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Title: Anomalies and Curiosities of Medicine

Author: George M. Gould
        Walter Lytle Pyle

Posting Date: August 3, 2008 [EBook #747]
Release Date: December, 1996

Language: English

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ANOMALIES and CURIOSITIES of MEDICINE

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

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



PREFATORY AND INTRODUCTORY.

----

Since the time when man's mind first busied itself with subjects beyond
his own self-preservation and the satisfaction of his bodily appetites,
the anomalous and curious have been of exceptional and persistent
fascination to him; and especially is this true of the construction and
functions of the human body.  Possibly, indeed, it was the anomalous
that was largely instrumental in arousing in the savage the attention,
thought, and investigation that were finally to develop into the body
of organized truth which we now call Science. As by the aid of
collected experience and careful inference we to-day endeavor to pass
our vision into the dim twilight whence has emerged our civilization,
we find abundant hint and even evidence of this truth. To the highest
type of philosophic minds it is the usual and the ordinary that demand
investigation and explanation. But even to such, no less than to the
most naive-minded, the strange and exceptional is of absorbing
interest, and it is often through the extraordinary that the
philosopher gets the most searching glimpses into the heart of the
mystery of the ordinary. Truly it has been said, facts are stranger
than fiction. In monstrosities and dermoid cysts, for example, we seem
to catch forbidden sight of the secret work-room of Nature, and drag
out into the light the evidences of her clumsiness, and proofs of her
lapses of skill,--evidences and proofs, moreover, that tell us much of
the methods and means used by the vital artisan of Life,--the loom, and
even the silent weaver at work upon the mysterious garment of
corporeality.

"La premiere chose qui s'offre a l' Homme quand il se regarde, c'est
son corps," says Pascal, and looking at the matter more closely we find
that it was the strange and mysterious things of his body that occupied
man's earliest as well as much of his later attention. In the
beginning, the organs and functions of generation, the mysteries of
sex, not the routine of digestion or of locomotion, stimulated his
curiosity, and in them he recognized, as it were, an unseen hand
reaching down into the world of matter and the workings of bodily
organization, and reining them to impersonal service and far-off ends.
All ethnologists and students of primitive religion well know the role
that has been played in primitive society by the genetic instincts.
Among the older naturalists, such as Pliny and Aristotle, and even in
the older historians, whose scope included natural as well as civil and
political history, the atypic and bizarre, and especially the
aberrations of form or function of the generative organs, caught the
eye most quickly. Judging from the records of early writers, when
Medicine began to struggle toward self-consciousness, it was again the
same order of facts that was singled out by the attention. The very
names applied by the early anatomists to many structures so widely
separated from the organs of generation as were those of the brain,
give testimony of the state of mind that led to and dominated the
practice of dissection.

In the literature of the past centuries the predominance of the
interest in the curious is exemplified in the almost ludicrously
monotonous iteration of titles, in which the conspicuous words are
curiosa, rara, monstruosa, memorabilia, prodigiosa, selecta, exotica,
miraculi, lusibus naturae, occultis naturae, etc., etc.  Even when
medical science became more strict, it was largely the curious and rare
that were thought worthy of chronicling, and not the establishment or
illustration of the common, or of general principles. With all his
sovereign sound sense, Ambrose Pare has loaded his book with references
to impossibly strange, and even mythologic cases.

In our day the taste seems to be insatiable, and hardly any medical
journal is without its rare or "unique" case, or one noteworthy chiefly
by reason of its anomalous features. A curious case is invariably
reported, and the insertion of such a report is generally productive of
correspondence and discussion with the object of finding a parallel for
it.

In view of all this it seems itself a curious fact that there has never
been any systematic gathering of medical curiosities. It would have
been most natural that numerous encyclopedias should spring into
existence in response to such a persistently dominant interest. The
forelying volume appears to be the first thorough attempt to classify
and epitomize the literature of this nature.  It has been our purpose
to briefly summarize and to arrange in order the records of the most
curious, bizarre, and abnormal cases that are found in medical
literature of all ages and all languages--a thaumatographia medica. It
will be readily seen that such a collection must have a function far
beyond the satisfaction of mere curiosity, even if that be stigmatized
with the word "idle." If, as we believe, reference may here be found to
all such cases in the literature of Medicine (including Anatomy,
Physiology, Surgery, Obstetrics, etc.) as show the most extreme and
exceptional departures from the ordinary, it follows that the future
clinician and investigator must have use for a handbook that decides
whether his own strange case has already been paralleled or excelled.
He will thus be aided in determining the truth of his statements and
the accuracy of his diagnoses.  Moreover, to know extremes gives
directly some knowledge of means, and by implication and inference it
frequently does more.  Remarkable injuries illustrate to what extent
tissues and organs may be damaged without resultant death, and thus the
surgeon is encouraged to proceed to his operation with greater
confidence and more definite knowledge as to the issue. If a mad cow
may blindly play the part of a successful obstetrician with her horns,
certainly a skilled surgeon may hazard entering the womb with his
knife. If large portions of an organ,--the lung, a kidney, parts of the
liver, or the brain itself,--may be lost by accident, and the patient
still live, the physician is taught the lesson of nil desperandum, and
that if possible to arrest disease of these organs before their total
destruction, the prognosis and treatment thereby acquire new and more
hopeful phases.

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

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

This connection suggests the question of credibility in general.  It
need hardly be said that the lay-journalist and newspaper reporter have
usually been ignored by us, simply because experience and investigation
have many times proved that a scientific fact, by presentation in most
lay-journals, becomes in some mysterious manner, ipso facto, a
scientific caricature (or worse!), and if it is so with facts, what
must be the effect upon reports based upon no fact whatsoever? It is
manifestly impossible for us to guarantee the credibility of chronicles
given. If we have been reasonably certain of unreliability, we may not
even have mentioned the marvelous statement. Obviously, we could do no
more with apparently credible cases, reported by reputable medical men,
than to cite author and source and leave the matter there, where our
responsibility must end.

But where our proper responsibility seemed likely never to end was in
carrying out the enormous labor requisite for a reasonable certainty
that we had omitted no searching that might lead to undiscovered facts,
ancient or modern. Choice in selection is always, of course, an affair
de gustibus, and especially when, like the present, there is
considerable embarrassment of riches, coupled with the purpose of
compressing our results in one handy volume. In brief, it may be said
that several years of exhaustive research have been spent by us in the
great medical libraries of the United States and Europe in collecting
the material herewith presented. If, despite of this, omissions and
errors are to be found, we shall be grateful to have them pointed out.
It must be remembered that limits of space have forbidden satisfactory
discussion of the cases, and the prime object of the whole work has
been to carefully collect and group the anomalies and curiosities, and
allow the reader to form his own conclusions and make his own
deductions.

As the entire labor in the preparation of the forelying volume, from
the inception of the idea to the completion of the index, has been
exclusively the personal work of the authors, it is with full
confidence of the authenticity of the reports quoted that the material
is presented.

Complete references are given to those facts that are comparatively
unknown or unique, or that are worthy of particular interest or further
investigation. To prevent unnecessary loading of the book with
foot-notes, in those instances in which there are a number of cases of
the same nature, and a description has not been thought necessary, mere
citation being sufficient, references are but briefly given or omitted
altogether. For the same reason a bibliographic index has been added at
the end of the text. This contains the most important sources of
information used, and each journal or book therein has its own number,
which is used in its stead all through the book (thus, 476 signifies
The Lancet, London; 597, the New York Medical Journal; etc.).  These
bibliographic numbers begin at 100.

Notwithstanding that every effort has been made to conveniently and
satisfactorily group the thousands of cases contained in the book (a
labor of no small proportions in itself), a complete general index is a
practical necessity for the full success of what is essentially a
reference-volume, and consequently one has been added, in which may be
found not only the subjects under consideration and numerous
cross-references, but also the names of the authors of the most
important reports. A table of contents follows this preface.

We assume the responsibility for innovations in orthography, certain
abbreviations, and the occasional substitution of figures for large
numerals, fractions, and decimals, made necessary by limited space, and
in some cases to more lucidly show tables and statistics. From the
variety of the reports, uniformity of nomenclature and numeration is
almost impossible.

As we contemplate constantly increasing our data, we shall be glad to
receive information of any unpublished anomalous or curious cases,
either of the past or in the future.

For many courtesies most generously extended in aiding our
research-work we wish, among others, to acknowledge our especial
gratitude and indebtedness to the officers and assistants of the
Surgeon-General's Library at Washington, D.C., the Library of the Royal
College of Surgeons of London, the Library of the British Museum, the
Library of the British Medical Association, the Bibliotheque de Faculte
de Medecine de Paris, the Bibliotheque Nationale, and the Library of
the College of Physicians of Philadelphia.

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



TABLE OF CONTENTS.

CHAPTER                                                   PAGES

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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




ANOMALIES AND CURIOSITIES OF MEDICINE.



CHAPTER I.

GENETIC ANOMALIES.

Menstruation has always been of interest, not only to the student of
medicine, but to the lay-observer as well. In olden times there were
many opinions concerning its causation, all of which, until the era of
physiologic investigation, were of superstitious derivation. Believing
menstruation to be the natural means of exit of the feminine bodily
impurities, the ancients always thought a menstruating woman was to be
shunned; her very presence was deleterious to the whole animal economy,
as, for instance, among the older writers we find that Pliny remarks:
"On the approach of a woman in this state, must will become sour, seeds
which are touched by her become sterile, grass withers away, garden
plants are parched up, and the fruit will fall from the tree beneath
which she sits." He also says that the menstruating women in Cappadocia
were perambulated about the fields to preserve the vegetation from
worms and caterpillars. According to Flemming, menstrual blood was
believed to be so powerful that the mere touch of a menstruating woman
would render vines and all kinds of fruit-trees sterile. Among the
indigenous Australians, menstrual superstition was so intense that one
of the native blacks, who discovered his wife lying on his blanket
during her menstrual period, killed her, and died of terror himself in
a fortnight. Hence, Australian women during this season are forbidden
to touch anything that men use. Aristotle said that the very look of a
menstruating woman would take the polish out of a mirror, and the next
person looking in it would be bewitched.  Frommann mentions a man who
said he saw a tree in Goa which withered because a catamenial napkin
was hung on it. Bourke remarks that the dread felt by the American
Indians in this respect corresponds with the particulars recited by
Pliny. Squaws at the time of menstrual purgation are obliged to seclude
themselves, and in most instances to occupy isolated lodges, and in all
tribes are forbidden to prepare food for anyone save themselves. It was
believed that, were a menstruating woman to step astride a rifle, a
bow, or a lance, the weapon would have no utility. Medicine men are in
the habit of making a "protective" clause whenever they concoct a
"medicine," which is to the effect that the "medicine" will be
effective provided that no woman in this condition is allowed to
approach the tent of the official in charge.

Empiricism had doubtless taught the ancient husbands the dangers of
sexual intercourse during this period, and the after-results of many
such connections were looked upon as manifestations of the
contagiousness of the evil excretions issuing at this period.  Hence at
one time menstruation was held in much awe and abhorrence.

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

As the advances of physiology enlightened the mind as to the true
nature of the menstrual period, and the age of superstition gradually
disappeared, the intense interest in menstruation vanished, and now,
rather than being held in fear and awe, the physicians of to-day
constantly see the results of copulation during this period. The
uncontrollable desire of the husband and the mercenary aims of the
prostitute furnish examples of modern disregard.

The anomalies of menstruation must naturally have attracted much
attention, and we find medical literature of all times replete with
examples. While some are simply examples of vicarious or compensatory
menstruation, and were so explained even by the older writers, there
are many that are physiologic curiosities of considerable interest.
Lheritier furnishes the oft-quoted history of the case of a young girl
who suffered from suppression of menses, which, instead of flowing
through the natural channels, issued periodically from vesicles on the
leg for a period of six months, when the seat of the discharge changed
to an eruption on the left arm, and continued in this location for one
year; then the discharge shifted to a sore on the thumb, and at the end
of another six months again changed, the next location being on the
upper eyelid; here it continued for a period of two years.  Brierre de
Boismont and Meisner describe a case apparently identical with the
foregoing, though not quoting the source.

Haller, in a collection of physiologic curiosities covering a period of
a century and a half, cites 18 instances of menstruation from the skin.
Parrot has also mentioned several cases of this nature. Chambers speaks
of bloody sweat occurring periodically in a woman of twenty-seven; the
intervals, however, were occasionally but a week or a fortnight, and
the exudation was not confined to any one locality. Van Swieten quotes
the history of a case of suppression of the menstrual function in which
there were convulsive contractions of the body, followed by paralysis
of the right arm. Later on, the patient received a blow on the left eye
causing amaurosis; swelling of this organ followed, and one month later
blood issued from it, and subsequently blood oozed from the skin of the
nose, and ran in jets from the skin of the fingers and from the nails.

D'Andrade cites an account of a healthy Parsee lady, eighteen years of
age, who menstruated regularly from thirteen to fifteen and a half
years; the catamenia then became irregular and she suffered occasional
hemorrhages from the gums and nose, together with attacks of
hematemesis. The menstruation returned, but she never became pregnant,
and, later, blood issued from the healthy skin of the left breast and
right forearm, recurring every month or two, and finally additional
dermal hemorrhage developed on the forehead. Microscopic examination of
the exuded blood showed usual constituents present. There are two
somewhat similar cases spoken of in French literature. The first was
that of a young lady, who, after ten years' suppression of the
menstrual discharge, exhibited the flow from a vesicular eruption on
the finger. The other case was quite peculiar, the woman being a
prostitute, who menstruated from time to time through spots, the size
of a five-franc piece, developing on the breasts, buttocks, back,
axilla, and epigastrium. Barham records a case similar to the
foregoing, in which the menstruation assumed the character of periodic
purpura. Duchesne mentions an instance of complete amenorrhea, in which
the ordinary flow was replaced by periodic sweats.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Menstruation in Man.--Periodic discharges of blood in man, constituting
what is called "male menstruation," have been frequently noticed and
are particularly interesting when the discharge is from the penis or
urethra, furnishing a striking analogy to the female function of
menstruation. The older authors quoted several such instances, and
Mehliss says that in the ancient days certain writers remarked that
catamenial lustration from the penis was inflicted on the Jews as a
divine punishment.  Bartholinus mentions a case in a youth; the
Ephemerides several instances; Zacutus Lusitanus, Salmuth, Hngedorn,
Fabricius Hildanus, Vesalius, Mead, and Acta Eruditorum all mention
instances. Forel saw menstruation in a man. Gloninger tells of a man of
thirty-six, who, since the age of seventeen years and five months, had
had lunar manifestations of menstruation. Each attack was accompanied
by pains in the back and hypogastric region, febrile disturbance, and a
sanguineous discharge from the urethra, which resembled in color,
consistency, etc., the menstrual flux. King relates that while
attending a course of medical lectures at the University of Louisiana
he formed the acquaintance of a young student who possessed the normal
male generative organs, but in whom the simulated function of
menstruation was periodically performed. The cause was inexplicable,
and the unfortunate victim was the subject of deep chagrin, and was
afflicted with melancholia. He had menstruated for three years in this
manner: a fluid exuded from the sebaceous glands of the deep fossa
behind the corona glandis; this fluid was of the same appearance as the
menstrual flux. The quantity was from one to two ounces, and the
discharge lasted from three to six days. At this time the student was
twenty-two years of age, of a lymphatic temperament, not particularly
lustful, and was never the victim of any venereal disease. The author
gives no account of the after-life of this man, his whereabouts being,
unfortunately, unknown or omitted.

Vicarious Menstruation in the Male.--This simulation of menstruation by
the male assumes a vicarious nature as well as in the female. Van
Swieten, quoting from Benivenius, relates a case of a man who once a
month sweated great quantities of blood from his right flank. Pinel
mentions a case of a captain in the army (M. Regis), who was wounded by
a bullet in the body and who afterward had a monthly discharge from the
urethra. Pinel calls attention particularly to the analogy in this case
by mentioning that if the captain were exposed to fatigue, privation,
cold, etc., he exhibited the ordinary symptoms of amenorrhea or
suppression. Fournier speaks of a man over thirty years old, who had
been the subject of a menstrual evacuation since puberty, or shortly
after his first sexual intercourse. He would experience pains of the
premenstrual type, about twenty-four hours before the appearance of the
flow, which subsided when the menstruation began. He was of an
intensely voluptuous nature, and constantly gave himself up to sexual
excesses. The flow was abundant on the first day, diminished on the
second, and ceased on the third.  Halliburton, Jouilleton, and Rayman
also record male menstruation.

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

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

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

Cases of menstruation commencing within a few days after birth and
exhibiting periodical recurrence are spoken of by Penada, Neues
Hannoverisehes Magazin, Drummond, Buxtorf, Arnold, The Lancet, and the
British Medical Journal.

Cecil relates an instance of menstruation on the sixth day, continuing
for five days, in which six or eight drams of blood were lost. Peeples
cites an instance in Texas in an infant at the age of five days, which
was associated with a remarkable development of the genital organs and
breasts. Van Swieten offers an example at the first month; the British
Medical Journal at the second month; Conarmond at the third month.
Ysabel, a young slave girl belonging to Don Carlos Pedro of Havana,
began to menstruate soon after birth, and at the first year was regular
in this function. At birth her mamma were well developed and her
axillae were slightly covered with hair. At the age of thirty-two
months she was three feet ten inches tall, and her genitals and mammae
resembled those of a girl of thirteen. Her voice was grave and
sonorous; her moral inclinations were not known. Deever records an
instance of a child two years and seven months old who, with the
exception of three months only, had menstruated regularly since the
fourth month. Harle speaks of a child, the youngest of three girls, who
had a bloody discharge at the age of five months which lasted three
days and recurred every month until the child was weaned at the tenth
month. At the eleventh month it returned and continued periodically
until death, occasioned by diarrhea at the fourteenth month. The
necropsy showed a uterus 1 5/8 inches long, the lips of which were
congested; the left ovary was twice the size of the right, but
displayed nothing strikingly abnormal.  Baillot and the British Medical
Journal cite instances of menstruation at the fourth month. A case is
on record of an infant who menstruated at the age of six months, and
whose menses returned on the twenty-eighth day exactly. Clark, Wall,
and the Lancet give descriptions of cases at the ninth month. Naegele
has seen a case at the eighteenth month, and Schmidt and Colly in the
second year. Another case is that of a child, nineteen months old,
whose breasts and external genitals were fully developed, although the
child had shown no sexual desire, and did not exceed other children of
the same age in intellectual development. This prodigy was
symmetrically formed and of pleasant appearance.  Warner speaks of
Sophie Gantz, of Jewish parentage, born in Cincinnati, July 27, 1865,
whose menses began at the twenty-third month and had continued
regularly up to the time of reporting. At the age of three years and
six months she was 38 inches tall, 38 pounds in weight, and her girth
at the hip was 33 1/2 inches. The pelvis was broad and well shaped, and
measured 10 1/2 inches from the anterior surface of the spinous process
of one ilium to that of the other, being a little more than the
standard pelvis of Churchill, and, in consequence of this pelvic
development, her legs were bowed. The mammae and labia had all the
appearance of established puberty, and the pubes and axillae were
covered with hair. She was lady-like and maidenly in her demeanor,
without unnatural constraint or effrontery. A case somewhat similar,
though the patient had the appearance of a little old woman, was a
child of three whose breasts were as well developed as in a girl of
twenty, and whose sexual organs resembled those of a girl at puberty.
She had menstruated regularly since the age of two years. Woodruff
describes a child who began to menstruate at two years of age and
continued regularly thereafter. At the age of six years she was still
menstruating, and exhibited beginning signs of puberty. She was 118 cm.
tall, her breasts were developed, and she had hair on the mons veneris.
Van der Veer mentions an infant who began menstruating at the early age
of four months and had continued regularly for over two years. She had
the features and development of a child ten or twelve years old. The
external labia and the vulva in all its parts were well formed, and the
mons veneris was covered with a full growth of hair. Sir Astley Cooper,
Mandelshof, the Ephemerides, Rause, Geoffroy-Saint-Hilaire, and several
others a report instances of menstruation occurring at three years of
age. Le Beau describes an infant prodigy who was born with the mammae
well formed and as much hair on the mons veneris as a girl of thirteen
or fourteen.  She menstruated at three and continued to do so
regularly, the flow lasting four days and being copious. At the age of
four years and five months she was 42 1/2 inches tall; her features
were regular, the complexion rosy, the hair chestnut, the eyes
blue-gray, her mamma the size of a large orange, and indications that
she would be able to bear children at the age of eight.  Prideaux cites
a case at five, and Gaugirau Casals, a doctor of Agde, has seen a girl
of six years who suffered abdominal colic, hemorrhage from the nose,
migraine, and neuralgia, all periodically, which, with the association
of pruritus of the genitals and engorged mammae, led him to suspect
amenorrhea. He ordered baths, and shortly the menstruation appeared and
became regular thereafter. Brierre de Boismont records cases of
catamenia at five, seven, and eight years; and Skene mentions a girl
who menstruated at ten years and five months. She was in the lowest
grade of society, living with a drunken father in a tenement house, and
was of wretched physical constitution, quite ignorant, and of low moral
character, as evinced by her specific vaginitis. Occurring from nine
years to the ordinary time of puberty, many cases are recorded.

