wound was sutured, tracheotomy
+done, and the head kept fixed on the chest by a copper splint. He was
+ingeniously fed by esophageal tubes and rectal enemata; in three weeks
+speech and deglutition were restored. Shortly afterward the esophageal
+tube was removed and recovery was virtually complete.  Little mentions
+an extraordinary case of a woman of thirty-six who was discharged from
+Garland's asylum, where she had been an inmate for three months. This
+unfortunate woman had attempted suicide by self-decapitation from
+behind forward. She was found, knife in hand, with a huge wound in the
+back of the neck and her head bobbing about in a ghastly manner. The
+incision had severed the skin, subcutaneous tissues and muscles, the
+ligaments and bone, opening the spinal canal, but not cutting the cord.
+The instrument used to effect this major injury was a blunt
+potato-peeling knife. Despite this terrible wound the patient lived to
+the sixth day.
+
+Hislop records a case of cut-throat in a man of seventy-four. He had a
+huge gaping wound of the neck, extending to within a half inch of the
+carotids on each side. The trachea was almost completely severed, the
+band left was not more than 1/4 inch wide. Hislop tied four arteries,
+brought the ends of the trachea together with four strong silk sutures,
+and, as the operation was in the country, he washed the big cavity of
+the wound out with cold spring-water. He brought the superficial
+surfaces together with ten interrupted sutures, and, notwithstanding
+the patient's age, the man speedily recovered. This emphasizes the fact
+that the old theory of leaving wounds of this nature open was
+erroneous. Solly reports the case of a tailor of twenty-two who
+attempted suicide by cutting through the larynx, entirely severing the
+epiglottis and three-fourths of the pharynx. No bleeding point was
+found, and recovery ensued.
+
+Cowles describes the case of a soldier of thirty-five who, while
+escaping from the patrols, was shot by the Officer of the Day with a
+small bullet from a pistol. The ball entered the right shoulder,
+immediately over the suprascapular notch, passed superficially upward
+and forward into the neck, wounding the esophagus posteriorly at a
+point opposite the thyroid cartilage, and lodged in the left side of
+the neck. The patient had little hemorrhage, but had expectorated and
+swallowed much blood. He had a constant desire to swallow, which
+continued several days. The treatment was expectant; and in less than
+three weeks the soldier was returned to duty. From the same authority
+there is a condensation of five reports of gunshot wounds of the neck,
+from all of which the patients recovered and returned to duty.
+
+Braman describes the case of a man on whom several injuries were
+inflicted by a drunken companion. The first wound was slight; the
+second a deep flesh-wound over the trapezius muscle; the third extended
+from the right sterno-cleido-mastoid midway upward to the middle of the
+jaw and down to the rapine of the trachea. The external jugular, the
+external thyroid, and the facial arteries were severed. Braman did not
+find it necessary to ligate, but was able to check the hemorrhage with
+lint and persulphate of iron, in powder, with pressure. After fourteen
+hours the wound was closed; the patient recovered, and was returned to
+duty in a short time.
+
+Thomas has reported the case of a man sixty-five years old who in an
+attempt at suicide with a penknife, had made a deep wound in the left
+side of the neck. The sternohyoid and omohyoid muscles were divided;
+the internal jugular vein was cut through, and its cut ends were
+collapsed and 3/4 inch apart; the common carotid artery was cut into,
+but not divided; the thyroid cartilage was notched, and the external
+and anterior jugular veins were severed. Clamp-forceps were immediately
+applied to the cut vessels and one on each side the aperture in the
+common carotid from which a small spurt of blood, certainly not half a
+teaspoonful, came out. The left median basilic vein was exposed by an
+incision, and 20 ounces of warm saline solution were slowly perfused,
+an ordinary glass syringe with a capacity of five ounces, with an
+India-rubber tubing attached to a canula in the vein being employed.
+After seven ounces of fluid had been injected, the man made a short,
+distinct inspiration; at ten ounces a deeper one (the radial pulse
+could now be felt beating feebly); at 15 ounces the breathing became
+regular and deep; at 18 ounces the man opened his eyes, but did not
+appear to be conscious. The clamped vessels were now tied with catgut
+and the wound cleansed with phenol lotion and dressed with
+cyanid-gauze.  The man was surrounded by hot-water bottles and the foot
+of the bed elevated 18 inches. In the course of an hour the patient had
+recovered sufficiently to answer in a squeaky voice to his name when
+called loudly. Improvement proceeded rapidly until the twenty-second
+day, when violent hemorrhage occurred, preceded a few hours previously
+by a small trickle, easily controlled by pressure. The wound was at
+once opened and blood found oozing from the distal extremities of the
+carotid artery and jugular vein, which were promptly clamped. The
+common carotid artery was not sound, so that ligatures were applied to
+the internal and external carotids and to the internal jugular with a
+small branch entering into it. The patient was in great collapse, but
+quickly rallied, only to suffer renewed hemorrhage from the internal
+carotid nine days later. This was controlled by pressure with sponges,
+and a quart of hot water was injected into the rectum.  From this time
+on the patient made a slow recovery, a small sinus in the lower part of
+the neck disappearing on the removal of the catgut ligature.
+
+Adams describes the case of a woman who attempted suicide with a common
+table-knife, severing the thyroid, cricoid, and first three rings of
+the trachea, and lacerating the sternohyoid and thyroid arteries; she
+finally recovered.
+
+There is a curious case of suicide of a woman who, while under the
+effects of opium, forced the handle of a mirror into her mouth. From
+all appearances, the handle had broken off near the junction and she
+had evidently fallen forward with the remaining part in her mouth,
+driving it forcibly against the spine, and causing the point of the
+handle to run downward in front of the cervical vertebrae. On
+postmortem examination, a sharp piece of wood about two inches long,
+corresponding to the missing portion of the broken mirror handle, was
+found lying between the posterior wall of the esophagus and the spine.
+Hennig mentions a case of gunshot wound of the neck in which the musket
+ball was lodged in the posterior portion of the neck and was
+subsequently discharged by the anus.
+
+Injuries of the cervical vertebrae, while extremely grave, and declared
+by some authors to be inevitably fatal, are, however, not always
+followed by death or permanently bad results. Barwell mentions a man of
+sixty-three who, in a fit of despondency, threw himself from a window,
+having fastened a rope to his neck and to the window-sill. He fell 11
+or 12 feet, and in doing so suffered a subluxation of the 4th cervical
+vertebra. It slowly resumed the normal position by the elasticity of
+the intervertebral fibrocartilage, and there was complete recovery in
+ten days.  Lazzaretto reports the history of the case of a seaman whose
+atlas was dislocated by a blow from a falling sail-yard. The
+dislocation was reduced and held by adhesive strips, and the man made a
+good recovery. Vanderpool of Bellevue Hospital, N.Y., describes a
+fracture of the odontoid process caused by a fall on the back of the
+head; death, however, did not ensue until six months later. According
+to Ashhurst, Philips, the elder Cline, Willard Parker, Bayard, Stephen
+Smith, May, and several other surgeons, have recorded complete recovery
+after fracture of the atlas and axis. The same author also adds that
+statistic investigation shows that as large a proportion as 18 per cent
+of injuries of the cervical vertebrae occurring in civil practice,
+recover. However, the chances of a fatal issue in injuries of the
+vertebrae vary inversely with the distance of the point of injury from
+the brain. Keen has recorded a case in which a conoidal ball lodged in
+the body of the third cervical vertebra, from which it was extracted
+six weeks later. The paralysis, which, up to the time of extraction,
+had affected all four limbs, rapidly diminished. In about five weeks
+after the removal of the bullet nearly the entire body of the 3d
+cervical vertebra, including the anterior half of the transverse
+process and vertebral foremen, was spontaneously discharged. Nearly
+eight years afterward Keen saw the man still living, but with his right
+shoulder and arm diminished in size and partly paralyzed.
+
+Doyle reports a case of dislocated neck with recovery. During a runaway
+the patient was thrown from his wagon, and was soon after found on the
+roadside apparently dead. Physicians who were quickly summoned from the
+immediate neighborhood detected faint signs of life; they also found a
+deformity of the neck, which led them to suspect dislocation. An
+ambulance was called, and without any effort being made to relieve the
+deformity the man was placed in it and driven to his home about a mile
+distant. The jolting over the rough roads greatly aggravated his
+condition. When Doyle saw the patient, his general appearance presented
+a hopeless condition, but being satisfied that a dislocation existed,
+Doyle immediately prepared to reduce it. Two men were told to grasp the
+feet and two more the head, and were directed to make careful but
+strong extension. At the same time the physician placed his right hand
+against the neck just over the pomum Adami, and his left against the
+occiput, and, while extension was being made, he flexed the head
+forward until the chin nearly touched the breast, after which the head
+was returned to its normal position. The manipulation was accompanied
+by a clicking sensation, caused by the replacement of the dislocated
+vertebra. The patient immediately showed signs of relief and improved
+rapidly.  Perceptible but feeble movements were made by all the limbs
+except the right arm. The patient remained in a comatose condition for
+eight or nine days, during which he had enuresis and intestinal torpor.
+He suffered from severe concussion of the brain, which accounted for
+his prolonged coma. Delirium was present, but he was carefully watched
+and not allowed to injure himself. His recovery was tedious and was
+delayed by several relapses. His first complaint after consciousness
+returned (on the tenth day) was of a sense of constriction about the
+neck, us if he were being choked. This gradually passed off, and his
+improvement went on without development of any serious symptoms.  At
+the time of report he appeared in the best of health and was quite able
+to attend to his daily avocations. Doyle appends to his report the
+statement that among 394 cases embraced in Ashhurst's statistics, in
+treatment of dislocations in the cervical region, the mortality has
+been nearly four times greater when constitutional or general treatment
+has been relied on exclusively than when attempts had been made to
+reduce the dislocation by extension, rotation, etc. Doyle strongly
+advocates attempts at reduction in such cases.
+
+Figure 205 represents a photograph of Barney Baldwin, a switchman of
+the Louisville and Nashville Railroad, who, after recovery from
+cervical dislocation, exhibited himself about the country, never
+appearing without his suspensory apparatus.
+
+Acheson records a case of luxation of the cervical spine with recovery
+after the use of a jury-mast. The patient was a man of fifty-five, by
+trade a train-conductor. On July 10, 1889, he fell backward in front of
+a train, his head striking between the ties; the brake-body caught his
+body, pushing it forward on his head, and turned him completely over.
+Three trucks passed over him.  When dragged from beneath the train, his
+upper extremities were paralyzed. At noon the next day, nineteen hours
+after the accident, examination revealed bruises over the body, and he
+suffered intense pain at the back of the neck and base of the skull.
+Posteriorly, the neck presented a natural appearance; but anteriorly,
+to use the author's description, his neck resembled a combined case of
+mumps and goiter. The sternomastoid muscle bulged at the angle of the
+jaw, and was flaccid, and his "Adam's apple" was on a level with the
+chin. Sensation in the upper extremities was partially restored, and,
+although numb, he now had power of movement in the arms and hands, but
+could not rotate his neck. A diagnosis of cervical dislocation was
+made, and violent extension, with oscillation forward and backward, was
+practiced, and the abnormal appearance subsided at once. No crepitus
+was noticed. On the fourth day there was slight hemorrhage from the
+mouth, which was more severe on the fifth and sixth days. The lower jaw
+had been forced past the upper, until the first molar had penetrated
+the tissues beneath the tongue. A plaster-of-Paris apparatus was
+applied, and in two months was exchanged for one of sole-leather. In
+rising from the recumbent position the man had to lift his head with
+his hands. Fifty days after the accident he suffered excruciating pain
+at the change of the weather, and at the approach of a storm the
+joints, as well as the neck, were involved. It was believed (one
+hundred and seven days after the accident) that both fracture and
+luxation existed. His voice had become guttural, but examination of the
+fauces was negative. The only evidence of paralysis was in the fingers,
+which, when applied to anything, experienced the sensation of touching
+gravel. The mottling of the tissues of the neck, which appeared about
+the fiftieth day, had entirely disappeared.
+
+According to Thorburn, Hilton had a patient who lived fourteen years
+with paraplegia due to fracture of the 5th, 6th, and 7th cervical
+vertebrae. Shaw is accredited with a case in which the patient lived
+fifteen months, the fracture being above the 4th cervical vertebra.
+
+In speaking of foreign bodies in the larynx and trachea, the first to
+be considered will be liquids. There is a case on record of an infant
+who was eating some coal, and being discovered by its mother was forced
+to rapidly swallow some water. In the excitement, part of the fluid
+swallowed fell into the trachea, and death rapidly ensued. It is hardly
+necessary to mention the instances in which pus or blood from ruptured
+abscesses entered the trachea and caused subsequent asphyxiation. A
+curious instance is reported by Gaujot of Val-de-Grace of a soldier who
+was wounded in the Franco-Prussian war, and into whose wound an
+injection of the tincture of iodin was made. The wound was of such an
+extent as to communicate with a bronchus, and by this means the iodin
+entered the respiratory tract, causing suffocation. According to
+Poulet, Vidal de Cassis mentions an inmate of the Charite Hospital, in
+Paris, who, full of wine, had started to vomit; he perceived Corvisart,
+and knew he would be questioned, therefore he quickly closed his mouth
+to hide the proofs of his forbidden ingestion. The materials in his
+mouth were forced into the larynx, and he was immediately asphyxiated.
+Laennec, Merat, and many other writers have mentioned death caused by
+the entrance of vomited materials into the air-passages. Parrot has
+observed a child who died by the penetration of chyme into the
+air-passages. The bronchial mucous and underlying membrane were already
+in a process of digestion.  Behrend, Piegu, and others cite analogous
+instances.
+
+The presence of a foreign body in the larynx is at all times the cause
+of distressing symptoms, and, sometimes, a substance of the smallest
+size will cause death. There is a curious accident recorded that
+happened to a young man of twenty-three, who was anesthetized in order
+to extract a tooth. A cork had been placed between the teeth to keep
+the mouth open. The tooth was extracted but slipped from the forceps,
+and, together with the cork, fell into the pharynx. The tooth was
+ejected in an effort at vomiting, but the cork entered the larynx, and,
+after violent struggles, asphyxiation caused death in an hour. The
+autopsy demonstrated the presence of the cork in the larynx. A somewhat
+analogous case, though not ending fatally, was reported by Hertz of a
+woman of twenty-six, who was anesthetized for the extraction of the
+right second inferior molar. The crown broke off during the operation,
+and immediately after the extraction she had a fit of coughing. About
+fifteen days later she experienced pain in the lungs. Her symptoms
+increased to the fifth week, when she became so feeble as to be
+confined to her bed. A body seemed to be moving in the trachea,
+synchronously with respiration. At the end of the fifth week the
+missing crown of the tooth was expelled after a violent fit of
+coughing; the symptoms immediately ameliorated, and recovery was rapid
+thereafter. Aronsohn speaks of a child who was playing with a toy
+wind-instrument, and in his efforts to forcibly aspirate air through
+it, the child drew the detached reed into the respiratory passages,
+causing asphyxiation. At the autopsy the foreign body was found at the
+superior portion of the left bronchus. There are other cases in which,
+while sucking oranges or lemons, seeds have been aspirated; and there
+is a case in which, in a like manner, the claw of a crab was drawn into
+the air-passages. There are two cases mentioned in which children
+playing with toy balloons, which they inflated with their breath, have,
+by inspiration, reversed them and drawn the rubber of the balloon into
+the opening of the glottis, causing death. Aronsohn, who has already
+been quoted, and whose collection of instances of this nature is
+probably the most extensive, speaks of a child in the street who was
+eating an almond; a carriage threw the child down and he suddenly
+inspired the nut into the air-passages, causing immediate asphyxia The
+same author also mentions a soldier walking in the street eating a
+plum, who, on being struck by a horse, suddenly started and swallowed
+the seed of the fruit.  After the accident he had little pain or
+oppression, and no coughing, but twelve hours afterward he rejected the
+seed in coughing.
+
+A curious accident is that in which a foreign body thrown into the air
+and caught in the mouth has caused immediate asphyxiation. Suetonius
+transmits the history of a young man, a son of the Emperor Claudius,
+who, in sport, threw a small pear into the air and caught it in his
+mouth, and, as a consequence, was suffocated. Guattani cites a similar
+instance of a man who threw up a chestnut, which, on being received in
+the mouth, lodged in the air-passages; the man died on the nineteenth
+day.  Brodie reported the classic observation of the celebrated
+engineer, Brunel, who swallowed a piece of money thrown into the air
+and caught in his mouth. It fell into the open larynx, was inspired,
+causing asphyxiation, but was removed by inversion of the man's body.
+
+Sennert says that Pope Adrian IV died from the entrance of a fly into
+his respiratory passages; and Remy and Gautier record instances of the
+penetration of small fish into the trachea.  There are, again,
+instances of leeches in this location.
+
+Occasionally the impaction of artificial teeth in the neighborhood of
+the larynx has been unrecognized for many years.  Lennox Browne reports
+the history of a woman who was supposed to have either laryngeal
+carcinoma or phthisis, but in whom he found, impacted in the larynx, a
+plate with artificial teeth attached, which had remained in this
+position twenty-two months unrecognized and unknown. The patient, when
+questioned, remembered having been awakened in the night by a violent
+attack of vomiting, and finding her teeth were missing assumed they
+were thrown away with the ejections. From that time on she had suffered
+pain and distress in breathing and swallowing, and became the subject
+of progressive emaciation. After the removal of the impacted plate and
+teeth she soon regained her health.  Paget speaks of a gentleman who
+for three months, unconsciously, carried at the base of the tongue and
+epiglottis, very closely fitted to all the surface on which it rested,
+a full set of lost teeth and gold palate-plate. From the symptoms and
+history it was suspected that he had swallowed his set of false teeth,
+but, in order to prevent his worrying, he was never informed of this
+suspicion, and he never once suspected the causes of his symptoms.
+
+Wrench mentions a case illustrative of the extent to which imagination
+may produce symptoms simulating those ordinarily caused by the
+swallowing of false teeth. This man awoke one morning with his nose and
+throat full of blood, and noticed that his false teeth, which he seldom
+removed at night, were missing.  He rapidly developed great pain and
+tumor in the larynx, together with difficulty in deglutition and
+speech. After a fruitless search, with instrumental and laryngoscopic
+aid, the missing teeth were found--in a chest of drawers; the symptoms
+immediately subsided when the mental illusion was relieved.
+
+There is a curious case of a man drowned near Portsmouth. After the
+recovery of his body it was seen that his false teeth were impacted at
+the anterior opening of the glottis, and it was presumed that the shock
+caused by the plunge into the cold water had induced a violent and deep
+inspiration which carried the teeth to the place of impaction.
+
+Perrin reports a case of an old man of eighty-two who lost his life
+from the impaction of a small piece of meat in the trachea and glottis.
+In the Musee Valde-Grace is a prepared specimen of this case showing
+the foreign body in situ. In the same museum Perrin has also deposited
+a preparation from the body of a man of sixty-two, who died from the
+entrance of a morsel of beef into the respiratory passages. At the
+postmortem a mobile mass of food about the size of a hazel-nut was
+found at the base of the larynx at the glossoepiglottic fossa. About
+the 5th ring of the trachea the caliber of this organ was obstructed by
+a cylindric alimentary bolus about six inches long, extending almost to
+the bronchial division. Ashhurst shows a fibrinous cast, similar to
+that found in croup, caused by a foreign body removed by Wharton,
+together with a shawl-pin, from a patient at the Children's Hospital
+seven hours after the performance of tracheotomy. Search for the
+foreign body at the time of the operation was prevented by profuse
+hemorrhage.
+
+The ordinary instances of foreign bodies in the larynx and trachea are
+so common that they will not be mentioned here. Their variety is
+innumerable and it is quite possible for more than two to be in the
+same location simultaneously. In his treatise on this subject Gross
+says that he has seen two, three, and even four substances
+simultaneously or successively penetrate the same location. Berard
+presented a stick of wood extracted from the vocal cords of a child of
+ten, and a few other similar instances are recorded.
+
+The Medical Press and Circular finds in an Indian contemporary some
+curious instances of misapplied ingenuity on the part of certain
+habitual criminals in that country. The discovery on a prisoner of a
+heavy leaden bullet about 3/4 inch in diameter led to an inquiry as to
+the object to which it was applied. It was ascertained that it served
+to aid in the formation of a pouch-like recess at the base of the
+epiglottis. The ball is allowed to slide down to the desired position,
+and it is retained there for about half an hour at a time. This
+operation is repeated many times daily until a pouch the desired size
+results, in which criminals contrive to secrete jewels, money, etc., in
+such a way as to defy the most careful search, and without interfering
+in any way with speech or respiration. Upward of 20 prisoners at
+Calcutta were found to be provided with this pouch-formation. The
+resources of the professional malingerer are exceedingly varied, and
+testify to no small amount of cunning.  The taking of internal
+irritants is very common, but would-be in-patients very frequently
+overshoot the mark and render recovery impossible. Castor-oil seeds,
+croton beans, and sundry other agents are employed with this object in
+view, and the medical officers of Indian prisons have to be continually
+on the lookout for artificially induced diseases that baffle diagnosis
+and resist treatment. Army surgeons are not altogether unfamiliar with
+these tricks, but compared with the artful Hindoos the British soldier
+is a mere child in such matters.
+
+Excision of the larynx has found its chief indication in carcinoma, but
+has been employed in sarcoma, polyps, tuberculosis, enchondroma,
+stenosis, and necrosis. Whatever the procedure chosen for the
+operation, preliminary tracheotomy is a prerequisite. It should be made
+well below the isthmus of the thyroid gland, and from three to fifteen
+days before the laryngectomy. This affords time for the lungs to become
+accustomed to the new manner of breathing, and the trachea becomes
+fixed to the anterior wall of the neck.
+
+Powers and White have gathered 69 cases of either total or partial
+extirpation of the larynx, to which the 240 cases collected and
+analyzed by Eugene Kraus, in 1890, have been added.  The histories of
+six new cases are given. Of the 309 operations, 101, or 32 per cent of
+the patients, died within the first eight weeks from shock, hemorrhage,
+pneumonia, septic infection, or exhaustion. The cases collected by
+these authors show a decrease in the death ratio in the total
+excision,--29 per cent as against 36 per cent in the Kraus tables. The
+mortality in the partial operation is increased, being 38 per cent as
+opposed to 25 per cent. Cases reported as free from the disease before
+the lapse of three years are of little value, except in that they
+diminish, by so much, the operative death-rate. Of 180 laryngectomies
+for carcinoma prior to January 1, 1892, 72, or 40 per cent, died as a
+result of the operation; 51 of the remaining 108 had recurrence during
+the first year, and 11, or ten per cent of the survivors, were free
+from relapse three or more years after operation. In 77 cases of
+partial laryngectomy for cancer, 26, or 33 per cent, died during the
+first two months; of the remaining 51, seven cases, or 13 per cent, are
+reported as free from the disease three or more years after the
+operation.
+
+Injuries destroying great portions of the face or jaw, but not causing
+death, are seldom seen, except on the battle-field, and it is to
+military surgery that we must look for the most striking instances of
+this kind. Ribes mentions a man of thirty-three who, in the Spanish
+campaign in 1811, received an injury which carried away the entire body
+of the lower jaw, half of each ramus, and also mangled in a great
+degree the neighboring soft parts. He was transported from the field of
+battle, and, despite enormous hemorrhage and suppuration, in two months
+recovered. At the time of report the wounded man presented no trace of
+the inferior maxillary bone, but by carrying the finger along the side
+of the pharynx in the direction of the superior dental arch the
+coronoid apophyses could be recognized, and about six lines nearer the
+temporal extremity the ramus could be discovered. The tongue was
+missing for about one-third its length, and was thicker than natural
+and retracted on the hyoid bone. The sublingual glands were adherent to
+the under part of the tongue and were red and over-developed. The
+inferior parts of the cheeks were cicatrized with the lateral and
+superior regions of the neck, and with the base of the tongue and the
+hyoid bone. The tongue was free under and in front of the larynx. The
+patient used a gilded silver plate to fix the tongue so that
+deglutition could be carried on.  He was not able to articulate sounds,
+but made himself understood through the intervention of this plate,
+which was fixed to a silver chin. The chin he used to maintain the
+tongue-plate, to diminish the deformity, and to retain the saliva,
+which was constantly dribbling on the neck. The same author quotes the
+instance of a man of fifty, who, during the siege of Alexandria in
+1801, was struck in the middle of his face, obliquely, by a cannonball,
+from below upward and from right to left. A part of the right malar
+bone, the two superior maxillary bones, the nasal bones, the cartilage,
+the vomer, the middle lamina of the ethmoid, the left maxillary bone, a
+portion of the left zygomatic arch, and a great portion of the inferior
+maxilla were carried away, or comminuted, and all the soft parts
+correspondingly lacerated. Several hours afterward this soldier was
+counted among the number of dead, but Larrey, the surgeon-in-chief of
+the army, with his typical vigilance and humanity, remarked that the
+patient gave signs of life, and that, despite the magnitude of his
+wound, he did not despair of his recovery. Those portions in which
+attrition was very great were removed, and the splinters of bone taken
+out, showing an enormous wound. Three months were necessary for
+cicatrization, but it was not until the capitulation of Marabou, at
+which place he was wounded, that the patient was returned to France. At
+this time he presented a hideous aspect. There were no signs of nose,
+nor cartilage separating the entrance of the nostrils, and the vault of
+the nasal fossa could be easily seen. There was a part of the posterior
+region of the right superior maxilla, but the left was entirely
+gone--in fact, the man presented an enormous triangular opening in the
+center of the face, as shown by the accompanying illustration. The
+tongue and larynx were severely involved, and the sight in the left eye
+was lost. This patient continually wore a gilded silver mask, which
+covered his deformity and rendered articulation a little less
+difficult. The saliva continually dribbled from the mouth and from the
+inferior internal portion of his mask, compelling him to carry some
+substance to receive the dribblings. Whymper mentions an analogous
+instance of a gunner who had his whole lower jaw torn away by a shell,
+but who recovered and used an ingenious contrivance in the shape of a
+silver mask for remedying the loss of the parts. Steiner mentions a
+wound from a cannon-ball, which carried away the left half of the
+inferior maxilla, stripping the soft parts as high as the malar, and on
+the left side of the neck to within 1 1/2 inches of the clavicle,
+laying bare the transverse processes of the 2d and 3d vertebrae, end
+exposing the external carotid and most of its branches.
+
+It sometimes happens that a foreign body, such as the breech of a gun,
+may be imbedded for some time in the face, with subsequent safe
+removal. Keith mentions an instance of the successful removal of the
+breech of a fowling-piece from the face, at the root of the nose, after
+a lodgment of four months; and Fraser cites an analogous instance in
+which the breech was imbedded in the bones of the face for eight years
+Smith records an instance in which a broken piece of tobacco-pipe
+penetrated the cheek, remained there for seven months, but was
+successfully extracted.
+
+Before leaving accidents to the head and neck, a most curious case,
+cited by O'Neill, will be briefly reviewed. A boy of twelve was
+entrusted to carry a new iron pot to the destination of its purchaser.
+Probably to facilitate transportation, the boy removed his hat and
+placed the pot obliquely on the back part of his head, but a sudden
+movement caused it to slip forward and downward over the head.
+Unavailing efforts were made at the time and after he reached home, to
+remove the pot from his head, but in vain, and he continued all the
+night greatly prostrated by fright, hunger, and thirst, together with
+the efforts at removal.  The next morning he was taken to a neighboring
+blacksmith, who, by greasing one of his fingers, managed to insinuate
+it between the head and pot. Placing the other side of the pot against
+an anvil he struck over the location of his finger a quick, heavy tap
+with a hammer, and the pot fell to pieces. The little patient was much
+exhausted by all his treatment and want of sleep, and, in fact, could
+hardly have endured his situation much longer.
+
+
+
+CHAPTER XI.
+
+SURGICAL ANOMALIES OF THE EXTREMITIES.
+
+Reunion of Digits.--An interesting phenomenon noticed in relation to
+severed digits is their wonderful capacity for reunion.  Restitution of
+a severed part, particularly if one of considerable function, naturally
+excited the interest of the older writers. Locher has cited an instance
+of avulsion of the finger with restitution of the avulsed portion; and
+Brulet, Van Esh, Farmer, Ponteau, Regnault, and Rosenberg cite
+instances of reunion of a digit after amputation or severance. Eve's
+"Remarkable Cases in Surgery" contains many instances of reunion of
+both fingers and thumbs, and in more recent years several other similar
+cases have been reported. At the Emergency Hospital in Washington,
+D.C., there was a boy brought in who had completely severed one of his
+digits by a sharp bread-cutter. The amputated finger was wrapped up in
+a piece of brown paper, and, being apparently healthy and the wound
+absolutely clean, it was fixed in the normal position on the stump, and
+covered by a bichlorid dressing. In a short time complete function was
+restored. In this instance no joint was involved, the amputation being
+in the middle of the 2d phalanx. Staton has described a case in which
+the hand was severed from the arm by an accidental blow from an axe.
+The wound extended from the styloid process directly across to the
+trapezium, dividing all the muscles and blood-vessels, cutting through
+bones. A small portion of the skin below the articulation, with the
+ulna, remained intact. After an unavoidable delay of an hour, Staton
+proceeded to replace the hand with silver sutures, adhesive plaster,
+and splints. On the third day pulsation was plainly felt in the hand,
+and on the fourteenth day the sutures were removed. After some time the
+patient was able to extend the fingers of the wounded member, and
+finally to grasp with all her wonted strength.
+
+The reproduction or accidental production of nails after the original
+part has been torn away by violence or destroyed by disease, is quite
+interesting. Sometimes when the whole last phalanx has been removed,
+the nail regrows at the tip of the remaining stump. Tulpius seems to
+have met with this remarkable condition. Marechal de Rougeres, Voigtel,
+and Ormancey have related instances of similar growths on the 2d
+phalanx after the loss of the 1st. For several months a woman had
+suffered from an ulcer of the middle finger of the right hand, in
+consequence of a whitlow; there was loss of the 3d phalanx, and the
+whole of the articular surface and part of the compact bony structure
+of the 2d. On examining the sore, Ormangey saw a bony sequestrum which
+appeared to keep it open. He extracted this, and, until cicatrization
+was complete, he dressed the stump with saturnine cerate. Some months
+afterward Ormangey saw with astonishment that the nail had been
+reproduced; instead of following the ordinary direction, however, it
+lay directly over the face of the stump, growing from the back toward
+the palmer aspect of the stump digit, as if to cover and protect the
+stump. Blandin has observed a case of the same description. A third
+occurred at the Hopital de la Charite, in a woman, who, in consequence
+of a whitlow, had lost the whole of the 3d phalanx of one of the
+forefingers. The soft and fleshy cushion which here covered the 2d
+phalanx was terminated by a small, blackish nail, like a grain of spur
+rye.  It is probable that in these cases the soft parts of the 3d
+phalanx, and especially the ungual matrix, had not been wholly
+destroyed. In his lectures Chevalier speaks of analogous cases.
+
+In some instances avulsion of a finger is effected in a peculiar
+manner. In 1886 Anche reported to his confreres in Bordeaux a rare
+accident of this nature that occurred to a carpenter. The man's finger
+was caught between a rope and the block of a pulley.  By a sudden and
+violent movement on his part he disengaged the hand but left the 3d
+finger attached to the pulley. At first examination the wound looked
+like that of an ordinary amputation by the usual oval incision; from
+the center of the wound the proximal fragment of the 1st phalanx
+projected. Polaillon has collected 42 similar instances, in none of
+which, however, was the severance complete.
+
+It occasionally happens that in avulsion of the finger an entire tendon
+is stripped up and torn off with the detached member.  Vogel describes
+an instance of this nature, in which the long flexor of the thumb was
+torn off with that digit. In the Surgical Museum at Edinburgh there is
+preserved a thumb and part of the flexor longus pollicis attached,
+which were avulsed simultaneously. Nunnely has seen the little finger
+together with the tendon and body of the longer flexor muscle avulsed
+by machinery. Stone details the description of the case of a boy named
+Lowry, whose left thumb was caught between rapidly twisting strands of
+a rope, and the last phalanx, the neighboring soft parts, and also the
+entire tendon of the flexor longus pollicis were instantly torn away.
+There was included even the tendinous portion of that small slip of
+muscle taking its origin from the anterior aspect of the head and upper
+portion of the ulna, and which is so delicate and insignificant as to
+be generally overlooked by anatomists. There was great pain along the
+course of the tract of abstraction of the tendon.
+
+Pinkerton describes a carter of thirty-one who was bitten on the thumb
+by a donkey. The man pulled violently in one direction, and the donkey,
+who had seized the thumb firmly with his teeth, pulled forcibly in the
+other direction until the tissues gave way and the man ran off, leaving
+his thumb in the donkey's mouth. The animal at once dropped the thumb,
+and it was picked up by a companion who accompanied the man to the
+hospital. On examination the detached portion was found to include the
+terminal phalanx of the thumb, together with the tendon of the flexor
+longus pollicis measuring ten inches, about half of which length had a
+fringe of muscular tissue hanging from the free borders, indicating the
+extent and the penniform arrangement of the fibers attached to it.
+Meyer cites a case in which the index finger was torn off and the
+flexor muscle twisted from its origin. The authors know of an
+unreported case in which a man running in the street touched his hand
+to a hitching block he was passing; a ring on one of his fingers caught
+in the hook of the block, and tore off the finger with the attached
+tendon and muscle. There is a similar instance of a Scotch gentleman
+who slipped, and, to prevent falling, he put out his hand to catch the
+railing. A ring on one of his fingers became entangled in the railing
+and the force of the fall tore off the soft parts of the finger
+together with the ring.
+
+The older writers mentioned as a curious fact that avulsion of the arm,
+unaccompanied by hemorrhage, had been noticed. Belchier, Carmichael,
+and Clough report instances of this nature, and, in the latter case,
+the progress of healing was unaccompanied by any uncomfortable
+symptoms. In the last century Hunezoysky observed complete avulsion of
+the arm by a cannon-ball, without the slightest hemorrhage. The
+Ephemerides contains an account of the avulsion of the hand without any
+bleeding, and Woolcomb has observed a huge wound of the arm from which
+hemorrhage was similarly absent. Later observations have shown that in
+this accident absence of hemorrhage is the rule and not the exception.
+The wound is generally lacerated and contused and the mouths of the
+vessels do not gape, but are twisted and crushed. The skin usually
+separates at the highest point and the muscles protrude, appearing to
+be tightly embraced and almost strangulated by the skin, and also by
+the tendons, vessels, and nerves which, crushed and twisted with the
+fragments of bone, form a conical stump.  Cheselden reports the history
+of a case, which has since become classic, that he observed in St.
+Thomas' Hospital in London, in 1837. A miller had carelessly thrown a
+slip-knot of rope about his wrist, which became caught in a revolving
+cog, drawing him from the ground and violently throwing his body
+against a beam.  The force exerted by the cog drawing on the rope was
+sufficient to avulse his whole arm and shoulder-blade. There was
+comparatively little hemorrhage and the man was insensible to pain;
+being so dazed and surprised he really was unconscious of the nature of
+his injury until he saw his arm in the wheel.
+
+According to Billroth the avulsion of an arm is usually followed by
+fatal shock. Fischer, however, relates the case of a lion-tamer whose
+whole left arm was torn from the shoulder by a lion; the loss of blood
+being very slight and the patient so little affected by shock that he
+was able to walk to the hospital.
+
+Mussey describes a boy of sixteen who had his left arm and
+shoulder-blade completely torn from his body by machinery. The patient
+became so involved in the bands that his body was securely fastened to
+a drum, while his legs hung dangling. In this position he made about 15
+revolutions around the drum before the motion of the machinery could be
+effectually stopped by cutting off the water to the great wheel. When
+he was disentangled from the bands and taken down from the drum a huge
+wound was seen at the shoulder, but there was not more than a pint of
+blood lost. The collar-bone projected from the wound about half an
+inch, and hanging from the wound were two large nerves (probably the
+median and ulnar) more than 20 inches long.  He was able to stand on
+his feet and actually walked a few steps; as his frock was opened, his
+arm, with a clot of blood, dropped to the floor. This boy made an
+excellent recovery. The space between the plastered ceiling and the
+drum in which the revolutions of the body had taken place was scarcely
+7 1/2 inches wide. Horsbeck's case was of a negro of thirty-five who,
+while pounding resin on a 12-inch leather band, had his hand caught
+between the wheel and band. His hand, forearm, arm, etc., were rapidly
+drawn in, and he was carried around until his shoulder came to a large
+beam, where the body was stopped by resistance against the beam, fell
+to the floor, and the arm and scapula were completely avulsed and
+carried on beyond the beam. In this case, also, the man experienced
+little pain, and there was comparatively little hemorrhage. Maclean
+reports the history of an accident to a man of twenty-three who had
+both arms caught between a belt and the shaft while working in a woolen
+factory, and while the machinery was in full operation. He was carried
+around the shaft with great velocity until his arms were torn off at a
+point about four inches below the shoulder-joint on each side. The
+patient landed on his feet, the blood spurting from each brachial
+artery in a large stream. His fellow-workmen, without delay, wound a
+piece of rope around each bleeding member, and the man recovered after
+primary amputation of each stump.  Will gives an excellent instance of
+avulsion of the right arm and scapula in a girl of eighteen, who was
+caught in flax-spinning machinery. The axillary artery was seen lying
+in the wound, pulsating feebly, but had been efficiently closed by the
+torsion of the machinery. The girl recovered.
+
+Additional cases of avulsion of the upper extremity are reported by
+Aubinais, Bleynie, Charles, George, James, Jones, Marcano, Belchier,
+Braithwaite, and Hendry.
+
+Avulsion of the Lower Extremity.--The symptoms following avulsion of
+the upper extremity are seen as well in similar accidents to the leg
+and thigh, although the latter are possibly the more fatal. Horlbeck
+quotes Benomont's description of a small boy who had his leg torn off
+at the knee by a carriage in motion; the child experienced no pain, and
+was more concerned about the punishment he expected to receive at home
+for disobedience than about the loss of his leg. Carter speaks of a boy
+of twelve who incautiously put the great toe of his left foot against a
+pinion wheel of a mill in motion. The toe was fastened and drawn into
+the mill, the leg following almost to the thigh. The whole left leg and
+thigh, together with the left side of the scrotum, were torn off; the
+boy died as a result of his injuries.
+
+Ashurst reported to the Pathological Society of Philadelphia the case
+of a child of nine who had its right leg caught in the spokes of a
+carriage wheel. The child was picked up unconscious, with its thigh
+entirely severed, and the bone broken off about the middle third; about
+three inches higher the muscles were torn from the sheaths and appeared
+as if cut with a knife. The great sciatic nerve was found hanging 15
+inches from the stump, having given way from its division in the
+popliteal space. The child died in twelve hours. One of the most
+interesting features of the case was the rapid cooling of the body
+after the accident and prolongation of the coolness with slight
+variations until death ensued. Ashurst remarks that while the cutaneous
+surface of the stump was acutely sensitive to the touch, there was no
+manifestation of pain evinced upon handling the exposed nerve.
+
+With reference to injuries to the sciatic nerve, Kuster mentions the
+case of a strong man of thirty, who in walking slipped and fell on his
+back. Immediately after rising to his feet he felt severe pain in the
+right leg and numbness in the foot. He was unable to stand, and was
+carried to his house, where Kuster found him suffering great pain. The
+diagnosis had been fracture of the neck of the femur, but as there was
+no crepitation and passive movements caused but little pain, Kuster
+suspected rupture of the sciatic nerve. The subsequent history of the
+case confirmed this diagnosis. The patient was confined to bed six
+weeks, and it was five months afterward before he was able to go about,
+and then only with a crutch and a stick.
+
+Park mentions an instance of rupture of the sciatic nerve caused by a
+patient giving a violent lurch during an operation at the hip-joint.
+
+The instances occasionally observed of recovery of an injured leg after
+extensive severance and loss of substance are most marvelous. Morton
+mentions a boy of sixteen, who was struck by one of the blades of a
+reaping machine, and had his left leg cut through about 1 1/4 inches
+above the ankle-joint. The foot was hanging by the portion of skin
+corresponding to the posterior quarter of the circumference of the leg,
+together with the posterior tibial vessels and nerves. These were the
+only structures escaping division, although the ankle-joint itself was
+intact. There was comparatively little hemorrhage and no shock; a
+ligature was applied to the vessels, the edges of the wound were drawn
+together by wire sutures, and the cut surfaces of the tibia were placed
+in as good apposition as possible, although the lower fragment
+projected slightly in front of the upper. The wound was dressed and
+healing progressed favorably; in three months the wound had filled up
+to such an extent that the man was allowed to go on crutches. The
+patient was discharged in five months, able to walk very well, but
+owing to the loss of the function of the extensor tendons the toes
+dragged.
+
+Washington reports in full the case of a boy of eleven, who, in handing
+a fowling piece across a ditch, was accidentally shot.  The contents of
+the gun were discharged through the leg above the ankle, carrying away
+five-sixths of the structure--at the time of the explosion the muzzle
+of the gun was only two feet away from his leg. The portions removed
+were more than one inch of the tibia and fibula (irregular fractures of
+the ends above and below), a corresponding portion of the posterior
+tibial muscle, and the long flexors of the great and small toes, as
+well as the tissue interposed between them and the Achilles tendon. The
+anterior tibial artery was fortunately uninjured. The remaining
+portions consisted of a strip of skin two inches in breadth in front of
+the wound, the muscles which it covered back of the wound, the Achilles
+tendon, and another piece of skin, barely enough to cover the tendon.
+The wound was treated by a bran-dressing, and the limb was saved with a
+shortening of but 1 1/2 inches.
+
+There are several anomalous injuries which deserve mention.  Markoe
+observed a patient of seventy-two, who ruptured both the quadriceps
+tendons of each patella by slipping on a piece of ice, one tendon first
+giving way, and followed almost immediately by the other. There was the
+usual depression immediately above the upper margin of the patella, and
+the other distinctive signs of the accident. In three months both
+tendons had united to such an extent that the patient was able to walk
+slowly. Gibney records a case in which the issue was not so successful,
+his patient being a man who, in a fall ten years previously, had
+ruptured the right quadriceps tendon, and four years later had suffered
+the same accident on the opposite side. As a result of his injuries, at
+the time Gibney saw him, he had completely lost all power of extending
+the knee-joint. Partridge mentions an instance, in a strong and healthy
+man, of rupture of the tendon of the left triceps cubiti, caused by a
+fall on the pavement. There are numerous cases in which the tendo
+Achillis has recovered after rupture,--in fact, it is unhesitatingly
+severed when necessity demands it, sufficient union always being
+anticipated. None of these cases of rupture of the tendon are unique,
+parallel instances existing in medical literature in abundance.
+
+Marshall had under his observation a case in which the femoral artery
+was ruptured by a cart wheel passing over the thigh, and death ensued
+although there were scarcely any external signs of contusion and
+positively no fracture. Boerhaave cites a curious instance in which a
+surgeon attempted to stop hemorrhage from a wounded radial artery by
+the application of a caustic, but the material applied made such
+inroads as to destroy the median artery and thus brought about a fatal
+hemorrhage.
+
+Spontaneous fractures are occasionally seen, but generally in advanced
+age, although muscular action may be the cause. There are several cases
+on record in which the muscular exertion in throwing a stone or ball,
+or in violently kicking the leg, has fractured one or both of the bones
+of an extremity. In old persons intracapsular fracture may be caused by
+such a trivial thing as turning in bed, and even a sudden twist of the
+ankle has been sufficient to produce this injury. In a boy of thirteen
+Storrs has reported fracture of the femur within the acetabulum.  In
+addition to the causes enumerated, inflammation of osseous tissue, or
+osteoid carcinoma, has been found at the seat of a spontaneous fracture.
+
+One of the most interesting subjects in the history of surgery is the
+gradual evolution of the rational treatment of dislocations.  Possibly
+no portion of the whole science was so backward as this.  Thirty-five
+centuries ago Darius, son of Hydaspis, suffered a simple luxation of
+the foot; it was not diagnosed in this land of Apis and of the deified
+discoverer of medicine. Among the wise men of Egypt, then in her acme
+of civilization, there was not one to reduce the simple luxation which
+any student of the present day would easily diagnose and successfully
+treat. Throughout the dark ages and down to the present century, the
+hideous and unnecessary apparatus employed, each decade bringing forth
+new types, is abundantly pictured in the older books on surgery; in
+some almost recent works there are pictures of windlasses and of
+individuals making superhuman efforts to pull the luxated member
+back--all of which were given to the student as advisable means of
+treatment.
+
+Relative to anomalous dislocations the field is too large to be
+discussed here, but there are two recent ones worthy of mention.
+Bradley relates an instance of death following a subluxation of the
+right humerus backward on the scapula It could not be reduced because
+the tendon of the biceps lay between the head of the humerus and a
+piece of the bone which was chipped off.
+
+Baxter-Tyrie reports a dislocation of the shoulder-joint, of unusual
+origin, in a man who was riding a horse that ran away up a steep hill.
+After going a few hundred yards the animal abated its speed, when the
+rider raised his hand to strike. Catching sight of the whip, the horse
+sprang forward, while the man felt an acute pain and a sense of
+something having given way at his shoulder. He did not fall off, but
+rode a little further and was helped to dismount. On examination a
+subcoracoid dislocation of the head of the humerus was found. The
+explanation is that as the weight of the whip was inconsiderable (four
+ounces) the inertia of the arm converted it into a lever of the first
+order. Instead of fulfilling its normal function of preventing
+displacement, the coraco-acromial arch acted as a fulcrum. The limb
+from the fingers to that point acted as the "long arm," and the head
+and part of the neck of the humerus served as the "short arm." The
+inertia of the arm, left behind as it were, supplied the power, while
+the ruptured capsular ligament and displacement of the head of the bone
+would represent the work done.
+
+Congenital Dislocations.--The extent and accuracy of the knowledge
+possessed by Hippocrates on the subject of congenital dislocations have
+excited the admiration of modern writers, and until a comparatively
+recent time examples of certain of the luxations described by him had
+not been recorded. With regard, for instance, to congenital
+dislocations at the shoulder-joint, little or nothing was known save
+what was contained in the writings of Hippocrates, till R. M. Smith and
+Guerin discussed the lesion in their works.
+
+Among congenital dislocations, those of the hips are most common--in
+fact, 90 per cent of all. They are sometimes not recognizable until
+after the lapse of months and sometimes for years, but their
+causes--faulty developments of the joint, paralysis, etc.--are supposed
+to have existed at birth. One or both joints may be involved, and
+according to the amount of involvement the gait is peculiar. As to the
+reduction of such a dislocation, the most that can be done is to
+diminish the deformity and functional disability by traction and
+palliative measures with apparatus. The normal structure of the joint
+does not exist, and therefore the dislocation admits of no reduction.
+Congenital dislocations of the shoulder are also seen, owing to faulty
+development of the glenoid fossa; and at the knee, the leg generally
+being in extreme hyperextension, the foot sometimes resting on the
+abdomen. Congenital luxation of the femora, when it appears in adult
+women is a prominent factor in dystocia.  There is a dislocation found
+at birth, or occurring shortly after, due to dropsy of the joint in
+utero; and another form due to succeeding paralysis of groups of
+muscles about the joint.
+
+The interesting instances of major amputations are so numerous and so
+well known as to need no comment here. Amputation of the hip with
+recovery is fast becoming an ordinary operation; at Westminster
+Hospital in London, there is preserved the right humerus and scapula,
+presenting an enormous bulk, which was removed by amputation at the
+shoulder-joint, for a large lymphosarcoma growing just above the
+clavicle. The patient was a man of twenty-two, and made a good
+recovery. Another similar preparation is to be seen in London at St.
+Bartholomew's Hospital.
+
+Simultaneous, synchronous, or consecutive amputations of all the limbs
+have been repeatedly performed. Champeuois reports the case of a
+Sumatra boy of seven, who was injured to such an extent by an explosion
+as to necessitate the amputation of all his extremities, and, despite
+his tender age and the extent of his injuries, the boy completely
+recovered. Jackson, quoted by Ashhurst, had a patient from whom he
+simultaneously amputated all four limbs for frost-bite.
+
+Muller reports a case of amputation of all four limbs for frost-bite,
+with recovery. The patient, aged twenty-six, while traveling to his
+home in Northern Minnesota, was overtaken by a severe snow storm, which
+continued for three days; on December 13th he was obliged to leave the
+stage in a snow-drift on the prairie, about 110 miles distant from his
+destination. He wandered over the prairie that day and night, and the
+following four days, through the storm, freezing his limbs, nose, ears,
+and cheeks, taking no food or water until, on December 16th, he was
+found in a dying condition by Indian scouts, and taken to a
+station-house on the road. He did not reach the hospital at Fort
+Ridgely until the night of December 24th--eleven days after his first
+exposure. He was almost completely exhausted, and, after thawing the
+ice from his clothes, stockings, and boots,--which had not been removed
+since December 13th,--it was found that both hands and forearms were
+completely mortified up to the middle third, and both feet and legs as
+far as the upper third; both knees over and around the patellae, and
+the alae and tip of the nose all presented a dark bluish appearance and
+fairly circumscribed swelling. No evacuation of the bowels had taken
+place for over two weeks, and as the patient suffered from singultus
+and constant pain over the epigastric region, a light cathartic was
+given, which, in twenty-four hours, gave relief.  The four frozen limbs
+were enveloped in a solution of zinc chlorid. The frozen ears and
+cheeks healed in due time, and the gangrenous parts of the nose
+separated and soon healed, with the loss of the tip and parts of the
+alae, leaving the septum somewhat exposed. On January 10th the lines of
+demarcation were distinct and deep on all four limbs, though the
+patient, seconded by his wife, at first obstinately opposed operative
+interference; on January 13th, after a little hesitancy, the man
+consented to an amputation of the arms. This was successfully carried
+out on both forearms, at the middle third, the patient losing hardly
+any blood and complaining of little pain. The great relief afforded by
+this operation so changed his aversion to being operated upon that on
+the next day he begged to have both legs amputated in the same manner,
+which was done, three days afterward, with the same favorable result.
+After some minor complications the patient left for his home, perfectly
+recovered, June 9, 1866.
+
+Begg of Dundee successfully performed quadruple amputation on a woman,
+the victim of idiopathic gangrene. With artificial limbs she was able
+to earn a livelihood by selling fancy articles which she made herself.
+This woman died in 1885, and the four limbs, mounted on a lay figure,
+were placed in the Royal College of Surgeons, in London. Wallace, of
+Rock Rapids, Iowa, has successfully removed both forearms, one leg, and
+half of the remaining foot, for frost-bite. Allen describes the case of
+a boy of eight who was run over by a locomotive, crushing his right
+leg, left foot, and left forearm to such an extent as to necessitate
+primary triple amputation at the left elbow, left foot, and right leg,
+the boy recovering. Ashhurst remarks that Luckie, Alexander, Koehler,
+Lowman, and Armstrong have successfully removed both legs and one arm
+simultaneously for frost-bite, all the patients making excellent
+recoveries in spite of their mutilations; he adds that he himself has
+successfully resorted to synchronous amputation of the right hip-joint
+and left leg for a railroad injury occurring in a lad of fifteen, and
+has twice synchronously amputated three limbs from the same patient,
+one case recovering.
+
+Wharton reports a case of triple major amputation on a negro of
+twenty-one, who was run over by a train. His right leg was crushed at
+the knee, and the left leg crushed and torn off in the middle third;
+the right forearm and hand were crushed. In order to avoid chill and
+exposure, he was operated on in his old clothes, and while one limb was
+being amputated the other was being prepared. The most injured member
+was removed first.  Recovery was uninterrupted.
+
+There are two cases of spontaneous amputation worthy of record.
+Boerhaave mentions a peasant near Leyden, whose axillary artery was
+divided with a knife, causing great effusion of blood, and the patient
+fainted. The mouth of the vessel was retracted so far as to render
+ligature impossible, and the poor man was abandoned to what was
+considered an inevitable fate by his unenlightened attendants.
+Expecting to die every moment, he continued several days in a languid
+state, but the hemorrhage ceased spontaneously, and the arm decayed,
+shrunk, and dried into a mummified stump, which he carried about for
+quite a while. Rooker speaks of a fracture of the forearm, near the
+lower part of the middle third, in a patient aged fourteen. Incipient
+gangrene below the seat of fracture, with associate inflammation,
+developed; but on account of the increasing gangrene it was determined
+to amputate. On the fifth day the line of demarcation extended to the
+spine of the scapula, laying bare the bone and exposing the acromion
+process and involving the pectoral muscles. It was again decided to let
+Nature continue her work. The bones exfoliated, the spine and the
+acromial end of the scapula came away, and a good stump was formed.
+Figure 212 represents the patient at the age of twenty-eight.
+
+By ingenious mechanical contrivances persons who have lost an extremity
+are enabled to perform the ordinary functions of the missing member
+with but slight deterioration. Artificial arms, hands, and legs have
+been developed to such a degree of perfection that the modern
+mechanisms of this nature are very unlike the cumbersome and intricate
+contrivances formerly used.
+
+Le Progres Medical contains an interesting account of a curious contest
+held between dismembered athletes at Nogent-Sur-Marne, a small town in
+the Department of the Seine, in France. Responding to a general
+invitation, no less than seven individuals who had lost either leg or
+thigh, competed in running races for prizes.  The enterprising cripples
+were divided into two classes: the cuissards, or those who had lost a
+thigh, and jambards, or those who had lost a leg; and, contrary to what
+might have been expected, the grand champion came from the former
+class. The distance in each race was 200 meters. M. Roullin, whose
+thigh, in consequence of an accident, was amputated in 1887, succeeded
+in traversing the course in the remarkable time of thirty seconds
+(about 219 yards); whereas M. Florrant, the speediest jambard, required
+thirty-six seconds to run the same distance; and was, moreover,
+defeated by two other cuissards besides the champion.  The junior race
+was won in thirty-five seconds, and this curious day's sport was ended
+by a course de consolation, which was carried off in thirty-three
+seconds by M. Mausire, but whether he was a cuissard or a jambard was
+not stated.
+
+On several occasions in England, cricket matches have been organized
+between armless and legless men. In Charles Dickens' paper, "All the
+Year Round," October 5, 1861, there is a reference to a cricket match
+between a one-armed eleven and a one-legged eleven. There is a recent
+report from De Kalb, Illinois, of a boy of thirteen who had lost both
+legs and one arm, but who was nevertheless enabled to ride a bicycle
+specially constructed for him by a neighboring manufacturer. With one
+hand he guided the handle bar, and bars of steel attached to his stumps
+served as legs. He experienced no trouble in balancing the wheel; it is
+said that he has learned to dismount, and soon expects to be able to
+mount alone; although riding only three weeks, he has been able to
+traverse one-half a mile in two minutes and ten seconds. While the
+foregoing instance is an exception, it is not extraordinary in the
+present day to see persons with artificial limbs riding bicycles, and
+even in Philadelphia, May 30, 1896, there was a special bicycle race
+for one-legged contestants.
+
+The instances of interesting cases of foreign bodies in the extremities
+are not numerous. In some cases the foreign body is tolerated many
+years in this location. There are to-day many veterans who have bullets
+in their extremities. Girdwood speaks of the removal of a foreign body
+after twenty-five years' presence in the forearm. Pike mentions a man
+in India, who, at the age of twenty-two, after killing a wounded hare
+in the usual manner by striking it on the back of the neck with the
+side of the hand, noticed a slight cut on the hand which soon healed
+but left a lump under the skin. It gave him no trouble until two months
+before the time of report, when he asked to have the lump removed,
+thinking it was a stone. It was cut down upon and removed, and proved
+to be the spinous process of the vertebra of a hare. The bone was
+living and healthy and had formed a sort of arthrodial joint on the
+base of the phalanx of the little finger and had remained in this
+position for nearly twenty-two years.
+
+White has described a case in which a nail broken off in the foot,
+separated into 26 splinters, which, after intense suffering, were
+successfully removed. There was a case recently reported of a man
+admitted to the Bellevue Hospital, New York, whose arm was supposed to
+have been fractured by an explosion, but instead of which 11 feet of
+lead wire were found in it by the surgeons. The man was a machinist in
+the employ of the East River Lead Co., and had charge of a machine
+which converted molten lead into wire. This machine consists of a steel
+box into which the lead is forced, being pressed through an aperture
+1/8 inch in diameter by hydraulic pressure of 600 tons. Reaching the
+air, the lead becomes hard and is wound on a large wheel in the form of
+wire. Just before the accident this small aperture had become clogged,
+and the patient seized the projecting wire in his hand, intending to
+free the action of the machine, as he had previously done on many
+occasions, by a sharp, strong pull; but in so doing an explosion
+occurred, and he was hurled to the floor unconscious. While on the way
+to the hospital in the ambulance, he became conscious and complained of
+but little pain except soreness of the left arm about the elbow. The
+swelling, which had developed very rapidly, made it impossible for the
+surgeons to make an examination, but on the following day, when the
+inflammation had subsided sufficiently, a diagnosis of fracture of the
+bones of the arm was made. There was no external injury of the skin of
+any magnitude, and the surgeons decided to cut down on the trifling
+contusion, and remove what appeared to be a fragment of bone, lodged
+slightly above the wrist. An anesthetic was administered, and an
+incision made, but to the amazement of the operators, instead of bone,
+a piece of wire one inch in length and 1/8 inch in diameter was
+removed. On further exploration piece after piece of the wire was taken
+out until finally the total length thus removed aggregated 11 feet, the
+longest piece measuring two feet and the shortest 1/4 inch. The wire
+was found imbedded under the muscles of the arm, and some of it had
+become wedged between the bones of the forearm. Probably the most
+remarkable feature of this curious accident was the fact that there was
+no fracture or injury to the bone, and it was thought possible that the
+function of the arm would be but little impaired.
+
+Tousey reports a case of foreign body in the axilla that was taken for
+a necrotic fragment of the clavicle. The patient was a boy of sixteen,
+who climbed up a lamp-post to get a light for his bicycle lamp; his
+feet slipped off the ornamental ledge which passed horizontally around
+the post about four feet from the ground, and he fell. In the fall a
+lead pencil in his waistcoat pocket caught on the ledge and was driven
+into the axilla, breaking off out of sight. This was supposed to be a
+piece of the clavicle, and was only discovered to be a pencil when it
+was removed six weeks after.
+
+There are several diseases of the bone having direct bearing on the
+anomalies of the extremities which should have mention here.
+Osteomalacia is a disease of the bones in adult life, occurring most
+frequently in puerperal women, but also seen in women not in the
+puerperal state, and in men. It is characterized by a progressive
+softening of the bone-substance, from a gradual absorption of the lime
+salts, and gives rise to considerable deformity, and occasionally to
+spontaneous fracture.
+
+Rachitis or rickets is not a disease of adult life, but of infancy and
+childhood, and never occurs after the age of puberty.  It seldom begins
+before six months or after three years. There are several theories as
+to its causation, one being that it is due to an abnormal development
+of acids. There is little doubt that defective nutrition and bad
+hygienic surroundings are prominent factors in its production. The
+principal pathologic change is seen in the epiphyseal lines of long
+bones and beneath the periosteum. Figure 213 shows the appearance
+during life of a patient with the highest grade of rachitis, and it can
+be easily understood what a barrier to natural child-birth it would
+produce. In rachitis epiphyseal swellings are seen at the wrists and
+ankle-joints, and in superior cases at the ends of the phalanges of the
+fingers and toes. When the shaft of a long bone is affected, not only
+deformity, but even fracture may occur.  Under these circumstances the
+humerus and femur appear to be the bones most likely to break; there is
+an associate deformity of the head, known as "craniotabes," together
+with pigeon-breast and various spinal curvature. The accompanying
+illustration is from a drawing of a skeleton in the Warren Museum in
+Boston. The subject was an Indian, twenty-one years of age, one of the
+Six Nations.  His mode of locomotion was by a large wooden bowl, in
+which he sat and moved forward by advancing first one side of the bowl
+and then the other, by means of his hands. The nodules or "adventitious
+joints" were the result of imperfect ossification, or, in other words,
+of motion before ossification was completed.
+
+Analogous to rachitis is achondroplasia, or the so called fetal
+rickets--a disease in which deformity results from an arrest, absence,
+or perversion of the normal process of enchondral ossification. It is
+decidedly an intrauterine affection, and the great majority of fetuses
+die in utero. Thomson reports three living cases of achondroplasia. The
+first was a child five months of age, of pale complexion, bright and
+intelligent, its head measuring 23 inches in length. There was a narrow
+thorax showing the distinct beads of rickets; the upper and lower limbs
+were very short, but improved under antirachitic treatment. The child
+died of pneumonia. The other two cases were in adults, one thirty-nine
+and the other thirty-six. The men were the same height, 49 inches, and
+resembled each other in all particulars.  They both enjoyed good
+health, and, though somewhat dwarfed, were of considerable
+intelligence. Neither had married. Both the upper and; lower limbs
+showed exaggerations of the normal curves; the hands and feet were
+broad and short; the gait of both of these little men was waddling, the
+hunk swaying when they attempted to make any rapid progress.
+
+Osteitis deformans is a hyperplasia of bone described by Paget in 1856.
+Paget's patient was a gentleman of forty-six who had always enjoyed
+good health; without assignable cause he began to be subject to aching
+pains in the thighs and legs. The bones of the left leg began to
+increase in size, and a year or two later the left femur; also enlarged
+considerably. During a period of twenty years these changes were
+followed by a growth of other bones. The spine became firm and; rigid,
+the head increased 5 1/4 inches in circumference. The bones of the face
+were not affected. When standing, the patient had a peculiar bowed
+condition of the legs, with marked flexure at the knees. He finally
+died of osteosarcoma, originating in the left radius, Paget collected
+eight cases, five of whom died of malignant disease. The postmortem of
+Paget's case showed extreme thickening in the bones affected, the femur
+and cranium particularly showing osteoclerosis. Several cases have been
+recorded in this country; according to Warren, Thieberge analyzed 43
+cases; 21 were men, 22 women; the disease appeared usually after forty.
+
+Acromegaly is distinguished from osteitis deformans in that it is
+limited to hypertrophy of the hands, feet, and face, and it usually
+begins earlier. In gigantism the so-called "giant growth of bones" is
+often congenital in character, and is unaccompanied by inflammatory
+symptoms.
+
+The deformities of the articulations may be congenital but in most
+cases are acquired. When these are of extreme degree, locomotion is
+effected in most curious ways. Ankylosis at unnatural angles and even
+complete reversion of the joints has been noticed. Pare gives a case of
+reversion, and of crooked hands and feet; and Barlow speaks of a child
+of two and three-quarter years with kyphosis, but mobility of the
+lumbar region, which walked on its elbows and knees. The pathology of
+this deformity is obscure, but there might have been malposition in
+utero. Wilson presented a similar case before the Clinical Society of
+London, in 1888. The "Camel-boy," exhibited some years ago throughout
+the United States, had reversion of the joints, which resembled those
+of quadrupeds. He walked on all fours, the mode of progression
+resembling that of a camel.
+
+Figure 216 represents Orloff, "the transparent man," an exhibitionist,
+showing curious deformity of the long bones and atrophy of the
+extremities. He derived his name from the remarkable transparency of
+his deformed members to electric light, due to porosity of the bones
+and deficiency of the overlying tissues.
+
+Figure 217, taken from Hutchinson's "Archives of Surgery," represents
+an extreme case of deformity of the knee-joints in a boy of seven, the
+result of severe osteoarthritis. The knees and elbows were completely
+ankylosed.
+
+Infantile spinal paralysis is often the cause of distressing
+deformities, forbidding locomotion in the ordinary manner. In a paper
+on the surgical and mechanical treatment of such deformities Willard
+mentions a boy of fourteen, the victim of infantile paralysis, who at
+the age of eleven had never walked, but dragged his legs along. His
+legs were greatly twisted, and there was flexion at right angles at the
+hips and knees. There was equinovarus in the left foot and equinovalgus
+in the right.  By an operation of subcutaneous section at the hips,
+knees, and feet, with application of plaster-of-Paris and extension,
+this hopeless cripple walked with crutches in two months, and with an
+apparatus consisting of elastic straps over the quadriceps femoris,
+peroneals, and weakened muscles, the valgus-foot being supported
+beneath the sole. In six months he was walking long distances; in one
+year he moved speedily on crutches. Willard also mentions another case
+of a girl of eleven who was totally unable to support the body in the
+erect position, but could move on all fours, as shown in figure 219.
+There was equinovarus in the right foot and valgus in the left. The
+left hip was greatly distorted, not only in the direction of flexion,
+but there was also twisting of the femoral neck, simulating
+dislocation. This patient was also operated on in the same manner as
+the preceding one.
+
+Relative to anomalous increase or hypertrophy of the bones of the
+extremities, Fischer shows that an increase in the length of bone may
+follow slight injuries. He mentions a boy of twelve, who was run over
+by a wagon and suffered a contusion of the bones of the right leg. In
+the course of a year this leg became 4 1/2 cm.  longer than the other,
+and the bones were also much thicker than in the other. Fischer also
+reports several cases of abnormal growth of bone following necrosis. A
+case of shortening 3 3/4 cm., after a fracture, was reduced to one cm.
+by compensatory growth. Elongation of the bone is also mentioned as the
+result of the inflammation of the joint. Warren also quotes Taylor's
+case of a lady who fell, injuring, but not fracturing, the thigh.
+Gradual enlargement, with an outward curving of the bone, afterward
+took place.
+
+
+
+CHAPTER XII.
+
+SURGICAL ANOMALIES OF THE THORAX AND ABDOMEN.
+
+Injuries of the lung or bronchus are always serious, but contrary to
+the general idea, recovery after extensive wound of the lung is quite a
+common occurrence. Even the older writers report many instances of
+remarkable recoveries from lung-injuries, despite the primitive and
+dirty methods of treatment. A review of the literature previous to this
+century shows the names of Arcaeus, Brunner, Collomb, Fabricius
+Hildanus, Vogel, Rhodius, Petit, Guerin, Koler, Peters, Flebbe, and
+Stalpart, as authorities for instances of this nature. In one of the
+journals there is a description of a man who was wounded by a
+broad-sword thrust in the mediastinum. After death it was found that
+none of the viscera were wounded, and death was attributed to the fact
+that the in-rush of air counterbalancing the pressure within the lungs
+left them to their own contractile force, with resultant collapse,
+obstruction to the circulation, and death. It is said that Vesalius
+demonstrated this condition on the thorax of a pig.
+
+Gooch gives an instance of a boy of thirteen who fell from the top of a
+barn upon the sharp prow of a plough, inflicting an oblique wound from
+the axilla to below the sternum, slightly above the insertion of the
+diaphragm. Several ribs were severed, and the left thoracic cavity was
+wholly exposed to view, showing the lungs, diaphragm, and pericardium
+all in motion. The lungs soon became gangrenous, and in this horrible
+state the patient lived twelve days. One of the curious facts noticed
+by the ancient writers was the amelioration of the symptoms caused by
+thoracic wounds after hemorrhage from other locations; and naturally,
+in the treatment of such injuries, this circumstance was used in
+advocacy of depletion. Monro speaks of a gentleman who was wounded in a
+duel, and who had all the symptoms of hemothorax; his condition was
+immediately relieved by the evacuation of a considerable quantity of
+bloody matter with the urine. Swammerdam records a similar case, and
+Fabricius ab Aquapendente noticed a case in which the opening in the
+thorax showed immediate signs of improvement after the patient voided
+large quantities of bloody urine. Glandorp also calls attention to the
+foregoing facts. Nicolaus Novocomensis narrates the details of the case
+of one of his friends, suffering from a penetrating wound of the
+thorax, who was relieved and ultimately cured by a bloody evacuation
+with the stool.
+
+There is an extraordinary recovery reported in a boy of fifteen who, by
+falling into the machinery of an elevator, was severely injured about
+the chest. There were six extensive lacerations, five through the skin
+about six inches long, and one through the chest about eight inches
+long. The 3d, 4th, 5th, and 6th ribs were fractured and torn apart, and
+about an inch of the substance of the 4th rib was lost. Several jagged
+fragments were removed; a portion of the pleura, two by four inches,
+had been torn away, exposing the pericardium and the left lung, and
+showing the former to have been penetrated and the latter torn. The
+lung collapsed completely, and for three or four months no air seemed
+to enter it, but respiration gradually returned. The lacerated
+integument could only be closed approximately by sutures. It is worthy
+of remark that, although extremely pale, the patient complained of but
+little pain, and exhibited only slight symptoms of shock. The pleural
+cavity subsequently filled with a dirty serum, but even this did not
+interfere with the healing of the wound and the restoration of the
+lung; the patient recovered without lateral curvature.
+
+Bartholf reports a case of rapid recovery after perforating wound of
+the lung. The pistol-ball entered the back 1 1/2 inches to the right of
+the spinous process of the 6th dorsal vertebra, and passed upward and
+very slightly inward toward the median line.  Its track could be
+followed only 1 1/4 inches. Emphysema appeared fifteen minutes after
+the reception of the wound, and soon became pronounced throughout the
+front and side of the neck, a little over the edge of the lower jaw,
+and on the chest two inches below the sternum and one inch below the
+clavicle. In four hours respiration became very frequent, short, and
+gasping, the thoracic walls and the abdomen scarcely moving. The man
+continued to improve rapidly, the emphysema disappeared on the seventh
+day, and eighteen days after the reception of the wound he was
+discharged. There was slight hemorrhage from the wound at the time, but
+the clot dried and closed the wound, and remained there until it was
+removed on the morning of his discharge, leaving a small, dry, white
+cicatrix.
+
+Loss of Lung-tissue.--The old Amsterdam authority, Tulpius, has
+recorded a case in which a piece of lung of about three fingers'
+breadth protruded through a large wound of the lung under the left
+nipple. This wound received no medical attention for forty-eight hours,
+when the protruding portion of lung was thought to be dead, and was
+ligated and cut off; it weighed about three ounces. In about two weeks
+the wound healed with the lung adherent to it and this condition was
+found six years later at the necropsy of this individual. Tulpius
+quoted Celaus and Hippocrates as authorities for the surgical treatment
+of this case. In 1787 Bell gave an account of a case in which a large
+portion of the lung protruded and was strangulated by the edges of the
+thoracic wound, yet the patient made a good recovery.  Fabricius
+Hildanus and Ruysch record instances of recovery in which large pieces
+of lung have been cut off; and it is said that with General Wolfe at
+Quebec there was another officer who was shot through the thorax and
+who recovered after the removal of a portion of the lung. In a letter
+to one of his medical friends Roscius says that he succeeded in cutting
+off part of a protruding, livid, and gangrenous lung, after a
+penetrating wound of the chest, with a successful result. Hale reports
+a case of a penetrating stab-wound in which a piece of lung was removed
+from a man of twenty-five.
+
+Tait claims that surgical treatment, as exemplified by Biondi's
+experiment in removing portions of lung from animals, such as dogs,
+sheep, cats, etc., is not practical; he adds that his deductions are
+misleading, as the operation was done on healthy tissue and in deep and
+narrow-chested animals. Excision of diseased portions of the lung has
+been practised by Kronlein (three cases), Ruggi of Bologna (two cases),
+Block, Milton, Weinlechner; one of Kronlein's patients recovered and
+Milton's survived four months, but the others promptly succumbed after
+the operation. Tuffier is quoted as showing a patient, aged
+twenty-nine, upon whom, for beginning tuberculosis, he had performed
+pneumonectomy four years before. At the operation he had removed the
+diseased area at the apex of the right lung, together with sound tissue
+for two cm. in every direction.  Tuffier stated that the result of his
+operation had been perfectly successful and the patient had shown no
+suspicious symptoms since.
+
+Rupture of the Lung Without Fracture.--It is quite possible for the
+lung to be ruptured by external violence without fracture of the ribs;
+there are several such cases on record. The mechanism of this rare and
+fatal form of injury has been very aptly described by Gosselin as due
+to a sudden pressure exerted on the thoracic wall at the moment of full
+inspiration, there being a spasm of the glottis or obstruction of the
+larynx, in consequence of which the lung bursts. An extravasation of
+air occurs, resulting in the development of emphysema, pneumothorax,
+etc.  Subsequently pleurisy, pneumonia, or even pus in the pleural
+cavity often result. Hemoptysis is a possible, but not a marked
+symptom. The mechanism is identical with that of the bursting of an
+inflated paper bag when struck by the hand. Other observers discard
+this theory of M. Gosselin and claim that the rupture is due to direct
+pressure, as in the cases in which the heart is ruptured without
+fracture of the ribs. The theory of Gosselin would not explain these
+cardiac ruptures from external violence on the thoracic walls, and,
+therefore, was rejected by some.  Pare, Morgagni, Portal, Hewson Smith,
+Dupuytren, Laennec, and others mention this injury. Gosselin reports
+two cases terminating in recovery. Ashurst reports having seen three
+cases, all of which terminated fatally before the fifth day; he has
+collected the histories of 39 cases, of which 12 recovered. Otis has
+collected reports of 25 cases of this form of injury from military
+practice exclusively. These were generally caused by a blow on the
+chest, by a piece of shell, or other like missile.  Among the 25 cases
+there were 11 recoveries. As Ashhurst very justly remarks, this injury
+appears more fatal in civil than in military life.
+
+Pyle reports a case successfully treated, as follows:--
+
+"Lewis W., ten years old, white, born in Maryland, and living now in
+the District of Columbia, was brought in by the Emergency Hospital
+ambulance, on the afternoon of November 10th, with a history of having
+been run over by a hose-cart of the District Fire Department. The boy
+was in a state of extreme shock, having a weak, almost imperceptible
+pulse; his respirations were shallow and rapid, and his temperature
+subnormal. There were no signs of external injury about his thoracic
+cavity and no fracture of the ribs could be detected, although
+carefully searched for; there was marked emphysema; the neck and side
+of the face were enormously swollen with the extravasated air; the
+tissues of the left arm were greatly infiltrated with air, which
+enabled us to elicit the familiar crepitus of such infiltration when an
+attempt at the determination of the radial pulse was made.
+Consciousness was never lost. There were several injuries to the face
+and scalp; and there was hemorrhage from the nose and mouth, which was
+attributed to the fact that the patient had fallen on his face,
+striking both nose and lip. This was confirmed subsequently by the
+absence of any evidences of hemoptysis during the whole period of
+convalescence. The saliva was not even blood-streaked; therefore, it
+can be said with verity that there was no hemoptysis. Shortly after
+admission the patient reacted to the stimulating treatment, his pulse
+became stronger, and all evidences of threatened collapse disappeared.
+He rested well the first night and complained of no pain, then or
+subsequently. The improvement was continuous. The temperature remained
+normal until the evening of the fifth day, when it rose to 102.2
+degrees, end again, on the evening of the sixth, to 102.3 degrees. This
+rise was apparently without significance as the patient at no time
+seemed disturbed by it. On the eighth day the temperature again reached
+the normal and has since remained there. The boy is apparently well
+now, suffers no inconvenience, and has left the hospital, safe from
+danger and apparently free from any pulmonary embarrassment. He uses
+well-developed diaphragmatic breathing which is fully sufficient."
+
+Pollock reports the case of a boy of seven, whose lung was ruptured by
+a four-wheeled cab which ran over him. He was discharged well in
+thirty-two days. Bouilly speaks of recovery in a boy of seventeen,
+after a rupture of the lung without fracture.  There are several other
+interesting cases of recovery on record.
+
+There are instances of spontaneous rupture of the lung, from severe
+cough. Hicks speaks of a child of ten months suffering with a severe
+cough resembling pertussis, whose lung ruptured about two weeks after
+the beginning of the cough, causing death on the second day. Ferrari
+relates a curious case of rupture of the lung from deep inspiration.
+
+Complete penetration or transfixion of the thoracic cavity is not
+necessarily fatal, and some marvelous instances of recovery after
+injuries of this nature, are recorded. Eve remarks that General Shields
+was shot through the body by a discharge of a cannon at Cerro Gordo,
+and was given up as certain to die. The General himself thought it was
+grape-shot that traversed his chest. He showed no signs of hemoptysis,
+and although in great pain, was able to give commands after reception
+of the wound. In this case, the ball had evidently entered within the
+right nipple, had passed between the lungs, through the mediastinum,
+emerging slightly to the right of the spine. Guthrie has mentioned a
+parallel instance of a ball traversing the thoracic cavity, the patient
+completely recovering after treatment. Girard, Weeds, Meacham, Bacon,
+Fryer and others report cases of perforating gunshot wounds of the
+chest with recovery.
+
+Sewell describes a case of transfixion of the chest in a youth of
+eighteen. After mowing and while carrying his scythe home, the patient
+accidentally fell on the blade; the point passed under the right
+axilla, between the 3d and 4th right ribs, horizontally through the
+chest, and came out through corresponding ribs of the opposite side,
+making a small opening. He fell to the ground and lay still until his
+brother came to his assistance; the latter with great forethought and
+caution carefully calculated the curvature of the scythe blade, and
+thus regulating his direction of tension, successfully withdrew the
+instrument. There was but little hemoptysis and the patient soon
+recovered. Chelius records an instance of penetration of the chest by a
+carriage shaft, with subsequent recovery. Hoyland mentions a man of
+twenty-five who was discharging bar-iron from the hold of a ship; in a
+stooping position, preparatory to hoisting a bundle on deck, he was
+struck by one of the bars which pinned him to the floor of the hold,
+penetrating the thorax, and going into the wood of the flooring to the
+extent of three inches, requiring the combined efforts of three men to
+extract it. The bar had entered posteriorly between the 9th and 10th
+ribs of the left side, and had traversed the thorax in an upward and
+outward direction, coming out anteriorly between the 5th and 6th ribs,
+about an inch below and slightly external to the nipple. There was
+little constitutional disturbance, and the man was soon discharged
+cured. Brown records a case of impalement in a boy of fourteen. While
+running to a fire, he struck the point of the shaft of a carriage,
+which passed through his left chest, below the nipple. There was,
+strangely, no hemorrhage, and no symptoms of so severe an injury; the
+boy recovered.
+
+There is deposited in the Museum of the Royal College of Surgeons in
+London, a mast-pivot, 15 inches in length and weighing between seven
+and eight pounds, which had passed obliquely through the body of a
+sailor. The specimen is accompanied by a colored picture of the
+sufferer himself in two positions. The name of the sailor was Taylor,
+and the accident occurred aboard a brig lying in the London docks. One
+of Taylor's mates was guiding the pivot of the try-sail into the main
+boom, when a tackle gave way. The pivot instantly left the man's hand,
+shot through the air point downward striking Taylor above the heart,
+passing out lower down posteriorly, and then imbedded itself in the
+deck. The unfortunate subject was carried at once to the London
+Hospital, and notwithstanding his transfixion by so formidable an
+instrument, in five months Taylor had recovered sufficiently to walk,
+and ultimately returned to his duties as a seaman.
+
+In the same museum, near to this spike, is the portion of a shaft of
+the carriage which passed through the body of a gentleman who happened
+to be standing near the vehicle when the horse plunged violently
+forward, with the result that the off shaft penetrated his body under
+the left arm, and came out from under the right arm, pinning the
+unfortunate man to the stable door. Immediately after the accident the
+patient walked upstairs and got in bed; his recovery progressed
+uninterruptedly, and his wounds were practically healed at the end of
+nine weeks; he is reported to have lived eleven years after this
+terrible accident.
+
+In the Indian Medical Gazette there is an account of a private of
+thirty-five, who was thrown forward and off his horse while endeavoring
+to mount. He fell on a lance which penetrated his chest and came out
+through the scapula. The horse ran for about 100 yards, the man hanging
+on and trying to stop him. After the extraction of the lance the
+patient recovered. Longmore gives an instance of complete transfixion
+by a lance of the right side of the chest and lung, the patient
+recovering. Ruddock mentions cases of penetrating wounds of both lungs
+with recovery.
+
+There is a most remarkable instance of recovery after major thoracic
+wounds recorded by Brokaw. In a brawl, a shipping clerk received a
+thoracic wound extending from the 3d rib to within an inch of the
+navel, 13 1/2 inches long, completely severing all the muscular and
+cartilaginous structures, including the cartilages of the ribs from the
+4th to the 9th, and wounding the pleura and lung. In addition there was
+an abdominal wound 6 1/2 inches long, extending from the navel to about
+two inches above Poupart's ligament, causing almost complete intestinal
+evisceration. The lung was partially collapsed. The cartilages were
+ligated with heavy silk, and the hemorrhage checked by ligature and by
+packing gauze in the inter-chondral spaces. The patient speedily
+recovered, and was discharged in a little over a month, the only
+disastrous result of his extraordinary injuries being a small ventral
+hernia.
+
+In wounds of the diaphragm, particularly those from stabs and gunshot
+injuries, death is generally due to accompanying lesions rather than to
+injury. Hollerius, and Alexander Benedictus, made a favorable diagnosis
+of wounds made in the fleshy portions of the diaphragm, but despaired
+of those in the tendinous portions.  Bertrand, Fabricius Hildanus, la
+Motte, Ravaton, Valentini, and Glandorp, record instances of recovery
+from wounds of the diaphragm.
+
+There are some peculiar causes of diaphragmatic injuries on record,
+laughter, prolonged vomiting, excessive eating, etc., being mentioned.
+On the other hand, in his "Essay on Laughter (du Ris)," Joubert quotes
+a case in which involuntary laughter was caused by a wound of the
+diaphragm; the laughter mentioned in this instance was probably caused
+by convulsive movements of the diaphragm, due to some unknown
+irritation of the phrenic nerve.  Bremuse gives an account of a man who
+literally split his diaphragm in two by the ingestion of four plates of
+potato soup, numerous cups of tea and milk, followed by a large dose of
+sodium bicarbonate to aid digestion. After this meal his stomach
+swelled to an enormous extent and tore the diaphragm on the right side,
+causing immediate death.
+
+The diaphragm may be ruptured by external violence (a fall on the chest
+or abdomen), or by violent squeezing (railroad accidents, etc.), or
+according to Ashhurst, by spasmodic contraction of the part itself. If
+the injury is unaccompanied by lesion of the abdominal or thoracic
+viscera, the prognosis is not so unfavorable as might be supposed.
+Unless the laceration is extremely small, protrusion of the stomach or
+some other viscera into the thoracic cavity will almost invariably
+result, constituting the condition known as internal or diaphragmatic
+hernia. Pare relates the case of a Captain who was shot through the
+fleshy portion of the diaphragm, and though the wound was apparently
+healed, the patient complained of a colicky pain.  Eight months
+afterward the patient died in a violent paroxysm of this pain. At the
+postmortem by Guillemeau, a man of great eminence and a pupil of Pare,
+a part of the colon was found in the thorax, having passed through a
+wound in the diaphragm. Gooch saw a similar case, but no history of the
+injury could be obtained. Bausch mentions a case in which the omentum,
+stomach, and pancreas were found in the thoracic cavity, having
+protruded through an extensive opening in the diaphragm. Muys, Bonnet,
+Blancard, Schenck, Sennert, Fantoni, and Godefroy record instances in
+which, after rupture of the diaphragm, the viscera have been found in
+the thorax; there are many modern cases on record. Internal hernia
+through the diaphragm is mentioned by Cooper, Bowles, Fothergill,
+Monro, Ballonius, Derrecagiax, and Schmidt. Sir Astley Cooper mentioned
+a case of hernia ventriculi from external violence, wherein the
+diaphragm was lacerated without any fracture of the ribs. The man was
+aged twenty-seven, and being an outside passenger on a coach (and also
+intoxicated), when it broke down he was projected some distance,
+striking the ground with considerable force. He died on the next day,
+and the diagnosis was verified at the necropsy, the opening in the
+diaphragm causing stricture of the bowel.
+
+Postempski successfully treated a wound of the diaphragm complicated
+with a wound of the omentum, which protruded between the external
+opening between the 10th and 11th ribs; he enlarged the wound, forced
+the ribs apart, ligated and cut off part of the omentum, returned its
+stump to the abdomen, and finally closed both the wound in the
+diaphragm and the external wound with sutures. Quoted by Ashhurst,
+Hunter recorded a case of gunshot wound, in which, after penetrating
+the stomach, bowels, and diaphragm the ball lodged in the thoracic
+cavity, causing no difficulty in breathing until shortly before death,
+and even then the dyspnea was mechanical--from gaseous distention of
+the intestines.
+
+Peritonitis in the thoracic cavity is a curious condition which may be
+brought about by a penetrating wound of the diaphragm. In 1872 Sargent
+communicated to the Boston Society for Medical Improvement an account
+of a postmortem examination of a woman of thirty-seven, in whom he had
+observed major injuries twenty years before. At that time, while
+sliding down some hay from a loft, she was impaled on the handle of a
+pitchfork which entered the vagina, penetrated 22 inches, and was
+arrested by an upper left rib, which it fractured; further penetration
+was possibly prevented by the woman's feet striking the floor. Happily
+there was no injury to the bladder, uterus, or intestines. The
+principal symptoms were hemorrhage from the vagina and intense pain
+near the fractured rib, followed by emphysema. The pitchfork-handle was
+withdrawn, and was afterward placed in the museum of the Society, the
+abrupt bloody stain, 22 inches from the rounded end, being plainly
+shown. During twenty years the woman could never lie on her right side
+or on her back, and for half of this time she spent most of the night
+in the sitting position. Her last illness attracted little attention
+because her life had been one of suffering. After death it was found
+that the cavity in the left side of the chest was entirely filled with
+abdominal viscera. The opening in the diaphragm was four inches in
+diameter, and through it had passed the stomach, transverse colon, a
+few inches of the descending colon, and a considerable portion of the
+small intestines. The heart was crowded to the right of the sternum and
+was perfectly healthy, as was also the right lung. The left lung was
+compressed to the size of a hand.  There were marked signs of
+peritonitis, and in the absence of sufficient other symptoms, it could
+be said that this woman had died of peritonitis in the left thoracic
+cavity.
+
+Extended tolerance of foreign bodies loose in the thoracic cavity has
+been noticed. Tulpins mentions a person who had a sponge shut up in his
+thoracic cavity for six weeks; it was then voided by the mouth, and the
+man recovered. Fabricius Hildanus relates a similar instance in which a
+sponge-tent was expelled by coughing.  Arnot reports a case in which a
+piece of iron was found in a cyst in the thorax, where it had remained
+for fourteen years. Leach gives a case in which a bullet was impacted
+in the chest for forty-two years. Snyder speaks of a fragment of
+knife-blade which was lodged in the chest twelve years and finally
+coughed up.
+
+Foreign Bodies in the Bronchi.--Walnut kernels, coins, seeds, beans,
+corks, and even sponges have been removed from the bronchi. In the
+presence of Sir Morrell Mackenzie, Johnston of Baltimore removed a toy
+locomotive from the subglottic cavity by tracheotomy and thyreotomy.
+The child had gone to sleep with the toy in his mouth and had
+subsequently swallowed it. Eldredge presented a hopeless consumptive,
+who as a child of five had swallowed an umbrella ferrule while
+whistling through it, and who expelled it in a fit of coughing
+twenty-three years after. Eve of Nashville mentions a boy who placed a
+fourpenny nail in a spool to make a whistle, and, by a violent
+inspiration, drew the nail deep into the left bronchus. It was removed
+by tracheotomy.  Liston removed a large piece of bone from the right
+bronchus of a woman, and Houston tells of a case in which a molar tooth
+was lodged in a bronchus causing death on the eleventh day. Warren
+mentions spontaneous expulsion of a horse-shoe nail from the bronchus
+of a boy of two and one-half years. From Dublin, in 1844, Houston
+reports the case of a girl of sixteen who inhaled the wooden peg of a
+small fiddle and in a fit of coughing three months afterward expelled
+it from the lungs. In 1849 Solly communicated the case of a man who
+inhaled a pebble placed on his tongue to relieve thirst. On removal
+this pebble weighed 144 grains. Watson of Murfreesboro removed a
+portion of an umbrella rib from a trachea, but as he failed to locate
+or remove the ferrule, the case terminated fatally. Brigham mentions a
+child of five who was seized with a fit of coughing while she had a
+small brass nail in her mouth; pulmonary phthisis ensued, and in one
+year she died. At the postmortem examination the nail was found near
+the bifurcation of the right bronchus, and, although colored black, was
+not corroded.
+
+Marcacci reported an observation of the removal of a bean from the
+bronchus of a child of three and a half years. The child swallowed the
+bean while playing, immediately cried, and became hoarse. No one having
+noticed the accident, a diagnosis of croup was made and four leeches
+were applied to the neck. The dyspnea augmented during the night, and
+there was a whistling sound with each respiratory movement. On the next
+day the medical attendants suggested the possibility of a foreign body
+in the larynx.  Tracheotomy was performed but the dyspnea continued,
+showing that the foreign body was lodged below the incision. The blood
+of one of the cut vessels entered the trachea and caused an extra
+paroxysm of dyspnea, but the clots of blood were removed by curved
+forceps. Marcacci fils practised suction, and placed the child on its
+head, but in vain. A feather was then introduced in the wound with the
+hope that it would clean the trachea and provoke respiration; when the
+feather was withdrawn the bean followed. The child was much
+asphyxiated, however, and five or six minutes elapsed before the first
+deep inspiration. The wound was closed, the child recovered its voice,
+and was well four days afterward. Annandale saw a little patient who
+had swallowed a bead of glass, which had lodged in the bronchus. He
+introduced the handle of a scalpel into the trachea, producing
+sufficient irritation to provoke a brusque expiration, and at the
+second attempt the foreign body was expelled. Hulke records the case of
+a woman, the victim of a peculiar accident happening during the
+performance of tracheotomy, for an affection of the larynx. The
+internal canule of the tracheotomy-tube fell into the right bronchus,
+but was removed by an ingenious instrument extemporaneously devised
+from silver wire. A few years ago in this country there was much public
+excitement and newspaper discussion over the daily reports which came
+from the bedside of a gentleman who had swallowed a cork, and which had
+become lodged in a bronchus. Tracheotomy was performed and a special
+corkscrew devised to extract it, but unfortunately the patient died of
+slow asphyxiation and exhaustion. Herrick mentions the case of a boy of
+fourteen months who swallowed a shawl-pin two inches long, which
+remained in the lungs four years, during which time there was a
+constant dry and spasmodic cough, and corresponding depression and
+emaciation. When it was ultimately coughed up it appeared in one large
+piece and several smaller ones, and was so corroded as to be very
+brittle. After dislodgment of the pin there was subsidence of the cough
+and rapid recovery.
+
+Lapeyre mentions an elderly gentleman who received a sudden slap on the
+back while smoking a cigarette, causing him to start and take a very
+deep inspiration. The cigarette was drawn into the right bronchus,
+where it remained for two months without causing symptoms or revealing
+its presence. It then set up a circumscribed pneumonia and cardiac
+dropsy which continued two months longer, at which time, during a
+violent fit of coughing, the cigarette was expelled enveloped in a
+waxy, mucus-like matter. Louis relates the case of a man who carried a
+louis-d'or in his lung for six and a half years.
+
+There is a case on record of a man who received a gunshot wound, the
+ball entering behind the left clavicle and passing downward and across
+to the right clavicle. Sometime afterward this patient expectorated two
+pieces of bone and a piece of gum blanket in which he was enveloped at
+the time of the injury. Carpenter describes a case of fatal pleuritis,
+apparently due to the presence of four artificial teeth which had been
+swallowed thirteen years before.
+
+Cardiac Injuries.--For ages it has been the common opinion relative to
+injuries of the heart that they are necessarily fatal and that, as a
+rule, death immediately follows their reception.  Notwithstanding this
+current belief a careful examination of the literature of medicine
+presents an astounding number of cases in which the heart has been
+positively wounded, and the patients have lived days, months, and even
+recovered; postmortem examination, by revealing the presence of
+cicatrices in the heart, confirming the original diagnosis. This
+question is one of great interest as, in recent years, there has been
+constant agitation of the possibility of surgical procedures in cardiac
+as well as cerebral injuries. Del Vecchio has reported a series of
+experiments on dogs with the conclusion that in case of wounds in human
+beings suture of the heart is a possible operation. In this connection
+he proposes the following operative procedure: Two longitudinal
+incisions to be made from the lower border of the 3d rib to the upper
+border of the 7th rib, one running along the inner margin of the
+sternum, the other about ten mm. inside the nipple-line. These
+incisions are joined by a horizontal cut made in the fourth intercostal
+space. The 4th, 5th, and 6th ribs and cartilages are divided and the
+outer cutaneous flaps turned up; pushing aside the pleura with the
+finger, expose the pericardium and incise it longitudinally; suture the
+heart-wound by interrupted sutures. Del Vecchio adds that Fischer has
+collected records of 376 cases of wounds of the heart with a mortality
+two to three minutes after the injury of 20 per cent. Death may occur
+from a few seconds to nine months after the accident. Keen and Da Costa
+quote Del Vecchio, and, in comment on his observations, remark that
+death in cases of wound of the heart is due to pressure of effused
+blood in the pericardial sac, and, because this pressure is itself a
+cheek to further hemorrhage, there seems, as far as hemorrhage is
+concerned, to be rather a question whether operative interference may
+not be itself more harmful than beneficial. It might be added that the
+shock to the cardiac action might be sufficient to check it, and at
+present we would have no sure means of starting pulsation if once
+stopped. In heart-injuries, paracentesis, followed, if necessary, by
+incision of the pericardium, is advised by some surgeons.
+
+Realizing the fatality of injuries of the heart, in consequence of
+which almost any chance by operation should be quickly seized by
+surgeons rather than trust the lives of patients to the infinitesimal
+chance of recovery, it would seem that the profession should carefully
+consider and discuss the feasibility of any procedure in this
+direction, no matter how hypothetic.
