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diff --git a/old/aacom10.txt b/old/aacom10.txt new file mode 100644 index 0000000..7444e76 --- /dev/null +++ b/old/aacom10.txt @@ -0,0 +1,41427 @@ +Project Gutenberg Etext of Anomalies and Curiosities of Medicine +by George M. Gould and Walter L. Pyle + + +Copyright laws are changing all over the world, be sure to check +the copyright laws for your country before posting these files!! + +Please take a look at the important information in this header. +We encourage you to keep this file on your own disk, keeping an +electronic path open for the next readers. Do not remove this. + + +**Welcome To The World of Free Plain Vanilla Electronic Texts** + +**Etexts Readable By Both Humans and By Computers, Since 1971** + +*These Etexts Prepared By Hundreds of Volunteers and Donations* + +Information on contacting Project Gutenberg to get Etexts, and +further information is included below. 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FOR PUBLIC DOMAIN ETEXTS*Ver.04.29.93*END* + + + + + +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 he 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 +oœ 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 am. 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, hut 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 n 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, polyp), +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 d 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. a 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 he 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 Project Gutenberg Etext of Anomalies and Curiosities of +Medicine + + diff --git a/old/aacom10.zip b/old/aacom10.zip Binary files differnew file mode 100644 index 0000000..46e9bd6 --- /dev/null +++ b/old/aacom10.zip |