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

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

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

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

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

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

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

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

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

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

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

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

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

Beck has reported an instance of delivery in a girl a little over ten
years of age. There are instances of fecundity at nine years recorded
by Ephemerides, Wolffius, Savonarola, and others.  Gleaves reports from
Wytheville, Va., the history of what he calls the case of the youngest
mother in Virginia--Annie H.--who was born in Bland County, July 15,
1885, and, on September 10, 1895, was delivered of a well-formed child
weighing 5 pounds. The girl had not the development of a woman,
although she had menstruated regularly since her fifth year. The labor
was short and uneventful, and, two hours afterward, the child-mother
wanted to arise and dress and would have done so had she been
permitted.  There were no developments of the mammae nor secretion of
milk.  The baby was nourished through its short existence (as it only
lived a week) by its grandmother, who had a child only a few months
old. The parents of this child were prosperous, intelligent, and worthy
people, and there was no doubt of the child's age. "Annie is now well
and plays about with the other children as if nothing had happened."
Harris refers to a Kentucky woman, a mother at ten years, one in
Massachusetts a mother at ten years, eight months, and seventeen days,
and one in Philadelphia at eleven years and three months. The first
case was one of infantile precocity, the other belonging to a much
later period, the menstrual function having been established but a few
months prior to conception. All these girls had well-developed pelves,
large mammae, and the general marks of womanhood, and bore living
children. It has been remarked of 3 very markedly precocious cases of
pregnancy that one was the daughter of very humble parents, one born in
an almshouse, and the other raised by her mother in a house of
prostitution. The only significance of this statement is the greater
amount of vice and opportunity for precocious sexual intercourse to
which they were exposed; doubtless similar cases under more favorable
conditions would never be recognized as such.

The instance in the Journal decavans is reiterated in 1775, which is
but such a repetition as is found all through medical literature--"new
friends with old faces," as it were. Haller observed a case of
impregnation in a girl of nine, who had menstruated several years, and
others who had become pregnant at nine, ten, and twelve years
respectively. Rowlett, whose case is mentioned by Harris, saw a child
who had menstruated the first year and regularly thereafter, and gave
birth to a child weighing 7 3/4 pounds when she was only ten years and
thirteen days old.  At the time of delivery she measured 4 feet 7
inches in height and weighed 100 pounds. Curtis, who is also quoted by
Harris, relates the history of Elizabeth Drayton, who became pregnant
before she was ten, and was delivered of a full-grown, living male
child weighing 8 pounds. She had menstruated once or twice before
conception, was fairly healthy during gestation, and had a rather
lingering but natural labor. To complete the story, the father of this
child was a boy of fifteen. One of the faculty of Montpellier has
reported an instance at New Orleans of a young girl of eleven, who
became impregnated by a youth who was not yet sixteen. Maygrier says
that he knew a girl of twelve, living in the Faubourg Saint-Germain,
who was confined.

Harris relates the particulars of the case of a white girl who began to
menstruate at eleven years and four months, and who gave birth to an
over-sized male child on January 21, 1872, when she was twelve years
and nine months old. She had an abundance of milk and nursed the child;
the labor was of about eighteen hours' duration, and laceration was
avoided. He also speaks of a mulatto girl, born in 1848, who began to
menstruate at eleven years and nine months, and gave birth to a female
child before she reached thirteen, and bore a second child when
fourteen years and seven months old. The child's father was a white boy
of seventeen.

The following are some Indian statistics: 1 pregnancy at ten, 6 at
eleven, 2 at eighteen, 1 at nineteen. Chevers speaks of a mother at ten
and others at eleven and twelve; and Green, at Dacca, performed
craniotomy upon the fetus of a girl of twelve.  Wilson gives an account
of a girl thirteen years old, who gave birth to a full-grown female
child after three hours' labor. She made a speedy convalescence, but
the child died four weeks afterward from bad nursing. The lad who
acknowledged paternity was nineteen years old. King reports a
well-verified case of confinement in a girl of eleven. Both the mother
and child did well.

Robertson of Manchester describes a girl, working in a cotton factory,
who was a mother at twelve; de La Motte mentions pregnancy before
twelve; Kilpatrick in a negress, at eleven years and six months; Fox,
at twelve; Hall, at twelve; Kinney, at twelve years, ten months, and
sixteen days; Herrick, at thirteen years and nine months; Murillo, at
thirteen years; Philippart, at fourteen years; Stallcup, at eleven
years and nine months; Stoakley, at thirteen years; Walker, at the age
of twelve years and eight months; another case, at twelve years and six
months; and Williams, at eleven.

An editorial article in the Indian Medical Gazette of Sept., 1890,
says:--

"The appearance of menstruation is held by the great majority of
natives of India to be evidence and proof of marriageability, but among
the Hindu community it is considered disgraceful that a girl should
remain unmarried until this function is established.  The consequence
is that girls are married at the age of nine or ten years, but it is
understood or professed that the consummation of the marriage is
delayed until after the first menstrual period. There is, however, too
much reason to believe that the earlier ceremony is very frequently,
perhaps commonly, taken to warrant resort to sexual intercourse before
the menstrual flux has occurred: it may be accepted as true that
premenstrual copulation is largely practised under the cover of
marriage in this country.

"From this practice it results that girls become mothers at the
earliest possible period of their lives. A native medical witness
testified that in about 20 per cent of marriages children were born by
wives of from twelve to thirteen years of age. Cases of death caused by
the first act of sexual intercourse are by no means rare. They are
naturally concealed, but ever and anon they come to light. Dr. Chevers
mentioned some 14 cases of this sort in the last edition of his
'Handbook of Medical Jurisprudence for India,' and Dr. Harvey found 5
in the medicolegal returns submitted by the Civil Surgeons of the
Bengal Presidency during the years 1870-71-72.

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

In 1816 some girls were admitted to the Paris Maternite as young as
thirteen, and during the Revolution several at eleven, and even
younger. Smith speaks of a legal case in which a girl, eleven years
old, being safely delivered of a living child, charged her uncle with
rape. Allen speaks of a girl who became pregnant at twelve years and
nine months, and was delivered of a healthy, 9-pound boy before the
physician's arrival; the placenta came away afterward, and the mother
made a speedy recovery. She was thought to have had "dropsy of the
abdomen," as the parents had lost a girl of about the same age who was
tapped for ascites.  The father of the child was a boy only fourteen
years of age.

Marvelous to relate, there are on record several cases of twins being
born to a child mother. Kay reports a case of twins in a girl of
thirteen; Montgomery, at fourteen; and Meigs reports the case of a
young girl, of Spanish blood, at Maracaibo, who gave birth to a child
before she was twelve and to twins before reaching fourteen years.

In the older works, the following authors have reported cases of
pregnancy before the appearance of menstruation: Ballonius, Vogel,
Morgagni, the anatomist of the kidney, Schenck, Bartholinus, Bierling,
Zacchias, Charleton, Mauriceau, Ephemerides, and Fabricius Hildanus.

In some cases this precocity seems to be hereditary, being transmitted
from mother to daughter, bringing about an almost incredible state of
affairs, in which a girl is a grandmother about the ordinary age of
maternity. Kay says that he had reported to him, on "pretty good"
authority, an instance of a Damascus Jewess who became a grandmother at
twenty-one years. In France they record a young grandmother of
twenty-eight. Ketchum speaks of a negress, aged thirteen, who gave
birth to a well-developed child which began to menstruate at ten years
and nine months and at thirteen became pregnant; hence the negress was
a grandmother at twenty-five years and nine months. She had a second
child before she was sixteen, who began to menstruate at seven years
and six months, thus proving the inheritance of this precocity, and
leaving us at sea to figure what degree of grandmother she may be if
she lives to an advanced age. Another interesting case of this nature
is that of Mrs. C., born 1854, married in 1867, and who had a daughter
ten months after. This daughter married in 1882, and in March, 1883,
gave birth to a 9-pound boy. The youthful grandmother, not twenty-nine,
was present at the birth. This case was remarkable, as the children
were both legitimate.

Fecundity in the old seems to have attracted fully as much attention
among the older observers as precocity. Pliny speaks of Cornelia, of
the family of Serpios, who bore a son at sixty, who was named Volusius
Saturnius; and Marsa, a physician of Venice, was deceived in a
pregnancy in a woman of sixty, his diagnosis being "dropsy." Tarenta
records the history of the case of a woman who menstruated and bore
children when past the age of sixty. Among the older reports are those
of Blanchard of a woman who bore a child at sixty years; Fielitz, one
at sixty; Ephemerides, one at sixty-two; Rush, one at sixty; Bernstein,
one at sixty years; Schoepfer, at seventy years; and, almost beyond
belief, Debes cites an instance as taking place at the very advanced
age of one hundred and three. Wallace speaks of a woman in the Isle of
Orkney bearing children when past the age of sixty. We would naturally
expect to find the age of child-bearing prolonged in the northern
countries where the age of maturity is later. Capuron cites an example
of child-birth in a woman of sixty; Haller, cases at fifty-eight,
sixty-three, and seventy; Dewees, at sixty-one; and Thibaut de
Chauvalon, in a woman of Martinique aged ninety years. There was a
woman delivered in Germany, in 1723, at the age of fifty-five; one at
fifty-one in Kentucky; and one in Russia at fifty. Depasse speaks of a
woman of fifty-nine years and five months old who was delivered of a
healthy male child, which she suckled, weaning it on her sixtieth
birthday. She had been a widow for twenty years, and had ceased to
menstruate nearly ten years before. In St. Peter's Church, in East
Oxford, is a monument bearing an inscription recording the death in
child-birth of a woman sixty-two years old. Cachot relates the case of
a woman of fifty-three, who was delivered of a living child by means of
the forceps, and a year after bore a second child without instrumental
interference. She had no milk in her breasts at the time and no signs
of secretion. This aged mother had been married at fifty-two, five
years after the cessation of her menstruation, and her husband was a
young man, only twenty-four years old.

Kennedy reports a delivery at sixty-two years, and the Cincinnati
Enquirer, January, 1863, says: "Dr. W. McCarthy was in attendance on a
lady of sixty-nine years, on Thursday night last, who gave birth to a
fine boy. The father of the child is seventy-four years old, and the
mother and child are doing well." Quite recently there died in Great
Britain a Mrs. Henry of Gortree at the age of one hundred and twelve,
leaving a daughter of nine years.

Mayham saw a woman seventy-three years old who recovered after delivery
of a child. A most peculiar case is that of a widow, seventy years old,
a native of Garches. She had been in the habit of indulging freely in
wine, and, during the last six months, to decided excess. After an
unusually prolonged libation she found herself unable to walk home; she
sat down by the roadside waiting until she could proceed, and was so
found by a young man who knew her and who proposed helping her home. By
the time her house was reached night was well advanced, and she invited
him to stop over night; finding her more than affable, he stopped at
her house over four nights, and the result of his visits was an ensuing
pregnancy for Madame.

Multiple births in the aged have been reported from authentic sources.
The Lancet quotes a rather fabulous account of a lady over sixty-two
years of age who gave birth to triplets, making her total number of
children 13. Montgomery, Colomb, and Knehel, each, have recorded the
birth of twins in women beyond the usual age of the menopause, and
there is a case recorded of a woman of fifty-two who was delivered of
twins.

Impregnation without completion of the copulative act by reason of some
malformation, such as occlusion of the vagina or uterus, fibrous and
unruptured hymen, etc., has been a subject of discussion in the works
of medical jurisprudence of all ages; and cases of conception without
entrance of the penis are found in abundance throughout medical
literature, and may have an important medicolegal bearing. There is
little doubt of the possibility of spermatozoa deposited on the
genitalia making progress to the seat of fertilization, as their power
of motility and tenacity of life have been well demonstrated. Percy
reports an instance in which semen was found issuing from the os uteri
eight and one-half days after the last intercourse; and a microscopic
examination of this semen revealed the presence of living as well as
dead spermatozoa. We have occasional instances of impregnation by
rectal coitus, the semen finding its way into an occluded vaginal canal
by a fistulous communication.

Guillemeau, the surgeon of the French king, tells of a girl of
eighteen, who was brought before the French officials in Paris, in
1607, on the citation of her husband of her inability to allow him
completion of the marital function. He alleged that he had made several
unsuccessful attempts to enter her, and in doing so had caused
paraphimosis. On examination by the surgeons she was found to have a
dense membrane, of a fibrous nature, entirely occluding the vagina,
which they incised. Immediately afterward the woman exhibited morning
sickness and the usual signs of pregnancy, and was delivered in four
months of a full-term child, the results of an impregnation occasioned
by one of the unsuccessful attempts at entrance. Such instances are
numerous in the older literature, and a mere citation of a few is
considered sufficient here. Zacchias, Amand, Fabricius Hildanus, Graaf,
the discoverer of the follicles that bear his name, Borellus, Blegny,
Blanchard, Diemerbroeck, Duddell, Mauriceau, a Reyes, Riolan, Harvey,
the discoverer of the circulation of the blood, Wolfius, Walther,
Rongier, Ruysch, Forestus, Ephemerides, and Schurig all mention cases
of conception with intact hymen, and in which there was no entrance of
the penis. Tolberg has an example of hymen integrum after the birth of
a fetus five months old, and there is recorded a case of tubal
pregnancy in which the hymen was intact.

Gilbert gives an account of a case of pregnancy in an unmarried woman,
who successfully resisted an attempt at criminal connection and yet
became impregnated and gave birth to a perfectly formed female child.
The hymen was not ruptured, and the impregnation could not have
preceded the birth more than thirty-six weeks. Unfortunately, this poor
woman was infected with gonorrhea after the attempted assault. Simmons
of St. Louis gives a curious peculiarity of conception, in which there
was complete closure of the vagina, subsequent conception, and delivery
at term. He made the patient's acquaintance from her application to him
in regard to a malcondition of her sexual apparatus, causing much
domestic infelicity.

Lawson speaks of a woman of thirty-five, who had been married ten
months, and whose husband could never effect an entrance; yet she
became pregnant and had a normal labor, despite the fact that, in
addition to a tough and unruptured hymen, she had an occluding vaginal
cyst. Hickinbotham of Birmingham reports the history of two cases of
labor at term in females whose hymens were immensely thickened. H. Grey
Edwards has seen a case of imperforate hymen which had to be torn
through in labor; yet one single act of copulation, even with this
obstacle to entrance, sufficed to impregnate. Champion speaks of a
woman who became pregnant although her hymen was intact. She had been
in the habit of having coitus by the urethra, and all through her
pregnancy continued this practice.

Houghton speaks of a girl of twenty-five into whose vagina it was
impossible to pass the tip of the first finger on account of the dense
cicatricial membrane in the orifice, but who gave birth, with
comparative ease, to a child at full term, the only interference
necessary being a few slight incisions to permit the passage of the
head. Tweedie saw an Irish girl of twenty-three, with an imperforate os
uteri, who had menstruated only scantily since fourteen and not since
her marriage. She became pregnant and went to term, and required some
operative interference. He incised at the point of usual location of
the os, and one of his incisions was followed by the flow of liquor
amnii, and the head fell upon the artificial opening, the diameter of
which proved to be one and a half or two inches; the birth then
progressed promptly, the child being born alive.

Guerard notes an instance in which the opening barely admitted a hair;
yet the patient reached the third month of pregnancy, at which time she
induced abortion in a manner that could not be ascertained. Roe gives a
case of conception in an imperforate uterus, and Duncan relates the
history of a case of pregnancy in an unruptured hymen, characterized by
an extraordinary ascent of the uterus. Among many, the following modern
observers have also reported instances of pregnancy with hymen
integrum: Braun, 3 cases; Francis, Horton, Oakman, Brill, 2 cases;
Burgess, Haig, Hay, and Smith.

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

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

A natural sequence to the subject of impregnation without entrance is
that of artificial impregnation. From being a matter of wonder and
hearsay, it has been demonstrated as a practical and useful method in
those cases in which, by reason of some unfortunate anatomic
malformation on either the male or the female side, the marriage is
unfruitful. There are many cases constantly occurring in which the
birth of an heir is a most desirable thing in a person's life. The
historic instance of Queen Mary of England, whose anxiety and efforts
to bear a child were the subject of public comment and prayers, is but
an example of a fact that is occurring every day, and doubtless some of
these cases could be righted by the pursuance of some of the methods
suggested.

There have been rumors from the beginning of the century of women being
impregnated in a bath, from contact with cloths containing semen, etc.,
and some authorities in medical jurisprudence have accepted the
possibility of such an occurrence. It is not in the province of this
work to speculate on what may be, but to give authoritative facts, from
which the reader may draw his own deductions. Fertilization of plants
has been thought to have been known in the oldest times, and there are
some who believe that the library at Alexandria must have contained
some information relative to it. The first authentic account that we
have of artificial impregnation is that of Schwammerdam, who in 1680
attempted it without success by the fecundation of the eggs of fish.
Roesel, his scholar, made an attempt in 1690, but also failed; and to
Jacobi, in 1700, belongs the honor of success. In 1780, Abbe
Spallanzani, following up the success of Jacobi, artificially
impregnated a bitch, who brought forth in sixty-two days 3 puppies, all
resembling the male. The illustrious John Hunter advised a man
afflicted with hypospadias to impregnate his wife by vaginal injections
of semen in water with an ordinary syringe, and, in spite of the
simplicity of this method, the attempt was followed by a successful
issue. Since this time, Nicholas of Nancy and Lesueur have practised
the simple vaginal method; while Gigon, d'Angouleme (14 cases), Girault
(10 cases), Marion Sims, Thomas, Salmon, Pajot, Gallard, Courty,
Roubaud, Dehaut, and others have used the more modern uterine method
with success.