+
+Hall states that his experience in the study of cardiac wounds, chiefly
+on game-animals, would lead him to the conclusion that transverse
+wounds the lower portions of the heart, giving rise to punctures rather
+than extensive lacerations, do not commonly cause cessation of life for
+a time varying from some considerable fraction of a minute to many
+minutes or even hours, and especially if the puncture be valvular in
+character, so as to prevent the loss of much blood. However, if the
+wound involve the base of the organ, with extensive laceration of the
+surrounding parts, death is practically instantaneous. It would seem
+that injury to the muscular walls of the heart is much less efficient
+in the production of immediate death than destruction of the cardiac
+nervous mechanism, serious irritation of the latter producing almost
+instantaneous death from shock. In addition, Hall cites several of the
+instances on which he based his conclusions. He mentions two wild geese
+which flew respectively 1/4 and 3/4 of a mile after having been shot
+through the heart, each with a pellet of BB shot, the base in each
+instance being uninjured; in several instances antelope and deer ran
+several rods after being shot with a rifle ball in a similar manner; on
+the other hand, death was practically instantaneous in several of these
+animals in which the base of the heart was extensively lacerated.
+Again, death may result instantaneously from wounds of the precordial
+region, or according to Erichsen, if held directly over the heart, from
+the discharge of a pistol containing powder alone, a result
+occasionally seen after a blow on the precordial region. It is well,
+however, to state that in times of excitement, one may receive an
+injury which will shortly prove fatal, and yet not be aware of the fact
+for some time, perhaps even for several minutes. It would appear that
+the nervous system is so highly tuned at such times, that it does not
+respond to reflex irritations as readily as in the absence of
+excitement.
+
+Instances of Survival after Cardiac Injuries.--We briefly cite the
+principal interesting instances of cardiac injuries in which death has
+been delayed for some time, or from which the patient ultimately
+recovered.
+
+Pare relates the case of a soldier who received a blow from a halberd,
+penetrating the left ventricle, and who walked to the surgeon's tent to
+have his wound dressed and then to his own tent 260 yards away.
+Diemerbroeck mentions two instances of long survival after cardiac
+injuries, in one of which the patient ran 60 paces after receiving the
+wound, had complete composure of mind, and survived nine days. There is
+an instance in which a man ran 400 paces after penetration of the left
+ventricle, and lived for five hours. Morand gives an instance of
+survival for five days after wound of the right ventricle. Saucerotte
+speaks of survival for three days after injury to the heart.
+
+Babington speaks of a case of heart-injury, caused by transfixion by a
+bayonet, in which the patient survived nine hours. Other older cases
+are as follows: l'Ecluse, seven days; the Ephemerides, four and six
+days; Col de Vilars, twelve days; Marcucci, eighteen days; Bartholinus,
+five days; Durande, five days; Boyer, five days; Capelle, twenty six
+hours; Fahner, eleven days; Marigues, thirteen days; Morgagni, eight
+days; la Motte, twelve hours; Rhodius, Riedlin, two days; Saviard,
+eleven days; Sennert, three days; Triller, fourteen days; and Tulpius,
+two and fifteen days; and Zittman, eight days.
+
+The Duc de Berri, heir to the French throne, who was assassinated in
+1826, lived several hours with one of his ventricles opened.  His
+surgeon, Dupuytren, was reprimanded for keeping the wound open with a
+probe introduced every two hours, but this procedure has its advocates
+at the present day. Randall mentions a gunshot wound of the right
+ventricle which did not cause death until the sixty-seventh day. Grant
+describes a wound in which a ball from a revolver entered a little to
+the right of the sternum, between the cartilages of the 5th and 6th
+ribs, and then entered the right ventricle about an inch from the apex.
+It emerged from the lower part, passed through the diaphragm, the
+cardiac end of the stomach, and lodged in the left kidney. The patient
+remained in a state of collapse fifteen hours after being shot, and
+with little or no nourishment lived twenty-six days. At the postmortem
+examination the wounds in the organs were found to be healed, but the
+cicatrices were quite evident. Bowling gives a case of gunshot wound of
+the shoulder in which death resulted eleven weeks after, the bullet
+being found in the left ventricle of the heart. Thompson has reported a
+bayonet wound of the heart, after the reception of which the patient
+lived four days. The bayonet entered the ventricle about 1 1/2 inches
+from the left apex, traversing the left wall obliquely, and making exit
+close to the septum ventriculorum. Roberts mentions a man who ran 60
+yards and lived one hour after being shot through both lungs and the
+right auricle. Curran mentions the case of a soldier who, in 1809, was
+wounded by a bullet which entered his body to the left of the sternum,
+between the 2d and 3d ribs. He was insensible a half hour, and was
+carried aboard a fighting ship crowded with sailors. There was little
+hemorrhage from his wound, and he survived fourteen days. At the
+postmortem examination some interesting facts were revealed. It was
+found that the right ventricle was transversely opened for about an
+inch, the ball having penetrated its anterior surface, near the origin
+of the pulmonary artery. The ball was found loose in the pericardium,
+where it had fallen during the necropsy. There was a circular lacerated
+opening in the tricuspid valve, and the ball must have been in the
+right auricle during the fourteen days in which the man lived. Vite
+mentions an example of remarkable tenacity of life after reception of a
+cardiac wound, the subject living four days after a knife-wound
+penetrating the chest into the pericardial sac and passing through the
+left ventricle of the heart into the opposite wall. Boone speaks of a
+gunshot wound in which death was postponed until the thirteenth day.
+Bullock mentions a case of gunshot wound in which the ball was found
+lodged in the cavity of the ventricle four days and eighteen hours
+after infliction of the wound. Carnochan describes a penetrating wound
+of the heart in a subject in whom life had been protracted eleven days.
+After death the bullet was found buried and encysted in the heart.
+Holly reports a case of pistol-shot wound through the right ventricle,
+septum, and aorta, with the ball in the left ventricle. There was
+apparent recovery in fourteen days and sudden death on the fifty-fifth
+day.
+
+Hamilton gives an instance of a shoemaker sixty-three years old who,
+while carrying a bundle, fell with rupture of the heart and lived
+several minutes. On postmortem examination an opening in the heart was
+found large enough to admit a blowpipe. Noble speaks of duration of
+life for five and a half days after rupture of the heart; and there are
+instances on record in which life has been prolonged for thirteen hours
+and for fifty-three hours after a similar injury. Glazebrook reports
+the case of a colored man of thirty, of powerful physique, who was
+admitted to the Freedmen's Hospital, Washington, D.C., at 12.30 A.M.,
+on February 5, 1895.  Upon examination by the surgeons, an incised
+wound was discovered one inch above the left nipple, 3 1/4 inches to
+the left of the median line, the incision being 2 1/4 inches in length
+and its direction parallel with the 3d rib. The man's general condition
+was fairly good, and the wound was examined. It was impossible to trace
+its depth further than the 3d rib, although probing was resorted to; it
+was therefore considered a simple wound, and dressed accordingly.
+Twelve hours later symptoms of internal hemorrhage were noticed, and at
+8 A.M., February 6th, the man died after surviving his injury
+thirty-two hours. A necropsy was held three hours after death, and an
+oblique incision 3/4 inch in length was found through the cartilage-end
+of the 3d rib. A similar wound was next found in the pericardium, and
+upon examining the heart there was seen a clean, incised wound 1/2 inch
+in length, directly into the right ventricle, the endocardial wound
+being 3/8 inch long. Both the pericardium and left pleura were
+distended with fresh blood and large clots.  Church reports a case of
+gunshot wound of the heart in a man of sixty-seven who survived three
+hours. The wound had been made by a pistol bullet (32 caliber), was
+situated 1 1/4 inches below the mammary line, and slightly to the left
+of the center of the sternum; through it considerable blood had
+escaped. The postmortem examination showed that the ball had pierced
+the sternum just above the xiphoid cartilage, and had entered the
+pericardium to the right and at the lower part. The sac was filled with
+blood, both fresh and clotted. There was a ragged wound in the anterior
+wall 1/2 inch in diameter. The wound of exit was 5/8 inch in diameter.
+After traversing the heart the ball had penetrated the diaphragm,
+wounded the omentum in several places, and become lodged under the skin
+posteriorly between the 9th and 10th ribs. Church adds that the "Index
+Catalogue of the Surgeon-General's Library" at Washington contains 22
+cases of direct injury to the heart, all of which lived longer than his
+case: 17 lived over three days; eight lived over ten days; two lived
+over twenty-five days; one died on the fifty-fifth day, and there were
+three well-authenticated recoveries. Purple tabulates a list of 42
+cases of heart-injury which survived from thirty minutes to seventy
+days.
+
+Fourteen instances of gunshot wounds of the heart have been collected
+from U.S. Army reports, in all of which death followed very promptly,
+except in one instance in which the patient survived fifty hours. In
+another case the patient lived twenty-six hours after reception of the
+injury, the conical pistol-ball passing through the anterior margin of
+the right lobe of the lung into the pericardium, through the right
+auricle, and again entered the right pleural cavity, passing through
+the posterior margin of the lower lobe of the right lung; at the
+autopsy it was found in the right pleural cavity. The left lung and
+cavity were perfectly normal. The right lung was engorged and somewhat
+compressed by the blood in the pleural cavity. The pericardium was much
+distended and contained from six to eight ounces of partially
+coagulated blood. There was a fibrinous clot in the left ventricle.
+
+Nonfatal Cardiac Injuries.--Wounds of the heart are not necessarily
+fatal. Of 401 cases of cardiac injury collected by Fischer there were
+as many as 50 recoveries, the diagnosis being confirmed in 33 instances
+by an autopsy in which there were found distinct signs of the cardiac
+injury. By a peculiar arrangement of the fibers of the heart, a wound
+transverse to one layer of fibers is in the direction of another layer,
+and to a certain extent, therefore, valvular in function; it is
+probably from this fact that punctured wounds of the heart are often
+attended with little or no bleeding.
+
+Among the older writers, several instances of nonfatal injuries to the
+heart are recorded. Before the present century scientists had observed
+game-animals that had been wounded in the heart in the course of their
+lives, and after their ultimate death such direct evidence as the
+presence of a bullet or an arrow in their hearts was found. Rodericus a
+Veiga tells the story of a deer that was killed in hunting, and in
+whose heart was fixed a piece of arrow that appeared to have been there
+some time. Glandorp experimentally produced a nonfatal wound in the
+heart of a rabbit. Wounds of the heart, not lethal, have been reported
+by Benivenius, Marcellus Donatus, Schott, Stalpart van der Wiel, and
+Wolff. Ollenrot reports an additional instance of recovery from
+heart-injury, but in his case the wound was only superficial.
+
+There is a recent case of a boy of fourteen, who was wounded in the
+heart by a pen-knife stab. The boy was discharged cured from the
+Middlesex Hospital, but three months after the reception of the injury
+he was taken ill and died. A postmortem examination showed that the
+right ventricle had been penetrated in a slanting direction; the cause
+of death was apoplexy, produced by the weakening and thinning of the
+heart's walls, the effect of the wound. Tillaux reports the case of a
+man of sixty-five, the victim of general paralysis, who passed into his
+chest a blade 16 cm. long and 2 mm. broad. The wound of puncture was 5
+cm. below the nipple and 2 cm. to the outside. The left side of the
+chest was emphysematous and ecchymosed. The heart-sounds were regular,
+and the elevation of the skin by the blade coincided with the
+ventricular systole. The blade was removed on the following day, and
+the patient gradually improved. Some thirteen months after he had
+expectoration of blood and pus and soon died. At the necropsy it was
+seen that the wound had involved both lungs; the posterior wall of the
+ventricle and the inferior lobe of the right lung were traversed from
+before backward, and from left to right, but the ventricular cavity was
+not penetrated. Strange to say, the blade had passed between the
+vertebral column and the esophagus, and to the right of the aorta, but
+had wounded neither of these organs.
+
+O'Connor mentions a graduate of a British University who, with suicidal
+intent, transfixed his heart with a darning-needle. It was extracted by
+a pair of watchmaker's pliers. In five days the symptoms had all
+abated, and the would-be suicide was well enough to start for the
+Continent. Muhlig was consulted by a mason who, ten years before, had
+received a blow from a stiletto near the left side of the sternum. The
+cicatrix was plainly visible, but the man said he had been able to
+perform his daily labors, although at the present time suffering from
+intense dyspnea and anasarca. A loud bellows-sound could be heard,
+which the man said had been audible since the time of reception of the
+injury. This was a double bruit accompanying systole, and entirely
+obscuring the physical signs. From this time the man speedily failed,
+and after his death there were cicatricial signs found, particularly on
+the wall of the left ventricle, together with patency of the
+interventricular septum, with signs of cicatrization about this rent.
+At the side of the left ventricle the rent was twice as large and lined
+with cicutricial tissue.
+
+Stelzner mentions a young student who attempted suicide by thrusting a
+darning-needle into his heart. He complained of pain and dyspnea; in
+twenty-four hours his symptoms increased to such an extent that
+operation was deemed advisable on account of collapse. The 5th rib was
+resected and the pleural cavity opened.  When the pericardial sac was
+incised, a teaspoonful of turbid fluid oozed out, and the needle was
+felt in an oblique position in the right ventricle. By pressure of a
+finger passed under the heart, the eye of the needle was pressed
+through the anterior wall and fixed on the operator's finger-nail. An
+attempt to remove by the forceps failed, as the violent movements of
+the heart drew the needle back into the cavity. About this stage of the
+operation an unfortunate accident happened--the iodoform tampon, which
+protected the exposed pleural cavity, was drawn into this cavity during
+a deep inspiration, and could not be found. Notwithstanding subsequent
+pneumothorax and extensive pleuritic effusion, the patient made a good
+recovery at the end of the fourth week and at the time of report it was
+still uncertain whether the needle remained in the heart or had
+wandered into the mediastinum. During the discussion which followed the
+report of this case, Hahn showed a portion of a knitting-needle which
+had been removed from the heart of a girl during life. The extraction
+was very slow in order to allow of coagulation along the course of the
+wound in the heart, and to guard against hemorrhage into the
+pericardial sac, which is so often the cause of death in punctured
+wounds of this organ. Hahn remarked that the pulse, which before the
+removal had been very rapid, sank to 90.
+
+Marks reports the case of a stab-wound penetrating the left 9th
+intercostal space, the diaphragm, pleura, pericardium, and apex of the
+heart. It was necessary to enlarge the wound, and, under an anesthetic,
+after removing one and one-half inches of the 9th and 10th ribs, the
+wound was thoroughly packed with iodoform gauze and in twenty-one days
+the patient recovered. Lavender mentions an incised wound of the heart
+penetrating the right ventricle, from which the patient recovered.
+Purple gives, an account of a recovery from a wound penetrating both
+ventricles.  The diagnosis was confirmed by a necropsy nine years
+thereafter.  Stoll records a nonfatal injury to the heart.
+
+Mastin reports the case of a man of thirty-two who was shot by a
+38-caliber Winchester, from an ambush, at a distance of 110 yards. The
+ball entered near the chest posteriorly on the left side just below and
+to the outer angle of the scapula, passed between the 7th and 8th ribs,
+and made its exit from the intercostal space of the 4th and 5th ribs, 2
+1/4 inches from the nipple. A line drawn from the wound of entrance to
+that of exit would pass exactly through the right ventricle. After
+receiving the wound the man walked about twenty steps, and then,
+feeling very weak from profuse hemorrhage from the front of the wound,
+he sat down. With little or no treatment the wound closed and steady
+improvement set in; the patient was discharged in three weeks. As the
+man was still living at last reports, the exact amount of damage done
+in the track of the bullet is not known, although Mastin's supposition
+is that the heart was penetrated.
+
+Mellichamp speaks of a gunshot wound of the heart with recovery, and
+Ford records an instance in which a wound of the heart by a buckshot
+was followed by recovery. O'Connor reports a case under his observation
+in which a pistol-ball passed through three of the four cavities of the
+heart and lodged in the root of the right lung. The patient, a boy of
+fifteen, died of the effects of cardiac disease three years and two
+months later. Bell mentions a case in which, six years after the
+receipt of a gunshot wound of the chest, a ball was found in the right
+ventricle. Christison speaks of an instance in which a bullet was found
+in the heart of a soldier in Bermuda, with no apparent signs of an
+opening to account for its entrance. There is a case on record of a boy
+of fourteen who was shot in the right shoulder, the bullet entering
+through the right upper border of the trapezius, two inches from the
+acromion process. Those who examined him supposed the ball was lodged
+near the sternal end of the clavicle, four or five inches from where it
+entered. In about six weeks the boy was at his labors. Five years later
+he was attacked with severe pneumonia and then first noticed tumultuous
+action of the heart which continued to increase after his recovery.
+Afterward the pulsation could be heard ten or 12 feet away. He died of
+another attack of pneumonia fifteen years later and the heart was found
+to be two or three times its natural size, soft and flabby, and, on
+opening the right ventricle, a bullet was discovered embedded in its
+walls. There was no scar of entrance discernible, though the
+pericardium was adherent. Biffi of Milan describes the case of a
+lunatic who died in consequence of gangrene of the tongue from a bite
+in a paroxysm of mania. At the necropsy a needle, six cm. in length,
+was found transfixing the heart, with which the relatives of the
+deceased said he had stabbed himself twenty-two months prior to his
+death. There is a collection of cases in which bullets have been lodged
+in the heart from twenty to thirty years.
+
+Balch reports a case in which a leaden bullet remained twenty years in
+the walls of the heart. Hamilton mentions an instance of gunshot wound
+of the heart, in which for twenty years a ball was embedded in the wall
+of the right ventricle, death ultimately being caused by pneumonia.
+Needles have quite frequently been found in the heart after death;
+Graves, Leaming, Martin, Neill, Piorry, Ryerson, and others record such
+cases. Callender mentions recovery of the patient after removal of a
+needle from the heart.
+
+Garangeot mentions an aged Jesuit of seventy-two, who had in the
+substance of his heart a bone 4 1/2 inches long and possibly an inch
+thick. This case is probably one of ossification of the cardiac muscle;
+in the same connection Battolini says that the heart of Pope Urban VII
+contained a bone shaped like the Arab T.
+
+Among the older writers we frequently read of hairs, worms, and snakes
+being found in the cavities of the heart. The Ephemerides, Zacutus
+Lusitanus, Pare, Swinger, Riverius, and Senac are among the authorities
+who mention this circumstance. The deception was possibly due to the
+presence of loose and shaggy membrane attached to the endocardial
+lining of the heart, or in some cases to echinococci or trichine. A
+strange case of foreign body in the heart was reported some time since
+in England. The patient had swallowed a thorn of the Prunus spinosa
+(Linn.), which had penetrated the esophagus and the pericardium and
+entered the heart. A postmortem examination one year afterward
+confirmed this, as a contracted cicatrix was plainly visible on the
+posterior surface of the heart about an inch above the apex, through
+which the thorn had penetrated the right ventricle and lodged in the
+tricuspid valve. The supposition was that the thorn had been swallowed
+while eating radishes. Buck mentions a case of hydatid cysts in the
+wall of the left ventricle, with rupture of the cysts and sudden death.
+
+It is surprising the extent of injury to the pericardium Nature will
+tolerate. In his "Comment on the Aphorisms of Hippocrates," Cardanus
+says that he witnessed the excision of a portion of the pericardium
+with the subsequent cure of the patient. According to Galen, Marulus,
+the son of Mimographus, recovered after a similar operation. Galen also
+adds, that upon one occasion he removed a portion of carious sternum
+and found the pericardium in a putrid state, leaving a portion of the
+heart naked. It is said that in the presence of Leucatel and several
+theologians, Francois Botta opened the body of a man who died after an
+extended illness and found the pericardium putrefied and a great
+portion of the heart destroyed, but the remaining portion still
+slightly palpitating.  In this connection Young mentions a patient of
+sixty-five who in January, 1860, injured his right thumb and lost the
+last joint by swelling and necrosis. Chloroform was administered to
+excise a portion of the necrosed bone and death ensued. Postmortem
+examination revealed gangrene of the heart and a remarkable tendency to
+gangrene elsewhere (omentum, small intestines, skin, etc.). Recently,
+Dalton records a remarkable case of stab-wound of the pericardium with
+division of the intercostal artery, upon which he operated. An incision
+eight inches long was made over the 4th rib, six inches of the rib were
+resected, the bleeding intercostal artery was ligated, the blood was
+turned out of the pericardial cavity, this cavity being irrigated with
+hot water.  The wound in the pericardium, which was two inches long,
+was sutured and the external wound was closed. Recovery followed.
+Harris gives an instance of a man who was injured by a bar of iron
+falling on his shoulder, producing a compound fracture of the ribs as
+low as the 7th, and laying the heart and lungs bare without seriously
+injuring the pericardium.
+
+Rupture of the heart from contusion of the chest is not always
+instantly fatal. According to Ashhurst, Gamgee has collected 28 cases
+of rupture of this viscus, including one observed by himself. In nine
+of these cases there was no fracture, and either no bruise of the
+parietes or a very slight one. The pericardium was intact in at least
+half of the cases, and in 22 in which the precise seat of lesion was
+noticed the right ventricle was ruptured in eight, the left in three,
+the left auricle in seven, the right in four. The longest period during
+which any patient survived the injury was fourteen hours.
+
+Among the older writers who note this traumatic injury are Fine, who
+mentions concussion rupturing the right ventricle, and Ludwig, who
+reports a similar accident. Johnson mentions rupture of the left
+ventricle in a paroxysm of epilepsy. There is another species of
+rupture of the heart which is not traumatic, in which the rupture
+occurs spontaneously, the predisposing cause being fatty degeneration,
+dilatation, or some other pathologic process in the cardiac substance.
+It is quite possible that the older instances of what was known as
+"broken-heart," which is still a by-word, were really cases in which
+violent emotion had produced rupture of a degenerated cardiac wall.
+Wright gives a case of spontaneous rupture of the heart in which death
+did not occur for forty-eight hours. Barth has collected 24 cases of
+spontaneous rupture of the heart, and in every instance the seat of
+lesion was in the left ventricle. It was noticed that in some of these
+cases the rupture did not take place all at once, but by repeated minor
+lacerations, death not ensuing in some instances for from two to eleven
+days after the first manifestation of serious symptoms. A more recent
+analysis is given by Meyer of cases reported since 1870: Meyer collects
+25 cases of rupture of the left ventricle seven of the right ventricle,
+and four of the right auricle. Within the last year Collings has
+reported a case of idiopathic rupture of the heart in a man of
+fifty-three, who had always lived a temperate life, and whose only
+trouble had been dyspepsia and a weak heart. There was no history of
+rheumatism or rheumatic fever. The man's father had died suddenly of
+heart disease. After feeling out of sorts for a time, the man
+experienced severe pain in the precordium and felt too ill to leave his
+bed. He gradually became worse and sick after taking food. Speech
+became thick, the mouth was drawn to the right, and the right eye was
+partially closed. The left arm became paralyzed, then the right leg.
+The tongue deviated to the right on protrusion. The sphincters were
+unaffected. The heart sounds were faint and without added sounds. The
+man was moved to a water-bed, his body and head being kept horizontal,
+and great care being taken to avoid sudden movement. Later, when his
+pelvis was raised to allow the introduction of a bed-pan, almost
+instantaneous death ensued. Upon postmortem examination prolonged and
+careful search failed to reveal any microscopic change in the brain,
+its vessels, or the meninges. On opening the pericardium it was found
+to be filled with blood-clot, and on washing this away a laceration
+about 1 1/2 inches in length was found in the left ventricle; the
+aperture was closed by a recent clot. The cavities of the heart were
+dilated, the walls thin and in advanced stage of fatty degeneration.
+There was no valvular disease. The aorta and its main branches were
+atheromatous. Both lungs contained calcifying tubercle; the abdomen was
+loaded with fat; the spleen was soft; the kidneys were engorged, but
+otherwise healthy.
+
+Stokes gives the case of a man who was severely crushed between the
+arms of a water-wheel of great size and the embankment on which the
+axle of the wheel was supported; a peculiar factor of the injury being
+that his heart was displaced from left to right.  At the time of
+report, after recovery from the injury, the patient exhibited
+remarkable tolerance of great doses of digitalis. When not taking
+digitalis, his pulse was 100 to 120, regular, and never intermittent.
+
+Hypertrophy of the Heart.--The heart of a man of ordinary size weighs
+nine ounces, and that of a woman eight; in cases of hypertrophy, these
+weights may be doubled, although weights above 25 ounces are rare.
+According to Osler, Beverly Robinson describes a heart weighing 53
+ounces, and Dulles has reported one weighing 48 ounces. Among other
+modern records are the following: Fifty and one-half ounces, 57 ounces,
+and one weighing four pounds and six ounces. The Ephemerides contains
+an incredible account of a heart that weighed 14 pounds. Favell
+describes a heart that only weighed 3 1/2 ounces.
+
+Wounds of the aorta are almost invariably fatal, although cases are
+recorded by Pelletan, Heil, Legouest, and others, in which patients
+survived such wounds for from two months to several years. Green
+mentions a case of stab-wound in the suprasternal fossa. The patient
+died one month after of another cause, and at the postmortem
+examination the aorta was shown to have been opened; the wound in its
+walls was covered with a spheric, indurated coagulum. No attempt at
+union had been made.
+
+Zillner observed a penetrating wound of the aorta after which the
+patient lived sixteen days, finally dying of pericarditis.  Zillner
+attributed this circumstance to the small size of the wound, atheroma
+and degeneration of the aorta and slight retraction of the inner coat,
+together with a possible plugging of the pericardial opening. In 1880
+Chiari said that while dissecting the body of a man who died of
+phthisis, he found a false aneurysm of the ascending aorta with a
+transverse rupture of the vessel by the side of it, which had
+completely cicatrized.  Hill reports the case of a soldier who was
+stabbed with a bowie-knife nine inches long and three inches wide. The
+blade passed through the diaphragm, cut off a portion of the liver, and
+severed the descending aorta at a point about the 7th dorsal vertebra;
+the soldier lived over three hours after complete division of this
+important vessel. Heil reports the case of a man of thirty-two, a
+soldier in the Bavarian army, who, in a quarrel in 1812, received a
+stab in the right side. The instrument used was a common table-knife,
+which was passed between the 5th and 6th ribs, entering the left lung,
+and causing copious hemorrhage.  The patient recovered in four months,
+but suffered from amaurosis which had commenced at the time of the
+stab. Some months afterward he contracted pneumonia and was readmitted
+to the hospital, dying in 1813. At the postmortem the cicatrix in the
+chest was plainly visible, and in the ascending aorta there was seen a
+wound, directly in the track of the knife, which was of irregular
+border and was occupied by a firm coagulum of blood.  The vessel had
+been completely penetrated, as, by laying it open, an internal cicatrix
+was found corresponding to the other. Fatal hemorrhage had been avoided
+in this case by the formation of coagulum in the wound during the
+syncope immediately following the stab, possibly aided by extended
+exposure to cold.
+
+Sundry Cases.--Sandifort mentions a curious case of coalescence of the
+esophagus and aorta, with ulceration and consequent rupture of the
+aorta, the hemorrhage proceeding from the stomach at the moment of
+rupture.
+
+Heath had a case of injury to the external iliac artery from external
+violence, with subsequent obliteration of the vessel.  When the patient
+was discharged no pulse could be found in the leg.
+
+Dismukes reports a case in which the patient had received 13 wounds,
+completely severing the subclavian artery, and, without any medical or
+surgical aid, survived the injury two hours.
+
+Illustrative of the degree of hemorrhage which may follow an injury so
+slight as that of falling on a needle we cite an instance, reported by
+a French authority, of a child who picked up a needle, and, while
+running with it to its mother, stumbled and fell, the needle
+penetrating the 4th intercostal space, the broadened end of it
+remaining outside of the wound. The mother seized the needle between
+her teeth and withdrew it, but the child died, before medical aid could
+be summoned, from internal hemorrhage, causing pulmonary pressure and
+dyspnea.
+
+Rupture of the esophagus is attributable to many causes. Dryden
+mentions vomiting as a cause, and Guersant reports the case of a little
+girl of seven, who, during an attack of fever, ruptured her esophagus
+by vomiting. In 1837 Heyfelder reported the case of a drunkard, who, in
+a convulsion, ruptured his esophagus and died. Williams mentions a case
+in which not only the gullet, but also the diaphragm, was ruptured in
+vomiting. In this country, Bailey and Fitz have recorded cases of
+rupture of the esophagus.  Brewer relates a parallel instance of
+rupture from vomiting. All the foregoing cases were linear ruptures,
+but there is a unique case given by Boerhaave in 1724, in which the
+rent was transverse. Ziemssen and Mackenzie have both translated from
+the Latin the report of this case which is briefly as follows: The
+patient, Baron de Wassenaer, was fifty years of age, and, with the
+exception that he had a sense of fulness after taking moderate meals,
+he was in perfect health. To relieve this disagreeable feeling he was
+in the habit of taking a copious draught of an infusion of "blessed
+thistle" and ipecacuanha. One day, about 10.30 in the evening, when he
+had taken no supper, but had eaten a rather hearty dinner, he was
+bothered by a peculiar sensation in his stomach, and to relieve this he
+swallowed about three tumbler-fuls of his usual infusion, but to no
+avail. He then tried to excite vomiting by tickling the fauces, when,
+in retching, he suddenly felt a violent pain; he diagnosed his own case
+by saying that it was "the bursting of something near the pit of the
+stomach." He became prostrated and died in eighteen and one-half hours;
+at the necropsy it was seen that without any previously existing signs
+of disease the esophagus had been completely rent across in a
+transverse direction.
+
+Schmidtmuller mentions separation of the esophagus from the stomach;
+and Flint reports the history of a boy of seven who died after being
+treated for worms and cerebral symptoms. After death the contents of
+the stomach were found in the abdominal cavity, and the esophagus was
+completely separated from the stomach.  Flint believed the separation
+was postmortem, and was possibly due to the softening of the stomach by
+the action of the gastric acids. In this connection may be mentioned
+the case reported by Hanford of a man of twenty-three who had an attack
+of hematemesis and melanema two years before death. A postmortem was
+made five hours after death, and there was so much destruction of the
+stomach by a process resembling digestion that only the pyloric and
+cardiac orifices were visible. Hanford suggests that this was an
+instance of antemortem digestion of the stomach which physiologists
+claim is impossible.
+
+Nearly all cases of rupture of the stomach are due to carcinoma, ulcer,
+or some similar condition, although there have been instances of
+rupture from pressure and distention. Wunschheim reports the case of a
+man of fifty-two who for six months presented symptoms of gastric
+derangement, and who finally sustained spontaneous rupture of the
+posterior border of the stomach due to overdistention. There was a tear
+two inches long, beginning near the cardiac end and running parallel to
+the lesser curvature. The margin of the tear showed no evidence of
+digestion. There were obstructing esophageal neoplasms about 10 1/3
+inches from the teeth, which prevented vomiting. In reviewing the
+literature Wunschheim found only six cases of spontaneous rupture of
+the stomach. Arton reports the case of a negro of fifty who suffered
+from tympanites. He was a hard drinker and had been aspirated several
+times, gas heavily laden with odors of the milk of asafetida being
+discharged with a violent rush. The man finally died of his malady, and
+at postmortem it was found that his stomach had burst, showing a slit
+four inches long. The gall bladder contained two quarts of inspissated
+bile. Fulton mentions a case of rupture of the esophageal end of a
+stomach in a child.  The colon was enormously distended and the walls
+thickened. When three months old it was necessary to puncture the bowel
+for distention. Collins describes spontaneous rupture of the stomach in
+a woman of seventy-four, the subject of lateral curvature of the spine,
+who had frequent attacks of indigestion and tympanites. On the day of
+death there was considerable distention, and a gentle purgative and
+antispasmodic were given.  Just before death a sudden explosive sound
+was heard, followed by collapse. A necropsy showed a rupture two inches
+long and two inches from the pyloric end. Lallemand mentions an
+instance of the rupture of the coats of the stomach by the act of
+vomiting.  The patient was a woman who had suffered with indigestion
+five or six months, but had been relieved by strict regimen. After
+indulging her appetite to a greater extent than usual, she experienced
+nausea, and made violent and ineffectual efforts to discharge the
+contents of the stomach. While suffering great agony she experienced a
+sensation as if something was tearing in the lower part of her belly.
+The woman uttered several screams, fell unconscious, and died that
+night. Postmortem examination showed that the anterior and middle part
+of the stomach were torn obliquely to the extent of five inches. The
+tear extended from the smaller toward the greater curvature. The edges
+were thin and irregular and presented no marks of disease. The cavity
+of the peritoneum was full of half-digested food. The records of St.
+Bartholomew's Hospital, London, contain the account of a man of
+thirty-four who for two years had been the subject of paroxysmal pain
+in the stomach. The pains usually continued for several hours and
+subsided with vomiting. At St. Bartholomew's he had an attack of
+vomiting after a debauch. On the following day he was seized with
+vomiting accompanied by nausea and flatus, and after a sudden attack of
+pain at the pit of the stomach which continued for two hours, he died.
+A ragged opening at the esophageal orifice, on the anterior surface of
+the stomach was found. This tear extended from below the lesser
+curvature to its extremity, and was four inches long. There were no
+signs of gastric carcinoma or ulcer.
+
+Clarke reports the case of a Hindoo of twenty-two, under treatment for
+ague, who, without pain or vomiting, suddenly fell into collapse and
+died twenty-three hours later. He also mentions a case of rupture of
+the stomach of a woman of uncertain history, who was supposed to have
+died of cholera. The examination of the bodies of both cases showed
+true rupture of the stomach and not mere perforation. In both cases, at
+the time of rupture, the stomach was empty, and the gastric juice had
+digested off the capsules of the spleens, thus allowing the escape of
+blood into the abdominal cavities. The seats of rupture were on the
+anterior walls. In the first case the coats of the stomach were
+atrophied and thin. In the second the coats were healthy and not even
+softened. There was absence of softening, erosion, or rupture on the
+posterior walls.
+
+As illustrative of the amount of paralytic distention that is possible,
+Bamberger mentions a case in which 70 pounds of fluid filled the
+stomach.
+
+Voluntary Vomiting.--It is an interesting fact that some persons
+exhibit the power of contracting the stomach at will and expelling its
+contents without nausea. Montegre mentions a distinguished member of
+the Faculty of Paris, who, by his own volition and without nausea or
+any violent efforts, could vomit the contents of his stomach. In his
+translation of "Spallanzani's Experiments on Digestion" Sennebier
+reports a similar instance in Geneva, in which the vomiting was brought
+about by swallowing air.
+
+In discussing wounds and other injuries of the stomach no chapter would
+be complete without a description of the celebrated case of Alexis St.
+Martin, whose accident has been the means of contributing so much to
+the knowledge of the physiology of digestion. This man was a French
+Canadian of good constitution, robust and healthy, and was employed as
+a voyageur by the American Fur Company. On June 16, 1822, when about
+eighteen years of age, he was accidentally wounded by a discharge from
+a musket.  The contents of the weapon, consisting of powder and
+duck-shot, entered his left side from a distance of not more than a
+yard off. The charge was directed obliquely forward and inward,
+literally blowing off the integument and muscles for a space about the
+size of a man's hand, carrying away the anterior half of the 6th rib,
+fracturing the 5th rib, lacerating the lower portion of the lowest lobe
+of the left lung, and perforating the diaphragm and the stomach. The
+whole mass of the discharge together with fragments of clothing were
+driven into the muscles and cavity of the chest. When first seen by Dr.
+Beaumont about a half hour after the accident, a portion of the lung,
+as large as a turkey's egg was found protruding through the external
+wound.  The protruding lung was lacerated and burnt. Immediately below
+this was another protrusion, which proved to be a portion of the
+stomach, lacerated through all its coats. Through an orifice, large
+enough to admit a fore-finger, oozed the remnants of the food he had
+taken for breakfast. His injuries were dressed; extensive sloughing
+commenced, and the wound became considerably enlarged. Portions of the
+lung, cartilages, ribs, and of the ensiform process of the sternum came
+away. In a year from the time of the accident, the wound, with the
+exception of a fistulous aperture of the stomach and side, had
+completely cicatrized. This aperture was about 2 1/2 inches in
+circumference, and through it food and drink constantly extruded unless
+prevented by a tent-compress and bandage. The man had so far recovered
+as to be able to walk and do light work, his digestion and appetite
+being normal. Some months later a small fold or doubling of the
+stomachal coats slightly protruded until the whole aperture was filled,
+so as to supersede the necessity of a compress, the protruding coats
+acting as a valve when the stomach was filled. This valvular protrusion
+was easily depressed by the finger. St. Martin suffered little pain
+except from the depression of the skin. He took his food and drink like
+any healthy person, and for eleven years remained under Dr. Beaumont's
+own care in the Doctor's house as a servant. During this time were
+performed the experiments on digestion which are so well known. St.
+Martin was at all times willing to lend himself in the interest of
+physiologic science. In August, 1879, The Detroit Lancet contains
+advices that St. Martin was living at that time at St. Thomas, Joliette
+County, Province of Quebec, Canada. At the age of seventy-nine he was
+comparatively strong and well, and had always been a hard worker. At
+this time the opening in the stomach was nearly an inch in diameter,
+and in spite of its persistence his digestion had never failed him.
+
+Spizharny relates a remarkable case of gastric fistula in the loin, and
+collects 61 cases of gastric fistula, none of which opened in the loin.
+The patient was a girl of eighteen, who had previously had
+perityphlitis, followed by abscesses about the navel and lumbar region.
+Two fistulae were found in the right loin, and were laid open into one
+canal, which, after partial resection of the 12th rib, was dilated and
+traced inward and upward, and found to be in connection with the
+stomach. Food was frequently found on the dressings, but with the
+careful use of tampons a cure was effected.
+
+In the olden times wounds of the stomach were not always fatal.  The
+celebrated anatomist, Fallopius, successfully treated two cases in
+which the stomach was penetrated so that food passed through the wound.
+Jacobus Orthaeus tells us that in the city of Fuldana there was a
+soldier who received a wound of the stomach, through which food passed
+immediately after being swallowed; he adds that two judicious surgeons
+stitched the edges of the wound to the integuments, thereby effecting a
+cure. There is another old record of a gastric fistula through which
+some aliment passed during the period of eleven years.
+
+Archer tells of a man who was stabbed by a negro, the knife entering
+the cartilages of the 4th rib on the right side, and penetrating the
+stomach to the extent of two inches at a point about two inches below
+the xiphoid cartilage. The stomachal contents, consisting of bacon,
+cabbage, and cider, were evacuated. Shortly after the reception of the
+injury, an old soldier sewed up the wound with an awl, needle, and
+wax-thread; Archer did not see the patient until forty-eight hours
+afterward, at which time he cleansed and dressed the wound. After a
+somewhat protracted illness the patient recovered, notwithstanding the
+extent of injury and the primitive mode of treatment.
+
+Travers mentions the case of a woman of fifty-three who, with suicidal
+intent, divided her abdominal parietes below the navel with a razor,
+wounding the stomach in two places. Through the wound protruded the
+greater part of the larger curvature of the stomach; the arch of the
+colon and the entire greater omentum were both strangulated. A small
+portion of the coats of the stomach, including the wound, was nipped
+up, a silk ligature tied about it, and the entrails replaced. Two
+months afterward the patient had quite recovered, though the ligature
+of the stomach had not been seen in the stool. Clements mentions a
+robust German of twenty-two who was stabbed in the abdomen with a dirk,
+producing an incised wound of the stomach. The patient recovered and
+was returned to duty the following month.
+
+There are many cases on record in which injury of the stomach has been
+due to some mistake or accident in the juggling process of
+knife-swallowing or sword-swallowing. The records of injuries of this
+nature extend back many hundred years, and even in the earlier days the
+delicate operation of gastrotomy, sometimes with a successful issue,
+was performed upon persons who had swallowed knives. Gross mentions
+that in 1502 Florian Mathias of Bradenberg removed a knife nine inches
+long from the stomach of a man of thirty-six, followed by a successful
+recovery. Glandorp, from whom, possibly, Gross derived his information,
+relates this memorable case as being under the direction of Florianus
+Matthaesius of Bradenburg. The patient, a native of Prague, had
+swallowed a knife eight or nine inches long, which lay pointing at the
+superior portion of the stomach. After it had been lodged in this
+position for seven weeks and two days gastrotomy was performed, and the
+knife extracted; the patient recovered. In 1613 Crollius reports the
+case of a Bohemian peasant who had concealed a knife in his mouth,
+thinking no one would suspect he possessed the weapon; while he was
+excited it slipped into the stomach, from whence it subsequently
+penetrated through to the skin; the man recovered. There is another old
+case of a man at Prague who swallowed a knife which some few weeks
+afterward made its exit from an abdominal abscess. Gooch quotes the
+case of a man, belonging to the Court of Paris, who, nine months after
+swallowing a knife, voided it at the groin. In the sixteenth century
+Laurentius Joubert relates a similar case, the knife having remained in
+the body two years. De Diemerbroeck mentions the fact that a knife ten
+inches long was extracted by gastrotomy, and placed among the rarities
+in the anatomic chamber of the University at Leyden. The operation was
+done in 1635 at Koenigsberg, by Schwaben, who for his surgical prowess
+was appointed surgeon to the King of Poland. The patient lived eight
+years after the operation.
+
+It is said that in 1691, while playing tricks with a knife 6 1/2 inches
+long, a country lad of Saxony swallowed it, point first.  He came under
+the care of Weserern, physician to the Elector of Brandenburgh, who
+successfully extracted it, two years and seven months afterward, from
+the pit of the lad's stomach. The horn haft of the knife was
+considerably digested. In 1720 Hubner of Rastembourg operated on a
+woman who had swallowed an open knife.  After the incision it was found
+that the knife had almost pierced the stomach and had excited a slight
+suppuration. After the operation recovery was very prompt.
+
+Bell of Davenport, Iowa, performed gastrotomy on a man, who, while
+attempting a feat of legerdemain, allowed a bar of lead, 10 1/8 inches
+long, 1 1/2 inches wide, and 9 1/2 ounces in weight, to slip into his
+stomach. The bar was removed and the patient recovered. Gussenbauer
+gives an account of a juggler who turned his head to bow an
+acknowledgment of applause while swallowing a sword; he thus brought
+his upper incisors against the sword, which broke off and slipped into
+his stomach. To relieve suffocation the sword was pushed further down.
+Gastrotomy was performed, and the piece of sword 11 inches long was
+extracted; as there was perforation of the stomach before the
+operation, the patient died of peritonitis.
+
+An hour after ingestion, Bernays of St. Louis successfully removed a
+knife 9 1/2 inches long. By means of an army-bullet forceps the knife
+was extracted easily through an incision 5/8 inch long in the walls of
+the stomach. Gross speaks of a man of thirty who was in the habit of
+giving exhibitions of sword-swallowing in public houses, and who
+injured his esophagus to such an extent as to cause abscess and death.
+In the Journal of the American Medical Association, March 1, 1896,
+there is an extensive list of gastrotomies performed for the removal of
+knives and other foreign bodies, from the seventeenth century to the
+present time.
+
+The physiologic explanation of sword-swallowing is quite interesting.
+We know that when we introduce the finger, a spoon, brush, etc., into
+the throat of a patient, we cause extremely disagreeable symptoms.
+There is nausea, gagging, and considerable hindrance with the function
+of respiration. It therefore seems remarkable that there are people
+whose physiologic construction is such that, without apparent
+difficulty, they are enabled to swallow a sword many inches long. Many
+of the exhibitionists allow the visitors to touch the stomach and
+outline the point of the sabre through the skin. The sabre used is
+usually very blunt and of rounded edges, or if sharp, a guiding tube of
+thin metal is previously swallowed. The explanation of these
+exhibitions is as follows: The instrument enters the mouth and pharynx,
+then the esophagus, traverses the cardiac end of the stomach, and
+enters the latter as far as the antrum of the pylorus, the small
+culdesac of the stomach. In their normal state in the adult these
+organs are not in a straight line, but are so placed by the passage of
+the sword. In the first place the head is thrown back, so that the
+mouth is in the direction of the esophagus, the curves of which
+disappear or become less as the sword proceeds; the angle that the
+esophagus makes with the stomach is obliterated, and finally the
+stomach is distended in the vertical diameter and its internal curve
+disappears, thus permitting the blade to traverse the greater diameter
+of the stomach. According to Guyot-Daubes, these organs, in a straight
+line, extend a distance of from 55 to 62 cm., and consequently the
+performer is enabled to swallow an instrument of this length. The
+length is divided as follows:--
+
+  Mouth and pharynx, . . . . . . . . . . . . 10 to 12 cm.
+  Esophagus, . . . . . . . . . . . . . . . . 25 to 28 cm.
+  Distended stomach, . . . . . . . . . . . . 20 to 22 cm.
+                                            -------------
+                                             55 to 62 cm.
+
+These acrobats with the sword have rendered important service to
+medicine. It was through the good offices of a sword-swallower that the
+Scotch physician, Stevens, was enabled to make his experiments on
+digestion. He caused this assistant to swallow small metallic tubes
+pierced with holes. They were filled, according to Reaumur's method,
+with pieces of meat. After a certain length of time he would have the
+acrobat disgorge the tubes, and in this way he observed to what degree
+the process of digestion had taken place. It was also probably the
+sword-swallower who showed the physicians to what extent the pharynx
+could be habituated to contact, and from this resulted the invention of
+the tube of Faucher, the esophageal sound, ravage of the stomach, and
+illumination of this organ by electric light. Some of these individuals
+also have the faculty of swallowing several pebbles, as large even as
+hen's eggs, and of disgorging them one by one by simple contractions of
+the stomach.  From time to time individuals are seen who possess the
+power of swallowing pebbles, knives, bits of broken glass, etc., and,
+in fact, there have been recent tricky exhibitionists who claimed to be
+able to swallow poisons, in large quantities, with impunity.  Henrion,
+called "Casaandra," a celebrated example of this class, was born at
+Metz in 1761. Early in life he taught himself to swallow pebbles,
+sometimes whole and sometimes after breaking them with his teeth. He
+passed himself off as an American savage; he swallowed as many as 30 or
+40 large pebbles a day, demonstrating the fact by percussion on the
+epigastric region.  With the aid of salts he would pass the pebbles and
+make them do duty the next day. He would also swallow live mice and
+crabs with their claws cut. It was said that when the mice were
+introduced into his mouth, they threw themselves into the pharynx where
+they were immediately suffocated and then swallowed. The next morning
+they would be passed by the rectum flayed and covered with a mucous
+substance. Henrion continued his calling until 1820, when, for a
+moderate sum, he was induced to swallow some nails and a plated iron
+spoon 5 1/2 inches long and one inch in breadth. He died seven days
+later.
+
+According to Bonet, there was a man by the name of Pichard who
+swallowed a razor and two knives in the presence of King Charles II of
+England, the King himself placing the articles into the man's mouth. In
+1810 Babbington and Curry are accredited with citing the history of an
+American sailor in Guy's Hospital, London, who frequently swallowed
+penknives for the amusement of his audiences. At first he swallowed
+four, and three days later passed them by the anus; on another occasion
+he swallowed 14 of different sizes with the same result. Finally he
+attempted to gorge himself with 17 penknives, but this performance was
+followed by horrible pains and alarming abdominal symptoms. His
+excrement was black from iron. After death the cadaver was opened and
+14 corroded knives were found in the stomach, some of the handles being
+partly digested; two were found in the pelvis and one in the abdominal
+cavity. Pare recalls the instance of a shepherd who suffered
+distressing symptoms after gulping a knife six inches long. Afterward
+the knife was abstracted from his groin. Fabricius Hildanus cites a
+somewhat similar case.
+
+Early in the century there was a man known as the "Yankee
+knife-swallower," whose name was John Cummings, an American sailor, who
+had performed his feats in nearly all the ports of the world. One of
+his chief performances was swallowing a billiard ball. Poland mentions
+a man (possibly Cummings) who, in 1807, was admitted to Guy's Hospital
+with dyspeptic symptoms which he attributed to knife-swallowing. His
+story was discredited at first; but after his death, in March, 1809,
+there were 30 or 40 fragments of knives found in his stomach. One of
+the back-springs on a knife had transfixed the colon and rectum.  In
+the Edinburgh Philosophical Journal for 1825 there is an account of a
+juggler who swallowed a knife which remained in his stomach and caused
+such intense symptoms that gastrotomy was advised; the patient,
+however, refused operation.
+
+Drake reports a curious instance of polyphagia. The person described
+was a man of twenty-seven who pursued the vocation of a
+"sword-swallower." He had swallowed a gold watch and chain with a seal
+and key attached; at another time he swallowed 34 bullets and voided
+them by the anus. At Poughkeepsie, N.Y., in August, 1819, in one day
+and night he swallowed 19 pocket-knives and 41 copper cents. This man
+had commenced when a lad of fifteen by swallowing marbles, and soon
+afterward a small penknife. After his death his esophagus was found
+normal, but his stomach was so distended as to reach almost to the
+spine of the ilium, and knives were found in the stomach weighing one
+pound or more. In his exhibitions he allowed his spectators to hear the
+click of the knives and feel them as low down as the anterior superior
+spine of the ilium.
+
+The present chief of the dangerous "profession" of sword-swallowing is
+Chevalier Cliquot, a French Canadian by birth, whose major trick is to
+swallow a real bayonet sword, weighted with a cross-bar and two
+18-pound dumbbells. He can swallow without difficulty a 22-inch cavalry
+sword; formerly, in New York, he gave exhibitions of swallowing
+fourteen 19-inch bayonet swords at once. A negro, by the name of Jones,
+exhibiting not long since in Philadelphia, gave hourly exhibitions of
+his ability to swallow with impunity pieces of broken glass and china.
+
+Foreign Bodies in the Alimentary Canal.--In the discussion of the
+foreign bodies that have been taken into the stomach and intestinal
+tract possibly the most interesting cases, although the least
+authentic, are those relating to living animals, such as fish, insects,
+or reptiles. It is particularly among the older writers that we find
+accounts of this nature. In the Ephemerides we read of a man who
+vomited a serpent that had crept into his mouth, and of another person
+who ejected a beetle that had gained entrance in a similar manner. From
+the same authority we find instances of the vomiting of live fish,
+mice, toads, and also of the passage by the anus of live snails and
+snakes. Frogs vomited are mentioned by Bartholinus, Dolaeus,
+Hellwigius, Lentilus, Salmuth, and others. Vege mentions a man who
+swallowed a young chicken whole. Paullini speaks of a person who, after
+great pain, vomited a mouse which he had swallowed. Borellus,
+Bartholinus, Thoner, and Viridet, are among the older authorities
+mentioning persons who swallowed toads. Hippocrates speaks of asphyxia
+from a serpent which had crawled into the mouth.
+
+Borellus states that he knew a case of a person who vomited a
+salamander. Plater reports the swallowing of eels and snails.  Rhodius
+mentions persons who have eaten scorpions and spiders with impunity.
+Planchon writes of an instance in which a live spider was ejected from
+the bowel; and Colini reports the passage of a live lizard which had
+been swallowed two days before, and there is another similar case on
+record. Marcellus Donatus records an instance in which a viper, which
+had previously crawled into the mouth, had been passed by the anus.
+There are also recorded instances in French literature in which persons
+affected with pediculosis, have, during sleep, unconsciously swallowed
+lice which were afterward found in the stools.
+
+There is an abundance of cases in which leeches have been accidentally
+swallowed. Pliny, Aetius, Dioscorides, Scribonius-Largus, Celsus,
+Oribasius, Paulus Aegineta, and others, describe such cases.
+Bartholinus speaks of a Neapolitan prince who, while hunting, quenched
+his thirst in a brook, putting his mouth in the running water. In this
+way he swallowed a leech, which subsequently caused annoying hemorrhage
+from the mouth. Timaeus mentions a child of five who swallowed several
+leeches, and who died of abdominal pains, hemorrhage, and convulsions.
+Rhodius, Riverius, and Zwinger make similar observations. According to
+Baron Larrey the French soldiers in Napoleon's Egyptian campaign
+occasionally swallowed leeches.  Grandchamp and Duval have commented on
+curious observations of leeches in the digestive tract. Dumas and
+Marques also speak of the swallowing of leeches. Colter reports a case
+in which beetles were vomited. Wright remarks on Banon's case of
+fresh-water shrimps passed from the human intestine. Dalton, Dickman,
+and others, have discussed the possibility of a slug living in the
+stomach of man. Pichells speaks of a case in which beetles were
+expelled from the stomach; and Pigault gives an account of a living
+lizard expelled by vomiting. Fontaine, Gaspard, Vetillart, Ribert,
+MacAlister, and Waters record cases in which living caterpillars have
+been swallowed.
+
+Sundry Cases.--The variety of foreign bodies that have been swallowed
+either accidentally or for exhibitional or suicidal purposes is
+enormous. Nearly every imaginable article from the minutest to the most
+incredible size has been reported. To begin to epitomize the literature
+on this subject would in itself consume a volume, and only a few
+instances can be given here, chosen in such a way as to show the
+variety, the effects, and the possibilities of their passage through
+the intestinal canal.
+
+Chopart says that in 1774 the belly of a ravenous galley-slave was
+opened, and in the stomach were found 52 foreign bodies, including a
+barrel-hoop 19 inches long, nails, pieces of pipe, spoons, buckles,
+seeds, glass, and a knife. In the intestines of a person Agnew found a
+pair of suspenders, a mass of straw, and three roller-bandages, an inch
+in width and diameter. Velpeau mentions a fork which was passed from
+the anus twenty months after it was swallowed. Wilson mentions an
+instance of gastrotomy which was performed for the extraction of a fork
+swallowed sixteen years before. There is an interesting case in which,
+in a delirium of typhoid fever, a girl of twenty-two swallowed two iron
+forks, which were subsequently expelled through an abdominal abscess. A
+French woman of thirty-five, with suicidal intent, swallowed a
+four-pronged fork, which was removed four years afterward from the
+thigh. For two years she had suffered intense pain in both thighs. In
+the Royal College of Surgeons in London there is a steel button-hook 3
+1/2 inches in length which was accidentally swallowed, and was passed
+three weeks later by the anus, without having given rise to any symptom.
+
+Among the insane a favorite trait seems to be swallowing nails.  In the
+Philosophical Transactions is an account of the contents of the stomach
+of an idiot who died at thirty-three. In this organ were found nine
+cart-wheel nails, six screws, two pairs of compasses, a key, an iron
+pin, a ring, a brass pommel weighing nine ounces, and many other
+articles. The celebrated Dr. Lettsom, in 1802, spoke of an idiot who
+swallowed four pounds of old nails and a pair of compasses. A lunatic
+in England e swallowed ten ounces of screws and bits of crockery, all
+of which were passed by the anus. Boardman gives an account of a child
+affected with hernia who swallowed a nail 2 1/2 inches long. In a few
+days the nail was felt in the hernia, but in due time it was passed by
+the rectum. Blower reports an account of a nail passing safely through
+the alimentary canal of a baby. Armstrong mentions an insane
+hair-dresser of twenty-three, in whose stomach after death were found
+30 or more spoon handles, 30 nails, and other minor articles.
+
+Closmadenc reported a remarkable case which was extensively quoted. The
+patient was an hysteric young girl, an inmate of a convent, to whom he
+was called to relieve a supposed fit of epilepsy. He found her
+half-asphyxiated, and believed that she had swallowed a foreign body.
+He was told that under the influence of exaggerated religious scruples
+this girl inflicted penance upon herself by swallowing earth and holy
+medals. At the first dose of the emetic, the patient made a strong
+effort to vomit, whereupon a cross seven cm. long appeared between her
+teeth. This was taken out of her mouth, and with it an enormous rosary
+220 cm. long, and having seven medals attached to it. Hunt recites a
+case occurring in a pointer dog, which swallowed its collar and chain,
+only imperfectly masticating the collar. The chain and collar were
+immediately missed and search made for them. For several days the dog
+was ill and refused food. Finally the gamekeeper saw the end of the
+chain hanging from the dog's anus, and taking hold of it, he drew out a
+yard of chain with links one inch long, with a cross bar at the end two
+inches in length; the dog soon recovered. The collar was never found,
+and had apparently been digested or previously passed.
+
+Fear of robbery has often led to the swallowing of money or jewelry.
+Vaillant, the celebrated doctor and antiquarian, after a captivity of
+four months in Algiers, was pursued by Tunis pirates, and swallowed 15
+medals of gold; shortly after arriving at Lyons he passed them all at
+stool. Fournier and Duret published the history of a galley slave at
+Brest in whose stomach were found 52 pieces of money, their combined
+weight being one pound, 10 1/4 ounces. On receiving a sentence of three
+years' imprisonment, an Englishman, to prevent them being taken from
+him, swallowed seven half-crowns. He suffered no bad effects, and the
+coins not appearing the affair was forgotten. While at stool some
+twenty months afterward, having taken a purgative for intense abdominal
+pain, the seven coins fell clattering into the chamber. Hevin mentions
+the case of a man who, on being captured by Barbary pirates, swallowed
+all the money he had on his person.  It is said that a certain Italian
+swallowed 100 louis d'ors at a time.
+
+It occasionally happens that false teeth are accidentally swallowed,
+and even passed through the intestinal tract. Easton mentions a young
+man who accidentally swallowed some artificial teeth the previous
+night, and, to further their passage through the bowel, he took a dose
+of castor oil. When seen he was suffering with pain in the stomach, and
+was advised to eat much heavy food and avoid aperients. The following
+day after several free movements he felt a sharp pain in the lower part
+of his back. A large enema was given and the teeth and plate came away.
+The teeth were cleansed and put back in his mouth, and the patient
+walked out. Nine years later the same accident again happened to the
+man but in spite of treatment nothing was seen of the teeth for a month
+afterward, when a body appeared in the rectum which proved to be a gold
+plate with the teeth in it. In The Lancet of December 10, 1881, there
+is an account of a vulcanite tooth-plate which was swallowed and passed
+forty-two hours later. Billroth mentions an instance of gastrotomy for
+the removal of swallowed artificial teeth, with recovery; and another
+case in which a successful esophagotomy was performed. Gardiner
+mentions a woman of thirty-three who swallowed two false teeth while
+supping soup. A sharp angle of the broken plate had caught in a fold of
+the cardiac end of the stomach and had caused violent hematemesis.
+Death occurred seventeen hours after the first urgent symptoms.
+
+In the Museum of the Royal College of Surgeons in London there is an
+intestinal concretion weighing 470 grains, which was passed by a woman
+of seventy who had suffered from constipation for many years. Sixteen
+years before the concretion was passed she was known to have swallowed
+a tooth. At one side of the concretion a piece had been broken off
+exposing an incisor tooth which represented the nucleus of the
+formation. Manasse recently reported the case of a man of forty-four
+whose stomach contained a stone weighing 75 grams. He was a joiner and,
+it was supposed, habitually drank some alcoholic solution of shellac
+used in his trade. Quite likely the shellac had been precipitated in
+the stomach and gave rise to the calculus.
+
+Berwick mentions a child of eight months who was playing with a
+detached organ-handle, and put it in its mouth. Seeing this the mother
+attempted to secure the handle, but it was pushed into the esophagus. A
+physician was called, but nothing was done, and the patient seemed to
+suffer little inconvenience. Three days later the handle was expelled
+from the anus. Teakle reports the successful passage through the
+alimentary canal of the handle of a music-box. Hashimoto,
+Surgeon-General of the Imperial Japanese Army, tells of a woman of
+forty-nine who was in the habit of inducing vomiting by irritating her
+fauces and pharynx with a Japanese toothbrush--a wooden instrument six
+or seven inches long with bristles at one end. In May, 1872, she
+accidentally swallowed this brush. Many minor symptoms developed, and
+in eleven months there appeared in the epigastric region a fluctuating
+swelling, which finally burst, and from it extended the end of the
+brush. After vainly attempting to extract the brush the attending
+physician contented himself with cutting off the projecting portion.
+The opening subsequently healed; and not until thirteen years later did
+the pain and swelling return. On admission to the hospital in October,
+1888, two fistulous openings were seen in the epigastric region, and
+the foreign body was located by probing. Finally, on November 19, 1888,
+the patient was anesthetized, one of the openings enlarged, and the
+brush extracted. Five weeks later the openings had all healed and the
+patient was restored to health.
+
+Garcia reports an interesting instance of foreign body in a man between
+forty-five and fifty. This man was afflicted with a syphilitic
+affection of the mouth, and he constructed a swab ten inches long with
+which to cleanse his fauces. While making the application alone one
+day, a spasmodic movement caused him to relinquish his grasp on the
+handle, and the swab disappeared. He was almost suffocated, and a
+physician was summoned; but before his arrival the swab had descended
+into the esophagus. Two weeks later, gastro-peritoneal symptoms
+presented, and as the stick was located, gastrotomy was proposed; the
+patient, however, would not consent to an operation. On the
+twenty-sixth day an abscess formed on the left side below the nipple,
+and from it was discharged a large quantity of pus and blood. Four days
+after this, believing himself to be better, the man began to redress
+the wound, and from it he saw the end of a stick protruding. A
+physician was called, and by traction the stick was withdrawn from
+between the 3d and 4th ribs; forty-nine days after the accident the
+wound had healed completely. Two years afterward the patient had an
+attack of cholera, but in the fifteen subsequent years he lived an
+active life of labor.
+
+Occasionally an enormous mass of hair has been removed from the
+stomach. A girl of twenty a with a large abdominal swelling was
+admitted to a hospital. Her illness began five years previously, with
+frequent attacks of vomiting, and on three occasions it was noticed
+that she became quite bald. Abdominal section was performed, the
+stomach opened, and from it was removed a mass of hair which weighed
+five pounds and three ounces. A good recovery ensued. In the Museum of
+St. George's Hospital, London, are masses of hair and string taken from
+the stomach and duodenum of a girl of ten. It is said that from the age
+of three the patient had been in the habit of eating these articles.
+There is a record in the last century of a boy of sixteen who ate all
+the hair he could find; after death his stomach and intestines were
+almost completely lined with hairy masses. In the Journal of the
+American Medical Association, March 1, 1896, there is a report of a
+case of hair-swallowing.
+
+Foreign Bodies in the Intestines.--White relates the history of a case
+in which a silver spoon was swallowed and successfully excised from the
+intestinal canal. Houston mentions a maniac who swallowed a rusty iron
+spoon 11 inches long. Fatal peritonitis ensued and the spoon was found
+impacted in the last acute turn of the duodenum. In 1895, in London,
+there was exhibited a specimen, including the end of the ileum with the
+adjacent end of the colon, showing a dessert spoon which was impacted
+in the latter.  The spoon was seven inches long, and its bowl measured
+1 1/2 inches across. There was much ulceration of the mucous membrane.
+This spoon had been swallowed by a lunatic of twenty-two, who had made
+two previous ineffectual attempts at suicide. Mason describes the case
+of a man of sixty-five who, after death by strangulated hernia, was
+opened, and two inches from the ileocecal valve was found an earthen
+egg-cup which he had swallowed. Mason also relates the instance of a
+man who swallowed metal balls 2 1/2 inches in diameter; and the case of
+a Frenchman who, to prevent the enemy from finding them, swallowed a
+box containing despatches from Napoleon. He was kept prisoner until the
+despatches were passed from his bowels. Denby discovered a large
+egg-cup in the ileum of a man. Fillion mentions an instance of recovery
+following the perforation of the jejunum by a piece of horn which had
+been swallowed. Madden tells of a person, dying of intestinal
+obstruction, in whose intestines were found several ounces of crude
+mercury and a plum-stone. The mercury had evidently been taken for
+purgative effect. Rodenbaugh mentions a most interesting case of beans
+sprouting while in the bowel.  Harrison relates a curious case in which
+the swallowed lower epiphysis of the femur of a rabbit made its way
+from the bowel to the bladder, and was discharged thence by the urethra.
+
+In cases of appendicitis foreign bodies have been found lodged in or
+about the vermiform appendix so often that it is quite a common lay
+idea that appendicitis is invariably the result of the lodgment of some
+foreign body accidentally swallowed. In recent years the literature of
+this subject proves that a great variety of foreign bodies may be
+present. A few of the interesting cases will be cited in the following
+lines:--
+
+In the New England Medical Journal, 1843, is an account of a vermiform
+appendix which was taken from the body of a man of eighty-eight who had
+died of pneumothorax. During life there were no symptoms of disease of
+the appendix, and after death no adhesions were found, but this organ
+was remarkably long, and in it were found 122 robin-shot. The old
+gentleman had been excessively fond of birds all his life, and was
+accustomed to bolt the meat of small birds without properly chewing it;
+to this fact was attributed the presence of these shot in the appendix.
+A somewhat similar case was that of a man who died in the Hotel-Dieu in
+1833. The ileum of this man contained 92 shot and 120 plum stones.
+Buckler reports a case of appendicitis in a child of twelve, in which a
+common-sized bird-shot was found in the appendix. Packard presented a
+case of appendicitis in which two pieces of rusty and crooked wire, one
+2 1/2 and the other 1 1/2 inches long, were found in the omentum,
+having escaped from the appendix. Howe describes a case in which a
+double oat, with a hard envelope, was found in the vermiform appendix
+of a boy of four years and one month of age. Prescott reports a case of
+what he calls fatal colic from the lodgment of a chocolate-nut in the
+appendix; and Noyes relates an instance of death in a man of thirty-one
+attributed to the presence of a raisin-seed in the vermiform appendix.
+Needles, pins, peanuts, fruit-stones, peas, grape-seeds, and many
+similar objects have been found in both normal and suppurative
+vermiform appendices.
+
+Intestinal Injuries.--The degree of injury that the intestinal tract
+may sustain, and after recovery perform its functions as usual, is most
+extraordinary; and even when the injury is of such an extent as to be
+mortal, the persistence of life is remarkable.  It is a well known fact
+that in bull-fights, after mortal injuries of the abdomen and bowels,
+horses are seen to struggle on almost until the sport is finished.
+Fontaine reports a case of a Welsh quarryman who was run over by a
+heavy four-horse vehicle.  The stump of a glass bottle was crushed into
+the intestinal cavity, and the bowels protruded and were bruised by the
+wheels of the wagon. The grit was so firmly ground into the bowel that
+it was impossible to remove it; yet the man made a complete recovery.
+Nicolls has the case of a man of sixty-nine, a workhouse maniac, who on
+August 20th attempted suicide by running a red-hot poker into his
+abdomen. His wound was dressed and he was recovering, but on September
+11th he tore the cast off his abdomen, and pulled out of the wound the
+omentum and 32 inches of colon, which he tore off and threw between his
+pallet and the wall. Strange to say he did not die until eight days
+after this horrible injury.
+
+Tardieu relates the case of a chemist who removed a large part of the
+mesentery with a knife, and yet recovered. Delmas of Montpellier
+reports the history of a wagoner with complete rupture of the
+intestines and rupture of the diaphragm, and who yet finished his
+journey, not dying until eighteen hours after.
+
+Successful Intestinal Resection.--In 1755 Nedham of Norfolk reported
+the case of a boy of thirteen who was run over and eviscerated. It was
+found necessary to remove 57 inches of the protruding bowel, but the
+boy made a subsequent recovery.  Koebererle of Strasburg performed an
+operation on a woman of twenty-two for the relief of intestinal
+obstruction. On account of numerous strictures it was found necessary
+to remove over two yards of the small intestine; the patient recovered
+without pain or trouble of any kind. In his dissertation on "Ruptures"
+Arnaud remarks that he cut away more than seven feet of gangrenous
+bowel, his patient surviving. Beehe reports recovery after the removal
+of 48 inches of intestine. The case was one of strangulation of an
+umbilical hernia.
+
+Sloughing of the Intestine Following Intussusception.--Lobstein
+mentions a peasant woman of about thirty who was suddenly seized with
+an attack of intussusception of the bowel, and was apparently in a
+moribund condition when she had a copious stool, in which she evacuated
+three feet of bowel with the mesentery attached. The woman recovered,
+but died five months later from a second attack of intussusception, the
+ileum rupturing and peritonitis ensuing. There is a record in this
+country of a woman of forty-five who discharged 44 inches of intestine,
+and who survived for forty-two days. The autopsy showed the sigmoid
+flexure gone, and from the caput ceci to the termination the colon only
+measured 14 inches. Vater gives a history of a penetrating abdominal
+wound in which a portion of the colon hung from the wound during
+fourteen years, forming an artificial anus.
+
+Among others mentioning considerable sloughing of intestine following
+intussusception, and usually with complete subsequent recovery, are
+Bare, 13 inches of the ileum; Blackton, nine inches; Bower, 14 inches;
+Dawson, 29 inches; Sheldon, 4 1/2 feet; Stanley, three feet; Tremaine,
+17 inches; and Grossoli, 40 cm.
+
+Rupture of the Intestines.--It is quite possible for the intestine to
+be ruptured by external violence, and cases of rupture of all parts of
+the bowel have been recorded. Titorier gives the history of a case in
+which the colon was completely separated from the rectum by external
+violence. Hinder reports the rupture of the duodenum by a violent kick.
+Eccles, Ely, and Pollock also mention cases of rupture of the duodenum.
+Zimmerman, Atwell, and Allan report cases of rupture of the colon.
+
+Operations upon the gastrointestinal tract have been so improved in the
+modern era of antisepsis that at the present day they are quite common.
+There are so many successful cases on record that the whole subject
+deserves mention here.
+
+Gastrostomy is an operation for establishing a fistulous opening in the
+stomach through the anterior wall. Many operations have been devised,
+but the results of this maneuver in malignant disease have not thus far
+been very satisfactory. It is quite possible that, being an operation
+of a serious nature, it is never performed early enough, the patient
+being fatally weakened by inanition. Gross and Zesas have collected,
+respectively, 207 and 162 cases with surprisingly different rates of
+mortality: that of Gross being only 29.47 per cent, while that of Zesas
+was for cicatricial stenoses 60 per cent, and for malignant cases 84
+per cent. It is possible that in Zesas's statistics the subjects were
+so far advanced that death would have resulted in a short time without
+operation. Gastrotomy we have already spoken of.
+
+Pyloroplasty is an operation devised by Heineke and Mikulicz, and is
+designed to remove the mechanic obstruction in cicatricial stenoses of
+the pylorus, at the same time creating a new pylorus.
+
+Gastroenterostomy and pylorectomy are operations devised for the relief
+of malignant disease of the pylorus, the diseased portions being
+removed and the parts resected.
+
+Gastrectomy or extirpation of the stomach is considered by most
+surgeons entirely unjustifiable, as there is seldom hope of cure or
+prospect of amelioration. La Tribune Medicale for January 16, 1895,
+gives an abstract of Langenbuch's contribution upon total extirpation
+of the stomach. Three patients were treated, of whom two died. In the
+first case, on opening the abdominal cavity the stomach was found very
+much contracted, presenting extensive carcinomatous infiltration on its
+posterior surface. After division of the epiploon section was made at
+the pylorus and at the cardiac extremities; the portions removed
+represented seven-eighths of the stomach. The pylorus was stitched to
+the remains of the cardiac orifice, making a cavity about the size of a
+hen's egg. In this case a cure was accomplished in three weeks.  The
+second case was that of a man in whom almost the entire stomach was
+removed, and the pyloric and cardiac ends were stitched together in the
+wound of the parietes. The third case was that of a man of sixty-two
+with carcinoma of the pylorus.  After pylorectomy, the line of suture
+was confined with iodoform-gauze packing. Unfortunately the patient
+suffered with bronchitis, and coughing caused the sutures to give way;
+the patient died of inanition on the twenty-third day.
+
+Enterostomy, or the formation of a fecal fistula above the ileocecal
+valve, was performed for the first time by Nelaton in 1840, but the
+mortality since 1840 has been so great that in most cases it is deemed
+inadmissible.
+
+Colostomy, an operation designed to make a fistulous opening in any
+portion of the rectum, was first practiced by Littre. In early times
+the mortality of inguinal colostomy was about five per cent, but has
+been gradually reduced until Konig reports 20 cases with only one death
+from peritonitis, and Cripps 26 cases with only one death. This will
+always retain its place in operative surgery as a palliative and
+life-saving operation for carcinomatous stenosis of the lower part of
+the colon, and in cases of carcinoma of the rectum in which operation
+is not feasible.
+
+Intestinal anastomosis, whereby two portions of a severed or resected
+bowel can be intimately joined, excluding from fecal circulation the
+portion of bowel which has become obstructed, was originally suggested
+by Maisonneuve, and was studied experimentally by von Hacken. Billroth
+resorted to it, and Senn modified it by substituting decalcified
+bone-plates for sutures.  Since that time, Abbe, Matas, Davis, Brokaw,
+Robinson, Stamm, Baracz, and Dawburn, have modified the material of the
+plates used, substituting catgut rings, untanned leather, cartilage,
+raw turnips, potatoes, etc. Recently Murphy of Chicago has invented a
+button, which has been extensively used all over the world, in place of
+sutures and rings, as a means of anastomosis. Hardly any subject has
+had more discussion in recent literature than the merits of this
+ingenious contrivance.
+
+Foreign Bodies in the Rectum.--Probably the most celebrated case of
+foreign body introduced into the rectum is the classic one mentioned by
+Hevin. Some students introduced the frozen tail of a pig in the anus of
+a French prostitute. The bristles were cut short, and having prepared
+the passage with oil, they introduced the tail with great force into
+the rectum, allowing a portion to protrude. Great pain and violent
+symptoms followed; there was distressing vomiting, obstinate
+constipation, and fever. Despite the efforts to withdraw the tail, the
+arrangement of the bristles which allowed entrance, prevented removal.
+On the sixth day, in great agony, the woman applied to Marchettis, who
+ingeniously adopted the simple procedure of taking a long hollow reed,
+and preparing one of its extremities so that it could be introduced
+into the rectum, he was enabled to pass the reed entirely around the
+tail and to withdraw both. Relief was prompt, and the removal of the
+foreign body was followed by the issue of stercoraceous matter which
+had accumulated the six days it had remained in situ.
+
+Tuffet is quoted as mentioning a farmer of forty-six who, in
+masturbation, introduced a barley-head into his urethra. It was found
+necessary to cut the foreign body out of the side of the glans. A year
+later he put in his anus a cylindric snuff-box of large size, and this
+had to be removed by surgical methods.  Finally, a drinking goblet was
+used, but this resulted in death, after much suffering and lay
+treatment. In his memoirs of the old Academy of Surgery in Paris,
+Morand speaks of a monk who, to cure a violent colic, introduced into
+his fundament a bottle of l'eau de la reine de Hongrie, with a small
+opening in its mouth, by which the contents, drop by drop, could enter
+the intestine. He found he could not remove the bottle, and violent
+inflammation ensued. It was at last necessary to secure a boy with a
+small hand to extract the bottle. There is a record of a case in which
+a tin cup or tumbler was pushed up the rectum and then passed into the
+colon where it caused gangrene and death. It was found to measure 3 1/2
+by 3 1/2 by two inches. There is a French case in which a preserve-pot
+three inches in diameter was introduced into the rectum, and had to be
+broken and extracted piece by piece.
+
+Cloquet had a patient who put into his rectum a beer glass and a
+preserving pot. Montanari removed from the rectum of a man a mortar
+pestle 30 cm. long, and Poulet mentions a pederast who accidentally
+killed himself by introducing a similar instrument, 55 cm. long, which
+perforated his intestine. Studsgaard mentions that in the pathologic
+collection at Copenhagen there is a long, smooth stone, 17 cm. long,
+weighing 900 gm., which a peasant had introduced into his rectum to
+relieve prolapsus. The stone was extracted in 1756 by a surgeon named
+Frantz Dyhr. Jeffreys speaks of a person who, to stop diarrhea,
+introduced into his rectum a piece of wood measuring seven inches.
+
+There is a remarkable case recorded of a stick in the anus of a man of
+sixty, the superior extremity in the right hypochondrium, the inferior
+in the concavity of the sacrum. The stick measured 32 cm. in length;
+the man recovered. It is impossible to comprehend this extent of
+straightening of the intestine without great twisting of the mesocolon.
+Tompsett mentions that he was called to see a workman of sixty-five,
+suffering from extreme rectal hemorrhage. He found the man very feeble,
+without pulse, pale, and livid. By digital examination he found a hard
+body in the rectum, which he was sure was not feces. This body he
+removed with a polyp-forceps, and found it to be a cylindric
+candle-box, which measured six inches in circumference, 2 1/2 in
+length, and 1 1/2 in diameter. The removal was followed by a veritable
+flood of fecal material, and the man recovered. Lane reports
+perforation of the rectum by the introduction of two large pieces of
+soap; there was coincident strangulated hernia.
+
+Hunter mentions a native Indian, a resident of Coorla, who had
+introduced a bullock's horn high up into his abdomen, which neither he
+nor his friends could extract. He was chloroformed and placed in the
+lithotomy position, his buttocks brought to the edge of the bed, and
+after dilatation of the sphincter, by traction with the fingers and
+tooth-forceps, the horn was extracted. It measured 11 inches long. The
+young imbecile had picked it up on the road, where it had been rendered
+extremely rough by exposure, and this caused the difficulty in
+extraction.
+
+In Nelson's Northern Lancet, 1852, there is the record of a case of a
+man at stool, who slipped on a cow's horn, which entered the rectum and
+lodged beyond the sphincter. It was only removed with great difficulty.
+
+A convict at Brest put up his rectum a box of tools. Symptoms of
+vomiting, meteorism, etc., began, and became more violent until the
+seventh day, when he died. After death, there was found in the
+transverse colon, a cylindric or conic box, made of sheet iron, covered
+with skin to protect the rectum and, doubtless, to aid expulsion. It
+was six inches long and five inches broad and weighed 22 ounces. It
+contained a piece of gunbarrel four inches long, a mother-screw steel,
+a screw-driver, a saw of steel for cutting wood four inches long,
+another saw for cutting metal, a boring syringe, a prismatic file, a
+half-franc piece and four one-franc pieces tied together with thread, a
+piece of thread, and a piece of tallow, the latter presumably for
+greasing the instruments. On investigation it was found that these
+conic cases were of common use, and were always thrust up the rectum
+base first. In excitement this prisoner had pushed the conic end up
+first, thus rendering expulsion almost impossible. Ogle gives an
+interesting case of foreign body in the rectum of a boy of seventeen.
+The boy was supposed to be suffering with an abdominal tumor about the
+size of a pigeon's egg under the right cartilages; it had been noticed
+four months before. On admission to the hospital the lad was suffering
+with pain and jaundice; sixteen days later he passed a stick ten inches
+long, which he reluctantly confessed that he had introduced into the
+anus.  During all his treatment he was conscious of the nature of his
+trouble, but he suffered rather than confess. Studsgaard mentions a man
+of thirty-five who, for the purpose of stopping diarrhea, introduced
+into his rectum a preserve-bottle nearly seven inches long with the
+open end uppermost. The next morning he had violent pain in the
+abdomen, and the bottle could be felt through the abdominal wall. It
+was necessary to perform abdominal section through the linea alba,
+divide the sigmoid flexure, and thus remove the bottle. The intestine
+was sutured and the patient recovered. The bottle measured 17 cm. long,
+five cm. in diameter at its lower end, and three cm. at its upper end.
+
+Briggs reports a case in which a wine glass was introduced into the
+rectum, and although removed twenty-four hours afterward, death ensued.
+Hockenhull extracted 402 stones from the rectum of a boy of seven.
+Landerer speaks of a curious case in which the absorptive power of the
+rectum was utilized in the murder of a boy of fifteen. In order to come
+into the possession of a large inheritance the murderess poisoned the
+boy by introducing the ends of some phosphorous matches into his
+rectum, causing death that night; there was intense inflammation of the
+rectum. The woman was speedily apprehended, and committed suicide when
+her crime was known.
+
+Complete transfixion of the abdomen does not always have a fatal issue.
+In fact, two older writers, Wisemann and Muys, testify that it is quite
+possible for a person to be transfixed without having any portion of
+the intestines or viscera wounded. In some nations in olden times, the
+extremest degree of punishment was transfixion by a stake. In his
+voyages and travels, in describing the death of the King of Demaa at
+the hands of his page, Mendez Pinto says that instead of being reserved
+for torture, as were his successors Ravaillac, and Gerard, the slayer
+of William the Silent, the assassin was impaled alive with a long stake
+which was thrust in at his fundament and came out at the nape of his
+neck. There is a record of a man of twenty-five, a soldier in the
+Chinese war of 1860, who, in falling from his horse, was accidentally
+transfixed by a bayonet. The steel entered his back two inches to the
+left of the last dorsal vertebra, and reappeared two inches to the left
+and below the umbilicus; as there was no symptom of visceral wound
+there were apparently no injuries except perforation of the parietes
+and the peritoneum.  The man recovered promptly.
+
+Ross reports a case of transfixion in a young male aborigine, a native
+of New South Wales, who had received a spear-wound in the epigastrium
+during a quarrel; extraction was impossible because of the
+sharp-pointed barbs; the spear was, therefore, sawed off, and was
+removed posteriorly by means of a small incision. The edges of the
+wound were cleansed, stitched, and a compress and bandage applied.
+During the night the patient escaped and joined his comrades in the
+camp, and on the second day was suffering with radiating pains and
+distention. The following day it was found that the stitches and
+plaster had been removed, and the anterior wound was gaping and
+contained an ichorous discharge.  The patient was bathing the wound
+with a decoction of the leaves of the red-gum tree. Notwithstanding
+that the spear measured seven inches, and the interference of
+treatment, the abdominal wound closed on the sixth day, and recovery
+was uninterrupted.  Gilkrist mentions an instance in which a ramrod was
+fired into a soldier's abdomen, its extremity lodging in the spinal
+column, without causing the slightest evidence of wounds of the
+intestines or viscera. A minute postmortem examination was held some
+time afterward, the soldier having died by drowning, but the results
+were absolutely negative as regards any injury done by the passage of
+the ramrod.
+
+Humphreys says that a boy of eleven, while "playing soldier" with
+another boy, accidentally fell on a rick-stake. The stake was slightly
+curved at its upper part, being 43 inches long and three inches in
+circumference, and sharp-pointed at its extremity. As much as 17 1/2
+inches entered the body of the lad. The stake entered just in front of
+the right spermatic cord, passed beneath Poupart's ligament into the
+cavity of the abdomen, traversed the whole cavity across to the left
+side; it then entered the thorax by perforating the diaphragm,
+displaced the heart by pushing it to the right of the sternum, and
+pierced the left lung. It then passed anteriorly under the muscles and
+integument in the axillary space, along the upper third of the humerus,
+which was extended beyond the head, the external skin not being
+ruptured.  The stick remained in situ for four hours before attempts at
+extraction were made. On account of the displacement of the heart it
+was decided not to give chloroform. The boy was held down by four men,
+and Humphreys and his assistant made all the traction in their power.
+After removal not more than a teaspoonful of blood followed. The heart
+still remained displaced, and a lump of intestine about the size of an
+orange protruded from the wound and was replaced. The boy made a slow
+and uninterrupted recovery, and in six weeks was able to sit up. The
+testicle sloughed, but five months later, when the boy was examined, he
+was free from pain and able to walk. There was a slight enlargement of
+the abdomen and a cicatrix of the wound in the right groin. The right
+testicle was absent, and the apex of the heart was displaced about an
+inch.
+
+Woodbury reports the case of a girl of fourteen, who fell seven or
+eight feet directly upon an erect stake in a cart; the tuberosity was
+first struck, and then the stake passed into the anus, up the rectum
+for two inches, thence through the rectal wall, and through the body in
+an obliquely upward direction.  Striking the ribs near the left nipple
+it fractured three, and made its exit. The stake was three inches in
+circumference, and 27 inches of its length passed into the body, six or
+seven inches emerging from the chest. This girl recovered so rapidly
+that she was able to attend school six weeks afterward. In a case
+reported by Bailey a middle-aged woman, while sliding down a hay-stack,
+struck directly upon a pitchfork handle which entered the vagina; the
+whole weight of the woman was successfully maintained by the cellular
+tissue of the uterovaginal culdesac.
+
+Minot speaks of the passage of one prong of a pitchfork through the
+body of a man of twenty-one, from the perineum to the umbilicus; the
+man recovered.
+
+Hamilton reports a case of laceration of the perineum with penetration
+of the pelvic cavity to the depth of ten inches by a stick 3/4 inch
+thick. Prowse mentions the history of a case of impalement in a man of
+thirty-four, who, coming down a hay-stack, alighted on the handle of a
+pitchfork which struck him in the middle of the scrotum, and passed up
+between the skin and fascia to the 10th rib. Recovery was prompt.
+
+There are several cases on record in which extensive wounds of the
+abdominal parietes with protrusion and injury to the intestine have not
+been followed by death. Injuries to the intestines themselves have
+already been spoken of, but there are several cases of evisceration
+worthy of record.
+
+Doughty says that at midnight on June 7, 1868, he was called to see a
+man who had been stabbed in a street altercation with a negro. When
+first seen in the street, the patient was lying on his back with his
+abdomen exposed, from which protruded an enormous mass of intestines,
+which were covered with sand and grit; the small intestine (ileum) was
+incised at one point and scratched at another by the passing knife. The
+incision, about an inch in length, was closed with a single stitch of
+silk thread, and after thorough cleansing the whole mass was returned
+to the abdominal cavity. In this hernial protrusion were recognized
+four or five feet of the ileum, the cecum with its appendix, part of
+the ascending colon with corresponding portions of the mesentery; the
+distribution of the superior mesentery, made more apparent by its
+living pulsation, was more beautifully displayed in its succession of
+arches than in any dissection that Doughty had ever witnessed.
+Notwithstanding the extent of his injuries the patient recovered, and
+at last reports was doing finely.
+
+Barnes reports the history of a negro of twenty-five who was admitted
+to the Freedmen's Hospital, New Orleans, May 15, 1867, suffering from
+an incised wound of the abdomen, from which protruded eight inches of
+colon, all of the stomach, and nearly the whole of the small
+intestines. About 2 1/2 feet of the small intestine, having a whitish
+color, appeared to be filled with food and had much of the
+characteristic feeling of a sausage. The rest of the small intestine
+had a dark-brown color, and the stomach and colon, distended with gas,
+were leaden-colored. The viscera had been exposed to the atmosphere for
+over an hour.  Having nothing but cold Mississippi water to wash them
+with, Barnes preferred returning the intestines without any attempt at
+removing blood and dirt further than wiping with a cambric handkerchief
+and the stripping they would naturally be subjected to in being
+returned through the opening. In ten minutes they were returned; they
+were carefully examined inch by inch for any wound, but none was found.
+Three silver sutures were passed through the skin, and a firm compress
+applied. The patient went to sleep shortly after his wound was dressed,
+and never had a single subsequent bad symptom; he was discharged on May
+24th, the wound being entirely healed, with the exception of a
+cartilage of a rib which had not reunited.
+
+Rogers mentions the case of a carpenter of thirty-six who was struck by
+a missile thrown by a circular saw, making a wound two inches above the
+umbilicus and to the left. Through the opening a mass of intestines and
+a portion of the liver, attached by a pedicle, protruded. A portion of
+the liver was detached, and the liver, as well as the intestines, were
+replaced, and the man recovered.
+
+Baillie, Bhadoory, Barker, Edmundson, Johnson, and others, record
+instances of abdominal wounds accompanied by extensive protrusion of
+the intestines, and recovery. Shah mentions an abdominal wound with
+protrusion of three feet of small intestine. By treatment with ice,
+phenol, and opium, recovery was effected without peritonitis.
+
+Among nonfatal perforating gunshot wounds of the abdomen, Loring:
+reports the case of a private in the First Artillery who recovered
+after a double gunshot perforation of the abdomen. One of the balls
+entered 5 1/2 inches to the left of the umbilicus, and two inches above
+the crest of the ilium, making its exit two inches above the crest of
+the ilium, on a line with and two inches from the 4th lumbar vertebra.
+The other ball entered four inches below and to the rear of the left
+nipple, making its exit four inches directly below the point of
+entrance. In their passages these balls did not wound any of the
+viscera, and with the exception of traumatic fever there was no
+disturbance of the health of the patient. Schell records the case of a
+soldier who was wounded July 3, 1867, by a conoid ball from a Remington
+revolver of the Army pattern. The ball entered on the left side of the
+abdomen, its lower edge grazing the center of Poupart's ligament, and
+passing backward, inward, and slightly upward, emerged one inch to the
+left of the spinous process of the sacrum. On July 6th all the symptoms
+of peritonitis made their appearance. On July 11th there was free
+discharge of fecal matter from both anterior and posterior wounds. This
+discharge continued for three days and then ceased. By August 12th both
+wounds were entirely healed. Mineer reports a case of a wound from a
+revolver-ball entering the abdomen, passing through the colon, and
+extracted just above the right ilium. Under simple treatment the
+patient recovered and was returned to duty about ten weeks afterward.
+
+There are a number of cases on record in which a bullet entering the
+abdominal cavity is subsequently voided either by the bladder or by the
+bowel. Ducachet mentions two cases at the Georgetown Seminary Hospital
+during the late war in which Minie balls entering the abdominal wall
+were voided by the anus in a much battered condition. Bartlett reports
+the case of a young man who was accidentally shot in the abdomen with a
+Colt's revolver.  Immediately after the accident he complained of
+constant and pressing desire to void his urine. While urinating on the
+evening of the third day, the ball escaped from the urethra and fell
+with a click into the chamber. After the discharge of the ball the
+intolerable symptoms improved, and in two or three weeks there was
+complete recovery. Hoag mentions a man who was wounded by a round
+musket-ball weighing 400 grains. It had evidently passed through the
+lung and diaphragm and entered the alimentary canal; it was voided by
+the rectum five days after the injury. Lenox mentions the fact of a
+bullet entering the abdominal wall and subsequently being passed from
+the rectum. Day and Judkins report similar cases. Rundle speaks of the
+lodgment of a bullet, and its escape, after a period of seven and
+one-half years, into the alimentary canal, causing internal
+strangulation and death.
+
+Wounds of the liver often end very happily, and there are many cases on
+record in which such injuries have been followed by recovery, even when
+associated with considerable loss of liver-substance. In the older
+records, Glandorp and Scultetus mention cures after large wounds of the
+liver. Fabricius Hildanus reports a case that ended happily, in which a
+piece of liver was found in the wound, having been separated by a
+sword-thrust.  There is a remarkable example of recovery after multiple
+visceral wounds, self-inflicted by a lunatic. This man had 18 wounds,
+14 having penetrated the abdomen, the liver, colon, and the jejunum
+being injured; by frequent bleeding, strict regimen, dressing, etc., he
+recovered his health and senses, but relapsing a year and a half later,
+he again attempted suicide, which gave the opportunity for a postmortem
+to learn the extent of the original injuries. Plater, Schenck,
+Cabrolius, the Ephemerides, and Nolleson mention recovery after wounds
+of the liver. Salmuth and the Ephemerides report questionable instances
+in which portions of the liver were ejected in violent vomiting.
+Macpherson describes a wound of the liver occurring in a Hindoo of
+sixty who had been struck by a spear. A portion of the liver was
+protruding, and a piece weighing 1 1/4 ounces was removed, complete
+recovery following.
+
+Postempski mentions a case of suture of the liver after a stab-wound.
+Six sutures of chromicized cat-gut were carefully tightened and
+fastened with a single loop. The patient left his bed on the sixth day
+and completely recovered. Gann reports a case of harpoon-wound of the
+liver. While in a dory spearing fish in the Rio Nuevo, after a sudden
+lurch of the boat, a young man of twenty-eight fell on the sharp point
+of a harpoon, which penetrated his abdomen. About one inch of the
+harpoon was seen protruding from below the tip of the ensiform
+cartilage; the harpoon was seven inches long. It was found that the
+instrument had penetrated the right lobe of the liver; on passing the
+hand backward along the inferior surface of the liver, the point could
+be felt projecting through its posterior border. On account of two
+sharp barbs on the spear-point, it was necessary to push the harpoon
+further in to disengage the barbs, after which it was easily removed.
+Recovery followed, and the patient was discharged in twenty-one days.
+
+Romme discusses the subject of punctured wounds of the liver, as a
+special text using the case of the late President Carnot. He says that
+in 543 cases of traumatism of the liver collected by Elder, 65 were
+caused by cutting or sharp-pointed instruments. Of this group, 23
+recovered and 42 died. The chief causes of death were hemorrhage and
+peritonitis. The principal symptoms of wounds of the liver, such as
+traumatic shock, collapse, local and radiating pains, nausea, vomiting,
+and respiratory disturbances were all present in the case of President
+Carnot. From an experience gained in the case of the President, Romme
+strongly recommends exploratory celiotomy in all penetrating wounds of
+the liver. Zeidler reports three cases of wound of the liver in which
+recovery ensued. The hemorrhage in one case was arrested by the tampon,
+and in the other by the Pacquelin cautery.
+
+McMillan describes a man of twenty who was kicked by a horse over the
+liver and rupturing that organ. A large quantity of offensive fluid was
+drawn off from the liver, and the man recovered. Frazer reports a case
+of rupture of liver and kidney in a boy of thirteen who was squeezed
+between the tire and driving chain of a mill, but who recovered despite
+his serious symptoms. Allen mentions recovery after an extensive
+incised wound of the abdomen, liver, and lung. Massie cites an instance
+of gunshot wound of the right hypochondrium, with penetration and
+protrusion of the liver. The patient, a boy of seven, recovered after
+excision of a small part of the protruding liver. Lawson Tait has
+incised the liver to the extent of three inches, evacuated two gallons
+of hydatids, and obtained successful recovery in ten weeks.
+
+There are several cases of wound of the liver followed by recovery
+reported by surgeons of the United States Army.  Whitehead mentions a
+man of twenty-two who on June 3, 1867, was shot in the liver by a slug
+from a pistol. At the time of the injury he bled freely from the wound
+of entrance continuing to lose blood and bile until daylight the next
+morning, when the hemorrhage ceased, but the flow of bile kept on. By
+June 10th there was considerable improvement, but the wound discharged
+blood-clots, bile, and serum. When the patient left the hospital on
+July 15th the wound was healthy, discharging less than 1 1/2 ounces
+during the twenty-four hours, of a mixture of free bile, and bile mixed
+with thick material. When last heard from--July 27, 1867--the patient
+was improving finely in flesh and strength.  McKee mentions a
+commissary-sergeant stationed at Santa Fe, New Mexico, who recovered
+after a gunshot wound of the liver. Hassig reports the case of a
+private of twenty-six who was wounded in a fray near Paducah, Kentucky,
+by a conoid ball, which passed through the liver. The ball was cut out
+the same day. The patient recovered and was returned to duty in May,
+1868. Patzki mentioned a private in the Sixth Cavalry, aged
+twenty-five, who recovered from a gunshot wound of the abdomen,
+penetrating the right lobe of the liver and the gall-bladder.
+
+Resection of the Liver.--It is remarkable to what extent portions of
+the liver may be resected by the knife, cautery, or ligature, and the
+patient recover. Langenbuch records a case in which he successfully
+removed the greater portion of the left lobe of a woman of thirty. The
+lobe had been extensively deformed by tight lacing, and caused serious
+inconvenience. There was considerable hemorrhage, but the vessels were
+secured, and the woman made a good recovery. McWhinnie, in The Lancet,
+records a case of dislodgment of an enlarged liver from tight lacing.
+Terrilon mentions an instance in which a portion of the liver was
+removed by ligature after celiotomy. The ligature was removed in seven
+days, and the sphacelated portion of the liver came off with it.  A
+cicatrix was completed at the end of six weeks, and the patient, a
+woman of fifty-three, made an excellent recovery.  Bastianelli
+discusses those cases in which portions of the liver, having been
+constricted from the general body of the organ and remaining attached
+by a pedicle, give rise to movable tumors of the abdomen. He records
+such a case in a woman of thirty-seven who had five children. A piece
+of liver weighing 500 grams was removed, and with it the gall-bladder,
+and the patient made an uninterrupted recovery. Tricomi reports a case
+in which it was found necessary to remove the left lobe of the liver.
+An attempt had been made to remove a liver-tumor the size of a fist by
+constricting the base with an elastic ligature. This attempt was a
+failure, and cure was also unsuccessfully attempted by wire ligature
+and the thermocautery. The growth was cut away, bleeding was arrested
+by the thermocautery and by iron-solution, the wound entirely healed,
+and the patient recovered. Valerian von Meister has proved that the
+liver has marvelous powers of regeneration, and that in rabbits, cats,
+and dogs, even three-fourths of the organ may be reproduced in from
+forty-five to sixty-five days.  This regeneration is brought about
+chiefly by hypertrophy of the lobules.
+
+Floating liver is a rare malady in which the liver forms an abdominal
+prominence that may be moved about, and which changes its situation as
+the patient shifts the attitude. The condition usually arises from a
+lax abdominal wall following repeated pregnancies. The accompanying
+illustration exhibits a typical case verified by postmortem examination.
+
+Hypertrophy of the Liver.--The average weight of the normal liver is
+from 50 to 55 ounces, but as noted by Powell, it may become so
+hypertrophic as to weigh as much as 40 pounds. Bonet describes a liver
+weighing 18 pounds; and in his "Medical and Surgical Observations,"
+Gooch speaks of a liver weighing 28 pounds.  Vieussens, the celebrated
+anatomist, reports an instance in which the liver weighed 20 pounds,
+and in his "Aphorisms," Vetter cites a similar instance. In 1811 Kraus
+of Germany describes a liver weighing 25 pounds; modern instances of
+enlarged liver are too numerous to be quoted here.
+
+Rupture of the gall-bladder, although generally followed by death, is
+not always fatal. In such cases bile is usually found in the abdominal
+cavity. Fergus mentions a case in which, after this accident, the
+patient was considered convalescent and was walking about, when, on the
+seventh day, peritonitis suddenly developed and proved fatal in two
+days. Several cases of this accident have been reported as treated
+successfully by incision and drainage (Lane) or by inspiration (Bell).
+In these cases large quantities of bile escaped into the abdominal
+cavity.  Peritonitis does not necessarily follow. Cholecystotomy for
+the relief of the distention of the gall-bladder from obstruction of
+the common or cystic duct and for the removal of gall-stones was first
+performed in 1867 by Bobbs of Indianapolis, but it is to Marion Sims,
+in 1878, that perfection of the operation is due. It has been gradually
+improved and developed, until today it is a most successful operation.
+Tait reports 54 cases with 52 perfect recoveries. Cholyecystectomy, or
+excision of the gall-bladder, was first practiced in 1880 by Langenbuch
+of Berlin, and is used in cases in which gall-stones are repeatedly
+forming. Ashhurst's statistics show only four deaths in 28 cases.
+
+At St. Bartholomew's Hospital, in London, is a preserved specimen of a
+gall-bladder which had formed the contents of a hernial sac, and which,
+near the fundus, shows a constriction caused by the femoral ring. It
+was taken from a woman of forty-five who was admitted into the hospital
+with a strangulated femoral hernia.  The sac was opened and its
+contents were returned. The woman died in a few days from peritonitis.
+The gall-bladder was found close to the femoral ring, and showed a
+marked constriction. The liver was misshapen from tight lacing,
+elongated and drawn downward toward the ring. There was no evidence
+that any portion of intestine or other structure besides the
+gall-bladder had passed through the ring.
+
+The fatality of rupture of the spleen is quite high. Out of 83 cases of
+injury to this organ collected by Elder, and quoted by MacCormac, only
+11 recovered; but the mortality is less in punctured or incised wounds
+of this organ, the same authorities mentioning 29 recoveries out of 35
+cases. In his "Surgery" Gooch says that at the battle of Dettingen one
+of Sir Robert Rich's Dragoons was left all night on the field,
+weltering in his blood, his spleen hanging out of his body in a
+gangrenous state. The next morning he was carried to the surgeons who
+ligated the large vessels, and extirpated the spleen; the man recovered
+and was soon able to do duty. In the Philosophical Transactions there
+is a report of a man who was wounded in the spleen by a large
+hunting-knife. Fergusson found the spleen hanging from the wound and
+ligated it. It separated in ten days and the patient recovered.
+
+Williams reports a stab-wound of the spleen in a negro of twenty-one.
+The spleen protruded, and the protruding part was ligated by a silver
+wire, one-half of the organ sloughing off; the patient recovered. Sir
+Astley Cooper mentions a curious case, in which, after vomiting, during
+which the spleen was torn from its attachments, this organ produced a
+swelling in the groin which was supposed to be a hernia. The vomiting
+continued, and at the end of a week the woman died; it was then found
+that the spleen had been turned half round on its axis, and detached
+from the diaphragm; it had become enlarged; the twist interrupted the
+return of the blood. Portal speaks of a rupture of the spleen simply
+from engorgement. There was no history of a fall, contusion, or other
+injury. Tait describes a case of rupture of the spleen in a woman who,
+in attempting to avoid her husband's kick, fell on the edge of the
+table. There were no signs of external violence, but she died the third
+day afterward. The abdomen was found full of blood, and the spleen and
+peritoneal covering was ruptured for three inches.
+
+Splenectomy, excision of the spleen, has been performed a number of
+times, with varying results, but is more successful when performed for
+injury than when for disease. Ashhurst has tabulated a total of 109
+operations, 27 having been for traumatic causes, and all but five
+having terminated successfully; of 82 operations for disease, only 32
+recovered. Vulpius has collected 117 cases of splenectomy, with a
+death-rate of 50 per cent. If, however, from these cases we deduct
+those suffering with leukocythemia and lardaceous spleen, in which the
+operation should not be performed, the mortality in the remaining 85
+cases is reduced to 33 per cent. Terrier speaks of splenectomy for
+torsion or twisting of the pedicle, and such is mentioned by Sir Astley
+Cooper, who has found records of only four such cases.  Conklin reports
+a successful case of splenectomy for malarial spleen, and in reviewing
+the subject he says that the records of the past decade in operations
+for simple hypertrophy, including malaria, show 20 recoveries and eight
+deaths. He also adds that extirpation in cases of floating or displaced
+spleen was attended with brilliant results. Zuccarelli is accredited
+with reporting two cases of splenectomy for malarial spleen, both of
+which recovered early. He gives a table of splenectomies performed in
+Italy, in which there were nine cases of movable spleen, with two
+deaths; eight cases of simple hypertrophy, with three deaths; 12 cases
+of malarial spleen, with three deaths; four cases of leukemia and
+pseudoleukemia, with two deaths. In his experiments on rabbits it was
+proved by Tizzoni, and in his experiments on dogs, by Crede, that an
+individual could live without a spleen; but these observations were
+only confirmatory of what had long been known, for, in 1867, Pean
+successfully removed a spleen from a woman of twenty. Tricomi reports
+eight cases in which he had extirpated the spleen for various morbid
+conditions, with a fortunate issue in all but one. In one case he
+ligated the splenic artery. In The Lancet there is an account of three
+recent excisions of the spleen for injury at St. Thomas Hospital in
+London, and it is added that they are among the first of this kind in
+Great Britain.
+
+Abnormalities of Size of the Spleen.--The spleen may be extremely
+small. Storck mentions a spleen that barely weighed an ounce; Schenck
+speaks of one in the last century that weighed as much as 20 pounds.
+Frank describes a spleen that weighed 16 pounds; there is another
+record of one weighing 15 pounds. Elliot mentions a spleen weighing 11
+pounds; Burrows one, 11 pounds; Blasius, four pounds; Osiander, nine
+pounds; Blanchard, 31 pounds; Richardson, 3 1/2 pounds; and Hare, 93
+ounces.
+
+The thoracic duct, although so much protected by its anatomical
+position, under exceptional circumstances has been ruptured or wounded.
+Kirchner has collected 17 cases of this nature, two of which were due
+to contusions of the chest, one each to a puncture, a cut, and a
+shot-wound, and three to erosion from suppuration. In the remaining
+cases the account fails to assign a definite cause. Chylothorax, or
+chylous ascites, is generally a result of this injury. Krabbel mentions
+a patient who was run over by an empty coal car, and who died on the
+fifth day from suffocation due to an effusion into the right pleural
+cavity. On postmortem examination it was found that the effusion was
+chyle, the thoracic duct being torn just opposite the 9th dorsal
+vertebra, which had been transversely fractured. In one of Kirchner's
+cases a girl of nine had been violently pushed against a window-sill,
+striking the front of her chest in front of the 3d rib. She suffered
+from pleural effusion, which, on aspiration, proved to be chyle. She
+ultimately recovered her health. In 1891 Eyer reported a case of
+rupture of the thoracic duct, causing death on the thirty-eighth day.
+The young man had been caught between a railroad car and an engine, and
+no bones were broken.
+
+Manley reports a case of rupture of the thoracic duct in a man of
+thirty-five, who was struck by the pole of a brewery wagon; he was
+knocked down on his back, the wheel passing squarely over his abdomen.
+There was subsequent bulging low down in the right iliac fossa, caused
+by the presence of a fluid, which chemic and microscopic examination
+proved was chyle. From five to eight ounces a day of this fluid were
+discharged, until the tenth day, when the bulging was opened and
+drained. On the fifteenth day the wound was healed and the man left the
+hospital quite restored to health.
+
+Keen has reported four instances of accidental injury to the thoracic
+duct, near its termination at the base of the left side of the neck;
+the wounding was in the course of removals for deep-seated growths in
+this region. Three of the cases recovered, having sustained no
+detriment from the injury to the thoracic duct. One died; but the fatal
+influence was not specially connected with the wound of the duct.
+
+Possibly the boldest operation in the history of surgery is that for
+ligation of the abdominal aorta for inguinal aneurysm. It was first
+practiced by Sir Astley Cooper in 1817, and has since been performed
+several times with a uniformly fatal result, although Monteiro's
+patient survived until the tenth day, and there is a record in which
+ligature of the abdominal aorta did not cause death until the eleventh
+day. Loreta of Bologna is accredited with operating on December 18,
+1885, for the relief of a sailor who was suffering from an abdominal
+aneurysm caused by a blow. An incision was made from the ensiform
+cartilage to the umbilicus, the aneurysm exposed, and its cavity filled
+up with two meters of silver-plated wire. Twenty days after no evidence
+of pulsation remained in the sac, and three months later the sailor was
+well and able to resume his duties.
+
+Ligation of the common iliac artery, which, in a case of gunshot
+injury, was first practiced by Gibson of Philadelphia in 1812, is,
+happily, not always fatal. Of 82 cases collected by Ashhurst, 23
+terminated successfully.
+
+Foreign bodies loose in the abdominal cavity are sometimes voided at
+stool, or may suppurate externally. Fabricius Hildanus gives us a
+history of a person wounded with a sword-thrust into the abdomen, the
+point breaking off. The sword remained one year in the belly and was
+voided at stool. Erichsen mentions an instance in which a cedar
+lead-pencil stayed for eight months in the abdominal cavity. Desgranges
+gives a case of a fish-spine in the abdominal cavity, and ten years
+afterward it ulcerated through an abscess in the abdominal wall.
+Keetley speaks of a man who was shot when a boy; at the time of the
+accident the boy had a small spelling-book in his pocket. It was not
+until adult life that from an abscess of the groin was expelled what
+remained of the spelling-book that had been driven into the abdomen
+during boyhood. Kyle speaks of the removal of a corn-straw 33 inches in
+length by an incision ten inches long, at a point about equidistant
+from the umbilicus to the anterior spinous process of the right ilium.
+
+There are several instances on record of tolerance of foreign bodies in
+the skin and muscles of the back for an extended period. Gay speaks of
+a curious case in which the point of a sheath-knife remained in the
+back of an individual for nine years. Bush reported to Sir Astley
+Cooper the history of a man who, as he supposed, received a wound in
+the back by canister shot while serving on a Tartar privateer in 1779.
+There was no ship-surgeon on board, and in about a month the wound
+healed without surgical assistance. The man suffered little
+inconvenience and performed his duties as a seaman, and was impressed
+into the Royal Navy. In August, 1810, he complained of pain in the
+lumbar region. He was submitted to an examination, and a cicatrix of
+this region was noticed, and an extraneous body about 1/2 inch under
+the integument was felt. An incision was made down it, and a rusty
+blade of a seaman's clasp-knife extracted from near the 3d lumbar
+vertebra. The man had carried this knife for thirty years. The wound
+healed in a few days and there was no more inconvenience.
+
+Fracture of the lower part of the spine is not always fatal, and
+notwithstanding the lay-idea that a broken back means certain death,
+patients with well-authenticated cases of vertebral fracture have
+recovered. Warren records the case of a woman of sixty who, while
+carrying a clothes-basket, made a misstep and fell 14 feet, the basket
+of wet clothes striking the right shoulder, chest, and neck. There was
+fracture of the 4th dorsal vertebra at the transverse processes. By
+seizing the spinous process it could be bent backward and forward, with
+the peculiar crepitus of fractured bone. The clavicle was fractured two
+inches from the acromial end, and the sternal end was driven high up
+into the muscles of the neck. The arm and hand were paralyzed, and the
+woman suffered great dyspnea. There was at first a grave emphysematous
+condition due to the laceration of several broken ribs. There was also
+suffusion and ecchymosis about the neck and shoulder. Although
+complicated with tertiary syphilis, the woman made a fair recovery, and
+eight weeks later she walked into a doctor's office. Many similar and
+equally wonderful injuries to the spine are on record.
+
+The results sometimes following the operation of laminectomy for
+fracture of the vertebrae are often marvelous. One of the most
+successful on record is that reported by Dundore. The patient was a
+single man who lived in Mahanoy, Pa., and was admitted to the State
+Hospital for Injured Persons, Ashland, Pa., June 17, 1889, suffering
+from a partial dislocation of the 9th dorsal vertebra.  The report is
+as follows--"He had been a laborer in the mines, and while working was
+injured March 18, 1889, by a fall of top rock, and from this date to
+that of his admission had been under the care of a local physician
+without any sign of improvement. At the time of his admission he
+weighed but 98 pounds, his weight previous to the injury being 145. He
+exhibited entire loss of motion in the lower extremities, with the
+exception of very slight movement in the toes of the left foot;
+sensation was almost nil up to the hips, above which it was normal; he
+had complete retention of urine, with a severe cystitis. His tongue was
+heavily coated, the bowels constipated, and there was marked anorexia,
+with considerable anemia. His temperature varied from 99 degrees to 100
+degrees in the morning, and from 101 degrees to 103 degrees in the
+evening. The time which had elapsed since the accident precluded any
+attempt at reduction, and his anemic condition would not warrant a more
+radical method.
+
+"He was put on light, nourishing diet, iron and strychnin were given
+internally, and electricity was applied to the lower extremities every
+other day; the cystitis was treated by irrigating the bladder each day
+with Thiersch's solution. By August his appetite and general condition
+were much improved, and his weight had increased to 125 pounds, his
+temperature being 99 degrees or less each morning, and seldom as high
+as 100 degrees at night. The cystitis had entirely disappeared, and he
+was able, with some effort, to pass his urine without the aid of a
+catheter. Sensation in both extremities had slightly improved, and he
+was able to slightly move the toes of the right foot. This being his
+condition, an operation was proposed as the only means of further and
+permanent improvement, and to this he eagerly consented, and,
+accordingly, on the 25th of August, the 9th dorsal vertebra was
+trephined.
+
+"The cord was found to be compressed and greatly congested, but there
+was no evidence of laceration. The laminae and spinous processes of the
+8th and 9th dorsal vertebrae were cut away, thus relieving all pressure
+on the cord; the wound was drained and sutured, and a plaster-of-Paris
+jacket applied, a hole being cut out over the wound for the purpose of
+changing the dressing when necessary. By September 1st union was
+perfect, and for the next month the patient remained in excellent
+condition, but without any sign of improvement as to sensation and
+motion. Early in October he was able to slightly move both legs, and
+had full control of urination; from this time on his paralysis rapidly
+improved; the battery was applied daily, with massage morning and
+evening; and in November the plaster-of-Paris jacket was removed, and
+he propelled himself about the ward in a rolling chair, and shortly
+after was able to get about slowly on crutches. He was discharged
+December 23d, and when I saw him six months later he walked very well
+and without effort; he carried a cane, but this seemed more from habit
+than from necessity. At present date he weighs 150 pounds, and drives a
+huckster wagon for a living, showing very little loss of motion in his
+lower extremities."
+
+Although few cases show such wonderful improvement as this one,
+statistics prove that the results of this operation are sometimes most
+advantageous. Thorburn collects statistics of 50 operations from 1814
+to 1885, undertaken for relief of injuries of the spinal cord. Lloyd
+has compiled what is possibly the most extensive collection of cases of
+spinal surgery, his cases including operations for both disease and
+injury. White has collected 37 cases of recent date; and Chipault
+reports two cases, and collected 33 cases. Quite a tribute to the
+modern treatment by antisepsis is shown in the results of laminectomy.
+Of his non-antiseptic cases Lloyd reports a mortality of 65 per cent;
+those surviving the operation are distributed as follows: Cured, one;
+partially cured, seven; unknown, two; no improvement, five. Of those
+cases operated upon under modern antiseptic principles, the mortality
+was 50 per cent; those surviving were distributed as follows: Cured,
+four; partially cured, 15; no improvement, 11. The mortality in White's
+cases, which were all done under antiseptic precautions, was 38 per
+cent. Of those surviving, there were six complete recoveries, six with
+benefit, and 11 without marked benefit. Pyle collects 52 cases of
+spinal disease and injury, in which laminectomy was performed. All the
+cases were operated upon since 1890. Of the 52 cases there were 15
+deaths (a mortality of 29.4 per cent), 26 recoveries with benefit, and
+five recoveries in which the ultimate result has not been observed. It
+must be mentioned that several of the fatal cases reported were those
+of cervical fracture, which is by far the most fatal variety.
+
+Injury to the spinal cord does not necessarily cause immediate death.
+Mills and O'Hara, both of Philadelphia, have recorded instances of
+recovery after penetrating wound of the spinal marrow. Eve reports
+three cases of gunshot wound in which the balls lodged in the vertebral
+canal, two of the patients recovering. He adds some remarks on the
+division of the spinal cord without immediate death.
+
+Ford mentions a gunshot wound of the spinal cord, the patient living
+ten days; after death the ball was found in the ascending aorta. Henley
+speaks of a mulatto of twenty-four who was stabbed in the back with a
+knife. The blade entered the body of the 6th dorsal vertebra, and was
+so firmly embedded that the patient could be raised entirely clear of
+the bed by the knife alone. An ultimate recovery ensued.
+
+Although the word hernia can be construed to mean the protrusion of any
+viscus from its natural cavity through normal or artificial openings in
+the surrounding structures, the usual meaning of the word is protrusion
+of the abdominal contents through the parietes--what is commonly spoken
+of as rupture.  Hernia may be congenital or acquired, or may be single
+or multiple--as many as five having been seen in one individual.  More
+than two-thirds of cases of rupture suffer from inguinal hernia In the
+oblique form of inguinal hernia the abdominal contents descend along
+the inguinal canal to the outer side of the epigastric artery, and
+enter the scrotum in the male, and the labium majus in the female. In
+this form of hernia the size of the sac is sometimes enormous, the
+accompanying illustration showing extreme cases of both scrotal and
+labial hernia.  Umbilical hernia may be classed under three heads:
+congenital, infantile, and adult. Congenital umbilical hernia occurs
+most frequently in children, and is brought about by the failure of the
+abdominal walls to close. When of large size it may contain not only
+the intestines, but various other organs, such as the spleen, liver,
+etc. In some monsters all the abdominal contents are contained in the
+hernia. Infantile umbilical hernia is common, and appears after the
+separation of the umbilical cord; it is caused by the yielding of the
+cicatrix in this situation.  It never reaches a large size, and shows a
+tendency to spontaneous cure. Adult umbilical hernia rarely commences
+in infancy. It is most commonly seen in persons with pendulous bellies,
+and is sometimes of enormous size, in addition to the ordinary
+abdominal contents, containing even the stomach and uterus. A few years
+since there was a man in Philadelphia past middle age, the victim of
+adult umbilical hernia so pendulous that while walking he had to
+support it with his arms and hands.  It was said that this hernia did
+not enlarge until after his service as a soldier in the late war.
+
+Abbott recites the case of an Irish woman of thirty-five who applied to
+know if she was pregnant. No history of a hernia could be elicited. No
+pregnancy existed, but there was found a ventral hernia of the
+abdominal viscera through an opening which extended the entire length
+of the linea alba, and which was four inches wide in the middle of the
+abdomen.
+
+Pim saw a colored woman of twenty-four who, on December 29, 1858, was
+delivered normally of her first child, and who died in bed at 3 A.M. on
+February 12, 1859. The postmortem showed a tumor from the ensiform
+cartilage to the symphysis pubis, which contained the omentum, liver
+(left lobe), small intestines, and colon. It rested upon the abdominal
+muscles of the right side. The pelvic viscera were normally placed and
+there was no inguinal nor femoral hernia.
+
+Hulke reports a case remarkable for the immense size of the rupture
+which protruded from a spot weakened by a former abscess.  There was a
+partial absence of the peritoneal sac, and the obstruction readily
+yielded to a clyster and laxative. The rupture had a transverse
+diameter of 14 1/2 inches, with a vertical diameter of 11 1/2 inches.
+The opening was in the abdominal walls outside of the internal inguinal
+ring. The writhings of the intestines were very conspicuous through the
+walls of the pouch.
+
+Dade reports a case of prodigious umbilical hernia. The patient was a
+widow of fifty-eight, a native of Ireland. Her family history was good,
+and she had never borne any children. The present dimensions of the
+tumor, which for fifteen years had been accompanied with pain, and had
+progressively increased in size, are as follows: Circumference at the
+base, 19 1/2 inches; circumference at the extremity, 11 1/4 inches;
+distance of extremity from abdominal wall, 12 3/4 inches. Inspection
+showed a large lobulated tumor protruding from the abdominal wall at
+the umbilicus. The veins covering it were prominent and distended.  The
+circulation of the skin was defective, giving it a blue appearance.
+Vermicular contractions of the small intestines could be seen at the
+distance of ten feet. The tumor was soft and velvety to the touch, and
+could only partially be reduced.  Borborygmus could be easily heard. On
+percussion the note over the bulk was tympanitic, and dull at the base.
+The distal extremity contained a portion of the small intestine instead
+of the colon, which Wood considered the most frequent occupant. The
+umbilicus was completely obliterated. Dade believed that this hernia
+was caused by the weakening of the abdominal walls from a blow, and
+considered that the protrusion came from an aperture near the umbilicus
+and not through it, in this manner differing from congenital umbilical
+hernia.
+
+A peculiar form of hernia is spontaneous rupture of the abdominal
+walls, which, however, is very rare. There is an account of such a case
+in a woman of seventy-two living in Pittsburg, who, after a spasmodic
+cough, had a spontaneous rupture of the parietes. The rent was four
+inches in length and extended along the linea alba, and through it
+protruded a mass of omentum about the size of a child's head. It was
+successfully treated and the woman recovered. Wallace reports a case of
+spontaneous rupture of the abdominal wall, following a fit of coughing.
+The skin was torn and a large coil of ileum protruded, uncovered by
+peritoneum.  After protracted exposure of the bowel it was replaced,
+the rent was closed, and the patient recovered.
+
+
+
+CHAPTER XIII.
+
+SURGICAL ANOMALIES OF THE GENITO-URINARY SYSTEM.
+
+Wounds of the kidney may be very severe without causing death, and even
+one entire kidney may be lost without interfering with the functions of
+life. Marvand, the Surgeon-Major of an Algerian regiment, reports the
+case of a young Arab woman who had been severely injured in the right
+lumbar region by a weapon called a "yataghan," an instrument which has
+only one cutting edge. On withdrawing this instrument the right kidney
+was extruded, became strangulated between the lips of the wound, and
+caused considerable hemorrhage. A ligature was put around the base of
+the organ, and after some weeks the mass separated. The patient
+continued in good health the whole time, and her urinary secretion was
+normal. She was discharged in two months completely recovered. Price
+mentions the case of a groom who was kicked over the kidney by a horse,
+and eighteen months later died of dropsy.  Postmortem examination
+showed traces of a line of rupture through the substance of the gland;
+the preparation was deposited in St.  George's Hospital Museum in
+London. The case is singular in that this man, with granular
+degeneration of the kidney, recovered from so extensive a lesion, and,
+moreover, that he remained in perfect health for over a year with his
+kidney in a state of destructive disease. Borthwick mentions a dragoon
+of thirty who was stabbed by a sword-thrust on the left side under the
+short rib, the sword penetrating the pelvis and wounding the kidney.
+There was no hemorrhage from the external wound, nor pain in the
+spermatic cord or testicle. Under expectant treatment the man
+recovered. Castellanos mentions a case of recovery from punctured wound
+of the kidney by a knife that penetrated the tubular and cortical
+substance, and entered the pelvis of the organ. The case was peculiar
+in the absence of two symptoms, viz., the escape of urine from the
+wound, and retraction of the corresponding testicle. Dusenbury reports
+the case of a corporal in the army who was wounded on April 6, 1865,
+the bullet entering both the liver and kidney. Though there was injury
+to both these important organs, there was no impairment of the
+patient's health, and he recovered.
+
+Bryant reports four cases of wound of the kidney, with recovery.  All
+of these cases were probably extraperitoneal lacerations or ruptures.
+Cock found a curious anomaly in a necropsy on the body of a boy of
+eighteen, who had died after a fall from some height.  There was a
+compound, transverse rupture of the left kidney, which was twice as
+large as usual, the ureter also being of abnormal size. Further search
+showed that the right kidney was rudimentary, and had no vein or artery.
+
+Ward mentions a case of ruptured kidney, caused by a fall of seven
+feet, the man recovering after appropriate treatment.  Vernon reports a
+case of serious injury to the kidney, resulting in recovery in nine
+weeks. The patient fell 40 feet, landing on some rubbish and old iron,
+and received a wound measuring six inches over the right iliac crest,
+through which the lower end of the right kidney protruded; a piece of
+the kidney was lost. The case was remarkable because of the slight
+amount of hemorrhage.
+
+Nephrorrhaphy is an operation in which a movable or floating kidney is
+fixed by suture through its capsule, including a portion of
+kidney-substance, and then through the adjacent lumbar fascia and
+muscles. The ultimate results of this operation have been most
+successful.
+
+Nephrolithotomy is an operation for the removal of stone from the
+kidney. The operation may be a very difficult one, owing to the
+adhesions and thickening of all the perinephric tissues, or to the
+small size or remote location of the stone.
+
+There was a recent exhibition in London, in which were shown the
+results of a number of recent operations on the kidney. There was
+one-half of a kidney that had been removed on account of a
+rapidly-growing sarcoma from a young man of nineteen, who had known of
+the tumor for six months; there was a good recovery, and the man was
+quite well in eighteen months afterward. Another specimen was a right
+kidney removed at St. Bartholomew's Hospital. It was much dilated, and
+only a small amount of the kidney-substance remained. A calculus
+blocked the ureter at its commencement. The patient was a woman of
+thirty-one, and made a good recovery. From the Middlesex Hospital was a
+kidney containing a uric acid calculus which was successfully removed
+from a man of thirty-five. From the Cancer Hospital at Brompton there
+were two kidneys which had been removed from a man and a woman
+respectively, both of whom made a good recovery. From the King's
+College Hospital there was a kidney with its pelvis enlarged and
+occupied by a large calculus, and containing little secreting
+substance, which was removed from a man of forty-nine, who recovered.
+These are only a few of the examples of this most interesting
+collection. Large calculi of the kidney are mentioned in Chapter XV.
+
+Rupture of the ureter is a very rare injury. Poland has collected the
+histories of four cases, one of which ended in recovery after the
+evacuation by puncture, at intervals, of about two gallons of fluid
+resembling urine. The other cases terminated in death during the first,
+fourth, and tenth weeks respectively.  Peritonitis was apparently not
+present in any of the cases, the urinary extravasation having occurred
+into the cellular tissue behind the peritoneum.
+
+There are a few recorded cases of uncomplicated wounds of the ureters.
+The only well authenticated case in which the ureter alone was divided
+is the historic injury of the Archbishop of Paris, who was wounded
+during the Revolution of 1848, by a ball entering the upper part of the
+lumbar region close to the spine.  Unsuccessful attempts were made to
+extract the ball, and as there was no urine in the bladder, but a
+quantity escaping from the wound, a diagnosis of divided ureter was
+made. The Archbishop died in eighteen hours, and the autopsy showed
+that the ball had fractured the transverse process of the 3d lumbar
+vertebra, and divided the cauda equina just below its origin; it had
+then changed direction and passed up toward the left kidney, dividing
+the ureter near the pelvis, and finally lodged in the psoas muscle.
+
+It occasionally happens that the ureter is wounded in the removal of
+uterine, ovarian, or other abdominal tumors. In such event, if it is
+impossible to transplant to the bladder, the divided or torn end should
+be brought to the surface of the loin or vagina, and sutured there. In
+cases of malignant growth, the ureter has been purposely divided and
+transplanted into the bladder.  Penrose, assisted by Baldy, has
+performed this operation after excision of an inch of the left ureter
+for carcinomatous involvement. The distal end of the ureter was
+ligated, and the proximal end implanted in the bladder according to Van
+Hook's method, which consists in tying the lowered end of the ureter,
+then making a slit into it, and invaginating the upper end into the
+lower through this slit. A perfect cure followed. Similar cases have
+been reported by Kelly, Krug, and Bache Emmet. Reed reports a most
+interesting series in which he has successfully transplanted ureters
+into the rectum.
+
+Ureterovaginal fistulae following total extirpation of the uterus,
+opening of pelvic abscesses, or ulcerations from foreign bodies, are
+repaired by an operation termed by Bazy of Paris ureterocystoneostomy,
+and suggested by him as a substitute for nephrectomy in those cases in
+which the renal organs are unaffected. In the repair of such a case
+after a vaginal hysterectomy Mayo reports a successful reimplantation
+of the ureter into the bladder.
+
+Stricture of the ureter is also a very rare occurrence except as a
+result of compression of abdominal or pelvic new growths.  Watson has,
+however, reported two cases of stricture, in both of which a ureter was
+nearly or quite obliterated by a dense mass of connective tissue. In
+one case there was a history of the passage of a renal calculus years
+previously. In both instances the condition was associated with
+pyonephrosis. Watson has collected the reports of four other cases from
+medical literature.
+
+A remarkable procedure recently developed by gynecologists,
+particularly by Kelly of Baltimore, is catheterization and sounding of
+the ureters. McClellan records a case of penetration of the ureter by
+the careless use of a catheter.
+
+Injuries of the Bladder.--Rupture of the bladder may result from
+violence without any external wound (such as a fall or kick) applied to
+the abdomen. Jones reports a fatal case of rupture of the bladder by a
+horse falling on its rider. In this case there was but little
+extravasation of urine, as the vesical aperture was closed by omentum
+and bowel. Assmuth reports two cases of rupture of the bladder from
+muscular action. Morris cites the history of a case in which the
+bladder was twice ruptured: the first time by an injury, and the second
+time by the giving way of the cicatrix. The patient was a man of
+thirty-six who received a blow in the abdomen during a fight in a
+public house on June 6, 1879. At the hospital his condition was
+diagnosed and treated expectantly, but he recovered perfectly and left
+the hospital July 10, 1879. He was readmitted on August 4, 1886, over
+seven years later, with symptoms of rupture of the bladder, and died on
+the 6th. The postmortem showed a cicatrix of the bladder which had
+given way and caused the patient's death.
+
+Rupture of the bladder is only likely to happen when the organ is
+distended, as when empty it sinks behind the pubic arch and is thus
+protected from external injury. The rupture usually occurs on the
+posterior wall, involving the peritoneal coat and allowing
+extravasation of urine into the peritoneal cavity, a condition that is
+almost inevitably fatal unless an operation is performed.  Bartels
+collected the data of 98 such cases, only four recovering. When the
+rent is confined to the anterior wall of the bladder the urine escapes
+into the pelvic tissues, and the prognosis is much more favorable.
+Bartels collected 54 such cases, 12 terminating favorably. When
+celiotomy is performed for ruptured bladder, in a manner suggested by
+the elder Gross, the mortality is much less. Ashhurst collected the
+reports of 28 cases thus treated, ten of which recovered--a mortality
+of 64.2 per cent. Ashhurst remarks that he has seen an extraperitoneal
+rupture of the anterior wall of the bladder caused by improper use of
+instruments, in the case of retention of urine due to the presence of a
+tight urethral stricture.
+
+There are a few cases on record in which the bladder has been ruptured
+by distention from the accumulation of urine, but the accident is a
+rare one, the urethra generally giving way first.  Coats reports two
+cases of uncomplicated rupture of the bladder.  In neither case was a
+history of injury obtainable. The first patient was a maniac; the
+second had been intoxicated previous to his admission to the hospital,
+with symptoms of acute peritonitis. The diagnosis was not made. The
+first patient died in five days and the second in two days after the
+onset of the illness. At the autopsies the rent was found to be in both
+instances in the posterior wall of the bladder a short distance from
+the fundus; the peritoneum was not inflamed, and there was absolutely
+no inflammatory reaction in the vesical wound. From the statistics of
+Ferraton and Rivington it seems that rupture of the bladder is more
+common in intoxicated persons than in others--a fact that is probably
+explained by a tendency to over-distention of the bladder which
+alcoholic liquors bring about. The liquor imbibed increases the amount
+of urine, and the state of blunted consciousness makes the call to
+empty the bladder less appreciated. The intoxicated person is also
+liable to falls, and is not so likely to protect himself in falling as
+a sober person.
+
+Gunshot Wounds of the Bladder.--Jackson relates the remarkable recovery
+of a private in the 17th Tennessee Regiment who was shot in the pelvis
+at the battle of Mill Springs or Fishing Creek, Ky.  He was left
+supposedly mortally wounded on the field, but was eventually picked up,
+and before receiving any treatment hauled 164 miles, over mountainous
+roads in the midst of winter and in a wagon without springs. His urine
+and excretions passed out through the wounds for several weeks and
+several pieces of bone came away. The two openings eventually healed,
+but for twenty-two months he passed pieces of bone by the natural
+channels.
+
+Eve records the case of a private in the Fifth Tennessee Cavalry who
+was shot in the right gluteal region, the bullet penetrating the
+bladder and making its exit through the pubis. He rode 30 miles, during
+which the urine passed through the wound. Urine was afterward voided
+through the left pubic opening, and spicules of bone were discharged
+for two years afterward; ultimate recovery ensued.
+
+Barkesdale relates the history of the case of a Confederate soldier who
+was shot at Fredericksburg in the median line of the body, 1 1/2 inches
+above the symphysis, the wound of exit being in the median line at the
+back, 1/2 inch lower down. Urine escaped from both wounds and through
+the urethra. There were no bad symptoms, and the wounds healed in four
+weeks.
+
+The bladder is not always injured by penetration of the abdominal wall,
+but may be wounded by penetration through the anus or vagina, or even
+by an instrument entering the buttocks and passing through the smaller
+sacrosciatic notch. Camper records the case of a sailor who fell from a
+mast and struck upon some fragments of wood, one of which entered the
+anus and penetrated the bladder, the result being a rectovesical
+fistula. About a year later the man consulted Camper, who
+unsuccessfully attempted to extract the piece of wood; but by incising
+the fistula it was found that two calculi had formed about the wooden
+pieces, and when these were extracted the patient recovered. Perrin
+gives the history of a man of forty who, while adjusting curtains, fell
+and struck an overturned chair; one of the chair-legs penetrated the
+anus. Its extraction was followed by a gush of urine, and for several
+days the man suffered from incontinence of urine and feces. By the
+tenth day he was passing urine from the urethra, and on the
+twenty-fifth day there was a complete cicatrix of the parts; fifteen
+days later he suffered from an attack of retention of urine lasting
+five days; this was completely relieved after the expulsion of a small
+piece of trouser-cloth which had been pushed into the bladder at the
+time of the accident. Post reports the case of a young man who, in
+jumping over a broomstick, was impaled upon it, the stick entering the
+anus without causing any external wound, and penetrating the bladder,
+thus allowing the escape of urine through the anus. A peculiar sequela
+was that the man suffered from a calculus, the nucleus of which was a
+piece of the seat of his pantaloons which the stick had carried in.
+
+Couper reports a fatal case of stab-wound of the buttocks, in which the
+knife passed through the lesser sacrosciatic notch and entered the
+bladder close to the trigone. The patient was a man of twenty-three, a
+seaman, and in a quarrel had been stabbed in the buttocks with a long
+sailor's knife, with resultant symptoms of peritonitis which proved
+fatal. At the autopsy it was found that the knife had passed through
+the gluteal muscles and divided part of the great sacrosciatic
+ligament. It then passed through the small sacrosciatic notch,
+completely dividing the pudic artery and nerve, and one vein, each end
+being closed by a clot.  The knife entered the bladder close to the
+trigone, making an opening large enough to admit the index finger.
+There were well-marked evidences of peritonitis and cellulitis.
+
+Old-time surgeons had considerable difficulty in extracting arrow-heads
+from persons who had received their injuries while on horseback. Conrad
+Gesner records an ingenious device of an old surgeon who succeeded in
+extracting an arrow which had resisted all previous attempts, by
+placing the subject in the very position in which he was at the time of
+reception of the wound.  The following noteworthy case shows that the
+bladder may be penetrated by an arrow or bullet entering the buttocks
+of a person on horseback. Forwood describes the removal of a vesical
+calculus, the nucleus of which was an iron arrow-head, as follows:
+"Sitimore, a wild Indian, Chief of the Kiowas, aged forty-two, applied
+to me at Fort Sill, Indian Territory, August, 1869, with symptoms of
+stone in the bladder. The following history was elicited: In the fall
+of 1862 he led a band of Kiowas against the Pawnee Indians, and was
+wounded in a fight near Fort Larned, Kansas. Being mounted and leaning
+over his horse, a Pawnee, on foot and within a few paces, drove an
+arrow deep into his right buttock. The stick was withdrawn by his
+companions, but the iron point remained in his body. He passed bloody
+urine immediately after the injury, but the wound soon healed, and in a
+few weeks he was able to hunt the buffalo without inconvenience.  For
+more than six years he continued at the head of his band, and traveled
+on horseback, from camp to camp, over hundreds of miles every summer. A
+long time after the injury he began to feel distress in micturating,
+which steadily increased until he was forced to reveal this sacred
+secret (as it is regarded by these Indians), and to apply for medical
+aid. His urine had often stopped for hours, at which times he had
+learned to obtain relief by elevating his hips, or lying in different
+positions. The urine was loaded with blood and mucus and with a few pus
+globules, and the introduction of a sound indicated a large, hard
+calculus in the bladder. The Indians advised me approximately of the
+depth to which the shaft had penetrated and the direction it took, and
+judging from the situation of the cicatrix and all the circumstances it
+was apparent that the arrow-head had passed through the glutei muscles
+and the obturator foremen and entered the cavity of the bladder, where
+it remained and formed the nucleus of a stone. Stone in the bladder is
+extremely rare among the wild Indians, owing, no doubt, to their almost
+exclusive meat diet and the very healthy condition of their digestive
+organs, and this fact, in connection with the age of the patient and
+the unobstructed condition of his urethra, went very far to sustain
+this conclusion. On August 23d I removed the stone without difficulty
+by the lateral operation through the perineum. The lobe of the prostate
+was enlarged, which seemed to favor the extent of the incision beyond
+what would otherwise have been safe. The perineum was deep and the
+tuberosities of the ischii unnaturally approximated. The calculus of
+the mixed ammoniaco-magnesian variety was egg-shaped, and weighed 19
+drams.  The arrow-point was completely covered and imbedded near the
+center of the stone. It was of iron, and had been originally about 2
+1/2 inches long, by 7/8 inch at its widest part, somewhat reduced at
+the point and edges by oxidation. The removal of the stone was
+facilitated by the use of two pairs of forceps,--one with broad blades,
+by which I succeeded in bringing the small end of the stone to the
+opening in the prostate, while the other, long and narrow, seized and
+held it until the former was withdrawn. In this way the forceps did not
+occupy a part of the opening while the large end of the stone was
+passing through it.  The capacity of the bladder was reduced, and its
+inner walls were in a state of chronic inflammation. The patient
+quickly recovered from the effects of the chloroform and felt great
+relief, both in body and mind, after the operation, and up to the
+eighth day did not present a single unfavorable symptom. The urine
+began to pass by the natural channel by the third day, and continued
+more or less until, on the seventh day, it had nearly ceased to flow at
+the wound. But the restless spirit of the patient's friends could no
+longer be restrained. Open hostility with the whites was expected to
+begin at every moment, and they insisted on his removal. He needed
+purgative medicine on the eighth day, which they refused to allow him
+to take. They assumed entire charge of the case, and the following day
+started with him to their camps 60 miles away. Nineteen days after he
+is reported to have died; but his immediate relatives have since
+assured me that his wound was well and that no trouble arose from it.
+They described his symptoms as those of bilious remittent fever, a
+severe epidemic of which was prevailing at the time, and from which
+several white men and many Indians died in that vicinity." The calculus
+was deposited in the Army Medical Museum at Washington, and is
+represented in the accompanying photograph, showing a cross-section of
+the calculus with the arrow-head in situ.
+
+As quoted by Chelius, both Hennen and Cline relate cases in which men
+have been shot through the skirts of the jacket, the ball penetrating
+the abdomen above the tuberosity of the ischium, and entering the
+bladder, and the men have afterward urinated pieces of clothing,
+threads, etc., taken in by the ball. In similar cases the bullet itself
+may remain in the bladder and cause the formation of a calculus about
+itself as a nucleus, as in three cases mentioned by McGuire of
+Richmond, or the remnants of cloth or spicules of bone may give rise to
+similar formation. McGuire mentions the case of a man of twenty-three
+who was wounded at the Battle of McDowell, May 8, 1862. The ball struck
+him on the horizontal ramus of the left pubic bone, about an inch from
+the symphysis, passed through the bladder and rectum, and came out just
+below the right sacrosciatic notch, near the sacrum. The day after the
+battle the man was sent to the general hospital at Staunton, Va., where
+he remained under treatment for four months.  During the first month
+urine passed freely through the wounds made by the entrance and exit of
+the ball, and was generally mixed with pus and blood. Fecal matter was
+frequently discharged through the posterior wound. Some time during the
+third week he passed several small pieces of bone by the rectum. At the
+end of the fifth week the wound of exit healed, and for the first time
+after his injury urine was discharged through the urethra. The wound of
+entrance gradually closed after five months, but opened again in a few
+weeks and continued, at varying intervals, alternately closed and open
+until September, 1865. At this time, on sounding the man, it was found
+that he had stone; this was removed by lateral operation, and was found
+to weigh 2 1/4 ounces, having for its nucleus a piece of bone about 1/2
+inch long. Dougherty reports the operation of lithotomy, in which the
+calculus removed was formed by incrustations about an iron bullet.
+
+In cases in which there is a fistula of the bladder the subject may
+live for some time, in some cases passing excrement through the
+urethra, in others, urine by the anus. These cases seem to have been of
+particular interest to the older writers, and we find the literature of
+the last century full of examples.  Benivenius, Borellus, the
+Ephemerides, Tulpius, Zacutus Lusitanus, and others speak of excrement
+passing through the penis; and there are many cases of vaginal anus
+recorded. Langlet cites an instance in which the intestine terminated
+in the bladder. Arand mentions recovery after atresia of the anus with
+passage of excrement from the vulva. Bartholinus, the Ephemerides,
+Fothergill, de la Croix, Riedlin, Weber, and Zacutus Lusitanus mention
+instances in which gas was passed by the penis and urethra. Camper
+records such a case from ulcer of the neighboring or connecting
+intestine; Frank, from cohesion and suppuration of the rectum;
+Marcellus Donatus, from penetrating ulcer of the rectum; and Petit,
+from communication of the rectum and bladder in which a cure was
+effected by the continued use of the catheter for the evacuation of
+urine.
+
+Flatus through the vagina, vulva, and from the uterus is mentioned by
+Bartholinus, the Ephemerides, Meckel, Mauriceau, Paullini, Riedlin,
+Trnka, and many others in the older literature. Dickinson mentions a
+Burmese male child, four years old, who had an imperforate anus and
+urethra, but who passed feces and urine successfully through an opening
+at the base of the glans penis. Dickinson eventually performed a
+successful operation on this case. Modern literature has many similar
+instances.
+
+In the older literature it was not uncommon to find accounts of persons
+passing worms from the bladder, no explanations being given to account
+for their presence in this organ. Some of these cases were doubtless
+instances of echinococcus, trichinae, or the result of rectovesical
+fistula, but Riverius mentions an instance in which, after drinking
+water containing worms, a person passed worms in the urine. In the old
+Journal de physique de Rozier is an account of a man of forty-five who
+enjoyed good health, but who periodically urinated small worms from the
+bladder. They were described as being about 1 1/2 lines long, and
+caused no inconvenience. There is also mentioned the case of a woman
+who voided worms from the bladder. Tupper describes a curious case of a
+woman of sixty-nine who complained of a severe, stinging pain that
+completely overcame her after micturition. An ulceration of the neck of
+the bladder was suspected, and the usual remedies were applied, but
+without effect. An examination of the urine was negative. On
+recommendation of her friends the patient, before going to bed, steeped
+and drank a decoction of knot-grass. During the night she urinated
+freely, and claimed that she had passed a worm about ten inches long
+and of the size of a knitting-needle.  It exhibited motions like those
+of a snake, and was quite lively, living five or six days in water. The
+case seems quite unaccountable, but there is, of course, a possibility
+that the animal had already been in the chamber, or that it was passed
+by the bowel. A rectovaginal or vesical fistula could account for the
+presence of this worm had it been voided from the bowel; nevertheless
+the woman adhered to her statement that she had urinated the worm, and,
+as confirmatory evidence, never complained of pain after passing the
+animal.
+
+Foreign bodies in the bladder, other than calculi (which will be spoken
+of in Chapter XV), generally gain entrance through one of the natural
+passages, as a rule being introduced, either in curiosity or for
+perverted satisfaction, through the urethra.  Morand mentions an
+instance in which a long wax taper was introduced into the bladder
+through the urethra by a man. At the University Hospital, Philadelphia,
+White has extracted, by median cystotomy, a long wax taper which had
+been used in masturbation.  The cystoscopic examination in this case
+was negative, and the man's statements were disbelieved, but the
+operation was performed, and the taper was found curled up and covered
+by mucus and folds of the bladder. It is not uncommon for needles,
+hair-pins, and the like to form nuclei for incrustations. Gross found
+three caudal vertebrae of a squirrel in the center of a vesical
+calculus taken from the bladder of a man of thirty-five.  It was
+afterward elicited that the patient had practiced urethral masturbation
+with the tail of this animal. Morand relates the history of a man of
+sixty-two who introduced a sprig of wheat into his urethra for a
+supposed therapeutic purpose. It slipped into the bladder and there
+formed the nucleus of a cluster calculus. Dayot reports a similar
+formation from the introduction of the stem of a plant. Terrilon
+describes the case of a man of fifty-four who introduced a pencil into
+his urethra. The body rested fifteen days in this canal, and then
+passed into the bladder. On the twenty-eighth day he had a chill, and
+during two days made successive attempts to break the pencil. Following
+each attempt he had a violent chill and intense evening fever. On the
+thirty-third day Terrilon removed the pencil by operation.  Symptoms of
+perivesical abscess were present, and seventeen days after the
+operation, and fifty days after the introduction of the pencil, the
+patient died. Caudmont mentions a man of twenty-six who introduced a
+pencil-case into his urethra, from whence it passed into his bladder.
+It rested about four years in this organ before violent symptoms
+developed. Perforation of the bladder took place, and the patient died.
+Poulet mentions the case of a man of seventy-eight, in whose bladder a
+metallic sound was broken off. The fractured piece of sound, which
+measured 17 cm.  in length, made its exit from the anus, and the
+patient recovered. Wheeler reports the case of a man of twenty-one who
+passed a button-hook into his anus, from whence it escaped into his
+bladder. The hook, which was subsequently spontaneously passed,
+measured 2 1/2 inches in length and 1/2 inch in diameter.
+
+Among females, whose urethrae are short and dilatable, foreign bodies
+are often found in the bladder, and it is quite common for smaller
+articles of the toilet, such as hair-pins, to be introduced into the
+bladder, and there form calculi. Whiteside describes a case in which a
+foreign body introduced into the bladder was mistaken for pregnancy,
+and giving rise to corresponding symptoms. The patient was a young girl
+of seventeen who had several times missed her menstruation, and who was
+considered pregnant. The abdomen was more developed than usual in a
+young woman. The breasts were voluminous, and the nipples surrounded by
+a somber areola. At certain periods after the cessation of
+menstruation, she had incontinence of urine, and had also repeatedly
+vomited. The urine was of high specific gravity, albuminous, alkaline,
+and exhaled a disagreeable odor. In spite of the signs of pregnancy
+already noted, palpitation and percussion did not show any augmentation
+in the size of the uterus, but the introduction of a catheter into the
+bladder showed the existence of a large calculus. Under chloroform the
+calculus and its nucleus were disengaged, and proved to be the handle
+of a tooth-brush, the exact size of which is represented in the
+accompanying illustration. The handle was covered with calcareous
+deposits, and was tightly fixed in the bladder. At first the young
+woman would give no explanation for its presence, but afterward
+explained that she had several times used this instrument for relief in
+retention of urine, and one day it had fallen into the bladder. A short
+time after the operation menstruation returned for the first time in
+seven months, and was afterward normal. Bigelow reports the case of a
+woman who habitually introduced hair-pins and common pins into her
+bladder.  She acquired this mania after an attempt at dilatation of the
+urethra in the relief of an obstinate case of strangury. Rode reports
+the case of a woman who had introduced a hog's penis into her urethra.
+It was removed by an incision into this canal, but the patient died in
+five days of septicemia. There is a curious case quoted of a young
+domestic of fourteen who was first seen suffering with pain in the
+sides of the genital organs, retention of urine, and violent tenesmus.
+She was examined by a midwife who found nothing, but on the following
+day the patient felt it necessary to go to bed. Her general symptoms
+persisted, and meanwhile the bladder became much distended. The patient
+had made allusion to the loss of a hair-pin, a circumstance which
+corresponded with the beginning of her trouble. Examination showed the
+orifice of the urethra to be swollen and painful to the touch, and from
+its canal a hair-pin 6.5 cm. long was extracted. The patient was unable
+to urinate, and it was necessary to resort to catheterization. By
+evening the general symptoms had disappeared, and the next day the
+patient urinated as usual.
+
+There are peculiar cases of hair in the bladder, in which all history
+as to the method of entrance is denied, and which leave as the only
+explanation the possibility that the bladder was in communication with
+some dermoid cyst. Hamelin mentions a case of this nature. It is said
+that all his life Sir William Elliot was annoyed by passing hairs in
+urination. They would lodge in the urethra and cause constant
+irritation. At his death a stone was taken from the bladder, covered
+with scurf and hair. Hall relates the case of a woman of sixty, from
+whose bladder, by dilatation of the urethra, was removed a bundle of
+hairs two inches long, which, Hall says, without a doubt had grown from
+the vesical walls.
+
+Retention of Foreign Bodies in the Pelvis.--It is a peculiar fact that
+foreign bodies which once gain entrance to the pelvis may be tolerated
+in this location for many years. Baxter describes a man who suffered an
+injury from a piece of white board which entered his pelvis, and
+remained in position for sixteen and a half years; at this time a piece
+of wood 7 1/2 inches long was discharged at stool, and the patient
+recovered. Jones speaks of a case in which splinters of wood were
+retained in the neighborhood of the rectum and vagina for sixteen
+years, and spontaneously discharged. Barwell mentions a case in which a
+gum elastic catheter that had been passed into the vagina for the
+purpose of producing abortion became impacted in the pelvis for twenty
+months, and was then removed.
+
+Rupture of the Male Urethra.--The male urethra is occasionally ruptured
+in violent coitus. Frank and the Philosophical Transactions are among
+the older authorities mentioning this accident. In Frank's case there
+was hemorrhage from the penis to the extent of five pounds. Colles
+mentions a man of thirty-eight, prone to obesity, and who had been
+married two months, who said that in sexual congress he had hurt
+himself by pushing his penis against the pubic bone, and added that he
+had a pain that felt as though something had broken in his organ. The
+integuments of the penis became livid and swollen and were extremely
+painful. His urine had to be drawn by a catheter, and by the fifth day
+his condition was so bad that an incision was made into the tumor, and
+pus, blood, urine, and air issued. The patient suffered intense rigors,
+his abdomen became tympanitic, and he died.  Postmortem examination
+revealed the presence of a ruptured urethra.
+
+Watson relates an instance of coitus performed en postillon by a man
+while drunk, with rupture of the urethra and fracture of the corpus
+spongiosum only. Loughlin mentions a rupture of the corpus spongiosum
+during coitus. Frank cites a curious case of hemorrhage from a fall
+while the penis was erect. It is not unusual to find ruptured urethrae
+following traumatism, and various explanations are given for it in the
+standard works on surgery.
+
+Fracture of the Penis.--A peculiar accident to the penis is fracture,
+which sometimes occurs in coitus. This accident consists in the
+laceration of the corpora cavernosa, followed by extensive
+extravasation of blood into the erectile tissue. It has also occurred
+from injury inflicted accidentally or maliciously, but always happening
+when the organ was erect. An annoying sequel following this accident is
+the tendency to curvature in erection, which is sometimes so marked as
+to interfere with coitus, and even render the patient permanently
+impotent.
+
+There is an account of a laborer of twenty-seven who, in attempting to
+micturate with his penis erect, pressed it downward with considerable
+force and fractured the corpora cavernosa.  Veazie relates a case of
+fracture of the corpora cavernosa occurring in coitus. During the act
+the female suddenly withdrew, and the male, following, violently struck
+the pubes, with the resultant injury. Recovery ensued. M'Clellan speaks
+of removing the cavernous septum from a man of fifty-two, in whom this
+part had become infiltrated with lime-salts and resembled a long,
+narrow bone. When the penis was erect it was bent in the form of a
+semicircular bow.
+
+The Transactions of the South Carolina Medical Association contain an
+account of a negro of sixty who had urethral stricture from gonorrhea
+and who had been treated for fifteen years by caustics. The penis was
+seven inches in circumference around the glans, and but little less
+near the scrotum. The glans was riddled with holes, and numerous
+fistulae existed on the inferior surface of the urethra, the meatus
+being impermeable. So great was the weight and hypertrophy that
+amputation was necessary.  John Hunter speaks of six strictures
+existing in one urethra at one time; Lallemand of seven; Bolot of
+eight; Ducamp of five; Boyer thought three could never exist together;
+Leroy D'Etoilles found 11, and Rokitansky met with four.
+
+Sundry Injuries to the Penis.--Fabricius Hildanus mentions a curious
+case of paraphimosis caused by violent coitus with a virgin who had an
+extremely narrow vagina. Joyce relates a history of a stout man who
+awoke with a vigorous erection, and feeling much irritation, he
+scratched himself violently. He soon bled copiously, his shirt and
+underlying sheets and blankets being soaked through. On examination the
+penis was found swollen, and on drawing back the foreskin a small jet
+of blood spurted from a small rupture in the frenum. The authors have
+knowledge of a case in which hemorrhage from the frenum proved fatal.
+The patient, in a drunken wager, attempted to circumcise himself with a
+piece of tin, and bled to death before medical aid could be summoned.
+It sometimes happens that the virile member is amputated by an animal
+bite. Paullini and Celliez mention amputation of the penis by a
+dog-bite. Morgan describes a boy of thirteen who was feeding a donkey
+which suddenly made a snap at him, unfortunately catching him by the
+trousers and including the penis in one of the folds. By the violence
+of the bite the boy was thrown to the ground, and his entire prepuce
+was stripped off to the root as if it had been done by a knife. There
+was little hemorrhage, and the prepuce was found in the trousers,
+looking exactly like the finger of a glove. Morgan stated that this was
+the third case of the kind of which he had knowledge. Bookey records a
+case in which an artilleryman was seized by the penis by an infuriated
+horse, and the two crura were pulled out entire.
+
+Amputation of the penis is not always followed by loss of the sexual
+power and instinct, but sometimes has the mental effect of temporarily
+increasing the desire. Haslam reports the case of a man who slipped on
+the greasy deck of a whaler, and falling forward with great violence
+upon a large knife used to cut blubber, completely severed his penis,
+beside inflicting a wound in the abdomen through which the intestines
+protruded. After recovery there was a distinct increase of sexual
+desire and frequent nocturnal emissions. In the same report there is
+recorded the history of a man who had entirely lost his penis, but had
+supplied himself with an ivory succedaneum. This fellow finally became
+so libidinous that it was necessary to exclude him from the workhouse,
+of which he was an inmate.
+
+Norris gives an account of a private who received a gunshot wound of
+the penis while it was partly erect. The wound was acquired at the
+second battle of Fredericksburg. The ball entered near the center of
+the glans penis, and taking a slightly oblique direction, it passed out
+of the right side of the penis 1 1/2 inches beyond the glans; it then
+entered the scrotum, and after striking the pelvis near the symphysis,
+glanced off around the innominate bone, and finally made its exit two
+inches above the anus. The after-effects of this injury were
+incontinence of urine, and inability to assume the erect position.
+
+Bookey cites the case of six wounds from one bullet with recovery. The
+bullet entered the sole and emerged from the dorsum of the foot. It
+then went through the right buttock and came out of the groin, only to
+penetrate the dorsum of the penis and emerge at the upper part of the
+glans. Rose speaks of a case in which a man had his clothes caught in
+machinery, drawing in the external genital organs. The testicles were
+found to be uninjured, but the penis was doubled out of sight and
+embedded in the scrotum, from whence it was restored to its natural
+position and the man recovered.
+
+Nelaton describes a case of luxation of the penis in a lad of six who
+fell from a cart. Nelaton found the missing member in the scrotum,
+where it had been for nine days. He introduced Sir Astley Cooper's
+instrument for tying deeply-seated arteries through a cutaneous tube,
+and conducting the hook under the corporus cavernosum, seized this
+crosswise, and by a to-and-fro movement succeeded in replacing the
+organ.
+
+Moldenhauer describes the case of a farmer of fifty-seven who was
+injured in a runaway accident, a wheel passing over his body close to
+the abdomen. The glans penis could not be recognized, since the penis
+in toto had been torn from its sheath at the corona, and had slipped or
+been driven into the inguinal region.  This author quotes Stromeyer's
+case, which was that of a boy of four and a half years who was kicked
+by a horse in the external genital region. The sheath was found empty
+of the penis, which had been driven into the perineum.
+
+Raven mentions a case of spontaneous retraction of the penis in a man
+of twenty-seven. While in bed he felt a sensation of coldness in the
+penis, and on examination he found the organ (a normal-sized one)
+rapidly retracting or shrinking. He hastily summoned a physician, who
+found that the penis had, in fact, almost disappeared, the glans being
+just perceptible under the pubic arch, and the skin alone visible. The
+next day the normal condition was restored, but the patient was weak
+and nervous for several days after his fright. In a similar case,
+mentioned by Ivanhoff, the penis of a peasant of twenty-three, a
+married man, bodily disappeared, and was only captured by repeated
+effort. The patient was six days under treatment, and he finally became
+so distrustful of his virile member that, to be assured of its
+constancy, he tied a string about it above the glans.
+
+Injuries of the penis and testicles self-inflicted are grouped together
+and discussed in Chapter XIV.
+
+As a rule, spontaneous gangrene of the penis has its origin in some
+intense fever. Partridge describes a man of forty who had been the
+victim of typhus fever, and whose penis mortified and dried up,
+becoming black and like the empty finger of a cast-off glove; in a few
+days it dropped off. Boyer cites a case of edema of the prepuce,
+noticed on the fifteenth day of the fever, and which was followed by
+gangrene of the penis. Rostan mentions gangrene of the penis from
+small-pox. Intermittent fever has been cited as a cause. Koehler
+reports a fatal instance of gangrene of the penis, caused by a
+prostatic abscess following gonorrhea. In this case there was
+thrombosis of the pelvic veins. Hutchinson mentions a man who, thirty
+years before, after six days' exposure on a raft, had lost both legs by
+gangrene. At the age of sixty-six he was confined to bed by subacute
+bronchitis, and during this period his whole penis became gangrenous
+and sloughed off. This is quite unusual, as gangrene is usually
+associated with fever; it is more than likely that the gangrene of the
+leg was not connected with that of the penis, but that the latter was a
+distinct after-result. Possibly the prolonged exposure at the time he
+lost his legs produced permanent injury to the blood-vessels and nerves
+of the penis. There is a case on record in which, in a man of
+thirty-seven, gangrene of the penis followed delirium tremens, and was
+attributed to alcoholism.  Quoted by Jacobson, Troisfontaines records a
+case of gangrene of the skin and body of the penis in a young man, and
+without any apparent cause. Schutz speaks of regeneration of the penis
+after gangrenous destruction.
+
+Gangrene of the penis does not necessarily hinder the performance of
+marital functions. Chance mentions a man whose penis sloughed off,
+leaving only a nipple-like remnant. However, he married four years
+later, and always lived in harmony with his wife. At the time of his
+death he was the father of a child, subsequent to whose birth his wife
+had miscarried, and at the time of report she was daily expecting to be
+again confined.
+
+Willett relates the instance of a horseman of thirty-three who, after
+using a combination of refuse oils to protect his horse from gnats, was
+prompted to urinate, and, in so doing, accidentally touched his penis
+with the mixture. Sloughing phagedena rapidly ensued, but under medical
+treatment he eventually recovered.
+
+Priapism is sometimes seen as a curious symptom of lesion of the spinal
+cord. In such cases it is totally unconnected with any voluptuous
+sensation and is only found accompanied by motor paralysis. It may
+occur spontaneously immediately after accident involving the cord, and
+is then probably due to undue excitement of the portion of the cord
+below the lesion, which is deprived of the regulating influence of the
+brain. Priapism may also develop spontaneously at a later period, and
+is then due to central irritation from extravasation into the substance
+of the cord, or to some reflex cause. It may also occur from simple
+concussion, as shown by a case reported by Le Gros Clark. Pressure on
+the cerebellum is supposed to account for cases of priapism observed in
+executions and suicides by hanging. There is an instance recorded of an
+Italian "castrate" who said he provoked sexual pleasure by partially
+hanging himself. He accidentally ended his life in pursuance of this
+peculiar habit. The facts were elicited by testimony at the inquest.
+
+There are, however, in literature, records of long continued priapism
+in which either the cause is due to excessive stimulation of the sexual
+center or in which the cause is obscure or unknown. There may or may
+not be accompanying voluptuous feelings. The older records contain
+instances of continued infantile priapism caused by the constant
+irritation of ascarides and also records of prolonged priapism
+associated with intense agony and spasmodic cramps. Zacutus Lusitanus
+speaks of a Viceroy of India who had a long attack of stubborn priapism
+without any voluptuous feeling. Gross refers to prolonged priapism, and
+remarks that the majority of cases seem to be due to excessive coitus.
+
+Moore reports a case in a man of forty who had been married fifteen
+years, and who suffered spasmodic contractions of the muscles of the
+penis after an incomplete coitus. This pseudopriapism continued for
+twenty-three days, during which time he had unsuccessfully resorted to
+the application of cold, bleeding, and other treatment; but on the
+twenty-sixth day, after the use of bladders filled with cold water,
+there was a discharge from the urethra of a glairy mucus, similar in
+nature to that in seminal debility. There was then complete relaxation
+of the organ. During all this time the man slept very little, only
+occasionally dozing. Donne describes an athletic laborer of twenty-five
+who received a wound from a rifle-ball penetrating the cranial parietes
+immediately in the posterior superior angle of the parietal bone, and a
+few lines from the lambdoid suture.  The ball did not make egress, but
+passed posteriorly downward.  Reaction was established on the third
+day, but the inflammatory symptoms influenced the genitalia. Priapism
+began on the fifth day, at which time the patient became affected with
+a salacious appetite, and was rational upon every subject except that
+pertaining to venery. He grew worse on the sixth day, and his medical
+adviser was obliged to prohibit a female attendant.  Priapism
+continued, but the man went into a soporose condition, with occasional
+intervals of satyriasis. In this condition he survived nine days; there
+was not the slightest abatement of the priapism until a few moments
+before his death. Tripe relates the history of a seaman of twenty-five,
+in perfect health, who, arriving from Calcutta on April 12, 1884,
+lodged with a female until the 26th. At this time he experienced an
+unusually fierce desire, with intense erection of the penis which, with
+pain, lasted throughout the night. Though coitus was frequently
+resorted to, these symptoms continued. He sought aid at the London
+Hospital, but the priapism was persistent, and when he left, on May
+10th, the penis formed an acute angle with the pubes, and he again had
+free intercourse with the same female. At the time of leaving England
+the penis made an angle of about 45 degrees with the pubes, and this
+condition, he affirmed, lasted three months. On his return to England
+his penis was flaccid, and his symptoms had disappeared.
+
+Salzer presents an interesting paper on priapism which was quoted in
+The Practitioner of London. Salzer describes one patient of forty-six
+who awoke one morning with a strong erection that could not be reduced
+by any means. Urine was voided by jerks and with difficulty, and only
+when the subject was placed in the knee and elbow position. Despite all
+treatment this condition continued for seven weeks. At this time the
+patient's spleen was noticed to be enormously enlarged. The man died
+about a year after the attack, but a necropsy was unfortunately
+refused. Salzer, in discussing the theories of priapism, mentions eight
+cases previously reported, and concludes, that such cases are
+attributable to leukemia. Kremine believes that continued priapism is
+produced by effusion of blood into the corpora cavernosa, which is
+impeded on its return. He thinks it corresponds to bleeding at the nose
+and rectum, which often occurs in perfectly healthy persons. Longuet
+regards the condition of the blood in leukemia as the cause of such
+priapism, and considers that the circulation of the blood is retarded
+in the smaller vessels, while, owing to the great increase in the
+number of white corpuscles, thrombi are formed. Neidhart and Matthias
+conclude that the origin of this condition might be sought for in the
+disturbance of the nerve-centers. After reviewing all these theories,
+Salzer states that in his case the patient was previously healthy and
+never had suffered the slightest hemorrhage in any part, and he
+therefore rejects the theory of extravasation. He is inclined to
+suppose that the priapism was due to the stimulation of the nervi
+erigentes, brought about either by anatomic change in the nerves
+themselves, or by pressure upon them by enlarged lumbar glands, an
+associate condition of leukemia.
+
+Burchard reports a most interesting case of prolonged priapism in an
+English gentleman of fifty-three. When he was called to see the man on
+July 15th he found him suffering with intense pain in the penis, and in
+a state of extreme exhaustion after an erection which had lasted five
+hours uninterruptedly, during the whole of which time the organ was in
+a state of violent and continuous spasm. The paroxysm was controlled by
+3/4 grain morphin and 1/50 grain atropin. Five hours later, after a
+troubled sleep, there was another erection, which was again relieved by
+hypodermic medication. During the day he had two other paroxysms, one
+lasting forty-five minutes; and another, three hours later, lasting
+eighteen minutes. Both these were controlled by morphin.  There was no
+loss of semen, but after the paroxysms a small quantity of glairy mucus
+escaped from the meatus. The rigidity was remarkable, simulating the
+spasms of tetanus. No language could adequately describe the suffering
+of the patient. Burchard elicited the history that the man had suffered
+from nocturnal emissions and erotic dreams of the most lascivious
+nature, sometimes having three in one night. During the day he would
+have eight or ten erections, unaccompanied by any voluptuous emotions.
+In these there would rarely be any emission, but occasionally a small
+mucous discharge. This state of affairs had continued three years up to
+the time Burchard saw him, and, chagrined by pain and his malady, the
+patient had become despondent. After a course of careful treatment, in
+which diet, sponging, application of ice-bags, and ergot were features,
+this unfortunate man recovered.
+
+Bruce mentions the case of an Irishman of fifty-five who, without
+apparent cause, was affected with a painful priapism which lasted six
+weeks, and did not subside even under chloroform. Booth mentions a case
+of priapism in a married seaman of fifty-five, due to local
+inflammation about the muscles, constricting the bulb of the penis. The
+affection lasted five weeks, and was extremely painful. There was a
+similar case of priapism which lasted for three weeks, and was
+associated with hydrocele in a man of forty-eight.
+
+Injuries of the testicle and scrotum may be productive of most serious
+issue. It is a well-known surgical fact that a major degree of shock
+accompanies a contusion of this portion of the body. In fact, Chevers
+states that the sensitiveness of the testicles is so well known in
+India, that there are cases on record in which premeditated murder has
+been effected by Cossiah women, by violently squeezing the testicles of
+their husbands. He also mentions another case in which, in frustrating
+an attempt at rape, death was caused in a similar manner. Stalkartt
+describes the case of a young man who, after drinking to excess with
+his paramour, was either unable, or indifferent in gratifying her
+sexual desire. The woman became so enraged that she seized the scrotum
+and wrenched it from its attachments, exposing the testicles. The left
+testicle was completely denuded, and was hanging by the vas deferens
+and the spermatic vessels. There was little hemorrhage, and the wound
+was healed by granulation.
+
+Avulsion of the male external genitalia is not always accompanied by
+serious consequences, and even in some cases the sexual power is
+preserved. Knoll described a case in 1781, occurring in a peasant of
+thirty-six who fell from a horse under the wheels of a carriage. He was
+first caught in the revolving wheels by his apron, which drew him up
+until his breeches were entangled, and finally his genitals were torn
+off. Not feeling much pain at the time, he mounted his horse and went
+to his house. On examination it was found that the injury was
+accompanied with considerable hemorrhage. The wound extended from the
+superior part of the pubes almost to the anus; the canal of the urethra
+was torn away, and the penis up to the neck of the bladder. There was
+no vestige of either the right scrotum or testicle. The left testicle
+was hanging by its cord, enveloped in its tunica vaginalis. The cord
+was swollen and resembled a penis stripped of its integument. The
+prostate was considerably contused. After two months of suffering the
+patient recovered, being able to evacuate his urine through a fistulous
+opening that had formed. In ten weeks cicatrization was perfect. In his
+"Memoirs of the Campaign of 1811," Larrey describes a soldier who,
+while standing with his legs apart, was struck from behind by a bullet.
+The margin of the sphincter and, the skin of the perineum, the bulbous
+portion of the urethra, some of the skin of the scrotum, and the right
+testicle were destroyed. The spermatic cord was divided close to the
+skin, and the skin of the penis and prepuce was torn. The soldier was
+left as dead on the field, but after four months' treatment he
+recovered.
+
+Madden mentions a man of fifty who fell under the feet of a pair of
+horses, and suffered avulsion of the testicles through the scrotum. The
+organs were mangled, the spermatic cord was torn and hung over the
+anus, and the penis was lacerated from the frenum down. The man lost
+his testicles, but otherwise completely recovered. Brugh reports an
+instance of injury to the genitalia in a boy of eighteen who was caught
+in a threshing-machine. The skin of the penis and scrotum, and the
+tissue from the pubes and inguinal region were torn from the body.
+Cicatrization and recovery were complete. Brigham cites an analogous
+case in a youth of seventeen who was similarly caught in threshing
+machinery. The skin of the penis and the scrotum was entirely torn
+away; both sphincters of the anus were lacerated, and the perineum was
+divested of its skin for a space 2 1/2 inches wide.  Recovery ensued,
+leaving a penis which measured, when flaccid, three inches long and 1
+1/2 inches in diameter.
+
+There is a case reported of a man who had his testicles caught in
+machinery while ginning cotton. The skin of the penis was stripped off
+to its root, the scrotum torn off from its base, and the testicles were
+contused and lacerated, and yet good recovery ensued. A peculiarity of
+this case was the persistent erection of the penis when cold was not
+applied.
+
+Gibbs mentions a case in which the entire scrotum and the perineum,
+together with an entire testicle and its cord attached, and nearly all
+the integument of the penis were torn off, yet the patient recovered
+with preservation of sexual powers. The patient was a negro of
+twenty-two who, while adjusting a belt, had his coat (closely buttoned)
+caught in the shafting, and his clothes and external genitals torn off.
+On examination it was found that the whole scrotum was wrenched off,
+and also the skin and cellular tissue, from 2 1/2 inches above the
+spine of the pubes down to the edge of the sphincter ani, including all
+the breadth of the perineum, together with the left testicle with five
+inches of its cord attached, and all the integument and cellular
+covering of the penis except a rim nearly half an inch wide at the
+extremity and continuous with the mucous membrane of the prepuce. The
+right testicle was hanging by its denuded cord, and was apparently
+covered only by the tunica vaginalis as high up as the abdominal ring,
+where the elastic feeling of the intestines was distinctly perceptible.
+There was not more than half an ounce of blood lost. The raw surface
+was dressed, the gap in the perineum brought together, and the patient
+made complete recovery, with preservation of his sexual powers. Other
+cases of injuries to the external genital organs (self-inflicted) will
+be found in the next chapter.
+
+The preservation of the sexual power after injuries of this kind is not
+uncommon. There is a case reported of a man whose testicles were
+completely torn away, and the perineal urethra so much injured that
+micturition took place through the wound. After a tedious process the
+wound healed and the man was discharged, but he returned in ten days
+with gonorrhea, stating that he had neither lost sexual desire nor
+power of satisfaction. Robbins mentions a man of thirty-eight who, in
+1874, had his left testicle removed. In the following year his right
+testicle became affected and was also removed. The patient stated that
+since the removal of the second gland he had regular sexual desire and
+coitus, apparently not differing from that in which he indulged before
+castration. For a few months previous to the time of report the cord on
+the left side, which had not been completely extirpated, became
+extremely painful and was also removed.
+
+Atrophy of the testicle may follow venereal excess, and according to
+Larrey, deep wounds of the neck may produce the same result, with the
+loss of the features of virility. Guthrie mentions a case of
+spontaneous absorption of the testicle. According to Larrey, on the
+return of the French Army from the Egyptian expedition the soldiers
+complained of atrophy and disappearance of the testicle, without any
+venereal affection. The testicle would lose its sensibility, become
+soft, and gradually diminish in size. One testicle at a time was
+attacked, and when both were involved the patient was deprived of the
+power of procreation, of which he was apprised by the lack of desire
+and laxity of the penis. In this peculiar condition the general health
+seemed to fail, and the subjects occasionally became mentally deranged.
+Atrophy of the testicles has been known to follow an attack of mumps.
+
+In his description of the diseases of Barbadoes Hendy mentions several
+peculiar cases under his observation in which the scrotum sloughed,
+leaving the testicles denuded. Alix and Richter mention a singular
+modification of rheumatic inflammation of the testicle, in which the
+affection flitted from one testicle to the other, and alternated with
+rheumatic pains elsewhere.
+
+There is a case of retraction of the testicle reported in a young
+soldier of twenty-one who, when first seen, complained of a swelling in
+the right groin. He stated that while riding bareback his horse
+suddenly plunged and threw him on the withers. He at once felt a
+sickening pain in the groin and became so ill that he had to dismount.
+On inspection an oval tumor was seen in the groin, tender to the touch
+and showing no impulse on coughing.  The left testicle was in its usual
+position, but the right was absent. The patient stated positively that
+both testicles were in situ before the accident. An attempt at
+reduction was made, but the pain was so severe that manipulation could
+not be endured. A warm bath and laudanum were ordered, but
+unfortunately, as the patient at stool gave a sudden bend to the left,
+his testicle slipped up into the abdomen and was completely lost to
+palpation.  Orchitis threatened, but the symptoms subsided; the patient
+was kept under observation for some weeks, and then as a tentative
+measure, discharged to duty. Shortly afterward he returned, saying that
+he was ill, and that while lifting a sack of corn his testicle came
+partly down, causing him great pain. At the time of report his left
+testicle was in position, but the right could not be felt. The scrotum
+on that side had retracted until it had almost disappeared; the right
+external ring was very patent, and the finger could be passed up in the
+inguinal canal; there was no impulse on coughing and no tendency to
+hernia.
+
+A unique case of ectopia of the testicle in a man of twenty-four is
+given by Popoff. The scrotum was normally developed, and the right
+testicle in situ. The left half of the scrotum was empty, and at the
+root of the penis there was a swelling the size of a walnut, covered
+with normal skin, and containing an oval body about four-fifths the
+size of the testicle, but softer in constituency. The patient claimed
+that this swelling had been present since childhood. His sexual power
+had been normal, but for the past six months he had been impotent. In
+childhood the patient had a small inguinal hernia, and Popoff thought
+this caused the displacement of the testicle.
+
+A somewhat similar case occurred in the Hotel-Dieu, Paris.  Through the
+agency of compression one of the testes was forced along the corpus
+cavernosum under the skin as far as the glans penis. It was easily
+reduced, and at a subsequent autopsy it was found that it had not been
+separated from the cord. Gluiteras a cites a parallel case of
+dislocation of the testicle into the penis. It was the result of
+traumatism--a fall upon the wheel of a cart. It was reduced under
+anesthesia, after two incisions had been made, the adhesions broken up,
+and the shrunken sac enlarged by stretching.
+
+Rupture of the spermatic arteries and veins has caused sudden death.
+Schleiser is accredited with describing an instance in which a healthy
+man was engaged in a fray in the dark, and, suddenly crying out, fell
+into convulsions and died in five minutes. On examination the only
+injury found was the rupture of both spermatic arteries at the internal
+ring, produced by a violent pull on the scrotum and testicles by one of
+his antagonists. Shock was evidently a strong factor in this case.
+Fabricius Hildanus gives a case of impotency due to lesions of the
+spermatic vessels following a burn. There is an old record of an aged
+man who, on marrying, found that he had erections but no ejaculations.
+He died of ague, and at the autopsy it was found that the verumontanum
+was hard and of the size of a walnut and that the ejaculatory ducts
+contained calculi about the size and shape of peas.
+
+Hydrocele is a condition in which there is an abnormal quantity of
+fluid in the tunica vaginalis. It is generally caused by traumatism,
+violent muscular efforts, or straining, and is much more frequent in
+tropic countries than elsewhere. It sometimes attains an enormous size.
+Leigh mentions a hydrocele weighing 120 pounds, and there are records
+of hydroceles weighing 40 and 60 pounds. Larrey speaks of a sarcocele
+in the coverings of the testicle which weighed 100 pounds. Mursinna
+describes a hydrocele which measured 27 inches in its longest and 17 in
+its transverse axis.
+
+Tedford gives a curious case of separation of the ovary in a woman of
+twenty-eight. After suffering from invagination of the bowel and
+inflammation of the ovarian tissue, an ovary was discharged through an
+opening in the sigmoid flexure, and thence expelled from the anus.
+
+In discussing injuries of the vagina, the first to be mentioned will be
+a remarkable case reported by Curran. The subject was an Irish girl of
+twenty. While carrying a bundle of clothes that prevented her from
+seeing objects in front of her, she started to pass over a stile, just
+opposite to which a goat was lying. The woman wore no underclothing,
+and in the ascent her body was partially exposed, and, while in this
+enforced attitude, the goat, frightened by her approach, suddenly
+started up, and in so doing thrust his horn forcibly into her anus and
+about two or three inches up her rectum. The horn then passed through
+the bowel and its coverings, just above the hymen, and was then
+withdrawn as she flinched and fell back. The resultant wound included
+the lower part of the vagina and rectum, the sphincter and, the
+fourchet, and perineum. Hemorrhage was profuse, and the wound caused
+excruciating pain. The subject fainted on the spot from hemorrhage and
+shock. Her modesty forbade her summoning medical aid for three days,
+during which time the wound was undergoing most primitive treatment.
+After suturing, cicatrization followed without delay.
+
+Trompert mentions a case of rupture of the vagina by the horn of a
+bull. There is a case recorded in the Pennsylvania Hospital Reports of
+a girl of nineteen who jumped out of a second-story window. On reaching
+the ground, her foot turned under her as she fell. The high heel of a
+French boot was driven through the perineum one inch from the median
+line, midway between the anus and the posterior commissure of the labia
+majora. The wound extended into the vagina above the external opening,
+in which the heel, now separated from the boot, projected, and whence
+it was removed without difficulty. This wound was the only injury
+sustained by the fall.
+
+Beckett records a case of impalement in a woman of forty-five who,
+while attempting to obtain water from a hogshead, fell with one limb
+inside the cistern, striking a projecting stave three inches wide and
+1/2 inch thick. The external labia were divided, the left crus of the
+clitoris separated, the nymphae lacerated, and the vaginal wall
+penetrated to the extent of five inches; the patient recovered by the
+fourth week.
+
+Homans reports recovery from extensive wounds acquired by a negress who
+fell from a roof, striking astride an upright barrel.  There was a
+wound of the perineum, and penetration of the posterior wall of the
+vagina, with complete separation of the soft parts from the symphysis
+pubis, and extrusion of the bladder.
+
+Howe reports a case of impalement with recovery in a girl of fifteen
+who slid down a hay-stack, striking a hay-hook which penetrated her
+perineum and passed into her body, emerging two inches below the
+umbilicus and one inch to the right of the median line.
+
+Injuries of the vagina may be so extensive as to allow protrusion of
+the intestines, and some horrible cases of this nature are recorded. In
+The Lancet for 1873 there is reported a murder or suicide of this
+description. The woman was found with a wound in the vagina, through
+which the intestines, with clean-cut ends, protruded. Over 7 1/2 feet
+of the intestines had been cut off in three pieces. The cuts were all
+clean and carefully separated from the mesentery. The woman survived
+her injuries a whole week, finally succumbing to loss of blood and
+peritonitis. Her husband was tried for murder, but was acquitted by a
+Glasgow jury. Taylor mentions similar cases of two women murdered in
+Edinburgh some years since, the wounds having been produced by razor
+slashes in the vagina. Taylor remarks that this crime seems to be quite
+common in Scotland. Starkey reports an instance in which the body of an
+old colored woman was found, with evidences of vomiting, and her
+clothing stained with blood that had evidently come from her vagina. A
+postmortem showed the abdominal cavity to be full of blood; at Douglas'
+culdesac there was a tear large enough to admit a man's hand, through
+which protruded a portion of the omentum; this was at first taken for
+the membranes of an abortion. There were distinct signs of acute
+peritonitis. After investigation it was proved that a drunken
+glass-blower had been seen leaving her house with his hand and arm
+stained with blood.  In his drunken frenzy this man had thrust his hand
+into the vagina, and through the junction of its posterior wall with
+the uterus, up into the abdominal cavity, and grasped the uterus,
+trying to drag it out. Outside of obstetric practice the injury is
+quite a rare one.
+
+There is a case of death from a ruptured clitoris reported by
+Gutteridge. The woman was kicked while in a stooping position and
+succumbed to a profuse hemorrhage, estimated to be between three and
+four pounds, and proceeding from a rupture of the clitoris.
+
+Discharge of Vaginal Parietes.--Longhi describes the case of a woman of
+twenty-seven, an epileptic, with metritis and copious catamenia twice a
+month. She was immoderately addicted to drink and sexual indulgence,
+and in February, 1835, her menses ceased.  On May 8th she was admitted
+to the hospital with a severe epileptic convulsion, and until the 18th
+remained in a febrile condition, with abdominal tenderness, etc. On the
+21st, while straining as if to discharge the contents of the rectum,
+she felt a voluminous body pass through the vagina, and fancied it was
+the expected fetus. After washing this mass it was found to be a
+portion of the vaginal parietes and the fleshy body of the neck of the
+uterus. The woman believed she had miscarried, and still persisted in
+refusing medicine. Cicatrization was somewhat delayed; immediately on
+leaving the hospital she returned to her old habits, but the pain and
+hemorrhage attending copulation was so great that she had finally to
+desist. The vagina, however, gradually yielding, ceased to interfere
+with the gratification of her desires. Toward the end of June the
+menses reappeared and flowed with the greatest regularity. The portions
+discharged are preserved in the Milan Hospital.
+
+The injuries received during coitus have been classified by Spaeth as
+follows: Deep tears of the hymen with profuse hemorrhage; tears of the
+clitoris and of the urethra (in cases of atresia hymenis);
+vesicovaginal fistula; laceration of the vaginal fornices, posteriorly
+or laterally; laceration of the septum of a duplex vagina; injuries
+following coitus after perineorrhaphy. In the last century Plazzoni
+reports a case of vaginal rupture occurring during coitus. Green of
+Boston; Mann of Buffalo; Sinclair and Munro of Boston, all mention
+lacerations occurring during coitus. There is an instance recorded of
+extensive laceration of the vagina in a woman, the result of coitus
+with a large dog. Haddon and Ross both mention cases of rupture of the
+vagina in coitus; and Martin reports a similar case resulting in a
+young girl's death. Spaeth speaks of a woman of thirty-one who, a few
+days after marriage, felt violent pain in coitus, and four days later
+she noticed that fecal matter escaped from the vagina during stool.
+Examination showed that the columns of the posterior wall were torn
+from their attachment, and that there was a rectovaginal fistula
+admitting the little finger. Hofmokl cites an instance in which a
+powerful young man, in coitus with a widow of fifty-eight, caused a
+tear of her fornix, followed by violent hemorrhage. In another case by
+the same author, coitus in a sitting posture produced a rupture of the
+posterior fornix, involving the peritoneum; although the patient lost
+much blood, she finally recovered. In a third instance, a young girl,
+whose lover had violent connection with her while she was in an
+exaggerated lithotomy position, suffered a large tear of the right
+vaginal wall. Hofmokl also describes the case of a young girl with an
+undeveloped vagina, absence of the uterus and adnexa, who during a
+forcible and unsuccessful attempt at coitus, had her left labium majus
+torn from the vaginal wall. The tear extended into the mons veneris and
+down to the rectum, and the finger could be introduced into the vaginal
+wound to the depth of two inches. The patient recovered in four weeks,
+but was still anemic from the loss of blood.
+
+Crandall cites instances in which hemorrhage, immediately after coitus
+of the marriage-night, was so active as to almost cause death. One of
+his patients was married three weeks previously, and was rapidly
+becoming exhausted from a constant flowing which started immediately
+after her first coitus. Examination showed this to be a case of active
+intrauterine hemorrhage excited by coitus soon after the menstrual flow
+had ceased and while the uterus and ovaries were highly congested. In
+another case the patient commenced flooding while at the dinner table
+in the Metropolitan Hotel in New York, and from the same cause an
+almost fatal hemorrhage ensued. Hirst of Philadelphia has remarked that
+brides have been found on their marital beds completely covered with
+blood, and that the hemorrhage may have been so profuse as to soak
+through the bed and fall on the floor. Lacerations of the urethra from
+urethral coitus in instances of vaginal atresia or imperforate hymen
+may also excite serious hemorrhage.
+
+Foreign Bodies in the Vagina.--The elasticity of the vagina allows the
+presence in this passage of the most voluminous foreign bodies. When we
+consider the passage of a fetal head through the vagina the ordinary
+foreign bodies, none of which ever approximate this size, seem quite
+reasonable. Goblets, hair-pins, needles, bottles, beer glasses,
+compasses, bobbins, pessaries, and many other articles have been found
+in the vagina.  It is quite possible for a phosphatic incrustation to
+be found about a foreign body tolerated in this location for some time.
+Hubbauer speaks of a young girl of nineteen in whose vagina there was a
+glass fixed by incrustations which held it solidly in place. It had
+been there for six months and was only removed with great difficulty.
+Holmes cites a peculiar case in which the neck of a bottle was found in
+the vagina of a woman. One point of the glass had penetrated the
+bladder and a calculus had formed on this as well as on the vaginal end.
+
+When a foreign body remains in the vagina for a long time and if it is
+composed of material other than glass, it becomes influenced by the
+corrosive action of the vaginal secretion. For instance, Cloquet
+removed a foreign body which was incrusted in the vagina, and found the
+cork pessary which had formed its nucleus completely rotted. A similar
+instrument found by Gosselin had remained in the vagina thirty-six
+years, and was incrustated with calcareous salts. Metal is always
+attacked by the vaginal secretions in the most marked manner. Cloquet
+mentions that at an autopsy of a woman who had a pewter goblet in her
+vagina, lead oxid was found in the gangrenous debris.
+
+Long Retention of Pessaries, etc.--The length of time during which
+pessaries may remain in the vagina is sometimes astonishing. The
+accompanying illustration shows the phosphatic deposits and
+incrustations around a pessary after a long sojourn in the vagina. The
+specimen is in the Musee Dupoytren. Pinet mentions a pessary that
+remained in situ for twenty-five years.  Gerould of Massilon, Ohio,
+reports a case in which a pessary had been worn by a German woman of
+eighty-four for more than fifty years. She had forgotten its existence
+until reminded of it by irritation some years before death. It was
+remarkable that when the pessary was removed it was found to have
+largely retained its original wax covering. Hurxthal mentions the
+removal of a pessary which had been in the pelvis for forty-one years.
+Jackson speaks of a glove-pessary remaining in the vagina thirty-five
+years.  Mackey reports the removal of a glass pessary after fifty-five
+years' incarceration.
+
+There is an account of a young girl addicted to onanism who died from
+the presence of a pewter cup in her vagina; it had been there fourteen
+months. Shame had led her to conceal her condition for all the period
+during which she suffered pain in the hypogastrium, and diarrhea. She
+had steadily refused examination.  Bazzanella of Innsbruck removed a
+drinking glass from the vagina by means of a pair of small obstetric
+forceps. The glass had been placed there ten years previously by the
+woman's husband.  Szigethy reports the case of a woman of seventy-five
+who, some thirty years before, introduced into her vagina a ball of
+string previously dipped in wax. The ball was effectual in relieving a
+prolapsed uterus, and was worn with so little discomfort that she
+entirely forgot it until it was forced out of place by a violent
+effort. The ball was seven inches in circumference, and covered with
+mucus, but otherwise unchanged. Breisky is accredited with the report
+of a case of a woman suffering with dysmenorrhea, in whose vagina was
+found a cotton reel which had been introduced seven years before. The
+woman made a good recovery. Pearse mentions a woman of thirty-six who
+had suffered menorrhagia for ten days, and was in a state of great
+prostration and suffering from strong colicky pains. On examination he
+found a silk-bobbin about an inch from the entrance, which the patient
+had introduced fourteen years before. She had already had attacks of
+peritonitis and hemorrhage, and a urethrovaginal fistula was found. The
+bobbin itself was black. This patient had been married twice, and had
+been cared for by physicians, but the existence of a body 3/4 inch long
+had never been noticed. Poulet quotes two curious cases: in one a
+pregnant woman was examined by a doctor who diagnosticated
+carcinomatous degeneration of the neck of the uterus. Capuron, who was
+consulted relative to the case, did not believe that the state of the
+woman's health warranted the diagnosis, and on further examination the
+growth was found to have been a sponge which had previously been
+introduced by the woman into the vagina. The other case, reported by
+Guyon, exemplified another error in diagnosis. The patient was a woman
+who suffered from continuous vaginal hemorrhage, and had been given
+extensive treatment without success. Finally, when the woman was in
+extreme exhaustion, an injection of vinegar-water was ordered, the use
+of which was followed by the expulsion from the vagina of a live leech
+of a species very abundant in the country. The hemorrhage immediately
+ceased and health returned.