A dog-breeder, by syringing the uterus of a bitch, has succeeded in
impregnating her. Those who are desirous of full information on this
subject, as regards the modus operandi, etc., are referred to Girault;
this author reports in full several examples. One case was that of a
woman, aged twenty-five, afflicted with blenorrhea, who, chagrined at
not having issue, made repeated forcible injections of semen in water
for two months, and finally succeeded in impregnating herself, and was
delivered of a living child. Another case was that of a female, aged
twenty-three, who had an extra long vaginal canal, probably accounting
for the absence of pregnancy. She made injections of semen, and was
finally delivered of a child. He also reports the case of a
distinguished musician who, by reason of hypospadias, had never
impregnated his wife, and had resorted to injections of semen with a
favorable result. This latter case seems hardly warranted when we
consider that men afflicted with hypospadias and epispadias have become
fathers. Percy gives the instance of a gentleman whom he had known for
some time, whose urethra terminated a little below the frenum, as in
other persons, but whose glans bulged quite prominently beyond it,
rendering urination in the forward direction impossible. Despite the
fact that this man could not perform the ejaculatory function, he was
the father of three children, two of them inheriting his penile
formation.

The fundamental condition of fecundity being the union of a
spermatozoid and an ovum, the object of artificial impregnation is to
further this union by introducing semen directly to the fundus of the
uterus. The operation is quite simple and as follows: The husband,
having been found perfectly healthy, is directed to cohabit with his
wife, using a condom. The semen ejaculated is sucked up by an
intrauterine syringe which has been properly disinfected and kept warm.
The os uteri is now exposed and wiped off with some cotton which has
been dipped in an antiseptic fluid; introduced to the fundus of the
uterus, and some drops of the fluid slowly expressed into the uterus.
The woman is then kept in bed on her back. This operation is best
carried out immediately before or immediately after the menstrual
epoch, and if not successful at the first attempt should be repeated
for several months. At the present day artificial impregnation in
pisciculture is extensively used with great success.

{footnote} The following extraordinary incident of accidental
impregnation, quoted from the American Medical Weekly by the Lancet, is
given in brief, not because it bears any semblance of possibility, but
as a curious example from the realms of imagination in medicine.

L. G. Capers of Vicksburg, Miss., relates an incident during the late
Civil War, as follows: A matron and her two daughters, aged fifteen and
seventeen years, filled with the enthusiasm of patriotism, stood ready
to minister to the wounds of their countrymen in their fine residence
near the scene of the battle of R----, May 12, 1863, between a portion
of Grant's army and some Confederates. During the fray a gallant and
noble young friend of the narrator staggered and fell to the earth; at
the same time a piercing cry was heard in the house near by.
Examination of the wounded soldier showed that a bullet had passed
through the scrotum and carried away the left testicle.  The same
bullet had apparently penetrated the left side of the abdomen of the
elder young lady, midway between the umbilicus and the anterior
superior spinous process of the ilium, and had become lost in the
abdomen. This daughter suffered an attack of peritonitis, but recovered
in two months under the treatment administered.

Marvelous to relate, just two hundred and seventy-eight days after the
reception of the minie-ball, she was delivered of a fine boy, weighing
8 pounds, to the surprise of herself and the mortification of her
parents and friends. The hymen was intact, and the young mother
strenuously insisted on her virginity and innocence. About three weeks
after this remarkable birth Dr. Capers was called to see the infant,
and the grandmother insisted that there was something wrong with the
child's genitals.  Examination showed a rough, swollen, and sensitive
scrotum, containing some hard substance. He operated, and extracted a
smashed and battered minie-ball. The doctor, after some meditation,
theorized in this manner: He concluded that this was the same ball that
had carried away the testicle of his young friend, that had penetrated
the ovary of the young lady, and, with some spermatozoa upon it, had
impregnated her. With this conviction he approached the young man and
told him the circumstances; the soldier appeared skeptical at first,
but consented to visit the young mother; a friendship ensued which soon
ripened into a happy marriage, and the pair had three children, none
resembling, in the same degree as the first, the heroic pater familias.


Interesting as are all the anomalies of conception, none are more so
than those of unconscious impregnation; and some well-authenticated
cases can be mentioned. Instances of violation in sleep, with
subsequent pregnancy as a result, have been reported in the last
century by Valentini, Genselius, and Schurig. Reports by modern
authorities seem to be quite scarce, though there are several cases on
record of rape during anesthesia, followed by impregnation. Capuron
relates a curious instance of a woman who was raped during lethargy,
and who subsequently became pregnant, though her condition was not
ascertained until the fourth month, the peculiar abdominal sensation
exciting suspicion of the true nature of the case, which had previously
been thought impossible.

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

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

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

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

Superfetation has been known for many centuries; the Romans had laws
prescribing the laws of succession in such cases, and many medical
writers have mentioned it. Hippocrates and Aristotle wrote of it, the
former at some length. Pliny speaks of a slave who bore two infants,
one resembling the master, the other a man with whom she had
intercourse, and cites the case as one of superfetation. Schenck
relates instances, and Zacchias, Velchius, and Sinibaldus mention
eases. Pare seemed to be well conversant with the possibility as well
as the actuality of superfetation; and Harvey reports that a certain
maid, gotten with child by her master, in order to hide her knavery
came to London in September, where she lay in by stealth, and being
recovered, returned home.  In December of the same year she was
unexpectedly delivered of another child, a product of superfetation,
which proclaimed the crime that she had so cunningly concealed before.

Marcellus Donatus, Goret, Schacher, and Mauriceau mention
superfetation. In the Academie des Sciences, at Paris, in 1702, there
was mentioned the case of a woman who was delivered of a boy; in the
placenta was discovered a sort of bladder which was found to contain a
female fetus of the age of from four to five months; and in 1729,
before the same society, there was an instance in which two fetuses
were born a day apart, one aged forty days and the other at full term.
From the description, it does not seem possible that either of these
were blighted twin pregnancies. Ruysch gives an account of a surgeon's
wife at Amsterdam, in 1686, who was delivered of a strong child which
survived, and, six hours after, of a small embryo, the funis of which
was full of hydatids and the placenta as large and thick as one of
three months. Ruysch accompanies his description with an illustrative
figure. At Lyons, in 1782, Benoite Franquet was unexpectedly delivered
of a child seven months old; three weeks later she experienced symptoms
indicative of the existence of another fetus, and after five months and
sixteen days she was delivered of a remarkably strong and healthy child.

Baudeloque speaks of a case of superfetation observed by Desgranges in
Lyons in 1780. After the birth of the first infant the lochia failed to
flow, no milk appeared in the breasts, and the belly remained large. In
about three weeks after the accouchement she had connection with her
husband, and in a few days felt fetal movements. A second child was
born at term, sixty-eight days after the first; and in 1782 both
children were living. A woman of Arles was delivered on November 11,
1796, of a child at term; she had connection with her husband four days
after; the lochia stopped, and the milk did not flow after this
intercourse. About one and a half months after this she felt quickening
again, and naturally supposed that she had become impregnated by the
first intercourse after confinement; but five months after the first
accouchement she was delivered of another child at term, the result of
a superfetation. Milk in abundance made its appearance, and she was
amply able to nourish both children from the breasts. Lachausse speaks
of a woman of thirty who bore one child on April 30, 1748, and another
on September 16th in the same year. Her breasts were full enough to
nourish both of the children. It might be remarked in comment on this
case that, according to a French authority, the woman died in 1755, and
on dissection was found to have had a double uterus.

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

Young speaks of a woman who three months previously had aborted a three
months' fetus, but a tumor still remained in the abdomen, the
auscultation of which gave evidence of a fetal heart-beat.  Vaginal
examination revealed a dilatation of the os uteri of at least one inch
and a fetal head pressing out; subsequently a living fetus of about six
months of age was delivered. Severe hemorrhage complicated the case,
but was controlled, and convalescence speedily ensued. Huse cites an
instance of a mother bearing a boy on November 4, 1834, and a girl on
August 3, 1835.  At birth the boy looked premature, about seven months
old, which being the case, the girl must have been either a
superfetation or a seven months' child also. Van Bibber of Baltimore
says he met a young lady who was born five months after her sister, and
who was still living.

The most curious and convincing examples of superfetation are those in
which children of different colors, either twins or near the same age,
are born to the same woman,--similar to that exemplified in the case of
the mare who was covered first by a stallion and a quarter of an hour
later by an ass, and gave birth at one parturition to a horse and a
mule. Parsons speaks of a case at Charleston, S.C., in 1714, of a white
woman who gave birth to twins, one a mulatto and the other white. She
confessed that after her husband left her a negro servant came to her
and forced her to comply with his wishes by threatening her life.
Smellie mentions the case of a black woman who had twins, one child
black and the other almost white. She confessed having had intercourse
with a white overseer immediately after her husband left her bed.
Dewees reports a similar case. Newlin of Nashville speaks of a negress
who bore twins, one distinctly black with the typical African features,
while the other was a pretty mulatto exhibiting the distinct characters
of the Caucasian race. Both the parents were perfect types of the black
African negro. The mother, on being questioned, frankly acknowledged
that shortly after being with her husband she had lain a night with a
white man. In this case each child had its own distinct cord and
placenta.

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

Delmas, a surgeon of Rouen, tells of a woman of thirty-six who was
delivered in the hospital of his city on February 26, 1806, of two
children, one black and the other a mulatto. She had been pregnant
eight months, and had had intercourse with a negro twice about her
fourth month of pregnancy, though living with the white man who first
impregnated her. Two placentae were expelled some time after the twins,
and showed a membranous junction. The children died shortly after birth.

Pregnancy often takes place in a unicorn or bicorn uterus, leading to
similar anomalous conditions. Galle, Hoffman, Massen, and Sanger give
interesting accounts of this occurrence, and Ross relates an instance
of triple pregnancy in a double uterus.  Cleveland describes a
discharge of an anomalous deciduous membrane during pregnancy which was
probably from the unimpregnated half of a double uterus.



CHAPTER II.

PRENATAL ANOMALIES.

Extrauterine Pregnancy.--In the consideration of prenatal anomalies,
the first to be discussed will be those of extrauterine pregnancy. This
abnormalism has been known almost as long as there has been any real
knowledge of obstetrics. In the writings of Albucasis, during the
eleventh century, extrauterine pregnancy is discussed, and later the
works of N. Polinus and Cordseus, about the sixteenth century, speak of
it; in the case of Cordseus the fetus was converted into a lithopedion
and carried in the abdomen twenty-eight years. Horstius in the
sixteenth century relates the history of a woman who conceived for the
third time in March, 1547, and in 1563 the remains of the fetus were
still in the abdomen.

Israel Spach, in an extensive gynecologic work published in 1557,
figures a lithopedion drawn in situ in the case of a woman with her
belly laid open. He dedicated to this calcified fetus, which he
regarded as a reversion, the following curious epigram, in allusion to
the classical myth that after the flood the world was repopulated by
the two survivors, Deucalion and Pyrrha, who walked over the earth and
cast stones behind them, which, on striking the ground, became people.
Roughly translated from the Latin, this epigram read as follows:
"Deucalion cast stones behind him and thus fashioned our tender race
from the hard marble. How comes it that nowadays, by a reversal of
things, the tender body of a little babe has limbs nearer akin to
stone?" Many of the older writers mention this form of fetation as a
curiosity, but offer no explanation as to its cause. Mauriceau and de
Graaf discuss in full extrauterine pregnancy, and Salmuth, Hannseus,
and Bartholinus describe it. From the beginning of the eighteenth
century this subject always demanded the attention and interest of
medical observers. In more modern times, Campbell and
Geoffroy-Saint-Hilaire, who named it "Grossesse Pathologique," have
carefully defined and classified the forms, and to-day every text-book
on obstetrics gives a scientific discussion and classification of the
different forms of extrauterine pregnancy.

The site of the conception is generally the wall of the uterus, the
Fallopian tube, or the ovary, although there are instances of pregnancy
in the vagina, as for example when there is scirrhus of the uterus; and
again, cases supposed to be only extrauterine have been instances
simply of double uterus, with single or concurrent pregnancy. Ross
speaks of a woman of thirty-three who had been married fourteen years,
had borne six children, and who on July 16, 1870, miscarried with twins
of about five months' development. After a week she declared that she
was still pregnant with another child, but as the physician had placed
his hand in the uterine cavity after the abortion, he knew the fetus
must be elsewhere or that no pregnancy existed. We can readily see how
this condition might lead to a diagnosis of extrauterine pregnancy, but
as the patient insisted on a thorough examination, the doctor found by
the stethoscope the presence of a beating fetal heart, and by vaginal
examination a double uterus. On introducing a sound into the new
aperture he discovered that it opened into another cavity; but as the
woman was pregnant in this, he proceeded no further. On October 31st
she was delivered of a female child of full growth. She had menstruated
from this bipartite uterus three times during the period between the
miscarriage of the twins and the birth of the child. Both the mother
and child did well.

In most cases there is rupture of the fetal sac into the abdominal
cavity or the uterus, and the fetus is ejected into this location, from
thence to be removed or carried therein many years; but there are
instances in which the conception has been found in situ, as depicted
in Figure 2. A sturdy woman of thirty was executed on January 16, 1735,
for the murder of her child. It was ascertained that she had passed her
catamenia about the first of the month, and thereafter had sexual
intercourse with one of her fellow-prisoners. On dissection both
Fallopian tubes were found distended, and the left ovary, which bore
signs of conception, was twice as large as the right. Campbell quotes
another such case in a woman of thirty-eight who for twenty years had
practised her vocation as a Cyprian, and who unexpectedly conceived. At
the third month of pregnancy a hard extrauterine tumor was found, which
was gradually increasing in size and extending to the left side of the
hypogastrium, the associate symptoms of pregnancy, sense of pressure,
pain, tormina, and dysuria, being unusually severe. There was
subsequently at attack of inflammatory fever, followed by tumefaction
of the abdomen, convulsions, and death on the ninth day. The fetus had
been contained in the peritoneal coat of the ovary until the fourth
month, when one of the feet passed through the cyst and caused the
fatal result. Signs of acute peritonitis were seen postmortem, the
abdominal cavity was full of blood, and the ovary much lacerated.

The termination of extrauterine pregnancy varies; in some cases the
fetus is extracted by operation after rupture; in others the fetus has
been delivered alive by abdominal section; it may be partially
absorbed, or carried many years in the abdomen; or it may ulcerate
through the confining walls, enter the bowels or bladder, and the
remnants of the fetal body be discharged.

The curious cases mentioned by older writers, and called abortion by
the mouth, etc., are doubtless, in many instances, remnants of
extrauterine pregnancies or dermoid cysts. Maroldus speaks in full of
such cases; Bartholinus, Salmuth, and a Reyes speak of women vomiting
remnants of fetuses. In Germany, in the seventeenth century, there
lived a woman who on three different occasions is said to have vomited
a fetus. The last miscarriage in this manner was of eight months'
growth and was accompanied by its placenta. The older observers thought
this woman must have had two orifices to her womb, one of which had
some connection with the stomach, as they had records of the dissection
of a female in whom was found a conformation similar to this.

Discharge of the fetal bones or even the whole of an extrauterine fetus
by the rectum is not uncommon. There are two early cases mentioned in
which the bones of a fetus were discharged at stool, causing intense
pain. Armstrong describes an anomalous case of pregnancy in a
syphilitic patient who discharged fetal bones by the rectum. Bubendorf
reports the spontaneous elimination of a fetal skeleton by the rectum
after five years of retention, with recovery of the patient. Butcher
speaks of delivery through the rectum at the fourth month, with
recovery. Depaul mentions a similar expulsion after a pregnancy of
about two months and a half. Jackson reports the dissection of an
extrauterine sac which communicated freely with the large intestine.
Peck has an example of spontaneous delivery of an extrauterine fetus by
the rectum, with recovery of the mother. Skippon, in the early part of
the last century, reports the discharge of the bones of a fetus through
an "imposthume" in the groin. Other cases of anal discharge of the
product of extrauterine conception are recorded by Winthrop, Woodbury,
Tuttle, Atkinson, Browne, Weinlechner, Gibson, Littre, Magruder,
Gilland, and many others. De Brun du Bois-Noir speaks of the expulsion
of extrauterine remains by the anus after seven years, and Heyerdahl
after thirteen years.  Benham mentions the discharge of a fetus by the
rectum; there was a stricture of the rectum associated with syphilitic
patches, necessitating the performance of colotomy.

Bartholinus and Rosseus speak of fetal bones being discharged from the
urinary passages. Ebersbach, in the Ephemerides of 1717, describes a
necropsy in which a human fetus was found contained in the bladder. In
1878 White reported an instance of the discharge of fetal remains
through the bladder.

Discharge of the Fetus through the Abdominal Walls.--Margaret Parry of
Berkshire in 1668 voided the bones of a fetus through the flesh above
the os pubis, and in 1684 she was alive and well, having had healthy
children afterward. Brodie reports the history of a case in a negress
who voided a fetus from an abscess at the navel about the seventeenth
month of conception. Modern instances of the discharge of the
extrauterine fetus from the walls of the abdomen are frequently
reported. Algora speaks of an abdominal pregnancy in which there was
spontaneous perforation of the anterior abdominal parietes, followed by
death. Bouzal cites an extraordinary case of ectopic gestation in which
there was natural expulsion of the fetus through abdominal walls, with
subsequent intestinal strangulation. An artificial anus was established
and the mother recovered. Brodie, Dunglison, Erich, Rodbard, Fox, and
Wilson are among others reporting the expulsion of remnants of ectopic
pregnancies through the abdominal parietes. Campbell quotes the case of
a Polish woman, aged thirty-five, the mother of nine children, most of
whom were stillborn, who conceived for the tenth time, the gestation
being normal up to the lying-in period. She had pains followed by
extraordinary effusion and some blood into the vagina. After various
protracted complaints the abdominal tumor became painful and inflamed
in the umbilical region. A breach in the walls soon formed, giving exit
to purulent matter and all the bones of a fetus. During this process
the patient received no medical treatment, and frequently no assistance
in dressing the opening.  She recovered, but had an artificial anus all
her life. Sarah McKinna was married at sixteen and menstruated for the
first time a month thereafter. Ten months after marriage she showed
signs of pregnancy and was delivered at full term of a living child;
the second child was born ten months after the first, and the second
month after the second birth she again showed signs of pregnancy.  At
the close of nine months these symptoms, with the exception of the
suppression of menses, subsided, and in this state she continued for
six years. During the first four years she felt discomfort in the
region of the umbilicus. About the seventh year she suffered
tumefaction of the abdomen and thought she had conceived again. The
abscess burst and an elbow of the fetus protruded from the wound. A
butcher enlarged the wound and, fixing his finger under the jaw of the
fetus, extracted the head.  On looking into the abdomen he perceived a
black object, whereupon he introduced his hand and extracted piecemeal
an entire fetal skeleton and some decomposed animal-matter. The abdomen
was bound up, and in six weeks the woman was enabled to superintend her
domestic affairs; excepting a ventral hernia she had no bad
after-results. Kimura, quoted by Whitney, speaks of a case of
extrauterine pregnancy in a Japanese woman of forty-one similar to the
foregoing, in which an arm protruded through the abdominal wall above
the umbilicus and the remains of a fetus were removed through the
aperture. The accompanying illustration shows the appearance of the arm
in situ before extraction of the fetus and the location of the wound.