+
+There is a record of a woman of twenty-eight who was suddenly surprised
+by some one entering her chamber at the moment she was introducing a
+cedar pencil into her vagina. With the purpose of covering up her act
+and dissembling the woman sat down, and the shank of the wood was
+pushed through the posterior wall of the vagina into the peritoneal
+cavity. The intestine was, without doubt, pierced in two of its curves,
+which was demonstrated later by an autopsy. A plastic exudation had
+evidently agglutinated the intestine at the points of penetration, and
+prevented an immediate fatal issue. Erichsen practiced extraction eight
+months after the accident, and a pencil 5 1/2 inches long, having a
+strong fecal odor, was brought out. The patient died the fourth day
+after the operation, from peritonitis, and an autopsy showed the
+perforation and agglutination of the two intestinal curvatures.
+Getchell relates the description of a calculus in the vagina, formed
+about a hair-pin as a nucleus. It is reported that a country girl came
+to the Hotel-Dieu to consult Dupoytren, and stated that several years
+before she had been violated by some soldiers, who had introduced an
+unknown foreign body into her vagina, which she never could extract.
+Dupuytren found this to be a small metallic pot, two inches in
+diameter, with its concavity toward the uterus. It contained a solid
+black substance of a most fetid odor.
+
+Foreign bodies are generally introduced in the uterus either
+accidentally in vaginal applications, or for the purpose of producing
+abortion. Zuhmeister describes a case of a woman who shortly after the
+first manifestations of pregnancy used a twig of a tree to penetrate
+the matrix. She thrust it so strongly into the uterus that the wall was
+perforated, and the twig became planted in the region of the kidneys.
+Although six inches long and of the volume of a goose feather, this
+branch remained five months in the pelvis without causing any
+particular inconvenience, and was finally discharged by the rectum.
+Brignatelli mentions the case of a woman who, in culpable practices,
+introduced the stalk of a reed into her uterus. She suffered no
+inconvenience until the next menstrual epoch which was accompanied by
+violent pains. She presented the appearance of one in the pains of
+labor. The matrix had augmented in volume, and the orifice of the
+uterine cervix was closed, but there was hypertrophy as if in the
+second or third month of pregnancy.  After examination a piece of reed
+three cm. long was extracted from the uterus, its external face being
+incrusted with hard calcareous material. Meschede of Schwetz, Germany,
+mentions death from a hair-pin in the uterine cavity.
+
+Crouzit was called to see a young girl who had attempted criminal
+abortion by a darning-needle. When he arrived a fetus of about three
+months had already been expelled, and had been wounded by the
+instrument. It was impossible to remove the needle, and the placenta
+was not expelled for two days. Eleven days afterward the girl commenced
+to have pains in the inguinal region, and by the thirty-fifth day an
+elevation was formed, and the pains increased in violence. On the
+seventy-ninth day a needle six inches long was expelled from the
+swelling in the groin, and the patient recovered. Lisfranc extracted
+from the uterus of a woman who supposed herself to be pregnant at the
+third month, a fragment of a large gum-elastic sound which during
+illicit maneuvers had broken off within five cm. of its extremity, and
+penetrated the organ. Lisfranc found there was not the slightest sign
+of pregnancy, despite the woman's belief that she was with child.
+
+
+
+CHAPTER XIV.
+
+MISCELLANEOUS SURGICAL ANOMALIES.
+
+Marvelous Recoveries from Multiple Injuries.--There are injuries so
+numerous or so great in extent, and so marvelous in their recovery,
+that they are worthy of record in a section by themselves. They are
+found particularly in military surgery. In the Medical and
+Philosophical Commentaries for 1779 is the report of the case of a
+lieutenant who was wounded through the lungs, liver, and stomach, and
+in whose armpit lodged a ball. It was said that when the wound in his
+back was injected, the fluid would immediately be coughed up from his
+lungs. Food would pass through the wound of the stomach. The man was
+greatly prostrated, but after eleven months of convalescence he
+recovered. In the brutal capture of Fort Griswold, Connecticut, in
+1781, in which the brave occupants were massacred by the British,
+Lieutenant Avery had an eye shot out, his skull fractured, the
+brain-substance scattering on the ground, was stabbed in the side, and
+left for dead; yet he recovered and lived to narrate the horrors of the
+day forty years after.
+
+A French invalid-artillery soldier, from his injuries and a peculiar
+mask he used to hide them, was known as "L'homme a la tete de cire."
+The Lancet gives his history briefly as follows: During the
+Franco-Prussian War, he was horribly wounded by the bursting of a
+Prussian shell. His whole face, including his two eyes, were literally
+blown away, some scanty remnants of the osseous and muscular systems,
+and the skull covered with hair being left. His wounds healed, giving
+him such a hideous and ghastly appearance that he was virtually
+ostracized from the sight of his fellows. For his relief a dentist by
+the name of Delalain constructed a mask which included a false palate
+and a set of false teeth. This apparatus was so perfect that the
+functions of respiration and mastication were almost completely
+restored to their former condition, and the man was able to speak
+distinctly, and even to play the flute. His sense of smell also
+returned. He wore two false eyes simply to fill up the cavities of the
+orbits, for the parts representing the eyes were closed.  The mask was
+so well-adapted to what remained of the real face, that it was
+considered by all one of the finest specimens of the prothetic art that
+could be devised. This soldier, whose name was Moreau, was living and
+in perfect health at the time of the report, his bizarre face, without
+expression, and his sobriquet, as mentioned, making him an object of
+great curiosity. He wore the Cross of Honor, and nothing delighted him
+more than to talk about the war. To augment his meager pension he sold
+a pamphlet containing in detail an account of his injuries and a
+description of the skilfully devised apparatus by which his declining
+life was made endurable. A somewhat similar case is mentioned on page
+585.
+
+A most remarkable case of a soldier suffering numerous and almost
+incredible injuries and recovering and pursuing his vocation with
+undampened ardor is that of Jacques Roellinger, Company B, 47th New
+York Volunteers. He appeared before a pension board in New York, June
+29, 1865, with the following history: In 1862 he suffered a sabre-cut
+across the quadriceps extensor of the left thigh, and a sabre-thrust
+between the bones of the forearm at the middle third. Soon afterward at
+Williamsburg, Va., he was shot in the thigh, the ball passing through
+the middle third external to the femur. At Fort Wagner, 1863, he had a
+sword-cut, severing the spinal muscles and overlying tissue for a
+distance of six inches.  Subsequently he was captured by guerillas in
+Missouri and tortured by burning splinters of wood, the cicatrices of
+which he exhibited; he escaped to Florida, where he was struck by a
+fragment of an exploding shell, which passed from without inward,
+behind the hamstring on the right leg, and remained embedded and could
+be plainly felt. When struck he fell and was fired on by the retiring
+enemy. A ball entered between the 6th and 7th ribs just beneath the
+apex of the heart, traversed the lungs and issued at the right 9th rib.
+He fired his revolver on reception of this shot, and was soon
+bayonetted by his own comrades by mistake, this wound also penetrating
+the body. He showed a depressed triangular cicatrix on the margin of
+the epigastrium.  If the scars are at all indicative, the bayonet must
+have passed through the left lobe of the liver and border of the
+diaphragm.  Finally he was struck by a pistol-ball at the lower angle
+of the left lower jaw, this bullet issuing on the other side of the
+neck. As exemplary of the easy manner in which he bore his many
+injuries during a somewhat protracted convalescence, it may be added
+that he amused his comrades by blowing jets of water through the
+apertures on both sides of his neck. Beside the foregoing injuries he
+received many minor ones, which he did not deem worthy of record or
+remembrance. The greatest disability he suffered at the time of
+applying for a pension resulted from an ankylosed knee. Not satisfied
+with his experience in our war, he stated to the pension examiners that
+he was on his way to join Garibaldi's army. This case is marvelous when
+we consider the proximity of several of the wounds to a vital part; the
+slightest deviation of position would surely have resulted in a fatal
+issue for this apparently charmed life. The following table shows the
+man's injuries in the order of their reception:--
+
+(1) Sabre-cut across the quadriceps femoris of right leg, dividing the
+tendinous and muscular structures.
+
+(2) Sabre-thrust between the bones in the middle third of the right
+forearm.
+
+(3) Shot in the right thigh, the ball passing through the middle third.
+
+(4) A sword-cut across the spinal muscles covering the lower dorsal
+vertebrae.
+
+(5) Tortured by guerillas in Indian fashion by having burning splinters
+of wood applied to the surface of his right thorax.
+
+(6) An exploded shell passed through the hamstring muscles of the right
+thigh and embedded itself in the ligamentous tissues of the internal
+condyle of the femur.
+
+(7) Shot by a ball between the 6th and 7th ribs of the left side.
+
+(8) Bayonetted through the body, the steel passing through the left
+lobe of the liver and penetrating the posterior border of the diaphragm.
+
+(9) Pistol-ball shot through the sternocleido muscle of one side of the
+neck, emerging through the corresponding muscle of the other side of
+the neck.
+
+(10) Sabre-thrust between the bones of the left forearm.
+
+(11) Pistol-shot through the left pectoralis major and left deltoid
+muscles.
+
+(12) Deep cut dividing the commissure between the left thumb and
+forefinger down to the carpal bones.
+
+Somewhat analogous to the foregoing is a case reported in 1834 by
+McCosh from Calcutta. The patient was a native who had been dreadfully
+butchered in the Chooar campaign. One of his hands was cut off above
+the wrist. The remaining stump was nearly amputated by a second blow. A
+third blow penetrated the shoulder-joint.  Beside these and several
+other slashes, he had a cut across the abdomen extending from the
+umbilicus to the spine. This cut divided the parietes and severed one
+of the coats of the colon.  The intestines escaped and lay by his side.
+He was then left on the ground as dead. On arrival at the hospital his
+wounds were dressed and he speedily convalesced, but the injured colon
+ruptured and an artificial anus was formed and part of the feces were
+discharged through the wound. This man was subsequently seen at
+Midnapore healthy and lusty although his body was bent to one side in
+consequence of a large cicatrix; a small portion of the feces
+occasionally passed through the open wound.
+
+There is an account of a private soldier, aged twenty-seven, who
+suffered a gunshot wound of the skull, causing compound fracture of the
+cranium, and who also received compound fractures of both bones of the
+leg. He did not present himself for treatment until ten days later. At
+this time the head-injury caused him no inconvenience, but it was
+necessary to amputate the leg and remove the necrosed bones from the
+cranial wounds; the patient recovered.
+
+Recovery After Injuries by Machinery, with Multiple Fractures,
+etc.--Persons accidentally caught in some portions of powerful
+machinery usually suffer several major injuries, any one of which might
+have been fatal, yet there are marvelous instances of recovery after
+wounds of this nature. Phares records the case of a boy of nine who,
+while playing in the saw-gate of a cotton-press, was struck by the
+lever in revolution, the blow fracturing both bones of the leg about
+the middle. At the second revolution his shoulder was crushed; the
+third passed over him, and the fourth, with maximum momentum struck his
+head, carrying away a large part of the integument, including one
+eyebrow, portions of the skull, membranes, and brain-substance. A piece
+of cranial bone was found sticking in the lever, and there were stains
+of brain on all the 24 posts around the circumference of the hole.
+Possibly from 1 1/2 to two ounces of cerebral substance were lost. A
+physician was called, but thinking the case hopeless he declined to
+offer surgical interference. Undaunted, the father of the injured lad
+straightened the leg, adjusted the various fractures, and administered
+calomel and salts. The boy progressively recovered, and in a few weeks
+his shoulder and legs were well. About this time a loosened fragment of
+the skull was removed almost the size and shape of a dessert spoon,
+with the handle attached, leaving a circular opening directly over the
+eye as large as a Mexican dollar, through which cerebral pulsation was
+visible. A peculiar feature of this case was that the boy never lost
+consciousness, and while one of his playmates ran for assistance he got
+out of the hole himself, and moved to a spot ten feet distant before
+any help arrived, and even then he declined proffered aid from a man he
+disliked. This boy stated that he remembered each revolution of the
+lever and the individual injuries that each inflicted. Three years
+after his injury he was in every respect well. Fraser mentions an
+instance of a boy of fifteen who was caught in the crank of a
+balance-wheel in a shingle-mill, and was taken up insensible. His skull
+was fractured at the parietal eminence and the pericranium stripped
+off, leaving a bloody tumor near the base of the fracture about two
+inches in diameter. The right humerus was fractured at the external
+condyle; there was a fracture of the coronoid process of the ulna, and
+a backward dislocation at the elbow. The annular ligament was ruptured,
+and the radius was separated from the ulna. On the left side there was
+a fracture of the anatomic neck of the humerus, and a dislocation
+downward. The boy was trephined, and the comminuted fragments removed;
+in about six weeks recovery was nearly complete. Gibson reports the
+history of a girl of eight who was caught by her clothing in a
+perpendicular shaft in motion, and carried around at a rate of 150 or
+200 times a minute until the machinery could be stopped.  Although she
+was found in a state of shock, she was anesthetized, in order that
+immediate attention could be given to her injuries, which were found to
+be as follows:--
+
+(1) An oblique fracture of the middle third of the right femur.
+
+(2) A transverse fracture of the middle third of the left femur.
+
+(3) A slightly comminuted transverse fracture of the middle third of
+the left tibia and fibula.
+
+(4) A transverse fracture of the lower third of the right humerus.
+
+(5) A fracture of the lower third of the right radius.
+
+(6) A partial radiocarpal dislocation.
+
+(7) Considerable injuries of the soft parts at the seats of fracture,
+and contusions and abrasions all over the body.
+
+During convalescence the little patient suffered an attack of measles,
+but after careful treatment it was found by the seventy-eighth day that
+she had recovered without bony deformity, and that there was bony union
+in all the fractures. There was slight tilting upward in the left
+femur, in which the fracture had been transverse, but there was no
+perceptible shortening.
+
+Hulke describes a silver-polisher of thirty-six who, while standing
+near a machine, had his sleeve caught by a rapidly-turning wheel, which
+drew him in and whirled him round and round, his legs striking against
+the ceiling and floor of the room. It was thought the wheel had made 50
+revolutions before the machinery was stopped. After his removal it was
+found that his left humerus was fractured at its lower third, and
+apparently comminuted. There was no pulse in the wrist in either the
+radial or ulnar arteries, but there was pulsation in the brachial as
+low as the ecchymosed swelling. Those parts of the hand and fingers
+supplied by the median and radial nerves were insensible. The right
+humerus was broken at the middle, the end of the upper fragment
+piercing the triceps, and almost protruding through the skin. One or
+more of the middle ribs on the right side were broken near the angle,
+and there was a large transverse rent in the quadriceps extensor.
+Despite this terrible accident the man made a perfect recovery, with
+the single exception of limitation of flexion in the left elbow-joint.
+
+Dewey details a description of a girl of six who was carried around the
+upright shaft of a flour mill in which her clothes became entangled.
+Some part of the body struck the bags or stones with each revolution.
+She sustained a fracture of the left humerus near the insertion of the
+deltoid, a fracture of the middle third of the left femur, a compound
+fracture of the left femur in the upper third, with protrusion of the
+upper fragment and considerable venous hemorrhage, and fracture of the
+right tibia and fibula at the upper third. When taken from the shafting
+the child was in a moribund state, with scarcely perceptible pulse, and
+all the accompanying symptoms of shock. Her injuries were dressed, the
+fractures reduced, and starch bandages applied; in about six weeks
+there was perfect union, the right leg being slightly shortened. Six
+months later she was playing about, with only a slight halt in her gait.
+
+Miscellaneous Multiple Fractures.--Westmoreland speaks of a man who was
+pressed between two cars, and sustained a fracture of both collar-bones
+and of the sternum; in addition, six or eight ribs were fractured,
+driven into and lacerating the lung. The heart was displaced. In spite
+of these terrible injuries, the man was rational when picked up, and
+lived nearly half a day. In comment on this case Battey mentions an
+instance in which a mill-sawyer was run over by 20 or 30 logs, which
+produced innumerable fractures of his body, constituting him a surgical
+curiosity. He afterward completely recovered, and, as a consequence of
+his miraculous escape, became a soothsayer in his region. West reports
+a remarkable recovery after a compound fracture of the femur, fracture
+of the jaw, and of the radius, and possibly injury to the base of the
+skull, and injury to the spine.
+
+There is on record an account of a woman of forty-three who, by
+muscular action in lifting a stone, fractured her pubes, external to
+the spine, on the left side. Not realizing her injury she continued
+hard work all that day, but fell exhausted on the next.  She recovered
+in about a month, and was able to walk as well as ever.
+
+Vinnedge reports recovery after concussion of the brain and extreme
+shock, associated with fracture of the left femur, and comminuted
+fractures of the left tibia and fibula.
+
+Tufnell mentions recovery after compound comminuted fracture of the
+leg, with simple fracture of both collar-bones, and dislocation of the
+thumb. Nankivell speaks of a remarkable recovery in an individual who
+suffered compound comminuted fracture of both legs, and fracture of the
+skull. It was found necessary to amputate the right thigh and left leg.
+Erichsen effected recovery by rest alone, in an individual whose ribs
+and both clavicles were fractured by being squeezed.
+
+Gilman records recovery after injuries consisting of fracture of the
+frontal bone near the junction with the right parietal; fracture of the
+right radius and ulna at the middle third and at the wrist; and
+compound fracture of the left radius and ulna, 1 1/4 inches above the
+wrist. Boulting reports a case of an individual who suffered compound
+fractures of the skull and humerus, together with extensive laceration
+of the thigh and chest, and yet recovered.
+
+Barwell mentions recovery after amputation of the shoulder-joint, in an
+individual who had suffered fracture of the base of the skull, fracture
+of the jaw, and compound fracture of the right humerus. There was high
+delirium followed by imbecility in this case. Bonnet reports a case of
+fracture of both thighs, two right ribs, luxation of the clavicle, and
+accidental club-foot with tenotomy, with good recovery from all the
+complications. Beach speaks of an individual who suffered fracture of
+both thighs, and compound comminuted fracture of the tibia, fibula, and
+tarsal bones into the ankle-joint, necessitating amputation of the leg.
+The patient not only survived the operation, but recovered with good
+union in both thighs. As illustrative of the numerous fractures a
+person may sustain at one time, the London Medical Gazette mentions an
+injury to a girl of fourteen, which resulted in 31 fractures.
+
+Remarkable Falls.--In this connection it is of interest to note from
+how great a height a person may fall without sustaining serious injury.
+A remarkable fall of a miner down 100 meters of shaft (about 333 feet)
+without being killed is recorded by M.  Reumeaux in the Bulletin de
+l'Industrie Minerale. Working with his brother in a gallery which
+issued on the shaft, he forgot the direction in which he was pushing a
+truck; so it went over, and he after it, falling into some mud with
+about three inches of water. As stated in Nature, he seems neither to
+have struck any of the wood debris, nor the sides of the shaft, and he
+showed no contusions when he was helped out by his brother after about
+ten minutes. He could not, however, recall any of his impressions
+during the fall. The velocity on reaching the bottom would be about 140
+feet, and time of fall 4.12 seconds; but it is thought he must have
+taken longer. It appears strange that he should have escaped simple
+suffocation and loss of consciousness during a time sufficient for the
+water to have drowned him.
+
+While intoxicated Private Gough of the 42d Royal Highlanders attempted
+to escape from the castle at Edinburgh. He fell almost perpendicularly
+170 feet, fracturing the right frontal sinus, the left clavicle, tibia,
+and fibula. In five months he had so far recovered as to be put on duty
+again, and he served as an efficient soldier. There is an account of
+recovery after a fall of 192 feet, from a cliff in County Antrim,
+Ireland. Manzini mentions a man who fell from the dome of the Invalides
+in Paris, without sustaining any serious accident, and there is a
+record from Madrid of a much higher fall than this without serious
+consequence. In 1792 a bricklayer fell from the fourth story of a high
+house in Paris, landing with his feet on the dirt and his body on
+stone. He bled from the nose, and lost consciousness for about
+forty-five minutes; he was carried to the Hotel-Dieu where it was found
+that he had considerable difficulty in breathing; the regions about the
+external malleoli were contused and swollen, but by the eighth day the
+patient had recovered. In the recent reparation of the Hotel Raleigh in
+Washington, D.C., a man fell from the top of the building, which is
+above the average height, fracturing several ribs and rupturing his
+lung. He was taken to the Emergency Hospital where he was put to bed,
+and persistent treatment for shock was pursued; little hope of the
+man's recovery was entertained. His friends were told of his apparently
+hopeless condition. There were no external signs of the injury with the
+exception of the emphysema following rupture of the lung. Respiration
+was limited and thoracic movement diminished by adhesive straps and a
+binder; under careful treatment the man recovered.
+
+Kartulus mentions an English boy of eight who, on June 1, 1879, while
+playing on the terrace in the third story of a house in Alexandria, in
+attempting to fly a kite in company with an Arab servant, slipped and
+fell 71 feet to a granite pavement below. He was picked up conscious,
+but both legs were fractured about the middle. He had so far recovered
+by the 24th of July that he could hobble about on crutches. On the 15th
+of November of the same year he was seen by Kartulus racing across the
+playground with some other boys; as he came in third in the race he had
+evidently lost little of his agility. Parrott reports the history of a
+man of fifty, weighing 196 pounds, who fell 110 feet from the steeple
+of a church. In his descent he broke a scaffold pole in two, and fell
+through the wooden roof of an engine-house below, breaking several
+planks and two strong joists, and landing upon some sacks of cement
+inside the house. When picked up he was unconscious, but regained his
+senses in a short time, and it was found that his injuries were not
+serious. The left metacarpal bones were dislocated from the carpal
+bones, the left tibia was fractured, and there were contusions about
+the back and hips. Twelve days later he left for home with his leg in
+plaster. Farber and McCassy report a case in which a man fell 50 feet
+perpendicularly through an elevator shaft, fracturing the skull. Pieces
+of bone at the superior angle of the occipital bone were removed,
+leaving the aura exposed for a space one by four inches. The man was
+unconscious for four days, but entirely recovered in eighteen days,
+with only a slightly subnormal hearing as an after-effect of his fall.
+
+For many years there have been persons who have given exhibitions of
+high jumps, either landing in a net or in the water. Some of these
+hazardous individuals do not hesitate to dive from enormous heights,
+being satisfied to strike head first or to turn a somersault in their
+descent. Nearly all the noted bridges in this country have had their
+"divers." The death of Odlum in his attempt to jump from Brooklyn
+bridge is well known. Since then it has been claimed that the feat has
+been accomplished without any serious injury. It is reported that on
+June 20, 1896, a youth of nineteen made a headlong dive from the top of
+the Eads bridge at St. Louis, Mo., a distance of 125 feet. He is said
+to have swum 250 feet to a waiting tug, and was taken on board without
+having been hurt.
+
+Probably the most interesting exhibition of this kind that was ever
+seen was at the Royal Aquarium, London, in the summer of 1895. A part
+of the regular nightly performance at this Hall, which is familiar on
+account of its immensity, was the jump of an individual from the
+rafters of the large arched roof into a tank of water about 15 by 20
+feet, and from eight to ten feet deep, sunken in the floor of the hall.
+Another performer, dressed in his ordinary street clothes, was tied up
+in a bag and jumped about two-thirds of this height into the same tank,
+breaking open the bag and undressing himself before coming to the
+surface. In the same performance a female acrobat made a backward dive
+from the topmost point of the building into a net stretched about ten
+feet above the floor. Nearly every large acrobatic entertainment has
+one of these individuals who seem to experience no difficulty in
+duplicating their feats night after night.
+
+It is a common belief that people falling from great heights die in the
+act of descent. An interview with the sailor who fell from the
+top-gallant of an East Indiaman, a height of 120 feet, into the water,
+elicited the fact that during the descent in the air, sensation
+entirely disappeared, but returned in a slight degree when he reached
+the water, but he was still unable to strike out when rising to the
+surface. By personal observation this man stated that he believed that
+if he had struck a hard substance his death would have been painless,
+as he was sure that he was entirely insensible during the fall.
+
+A writer in the Pall Mall Gazette, in speaking of the accidents which
+had happened in connection with the Forth Bridge, tells of a man who
+trusted himself to work at the height of 120 feet above the waters of
+the Firth, simply grasping a rope. His hands became numb with cold, his
+grasp relaxed, and he fell backward down into the water, but was
+brought out alive. In another instance a spanner fell a distance of 300
+feet, knocked off a man's cap, and broke its way through a four-inch
+plank. Again, another spanner fell from a great height, actually
+tearing off a man's clothes, from his waistcoat to his ankle, but
+leaving him uninjured. On another occasion a staging with a number of
+workmen thereon gave way. Two of the men were killed outright by
+striking some portion of the work in their descent; two others fell
+clear of the girders, and were rescued from the Firth little worse for
+their great fall.
+
+Resistance of Children to Injuries.--It is a remarkable fact that young
+children, whose bones, cartilages, and tissues are remarkably elastic,
+are sometimes able to sustain the passage over their bodies of vehicles
+of great weight without apparent injury. There is a record early in
+this century of a child of five who was run over across the epigastrium
+by a heavy two-wheeled cart, but recovered without any bad symptoms.
+The treatment in this case is quite interesting, and was as follows:
+venesection to faintness, castor oil in infusion of senna until there
+was a free evacuation of the bowels, 12 leeches to the abdomen and
+spine, and a saline mixture every two hours! Such depleting
+therapeutics would in themselves seem almost sufficient to provoke a
+fatal issue, and were given in good faith as the means of effecting a
+recovery in such a case. In a similar instances a wagon weighing 1200
+pounds passed over a child of five, with no apparent injury other than
+a bruise near the ear made by the wheel.
+
+Infant-vitality is sometimes quite remarkable, a newly-born child
+sometimes surviving extreme exposure and major injuries. There was a
+remarkable instance of this kind brought to light in the Mullings vs.
+Mullings divorce-case, recorded in The Lancet. It appeared that Mrs.
+Mullings, a few hours after her confinement at Torquay, packed her
+newly-born infant boy in a portmanteau, and started for London. She had
+telegraphed Dr. J. S. Tulloch to meet her at Paddington, where he found
+his patient apparently in good condition, and not weak, as he expected
+in a woman shortly to be confined. On the way to her apartments, which
+had been provided by Dr. Tulloch, Mrs. Mullings remarked to the Doctor
+that she had already borne her child. Dr. Tulloch was greatly
+surprised, and immediately inquired what she had done with the baby.
+She replied that it was in a box on top of the cab. When the box was
+opened the child was found alive. The Lancet comments on the remarkable
+fact that, shortly after confinement, a woman can travel six or seven
+hours in a railroad train, and her newly-born babe conveyed the same
+distance in a portmanteau, without apparent injury, and without
+attracting attention.
+
+Booth reports a remarkable case of vitality of a newly-born child which
+came under his observation in October, 1894. An illegitimate child,
+abandoned by its mother, was left at the bottom of a cesspool vault;
+she claimed that ten hours before Booth's visit it had been
+accidentally dropped during an attempt to micturate. The infant lived
+despite the following facts: Its delivery from an ignorant,
+inexperienced, unattended negress; its cord not tied; its fall of 12
+feet down the pit; its ten hours' exposure in the cesspool; its
+smothering by foul air, also by a heavy covering of rags, paper, and
+straw; its pounding by three bricks which fell in directly from eight
+feet above (some loose bricks were accidentally dislodged from the
+sides of the vault, in the maneuvers to extricate the infant); its
+lowered temperature previous to the application of hot bottles,
+blankets, and the administration of cardiac stimulants. Booth adds that
+the morning after its discovery the child appeared perfectly well, and
+some two months afterward was brought into court as evidence in the
+case. A remarkable case of infant vitality is given on page 117.
+
+Operations in the Young and Old.--It might be of interest to mention
+that such a major operation as ovariotomy has been successfully
+performed in an infant. In a paper on infant ovariotomy, several
+instances of this nature are mentioned.  Roemer successfully performed
+ovariotomy on a child one year and eight months old; Swartz, on a child
+of four; Barker, on a child of four; Knowsley Thornton, on a child of
+seven, and Spencer Wells Cupples, and Chenoweth, on children of eight.
+Rein performed ovariotomy on a girl of six, suffering from a
+multilocular cyst of the left ovary. He expresses his belief that
+childhood and infancy are favorable to laparotomy.
+
+Kidd removed a dermoid from a child of two years and eleven months;
+Hooks performed the same operation on a child of thirty months. Chiene
+extirpated an ovary from a child of three; Neville duplicated this
+operation in a child one month younger; and Alcock performed ovariotomy
+on a child of three.
+
+Successful ovariotomies are infrequent in the extremely aged.  Bennett
+mentions an instance in a woman of seventy-five, and Davies records a
+similar instance. Borsini and Terrier cite instances of successful
+ovariotomy in patients of seventy-seven.  Carmichael performed the
+operation at seventy-four. Owens mentions it at eighty; and Homans at
+eighty-two years and four months. Dewees records a successful case of
+ovariotomy in a woman over sixty-seven; McNutt reports a successful
+instance in a patient of sixty-seven years and six months; the tumor
+weighed 60 pounds, and there were extensive adhesions. Maury removed a
+monocystic ovarian tumor from a woman of seventy-four, his patient
+recovering. Pippingskold mentions an ovariotomy at eighty. Terrier
+describes double ovariotomy for fibromata in a woman of seventy-seven.
+Aron speaks of an operation for pilous dermoid of the ovary in a woman
+of seventy-five. Shepherd reports a case of recurrent proliferous cyst
+in a woman of sixty-three, on whom successful ovariotomy was performed
+twice within nine months. Wells mentions an ovarian cyst in a woman of
+sixty-five, from which 72 pints of fluid were removed.
+
+Hawkins describes the case of a musician, M. Rochard, who at the age of
+one hundred and seven was successfully operated on for strangulated
+hernia of upward of thirty hours' duration. The wound healed by first
+intention, and the man was well in two weeks. Fowler operated
+successfully for strangulated umbilical hernia on a patient of
+sixty-eight.
+
+Repeated Operations.--Franzolini speaks of a woman of fifty on whom he
+performed six celiotomies between June, 1879, and April, 1887. The
+first operation was for fibrocystic disease of the uterus. Since the
+last operation the woman had had remarkably good health, and there was
+every indication that well-merited recovery had been effected. The
+Ephemerides contains an account of a case in which cystotomy was
+repeated four times, and there is another record of this operation
+having been done five times on a man. Instances of repeated Cesarean
+section are mentioned on page 130.
+
+Before leaving this subject, we mention a marvelous operation performed
+by Billroth on a married woman of twenty-nine, after her sixth
+pregnancy. This noted operator performed, synchronously, double
+ovariotomy and resections of portions of the bladder and ileum, for a
+large medullary carcinomatous growth of the ovary, with surrounding
+involvement. Menstruation returned three months after the operation,
+and in fifteen months the patient was in good health in every way, with
+no apparent danger of recurrence of the disease.
+
+Self-performed Surgical Operations.--There have been instances in which
+surgeons and even laymen have performed considerable operations upon
+themselves. On the battlefield men have amputated one of their own
+limbs that had been shattered. In such cases there would be little
+pain, and premeditation would not be brought into play in the same
+degree as in the case of M. Clever de Maldigny, a surgeon in the Royal
+Guards of France, who successfully performed a lithotomy on himself
+before a mirror. He says that after the operation was completed the
+urine flowed in abundance; he dressed the wound with lint dipped in an
+emollient solution, and, being perfectly relieved from pain, fell into
+a sound sleep. On the following day, M. Maldigny says, he was as
+tranquil and cheerful as if he had never been a sufferer. A Dutch
+blacksmith and a German cooper each performed lithotomy on themselves
+for the intense pain caused by a stone in the bladder.  Tulpius,
+Walther, and the Ephemerides each report an instance of self-performed
+cystotomy.
+
+The following case is probably the only instance in which the patient,
+suffering from vesical calculus, tried to crush and break the stone
+himself. J. B., a retired draper, born in 1828, while a youth of
+seventeen, sustained a fracture of the leg, rupture of the urethra, and
+laceration of the perineum, by a fall down a well, landing astride an
+iron bar. A permanent perineal fistula was established, but the patient
+was averse to any operative remedial measure. In the year 1852 he
+became aware of the presence of a calculus, but not until 1872 did he
+ask for medical assistance. He explained that he had introduced a
+chisel through his perineal fistula to the stone, and attempted to
+comminute it himself and thus remove it, and by so doing had removed
+about an ounce of the calculus. The physician started home for his
+forceps, but during the interval, while walking about in great pain,
+the man was relieved by the stone bursting through the perineum,
+falling to the floor, and breaking in two.  Including the ounce already
+chiselled off, the stone weighed 14 1/2 ounces, and was 10 5/8 inches
+in its long circumference. B.  recovered and lived to December, 1883,
+still believing that he had another piece of stone in his bladder.
+
+In Holden's "Landmarks" we are told that the operation of dividing the
+Achilles tendon was first performed by an unfortunate upon himself, by
+means of a razor. According to Patterson, the late Mr. Symes told of a
+patient in North Scotland who, for incipient hip-disease, had the
+cautery applied at the Edinburgh Infirmary with resultant great relief.
+After returning home to the country he experienced considerable pain,
+and despite his vigorous efforts he was unable to induce any of the men
+to use the cautery upon him; they termed it "barbarous treatment." In
+desperation and fully believing in the efficacy of this treatment as
+the best means of permanently alleviating his pain, the crippled
+Scotchman heated a poker and applied the cautery himself.
+
+We have already mentioned the marvelous instances of Cesarean sections
+self-performed, and in the literature of obstetric operations many of
+the minor type have been done by the patient herself. In the foregoing
+cases it is to be understood that the operations have been performed
+solely from the inability to secure surgical assistance or from the
+incapacity to endure the pain any longer. These operations were not the
+self-mutilations of maniacs, but were performed by rational persons,
+driven to desperation by pain.
+
+Possibly the most remarkable instances of extensive loss of blood, with
+recoveries, are to be found in the older records of venesection. The
+chronicles of excessive bleeding in the olden days are well known to
+everybody. Perhaps no similar practice was so universally indulged in.
+Both in sickness and in health, depletion was indicated, and it is no
+exaggeration to say that about the hospital rooms at times the floors
+were covered with blood. The reckless way in which venesection was
+resorted to, led to its disuse, until to-day it has so vanished from
+medical practice that even its benefits are overlooked, and depletion
+is brought about in some other manner. Turning to the older writers, we
+find Burton describing a patient from whom he took 122 ounces of blood
+in four days. Dover speaks of the removal of 111 and 190 ounces; Galen,
+of six pounds; and Haen, of 114 ounces. Taylor relates the history of a
+case of asphyxia in which he produced a successful issue by extracting
+one gallon of blood from his patient during twelve hours. Lucas speaks
+of 50 venesections being practiced during one pregnancy. Van der Wiel
+performed venesection 49 times during a single pregnancy. Balmes
+mentions a case in which 500 venesections were performed in twenty-five
+years. Laugier mentions 300 venesections in twenty-six months.
+Osiander speaks of 8000 ounces of blood being taken away in thirty-five
+years. Pechlin reports 155 venesections in one person in sixteen years,
+and there is a record of 1020 repeated venesections.
+
+The loss of blood through spontaneous hemorrhage is sometimes
+remarkable. Fabricius Hildanus reports the loss of 27 pounds of blood
+in a few days; and there is an older record of 40 pounds being lost in
+four days. Horstius, Fabricius Hildanus, and Schenck, all record
+instances of death from hemorrhage of the gums. Tulpius speaks of
+hemoptysis lasting chronically for thirty years, and there is a similar
+record of forty years' duration in the Ephemerides. Chapman gives
+several instances of extreme hemorrhage from epistaxis. He remarks that
+Bartholinus has recorded the loss of 48 pounds of blood from the nose;
+and Rhodius, 18 pounds in thirty-six hours. The Ephemerides contains an
+account of epistaxis without cessation for six weeks. Another writer in
+an old journal speaks of 75 pounds of blood from epistaxis in ten days.
+Chapman also mentions a case in which, by intestinal hemorrhage, eight
+gallons of blood were lost in a fortnight, the patient recovering. In
+another case a pint of blood was lost daily for fourteen days, with
+recovery. The loss of eight quarts in three days caused death in
+another case; and Chapman, again, refers to the loss of three gallons
+of blood from the bowel in twenty-four hours. In the case of
+Michelotti, recorded in the Transactions of the Royal Society, a young
+man suffering from enlargement of the spleen vomited 12 pounds of blood
+in two hours, and recovered.
+
+In hemorrhoidal hemorrhages, Lieutaud speaks of six quarts being lost
+in two days; Hoffman, of 20 pounds in less than twenty-four hours, and
+Panaroli, of the loss of one pint daily for two years.
+
+Arrow-Wounds.--According to Otis the illustrious Baron Percy was wont
+to declare that military surgery had its origin in the treatment of
+wounds inflicted by darts and arrows; he used to quote Book XI of the
+Iliad in behalf of his belief, and to cite the cases of the patients of
+Chiron and Machaon, Menelaus and Philoctetes, and Eurypiles, treated by
+Patroclus; he was even tempted to believe with Sextus that the name
+iatros, medicus, was derived from ios, which in the older times
+signified "sagitta," and that the earliest function of our professional
+ancestors was the extraction of arrows and darts. An instrument called
+beluleum was invented during the long Peloponnesian War, over four
+hundred years before the Christian era. It was a rude
+extracting-forceps, and was used by Hippocrates in the many campaigns
+in which he served. His immediate successor, Diocles, invented a
+complicated instrument for extracting foreign bodies, called
+graphiscos, which consisted of a canula with hooks. Otis states that it
+was not until the wars of Augustus that Heras of Cappadocia designed
+the famous duck-bill forceps which, with every conceivable
+modification, has continued in use until our time. Celsus instructs
+that in extracting arrow-heads the entrance-wound should be dilated,
+the barb of the arrow-head crushed by strong pliers, or protected
+between the edges of a split reed, and thus withdrawn without
+laceration of the soft parts. According to the same authority, Paulus
+Aegineta also treated fully of wounds by arrow-heads, and described a
+method used in his time to remove firmly-impacted arrows. Albucasius
+and others of the Arabian school did little or nothing toward aiding
+our knowledge of the means of extracting foreign bodies. After the
+fourteenth century the attention of surgeons was directed to wounds
+from projectiles impelled by gunpowder. In the sixteenth century arrows
+were still considerably used in warfare, and we find Pare a delineating
+the treatment of this class of injuries with the sovereign good sense
+that characterized his writings. As the use of firearms became
+prevalent the literature of wounds from arrows became meager, and the
+report of an instance in the present day is very rare.
+
+Bill has collected statistics and thoroughly discussed this subject,
+remarking upon the rapidity with which American Indians discharge their
+arrows, and states that it is exceptional to meet with only a single
+wound. It is commonly believed that the Indian tribes make use of
+poisoned arrows, but from the reports of Bill and others, this must be
+a very rare custom. Ashhurst states that he was informed by Dr. Schell,
+who was stationed for some time at Fort Laramie, that it is the
+universal custom to dip the arrows in blood, which is allowed to dry on
+them; it is not, therefore, improbable that septic material may thus be
+inoculated through a wound.
+
+Many savage tribes still make use of the poisonous arrow. The Dyak uses
+a sumpitan, or blow-tube, which is about seven feet long, and having a
+bore of about half an inch. Through this he blows his long, thin dart,
+anointed on the head with some vegetable poison. Braidwood speaks of
+the physiologic action of Dajaksch, an arrow-poison used in Borneo.
+Arnott has made observations relative to a substance produced near
+Aden, which is said to be used by the Somalies to poison their arrows.
+Messer of the British Navy has made inquiries into the reputed
+poisonous nature of the arrows of the South Sea Islanders.
+
+Otis has collected reports of arrow-wounds from surgical cases
+occurring in the U. S. Army. Of the multiple arrow-wounds, six out of
+the seven cases were fatal. In five in which the cranial cavity was
+wounded, four patients perished. There were two remarkable instances of
+recovery after penetration of the pleural cavity by arrows. The great
+fatality of arrow-wounds of the abdomen is well known, and, according
+to Bill, the Indians always aim at the umbilicus; when fighting
+Indians, the Mexicans are accustomed to envelop the abdomen, as the
+most vulnerable part, in many folds of a blanket.
+
+Of the arrow-wounds reported, nine were fatal, with one exception, in
+which the lesion implicated the soft parts only.  The regions injured
+were the scalp, face, and neck, in three instances; the parietes of the
+chest in six; the long muscles of the back in two; the abdominal
+muscles in two; the hip or buttocks in three; the testis in one; the
+shoulder or arm in 13; forearm or hand in six; the thigh or leg in
+seven.
+
+The force with which arrows are projected by Indians is so great that
+it has been estimated that the initial velocity nearly equals that of a
+musket-ball. At a short distance an arrow will perforate the larger
+bones without comminuting them, causing a slight fissure only, and
+resembling the effect of a pistol-ball fired through a window-glass a
+few yards off.
+
+Among extraordinary cases of recovery from arrow-wounds, several of the
+most striking will be recorded. Tremaine mentions a sergeant of
+thirty-four who, in a fray with some hostile Indians, received seven
+arrow-wounds: two on the anterior surface of the right arm; one in the
+right axilla; one on the right side of the chest near the axillary
+border; two on the posterior surface of the left arm near the
+elbow-joint, and one on the left temple. On June 1st he was admitted to
+the Post Hospital at Fort Dodge, Kan.  The wound on the right arm near
+the deltoid discharged, and there was slight exfoliation of the
+humerus. The patient was treated with simple dressings, and was
+returned to duty in July, 1870.
+
+Goddard mentions an arrow-wound by which the body was transfixed.  The
+patient was a cutler's helper at Fort Rice, Dakota Territory.  He was
+accidentally wounded in February, 1868, by an arrow which entered the
+back three inches to the right of the 5th lumbar vertebra, and emerged
+about two inches to the right of the ensiform cartilage. During the
+following evening the patient lost about eight ounces of blood
+externally, with a small amount internally. He was confined to his bed
+some two weeks, suffering from circumscribed peritonitis with
+irritative fever. In four weeks he was walking about, and by July 1st
+was actively employed. The arrow was deposited in the Army Medical
+Museum.
+
+Muller gives a report of an arrow-wound of the lung which was
+productive of pleurisy but which was followed by recovery. Kugler
+recites the description of the case of an arrow-wound of the thorax,
+complicated by frightful dyspnea and blood in the pleural cavity and in
+the bronchi, with recovery.
+
+Smart extracted a hoop-iron arrow-head, 1 3/4 inches long and 1/2 inch
+in breadth, from the brain of a private, about a month after its
+entrance. About a dram of pus followed the exit of the arrow-head.
+After the operation the right side was observed to be paralyzed, and
+the man could not remember his name. He continued in a varying
+condition for a month, but died on May 13, 1866, fifty-two days after
+the injury. At the postmortem it was found that the brain-tissue, to
+the extent of 3/4 inch around the track of the arrow as a center, was
+softened and disorganized. The track itself was filled with thick pus
+which extended into the ventricles.
+
+Peabody reports a most remarkable case of recovery from multiple
+arrow-wounds. In a skirmish with some Indians on June 3, 1863, the
+patient had been wounded by eight distinct arrows which entered
+different parts of the body. They were all extracted with the exception
+of one, which had entered at the outer and lower margin of the right
+scapula, and had passed inward and upward through the upper lobe of the
+right lung or trachea. The hemorrhage at this time was so great that
+all hope was abandoned.  The patient, however, rallied, but continued
+to experience great pain on swallowing, and occasionally spat blood. In
+July, 1866, more than three years after the injury, he called on Dr.
+Peabody to undergo an examination with a view of applying for a
+pension, stating that his health was affected from the presence of an
+arrow-head. He was much emaciated, and expressed himself as tired of
+life. Upon probing through a small fistulous opening just above the
+superior end of the sternum, the point of the arrow was found resting
+against the bone, about 1 1/2 inches below, the head lying against the
+trachea and esophagus, with the carotid artery, jugular vein, and
+nerves overlying. After some little difficulty the point of the arrow
+was raised above the sternum, and it was extracted without the loss of
+an ounce of blood. The edge grazed against the sheath of the innominate
+artery during the operation. The missile measured an inch at the base,
+and was four inches long. The health of the patient underwent
+remarkable improvement immediately after the operation.
+
+Serious Insect-stings.--Although in this country the stings of insects
+are seldom productive of serious consequences, in the tropic climates
+death not unfrequently results from them. Wounds inflicted by large
+spiders, centipedes, tarantulae, and scorpions have proved fatal. Even
+in our country deaths, preceded by gangrene, have sometimes followed
+the bite of a mosquito or a bee, the location of the bite and the
+idiosyncrasy of the individual probably influencing the fatal issue. In
+some cases, possibly, some vegetable poison is introduced with the
+sting.  Hulse, U.S.N., reports the case of a man who was bitten on the
+penis by a spider, and who subsequently exhibited violent symptoms
+simulating spinal meningitis, but ultimately recovered.  Kunst mentions
+a man of thirty-six who received several bee-stings while taking some
+honey from a tree, fell from the tree unconscious, and for some time
+afterward exhibited signs of cerebral congestion. Chaumeton mentions a
+young man who did not perceive a wasp in a glass of sweet wine, and
+swallowed the insect. He was stung in the throat, followed by such
+intense inflammation that the man died asphyxiated in the presence of
+his friends, who could do nothing to relieve him. In connection with
+this case there is mentioned an English agriculturist who saved the
+life of one of his friends who had inadvertently swallowed a wasp with
+a glass of beer. Alarming symptoms manifested themselves at the moment
+of the sting. The farmer made a kind of paste from a solution of common
+salt in as little water as possible, which he gave to the young man,
+and, after several swallows of the potion, the symptoms disappeared as
+if by enchantment. There is a recent account from Bridgeport, Conn., of
+a woman who, while eating a pear, swallowed a hornet that had alighted
+on the fruit. In going down the throat the insect stung her on the
+tonsil. Great pain and inflammation followed, and in a short time there
+was complete deprivation of the power of speech.
+
+Mease relates the case of a corpulent farmer who, in July, 1835, was
+stung upon the temple by a common bee. He walked to a fence a short
+distance away, thence to his house, 20 yards distant, lay down, and
+expired in ten minutes. A second case, which occurred in June, 1811, is
+also mentioned by Mease. A vigorous man was stung in the septum of the
+nose by a bee. Supported by a friend he walked to his house, a few
+steps distant, and lay down. He rose immediately to go to the well,
+stepped a few paces, fell, and expired. It was thirty minutes from the
+time of the accident to the man's death. A third case is reported by
+the same author from Kentucky. A man of thirty-five was stung on the
+right superior palpebrum, and died in twenty minutes. Mease reports a
+fourth ease from Connecticut, in which a man of twenty-six was stung by
+a bee on the tip of the nose. He recovered after treatment with
+ten-grain doses of Dover's Powder, and persistent application of
+plantain leaves. A fifth case was that of a farmer in Pennsylvania who
+was stung in the left side of the throat by a wasp which he had
+swallowed in drinking cider. Notwithstanding medical treatment, death
+ensued twenty-seven hours afterward. A sixth case, which occurred in
+October, 1834, is given by the same author. A middle-aged man was stung
+by a yellow wasp on the middle finger of the right hand, and died in
+less than twenty minutes after having received his wound. A seventh
+case was that of a New York farmer who, while hoeing, was bitten on the
+foot by a spider. Notwithstanding medical treatment, principally
+bleeding, the man soon expired.
+
+Desbrest mentions the sting of a bee above the eyebrow followed by
+death. Zacutus saw a bee-sting which was followed by gangrene.
+Delaistre mentions death from a hornet-sting in the palate.  Nivison
+relates the case of a farmer of fifty who was stung in the neck by a
+bee. The usual swelling and discoloration did not follow, but
+notwithstanding vigorous medical treatment the man died in six days.
+Thompson relates three cases of bee-sting, in all of which death
+supervened within fifteen minutes,--one in a farmer of fifty-eight who
+was stung in the neck below the right ear; a second in an inn-keeper of
+fifty who was stung in the neck, and a third of a woman of sixty-four
+who was stung on the left brow. "Chirurgus" recalls the details of a
+case of a wasp-sting in the middle finger of the right hand of a man of
+forty, depriving him of all sense and of muscular power. Ten minutes
+after receiving it he was unconscious, his heart-beats were feeble, and
+his pulse only perceptible.
+
+Syphilis from a Flea-bite.--Jonathan Hutchinson, in the October, 1895,
+number of his unique and valuable Archives of Surgery, reports a
+primary lesion of most unusual origin. An elderly member of the
+profession presented himself entirely covered with an evident
+syphilitic eruption, which rapidly disappeared under the use of
+mercury. The only interest about the case was the question as to how
+the disease had been acquired. The doctor was evidently anxious to give
+all the information in his power, but was positive that he had never
+been exposed to any sexual risk, and as he had retired from practice,
+no possibility of infection in that manner existed. He willingly
+stripped, and a careful examination of his entire body surface revealed
+no trace of lesion whatever on the genitals, or at any point, except a
+dusky spot on one leg, which looked like the remains of a boil. This,
+the doctor stated, had been due to a small sore, the dates of the
+appearance and duration of which were found to fit exactly with those
+of a primary lesion. There had also been some enlargement of the
+femoral glands. He had never thought of the sore in this connection,
+but remembered most distinctly that it followed a flea-bite in an
+omnibus, and had been caused, as he supposed, by his scratching the
+place, though he could not understand why it lasted so long. Mr.
+Hutchinson concludes that all the evidence tends to show that the
+disease had probably been communicated from the blood of an infected
+person through the bite of the insect. It thus appears that even the
+proverbially trivial fleabite may at times prove a serious injury.
+
+Snake-bites.--A writer in an Indian paper asserts that the traditional
+immunity of Indian snake-charmers is due to the fact that having been
+accidentally bitten by poisonous serpents or insects more than once,
+and having survived the first attack, they are subsequently immune. His
+assertion is based on personal acquaintance with Madari Yogis and
+Fakirs, and an actual experiment made with a Mohammedan Fakir who was
+immune to the bites of scorpions provided by the writer. The animals
+were from five to seven inches long and had lobster-like claws. Each
+bite drew blood, but the Fakir was none the worse.
+
+The venom of poisonous snakes may be considered the most typical of
+animal poisons, being unrivaled in the fatality and rapidity of its
+action. Fortunately in our country there are few snake-bites, but in
+the tropic countries, particularly India, the mortality from this cause
+is frightful. Not only are there numerous serpents in that country, but
+the natives are lightly dressed and unshod, thus being exposed to the
+bites of the reptiles. It is estimated by capable authorities that the
+deaths in India each year from snake-bites exceed 20,000. It is stated
+that there were 2893 human beings killed by tigers, leopards, hyenas,
+and panthers in India during the year 1894, and in the same year the
+same species of beasts, aided by snakes, killed 97,371 head of cattle.
+The number of human lives destroyed by snakes in India in 1894 was
+21,538. The number of wild beasts killed in the same year was 13,447,
+and the number of snakes killed was 102,210.
+
+Yarrow of Washington, who has been a close student of this subject, has
+found in this country no less than 27 species of poisonous snakes,
+belonging to four genera. The first genus is the Crotalus, or
+rattlesnake proper; the second is the Caudisona, or ground-rattlesnake;
+the third is the Ancistrodon, or moccasin, one of the species of which
+is a water-snake; and the fourth is the Elaps, or harlequin snake.
+There is some dispute over the exact degree of the toxic qualities of
+the venom of the Heloderma suspectum, or Gila monster. In India the
+cobra is the most deadly snake. It grows to the length of 5 1/2 feet,
+and is most active at night. The Ophiophagus, or hooded cobra, is one
+of the largest of venomous snakes, sometimes attaining a length of 15
+feet; it is both powerful, active, and aggressive. The common snakes of
+the deadly variety in the United States are the rattlesnake, the
+"copperhead," and the moccasin; and it is from the bites of one of
+these varieties that the great majority of reported deaths are caused.
+But in looking over medical literature one is struck with the scarcity
+of reports of fatal snake-bites. This is most likely attributable to
+the fact that, except a few army-surgeons, physicians rarely see the
+cases. The natural abode of the serpents is in the wild and uninhabited
+regions.
+
+The venom is delivered to the victim through the medium of a long fang
+which is connected with a gland in which the poison is stored. The
+supply may be readily exhausted; for a time the bite would then be
+harmless. Contrary to the general impression, snake-venom when
+swallowed is a deadly poison, as proved by the experiments of Fayrer,
+Mitchell, and Reichert. Death is most likely caused by paralysis of the
+vital centers through the circulation. In this country the wounds
+invariably are on the extremities, while in India the cobra sometimes
+strikes on the shoulder or neck.
+
+If called on to describe accurately the symptoms of snake-venom
+poisoning, few medical men could respond correctly. In most cases the
+wound is painful, sometimes exaggerated by the mental condition, which
+is wrought up to a pitch rarely seen in other equally fatal injuries.
+It is often difficult to discern the exact point of puncture, so minute
+is it. There is swelling due to effusion of blood, active inflammation,
+and increasing pain.  If the poison has gained full entrance into the
+system, in a short time the swelling extends, vesicles soon form, and
+the disorganization of the tissues is so rapid that gangrene is liable
+to intervene before the fatal issue. The patient becomes prostrated
+immediately after the infliction of the wound, and his condition
+strongly indicates the use of stimulants, even if the medical attendant
+were unfamiliar with the history of the snake-bite. There may be a
+slight delirium; the expression becomes anxious, the pulse rapid and
+feeble, the respiration labored, and the patient complains of a sense
+of suffocation.  Coma follows, and the respirations become slower and
+slower until death results. If the patient lives long enough, the
+discoloration of the extremity and the swelling may spread to the neck,
+chest and back. Loss of speech after snake-bite is discussed in Chapter
+XVII, under the head of Aphasia.
+
+A peculiar complication is a distressing inflammation of the mouth of
+individuals that have sucked the wounds containing venom. This custom
+is still quite common, and is preferred by the laity to the surer and
+much wiser method of immediate cauterization by fire. There is a
+curious case reported of a young man who was bitten on the ankle by a
+viper; he had not sucked the wound, but he presented such an enormous
+swelling of the tongue as to be almost provocative of a fatal issue. In
+this case the lingual swelling was a local effect of the general
+constitutional disturbance.
+
+Cases of Snake-bite.--The following case illustrative of the tenacity
+of virulence of snake-venom was reported by Mr. Temple, Chief Justice
+of Honduras, and quoted by a London authority.  While working at some
+wood-cutting a man was struck on a heavy boot by a snake, which he
+killed with an axe. He imagined that he had been efficiently protected
+by the boot, and he thought little of the incident. Shortly afterward
+he began to feel ill, sank into a stupor, and succumbed. His boots were
+sold after his death, as they were quite well made and a luxury in that
+country.  In a few hours the purchaser of the boots was a corpse, and
+every one attributed his death to apoplexy or some similar cause. The
+boots were again sold, and the next unfortunate owner died in an
+equally short time. It was then thought wise to examine the boots, and
+in one of them was found, firmly embedded, the fang of the serpent. It
+was supposed that in pulling on the boots each of the subsequent owners
+had scratched himself and became fatally inoculated with the venom,
+which was unsuspected and not combated. The case is so strange as to
+appear hypothetic, but the authority seems reliable.
+
+The following are three cases of snake-bite reported by surgeons of the
+United States Army, two followed by recovery, and the other by death:
+Middleton mentions a private in the Fourth Cavalry, aged twenty-nine,
+who was bitten by a rattlesnake at Fort Concho, Texas, June 27, 1866.
+The bite opened the phalangeal joint of the left thumb, causing violent
+inflammation, and resulted in the destruction of the joint. Three years
+afterward the joint swelled and became extremely painful, and it was
+necessary to amputate the thumb. Campbell reports the case of a private
+of the Thirteenth Infantry who was bitten in the throat by a large
+rattlesnake. The wound was immediately sucked by a comrade, and the man
+reported at the Post Hospital, at Camp Cooke, Montana, three hours
+after the accident. The only noticeable appearance was a slightly wild
+look about the eyes, although the man did not seem to be the least
+alarmed. The region of the wound was hard and somewhat painful,
+probably from having been bruised by the teeth of the man who sucked
+the wound; it remained so for about three hours. The throat was bound
+up in rancid olive oil (the only kind at hand) and no internal remedy
+was administered. There were no other bad consequences, and the patient
+soon returned to duty.
+
+Le Carpentier sends the report of a fatal case of rattlesnake-bite: A
+private, aged thirty-seven, remarkable for the singularity of his
+conduct, was known in his Company as a snake-charmer, as he had many
+times, without injury, handled poisonous snakes. On the morning of July
+13, 1869, he was detailed as guard with the herd at Fort Cummings, New
+Mexico, when, in the presence of the herders, he succeeded in catching
+a rattlesnake and proving his power as a sorcerer. The performance
+being over and the snake killed, he caught sight of another of the same
+class, and tried to duplicate his previous feat; but his dexterity
+failed, and he was bitten in the middle finger of the right hand. He
+was immediately admitted to the Post Hospital, complaining only of a
+little pain, such as might follow the sting of a bee or wasp. A
+ligature was applied above the wound; the two injuries made by the
+fangs were enlarged by a bistoury; ammonia and the actual cautery were
+applied; large doses of whiskey were repeated frequently, the
+constitution of the patient being broken and poor. Vomiting soon came
+on but was stopped without trouble, and there were doubts from the
+beginning as to his recovery. The swelling of the hand and arm
+gradually increased, showing the particular livid and yellowish tint
+following the bites of poisonous snakes. A blister was applied to the
+bitten finger, tincture of iodin used, and two ounces of whiskey given
+every two hours until inebriety was induced. The pulse, which was very
+much reduced at first, gained gradually under the influence of
+stimulants; two grains of opium were given at night, the patient slept
+well, and on the next day complained only of numbness in the arm. The
+swelling had extended as far as the shoulder-joint, and the blood,
+which was very fluid, was incessantly running from the wound. Carbolic
+acid and cerate were applied to the arm, with stimulants internally. On
+the 15th his condition was good, the swelling had somewhat augmented,
+there was not so much lividity, but the yellowish hue had increased. On
+the 16th the man complained of pain in the neck, on the side of the
+affected limb, but his general condition was good. Examining his
+genitals, an iron ring 3/4 inch in diameter was discovered, imbedded in
+the soft tissues of the penis, constricting it to such a degree as to
+have produced enormous enlargement of the parts. Upon inquiry it seemed
+that the ring had been kept on the parts very long, as a means of
+preservation of chastity; but under the influence of the snake's venom
+the swelling had increased, and the patient having much trouble in
+passing water was obliged to complain. The ring was filed off with some
+difficulty. Gangrene destroyed the extremity of the bitten finger. From
+this date until the 30th the man's condition improved somewhat. The
+progress of the gangrene was stopped, and the injured finger was
+disarticulated at the metacarpal articulation. Anesthesia was readily
+obtained, but the appearance of the second stage was hardly
+perceptible. Le Carpentier was called early on the next morning, the
+patient having been observed to be sinking; there was stertorous
+respiration, the pulse was weak and slow, and the man was only partly
+conscious. Electricity was applied to the spine, and brandy and
+potassium bromid were given, but death occurred about noon. A necropsy
+was made one hour after death. There was general softening of the
+tissues, particularly on the affected side. The blood was black and
+very fluid,--not coagulable. The ventricles of the brain were filled
+with a large amount of serum; the brain was somewhat congested. The
+lungs were healthy, with the exception of a few crude tubercles of
+recent formation on the left side. The right ventricle of the heart was
+empty, and the left filled with dark blood, which had coagulated. The
+liver and kidneys were healthy, and the gall-bladder very much
+distended with bile. The intestines presented a few livid patches on
+the outside.
+
+Hydrophobia.--The bite of an enraged animal is always of great danger
+to man, and death has followed a wound inflicted by domestic animals or
+even fowls; a human bite has also caused a fatal issue. Rabies is
+frequently observed in herbivorous animals, such as the ox, cow, or
+sheep, but is most commonly found in the carnivore, such as the dog,
+wolf, fox, jackal, hyena, and cat and other members of the feline
+tribe. Fox reports several cases of death from symptoms resembling
+those of hydrophobia in persons who were bitten by skunks. Swine,
+birds, and even domestic poultry have caused hydrophobia by their
+bites.  Le Cat speaks of the bite of an enraged duck causing death, and
+Thiermeyer mentions death shortly following the bite of a goose, as
+well as death in three days from a chicken-bite. Camerarius describes a
+case of epilepsy which he attributed to a horse-bite.  Among the older
+writers speaking of death following the bite of an enraged man, are van
+Meek'ren, Wolff, Zacutus Lusitanus, and Glandorp. The Ephemerides
+contains an account of hydrophobia caused by a human bite. Jones
+reports a case of syphilitic inoculation from a human bite on the hand.
+
+Hydrophobia may not necessarily be from a bite; a previously-existing
+wound may be inoculated by the saliva alone, conveyed by licking.
+Pliny, and some subsequent writers, attributed rabies to a worm under
+the animal's tongue which they called "lytta." There is said to be a
+superstition in India that, shortly after being bitten by a mad dog,
+the victim conceives pups in his belly; at about three months these
+move rapidly up and down the patient's intestines, and being mad like
+their progenitor, they bite and bark incessantly, until they finally
+kill the unfortunate victim. The natives of Nepaul firmly believe this
+theory. All sorts of curious remedies have been suggested for the cure
+of hydrophobia. Crabs-claws, Spanish fly, and dragon roots, given three
+mornings before the new or full moon, was suggested as a specific by
+Sir Robert Gordon. Theodore De Vaux remarks that the person bitten
+should immediately pluck the feathers from the breech of an old cock
+and apply them bare to the bites. If the dog was mad the cock was
+supposed to swell and die. If the dog was not mad the cock would not
+swell; in either case the person so treated was immune. Mad-stones, as
+well as snake-stones, are believed in by some persons at the present
+day.  According to Curran, at one time in Ireland the fear of
+hydrophobia was so great that any person supposed to be suffering from
+it could be legally smothered.
+
+According to French statistics, hydrophobia is an extremely fatal
+disease, although the proportion of people bitten and escaping without
+infection is overwhelmingly greater than those who acquire the disease.
+The mortality of genuine hydrophobia is from 30 to 80 per cent,
+influenced by efficient and early cauterization and scientific
+treatment. There is little doubt that many of the cases reported as
+hydrophobia are merely examples of general systemic infection from a
+local focus of sepsis, made possible by some primitive and uncleanly
+treatment of the original wound. There is much superstition relative to
+hydrophobia; the majority of wounds seen are filled with the hair of
+the dog, soot, ham-fat, and also with particles of decayed food and
+saliva from the mouth of some person who has practiced sucking the
+wound.
+
+Ordinarily, the period of incubation of hydrophobia in man is before
+the end of the second month, although rarely cases are seen as many as
+six months from the reception of the bite. The first symptoms of the
+disease are melancholia, insomnia, loss of appetite, and occasionally
+shooting pains, radiating from the wound. There may be severe pain at
+the back of the head and in the neck. Difficulty in swallowing soon
+becomes a marked symptom.  The speech assumes a sobbing tone, and
+occasionally the expression of the face is wild and haggard. As regards
+the crucial diagnostic test of a glass of water, the following account
+of a patient's attempt to drink is given by Curtis and quoted by
+Warren: "A glass of water was offered the patient, which he refused to
+take, saying that he could not stand so much as that, but would take it
+from a teaspoon. On taking the water from the spoon he evinced some
+discomfort and agitation, but continued to raise the spoon. As it came
+within a foot of his lips, he gagged and began to gasp violently, his
+features worked, and his head shook. He finally almost tossed the water
+into his mouth, losing the greater part of it, and staggered about the
+room gasping and groaning. At this moment the respirations seemed
+wholly costal, and were performed with great effort, the elbows being
+jerked upward with every inspiration. The paroxysm lasted about half a
+minute. The act of swallowing did not appear to cause distress, for he
+could go through the motions of deglutition without any trouble. The
+approach of liquid toward the mouth would, however, cause distress." It
+is to be remarked that the spasm affects the mechanism of the
+respiratory apparatus, the muscles of mastication and deglutition being
+only secondarily contracted.
+
+Pasteur discovered that the virulence of the virus of rabies could be
+attenuated in passing it through different species of animals, and also
+that inoculation of this attenuated virus had a decided prophylactic
+effect on the disease; hence, by cutting the spinal cord of inoculated
+animals into fragments a few centimeters long, and drying them, an
+emulsion could be made containing the virus. The patients are first
+inoculated with a cord fourteen days old, and the inoculation is
+repeated for nine days, each time with a cord one day fresher. The
+intensive method consists in omitting the weakest cords and giving the
+inoculations at shorter intervals. As a curious coincidence, Pliny and
+Pasteur, the ancient and modern, both discuss the particular virulence
+of saliva during fasting.
+
+There is much discussion over the extent of injury a shark-bite can
+produce. In fact some persons deny the reliability of any of the
+so-called cases of shark-bites. Ensor reports an interesting case
+occurring at Port Elizabeth, South Africa. While bathing, an expert
+swimmer felt a sharp pain in the thigh, and before he could cry out,
+felt a horrid crunch and was dragged below the surface of the water. He
+struggled for a minute, was twisted about, shaken, and then set free,
+and by a supreme effort, reached the landing stairs of the jetty,
+where, to his surprise, he found that a monstrous shark had bitten his
+leg off. The leg had been seized obliquely, and the teeth had gone
+across the joints, wounding the condyles of the femur. There were three
+marks on the left side showing where the fish had first caught him. The
+amputation was completed at once, and the man recovered.  Macgrigor
+reports the case of a man at a fishery, near Manaar, who was bitten by
+a shark. The upper jaw of the animal was fixed in the left side of the
+belly, forming a semicircular wound of which a point one inch to the
+left of the umbilicus was the upper boundary, and the lower part of the
+upper third of the thigh, the lower boundary. The abdominal and lumbar
+muscles were divided and turned up, exposing the colon in its passage
+across the belly.  Several convolutions of the small intestines were
+also laid bare, as were also the three lowest ribs. The gluteal muscles
+were lacerated and torn, the tendons about the trochanter divided,
+laying the bone bare, and the vastus externus and part of the rectus of
+the thigh were cut across. The wound was 19 inches in length and four
+or five inches in breadth. When Dr. Kennedy first saw the patient he
+had been carried in a boat and then in a palanquin for over five miles,
+and at this time, three hours after the reception of the wound, Kennedy
+freed the abdominal cavity of salt water and blood, thoroughly cleansed
+the wound of the hair and the clots, and closed it with adhesive
+strips. By the sixteenth day the abdominal wound had perfectly closed,
+the lacerations granulated healthily, and the man did well. Boyle
+reports recovery from extensive lacerated wounds from the bite of a
+shark. Both arms were amputated as a consequence of the injuries.
+Fayrer mentions shark-bites in the Hooghley.
+
+Leprosy from a Fish-bite.--Ashmead records the curious case of a man
+that had lived many years in a leprous country, and while dressing a
+fish had received a wound of the thumb from the fin of the fish.
+Swelling of the arm followed, and soon after bullae upon the chest,
+head, and face. In a few months the blotches left from this eruption
+became leprous tubercles, and other well-marked signs of the malady
+followed. The author asked if in this case we have to do with a latent
+leprosy which was evoked by the wound, or if it were a case of
+inoculation from the fish?
+
+Cutliffe records recovery after amputation at the elbow-joint, as a
+consequence of an alligator-bite nine days before admission to the
+hospital. The patient exhibited a compound comminuted fracture of the
+right radius and ulna in their lower thirds, compound comminuted
+fractures of the bones of the carpus and metacarpus, with great
+laceration of the soft parts, laying bare the wrist-joint, besides
+several penetrating wounds of the arm and fore-arm. Mourray gives some
+notes on a case of crocodile-bite with removal of a large portion of
+omentum. Sircar speaks of recovery from a crocodile-bite. Dudgeon
+reports two cases of animal-bites, both fatal, one by a bear, and the
+other by a camel. There is mention of a compound dislocation of the
+wrist-joint from a horse-bite. Fayrer speaks of a wolf-bite of the
+forearm, followed by necrosis and hemorrhage, necessitating ligature of
+the brachial artery and subsequent excision of the elbow-joint.
+
+Injuries from Lightning.--The subject of lightning-stroke, with its
+diverse range of injuries, is of considerable interest, and, though not
+uncommon, the matter is surrounded by a veil of superstition and
+mystery. It is well known that instantaneous or temporary
+unconsciousness may result from lightning-stroke.  Sometimes
+superficial or deep burns may be the sole result, and again paralysis
+of the general nerves, such as those of sensation and motion, may be
+occasioned. For many years the therapeutic effect of a lightning-stroke
+has been believed to be a possibility, and numerous instances are on
+record. The object of this article will be to record a sufficient
+number of cases of lightning-stroke to enable the reader to judge of
+its various effects, and form his own opinion of the good or evil of
+the injury. It must be mentioned here that half a century ago Le Conte
+wrote a most extensive article on this subject, which, to the present
+time, has hardly been improved upon.
+
+The first cases to be recorded are those in which there has been
+complete and rapid recovery from lightning-stroke. Crawford mentions a
+woman who, while sitting in front of her fireplace on the first floor
+of a two-story frame building, heard a crash about her, and realized
+that the house had been struck by lightning. The lightning had torn all
+the weather-boarding off the house, and had also followed a spouting
+which terminated in a wooden trough in a pig-sty, ten feet back of the
+house, and killed a pig. Another branch of the fluid passed through the
+inside of the building and, running along the upper floor to directly
+over where Mrs. F. was sitting, passed through the floor and descended
+upon the top of her left shoulder. Her left arm was lying across her
+abdomen at the time, the points of the fingers resting on the crests of
+the ilium. There was a rent in the dress at the top of the shoulder,
+and a red line half an inch wide running from thence along the inside
+of the arm and fore-arm. In some places there was complete vesication,
+and on its palmer surface the hand lying on the abdomen was completely
+denuded. The abdomen, for a space of four inches in length and eight
+inches in breadth, was also blistered. The fluid then passed from the
+fingers to the crest of the ilium, and down the outside of the leg,
+bursting open the shoes, and passing then through the floor.  Again a
+red line half an inch wide could be traced from the ilium to the toes.
+The clothing was not scorched, but only slightly rent at the point of
+the shoulder and where the fingers rested.  This woman was neither
+knocked off her chair nor stunned, and she felt no shock at the time.
+After ordinary treatment for her burns she made rapid and complete
+recovery.
+
+Halton reports the history of a case of a woman of sixty-five who,
+about thirty-five minutes before he saw her, had been struck by
+lightning. While she was sitting in an outbuilding a stroke of
+lightning struck and shattered a tree about a foot distant. Then,
+leaving the tree about seven feet from the ground, it penetrated the
+wall of the building, which was of unplastered frame, and struck Mrs.
+P. on the back of the head, at a point where her hair was done up in a
+knot and fastened by two ordinary hair-pins. The hair was much
+scorched, and under the knot the skin of the scalp was severely burned.
+The fluid crossed, burning her right ear, in which was a gold ear-ring,
+and then passed over her throat and down the left sternum, leaving a
+burn three inches wide, covered by a blister. There was another burn,
+12 inches long and three inches wide, passing from just above the crest
+of the ilium forward and downward to the symphysis pubis. The next burn
+began at the patella of the right knee, extending to the bottom of the
+heel, upon reaching which it wound around the inner side of the leg.
+About four inches below the knee a sound strip of cuticle, about 1 1/2
+inches, was left intact. The lightning passed off the heel of the foot,
+bursting open the heel of a strongly sewed gaiter-boot. The woman was
+rendered unconscious but subsequently recovered.
+
+A remarkable feature of a lightning-stroke is the fact that it very
+often strips the affected part of its raiment, as in the previous case
+in which the shoe was burst open. In a discussion before the Clinical
+Society of London, October 24 1879, there were several instances
+mentioned in which clothes had been stripped off by lightning. In one
+case mentioned by Sir James Paget, the clothes were wet and the man's
+skin was reeking with perspiration. In its course the lightning
+traveled down the clothes, tearing them posteriorly, and completely
+stripping the patient. The boots were split up behind and the laces
+torn out.  This patient, however, made a good recovery. Beatson
+mentions an instance in which an explosion of a shell completely tore
+off the left leg of a sergeant instructor, midway between the knee and
+ankle. It was found that the foot and lower third of the leg had been
+completely denuded of a boot and woolen stocking, without any apparent
+abrasion or injury to the skin. The stocking was found in the battery
+and the boot struck a person some distance off. The stocking was much
+torn, and the boot had the heel missing, and in one part the sole was
+separated from the upper.  The laces in the upper holes were broken but
+were still present in the lower holes. The explanation offered in this
+case is similar to that in analogous cases of lightning-stroke, that
+is, that the gas generated by the explosion found its way between the
+limb and the stocking and boot and stripped them off.
+
+There is a curious collection of relics, consisting of the clothes of a
+man struck by lightning, artistically hung in a glass case in the
+Museum of the Royal College of Surgeons, London, and the history of the
+injury, of which these remnants are the result, is given by Professor
+Stewart, the curator, as follows: At half past four on June 8, 1878,
+James Orman and others were at work near Snave, in Romney Marsh, about
+eight miles from Ashford. The men were engaged in lopping willows, when
+the violence of the rain compelled them to take refuge under a hedge.
+Three of the men entered a shed near by, but Orman remained by the
+willow, close to the window of the shed. Scarcely were the three inside
+when a lightning-stroke entered the door, crossed the shed, and passed
+out the window, which it blew before it into the field. The men noticed
+that the tree under which Orman stood was stripped of its bark. Their
+companion's boots stood close to the foot of the tree, while the man
+himself lay almost perfectly naked a few yards further on, calling for
+help.  When they left him a few moments previously, he was completely
+clad in a cotton shirt, cotton jacket, flannel vest, and cotton
+trousers, secured at the waist with leather straps and buckles.  Orman
+also wore a pair of stout hobnail boots, and had a watch and chain.
+After the lightning-stroke, however, all he had on him was the left arm
+of his flannel vest. The field was strewn for some distance with
+fragments of the unfortunate man's clothing.  Orman was thrown down,
+his eyebrows burned off, and his whiskers and beard much scorched. His
+chest was covered with superficial burns, and he had sustained a
+fracture of the leg. His strong boots were torn from his feet, and his
+watch had a hole burned right through it, as if a soldering iron had
+been used. The watch-chain was almost completely destroyed, only a few
+links remaining. Together with some fused coins, these were found close
+by, and are deposited in a closed box in the Museum. According to
+Orman's account of the affair, he first felt a violent blow on the
+chest and shoulders, and then he was involved in a blinding light and
+hurled into the air. He said he never lost consciousness; but when at
+the hospital he seemed very deaf and stupid. He was discharged
+perfectly cured twenty weeks after the occurrence. The scientific
+explanation of this amazing escape from this most eccentric vagary of
+the electric fluid is given,--the fact that the wet condition of the
+man's clothing increased its power of conduction, and in this way saved
+his life. It is said that the electric current passed down the side of
+Orman's body, causing everywhere a sudden production of steam, which by
+its expansion tore the clothing off and hurled it away.  It is a
+curious fact that where the flannel covered the man's skin the burns
+were merely superficial, whereas in those parts touched by the cotton
+trousers they were very much deeper. This case is also quoted and
+described by Dr. Wilks.
+
+There was a curious case of lightning-stroke reported at Cole Harbor,
+Halifax. A diver, while at work far under the surface of the water, was
+seriously injured by the transmission of a lightning-stroke, which
+first struck the communicating air pump to which the diver was
+attached. The man was brought to the surface insensible, but he
+afterward recovered.
+
+Permanent Effect of Lightning on the Nervous System.--MacDonald
+mentions a woman of seventy-eight who, some forty-two years previous,
+while ironing a cap with an Italian iron, was stunned by an extremely
+vivid flash of lightning and fell back unconscious into a chair. On
+regaining consciousness she found that the cap which she had left on
+the table, remote from the iron, was reduced to cinders. Her clothes
+were not burned nor were there any marks on the skin. After the stroke
+she felt a creeping sensation and numbness, particularly in the arm
+which was next to the table. She stated positively that in consequence
+of this feeling she could predict with the greatest certainty when the
+atmosphere was highly charged with electricity, as the numbness
+increased on these occasions. The woman averred that shortly before or
+during a thunder storm she always became nauseated. MacDonald offers as
+a physiologic explanation of this case that probably the impression
+produced forty-two years before implicated the right brachial plexus
+and the afferent branches of the pneumogastric, and to some degree the
+vomiting center in the medulla; hence, when the atmosphere was highly
+charged with electricity the structures affected became more readily
+impressed. Camby relates the case of a neuropathic woman of
+thirty-eight, two of whose children were killed by lightning in her
+presence. She herself was unconscious for four days, and when she
+recovered consciousness, she was found to be hemiplegic and
+hemianesthetic on the left side. She fully recovered in three weeks.
+Two years later, during a thunder storm, when there was no evidence of
+a lightning-stroke, she had a second attack, and three years later a
+third attack under similar circumstances.
+
+There are some ocular injuries from lightning on record. In these cases
+the lesions have consisted of detachment of the retina, optic atrophy,
+cataract, hemorrhages into the retina, and rupture of the choroid,
+paralysis of the oculomotor muscles, and paralysis of the optic nerve.
+According to Buller of Montreal, such injuries may arise from the
+mechanic violence sustained by the patient rather than by the thermal
+or chemic action of the current. Buller describes a case of
+lightning-stroke in which the external ocular muscles, the crystalline
+lens, and the optic nerve were involved. Godfrey reports the case of
+Daniel Brown, a seaman on H.M.S. Cambrian. While at sea on February 21,
+1799, he was struck both dumb and blind by a lightning-stroke. There
+was evidently paralysis of the optic nerve and of the oculomotor
+muscles; and the muscles of the glottis were also in some manner
+deprived of motion.
+
+That an amputation can be perfectly performed by a lightning-stroke is
+exemplified in the case of Sycyanko of Cracow, Poland. The patient was
+a boy of twelve, whose right knee was ankylosed. While riding in a
+field in a violent storm, a loud peal of thunder caused the horse to
+run away, and the child fell stunned to the ground. On coming to his
+senses the boy found that his right leg was missing, the parts having
+been divided at the upper end of the tibia. The wound was perfectly
+round and the patella and femur were intact. There were other signs of
+burns about the body, but the boy recovered. Some days after the injury
+the missing leg was found near the place where he was first thrown from
+the horse.
+
+The therapeutic effect of lightning-stroke is verified by a number of
+cases, a few of which will be given. Tilesius mentions a peculiar case
+which was extensively quoted in London. Two brothers, one of whom was
+deaf, were struck by lightning. It was found that the inner part of the
+right ear near the tragus and anti-helix of one of the individuals was
+scratched, and on the following day his hearing returned. Olmstead
+quotes the history of a man in Carteret County, N.C., who was seized
+with a paralytic affection of the face and eyes, and was quite unable
+to close his lids. While in his bedroom, he was struck senseless by
+lightning, and did not recover until the next day, when it was found
+that the paralysis had disappeared, and during the fourteen years which
+he afterward lived his affection never returned.  There is a record of
+a young collier in the north of England who lost his sight by an
+explosion of gunpowder, utterly destroying the right eye and fracturing
+the frontal bone. The vision of the left eye was lost without any
+serious damage to the organ, and this was attributed to shock. On
+returning from Ettingshall in a severe thunder storm, he remarked to
+his brother that he had seen light through his spectacles, and had
+immediately afterward experienced a piercing sensation which had passed
+through the eye to the back of the head. The pain was brief, and he was
+then able to see objects distinctly. From this occasion he steadily
+improved until he was able to walk about without a guide.
+
+Le Conte mentions the case of a negress who was struck by lightning
+August 19, 1842, on a plantation in Georgia. For years before the
+reception of the shock her health had been very bad, and she seemed to
+be suffering from a progressive emaciation and feebleness akin to
+chlorosis. The difficulty had probably followed a protracted
+amenorrhea, subsequent to labor and a retained placenta In the course
+of a week she had recovered from the effects of lightning and soon
+experienced complete restoration to health; and for two years had been
+a remarkably healthy and vigorous laborer. Le Conte quotes five similar
+cases, and mentions one in which a lightning-shock to a woman of
+twenty-nine produced amenorrhea, whereas she had previously suffered
+from profuse menstruation, and also mentions another case of a woman of
+seventy who was struck unconscious; the catamenial discharge which had
+ceased twenty years before, was now permanently reestablished, and the
+shrunken mammae again resumed their full contour.
+
+A peculiar feature or superstition as to lightning-stroke is its
+photographic properties. In this connection Stricker of Frankfort
+quotes the case of Raspail of a man of twenty-two who, while climbing a
+tree to a bird's nest, was struck by lightning, and afterward showed
+upon his breast a picture of the tree, with the nest upon one of its
+branches. Although in the majority of cases the photographs resembled
+trees, there was one case in which it resembled a horse-shoe; another,
+a cow; a third, a piece of furniture; a fourth, the whole surrounding
+landscape. This theory of lightning-photographs of neighboring objects
+on the skin has probably arisen from the resemblance of the burns due
+to the ramifications of the blood-vessels as conductors, or to peculiar
+electric movements which can be demonstrated by positive charges on
+lycopodium powder.
+
+A lightning-stroke does not exhaust its force on a few individuals or
+objects, but sometimes produces serious manifestations over a large
+area, or on a great number of people.  It is said that a church in the
+village of Chateauneuf, in the Department of the Lower Alps, in France,
+was struck by three successive lightning strokes on July 11, 1819,
+during the installation of a new pastor. The company were all thrown
+down, nine were killed and 82 wounded. The priest, who was celebrating
+mass, was not affected, it is believed, on account of his silken robe
+acting as an insulator. Bryant of Charlestown, Mass., has communicated
+the particulars of a stroke of lightning on June 20, 1829, which
+shocked several hundred persons. The effect of this discharge was felt
+over an area of 172,500 square feet with nearly the same degree of
+intensity. Happily, there was no permanent injury recorded. Le Conte
+reports that a person may be killed when some distance--even as far as
+20 miles away from the storm--by what Lord Mahon calls the "returning
+stroke."
+
+Skin-grafting is a subject which has long been more or less familiar to
+medical men, but which has only recently been developed to a
+practically successful operation. The older surgeons knew that it was
+possible to reunite a resected nose or an amputated finger, and in
+Hunter's time tooth-replantation was quite well known. Smellie has
+recorded an instance in which, after avulsion of a nipple in suckling,
+restitution was effected.  It is not alone to the skin that grafting is
+applicable; it is used in the cornea, nerves, muscles, bones, tendons,
+and teeth.  Wolfer has been successful in transplanting the mucous
+membranes of frogs, rabbits, and pigeons to a portion of mucous
+membrane previously occupied by cicatricial tissue, and was the first
+to show that on mucous surfaces, mucous membrane remains mucous
+membrane, but when transplanted to skin, it becomes skin.  Attempts
+have been made to transplant a button of clear cornea of a dog, rabbit,
+or cat to the cornea of a human being, opaque as the result of
+ophthalmia, and von Hippel has devised a special method of doing this.
+Recently Fuchs has reported his experience in cornea-grafting in
+sections, as a substitute for von Hippel's method, in parenchymatous
+keratitis and corneal staphyloma, and though not eminently successful
+himself, he considers the operation worthy of trial in cases that are
+without help, and doomed to blindness.
+
+John Hunter was the first to perform the implantation of teeth; and
+Younger the first to transplant the teeth of man in the jaws of man;
+the initial operation should be called replantation, as it was merely
+the replacement of a tooth in a socket from which it had accidentally
+or intentionally been removed. Hunter drilled a hole in a cock's comb
+and inserted a tooth, and held it by a ligature. Younger drilled a hole
+in a man's jaw and implanted a tooth, and proved that it was not
+necessary to use a fresh tooth.  Ottolengni mentions the case of a man
+who was struck by a ruffian and had his two central incisors knocked
+out. He searched for them, washed them in warm water, carefully washed
+the teeth-sockets, and gently placed the teeth back in their position,
+where they remained firmly attached. At the time of report, six years
+after the accident, they were still firmly in position. Pettyjohn
+reports a successful case of tooth-replantation in his young daughter
+of two, who fell on the cellar stairs, completely excising the central
+incisors. The alveolar process of the right jaw was fractured, and the
+gum lacerated to the entire length of the root. The teeth were placed
+in a tepid normal saline solution, and the child chloroformed, narcosis
+being induced in sleep; the gums were cleaned antiseptically, and 3 1/2
+hours afterward the child had the teeth firmly in place. They had been
+out of the mouth fully an hour.  Four weeks afterward they were as firm
+as ever. By their experiments Gluck and Magnus prove that there is a
+return of activity after transplantation of muscle. After excision of
+malignant tumors of muscles, Helferich of Munich, and Lange of New
+York, have filled the gap left by the excision of the muscle affected
+by the tumor with transplanted muscles from dogs. Gluck has induced
+reproduction of lost tendons by grafting them with cat-gut, and
+according to Ashhurst, Peyrot has filled the gaps in retracted tendons
+by transplanting tendons, taken in one case from a dog, and in another
+from a cat.
+
+Nerve-grafting, as a supplementary operation to neurectomy, has been
+practiced, and Gersung has transplanted the nerves of lower animals to
+the nerve stumps of man.
+
+Bone-grafting is quite frequently practiced, portions from a recently
+amputated limb, or portions removed from living animals, or bone-chips,
+may be used. Senn proposed decalcified bone-plates to be used to fill
+in the gaps. Shifting of the bone has been done, e.g., by dividing a
+strip of the hard palate covered with its soft parts, parallel to the
+fissure in cleft palate, but leaving unsevered the bony attachments in
+front, and partially fracturing the pedicle, drawing the bony flaps
+together with sutures; or, when forming a new nose, by turning down
+with the skin and periosteum the outer table of the frontal bone, split
+off with a chisel, after cutting around the part to be removed.
+Trueheart reports a case of partial excision of the clavicle,
+successfully followed by the grafting of periosteal and osseous
+material taken from a dog. Robson and Hayes of Rochester, N.Y., have
+successfully supplemented excision of spina bifida by the
+transplantation of a strip of periosteum from a rabbit. Poncet hastened
+a cure in a case of necrosis with partial destruction of the periosteum
+by inserting grafts taken from the bones of a dead infant and from a
+kid. Ricketts speaks of bone-grafting and the use of ivory, and remarks
+that Poncet of Lyons restored a tibia in nine months by grafting to the
+superior articular surface.  Recently amalgam fillings have been used
+in bone-cavities to supplant grafting.
+
+In destructive injuries of the skin, various materials were formerly
+used in grafting, none of which, however, have produced the same good
+effect as the use of skin by the Thiersch Method, which will be
+described later.
+
+Rodgers, U.S.N., reports the case of a white man of thirty-eight who
+suffered from gangrene of the skin of the buttocks caused by sitting in
+a pan of caustic potash. When seen the man was intoxicated, and there
+was a gangrenous patch four by six inches on his buttocks. Rodgers used
+grafts from the under wing of a young fowl, as suggested by Redard,
+with good result. Vanmeter of Colorado describes a boy of fourteen with
+a severe extensive burn; a portion beneath the chin and lower jaw, and
+the right arm from the elbow to the fingers, formed a granulating
+surface which would not heal, and grafting was resorted to. The
+neck-grafts were supplied by the skin of the father and brother, but
+the arm-grafts were taken from two young puppies of the Mexican
+hairless breed, whose soft, white, hairless skin seemed to offer itself
+for the purpose with good prospect of a successful result.  The outcome
+was all that could be desired. The puppy-grafts took faster and proved
+themselves to be superior to the skin-grafts.  There is a case reported
+in which the skin of a greyhound seven days old, taken from the
+abdominal wall and even from the tail, was used with most satisfactory
+results in grafting an extensive ulcer following a burn on the left leg
+of a boy of ten. Masterman has grafted with the inner membrane of a
+hen's egg, and a Mexican surgeon, Altramirano, used the gills of a cock.
+
+Fowler of Brooklyn has grafted with the skin from the back and abdomen
+of a large frog. The patient was a colored boy of sixteen, who was
+extensively burned by a kerosene lamp. The burns were on the legs,
+thighs, buttocks, and right ankle, and the estimated area of burnt
+surface was 247.95 square inches. The frog skin was transferred to the
+left buttocks, and on the right buttocks eight long strips of white
+skin were transferred after the manner of Thiersch. A strip of human
+skin was placed in one section over the frog skin, but became necrotic
+in four days, not being attached to the granulating surface. The man
+was discharged cured in six months. The frog skin was soft, pliable,
+and of a reddish hue, while the human white skin was firm and rapidly
+becoming pigmented. Leale cites the successful use of common warts in a
+case of grafting on a man of twenty who was burned on the foot by a
+stream of molten metal. Leale remarks that as common warts of the skin
+are collections of vascular papillae, admitting of separation without
+injury to their exceptionally thick layer of epidermis, they are
+probably better for the purposes of skin-grafting than ordinary skin of
+less vitality or vascularity. Ricketts has succeeded in grafting the
+skin of a frog to that of a tortoise, and also grafting frog skin to
+human skin. Ricketts remarks that the prepuce of a boy is remarkably
+good material for grafting. Sponge-grafts are often used to hasten
+cicatrization of integumental wounds. There is recorded an instance in
+which the breast of a crow and the back of a rat were grafted together
+and grew fast. The crow dragged the rat along, and the two did not seem
+to care to part company.
+
+Relative to skin-grafting proper, Bartens succeeded in grafting the
+skin of a dead man of seventy on a boy of fourteen. Symonds reports
+cases of skin-grafting of large flaps from amputated limbs, and says
+this method is particularly available in large hospitals where they
+have amputations and grafts on the same day.  Martin has shown that,
+after many hours of exposure in the open air at a temperature of nearly
+32 degrees F., grafts could be successfully applied, but in such
+temperatures as 82 degrees F., exposure of from six to seven hours
+destroyed their vitality, so that if kept cool, the limb of a healthy
+individual amputated for some accident, may be utilized for grafting
+purposes.
+
+Reverdin originated the procedure of epidermic grafting. Small grafts
+the size of a pin-head doing quite as well as large ones.
+Unfortunately but little diminution of the cicatricial contraction is
+effected by Reverdin's method. Thiersch contends that healing of a
+granulated surface results first from a conversion of the soft,
+vascular granulation-papillae, by contraction of some of their elements
+into young connective-tissue cells, into "dry, cicatricial papillae,"
+actually approximating the surrounding tissues, thus diminishing the
+area to be covered by epidermis; and, secondly, by the covering of
+these papillae by epidermic cells. Thiersch therefore recommends that
+for the prevention of cicatricial contraction, the grafting be
+performed with large strips of skin.
+
+Harte gives illustrations of a case of extensive skin-grafting on the
+thigh from six inches above the great trochanter well over the median
+line anteriorly and over the buttock. This extent is shown in Figure
+228, taken five months after the accident, when the granulations had
+grown over the edge about an inch. Figure 229 shows the surface of the
+wound, six and one-half months after the accident and three months
+after the applications of numerous skin-grafts.
+
+Cases of self-mutilation may be divided into three classes:--those in
+which the injuries are inflicted in a moment of temporary insanity from
+hallucinations or melancholia; with suicidal intent; and in religious
+frenzy or emotion.  Self-mutilation is seen in the lower animals, and
+Kennedy, in mentioning the case of a hydrocephalic child who ate off
+its entire under lip, speaks also of a dog, of cats, and of a lioness
+who ate off their tails. Kennedy mentions the habit in young children
+of biting the finger-nails as an evidence of infantile trend toward
+self-mutilation. In the same discussion Collins states that he knew of
+an instance in India in which a horse lay down, deliberately exposing
+his anus, and allowing the crows to pick and eat his whole rectum. In
+temporary insanity, in fury, or in grief, the lower animals have been
+noticed by naturalists to mutilate themselves.
+
+Self-mutilation in man is almost invariably the result of meditation
+over the generative function, and the great majority of cases of this
+nature are avulsions or amputations of some parts of the genitalia. The
+older records are full of such instances. Benivenius, Blanchard,
+Knackstedt, and Schenck cite cases. Smetius mentions castration which
+was effected by using the finger-nails, and there is an old record in
+which a man avulsed his own genitals. Scott mentions an instance in
+which a man amputated his genitals and recovered without subsequent
+symptoms. Gockelius speaks of self-castration in a ruptured man, and
+Golding, Guyon, Louis, Laugier, the Ephemerides, Alix, Marstral, and
+others, record instances of self-castration. In his Essays Montaigne
+mentions an instance of complete castration performed by the individual
+himself.
+
+Thiersch mentions a case of a man who circumcised himself when
+eighteen. He married in 1870, and upon being told that he was a father
+he slit up the hypogastrium from the symphysis pubis to the umbilicus,
+so that the omentum protruded; he said his object was to obtain a view
+of the interior. Although the knife was dirty and blunt, the wound
+healed after the removal of the extruding omentum. A year later he laid
+open one side of the scrotum. The prolapsed testicle was replaced, and
+the wound healed without serious effect. He again laid open his abdomen
+in 1880, the wound again healing notwithstanding the prolapse of the
+omentum. In May of the same year he removed the right testicle, and
+sewed the wound up himself. Four days later the left was treated the
+same way. The spermatic cord however escaped, and a hematoma, the size
+of a child's head, formed on account of which he had to go to the
+hospital. This man acted under an uncontrollable impulse to mutilate
+himself, and claimed that until he castrated himself he had no peace of
+mind.
+
+There is a similar report in an Italian journal which was quoted in
+London. It described a student at law, of delicate complexion, who at
+the age of fourteen gave himself up to masturbation. He continually
+studied until the age of nineteen, when he fell into a state of
+dulness, and complained that his head felt as if compressed by a circle
+of fire. He said that a voice kept muttering to him that his generative
+organs were abnormally deformed or the seat of disease. After that, he
+imagined that he heard a cry of "amputation! amputation!" Driven by
+this hallucination, he made his first attempt at self-mutilation ten
+days later. He was placed in an Asylum at Astino where, though closely
+watched, he took advantage of the first opportunity and cut off
+two-thirds of his penis, when the delirium subsided. Camp describes a
+stout German of thirty-five who, while suffering from delirium tremens,
+fancied that his enemies were trying to steal his genitals, and seizing
+a sharp knife he amputated his penis close to the pubes. He threw the
+severed organ violently at his imaginary pursuers. The hemorrhage was
+profuse, but ceased spontaneously by the formation of coagulum over the
+mouth of the divided vessels. The wound was quite healed in six weeks,
+and he was discharged from the hospital, rational and apparently
+content with his surgical feat.
+
+Richards reports the case of a Brahman boy of sixteen who had
+contracted syphilis, and convinced, no doubt, that "nocit empta dolore
+voluptus," he had taken effective means of avoiding injury in the
+future by completely amputating his penis at the root.  Some days after
+his admission to the hospital he asked to be castrated, stating that he
+intended to become an ascetic, and the loss of his testes as well as of
+his penis appeared to him to be an imperative condition to the
+attainment of that happy consummation. Chevers mentions a somewhat
+similar case occurring in India.
+
+Sands speaks of a single man of thirty who amputated his penis.  He
+gave an incomplete history of syphilis. After connection with a woman
+he became a confirmed syphilophobe and greatly depressed.  While
+laboring under the hallucination that he was possessed of two bodies he
+tied a string around the penis and amputated the organ one inch below
+the glans. On loosening the string, three hours afterward, to enable
+him to urinate, he lost three pints of blood, but he eventually
+recovered. In the Pennsylvania Hospital Reports there is an account of
+a married man who, after drinking several weeks, developed mania a
+potu, and was found in his room covered with blood. His penis was
+completely cut off near the pubes, and the skin of the scrotum was so
+freely incised that the testicles were entirely denuded, but not
+injured. A small silver cap was made to cover the sensitive urethra on
+a line with the abdominal wall.
+
+There is a record of a tall, powerfully-built Russian peasant of
+twenty-nine, of morose disposition, who on April 3d, while reading his
+favorite book, without uttering a cry, suddenly and with a single pull
+tore away his scrotum together with his testes. He then arose from the
+bank where he had been sitting, and quietly handed the avulsed parts to
+his mother who was sitting near by, saying to her: "Take that; I do not
+want it any more." To all questions from his relatives he asked pardon
+and exemption from blame, but gave no reason for his act. This patient
+made a good recovery at the hospital. Alexeef, another Russian, speaks
+of a similar injury occurring during an attack of delirium tremens.
+
+Black details the history of a young man of nineteen who went to his
+bath-room and deliberately placing his scrotum on the edge of the tub
+he cut it crossways down to the wood. He besought Black to remove his
+testicle, and as the spermatic cord was cut and much injured, and
+hemorrhage could only be arrested by ligature, the testicle was
+removed. The reason assigned for this act of mutilation was that he had
+so frequent nocturnal emissions that he became greatly disgusted and
+depressed in spirit thereby. He had practiced self-abuse for two years
+and ascribed his emissions to this cause. Although his act was that of
+a maniac, the man was perfectly rational. Since the injury he had had
+normal and frequent emissions and erections.
+
+Orwin mentions the case of a laborer of forty who, in a fit of remorse
+after being several days with a prostitute, atoned for his
+unfaithfulness to his wife by opening his scrotum and cutting away his
+left testicle with a pocket knife. The missing organ was found about
+six yards away covered with dirt. At the time of infliction of this
+injury the man was calm and perfectly rational. Warrington relates the
+strange case of Isaac Brooks, an unmarried farmer of twenty-nine, who
+was found December 5, 1879, with extensive mutilations of the scrotum;
+he said that he had been attacked and injured by three men. He swore to
+the identity of two out of the three, and these were transported to ten
+years' penal servitude. On February 13, 1881, he was again found with
+mutilation of the external genitals, and again said he had been set
+upon by four men who had inflicted his injury, but as he wished it kept
+quiet he asked that there be no prosecution. Just before his death on
+December 31, 1881, he confessed that he had perjured himself, and that
+the mutilations were self-performed.  He was not aware of any morbid
+ideas as to his sexual organs, and although he had an attack of
+gonorrhea ten years before he seemed to worry very little over it.
+There is an account of a Scotch boy who wished to lead a "holy life,"
+and on two occasions sought the late Mr. Liston's skilful aid in
+pursuance of this idea. He returned for a third time, having himself
+unsuccessfully performed castration.
+
+A case of self-mutilation by a soldier who was confined in the
+guard-house for drunkenness is related by Beck. The man borrowed a
+knife from a comrade and cut off the whole external genital apparatus,
+remarking as he flung the parts into a corner: "Any----fool can cut his
+throat, but it takes a soldier to cut his privates off!" Under
+treatment he recovered, and then he regretted his action.
+
+Sinclair describes an Irishman of twenty-five who, maniacal from
+intemperance, first cut off one testicle with a wire nail, and then the
+second with a trouser-buckle. Not satisfied with the extent of his
+injuries he drove a nail into his temple, first through the skin by
+striking it with his hand, and then by butting it against the
+wall,--the latter maneuver causing his death.
+
+There is on record the history of an insane medical student in Dublin
+who extirpated both eyes and threw them on the grass. He was in a state
+of acute mania, and the explanation offered was that as a "grinder"
+before examination he had been diligently studying the surgery of the
+eye, and particularly that relating to enucleation. Another Dublin case
+quoted by the same authority was that of a young girl who, upon being
+arrested and committed to a police-cell in a state of furious
+drunkenness, tore out both her eyes. In such cases, as a rule, the
+finger-nails are the only instrument used. There is a French case also
+quoted of a woman of thirty-nine who had borne children in rapid
+succession. While suckling a child three months old she became much
+excited, and even fanatical, in reading the Bible. Coming to the
+passage, "If thy right eye offend thee, pluck it out, etc.," she was so
+impressed with the necessity of obeying the divine injunction that she
+enucleated her eye with a meat-hook. There is mentioned the case of a
+young woman who cut off her right hand and cast it into the fire, and
+attempted to enucleate her eyes, and also to hold her remaining hand in
+the fire. Haslam reports the history of a female who mutilated herself
+by grinding glass between her teeth.
+
+Channing gives an account of the case of Helen Miller, a German Jewess
+of thirty, who was admitted to the Asylum for Insane Criminals at
+Auburn, N.Y., in October, 1872, and readmitted in June, 1875, suffering
+from simulation of hematemesis. On September 25th she cut her left
+wrist and right hand; in three weeks she became again "discouraged"
+because she was refused opium, and again cut her arms below the elbows,
+cleanly severing the skin and fascia, and completely hacking the
+muscles in every direction. Six weeks later she repeated the latter
+feat over the seat of the recently healed cicatrices. The right arm
+healed, but the left showed erysipelatous inflammation, culminating in
+edema, which affected the glottis to such an extent that tracheotomy
+was performed to save her life. Five weeks after convalescence, during
+which her conduct was exemplary, she again cut her arms in the same
+place. In the following April, for the merest trifle, she again
+repeated the mutilation, but this time leaving pieces of glass in the
+wounds. Six months later she inflicted a wound seven inches in length,
+in which she inserted 30 pieces of glass, seven long splinters, and
+five shoe-nails. In June, 1877, she cut herself for the last time. The
+following articles were taken from her arms and preserved: Ninety-four
+pieces of glass, 34 splinters, two tacks, five shoe-nails, one pin, and
+one needle, besides other things which were lost,--making altogether
+about 150 articles.
+
+"Needle-girls," etc.--A peculiar type of self-mutilation is the habit
+sometimes seen in hysteric persons of piercing their flesh with
+numerous needles or pins. Herbolt of Copenhagen tells of a young Jewess
+from whose body, in the course of eighteen months, were extracted 217
+needles. Sometime after 100 more came from a tumor on the shoulder. As
+all the symptoms in this case were abdominal, it was supposed that
+during an epileptic seizure this girl had swallowed the needles; but as
+she was of an hysteric nature it seems more likely they had entered the
+body through the skin. There is an instance in which 132 needles were
+extracted from a young lady's person. Caen describes a woman of
+twenty-six, while in prison awaiting trial, succeeding in committing
+suicide by introducing about 30 pins and needles in the chest region,
+over the heart. Her method was to gently introduce them, and then to
+press them deeper with a prayer-book. An autopsy showed that some of
+the pins had reached the lungs, some were in the mediastinum, on the
+back part of the right auricle; the descending vena cave was
+perforated, the anterior portion of the left ventricle was transfixed
+by a needle, and several of the articles were found in the liver.
+Andrews removed 300 needles from the body of an insane female. The
+Lancet records an account of a suicide by the penetration of a
+darning-needle in the epigastrium. There were nine punctures in this
+region, and in the last the needle was left in situ and fixed by
+worsted. In 1851 the same journal spoke of an instance in which 30 pins
+were removed from the limbs of a servant girl. It was said that while
+hanging clothes, with her mouth full of pins, she was slapped on the
+shoulder, causing her to start and swallow the pins. There is another
+report of a woman who swallowed great numbers of pins. On her death one
+pound and nine ounces of pins were found in her stomach and duodenum.
+There are individuals known as "human pin-cushions," who publicly
+introduce pins and needles into their bodies for gain's sake.
+
+The wanderings of pins and needles in the body are quite well known.
+Schenck records the finding of a swallowed pin in the liver. Haller
+mentions one that made its way to the hand. Silvy speaks of a case in
+which a quantity of swallowed pins escaped through the muscles, the
+bladder, and vagina; there is another record in which the pins escaped
+many years afterward from the thigh. The Philosophical Transactions
+contain a record of the escape of a pin from the skin of the arm after
+it had entered by the mouth. Gooch, Ruysch, Purmann, and Hoffman speak
+of needle-wanderings. Stephenson gives an account of a pin which was
+finally voided by the bladder after forty-two years' sojourn in a
+lady's body. On November 15, 1802, the celebrated Dr. Lettsom spoke of
+an old lady who sat on a needle while riding in a hackney coach; it
+passed from the injured leg to the other one, whence it was extracted.
+Deckers tells of a gentleman who was wounded in the right
+hypochondrium, the ball being taken thirty years afterward from the
+knee. Borellus gives an account of a thorn entering the digit and
+passing out of the body by the anus.
+
+Strange as it may seem, a prick of a pin not entering a vital center or
+organ has been the indirect cause of death. Augenius writes of a tailor
+who died in consequence of a prick of a needle between the nail and
+flesh of the end of the thumb. Amatus Lusitanus mentions a similar
+instance in an old woman, although, from the symptoms given, the direct
+cause was probably tetanus.  In modern times Cunninghame, Boring, and
+Hobart mention instances in which death has followed the prick of a
+pin: in Boring's case the death occurred on the fifth day.
+
+Manufacture of Crippled Beggars.--Knowing the sympathy of the world in
+general for a cripple, in some countries low in the moral scale,
+voluntary mutilation is sometimes practiced by those who prefer begging
+to toiling. In the same manner artificial monstrosities have been
+manufactured solely for gain's sake. We quite often read of these
+instances in lay-journals, but it is seldom that a case comes under the
+immediate observation of a thoroughly scientific mind. There is,
+however, on record a remarkable instance accredited to Jamieson of
+Shanghai who presented to the Royal College of Surgeons a pair of feet
+with the following history: Some months previously a Chinese beggar had
+excited much pity and made a good business by showing the mutilated
+stumps of his legs, and the feet that had belonged to them slung about
+his neck. While one day scrambling out of the way of a constable who
+had forbidden this gruesome spectacle, he was knocked down by a
+carriage in the streets of Shanghai, and was taken to the hospital,
+where he was questioned about the accident which deprived him of his
+feet. After selling the medical attendant his feet he admitted that he
+had purposely performed the amputations himself, starting about a year
+previously. He had fastened cords about his ankles, drawing them as
+tightly as he could bear them, and increasing the pressure every two or
+three days. For a fortnight his pain was extreme, but when the bones
+were bared his pains ceased. At the end of a month and a half he was
+able to entirely remove his feet by partly snapping and partly cutting
+the dry bone. Such cases appear to be quite common in China, and by
+investigation many parallels could elsewhere be found.
+
+The Chinese custom of foot-binding is a curious instance of
+self-mutilation. In a paper quoted in the Philadelphia Medical Times,
+January 31, 1880, a most minute account of the modus operandi, the
+duration, and the suffering attendant on this process are given.
+Strapping of the foot by means of tight bandages requires a period of
+two or three years' continuance before the desired effect is produced.
+There is a varying degree of pain, which is most severe during the
+first year and gradually diminishes after the binding of all the joints
+is completed.  During the binding the girl at night lies across the
+bed, putting her legs on the edge of the bed-stead in such a manner as
+to make pressure under the knees, thus benumbing the parts below and
+avoiding the major degree of pain. In this position, swinging their
+legs backward and forward, the poor Chinese girls pass many a weary
+night. During this period the feet are unbound once a month only. The
+operation is begun by placing the end of a long, narrow bandage on the
+inside of the instep and carrying it over the four smaller toes,
+securing them under the foot. After several turns the bandage is
+reversed so as to compress the foot longitudinally. The young girl is
+then left for a month, and when the bandage is removed the foot is
+often found gangrenous and ulcerated, one or two toes not infrequently
+being lost. If the foot is thus bound for two years it becomes
+virtually dead and painless. By this time the calf disappears from lack
+of exercise, the bones are attenuated, and all the parts are dry and
+shrivelled. In after-life the leg frequently regains its muscles and
+adipose tissue, but the foot always remains small. The binding process
+is said to exert a markedly depressing influence upon the emotional
+character of the subject, which lasts through life, and is very
+characteristic.
+
+To show how minute some of the feet of the Chinese women are, Figure I
+of the accompanying plate, taken from a paper by Kenthughes on the
+"Feet of Chinese Ladies" is from a photograph of a shoe that measured
+only 3 1/4 inches anteroposteriorly. The foot which it was intended to
+fill must have been smaller still, for the bandage would take up a
+certain amount of space. Figure II is a reproduction of a photograph of
+a foot measuring 5 1/2 inches anteroposteriorly, the wrinkled
+appearance of the skin being due to prolonged immersion in spirit. This
+photograph shows well the characteristics of the Chinese foot--the
+prominent and vertically placed heel, which is raised generally about
+an inch from the level of the great toe; the sharp artificial cavus,
+produced by the altered position of the os calcis, and the downward
+deflection of the foot in front of the mediotarsal joint; the straight
+and downward pointing great toe, and the infolding of the smaller toes
+underneath the great toe. In Figure III we have a photograph of the
+skeleton of a Chinese lady's foot about five inches in anteroposterior
+diameter. The mesial axis of the os calcis is almost directly vertical,
+with a slight forward inclination, forming a right angle with the bones
+in front of the mediotarsal joint. The upper three-quarters of the
+anterior articular surface of the calcis is not in contact with the
+cuboid, the latter being depressed obliquely forward and downward, the
+lower portion of the posterior facet on the cuboid articulating with a
+new surface on the under portion of the bone.  The general shape of the
+bone closely resembles that of a normal one--a marked contrast to its
+wasted condition and tapering extremity in paralytic calcaneus.
+Extension and flexion at the ankle are only limited by the shortness of
+the ligaments; there is no opposition from the conformation of the
+bones. The astragalus is almost of normal shape; the trochlea is
+slightly prolonged anteriorly, especially on the inner side, from
+contact with the tibial articular surface. The cartilage on the exposed
+posterior portion of the trochlea seems healthy. The head of the
+astragalus is very prominent on the outer side, the scaphoid being
+depressed downward and inward away from it. The anterior articular
+surface is prolonged in the direction of the displaced scaphoid. The
+scaphoid, in addition to its displacement, is much compressed on the
+planter surface, being little more than one-half the width of the
+dorsal surface. The cuboid is displaced obliquely downward and forward,
+so that the upper part of the posterior articular surface is not in
+contact with the calcis.
+
+A professional leg-breaker is described in the Weekly Medical Review of
+St. Louis, April, 1890. This person's name was E. L.  Landers, and he
+was accredited with earning his living by breaking or pretending to
+break his leg in order to collect damages for the supposed injury.
+Moreover, this individual had but one leg, and was compelled to use
+crutches. At the time of report he had succeeded in obtaining damages
+in Wichita, Kansas, for a supposed fracture. The Review quotes a
+newspaper account of this operation as follows.--
+
+"According to the Wichita Dispatch he represented himself as a
+telegraph operator who was to have charge of the postal telegraph
+office in that city as soon as the line reached there. He remained
+about town for a month until he found an inviting piece of defective
+sidewalk, suitable for his purpose, when he stuck his crutch through
+the hole and fell screaming to the ground, declaring that he had broken
+his leg. He was carried to a hospital, and after a week's time, during
+which he negotiated a compromise with the city authorities and
+collected $1000 damages, a confederate, claiming to be his nephew,
+appeared and took the wounded man away on a stretcher, saying that he
+was going to St.  Louis. Before the train was fairly out of Wichita,
+Landers was laughing and boasting over his successful scheme to beat
+the town. The Wichita story is in exact accord with the artistic
+methods of a one-legged sharper who about 1878 stuck his crutch through
+a coal-hole here, and, falling heels over head, claimed to have
+sustained injuries for which he succeeded in collecting something like
+$1500 from the city. He is described as a fine-looking fellow, well
+dressed, and wearing a silk hat. He lost one leg in a railroad
+accident, and having collected a good round sum in damages for it,
+adopted the profession of leg-breaking in order to earn a livelihood.
+He probably argued that as he had made more money in that line than in
+any other he was especially fitted by natural talents to achieve
+distinction in this direction. But as it would be rather awkward to
+lose his remaining leg altogether he modified the idea and contents
+himself with collecting the smaller amounts which ordinary fractures of
+the hip-joint entitle such an expert 'fine worker' to receive.
+
+"He first appeared here in 1874 and succeeded, it is alleged, in
+beating the Life Association of America. After remaining for some time
+in the hospital he was removed on a stretcher to an Illinois village,
+from which point the negotiations for damages were conducted by
+correspondence, until finally a point of agreement was reached and an
+agent of the company was sent to pay him the money. This being
+accomplished the agent returned to the depot to take the train back to
+St. Louis when he was surprised to see the supposed sufferer stumping
+around on his crutches on the depot platform, laughing and jesting over
+the ease with which he had beaten the corporation.
+
+"He afterward fell off a Wabash train at Edwardsville and claimed to
+have sustained serious injuries, but in this case the company's
+attorneys beat him and proved him to be an impostor. In 1879 he
+stumbled into the telegraph office at the Union Depot here, when Henry
+C. Mahoney, the superintendent, catching sight of him, put him out,
+with the curt remark that he didn't want him to stick that crutch into
+a cuspidor and fall down, as it was too expensive a performance for the
+company to stand. He beat the Missouri Pacific and several other
+railroads and municipalities at different times, it is claimed, and
+manages to get enough at each successful venture to carry him along for
+a year or eighteen months, by which time the memory of his trick fades
+out of the public mind, when he again bobs up serenely."
+
+Anomalous Suicides.--The literature on suicide affords many instances
+of self-mutilations and ingenious modes of producing death. In the
+Dublin Medical Press for 1854 there is an extraordinary case of
+suicide, in which the patient thrust a red-hot poker into his abdomen
+and subsequently pulled it out, detaching portions of the omentum and
+32 inches of the colon.  Another suicide in Great Britain swallowed a
+red-hot poker. In commenting on suicides, in 1835, Arntzenius speaks of
+an ambitious Frenchman who was desirous of leaving the world in a
+distinguished manner, and who attached himself to a rocket of enormous
+size which he had built for the purpose, and setting fire to it, ended
+his life. On September 28, 1895, according to the Gaulois and the New
+York Herald (Paris edition) of that date, there was admitted to the
+Hopital St. Louis a clerk, aged twenty-five, whom family troubles had
+rendered desperate and who had determined to seek death as a relief
+from his misery.  Reviewing the various methods of committing suicide
+he found none to his taste, and resolved on something new. Being
+familiar with the constituents of explosives, he resolved to convert
+his body into a bomb, load it with explosives, and thus blow himself to
+pieces. He procured some powdered sulphur and potassium chlorate, and
+placing each in a separate wafer he swallowed both with the aid of
+water. He then lay down on his bed, dressed in his best clothes,
+expecting that as soon as the two explosive materials came into contact
+he would burst like a bomb and his troubles would be over. Instead of
+the anticipated result the most violent collicky pains ensued, which
+finally became so great that he had to summon his neighbors, who took
+him to the hospital, where, after vigorous application with the
+stomach-pump, it was hoped that his life would be saved. Sankey
+mentions an epileptic who was found dead in his bed in the Oxford
+County Asylum; the man had accomplished his end by placing a round
+pebble in each nostril, and thoroughly impacting in his throat a strip
+of flannel done up in a roll. In his "Institutes of Surgery" Sir
+Charles Bell remarks that his predecessor at the Middlesex Hospital
+entered into a conversation with his barber over an attempt at suicide
+in the neighborhood, during which the surgeon called the "would-be
+suicide" a fool, explaining to the barber how clumsy his attempts had
+been at the same time giving him an extempore lecture on the anatomic
+construction of the neck, and showing him how a successful suicide in
+this region should be performed. At the close of the conversation the
+unfortunate barber retired into the back area of his shop, and
+following minutely the surgeon's directions, cut his throat in such a
+manner that there was no hope of saving him. It is supposed that one
+could commit suicide by completely gilding or varnishing the body, thus
+eliminating the excretory functions of the skin. There is an old story
+of an infant who was gilded to appear at a Papal ceremony who died
+shortly afterward from the suppression of the skin-function. The fact
+is one well established among animals, but after a full series of
+actual experiments, Tecontjeff of St.  Petersburg concludes that in
+this respect man differs from animals. This authority states that in
+man no tangible risk is entailed by this process, at least for any
+length of time required for therapeutic purposes. "Tarred and
+feathered" persons rarely die of the coating of tar they receive. For
+other instances of peculiar forms of suicide reference may be made to
+numerous volumes on this subject, prominent among which is that by
+Brierre de Boismont, which, though somewhat old, has always been found
+trustworthy, and also to the chapters on this subject written by
+various authors on medical jurisprudence.
+
+Religious and Ceremonial Mutilations.--Turning now to the subject of
+self-mutilation and self-destruction from the peculiar customs or
+religious beliefs of people, we find pages of information at our
+disposal. It is not only among the savage or uncivilized tribes that
+such ideas have prevailed, but from the earliest times they have had
+their influence upon educated minds. In the East, particularly in
+India, the doctrines of Buddhism, that the soul should be without fear,
+that it could not be destroyed, and that the flesh was only its
+resting-place, the soul several times being reincarnated, brought about
+great indifference to bodily injuries and death. In the history of the
+Brahmans there was a sect of philosophers called the Gymnosophists, who
+had the extremest indifference to life. To them incarnation was a
+positive fact, and death was simply a change of residence. One of these
+philosophers, Calanus, was burned in the presence of Alexander; and,
+according to Plutarch, three centuries later another Gymnosophist named
+Jarmenochegra, was similarly burned before Augustus. Since this time,
+according to Brierre de Boismont, the suicides from indifference to
+life in this mystic country are counted by the thousands. Penetrating
+Japan the same sentiment, according to report, made it common in the
+earlier history of that country to see ships on its coasts, filled with
+fanatics who, by voluntary dismantling, submerged the vessels little by
+little, the whole multitude sinking into the sea while chanting praises
+to their idols. The same doctrines produced the same result in China.
+According to Brucker it is well known that among the 500 philosophers
+of the college of Confucius, there were many who disdained to survive
+the loss of their books (burned by order of the savage Emperor
+Chi-Koung-ti), and throwing themselves into the sea, they disappeared
+under the waves. According to Brierre de Boismont, voluntary mutilation
+or death was very rare among the Chaldeans, the Persians, or the
+Hebrews, their precepts being different from those mentioned. The
+Hebrews in particular had an aversion to self-murder, and during a
+period in their history of 4000 years there were only eight or ten
+suicides recorded. Josephus shows what a marked influence on suicides
+the invasion of the Romans among the Hebrews had.
+
+In Africa, as in India, there were Gymnosophists. In Egypt Sesostris,
+the grandest king of the country, having lost his eyesight in his old
+age, calmly and deliberately killed himself.  About the time of Mark
+Anthony and Cleopatra, particularly after the battle of Actium, suicide
+was in great favor in Egypt. In fact a great number of persons formed
+an academy called The Synapothanoumenes, who had for their object the
+idea of dying together. In Western Europe, as shown in the ceremonies
+of the Druids, we find among the Celts a propensity for suicide and an
+indifference to self-torture. The Gauls were similarly minded,
+believing in the dogma of immortality and eternal repose. They thought
+little of bodily cares and ills. In Greece and Rome there was always an
+apology for suicide and death in the books of the philosophers. "Nil
+igitur mors est, ad nos neque pertinet hilum; quando quidem natura
+animi mortalis habetur!" cries Lucretius.  With the advent of
+Christianity, condemning as it did the barbarous customs of
+self-mutilation and self-murder, these practices seem to disappear
+gradually; but stoicism and indifference to pain were exhibited in
+martyrdom. Toward the middle ages, when fanaticism was at its height
+and the mental malady of demoniacal possession was prevalent, there was
+something of a reversion to the old customs. In the East the Juggernaut
+procession was still in vogue, but this was suppressed by civilized
+authorities; outside of a few minor customs still prevalent among our
+own people we must to-day look to the savage tribes for the
+perpetuation of such practices.
+
+In an excellent article on the evolution of ceremonial institutions
+Herbert Spencer mentions the Fuegians, Veddahs, Andamanese, Dyaks,
+Todas, Gonds, Santals, Bodos, and Dhimals, Mishmis, Kamchadales, and
+Snake Indians, as among people who form societies to practice simple
+mutilations in slight forms.  Mutilations in somewhat graver forms, but
+still in moderation, are practiced by the Tasmanians, Tamaese, the
+people of New Guinea, Karens, Nagas, Ostiaks, Eskimos, Chinooks,
+Comanches, and Chippewas. What might be called mixed or compound
+mutilations are practiced by the New Zealanders, East Africans, Kondes,
+Kukas, and Calmucks. Among those practising simple but severe
+mutilations are the New Caledonians, the Bushmen, and some indigenous
+Australians. Those tribes having for their customs the practice of
+compound major mutilations are the Fiji Islanders, Sandwich Islanders,
+Tahitians, Tongans, Samoans, Javanese, Sumatrans, natives of Malagasy,
+Hottentots, Damaras, Bechuanas, Kaffirs, the Congo people, the Coast
+Negroes, Inland Negroes, Dahomeans, Ashantees, Fulahs, Abyssinians,
+Arabs, and Dakotas.  Spencer has evidently made a most extensive and
+comprehensive study of this subject, and his paper is a most valuable
+contribution to the subject. In the preparation of this section we have
+frequently quoted from it.
+
+The practice of self-bleeding has its origin in other mutilations,
+although the Aztecs shed human blood in the worship of the sun. The
+Samoiedes have a custom of drinking the blood of warm animals. Those of
+the Fijians who were cannibals drank the warm blood of their victims.
+Among the Amaponda Kaffirs there are horrible accounts of kindred
+savage customs. Spencer quotes:--"It is usual for the ruling chief on
+his accession to be washed in the blood of a near relative, generally a
+brother, who is put to death for the occasion." During a Samoan
+marriage-ceremony the friends of the bride "took up stones and beat
+themselves until their heads were bruised and bleeding." In Australia a
+novitiate at the ceremony of manhood drank a mouthful of blood from the
+veins of the warrior who was to be his sponsor.
+
+At the death of their kings the Lacedemonians met in large numbers and
+tore the flesh from their foreheads with pins and needles. It is said
+that when Odin was near his death he ordered himself to be marked with
+a spear; and Niort, one of his successors, followed the example of his
+predecessor. Shakespeare speaks of "such as boast and show their
+scars." In the olden times it was not uncommon for a noble soldier to
+make public exhibition of his scars with the greatest pride; in fact,
+on the battlefield they invited the reception of superficial
+disfiguring injuries, and to-day some students of the learned
+universities of Germany seem prouder of the possession of scars
+received in a duel of honor than in awards for scholastic attainments.
+
+Lichtenstein tells of priests among the Bechuanas who made long cuts
+from the thigh to the knee of each warrior who slew an enemy in battle.
+Among some tribes of the Kaffirs a kindred custom was practiced; and
+among the Damaras, for every wild animal a young man destroyed his
+father made four incisions on the front of his son's body. Speaking of
+certain Congo people, Tuckey says that they scar themselves principally
+with the idea of rendering themselves agreeable to the women of their
+tribe. Among the Itzaex Indians of Yucatan, a race with particularly
+handsome features, some are marked with scarred lines, inflicted as
+signs of courage.
+
+Cosmetic Mutilations.--In modern times there have been individuals
+expert in removing facial deformities, and by operations of various
+kinds producing pleasing dimples or other artificial signs of beauty.
+We have seen an apparatus advertised to be worn on the nose during the
+night for the purpose of correcting a disagreeable contour of this
+organ. A medical description of the artificial manufacture of dimples
+is as follows:--"The modus operandi was to make a puncture in the skin
+where the dimple was required, which would not be noticed when healed,
+and, with a very delicate instrument, remove a portion of the muscle.
+Inflammation was then excited in the skin over the subcutaneous pit,
+and in a few days the wound, if such it may be called, was healed, and
+a charming dimple was the result." It is quite possible that some of
+our modern operators have overstepped the bounds of necessity, and
+performed unjustifiable plastic operations to satisfy the vanity of
+their patients.
+
+Dobrizhoffer says of the Abipones that boys of seven pierce their
+little arms in imitation of their parents. Among some of the indigenous
+Australians it is quite customary for ridged and linear scars to be
+self-inflicted. In Tanna the people produce elevated scars on the arms
+and chests. Bancroft recites that family-marks of this nature existed
+among the Cuebas of Central America, refusal being tantamount to
+rebellion. Schomburgk tells that among the Arawaks, after a Mariquawi
+dance, so great is their zeal for honorable scars, the blood will run
+down their swollen calves, and strips of skin and muscle hang from the
+mangled limbs. Similar practices rendered it necessary for the United
+States Government to stop some of the ceremonial dances of the Indians
+under their surveillance.
+
+A peculiar custom among savages is the amputation of a finger as a
+sacrifice to a deity. In the tribe of the Dakotas the relatives of a
+dead chief pacified his spirit by amputating a finger. In a similar
+way, during his initiation, the young Mandan warrior, "holding up the
+little finger of his left hand to the Great Spirit," ... "expresses his
+willingness to give it as a sacrifice, and he lays it on the dried
+buffalo skull, when another chops it off near the hand with a blow of
+the hatchet." According to Mariner the natives of Tonga cut off a
+portion of the little finger as a sacrifice to the gods for the
+recovery of a superior sick relative. The Australians have a custom of
+cutting off the last joint of the little finger of females as a token
+of submission to powerful beings alive and dead. A Hottentot widow who
+marries a second time must have the distal joint of her little finger
+cut off; another joint is removed each time she remarries.
+
+Among the mutilations submitted to on the death of a king or chief in
+the Sandwich Islands, Cook mentions in his "Voyages" the custom of
+knocking out from one to four front teeth.
+
+Among the Australian tribes the age of virility and the transition into
+manhood is celebrated by ceremonial customs, in which the novices are
+subjected to minor mutilations. A sharp bone is used for lancing their
+gums, while the throw-stick is used for knocking out a tooth.
+Sometimes, in addition to this crude dentistry, the youth is required
+to submit to cruel gashes cut upon his back and shoulders, and should
+he flinch or utter any cry of pain he is always thereafter classed with
+women.  Haygarth writes of a semi-domesticated Australian who said one
+day, with a look of importance, that he must go away for a few days, as
+he had grown to man's estate, and it was high time he had his teeth
+knocked out. It is an obligatory rite among various African tribes to
+lose two or more of their front teeth. A tradition among certain
+Peruvians was that the Conqueror Huayna Coapae made a law that they and
+their descendants should have three front teeth pulled out in each jaw.
+Cieza speaks of another tradition requiring the extraction of the teeth
+of children by their fathers as a very acceptable service to their
+gods. The Damaras knock out a wedge-shaped gap between two of their
+front teeth; and the natives of Sierra Leone file or chip their teeth
+after the same fashion.
+
+Depilatory customs are very ancient, and although minor in extent are
+still to be considered under the heading of mutilations. The giving of
+hair to the dead as a custom, has been perpetuated through many tribes
+and nations. In Euripides we find Electra admonishing Helen for sparing
+her locks, and thereby defrauding the dead. Alexander the Great shaved
+his locks in mourning for his friend, Hephaestion, and it was supposed
+that his death was hastened by the sun's heat on his bare head after
+his hat blew off at Babylon. Both the Dakota Indians and the Caribs
+maintain the custom of sacrificing hair to the dead. In Peru the custom
+was varied by pulling out eyelashes and eyebrows and presenting them to
+the sun, the hills, etc. It is said this custom is still in
+continuance. When Clovis was visited by the Bishop of Toulouse he gave
+him a hair from his beard and was imitated by his followers. In the
+Arthurian legends we find "Then went Arthur to Caerleon; and thither
+came messages from King Ryons who said, 'even kings have done me
+homage, and with their beards I have trimmed a mantle. Send me now thy
+beard, for there lacks yet one to the finishing of the mantle.'" The
+association between short hair and slavery arose from the custom of
+taking hair from the slain. It existed among the Greeks and Romans, and
+was well known among the indigenous tribes of this continent. Among the
+Shoshones he who took the most scalps gained the most glory.
+
+In speaking of the prisoners of the Chicimecs Bancroft says they were
+often scalped while yet alive, and the bloody trophies placed on the
+heads of their tormentors. In this manner we readily see that long hair
+among the indigenous tribes and various Orientals, Ottomans, Greeks,
+Franks, Goths, etc., was considered a sign of respect and honor. The
+respect and preservation of the Chinese queue is well known in the
+present day. Wishing to divide their brother's kingdom, Clothair and
+Childebert consulted whether to cut off the hair of their nephews, the
+rightful successors, so as to reduce them to the rank of subjects, or
+to kill them. The gods of various people, especially the greater gods,
+were distinguished by their long beards and flowing locks. In all
+pictures Thor and Samson were both given long hair, and the belief in
+strength and honor from long hair is proverbial. Hercules is always
+pictured with curls.  According to Goldzhier, long locks of hair and a
+long beard are mythologic attributes of the sun. The sun's rays are
+compared to long locks or hairs on the face of the sun. When the sun
+sets and leaves his place to the darkness, or when the powerful summer
+sun is succeeded by the weak rays of the winter sun, then Samson's long
+locks, through which alone his strength remains, are cut off by the
+treachery of his deceitful concubine Delilah (the languishing,
+according to the meaning of the name). The beaming Apollo was,
+moreover, called the "Unshaven;" and Minos cannot conquer the solar
+hero, Nisos, until the latter loses his golden hair. In Arabic
+"Shams-on" means the sun, and Samson had seven locks of hair, the
+number of the planetary bodies. In view of the foregoing facts it seems
+quite possible that the majority of depilatory processes on the scalp
+originated in sun-worship, and through various phases and changes in
+religions were perpetuated to the Middle Ages. Charles Martel sent
+Pepin, his son, to Luithprand, king of the Lombards, that he might cut
+his first locks, and by this ceremony hold for the future the place of
+his illustrious father. To make peace with Alaric, Clovis became his
+adopted son by offering his beard to be cut. Among the Caribs the hair
+constituted their chief pride, and it was considered unequivocal proof
+of the sincerity of their sorrow, when on the death of a relative they
+cut their hair short. Among the Hebrews shaving of the head was a
+funeral rite, and among the Greeks and Romans the hair was cut short in
+mourning, either for a relative or for a celebrated personage.
+According to Krehl the Arabs also had such customs. Spencer mentions
+that during an eruption in Hawaii, "King Kamahameha cut off part of his
+own hair" ... "and threw it into the torrent (of lava)."
+
+The Tonga regarded the pubic hairs as under the special care of the
+devil, and with great ceremony made haste to remove them. The female
+inhabitants of some portions of the coast of Guinea remove the pubic
+hairs as fast as they appear. A curious custom of Mohammedan ladies
+after marriage is to rid themselves of the hirsute appendages of the
+pubes. Depilatory ointments are employed, consisting of equal parts of
+slaked lime and arsenic made into a paste with rose-water. It is said
+that this important ceremony is not essential in virgins. One of the
+ceremonies of assuming the toga virilis among the indigenous
+Australians consists in submitting to having each particular hair
+plucked singly from the body, the candidate being required not to
+display evidences of pain during the operation. Formerly the Japanese
+women at marriage blackened their teeth and shaved or pulled out their
+eyebrows.
+
+The custom of boring the ear is very old, mention of it being made in
+Exodus xxi., 5 and 6, in which we find that if a Hebrew servant served
+for six years, his freedom was optional, but if he plainly said that he
+loved his master, and his wife and children, and did not desire to
+leave their house, the master should bring him before the judges; and
+according to the passage in Exodus, "he shall also bring him to the
+door or unto the doorpost, and his master shall bore his ear through
+with an awl; and he shall serve him forever." All the Burmese, says
+Sangermano, without exception, have the custom of boring their ears.
+The days when the operations were performed were kept as festivals. The
+ludicrous custom of piercing the ears for the wearing of ornaments,
+typical of savagery and found in all indigenous African tribes, is
+universally prevalent among our own people.
+
+The extremists in this custom are the Botocudos, who represent the most
+cruel and ferocious of the Brazilian tribes, and who especially cherish
+a love for cannibalism. They have a fondness for disfiguring themselves
+by inserting in the lower parts of their ears and in their under lips
+variously shaped pieces of wood ornaments called peleles, causing
+enormous protrusion of the under lip and a repulsive wide mouth, as
+shown in Figure 230.
+
+Tattooing is a peculiar custom originating in various ways. The
+materials used are vermilion, indigo, carbon, or gunpowder. At one time
+this custom was used in the East to indicate caste and citizenship.
+Both sexes of the Sandwich Islanders have a peculiar tattooed mark
+indicative of their tribe or district. Among the Uapes, one tribe, the
+Tucanoes, have three vertical blue lines.  Among other people tattooed
+marks indicated servility, and Boyle says the Kyans, Pakatans, and
+Kermowits alone, among the Borneo people, practised tattooing, and adds
+that these races are the least esteemed for bravery. Of the Fijians the
+women alone are tattooed, possibly as a method of adornment.
+
+The tattooing of the people of Otaheite, seen by Cook, was surmised by
+him to have a religious significance, as it presented in many instances
+"squares, circles, crescents, and ill-designed representations of men
+and dogs." Every one of these people was tattooed upon reaching
+majority. According to Carl Bock, among the Dyaks of Borneo all of the
+married women were tattooed on the hands and feet, and sometimes on the
+thighs. The decoration is one of the privileges of matrimony, and is
+not permitted to unmarried girls. Andrew Lang says of the Australian
+tribes that the Wingong or the Totem of each man is indicated by a
+tattooed representation of it on his flesh. The celebrated American
+traveler, Carpenter, remarks that on his visit to a great prison in
+Burmah, which contains more than 3000 men, he saw 6000 tattooed legs.
+The origin of the custom he was unable to find out, but in Burmah
+tattooing was a sign of manhood, and professional tattooers go about
+with books of designs, each design warding off some danger. Bourke
+quotes that among the Apaches-Yumas of Arizona the married women are
+distinguished by several blue lines running from the lower lip to the
+chin; and he remarks that when a young woman of this tribe is anxious
+to become a mother she tattoos the figure of a child on her forehead.
+After they marry Mojave girls tattoo the chin with vertical blue lines;
+and when an Eskimo wife has her face tattooed with lamp-black she is
+regarded as a matron in society.  The Polynesians have carried this
+dermal art to an extent which is unequaled by any other people, and it
+is universally practiced among them. Quoted by Burke, Sullivan states
+that the custom of tattooing continued in England and Ireland down to
+the seventh century. This was the tattooing with the woad. Fletcher
+remarks that at one time, about the famous shrine of Our Lady of
+Loretto, were seen professional tattooers, who for a small sum of money
+would produce a design commemorative of the pilgrim's visit to the
+shrine. A like profitable industry is pursued in Jerusalem.
+
+Universal tattooing in some of the Eastern countries is used as a means
+of criminal punishment, the survival of the persecuted individual being
+immaterial to the torturers, as he would be branded for life and
+ostracized if he recovered. Illustrative of this O'Connell tells of a
+case in Hebra's clinic. The patient, a man five feet nine inches in
+height, was completely tattooed from head to foot with all sorts of
+devices, such as elephants, birds, lions, etc., and across his
+forehead, dragons. Not a square of even a quarter inch had been exempt
+from the process. According to his tale this man had been a leader of a
+band of Greek robbers, organized to invade Chinese Tartary, and,
+together with an American and a Spaniard, was ordered by the ruler of
+the invaded province to be branded in this manner as a criminal. It
+took three months' continuous work to carry out this sentence, during
+which his comrades succumbed to the terrible agonies.  During the
+entire day for this extended period indigo was pricked in this
+unfortunate man's skin. Accounts such as this have been appropriated by
+exhibitionists, who have caused themselves to be tattooed merely for
+mercenary purposes. The accompanying illustration represents the
+appearance of a "tattooed man" who exhibited himself. He claimed that
+his tattooing was done by electricity. The design showing on his back
+is a copy of a picture of the Virgin Mary surrounded by 31 angels.
+
+The custom of tattooing the arms, chest, or back is quite prevalent,
+and particularly among sailors and soldiers. The sequences of this
+custom are sometimes quite serious. Syphilis has been frequently
+contracted in this manner, and Maury and Dulles have collected 15 cases
+of syphilis acquired in tattooing.  Cheinisse reports the case of a
+young blacksmith who had the emblems of his trade tattooed upon his
+right forearm. At the end of forty days small, red, scaly elevations
+appeared at five different points in the tattooed area. These broke
+down and formed ulcers. When examined these ulcers presented the
+peculiarities of chancres, and there was upon the body of the patient a
+well-marked syphilitic roseola. It was ascertained that during the
+tattooing the operator had moistened the ink with his own saliva.
+
+Hutchinson exhibited drawings and photographs showing the condition of
+the arms of two boys suffering from tuberculosis of the skin, who had
+been inoculated in the process of tattooing.  The tattooing was done by
+the brother of one of the lads who was in the last stages of phthisis,
+and who used his own saliva to mix the pigment. The cases were under
+the care of Murray of Tottenham, by whom they had been previously
+reported. Williams has reported the case of a militiamen of seventeen
+who, three days after an extensive tattooing of the left forearm,
+complained of pain, swelling, and tenderness of the left wrist. A day
+later acute left-sided pneumonia developed, but rapidly subsided. The
+left shoulder, knee, and ankle were successively involved in the
+inflammation, and a cardiac bruit developed. Finally chorea developed
+as a complication, limited for a time to the left side, but shortly
+spreading to the right, where rheumatic inflammation was attacking the
+joints. The last, however, quickly subsided, leaving a general, though
+mild chorea and a permanently damaged heart.
+
+Infibulation of the male and female external genital organs for the
+prevention of sexual congress is a very ancient custom. The Romans
+infibulated their singers to prevent coitus, and consequent change in
+the voice, and pursued the same practice with their actors and dancers.
+According to Celsus, Mercurialis, and others, the gladiators were
+infibulated to guard against the loss of vigor by sexual excesses. In
+an old Italian work there is a figure of an infibulated musician--a
+little bronze statue representing a lean individual tortured or
+deformed by carrying an enormous ring through the end of the penis. In
+one of his pleasantries Martial says of these infibulated singers that
+they sometimes break their rings and fail to place them back--"et cujus
+refibulavit turgidum faber peruem." Heinsius considers Agamemnon
+cautious when he left Demodocus near Clytemnestra, as he remarks that
+Demodocus was infibulated. For such purposes as the foregoing
+infibulation offered a more humane method than castration.
+
+Infibulation by a ring in the prepuce was used to prevent premature
+copulation, and was in time to be removed, but in some cases its
+function was the preservation of perpetual chastity.  Among some of the
+religious mendicants in India there were some who were condemned to a
+life of chastity, and, in the hotter climates, where nudity was the
+custom, these persons traveled about exposing an enormous preputial
+ring, which was looked upon with adoration by devout women. It is said
+these holy persons were in some places so venerated that people came on
+their knees, and bowing below the ring, asked forgiveness--possibly for
+sexual excesses.
+
+Rhodius mentions the usage of infibulation in antiquity, and Fabricius
+d'Aquapendente remarks that infibulation was usually practiced in
+females for the preservation of chastity. No Roman maiden was able to
+preserve her virginity during participation in the celebrations in the
+Temples of Venus, the debauches of Venus and Mars, etc., wherein vice
+was authorized by divine injunction; for this reason the lips of the
+vagina were closed by rings of iron, copper, or silver, so joined as to
+hinder coitus, but not prevent evacuation. Different sized rings were
+used for those of different ages. Although this device provided against
+the coitus, the maiden was not free from the assaults of the Lesbians.
+During the Middle Ages, in place of infibulation, chastity-girdles were
+used, and in the Italian girdles, such as the one exhibited in the
+Musee Cluny in Paris, both the anus and vulva were protected by a steel
+covering perforated for the evacuations. In the Orient, particularly in
+India and Persia, according to old travelers, the labia were sewed
+together, allowing but a small opening for excretions. Buffon and Brown
+mention infibulation in Abyssinia, the parts being separated by a
+bistoury at the time of marriage. In Circassia the women were protected
+by a copper girdle or a corset of hide and skin which, according to
+custom, only the husband could undo. Peney speaks of infibulation for
+the preservation of chastity, as observed by him in the Soudan. Among
+the Nubians this operation was performed at about the age of eight with
+great ceremony, and when the time for marriage approached the vulva had
+to be opened by incision. Sir Richard Buxton, a distinguished traveler,
+also speaks of infibulation, and, according to him, at the time of the
+marriage ceremony the male tries to prove his manhood by using only
+Nature's method and weapon to consummate the marriage, but if he failed
+he was allowed artificial aid to effect entrance. Sir Samuel Baker is
+accredited in The Lancet with giving an account in Latin text of the
+modus operandi of a practice among the Nubian women of removing the
+clitoris and nymphae in the young girl, and abrading the adjacent walls
+of the external labia so that they would adhere and leave only a
+urethral aperture.
+
+This ancient custom of infibulation is occasionally seen at the present
+day in civilized countries, and some cases of infibulation from
+jealousy are on record. There is mentioned, as from the Leicester
+Assizes, the trial of George Baggerly for execution of a villainous
+design on his wife. In jealousy he "had sewed up her private parts."
+Recently, before the New York Academy of Medicine, Collier reported a
+case of pregnancy in a woman presenting nympha-infibulation. The
+patient sought the physician's advice in the summer of 1894, while
+suffering from uterine disease, and being five weeks pregnant. She was
+a German woman of twenty-eight, had been married several years, and was
+the mother of several children. Collier examined her and observed two
+holes in the nymphae. When he asked her concerning these, she
+reluctantly told him that she had been compelled by her husband to wear
+a lock in this region. Her mother, prior to their marriage, sent her
+over to the care of her future husband (he having left Germany some
+months before). On her arrival he perforated the labia minora, causing
+her to be ill several weeks; after she had sufficiently recovered he
+put on a padlock, and for many years he had practiced the habit of
+locking her up after each intercourse. Strange to relate, no physician,
+except Collier, had ever inquired about the openings. In this
+connection the celebrated Harvey mentions a mare with infibulated
+genitals, but these did not prevent successful labor.
+
+Occasionally infibulation has been used as a means of preventing
+masturbation. De la Fontaine has mentioned this fact, and there is a
+case in this country in which acute dementia from masturbation was
+cured by infibulation. In this instance the prepuce was perforated in
+two opposite places by a trocar, and two pewter sounds (No. 2) were
+introduced into the wounds and twisted like rings. On the eleventh day
+one of the rings was removed, and a fresh one introduced in a new
+place. A cure was effected in eight weeks. There is recent mention made
+of a method of preventing masturbation by a cage fastened over the
+genitals by straps and locks. In cases of children the key was to be
+kept by the parents, but in adults to be put in some part of the house
+remote from the sleeping apartment, the theory being that the desire
+would leave before the key could be obtained.
+
+Among some peoples the urethra was slit up as a means of preventing
+conception, making a meatus near the base of the penis. Herodotus
+remarks that the women of a certain portion of Egypt stood up while
+they urinated, while the men squatted.  Investigation has shown that
+the women were obliged to stand up on account of elongated nymphae and
+labia, while the men sought a sitting posture on account of the
+termination of the urethra being on the inferior side of the base of
+the penis, artificially formed there in order to prevent conception. In
+the Australian Medical Gazette, May, 1883, there is an account of some
+of the methods of the Central Australians of preventing conception. One
+was to make an opening into the male urethra just anterior to the
+scrotum, and another was to slit up the entire urethra so far as to
+make but a single canal from the scrotum to the glans penis.  Bourke
+quotes Palmer in mentioning that it is a custom to split the urethra of
+the male of the Kalkadoon tribe, near Cloncurry, Queensland, Australia
+Mayer of Vienna describes an operation of perforation of the penis
+among the Malays; and Jagor and Micklucho-Maclay report similar customs
+among the Dyaks and other natives of Borneo, Java, and Phillipine
+Islands.
+
+Circumcision is a rite of great antiquity. The Bible furnishes frequent
+records of this subject, and the bas-reliefs on some of the old
+Egyptian ruins represent circumcised children. Labat has found traces
+of circumcision and excision of nymphae in mummies.  Herodotus remarks
+that the Egyptians practiced circumcision rather as a sanitary measure
+than as a rite. Voltaire stated that the Hebrews borrowed circumcision
+from the Egyptians; but the Jews claimed that the Phoenicians borrowed
+this rite from the Israelites.
+
+Spencer and others say that in the early history of the Christian
+religion, St. Paul and his Disciples did not believe in circumcision,
+while St. Peter and his followers practiced it.  Spencer mentions that
+the Abyssinians take a phallic trophy by circumcision from the enemy's
+dead body. In his "History of Circumcision," Remondino says that among
+the modern Berbers it is not unusual for a warrior to exhibit virile
+members of persons he has slain; he also says that, according to
+Bergman, the Israelites practiced preputial mutilations; David brought
+200 prepuces of the Philistines to Saul. Circumcision is practiced in
+nearly every portion of the world, and by various races, sometimes
+being a civil as well as a religious custom. Its use in surgery is too
+well known to be discussed here. It might be mentioned, however, that
+Rake of Trinidad, has performed circumcision 16 times, usually for
+phimosis due to leprous tuberculation of the prepuce. Circumcision, as
+practiced on the clitoris in the female, is mentioned on page 308.
+
+Ceremonial Ovariotomy.--In the writings of Strabonius and Alexander ab
+Alexandro, allusion is made to the liberties taken with the bodies of
+females by the ancient Egyptians and Lydians.  Knott says that ablation
+of the ovaries is a time-honored custom in India, and that he had the
+opportunity of physically examining some of the women who had been
+operated on in early life. At twenty-five he found them strong and
+muscular, their mammary glands wholly undeveloped, and the normal
+growth of pubic hairs absent. The pubic arch was narrow, and the
+vaginal orifice practically obliterated. The menses had never appeared,
+and there seemed to be no sexual desire. Micklucho-Maclay found that
+one of the most primitive of all existing races--the New
+Hollanders--practiced ovariotomy for the utilitarian purpose of
+creating a supply of prostitutes, without the danger of burdening the
+population by unnecessary increase. MacGillibray found a native
+ovariotomized female at Cape York who had been subjected to the
+operation because, having been born dumb, she would be prevented from
+bearing dumb children,--a wise, though primitive, method of preventing
+social dependents.
+
+Castration has long been practiced, either for the production of
+eunuchs, or castrata, through vengeance or jealousy, for excessive
+cupidity, as a punishment for crime, in fanaticism, in ignorance, and
+as a surgical therapeutic measure (recently, for the relief of
+hypertrophied prostate). The custom is essentially Oriental in origin,
+and was particularly used in polygamous countries, where the mission of
+eunuchs was to guard the females of the harem. They were generally
+large, stout men, and were noted for their vigorous health. The history
+of eunuchism is lost in antiquity. The ancient Book of Job speaks of
+eunuchs, and they were in vogue before the time of Semiramis; the King
+of Lydia, Andramytis, is said to have sanctioned castration of both
+male and female for social reasons. Negro eunuchs were common among the
+Romans. All the great emperors and conquerors had their eunuchs.
+Alexander the Great had his celebrated eunuch, Bagoas, and Nero, his
+Sporus, etc. Chevers says that the manufacture of eunuchs still takes
+place in the cities of Delhi, Lucknow, and Rajpootana. So skilful are
+the traveling eunuch-makers that their mortality is a small fraction of
+one per cent. Their method of operation is to encircle the external
+genital organs with a tight ligature, and then sweep them off at one
+stroke. He also remarks that those who retain their penises are of but
+little value or trusted. He divided the Indian eunuchs into three
+classes: those born so, those with a penis but no testicles, and those
+minus both testicles and penis. Curran describes the traveling
+eunuch-makers in Central India, and remarks upon the absence of death
+after the operation, and invites the attention of gynecologists and
+operators to the successful, though crude, methods used. Curran says
+that, except those who are degraded by practices of sexual perversions,
+these individuals are vigorous bodily, shrewd, and sagacious, thus
+proving the ancient descriptions of them.
+
+Jamieson recites a description of the barbarous methods of making
+eunuchs in China. The operators follow a trade of eunuch-making, and
+keep it in their families from generation to generation; they receive
+the monetary equivalent of about $8.64 for the operation.  The patient
+is grasped in a semi-prone position by an assistant, while two others
+hold the legs. After excision the wounded parts are bathed three times
+with a hot decoction of pepper-pods, the wound is covered with paper
+soaked in cold water, and bandages applied. Supported by two men the
+patient is kept walking for two or three hours and then tied down. For
+three days he is allowed nothing to drink, and is not allowed to pass
+his urine, the urethra being filled with a pewter plug. It generally
+takes about one hundred days for the wound to heal, and two per cent of
+the cases are fatal. There is nocturnal incontinence of urine for a
+long time after the operation.
+
+Examples of castration because of excessive cupidity, etc.,--a most
+unwarranted operation,--are quite rare and are usually found among
+ecclesiastics. The author of "Faustin, or le Siecle Philosophique,"
+remarked that there were more than 4000 castrated individuals among the
+ecclesiastics and others of Italy. The virtuous Pope Clement XIV
+forbade this practice, and describes it as a terrible abuse; but in
+spite of the declaration of the Pope the cities of Italy, for some
+time, still continued to contain great numbers of these victims. In
+France an article was inserted into the penal code providing severe
+punishment for such mutilations. Fortunately castration for the
+production of "castrata," or tenor singers, has almost fallen into
+disuse.  Among the ancient Egyptians and Persians amputation of the
+virile member was inflicted for certain crimes of the nature of rape.
+
+Castration as a religious rite has played a considerable role.  With
+all their might the Emperors Constantine and Justinian opposed the
+delirious religion of the priests of Cybele, and rendered their offence
+equivalent to homicide. At the annual festivals of the Phrygian Goddess
+Amma (Agdistis) it was the custom of young men to make eunuchs of
+themselves with sharp shells, and a similar rite was recorded among
+Phoenicians.  Brinton names severe self-mutilators of this nature among
+the ancient Mexican priests. Some of the Hottentots and indigenous
+Australians enforced semicastration about the age of eight or nine.
+
+The Skoptzies, religious castrators in Russia, are possibly the most
+famous of the people of this description. The Russian government has
+condemned members of this heresy to hard labor in Siberia, but has been
+unable to extinguish the sect. Pelikan, Privy Counsel of the
+government, has exhaustively considered this subject. Articles have
+appeared in Le Progres Medical, December.  1876. and there is an
+account in the St. Louis Clinical Record, 1877-78. The name Skoptzy
+means "the castrated," and they call themselves the "White Doves." They
+arose about 1757 from the Khlish or flagellants. Paul I caused
+Sseliwanow, the true founder, to return from Siberia, and after seeing
+him had him confined in an insane asylum. After an interview, Alexander
+I transferred him to a hospital. Later the Councillor of State,
+Jelansky, converted by Sseliwanow, set the man free and soon the
+Skoptzies were all through Russia and even at the Court. The principal
+argument of these people is the nonconformity of orthodox believers,
+especially the priests, to the doctrines professed, and they contrast
+the lax morals of these persons with the chaste lives, the abstinence
+from liquor, and the continual fasts of the "White Doves." For the
+purpose of convincing novices of the Scriptural foundation of their
+rites and belief they are referred to Matthew xix., 12: "and there be
+eunuchs which have made themselves for the kingdom of Heaven's sake,"
+etc.; and Mark ix., 43-47; Luke xxiii., 29: "blessed are the barren,"
+etc., and others of this nature. As to the operation itself, pain is
+represented as voluntary martyrdom, and persecution as the struggle of
+the spirit of darkness with that of light. They got persons to join the
+order by monetary offers. Another method was to take into service young
+boys, who soon became lost to society, and lied with effrontery and
+obstinacy. They had secret methods of communicating with one another,
+and exhibited a passion for riches, a fact that possibly accounts for
+their extended influence. The most perfect were those "worthy of
+mounting the white horse," the "bearers of the Imperial seal," who were
+deprived of the testicles, penis, and scrotum. The operation of
+castration among these people was performed at one stroke or at two
+different times, in the former case one cicatrix being left, and in the
+latter two. The greater number--those who had submitted to the "first
+purification," conferring upon them the "lesser seal"--had lost
+testicles and scrotum. These people are said to have lost the "keys of
+hell," but to retain the "key of the abyss" (female genitals). As
+instruments of excision the hot iron, pieces of glass, old wire,
+sharpened bone, and old razors are used. Only nine fatal cases
+resulting from the operation are known. At St. Petersburg Liprandi knew
+a rich Skoptzy who constantly kept girls--mostly Germans--for his own
+gratification, soon after having entered into the "first purification."
+Few of them were able to remain with him over a year, and they always
+returned to their homes with health irretrievably lost. Women members
+of the order do not have their ovaries removed, but mutilation is
+practiced upon the external genitals, the mammae, and nipples. The
+first ablation is obtained by applying fire or caustics to the nipples,
+the second by amputation of the breasts, one or both, the third by
+diverse gashes, chiefly across the breast, and the fourth by resection
+of the nymphae or of the nymphae and clitoris, and the superior major
+labia, the cicatrices of which would deform the vulva. Figure 232
+represents the appearance of the external genital organs of a male
+Skoptzy after mutilation; Figure 233 those of a female.
+
+Battey speaks of Skoptzies in Roumania who numbered at the time of
+report 533 persons. They came from Russia and practiced the same
+ceremonies as the heretics there.
+
+
+
+CHAPTER XV.
+
+ANOMALOUS TYPES AND INSTANCES OF DISEASE.
+
+Tumors.--In discussing tumors and similar growths no attempt will be
+made to describe in detail the various types. Only the anomalous
+instances or examples, curious for their size and extent of
+involvement, will be mentioned. It would be a difficult matter to
+decide which was the largest tumor ever reported. In reviewing
+literature so many enormous growths are recorded that but few can be
+given here. Some of the large cystic formations have already been
+mentioned; these are among the largest tumors.  Scrotal tumors are
+recorded that weighed over 200 pounds; and a limb affected with
+elephantiasis may attain an astonishing size.  Delamater is accredited
+with a report of a tumor that weighed 275 pounds, the patient only
+weighing 100 pounds at death. Benign tumors will be considered first.
+
+Pure adenoma of the breast is a rare growth. Gross was able to collect
+but 18 examples; but closely allied to this condition is what is known
+as diffuse hypertrophy of the breast. In some parts of the world,
+particularly in India and Africa, long, dependent breasts are signs of
+beauty. On the other hand we learn from Juvenal and Martial that, like
+ourselves, the Greeks detested pendant and bulky breasts, the signs of
+beauty being elevation, smallness, and regularity of contour. In the
+Grecian images of Venus the breasts are never pictured as engorged or
+enlarged. The celebrated traveler Chardin says that the Circassian and
+Georgian women have the most beautiful breasts in the world; in fact
+the Georgians are so jealous of the regular contour and wide interval
+of separation of their breasts that they refuse to nourish their
+children in the natural manner.
+
+The amount of hypertrophy which is sometimes seen in the mammae is
+extraordinary. Borellus remarks that he knew of a woman of ordinary
+size, each of whose mammae weighed about 30 pounds, and she supported
+them in bags hung about her neck. Durston reports a case of sudden
+onset of hypertrophy of the breast causing death.  At the postmortem it
+was found that the left breast weighed 64 pounds and the right 40
+pounds. Boyer successfully removed two breasts at an interval of
+twenty-six days between the two operations. The mass excised was
+one-third of the total body-weight.
+
+Schaeffer speaks of hypertrophied mammae in a girl of fourteen, the
+right breast weighing 3900 grams (136 1/2 oz.) and the right 3500 grams
+(122 1/2 oz.). Hamilton reports a case of hypertrophied glands in a
+woman of thirty-two, which, within the short space of a year, reached
+the combined weight of 52 pounds.  They were successfully excised.
+Velpeau, Billroth, and Labarracque have reported instances of the
+removal of enormously hypertrophied mammae. In 1886 Speth of Munich
+described a hypertrophy of the right breast which increased after every
+pregnancy. At the age of twenty-six the woman had been five times
+pregnant in the space of a little over five years, and at this time the
+right breast hung down to the anterior superior spine of the ilium. It
+weighed 20 pounds, and its greatest circumference was 25 inches. There
+was no milk in this breast, although the left was in perfect lactation.
+This case was one of pure hypertrophy and not an example of
+fibro-adenoma, as illustrated by Billroth. Warren figures a case of
+diffused hypertrophy of the breast which was operated on by Porter. The
+right breast in its largest circumference measured 38 inches and from
+the chest-wall to the nipple was 17 inches long, the circumference at
+the base being 23 inches; the largest circumference of the left breast
+was 28 inches; its length from the chest-wall to the nipple was 14
+inches, and its circumference at the base 23 inches. The skin was
+edematous and thickened. Throughout both breasts were to be felt
+hardened movable masses, the size of oranges. Microscopic examination
+showed the growth to be a diffused intracanalicular fibroma. A peculiar
+case was presented before the Faculty at Montpellier. The patient was a
+young girl of fifteen and a half years. After a cold bath, just as the
+menses were appearing, it was found that the breasts were rapidly
+increasing in size; she was subsequently obliged to leave service on
+account of their increased size, and finally the deformity was so great
+as to compel her to keep from the public view. The circumference of the
+right breast was 94 cm. and of the left 105 cm.; the pedicle of the
+former measured 67 cm. and of the latter 69 cm.; only the slightest
+vestige of a nipple remained. Removal was advocated, as applications of
+iodin had failed; but she would not consent to operation. For eight
+years the hypertrophy remained constant, but, despite this fact, she
+found a husband. After marriage the breasts diminished, but she was
+unable to suckle either of her three children, the breasts becoming
+turgid but never lactescent.  The hypertrophy diminished to such a
+degree that, at the age of thirty-two, when again pregnant, the
+circumference of the right breast was only 27 cm. and of the left 33
+cm. Even thus reduced the breasts descended almost to the navel. When
+the woman was not pregnant they were still less voluminous and seemed
+to consist of an immense mass of wrinkled, flaccid skin, traversed by
+enormous dilated and varicose blood-vessels, the mammary glands
+themselves being almost entirely absent.
+
+Diffuse hypertrophy of the breast is occasionally seen in the male
+subject. In one case reported from the Westminster Hospital in London,
+a man of sixty, after a violent fall on the chest, suffered enormous
+enlargement of the mammae, and afterward atrophy of the testicle and
+loss of sexual desire.
+
+The names goiter, struma, and bronchocele are applied indiscriminately
+to all tumors of the thyroid gland; there are, however, several
+distinct varieties among them that are true adenoma, which, therefore,
+deserves a place here. According to Warren, Wolfler gives the following
+classification of thyroid tumors: 1. Hypertrophy of the thyroid gland,
+which is a comparatively rare disease; 2. Fetal adenoma, which is a
+formation of gland tissue from the remains of fetal structures in the
+gland; 3. Gelatinous or interacinous adenoma, which consists in an
+enlargement of the acini by an accumulation of colloid material, and an
+increase in the interacinous tissue by a growth of round cells. It is
+this latter form in which cysts are frequently found. The accompanying
+illustration pictures an extreme ease of cystic goiter shown by Warren.
+A strange feature of tumors of the thyroid is that pressure-atrophy and
+flattening of the trachea do not take place in proportion to the size
+of the tumor. A small tumor of the middle lobe of the gland, not larger
+that a hen's egg, will do more damage to the trachea than will a large
+tumor, such as that shown by Senn, after Bruns. When a tumor has
+attained this size, pressure-symptoms are often relieved by the weight
+of the tumor making traction away from the trachea. Goiter is endemic
+in some countries, particularly in Switzerland and Austria, and appears
+particularly at the age of childhood or of puberty. Some communities in
+this country using water containing an excess of calcium salt show
+distinct evidences of endemic goiter. Extirpation of the thyroid gland
+has in recent years been successfully practiced. Warren has extirpated
+one lobe of the thyroid after preliminary ligation of the common
+carotid on the same side. Green practiced rapid removal of the tumor
+and ligated the bleeding vessels later. Rose tied each vessel before
+cutting, proceeding slowly. Senn remarks that in 1878 he witnessed one
+of Rose's operations which lasted for four hours. Although the operatic
+technic of removal of the thyroid gland for tumor has been greatly
+perfected by Billroth, Lucke, Julliard, Reverdin, Socin, Kocher, and
+others, the current opinion at the present day seems to be that
+complete extirpation of the thyroid gland, except for malignant
+disease, is unjustifiable. Partial extirpation of the thyroid gland is
+still practiced; and Wolfler has revived the operation of ligating the
+thyroid arteries in the treatment of tumors of the thyroid gland.
+
+Fibromata.--One of the commonest seats of fibroma is the skin.
+Multiple fibromata of the skin sometimes occur in enormous numbers and
+cover the whole surface of the body; they are often accompanied by
+pendulous tumors of enormous size. Virchow called such tumors fibroma
+molluscum. Figure 237 represents a case of multiple fibromata of the
+skin shown by Octerlony. Pode mentions a somewhat similar case in a man
+of fifty-six, under the care of Thom. The man was pale and emaciated,
+with anxious expression, complaining of a tumor which he described as a
+"wishing-mark." On examination he was found to be covered with a number
+of small tumors, ranging in size from that of a small orange to that of
+a pin's head; from the thoracic wall over the lower true ribs of the
+right side was situated a large pendulous tumor, which hung down as far
+as the upper third of the thigh. He said that it had always been as
+long as this, but had lately become thicker, and two months previously
+the skin over the lower part of the tumor had ulcerated. This large
+tumor was successfully removed; it consisted of fibrous tissue, with
+large veins running in its substance. The excised mass weighed 51
+pounds. The patient made an early recovery.
+
+Keloids are fibromata of the true skin, which may develop spontaneously
+or in a scar. Although the distinction of true and false keloid has
+been made, it is generally discarded. According to Hebra a true typical
+keloid is found once in every 2000 cases of skin-disease. It is,
+however, particularly the false keloid, or keloid arising from
+cicatrices, with which we have mostly to deal. This tumor may arise
+from a scar in any portion of the body, and at any age. There seems to
+be a disposition in certain families and individuals to
+keloid-formations, and among negroes keloids are quite common, and
+often of remarkable size and conformation. The form of injury causing
+the cicatrix is no factor in the production of keloid, the sting of an
+insect, the prick of a needle, and even the wearing of ear-rings having
+been frequent causes of keloid-formations among the negro race.
+Collins describes a negress of ninety, born of African parents, who
+exhibited multiple keloids produced by diverse injuries. At fourteen
+she was burned over her breasts by running against a shovelful of hot
+coals, and several months later small tumors appeared, which never
+suppurated. When a young girl a tumor was removed from the front of her
+neck by operation, and cicatricial tumors then spread like a band
+encircling one-half her neck.  There were keloids over her scapulae,
+which followed the application of blisters. On her back, over, and
+following the direction of the ribs, were growths attributed to the
+wounds caused by a flogging. This case was quite remarkable for the
+predisposition shown to keloid at an early age, and the variety of
+factors in causation.
+
+About 1867 Duhring had under his observation at the Philadelphia
+Hospital a negro whose neck was encircled by enormous keloids, which,
+although black, otherwise resembled tomatoes. A photograph of this
+remarkable case was published in Philadelphia in 1870.
+
+A lipoma is a tumor consisting of adipose tissue. When there is much
+fibrous tissue in the tumor it is much firmer, and is known as a
+fibro-lipoma. Brander describes a young native of Manchuria, North
+China, from whom he removed a fibro-lipoma weighing 50 pounds. The
+growth had progressively enlarged for eleven years, and at the time of
+extirpation hung as an enormous mass from beneath the left scapula. In
+operating the tumor had to be swung on a beam. The hemorrhage was
+slight and the patient was discharged in five days.
+
+The true lipoma must be distinguished from diffuse accumulations of fat
+in different parts of the body in the same way that fibroma is
+distinguished from elephantiasis. Circumscribed lipoma appears as a
+lobulated soft tumor, more or less movable, lying beneath the skin. It
+sometimes reaches enormous size and assumes the shape of a pendulous
+tumor.
+
+Diffuse lipoma, occurring in the neck, often gives the patient a
+grotesque and peculiar appearance. It is generally found in men
+addicted to the use of alcohol, and occurs between thirty-five and
+forty-five years of age; in no case has general obesity been described.
+In one of Madelung's cases a large lobe extended downward over the
+clavicle. The growth has been found between the larynx and the pharynx.
+Black reports a remarkable case of fatty tumor in a child one year and
+five months old which filled the whole abdominal cavity, weighing nine
+pounds and two ounces.  Chipault mentions a case of lipoma of the
+parietal region, observed by Rotter. This monstrous growth was three
+feet three inches long, descending to the knees. It had its origin in
+the left parietal region, and was covered by the skin of the whole left
+side of the face and forehead. The left ear was plainly visible in the
+upper third of the growth.
+
+Chondroma, or enchondroma, is a cartilaginous tumor occurring
+principally where cartilage is normally found, but sometimes in regions
+containing no cartilage. Enchondroma may be composed of osteoid tissue,
+such as is found in the ossifying callous between the bone and the
+periosteum, and, according to Virchow, then takes the name of
+osteochondroma. Virchow has divided chondromata into two forms--those
+which he calls ecchondromata, which grow from cartilage, and those that
+grow independently from cartilage, or the enchondromata, which latter
+are in the great majority.  Enchondroma is often found on the long
+bones, and very frequently upon the bones of the hands or on the
+metatarsal bones.
+
+Figure 244 represents an enchondroma of the thumb. Multiple
+enchondromata are most peculiar, and may attain enormous sizes.
+Whittaker describes a farmer of forty who exhibited peculiar tumors of
+the fingers, which he calls multiple osteoecchondromata. His family
+history was negative. He stated that at an early age he received a
+stroke of lightning, which rendered him unconscious for some time. He
+knows of nothing else that could be in possible relation with his
+present condition.  Nine months after this accident there was noticed
+an enlargement of the middle joint of the little finger, and about the
+same time an enlargement on the middle finger. Gradually all the joints
+of the right hand became involved. The enlargement increased so that at
+the age of twelve they were of the size of walnuts, and at this time
+the patient began to notice the same process developing in the left
+hand. The growths continued to develop, new nodules appearing, until
+the fingers presented the appearance of nodulated potatoes.
+
+One of the most frequent of the fibro-cartilaginous tumors is the
+"mixed cartilaginous" tumor of Paget, which grows in the interstitial
+tissues of the parotid gland, and sometimes attains enormous size.
+Matas presented the photograph of a negress having an enormous fibroma
+growing from the left parotid region; and there is a photograph of a
+similar case in the Mutter Museum of the College of Physicians,
+Philadelphia.
+
+The hyaline enchondroma is of slow growth, but may at times assume
+immense proportions, as is shown in the accompanying illustration,
+given by Warren, of a patient in whom the growth was in the scapula.
+
+In 1824 there is quoted the description of a peculiar growth which,
+though not definitely described, may be spoken of here. It was an
+enormous encysted tumor, springing from the clavicle of a Veronese
+nobleman. Contrary to general expectations it was successfully removed
+by Portalupi, a surgeon of Venice. It weighed 57 pounds, being 20 1/2
+inches long and 30 inches in circumference. It is said this tumor
+followed the reception of a wound.
+
+Among the benign bone tumors are exostoses--homologous outgrowths
+differing from hypertrophies, as they only involve a limited part of
+the circumference. When developmental, originating in childhood, the
+outgrowths may be found on any part of the skeleton, and upon many and
+generally symmetric parts at the same time, as is shown in Figure 248.
+
+Barwell had a case of a girl with 38 exostoses. Erichsen mentions a
+young man of twenty-one with 15 groups of symmetric exostoses in
+various portions of the body; they were spongy or cancellous in nature.
+
+Hartmann shows two cases of multiple exostoses, both in males, and
+universally distributed over the body.
+
+Macland of the French navy describes an affection of the bones of the
+face known as anakhre or goundron (gros-nez). It is so common that
+about one per cent of the natives of certain villages on the Ivory
+Coast, West Africa, are subject to it. As a rule the earliest symptoms
+in childhood are: more or less persistent headache, particularly
+frontal, sanguineous and purulent discharge from the nostrils, and the
+formation of symmetric swellings the size of an almond in the region of
+the nasal processes of the superior maxilla. The cartilage does not
+seem to be involved, and, although it is not so stated, the nasal duct
+appears to remain intact.
+
+The headache and discharge continue for a year, and the swelling
+continually increases through life, although the symptoms gradually
+disappear, the skin not becoming involved, and no pain being present.
+It has been noticed in young chimpanzees. The illustration represents a
+man of forty who suffered from the disease since puberty. Pressure on
+the eyeball had started and the native said he expected that in two
+years he would lose his sight. Figure 251 shows an analogous condition,
+called by Hutchinson symmetric osteomata of the nasal processes of the
+maxilla. His patient was a native of Great Britain.
+
+Among neuromata, multiple neurofibroma is of considerable interest,
+chiefly for the extent of general involvement.  According to Senn,
+Heusinger records the case of a sailor of twenty-three in whom all the
+nerves were affected by numerous nodular enlargements. Not a nerve in
+the entire body was found normal. The enlargement was caused by
+increase in the connective tissue, the axis-cylinders being normal. In
+this case there was neither pain nor tenderness.
+
+Prudden reports the case of a girl of twenty-five who, during
+convalescence from variola, became paraplegic, and during this time
+multiple neuromata appeared. At the postmortem more than a thousand
+tumors were found affecting not only the peripheral branches and the
+sympathetic, but also the cranial nerves and the pneumogastric. Under
+the microscope these tumors showed an increase in the interfascicular
+as well as perivascular fibers, but the nerve-fibers were not increased
+in size or number.  Virchow collected 30 cases of multiple
+neurofibromata. In one case he found 500, in another from 800 to 1000
+tumors.
+
+Plexiform neuroma is always congenital, and is found most frequently in
+the temporal region, the neck, and the sides of the face, but almost
+any part of the body may be affected. Christot reports two cases in
+which the tumors were located upon the cheek and the neck. Czerny
+observed a case in which the tumor involved the lumbar plexus. Quoted
+by Senn, Campbell de Morgan met with a plexiform neuroma of the
+musculo-spiral nerve and its branches.  The patient was a young lady,
+and the tumor, which was not painful, had undergone myxomatous
+degeneration.
+
+Neuroma of the vulva is a pathologic curiosity. Simpson reports a case
+in which the tumor was a painful nodule situated near the urinary
+meatus. Kennedy mentions an instance in which the tumor appeared as
+extremely tender tubercles.
+
+Tietze describes a woman of twenty-seven who exhibited a marked type of
+plexiform neurofibroma. The growth was simply excised and recovery was
+promptly effected.
+
+Carcinomatous growths, if left to themselves, make formidable
+devastations of the parts which they affect. Warren pictures a case of
+noli-me-tangere, a destructive type of epithelial carcinoma. The
+patient suffered no enlargement of the lymphatic glands. The same
+absence of glandular involvement was observed in another individual, in
+whom there was extensive ulceration. The disease had in this case
+originated in the scar of a gunshot wound received during the Civil
+War, and had destroyed the side of the nose, the eye, the ear, the
+cheek, including the corresponding half of the upper and lower lips.
+
+Harlan reports a most extraordinary epithelioma of the orbit in a boy
+of about five years. It followed enucleation, and attained the size
+depicted in a few months.
+
+Sarcomata, if allowed full progress, may attain great size. Plate 10
+shows an enormous sarcoma of the buttocks in an adult negro.  Fascial
+sarcomata are often seen of immense size. Senn shows a tumor of this
+variety which was situated between the scapulae.
+
+Schwimmer records a curious case of universal small sarcomata over the
+whole body of a teacher of the age of twenty-one, in the Hungarian
+lowlands. The author called the disease sarcomata pigmentosum diffusum
+multiplex.
+
+The bones are a common seat of sarcomatous growths, the tumor in this
+instance being called osteosarcoma. It may affect any bone, but rarely
+involves an articulation; at times it skips the joint and goes to the
+neighboring bone.
+
+A case of nasal sarcoma is shown by Moore. The tumor was located in the
+nasal septum, and caused a frightful deformity. In this case pain was
+absent, the sense of smell was lost, and the sight of the right eye
+impaired. Moore attempted to remove the tumor, but in consequence of
+some interference of respiration the patient died on the table.
+
+Tiffany reports several interesting instances of sarcoma, one in a
+white female of nineteen following a contusion of tibia. The growth had
+all the clinical history of an osteosarcoma of the tibia, and was
+amputated and photographed after removal. In another case, in a white
+male of thirty, the same author successfully performed a hip-amputation
+for a large sarcoma of the left femur. The removed member was sent
+entire to the Army Medical Museum at Washington.
+
+The fatality and incurability of malignant growths has done much to
+stimulate daring and marvelous operations in surgery. The utter
+hopelessness of the case justifies almost any means of relief, and many
+of the visceral operations, resections of functional organs, and
+extraordinary amputations that were never dreamed of in the early
+history of medicine are to-day not only feasible and justifiable, but
+even peremptorily demanded.
+
+Varicose veins sometimes become so enlarged and distorted as to
+simulate the appearance of one varicose tumor. Adams describes a
+curious case of congenital dilatation of the arteries and veins in the
+right lower limb, accompanied by an anastomosis with the interior of
+the os calcis. The affected thigh exceeded the other in size by
+one-third, all the veins being immensely swelled and distorted. The
+arteries were also distorted and could be felt pulsating all over the
+limb. The patient died at thirty from rupture of the aneurysm.
+
+Abbe shows a peculiar aneurysmal varix of the finger in a boy of nine.
+When a babe the patient had, on the dorsum of the little finger, a
+small nevus, which was quiescent for many years. He received a deep cut
+at the base of the thumb, and immediately after this accident the nevus
+began to enlarge rapidly. But for the local aneurysmal thrill at the
+point of the scar the condition would have been diagnosed as angioma,
+but as a bruit could be heard over the entire mass it was called an
+aneurysmal varix, because it was believed there was a connection
+between a rather large artery and a vein close to the mass. There is a
+curious case reported of cirsoid tumor of the ear of a boy of thirteen.
+Figure 259 shows the appearance before and after operation.
+
+Jessop records a remarkable case of multiple aneurysm. This case was
+particularly interesting as it was accompanied by a postmortem
+examination. Pye-Smith reports an extremely interesting case in which
+death occurred from traumatic aneurysm of an aberrant subclavian
+artery. The patient fell from a height of 28 feet, lost consciousness
+for a few minutes, but soon recovered it. There was no evidence of any
+fracture, but the man suffered greatly from dyspnea, pain between the
+shoulders, and collapse. The breath-sounds on auscultation and the
+difficulty in swallowing led to the belief that one of the bronchi was
+blocked by the pressure of a hematoma. Dyspnea continued to increase,
+and eighteen days after admission the man was in great distress, very
+little air entering the chest. He had no pulse at the right wrist, and
+Pye-Smith was unable to feel either the temporal or carotid beats on
+the right side, although these vessels were felt pulsating on the left
+side. Laryngotomy was done with the hope of removing a foreign body,
+but the man died on the tenth day. A postmortem examination disclosed
+the existence of an aberrant right subclavian artery in the posterior
+mediastinum, and this was the seat of a traumatic aneurysm that had
+ruptured into the esophagus.
+
+Relative to the size of an aneurysm, Warren reported a case of the
+abdominal aorta which commenced at the origin of the celiac axis and
+passed on to the surfaces of the psoas and iliac muscles, descending to
+the middle of the thigh The total length of the aneurysm was 19 inches,
+and it measured 18 inches in circumference.
+
+A peculiar sequence of an aortic aneurysm is perforation of the sternum
+or rib. Webb mentions an Irish woman who died of aneurysm of the aorta,
+which had perforated the sternum, the orifice being plugged by a large
+clot. He quotes 17 similar cases which he has collected as occurring
+from 1749 to 1874, and notes that one of the patients lived seven weeks
+after the rupture of the aneurysmal sac.
+
+Large Uterine Tumors.--Before the meeting of the American Medical
+Association held in Washington, D.C., 1891, McIntyre a reported a case
+of great interest. The patient, a woman of thirty-eight, five feet 5
+1/2 inches in height, coarse, with masculine features, having hair on
+her upper lip and chin, and weighing 199 1/2 pounds, was found in a
+poor-house in Trenton, Missouri, on November 26, 1890, suffering from a
+colossal growth of the abdomen. The accompanying illustration is from a
+photograph which was taken at the time of the first interview. The
+measurements made at the time were as follows: circumference at the
+largest part, just below the umbilicus, 50 inches; circumference just
+below the mammae, 35 inches; from the xiphoid cartilage to the
+symphysis pubis, 32 inches, not including the appendum, which is shown
+in the picture. Percussion suggested a fluid within a sac.  The uterus
+was drawn up to the extent of from 12 to 14 inches.  The woman walked
+with great difficulty and with a waddling gait, bending far backward
+the better to keep "the center of gravity within the base," and to
+enable her to sustain the enormous weight of the abdomen. She was
+compelled to pass her urine while standing. Attempts had been made six
+and two years before to tap this woman, but only a few drops of blood
+followed several thrusts of a large trocar. A diagnosis was made of
+multilocular ovarian cyst or edematous myoma of the uterus, and on the
+morning of December 7, 1890, an operation was performed. An incision 14
+inches in length was first made in the linea alba, below the umbilicus,
+and afterward extended up to the xiphoid cartilage.  The hemorrhage
+from the abdominal wall was very free, and the enormously distended
+vessels required the application of a large number of pressure-forceps.
+Adhesions were found almost everywhere the most difficult to manage
+being those of the liver and diaphragm. The broad ligaments and
+Fallopian tubes were ligated on either side, the tumor turned out, the
+thick, heavy pedicle transfixed and ligated, and the enormous growth
+cut away.  After operation the woman was immediately placed on platform
+scales, and it was found that she had lost 93 1/2 pounds.
+Unfortunately the patient developed symptoms of septicemia and died on
+the fifth day. In looking over the literature on this subject McIntyre
+found no mention of any solid tumor of this size having been removed.
+On April 18, 1881, Keith, late of Edinburgh, now of London,
+successfully removed an edematous myoma, together with the uterus,
+which was 42 pounds in weight. In a recent work Tait remarks that the
+largest uterine myoma which he ever removed weighed 68 pounds, and adds
+that it grew after the menopause.  McIntyre believes that his tumor,
+weighing 93 1/2 pounds, is the largest yet reported. Eastman reports
+the removal of a fibroid tumor of the uterus weighing 60 pounds. The
+patient recovered from the operation.
+
+It is quite possible for a fibrocyst of the uterus to attain an
+enormous size, equaling the ovarian cysts. Stockard describes an
+instance of this nature in a negress of fifty, the mother of several
+children. About twelve years before a cyst in the right iliac region
+was tapped. The woman presented the following appearance: The navel
+hung below her knees, and the skin near the umbilicus resembled that of
+an elephant. The abdomen in its largest circumference measured 68
+inches, and 27 inches from the ensiform cartilage to the umbilicus. The
+umbilicus was five inches in diameter and three inches in length. Eight
+gallons and seven pints of fluid were removed by tapping, much
+remaining. The whole tumor weighed 135 pounds. Death from exhaustion
+followed on the sixth day after the tapping.
+
+Ovarian cysts, of which by far the greater number are of the glandular
+variety, form extremely large tumors; ovarian dropsies of enormous
+dimensions are recorded repeatedly throughout medical literature. Among
+the older writers Ford mentions an instance of ovarian dropsy from
+which, by repeated operations, 2786 pints of water were drawn.
+Martineau describes a remarkable case of twenty-five years' duration,
+in which 80 paracenteses were performed and 6630 pints of fluid were
+withdrawn. In one year alone 495 pints were withdrawn. Tozzetti
+mentions an ovarian tumor weighing 150 pounds. Morand speaks of an
+ovarian cyst from which, in ten months, 427 pounds of fluid were
+withdrawn. There are old records of tubal cysts weighing over 100
+pounds. Normand speaks of an ovary degenerating into a scirrhous mass
+weighing 55 pounds. Among recent operations Briddon describes the
+removal of an ovarian cyst which weighed 152 pounds, death resulting.
+Helmuth mentions an ovarian cyst from which, in 12 tappings, 559 pounds
+of fluid were withdrawn. Delivery was effected by instrumental aid. The
+tumor of 70 pounds was removed and death followed. McGillicuddy
+mentions a case of ovarian cyst containing 132 pounds of fluid. The
+patient was a woman of twenty-eight whose abdomen at the umbilicus
+measured 69 inches in circumference and 47 inches from the sternum to
+the pubes. Before the operation the great tumor hung down as far as the
+knees, the abdominal wall chafing the thighs. Figure 263 shows the
+appearance of a large ovarian cyst weighing 149 pounds. The emaciation
+of the subject is particularly noticeable. Reifsnyder describes a
+native Chinese woman affected with an ovarian tumor seen at the
+Margaret Williamson Hospital at Shanghai. She was four feet eight
+inches in height, and twenty-five years of age.  The tumor had been
+growing for six years until the circumference at the umbilicus measured
+five feet 7 3/4 inches; 88 quarts of fluid were drawn off and the woman
+recovered. In the College of Physicians, Philadelphia, there are
+photographs of this case, with an inscription saying that the patient
+was a young Chinese woman who measured but four feet eight inches in
+height, while her girth was increased by an ovarian cyst to five feet 9
+1/8 inches. The tumor was removed and weighed 182 1/2 pounds; it
+contained 22 gallons of fluid. Figure 265 shows the appearance of the
+woman two months after the operation, when the girth was reduced to
+normal. Stone performed ovariotomy on a girl of fifteen, removing a
+tumor weighing 81 1/2 pounds. Ranney speaks of the successful removal
+of a unilocular tumor weighing 95 pounds; and Wall tells of a death
+after removal of an ovarian tumor of the same weight. Rodenstein
+portrays the appearance of a patient of forty-five after death from an
+enormous glandular ovarian cystoma. The tumor was three feet high,
+covered the breasts, extended to the knees, and weighed 146 pounds.
+Kelly speaks of a cyst weighing 116 pounds; Keith one of 89 1/2 pounds;
+Gregory, 80 pounds; Boerstler, 65 pounds; Bixby, 70 pounds; and Alston
+a tumor of 70 pounds removed in the second operation of ovariotomy.
+
+Dayot reports the removal of an enormous ovarian cyst from a girl of
+seventeen. The tumor had been present three years, but the patient and
+her family refused an operation until the size of the tumor alarmed
+them. Its largest circumference was five feet 11 inches. The distance
+from the xiphoid to the symphysis pubis was three feet. The tumor was
+covered with veins the size of the little finger. The apex of the heart
+was pushed to the 3d interspace and the umbilicus had disappeared.
+There were 65 quarts of a thick, brown fluid in the tumor. The patient
+recovered in twenty-five days.
+
+Cullingworth of St. Thomas Hospital, London, successfully removed from
+a girl of sixteen an ovarian cyst weighing over 80 pounds.  The patient
+was admitted to the hospital April 30, 1895. She gave a history of a
+single menstruation, which took place in March or April, 1893, and said
+that in the latter month she noticed that she was growing large. She
+was tapped at Christmas, 1893, when a large quantity of fluid was
+removed, and again in February, 1894, and a third time in May, 1894,
+but without useful results. For the previous six months she had been
+almost entirely bedridden because of the great size of the tumor. There
+were no symptoms referring to the bladder and rectum. At the time she
+entered the hospital she was much emaciated, the eyes were sunken, and
+her cheeks had a livid hue. The chest was thin and the lower ribs were
+everted; dulness began at the lower border of the 3d cartilage, and the
+apex-beat was best felt in the third space.  Liver-dulness began at the
+4th rib cartilage in the nipple line.  The abdomen was enormously
+distended, and covered by large veins running from below upward to the
+thorax. About 3 1/2 inches above the umbilicus there was a sulcus with
+its convexity downward.  There was dulness over the whole abdomen,
+except at the sides parallel with the lumbar spines, and a resonant
+band over the stomach. The greatest girth was 54 1/2 inches. By vaginal
+examination the cervix was found to be pulled up and obliterated; the
+anterior vaginal wall was bulged downward by the tumor. On May 3d
+abdominal section was performed. An incision eight inches long was made
+in the mid-line of the abdomen. A cystic tumor, formed of small cysts
+in its upper part and of somewhat larger ones in the lower part, was
+revealed. It was adherent to the abdominal wall, liver, spleen, and
+omentum. The adhesions were separated and the cyst tapped with a large
+trocar, and then the septa between the cysts were broken down with the
+fingers. The pedicle was rather small and was tied in the usual way,
+and the tumor was removed. Its seat of origin was the left ovary. The
+right ovary and the uterus were healthy, but poorly developed.  The
+tumor weighed between 80 and 90 pounds,--the patient having weighed 170
+pounds on the night before the operation and 79 1/2 pounds a week after
+the operation. Alarming symptoms of collapse were present during the
+night after the operation, but the patient responded to stimulation by
+hypodermic injections of 1/20 grain of strychnin and of brandy, and
+after the first twenty-four hours the recovery was uninterrupted.
+Cullingworth thinks that the most interesting points in the case are:
+the age of the patient, the enormous size of the tumor, and the advice
+given by the surgeon who first attended the patient (insisting that no
+operation should be performed). This case shows anew the uselessness of
+tapping ovarian cysts.
+
+In the records of enormous dropsies much material of interest is to be
+found, and a few of the most interesting cases on record will be cited.
+In the older times, when the knowledge of the etiology and pathology of
+dropsies was obscure, we find the records of the most extraordinary
+cases. Before the Royal Society, in 1746, Glass of Oxford read the
+report of a case of preternatural size of the abdomen, and stated that
+the dropsy was due to the absence of one kidney. The circumference of
+the abdomen was six feet four inches, and the distance from the xiphoid
+to the os pubis measured four feet 1/2 inch. In this remarkable case 30
+gallons of fluid were drawn off from the abdomen after death.
+Bartholinus mentions a dropsy of 120 pounds; and Gockelius one of 180
+pounds; there is recorded an instance of a dropsy of 149 pounds. There
+is an old record of a woman of fifty who had suffered from ascites for
+thirty years. She had been punctured 154 times, and each time about 20
+pints were drawn off. During each of two pregnancies she was punctured
+three or four times; one of her children was still living. It has been
+said that there was a case in Paris of a person who was punctured 300
+times for ascites. Scott reports a case of ascites in which 928 pints
+of water were drawn off in 24 successive tappings, from February, 1777,
+to May, 1778. Quoted by Hufeland, Van Wy mentions 1256 pounds of fluid
+being drawn from the abdomen of a woman in five years. Kaltschmid
+describes a case of ascites in which, in 12 paracenteses, 500 pounds of
+fluid were removed. In 1721 Morand reported two cases of ascites in one
+of which, by the means of 57 paracenteses, 970 pounds of fluid were
+drawn off in twenty-two months. In the other case 1708 pounds of fluid
+issued in ten months. There is a record of 484 pounds of "pus" being
+discharged during a dropsy.
+
+The Philosophical Transactions contain the account of a case of
+hydronephrosis in which there were 240 pounds of water in the sac.
+There are several cases on record in which ovarian dropsies have
+weighed over 100 pounds; and Blanchard mentions a uterine dropsy of 80
+pounds.
+
+The Ephemerides contains an account of a case of hydrocephalus in which
+there were 24 pounds of fluid, and similar cases have been noted.
+
+Elliotson reports what he calls the largest quantity of pus from the
+liver on record. His patient was a man of thirty-eight, a victim of
+hydatid disease of the liver, from whom he withdrew one gallon of
+offensive material.