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

Combined Intrauterine and Extrauterine Gestation.--Many
well-authenticated cases of combined pregnancy, in which one of the
products of conception was intrauterine and the other of extrauterine
gestation, have been recorded. Clark and Ramsbotham report instances of
double conception, one fetus being born alive in the ordinary manner
and the other located extrauterine.  Chasser speaks of a case in which
there was concurrent pregnancy in both the uterus and the Fallopian
tube. Smith cites an instance of a woman of twenty-three who became
pregnant in August, 1870. In the following December she passed fetal
bones from the rectum, and a month later gave birth to an intrauterine
fetus of six months' growth. McGee mentions the case of a woman of
twenty-eight who became pregnant in July, 1872, and on October 20th and
21st passed several fetal bones by the rectum, and about four months
later expelled some from the uterus. From this time she rapidly
recovered her strength and health. Devergie quotes an instance of a
woman of thirty who had several children, but who died suddenly, and
being pregnant was opened. In the right iliac fossa was found a male
child weighing 5 pounds and 5 ounces, 8 1/2 inches long, and of about
five months' growth. The uterus also contained a male fetus of about
three months' gestation.  Figure 4 shows combined intrauterine and
extrauterine gestation.  Hodgen speaks of a woman of twenty-seven, who
was regular until November, 1872; early in January, 1873, she had an
attack of pain with peritonitis, shortly after which what was
apparently an extrauterine pregnancy gradually diminished. On August
17, 1873, after a labor of eight hours, she gave birth to a healthy
fetus.  The hand in the uterus detected a tumor to the left, which wag
reduced to about one-fourth the former size. In April, 1874, the woman
still suffered pain and tenderness in the tumor. Hodgen believed this
to have been originally a tubal pregnancy, which burst, causing much
hemorrhage and the death of the fetus, together with a limited
peritonitis. Beach has seen a twin compound pregnancy in which after
connection there was a miscarriage in six weeks, and four years after
delivery of an extrauterine fetus through the abdominal walls. Cooke
cites an example of intrauterine and extrauterine pregnancy progressing
simultaneously to full period of gestation, with resultant death.
Rosset reports the case of a woman of twenty-seven, who menstruated
last in November, 1878, and on August 5, 1879, was delivered of a
well-developed dead female child weighing seven pounds. The uterine
contractions were feeble, and the attached placenta was removed only
with difficulty; there was considerable hemorrhage. The hemorrhage
continued to occur at intervals of two weeks, and an extrauterine tumor
remained. Two weeks later septicemia supervened and life was despaired
of. On the 15th of October a portion of a fetus of five months' growth
in an advanced stage of decomposition protruded from the vulva. After
the escape of this putrid mass her health returned, and in four months
she was again robust and healthy. Whinery speaks of a young woman who
at the time of her second child-birth observed a tumor in the abdomen
on her right side and felt motion in it. In about a month she was with
severe pain which continued a week and then ceased. Health soon
improved, and the woman afterward gave birth to a third child;
subsequently she noticed that the tumor had enlarged since the first
birth, and she had a recurrence of pain and a slight hemorrhage every
three weeks, and distinctly felt motion in the tumor. This continued
for eighteen months, when, after a most violent attack of pain, all
movement ceased, and, as she expressed it, she knew the moment the
child died. The tumor lost its natural consistence and felt flabby and
dead. An incision was made through the linea alba, and the knife came
in contact with a hard, gritty substance, three or four lines thick.
The escape of several quarts of dark brown fluid followed the incision,
and the operation had to be discontinued on account of the ensuing
syncope. About six weeks afterward a bone presented at the orifice,
which the woman extracted, and this was soon followed by a mass of
bones, hair, and putrid matter. The discharge was small, and gradually
grew less in quantity and offensiveness, soon ceasing altogether, and
the wound closed. By December health was good and the menses had
returned.

Ahlfeld, Ambrosioni, Galabin, Packard, Thiernesse, Maxson, de
Belamizaran, Dibot, and Chabert are among others recording the
phenomenon of coexisting extrauterine and intrauterine pregnancy.
Argles mentions simultaneous extrauterine fetation and superfetation.

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

The instances of delivery of an extrauterine fetus, with viability of
the child, from the abdomen of the mother would attract attention from
their rarity alone, but when coupled with associations of additional
interest they surely deserve a place in a work of this nature. Osiander
speaks of an abdominal fetus being taken out alive, and there is a
similar case on record in the early part of this century. The London
Medical and Physical Journal, in one of its early numbers, contained an
account of an abdominal fetus penetrating the walls of the bladder and
being extracted from the walls of the hypogastrium; but Sennertus gives
a case which far eclipses this, both mother and fetus surviving.  He
says that in this case the woman, while pregnant, received a blow on
the lower part of her body, in consequence of which a small tumor
appeared shortly after the accident. It so happened in this case that
the peritoneum was extremely dilatable, and the uterus, with the child
inside, made its way into the peritoneal sac. In his presence an
incision was made and the fetus taken out alive. Jessop gives an
example of extrauterine gestation in a woman of twenty-six, who had
previously had normal delivery. In this case an incision was made and a
fetus of about eight months' growth was found lying loose in the
abdominal cavity in the midst of the intestines. Both the mother and
child were saved. This is a very rare result. Campbell, in his
celebrated monograph, in a total of 51 operations had only seen
recorded the accounts of two children saved, and one of these was too
marvelous to believe.  Lawson Tait reports a case in which he saved the
child, but lost the mother on the fourth day. Parvin describes a case
in which death occurred on the third day. Browne quotes Parry as saying
that there is one twin pregnancy in 23 extrauterine conceptions.  He
gives 24 cases of twin conception, one of which was uterine, the other
extrauterine, and says that of 7 in the third month, with no operation,
the mother died in 5. Of 6 cases of from four and a half to seven
months' duration, 2 lived, and in 1 case at the fifth month there was
an intrauterine fetus delivered which lived. Of 11 such cases at nine
months, 6 mothers lived and 6 intrauterine fetuses lived. In 6 of these
cases no operation was performed. In one case the mother died, but both
the uterine and the extrauterine conceptions lived. In another the
mother and intrauterine fetus died, and the extrauterine fetus lived.
Wilson a gives an instance of a woman delivered of a healthy female
child at eight months which lived. The after-birth came away without
assistance, but the woman still presented every appearance of having
another child within her, although examination by the vagina revealed
none. Wilson called Chatard in consultation, and from the fetal
heart-sounds and other symptoms they decided that there was another
pregnancy wholly extrauterine. They allowed the case to go twenty-three
days, until pains similar to those of labor occurred, and then decided
on celiotomy. The operation was almost bloodless, and a living child
weighing eight pounds was extracted. Unfortunately, the mother
succumbed after ninety hours, and in a month the intrauterine child
died from inanition, but the child of extrauterine gestation thrived.
Sales gives the case of a negress of twenty-two, who said that she had
been "tricked by a negro," and had a large snake in the abdomen, and
could distinctly feel its movements. She stoutly denied any
intercourse. It was decided to open the abdominal cyst; the incision
was followed by a gush of blood and a placenta came into view, which
was extracted with a living child. To the astonishment of the operators
the uterus was distended, and it was decided to open it, when another
living child was seen and extracted. The cyst and the uterus were
cleansed of all clots and the wound closed. The mother died of
septicemia, but the children both lived and were doing well six weeks
after the operation. A curious case was seen in 1814 of a woman who at
her fifth gestation suffered abdominal uneasiness at the third month,
and this became intolerable at the ninth month.  The head of the fetus
could be felt through the abdomen; an incision was made through the
parietes; a fully developed female child was delivered, but,
unfortunately, the mother died of septic infection.

The British Medical Journal quotes: "Pinard (Bull. de l'Acad. de Med.,
August 6, 1895) records the following, which he describes as an ideal
case. The patient was aged thirty-six, had had no illness, and had been
regular from the age of fourteen till July, 1894. During August of that
year she had nausea and vomiting; on the 22d and 23d she lost a fluid,
which was just pink. The symptoms continued during September, on the
22d and 23d of which month there was a similar loss. In October she was
kept in bed for two days by abdominal pain, which reappeared in
November, and was then associated with pain in micturition and
defecation. From that time till February 26, 1895, when she came under
Pinard's care, she was attended by several doctors, each of whom
adopted a different diagnosis and treatment. One of them, thinking she
had a fibroid, made her take in all about an ounce of savin powder,
which did not, however, produce any ill effect. When admitted she
looked ill and pinched. The left thigh and leg were painful and
edematous. The abdomen looked like that of the sixth month of
pregnancy. The abdominal wall was tense, smooth, and without lineae
albicantes. Palpation revealed a cystic immobile tumor, extending 2
inches above the umbilicus and apparently fixed by deep adhesions. The
fetal parts could only be made out with difficulty by deep palpation,
but the heart-sounds were easily heard to the right of and below the
umbilicus. By the right side of this tumor one could feel a small one,
the size of a Tangerine orange, which hardened and softened under
examination. When contracted the groove between it and the large tumor
became evident. Vaginal examination showed that the cervix, which was
slightly deflected forward and to the right and softened, as in uterine
gestation, was continuous with the smaller tumor.  Cephalic
ballottement was obtained in the large tumor. No sound was passed into
the uterus for fear of setting up reflex action; the diagnosis of
extrauterine gestation at about six and a half months with a living
child was established without requiring to be clinched by proving the
uterus empty. The patient was kept absolutely at rest in bed and the
edema of the left leg cured by position. On April 30th the fundus of
the tumor was 35 cm. above the symphysis and the uterus 11 1/2 cm.; the
cervix was soft as that of a primipara at term. Operation, May 2d:
Uterus found empty, cavity 14 1/2 cm. long. Median incision in
abdominal wall; cyst walls exposed; seen to be very slight and filled
with enormous vessels, some greater than the little finger. On seizing
the wall one of these vessels burst, and the hemorrhage was only
rendered greater on attempting to secure it, so great was the
friability of the walls. The cyst was therefore rapidly opened and the
child extracted by the foot. Hemorrhage was restrained first by
pressure of the hands, then by pressure-forceps and ligatures. The
walls of the cyst were sewn to the margins of the abdominal wound, the
edge of the placenta being included in the suture. A wound was thus
formed 10 cm. in diameter, with the placenta for its base; it was
filled with iodoform and salicylic gauze. The operation lasted an hour,
and the child, a boy weighing 5 1/2 pounds, after a brief period of
respiratory difficulties, was perfectly vigorous. There was at first a
slight facial asymmetry and a depression on the left upper jaw caused
by the point of the left shoulder, against which it had been pressed in
the cyst; these soon disappeared, and on the nineteenth day the boy
weighed 12 pounds. The maternal wound was not dressed till May 13th,
when it was washed with biniodid, 1:4000. The placenta came away
piecemeal between May 25th and June 2d. The wound healed up, and the
patient got up on the forty-third day, having suckled her infant from
the first day after its birth."

Quite recently Werder has investigated the question of the ultimate
fate of ectopic children delivered alive. He has been able to obtain
the record of 40 cases. Of these, 18 died within a week after birth; 5
within a month; 1 died at six months of bronchopneumonia; 1 at seven
months of diarrhea; 2 at eleven months, 1 from croup; 1 at eighteen
months from cholera infantum--making a total of 26 deaths and leaving
14 children to be accounted for. Of these, 5 were reported as living
and well after operation, with no subsequent report; 1 was strong and
healthy after three weeks, but there has been no report since; 1 was
well at six months, then was lost sight of; 1 was well at the Last
report; 2 live and are well at one year; 2 are living and well at two
years; 1 (Beisone's case) is well at seven years; and 1 (Tait's case)
is well at fourteen and one-half years. The list given on pages 60 and
61 has been quoted by Hirst and Dorland. It contains data relative to
17 cases in which abdominal section has been successfully performed for
advanced ectopic gestation with living children.

Long Retention of Extrauterine Pregnancy.--The time of the retention of
an extrauterine gestation is sometimes remarkable, and it is no
uncommon occurrence for several pregnancies to successfully ensue
during such retention. The Ephemerides contains examples of
extrauterine pregnancy remaining in the abdomen forty-six years;
Hannaeus mentioned an instance remaining ten years, the mother being
pregnant in the meantime; Primperosius speaks of a similar instance; de
Blegny, one of twenty-five years in the abdomen; Birch, a case of
eighteen years in the abdomen, the woman bearing in the meantime;
Bayle, one of twenty-six years, and the Ephemerides, another. In a
woman of forty-six, the labor pains intervened without expulsion of the
fetus. Impregnation ensued twice afterward, each followed by the birth
of a living child. The woman lived to be ninety-four, and was persuaded
that the fetus was still in the abdomen, and directed a postmortem
examination to be made after her decease, which was done, and a large
cyst containing an ossified fetus was discovered in the left side of
the cavity. In 1716 a woman of Joigny when thirty years old, having
been married four years, became pregnant, and three months later felt
movements and found milk in her breasts. At the ninth month she had
labor-pains, but the fetus failed to present; the pains ceased, but
recurred in a month, still with a negative result. She fell into a most
sickly condition and remained so for eighteen months, when the pains
returned again, but soon ceased. Menstruation ceased and the milk in
her breasts remained for thirty years. She died at sixty-one of
peripneumonia, and on postmortem examination a tumor was found
occupying part of the hypogastric and umbilical regions. It weighed
eight pounds and consisted of a male fetus of full term with six teeth;
it had no odor and its sac contained no liquid.  The bones seemed
better developed than ordinarily; the skin was thick, callous, and
yellowish The chorion, amnion, and placenta were ossified and the cord
dried up. Walther mentions the case of an infant which remained almost
petrified in the belly of its mother for twenty-three years. No trace
of the placenta, cord, or enveloping membrane could be found.

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

Lospichlerus gives an account of a mother carrying twins, extrauterine,
for six years. Mounsey of Riga, physician to the army of the Czarina,
sent to the Royal Society in 1748 the bones of a fetus that had been
extracted from one of the fallopian tubes after a lodgment of thirteen
years. Starkey Middleton read the report of a case of a child which had
been taken out of the abdomen, having lain there nearly sixteen years,
during which time the mother had borne four children. It was argued at
this time that boys were conceived on the right side and girls on the
left, and in commenting on this Middleton remarks that in this case the
woman had three boys and one girl after the right fallopian tube had
lost its function. Chester cites the instance of a fetus being retained
fifty-two years, the mother not dying until her eightieth year.
Margaret Mathew carried a child weighing eight pounds in her abdomen
for twenty-six years, and which after death was extracted. Aubrey
speaks of a woman aged seventy years unconsciously carrying an
extrauterine fetus for many years, which was only discovered
postmortem. She had ceased to menstruate at forty and had borne a child
at twenty-seven.  Watkins speaks of a fetus being retained forty-three
years; James, others for twenty-five, thirty, forty-six, and fifty
years; Murfee, fifty-five years; Cunningham, forty years; Johnson,
forty-four years; Josephi, fifteen years (in the urinary bladder);
Craddock, twenty-two years, and da Costa Simoes, twenty-six years.

Long Retention of Uterine Pregnancy.--Cases of long retained
intrauterine pregnancies are on record and deserve as much
consideration as those that were extrauterine. Albosius speaks of a
mother carrying a child in an ossified condition in the uterus for
twenty-eight years. Cheselden speaks of a case in which a child was
carried many years in the uterus, being converted into a clay-like
substance, but preserving form and outline. Caldwell mentions the case
of a woman who carried an ossified fetus in her uterus for sixty years.
Camerer describes the retention of a fetus in the uterus for forty-six
years; Stengel, one for ten years, and Storer and Buzzell, for
twenty-two months. Hannaeus, in 1686, issued a paper on such a case
under the title, "Mater, Infantis Mortui Vivum Sepulchrum," which may
be found in French translation.

Buchner speaks of a fetus being retained in the uterus for six years,
and Horstius relates a similar case. Schmidt's Jahrbucher contain the
report of a woman of forty-nine, who had borne two children. While
threshing corn she felt violent pain like that of labor, and after an
illness suffered a constant fetid discharge from the vagina for eleven
years, fetal bones being discharged with occasional pain. This poor
creature worked along for eleven years, at the end of which time she
was forced to bed, and died of symptoms of purulent peritonitis. At the
necropsy the uterus was found adherent to the anterior wall of the
abdomen and containing remnants of a putrid fetus with its numerous
bones.  There is an instance recorded of the death of a fetus occurring
near term, its retention and subsequent discharge being through a
spontaneous opening in the abdominal wall one or two months after.

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

There are many narratives of the long continuation of fetal movements,
and during recent years, in the Southern States, there was quite a
prevalence of this kind of imposters. Many instances of the exhibition
of fetal movements in the bellies of old negro women have been noticed
by the lay journals, but investigation proves them to have been nothing
more than an exceptional control over the abdominal muscles, with the
ability to simulate at will the supposed fetal jerks. One old woman
went so far as to show the fetus dancing to the music of a banjo with
rhythmical movements. Such imposters flourished best in the regions
given to "voodooism." We can readily believe how easy the deception
might be when we recall the exact simulation of the fetal movements in
instances of pseudocyesis.

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

Short Pregnancies.--Hasenet speaks of the possibility of a living birth
at four months; Capuron relates the instance of Fortunio Liceti, who
was said to have been born at the end of four and a half months and
lived to complete his twenty-fourth year. In the case of the Marechal
de Richelieu, the Parliament of Paris decreed that an infant of five
months possessed that capability of living the ordinary period of
existence, i.e., the "viabilite," which the law of France requires for
the establishment of inheritance. In his seventh book Pliny gives
examples of men who were born out of time. Jonston gives instances of
births at five, six, seven, and eight months. Bonnar quotes 5 living
births before the one hundred and fiftieth day; 1 of one hundred and
twenty-five days; 1 of one hundred and twenty days; 1 of one hundred
and thirty-three days, surviving to twenty-one months; and 1 of one
hundred and thirty-five days' pregnancy surviving to eighty years.
Maisonneuve describes a case in which abortion took place at four and a
half months; he found the fetus in its membranes two hours after
delivery, and, on laying the membranes open, saw that it was living. He
applied warmth, and partly succeeded in restoring it; for a few minutes
respiratory movements were performed regularly, but it died in six
hours. Taylor quotes Carter concerning the case of a fetus of five
months which cried directly after it was born, and in the half hour it
lived it tried frequently to breathe. He also quotes Davies, mentioning
an instance of a fetus of five months, which lived twelve hours,
weighing 2 pounds, and measuring 12 inches, and which cried vigorously.
The pupillary membrane was entire, the testes had not descended, and
the head was well covered with hair. Usher speaks of a woman who in
1876 was delivered of 2 male children on the one hundred and
thirty-ninth day; both lived for an hour; the first weighed 10 ounces 6
drams and measured 9 3/4 inches; the other 10 ounces 7 drams, with the
same length as the first. Routh speaks of a Mrs. F----, aged
thirty-eight, who had borne 9 children and had had 3 miscarriages, the
last conception terminating as such. Her husband was away, and returned
October 9, 1869. She did not again see her husband until the 3d or 4th
of January. The date of quickening was not observed, and the child was
born June 8, 1870. During gestation she was much frightened by a rat.
The child was weak, the testes undescended, and it lived but eighteen
days, dying of symptoms of atrophy. The parents were poor, of excellent
character, and although, according to the evidence, this pregnancy
lasted but twenty-two weeks and two days, there was absolutely no
reason to suspect infidelity.

Ruttel speaks of a child of five months who lived twenty-four hours;
and he saw male twins born at the sixth month weighing 3 pounds each
who were alive and healthy a year after. Barker cites the case of a
female child born on the one hundred and fifty-eighth day that weighed
1 pound and was 11 inches long. It had rudimentary nails, very little
hair on the head, its eyelids were closed, and the skin much shriveled;
it did not suckle properly, and did not walk until nineteen months old.
Three and a half years after, the child was healthy and thriving, but
weighed only 29 1/2 pounds. At the time of birth it was wrapped up in a
box and placed before the fire. Brouzet speaks of living births of from
five to six months' pregnancy, and Kopp speaks of a six months' child
which lived four days. The Ephemerides contains accounts of living
premature births.

Newinton describes a pregnancy of five months terminating with the
birth of twins, one of whom lived twenty minutes and the other fifteen.
The first was 11 1/2 inches long, and weighed 1 pound 3 1/2 ounces, and
the other was 11 inches long, and weighed 1 pound. There is a recent
instance of premature birth following a pregnancy of between five and a
half and six months, the infant weighing 955 grams. One month after
birth, through the good offices of the wet-nurse and M. Villemin, who
attended the child and who invented a "couveuse" for the occasion, it
measured 38 cm. long.