+
+Lieutaud cites a case, reported by Blanchard, in which, in a case of
+hydatid disease, the stomach contained 90 pounds of fluid.
+
+Ankylosis of the articulations, a rare and curious anomaly, has been
+seen in the human fetus by Richaud, Joulin, Bird, and Becourt.
+Ankylosis of all the joints, with muscular atrophy, gives rise to a
+condition that has been popularly termed "ossified man." A case of this
+nature is described, the patient being a raftsman, aged seventeen, who
+suffered with inflammatory symptoms of the right great toe, which were
+followed in the next ten years by progressive involvement of all the
+joints of the extremities, and of the vertebrae and temporo-maxillary
+articulations, with accompanying signs of acute articular rheumatism.
+At the age of thirty-one the pains had subsided, leaving him completely
+disabled. All the joints except the fingers and toes had become
+ankylosed, and from nonusage the muscles had atrophied. There were no
+dislocations, anesthesia, or bedsores, and the viscera were normal;
+there were apparently no gouty deposits, as an examination of the urine
+was negative.
+
+J. R. Bass, the well-known "ossified man" of the dime museums, has been
+examined by many physicians, and was quite intelligent and cheerful in
+spite of his complete ankylosis. Figure 269 represents his appearance
+in 1887.
+
+Percy speaks of a man named Simoore, born in 1752, who at the age of
+fifteen was afflicted with ankylosis of all the joints, and at
+different angles He was unable to move even his jaw, and his teeth had
+to be extracted in order to supply him with nourishment. Even his ribs
+were ankylosed; his chest puffed up, and the breathing was entirely
+abdominal. In spite of his infirmities, after his pains had ceased he
+lived a comparatively comfortable life. His digestion was good, and his
+excretory functions were sufficient. The urine always showed
+phosphates, and never the slightest sign of free phosphoric acid. He
+still retained his sexual feeling, and occasionally had erections. This
+man died in 1802 at the age of fifty, asphyxia being the precursor of
+death. His skeleton was deposited in the Museum of the ecole de
+Medecine de Paris. In the same Museum there was another similar
+skeleton, but in this subject there was motion of the head upon the
+first vertebra, the lower jaw was intact, and the clavicle, arms, and
+some of the digits of the right hand were movable.
+
+An ossified man has been recently found and exhibited to the Paris
+Academy of Medicine. He is a Roumanian Jew of thirty who began to
+ossify twelve years ago, first up the right side of his back, then down
+the left side. He has hardened now to the nape of the neck, his head is
+turned to the left, and the jaws are ankylosed. He can still move his
+arms and legs a little with great difficulty.
+
+Akin to the foregoing condition is what is known as petrifaction or
+ossification of portions of the living human body other than the
+articulations. Of the older writers Hellwigius, Horstius, and Schurig
+speak of petrifaction of the arm. In the Philosophical Transactions
+there was a case recorded in which the muscles and ligaments were so
+extensively converted into bone that all the joints were fixed, even
+including the vertebrae, head, and lower jaw. In a short time this man
+was, as it were, one single bone from his head to his knees, the only
+joints movable being the right wrist and knee. For over a century there
+has been in the Trinity College at Dublin the skeleton of a man who
+died about 20 miles from the city of Cork. The muscles about the
+scapula, and the dorsum of the ilium (the glutei) were converted into
+great masses of bone, equal to the original muscles in thickness and
+bulk. Half of the muscles of the hips and thighs were converted into
+bone, and for a long time this specimen was the leading curiosity of
+the Dublin Museum. In the Isle of Man, some years ago, there was a case
+of ossification which continued progressively for many years. Before
+death this man was reduced to almost a solid mass of bony substance.
+With the exception of one or two toes his entire frame was solidified.
+He was buried in Kirk Andreas Churchyard, and his grave was strictly
+guarded against medical men by his friends, but the body was finally
+secured and taken to Dublin by Dr. McCartney.
+
+Calculi.--In reviewing the statistics of vesical calculi, the strangest
+anomalies in their size and weight have been noticed.  Among the older
+writers the largest weights have been found. Le Cat speaks of a
+calculus weighing over three pounds, and Morand is accredited with
+having seen a calculus which weighed six pounds. In his statistics in
+1883 Cross collected reports on 704 stones, and remarked that only nine
+of these weighed above four ounces, and only two above six, and that
+with the last two the patient succumbed. Of those removed successfully
+Harmer of Norwich reports one of 15 ounces; Kline, one of 13 ounces 30
+grains; Mayo of Winchester, 14 ounces two drams; Cheselden, 12 ounces;
+and Pare in 1570 removed a calculus weighing nine ounces.  Sir Astley
+Cooper remarks that the largest stone he ever saw weighed four ounces,
+and that the patient died within four hours after its removal. Before
+the Royal Society of London in 1684 Birch reported an account of a
+calculus weighing five ounces.  Fabricius Hildanus mentions calculi
+weighing 20 and 21 ounces; Camper, 13 ounces; Foschini, 19 ounces six
+drams; Garmannus, 25 ounces; Greenfield, 19 ounces; Heberden, 32
+ounces; Wrisberg, 20 ounces; Launai, 51 ounces; Lemery, 27 ounces;
+Paget, in Kuhn's Journal, 27 ounces (from a woman); Pauli, 19 ounces;
+Rudolphi, 28 ounces; Tozzetti, 39 ounces; Threpland, 35 ounces; and
+there is a record of a calculus weighing over six pounds. There is
+preserved in Trinity College, Cambridge, a stone weighing 34 ounces
+taken from the bladder of the wife of Thomas Raisin, by Gutteridge, a
+surgeon of Norwich. This stone was afterward sent to King Charles II
+for inspection. In his "Journey to Paris" Dr. Lister said that he saw a
+stone which weighed 51 ounces; it had been taken from one of the
+religious brothers in June, 1690, and placed in the Hopital de la
+Charite. It was said that the monk died after the operation. There is a
+record of a calculus taken from the bladder of an individual living in
+Aberdeen. This stone weighed two pounds, three ounces, and six drams.
+In the Hunterian Museum in London there is a stone weighing 44 ounces,
+and measuring 16 inches in circumference. By suprapubic operation
+Duguise removed a stone weighing 31 ounces from a patient who survived
+six days.  A Belgian surgeon by the name of Uytterhoeven, by the
+suprapubic method extracted a concretion weighing two pounds and
+measuring 6 1/2 inches long and four wide. Frere Come performed a high
+operation on a patient who died the next day after the removal of a
+24-ounce calculus. Verduc mentions a calculus weighing three pounds
+three ounces. It was said that a vesical calculus was seen in a dead
+boy at St. Edmund's which was as large as the head of a new-born child.
+It has been remarked that Thomas Adams, Lord Mayor of London, who died
+at the age of eighty-two, had in his bladder at the time of his death a
+stone which filled the whole cavity, and which was grooved from the
+ureters to the urethral opening, thus allowing the passage of urine.
+Recent records of large calculi are offered: by Holmes, 25 ounces;
+Hunter, 25 ounces; Cayley, 29 ounces; Humphrys, 33 ounces; Eve, 44
+ounces; and Janeway, 51 ounces. Kirby has collected reports ol a number
+of large vesical calculi.
+
+Barton speaks of stone in the bladder in very young children.  There is
+a record of a stone at one month, and another at three years. Todd
+describes a stone in the bladder of a child of sixteen months. May
+removed an enormous stone from a young girl, which had its nucleus in a
+brass penholder over three inches long.
+
+Multiple Vesical Calculi.--Usually the bladder contains a single
+calculus, but in a few instances a large number of stones have been
+found to coexist. According to Ashhurst, the most remarkable case on
+record is that of the aged Chief Justice Marshal, from whose bladder
+Dr. Physick of Philadelphia is said to have successfully removed by
+lateral lithotomy more than 1000 calculi.  Macgregor mentions a case in
+which 520 small calculi coexisted with a large one weighing 51 ounces.
+There is an old record of 32 stones having been removed from a man of
+eighty-one, a native of Dantzic, 16 of which were as large as a
+pigeon's egg. Kelly speaks of 228 calculi in the bladder of a man of
+seventy-three, 12 being removed before death. The largest weighed 111
+grains.  Goodrich took 96 small stones from the bladder of a lad. Among
+the older records of numerous calculi Burnett mentions 70; Desault,
+over 200; the Ephemerides, 120; Weickman, over 100; Fabricius Hildanus,
+2000 in two years; and there is a remarkable case of 10,000 in all
+issuing from a young girl. Greenhow mentions 60 stones removed from the
+bladder. An older issue of The Lancet contains an account of lithotrity
+performed on the same patient 48 times.
+
+Occasionally the calculi are discharged spontaneously. Trioen mentions
+the issue of a calculus through a perineal aperture, and there are many
+similar cases on record. There is an old record of a stone weighing
+five ounces being passed by the penis. Schenck mentions a calculus
+perforating the bladder and lodging in the groin. Simmons reports a
+case in which a calculus passed through a fistulous sore in the loins
+without any concomitant passage of urine through the same passage.
+Vosberg mentions a calculus in a patent urachus; and calculi have
+occasionally been known to pass from the umbilicus. Gourges mentions
+the spontaneous excretion of a five-ounce calculus; and Thompson speaks
+of the discharge of two calculi of enormous size.
+
+Of the extravesical calculi some are true calculi, while others are
+simply the result of calcareous or osseous degeneration.  Renal and
+biliary calculi are too common to need mention here.  There are some
+extraordinary calculi taken from a patient at St.  Bartholomew's
+Hospital and deposited in the museum of that institution. The patient
+was a man of thirty-eight. In the right kidney were found a calculus
+weighing 36 1/2 ounces, about 1000 small calculi, and a quantity of
+calcareous dust. In the left kidney there was a calculus weighing 9 3/4
+ounces, besides a quantity of calcareous dust. The calculi in this case
+consisted chiefly of phosphate of magnesium and ammonium. Cordier of
+Kansas City, Mo., successfully removed a renal calculus weighing over
+three ounces from a woman of forty-two. The accompanying illustration
+shows the actual size of the calculus.
+
+At the University College Hospital, London, there are exhibited 485
+gall-stones that were found postmortem in a gall-bladder.  Vanzetti
+reports the removal of a preputial calculus weighing 224 grams.
+Phillipe mentions the removal of a calculus weighing 50 grams from the
+prepuce of an Arab boy of seven. Croft gives an account of some
+preputial calculi removed from two natives of the Solomon Islands by an
+emigrant medical officer in Fiji. In one case 22 small stones were
+removed, and in the other a single calculus weighing one ounce 110
+grains. Congenital phimosis is said to be very common among the natives
+of Solomon Islands.
+
+In September, 1695, Bernard removed two stones from the meatus
+urinarius of a man, after a lodgment of twenty years. Block mentions a
+similar case, in which the lodgment had lasted twenty-eight years.
+Walton speaks of a urethral calculus gradually increasing in size for
+fifty years. Ashburn shows what he considers the largest calculus ever
+removed from the urethra.  It was 2 1/8 inches long, and 1 1/4 inches
+in diameter; it was white on the outside, very hard, and was shaped and
+looked much like a potato. Its dry weight was 660 grains. At one end
+was a polished surface that corresponded with a similar surface on a
+smaller stone that lay against it; the latter calculus was shaped like
+a lima bean, and weighed 60 grains. Hunt speaks of eight calculi
+removed from the urethra of a boy of five. Herman and the Ephemerides
+mention cases of calculi in the seminal vesicles.
+
+Calcareous degeneration is seen in the ovary, and Peterman speaks of a
+stone in the ovary. Uterine calculi are described by Cuevas and Harlow;
+the latter mentions that the calculus he saw was egg-shaped. There is
+an old chronicle of a stone taken from the womb of a woman near Trent,
+Somersetshire, at Easter, 1666, that weighed four ounces. The
+Ephemerides speaks of a calculus coming away with the menstrual fluid.
+
+Stones in the heart are mentioned by medical writers, and it is said
+that two stones as large as almonds were found in the heart of the Earl
+of Balcarres.
+
+Morand speaks of a calculus ejected from the mouth by a woman.
+
+An old record says that stones in the brain sometimes are the cause of
+convulsions. D'Hericourt reports the case of a girl who died after six
+months' suffering, whose pineal gland was found petrified, and the
+incredible size of a chicken's egg. Blasius, Diemerbroeck, and the
+Ephemerides, speak of stones in the location of the pineal gland.
+
+Salivary calculi are well known; they may lodge in any of the buccal
+ducts. There is a record of the case of a man of thirty-seven who
+suffered great pain and profuse salivation. It was found that he had a
+stone as large as a pigeon's egg under his tongue.
+
+Umbilical calculi are sometimes seen, and Deani reports such a case.
+There is a French record of a case of exstrophy of the umbilicus,
+attended with abnormal concretions.
+
+Aetius, Marcellus Donatus, Scaliger, and Schenck mention calculi of the
+eyelids.
+
+There are some extraordinary cases of retention and suppression of
+urine on record. Actual retention of urine, that is, urinary secretion
+passed into the bladder, but retention in the latter viscus by
+inanition, stricture, or other obstruction, naturally cannot continue
+any great length of time without mechanically rupturing the vesical
+walls; but suppression of urine or absolute anuria may last an
+astonishingly extended period. Of the cases of retention of urine,
+Fereol mentions that of a man of forty-nine who suffered absolute
+retention of urine for eight days, caused by the obstruction of a uric
+acid calculus. Cunyghame reports a ease of mechanic obstruction of the
+flow of urine for eleven days. Trapenard speaks of retention of urine
+for seven days.  Among the older writers Bartholinus mentions ischuria
+lasting fourteen days; Cornarius, fourteen days; Rhoclius, fifteen
+days; the Ephemerides, ten, eleven, and twelve days. Croom notes a case
+of retention of urine from laceration of the vagina during first
+coitus. Foucard reports a case of retention of urine in a young girl of
+nineteen, due to accumulation of the menstrual fluid behind an
+imperforate hymen.
+
+The accumulation of urine in cases of ischuria is sometimes quite
+excessive. De Vilde speaks of 16 pints being drawn off. Mazoni cites a
+case in which 15 pounds of urine were retained; and Wilson mentions 16
+pounds of urine being drawn off. Frank reports instances in which both
+12 and 30 pounds of urine were evacuated.  There is a record at the
+beginning of this century in which it is stated that 31 pounds of urine
+were evacuated in a case of ischuria.
+
+Following some toxic or thermic disturbance, or in diseased kidneys,
+suppression of urine is quite frequently noticed. The older writers
+report some remarkable instances: Haller mentions a case lasting
+twenty-two weeks; Domonceau, six months; and Marcellus Donatus, six
+months.
+
+Whitelaw describes a boy of eight who, after an attack of scarlet
+fever, did not pass a single drop of urine from December 7th to
+December 20th when two ounces issued, after vesication over the
+kidneys. On January 2d two ounces more were evacuated, and no more was
+passed until the bowel acted regularly. On January 5th a whole pint of
+urine passed; after that the kidneys acted normally and the boy
+recovered. It would be no exaggeration to state that this case lasted
+from December 5th to January 5th, for the evacuations during this
+period were so slight as to be hardly worthy of mention.
+
+Lemery reports observation of a monk who during eight years vomited
+periodically instead of urinating in a natural way. Five hours before
+vomiting he experienced a strong pain in the kidneys. The vomitus was
+of dark-red color, and had the odor of urine. He ate little, but drank
+wine copiously, and stated that the vomiting was salutary to him, as he
+suffered more when he missed it.
+
+Bryce records a case of anuria of seventeen days' standing.  Butler
+speaks of an individual with a single kidney who suffered suppression
+of urine for thirteen days, caused by occlusion of the ureter by an
+inspissated thrombus. Dubuc observed a case of anuria which continued
+for seventeen days before the fatal issue.  Fontaine reports a case of
+suppression of urine for twenty-five days. Nunneley showed the kidneys
+of a woman who did not secrete any urine for a period of twelve days,
+and during this time she had not exhibited any of the usual symptoms of
+uremia. Peebles mentions a case of suspension of the functions of the
+kidneys more than once for five weeks, the patient exhibiting neither
+coma, stupor, nor vomiting. Oke speaks of total suppression of urine
+during seven days, with complete recovery; and Paxon mentions a case in
+a child that recovered after five days' suppression. Russell reports a
+case of complete obstructive suppression for twenty days followed by
+complete recovery. Scott and Shroff mention recovery after nine days'
+suppression.
+
+The most persistent constipation may exist for weeks, or even months,
+with fair health. The fact seemed to be a subject of much interest to
+the older writers. De Cabalis mentions constipation lasting
+thirty-seven days; Caldani, sixty-five days; Lecheverel, thirty-four
+days; and Pomma, eight months; Sylvaticus, thirty months; Baillie,
+fifteen weeks; Blanchard, six weeks; Smetius, five mouths; Trioen,
+three months; Devilliers, two years; and Gignony, seven years. Riverius
+mentions death following constipation of one month, and says that the
+intestines were completely filled. Moosman mentions death from the same
+cause in sixty days. Frank speaks of constipation from intestinal
+obstructions lasting for three weeks, and Manget mentions a similar
+case lasting three months.
+
+Early in the century Revolat reported in Marseilles an observation of
+an eminently nervous subject addicted to frequent abuse as regards
+diet, who had not had the slightest evacuation from the bowel for six
+months. A cure was effected in this case by tonics, temperance,
+regulation of the diet, etc. In Tome xv of the Commentaries of Leipzig
+there is an account of a man who always had his stercoral evacuations
+on Wednesdays, and who suffered no evil consequences from this
+abnormality. This state of affairs had existed from childhood, and, as
+the evacuations were abundant and connected, no morbific change or
+malformation seemed present. The other excretions were slightly in
+excess of the ordinary amount. There are many cases of constipation on
+record lasting longer than this, but none with the same periodicity and
+without change in the excrement. Tommassini records the history of a
+man of thirty, living an ordinary life, who became each year more
+constipated. Between the ages of twenty and twenty-four the evacuations
+were gradually reduced to one in eight or ten days, and at the age of
+twenty-six, to one every twenty-two days. His leanness increased in
+proportion to his constipation, and at thirty his appetite was so good
+that he ate as much as two men. His thirst was intense, but he secreted
+urine natural in quantity and quality. Nothing seemed to benefit him,
+and purgatives only augmented his trouble. His feces came in small,
+hard balls. His tongue was always in good condition, the abdomen not
+enlarged, the pulse and temperature normal.
+
+Emily Plumley was born on June 11,1850, with an imperforate anus, and
+lived one hundred and two days without an evacuation. During the whole
+period there was little nausea and occasional regurgitation of the
+mother's milk, due to over-feeding. Cripps mentions a man of forty-two
+with stricture of the rectum, who suffered complete intestinal
+obstruction for two months, during which time he vomited only once or
+twice. His appetite was good, but he avoided solid food. He recovered
+after the performance of proctotomy.
+
+Fleck reports the case of a Dutchman who, during the last two years, by
+some peculiar innervation of the intestine, had only five or six bowel
+movements a year. In the intervals the patient passed small quantities
+of hard feces once in eight or ten days, but the amount was so small
+that they constituted no more than the feces of one meal. Two or three
+days before the principal evacuation began the patient became ill and
+felt uncomfortable in the back; after sharp attacks of colic he would
+pass hard and large quantities of offensive feces. He would then feel
+better for two or three hours, when there would be a repetition of the
+symptoms, and so on until he had four or five motions that day.  The
+following day he would have a slight diarrhea and then the bowels would
+return to the former condition. The principal fecal accumulations were
+in the ascending and transverse colon and not only could be felt but
+seen through the abdominal wall. The patient was well nourished and had
+tried every remedy without success. Finally he went to Marienbad where
+he drank freely of the waters and took the baths until the bowel
+movements occurred once in two or three days.
+
+There is a record of a man who stated that for two years he had not
+passed his stool by the anus, but that at six o'clock each evening he
+voided feces by the mouth. His statement was corroborated by
+observation. At times the evacuation took place without effort, but was
+occasionally attended with slight pain in the esophagus and slight
+convulsions. Several hours before the evacuation the abdomen was hard
+and distended, which appearance vanished in the evening. In this case
+there was a history of an injury in the upper iliac region.
+
+The first accurate ideas in reference to elephantiasis arabum are given
+by Rhazes, Haly-Abas, and Avicenna, and it is possibly on this account
+that the disease received the name elephantiasis arabum. The disease
+was afterward noticed by Forestus, Mercurialis, Kaempfer, Ludoff, and
+others. In 1719 Prosper Alpinus wrote of it in Egypt, and the medical
+officers of the French army that invaded Egypt became familiar with it;
+since then the disease has been well known.
+
+Alard relates as a case of elephantiasis that of a lady of Berlin,
+mentioned in the Ephemerides of 1694, who had an abdominal tumor the
+lower part of which reached to the knees. In this case the tumor was
+situated in the skin and no vestige of disease was found in the
+abdominal cavity and no sensible alteration had taken place in the
+veins. Delpech quotes a similar case of elephantiasis in the walls of
+the abdomen in a young woman of twenty-four, born at Toulouse.
+
+Lymphedema, or elephantiasis arabum, is a condition in which, in the
+substance of a limb or a part, there is diffused dilatation of the
+lymphatics, with lymphostasis. Such a condition results when there is
+obstruction of so large a number of the ducts converging to the root of
+the extremity or part that but little relief through collateral trunks
+is possible. The affected part becomes swollen and hardened, and
+sometimes attains an enormous size. It is neither reducible by position
+nor pressure. There is a corresponding dilatation and multiplication of
+the blood-vessels with the connective-tissue hypertrophy. The muscles
+waste, the skin becomes coarse and hypertrophied. The swollen limb
+presents immense lobulated masses, heaped up at different parts,
+separated from one another by deep sulci, which are especially marked
+at the flexures of the joints. Although elephantiasis is met with in
+all climates, it is more common in the tropics, and its occurrence has
+been repeatedly demonstrated in these localities to be dependent on the
+presence in the lymphatics of the filaria sanguinis hominis. The
+accompanying illustration shows the condition of the limb of a girl of
+twenty-one, the subject of lymphedema, five years after the inception
+of the disease. The changes in the limb were as yet moderate. The
+photograph from which the cut was made was taken in 1875 At the present
+time (seventeen years later) the case presents the typical condition of
+the worst form of elephantiasis. Repeated attacks of lymphangitis have
+occurred during this period, each producing an aggravation of the
+previous condition. The leg below the knee has become enormously
+deformed by the production of the elephantoid masses; the outer side of
+the thigh remains healthy, but the skin of the inner side has developed
+so as to form a very large and pendant lobulated mass.  A similar
+condition has begun to develop in the other leg, which is row about in
+the condition of the first, as shown in the figure. Figure 273
+represents this disease in its most aggravated form, a condition rarely
+observed in this country. As an example of the change in the weight of
+a person after the inception of this disease, we cite a case reported
+by Griffiths. The patient was a woman of fifty-two who, five years
+previous, weighed 148 pounds. The elephantoid change was below the
+waist, yet at the time of report the woman weighed 387 pounds. There
+was little thickening of the skin. The circumference of the calf was 28
+inches; of the thigh, 38 inches; and of the abdomen, 80 inches; while
+that of the arm was only 15 inches.
+
+The condition commonly known as "Barbadoes leg" is a form of
+elephantiasis deriving its name from its relative frequency in
+Barbadoes.
+
+Figure 275 represents a well-known exhibitionist who, from all
+appearances, is suffering from an elephantoid hypertrophy of the lower
+extremities, due to a lymphedema. Quite a number of similar
+exhibitionists have been shown in recent years, the most celebrated of
+whom was Falmy Mills, one of whose feet alone was extensively involved,
+and was perhaps the largest foot ever seen.
+
+Elephantiasis seldom attacks the upper extremities. Of the older cases
+Rayer reports four collected by Alard. In one case the hard and
+permanent swelling of the arm occurred after the application of a
+blister; in another the arm increased so that it weighed more than 200
+Genoese pounds, 40 of which consisted of serum. The swellings of the
+arm and forearm resembled a distended bladder.  The arteries, veins,
+and nerves had not undergone any alteration, but the lymphatics were
+very much dilated and loaded with lymph.
+
+The third case was from Fabricius Hildanus, and the fourth from Hendy.
+Figure 276 represents a remarkable elephantoid change in the hand of an
+elderly German woman. Unfortunately there is no medical description of
+the case on record, but the photograph is deemed worthy of reproduction.
+
+Terry describes a French mulatto girl of eleven whose left hand was
+enormously increased in weight and consistency, the chief enlargement
+being in the middle finger, which was 6 1/2 inches long, and 5 1/2
+inches about the nail, and 8 1/2 around the base of the finger. The
+index finger was two inches thick and four inches long, twisted and
+drawn, while the other fingers were dwarfed. The elephantiasis in this
+case slowly and gradually increased in size until the hand weighed 3
+1/2 pounds. The skin of the affected finger, contrary to the general
+appearance of a part affected with elephantiasis, was of normal color,
+smooth, shiny, showed no sensibility, and the muscles had undergone
+fatty degeneration. It was successfully amputated in August, 1894. The
+accompanying illustration shows a dorsal view of the affected hand.
+
+Magalhaes of Rio Janeiro reports a very interesting case of
+elephantiasis of the scalp, representing dermatolysis, in which the
+fold of hypertrophied skin fell over the face like the hide of an
+elephant, somewhat similar in appearance to the "elephant-man." Figure
+279 represents a somewhat similar hypertrophic condition of the scalp
+and face reported in the Photographic Review of Medicine and Surgery,
+1870.
+
+Elephantiasis of the face sometimes only attacks it on one side.  Such
+a case was reported by Alard, in which the elephantiasis seems to have
+been complicated with eczema of the ear. Willier, also quoted by Alard,
+describes a remarkable case of elephantiasis of the face. After a
+debauch this patient experienced violent pain in the left cheek below
+the zygomatic arch; this soon extended under the chin, and the
+submaxillary glands enlarged and became painful; the face swelled and
+became erythematous, and the patient experienced nausea and slight
+chills. At the end of six months there was another attack, after which
+the patient perceived that the face continued puffed. This attack was
+followed by several others, the face growing larger and larger. In
+similar cases tumefaction assumes enormous proportions, and Schenck
+speaks of a man whose head exceeded that of an ox in size, the lower
+part of the face being entirely covered with the nose, which had to be
+raised to enable its unhappy owner to breathe.
+
+Rayer cites two instances in which elephantiasis of the breast enlarged
+these organs to such a degree that they hung to the knees. Salmuth
+speaks of a woman whose breasts increased to such a size that they hung
+down to her knees. At the same time she had in both axillae glandular
+tumors as large as the head of a fetus.  Borellus also quotes the case
+of a woman whose breasts became so large that it was necessary to
+support them by straps, which passed over the shoulders and neck.
+
+Elephantiasis is occasionally seen in the genital regions of the
+female, but more often in the scrotum of the male, in which location it
+produces enormous tumors, which sometimes reach to the ground and
+become so heavy as to prevent locomotion. This condition is curious in
+the fact that these immense tumors have been successfully removed, the
+testicles and penis, which had long since ceased to be distinguished,
+saved, and their function restored. Alibert mentions a patient who was
+operated upon by Clot-Bey, whose scrotum when removed weighed 110
+pounds; the man had two children after the disease had continued for
+thirteen years, but before it had obtained its monstrous development--a
+proof that the functions of the testicles had not been affected by the
+disease.
+
+There are several old accounts of scrotal tumors which have evidently
+been elephantoid in conformation. In the Ephemerides in 1692 there was
+mentioned a tumor of the scrotum weighing 200 pounds. In the West
+Indies it was reported that rats have been known to feed on these
+enormous tumors, while the deserted subjects lay in a most helpless
+condition. Larrey mentioned a case of elephantiasis of the scrotum in
+which the tumor weighed over 200 pounds. Sir Astley Cooper removed a
+tumor of 56 pounds weight from a Chinese laborer. It extended from
+beneath the umbilicus to the anterior border of the anus; it had begun
+in the prepuce ten years previously. Clot-Bey removed an elephantoid
+tumor of the scrotum weighing 80 pounds, performing castration at the
+same time. Alleyne reports a case of elephantiasis, in which he
+successfully removed a tumor of the integuments of the scrotum and
+penis weighing 134 pounds.
+
+Bicet mentions a curious instance of elephantiasis of the penis and
+scrotum which had existed for five years. The subject was in great
+mental misery and alarm at his unsightly condition. The parts of
+generation were completely buried in the huge mass. An operation was
+performed in which all of the diseased structures that had totally
+unmanned him were removed, the true organs of generation escaping
+inviolate. Thebaud mentions a tumor of the scrotum, the result of
+elephantiasis, which weighed 63 1/2 pounds. The weight was ascertained
+by placing the tumor on the scales, and directing the patient to squat
+over them without resting any weight of the body on the scales. This
+man could readily feel his penis, although his surgeons could not do
+so.  The bladder was under perfect control, the urine flowing over a
+channel on the exterior of the scrotum, extending 18 inches from the
+meatus. Despite his infirmity this patient had perfect sexual desire,
+and occasional erections and emissions. A very interesting operation
+was performed with a good recovery.
+
+Partridge reports an enormous scrotal tumor which was removed from a
+Hindoo of fifty-five, with subsequent recovery of the subject. The
+tumor weighed 111 1/2 pounds. The ingenious technic of this operation
+is well worth perusal by those interested.  Goodman successfully
+removed an elephantiasis of the scrotum from a native Fiji of
+forty-five. The tumor weighed 42 pounds, without taking into
+consideration the weight of the fluid which escaped in abundance during
+the operation and also after the operation, but before it was weighed.
+Van Buren and Keyes mention a tumor of the scrotum of this nature
+weighing 165 pounds. Quoted by Russell, Hendy describes the case of a
+negro who had successive attacks of glandular swelling of the scrotum,
+until finally the scrotum was two feet long and six feet in
+circumference. It is mentioned that mortification of the part caused
+this patient's ultimate death.
+
+Figure 281 is taken from a photograph loaned to the authors by Dr.
+James Thorington. The patient was a native of Fiji, and was
+successfully operated on, with preservation of the testes. The tumor,
+on removal, weighed 120 pounds.
+
+W. R. Browne, Surgeon-General, reports from the Madras General Hospital
+an operation on a patient of thirty-five with elephantoid scrotum of
+six years' duration. The proportions of the scrotum were as follows:
+Horizontally the circumference was six feet 6 1/2 inches, and
+vertically the circumference was six feet ten inches. The penis was
+wholly hidden, and the urine passed from an opening two feet 5 1/2
+inches from the pubis. The man had complete control of his bladder, but
+was unable to walk.  The operation for removal occupied one hour and
+twenty minutes, and the tumor removed weighed 124 3/4 pounds. Little
+blood was lost on account of an elastic cord tied about the neck of the
+tumor, and secured by successful removal of a scrotal tumor weighing 56
+pounds.
+
+Fenger describes a case of the foregoing nature in a German of
+twenty-three, a resident of Chicago. The growth had commenced eight
+years previously, and had progressively increased. There was no pain or
+active inflammation, and although the patient had to have especially
+constructed trousers he never ceased his occupation as a driver. The
+scrotum was represented by a hairless tumor weighing 22 pounds, and
+hanging one inch below the knees.  No testicles or penis could be made
+out. Fenger removed the tumor, and the man was greatly improved in
+health. There was still swelling of the inguinal glands on both sides,
+but otherwise the operation was very successful. The man's mental
+condition also greatly improved. Fenger also calls especial attention
+to the importance of preserving the penis and testes in the operation,
+as although these parts may apparently be obliterated their functions
+are undisturbed.
+
+The statistics of this major operation show a surprisingly small
+mortality. Fayrer operated on 28 patients with 22 recoveries and six
+deaths, one from shock and five from pyemia The same surgeon collected
+193 cases, and found the general mortality to be 18 per cent. According
+to Ashhurst, Turner, who practiced as a medical missionary in the
+Samoan Islands, claims to have operated 136 times with only two deaths.
+McLeod, Fayrer's successor in India, reported 129 cases with 23 deaths.
+
+Early in this century Rayer described a case of elephantiasis in a boy
+of seventeen who, after several attacks of erysipelas, showed marked
+diminution of the elephantoid change; the fact shows the antagonism of
+the streptococcus erysipelatis to hypertrophic and malignant processes.
+
+Acromegaly is a term introduced by Marie, and signifies large
+extremities. It is characterized by an abnormally large development of
+the extremities and of the features of the face,--the bony as well as
+the soft parts. In a well-marked case the hands and feet are greatly
+enlarged, but not otherwise deformed, and the normal functions are not
+disturbed. The hypertrophy involves all the tissues, giving a curious
+spade-like appearance to the hands. The feet are similarly enlarged,
+although the big toe may be relatively much larger. The nails also
+become broad and large. The face increases in volume and becomes
+elongated, in consequence of the hypertrophy of the superior and
+inferior maxillary bones. The latter often projects beyond the upper
+teeth. The teeth become separated, and the soft parts increase in size.
+The nose is large and broad, and the skin of the eyelids and ears is
+enormously hypertrophied. The tongue is greatly hypertrophied. The
+disease is of long duration, and late in the history the bones of the
+spine and thorax may acquire great deformity. As we know little of the
+influences and sources governing nutrition, the pathology and etiology
+of acromegaly are obscure. Marie regards the disease as a systemic
+dystrophy analogous to myxedema, due to a morbid condition of the
+pituitary body, just as myxedema is due to disease of the thyroid. In
+several of the cases reported the squint and optic atrophy and the
+amblyopia have pointed to the pituitary body as the seat of a new
+growth of hypertrophy. Pershing shows a case of this nature.  The
+enlargement of the face and extremities was characteristic, and the
+cerebral and ocular symptoms pointed to the pituitary body as the seat
+of the lesion. Unverricht, Thomas, and Ransom report cases in which the
+ocular lesions, indicative of pituitary trouble, were quite prominent.
+Of 22 cases collected by Tamburini 19 showed some change in the
+pituitary body, and in the remaining three cases either the diagnosis
+was uncertain or the disease was of very short duration. Linsmayer
+reported a case in which there was a softened adenoma in the pituitary
+body, and the thymus was absent.
+
+Hersman reports an interesting case of progressive enlargement of the
+hands in a clergyman of fifty. Since youth he had suffered with pains
+in the joints. About three years before the time of report he noticed
+enlargement of the phalangeal joint of the third finger of the right
+hand. A short time later the whole hand became gradually involved and
+the skin assumed a darker hue.  Sensation and temperature remained
+normal in both hands; acromegaly was excluded on account of the absence
+of similar changes elsewhere. Hersman remarks that the change was
+probably due to increase in growth of the fibrous elements of the
+subcutaneous lesions about the tendons, caused by rheumatic poison.
+Figure 283 shows the palmer and dorsal surfaces of both hands.
+
+Chiromegaly is a term that has been applied by Charcot and Brissaud to
+the pseudoacromegaly that sometimes occurs in syringomyelia. Most of
+the cases that have been reported as a combination of these two
+diseases are now thought to be only a syringomyelia. A recent case is
+reported by Marie. In this connection it is interesting to notice a
+case of what might be called acute symptomatic transitory
+pseudoacromegaly, reported by Potovski: In an insane woman, and without
+ascertainable cause, there appeared an enlargement of the ankles,
+wrists, and shoulders, and later of the muscles, with superficial
+trophic disturbances that gradually disappeared. The author excludes
+syphilis, tuberculosis, rheumatism, gout, hemophilia, etc., and
+considers it to have been a trophic affection of cerebral origin.
+Cases of pneumonia osteoarthropathy simulating acromegaly have been
+reported by Korn and Murray.
+
+Megalocephaly, or as it was called by Virchow, leontiasis ossea, is due
+to a hypertrophic process in the bones of the cranium. The cases
+studied by Virchow were diffuse hyperostoses of the cranium. Starr
+describes what he supposes to be a case of this disease, and proposes
+the title megalocephaly as preferable to Virchow's term, because the
+soft parts are also included in the hypertrophic process. A woman of
+fifty-two, married but having no children, and of negative family
+history, six years before the time of report showed the first symptoms
+of the affection, which began with formication in the finger-tips. This
+gradually extended to the shoulders, and was attended with some
+uncertainty of tactile sense and clumsiness of movement, but actual
+anesthesia had never been demonstrated. This numbness had not invaded
+the trunk or lower extremities, although there was slight uncertainty
+in the gait. There had been a slowly progressing enlargement of the
+head, face, and neck, affecting the bone, skin, and subcutaneous
+tissues, the first to the greatest degree.  The circumference of the
+neck was 16 inches; the horizontal circumference of the head was 24
+inches; from ear to ear, over the vertex, 16 inches; and from the root
+of the nose to the occipital protuberance, 16 inches. The cervical
+vertebrae were involved, and the woman had lost five inches in height.
+It may be mentioned here that Brissaud and Meige noticed the same loss
+in height, only more pronounced, in a case of gigantism, the loss being
+more than 15 inches. In Starr's case the tongue was normal and there
+was no swelling of the thyroid.
+
+Cretinism is an endemic disease among mountainous people who drink
+largely of lime water, and is characterized by a condition of physical,
+physiologic, and mental degeneracy and nondevelopment, and possibly
+goiter. The subjects of this disease seldom reach five feet in height,
+and usually not more than four.  The word cretin is derived from the
+Latin creatura. They are found all over the world. In Switzerland it is
+estimated that in some cantons there is one cretin to every 25
+inhabitants. In Styria, the Tyrol, and along the Rhine cretins are
+quite common, and not long since cases existed in Derbyshire. These
+creatures have been allowed to marry and generate, and thus extend
+their species. In "Le Medicin de Campagne," Balzac has given a vivid
+picture of the awe and respect in which they were held and the way in
+which they were allowed to propagate. Speaking of the endemic cretins,
+Beaupre says: "I see a head of unusual form and size, a squat and
+bloated figure, a stupid look, bleared, hollow, and heavy eyes, thick,
+projecting eyelids, and a flat nose. His face is of a leaden hue, his
+skin dirty, flabby, covered with tetters, and his thick tongue hangs
+down over his moist, livid lips; his mouth, always open and full of
+saliva, shows teeth going to decay. His chest is narrow, his back
+curved, his breath asthmatic, his limbs short, misshapen, without
+power. The knees are thick and inclined inward, the feet flat. The
+large head droops listlessly on the breast; the abdomen is like a bag."
+The cretin is generally deaf and dumb, or only able to give a hoarse
+cry. He is indifferent to heat and cold, and even to the most revolting
+odors. The general opinion has always been that the sexual desire and
+genital organs are fully developed.
+
+A quotation under our observation credits Colonel Sykes with the
+following statistics of cretinism, which show how in some locations it
+may be a decided factor of population. In December, 1845, in a
+population of 2,558,349 souls (the locality not mentioned), there were
+18,462 people with simple goiter. Of the cretins without goiter there
+were 2089. Of cretins with goiter there were 3909; and cretins in which
+goiter was not stated 962, making a total of 6960. Of these 2185 had
+mere animal instincts; 3531 possessed very small intellectual
+faculties; 196 were almost without any; 1048 not classified. Of this
+number 2483 were born of healthy and sane fathers; 2285 from healthy
+mothers; 961 from goitrous fathers; 1267 from goitrous mothers; 49 from
+cretin fathers; 41 from cretin mothers; 106 from cretin fathers with
+goiter; 66 from cretin mothers with goiter; 438 fathers and 405 mothers
+were not specified.
+
+Sporadic cretinism, or congenital myzedema, is characterized by a
+congenital absence of the thyroid, diminutiveness of size, thickness of
+neck, shortness of arms and legs, prominence of the abdomen, large size
+of the face, thickness of the lips, large and protruding tongue, and
+imbecility or idiocy. It is popularly believed that coitus during
+intoxication is the cause of this condition. Osler was able to collect
+11 or 12 cases in this country. The diagnosis is all-important, as the
+treatment by the thyroid extract produces the most noteworthy results.
+There are several remarkable recoveries on record, but possibly the
+most wonderful is the case of J. P. West of Bellaire, Ohio, the
+portraits of which are reproduced in Plate 11. At seventeen months the
+child presented the typical appearance of a sporadic cretin. The
+astonishing results of six months' treatment with thyroid extract are
+shown in the second figure. After a year's treatment the child presents
+the appearance of a healthy and well-nourished little girl.
+
+Myxedema proper is a constitutional condition due to the loss of the
+function of the thyroid gland. The disease was first described by Sir
+William Gull as a cretinoid change, and later by William Ord of London,
+who suggested the name. It is characterized clinically by a
+myxedematous condition of the subcutaneous tissues and mental failure,
+and anatomically by atrophy of the thyroid gland. The symptoms of
+myxedema, as given by Ord, are marked increase in the general bulk of
+the body, a firm, inelastic swelling of the skin, which does not pit on
+pressure; dryness and roughness which tend, with swelling, to
+obliterate the lines of expression in the face; imperfect nutrition of
+the hair; local tumefaction of the skin and subcutaneous tissues,
+particularly in the supraclavicular region.  The physiognomy is
+remarkably altered; the features are coarse and broad, the lips thick,
+the nostrils broad and thick, and the mouth enlarged. There is a
+striking slowness of thought and of movement; the memory fails, and
+conditions leading to incipient dementia intervene. The functions of
+the thoracic and abdominal organs seem to be normal, and death is
+generally due to some intercurrent disease, possibly tuberculosis. A
+condition akin to myxedema occurs after operative removal of the
+thyroid gland.
+
+In a most interesting lecture Brissaud shows the intimate relation
+between myxedema, endemic cretinism, sporadic cretinism, or
+myxedematous idiocy, and infantilism. He considers that they are all
+dependent upon an inherited or acquired deficiency or disease of the
+thyroid gland, and he presents cases illustrating each affection.
+Figure 285 shows a case of myxedema, one of myxedema in a case of
+arrested development--a transition case between myxedema of the adult
+and sporadic cretinism--and a typical case of sporadic cretinism.
+
+Cagots are an outcast race or clan of dwarfs in the region of the
+Pyrenees, and formerly in Brittany, whose existence has been a
+scientific problem since the sixteenth century, at which period they
+were known as Cagots, Gahets, Gafets, Agotacs, in France; Agotes or
+Gafos, in Spain; and Cacous, in Lower Brittany. Cagot meant the dog of
+a Goth; they were of supposed Gothic origin by some, and of Tartar
+origin by others. These people were formerly supposed to have been the
+descendants of lepers, or to have been the victims of leprosy
+themselves. From the descriptions there is a decided difference between
+the Cagots and the cretins. In a recent issue of Cosmos a writer
+describes Cagots as follows:--
+
+"They inhabit the valley of the Ribas in the northwestern part of the
+Spanish province now called Gerona. They never exceed 51 1/2 inches in
+height, and have short, ill-formed legs, great bellies, small eyes,
+flat noses, and pale, unwholesome complexions. They are usually stupid,
+often to the verge of idiocy, and much subject to goiter and scrofulous
+affections. The chief town of the Ribas Valley is Ribas, a place of
+1500 inhabitants, about 800 feet above sea-level. The mountains rise
+about the town to a height of from 6000 to 8000 feet, and command an
+amazingly beautiful panorama of mountain, plain, and river, with
+Spanish cities visible upon the one side and French upon the other. The
+region is rich, both agriculturally and minerally, and is famous for
+its medicinal springs. In this paradise dwell the dwarfs, perhaps as
+degraded a race of men and women as may be found in any civilized
+community. They are almost without education, and inhabit wretched huts
+when they have any shelter. The most intelligent are employed as
+shepherds, and in summer they live for months at an elevation of more
+than 6000 feet without shelter. Here they see no human creature save
+some of their own kind, often idiots, who are sent up every fifteen or
+twenty days with a supply of food.
+
+"It is said that formal marriage is almost unknown among them.  The
+women in some instances are employed in the village of Ribas as nurses
+for children, and as such are found tender and faithful. Before
+communication throughout the region was as easy as it is now, it was
+thought lucky to have one of these dwarfs in a family, and the dwarfs
+were hired out and even sold to be used in beggary in neighboring
+cities. There are somewhat similar dwarfs in other valleys of the
+Pyrenees, but the number is decreasing, and those of the Ribas Valley
+are reduced to a few individuals."
+
+Hiccough is a symptom due to intermittent, sudden contraction of the
+diaphragm. Obstinate cases are most peculiar, and sometimes exhaust the
+physician's skill. Symes divides these cases into four groups:--
+
+(1) Inflammatory, seen particularly in inflammatory diseases of the
+viscera or abdominal membranes, and in severe cases of typhoid fever.
+
+(2) Irritative, as in direct stimulus of the diaphragm in swallowing
+some very hot substance; local disease of the esophagus near the
+diaphragm, and in many conditions of gastric and intestinal disorder,
+more particularly those associated with flatus.
+
+(3) Specific or idiopathic, in which there are no evident causes
+present; it is sometimes seen in cases of nephritis and diabetes.
+
+(4) Neurotic, in which the primary cause is in the nervous
+system,--hysteria, epilepsy, shock, or cerebral tumors.
+
+The obstinacy of continued hiccough has long been discussed.  Osler
+calls to mind that in Plato's "Symposium" the physician, Eryximachus,
+recommended to Aristophanes, who had hiccough from eating too much,
+either to hold his breath or to gargle with a little water; but if it
+still continued, "tickle your nose with something and sneeze, and if
+you sneeze once or twice even the most violent hiccough is sure to go."
+The attack must have been a severe one, as it is stated subsequently
+that the hiccough did not disappear until Aristophanes had excited the
+sneezing.
+
+Among the older medical writers Weber speaks of singultus lasting for
+five days; Tulpius, for twelve days; Eller and Schenck, for three
+months; Taranget, for eight months; and Bartholinus, for four years.
+
+At the present day it is not uncommon to read in the newspapers
+accounts of prolonged hiccoughing. These cases are not mythical, and
+are paralleled by a number of instances in reliable medical literature.
+The cause is not always discernible, and cases sometimes resist all
+treatment.
+
+Holston reports a case of chronic singultus of seven years' standing.
+It had followed an attack of whooping-cough, and was finally cured
+apparently by the administration of strychnin.  Cowan speaks of a
+shoemaker of twenty-two who experienced an attack of constant singultus
+for a week, and then intermittent attacks for six years. Cowan also
+mentions instances of prolonged hiccough related by Heberden, Good,
+Hoffman, and Wartmouth.  Barrett is accredited with reporting a case of
+persistent hiccough in a man of thirty-five. Rowland speaks of a man of
+thirty-five who hiccoughed for twelve years. The paroxysms were almost
+constant, and occurred once or twice a minute during the hours when the
+man was not sleeping. There was no noise with the cough. There is
+another case related in the same journal of a man who died on the
+fourth day of an attack of singultus, probably due to abscess of the
+diaphragm, which no remedy would relieve.  Moore records a case of a
+child, injured when young, who hiccoughed until about twenty years of
+age (the age at the time of report). Foot mentions a lad of fifteen
+who, except when asleep, hiccoughed incessantly for twenty-two weeks,
+and who suffered two similar, but less severe, attacks in the summer of
+1879, and again in 1880. The disease was supposed to be due to the
+habit of pressing the chest against the desk when at school.  Dexter
+reports a case of long-continued singultus in an Irish girl of
+eighteen, ascribed to habitual masturbation. There was no intermission
+in the paroxysm, which increased in force until general convulsions
+ensued. The patient said that the paroxysm could be stopped by firm
+pressure on the upper part of the external genital organs. Dexter
+applied firm pressure on her clitoris, and the convulsions subsided,
+and the patient fell asleep. They could be excited by firm pressure on
+the lower vertebrae. Corson speaks of a man of fifty-seven who, after
+exposure to cold, suffered exhausting hiccough for nine days; and also
+records the case of an Irish servant who suffered hiccough for four
+months; the cause was ascribed to fright. Stevenson cites a fatal
+instance of hiccough in a stone-mason of forty-four who suffered
+continuously from May 14th to May 28th. The only remedy that seemed to
+have any effect in this case was castor-oil in strong purgative doses.
+
+Willard speaks of a man of thirty-four who began to hiccough after an
+attack of pneumonia, and continued for eighty-six hours.  The treatment
+consisted of the application of belladonna and cantharides plasters,
+bismuth, and lime-water, camphor, and salts of white hellebore inhaled
+through the nose in finest powder. Two other cases are mentioned by the
+same author. Gapper describes the case of a young man who was seized
+with loud and distressing hiccough that never ceased for a minute
+during eighty hours. Two ounces of laudanum were administered in the
+three days without any decided effect, producing only slight languor.
+
+Ranney reports the case of an unmarried woman of forty-four who
+suffered from paroxysms of hiccough that persisted for four years. A
+peculiarity of this attack was that it invariably followed movements of
+the upper extremities. Tenderness and hyperesthesia over the spinous
+processes of the 4th, 5th, and 6th cervical vertebrae led to the
+application of the thermocautery, which, in conjunction with the
+administration of ergot and bromide, was attended with marked benefit,
+though not by complete cure. Barlow mentions a man with a rheumatic
+affection of the shoulder who hiccoughed when he moved his joints.
+Barlow also recites a case of hiccough which was caused by pressure on
+the cicatrix of a wound in the left hand.
+
+Beilby reports a peculiar case in a girl of seventeen who suffered an
+anomalous affection of the respiratory muscle, producing a sound like a
+cough, but shriller, almost resembling a howl. It was repeated every
+five or six seconds during the whole of the waking moments, and
+subsided during sleep. Under rest and free purgation the patient
+recovered, but the paroxysms continued during prolonged intervals, and
+in the last six years they only lasted from twenty-four to forty-eight
+hours.
+
+Parker reports four rebellious cases of singultus successfully treated
+by dry cups applied to the abdomen. In each case it was necessary to
+repeat the operation after two hours, but recovery was then rapid.
+Tatevosoff reports a brilliant cure in a patient with chronic chest
+trouble, by the use of common snuff, enough being given several times
+to induce lively sneezing. Griswold records a successful treatment of
+one case in a man of fifty, occurring after a debauch, by the
+administration of glonoin, 1/150 of a grain every three hours.
+Heidenhain records a very severe and prolonged case caused, as shown
+later at the operation and postmortem examination, by carcinoma of the
+pancreas. The spasms were greatly relieved by cocain administered by
+the mouth, as much as 15 grains being given in twelve hours. Laborde
+and Lepine report the case of a young girl who was relieved of an
+obstinate case of hiccough lasting four days by traction on her tongue.
+After the tongue had been held out of the mouth for a few minutes the
+hiccoughs ceased. Laborde referred to two cases of a similar character
+reported by Viand.
+
+Anomalous Sneezing.--In the olden times sneezing was considered a good
+omen, and was regarded as a sacred sign by nearly all of the ancient
+peoples. This feeling of reverence was already ancient in the days of
+Homer. Aristotle inquired into the nature and origin of the
+superstition, somewhat profanely wondering why sneezing had been
+deified rather than coughing. The Greeks traced the origin of the
+sacred regard for sneezing to the days of Prometheus, who blessed his
+man of clay when he sneezed.  According to Seguin the rabbinical
+account says that only through Jacob's struggle with the angel did
+sneezing cease to be an act fatal to man. Not only in Greece and Rome
+was sneezing revered, but also by races in Asia and Africa, and even by
+the Mexicans of remote times. Xenophon speaks of the reverence as to
+sneezing, in the court of the King of Persia. In Mesopotamia and some
+of the African towns the populace rejoiced when the monarch sneezed. In
+the present day we frequently hear "God bless you" addressed to persons
+who have just sneezed, a perpetuation of a custom quite universal in
+the time of Gregory the Great, in whose time, at a certain season, the
+air was filled with an unwholesome vapor or malaria which so affected
+the people that those who sneezed were at once stricken with
+death-agonies. In this strait the pontiff is said to have devised a
+form of prayer to be uttered when the paroxysm was seen to be coming
+on, and which, it was hoped, would avert the stroke of the death-angel.
+
+There are some curious cases of anomalous sneezing on record, some of
+which are possibly due to affections akin to our present "hay fever,"
+while others are due to causes beyond our comprehension. The
+Ephemerides records a paroxysm of continual sneezing lasting thirty
+days. Bonet, Lancisi, Fabricius Hildanus, and other older observers
+speak of sneezing to death. Morgagni mentions death from congestion of
+the vasa cerebri caused by sneezing. The Ephemerides records an
+instance of prolonged sneezing which was distinctly hereditary.
+
+Ellison makes an inquiry for treatment of a case of sneezing in a white
+child of ten. The sneezing started without apparent cause and would
+continue 20 or 30 times, or until the child was exhausted, and then
+stop for a half or one minute, only to relapse again. Beilby speaks of
+a boy of thirteen who suffered constant sneezing (from one to six times
+a minute) for one month.  Only during sleep was there any relief. The
+patient recovered under treatment consisting of active leeching,
+purgation, and blisters applied behind the ear, together with the
+application of olive oil to the nostrils.
+
+Lee reports a remarkable case of yawning followed by sneezing in a girl
+of fifteen who, just before, had a tooth removed without difficulty.
+Half an hour afterward yawning began and continued for five weeks
+continuously. There was no pain, no illness, and she seemed amused at
+her condition. There was no derangement of the sexual or other organs
+and no account of an hysteric spasm.  Potassium bromid and belladonna
+were administered for a few days with negative results, when the
+attacks of yawning suddenly turned to sneezing. One paroxysm followed
+another with scarcely an interval for speech. She was chloroformed once
+and the sneezing ceased, but was more violent on recovery therefrom.
+Ammonium bromid in half-drachm doses, with rest in bed for psychologic
+reasons, checked the sneezing. Woakes presented a paper on what he
+designated "ear-sneezing," due to the caking of cerumen in one ear.
+Irritation of the auricular branch of the vagus was produced, whence an
+impression was propagated to the lungs through the pulmonary branches
+of the vagus. Yawning was caused through implication of the third
+division of the 5th nerve, sneezing following from reflex implication
+of the spinal nerves of respiration, the lungs being full of air at the
+time of yawning. Woakes also speaks of "ear-giddiness" and offers a new
+associate symptom--superficial congestion of the hands and forearm.
+
+A case of anomalous sneezing immediately prior to sexual intercourse is
+mentioned on page 511.
+
+Hemophilia is an hereditary, constitutional fault, characterized by a
+tendency to uncontrollable bleeding, either spontaneous or from slight
+wounds. It is sometimes associated with a form of arthritis (Ogler).
+This hemorrhagic diathesis has been known for many years; and the fact
+that there were some persons who showed a peculiar tendency to bleed
+after wounds of a trifling nature is recorded in some of the earliest
+medical literature. Only recently, however, through the writings of
+Buel, Otto, Hay, Coates, and others, has the hereditary nature of the
+malady and its curious mode of transmission through the female line
+been known. As a rule the mother of a hemophile is not a "bleeder"
+herself, but is the daughter of one. The daughters of a hemophile,
+though healthy and free from any tendency themselves, are almost
+certain to transmit the disposition to the male offspring. The
+condition generally appears after some slight injury in the first two
+years of life; but must be distinguished from the hemorrhagic
+affections of the new-born, which will be discussed later. The social
+condition of the family does not alter the predisposition; the old Duke
+of Albany was a "bleeder"; and bleeder families are numerous, healthy
+looking, and have fine, soft skins.
+
+The duration of this tendency, and its perpetuation in a family, is
+remarkable. The Appleton-Swain family of Reading, Mass., has shown
+examples for two centuries. Osler has been advised of instances already
+occurring in the seventh generation. Kolster has investigated
+hemophilia in women, and reports a case of bleeding in the daughter of
+a hemophilic woman. He also analyzes 50 genealogic trees of hemophilic
+families, and remarks that Nasse's law of transmission does not hold
+true. In 14 cases the transmission was direct from the father to the
+child, and in 11 cases it was direct from the mother to the infant.
+
+The hemorrhagic symptoms of bleeders may be divided into external
+bleedings, either spontaneous or traumatic; interstitial bleedings,
+petechiae, and ecchymoses; and the joint-affections.  The external
+bleedings are seldom spontaneous, and generally follow cuts, bruises,
+scratches, and often result seriously. A minor operation on a hemophile
+may end in death; so slight an operation as drawing a tooth has been
+followed by the most disastrous consequences.
+
+Armstrong, Blagden, and Roberts, have seen fatal hemorrhage after the
+extraction of teeth. MacCormac observed five bleeders at St.  Thomas
+Hospital, London, and remarks that one of these persons bled twelve
+days after a tooth-extraction. Buchanan and Clay cite similar
+instances. Cousins mentions an individual of hemorrhagic diathesis who
+succumbed to extensive extravasation of blood at the base of the brain,
+following a slight fall during an epileptic convulsion. Dunlape reports
+a case of hemorrhagic diathesis, following suppression of the
+catamenia, attended by vicarious hemorrhage from the gums, which
+terminated fatally.  Erichsenf cites an instance of extravasation of
+blood into the calf of the leg of an individual of hemophilic
+tendencies. A cavity was opened, which extended from above the knee to
+the heel; the clots were removed, and cautery applied to check the
+bleeding. There was extension of the blood-cavity to the thigh, with
+edema and incipient gangrene, necessitating amputation of the thigh,
+with a fatal termination.
+
+Mackenzie reports an instance of hemophilic purpura of the retina,
+followed by death. Harkin gives an account of vicarious bleeding from
+the under lip in a woman of thirty-eight. The hemorrhage occurred at
+every meal and lasted ten minutes. There is no evidence that the woman
+was of hemophilic descent.
+
+Of 334 cases of bleeding in hemophilia collected by Grandidier, 169
+were from the nose, 43 from the mouth, 15 from the stomach, 36 from the
+bowels, 16 from the urethra, 17 from the lungs, and a few from the skin
+of the head, eyelids, scrotum, navel, tongue, finger-tips, vulva, and
+external ear. Osler remarks that Professor Agnew knew of a case of a
+bleeder who had always bled from cuts and bruises above the neck, never
+from those below. The joint-affections closely resemble acute
+rheumatism. Bleeders do not necessarily die of their early bleedings,
+some living to old age. Oliver Appleton, the first reported American
+bleeder, died at an advanced age, owing to hemorrhage from a bed-sore
+and from the urethra. Fortunately the functions of menstruation and
+parturition are not seriously interfered with in hemophilia.
+Menstruation is never so excessive as to be fatal. Grandidier states
+that of 152 boy subjects 81 died before the termination of the seventh
+year. Hemophilia is rarely fatal in the first year.
+
+Of the hemorrhagic diseases of the new-born three are worthy of note.
+In syphilis haemorrhagica neonatorum the child may be born healthy, or
+just after birth there may appear extensive cutaneous extravasations
+with bleeding from the mucous surfaces and from the navel; the child
+may become deeply jaundiced. Postmortem examination shows extensive
+extravasations into the internal viscera, and also organic syphilitic
+lesions.
+
+Winckel's disease, or epidemic hemoglobinuria, is a very fatal
+affection, sometimes epidemic in lying-in institutions; it develops
+about the fourth day after birth. The principal symptom is hematogenous
+icterus with cyanosis,--the urine contains blood and blood-coloring
+matter. Some cases have shown in a marked degree acute fatty
+degeneration of the internal organs--Buhl's disease.
+
+Apart from the common visceral hemorrhages, the results of injuries at
+birth, bleeding from one or more of the surfaces is a not uncommon
+event in the new-born, particularly in hospital-practice. According to
+Osler Townsend reports 45 cases in 6700 deliveries, the hemorrhage
+being both general and from the navel alone. Bleeding also occurs from
+the bowels, stomach, and mouth, generally beginning in the first week,
+but in rare instances it is delayed to the second or third. Out of 50
+cases collected by Townsend 31 died and 19 recovered. The nature of the
+disease is unknown, and postmortem examination reveals no pathologic
+changes, although the general and not local nature of the affection,
+its self-limited character, the presence of fever, and the greater
+prevalence of the disease in hospitals, suggest an infectious origin
+(Townsend). Kent a speaks of a new-born infant dying of spontaneous
+hemorrhage from about the hips.
+
+Infantile scurvy, or Barlow's disease, has lately attracted marked
+attention, and is interesting for the numerous extravasations and
+spontaneous hemorrhages which are associated with it. A most
+interesting collection of specimens taken from the victims of Barlow's
+disease were shown in London in 1895.
+
+In an article on the successful preventive treatment of tetanus
+neonatorum, or the "scourge of St. Kilda," of the new-born, Turner says
+the first mention of trismus nascentium or tetanus neonatorum was made
+by Rev. Kenneth Macaulay in 1764, after a visit to the island of St.
+Kilda in 1758. This gentleman states that the infants of this island
+give up nursing on the fourth or fifth day after birth; on the seventh
+day their gums are so clinched together that it is impossible to get
+anything down their throats; soon after this they are seized with
+convulsive fits and die on the eighth day. So general was this trouble
+on the island of St. Kilda that the mothers never thought of making any
+preparation for the coming baby, and it was wrapped in a dirty piece of
+blanket till the ninth or tenth day, when, if the child survived, the
+affection of the mother asserted itself. This lax method of caring for
+the infant, the neglect to dress the cord, and the unsanitary condition
+of the dwellings, make it extremely probable that the infection was
+through the umbilical cord. All cases in which treatment was properly
+carried out by competent nurses have survived. This treatment consisted
+in dressing the cord with iodoform powder and antiseptic wool, the
+breast-feeding of the baby from the first, and the administration of
+one-grain doses of potassium bromid at short intervals. The infant
+death-rate on the island of St. Kilda has, consequently, been much
+reduced. The author suggests the use of a new iodin-preparation called
+loretin for dressing the cord. The powder is free from odor and is
+nonpoisonous.
+
+Human Parasites.--Worms in the human body are of interest on account of
+the immense length some species attain, the anomalous symptoms which
+they cause, or because of their anomalous location and issue. According
+to modern writers the famous Viennese collection of helminths contains
+chains of tenia saginata 24 feet long. The older reports, according to
+which the taenia solium (i.e., generally the taenia saginata) grew to
+such lengths as 40, 50, 60, and even as much as 800 yards, are
+generally regarded as erroneous. The observers have apparently taken
+the total of all the fragments of the worm or worms evacuated at any
+time and added them, thus obtaining results so colossal that it would
+be impossible for such an immense mass to be contained in any human
+intestine.
+
+The name solium has no relation to the Latin solus, or solium. It is
+quite possible for a number of tapeworms to exist simultaneously in the
+human body. Palm mentions the fact of four tapeworms existing in one
+person; and Mongeal has made observations of a number of cases in which
+several teniae existed simultaneously in the stomach. David speaks of
+the expulsion of five teniae by the ingestion of a quantity of sweet
+wine. Cobbold reports the case of four simultaneous tapeworms; and
+Aguiel describes the case of a man of twenty-four who expelled a mass
+weighing a kilogram, 34.5 meters long, consisting of several different
+worms. Garfinkel mentions a case which has been extensively quoted, of
+a peasant who voided 238 feet of tapeworms, 12 heads being found.
+Laveran reports a case in which 23 teniae were expelled in the same
+day. Greenhow mentions the occurrence of two teniae mediocanellata.
+
+The size of a tapeworm in a small child is sometimes quite surprising.
+Even the new-born have exhibited signs of teniae, and Haussmann has
+discussed this subject. Armor speaks of a fully-matured tapeworm being
+expelled from a child five days old.  Kennedy reports cases in which
+tapeworms have been expelled from infants five, and five and one-half
+months old. Heisberg gives an account of a tapeworm eight feet in
+length which came from a child of two. Twiggs describes a case in which
+a tapeworm 36 feet long was expelled from a child of four; and Fabre
+mentions the expulsion of eight teniae from a child. Occasionally the
+tapeworm is expelled from the mouth. Such cases are mentioned by Hitch
+and Martel. White speaks of a tapeworm which was discharged from the
+stomach after the use of an emetic. Lile mentions the removal of a
+tapeworm which had been in the bowel twenty-four years.
+
+The peculiar effects of a tapeworm are exaggerated appetite and thirst,
+nausea, headaches, vertigo, ocular symptoms, cardiac palpitation, and
+Mursinna has even observed a case of trismus, or lockjaw, due to taenia
+solium. Fereol speaks of a case of vertigo, accompanied with epileptic
+convulsions, which was caused by teniae. On the administration of
+kousso three heads were expelled simultaneously. There is a record of
+an instance of cardiac pulsation rising to 240 per minute, which ceased
+upon the expulsion of a large tapeworm. It is quite possible for the
+presence of a tapeworm to indirectly produce death. Garroway describes
+a case in which death was apparently imminent from the presence of a
+tapeworm. Kisel has recorded a fatal case of anemia, in a child of six,
+dependent on teniae.
+
+The number of ascarides or round-worms in one subject is sometimes
+enormous. Victor speaks of 129 round-worms being discharged from a
+child in the short space of five days. Pole mentions the expulsion of
+441 lumbricoid worms in thirty-four days, and Fauconneau-Dufresne has
+reported a most remarkable case in which 5000 ascarides were discharged
+in less than three years, mostly by vomiting. The patient made an
+ultimate recovery.
+
+There are many instances in which the lumbricoid worms have pierced the
+intestinal tract and made their way to other viscera, sometimes leading
+to an anomalous exit. There are several cases on record in which the
+lumbricoid worms have been found in the bladder. Pare speaks of a case
+of this kind during a long illness; and there is mention of a man who
+voided a worm half a yard long from his bladder after suppression of
+urine. The Ephemerides contains a curious case in which a stone was
+formed in the bladder, having for its nucleus a worm. Fontanelle
+presented to the Royal Academy of Medicine of Paris several yards of
+tapeworm passed from the urethra of a man of fifty-three. The following
+is a quotation from the British Medical Journal: "I have at present a
+patient passing in his urine a worm-like body, not unlike a tapeworm as
+far as the segments and general appearance are concerned, the length of
+each segment being about 1/4 inch, the breadth rather less; sometimes 1
+1/2 segments are joined together. The worm is serrated on the one side,
+each segment having 1 1/2 cusps. The urine pale, faintly acid at first,
+within the last week became almost neutral. There was considerable
+vesical irritation for the first week, with abundant mucus in the
+urine, specific gravity was 1010; there were no albumin nor tube-casts
+nor uric acid in the urinary sediments.  Later there were pus-cells and
+abundant pus. Tenderness existed behind the prostate and along the
+course of left ureter.  Temperature of patient oscillated from 97.5
+degrees to 103.2 degrees F. There was no history at any time of
+recto-vesical fistula. Can anyone suggest the name, etc., of this
+helminth?"
+
+Other cases of worms in the bladder are mentioned in Chapter XIII
+
+Mitra speaks of the passage of round-worms through the umbilicus of an
+adult; and there is a case mentioned in which round-worms about seven
+inches long were voided from the navel of a young child. Borgeois
+speaks of a lumbricoid worm found in the biliary passages, and another
+in the air passages.
+
+Turnbull has recorded two cases of perforation of the tympanic membrane
+from lumbricoides. Dagan speaks of the issue of a lumbricoid from the
+external auditory meatus. Laughton reports an instance of lumbricoid in
+the nose. Rake speaks of asphyxia from a round-worm. Morland mentions
+the ejection of numerous lumbricoid worms from the mouth.
+
+Worms have been found in the heart; and it is quite possible that in
+cases of trichinosis, specimens of the trichinae may be discovered
+anywhere in the line of cardiac or lymphatic circulation. Quoted by
+Fournier, Lapeyronnie has seen worms in the pericardial sac, and also
+in the ventricle. There is an old record of a person dying of
+intestinal worms, one of which was found in the left ventricle. Castro
+and Vidal speak of worms in the aorta. Rake reports a case of sudden
+death from round-worm; and Brown has noted a similar instance.
+
+The echinococcus is a tiny cestode which is the factor in the
+production of the well-known hydatid cysts which may be found in any
+part of the body. Delafield and Prudden report the only instance of
+multilocular echinococcus seen in this country. Their patient was a
+German who had been in this country five years.  There are only about
+100 of these cases on record, most of them being in Bavaria and
+Switzerland.
+
+The filaria sanguinis hominis is a small worm of the nematode species,
+the adult form of which lives in the lymphatics, and either the adult
+or the prematurely discharged ova (Manson) block the lymph-channels,
+producing the conditions of hematochyluria, elephantiasis, and
+lymph-scrotum. The Dracunculus medinensis or Guinea-worm is a
+widely-spread parasite in parts of Africa and the West Indies.
+According to Osler several cases have occurred in the United States.
+Jarvis reports a case in a post-chaplain who had lived at Fortress
+Monroe, Va., for thirty years. Van Harlingen's patient, a man of
+forty-seven, had never lived out of Philadelphia, so that the worm must
+be included among the parasites infesting this country.
+
+In February, 1896, Henry of Philadelphia showed microscopic slides
+containing blood which was infested with numbers of living and active
+filaria embryos. The blood was taken from a colored woman at the
+Woman's Hospital, who developed hematochyluria after labor. Henry
+believed that the woman had contracted the disease during her residence
+in the Southern States.
+
+Curran gives quite an exhaustive article on the disease called in olden
+times "eaten of worms,"--a most loathsome malady. Herod the Great, the
+Emperor Galerius, and Philip II of Spain perished from it. In speaking
+of the Emperor Galerius, Dean Milman, in his "History of Latin
+Christianity," says, "a deep and fetid ulcer preyed on the lower parts
+of his body and ate them away into a mass of living corruption."
+Gibbon, in his "Decline and Fall," also says that "his (Galerius's)
+death was caused by a very painful and lingering disorder. His body,
+swelled by an intemperate course of life to an unwieldy corpulence, was
+covered with ulcers and devoured by immense swarms of those insects who
+have given their names to this most loathsome disease." It is also said
+that the African Vandal King, the Arian Huneric, died of the disease.
+Antiochus, surnamed the "Madman," was also afflicted with it; and
+Josephus makes mention of it as afflicting the body of Herod the Great.
+The so-called "King Pym" died of this "morbus pedicularis," but as
+prejudice and passion militated against him during his life and after
+his death, this fact is probably more rumor than verity. A case is
+spoken of by Curran, which was seen by an army-surgeon in a very aged
+woman in the remote parts of Ireland, and another in a female in a
+dissecting-room in Dublin. The tissues were permeated with lice which
+emerged through rents and fissures in the body.
+
+Instances of the larvae of the estrus or the bot-fly in the skin are
+not uncommon. In this country Allen removed such larvae from the skin
+of the neck, head, and arm of a boy of twelve. Bethune, Delavigne,
+Howship, Jacobs, Jannuzzi and others, report similar cases. These
+flesh-flies are called creophilae, and the condition they produce is
+called myiosis. According to Osler, in parts of Central America, the
+eggs of a bot-fly, called the dermatobia, are not infrequently
+deposited in the skin, and produce a swelling very like the ordinary
+boil. Matas has described a case in which the estrus larvae were found
+in the gluteal region.  Finlayson of Glasgow has recently reported an
+interesting case in a physician who, after protracted constipation and
+pain in the back and sides, passed large numbers of the larvae of the
+flower-fly, anthomyia canicularis, and there are other instances of
+myiosis interna from swallowing the larvae of the common house-fly.
+
+There are forms of nasal disorder caused by larvae, which some native
+surgeons in India regard as a chronic and malignant ulceration of the
+mucous membranes of the nose and adjacent sinuses in the debilitated
+and the scrofulous. Worms lodging in the cribriform plate of the
+ethmoid feed on the soft tissues of that region. Eventually their
+ravages destroy the olfactory nerves, with subsequent loss of the sense
+of smell, and they finally eat away the bridge of the nose. The head of
+the victim droops, and he complains of crawling of worms in the
+interior of the nose. The eyelids swell so that the patient cannot see,
+and a deformity arises which exceeds that produced by syphilis. Lyons
+says that it is one of the most loathsome diseases that comes under the
+observation of medical men. He describes the disease as "essentially a
+scrofulous inflammation of the Schneiderian membrane, ... which finally
+attacks the bones." Flies deposit their ova in the nasal discharges,
+and from their infection maggots eventually arise. In Sanskrit peenash
+signifies disease of the nose, and is the Indian term for the disease
+caused by the deposition of larvae in the nose. It is supposed to be
+more common in South America than in India.
+
+
+
+CHAPTER XVI.
+
+ANOMALOUS SKIN-DISEASES.
+
+Ichthyosis is a disease of the skin characterized by a morbid
+development of the papillae and thickening of the epidermic lamellae;
+according as the skin is affected over a larger or smaller area, or
+only the epithelial lining of the follicles, it is known as ichthyosis
+diffusa, or ichthyosis follicularis. The hardened masses of epithelium
+develop in excess, the epidermal layer loses in integrity, and the
+surface becomes scaled like that of a fish. Ichthyosis may be
+congenital, and over sixty years ago Steinhausen described a fetal
+monster in the anatomic collection in Berlin, the whole surface of
+whose body was covered with a thick layer of epidermis, the skin being
+so thick as to form a covering like a coat-of-mail. According to Rayer
+the celebrated "porcupine-man" who exhibited himself in England in 1710
+was an example of a rare form of ichthyosis. This man's body, except
+the face, the palms of the hands, and the soles of the feet, was
+covered with small excrescences in the form of prickles. These
+appendages were of a reddish-brown color, and so hard and elastic that
+they rustled and made a noise when the hand was passed over their
+surfaces. They appeared two months after birth and fell off every
+winter, to reappear each summer. In other respects the man was in very
+good health. He had six children, all of whom were covered with
+excrescences like himself. The hands of one of these children has been
+represented by Edwards in his "Gleanings of Natural History." A picture
+of the hand of the father is shown in the fifty-ninth volume of the
+Philosophical Transactions.
+
+Pettigrew mentions a man with warty elongations encasing his whole
+body. At the parts where friction occurred the points of the
+elongations were worn off. This man was called "the biped armadillo."
+His great grandfather was found by a whaler in a wild state in Davis's
+Straits, and for four generations the male members of the family had
+been so encased. The females had normal skins. All the members of the
+well-known family of Lambert had the body covered with spines. Two
+members, brothers, aged twenty-two and fourteen, were examined by
+Geoffroy-Saint-Hilaire.  This thickening of the epidermis and hair was
+the effect of some morbid predisposition which was transmitted from
+father to son, the daughters not being affected. Five generations could
+be reckoned which had been affected in the manner described.
+
+The "porcupine-man" seen by Baker contracted small-pox, and his skin
+was temporarily freed from the squamae, but these reappeared shortly
+afterward. There are several older records of prickly men or
+porcupine-men. Ascanius mentions a porcupine-man, as do Buffon and
+Schreber. Autenreith speaks of a porcupine-man who was covered with
+innumerable verrucae. Martin described a remarkable variety of
+ichthyosis in which the skin was covered with strong hairs like the
+bristles of a boar. When numerous and thick the scales sometimes
+assumed a greenish-black hue. An example of this condition was the
+individual who exhibited under the name of the "alligator-boy." Figure
+286 represents an "alligator-boy" exhibited by C. T. Taylor. The skin
+affected in this case resembled in color and consistency that of a
+young alligator. It was remarked that his olfactory sense was intact.
+
+The harlequin fetus, of which there are specimens in Guy's Hospital,
+London Hospital, and the Royal College of Surgeons Museum, is the
+result of ichthyosis congenita. According to Crocker either after the
+removal of the vernix caseosa, which may be thick, or as the skin dries
+it is noticeably red, smooth, shiny, and in the more severe cases
+covered with actual plates.  In the harlequin fetus the whole surface
+of the body is thickly covered with fatty epidermic plates, about 1/16
+inch in thickness, which are broken up by horizontal and vertical
+fissures, and arranged transversely to the surface of the body like a
+loosely-built stone wall. After birth these fissures may extend down
+into the corium, and on movement produce much pain.  The skin is so
+stiff and contracted that the eyes cannot be completely opened or shut,
+the lips are too stiff to permit of sucking, and are often inverted;
+the nose and ears are atrophied, the toes are contracted and cramped,
+and, if not born dead, the child soon dies from starvation and loss of
+heat. When the disease is less severe the child may survive some time.
+Crocker had a patient, a male child one month old, who survived three
+months. Hallopeau and Elliot also report similar cases.
+
+Contagious follicular keratosis is an extremely rare affection in which
+there are peculiar, spine-like outgrowths, consisting in exudations of
+the mouths of the sebaceous glands. Leloir and Vidal shorten the name
+to acne cornee.
+
+Erasmus Wilson speaks of it as ichthyosis sebacea cornea. H. G.  Brooke
+describes a case in a girl of six. The first sign had been an eruption
+of little black spots on the nape of the neck. These spots gradually
+developed into papules, and the whole skin took on a dirty yellow
+color. Soon afterward the same appearances occurred on both shoulders,
+and, in the same order, spread gradually down the outer sides of the
+arms--first black specks, then papules, and lastly pigmentation. The
+black specks soon began to project, and comedo-like plugs and small,
+spine-like growths were produced. Both the spines and plugs were very
+hard and firmly-rooted. They resisted firm pressure with the forceps,
+and when placed on sheets of paper rattled like scraps of metal.  A
+direct history of contagion was traced from this case to others.
+
+Mibelli describes an uncommon form of keratodermia (porokeratosis). The
+patient was a man of twenty-one, and exhibited the following changes in
+his skin: On the left side of the neck, beyond a few centimeters below
+the lobe of the ear, there were about ten small warty patches,
+irregularly scattered, yellowish-brown in color, irregular in outline,
+and varying in size from a lentil to a half-franc piece, or rather
+more. Similar patches were seen on other portions of the face. Patches
+of varying size and form, sharply limited by a kind of small,
+peripheral "dike," sinuous but uninterrupted, of a color varying from
+red to whitish-red, dirty white, and to a hue but little different from
+that of the healthy skin. Similar patches were seen on the right hand,
+and again on the back of the right hand was a wide space, prolonged
+upward in the form of a broad band on the posterior surface of the
+forearm to just below the olecranon, where the skin was a little
+smoother and thinner than the surrounding skin, and altogether bare of
+hairs. The disease was noticed at the age of two, and gradually
+progressed. The patient always enjoyed the most perfect health, but had
+contracted syphilis three years before. A brother of the patient, aged
+twenty-four, for sixteen years has had the same skin-affection as this
+patient, on the back of the hand, and the sister and father had noticed
+similar lesions.
+
+Diffuse symmetric scleroderma, or hide-bound disease, is quite rare,
+and presents itself in two phases: that of infiltration (more properly
+called hypertrophy) and atrophy, caused by shrinkage. The whole body
+may be involved, and each joint may be fixed as the skin over it
+becomes rigid. The muscles may be implicated independently of the skin,
+or simultaneously, and they give the resemblance of rigor mortis. The
+whole skin is so hard as to suggest the idea of a frozen corpse,
+without the coldness, the temperature being only slightly subnormal.
+The skin can neither be pitted nor pinched. As Crocker has well put it,
+when the face is affected it is gorgonized, so to speak, both to the
+eye and to the touch. The mouth cannot be opened; the lids usually
+escape, but if involved they are half closed, and in either case
+immovable. The effect of the disease on the chest-walls is to seriously
+interfere with the respiration and to flatten and almost obliterate the
+breasts; as to the limbs, from the shortening of the distended skin the
+joints are fixed in a more or less rigid position. The mucous membranes
+may be affected, and the secretion of both sweat and sebum is
+diminished in proportion to the degree of the affection, and may be
+quite absent. The atrophic type of scleroderma is preceded by an edema,
+and from pressure-atrophy of the fat and muscles the skin of the face
+is strained over the bones; the lips are shortened, the gums shrink
+from the teeth and lead to caries, and the nostrils are compressed. The
+strained skin and the emotionless features (relieved only by
+telangiectatic striae) give the countenance a ghastly, corpse-like
+aspect. The etiology and pathology of this disease are quite obscure.
+Happily the prognosis is good, as there is a tendency to spontaneous
+recovery, although the convalescence may be extended.
+
+Although regarded by many as a disease distinct from scleroderma,
+morphea is best described as a circumscribed scleroderma, and presents
+itself in two clinical aspects: patches and bands, the patches being
+the more common.
+
+Scleroderma neonatorum is an induration of the skin, congenital and
+occurring soon after birth, and is invariably fatal. A disease somewhat
+analogous is edema neonatorum, which is a subcutaneous edema with
+induration affecting the new-born. If complete it is invariably fatal,
+but in a few cases in which the process has been incomplete recovery
+has occurred. Gerard reports recovery from a case of sclerema
+neonatorum in an infant five weeks old, which seemed in perfect health
+but for this skin-affection. The back presented a remarkable induration
+which involved the entire dorsal aspect, including the deltoid regions,
+the upper arms, the buttocks, and the thighs, down to and involving the
+popliteal spaces. The edges of the indurated skin were sharply defined,
+irregular, and map-like. The affected skin was stretched, but not
+shiny, and exhibited a pink mottling; it could not be pinched between
+the fingers; pressure produced no pitting, but rendered the surface
+pale for a time. The induration upon the buttocks had been noticed
+immediately after birth, and the region was at first of a deep pink
+color. During the first nine days the trouble had extended to the
+thighs, but only shortly before the examination had it attacked the
+arms.  Inunctions of codliver oil were at first used, but with little
+improvement. Blue ointment was substituted, and improvement commenced.
+As the induration cleared up, outlying patches of the affected skin
+were left surrounded by normal integument. No pitting could be produced
+even after the tension of the skin had decreased during recovery. The
+lowest rectal temperature was 98 degrees F. In a little more than four
+months the skin became normal. The treatment with mercurial ointment
+was stopped some time before recovery.
+
+Possibly the most interesting of the examples of skin-anomaly was the
+"elephant-man" of London. His real name was Merrick. He was born at
+Leicester, and gave an elaborate account of shock experienced by his
+mother shortly before his birth, when she was knocked down by an
+elephant at a circus; to this circumstance he attributed his
+unfortunate condition. He derived his name from a proboscis-like
+projection of his nose and lips, together with a peculiar deformity of
+the forehead. He was victimized by showmen during his early life, and
+for a time was shown in Whitechapel Road, where his exhibition was
+stopped by the police. He was afterward shown in Belgium, and was there
+plundered of all his savings. The gruesome spectacle he presented
+ostracized him from the pleasures of friendship and society, and
+sometimes interfered with his travels. On one occasion a steamboat
+captain refused to take him as a passenger. Treves exhibited him twice
+before the Pathological Society of London. His affection was not
+elephantiasis, but a complication of congenital hypertrophy of certain
+bones and pachydermatocele and papilloma of the skin.  From his youth
+he suffered from a disease of the left hip-joint.  The papillary masses
+developed on the skin of the back, buttock, and occiput. In the right
+pectoral and posterior aspect of the right axillary region, and over
+the buttocks, the affected skin hung in heavy pendulous flaps. His left
+arm was free from disease. His head grew so heavy that at length he had
+great difficulty in holding it up. He slept in a sitting or crouching
+position, with his hands clasped over his legs, and his head on his
+knees. If he lay down flat, the heavy head showed a tendency to fall
+back and produce a sense of suffocation. For a long time he was an
+inmate of the London Hospital, where special quarters were provided for
+him, and it was there that he was found dead, April 11, 1890; while in
+bed his ponderous head had fallen backward and dislocated his neck.
+
+Ainhum may be defined as a pathologic process, the ultimate result of
+which is a spontaneous amputation of the little toe. It is confined
+almost exclusively to negroes, chiefly males, and of African descent.
+In Brazil it is called "ainham" or "quigila." "Ainham" literally means
+to saw, and is doubtless a colloquial name derived from a supposed
+slow, sawing process. The Hindoo name for it is "sukha pakla," meaning
+dry suppuration.
+
+In 1866 da Silva Lima of Bahia, at the Misericordia Hospital, gave the
+first reports of this curious disease, and for quite a period it was
+supposed to be confined to Brazilian territory.  Since then, however,
+it has been reported from nearly every quarter of the globe. Relative
+to its geographic distribution, Pyle states that da Silva Lima and
+Seixas of Bahia have reported numerous cases in Brazil, as have
+Figueredo, Pereira, Pirovano, Alpin, and Guimares. Toppin reports it in
+Pernambuco. Mr. Milton reports a case from Cairo, and Dr. Creswell at
+Suez, both in slaves. E. A. G. Doyle reports several cases at the
+Fernando Hospital, Trinidad. Digby reports its prevalence on the west
+coast of Africa, particularly among a race of negroes called Krumens.
+Messum reports it in the South African Republic, and speaks of its
+prevalence among the Kaffirs. Eyles reports it on the Gold Coast. It
+has also been seen in Algiers and Madagascar.  Through the able efforts
+of Her Majesty's surgeons in India the presence of ainhum has been
+shown in India, and considerable investigation made as to its etiology,
+pathologic histology, etc.  Wise at Dacca, Smyth and Crombie at
+Calcutta, Henderson at Bombay, and Warden, Sen, Crawford, and Cooper in
+other portions of Southern India have all rendered assistance in the
+investigation of ainhum. In China a case has been seen, and British
+surgeons speak of it as occurring in Ceylon. Von Winckler presents an
+admirable report of 20 cases at Georgetown, British Guiana. Dr.
+Potoppidan sends a report of a case in a negress on St. Thomas Island.
+The disease has several times been observed in Polynesia.
+
+Dr. Hornaday reports a case in a negress from North Carolina, and,
+curious to relate, Horwitz of Philadelphia and Shepherd of Canada found
+cases in negroes both of North Carolina antecedents.  Dr. James Evans
+reports a case in a negro seventy-four years of age, at Darlington,
+S.C. Dr. R. H. Days of Baton Rouge, La., had a case in a negress, and
+Dr. J. L. Deslates, also of Louisiana, reports four cases in St. James
+Parish. Pyle has seen a case in a negress aged fifty years, at the
+Emergency Hospital in Washington.
+
+So prevalent is the disease in India that Crawford found a case in
+every 2500 surgical cases at the Indian hospitals. The absence of pain
+or inconvenience in many instances doubtless keeps the number of cases
+reported few, and again we must take into consideration the fact that
+the class of persons afflicted with ainhum are seldom brought in
+contact with medical men.
+
+The disease usually affects the 5th phalanx at the interphalangeal
+joint. Cases of the 4th and other phalanges have been reported. Cooper
+speaks of a young Brahman who lost his left great toe by this process.
+Crombie speaks of a simultaneous amputation of both fourth toes.
+Potoppidan reports a similar case in a negress on St. Thomas Island.
+Sen reports a case in a supernumerary digit in a child, whose father, a
+Hindoo, lost a toe by ainhum. Eyles reports a case in a negro in whom
+the second finger was affected. Mirault, at Angiers, speaks of a case
+in which two fingers were lost in fifteen days, a fact which makes his
+diagnosis dubious. Beranger-Ferraud has seen all the toes amputated,
+and there is a wax model by Baretta, Paris, in the Army Medical Museum
+at Washington, in which all the toes of the right foot have been
+amputated, and the process is fast making progress at the middle third
+of the leg.
+
+Ainhum is much more common in males than in females; it is, in fact,
+distinctly rare in the latter. Of von Winckler's 20 cases all were
+males.
+
+It may occur at any age, but is most common between thirty and
+thirty-five. It has been reported in utero by Guyot, and was seen to
+extend up to the thigh, a statement that is most likely fallacious.
+However, there are well-authenticated cases in infants, and again in
+persons over seventy years of age.
+
+In some few cases the metatarso-phalangeal joint is affected; but no
+case has been seen at the base of the ungual phalanx. The duration of
+the disease is between two and four years, but Dr. Evans's case had
+been in progress fifty years. It rarely runs its full course before a
+year.
+
+Ainhum begins as a small furrow or crack, such as soldiers often
+experience, at the digito-plantar fold, seen first on the inner side.
+This process of furrowing never advances in soldiers, and has been
+given a name more expressive than elegant. In ainhum the toe will swell
+in a few days, and a pain, burning or shooting in nature, may be
+experienced in the foot and leg affected. Pain, however, is not
+constant. There may be an erythematous eruption accompanying the
+swelling. The furrow increases laterally and in depth, and meets on the
+dorsal aspect of the toe, giving the toe the appearance of being
+constricted by a piece of fine cord. As the furrow deepens the distal
+end of the toe becomes ovoid, and soon an appearance as of a marble
+attached to the toe by a fibrous pedicle presents itself. By this time
+the swelling, if any, has subsided. The distal end of the toe bends
+under the foot, and becomes twisted when walking, and causes
+inconvenience, and, unfortunately, says Eyles, it is in this last stage
+only that the Fanti presents himself. There is in the majority of cases
+a small ulcer in or near the digito-plantar fold, which causes most of
+the pain, particularly when pressed upon. This ulcer does not occur
+early, and is not constant. The case under Pyle's observation showed no
+ulceration, and was absolutely painless, the negress applying for
+diagnosis rather than treatment. The furrow deepens until spontaneous
+amputation takes place, which rarely occurs, the patient generally
+hastening the process by his own operation, or by seeking surgical
+treatment. A dry scab forms at the furrow, and when picked and repicked
+constantly re-forms, being composed of horny desquamation or necrosis.
+
+The histology of ainhum shows it to be a direct ingrowth of epithelium,
+with a corresponding depression of surface due to a rapid hyperplasia
+that pushes down and strangles the papillae, thus cutting off the blood
+supply from the epithelial cells, causing them to undergo a horny
+change.
+
+The disease is not usually symmetric, as formerly stated, nor is it
+simultaneous in different toes. There are no associated constitutional
+symptoms, no tendency to similar morbid changes in other parts, and no
+infiltration elsewhere. There is little or no edema with ainhum. In
+ainhum there is, first, simple hypertrophy, then active hyperplasia The
+papillae degenerate when deprived of blood supply, and become horny.
+Meanwhile the pressure thus exerted on the nervi vasorum sets up
+vascular changes which bring about epithelial changes in more distant
+areas, the process advancing anteriorly, that is, in the direction of
+the arteries.  This makes the cause, according to Eyles, an
+inflammatory and trophic phenomenon due mainly to changes following
+pressure on the vasomotor nerves.
+
+Etiology.--The theories of the causation of ainhum are quite numerous.
+The first cause is the admirable location for a furrow in the
+digito-plantar fold, and the excellent situation of the furrow for the
+entrance of sand or other particles to make the irritation constant,
+thus causing chronic inflammatory changes, which are followed
+subsequently by the changes peculiar to ainhum. The cause has been
+ascribed to the practice of wearing rings on the toes; but von Winckler
+says that in his locality (British Guinea) this practice is confined to
+the coolie women, and in not one of his 20 cases had a ring been
+previously worn on the toe; in fact all of the patients were males.
+Digby says, however, that the Krumens, among whom the disease is
+common, have long worn brass or copper rings on the fifth toe. Again
+the natives of India, who are among those most frequently afflicted,
+have no such custom.
+
+Injury, such as stone-bruise, has been attributed as the initial cause,
+and well-authenticated cases have been reported in which traumatism is
+distinctly remembered; but Smyth, Weber, and several other observers
+deny that habits, accidents, or work, are a feature in causation.
+
+Von During reports a curious case which he calls sclerodactylia
+annularis ainhumoides. The patient was a boy about twelve years old,
+born in Erzeroum, brought for treatment for scabies, and not for the
+affection about to be described. A very defective history led to the
+belief that a similar affection had not been observed in the family.
+When he was six years old it began on the terminal phalanges of the
+middle fingers. A myxomatous swelling attacked the phalanges and
+effected a complete absorption of the terminal phalanx. It did not
+advance as far as gangrene or exfoliation of bone. At the time of
+report the whole ten fingers were involved; the bones seemed to be
+thickened, the soft parts being indurated or sclerosed. In the right
+index finger a completely sclerosed ring passed around the middle
+phalanx. The nails on the absorbed phalanges had become small and
+considerably thickened plates. No analogous changes were found
+elsewhere, and sensation was perfectly normal in the affected parts.
+There were no signs whatever of a multiple neuritis nor of a leprous
+condition.
+
+There is a rare and curious condition known as "deciduous skin" or
+keratolysis, in which the owners possess a skin, which, like that of a
+serpent, is periodically cast off, that of the limbs coming off like
+the finger of a glove. Preston of Canterbury, New Zealand, mentions the
+case of a woman who had thus shed her skin every few weeks from the age
+of seven or even earlier. The woman was sixty-seven years of age; the
+skin in every part of the body came away in casts and cuticles which
+separated entire and sometimes in one unbroken piece like a glove or
+stocking. Before each paroxysm she had an associate symptom of malaise.
+Even the skin of the nose and ears came off complete. None of the
+patient's large family showed this idiosyncrasy, and she said that she
+had been told by a medical man that it had been due to catching cold
+after an attack of small-pox. Frank mentions a case in which there was
+periodic and complete shedding of the cuticle and nails of the hands
+and feet, which was repeated for thirty-three consecutive years on July
+24th of each year, and between the hours of 3 P.M. and 9 P.M. The
+patient remembered shedding for the first time while a child at play.
+The paroxysms always commenced abruptly, constitutional febrile
+symptoms were first experienced, and the skin became dry and hot. The
+acute symptoms subsided in three or four hours and were entirely gone
+in twelve hours, with the exception of the redness of the skin, which
+did not disappear for thirty-six hours more. The patient had been
+delirious during this period. The cuticle began to shed some time
+between the third and twelfth day, in large sheets, as pictured in the
+accompanying illustrations. The nails were shed in about four weeks
+after the acute stage. Crocker had an instance of this nature in a man
+with tylosis palmae, in which the skin was cast off every autumn, but
+the process lasted two months. Lang observed a case in which the
+fingers alone were affected.
+
+There is a case of general and habitual desquamation of the skin in the
+Ephemerides of 1686; and Newell records a case which recovered under
+the use of Cheltenham water for several seasons.  Latham describes a
+man of fifty who was first seized about ten years previously with a
+singular kind of fever, and this returned many times afterward, even
+twice in the course of the same year, attended with the same symptoms
+and circumstances, and appearing to be brought on by obstructed
+perspiration, in consequence of catching cold. Besides the common
+febrile symptoms, upon the invasion of the disease his skin universally
+itched, more especially at the joints, and the itching was followed by
+many little red spots, with a small degree of swelling. Soon after this
+his fingers became stiff; hard, and painful at the ends, and at the
+roots of the nails. In about twenty-four hours the cuticle began to
+separate from the cutis, and in ten or twelve days this separation was
+general from head to foot, during which time he completely turned the
+cuticle off from the wrists to the fingers' ends like a glove, and in
+like manner on the legs to the toes, after which his nails shot
+gradually from their roots, at first with exquisite pain, which abated
+as the separation of the cuticle advanced, and the old nails were
+generally thrown off by new ones in about six months. The cuticle rose
+in the palms and soles like blisters, having, however, no fluid
+beneath, and when it came off it left the underlying cutis exposed for
+a few days.  Sometimes, upon catching cold, before quite free from
+feverish symptoms, a second separation of the cuticle from the cutis
+occurred, but it appeared so thin as to be like scurf, demonstrating
+the quick renewal of the parts.
+
+There is a similar case in the Philosophical Transactions in a miller
+of thirty-five who was exposed to great heat and clouds of dust. On the
+first cold a fever attacked him, and once or twice a year, chiefly in
+the autumn, this again occurred, attended with a loosening and
+detachment of the cuticle. The disorder began with violent fever,
+attended with pains in the head, back, limbs, retching, vomiting, dry
+skin, furred tongue, urgent thirst, constipation, and high-colored
+urine. Usually the whole surface of the body then became yellow. It
+afterward became florid like a rash, and then great uneasiness was felt
+for several days, with general numbness and tingling; the urine then
+began to deposit a thick sediment. About the third week from the first
+attack the cuticle appeared elevated in many places, and in eight or
+ten days afterward became so loose as to admit of its easy removal in
+large flakes. The cuticle of the hands, from the wrists to the fingers'
+ends, came off like a glove. The patient was never disposed to sweat,
+and when it was attempted to force perspiration he grew worse; nor was
+he much at ease until his urine deposited a sediment, after which he
+felt little inconvenience but from the rigidity of the skin. The nails
+were not detached as in the previous case.
+
+It is quite natural that such cases as this should attract the
+attention of the laity, and often find report in newspapers. The
+following is a lay-report of a "snake-boy" in Shepardstown, Va.:--
+
+"Jim Twyman, a colored boy living with his foster-parents ten miles
+from this place, is a wonder. He is popularly known as the "snake-boy."
+Mentally he is as bright as any child of his age, and he is popular
+with his playmates, but his physical peculiarities are probably
+unparalleled. His entire skin, except the face and hands, is covered
+with the scales and markings of a snake. These exceptions are kept so
+by the constant use of Castile soap, but on the balance of his body the
+scales grow abundantly. The child sheds his skin every year. It causes
+him no pain or illness. From the limbs it can be pulled in perfect
+shape, but off the body it comes in pieces. His feet and hands are
+always cold and clammy. He is an inordinate eater, sometimes spending
+an hour at a meal, eating voraciously all the time, if permitted to do
+so. After these gorgings he sometimes sleeps two days. There is a
+strange suggestion of a snake in his face, and he can manipulate his
+tongue, accompanied by hideous hisses, as viciously as a serpent."
+
+Under the name of dermatitis exfoliativa neonatorum, Ritter has
+described an eruption which he observed in the foundling asylum at
+Prague, where nearly 300 cases occurred in ten years.  According to
+Crocker it begins in the second or third week of life, and occasionally
+as late as the fifth week, with diffuse and universal scaling, which
+may be branny or in laminae like pityriasis rubra, and either dry or
+with suffusion beneath the epidermis. Sometimes it presents flaccid
+bullae like pemphigus foliaceus, and then there are crusts as well as
+scales, with rhagades on the mouth, anus, etc.; there is a total
+absence of fever or other general symptoms. About 50 per cent die of
+marasmus and loss of heat, with or without diarrhea. In those who
+recover the surface gradually becomes pale and the desquamation ceases.
+Opinions differ regarding it, some considering it of septic origin,
+while others believe it to be nothing but pemphigus foliaceus. Kaposi
+regards it as an aggravation of the physiologic exfoliation of the
+new-born. Elliott of New York reports two cases with a review of the
+subject, but none have been reported in England. Cases on the Continent
+have been described by Billard, von Baer, Caspary, those already
+mentioned, and others.
+
+The name epidemic exfoliative dermatitis has been given to an epidemic
+skin-disease which made its appearance in 1891 in England; 425 cases
+were collected in six institutions, besides sporadic cases in private
+houses.
+
+In 1895, in London, some photographs and sketches were exhibited that
+were taken from several of the 163 cases which occurred in the
+Paddington Infirmary and Workhouse, under the care of Dr. Savill, from
+whose negatives they were prepared. They were arranged in order to
+illustrate the successive stages of the disorder. The eruption starts
+usually with discrete papules, often in stellate groups, and generally
+arranged symmetrically when on the limbs. These become fused into
+crimson, slightly raised maculae, which in severe cases become further
+fused into red thickened patches, in which the papules can still be
+felt and sometimes seen. Vesicles form, and exudation occurs in only
+about one-third of the cases. Desquamation of the epidermis is the
+invariable feature of all cases, and it usually commences between the
+fourth and eighth days. In severe cases successive layers of the
+epidermis are shed, in larger or smaller scales, throughout the whole
+course of the malady. One-half of the epidermis shed from the hand of a
+patient is exhibited in this collection.
+
+Of sphaceloderma, or gangrene of the skin, probably the most
+interesting is Raynaud's disease of symmetric gangrene, a vascular
+disorder, which is seen in three grades of intensity: there is local
+syncope, producing the condition known as dead-fingers or dead-toes,
+and analogous to that produced by intense cold; and local asphyxia,
+which usually follows local syncope, or may develop independently.
+Chilblains are the mildest manifestation of this condition. The
+fingers, toes, and ears, are the parts usually affected. In the most
+extreme degree the parts are swollen, stiff, and livid, and the
+capillary circulation is almost stagnant; this is local or symmetric
+gangrene, the mildest form of which follows asphyxia. Small areas of
+necrosis appear on the pads of the fingers and of the toes; also at the
+edges of the ears and tip of the nose. Occasional symmetric patches
+appear on the limbs and trunk, and in extensive cases terminate in
+gangrene. Raynaud suggested that the local syncope was produced by
+contraction of the vessels; the asphyxia is probably caused by a
+dilatation of the capillaries and venules, with persistence of the
+spasm of the arterioles. According to Osler two forms of congestion
+occur, which may be seen in adjacent fingers, one of which may be
+swollen, intensely red, and extremely hot; the other swollen, cyanotic,
+and intensely cold. Sometimes all four extremities are involved, as in
+Southey's case, in a girl of two and a half in whom the process began
+on the calves, after a slight feverish attack, and then numerous
+patches rapidly becoming gangrenous appeared on the backs of the legs,
+thighs, buttocks, and upper arms, worse where there was pressure; the
+child died thirty-two hours after the onset. The whole phenomenon may
+be unilateral, as in Smith's case, quoted by Crocker,--in a girl of
+three years in whom the left hand was cold and livid, while on the
+right there was lividity, progressing to gangrene of the fingers and of
+the thumb up to the first knuckles, where complete separation occurred.
+
+A considerable number of cases of apparently spontaneous gangrene of
+the skin have been recorded in medical literature as occurring
+generally in hysteric young women. Crocker remarks that they are
+generally classified as erythema gangraenosum, and are always to be
+regarded with grave suspicion of being self-induced. Ehrl records an
+interesting case of this nature with an accompanying illustration. The
+patient was a girl of eighteen whose face, left breast, anus, legs, and
+feet became affected every autumn since her sixth year, after an attack
+of measles. At first the skin became red, then water-blisters formed,
+the size of a grain of corn, and in three days reaching the size of a
+hazel-nut; these burst and healed, leaving no scars. The menses
+appeared at the fifteenth year, lasted eight days, with great loss of
+blood, but there was no subsequent menstruation, and no vicarious
+hemorrhage. Afterward the right half of the face became red for three
+or four weeks, with a disturbance of the sensibility of this part,
+including the right half of the mucosa of the mouth and the conjunctive
+of the right eye. At the seventeenth year the patient began to have a
+left-sided headache and increased sweating of the right half of the
+body. In 1892 the periodically-appearing skin-affection became worse.
+Instead of healing, the broken vessels became blackish and healed
+slowly, leaving ulcers, granulations, and scars, and the gangrenous
+tendency of the skin increased. Disturbance of the sight shortly
+intervened, associated with aphonia. The sensibility of the whole body,
+with the exception of the face, was greatly impaired, and there was
+true gangrene of the corium. A younger sister of the patient was
+similarly affected with symptoms of hysteria, hemianesthesia, etc.
+
+Neuroses of the skin consist in augmentation of sensibility or
+hyperesthesia and diminution of sensibility or anesthesia. There are
+some curious old cases of loss of sensation. Ferdinandus mentions a
+case of a young man of twenty-four who, after having been seized with
+insensibility of the whole body with the exception of the head, was
+cured by purgatives and other remedies. Bartholinus cites the case of a
+young man who lost the senses of taste and feeling; and also the case
+of a young girl who could permit the skin of her forehead to be pricked
+and the skin of her neck to be burned without experiencing any pain. In
+his "Surgery" Lamothe mentions a case of insensibility of the hands and
+feet in consequence of a horse-kick in the head without the infliction
+of any external wound. In the "Memoires de l'Academie des Sciences" for
+the year 1743, we read an account of a soldier who, after having
+accidentally lost all sensation in his left arm, continued to go
+through the whole of the manual exercise with the same facility as
+ever. It was also known that La Condamine was able to use his hands for
+many years after they had lost their sensation. Rayer gives a case of
+paralysis of the skin of the left side of the trunk without any
+affection of the muscles, in a man of forty-three of apoplectic
+constitution. The paralysis extended from the left mammary region to
+the haunch, and from the vertebrae to the linea alba. Throughout this
+whole extent the skin was insensible and could be pinched or even
+punctured without the patient being aware that he was even touched. The
+parts did not present any perceptible alteration in texture or in
+color. The patient was free from fever and made no complaint except a
+slight headache. Rayer quotes another case in a man of sixty who had
+been bitten three years previously by a dog that was not mad. He was
+greatly frightened by the accident and every time he saw a dog he
+trembled violently, and on one occasion he suffered a convulsive attack
+for one and a half hours. The convulsions increased in number and
+frequency, he lost his memory, and exhibited other signs of incipient
+dementia. He was admitted to the hospital with two small wounds upon
+the head, one above the left eyebrow and the other on the scalp,
+occasioned by a fall on his entrance into the hospital. For several
+days a great degree of insensibility of the skin of the whole body was
+observed without any implication of the power of voluntary motion. He
+was entirely cured in eighteen days.
+
+Duhring reports a very rare form of disease of the skin, which may be
+designated neuroma cutis dolorosum, or painful neuroma of the skin. The
+patient was a boiler-maker of seventy who had no family history bearing
+on the disease. Ten years previously a few cutaneous tubercles the size
+and shape of a split-pea were noticed on the left shoulder, attended
+with decided itching but not with pain. The latter symptom did not come
+on until three years later. In the course of a year or two the lesions
+increased in number, so that in four years the shoulder and arm were
+thickly studded with them. During the next five years no particular
+changes occurred either in lesions or in the degree of pain. The region
+affected simply looked like a solid sheet of variously-sized,
+closely-packed, confluent tubercles, hard and dense. The tubercles were
+at all times painful to the touch, and even the contact of air was
+sufficient to cause great suffering.  During the paroxysms, which
+occurred usually at several short intervals every day, the skin changed
+color frequently and rapidly, passing through various reddish and
+violet tints, at times becoming purplish.
+
+As a paroxysm came on the man was in the habit of gently pressing and
+holding the arm closely to his body. At one time he endured the attack
+in a standing posture, walking the floor, but usually he seated himself
+very near a hot stove, in a doubled-up, cramped position, utterly
+unmindful of all surroundings, until the worst pain had ceased.
+Frequently he was unable to control himself, calling out piteously and
+vehemently and beseeching that his life be terminated by any means. In
+desperation he often lay and writhed on the floor in agony. The intense
+suffering lasted, as a rule, for about a half hour, but he was never
+without pain of the neuralgic type. He was freer of pain in summer than
+in winter.  Exsection of the brachial plexus was performed, but gave
+only temporary relief. The man died in his eighty-fourth year of senile
+debility.
+
+According to Osler the tubercula dolorosa or true fascicular neuroma is
+not always made up of nerve-fibers, but, as shown by Hoggan, may be an
+adenomatous growth of the sweat-glands.
+
+Yaws may be defined as an endemic, specific, and contagious disease,
+characterized by raspberry-like nodules with or without constitutional
+disturbance. Its synonym, frambesia, is from the French, framboise, a
+raspberry. Yaws is derived from a Carib word, the meaning of which is
+doubtful. It is a disease confined chiefly to tropical climates, and is
+found on the west coast of Africa for about ten degrees on each side of
+the equator, and also on the east coast in the central regions, but
+rarely in the north. It is also found in Madagascar, Mozambique,
+Ceylon, Hindoostan, and nearly all the tropical islands of the world.
+Crocker believes it probable that the button-scurvy of Ireland, now
+extinct, but described by various writers of 1823 to 1857 as a
+contagious disease which was prevalent in the south and in the interior
+of the island, was closely allied to yaws, if not identical with it.
+The first mention of the yaws disease is by Oviedo, in 1535, who met
+with it in San Domingo. Although Sauvages at the end of the last
+century was the first to give an accurate description of this disease,
+many physicians had observed it before.
+
+Frambesia or yaws was observed in Brazil as early as 1643, and in
+America later by Lebat in 1722. In the last century Winterbottom and
+Hume describe yaws in Africa, Hume calling it the African distemper. In
+1769 in an essay on the "Natural History of Guiana," Bancroft mentions
+yaws; and Thomson speaks of it in Jamaica. Hillary in 1759 describes
+yaws in Barbadoes; and Bajou in Domingo and Cayenne in 1777, Dazille
+having already observed it in San Domingo in 1742.
+
+Crocker takes his account of yaws from Numa Rat of the Leeward Islands,
+who divides the case into four stages: incubation, primary, secondary,
+and tertiary. The incubation stage is taken from the date of infection
+to the first appearance of the local lesion at the sight of
+inoculation. It varies from three to ten weeks. The symptoms are vague,
+possibly palpitation, vertigo, edema of the limbs and eyelids. The
+primary stage begins with the initial lesion, which consists of a
+papule which may be found most anywhere on the body. This papule
+ulcerates. The secondary stage commences about a fortnight after the
+papule has healed.  There is intermittent fever, headache, backache,
+and shooting pains in the limbs and intercostal spaces, like those of
+dengue, with nocturnal exacerbations. An eruption of minute red spots
+appears first on the face, and gradually extends so that the whole body
+is covered at the end of three days. By the seventh day the apex of the
+papule is of a pale yellow color, and the black skin has the appearance
+of being dotted over with yellow wax. The papule then develops into
+nodules of cylindric shape, with a dome-shaped, thick, yellow crust. It
+is only with the crust off that there is any resemblance to a
+raspberry. During the month following the raspberry appearance the skin
+is covered with scabs which, falling off, leave a pale macula; in dark
+races the macula becomes darker than normal, but in pale races it
+becomes paler than the natural skin, and in neither case is it scarcely
+ever obliterated. Intense itching is almost always present, and anemia
+is also a constant symptom. The disease is essentially contagious and
+occurs at all ages and among all sexes, to a lesser degree in whites
+and hybrids, and is never congenital. It seems to have a tendency to
+undergo spontaneous recovery.
+
+Furunculus orientalis, or its synonyms, Oriental boil, Aleppo boil,
+Delhi boil, Biskra button, etc., is a local disease occurring chiefly
+on the face and other uncovered spots, endemic in limited districts in
+hot climates, characterized by the formation of a papule, a nodule, and
+a scab, and beneath the last a sharply punched-out ulcer. Its different
+names indicate the districts in which it is common, nearly always in
+tropical or subtropical climates. It differs from yaws in the absence
+of febrile symptoms, in its unity, its occurrence often on the feet and
+the backs of the hands, its duration, and the deep scar which it
+leaves. A fatal issue is rare, but disfiguring and disabling cicatrices
+may be left unless great care is employed.
+
+Pigmentary Processes.--Friction, pressure, or scratching, if long
+continued, may produce extensive and permanent pigmentation. This is
+seen in its highest degree in itching diseases like prurigo and
+pityriasis. Greenhow has published instances of this kind under the
+name of "vagabond's disease," a disease simulating morbus addisonii,
+and particularly found in tramps and vagrants.  In aged people this
+condition is the pityriasis nigra of Willan.  According to Crocker in
+two cases reported by Thibierge, the oral mucous membrane was also
+stained. Carrington and Crocker both record cases of permanent
+pigmentation following exposure to great cold. Gautier is accredited
+with recording in 1890 the case of a boy of six in whom pigmented
+patches from sepia to almost black began to form at the age of two, and
+were distributed all over the body. Precocious maturity of the genital
+organs preceded and accompanied the pigmentation, but the hair was illy
+developed.
+
+Chloasma uterinum presents some interesting anomalies. Swayne records a
+singular variety in a woman in whom, during the last three months of
+three successive pregnancies, the face, arms, hands, and legs were
+spotted like a leopard, and remained so until after her confinement.
+Crocker speaks of a lady of thirty whose skin during each pregnancy
+became at first bronze, as if it had been exposed to a tropical sun,
+and then in spots almost black. Kaposi knew a woman with a pigmented
+mole two inches square on the side of the neck, which became quite
+black at each pregnancy, and which was the first recognizable sign of
+her condition. It is quite possible that the black disease of the Garo
+Hills in Assam is due to extreme and acute development of a pernicious
+form of malaria. In chronic malaria the skin may be yellowish, from a
+chestnut-brown to a black color, after long exposure to the influence
+of the fever. Various fungi, such as tinea versicolor and the Mexican
+"Caraati," may produce discoloration on the skin.
+
+Acanthosis Nigricans may be defined as a general pigmentation with
+papillary mole-like growths. In the "International Atlas of Rare Skin
+Diseases" there are two cases pictured, one by Politzer in a woman of
+sixty-two, and the other by Janovsky in a man of forty-two. The regions
+affected were mostly of a dirty-brown color, but in patches of a
+bluish-gray. The disease began suddenly in the woman, but gradually in
+the man. Crocker has reported a case somewhat similar to these two,
+under the head of general bronzing without constitutional symptoms, in
+a Swedish sailor of twenty-two, with rapid onset of pigmentation.
+
+Xeroderma pigmentosum, first described by Kaposi in 1870, is a very
+rare disease, but owing to its striking peculiarities is easily
+recognized. Crocker saw the first three cases in England, and describes
+one as a type. The patient was a girl of twelve, whose general health
+and nutrition were good. The disease began when she was between twelve
+and eighteen months old, without any premonitory symptom. The disease
+occupied the parts habitually uncovered in childhood. The whole of
+these areas was more or less densely speckled with pigmented,
+freckle-like spots, varying in tint from a light, raw umber to a deep
+sepia, and in size from a pin's head to a bean, and of a roundish and
+irregular shape.  Interspersed among the pigment-spots, but not so
+numerous, were white atrophic spots, which in some parts coalesced,
+forming white, shining, cicatrix-like areas. The skin upon this was
+finely wrinkled, and either smooth or shiny, or covered with thin,
+white scales. On these white areas bright red spots were conspicuous,
+due to telangiectasis, and there were also some stellate vascular spots
+and strife interspersed among the pigment. Small warts were seen
+springing up from some of the pigment spots. These warts ulcerated and
+gave rise to numerous superficial ulcerations, covered with yellow
+crusts, irregularly scattered over the face, mostly on the right side.
+The pus coming from these ulcers was apparently innocuous. The patient
+complained neither of itching nor of pain. Archambault has collected 60
+cases, and gives a good resume to date. Amiscis reports two cases of
+brothers, in one of whom the disease began at eight months, and in the
+other at a year, and concludes that it is not a lesion due to external
+stimuli or known parasitic elements, but must be regarded as a
+specific, congenital dystrophy of the skin, of unknown pathogenesis.
+However, observations have shown that it may occur at forty-three years
+(Riehl), and sixty-four years (Kaposi). Crocker believes that the
+disease is an atrophic degeneration of the skin, dependent on a primary
+neurosis, to which there is a congenital predisposition.
+
+Nigrities is a name given by the older writers to certain black
+blotches occurring on the skin of a white person--in other words, it is
+a synonym of melasma. According to Rayer it is not uncommon to see the
+scrotum and the skin of the penis of adults almost black, so as to form
+a marked contrast with the pubes and the upper part of the thighs.
+Haller met with a woman in whom the skin of the pubic region was as
+black as that of a negress.  During nursing the nipples assume a deep
+black color which disappears after weaning. Le Cat speaks of a woman of
+thirty years, whose forehead assumed a dusky hue of the color of iron
+rust when she was pregnant about the seventh month. By degrees the
+whole face became black except the eyes and the edges of the lips,
+which retained their natural color. On some days this hue was deeper
+than on others; the woman being naturally of a very fair complexion had
+the appearance of an alabaster figure with a black marble head. Her
+hair, which was naturally exceedingly dark, appeared coarser and
+blacker. She did not suffer from headache, and her appetite was good.
+After becoming black, the face was very tender to the touch. The black
+color disappeared two days after her accouchement, and following a
+profuse perspiration by which the sheets were stained black. Her child
+was of a natural color. In the following pregnancy, and even in the
+third, the same phenomenon reappeared in the course of the seventh
+month; in the eighth month it disappeared, but in the ninth month this
+woman became the subject of convulsions, of which she had one each day.
+The existence of accidental nigrities rests on well-established facts
+which are distinctly different from the pigmentation of purpura,
+icterus, or that produced by metallic salts. Chomel quotes the case of
+a very apathic old soldier, whose skin, without any appreciable cause,
+became as brown as that of a negro in some parts, and a yellowish-brown
+in others. Rustin has published the case of a woman of seventy who
+became as black as a negress in a single night. Goodwin relates the
+case of an old maiden lady whose complexion up to the age of twenty-one
+was of ordinary whiteness, but then became as black as that of an
+African. Wells and Rayer have also published accounts of cases of
+accidental nigrities. One of the latter cases was a sailor of
+sixty-three who suffered from general nigrities, and the other was in a
+woman of thirty, appearing after weaning and amenorrhea.
+
+Mitchell Bruce has described an anomalous discoloration of the skin and
+mucous membranes resembling that produced by silver or cyanosis. The
+patient, a harness-maker of forty-seven, was affected generally over
+the body, but particularly in the face, hands, and feet. The
+conjunctival, nasal, and aural mucosa were all involved. The skin felt
+warm, and pressure did not influence the discoloration. The pains
+complained of were of an intermittent, burning, shooting character,
+chiefly in the epigastric and left lumbar regions. The general health
+was good, and motion and sensation were normal. Nothing abnormal was
+discovered in connection with the abdominal and thoracic examinations.
+The pains and discoloration had commenced two years before his
+admission, since which time the skin had been deepening in tint. He
+remained under observation for three months without obvious change in
+his symptoms. There was nothing in the patient's occupation to account
+for the discoloration. A year and a half previously he had taken
+medicine for his pains, but its nature could not be discovered. He had
+had syphilis.
+
+Galtier mentions congenital and bronze spots of the skin. A man born in
+Switzerland the latter part of the last century, calling himself Joseph
+Galart, attracted the attention of the curious by exhibiting himself
+under the name of the "Living Angel." He presented the following
+appearance: The skin of the whole posterior part of the trunk, from the
+nape of the neck to the loins, was of a bronze color. This color
+extended over the shoulders and the sides of the neck, and this part
+was covered with hairs of great fineness and growing very thick; the
+skin of the rest of the body was of the usual whiteness. Those parts
+were the darkest which were the most covered with hair; on the back
+there was a space of an inch in diameter, which had preserved its
+whiteness, and where the hairs were fewer in number, darker at their
+bases, and surrounded by a very small black circle; the hair was
+thinner at the sides of the neck; there were a great many individual
+hairs surrounded by circles of coloring matter; but there were also
+many which presented nothing of this colored areola. In some places the
+general dark color of the skin blended with the areola surrounding the
+roots of the hair, so that one uniform black surface resulted. In many
+places the dark color changed into black. The irides were brown. The
+man was of very unstable character, extremely undecided in all his
+undertakings, and had a lively but silly expression of countenance. A
+distinct smell, as of mice, with a mixture of a garlicky odor, was
+emitted from those parts where the excessive secretion of the coloring
+matter took place. In those places the heat was also greater than
+natural. Rayer recites the case of a young man whom he saw, whose
+eyelids and adjacent parts of the cheeks were of a bluish tint, similar
+to that which is produced on the skin by the explosion of gunpowder.
+
+Billard has published an extraordinary case of blue discoloration of
+the skin in a young laundress of sixteen. Her neck, face, and upper
+part of the chest showed a beautiful blue tint, principally spreading
+over the forehead, the alae, and the mouth. When these parts were
+rubbed with a white towel the blue parts of the skin were detached on
+the towel, coloring it, and leaving the skin white. The girl's lips
+were red, the pulse was regular and natural, and her strength and
+appetite like that of a person in health. The only morbid symptom was a
+dry cough, but without mucous rattle or any deficiency of the sound of
+the chest or alteration of the natural beat of the heart. The catamenia
+had never failed. She had been engaged as a laundress for the past two
+years. From the time she began this occupation she perceived a blueness
+around her eyes, which disappeared however on going into the air. The
+phenomenon reappeared more particularly when irons were heated by a
+bright charcoal fire, or when she worked in a hot and confined place.
+The blueness spread, and her breast and abdomen became shaded with an
+azure blue, which appeared deeper or paler as the circulation was
+accelerated or retarded.  When the patient's face should have blushed,
+the face became blue instead of red. The changes exhibited were like
+the sudden transition of shades presented by the chameleon. The
+posterior part of the trunk, the axillae, the sclerotic coats of the
+eyes, the nails, and the skin of the head remained in their natural
+state and preserved their natural color. The linen of the patient was
+stained blue. Chemical analysis seemed to throw no light on this case,
+and the patient improved on alkaline treatment. She vomited blood,
+which contained sufficient of the blue matter to stain the sides of the
+vessel. She also stated that in hemorrhage from the nose she had seen
+blue drops among the drops of blood.  One cannot but suspect indigo as
+a factor in the causation of this anomalous coloration.
+
+Artificial discolorations of the skin are generally produced by
+tattooing, by silver nitrate, mercury, bismuth, or some other metallic
+salt.
+
+Melasma has been designated as an accidental and temporary blackish
+discoloration of the skin. There are several varieties: that called
+Addison's disease, that due to uterine disease, etc.  In this affection
+the skin assumes a dark and even black hue.
+
+Leukoderma is a pathologic process, the result of which is a deficiency
+in the normal pigmentation of the skin, and possibly its appendages.
+Its synonyms are leukopathia, vitiligo, achroma, leukasmus, and
+chloasma album. In India the disease is called sufaid-korh, meaning
+white leprosy. It has numerous colloquial appellations, such as chumba
+or phoolyree (Hindoo), buras (Urdu), cabbore (Singalese), kuttam
+(Taneil), dhabul (Bengal). It differs from albinism in being an
+acquired deficiency of pigment, not universal and not affecting the
+eye. Albinism is congenital, and the hair and eyes are affected as well
+as the skin.
+
+The disease is of universal distribution, but is naturally more
+noticeable in the dark-skinned races. It is much more common in this
+country among the negroes than is generally supposed.
+
+The "leopard-boy of Africa," so extensively advertised by dime museums
+over the country, was a well-defined case of leukoderma in a young
+mulatto, a fitting parallel for the case of ichthyosis styled the
+"alligator-boy."
+
+Figure 293 represents a family of three children, all the subjects of
+leukoderma. Leukoderma is more common among females.  It is rarely seen
+in children, being particularly a disease of middle age. Bissell
+reports a case in an Indian ninety years of age, subsequent to an
+attack of rheumatism thirty years previous.  It is of varying duration,
+nearly every case giving a different length of time. It may be
+associated with most any disease, and is directly attributable to none.
+In a number of cases collected rheumatism has been a marked feature. It
+has been noticed following typhoid fever and pregnancy.
+
+In white persons there are spots or blotches of pale, lustreless
+appearance either irregular or symmetric, scattered over the body. In
+the negro and other dark-skinned races a mottled appearance is seen. If
+the process goes to completion, the whole surface changes to white. The
+hair, though rarely affected, may present a mottled appearance. There
+seems to be no constitutional disturbances, no radical change in the
+skin, no pain--in fact, no disturbance worthy of note. The eye is not
+affected; but in a negro the sclerotic generally appears muddy.
+
+It appears first in small spots, either on the lips, nose, eyelids,
+soles, palms, or forehead, and increases peripherally--the several
+spots fusing together. The skin is peculiarly thin and easily
+irritated. Exposure to the sun readily blisters it, and after the
+slightest abrasion it bleeds freely.  Several cases have been reported
+in which the specific gravity of the urine was extremely high, due to
+an excess of urea. Wood calls attention to the wave-like course of
+leukoderma, receding on one side, increasing on the other. The fading
+is gradual, and the margins may be abrupt or diffuse. The mucous
+membranes are rosy. The functions of the swell-glands are unimpaired.
+
+The theory of the absence of pigment causing a loss of the olfactory
+sense, spoken of by Wallace, is not borne out by several observations
+of Wood and others. Wilson says: "Leukasma is a neurosis, the result of
+weakened innervation of the skin, the cause being commonly referable to
+the organs of assimilation or reproduction." It is not a dermatitis, as
+a dermatitis usually causes deposition of pigment. The rays of the sun
+bronze the skin; mustard, cantharides, and many like irritants cause a
+dermatitis, which is accompanied by a deposition of pigment.
+Leukoderma is as common in housemaids as in field-laborers, and is in
+no way attributable to exposure of sun or wind. True leukodermic
+patches show no vascular changes, no infiltration, but a partial
+obliteration of the rete mucosum. It has been ascribed to syphilis; but
+syphilitic leukoderma is generally the result of cicatrices following
+syphilitic ulceration.
+
+Many observers have noticed that negroes become several degrees lighter
+after syphilization; but no definite relation between syphilis and
+leukoderma has yet been demonstrated in this race.  Postmortem
+examinations of leukodermic persons show no change in the suprarenal
+capsule, a supposed organ of pigmentation.
+
+Climate has no influence. It is seen in the Indians of the Isthmus of
+Darien, the Hottentots, and the Icelanders. Why the cells of the rete
+mucosum should have the function in some races of manufacturing or
+attracting pigment in excess of those of other races, is in itself a
+mystery. By his experiments on the pigment-cells of a frog Lister has
+established the relation existing between these elements and
+innervation, which formerly had been supposititious.
+
+Doubtless a solution of the central control of pigmentation would
+confirm the best theory of the cause of leukoderma--i.e., faulty
+innervation of the skin. At present, whether the fault is in the cell
+proper, the conducting media, or the central center, we are unable to
+say. It is certainly not due to any vascular disturbances, as the skin
+shows no vascular changes.
+
+White spots on the nails are quite common, especially on young people.
+The mechanic cause is the presence of air between the lamellae of the
+affected parts, but their origin is unknown.  According to Crocker in
+some cases they can be shown to be a part of trophic changes.
+Bielschowsky records the case of a man with peripheral neuritis, in
+whom white spots appeared at the lower part of the finger-nails, grew
+rapidly, and in three weeks coalesced into a band across each nail a
+millimeter wide. The toes were not affected. Shoemaker mentions a
+patient who suffered from relapsing fever and bore an additional band
+for each relapse. Crocker quotes a case reported by Morison of
+Baltimore, in which transverse bars of white, alternating with the
+normal color, appeared without ascertainable cause on the finger-nails
+of a young lady and remained unchanged.
+
+Giovannini describes a case of canities unguium in a patient of
+twenty-nine, following an attack of typhoid fever. On examining the
+hands of this patient the nails showed in their entire extent a white,
+opaque, almost ivory color. An abnormal quantity of air found in the
+interior of the nails explains in this particular case their impaired
+appearance. It is certain that the nails, in order to have admitted
+such a large quantity of air into their interior must have altered in
+their intimate structure; and Giovannini suggests that they were
+subject to an abnormal process of keratinization. Unna describes a
+similar case, which, however, he calls leukonychia.
+
+Plica polonica, or, as it was known in Cracow--weicselzopf, is a
+disease peculiar to Poland, or to those of Polish antecedents,
+characterized by the agglutination, tangling, and anomalous development
+of the hair, or by an alteration of the nails, which become spongy and
+blackish. In older days the disease was well known and occupied a
+prominent place in books on skin-diseases.  Hercules de Saxonia and
+Thomas Minadous, in 1610, speak of plica as a disease already long
+known. The greater number of writers fix the date of its appearance in
+Poland at about the year 1285, under the reign of Lezekle-Noir.
+Lafontaine stated that in the provinces of Cracow and Sandomir plica
+formerly attacked the peasantry, beggars, and Jews in the proportion of
+1 1/2 in 20; and the nobility and burghers in the proportion of two in
+30 or 40. In Warsaw and surrounding districts the disease attacked the
+first classes in the proportion of one to ten, and in the second
+classes one to 30. In Lithuania the same proportions were observed as
+in Warsaw; but the disease has gradually grown rarer and rarer to the
+present day, although occasional cases are seen even in the United
+States.
+
+Plica has always been more frequent on the banks of the Vistula and
+Borysthenes, in damp and marshy situations, than in other parts of
+Poland. The custom formerly prevailing in Poland of shaving the heads
+of children, neglect of cleanliness, the heat of the head-dress, and
+the exposure of the skin to cold seem to favor the production of this
+disease.
+
+Plica began after an attack of acute fever, with pains like those of
+acute rheumatism in the head and extremities, and possibly vertigo,
+tinnitus aurium, ophthalmia, or coryza. Sometimes a kind of redness was
+observed on the thighs, and there was an alteration of the nails, which
+became black and rough, and again, there was clammy sweat. When the
+scalp was affected the head was sore to the touch and excessively
+itchy. A clammy and agglutinating sweat then occurred over the cranium,
+the hair became unctuous, stuck together, and appeared distended with
+an adhesive matter of reddish-brown color, believed by many observers
+to be sanguineous. The hair was so acutely sensitive that the slightest
+touch occasioned severe pain at the roots. A viscid matter of a very
+offensive smell, like that of spoiled vinegar, or according to Rayer
+like that of mice or garlic, exuded from the whole surface of each
+affected hair. This matter glued the hairs together, at first from
+their exit at the skin, and then along the entire length; it appeared
+to be secreted from the whole surface of the scalp and afterward dried
+into an incrustation. If there was no exudation the disease was called
+plica sicca. The hair was matted and stuck together in a variety of
+ways, so as to resemble ropes (plica multiformis). Sometimes these
+masses united together and formed one single thick club like the tail
+of a horse (plica caudiformis). Again, and particularly in females, the
+hair would become matted and glued together into one uniform intricate
+mass of various magnitudes.  The hair of the whole body was likely to
+be attacked with this disease. Kalschmidt of Jena possessed the pubes
+of a woman dead of plica, the hair of which was of such length that it
+must have easily gone around the body. There was formerly a
+superstition that it was dangerous to cut the hair until the discharge
+diminished. Lafontaine, Schlegel, and Hartman all assure us that the
+section of the affected masses before this time has been known to be
+followed by amaurosis, convulsions, apoplexy, epilepsy, and even death.
+Alarmed or taught by such occurrences, the common people often went
+about all their lives with the plica gradually dropping off. Formerly
+there was much theorizing and discussion regarding the etiology and
+pathology of plica, but since this mysterious affection has been proved
+to be nothing more than the product of neglect, and the matting due to
+the inflammatory exudation, excited by innumerable pediculi,
+agglutinating the hair together, the term is now scarcely mentioned in
+dermatologic works. Crocker speaks of a rare form which he entitles
+neuropathic plica, and cites two cases, one reported by Le Page whose
+specimen is in the Royal College of Surgeons Museum; and the other was
+in a Hindoo described by Pestonji. Both occurred in young women, and in
+both it came on after washing the hair in warm water, one in a few
+minutes, and the other in a few hours. The hair was drawn up into a
+hard tangled lump, impossible to unravel, limited to the right side in
+Le Page's patient, who had very long hair, and in Pestonji's case to
+the back of the head, where on each side was an elongated mass, very
+hard and firm, like a rope and about the size of the fist. There was no
+reason to believe that it was ascribable to imposture; the Hindoo woman
+cut the lumps off herself and threw them away. Le Page found the most
+contracted hairs flattened.  Stellwagon reports a case of plica in a
+woman. It occupied a dollar-sized area above the nape of the neck, and
+in twelve years reached the length of 12 feet. There was no history of
+its manner of onset.
+
+Tinea nodosa is a name given by Morris and Cheadle to a case of nodular
+growth on the beard and whiskers of a young man. In a case noticed by
+Crocker this disease affected the left side of the mustache of a
+medical man, who complained that the hair, if twisted up, stuck
+together. When disintegrated the secretion in this case seemed to be
+composed of fungous spores. Epithelium fragments, probably portions of
+the internal root-sheath, sometimes adhere to the shaft of the hair as
+it grows up, and look like concretions. Crocker states that he is
+informed by White of Boston that this disease is common in America in
+association with alopecia furfuracea, and is erroneously thought to be
+the cause of the loss of hair, hence the popular name, "hair-eaters."
+
+Thomson describes a case of mycosis fungoides in a young girl of the
+age of fourteen, whom he saw in Brussels toward the end of October,
+1893. She was the third of a family of 13 children of whom only five
+survived. Of the children born subsequently to the patient, the first
+were either premature or died a few days after their births. The
+seventh was under treatment for interstitial keratitis and tuberculous
+ulceration of the lips and throat. The disease in the patient made its
+appearance about seven months previously, as a small raised spot in the
+middle of the back just above the buttocks. Many of the patches
+coalesced. At the time of report the lumbar region was the seat of the
+disease, the affection here presenting a most peculiar appearance,
+looking as if an enormous butterfly had alighted on the patient's back,
+with its dark blue wings covered with silvery scales, widely expanded.
+The patient was not anemic and appeared to be in the best of health.
+None of the glands were affected. According to Thomson there is little
+doubt that this disease is caused by non-pyogenic bacteria gaining
+access to the sweat-glands. The irritation produced by their presence
+gives rise to proliferation of the connective-tissue corpuscles.
+
+Jamieson reports a case of mycosis in a native of Aberdeenshire aged
+thirty-eight. There was no history of any previous illness.  The
+disease began three years previous to his application for treatment, as
+a red, itching, small spot on the cheek. Two years later lumps
+presented themselves, at first upon his shoulders.  The first thing to
+strike an observer was the offensive odor about the patient. In the
+hospital wards it made all the occupants sick. The various stages of
+the disease were marked upon the different parts of the body. On the
+chest and abdomen it resembled an eczema, on the shoulders there were
+brown, pinkish-red areas. On the scalp the hair was scanty, the
+eye-brows denuded, and the eyelashes absent. The forehead was leonine
+in aspect. From between the various nodosities a continual discharge
+exuded, the nodosities being markedly irregular over the limbs. The
+backs of the hands, the dorsums of the feet, the wrists and ankles, had
+closely approximating growths upon them, while under the thick
+epidermis of the palms of the hands were blisters. Itching was intense.
+The patient became emaciated and died thirteen days after his admission
+into the hospital. A histologic examination showed the sarcomatous
+nature of the various growths. The disease differed from
+"button-scurvy." Mycosis fungoides approximates, clinically and
+histologically, granulomata and sarcomata.
+
+Morris described an interesting case of universal dermatitis, probably
+a rare variety of mycosis fungoides. The patient had for many years a
+disease which had first appeared on the arms and legs, and which was
+usually regarded by the physicians who saw the case as eczema. At times
+the disease would entirely disappear, but it relapsed, especially
+during visits to India. At the time the patient came under the care of
+Morris, his general health seemed unaffected. The skin of the whole
+body, except the face, the scalp, and the front of the chest, was of a
+mahogany color. The skin of the lips was so thickened that it could not
+be pinched into folds, and was of a mottled appearance, due to
+hemorrhagic spots. All over the thickened and reddened surface were
+scattered crops of vesicles and boils. The nails were deformed, and the
+toes beyond the nails were tense with a serous accumulation. The glands
+in the right axilla and the groin were much enlarged. The hair on the
+pubes had disappeared. The abdomen was in a condition similar to that
+upon the limbs, but less in degree. The front of the chest below the
+nipples was covered with dark papules the size of a pin's head. The
+back, the buttocks, the face, and the scalp presented similar lesions.
+The most striking lesions were three ulcers--one on the back of the
+right hand, one on the right temple, and the other on the left cheek.
+The largest was the size of a florin, and had elevated borders,
+somewhat infiltrated; they were covered with a brown, dry scab.  The
+patient suffered from itching at night so that he could not sleep. He
+was kept under observation, and in spite of treatment the malady
+advanced in a periodic manner, each exacerbation being preceded by a
+feeling of tension in the parts, after which a crop of vesicles would
+appear. Sometimes, especially on the feet, bullae formed. The patient
+finally left the hospital and died of an intercurrent attack of
+pneumonia. A microscopic examination revealed a condition which might
+be found with a number of the chronic affections of the skin, but, in
+addition, there were certain cell-inclusions which were thought to
+represent psorosperms. Morris thought this case corresponded more to
+mycosis fungoides than any other malady.
+
+
+
+CHAPTER XVII.
+
+ANOMALOUS NERVOUS AND MENTAL DISEASES.
+
+Epilepsy has been professionally recognized as a distinct type of
+disease since the time of Hippocrates, but in earlier times, and
+popularly throughout later times, it was illy defined. The knowledge of
+the clinical symptoms has become definite only since the era of
+cerebral local anatomy and localization. Examination of the older
+records of epilepsy shows curious forms recorded.  The Ephemerides
+speaks of epilepsy manifested only on the birthday. Testa mentions
+epilepsy recurring at the festival of St. John, and Bartholinus reports
+a case in which the convulsions corresponded with the moon's phases.
+Paullini describes epilepsy which occurred during the blowing of wind
+from the south, and also speaks of epilepsy during the paroxysms of
+which the individual barked. Fabricius and the Ephemerides record
+dancing epilepsy. Bartholinus and Hagendorn mention cases during which
+various splendors appeared before the eyes during the paroxysm.  Godart
+Portius, and Salmuth speak of visions occurring before and after
+epileptic paroxysms. The Ephemerides contains records of epilepsy in
+which blindness preceded the paroxysm, in which there was singing
+during it, and a case in which the paroxysm was attended with
+singultus. Various older writers mention cases of epilepsy in which
+curious spots appeared on the face; and the kinds of aura mentioned are
+too numerous to transcribe.
+
+Baly mentions a case of epilepsy occasioned by irritation in the socket
+of a tooth. Webber reports a case of epilepsy due to phimosis and to
+irritation from a tooth. Beardsley speaks of an attempt at
+strangulation that produced epilepsy. Brown-Sequard records an instance
+produced by injury to the sciatic nerve.  Doyle gives an account of the
+production of epilepsy from protracted bathing in a pond. Duncan cites
+an instance of epilepsy connected with vesical calculus that was cured
+by lithotomy. Museroft mentions an analogous case. Greenhow speaks of
+epilepsy arising from an injury to the thumb. Garmannus, early in the
+eighteenth century, describes epilepsy arising from fright and terror.
+Bristowe in 1880, and Farre speak of similar instances. In Farre's case
+the disease was temporarily cured by an attack of acute rheumatism.
+Thorington of Philadelphia has seen a paroxysm of epilepsy induced by
+the instillation of atropia in the eye of a child nearly cured of the
+malady. It was supposed that the child was terrified on awakening and
+finding its vision suddenly diminished, and that the convulsions were
+directly due to the emotional disturbance. Orwin describes epilepsy
+from prolonged lactation, and instances of ovarian and uterine epilepsy
+are quite common.
+
+There is a peculiar case of running epilepsy recorded. The patient was
+a workman who would be suddenly seized with a paroxysm, and
+unconsciously run some distance at full speed. On one occasion he ran
+from Peterborough to Whittlesey, where he was stopped and brought back.
+Once he ran into a pit containing six feet of water, from which he was
+rescued. Yeo says that sexual intercourse occasionally induces
+epilepsy, and relates a case in which a severe epileptic fit terminated
+fatally three days after the seizure, which occurred on the nuptial
+night.
+
+Drake reports the case of a man who was wounded in the War of 1812,
+near Baltimore, the ball passing along the left ear and temple so close
+as to graze the skin. Eighteen years after the accident he suffered
+with pain in the left ear and temple, accompanied by epileptic fits and
+partial amnesia, together with an entire loss of power of remembering
+proper names and applying them to the objects to which they belonged.
+He would, for instance, invariably write Kentucky for Louisville.
+Beirne records the case of a dangerous lunatic, an epileptic, who was
+attacked by a fellow-inmate and sustained an extensive fracture of the
+right parietal bone, with great hemorrhage, followed by coma. Strange
+to say, after the accident he recovered his intellect, and was cured of
+his epileptic attacks, but for six years he was a paralytic from the
+hips down.
+
+The Dancing Mania.--Chorea has appeared in various epidemic forms under
+the names of St. Vitus's dance, St. Guy's dance, St.  Anthony's dance,
+choromania, tanzplage, orchestromania, dance of St. Modesti or St.
+John, the dancing mania, etc.; although these various functional
+phenomena of the nervous system have been called chorea, they bear very
+little resemblance to what, at the present day, is called by this name.
+The epidemic form appeared about 1374, although Hecker claims that, at
+that time, it was no new thing. Assemblages of men and women were seen
+at Aix-la-Chapelle who, impelled by a common delusion, would form
+circles, hand in hand, and dance in wild delirium until they fell to
+the ground exhausted, somewhat after the manner of the Ghost-Dance or
+Messiah-Dance of our North American Indians. In their Bacchantic leaps
+they were apparently haunted by visions and hallucinations, the fancy
+conjuring up spirits whose names they shrieked out. Some of them
+afterward stated that they appeared to be immersed in a stream of blood
+which obliged them to leap so high. Others saw the heavens open and
+disclose the Saviour enthroned with the Virgin Mary. The participants
+seemed to suffer greatly from tympanites which was generally relieved
+by compression or thumping on the abdomen. A few months after this
+dancing malady had made its appearance at Aix-la-Chapelle it broke out
+at Cologne, and about the same time at Metz, the streets of which were
+said to have been filled with 1100 dancers.  This rich city became the
+scene of the most ruinous disorder.  Peasants left their plows,
+mechanics their shops, servants their masters, children their homes;
+and beggars and idle vagabonds, who understood how to imitate the
+convulsions, roved from place to place, inducing all sorts of crime and
+vice among the afflicted. Strasburg was visited by the dancing plague
+in 1418, and it was here that the plague assumed the name of St.
+Vitus's dance. St. Vitus was a Sicilian youth who, just at the time he
+was about to undergo martyrdom by order of Diocletian, in the year 303,
+is said to have prayed to God that He might protect all those who would
+solemnize the day of his commemoration and fast upon its eve. The
+people were taught that a voice from heaven was then heard saying,
+"Vitus, thy prayer is accepted."
+
+Paracelsus called this malady (Chorus sancti viti) the lascivious
+dance, and says that persons stricken with it were helpless until
+relieved by either recovery or death. The malady spread rapidly through
+France and Holland, and before the close of the century was introduced
+into England. In his "Anatomy of Melancholy" Burton refers to it, and
+speaks of the idiosyncrasies of the individuals afflicted. It is said
+they could not abide one in red clothes, and that they loved music
+above all things, and also that the magistrates in Germany hired
+musicians to give them music, and provided them with sturdy companions
+to dance with.  Their endurance was marvelous. Plater speaks of a woman
+in Basle whom he saw, that danced for a month. In Strasburg many of
+them ate nothing for days and nights until their mania subsided.
+Paracelsus, in the beginning of the sixteenth century, was the first to
+make a study of this disease. He outlined the severest treatment for
+it, and boasted that he cured many of the victims.  Hecker conjectures
+that probably the wild revels of St. John's day, 1374, gave rise to
+this mental plague, which thenceforth visited so many thousands with
+incurable aberrations of mind and disgusting distortions of the body.
+Almost simultaneous with the dance of "St. With," there appeared in
+Italy and Arabia a mania very similar in character which was called
+"tarantism," which was supposed to originate in the bite of the
+tarantula. The only effective remedy was music in some form. In the
+Tigre country, Abyssinia, this disease appeared under the name of
+"Tigretier." The disease, fortunately, rapidly declined, and very
+little of it seems to have been known in the sixteenth century, but in
+the early part of the eighteenth century a peculiar sect called the
+"Convulsionnaires" arose in France; and throughout England among the
+Methodist sect, insane convulsions of this nature were witnessed; and
+even to the present day in some of the primitive religious meetings of
+our people, something not unlike this mania of the Middle Ages is
+perpetuated.
+
+Paracelsus divided the sufferers of St. Vitus's dance into three
+classes .--
+
+(1) Those in which the affliction arose from imagination (chorea
+imaginativa).
+
+(2) Those which had their origin in sexual desires depending on the
+will.
+
+(3) Those arising from corporeal causes (chorea naturalis). This last
+case, according to a strange notion of his own he explained by
+maintaining that in certain vessels which are susceptible of an
+internal pruriency, and thence produced laughter, the blood is set into
+commotion in consequence of an alteration in the vital spirits, whereby
+are occasioned involuntary fits of intoxicating joy, and a propensity
+to dance. The great physician Sydenham gave the first accurate
+description of what is to-day called chorea, and hence the disease has
+been named "Sydenham's chorea." So true to life was his portrayal of
+the disease that it has never been surpassed by modern observers.
+
+The disease variously named palmus, the jumpers, the twitchers, lata,
+miryachit, or, as it is sometimes called, the emeryaki of Siberia, and
+the tic-convulsif of La Tourette, has been very well described by Gray
+who says that the French authors had their attention directed to the
+subject by the descriptions of two American authors--those of Beard
+upon "The Jumpers of Maine," published in 1880, and that of Hammond
+upon "Miryachit," a similar disease of the far Orient. Beard found that
+the jumpers of Maine did unhesitatingly whatever they were told to do.
+Thus, one who was sitting in a chair was told to throw a knife that he
+had in his hand, and he obeyed so quickly that the weapon stuck in a
+house opposite; at the same time he repeated the command given him,
+with a cry of alarm not unlike that of hysteria or epilepsy. When he
+was suddenly clapped upon the shoulder he threw away his pipe, which he
+had been filling with tobacco. The first parts of Virgil's aeneid and
+Homer's Iliad were recited to one of these illiterate jumpers, and he
+repeated the words as they came to him in a sharp voice, at the same
+time jumping or throwing whatever he had in his hand, or raising his
+shoulder, or making some other violent motion. It is related by
+O'Brien, an Irishman serving on an English naval vessel, that an
+elderly and respectable Malay woman, with whom he was conversing in an
+entirely unsuspecting manner, suddenly began to undress herself, and
+showed a most ominous and determined intention of stripping herself
+completely, and all because a by-standing friend had suddenly taken off
+his coat; at the same time she manifested the most violent anger at
+what she deemed this outrage to her sex, calling the astonished friend
+an abandoned hog, and begging O'Brien to kill him. O'Brien,
+furthermore, tells of a cook who was carrying his child in his arms
+over the bridge of a river, while at the same time a sailor carried a
+log of wood in like manner; the sailor threw his log of wood on an
+awning, amusing himself by causing it to roll over the cloth, and
+finally letting it fall to the bridge; the cook repeated every motion
+with his little boy, and killed him on the spot. This miryachit was
+observed in Malaysia, Bengal, among the Sikhs and the Nubians, and in
+Siberia, whilst Beard has observed it in Michigan as well as in Maine.
+Crichton speaks of a leaping ague in Angusshire, Scotland.
+
+Gray has seen only one case of acute palmus, and records it as follows:
+"It was in a boy of six, whose heredity, so far as I could ascertain
+from the statements of his mother, was not neurotic. He had had trouble
+some six months before coming to me.  He had been labeled with a number
+of interesting diagnoses, such as chorea, epilepsy, myotonia, hysteria,
+and neurasthenia. His palmodic movements were very curious. When
+standing near a table looking at something, the chin would suddenly
+come down with a thump that would leave a black-and-blue mark, or his
+head would be thrown violently to one side, perhaps coming in contact
+with some adjacent hard object with equal force, or, while standing
+quietly, his legs would give a sudden twitch, and he would be thrown
+violently to the ground, and this even happened several times when he
+was seated on the edge of a stool. The child was under my care for two
+weeks, and, probably because of an intercurrent attack of diarrhea,
+grew steadily worse during that time, in spite of the full doses of
+arsenic which were administered to him. He was literally covered with
+bruises from the sudden and violent contacts with articles of
+furniture, the floor, and the walls. At last, in despair at his
+condition, I ordered him to be undressed and put to bed, and steadily
+pushed the Fowler's solution of arsenic until he was taking ten drops
+three times a day, when, to my great surprise, he began to improve
+rapidly, and at the end of six weeks was perfectly well.  Keeping him
+under observation for two weeks longer I finally sent him to his home
+in the West, and am informed that he has since remained perfectly well.
+It has seemed to me that many of the cases recorded as paramyoclonus
+multiples have been really acute palmus."
+
+Gray mentions two cases of general palmus with pseudomelancholia, and
+describes them in the following words:--
+
+"The muscular movements are of the usual sudden, shock-like type, and
+of the same extent as in what I have ventured to call the general form.
+With them, however, there is associated a curious pseudomelancholia,
+consisting of certain fixed melancholy suspicious delusions, without,
+however, any of the suicidal tendencies and abnormal sensations up and
+down the back of the head, neck, or spine, or the sleeplessness, which
+are characteristic of most cases of true melancholia. In both of my
+cases the palmus had existed for a long period, the exact limits of
+which, however, I could not determine, because the patient scouted the
+idea that he had had any trouble of the kind, but which the testimony
+of friends and relatives seemed to vouch for.  They were both men, one
+thirty-six and one thirty-eight years of age. The pseudomelancholia,
+however, had only existed in one case for about a year, and in the
+other for six months. One case passed away from my observation, and I
+know nothing of its further course. The other case recovered in nine
+months' treatment, and during the three years that have since elapsed
+he has been an active business man, although I have not seen him myself
+during that period, as he took a great dislike to me because I was
+forced to take strong measures to keep him under treatment, so
+persistent were his suspicions."
+
+Athetosis was first described by Hammond in 1871, who gave it the name
+because it was mainly characterized by an inability to retain the
+fingers and toes in any position in which they might be planed, as well
+as by their continuous motion. According to Drewry "athetosis is a
+cerebral affection, presenting a combination of symptoms characterized
+chiefly by a more or less constant mobility of the extremities and an
+inability to retain them in any fixed position. These morbid,
+grotesque, involuntary movements are slow and wavy, somewhat regular
+and rigid, are not jerky, spasmodic, nor tremulous. The movements of
+the digits are quite different from those attending any other disease,
+impossible to imitate even by the most skilful malingerer, and, if once
+seen, are not likely to be forgotten. In an athetoid hand, says Starr,
+the interossei and lumbricales, which flex the metacarpo-phalangeal and
+extend the phalangeal joints, are affected; rarely are the long
+extensors and the long flexors affected. Therefore the hand is usually
+in the so-called interosseal position, with flexion of the proximal and
+extension of the middle and distal phalanges. The athetoid movements of
+the toes correspond to those of the fingers in point of action. In a
+great majority of cases the disease is confined to one side
+(hemiathetosis), and is a sequel of hemiplegia. The differential
+diagnosis of athetosis is generally easily made. The only nervous
+affections with which it could possibly be confounded are chorea and
+paralysis agitans. Attention to the twitching, spasmodic, fibrillary
+movements, having a quick beginning and a quick ending, which is
+characteristic in Sydenham's chorea, would at once exclude that
+disease. These jerky movements peculiar to St.  Vitus's dance may be
+easily detected in a few or many muscles, if moderate care and patience
+be exercised on the part of the examiner. This form of chorea is almost
+always a disease of childhood. So-called post-hemiplegic chorea is, in
+the opinion of both Hammond and Gray, simply athetosis. The silly,
+dancing, posturing, wiry movements, and the facial distortion observed
+in Huntington's chorea would hardly be mistaken by a careful observer
+for athetosis. The two diseases, however, are somewhat alike. Paralysis
+agitans (shaking palsy), with its coarse tremor, peculiar facies,
+immobility, shuffling gait, the 'bread-crumbling' attitude of the
+fingers, and deliberate speech, would be readily eliminated even by a
+novice. It is, too, a disease of advanced life, usually. Charcot, Gray,
+Ringer, Bernhardt, Shaw, Eulenberg, Grassel; Kinnicutt, Sinkler, and
+others have written on this affection."
+
+The following is the report of a case by Drewry, of double (or, more
+strictly speaking, quadruple) athetosis, associated with epilepsy and
+insanity: "The patient was a negro woman, twenty-six years old when she
+was admitted into this, the Central State (Va.) Hospital, in April,
+1886. She had had epilepsy of the grand mal type for a number of years,
+was the mother of one child, and earned her living as a domestic. A
+careful physical examination revealed nothing of importance as an
+etiologic factor. Following in the footsteps of many of those
+unfortunates afflicted with epilepsy, she degenerated into a state of
+almost absolute imbecility.
+
+"Some degree of mental deficiency seems usually to accompany athetosis,
+even when uncomplicated by any other degenerating neurosis. Athetoid
+symptoms of an aggravated character, involving both upper and both
+lower extremities, had developed previous to her admission into this
+hospital, but it was impossible to find out when and how they began.
+She had never had, to the knowledge of her friends, an attack of
+'apoplexy,' nor of paralysis. The head was symmetric, and without scars
+thereon. The pedal extremities involuntarily assumed various distorted
+positions and were constantly in motion. The toes were usually in a
+state of tonic spasm,--contracted, and drawn downward or extended,
+pointing upward, and slightly separated. Irregular alternate extension
+and flexion of the toes were marked. The feet were moved upon the
+ankles in a stiff and awkward manner. During these 'complex involuntary
+movements,' the muscles of the calf became hard and rigid. The act of
+walking was accomplished with considerable difficulty, on account of
+contractures, and because the feet were not exactly under the control
+of the will. The unnatural movements of the hands corresponded to those
+of the lower extremities, though they were more constant and active.
+The fingers, including the thumbs, were usually widely separated and
+extended, though they were sometimes slightly flexed. The hands were
+continually in slow, methodic, quasi-rhythmic motion, never remaining
+long in the same attitude. In grasping an object the palm of the hand
+was used, it being difficult to approximate the digits. The
+wrist-joints were also implicated, there being alternate flexion and
+extension. In fact these odd contortions affected the entire limb from
+the shoulder to the digital extremities. When standing or walking the
+arms were held out horizontally, as if to maintain the equilibrium of
+the body. The patient's general physical health was fairly good. She
+frequently complained of headache, and when she was exceedingly
+irritable and violent all the athetoid movements would be intensified.
+Speech was jerky and disordered, which gave it a distinctive character.
+The special senses seemed to be unimpaired, and the pupils were normal,
+except when an epileptic attack came on.  Death occurred in January,
+1895, after an obstinate attack of status epilepticus." Paramyoclonus
+multiplex is a condition of chronic muscular spasm affecting the trunk,
+occasionally the muscles of the face, abdomen, or diaphragm. The
+muscles affected are usually in the trunk and in the limbs, and not in
+the toes and hand; occasionally the movements are tonic as well as
+clonic; the degree of spasm varies greatly, and according to Gray may
+sometimes be so violent as to throw the patient down or out of the
+chair.
+
+Saltatoric spasm is an extremely rare condition, first observed by
+Bamberger in 1859. The calf, hip, knee, and back-muscles are affected
+by clonic spasm, causing springing or jumping movements when the
+patient attempts to stand. The disease is transient, and there are no
+mental symptoms.
+
+Progressive muscular atrophy has been observed as far back as
+Hippocrates, but it is only in recent times that we have had any
+definite knowledge of the subject. It is divided into four types, the
+hand type (causing the griffin-or claw-hand, or the ape-hand); the
+juvenile type (generally in the muscles of the shoulder and arm); the
+facial type; and the peroneal type.  Generalized progressive atrophy
+leads to a condition that simulates the appearance of a "living
+skeleton."
+
+Facial hemiatrophy is an incurable disease, as yet of unknown
+pathology. It consists of wasting of the bones, subcutaneous tissues,
+and muscles of one-half of the face or head, the muscles suffering but
+slightly. The accompanying illustration shows a case in which there was
+osseous depression of the cranium and a localized alopecia. The disease
+is very rare, only about 100 cases having been reported. Of five cases
+seen by Dana, three were in females and two in males; in all the cases
+that could be found the origin was between the tenth and twentieth
+years. It is a chronic affection, usually beginning in early life,
+increasing slowly for years, and then becoming stationary. It is
+distinguished from one-sided muscular atrophy by the electric reaction,
+which is not lost in the facial muscles in facial hemiatrophy, and
+there is no atrophy of other muscles of the body.
+
+Burr contributes an exhaustive paper on hemiatrophy of the tongue with
+report of a case as follows: "L. B., female, mulatto, thirty-one years
+old, married, came to the Medico-Chirurgical Hospital, Philadelphia,
+September 23, 1895, complaining that her 'tongue was crooked.' Save
+that she had had syphilis, her personal history is negative. In
+February, 1895, she began to suffer from headache, usually behind the
+left ear, and often preventing sleep. At times there is quite severe
+vertigo. Several weeks after the onset, headache persisting, she awoke
+in the night and found the left side of the tongue swollen, black, and
+painless. For some hours she could neither speak nor chew, but
+breathing was not interfered with. After a few days all symptoms passed
+away except headache, and she thought no more of the matter until
+recently, as stated above, she noticed by accident that her tongue was
+deformed. She is a spare, poorly-fed, muddy-skinned mulatto girl. The
+left half of the tongue is only about one-half as large as the right.
+The upper surface is irregularly depressed and elevated. There are no
+scars. When protruded it turns sharply to the left. Fibrillary
+twitching is not present. The mucous membrane is normal. Common
+sensation and taste are preserved. The pharyngeal reflex is present.
+The palate moves well. There is no palsy or wasting of the face. The
+pupils are of normal size and react well to light and with
+accommodation. Station and gait are normal. There is no incoordination
+of movement in the arms or legs. The knee-jerks are much increased.
+There is an attempt at, but no true, clonus; that is, passive flexion
+of the foot causes two or three jerky movements. There is no glandular
+swelling or tumor about the jaw or in the neck. Touch and pain-sense
+are normal in the face and hands, but she complains of numbness in the
+hands as if she had on tight gloves. There is no trouble in speaking,
+chewing, or swallowing. There is no pain or rigidity in the neck
+muscles.  Examination of the pharynx reveals no disease of the bones.
+Under specific treatment the patient improved."
+
+Astasia-abasia was named by Blocq, who collected 11 cases.  According
+to Knapp, four cases have been reported in America. The disease
+consists in an inability to stand erect or walk normally, although
+there is no impairment of sensation, of muscular strength, or of the
+coordination of other muscles in walking than the lower extremities. In
+attempting to walk the legs become spasmodic; there are rapid flexions
+and extensions of the legs on the thighs, and of the thighs on the
+pelvis. The steps are short, and the feet drag; the body may make great
+oscillations if the patient stands, walks, or sits, and the head and
+arms make rhythmical movements; walking may become impossible, the
+patient appearing to leap up on one foot and then up on the other, the
+body and head oscillating as he advances; he may be able to walk
+cross-legged, or by raising the legs high; or to walk on his hands and
+feet; he may be able to walk at certain times and not at others; or to
+hop with both feet together; he may succeed with great strides and with
+the arms extended; or finally he may be able to use his legs perfectly
+if suspended (Gray). There are various types which have been called the
+paralytic, the choreic, and the saltatory. A tendency to go backward or
+retropulsion has been observed, according to Gray, as has also a
+tendency to go forward or propulsion. A curious phenomenon in this
+disease is that the patient can use the legs perfectly well lying in
+bed.  The prognosis seems to be favorable.
+
+Meniere's disease is a disease probably of the semicircular canals,
+characterized by nausea, vomiting, vertigo, deafness, tinnitus aurium,
+and various other phenomena. It is also called aural or auditory
+vertigo. The salient symptom is vertigo, and this varies somewhat in
+degree according to the portions of the ear affected. If the disease is
+in the labyrinth, the patient is supposed to stagger to one side, and
+the vertigo is paroxysmal, varying to such a degree as to cause simple
+reeling, or falling as if shot. Gray reports the history of a patient
+with this sensational record: He had been a peasant in Ireland, and one
+day crossing one of the wide moors in a dog-cart, he was suddenly, as
+he thought, struck a violent blow from behind, so that he believed that
+he lost consciousness for some time. At all events, when he was able to
+get up he found his horse and cart some distance off, and, of course,
+not a soul in sight. Under the belief that he had been struck by some
+enemy he went quietly home and said nothing about it. Some time
+afterward, however, in crossing another lonely place he had a similar
+experience, and as he came to the conclusion that nobody could have
+been near him, he made up his mind that it was some malevolent stroke
+of the devil and he consulted a priest who agreed with him in his
+belief, and gave him an amulet to wear. A series of similar attacks
+occurred and puzzled as to whether there was some diabolical agency at
+work, or whether he was the victim of some conspiracy, he emigrated to
+America; for several months he had no attacks. A new paroxysm occurring
+he consulted Gray, who found indubitable evidence of labyrinthine
+disease. The paroxysms of this disease are usually accompanied by
+nausea and vomiting, and on account of the paleness of the face, and
+the cold, clammy perspiration, attacks have frequently been mistaken
+for apoplexy.  In disease of the middle ear the attacks are continuous
+rather than paroxysmal. If the disease is in the middle or internal
+ears, loud noises are generally heard, but if the disease is in the
+external ear, the noises are generally absent, and the vertigo of less
+degree but continuous. The prognosis varies with the location of the
+disease, but is always serious.
+
+Human rumination has been known for many years. Bartholinus, Paullinus,
+Blanchard, Bonet, the Ephemerides, Fabricius Hildanus, Horstius,
+Morgagni, Peyer, Rhodius, Vogel, Salmuth, Percy, Laurent, and others
+describe it. Fabricius d'Aquapendente personally knew a victim of
+rumination, or, as it is generally called, merycism. The dissection by
+Bartholinus of a merycol showed nothing extraordinary in the cadaver.
+Winthier knew a Swede of thirty-five, in Germany, apparently healthy,
+but who was obliged when leaving the table to retire to some remote
+place where he might eject his food into his mouth again, saying that
+it gave him the sensation of sweetest honey. The patient related that
+from his infancy he had been the subject of acid eructations, and at
+the age of thirty he commenced rumination as a means of relief. To
+those who are interested in the older records of these cases Percy and
+Laurent offer the descriptions of a number of cases.
+
+In a recent discussion before the American Neurological Association
+Hammond defined merycism as the functions of remastication and
+rumination in the human subject. He referred to several cases, among
+them that of the distinguished physiologist, Brown-Sequard, who
+acquired the habit as a result of experiments performed upon himself.
+Hammond reported a case of a young man who was the subject of merycism,
+and whose mental condition was also impaired. No special treatment was
+undertaken, but the patient was trephined, with the purpose of
+improving his mental condition. There were no unusual features
+connected with the operation, but it was noticed that there were no
+ruminations with the meals he took until the fifth day, when a slight
+rumination occurred. Eight days later a similar button was removed from
+the corresponding side of the left skull, and from that time (about six
+months) to the time of report, there had been no regurgitation. Whether
+the cure of the merycism in this case was directly due to the
+operations on the cranium, or the result of the mental improvement, is
+a question for discussion. Hammond added that, when acquired, merycism
+was almost invariably the result of over-eating and loading the
+esophagus, or the result of fast eating.
+
+In remarks upon Hammond's paper Knapp said that two cases had come to
+his knowledge, both in physicians, but one of them he knew of only by
+hearsay. The other man, now over thirty, had regurgitated his food from
+early childhood, and he did not know that he had anything very unusual
+the matter with him until he began some investigations upon the
+functions and diseases of the stomach. This man was not nervous, and
+was certainly not an idiot. He had done active work as a physician, and
+called himself in perfect health. He was something of an epicure, and
+never suffered from indigestion. After a hearty meal the regurgitation
+was more marked. Food had been regurgitated, tasting as good as when
+first eaten, several hours after the eating. If he attempted to check
+the regurgitation he sometimes had a slight feeling of fulness in the
+stomach. Lloyd said that these cases were forms of neuroses, and were
+types of hysteric vomiting. There was no gustatory satisfaction
+connected with any form of hysteric vomiting that he had seen. In some
+of these cases of hysteric vomiting the food does not appear to enter
+the stomach, but is rejected by a sort of spasm of the esophagus. This
+has been called "esophagismus," and is apparently closely allied to
+this neurosis, which some have called "merycism." The President of the
+Association said that this would seem to be an affection common among
+physicians. A student friend of his who had been affected in this way,
+had written an elaborate monograph on the subject.  He was disgusted
+with the habit, and finally overcame it by the exercise of his
+will-power.
+
+Runge discusses three cases of hereditary rumination. These patients
+belonged to three generations in the male line. The author subjected
+the contents of the stomach of one patient to quite an extensive
+analysis, without finding any abnormality of secretion.
+
+Wakefulness.--Generally speaking, the length of time a person can go
+without sleep is the same as that during which he can survive without
+food. Persons, particularly those of an hysteric nature, are prone to
+make statements that they have not slept for many days, or that they
+never sleep at all, but a careful examination and watch during the
+night over these patients show that they have at least been in a
+drowsy, somnolent condition, which is in a measure physiologically
+equivalent to sleep. Accounts of long periods of wakefulness arise from
+time to time, but a careful examination would doubtless disprove them.
+As typical of these accounts, we quote one from Anderson, Indiana,
+December 11, 1895:--
+
+"David Jones of this city, who attracted the attention of the entire
+medical profession two years ago by a sleepless spell of ninety-three
+days, and last year by another spell which extended over one hundred
+and thirty-one days, is beginning on another which he fears will be
+more serious than the preceding ones. He was put on the circuit jury
+three weeks ago, and counting to-day has not slept for twenty days and
+nights. He eats and talks as well as usual, and is full of business and
+activity. He does not experience any bad effects whatever from the
+spell, nor did he during his one hundred and thirty-one days. During
+that spell he attended to all of his farm business. He says now that he
+feels as though he never will sleep again. He does not seem to bother
+himself about the prospects of a long and tedious wake. He cannot
+attribute it to any one thing, but thinks that it was probably
+superinduced by his use of tobacco while young."
+
+Somnambulism, or, as it has been called, noctambulation, is a curious
+phase of nocturnal cerebration analogous to the hypnotic state, or
+double consciousness occasionally observed in epileptics. Both
+Hippocrates and Aristotle discuss somnambulism, and it is said that the
+physician Galen was a victim of this habit. Horstius, ab Heers, and
+many others of the older writers recorded interesting examples of this
+phenomenon. Schenck remarks on the particular way in which
+somnambulists seem to escape injury. Haller, Hoffmann, Gassendi,
+Caelius Rhodiginus, Pinel, Hechler, Bohn, Richter,--in fact nearly all
+the ancient physiologists and anatomists have written on this subject.
+The marvelous manifestations of somnambulism are still among the more
+surprising phenomena with which science has to deal. That a person
+deeply immersed in thought should walk and talk while apparently
+unconscious, excites no surprise, but that anyone should when fast
+asleep perform a series of complicated actions which undoubtedly demand
+the assistance of the senses is marvelous indeed. Often he will rise in
+the night, walk from room to room, go out on porticoes, and in some
+cases on steep roofs, where he would not dare to venture while awake.
+Frequently he will wander for hours through streets and fields,
+returning home and to bed without knowledge of anything having
+transpired.
+
+The state of the eyes during somnambulism varies considerably.  They
+are sometimes closed, sometimes half-closed, and frequently quite open;
+the pupil is sometimes widely dilated, sometimes contracted, sometimes
+natural, and for the most part insensible to light.
+
+Somnambulism seems to be hereditary. Willis cites an example in which
+the father and the children were somnambulists, and in other cases
+several individuals in the same family have been afflicted. Horstius
+gives a history of three young brothers who became somnambulistic at
+the same epoch. A remarkable instance of somnambulism was the case of a
+lad of sixteen and a half years who, in an attack of somnambulism, went
+to the stable, saddled his horse, asked for his whip, and disputed with
+the toll-keeper about his fare, and when he awoke had no recollection
+whatever of his acts, having been altogether an hour in his trance.
+
+Marville quotes the case of an Italian of thirty, melancholic, and a
+deep thinker, who was observed one evening in his bed. It was seen that
+he slept with his eyes open but fixed and immovable. His hands were
+cold, and his pulse extremely slow. At midnight he brusquely tore the
+curtains of his bed aside, dressed himself, went to his stable, and
+mounted a horse. Finding the gate of the court yard closed he opened it
+with the aid of a large stone. Soon he dismounted, went to a billiard
+room, and simulated all the movements of one playing. In another room
+he struck with his empty hands a harpsichord, and finally returned to
+his bed. He appeared to be irritated when anybody made a noise, but a
+light placed under his nose was apparently unnoticed. He awoke if his
+feet were tickled, or if a horn was blown in his ear. Tissot transmits
+to us the example of a medical student who arose in the night, pursued
+his studies, and returned to bed without awaking; and there is another
+record of an ecclesiastic who finished his sermon in his sleep.
+
+The Archbishop of Bordeaux attests the case of a young ecclesiastic who
+was in the habit of getting up during the night in a state of
+somnambulism, taking pen, ink, and paper, and composing and writing
+sermons. When he had finished a page he would read aloud what he had
+written and correct it. In order to ascertain whether the somnambulist
+made any use of his eyes the Archbishop held a piece of cardboard under
+his chin to prevent his seeing the paper upon which he was writing. He
+continued to write without being in the slightest degree incommoded. In
+this state he also copied out pieces of music, and when it happened
+that the words were written in too large characters and did not stand
+over the corresponding notes he perceived his error, blotted them out,
+and wrote them over again with great exactness.
+
+Negretti, a sleep-walker, sometimes carried a candle about with him as
+if to furnish him light in his employment, but when a bottle was
+substituted he carried it, fancying that he had the candle. Another
+somnambulist, Castelli, was found by Dr. Sloane translating Italian and
+French and looking out words in his dictionary. His candle was
+purposely extinguished, whereupon he immediately began groping about,
+as if in the dark, and, although other lighted candles were in the
+room, he did not resume his occupation until he had relighted his
+candle at the fire. He was insensible to the light of every candle
+excepting the one upon which his attention was fixed.
+
+Tuke tells of a school-boy who being unable to master a school-problem
+in geometry retired to bed still thinking of the subject; he was found
+late at night by his instructor on his knees pointing from spot to spot
+as though he were at the blackboard. He was so absorbed that he paid no
+attention to the light of the candle, nor to the speech addressed to
+him. The next morning the teacher asked him if he had finished his
+problem, and he replied that he had, having dreamt it and remembered
+the dream. There are many such stories on record. Quoted by Gray,
+Mesnet speaks of a suicidal attempt made in his presence by a
+somnambulistic woman. She made a noose of her apron, fastened one end
+to a chair and the other to the top of a window. She then kneeled down
+in prayer, made the sign of the cross, mounted a stool, and tried to
+hang herself. Mesnet, scientific to the utmost, allowed her to hang as
+long as he dared, and then stopped the performance. At another time she
+attempted to kill herself by violently throwing herself on the floor
+after having failed to fling herself out of the window. At still
+another time she tried poison, filling a glass with water, putting
+several coins into it, and hiding it after bidding farewell to her
+family in writing; the next night, when she was again somnambulistic,
+she changed her mind once more, writing to her family explaining her
+change of purpose. Mesnet relates some interesting experiments made
+upon a French sergeant in a condition of somnambulism, demonstrating
+the excitation of ideas in the mind through the sense of touch in the
+extremities. This soldier touched a table, passed his hands over it,
+and finding nothing on it, opened the drawer, took out a pen, found
+paper and an inkstand, and taking a chair he sat down and wrote to his
+commanding officer speaking of his bravery, and asking for a medal. A
+thick metallic plate was then placed before his eyes so as to
+completely intercept vision.  After a few minutes, during which he
+wrote a few words with a jumbled stroke, he stopped, but without any
+petulance. The plate was removed and he went on writing. Somnambulism
+may assume such a serious phase as to result in the commission of
+murder. There is a case of a man of twenty-seven, of steady habits, who
+killed his child when in a state of somnambulism. He was put on trial
+for murder, and some of the most remarkable facts of his somnambulistic
+feats were elicited in the evidence. It is said that once when a boy he
+arose at night while asleep, dressed himself; took a pitcher and went
+for milk to a neighboring farm, as was his custom. At another time he
+worked in a lumber-yard in a rain-storm while asleep. Again, when about
+twenty-one, he was seen in a mill-pond wading about attempting to save
+his sister who he imagined was drowning. The worst phase of his
+somnambulism was the impending fears and terrible visions to which he
+was subjected. Sometimes he would imagine that the house was on fire
+and the walls about to fall upon him, or that a wild beast was
+attacking his wife and child; and he would fight, screaming
+inarticulately all the while. He would chase the imaginary beast about
+the room, and in fact had grasped one of his companions, apparently
+believing he was in a struggle with a wild beast. He had often injured
+himself in these struggles, and had often attacked his father, his
+wife, sister, fellow-lodgers, and while confined in jail he attacked
+one of his fellow-prisoners. His eyes would always be wide open and
+staring; he was always able to avoid pieces of furniture which were in
+his way, and he occasionally threw them at his visionary enemies. At
+the time of the murder of his child, in a somnambulistic attack, he
+imagined that he saw a wild beast rise up from the floor and fly at his
+child, a babe of eighteen months. He sprang at the beast and dashed it
+to the ground, and when awakened, to his horror and overwhelming grief
+he found that he had killed his beloved baby.  A similar record has
+been reported of a student who attempted during the night to stab his
+teacher; the man was disarmed and locked up in another portion of the
+building; but he had not the slightest remembrance of the events of the
+night.
+
+Yellowlees speaks of homicide by a somnambulist. According to a
+prominent New York paper, one of the most singular and at the same time
+sad cases of somnambulism occurred a few years ago near Bakersville,
+N.C. A young man there named Garland had been in the habit of walking
+in his sleep since childhood. Like most other sleep-walkers when
+unmolested, his ramblings had been without harm to himself or others.
+Consequently his wife paid little attention to them. But finally he
+began to stay away from the house longer than usual and always returned
+soaking wet. His wife followed him one night. Leaving his home he
+followed the highway until he came to a rough, narrow pig-trail leading
+to the Tow River. His wife followed with difficulty, as he picked his
+way through the tangled forest, over stones and fallen trees and along
+the sides of precipitous cliffs. For more than a mile the sleeper
+trudged on until he came to a large poplar tree, which had fallen with
+its topmost branches far out in the river.  Walking on the log until he
+came to a large limb extending over the water, he got down on his hands
+and knees and began crawling out on it. The frightened wife screamed,
+calling to him to wake up and come back. He was awakened by the cries,
+fell into the river, and was drowned. Each night for weeks he had been
+taking that perilous trip, crawling out on the limb, leaping from it
+into the river, swimming to the shore, and returning home unconscious
+of anything having happened.
+
+Dreams, nightmare, and night terrors form too extensive a subject and
+one too well known to be discussed at length here, but it might be well
+to mention that sometimes dreams are said to be pathognomonic or
+prodromal of approaching disease. Cerebral hemorrhage has often been
+preceded by dreams of frightful calamities, and intermittent fever is
+often announced by persistent and terrifying dreams. Hammond has
+collected a large number of these prodromic dreams, seeming to indicate
+that before the recognizable symptoms of disease present themselves a
+variety of morbid dreams may occur. According to Dana, Albers says:
+"Frightful dreams are signs of cerebral congestion. Dreams about fire
+are, in women, signs of impending hemorrhage. Dreams about blood and
+red objects are signs of inflammatory conditions.  Dreams of distorted
+forms are frequently a sign of abdominal obstruction and diseases of
+the liver."
+
+Catalepsy, trance, and lethargy, lasting for days or weeks, are really
+examples of spontaneously developed mesmeric sleep in hysteric patients
+or subjects of incipient insanity. If the phenomenon in these cases
+takes the form of catalepsy there is a waxy-like rigidity of the
+muscles which will allow the limbs to be placed in various positions,
+and maintain them so for minutes or even hours. In lethargy or
+trance-states the patient may be plunged into a deep and prolonged
+unconsciousness lasting from a few hours to several years. It is in
+this condition that the lay journals find argument for their stories of
+premature burial, and from the same source the fabulous "sleeping
+girls" of the newspapers arise. Dana says that some persons are in the
+habit of going into a mesmeric sleep spontaneously. In these states
+there may be a lowering of bodily temperature, a retarding of the
+respiration and heart-action, and excessive sluggishness of the action
+of the bowels. The patients can hear and may respond to suggestions,
+though apparently insensible to painful impressions, and do not appear
+to smell, taste, or see; the eyes are closed, turned upward, and the
+pupils contracted as in normal sleep.
+
+This subject has been investigated by such authorities as Weir Mitchell
+and Hammond, and medical literature is full of interesting cases, many
+differing in the physiologic phenomena exhibited; some of the most
+striking of these will be quoted. Van Kasthoven of Leyden reports a
+strange case of a peasant of Wolkwig who, it is alleged, fell asleep on
+June 29, 1706, awakening on January 11, 1707, only to fall asleep again
+until March 15th of the same year. Tuke has resurrected the remarkable
+case reported by Arnold of Leicester, early in this century. The
+patient's name was John Engelbrecht. This man passed into a condition
+of catalepsy in which he heard everything about him distinctly, but in
+his imagination he seemed to have passed away to another world, this
+condition coming on with a suddenness which he describes as with "far
+more swiftness than any arrow can fly when discharged from a
+cross-bow." He also lost his sensation from the head downward, and
+recovered it in the opposite direction. At Bologna there was observed
+the case of a young female who after a profound grief had for forty-two
+successive days a state of catalepsy lasting from midday to midnight.
+Muller of Lowenburg records a case of lethargy in a young female,
+following a sudden fright in her fourteenth year, and abrupt
+suppression of menstruation. This girl was really in a sleep for four
+years. In the first year she was awake from one minute to six hours
+during the day. In the second and third years she averaged four hours
+wakefulness in ninety-six hours. She took very little nourishment and
+sometimes had no bowel-movement for sixteen days. Scull reports the
+history of a man of twenty-seven suffering with incipient phthisis, who
+remained bedridden and in a state of unconsciousness for fifteen
+months. One day while being fed he spoke out and asked for a glass of
+water in his usual manner, and so frightened his sister that she ran
+from the room. The man had remembered nothing that had occurred during
+the fifteen months, and asked who was president and seemed eager for
+news. One curious fact was that he remembered a field of oats which was
+just sprouting about the time he fell in the trance.  The same field
+was now standing in corn knee-high. After his recovery from the trance
+he rapidly became worse and died in eighteen months. There is a record
+of a man near Rochester, N.Y., who slept for five years, never waking
+for more than sixteen hours at a time, and then only at intervals of
+six weeks or over.  When seized with his trance he weighed 160, but he
+dwindled down to 90 pounds. He passed urine once or twice a day, and
+had a stool once in from six to twenty days. Even such severe treatment
+as counter-irritation proved of no avail. Gunson mentions a man of
+forty-four, a healthy farmer, who, after being very wet and not
+changing his clothes, contracted a severe cold and entered into a long
+and deep sleep lasting for twelve hours at a time, during which it was
+impossible to waken him. This attack lasted eight or nine months, but
+in 1848 there was a recurrence accompanied by a slight trismus which
+lasted over eighteen months, and again in 1860 he was subjected to
+periods of sleep lasting over twenty-four hours at a time. Blaudet
+describes a young woman of eighteen who slept forty days, and again
+after her marriage in her twentieth year she slept for fifty days; it
+was necessary to draw a tooth to feed her. Four years later, on Easter
+day, 1862, she became insensible for twelve months, with the exception
+of the eighth day, when she awoke and ate at the table, but fell asleep
+in the chair. Her sleep was so deep that nothing seemed to disturb her;
+her pulse was slow, the respirations scarcely perceptible, and there
+were apparently no evacuations.
+
+Weir Mitchell collected 18 cases of protracted sleep, the longest
+continuing uninterruptedly for six months. Chilton's case lasted
+seventeen weeks. Six of the 18 cases passed a large part of each day in
+sleep, one case twenty-one hours, and another twenty-three hours. The
+patients were below middle life; ten were females, seven males, and one
+was a child whose sex was not given. Eight of the 18 recovered easily
+and completely, two recovered with loss of intellect, one fell a victim
+to apoplexy four months after awakening, one recovered with insomnia as
+a sequel, and four died in sleep. One recovered suddenly after six
+months' sleep and began to talk, resuming the train of thought where it
+had been interrupted by slumber. Mitchell reports a case in an
+unmarried woman of forty-five. She was a seamstress of dark complexion
+and never had any previous symptoms. On July 20, 1865, she became
+seasick in a gale of wind on the Hudson, and this was followed by an
+occasional loss of sight and by giddiness.  Finally, in November she
+slept from Wednesday night to Monday at noon, and died a few days
+later. Jones of New Orleans relates the case of a girl of twenty-seven
+who had been asleep for the last eighteen years, only waking at certain
+intervals, and then remaining awake from seven to ten minutes. The
+sleep commenced at the age of nine, after repeated large doses of
+quinin and morphin. Periods of consciousness were regular, waking at 6
+A.M.  and every hour thereafter until noon, then at 3 P.M., again at
+sunset, and at 9 P.M., and once or twice before morning. The sleep was
+deep, and nothing seemed to arouse her. Gairdner mentions the case of a
+woman who, for one hundred and sixty days, remained in a lethargic
+stupor, being only a mindless automaton.  Her life was maintained by
+means of the stomach tube. The Revue d'Hypnotisme contains the report
+of a young woman of twenty-five, who was completing the fourth year of
+an uninterrupted trance.  She began May 30, 1883, after a fright, and
+on the same day, after several convulsive attacks, she fell into a
+profound sleep, during which she was kept alive by small quantities of
+liquid food, which she swallowed automatically. The excretions were
+greatly diminished, and menstruation was suppressed. There is a case
+reported of a Spanish soldier of twenty-two, confined in the Military
+Hospital of San Ambrosio, Cuba, who had been in a cataleptic state for
+fourteen months. His body would remain in any position in which it was
+placed; defecation and micturition were normal; he occasionally sneezed
+or coughed, and is reported to have uttered some words at night. The
+strange feature of this case was that the man was regularly nourished
+and increased in weight ten pounds. It was noted that, some months
+before, this patient was injured and had suffered extreme depression,
+which was attributed to nostalgia, after which he began to have
+intermittent and temporary attacks, which culminated as related.
+Camuset and Planes in January, 1896, mention a man who began to have
+grand hallucinations in 1883. In March, 1884, he exhibited the first
+signs of sleep, and on March 10th it was necessary to put him to bed,
+where he remained, more or less continuously for three months,
+awakening gradually, and regaining his normal condition by the middle
+of June. He was fed by hand three times daily, was placed on a
+night-chair, and with one exception never evacuated in bed. Five months
+afterward he showed no signs of relapse. The latest report of a
+"sleeping girl" is that of the young Dutch maiden, Maria Cvetskens, of
+Stevenswerth, who on December 5, 1895, had been asleep for two hundred
+and twenty days. She had been visited by a number of men of good
+professional standing who, although differing as to the cause of her
+prolonged sleep, universally agreed that there was no deception in the
+case. Her parents were of excellent repute, and it had never occurred
+to them to make any financial profit out of the unnatural state of
+their daughter.
+
+Hypnotism.--The phenomenon of hypnotism was doubtless known to the
+Oriental nations, and even to the Greeks, Romans, and Egyptians, as
+well as to other nations since the downfall of the Roman Empire. "The
+fakirs of India, the musicians of Persia, the oracles of Greece, the
+seers of Rome, the priests and priestesses of Egypt, the monastic
+recluses of the Middle Ages, the ecstatics of the seventeenth and early
+part of the eighteenth century exhibited many symptoms that were, and
+are still, attributed by religious enthusiasts to supernatural
+agencies, but which are explainable by what we know of hypnotism. The
+Hesychasts of Mount Athos who remained motionless for days with their
+gaze directed steadily to the navel; the Taskodrugites who remained
+statuesque for a long period with the finger applied to the nose; the
+Jogins who could hibernate at will; the Dandins of India who became
+cataleptoid by 12,000 repetitions of the sacred word Om; St.  Simeon
+Stylites who, perched on a lofty pillar, preserved an attitude of
+saint-like withdrawal from earthly things for days; and even Socrates,
+of whom it was said that he would stand for hours motionless and
+wordless--all these are probable instances of autohypnotism." (Gray.)
+
+Hypnotism is spoken of as a morbid mental state artificially produced,
+and characterized by perversion or suspension of consciousness, and
+abeyance of volition; a condition of suggestibility leads the patient
+to yield readily to commands of external sense-impressions, and there
+is intense concentration of the mental faculties upon some idea or
+feeling. There are several methods of inducing hypnosis, one of which
+is to give particular direction to the subject's imagination by
+concentrating the attention upon an arbitrary point, or by raising an
+image of the hypnotic state in the patient's mind. The latter is most
+readily induced by speech. Faria formerly strained the attention of the
+subject as much as possible, and suddenly called out, "Sleep!" This
+method has been used by others. Physical methods consist of certain
+stimuli of sight, hearing, and touch. Taste and smell have generally
+given negative results. Fixation of the gaze has been the most
+successful, but the ticking of a watch has been used. According to
+Moll, among uncivilized races particular instruments are used to
+produce similar states, for example, the magic drum's sound among the
+Lapps, or among other races the monotony of rhythm in song, etc.
+Instead of these continuous, monotonous, weak stimulations of the
+senses, we find also that sudden and violent ones are made use of--for
+example in the Salpetriere, the field of Charcot's work, the loud noise
+of a gong, or a sudden ray of light; however, it is more than doubtful
+whether these sudden, strong, physical stimuli, without any mental
+stimuli, can induce hypnosis. Perhaps we have to do here with states
+not far removed from paralysis from fright. The sense of touch is also
+brought into play in hypnosis; Richet set great value on the so-called
+mesmeric strokes or passes. It is often stated that touches on the
+forehead induce a sleepy state in many persons. Hypnotism is practiced
+by stimulation of the muscular sense, such as cradle-rocking, used to
+send little children to sleep. Similar states are said to be produced
+among uncivilized people by violent whirling or dancing movements; the
+movements are, however, accompanied by music and other mental
+excitations.
+
+Hypnosis is spoken of by Huc and Hellwald of the Buddhist convents in
+Thibet; and Sperling, who has had a particularly wide experience in the
+field of hypnotism, and whose opinion is of particular value, says that
+he has seen dervishes in Constantinople who, from the expression of
+their eyes and their whole appearance, as well as from peculiar
+postures they maintain for a long time, impressed him as being in a
+hypnotic state. The state may have been induced by singing and uniform
+whirling motions. Hildebrandt, Jacolliot, Fischer, Hellwald, and other
+trustworthy witnesses and authors tell us strange things about the
+fakirs of India, which set any attempt at explanation on the basis of
+our present scientific knowledge at defiance--that is, if we decline to
+accept them as mere juggler's tricks. Hypnotism seems to be the only
+explanation. It is a well known fact that both wild and domestic beasts
+can be hypnotized and the success of some of the animal-tamers is due
+to this fact. In hypnotism we see a probable explanation for the
+faith-cures which have extended over many centuries, and have their
+analogy in the supposed therapeutic powers of the Saints.
+
+The medicolegal aspect of hypnotism may be called in to answer whether
+crime may be committed at suggestion. Such examples have already been
+before the public in the recent trial of the Parisian strangler,
+Eyraud. It was claimed that his accomplice in the crime, Gabrielle
+Bompard, had been hypnotized. Bernheim narrates a case of outrage
+effected in the hypnotic condition, which was brought to light by a
+trial in the South of France.
+
+As to the therapeutic value of hypnotism, with the exception of some
+minor benefits in hysteric cases and in insomnia, the authors must
+confess that its use in Medicine seems very limited.
+
+African sleep-sickness is a peculiar disorder, apparently infectious in
+character, which occurs among the negroes of the western coast of
+Africa. It has been transported to other regions but is endemic in
+Africa. According to Dana it begins gradually with malaise and
+headache. Soon there is drowsiness after meals which increases until
+the patient is nearly all the time in a stupor. When awake he is dull
+and apathetic. There is no fever; the temperature may be subnormal. The
+pulse, too, is not rapid, the skin is dry, the tongue moist but coated,
+the bowels regular.  The eyes become congested and prominent. The
+cervical glands enlarge. The disease ends in coma and death. Recovery
+rarely occurs. Sometimes the disease is more violent, and toward the
+end there are epileptic convulsions and muscular tremors. Autopsies
+have revealed no pathologic changes.