Moore is accredited with the trustworthy report of the case of a woman
who bore a child at the end of the fifth month weighing 1 1/2 pounds
and measuring 9 inches. It was first nourished by dropping liquid food
into its mouth; and at the age of fifteen months it was healthy and
weighed 18 pounds. Eikam saw a case of abortion at the fifth month in
which the fetus was 6 inches in length and weighed about 8 ounces. The
head was sufficiently developed and the cranial bones considerably
advanced in ossification. He tied the cord and placed the fetus in warm
water. It drew up its feet and arms and turned its head from one side
to the other, opening its mouth and trying to breathe. It continued in
this wise for an hour, the action of the heart being visible ten
minutes after the movements ceased. From its imperfectly developed
genitals it was supposed to have been a female. Professor J. Muller, to
whom it was shown, said that it was not more than four months old, and
this coincided with the mother's calculation.

Villemin before the Societe Obstetricale et Gynecologique reported the
case of a two-year-old child, born in the sixth month of pregnancy.
That the child had not had six months of intrauterine life he could
vouch, the statement being borne out by the last menstrual period of
the mother, the date of the first fetal movements, the child's weight,
which was 30 1/2 ounces, and its appearance. Budin had had this infant
under observation from the beginning and corroborated Villemin's
statements. He had examined infants of six or seven months that had
cried and lived a few days, and had found the alveolar cavities filled
with epithelial cells, the lung sinking when placed in a vessel of
water. Charpentier reported a case of premature birth in his practice,
the child being not more than six and a half months and weighing 33 1/2
ounces. So sure was he that it would not live that he placed it in a
basin while he attended to the mother.  After this had been done, the
child being still alive, he wrapped it in cotton and was surprised next
day to find it alive. It was then placed in a small, well-heated room
and fed with a spoon on human milk; on the twelfth day it could take
the breast, since which time it thrived and grew.

There is a case on record of a child viable at six months and twenty
days. The mother had a miscarriage at the beginning of 1877, after
which menstruation became regular, appearing last from July 3 to 9,
1877. On January 28, 1878, she gave birth to a male infant, which was
wrapped in wadding and kept at an artificial temperature. Being unable
to suckle, it was fed first on diluted cow's milk. It was so small at
birth that the father passed his ring over the foot almost to the knee.
On the thirteenth day it weighed 1250 grams, and at the end of a week
it was taking the breast. In December, 1879, it had 16 teeth, weighed
10 kilograms, walked with agility, could pronounce some words, and was
especially intelligent. Capuron relates an instance of a child born
after a pregnancy of six and a half months and in excellent health at
two years, and another living at ten years of the same age at birth.
Tait speaks of a living female child, born on the one hundred and
seventy-ninth day, with no nails on its fingers or toes, no hair, the
extremities imperfectly developed, and the skin florid and thin. It was
too feeble to grasp its mother's nipple, and was fed for three weeks by
milk from the breast through a quill. At forty days it weighed 3 pounds
and measured 13 inches. Before the expiration of three months it died
of measles. Dodd describes a case in which the catamenia were on the
24th of June, 1838, and continued a week; the woman bore twins on
January 11, 1839, one of which survived, the other dying a few minutes
after birth. She was never irregular, prompt to the hour, and this
fact, coupled with the diminutive size of the children, seemed to
verify the duration of the pregnancy. In 1825, Baber of Buxur, India,
spoke of a child born at six and a half months, who at the age of fifty
days weighed 1 pound and 13 ounces and was 14 inches long. The longest
circumference of the head was 10 inches and the shortest 9.1 inches.
The child suckled freely and readily. In Spaeth's clinic there was a
viable infant at six and a half months weighing 900 grams. Spaeth says
that he has known a child of six months to surpass in eventual
development its brothers born at full term.

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

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

The question of retardation of labor, like that of premature birth, is
open to much discussion, and authorities differ as to the limit of
protraction with viability. Aulus Gellius says that, after a long
conversation with the physicians and wise men, the Emperor Adrian
decided in a case before him, that of a woman of chaste manners and
irreproachable character, the child born eleven months after her
husband's death was legitimate. Under the Roman law the Decenviri
established that a woman may bear a viable child at the tenth month of
pregnancy. Paulus Zacchias, physician to Pope Innocent X, declared that
birth may be retarded to the tenth month, and sometimes to a longer
period. A case was decided in the Supreme Court of Friesland, a
province in the northern part of the Netherlands, October, 1634, in
which a child born three hundred and thirty-three days after the death
of the husband was pronounced legitimate. The Parliament of Paris was
gallant enough to come to the rescue of a widow and save her reputation
by declaring that a child born after a fourteen months' gestation was
legitimate. Bartholinus speaks of an unmarried woman of Leipzig who was
delivered after a pregnancy of sixteen months. The civil code of France
provides that three hundred days shall constitute the longest period of
the legitimacy of an infant; the Scottish law, three hundred days; and
the Prussian law, three hundred and one days.

There are numerous cases recorded by the older writers. Amman has one
of twelve months' duration; Enguin, one of twelve months'; Buchner, a
case of twelve months'; Benedictus, one of fourteen months'; de Blegny,
one of nineteen months'; Marteau, Osiander, and others of forty-two and
forty-four weeks'; and Stark's Archives, one of forty-five weeks',
living, and also another case of forty-four weeks'. An incredible case
is recorded of an infant which lived after a three years' gestation.
Instances of twelve months' duration are also recorded. Jonston quotes
Paschal in relating an instance of birth after pregnancy of
twenty-three months; Aventium, one after two years; and Mercurialis, a
birth after a four years' gestation--which is, of course, beyond belief.

Thormeau writes from Tours, 1580, of a case of gestation prolonged to
the twenty-third month, and Santorini, at Venice, in 1721, describes a
similar case, the child reaching adult life.  Elvert records a case of
late pregnancy, and Henschel one of forty-six weeks, but the fetus was
dead. Schneider cites an instance of three hundred and eight days'
duration. Campbell says that Simpson had cases of three hundred and
nineteen, three hundred and thirty-two, and three hundred and
thirty-six days'; Meigs had one of four hundred and twenty. James Reid,
in a table of 500 mature births, gives 14 as being from three hundred
and two to three hundred and fifteen days'.

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

Talcott, Superintendent of the State Homeopathic Asylum for the Insane,
explained the pregnancy of an inmate who had been confined for four
years in this institution as one of protracted labor. He said that many
such cases have been reported, and that something less than two years
before he had charge of a case in which the child was born. He made the
report to the New York Senate Commission on Asylums for the Insane as
one of three years' protraction. Tidd speaks of a woman who was
delivered of a male child at term, and again in ten months delivered of
a well-developed male child weighing 7 1/4 pounds; he relates the
history of another case, in Clifton, W. Va., of a woman expecting
confinement on June 1st going over to September 16th, the fetus being
in the uterus over twelve months, and nine months after quickening was
felt.

Two extraordinary cases are mentioned, one in a woman of thirty-five,
who expected to be confined April 24, 1883. In May she had a few
labor-pains that passed away, and during the next six months she
remained about as large as usual, and was several times thought to be
in the early stages of labor. In September the os dilated until the
first and second fingers could be passed directly to the head. This
condition lasted about a month, but passed away. At times during the
last nine months of pregnancy she was almost unable to endure the
movements of the child.  Finally, on the morning of November 6th, after
a pregnancy of four hundred and seventy-six days, she was delivered of
a male child weighing 13 pounds. Both the mother and child did well
despite the use of chloroform and forceps. The other case was one
lasting sixteen months and twenty days.

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

Lundie relates an example of protracted gestation of eleven months, in
which an anencephalous fetus was born; and Martin of Birmingham
describes a similar case of ten and a half months' duration.
Raux-Tripier has seen protraction to the thirteenth month. Enguin
reports an observation of an accouchement of twins after a pregnancy
that had been prolonged for eleven months.  Resnikoff mentions a
pregnancy of eleven months' duration in an anemic secundipara. The case
had been under his observation from the beginning of pregnancy; the
patient would not submit to artificial termination at term, which he
advised. After a painful labor of twenty-four hours a macerated and
decomposed child was born, together with a closely-adherent placenta.
Tarnier reports an instance of partus serotinus in which the product of
conception was carried in the uterus forty days after term. The fetus
was macerated but not putrid, and the placenta had undergone fatty
degeneration. At a recent meeting of the Chicago Gynecological Society,
Dr. F. A. Stahl reported the case of a German-Bohemian woman in which
the fifth pregnancy terminated three hundred and two days after the
last menstruation. Twenty days before there had occurred pains similar
to those of labor, but they gradually ceased. The sacral promontory was
exaggerated, and the anteroposterior pelvic diameter of the inlet in
consequence diminished. The fetus was large and occupied the first
position. Version was with difficulty effected and the passage of the
after-coming head through the superior strait required expression and
traction, during which the child died.  The mother suffered a deep
laceration of the perineum involving an inch of the wall of the rectum.

Among others reporting instances of protracted pregnancy are Collins,
eleven months; Desbrest, eighteen months; Henderson, fifteen months;
Jefferies, three hundred and fifty-eight days, and De la Vergne gives
the history of a woman who carried an infant in her womb for
twenty-nine months; this case may possibly belong under the head of
fetus long retained in the uterus.

Unconscious Pregnancy.--There are numerous instances of women who have
had experience in pregnancy unconsciously going almost to the moment of
delivery, yet experiencing none of the usual accompanying symptoms of
this condition. Crowell speaks of a woman of good social position who
had been married seven years, and who had made extensive preparations
for a long journey, when she was seized with a "bilious colic," and, to
her dismay and surprise, a child was born before the arrival of the
doctor summoned on account of her sudden colic and her inability to
retain her water. A peculiar feature of this case was the fact that
mental disturbance set in immediately afterward, and the mother became
morbid and had to be removed to an asylum, but recovered in a few
months. Tanner saw a woman of forty-two who had been suffering with
abdominal pains. She had been married three years and had never been
pregnant. Her catamenia were very scant, but this was attributed to her
change of life. She had conceived, had gone to the full term of
gestation, and was in labor ten hours without any suspicion of
pregnancy. She was successfully delivered of a girl, which occasioned
much rejoicing in the household.

Tasker of Kendall's Mills, Me., reports the case of a young married
woman calling him for bilious colic. He found the stomach slightly
distended and questioned her about the possibility of pregnancy. Both
she and her husband informed him that such could not be the case, as
her courses had been regular and her waist not enlarged, as she had
worn a certain corset all the time.  There were no signs of quickening,
no change in the breasts, and, in fact, none of the usual signs of
pregnancy present. He gave her an opiate, and to her surprise, in about
six hours she was the mother of a boy weighing five pounds. Both the
mother and child made a good recovery. Duke cites the instance of a
woman who supposed that she was not pregnant up to the night of her
miscarriage. She had menstruated and was suckling a child sixteen
months old. During the night she was attacked with pains resembling
those of labor and a fetus slipped into the vagina without any
hemorrhage; the placenta came away directly afterward. In this peculiar
case the woman was menstruating regularly, suckling a child, and at the
same time was unconsciously pregnant.

Isham speaks of a case of unconscious pregnancy in which extremely
small twins were delivered at the eighth month. Fox cites an instance
of a woman who had borne eight children, and yet unconscious of
pregnancy. Merriman speaks of a woman forty years of age who had not
borne a child for nine years, but who suddenly gave birth to a stout,
healthy boy without being cognizant of pregnancy. Dayral tells of a
woman who carried a child all through pregnancy, unconscious of her
condition, and who was greatly surprised at its birth. Among the French
observers speaking of pregnancy remaining unrecognized by the mother
until the period of accouchement, Lozes and Rhades record peculiar
cases; and Mouronval relates an instance in which a woman who had borne
three children completely ignored the presence of pregnancy until the
pains of labor were felt.  Fleishman and Munzenthaler also record
examples of unconscious pregnancy.

Pseudocyesis.--On the other hand, instances of pregnancy with imaginary
symptoms and preparations for birth are sometimes noticed, and many
cases are on record. In fact, nearly every text-book on obstetrics
gives some space to the subject of pseudocyesis. Suppression of the
menses, enlargement of the abdomen, engorgement of the breasts,
together with the symptoms produced by the imagination, such as nausea,
spasmodic contraction of the abdomen, etc., are for the most part the
origin of the cases of pseudocyesis. Of course, many of the cases are
not examples of true pseudocyesis, with its interesting phenomena, but
instances of malingering for mercenary or other purposes, and some are
calculated to deceive the most expert obstetricians by their tricks.
Weir Mitchell delineates an interesting case of pseudocyesis as
follows: "A woman, young, or else, it may be, at or past the
climacteric, eagerly desires a child or is horribly afraid of becoming
pregnant. The menses become slight in amount, irregular, and at last
cease or not.  Meanwhile the abdomen and breasts enlarge, owing to a
rapid taking on of fat, and this is far less visible elsewhere. There
comes with this excess of fat the most profound conviction of the fact
of pregnancy. By and by the child is felt, the physician takes it for
granted, and this goes on until the great diagnostician, Time, corrects
the delusion. Then the fat disappears with remarkable speed, and the
reign of this singular simulation is at an end." In the same article,
Dr. Mitchell cites the two following cases under his personal
observation: "I was consulted by a lady in regard to a woman of thirty
years of age, a nurse in whom she was interested. This person had been
married some three years to a very old man possessed of a considerable
estate. He died, leaving his wife her legal share and the rest to
distant cousins, unless the wife had a child. For two months before he
died the woman, who was very anemic, ceased to menstruate. She became
sure that she was pregnant, and thereupon took on flesh at a rate and
in a way which seemed to justify her belief. Her breasts and abdomen
were the chief seats of this overgrowth. The menses did not return, her
pallor increased; the child was felt, and every preparation made for
delivery. At the eighth month a physician made an examination and
assured her of the absence of pregnancy. A second medical opinion
confirmed the first, and the tenth month found her of immense size and
still positive as to her condition. At the twelfth month her menstrual
flow returned, and she became sure it was the early sign of labor. When
it passed over she became convinced of her error, and at once dropped
weight at the rate of half a pound a day despite every effort to limit
the rate of this remarkable loss. At the end of two months she had
parted with fifty pounds and was, on the whole, less anemic. At this
stage I was consulted by letter, as the woman had become exceedingly
hysteric. This briefly stated case, which occurred many years ago, is a
fair illustration of my thesis.

"Another instance I saw when in general practice. A lady who had
several children and suffered much in her pregnancies passed five years
without becoming impregnated. Then she missed a period, and had, as
usual, vomiting. She made some wild efforts to end her supposed
pregnancy, and failing, acquiesced in her fate. The menses returned at
the ninth month and were presumed to mean labor. Meanwhile she vomited,
up to the eighth month, and ate little. Nevertheless, she took on fat
so as to make the abdomen and breasts immense and to excite unusual
attention. No physician examined her until the supposed labor began,
when, of course, the truth came out. She was pleased not to have
another child, and in her case, as in all the others known to me, the
fat lessened as soon as the mind was satisfied as to the non-existence
of pregnancy. As I now recall the facts, this woman was not more than
two months in getting rid of the excess of adipose tissue.  Dr. Hirst
tells me he has met with cases of women taking on fat with cessation of
the menses, and in which there was also a steady belief in the
existence of pregnancy. He has not so followed up these cases as to
know if in them the fat fell away with speed when once the patient was
assured that no child existed within her."

Hirst, in an article on the difficulties in the diagnosis of pregnancy,
gives several excellent photographs showing the close resemblance
between several pathologic conditions and the normal distention of the
abdomen in pregnancy. A woman who had several children fell sick with a
chest-affection, followed by an edema.  For fifteen months she was
confined to her bed, and had never had connection with her husband
during that time. Her menses ceased; her mammae became engorged and
discharged a serous lactescent fluid; her belly enlarged, and both she
and her physician felt fetal movements in her abdomen. As in her
previous pregnancies, she suffered nausea. Naturally, a suspicion as to
her virtue came into her husband's mind, but when he considered that
she had never left her bed for fifteen months he thought the pregnancy
impossible. Still the wife insisted that she was pregnant and was
confirmed in the belief by a midwife. The belly continued to increase,
and about eleven months after the cessation of the menses she had the
pains of labor. Three doctors and an accoucheur were present, and when
they claimed that the fetal head presented the husband gave up in
despair; but the supposed fetus was born shortly after, and proved to
be only a mass of hydatids, with not the sign of a true pregnancy.
Girard of Lyons speaks of a female who had been pregnant several times,
but again experienced the signs of pregnancy. Her mammae were engorged
with a lactescent fluid, and she felt belly-movements like those of a
child; but during all this time she had regular menstruation. Her
abdomen progressively increased in size, and between the tenth and
eleventh months she suffered what she thought to be labor-pains. These
false pains ceased upon taking a bath, and with the disappearance of
the other signs was dissipated the fallacious idea of pregnancy.

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

The most noteworthy historic case of pseudocyesis is that of Queen Mary
of England, or "Bloody Mary," as she was called. To insure the
succession of a Catholic heir, she was most desirous of having a son by
her consort, Philip, and she constantly prayed and wished for
pregnancy.  Finally her menses stopped; the breasts began to enlarge
and became discolored around the nipples. She had morning-sickness of a
violent nature and her abdomen enlarged. On consultation with the
ladies of her court, her opinion of pregnancy was strongly confirmed.
Her favorite amusement then was to make baby-clothes and count on her
fingers the months of pregnancy. When the end of the ninth month
approached, the people were awakened one night by the joyous peals of
the bells of London announcing the new heir.  An ambassador had been
sent to tell the Pope that Mary could feel the new life within her, and
the people rushed to St. Paul's Cathedral to listen to the venerable
Archbishop of Canterbury describe the baby-prince and give thanks for
his deliverance. The spurious labor pains passed away, and after being
assured that no real pregnancy existed in her case, Mary went into
violent hysterics, and Philip, disgusted with the whole affair,
deserted her; then commenced the persecution of the Protestants, which
blighted the reign.

Putnam cites the case of a healthy brunet, aged forty, the mother of
three children. She had abrupt vertical abdominal movements, so strong
as to cause her to plunge and sway from side to side.  Her breasts were
enlarged, the areolae dark, and the uterus contained an elastic tumor,
heavy and rolling under the hand. Her abdomen progressively enlarged to
the regular size of matured gestation; but the extrauterine pregnancy,
which was supposed to have existed, was not seen at the autopsy,
nothing more than an enlarged liver being found. The movement was due
to spasmodic movements of the abdominal muscles, the causes being
unknown.  Madden gives the history of a primipara of twenty-eight,
married one year, to whom he was called. On entering the room he was
greeted by the midwife, who said she expected the child about 8 P.M.
The woman was lying in the usual obstetric position, on the left side,
groaning, crying loudly, and pulling hard at a strap fastened to the
bed-post. She had a partial cessation of menses, and had complained of
tumultuous movements of the child and overflow of milk from the
breasts. Examination showed the cervix low down, the os small and
circular, and no signs of pregnancy in the uterus. The abdomen was
distended with tympanites and the rectum much dilated with accumulated
feces. Dr. Madden left her, telling her that she was not pregnant, and
when she reappeared at his office in a few days, he reassured her of
the nonexistence of pregnancy; she became very indignant, triumphantly
squeezed lactescent fluid from her breasts, and, insisting that she
could feel fetal movements, left to seek a more sympathetic accoucheur.
Underhill, in the words of Hamilton, describes a woman as "having
acquired the most accurate description of the breeding symptoms, and
with wonderful facility imagined that she had felt every one of them."
He found the woman on a bed complaining of great labor-pains, biting a
handkerchief, and pulling on a cloth attached to her bed. The finger on
the abdomen or vulva elicited symptoms of great sensitiveness. He told
her she was not pregnant, and the next day she was sitting up, though
the discharge continued, but the simulated throes of labor, which she
had so graphically pictured, had ceased.

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

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

Sympathetic Male Nausea of Pregnancy.--Associated with pregnancy there
are often present morning-nausea and vomiting as prominent and reliable
symptoms. Vomiting is often so excessive as to be provocative of most
serious issue and even warranting the induction of abortion. This fact
is well known and has been thoroughly discussed, but with it is
associated an interesting point, the occasional association of the same
symptoms sympathetically in the husband. The belief has long been a
superstition in parts of Great Britain, descending to America, and even
exists at the present day. Sir Francis Bacon has written on this
subject, the substance of his argument being that certain loving
husbands so sympathize with their pregnant wives that they suffer
morning-sickness in their own person. No less an authority than S. Weir
Mitchell called attention to the interesting subject of sympathetic
vomiting in the husband in his lectures on nervous maladies some years
ago. He also quotes the following case associated with pseudocyesis:--

"A woman had given birth to two female children. Some years passed and
her desire for a boy was ungratified. Then she missed her flow once,
and had thrice after this, as always took place with her when pregnant,
a very small but regular loss. At the second month morning-vomiting
came on as usual with her.  Meanwhile she became very fat, and as the
growth was largely, in fact excessively, abdominal, she became easily
sure of her condition. She was not my patient, but her husband
consulted me as to his own morning-sickness, which came on with the
first occurrence of this sign in his wife, as had been the case twice
before in her former pregnancies. I advised him to leave home, and this
proved effectual. I learned later that the woman continued to gain
flesh and be sick every morning until the seventh month. Then
menstruation returned, an examination was made, and when sure that
there was no possibility of her being pregnant she began to lose flesh,
and within a few months regained her usual size."

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

The perverted appetites and peculiar longings of pregnant women furnish
curious matter for discussion. From the earliest times there are many
such records. Borellus cites an instance, and there are many others, of
pregnant women eating excrement with apparent relish. Tulpius, Sennert,
Langius, van Swieten, a Castro, and several others report depraved
appetites. Several writers have seen avidity for human flesh in such
females.  Fournier knew a woman with an appetite for the blood of her
husband. She gently cut him while he lay asleep by her side and sucked
blood from the wounds--a modern "Succubus." Pare mentions the perverted
appetites of pregnant women, and says that they have been known to eat
plaster, ashes, dirt, charcoal, flour, salt, spices, to drink pure
vinegar, and to indulge in all forms of debauchery. Plot gives the case
of a woman who would gnaw and eat all the linen off her bed. Hufeland's
Journal records the history of a case of a woman of thirty-two, who had
been married ten years, who acquired a strong taste for charcoal, and
was ravenous for it. It seemed to cheer her and to cure a supposed
dyspepsia. She devoured enormous quantities, preferring hard-wood
charcoal. Bruyesinus speaks of a woman who had a most perverted
appetite for her own milk, and constantly drained her breasts;
Krafft-Ebing cites a similar case. Another case is that of a pregnant
woman who had a desire for hot and pungent articles of food, and who in
a short time devoured a pound of pepper.  Scheidemantel cites a case in
which the perverted appetite, originating in pregnancy, became
permanent, but this is not the experience of most observers. The
pregnant wife of a farmer in Hassfort-on-the-Main ate the excrement of
her husband.

Many instances could be quoted, some in which extreme cases of
polydipsia and bulimia developed; these can be readily attributed to
the increased call for liquids and food. Other cases of diverse new
emotions can be recalled, such as lasciviousness, dirty habits,
perverted thoughts, and, on the other hand, extreme piety, chastity,
and purity of the mind. Some of the best-natured women are when
pregnant extremely cross and irritable and many perversions of
disposition are commonly noticed in pregnancy.  There is often a
longing for a particular kind of food or dish for which no noticeable
desire had been displayed before.

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

We shall cite only a few of the most interesting cases from medical
literature. Hippocrates saved the honor of a princess, accused of
adultery with a negro because she bore a black child, by citing it as a
case of maternal impression, the husband of the princess having placed
in her room a painting of a negro, to the view of which she was
subjected during the whole of her pregnancy. Then, again, in the
treatise "De Superfoetatione" there occurs the following distinct
statement: "If a pregnant woman has a longing to eat earth or coals,
and eats of them, the infant which is born carries on its head the mark
of these things." This statement, however, occurs in a work which is
not mentioned by any of the ancient authorities, and is rejected by
practically all the modern ones; according to Ballantyne, there is,
therefore, no absolute proof that Hippocrates was a believer in one of
the most popular and long-persisting beliefs concerning fetal
deformities.

In the explanation of heredity, Hippocrates states "that the body of
the male as well as that of the female furnishes the semen.  That which
is weak (unhealthy) is derived from weak (unhealthy) parts, that which
is strong (healthy) from strong (healthy) parts, and the fetus will
correspond to the quality of the semen.  If the semen of one part come
in greater quantity from the male than from the female, this part will
resemble more closely the father; if, however, it comes more from the
female, the part will rather resemble the mother. If it be true that
the semen comes from both parents, then it is impossible for the whole
body to resemble either the mother or the father, or neither the one
nor the other in anything, but necessarily the child will resemble both
the one and the other in something. The child will most resemble the
one who contributes most to the formation of the parts." Such was the
Hippocratic theory of generation and heredity, and it was ingeniously
used to explain the hereditary nature of certain diseases and
malformations. For instance, in speaking of the sacred disease
(epilepsy), Hippocrates says: "Its origin is hereditary, like that of
other diseases; for if a phlegmatic person be born of a phlegmatic, and
a bilious of a bilious, and a phthisical of a phthisical, and one
having spleen disease of another having disease of the spleen, what is
to hinder it from happening that where the father and mother were
subject to this disease certain of their offspring should be so
affected also? As the semen comes from all parts of the body, healthy
particles will come from healthy parts, and unhealthy from unhealthy
parts."

According to Pare, Damascene saw a girl with long hair like a bear,
whose mother had constantly before her a picture of the hairy St. John.
Pare also appends an illustration showing the supposed resemblance to a
bear. Jonston quotes a case of Heliodorus; it was an Ethiopian, who by
the effect of the imagination produced a white child. Pare describes
this case more fully: "Heliodorus says that Persina, Queen of Ethiopia,
being impregnated by Hydustes, also an Ethiopian, bore a daughter with
a white skin, and the anomaly was ascribed to the admiration that a
picture of Andromeda excited in Persina throughout the whole of the
pregnancy." Van Helmont cites the case of a tailor's wife at Mechlin,
who during a conflict outside her house, on seeing a soldier lose his
hand at her door, gave birth to a daughter with one hand, the other
hand being a bleeding stump; he also speaks of the case of the wife of
a merchant at Antwerp, who after seeing a soldier's arm shot off at the
siege of Ostend gave birth to a daughter with one arm. Plot speaks of a
child bearing the figure of a mouse; when pregnant, the mother had been
much frightened by one of these animals. Gassendus describes a fetus
with the traces of a wound in the same location as one received by the
mother. The Lancet speaks of several cases--one of a child with a face
resembling a dog whose mother had been bitten; one of a child with one
eye blue and the other black, whose mother during confinement had seen
a person so marked; of an infant with fins as upper and lower
extremities, the mother having seen such a monster; and another, a
child born with its feet covered with scalds and burns, whose mother
had been badly frightened by fireworks and a descending rocket. There
is the history of a woman who while pregnant at seven months with her
fifth child was bitten on the right calf by a dog. Ten weeks after, she
bore a child with three marks corresponding in size and appearance to
those caused by the dog's teeth on her leg. Kerr reports the case of a
woman in her seventh month whose daughter fell on a cooking stove,
shocking the mother, who suspected fatal burns. The woman was delivered
two months later of an infant blistered about the mouth and extremities
in a manner similar to the burns of her sister. This infant died on the
third day, but another was born fourteen months later with the same
blisters. Inflammation set in and nearly all the fingers and toes
sloughed of. In a subsequent confinement, long after the mental
agitation, a healthy unmarked infant was born.

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

Webb reports the history of a negress who during a convulsion while
pregnant fell into a fire, burning the whole front of the abdomen, the
front and inside of the thighs to the knees, the external genitals, and
the left arm. Artificial delivery was deemed necessary, and a dead
child, seemingly burned much like its mother, except less intensely,
was delivered. There was also one large blister near the inner canthus
of the eye and some large blisters about the neck and throat which the
mother did not show. There was no history of syphilis nor of any
eruptive fever in the mother, who died on the tenth day with tetanus.

Graham describes a woman of thirty-five, the mother of seven children,
who while pregnant was feeding some rabbits, when one of the animals
jumped at her with its eyes "glaring" upon her, causing a sudden
fright. Her child was born hydrocephalic. Its mouth and face were small
and rabbit-shaped. Instead of a nose, it had a fleshy growth 3/4 inch
long by 1/4 inch broad, directed upward at an angle of 45 degrees. The
space between this and the mouth was occupied by a body resembling an
adult eye. Within this were two small, imperfect eyes which moved
freely while life lasted (ten minutes). The child's integument was
covered with dark, downy, short hair. The woman recovered and afterward
bore two normal children.

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

Copeland mentions a curious case in which a woman was attacked by a
rattlesnake when in her sixth month of pregnancy, and gave birth to a
child whose arm exhibited the shape and action of a snake, and
involuntarily went through snake-like movements. The face and mouth
also markedly resembled the head of a snake.

The teeth were situated like a serpent's fangs. The mere mention of a
snake filled the child (a man of twenty-nine) with great horror and
rage, "particularly in the snake season." Beale gives the history of a
case of a child born with its left eye blackened as by a blow, whose
mother was struck in a corresponding portion of the face eight hours
before confinement. There is on record an account of a young man of
twenty-one suffering from congenital deformities attributed to the fact
that his mother was frightened by a guinea-pig having been thrust into
her face during pregnancy. He also had congenital deformity of the
right auricle.  At the autopsy, all the skin, tissues, muscles, and
bones were found involved. Owen speaks of a woman who was greatly
excited ten months previously by a prurient curiosity to see what
appearance the genitals of her brother presented after he had submitted
to amputation of the penis on account of carcinoma. The whole penis had
been removed. The woman stated that from the time she had thus
satisfied herself, her mind was unceasingly engaged in reflecting and
sympathizing on the forlorn condition of her brother. While in this
mental state she gave birth to a son whose penis was entirely absent,
but who was otherwise well and likely to live. The other portions of
the genitals were perfect and well developed. The appearance of the
nephew and the uncle was identical. A most peculiar case is stated by
Clerc as occurring in the experience of Kuss of Strasburg. A woman had
a negro paramour in America with whom she had had sexual intercourse
several times. She was put in a convent on the Continent, where she
stayed two years. On leaving the convent she married a white man, and
nine months after she gave birth to a dark-skinned child. The
supposition was that during her abode in the convent and the nine
months subsequently she had the image of her black paramour constantly
before her. Loin speaks of a woman who was greatly impressed by the
actions of a clown at a circus, and who brought into the world a child
that resembled the fantastic features of the clown in a most striking
manner.

Mackay describes five cases in which fright produced distinct marks on
the fetus. There is a case mentioned in which a pregnant woman was
informed that an intimate friend had been thrown from his horse; the
immediate cause of death was fracture of the skull, produced by the
corner of a dray against which the rider was thrown. The mother was
profoundly impressed by the circumstance, which was minutely described
to her by an eye-witness. Her child at birth presented a red and
sensitive area upon the scalp corresponding in location with the fatal
injury in the rider. The child is now an adult woman, and this area
upon the scalp remains red and sensitive to pressure, and is almost
devoid of hair. Mastin of Mobile, Alabama, reports a curious instance
of maternal impression. During the sixth month of the pregnancy of the
mother her husband was shot, the ball passing out through the left
breast. The woman was naturally much shocked, and remarked to Dr.
Mastin: "Doctor, my baby will be ruined, for when I saw the wound I put
my hands over my face, and got it covered with blood, and I know my
baby will have a bloody face." The child came to term without a bloody
face. It had, however, a well-defined spot on the left breast just
below the site of exit of the ball from its father's chest. The spot
was about the size of a silver half-dollar, and had elevated edges of a
bright red color, and was quite visible at the distance of one hundred
feet. The authors have had personal communication with Dr. Mastin in
regard to this case, which he considers the most positive evidence of a
case of maternal impression that he has ever met.

Paternal Impressions.--Strange as are the foregoing cases, those of
paternal impression eclipse them. Several are on record, but none are
of sufficient authenticity to warrant much discussion on the subject.
Those below are given to illustrate the method of report. Stahl, quoted
by Steinan, 1843, speaks of the case of a child, the father being a
soldier who lost an eye in the war. The child was born with one of its
eyes dried up in the orbit, in this respect presenting an appearance
like that of the father.  Schneider says a man whose wife was expecting
confinement dreamt that his oldest son stood beside his bedside with
his genitals much mutilated and bleeding. He awoke in a great state of
agitation, and a few days later the wife was delivered of a child with
exstrophy of the bladder. Hoare recites the curious story of a man who
vowed that if his next child was a daughter he would never speak to it.
The child proved to be a son, and during the whole of the father's life
nothing could induce the son to speak to his father, nor, in fact, to
any other male person, but after the father's death he talked fluently
to both men and women.  Clark reports the birth of a child whose father
had a stiff knee-joint, and the child's knee was stiff and bent in
exactly the same position as that of its father.

Telegony.--The influence of the paternal seed on the physical and
mental constitution of the child is well known. To designate this
condition, Telegony is the word that was coined by Weismann in his "Das
Keimplasma," and he defines it as "Infection of the Germ," and, at
another time, as "Those doubtful instances in which the offspring is
said to resemble, not the father, but an early mate of the
mother,"--or, in other words, the alleged influence of a previous sire
on the progeny produced by a subsequent one from the same mother. In a
systematic discussion of telegony before the Royal Medical Society,
Edinburgh, on March 1, 1895, Brunton Blaikie, as a means of making the
definition of telegony plainer by practical example, prefaced his
remarks by citing the classic example which first drew the attention of
the modern scientific world to this phenomenon. The facts of this case
were communicated in a letter from the Earl of Morton to the President
of the Royal Society in 1821, and were as follows: In the year 1816
Lord Morton put a male quagga to a young chestnut mare of 7/8 Arabian
blood, which had never before been bred from.  The result was a female
hybrid which resembled both parents. He now sold the mare to Sir Gore
Ousley, who two years after she bore the hybrid put her to a black
Arabian horse. During the two following years she had two foals which
Lord Morton thus describes: "They have the character of the Arabian
breed as decidedly as can be expected when 15/16 of the blood are
Arabian, and they are fine specimens of the breed; but both in their
color and in the hair of their manes they have a striking resemblance
to the quagga. Their color is bay, marked more or less like the quagga
in a darker tint. Both are distinguished by the dark line along the
ridge of the back, the dark stripes across the forehand, and the dark
bars across the back part of the legs." The President of the Royal
Society saw the foals and verified Lord Morton's statement.

"Herbert Spencer, in the Contemporary Review for May, 1893, gives
several cases communicated to him by his friend Mr. Fookes, whom
Spencer says is often appointed judge of animals at agricultural shows.
After giving various examples he goes on to say: 'A friend of mine near
this had a valuable Dachshund bitch, which most unfortunately had a
litter by a stray sheep-dog. The next year the owner sent her on a
visit to a pure Dachshund dog, but the produce took quite as much of
the first father as the second, and the next year he sent her to
another Dachshund, with the same result. Another case: A friend of mine
in Devizes had a litter of puppies unsought for, by a setter from a
favorite pointer bitch, and after this she never bred any true
pointers, no matter what the paternity was.'

"Lord Polwarth, whose very fine breed of Border Leicesters is famed
throughout Britain, and whose knowledge on the subject of breeding is
great, says that 'In sheep we always consider that if a ewe breeds to a
Shrop ram, she is never safe to breed pure Leicesters from, as dun or
colored legs are apt to come even when the sire is a pure Leicester.
This has been proved in various instances, but is not invariable.'"

Hon. Henry Scott says: "Dog-breeders know this theory well; and if a
pure-bred bitch happens to breed to a dog of another breed, she is of
little use for breeding pure-bred puppies afterward.  Animals which
produce large litters and go a short time pregnant show this throwing
back to previous sires far more distinctly than others--I fancy dogs
and pigs most of all, and probably horses least. The influence of
previous sires may be carried into the second generation or further, as
I have a cat now which appears to be half Persian (long hair). His dam
has very long hair and every appearance of being a half Persian,
whereas neither have really any Persian blood, as far as I know, but
the grand-dam (a very smooth-haired cat) had several litters by a
half-Persian tom-cat, and all her produce since have showed the
influence retained. The Persian tom-cat died many years ago, and was
the only one in the district, so, although I cannot be absolutely
positive, still I think this case is really as stated."

Breeders of Bedlington terriers wish to breed dogs with as powerful
jaws as possible. In order to accomplish this they put the Bedlington
terrier bitch first to a bull-terrier dog, and get a mongrel litter
which they destroy. They now put the bitch to a Bedlington terrier dog
and get a litter of puppies which are practically pure, but have much
stronger jaws than they would otherwise have had, and also show much of
the gameness of the bull-terrier, thus proving that physiologic as well
as anatomic characters may be transmitted in this way.

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

"We might expect from the foregoing account of telegony amongst animals
that whenever a black woman had a child to a white man, and then
married a black man, her subsequent children would not be entirely
black. Dr. Robert Balfour of Surinam in 1851 wrote to Harvey that he
was continually noticing amongst the colored population of Surinam
'that if a negress had a child or children by a white, and afterward
fruitful intercourse with a negro, the latter offspring had generally a
lighter color than the parents.' But, as far as I know, this is the
only instance of this observation on record. Herbert Spencer has shown
that when a pure-bred animal breeds with an animal of a mixed breed,
the offspring resembles much more closely the parent of pure blood, and
this may explain why the circumstance recorded by Balfour has been so
seldom noted. For a negro, who is of very pure blood, will naturally
have a stronger influence on the subsequent progeny than an
Anglo-Saxon, who comes of a mixed stock. If this be the correct
explanation, we should expect that when a white woman married first a
black man, and then a white, the children by the white husband would be
dark colored. Unfortunately for the proof of telegony, it is very rare
that a white woman does marry a black man, and then have a white as
second husband; nevertheless, we have a fair number of recorded
instances of dark-colored children being born in the above way of white
parents.

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

"But it is not only in relation to color that we find telegony to have
been noticed in the human subject. Dr. Middleton Michel gives a most
interesting case in the American Journal of the Medical Sciences for
1868: 'A black woman, mother of several negro children, none of whom
were deformed in any particular, had illicit intercourse with a white
man, by whom she became pregnant. During gestation she manifested great
uneasiness of mind, lest the birth of a mulatto offspring should
disclose her conduct.... It so happened that her negro husband
possessed a sixth digit on each hand, but there was no peculiarity of
any kind in the white man, yet when the mulatto child was born it
actually presented the deformity of a supernumerary finger.' Taruffi,
the celebrated Italian teratologist, in speaking of the subject, says:
'Our knowledge of this strange fact is by no means recent for Fienus,
in 1608, said that most of the children born in adultery have a greater
resemblance to the legal than to the real father'--an observation that
was confirmed by the philosopher Vanini and by the naturalist
Ambrosini. From these observations comes the proverb: 'Filium ex
adultera excusare matrem a culpa.' Osiander has noted telegony in
relation to moral qualities of children by a second marriage. Harvey
said that it has long been known that the children by a second husband
resemble the first husband in features mind, and disposition. He then
gave a case in which this resemblance was very well marked.  Orton,
Burdach (Traite de Physiologie), and Dr. William Sedgwick have all
remarked on this physical resemblance; and Dr. Metcalfe, in a
dissertation delivered before this society in 1855, observed that in
the cases of widows remarrying the children of the second marriage
frequently resemble the first husband.