+
+Recently Forbes contributes an interesting paper on the sleeping
+sickness of Africa. The disease may occur in either sex and at any age,
+though it is most frequent from the twelfth to the twentieth years, and
+in the male sex. It begins with enlargement of the cervical glands, and
+drowsiness and sleep at unusual hours. At first the patient may be
+aroused, but later sinks into a heavy stupor or coma. Death occurs in
+from three to twelve months, and is due to starvation. Forbes reports
+11 fatal cases, and two that passed from observation. At the autopsy
+are found hyperemia of the arachnoid, and slight chronic
+leptomeningitis and pachymeningitis. There is also anemia of the
+brain-substance.  In one of his cases the spleen was enlarged. He was
+inclined to regard the disease as a neurosis.
+
+Aphasia is a disease of the faculty of language, that is, a disturbance
+of the processes by which we see, hear, and at the same time appreciate
+the meaning of symbols. It includes also the faculty of expressing our
+ideas to others by means of the voice, gesture, writing, etc. The
+trouble may be central or in the conducting media. The varieties of
+aphasia are:--
+
+(1) Amnesia of speech.
+
+(2) Amnesia of speech and written language.
+
+(3) Amnesia of speech, written language, and gesture.
+
+In most cases there is no paralysis of the tongue or speech-forming
+organs. As a rule the intellect is unaffected, the patient has the
+ideas, but lacks the power to give them proper expression through
+words, written language, or gesture. If the patient is enable to write,
+the condition is known as agraphia.  Word-blindness, word-deafness,
+etc., are terms of different forms of aphasia.
+
+What was probably a case of incomplete aphasia is mentioned by Pliny,
+that of Messala Corvinus who was unable to tell his own name; and many
+instances of persons forgetting their names are really nothing but
+cases of temporary or incomplete aphasia. In some cases of incomplete
+and in nearly all cases of complete aphasia, involuntary sentences are
+ejaculated. According to Seguin a reverend old gentleman affected with
+amnesia of words was forced to utter after the sentence, "Our Father
+who art in heaven," the words "let Him stay there." A lady seen by
+Trousseau would rise on the coming of a visitor to receive him with a
+pleased and amiable expression of countenance, and show him to a chair,
+at the same time addressing to him the words, "cochon, animal, fichue
+bete," French words hardly allowable in drawing-room usage. She was
+totally aphasic but not paralyzed.  Women often use semi-religious
+expressions like "Oh dear," or "Oh Lord." Men of the lower classes
+retain their favorite oaths remarkably. Sometimes the phrases
+ejaculated are meaningless, as in Broca's celebrated case.
+
+Aphasia may be the result of sudden strong emotions, in such cases
+being usually temporary; it may be traumatic; it may be the result of
+either primary or secondary malnutrition or degeneration.
+
+There are some cases on record in which the sudden loss and the sudden
+return of the voice are quite marvelous.
+
+Habershon reports the case of a woman who on seeing one of her children
+scalded fell unconscious and motionless, and remained without food for
+three days. It was then found that she suffered from complete aphasia.
+Five weeks after the incident she could articulate only in a very
+limited vocabulary.
+
+In the Philosophical Transactions Archdeacon Squire tells of the case
+of Henry Axford, who lost the power of articulation for four years;
+after a horrible dream following a debauch he immediately regained his
+voice, and thereafter he was able to articulate without difficulty.
+
+Ball records a curious case of what he calls hysteric aphonia.  The
+patient was a young lady who for several months could neither sing nor
+speak, but on hearing her sister sing a favorite song, she began to
+sing herself; but, although she could sing, speech did not return for
+several weeks. Ball remarks that during sleep such patients may cry out
+loudly in the natural voice.
+
+Wadham reports the case of a boy of eighteen who was admitted to his
+ward suffering with hemiplegia of the left side. Aphasia developed
+several days after admission and continued complete for three months.
+The boy gradually but imperfectly recovered his speech. Over six months
+after the original admission he was readmitted with necrosis of the
+jaw, for which he underwent operation, and was discharged a month
+later. From this time on he became progressively emaciated until his
+death, twelve months after Wadham first saw him. A postmortem
+examination showed nearly total destruction of the Island of Reil,
+popularly called the speech-center. Jackson mentions a hemiplegic
+patient with aphasia who could only utter the words "come on to me,"
+"come on," and "yes" and "no." Bristowe cites the history of a sailor
+of thirty-six, a patient of St. Thomas Hospital, London, who suffered
+from aphasia for nine months. His case was carefully explained to him
+and he nodded assent to all the explanations of the process of speech
+as though he understood all thoroughly. He was gradually educated to
+speak again by practicing the various sounds. It may be worth while to
+state that after restoration of speech he spoke with his original
+American accent.
+
+Ogle quotes six cases of loss of speech after bites of venomous snakes.
+Two of the patients recovered. According to Russ this strange symptom
+is sometimes instantaneous and in other instances it only appears after
+an interval of several hours. In those who survive the effects of the
+venom it lasts for an indefinite period. One man seen by Russ had not
+only lost his speech in consequence of the bite of a fer-de-lance
+snake, but had become, and still remained, hemiplegic. In the rest of
+Russ's cases speech alone was abolished. Russ remarks that the
+intelligence was altogether intact, and sensibility and power of motion
+were unaffected. One woman who had been thus condemned to silence,
+suddenly under the influence of a strong excitement recovered her
+speech, but when the emotion passed away speech again left her.  Ogle
+accounts for this peculiar manifestation of aphasia by supposing that
+the poison produces spasm of the middle cerebral arteries, and when the
+symptom remains a permanent defect the continuance of the aphasia is
+probably due to thrombosis of arteries above the temporary constriction.
+
+Anosmia, or loss of smell, is the most common disorder of olfaction; it
+may be caused by cortical lesions, olfactory nerve-changes, congenital
+absence, or over-stimulation of the nerves, or it may be a symptom of
+hysteria.
+
+Ogle, after mentioning several cases of traumatic anosmia, suggests
+that a blow on the occiput is generally the cause. Legg reports a
+confirmatory case, but of six cases mentioned by Notta two were caused
+by a blow on the crown of the head, and two on the right ear. The
+prognosis in traumatic anosmia is generally bad, although there is a
+record of a man who fell while working on a wharf, striking his head
+and producing anosmia with partial loss of hearing and sight, and who
+for several weeks neither smelt nor tasted, but gradually recovered.
+
+Mitchell reports a case of a woman of forty who, after an injury to her
+nose from a fall, suffered persistent headache and loss of smell. Two
+years later, at bedtime, or on going to sleep, she had a sense of
+horrible odors, which were fecal or animal, and most intense in nature.
+The case terminated in melancholia, with delirium of persecution,
+during which the disturbance of smell passed away.
+
+Anosmia has been noticed in leukoderma and allied disturbances of
+pigmentation. Ogle mentions a negro boy in Kentucky whose sense of
+smell decreased as the leukoderma extended. Influenza, causing
+adhesions of the posterior pillars of the fauces, has given rise to
+anosmia.
+
+Occasionally overstimulation of the olfactory system may lead to
+anosmia. Graves mentions a captain of the yeomanry corps who while
+investigating the report that 500 pikes were concealed at the bottom of
+a cesspool in one of the city markets superintended the emptying of the
+cesspool, at the bottom of which the arms were found. He suffered
+greatly from the abominable effluvia, and for thirty-six years
+afterward he remained completely deprived of the sense of smell.
+
+In a discussion upon anosmia before the Medico-Chirurgical Association
+of London, January 25, 1870, there was an anosmic patient mentioned who
+was very fond of the bouquet of moselle, and Carter mentioned that he
+knew a man who had lost both the senses of taste and smell, but who
+claimed that he enjoyed putrescent meat. Leared spoke of a case in an
+epileptic affected with loss of taste and smell, and whose paroxysms
+were always preceded by an odor of peach-blossoms.
+
+Hyperosmia is an increase in the perception of smell, which rarely
+occurs in persons other than the hysteric and insane. It may be
+cultivated as a compensatory process, as in the blind, or those engaged
+in particular pursuits, such as tea-tasting.  Parosmia is a rare
+condition, most often a symptom of hysteria or neurasthenia, in which
+everything smells of a similar, peculiar, offensive odor.
+Hallucinations of odor are sometimes noticed in the insane. They form
+most obstinate cases, when the hallucination gives rise to imaginary
+disagreeable, personal odors.
+
+Perversion of the tactile sense, or wrong reference to the sensation of
+pain, has occasionally been noticed. The Ephemerides records a case in
+which there was the sense of two objects from a single touch on the
+hypochondrium. Weir Mitchell remarks that soldiers often misplace the
+location of pain after injuries in battle. He also mentions several
+cases of wrong reference of the sensation of pain. These instances
+cannot be called reflex disturbances, and are most interesting. In one
+case the patient felt the pain from a urethral injection in gonorrhea,
+on the top of the head. In another an individual let an omnibus-window
+fall on his finger, causing but brief pain in the finger, but violent
+pains in the face and neck of that side. Mitchell also mentions a
+naturalist of distinction who had a small mole on one leg which, if
+roughly rubbed or pinched, invariably seemed to cause a sharp pain in
+the chin.
+
+Nostalgia is the name generally given to that variety of melancholia in
+which there is an intense longing for home or country. This subject has
+apparently been overlooked in recent years, but in the olden times it
+was extensively discussed.  Swinger, Harderus, Tackius, Guerbois,
+Hueber, Therrin, Castellanau, Pauquet, and others have written
+extensively upon this theme. It is said that the inhabitants of cold
+countries, such as the Laplanders and the Danes, are the most
+susceptible to this malady. For a long time many writers spoke of the
+frequency and intensity of nostalgia among the Swiss. Numerous cases of
+suicide from this affliction have been noticed among these hardy
+mountaineers, particularly on hearing the mountain-song of their homes,
+"Ranz des vaches." This statement, which is an established fact, is
+possibly due to the social constitution of the Swiss mountaineers, who
+are brought up to a solitary home life, and who universally exhibit
+great attachment to and dependence upon their parents and immediate
+family. In the European armies nostalgia has always been a factor in
+mortality. In the Army of the Moselle, and in Napoleon's Alpine Army,
+the terrible ravages of suicide among the young Bretons affected with
+nostalgia have been recorded; it is among the French people that most
+of the investigation on this subject has been done. Moreau speaks of a
+young soldier in a foreign country and army who fell into a most
+profound melancholy when, by accident, he heard his native tongue.
+According to Swinger and Sauvages women are less subject to nostalgia
+than men. Nostalgia has been frequently recorded in hospital wards.
+Percy and Laurent have discussed this subject very thoroughly, and cite
+several interesting cases among emigrants, soldiers, marines, etc.
+Hamilton speaks of a recruit who became prostrated by longing for his
+home in Wales. He continually raved, but recovered from his delirium
+when assured by the hospital authorities of his forthcoming furlough.
+Taylor records two cases of fatal nostalgia. One of the victims was a
+Union refugee who went to Kentucky from his home in Tennessee. He died
+talking about and pining for his home. The second patient was a member
+of a regiment of colored infantry; he died after repeatedly pining for
+his old home.
+
+Animals are sometimes subject to nostalgia, and instances are on record
+in which purchasers have been compelled to return them to the old home
+on account of their literal home-sickness. Oswald tells of a bear who,
+in the presence of food, committed suicide by starvation.
+
+Hypochondria consists of a mild form of insanity in which there is a
+tendency to exaggerate the various sensations of the body and their
+importance, their exaggeration being at times so great as to amount to
+actual delusion. All sorts of symptoms are dwelt upon, and the doctor
+is pestered to the extreme by the morbid fears of the patient.
+
+Morbid fears or impulses, called by the Germans Zwangsvorstellungen, or
+Zwangshandlungen, and by the French, peurs maladies, have only been
+quite recently studied, and form most interesting cases of minor
+insanity. Gelineau has made extensive investigations in this subject,
+and free reference has been made to his work in the preparation of the
+following material.
+
+Aichmophobia is a name given by the French to the fear of the sight of
+any sharp-pointed instrument, such as a pin, needle, fish-spine, or
+naked sword. An illustrious sufferer of this 'phobia was James I of
+England, who could never tolerate the appearance of a drawn sword.
+Gelineau reports an interesting case of a female who contracted this
+malady after the fatigue of lactation of two children. She could not
+tolerate knives, forks, or any pointed instruments on the table, and
+was apparently rendered helpless in needle-work on account of her
+inability to look at the pointed needle.
+
+Agoraphobia is dread of an open space, and is sometimes called
+Kenophobia. The celebrated philosopher Pascal was supposed to have been
+affected with this fear. In agoraphobia the patient dreads to go across
+a street or into a field, is seized with an intense feeling of fright,
+and has to run to a wall or fall down, being quite unable to proceed.
+There is violent palpitation, and a feeling of constriction is
+experienced. According to Suckling, pallor and profuse perspiration are
+usually present, but there is no vertigo, confusion of mind, or loss of
+consciousness. The patient is quite conscious of the foolishness of the
+fears, but is unable to overcome them. The will is in abeyance and is
+quite subservient to the violent emotional disturbances. Gray mentions
+a patient who could not go over the Brooklyn Bridge or indeed over any
+bridge without terror. Roussel speaks of a married woman who had never
+had any children, and who was apparently healthy, but who for the past
+six months had not been able to put her head out of the window or go
+upon a balcony. When she descended into the street she was unable to
+traverse the open spaces. Chazarin mentions a case in a woman of fifty,
+without any other apparent symptom of diathesis. Gelineau quotes a case
+of agoraphobia, secondary to rheumatism, in a woman of thirty-nine.
+There is a corresponding fear of high places often noticed, called
+acrophobia; so that many people dare not trust themselves on high
+buildings or other eminences.
+
+Thalassophobia is the fear of the view of immense spaces or
+uninterrupted expanses. The Emperor Heraclius, at the age of
+fifty-nine, had an insurmountable fear of the view of the sea; and it
+is said that when he crossed the Bosphorus a bridge of boats was
+formed, garnished on both sides with plants and trees, obscuring all
+view of the water over which the Emperor peacefully traversed on
+horseback. The moralist Nicole, was equally a thalassophobe, and always
+had to close his eyes at the sight of a large sheet of water, when he
+was seized with trembling in all his limbs. Occasionally some accident
+in youth has led to an aversion to traversing large sheets of water,
+and there have been instances in which persons who have fallen into the
+water in childhood have all their lives had a terror of crossing
+bridges.
+
+Claustrophobia is the antithesis of agoraphobia. Raggi describes a case
+of such a mental condition in a patient who could not endure being
+within an enclosure or small space. Suckling mentions a patient of
+fifty-six who suffered from palpitation when shut in a railway carriage
+or in a small room. She could only travel by rail or go into a small
+room so long as the doors were not locked, and on the railroad she had
+to bribe the guard to leave the doors unlocked. The attacks were purely
+mental, for the woman could be deceived into believing that the door to
+a railroad carriage was unlocked, and then the attack would immediately
+subside. Suckling also mentions a young woman brought to him at Queen's
+Hospital who had a great fear of death on getting into a tram car, and
+was seized with palpitation and trembling on merely seeing the car.
+This patient had been in an asylum. The case was possibly due more to
+fear of an accident than to true claustrophobia. Gorodoichze mentions a
+case of claustrophobia in a woman of thirty-eight, in whose family
+there was a history of hereditary insanity. Ball speaks of a case in a
+woman who was overcome with terror half way in the ascension of the
+Tour Saint-Jacques, when she believed the door below was closed.
+Gelineau quotes the case of a brave young soldier who was believed to
+be afraid of nothing, but who was unable to sleep in a room of which
+the door was closed.
+
+Astrophobia or astropaphobia is a morbid fear of being struck by
+lightning. It was first recognized by Bruck of Westphalia, who knew a
+priest who was always in terror when on a country road with an
+unobstructed view of the sky, but who was reassured when he was under
+the shelter of trees. He was advised by an old physician always to use
+an umbrella to obstruct his view of the heavens, and in this way his
+journeys were made tranquil. Beard knew an old woman who had suffered
+all her life from astrophobia.  Her grandmother had presented the same
+susceptibility and the same fears. Sometimes she could tell the
+approach of a storm by her nervous symptoms. Caligula, Augustus, Henry
+III, and other celebrated personages, were overcome with fear during a
+storm.
+
+Mysophobia is a mild form of insanity characterized by a dread of the
+contact of dirt. It was named by Hammond, whose patient washed her
+hands innumerable times a day, so great was the fear of contamination.
+These patients make the closest inspection of their toilet, their
+eating and drinking utensils, and all their lives are intensely worried
+by fear of dirt.
+
+Hematophobia is a horror of blood, which seems to be an instinctive
+sentiment in civilized man, but which is unknown among savages. When
+the horror is aggravated to such an extent as to cause distressing
+symptoms or unconsciousness, it takes the name of hematophobia. There
+are many cases on record and nearly every physician has seen one or
+more, possibly among his colleagues.
+
+Necrophobia and thanatophobia are allied maladies, one being the fear
+of dead bodies and the other the fear of death itself.
+
+Anthropophobia is a symptom of mental disease consisting in fear of
+society. Beard, Mitchell, Baillarger, and others have made observations
+on this disease. The antithesis of this disease is called monophobia.
+Patients are not able to remain by themselves for even the shortest
+length of time. This morbid dread of being alone is sometimes so great
+that even the presence of an infant is an alleviation. Gelineau cites
+an instance in a man of forty-five which was complicated with
+agoraphobia.
+
+Bacillophobia is the result of abnormal pondering over bacteriology.
+Huchard's case was in a woman of thirty-eight who, out of curiosity,
+had secretly read the works of Pasteur, and who seemed to take
+particular pleasure in conning over the causes of death in the
+health-reports. Goyard mentions an instance in a Swiss veterinary
+surgeon.
+
+Kleptophobia, examples of which have been cited by Cullere, is the fear
+of stealing objects in view, and is often the prelude of kleptomania.
+The latter disease has gained notoriety in this country, and nearly
+every large store has agents to watch the apparently growing number of
+kleptomaniacs. These unfortunate persons, not seldom from the highest
+classes of society, are unable to combat an intense desire to purloin
+articles. Legal proceedings have been instituted against many, and
+specialists have been called into court to speak on this question.
+Relatives and friends have been known to notify the large stores of the
+thieving propensities of such patients.
+
+Le Grande du Saulle has given to the disease in which there is a morbid
+doubt about everything done, the name folie de doute. Gray mentions a
+case in a patient who would go out of a door, close it, and then come
+back, uncertain as to whether he had closed it, close it again, go off
+a little way, again feel uncertain as to whether he had closed it
+properly, go back again, and so on for many times. Hammond relates the
+history of a case in an intelligent man who in undressing for bed would
+spend an hour or two determining whether he should first take off his
+coat or his shoes. In the morning he would sit for an hour with his
+stockings in his hands, unable to determine which he should put on
+first.
+
+Syphilophobia is morbid fear of syphilis. Lyssophobia is a fear of
+hydrophobia which sometimes assumes all the symptoms of the major
+disease, and even produces death. Gelineau, Colin, Berillon, and others
+have studied cases. In Berillon's case the patient was an artist, a
+woman of brunet complexion, who for six years had been tormented with
+the fear of becoming mad, and in whom the symptoms became so intense as
+to constitute pseudobydrophobia. At their subsidence she was the victim
+of numerous hallucinations which almost drove her to the point of
+suicide.
+
+Spermatophobia has been noticed among the ignorant, caused or increased
+by inspection of sensational literature, treatises on the subject of
+spermatorrhea, etc. Ferre mentions a woman of thirty-six, of intense
+religious scruples, who was married at eighteen, and lost her husband
+six years afterward. She had a proposition of marriage which she
+refused, and was prostrated by the humid touch of the proposer who had
+kissed her hand, imagining that the humidity was due to semen. She was
+several times overcome by contact with men in public conveyances, her
+fear of contamination being so great. Zoophobia, or dread of certain
+animals, has been mentioned under another chapter under the head of
+idiosyncrasies. Pantophobia is a general state of fear of everything
+and everybody. Phobophobia, the fear of being afraid, is another
+coinage of the wordmakers. The minor 'phobias, such as pyrophobia, or
+fear of fire; stasophobia, or inability to arise and walk, the victims
+spending all their time in bed; toxicophobia or fear of poison, etc.,
+will be left to the reader's inspection in special works on this
+subject.
+
+Demonomania is a form of madness in which a person imagines himself
+possessed of the devil. Ancient records of this disease are frequent,
+and in this century Lapointe reports the history of demonomania in
+father, mother, three sons, and two daughters, the whole family, with
+the exception of one son, who was a soldier, being attacked. They
+imagined themselves poisoned by a sorceress, saw devils, and had all
+sorts of hallucinations, which necessitated the confinement of the
+whole family in an asylum for over a month. They continued free from
+the hallucinations for two years, when first the mother, and then
+gradually all the other members of the family, again became afflicted
+with demonomania and were again sent to the asylum, when, after a
+residence therein of five months, they were all sufficiently cured to
+return home.
+
+Particular aversions may be temporary only, that is, due to an existing
+condition of the organism, which, though morbid, is of a transitory
+character. Such, for instance, are those due to dentition, the
+commencement or cessation of the menstrual function, pregnancy, etc.
+These cases are frequently of a serious character, and may lead to
+derangement of the mind. Millington relates the history of a lady who,
+at the beginning of her first pregnancy, acquired an overpowering
+aversion to a half-breed Indian woman who was employed in the house as
+a servant. Whenever this woman came near her she was at once seized
+with violent trembling; this ended in a few minutes with vomiting and
+great mental and physical prostration lasting several hours. Her
+husband would have sent the woman away, but Mrs. X insisted on her
+remaining, as she was a good servant, in order that she might overcome
+what she regarded as an unreasonable prejudice. The effort was,
+however, too great, for upon one occasion when the woman entered Mrs.
+X's apartment rather unexpectedly, the latter became greatly excited,
+and, jumping from an open window in her fright, broke her arm, and
+otherwise injured herself so severely that she was confined to her bed
+for several weeks. During this period, and for some time afterward, she
+was almost constantly subject to hallucinations, in which the Indian
+woman played a prominent part. Even after her recovery the mere thought
+of the woman would sometimes bring on a paroxysm of trembling, and it
+was not till after her confinement that the antipathy disappeared.
+
+Circular or periodic insanity is a rare psychosis. According to Drewry
+reports of very few cases have appeared in the medical journals. "Some
+systematic writers," says Drewry, "regard it as a mere subdivision of
+periodic insanity (Spitzka). A distinguished alienist and author of
+Scotland however has given us an admirable lecture on the subject. He
+says: 'I have had under my care altogether about 40 cases of typical
+folie circulaire.' In the asylum at Morningside there were, says Dr.
+Clouston, in 800 patients 16 cases of this peculiar form of mental
+disease. Dr. Spitzka, who was the first American to describe it, found
+in 2300 cases of pauper insane four per cent to be periodic, and its
+sub-group, circular, insanity. Dr. Stearns states that less than
+one-fourth of one per cent of cases in the Hartford (Conn.) Retreat
+classed as mania and melancholia have proved to be folie circulaire.
+Upon examination of the annual reports of the superintendents of
+hospitals for the insane in this country, in only a few are references
+made to this as a distinct form of insanity. In the New York State
+hospitals there is a regular uniform classification of mental diseases
+in which 'circular (alternating) insanity' occupies a place. In the
+report of the Buffalo Hospital for 1892, in statistical table No. 4,
+'showing forms of insanity in those admitted, etc., since 1888,' out of
+1428 cases, only one was 'alternating (circular) insanity.' In the St.
+Lawrence Hospital only one case in 992 was credited to this special
+class. In the institution in Philadelphia, of which Dr. Chapin is the
+superintendent, 10,379 patients have been treated, only three of whom
+were diagnosed cases of manie circulaire. Of the 900 cases of insanity
+in the State Hospital at Danville, Pa., less than four per cent were
+put in this special class. There are in the Central (Va.) State
+Hospital (which is exclusively for the colored insane) 775 patients,
+three of whom are genuine cases of circular insanity, but they are
+included in 'periodic insanity.' This same custom evidently prevails in
+many of the other hospitals for the insane."
+
+Drewry reports three cases of circular insanity, one of which was as
+follows:--
+
+"William F., a negro, thirty-six years old, of fair education, steady,
+sober habits, was seized with gloomy depression a few weeks prior to
+his admission to this hospital, in September, 1886. This condition came
+on after a period of fever. He was a stranger in the vicinity and
+scarcely any information could be obtained regarding his antecedents.
+When admitted he was in a state of melancholic hypochondriasis; he was
+the very picture of abject misery. Many imaginary ills troubled his
+peace of mind. He spoke of committing suicide, but evidently for the
+purpose of attracting attention and sympathy. On one occasion he said
+he intended to kill himself, but when the means to do so were placed at
+his command, he said he would do the deed at another time. The most
+trivial physical disturbances were exaggerated into very serious
+diseases. From this state of morbid depression he slowly emerged, grew
+brighter, more energetic, neater in personal appearance, etc. During
+this period of slow transition or partial sanity he was taken out on
+the farm where he proved to be a careful and industrious laborer. He
+escaped, and when brought back to the hospital a few weeks subsequently
+he was in a condition of great excitement and hilarity. His expression
+was animated, and he was, as it were, overflowing with superabundance
+of spirit, very loquacious, and incessantly moving. He bore an air of
+great importance and self-satisfaction; said he felt perfectly well and
+happy, but abused the officers for keeping him 'confined unjustly in a
+lunatic asylum.' It was his habit almost daily, if not interfered with,
+to deliver a long harangue to his fellow-patients, during which he
+would become very excited and noisy. He showed evidences of having a
+remarkable memory, particularly regarding names and dates. (Unusual
+memory is frequently observed in this type of insanity, says Stearns.)
+He was sometimes disposed to be somewhat destructive to furniture,
+etc., was neat in person, but would frequently dress rather
+'gorgeously,' wearing feathers and the like in his hat, etc. He was not
+often noisy and sleepless at night, and then only for a short time. His
+physical health was good. This 'mental intoxication,' as it were,
+lasted nearly a year. After this long exacerbation of excitement there
+was a short remission and then depression again set in, which lasted
+about fifteen months. At this time this patient is in the depressed
+stage or period of the third circle. So, thus the cycles have
+continuously repeated their weary rounds, and in all probability they
+will keep this up 'until the final capitation in the battle of life has
+taken place.'"
+
+Katatonia, according to Gray, is a cerebral disease of cyclic symptoms,
+ranging in succession from primary melancholia to mania, confusion, and
+dementia, one or more of these stages being occasionally absent, while
+convulsive and epileptoid symptoms accompany the mental changes.
+
+It is manifestly impossible to enter into the manifold forms and
+instances of insanity in this volume, but there is one case, seldom
+quoted, which may be of interest. It appeared under the title, "A
+Modern Pygmalion." It recorded a history of a man named Justin, who
+died in the Bicetre Insane Asylum. He had been an exhibitor of wax
+works at Montrouge, and became deeply impressed with the beautiful
+proportions of the statue of a girl in his collection, and ultimately
+became intensely enamored with her. He would spend hours in
+contemplation of the inanimate object of his affections, and finally
+had the illusion that the figure, by movements of features, actually
+responded to his devotions.  Nemesis as usual at last arrived, and the
+wife of Justin, irritated by his long neglect, in a fit of jealousy
+destroyed the wax figure, and this resulted in a murderous attack on
+his wife by Justin who resented the demolition of his love. He was
+finally secured and lodged in Bicetre, where he lived for five years
+under the influence of his lost love.
+
+An interesting condition, which has been studied more in France than
+elsewhere, is double consciousness, dual personality, or, as it is
+called by the Germans, Doppelwahrnehmungen. In these peculiar cases an
+individual at different times seems to lead absolutely different
+existences. The idea from a moralist's view is inculcated in
+Stevenson's "Dr. Jekyl and Mr. Hyde." In an article on this subject
+Weir Mitchell illustrated his paper by examples, two of which will be
+quoted. The first was the case of Mary Reynolds who, when eighteen
+years of age, became subject to hysteric attacks, and on one occasion
+she continued blind and deaf for a period of five or six weeks. Her
+hearing returned suddenly, and her sight gradually. About three months
+afterward she was discovered in a profound sleep. Her memory had fled,
+and she was apparently a new-born individual. When she awoke it became
+apparent that she had totally forgotten her previous existence, her
+parents, her country, and the house where she lived. She might be
+compared to an immature child. It was necessary to recommence her
+education. She was taught to write, and wrote from right to left, as in
+the Semitic languages. She had only five or six words at her
+command--mere reflexes of articulation which were to her devoid of
+meaning. The labor of re-education, conducted methodically, lasted from
+seven to eight weeks. Her character had experienced as great a change
+as her memory; timid to excess in the first state, she became gay,
+unreserved, boisterous, daring, even to rashness. She strolled through
+the woods and the mountains, attracted by the dangers of the wild
+country in which she lived. Then she had a fresh attack of sleep, and
+returned to her first condition; she recalled all the memories and
+again assumed a melancholy character, which seemed to be aggravated. No
+conscious memory of the second state existed. A new attack brought back
+the second state, with the phenomenon of consciousness which
+accompanied it the first time.  The patient passed successively a great
+many times from one of these states to the other. These repeated
+changes stretched over a period of sixteen years. At the end of that
+time the variations ceased. The patient was then thirty-six years of
+age; she lived in a mixed state, but more closely resembling the second
+than the first; her character was neither sad nor boisterous, but more
+reasonable. She died at the age of sixty-five years.
+
+The second case was that of an itinerant Methodist minister named
+Bourne, living in Rhode Island, who one day left his home and found
+himself, or rather his second self, in Norristown, Pennsylvania. Having
+a little money, he bought a small stock in trade, and instead of being
+a minister of the gospel under the Methodist persuasion, he kept a
+candy shop under the name of A.  J. Brown, paid his rent regularly, and
+acted like other people.  At last, in the middle of the night, he awoke
+to his former consciousness, and finding himself in a strange place,
+supposed he had made a mistake and might be taken for a burglar. He was
+found in a state of great alarm by his neighbors, to whom he stated
+that he was a minister, and that his home was in Rhode Island. His
+friends were sent for and recognized him, and he returned to his home
+after an absence of two years of absolutely foreign existence. A most
+careful investigation of the case was made on behalf of the London
+Society for Psychical Research.
+
+An exhaustive paper on this subject, written by Richard Hodgson in the
+proceedings of the Society for Psychical Research, states that Mr.
+Bourne had in early life shown a tendency to abnormal psychic
+conditions; but he had never before engaged in trade, and nothing could
+be remembered which would explain why he had assumed the name A. J.
+Brown, under which he did business. He had, however, been hypnotized
+when young and made to assume various characters on the stage, and it
+is possible that the name A. J. Brown was then suggested to him, the
+name resting in his memory, to be revived and resumed when he again
+went into a hypnotic trance.
+
+Alfred Binet describes a case somewhat similar to that of Mary
+Reynolds: "Felida, a seamstress, from 1858 up to the present time (she
+is still living) has been under the care of a physician named Azam in
+Bordeaux. Her normal, or at least her usual, disposition when he first
+met her was one of melancholy and disinclination to talk, conjoined
+with eagerness for work.  Nevertheless her actions and her answers to
+all questions were found to be perfectly rational. Almost every day she
+passed into a second state. Suddenly and without the slightest
+premonition save a violent pain in the temples she would fall into a
+profound slumber-like languor, from which she would awake in a few
+moments a totally different being. She was now as gay and cheery as she
+had formerly been morose. Her imagination was over-excited.  Instead of
+being indifferent to everything, she had become alive to excess. In
+this state she remembered everything that had happened in the other
+similar states that had preceded it, and also during her normal life.
+But when at the end of an hour or two the languor reappeared, and she
+returned to her normal melancholy state, she could not recall anything
+that had happened in her second, or joyous, stage. One day, just after
+passing into the second stage, she attended the funeral of an
+acquaintance.  Returning in a cab she felt the period coming on which
+she calls her crisis (normal state). She dozed several seconds, without
+attracting the attention of the ladies who were in the cab, and awoke
+in the other state, absolutely at a loss to know why she was in a
+mourning carriage with people who, according to custom, were praising
+the qualities of a deceased person whose name she did not even know.
+Accustomed to such positions, she waited; by adroit questions she
+managed to understand the situation, and no one suspected what had
+happened. Once when in her abnormal condition she discovered that her
+husband had a mistress, and was so overcome that she sought to commit
+suicide. Yet in her normal mind she meets the woman with perfect
+equilibrium and forgetfulness of any cause for quarrel. It is only in
+her abnormal state that the jealousy recurs. As the years went on the
+second state became her usual condition. That which was at first
+accidental and abnormal now constitutes the regular center of her
+psychic life. It is rather satisfactory to chronicle that as between
+the two egos which alternately possess her, the more cheerful has
+finally reached the ascendant."
+
+Jackson reports the history of the case of a young dry-goods clerk who
+was seized with convulsions of a violent nature during which he became
+unconscious. In the course of twenty-four hours his convulsions abated,
+and about the third day he imagined himself in New York paying court to
+a lady, and having a rival for her favors; an imaginary quarrel and
+duel ensued. For a half-hour on each of three days he would start
+exactly where he had left off on the previous day. His eyes were open
+and to all appearances he was awake during this peculiar delirium. When
+asked what he had been doing he would assert that he had been asleep.
+His language assumed a refinement above his ordinary discourse. In
+proportion as his nervous system became composed, and his strength
+improved, this unnatural manifestation of consciousness disappeared,
+and he ultimately regained his health.
+
+A further example of this psychologic phenomenon was furnished quite
+meetly at a meeting of the Clinical Society of London, where a well
+known physician exhibited a girl of twelve, belonging to a family of
+good standing, who displayed in the most complete and indubitable form
+this condition of dual existence. A description of the case is as
+follows:--
+
+"Last year, after a severe illness which was diagnosed to be
+meningitis, she became subject to temporary attacks of unconsciousness,
+on awakening from which she appeared in an entirely different
+character. In her normal condition she could read and write and speak
+fluently, and with comparative correctness. In the altered mental
+condition following the attack she loses all memory for ordinary
+events, though she can recall things that have taken place during
+previous attacks. So complete is this alteration of memory, that at
+first she was unable to remember her own name or to identify herself or
+her parents. By patient training in the abnormal condition she has been
+enabled to give things their names, though she still preserves a
+baby-fashion of pronouncing. She sometimes remains in the abnormal
+condition for days together and the change to her real self takes place
+suddenly, without exciting surprise or dismay, and she forthwith
+resumes possession of her memory for events of her ordinary life.
+During the last month or two she appears to have entered on a new
+phase, for after a mental blank of a fortnight's duration she awakened
+completely oblivious of all that had happened since June, 1895, and she
+alludes to events that took place just anterior to that date as though
+they were of recent occurrence; in fact she is living mentally in July,
+1895.  These cases, though rare, are of course not infrequently met
+with, and they have been carefully studied, especially in France, where
+women appear more prone to neurotic manifestations. The hypothesis that
+finds most favor is that the two halves of the brain do not work in
+unison; in other words, that there has been some interference with the
+connections which in the ordinary normal being make of a wonderful
+composite organ like the brain one organic whole."
+
+Proust tells a story of a Parisian barrister of thirty-three. His
+father was a heavy drinker, his mother subject to nervous attacks, his
+younger brother mentally deficient, and the patient himself was very
+impressionable. It was said that a judge in a court, by fixing his gaze
+on him, could send him into an abnormal state. On one occasion, while
+looking into a mirror in a cafe, he suddenly fell into a sleep, and was
+taken to the Charite where he was awakened. He suffered occasional loss
+of memory for considerable lengths of time, and underwent a change of
+personality during these times. Though wide awake in such conditions he
+could remember nothing of his past life, and when returned to his
+original state he could remember nothing that occurred during his
+secondary state, having virtually two distinct memories. On September
+23, 1888, he quarreled with his stepfather in Paris and became his
+second self for three weeks.  He found himself in a village 100 miles
+from Paris, remembering nothing about his journey thereto; but on
+inquiry he found that he had paid a visit to the priest of the village
+who thought his conduct odd, and he had previously stayed with an
+uncle, a bishop, in whose house he had broken furniture, torn up
+letters, and had even had sentence passed upon him by a police court
+for misdemeanor. During these three weeks he had spent the equivalent
+of $100, but he could not recall a single item of expenditure.  Davies
+cites a remarkable case of sudden loss of memory in a man who, while on
+his way to Australia, was found by the police in an exhausted condition
+and who was confined in the Kent County Insane Asylum. He suffered
+absolute loss of all memory with the exception of the names of two men
+not close acquaintances, both of whom failed to recognize him in his
+changed condition in confinement. Four months later his memory returned
+and his identity was established.
+
+In the Revue Philosophique for 1885 there are the details of a case of
+a young man who seemed able to assume six states of what might be
+fairly called different personalities. The memories attached to each of
+these states were very different, though only one was completely
+exclusive of the others. The handwriting varied from complete
+competence to complete incompetence. His character varied between
+childish timidity, courteous reserve, and reckless arrogance; and to
+four of his conditions there was a form of hysteric paralysis attached.
+Mere suggestion would not only induce any one of these varied forms of
+paralysis, but also the memories, capacities, and characters habitually
+accompanying it.
+
+A young man named Spencer, an inmate of the Philadelphia Hospital, was
+exhibited before the American Neurological Society in June, 1896, as an
+example of dual personality. At the time of writing he is and has been
+in apparently perfect health, with no evidence of having been in any
+other condition. His faculties seem perfect, his education manifests
+itself in his intelligent performance of the cleric duties assigned to
+him at the hospital, yet the thread of continuous recollection which
+connects the present moment with its predecessors--consciousness and
+memory--has evidently been snapped at some point of time prior to March
+3d and after January 19th, the last date at which he wrote to his
+parents, and as if in a dream, he is now living another life. The
+hospital staff generally believe that the man is not "shamming," as
+many circumstances seem to preclude that theory.  His memory is perfect
+as to everything back to March 3d. The theory of hypnotism was advanced
+in explanation of this case.
+
+The morbid sympathy of twin brothers, illustrated in Dumas's "Corsican
+Brothers," has been discussed by Sedgwick, Elliotson, Trousseau,
+Laycock, Cagentre, and others. Marshall Hall relates what would seem to
+verify the Corsican myth, the history of twin brothers nine months of
+age, who always became simultaneously affected with restlessness,
+whooping and crowing in breathing three weeks previous to simultaneous
+convulsions, etc. Rush describes a case of twin brothers dwelling in
+entirely different places, who had the same impulse at the same time,
+and who eventually committed suicide synchronously. Baunir describes a
+similar development of suicidal tendency in twin brothers. A peculiar
+case of this kind was that of the twin brothers Laustand who were
+nurses in a hospital at Bordeaux; they invariably became ill at the
+same time, and suffered cataract of the lens together.
+
+Automatism has been noticed as a sequel to cranial injuries, and Huxley
+quotes a remarkable case reported by Mesnet. The patient was a young
+man whose parietal bone was partially destroyed by a ball. He exhibited
+signs of hemiplegia on the right side, but these soon disappeared and
+he became subject to periodic attacks lasting from twenty-four to
+forty-eight hours, during which he was a mere automaton. In these
+attacks he walked continually, incessantly moving his jaw, but not
+uttering a word. He was insensible to pain, electric shock, or
+pin-prick. If a pen was placed in his hand he would write a good
+letter, speaking sensibly about current topics. When a cigarette-paper
+was placed in his hand he sought his tobacco box, and adroitly rolled a
+cigarette and lighted it. If the light went out he procured another,
+but would not allow another to substitute a match. He allowed his
+mustache to be burned without resistance, but would not allow a light
+to be presented to him. If chopped charpie was put in his pocket
+instead of tobacco he knew no difference. While in his periods of
+automatism he was in the habit of stealing everything within his grasp.
+He had been a concert singer, and a peculiar fact was that if given
+white gloves he would carefully put them on and commence a pantomime of
+the actions of a singer, looking over his music, bowing, assuming his
+position, and then singing.
+
+It is particularly in hypnotic subjects that manifestations of
+automatism are most marked. At the suggestion of battle an imaginary
+struggle at once begins, or if some person present is suggested as an
+enemy the fight is continued, the hypnotic taking care not to strike
+the person in question. Moll conceded that this looked like simulation,
+but repetition of such experiments forced him to conclude that these
+were real, typical hypnoses, in which, in spite of the sense-delusions,
+there was a dim, dreamy consciousness existing, which influenced the
+actions of the subject, and which prevented him from striking at a
+human being, although hitting at an imaginary object. Many may regard
+this behavior of hypnotics as pure automatism; and Moll adds that, as
+when walking in the street while reading we automatically avoid
+knocking passers-by, so the hypnotic avoids hitting another person,
+although he is dimly or not at all aware of his existence.
+
+Gibbs reports a curious case of lack of integrity of the will in a man
+of fifty-five. When he had once started on a certain labor he seemed to
+have no power to stop the muscular exercise that the task called forth.
+If he went to the barn to throw down a forkful of hay, he would never
+stop until the hay was exhausted or someone came to his rescue. If sent
+to the wood-pile for a handful of wood, he would continue to bring in
+wood until the pile was exhausted or the room was full. On all
+occasions his automatic movements could only be stopped by force.
+
+At a meeting in Breslau Meschede rendered an account of a man who
+suffered from simple misdirection of movement without any mental
+derangement. If from his own desire, or by direction of others, he
+wanted to attempt any muscular movement, his muscles performed the
+exact opposite to his inclinations. If he desired to look to the right,
+his eyes involuntarily moved to the left. In this case the movement was
+not involuntary, as the muscles were quiet except when called to action
+by the will, and then they moved to the opposite.
+
+Presentiment, or divination of approaching death, appearing to be a
+hypothetic allegation, has been established as a strong factor in the
+production of a fatal issue in many cases in which there was every hope
+for a recovery. In fact several physicians have mentioned with dread
+the peculiar obstinacy of such presentiment.  Hippocrates, Romanus,
+Moller, Richter, Jordani, and other older writers speak of it.
+Montgomery reports a remarkable case of a woman suffering from
+carcinoma of the uterus. He saw her on October 6, 1847, when she told
+him she had a strong presentiment of death on October 28th. She stated
+that she had been born on that day, her first husband had died on
+October 28th, and she had married her second husband on that day. On
+October 27th her pulse began to fail, she fell into a state of extreme
+prostration, and at noon on the 28th she died. In substantiation of the
+possibility of the influence of presentiment Montgomery cites another
+case in which he was called at an early hour to visit a lady, the
+mother of several children. He found her apparently much agitated and
+distressed, and in great nervous excitement over a dream she had had,
+in which she saw a handsome monument erected by some children to their
+mother. She had awakened and became dreadfully apprehensive, she could
+not tell as to what.  The uneasiness and depression continued, her
+pulse continued to grow weak, and she died at twelve that night without
+a struggle.  Andrews has made several observations on this subject, and
+concludes that presentiment of death is a dangerous symptom, and one
+which should never be overlooked. One of his cases was in a man with a
+fractured leg in the Mercy Hospital at Pittsburg. The patient was in
+good health, but one day he became possessed of a cool, quiet, and
+perfectly clear impression that he was about to die. Struck with his
+conviction, Andrews examined his pulse and general condition minutely,
+and assured the patient there was not the slightest ground for
+apprehension. But he persisted, and was attacked by pneumonia three
+days later which brought him to the verge of the grave, although he
+ultimately recovered. In another instance a young man of ruddy
+complexion and apparent good health, after an operation for varicocele,
+had a very clear impression that he would die. Careful examination
+showed no reason for apprehension. After five or six days of
+encouragement and assurance, he appeared to be convinced that his
+reasoning was foolish, and he gave up the idea of death. About the
+ninth day the wound presented a healthy, rosy appearance, and as the
+patient was cheerful he was allowed to leave his bed. After a few hours
+the nurse heard the noise of labored breathing, and on investigation
+found the patient apparently in a dying condition.  He was given
+stimulants and regained consciousness, but again relapsed, and died in
+a few moments. At the necropsy the heart was found healthy, but there
+were two or three spots of extravasated blood in the brain, and
+evidences of cerebral congestion. Vos remarks that he remembers a case
+he had when dressing for Mr. Holden at St. Bartholomew's Hospital: "A
+man who had been intemperate was rolling a sod of grass, and got some
+grit into his left palm. It inflamed; he put on hot cow-dung poultices
+by the advice of some country friends. He was admitted with a
+dreadfully swollen hand. It was opened, but the phlegmonous process
+spread up to the shoulder, and it was opened in many places, and at
+last, under chloroform, the limb was amputated below the joint. The
+stump sloughed, and pus pointing at the back of the neck, an opening
+was again made. He became in such a weak state that chloroform could
+not be administered, and one morning he had such a dread of more
+incisions that, saying to us all standing round his bed, 'I can bear it
+no more, I must now die,' he actually did die in a few minutes in our
+presence. His was the last arm that Mr. Holden ever amputated at St.
+Bartholomew's."
+
+
+
+CHAPTER XVIII.
+
+HISTORIC EPIDEMICS.
+
+A short history of the principal epidemics, including as it does the
+description of anomalous diseases, many of which are now extinct, and
+the valuable knowledge which finally led to their extinction, the
+extraordinary mortalities which these epidemics caused, and many other
+associate points of interest would seem fitting to close the
+observations gathered in this volume. As the illustrious Hecker says,
+in the history of every epidemic, from the earliest times, the spirit
+of inquiry was always aroused to learn the machinery of such stupendous
+engines of destruction; and even in the earliest times there was
+neither deficiency in courage nor in zeal for investigation. "When the
+glandular plague first made its appearance as a universal epidemic,
+whilst the more pusillanimous, haunted by visionary fears, shut
+themselves up in their closets, some physicians at Constantinople,
+astonished at the phenomena opened the boils of the deceased. The like
+has occurred both in ancient and modern times, not without favorable
+results for Science; nay, more mature views excited an eager desire to
+become acquainted with similar or still greater visitations among the
+ancients, but, as later ages have always been fond of referring to
+Grecian antiquity, the learned of those times, from a partial and
+meagre predilection, were contented with the descriptions of
+Thucydides, even where nature had revealed, in infinite diversity, the
+workings of her powers."
+
+There cannot but be a natural interest in every medical mind to-day in
+the few descriptions given of the awful ravages of the epidemics which,
+fortunately, in our enlightened sanitary era, have entirely
+disappeared. In the history of such epidemics the name of Hecker stands
+out so prominently that any remarks on this subject must necessarily,
+in some measure, find their origin in his writings, which include
+exhaustive histories of the black death, the dancing mania, and the
+sweating sickness. Few historians have considered worthy of more than a
+passing note an event of such magnitude as the black death, which
+destroyed millions of the human race in the fourteenth century and was
+particularly dreadful in England. Hume has given but a single paragraph
+to it and others have been equally brief. Defoe has given us a journal
+of the plague, but it is not written in a true scientific spirit; and
+Caius, in 1562, gave us a primitive treatise on the sweating sickness.
+It is due to the translation of Hecker's "Epidemics of the Middle Ages"
+by Babbington, made possible through the good offices of the Sydenham
+Society, that a major part of the knowledge on this subject of the
+English-reading populace has been derived.
+
+The Black Death, or, as it has been known, the Oriental plague, the
+bubonic plague, or in England, simply the plague, and in Italy, "la
+Mortalega" (the great mortality) derived its name from the Orient; its
+inflammatory boils, tumors of the glands, and black spots, indicative
+of putrid decomposition, were such as have been seen in no other
+febrile disease. All the symptoms were not found in every case, and in
+many cases one symptom alone preceded death. Although afflicted with
+all the manifestations of the plague, some patients recovered.
+According to Hecker the symptoms of cephalic affliction were seen; many
+patients were stupefied and fell into a deep sleep, or became
+speechless from palsy of the tongue, while others remained sleepless
+and without rest. The fauces and tongue were black and as if suffused
+with blood; no beverage could assuage the burning thirst, so that
+suffering continued without alleviation until death, which many in
+their despair accelerated with their own hands. Contagion was evident,
+for attendants caught the disease from their parents and friends, and
+many houses were emptied of their inhabitants. In the fourteenth
+century this affection caused still deeper sufferings, such as had not
+been hitherto experienced. The organs of respiration became the seats
+of a putrid inflammation, blood was expectorated, and the breath
+possessed a pestiferous odor. In the West an ardent fever, accompanied
+by an evacuation of blood, proved fatal in the first three days. It
+appears that buboes and inflammatory boils did not at first appear, but
+the disease in the form of carbuncular affection of the lungs (anthrax
+artigen) caused the fatal issue before the other symptoms developed.
+Later on in the history of the plague the inflammatory boils and buboes
+in the groins and axillae were recognized at once as prognosticating a
+fatal issue.
+
+The history of this plague extends almost to prehistoric times.  There
+was a pest in Athens in the fifth century before Christ.  There was
+another in the second century, A.D., under the reign of Marcus
+Aurelius, and again in the third century, under the reign of the Gauls;
+following this was the terrible epidemic of the sixth century, which,
+after having ravaged the territory of the Gauls, extended westward. In
+542 a Greek historian, Procopius, born about the year 500, gives a good
+description of this plague in a work, "Pestilentia Gravissima," so
+called in the Latin translation. Dupouy in "Le Moyen Age Medical," says
+that it commenced in the village of Peleuse, in Egypt, and followed a
+double course, one branch going to Alexandria and the other to
+Palestine. It reached Constantinople in the Spring of 543, and produced
+the greatest devastation wherever it appeared. In the course of the
+succeeding half century this epidemic became pandemic and spread over
+all the inhabited earth. The epidemic lasted four months in
+Constantinople, from 5000 to 10,000 people dying each day. In his
+"History of France," from 417 to 591, Gregorius speaks of a malady
+under the name inguinale which depopulated the Province of Arles. In
+another passage this illustrious historian of Tours says that the town
+of Narbonne was devastated by a maladie des aines. We have records of
+epidemics in France from 567 to 590, in which bubonic symptoms were a
+prominent feature. About the middle of the fourteenth century the
+bubonic plague made another incursion from the East. In 1333, fifteen
+years before the plague appeared in Europe, there were terrible
+droughts in China followed by enormous floods in which thousands of
+people perished. There are traditions of a plague in Tche in 1334,
+following a drought, which is said to have carried off about 5,000,000
+people. During the fifteen years before the appearance of the plague in
+Europe there were peculiar atmospheric phenomena all over the world,
+besides numerous earthquakes. From the description of the stinking
+atmosphere of Europe itself at this time it is quite possible that part
+of the disease came, not from China, but originated in Southern Europe
+itself. From China the route of caravans ran to the north of the
+Caspian Sea, through Asia, to Tauris. Here ships were ready to take the
+produce of the East to Constantinople, the capital of commerce, and the
+medium of communication between Europe, Asia, and Africa. Other
+caravans went from Europe to Asia Minor and touched at the cities south
+of the Caspian Sea, and lastly there were others from Bagdad through
+Arabia to Egypt; the maritime communication on the Red Sea to Arabia
+and Egypt was also not inconsiderable. In all these directions
+contagion found its way, though doubtless Constantinople and the
+harbors of Asia Minor were the chief foci of infection, whence it
+radiated to the most distant seaports and islands. As early as 1347 the
+Mediterranean shores were visited by the plague, and in January, 1348,
+it appeared in the south of France, the north of Italy, and also in
+Spain. Place after place was attacked throughout the year, and after
+ravishing the whole of France and Germany, the plague appeared in
+England, a period of three months elapsing before it reached London.
+The northern kingdoms were attacked in 1349, but in Russia it did not
+make its appearance before 1351.
+
+As to the mortality of this fearful epidemic Dupony considers that in
+the space of four years more than 75,000,000 fell victims, that is,
+about half of the population of the countries visited. Hecker estimates
+that from 1347 to 1351, 25,000,000 people died, or one-quarter of the
+total population of Europe. It was reported to Pope Clement that
+throughout the East, probably with the exception of China, nearly
+24,000,000 people had fallen victims to the plague. Thirteen millions
+are said to have died in China alone. Constantinople lost two-thirds of
+its population.  When the plague was at its greatest violence Cairo
+lost daily from 10,000 to 15,000, as many as modern plagues have
+carried off during their whole course. India was depopulated. Tartary,
+Mesopotamia, Syria, Armenia, and Arabia were covered with dead bodies.
+In this latter country Arabian historians mention that Maara el nooman,
+Schisur, and Harem in some unaccountable manner remained free. The
+shores of the Mediterranean were ravaged and ships were seen on the
+high seas without sailors. In "The Decameron" Boccaccio gives a most
+graphic description of the plague and states that in Florence, in four
+months, 100,000 perished; before the calamity it was hardly supposed to
+contain so many inhabitants. According to Hecker, Venice lost 100,000;
+London, 100,000; Paris, 50,000; Siena, 70,000; Avignon, 60,000;
+Strasburg, 16,000; Norwich, 51,100. Dupony says that in one month there
+were 56,000 victims in Marseilles, and at Montpellier three-quarters of
+the population and all the physicians were stricken with the epidemic.
+
+Johanna of Burgundy, wife of King Philip VI of Valois; Johanna II,
+Queen of Navarre, granddaughter of Philippe le Bel; Alphonse XI of
+Castile, and other notable persons perished. All the cities of England
+suffered incredible losses. Germany seems to have been particularly
+spared; according to a probable calculation, only about 1,250,000
+dying. Italy was most severely visited, and was said to have lost most
+of its inhabitants. In the north of Europe two of the brothers of
+Magnus, King of Sweden, died; and in Westgothland alone 466 priests
+died. The plague showed no decrease in the northern climates of Iceland
+and Greenland, and caused great havoc in those countries.
+
+The moral effect of such a great pandemic plague can be readily
+surmised. The mental shock sustained by all nations during the
+prevalence of the black plague is beyond parallel and description. An
+awful sense of contrition and repentance seized Christians of every
+community. They resolved to forsake their vices, and to make
+restitution for past offenses; hence extreme religious fanaticism held
+full sway throughout Europe. The zeal of the penitents stopped at
+nothing. The so-called Brotherhood of the Cross, otherwise known as the
+Order of Flagellants, which had arisen in the thirteenth century, but
+was suppressed by the mandates and strenuous efforts of the Church, was
+revived during the plague, and numbers of these advocates of
+self-chastisement roamed through the various countries on their great
+pilgrimages.  Their power increased to such an extent that the Church
+was in considerable danger, for these religious enthusiasts gained more
+credit among the people, and operated more strongly on their minds than
+the priests from whom they so entirely withdrew that they even absolved
+each other. Their strength grew with such rapidity, and their numbers
+increased to such an extent daily, that the State and the Church were
+forced to combine for their suppression. Degeneracy, however, soon
+crept in, crimes were committed, and they went beyond their strength in
+attempting the performance of miracles. One of the most fearful
+consequences of this frenzy was the persecution of the Jews. This alien
+race was given up to the merciless fury and cruelty of the populace.
+The persecution of the Jews commenced in September and October, 1348,
+at Chillon on Lake Geneva, where criminal proceedings were instituted
+against them on the mythic charge of poisoning the public wells. These
+persecuted people were summoned before sanguinary tribunals, beheaded
+and burned in the most fearful manner. At Strasburg 2000 Jews were
+burned alive in their own burial-ground, where a large scaffold had
+been erected, their wealth being divided among the people. In Mayence
+12,000 Jews were said to have been put to a cruel death. At Eslingen
+the whole Jewish community burned themselves in their synagogue, and
+mothers were often seen throwing their children on the pile, to prevent
+them from being baptized, and then precipitating themselves into the
+flames. The cruel and avaricious desires of the monarchs against these
+thrifty and industrious people added fuel to the flames of the popular
+passion, and even a fanatic zeal arose among the Jews to perish as
+martyrs to their ancient religion. When we sum up the actual effects as
+well as the after effects of the black death, we are appalled at the
+magnitude of such a calamity, the like of which the world had never
+seen before.
+
+In the fifteenth and sixteenth centuries the plague was generally
+diffused throughout Europe, and in the latter half of the seventeenth
+century a final Occidental incursion of the plague took place. From
+1603 to 1604 over 30,000 people perished in London from the plague, and
+in 1625 the mortality in that city amounted to 35,417 persons. But the
+great plague of London did not begin until 1664. In this plague the
+patient at first became sensible of great weariness and fatigue, had
+slight chills, nausea, vomiting, vertigo, and pains in the loins. The
+mental disturbance rapidly increased, and stupor and delirium ensued.
+The face was alternately flushed and pallid, and a sense of
+constriction was experienced in the region of the heart. Darting pains
+were felt all over the body, soon followed by the enlargement of the
+lymphatic glands, or by the formation of carbuncles in various parts of
+the body. About the third day the tongue became dry and brown, and the
+gums, tongue, and teeth were covered with a dark fur, and the
+excretions became offensive; paralysis intervened; ecchymosed patches
+or stripes due to extravasation appeared on the skin; finally the pulse
+sank, the body grew cold and clammy, delirium or coma seized the
+victim, and in five or six days, sometimes in two or three, the painful
+struggle was at an end.
+
+It was supposed that the disease originated in the Orient and was
+brought to London from Holland. In his "Journal of the Plague in
+London" Defoe describes its horrors, and tells of the dead-cart which
+went through the streets gathering the victims. A few extracts from
+Pepys's "Diary," the evidence of an eye-witness and a contemporary,
+show the ghastly aspects of this terrible visitation. On August 31st he
+writes: "In the City, this week, died 7496, and of them 6102 died of
+the plague. But it is found that the true number of the dead this week
+is nearer 10,000; partly from the poor who cannot be taken care of
+through the greatness of the number, and partly from the Quakers and
+others that will not have any bell rung for them." According to Adams,
+John Evelyn noted in his "Kalendarium":--"Sept. 7th.--Near 10,000 now
+died weekly; however, I went all along the City and suburbs from Kent
+street to St. James's, a dismal passage, and dangerous to see so many
+coffins exposed in the streets; the streets thin of people, the shops
+shut up, and all in silence, no one knowing whose turn might be next."
+
+As the cold weather came on the plague diminished in intensity and the
+people regained their confidence and returned to the city. According to
+Adams, in the first week of March, 1666, deaths by the plague had
+decreased to 42; and by the end of the month it was nearly extinct
+after carrying off about 100,000 victims. In our days we can hardly
+comprehend the filthy hygienic conditions under which the people in the
+cities lived, and it was probably to this fact that the growth and
+perpetuation of this plague was due.
+
+As to the bubonic plague recently raging in Camptown, China, Mary Niles
+says that it was the same disease as the great London plague, and was
+characterized mainly by glandular enlargement. It had not appeared in
+the Canton district for forty years or more, though it was endemic in
+Yunnan. In some places it began in the winter; and as early as January
+she herself found the first case in Canton in an infected house. In no
+case was direct contagiousness found to exist. The glands enlarged
+twelve hours after the fever began, and sometimes suppurated in
+nonfatal cases in a short time. Kitasato has recently announced the
+discovery of the specific cause of the bubonic plague.
+
+Sweating Sickness.--According to Hecker, very shortly after Henry's
+triumphant march from Bosworth Field, and his entry into the capital on
+August 8, 1485, the sweating sickness began its ravages among the
+people of the densely populated city. According to Lord Bacon the
+disease began about September 21st, and lasted to the end of October,
+1485. The physicians could do little or nothing for the people, and
+seemed to take no account of the clinical history of the disease,--in
+this respect not unlike the Greek physicians who for four hundred years
+paid no attention to small-pox because they could find no description
+of it in the immortal works of Galen. The causes seemed to be
+uncleanliness, gluttony, immoderate drinking, and also severe
+inundations leaving decaying vegetation. Richmond's army has been
+considered a factor in the germination of the seeds of pestilent
+disorder which broke out soon after in the camps of Litchfield, and on
+the banks of the Severn.
+
+Sweating sickness was an inflammatory rheumatic fever, with great
+disorder of the nervous system, and was characterized by a profuse and
+injurious perspiration. In the English epidemic the brain, meninges,
+and the nerves were affected in a peculiar manner. The functions of the
+pneumogastric nerves were violently disordered in this disease, as was
+shown by the oppressed respiration and extreme anxiety, with nausea and
+vomiting,--symptoms to which modern physicians attach much importance.
+The stupor and profound lethargy show that there was an injury to the
+brain, to which, in all probability, was added a stagnation of black
+blood in the torpid veins. Probably decomposing blood gave rise to the
+offensive odor of the person.  The function of the lungs was
+considerably impaired. The petechial fever in Italy in 1505 was a form
+of the sweating sickness. There were visitations in 1506 and in 1515 in
+England.  In 1517 the disease lasted full six months and reached its
+greatest height about six weeks after its appearance, but was
+apparently limited to England. Meningeal symptoms were characteristic
+of the third visitation of the disease. In 1528 and 1529 there was a
+fourth visitation which resulted in the destruction of the French Army
+before Naples. It is said that in 1524 a petechial fever carried off
+50,000 people in Milan, and possibly this was the same disease. In 1529
+the disease had spread all over Europe, attended with great mortality.
+
+Germany, France, and Italy were visited equally. The famine in Germany,
+at this time, is described by authorities in a tone of deep sympathy.
+Swabia, Lorraine, Alsace, and provinces on the border of the lower
+Rhine, were frightfully affected, so that the disease reached the same
+heights there as in France. In England Henry VIII endeavored to avoid
+the epidemic by continual traveling, until at last he grew tired of so
+unsettled a life and determined to await his destiny at Tytynhangar. It
+was not the inhabitants of the land alone who were affected, but even
+fish and the fowls of the air sickened. According to Schiller, in the
+neighborhood of Freiburg in Breisgau, dead birds were found scattered
+under the trees with boils as large as peas under their
+wings,--indicating among them a disease, and this extended far beyond
+the southern districts of the Rhine. The disease was undoubtedly of a
+miasmatic infectious nature, as was proved by its rapid spread and the
+occasional absence of a history of contagion. It was particularly
+favored in its development by high temperature and humidity.
+
+The moral effect of the sweating sickness, similar to that of the black
+plague, was again to increase religious fanaticism and recreate the
+zeal of persecution.
+
+On the 15th of April, 1551, there was an outbreak of the fifth and last
+epidemic of sweating fever in Shrewsbury, on the Severn.  With stinking
+mists it gradually spread all over England, and on the 9th of July it
+reached London. The mortality was very considerable. The English
+residents were particularly susceptible, foreigners being comparatively
+exempt. The epidemic terminated about the 30th of September. Since that
+time the sweating sickness has never reappeared in England; but in the
+beginning of the eighteenth century a disease very similar in symptoms
+and course broke out in Picardy, in Northern France.  Toward the end of
+the century it spread to the South of France, and since that time has
+appeared epidemically, 195 distinct outbreaks having been observed in
+the course of one hundred and sixty-nine years, from 1618 to 1787. The
+disease has frequently appeared in Italy since 1755, and in various
+parts of Germany since 1801. In Belgium it has been observed in a few
+places within the present century (Rohe).
+
+Chronologic Table of the Principal Plagues.--In December, 1880, H. P.
+Potter, F.R.C.S., published a chronologic table of some of the
+principal plagues on record. In comments on his table, Potter says that
+he has doubtless included mention of many plagues which, although
+described under that name, are probably a dissimilar disease, writers
+having applied the terms pestilential and pestilent in a generic sense
+to diseases specifically different. It must also be remembered that, in
+some cases, death must have been due to famine, want, and privation,
+which are so frequently coexistent with pestilence. Following the idea
+of Hecker, the dancing manias have been included in this table.
+
+{table omitted}
+
+Small-pox.--From certain Chinese records it appears that small-pox, or
+a disease with similar symptoms, was known in China before the
+Christian era, and it was supposed to have been known at a very early
+period in India. Most likely it was introduced into Europe in the
+second century by a Roman army returning from Asia. Before the sixth
+century, the terrible century of the great plague, there seem to be no
+records of small-pox or other eruptive fevers. Neither Hippocrates,
+Galen, nor the Greek physicians who practiced at Rome, mention
+small-pox, although it is now believed that the Emperor Marcus Aurelius
+died of this disease. According to Dupony, the first document
+mentioning variola was in 570 A.D., by Marius, a scholar of Avenches,
+in Switzerland. ("Anno 570, morbus validus cum profluvio ventris, et
+variola, Italiam Galliamque valde affecit.") Ten years later Gregory of
+Tours describes an epidemic with all the symptoms of small-pox in the
+fifth reign of King Childebert (580); it started in the region of
+Auvergne, which was inundated by a great flood; he also describes a
+similar epidemic in Touraine in 582. Rhazes, or as the Arabs call him,
+Abu Beer Mohammed Ibn Zacariya Ar-Razi, in the latter part of the ninth
+century wrote a most celebrated work on small-pox and measles, which is
+the earliest accurate description of these diseases, although Rhazes
+himself mentions several writers who had previously described them, and
+who had formulated rules for their cure. He explained these diseases by
+the theory of fermentation, and recommended the cooling treatment.
+Adams remarks that although it is probable that small-pox existed for
+ages in Hindoostan and China, being completely isolated in those
+countries from the European world, it was not introduced into the West
+until the close of the seventh century. Imported into Egypt by the
+Arabians, it followed in the tracks of their conquests, and was in this
+way propagated over Europe. The foregoing statement disagrees with
+Dupony and others. It is well known that small-pox was prevalent in
+Europe before Rhazes's description of it, and after the Crusades it
+spread over Central and Western Europe, but did not extend to the
+northern countries until some years later. In 1507 the Spaniards
+introduced it into San Domingo, and in 1510 into Mexico, where it
+proved a more fatal scourge than the swords of Cortez and his
+followers, for according to Robertson it swept away in Mexico three
+millions and a half of people. In 1707 it appeared in Iceland, and
+carried off more than one-fourth of its inhabitants; in 1733, according
+to Collinson, it almost depopulated Greenland.  The Samoyeds, Ostiaks,
+and other natives of Eastern Siberia, have frequently suffered from
+devastating epidemics. In Kamchatka the disease was introduced in 1767,
+and many villages were completely depopulated. According to Moore, at
+the beginning of the eighteenth century nearly one-fourteenth of the
+population died from small-pox in England, and at the end of the
+century the number of the victims had increased to one-tenth. In the
+last century the statement was made in England that one person in every
+three was badly pock-marked. The mortality of the disease at the latter
+half of the eighteenth century was about three to every thousand
+inhabitants annually. India has always been a fertile ground for the
+development of small-pox, and according to Rohe the mortality from
+small-pox has been exceedingly great for the past twenty years. From
+1866 to 1869, 140,000 persons died in the Presidencies of Bombay and
+Calcutta, and several years later, from 1873 to 1876, 700,000 died from
+this disease. China, Japan, and the neighboring countries are
+frequently visited with small-pox, and nearly all the inhabitants of
+Corea are said to bear evidences of the disease. In the Marquesas
+Islands one-fourth of the inhabitants had fallen victims to the disease
+since 1863. It was first introduced into the Sandwich Islands in 1853,
+and it then carried off eight per cent of the natives.  Australia,
+Tasmania, New Zealand, and the Fiji Archipelago have to the present day
+remained exempt from small-pox; although it has been carried to
+Australia in vessels, rigorous quarantine methods have promptly checked
+it. On the American continent it was believed that small-pox was
+unknown until the conquest of Mexico. It has been spread through
+various channels to nearly all the Indian tribes of both North and
+South America, and among these primitive people, unprotected by
+inoculation or vaccination, its ravages have been frightful.
+
+That small-pox a disease so general and so fatal at one time--has,
+through the ingenuity of man, in civilized communities at least, become
+almost extinct, is one of the greatest triumphs of medicine.
+
+Inoculation was known in Europe about 1700, and in 1717 the famous
+letter of Lady Montagu from Adrianople was issued, containing in part
+the following statements:--
+
+"The small-pox, so fatal and so general amongst us, is here entirely
+harmless, by the invention of ingrafting, which is the term they give
+it. There is a set of old women who make it their business to perform
+the operation every autumn in the month of September, when the great
+heat is abated. People send to one another to know if any of their
+family has a mind to have the small-pox; they make parties for this
+purpose, and when they are met, the old woman comes with a nut-shell
+full of the matter of the best sort of small-pox, and asks what vein
+you please to have opened. She immediately rips open that you offer her
+with a large needle, and puts into the vein as much matter as can lie
+upon the head of her needle, and after that binds up the little wound
+with a hollow shell, and in this manner opens four or five veins."
+
+Soon after this letter Lady Montagu had her son inoculated in Turkey,
+and four years later her daughter was to be the first subject
+inoculated in England. She made rapid progress notwithstanding the
+opposition of the medical profession, and the ignorance and credulity
+of the public. The clergy vituperated her for the impiety of seeking to
+control the designs of Providence.  Preaching in 1722, the Rev. Edward
+Massey, for example, affirmed that Job's distemper was confluent
+small-pox, and that he had been inoculated by the Devil. Lady Montagu,
+however, gained many supporters among the higher classes. In 1721 Mead
+was requested by the Prince of Wales to superintend the inoculation of
+some condemned criminals, the Prince intending afterward to continue
+the practice in his own family; the experiment was entirely successful,
+and the individuals on whom it was made afterward received their
+liberty (Adams).
+
+According to Rohe, inoculation was introduced into this country in 1721
+by Dr. Zabdiel Boylston of Boston, who had his attention directed to
+the practice by Cotton Mather, the eminent divine.  During 1721 and
+1722 286 persons were inoculated by Boylston and others in
+Massachusetts, and six died. These fatal results rendered the practice
+unpopular, and at one time the inoculation hospital in Boston was
+closed by order of the Legislature. Toward the end of the century an
+inoculating hospital was again opened in that city.
+
+Early in the eighteenth century inoculation was extensively practiced
+by Dr. Adam Thomson of Maryland, who was instrumental in spreading a
+knowledge of the practice throughout the Middle States.
+
+Despite inoculation, as we have already seen, during the eighteenth
+century the mortality from small-pox increased. The disadvantage of
+inoculation was that the person inoculated was affected with a mild
+form of small-pox, which however, was contagious, and led to a virulent
+form in uninoculated persons.  As universal inoculation was manifestly
+impracticable, any half-way measure was decidedly disadvantageous, and
+it was not until vaccination from cow-pox was instituted that the first
+decided check on the ravages of small-pox was made.
+
+Vaccination was almost solely due to the persistent efforts of Dr.
+Edward Jenner, a pupil of the celebrated John Hunter, born May 17, 1749.
+
+In his comments on the life of Edward Jenner, Adams, in "The Healing
+Art," has graphically described his first efforts to institute
+vaccination, as follows: "To the ravages of small-pox, and the
+possibility of finding some preventive Jenner had long given his
+attention. It is likely enough that his thoughts were inclined in this
+direction by the remembrance of the sufferings inflicted upon himself
+by the process of inoculation. Through six weeks that process lingered.
+He was bled, purged, and put on a low diet, until 'this barbarism of
+human veterinary practice' had reduced him to a skeleton. He was then
+exposed to the contagion of the small-pox. Happily, he had but a mild
+attack; yet the disease itself and the inoculating operations, were
+probably the causes of the excessive sensitiveness which afflicted him
+through life.
+
+"When Jenner was acting as a surgeon's articled pupil at Sudbury, a
+young countrywoman applied to him for advice. In her presence some
+chance allusion was made to the universal disease, on which she
+remarked: 'I shall never take it, for I have had the cow-pox.' The
+remark induced him to make inquiries; and he found that a pustular
+eruption, derived from infection, appeared on the hands of milkers,
+communicated from the teats of cows similarly disordered; this eruption
+was regarded as a safeguard against small-pox. The subject occupied his
+mind so much that he frequently mentioned it to John Hunter and the
+great surgeon occasionally alluded to it in his lectures, but never
+seems to have adopted Jenner's idea that it might suggest some
+efficacious substitute for inoculation. Jenner, however, continued his
+inquiries, and in 1780 he confided to his friend, Edward Gardner, his
+hope and prayer that it might be his work in life to extirpate smallpox
+by the mode of treatment now so familiar under the name of vaccination.
+
+"At the meetings of the Alveston and Radborough Medical Clubs, of both
+of which Jenner was a member, he so frequently enlarged upon his
+favorite theme, and so repeatedly insisted upon the value of cow-pox as
+a prophylactic, that he was denounced as a nuisance, and in a jest it
+was even proposed that if the orator further sinned, he should then and
+there be expelled. Nowhere could the prophet find a disciple and
+enforce the lesson upon the ignorant; like most benefactors of mankind
+he had to do his work unaided.  Patiently and perseveringly he pushed
+forward his investigations.  The aim he had in view was too great for
+ridicule to daunt, or indifference to discourage him. When he surveyed
+the mental and physical agony inflicted by the disease, and the thought
+occurred to him that he was on the point of finding a sure and certain
+remedy, his benevolent heart overflowed with unselfish gladness.  No
+feeling of personal ambition, no hope or desire of fame, sullied the
+purity of his noble philanthropy. 'While the vaccine discovery was
+progressive,' he writes, 'the joy at the prospect before me of being
+the instrument destined to take away from the world one of its greatest
+calamities, blended with the fond hope of enjoying independence, and
+domestic peace and happiness, were often so excessive, that, in
+pursuing my favorite subject among the meadows, I have sometimes found
+myself in a kind of reverie.  It is pleasant to recollect that those
+reflections always ended in devout acknowledgments to that Being from
+whom this and all other blessings flow.' At last an opportunity
+occurred of putting his theory to the test. On the 14th day of May,
+1796,--the day marks an epoch in the Healing Art, and is not less
+worthy of being kept as a national thanksgiving than the day of
+Waterloo--the cow-pox matter or pus was taken from the hand of one
+Sarah Holmes, who had been infected from her master's cows, and was
+inserted by two superficial incisions into the arms of James Phipps, a
+healthy boy of about eight years of age. The cow-pox ran its ordinary
+course without any injurious effect, and the boy was afterward
+inoculated for the small-pox,--happily in vain. The protection was
+complete; and Jenner thenceforward pursued his experiments with
+redoubled ardor. His first summary of them, after having been examined
+and approved by several friends, appeared under the title of 'An
+Inquiry into the Causes and Effects of the Variolae Vaccinae,' in June,
+1798. In this important work he announced the security against the
+small-pox afforded by the true cow-pox, and proceeded to trace the
+origin of that disease in the cow to a similar affection of the horse's
+heel."
+
+This publication produced a great sensation in the medical world, and
+vaccination spread so rapidly that in the following summer Jenner had
+the indorsement of the majority of the leading surgeons of London.
+Vaccination was soon introduced into France, where Napoleon gave
+another proof of his far-reaching sagacity by his immediate recognition
+of the importance of vaccination. It was then spread all over the
+continent; and in 1800 Dr. Benjamin Waterhouse of Boston introduced it
+into America; in 1801, with his sons-in-law, President Jefferson
+vaccinated in their own families and those of their friends nearly 200
+persons. Quinan has shown that vaccination was introduced into Maryland
+at least simultaneously with its introduction into Massachusetts. De
+Curco introduced vaccination into Vienna, where its beneficial results
+were displayed on a striking scale; previously the average annual
+mortality had been about 835; the number now fell to 164 in 1801, 61 in
+1802, and 27 in 1803. After the introduction of vaccination in England
+the mortality was reduced from nearly 3000 per million inhabitants
+annually to 310 per million annually. During the small-pox epidemic in
+London in 1863, Seaton and Buchanan examined over 50,000 school
+children, and among every thousand without evidences of vaccination
+they found 360 with the scars of small-pox, while of every thousand
+presenting some evidence of vaccination, only 1.78 had any such traces
+of small-pox to exhibit. Where vaccination has been rendered
+compulsory, the results are surprising. In 1874 a law was established
+in Prussia that every child that had not already had small-pox must be
+vaccinated in the first year of its life, and every pupil in a private
+or public institution must be revaccinated during the year in which his
+or her twelfth birthday occurs. This law virtually stamped small-pox
+out of existence; and according to Frolich not a single death from
+small-pox occurred in the German army between 1874 and 1882.
+Notwithstanding the arguments advanced in this latter day against
+vaccination, the remembrance of a few important statistic facts is all
+that is necessary to fully appreciate the blessing which Jenner
+conferred upon humanity. In the last century, besides the enormous
+mortality of small-pox (it was computed that, in the middle of the last
+century, 2,000,000 victims perished in Russia from small-pox), the
+marks of affliction, blindness, deafness, etc., were plain in at least
+one member of every family.
+
+Asiatic cholera probably originated centuries ago in India, where it is
+now endemic and rages to such an extent as to destroy 750,000
+inhabitants in the space of five years. There is questionable evidence
+of the existence of cholera to be found in the writings of some of the
+classic Grecian and Indian authors, almost as far back as the beginning
+of the Christian era. In the sixteenth and seventeenth centuries
+travelers in the East gave accounts of this disease. Sonnerat, a French
+traveler, describes a pestilence having all the characteristics of
+Asiatic cholera which prevailed in the neighborhood of Pondicherry and
+the Coromandel coast from 1768 to 1769, and which, within a year,
+carried off 60,000 of those attacked. According to Rohe, Jasper Correa,
+an officer in Vasco da Gama's expedition to Calicut, states that
+Zamorin, the chief of Calicut, lost 20,000 troops by the disease.
+Although cholera has frequently extended to Europe and America, its
+ravages have never been nearly as extensive as in the Oriental
+outbreaks. An excellent short historic sketch of the epidemics of the
+cholera observed beyond the borders of India has been given by Rohe. In
+1817 cholera crossed the boundaries of India, advancing southeasterly
+to Ceylon, and westerly to Mauritius, reaching the African coast in
+1820. In the following two years it devastated the Chinese Empire and
+invaded Japan, appearing at the port of Nagasaki in 1822. It advanced
+into Asiatic Russia, and appeared as far east as St. Petersburg in
+1830, from whence it spread north to Finland. In 1831 it passed through
+Germany, invading France and the western borders of Europe, entering
+the British Isles in 1832, and crossing the Atlantic Ocean for the
+first time, appeared in Canada, having been carried thence by some
+Irish emigrants.
+
+From Canada it directly made its way to the United States by way of
+Detroit. In the same year (1832) it appeared in New York and rapidly
+spread along the Atlantic coast.
+
+"During the winter of 1832 it appeared at New Orleans, and passed
+thence up the Mississippi Valley. Extending into the Indian country,
+causing sad havoc among the aborigines, it advanced westward until its
+further progress was stayed by the shores of the Pacific Ocean. In 1834
+it reappeared on the east coast of the United States, but did not gain
+much headway, and in the following year New Orleans was again invaded
+by way of Cuba. It was again imported into Mexico in 1833. In 1835 it
+appeared for the first time in South America, being restricted,
+however, to a mild epidemic on the Guiana coast.
+
+"In 1846 the disease again advanced beyond its natural confines,
+reaching Europe by way of Turkey, in 1848. In the autumn of this year
+it also appeared in Great Britain, Belgium, the Netherlands, Sweden,
+and the United States, entering by way of New York and New Orleans. In
+the succeeding two years the entire extent of country east of the Rocky
+Mountains was invaded. During 1851 and 1852 the disease was frequently
+imported by emigrants, who were annually arriving in great numbers from
+the various infected countries of Europe. In 1853 and 1854 cholera
+again prevailed extensively in this country, being, however, traceable
+to renewed importation of infected material from abroad. In the
+following two years it also broke out in numerous South American
+States, where it prevailed at intervals until 1863. Hardly had this
+third great pandemic come to an end before the disease again advanced
+from the Ganges, spreading throughout India, and extending to China,
+Japan, and the East Indian Archipelago, during the years 1863 to 1865.
+In the latter year it reached Europe by way of Malta and Marseilles. It
+rapidly spread over the Continent, and in 1866 was imported into this
+country by way of Halifax, New York, and New Orleans. This epidemic
+prevailed extensively in the Western States, but produced only slight
+ravages on the Atlantic Coast, being kept in check by appropriate
+sanitary measures. In the same year (1866) the disease was also carried
+to South America, and invaded for the first time the states bordering
+on the Rio de la Plata and the Pacific coast of the Continent.
+
+"Cholera never entirely disappeared in Russia during the latter half of
+the sixth decade, and in 1870 it again broke out with violence,
+carrying off a quarter of a million of the inhabitants before dying out
+in 1873. It spread from Russia into Germany and France and was
+imported, in 1873, into this country, entering by way of New Orleans
+and extending up the Mississippi Valley. None of the Atlantic coast
+cities suffered from this epidemic in 1873, and since that year the
+United States has been entirely free from the disease, with the
+exception of a few imported cases in New York harbor in 1887" (and in
+1893). In 1883 an epidemic of cholera raged in Egypt and spread to many
+of the Mediterranean ports, and reappeared in 1885 with renewed
+violence. In Spain alone during this latter epidemic the total number
+of cases was over one-third of a million, with nearly 120,000 deaths.
+In 1886 cholera caused at least 100,000 deaths in Japan. In the latter
+part of 1886 cholera was carried from Genoa to Buenos Ayres, and
+crossing the Andean range invaded the Pacific coast for a second time.
+In Chili alone there were over 10,000 deaths from cholera in the first
+six months of 1887. Since then the entire Western hemisphere has been
+virtually free from the disease.
+
+In 1889 there was an epidemic of cholera in the Orient; and in 1892 and
+1893 it broke out along the shores of the Mediterranean, invading all
+the lines of commerce of Europe, Hamburg in the North and Marseilles in
+the South being especially affected. In the summer of 1893 a few cases
+appeared in New York Bay and several in New York city, but rigorous
+quarantine methods prevented any further spread.
+
+Typhus fever is now a rare disease, and epidemics are quite infrequent.
+It has long been known under the names of hospital-fever,
+spotted-fever, jail-fever, camp-fever, and ship-fever, and has been the
+regular associate of such social disturbances as overcrowding,
+excesses, famine, and war. For the past eight centuries epidemics of
+typhus have from time to time been noticed, but invariably can be
+traced to some social derangement.
+
+Yellow Fever is a disease prevailing endemically in the West Indies and
+certain sections of what was formerly known as the Spanish Main.
+Guiteras recognizes three areas of infection:--
+
+(1) The focal zone from which the disease is never absent, including
+Havana, Vera Cruz, Rio, and the other various Spanish-American points.
+
+(2) The perifocal zone, or regions of periodic epidemics, including the
+ports of the tropical Atlantic and Africa.
+
+(3) The zone of accidental epidemics, between the parallels of 45
+degrees north and 35 degrees south latitude.
+
+In the seventeenth century Guadaloupe, Dominica, Martinique, and
+Barbadoes suffered from epidemics of yellow fever. After the first half
+of the seventeenth century the disease was prevalent all through the
+West Indies. It first appeared in the United States at the principal
+ports of Boston, Philadelphia, and Charleston, in 1693, and in 1699 it
+reappeared in Philadelphia and Charleston, and since that time many
+invasions have occurred, chiefly in the Southern States.
+
+The epidemic of 1793 in Philadelphia, so graphically described by
+Matthew Carey, was, according to Osler, the most serious that has ever
+prevailed in any city of the Middle States. Although the population of
+the city was only 40,000, during the months of August, September,
+October, and November the mortality, as given by Carey, was 4041, of
+whom 3435 died in the months of September and October. During the
+following ten years epidemics of a lesser degree occurred along the
+coast of the United States, and in 1853 the disease raged throughout
+the Southern States, there being a mortality in New Orleans alone of
+nearly 8000. In the epidemic of 1878 in the Southern States the
+mortality was nearly 16,000.  South America was invaded for the first
+time in 1740, and since 1849 the disease has been endemic in Brazil.
+Peru and the Argentine Republic have also received severe visitations
+of yellow fever since 1854. In Cuba the disease is epidemic during
+June, July, and August, and it appears with such certainty that the
+Revolutionists at the present time count more on the agency of yellow
+fever in the destruction of the unacclimated Spanish soldiers than on
+their own efforts.
+
+Leprosy is distinctly a malady of Oriental origin, and existed in
+prehistoric times in Egypt and Judea. It was supposed to have been
+brought into Europe by a Roman army commanded by Pompey, after an
+expedition into Palestine. Leprosy was mentioned by several authors in
+the Christian era. France was invaded about the second century, and
+from that time on to the Crusades the disease gradually increased. At
+this epoch, the number of lepers or ladres becoming so large, they were
+obliged to confine themselves to certain portions of the country, and
+they took for their patron St. Lazare, and small hospitals were built
+and dedicated to this saint. Under Louis VIII 2000 of these hospitals
+were counted, and later, according to Dupony, there were 19,000 in the
+French kingdom. Various laws and regulations were made to prevent the
+spread of the contagion. In 1540 it was said that there were as many as
+660 lepers in one hospital in Paris.
+
+No mention is made in the Hippocratic writings of elephantiasis
+graecorum, which was really a type of leprosy, and is now considered
+synonymous with it. According to Rayer, some writers insist that the
+affection then existed under the name of the Phoenician disease. Before
+the time of Celsus, the poet Lucretius first speaks of elephantiasis
+graecorum, and assigns Egypt as the country where it occurs. Celsus
+gives the principal characteristics, and adds that the disease is
+scarcely known in Italy, but is very common in certain other countries.
+Galen supplies us with several particular but imperfect
+cases--histories of elephantiasis graecorum, with a view to demonstrate
+the value of the flesh of the viper, and in another review he adds that
+the disease is common in Alexandria. Aretaeus has left a very accurate
+picture of the symptoms of elephantiasis graecorum; and Pliny
+recapitulates the principal features and tells us that the disease is
+indigenous in Egypt. The opinion of the contagiousness of elephantiasis
+graecorum which we find announced in Herodotus and Galen is more
+strongly insisted upon by Caelius Aurelianus who recommends isolation
+of those affected.  Paulus aegenita discusses the disease. The Arabian
+writers have described elephantiasis graecorum under the name of juzam,
+which their translators have rendered by the word lepra. Later,
+Hensler, Fernel Pare, Vesalius, Horstius, Forestus, and others have
+discussed it.
+
+The statistics of leprosy in Europe pale before the numbers affected in
+the East. The extent of its former ravages is unknown, but it is
+estimated that at the present day there are over 250,000 lepers in
+India, and the number in China is possibly beyond computation.
+According to Morrow, in 1889 in the Sandwich Islands there were 1100
+lepers in the settlement at Molokai.  Berger states that there were 100
+cases at Key West; and Blanc found 40 cases at New Orleans. Cases of
+leprosy are not infrequently found among the Chinese on the Pacific
+coast, and an occasional case is seen in the large cities of this
+country. At the present day in Europe, where leprosy was once so well
+known, it is never found except in Norway and the far East.
+
+Possibly few diseases have caused so much misery and suffering as
+leprosy. The banishment from all friends and relatives, the
+confiscation of property and seclusion from the world, coupled with
+poverty and brutality of treatment,--all emphasize its physical horror
+a thousandfold. As to the leper himself, no more graphic description
+can be given than that printed in The Ninteenth Century, August, 1884:
+"But leprosy! Were I to describe it no one would follow me. More cruel
+than the clumsy torturing weapons of old, it distorts, and scars, and
+hacks, and maims, and destroys its victim inch by inch, feature by
+feature, member by member, joint by joint, sense by sense, leaving him
+to cumber the earth and tell the horrid tale of a living death, till
+there is nothing left of him. Eyes, voice, nose, toes, fingers, feet,
+hands, one after the other are slowly deformed and rot away, until at
+the end of ten, fifteen, twenty years, it may be, the wretched leper,
+afflicted in every sense himself, and hateful to the sight, smell,
+hearing, and touch of others, dies, despised and the most abject of
+men."
+
+Syphilis.--Heretofore the best evidence has seemed to prove that
+syphilis had its origin in 1494, during the siege of Naples by Charles
+VIII of France; but in later days many investigators, prominent among
+them Buret, have stated that there is distinct evidence of the
+existence of syphilis in prehistoric times. Buret finds evidence of
+traces of syphilis among the Chinese five thousand years ago, among the
+Egyptians at the time of the Pharaohs, among the Hebrews and Hindoos in
+biblic times, and among the Greeks and Romans after Christ. Some
+American writers claim to have found evidences of syphilitic disease in
+the skulls and other bones of the prehistoric Indian mounds, thus
+giving further evidence to the advocates of the American origin of
+syphilis. The Spaniards claimed that, returning from America in 1493,
+Columbus brought with him syphilis. Friend says: "One thing is
+remarkable; the Spaniards, upon their first expedition to America,
+brought home from thence this contagious disorder, and soon after
+carried another affection thither, the small-pox, of which the Indian
+Prince Montezuma died." The first descriptions of syphilis are given
+under the name of morbus gallicus, while the French in return called it
+morbus neapolitanus or mal d'Italie. The name of syphilis was said to
+have been first given to it by a physician of Verona, in a poem
+describing the disease.  Inspired by heroic epics Fracastor places
+before us the divinities of paganism, and supposes that a shepherd,
+whom he called Syphilus, had addressed words offensive to Apollo, and
+had deserted his altars. To punish him the God sent him a disease of
+the genitals, which the inhabitants of the country called the disease
+of Syphilus.
+
+"Syphilidemque ab eo labem dixere coloni."
+
+Buret traces the origin of the word syphilis from sun, with, and filia,
+love, the companion of love; which means in plain language that the pox
+is a disease transmitted more especially by venereal relations. The
+first great epidemic of syphilis occurred between 1493 and 1496, and
+attacked all ranks, neither the Church nor the Crown being spared. The
+ravages of this disease were increased by the treatment with mercury
+which soon afterward was found in proper doses to be a specific in this
+disease. It is possible that the terrible manifestations of syphilis of
+which we read in the older writers were in a great measure due to the
+enormous doses of mercury. At the present day syphilis is universally
+prevalent. In his excellent monograph Sturgis estimated in New York, in
+1873, that one out of 18 suffered from it; and White of Philadelphia
+pronounces the opinion that "not less than 50,000 people in that city
+are affected with syphilis." According to Rohe, on this basis Gihon
+estimates the number of syphilitics in the United States at one time as
+2,000,000.
+
+To-day no disease, except possibly tuberculosis, is a greater agency in
+augmenting the general mortality and furthering sickness than syphilis.
+Its hereditary features, the numerous ways in which it may be
+communicated outside of the performance of the sexual act, and the
+careful way in which it is kept from the sanitary authorities render it
+a scourge which, at the present day, we seem to have no method of
+successfully repressing.
+
+Modern Mortality from Infectious Diseases.--As to the direct influence
+on the mortality of the most common infectious diseases of the present
+day, tuberculosis, universally prevalent, is invariably in the lead. No
+race or geographic situation is exempt from it. Osler mentions that in
+the Blood Indian Reserve of the Canadian Northwest Territories, during
+six years, among a population of about 2000 there were 127 deaths from
+pulmonary consumption. This enormous death-rate, it is to be
+remembered, occurred in a tribe occupying one of the finest climates of
+the world, among the foothills of the Rocky Mountains, a region in
+which consumption is extremely rare among the white population, and in
+which cases of tuberculosis from the Eastern provinces do remarkably
+well. Mayo-Smith quotes a table illustrating the annual deaths (based
+on the returns from 1887 to 1891) from certain infectious diseases per
+10,000 European inhabitants. The figures for each disease give a rough
+measure of its prevalence in different countries. The large figures as
+to small-pox show the absence in Italy and "Hieronymi Fracastorii,"
+Veronae, 1530.  Statistics and Sociology, New York, 1885.
+
+Austria of vaccination; diphtheria seems to be very fatal in Germany
+and Austria; Italy has a large rate for typhoid fever, and the same is
+true of the other fevers; France, Germany, and Austria show a very
+large rate for tuberculosis, while Italy has a small rate.
+
+       DEATHS FROM CERTAIN DISEASES PER 10,000 INHABITANTS.
+
+                   Small-       Scarlet Diphtheria Typhoid Tuber-
+  COUNTRY.         pox.  Measles. fever            fever.  culosis
+
+  Italy, . . . . .  3.86   6.17    2.99     6.08     7.49    13.61
+  France (cities).  2.3    5.18    3.1      6.66     5.32    33.
+  England, . . . .  0.11   4.68    2.31     1.74     1.9     16.09
+  Ireland, . . . .  0.01   2.01    1.22     0.76     2.33    21.15
+  Germany (cities). 0.04   2.8     2.15    10.21     2.11    31.29
+  Prussia, . . . .  0.03   3.2     2.46    14.17     2.26    28.06
+  Austria, . . . .  4.43   5.36    5.57    13.2      5.42    37.2
+  Switzerland, . .  0.06   1.53    1.22     3.53     1.47    21.07
+  Belgium, . . . .  1.52   6.2     1.62     5.77     3.83    19.87
+  Holland, . . . .  0.02   3.93    0.38     1.45     2.5     19.21
+  Sweden, . . . . . 0.01   2.3     3.69     3.89     2.22     0.
+
+Based upon the Tenth Census Reports, we figure that of every 10,000
+inhabitants of the United States the number of deaths for the census
+year from similar diseases was as follows:--
+
+                      Rural.  Cities.
+
+  Measles, . . . . . . . 1.62   1.54
+  Scarlet Fever, . . . . 2.84   5.54
+  Diphtheria, . . . . .  7.53   8.
+  Croup, . . . . . . . . 3.51   4.08
+  Typhoid Fever, . . . . 4.75   3.46
+  Tuberculosis, . . . . 16.29   28.55
+
+The general average of deaths from small-pox was about 0.14.
+
+
+
+
+
+
+
+
+
+End of the Project Gutenberg EBook of Anomalies and Curiosities of Medicine, by 
+George M. Gould and Walter Lytle Pyle
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