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

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

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

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

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

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

Antenatal Pathology.--We have next to deal with the diseases,
accidents, and operations that affect the pregnant uterus and its
contents; these are rich in anomalies and facts of curious interest,
and have been recognized from the earliest times. In the various works
usually grouped together under the general designation of "Hippocratic"
are to be found the earliest opinions upon the subject of antenatal
pathology which the medical literature of Greece has handed down to
modern times.  That there were medical writers before the time of
Hippocrates cannot be doubted, and that the works ascribed to the
"Father of Medicine" were immediately followed by those of other
physicians, is likewise not to be questioned; but whilst nearly all the
writings prior to and after Hippocrates have been long lost to the
world, most of those that were written by the Coan physician and his
followers have been almost miraculously preserved. As Littre puts it,
"Les ecrits hippocratiques demeurent isoles au milieu des debris de
l'antique litterature medicale."--(Ballantyne.)

The first to be considered is the transmission of contagious disease to
the fetus in utero. The first disease to attract attention was
small-pox. Devilliers, Blot, and Depaul all speak of congenital
small-pox, the child born dead and showing evidences of the typical
small-pox pustulation, with a history of the mother having been
infected during pregnancy. Watson reports two cases in which a child in
utero had small-pox. In the first case the mother was infected in
pregnancy; the other was nursing a patient when seven months pregnant;
she did not take the disease, although she had been infected many
months before.  Mauriceau delivered a woman of a healthy child at full
term after she had recovered from a severe attack of this disease
during the fifth month of gestation. Mauriceau supposed the child to be
immune after the delivery. Vidal reported to the French Academy of
Medicine, May, 1871, the case of a woman who gave birth to a living
child of about six and one-half months' maturation, which died some
hours after birth covered with the pustules of seven or eight days'
eruption. The pustules on the fetus were well umbilicated and typical,
and could have been nothing but those of small-pox; besides, this
disease was raging in the neighborhood at the time. The mother had
never been infected before, and never was subsequently. Both parents
were robust and neither of them had ever had syphilis. About the time
of conception, the early part of December, 1870, the father had
suffered from the semiconfluent type, but the mother, who had been
vaccinated when a girl, had never been stricken either during or after
her husband's sickness. Quirke relates a peculiar instance of a child
born at midnight, whose mother was covered with the eruption eight
hours after delivery. The child was healthy and showed no signs of the
contagion, and was vaccinated at once. Although it remained with its
mother all through the sickness, it continued well, with the exception
of the ninth day, when a slight fever due to its vaccination appeared.
The mother made a good recovery, and the author remarks that had the
child been born a short time later, it would most likely have been
infected.

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

Varicella, Measles, Pneumonia, and even Malaria are reported as having
been transmitted to the child in utero. Hubbard attended a woman on
March 17, 1878, in her seventh accouchement. The child showed the rash
of varicella twenty-four hours after birth, and passed through the
regular coarse of chicken-pox of ten days' duration. The mother had no
signs of the disease, but the children all about her were infected.
Ordinarily the period of incubation is from three to four days, with a
premonitory fever of from twenty-four to seventy-two hours' duration,
when the rash appears; this case must therefore have been infected in
utero.  Lomer of Hamburg tells of the case of a woman, twenty-two
years, unmarried, pregnant, who had measles in the eighth month, and
who gave birth to an infant with measles. The mother was attacked with
pneumonia on the fifth day of her puerperium, but recovered; the child
died in four weeks of intestinal catarrh. Gautier found measles
transmitted from the mother to the fetus in 6 out of 11 cases, there
being 2 maternal deaths in the 11 cases.

Netter has observed the case of transmission of pneumonia from a mother
to a fetus, and has seen two cases in which the blood from the uterine
vessels of patients with pneumonia contained the pneumococcus. Wallick
collected a number of cases of pneumonia occurring during pregnancy,
showing a fetal mortality of 80 per cent.

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

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

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

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

At a discussion held in New York some years ago as to the real effect
on the fetus of giving narcotics to the mother, Dr. Gaillard Thomas was
almost alone in advocating that the effect was quite visible. Fordyce
Barker was strongly on the negative side. Henning and Ahlfeld, two
German observers, vouch for the opinion of Thomas, and Thornburn states
that he has witnessed the effect of nux vomica and strychnin on the
fetus shortly after birth. Over fifty years ago, in a memoir on
"Placental Phthisis," Sir James Y. Simpson advanced a new idea in the
recommendation of potassium chlorate during the latter stages of
pregnancy. The efficacy of this suggestion is known, and whether, as
Simpson said, it acts by supplying extra oxygen to the blood, or
whether the salt itself is conveyed to the fetus, has never been
definitely settled.

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

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

Intrauterine amputations are of interest to the medical man,
particularly those cases in which the accident has happened in early
pregnancy and the child is born with a very satisfactory and clean
stump. Montgomery, in an excellent paper, advances the theory, which is
very plausible, that intrauterine amputations are caused by contraction
of bands or membranes of organized lymph encircling the limb and
producing amputation by the same process of disjunctive atrophy that
the surgeons induce by ligature. Weinlechner speaks of a case in which
a man devoid of all four extremities was exhibited before the Vienna
Medical Society. The amputations were congenital, and on the right side
there was a very small stump of the upper arm remaining, admitting the
attachment of an artificial apparatus. He was twenty-seven years old,
and able to write, to thread a needle, pour water out of a bottle, etc.
Cook speaks of a female child born of Indian parents, the fourth birth
of a mother twenty-six years old. The child weighed 5 1/2 pounds; the
circumference of the head was 14 inches and that of the trunk 13
inches. The upper extremities consisted of perfect shoulder joints, but
only 1/4 of each humerus was present. Both sides showed evidences of
amputation, the cicatrix on the right side being 1 inch long and on the
left 1/4 inch long. The right lower limb was merely a fleshy corpuscle
3/4 inch wide and 1/4 inch long; to the posterior edge was attached a
body resembling the little toe of a newly-born infant. On the left side
the limb was represented by a fleshy corpuscle 1 inch long and 1/4 inch
in circumference, resembling the great toe of an infant. There was no
history of shock or injury to the mother. The child presented by the
breech, and by the absence of limbs caused much difficulty in
diagnosis.  The three stages of labor were one and one-half hours,
forty-five minutes, and five minutes, respectively. The accompanying
illustration shows the appearance of the limbs at the time of report.

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

There is an instance reported in which a child at full term was born
with an amputated arm, and at the age of seventeen the stump was
scarcely if at all smaller than the other. Blake speaks of a case of
congenital amputation of both the upper extremities.  Gillilam a
mentions a case that shows the deleterious influence of even the weight
of a fetal limb resting on a cord or band. His case was that of a
fetus, the product of a miscarriage of traumatic origin; the soft
tissues were almost cut through and the bone denuded by the limb
resting on one of the two umbilical cords, not encircling it, but in a
sling. The cord was deeply imbedded in the tissues.

The coilings of the cord are not limited to compression about the
extremities alone, but may even decapitate the head by being firmly
wrapped several times about the neck. According to Ballantyne, there is
in the treatise De Octimestri Partu, by Hippocrates, a reference to
coiling of the umbilical cord round the neck of the fetus. This coiling
was, indeed, regarded as one of the dangers of the eighth month, and
even the mode of its production is described. It is said that if the
cord he extended along one side of the uterus, and the fetus lie more
to the other side, then when the culbute is performed the funis must
necessarily form a loop round the neck or chest of the infant. If it
remain in this position, it is further stated, the mother will suffer
later and the fetus will either perish or be born with difficulty. If
the Hippocratic writers knew that this coiling is sometimes quite
innocuous, they did not in any place state the fact.

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

Bizzen mentions an instance in which from strangulation the head of a
fetus was in a state of putrefaction, the funis being twice tightly
bound around the neck. Cleveland, Cuthbert, and Germain report
analogous instances. Matthyssens observed the twisting of the funis
about the arm and neck of a fetus the body of which was markedly
wasted. There was complete absence of amniotic fluid during labor.
Blumenthal presented to the New York Pathological Society an ovum
within which the fetus was under going intrauterine decapitation.
Buchanan describes a case illustrative of the etiology of spontaneous
amputation of limbs in utero Nebinger reports a case of abortion,
showing commencing amputation of the left thigh from being encircled by
the funis.  The death of the fetus was probably due to compression of
the cord. Owen mentions an instance in which the left arm and hand of a
fetus were found in a state of putrescence from strangulation, the
funis being tightly bound around at the upper part. Simpson published
an article on spontaneous amputation of the forearm and rudimentary
regeneration of the hand in the fetus. Among other contributors to this
subject are Avery, Boncour, Brown, Ware, Wrangell, Young, Nettekoven,
Martin, Macan, Leopold, Hecker, Gunther, and Friedinger.

Wygodzky finds that the greatest number of coils of the umbilical cord
ever found to encircle a fetus are 7 (Baudelocque), 8 (Crede), and 9
(Muller and Gray). His own case was observed this year in Wilna. The
patient was a primipara aged twenty. The last period was seen on May
10, 1894. On February 19th the fetal movements suddenly ceased. On the
20th pains set in about two weeks before term. At noon turbid liquor
amnii escaped. At 2 P.M., on examination, Wygodzky defined a dead fetus
in left occipito-anterior presentation, very high in the inlet. The os
was nearly completely dilated, the pains strong. By 4 P.M. the head was
hardly engaged in the pelvic cavity. At 7 P.M. it neared the outlet at
the height of each pain, but retracted immediately afterward. After 10
P.M. the pains grew weak. At midnight Wygodzky delivered the dead child
by expression. Not till then was the cause of delay clear. The funis
was very tense and coiled 7 times round the neck and once round the
left shoulder; there was also a distinct knot. It measured over 65
inches in length.  The fetus was a male, slightly macerated. It weighed
over 5 pounds, and was easily delivered entire after division and
unwinding of the funis. No marks remained on the neck. The placenta
followed ten minutes later and, so far as naked-eye experience
indicated, seemed healthy.

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

Dolbeau describes an instance in which multiple fractures were found in
a fetus, some of which were evidently postpartum, while others were
assuredly antepartum. Hirschfeld describes a fetus showing congenital
multiple fractures. Gross speaks of a wonderful case of Chaupier in
which no less than 113 fractures were discovered in a child at birth.
It survived twenty-four hours, and at the postmortem examination it was
found that some were already solid, some uniting, whilst others were
recent. It often happens that the intrauterine fracture is well united
at birth. There seems to be a peculiar predisposition of the bones to
fracture in the cases in which the fractures are multiple and the cause
is not apparent.

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

It is a well-known fact that injuries to the pregnant mother show
visible effects on the person of the fetus. The older writers kept a
careful record of the anomalous and extraordinary injuries of this
character and of their effects. Brendelius tells us of hemorrhage from
the mouth and nose of the fetus occasioned by the fall of the mother;
Buchner mentions a case of fracture of the cranium from fright of the
mother; Reuther describes a contusion of the os sacrum and abdomen in
the mother from a fall, with fracture of the arm and leg of the fetus
from the same cause; Sachse speaks of a fractured tibia in a fetus,
caused by a fall of the mother; Slevogt relates an instance of rupture
of the abdomen of a fetus by a fall of the mother; the Ephemerides
contains accounts of injuries to the fetus of this nature, and among
others mentions a stake as having been thrust into a fetus in utero;
Verduc offers several examples, one a dislocation of the fetal foot
from a maternal fall; Plocquet gives an instance of fractured femur;
Walther describes a case of dislocation of the vertebrae from a fall;
and there is also a case of a fractured fetal vertebra from a maternal
fall. There is recorded a fetal scalp injury, together with clotted
blood in the hair, after a fall of the mother: Autenrieth describes a
wound of the pregnant uterus, which had no fatal issue, and there is
also another similar case on record.

The modern records are much more interesting and wonderful on this
subject than the older ones. Richardson speaks of a woman falling down
a few weeks before her delivery. Her pelvis was roomy and the birth was
easy; but the infant was found to have extensive wounds on the back,
reaching from the 3d dorsal vertebra across the scapula, along the back
of the humerus, to within a short distance of the elbow. Part of these
wounds were cicatrized and part still granulating, which shows that the
process of reparation is as active in utero as elsewhere.

Injuries about the genitalia would naturally be expected to exercise
some active influence on the uterine contents; but there are many
instances reported in which the escape of injury is marvelous. Gibb
speaks of a woman, about eight months pregnant, who fell across a
chair, lacerating her genitals and causing an escape of liquor amnii.
There was regeneration of this fluid and delivery beyond term. The
labor was tedious and took place two and a half months after the
accident. The mother and the female child did well. Purcell reports
death in a pregnant woman from contused wound of the vulva. Morland
relates an instance of a woman in the fifth month of her second
pregnancy, who fell on the roof of a woodshed by slipping from one of
the steps by which she ascended to the roof, in the act of hanging out
some clothes to dry. She suffered a wound on the internal surface of
the left nympha 1 1/2 inch long and 1/2 inch deep. She had lost about
three quarts of blood, and had applied ashes to the vagina to stop the
bleeding. She made a recovery by the twelfth day, and the fetal sounds
were plainly audible. Cullingworth speaks of a woman who, during a
quarrel with her husband, was pushed away and fell between two chairs,
knocking one of them over, and causing a trivial wound one inch long in
the vagina, close to the entrance.  She screamed, there was a gush of
blood, and she soon died. The uterus contained a fetus three or four
months old, with the membranes intact, the maternal death being due to
the varicosity of the pregnant pudenda, the slight injury being
sufficient to produce fatal hemorrhage. Carhart describes the case of a
pregnant woman, who, while in the stooping position, milking a cow, was
impaled through the vagina by another cow. The child was born seven
days later, with its skull crushed by the cow's horn.  The horn had
entered the vagina, carrying the clothing with it.

There are some marvelous cases of recovery and noninterference with
pregnancy after injuries from horns of cattle. Corey speaks of a woman
of thirty-five, three months pregnant, weighing 135 pounds, who was
horned by a cow through the abdominal parietes near the hypogastric
region; she was lifted into the air, carried, and tossed on the ground
by the infuriated animal. There was a wound consisting of a ragged rent
from above the os pubis, extending obliquely to the left and upward,
through which protruded the great omentum, the descending and
transverse colon, most of the small intestines, as well as the pyloric
extremity of the stomach. The great omentum was mangled and comminuted,
and bore two lacerations of two inches each. The intestines and stomach
were not injured, but there was considerable extravasation of blood
into the abdominal cavity. The intestines were cleansed and an
unsuccessful attempt was made to replace them. The intestines remained
outside of the body for two hours, and the great omentum was carefully
spread out over the chest to prevent interference with the efforts to
return the intestines.  The patient remained conscious and calm
throughout; finally deep anesthesia was produced by ether and
chloroform, three and a half hours after the accident, and in twenty
minutes the intestines were all replaced in the abdominal cavity. The
edges were pared, sutured, and the wound dressed. The woman was placed
in bed, on the right side, and morphin was administered. The sutures
were removed on the ninth day, and the wound had healed except at the
point of penetration. The woman was discharged twenty days after, and,
incredible to relate, was delivered of a well-developed, full-term
child just two hundred and two days from the time of the accident. Both
the mother and child did well.

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

Richard, quoted also by Tiffany, speaks of a woman, twenty-two, who
fell in a dark cellar with some empty bottles in her hand, suffering a
wound in the abdomen 2 inches above the navel on the left side 8 cm.
long. Through this wound a mass of intestines, the size of a man's
head, protruded. Both the mother and the child made a good
convalescence. Harris cites the instance of a woman of thirty, a
multipara, six months pregnant, who was gored by a cow; her intestines
and omentum protruded through the rip and the uterus was bruised. There
was rapid recovery and delivery at term. Wetmore of Illinois saw a
woman who in the summer of 1860, when about six months pregnant, was
gored by a cow, and the large intestine and the omentum protruded
through the wound.  Three hours after the injury she was found swathed
in rags wet with a compound solution of whiskey and camphor, with a
decoction of tobacco. The intestines were cold to the touch and dirty,
but were washed and replaced. The abdomen was sewed up with a darning
needle and black linen thread; the woman recovered and bore a healthy
child at the full maturity of her gestation. Crowdace speaks of a
female pauper, six months pregnant, who was attacked by a buffalo, and
suffered a wound about 1 1/2 inch long and 1/2 inch wide just above the
umbilicus. Through this small opening 19 inches of intestine protruded.
The woman recovered, and the fetal heart-beats could be readily
auscultated.

Major accidents in pregnant women are often followed by the happiest
results. There seems to be no limit to what the pregnant uterus can
successfully endure. Tiffany, who has collected some statistics on this
subject, as well as on operations successfully performed during
pregnancy, which will be considered later, quotes the account of a
woman of twenty-seven, eight months pregnant, who was almost buried
under a clay wall. She received terrible wounds about the head, 32
sutures being used in this location alone. Subsequently she was
confined, easily bore a perfectly normal female child, and both did
well. Sibois describes the case of a woman weighing 190 pounds, who
fell on her head from the top of a wall from 10 to 12 feet high. For
several hours she exhibited symptoms of fracture of the base of the
skull, and the case was so diagnosed; fourteen hours after the accident
she was perfectly conscious and suffered terrible pain about the head,
neck, and shoulders. Two days later an ovum of about twenty days was
expelled, and seven months after she was delivered of a healthy boy
weighing 10 1/2 pounds. She had therefore lost after the accident
one-half of a double conception.

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

Bancroft speaks of a woman who, being mistaken for a burglar, was shot
by her husband with a 44-caliber bullet. The missile entered the second
and third ribs an inch from the sternum, passed through the right lung,
and escaped at the inferior angle of the scapula, about three inches
below the spine; after leaving her body it went through a pine door.
She suffered much hemorrhage and shock, but made a fair recovery at the
end of four weeks, though pregnant with her first child at the seventh
month. At full term she was delivered by foot-presentation of a healthy
boy. The mother at the time of report was healthy and free from cough,
and was nursing her babe, which was strong and bright.

All the cases do not have as happy an issue as most of the foregoing
ones, though in some the results are not so bad as might be expected. A
German female, thirty-six, while in the sixth month of pregnancy, fell
and struck her abdomen on a tub.  She was delivered of a normal living
child, with the exception that the helix of the left ear was pushed
anteriorly, and had, in its middle, a deep incision, which also
traversed the antihelix and the tragus, and continued over the cheek
toward the nose, where it terminated. The external auditory meatus was
obliterated. Gurlt speaks of a woman, seven months pregnant, who fell
from the top of a ladder, subsequently losing some blood and water from
the vagina. She had also persistent pains in the belly, but there was
no deterioration of general health. At her confinement, which was
normal, a strong boy was born, wanting the arm below the middle, at
which point a white bone protruded. The wound healed and the separated
arm came away after birth.  Wainwright relates the instance of a woman
of forty, who when six months pregnant was run over by railway cars.
After a double amputation of the legs she miscarried and made a good
recovery.  Neugebauer reported the history of a case of a woman who,
while near her term of pregnancy, committed suicide by jumping from a
window. She ruptured her uterus, and a dead child with a fracture of
the parietal bone was found in the abdominal cavity. Staples speaks of
a Swede of twenty-eight, of Minnesota, who was accidentally shot by a
young man riding by her side in a wagon.  The ball entered the abdomen
two inches above the crest of the right ilium, a little to the rear of
the anterior superior spinous process, and took a downward and forward
course. A little shock was felt but no serious symptoms followed. In
forty hours there was delivery of a dead child with a bullet in its
abdomen.  Labor was normal and the internal recovery complete. Von
Chelius, quoting the younger Naegele, gives a remarkable instance of a
young peasant of thirty-five, the mother of four children, pregnant
with the fifth child, who was struck on the belly violently by a blow
from a wagon pole. She was thrown down, and felt a tearing pain which
caused her to faint. It was found that the womb had been ruptured and
the child killed, for in several days it was delivered in a putrid
mass, partly through the natural passage and partly through an abscess
opening in the abdominal wall. The woman made a good recovery. A
curious accident of pregnancy is that of a woman of thirty-eight,
advanced eight months in her ninth pregnancy, who after eating a hearty
meal was seized by a violent pain in the region of the stomach and soon
afterward with convulsions, supposed to have been puerperal. She died
in a few hours, and at the autopsy it was found that labor had not
begun, but that the pregnancy had caused a laceration of the spleen,
from which had escaped four or five pints of blood. Edge speaks of a
case of chorea in pregnancy in a woman of twenty-seven, not
interrupting pregnancy or retarding safe delivery. This had continued
for four pregnancies, but in the fourth abortion took place.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A few of the examples on record of operations during pregnancy of
special interest, will be given below. Polaillon speaks of a double
ovariotomy on a woman pregnant at three months, with the subsequent
birth of a living child at term. Gordon reports five successful
ovariotomies during pregnancy, in Lebedeff's clinic.  Of these cases, 1
aborted on the fifth day, 2 on the fifteenth, and the other 2 continued
uninterrupted. He collected 204 cases with a mortality of only 3 per
cent; 22 per cent aborted, and 69.4 per cent were delivered at full
term. Kreutzman reports two cases in which ovarian tumors were
successfully removed from pregnant subjects without the interruption of
gestation. One of these women, a secundipara, had gone two weeks over
time, and had a large ovarian cyst, the pedicle of which had become
twisted, the fluid in the cyst being sanguineous. May describes an
ovariotomy performed during pregnancy at Tottenham Hospital. The woman,
aged twenty-two, was pale, diminutive in size, and showed an enormous
abdomen, which measured 50 inches in circumference at the umbilicus and
27 inches from the ensiform cartilage to the pubes. At the operation,
36 pints of brown fluid were drawn off.  Delivery took place twelve
hours after the operation, the mother recovering, but the child was
lost. Galabin had a case of ovariotomy performed on a woman in the
sixth month of pregnancy without interruption of pregnancy; Potter had
a case of double ovariotomy with safe delivery at term; and Storry had
a similar case. Jacobson cites a case of vaginal lithotomy in a patient
six and a half months pregnant, with normal delivery at full term.
Tiffany quotes Keelan's description of a woman of thirty-five, in the
eighth month of pregnancy, from whom he removed a stone weighing 12 1/2
ounces and measuring 2 by 2 1/2 inches, with subsequent recovery and
continuation of pregnancy. Rydygier mentions a case of obstruction of
the intestine during the sixth month of gestation, showing symptoms of
strangulation for seven days, in which he performed abdominal section.
Recovery of the woman without abortion ensued. The Revue de Chirurgien
1887, contains an account of a woman who suffered internal
strangulation, on whom celiotomy was performed; she recovered in
twenty-five days, and did not miscarry, which shows that severe injury
to the intestine with operative interference does not necessarily
interrupt pregnancy. Gilmore, without inducing abortion, extirpated the
kidney of a negress, aged thirty-three, for severe and constant pain.
Tiffany removed the kidney of a woman of twenty-seven, five months
pregnant, without interruption of this or subsequent pregnancies. The
child was living. He says that Fancon cites instances of operation
without abortion.

Lovort describes an enucleation of the eye in the second month of
pregnancy. Pilcher cites the instance of a woman of fifty-eight, eight
months in her fourth pregnancy, whose breast and axilla he removed
without interruption of pregnancy. Robson, Polaillon, and Coen report
similar instances.

Rein speaks of the removal of an enormous echinococcus cyst of the
omentum without interruption of pregnancy. Robson reports a
multi-locular cyst of the ovary with extensive adhesions of the uterus,
removed at the tenth week of pregnancy and ovariotomy performed without
any interruption of the ordinary course of labor. Russell cites the
instance of a woman who was successfully tapped at the sixth month of
pregnancy.

McLean speaks of a successful amputation during pregnancy; Napper, one
of the arm; Nicod, one of the arm; Russell, an amputation through the
shoulder joint for an injury during pregnancy, with delivery and
recovery; and Vesey speaks of amputation for compound fracture of the
arm, labor following ten hours afterward with recovery. Keen reports
the successful performance of a hip-joint amputation for malignant
disease of the femur during pregnancy. The patient, who was five months
advanced in gestation, recovered without aborting.

Robson reports a case of strangulated hernia in the third month of
pregnancy with stercoraceous vomiting. He performed herniotomy in the
femoral region, and there was a safe delivery at full term. In the
second month of pregnancy he also rotated an ovarian tumor causing
acute symptoms and afterward performed ovariotomy without interfering
with pregnancy. Mann quotes Munde in speaking of an instance of removal
of elephantiasis of the vulva without interrupting pregnancy, and says
that there are many cases of the removal of venereal warts without any
interference with gestation. Campbell of Georgia operated inadvertently
at the second and third month in two cases of vesicovaginal fistula in
pregnant women. The first case showed no interruption of pregnancy, but
in the second case the woman nearly died and the fistula remained
unhealed. Engelmann operated on a large rectovaginal fistula in the
sixth month of pregnancy without any interruption of pregnancy, which
is far from the general result.  Cazin and Rey both produced abortion
by forcible dilatation of the anus for fissure, but Gayet used both the
fingers and a speculum in a case at five months and the woman went to
term. By cystotomy Reamy removed a double hair-pin from a woman
pregnant six and a half months, without interruption, and according to
Mann again, McClintock extracted stones from the bladder by the urethra
in the fourth month of pregnancy, and Phillips did the same in the
seventh month. Hendenberg and Packard report the removal of a tumor
weighing 8 3/4 pounds from a pregnant uterus without interrupting
gestation.

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

"Fraipont (Annales de la Societe Medico-Chirurgicale de Liege, 1894)
reports four cases where pregnancy and labor were practically normal,
though the uterus of each patient had been fixed to the abdominal
walls. In two of the cases the hysteropexy had been performed over five
years before the pregnancy occurred, and, although the bands of
adhesion between the fundus and the parietes must have become very
tough after so long a period, no special difficulty was encountered. In
two of the cases the forceps was used, but not on account of uterine
inertia; the fetal head was voluminous, and in one of the two cases
internal rotation was delayed. The placenta was always expelled easily,
and no serious postpartum hemorrhage occurred. Fraipont observed the
progress of pregnancy in several of these cases. The uterus does not
increase specially in its posterior part, but quite uniformly, so that,
as might be expected, the fundus gradually detaches itself from the
abdominal wall. Even if the adhesions were not broken down they would
of necessity be so stretched as to be useless for their original
purpose after delivery. Bands of adhesion could not share in the
process of involution. As, however, the uterus undergoes perfect
involution, it is restored to its original condition before the onset
of the disease which rendered hysteropexy necessary."

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

Von Quast speaks of a fibromyoma removed five days after labor.  Gervis
reports the removal of a large polypus of the uterus on the fifth day
after confinement. Davis describes the spontaneous expulsion of a large
polypus two days after the delivery of a fine, healthy, male child.
Deason mentions a case of anomalous tumor of the uterus during
pregnancy which was expelled after the birth of the child; and Daly
also speaks of a tumor expelled from the uterus after delivery. Cathell
speaks of a case of pregnancy complicated with both uterine fibroids
and measles. Other cases of a similar nature to the foregoing are too
numerous to mention.  Figure 13, taken from Spiegelberg, shows a large
fibroid blocking the pelvis of a pregnant woman.

There are several peculiar accidents and anomalies not previously
mentioned which deserve a place here, viz., those of the membranes
surrounding the fetus. Brown speaks of protrusion of the membranes from
the vulva several weeks before confinement.  Davies relates an instance
in which there was a copious watery discharge during pregnancy not
followed by labor. There is a case mentioned in which an accident and
an inopportune dose of ergot at the fifth month of pregnancy were
followed by rupture of the amniotic sac, and subsequently a constant
flow of watery fluid continued for the remaining three months of
pregnancy. The fetus died at the time, and was born in an advanced
state of putrefaction, by version, three months after the accident. The
mother died five months after of carcinoma of the uterus.  Montgomery
reports the instance of a woman who menstruated last on May 22, 1850,
and quickened on September 26th, and continued well until the 11th of
November. At this time, as she was retiring, she became conscious that
there was a watery discharge from the vagina, which proved to be liquor
amnii. Her health was good. The discharge continued, her size
increased, and the motions of the child continued active. On the 18th
of January a full-sized eight months' child was born. It had an
incessant, wailing, low cry, always of evil augury in new-born infants.
The child died shortly after. The daily discharge was about 5 ounces,
and had lasted sixty-eight days, making 21 pints in all. The same
accident of rupture of the membranes long before labor happened to the
patient's mother.

Bardt speaks of labor twenty-three days after the flow of the waters;
and Cobleigh one of seventeen days; Bradley relates the history of a
case of rupture of the membranes six weeks before delivery. Rains cites
an instance in which gestation continued three months after rupture of
the membranes, the labor-pains lasting thirty-six hours. Griffiths
speaks of rupture of the amniotic sac at about the sixth month of
pregnancy with no untoward interruption of the completion of gestation
and with delivery of a living child. There is another observation of an
accouchement terminating successfully twenty-three days after the loss
of the amniotic fluid. Campbell mentions delivery of a living child
twelve days after rupture of the membranes. Chesney relates the history
of a double collection of waters. Wood reports a case in which there
was expulsion of a bag of waters before the rupture of the membranes.
Bailly, Chestnut, Bjering, Cowger, Duncan, and others also record
premature rupture of the membranes without interruption of pregnancy.

Harris gives an instance of the membranes being expelled from the
uterus a few days before delivery at the full term. Chatard, Jr.,
mentions extrusion of the fetal membranes at the seventh month of
pregnancy while the patient was taking a long afternoon walk, their
subsequent retraction, and normal labor at term. Thurston tells of a
case in which Nature had apparently effected the separation of the
placenta without alarming hemorrhage, the ease being one of placenta
praevia, terminating favorably by natural processes. Playfair speaks of
the detachment of the uterine decidua without the interruption of
pregnancy.

Guerrant gives a unique example of normal birth at full term in which
the placenta was found in the vagina, but not a vestige of the
membranes was noticed. The patient had experienced nothing unusual
until within three months of expected confinement, since which time
there had been a daily loss of water from the uterus.  She recovered
and was doing her work. There was no possibility that this was a case
of retained secundines.

Anomalies of the Umbilical Cord.--Absence of the membranes has its
counterpart in the deficiency of the umbilical cord, so frequently
noticed in old reports. The Ephemerides, Osiander, Stark's Archives,
Thiebault, van der Wiel, Chatton, and Schurig all speak of it, and it
has been noticed since. Danthez speaks of the development of a fetus in
spite of the absence of an umbilical cord. Stute reports an observation
of total absence of the umbilical cord, with placental insertion near
the cervix of the uterus.

There is mentioned a bifid funis. The Ephemerides and van der Wiel
speak of a duplex funis. Nolde reports a cord 38 inches long; and
Werner cites the instance of a funis 51 inches long.  There are modern
instances in which the funis has been bifid or duplex, and there is
also a case reported in which there were two cords in a twin pregnancy,
each of them measuring five feet in length. The Lancet gives the
account of a most peculiar pregnancy consisting of a placenta alone,
the fetus wanting. What this "placenta" was will always be a matter of
conjecture.

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

The diverse causes of abortion are too numerous to attempt giving them
all, but some are so curious and anomalous that they deserve mention.
Epidemics of abortion are spoken of by Fickius, Fischer, and the
Ephemerides. Exposure to cold is spoken of as a cause, and the same is
alluded to by the Ephemerides; while another case is given as due to
exposure white nude. There are several cases among the older writers in
which odors are said to have produced abortion, but as analogues are
not to be found in modern literature, unless the odor is very poisonous
or pungent, we can give them but little credence. The Ephemerides gives
the odor of urine as provocative of abortion; Sulzberger, Meyer, and
Albertus all mention odors; and Vesti gives as a plausible cause the
odor of carbonic vapor. The Ephemerides mentions singultus as a cause
of abortion. Mauriceau, Pelargus, and Valentini mention coughing.
Hippocrates mentions the case of a woman who induced abortion by
calling excessively loud to some one. Fabrieius Hildanus speaks of
abortion following a kick in the region of the coccyx.  Gullmannus
speaks of an abortion which he attributes to the woman's constant
neglect to answer the calls of nature, the rectum being at all times in
a state of irritation from her negligence. Hawley mentions abortion at
the fourth or fifth month due to the absorption of spirits of
turpentine. Solingen speaks of abortion produced by sneezing. Osiander
cites an instance in which a woman suddenly arose, and in doing so
jolted herself so severely that she produced abortion. Hippocrates
speaks of extreme hunger as a cause of abortion. Treuner speaks of
great anger and wrath in a woman disturbing her to the extent of
producing abortion.

The causes that are observed every day, such tight lacing, excessive
venery, fright, and emotions, are too well known to be discussed here.

There has been reported a recent case of abortion following a
viper-bite, and analogues may be found in the writings of Severinus and
Oedman, who mention viper-bites as the cause; but there are so many
associate conditions accompanying a snake-bite, such as fright,
treatment, etc., any one of which could be a cause in itself, that this
is by no means a reliable explanation.  Information from India an this
subject would be quite valuable.

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

Abortion in a twin pregnancy does not necessarily mean the abortion or
death of both the products of conception. Chapman speaks of the case of
the expulsion of a blighted fetus at the seventh month, the living
child remaining to the full term, and being safely delivered, the
placenta following. Crisp says of a case of labor that the head of the
child was obstructed by a round body, the nature of which he was for
some time unable to determine. He managed to push the obstructing body
up and delivered a living, full-term child; this was soon followed by a
blighted fetus, which was 11 inches long, weighed 12 ounces, with a
placenta attached weighing 6 1/2 ounces. It is quite common for a
blighted fetus to be retained and expelled at term with a living child,
its twin.

Bacon speaks of twin pregnancy, with the death of one fetus at the
fourth month and the other delivered at term. Beall reports the
conception of twins, with one fetus expelled and the other retained;
Beauchamp cites a similar instance. Bothwell describes a twin labor at
term, in which one child was living and the other dead at the fifth
month and macerated. Belt reports an analogous case. Jameson gives the
history of an extraordinary case of twins in which one (dead) child was
retained in the womb for forty-nine weeks, the other having been born
alive at the expiration of nine months. Hamilton describes a case of
twins in which one fetus died from the effects of an injury between the
fourth and fifth months and the second arrived at full period. Moore
cites an instance in which one of the fetuses perished about the third
month, but was not expelled until the seventh, and the other was
carried to full term. Wilson speaks of a secondary or blighted fetus of
the third month with fatty degeneration of the membranes retained and
expelled with its living twin at the eighth month of uterogestation.

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

Worms in the Uterus.--Haines speaks of a most curious case--that of a
woman who had had a miscarriage three days previous; she suffered
intense pain and a fetid discharge. A number of maggots were seen in
the vagina, and the next day a mass about the size of an orange came
away from the uterus, riddled with holes, and which contained a number
of dead maggots, killed by the carbolic acid injection given soon after
the miscarriage. The fact seems inexplicable, but after their expulsion
the symptoms immediately ameliorated. This case recalls a somewhat
similar one given by the older writers, in which a fetus was eaten by a
worm.  Analogous are those cases spoken of by Bidel of lumbricoides
found in the uterus; by Hole, in which maggots were found in the vagina
and uterus; and Simpson, in which the abortion was caused by worms in
the womb--if the associate symptoms were trustworthy.

We can find fabulous parallels to all of these in some of the older
writings. Pare mentions Lycosthenes' account of a woman in Cracovia in
1494 who bore a dead child which had attached to its back a live
serpent, which had gnawed it to death. He gives an illustration showing
the serpent in situ. He also quotes the case of a woman who conceived
by a mariner, and who, after nine months, was delivered by a midwife of
a shapeless mass, followed by an animal with a long neck, blazing eyes,
and clawed feet.  Ballantyne says that in the writings of Hippocrates
there is in the work on "Diseases", which is not usually regarded as
genuine, a some what curious statement with regard to worms in the
fetus.  It is affirmed that flat worms develop in the unborn infant,
and the reason given is that the feces are expelled so soon after birth
that there would not be sufficient time during extrauterine life for
the formation of creatures of such a size. The same remark applies to
round worms. The proof of these statements is to be found in the fact
that many infants expel both these varieties of parasites with the
first stool. It is difficult to know what to make of these opinions;
for, with the exception of certain cases in some of the seventeenth and
eighteenth century writers, there are no records in medicine of the
occurrence of vermes in the infant at birth. It is possible that other
things, such as dried pieces of mucus, may have been erroneously
regarded as worms.



CHAPTER III.

OBSTETRIC ANOMALIES.

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

It seems strange that a physiologic process like parturition should be
attended by so much pain and difficulty. Savages in their primitive and
natural state seem to have difficulty in many cases, and even animals
are not free from it. We read of the ancient wild Irish women breaking
the pubic bones of their female children shortly after birth, and by
some means preventing union subsequently, in order that these might
have less trouble in child-birth--as it were, a modified and early form
of symphysiotomy. In consequence of this custom the females of this
race, to quote an old English authority, had a "waddling, lamish
gesture in their going." These old writers said that for the same
reason the women in some parts of Italy broke the coccyxes of their
female children. This report is very likely not veracious, because this
bone spontaneously repairs itself so quickly and easily. Rodet and
Engelmunn, in their most extensive and interesting papers on the modes
of accouchement among the primitive peoples, substantiate the fear,
pain, and difficulty with which labor is attended, even in the lowest
grades of society.

In view of the usual occurrence of pain and difficulty with labor, it
seems natural that exceptions to the general rule should in all ages
have attracted the attention of medical men, and that literature should
be replete with such instances.  Pechlin and Muas record instances of
painless births. The Ephemerides records a birth as having occurred
during asphyxia, and also one during an epileptic attack. Storok also
speaks of birth during unconsciousness in an epileptic attack; and Haen
and others describe cases occurring during the coma attending
apoplectic attacks. King reports the histories of two married women,
fond mothers and anticipating the event, who gave birth to children,
apparently unconsciously. In the first case, the appearance of the
woman verified the assertion; in the second, a transient suspension of
the menstrual influence accounted for it.  After some months epilepsy
developed in this case. Crawford speaks of a Mrs. D., who gave birth to
twins in her first confinement at full term, and who two years after
aborted at three months. In December, 1868, a year after the abortion,
she was delivered of a healthy, living fetus of about five or six
months' growth in the following manner: While at stool, she discovered
something of a shining, bluish appearance protruding through the
external labia, but she also found that when she lay down the tumor
disappeared. This tumor proved to be the child, which had been expelled
from the uterus four days before, with the waters and membranes intact,
but which had not been recognized; it had passed through the os without
pain or symptoms, and had remained alive in the vagina over four days,
from whence it was delivered, presenting by the foot.

The state of intoxication seems by record of several cases to render
birth painless and unconscious, as well as serving as a means of
anesthesia in the preanesthetic days.

The feasibility of practising hypnotism in child-birth has been
discussed, and Fanton reports 12 cases of parturition under the
hypnotic influence. He says that none of the subjects suffered any pain
or were aware of the birth, and offers the suggestion that to
facilitate the state of hypnosis it should be commenced before strong
uterine contractions have occurred.

Instances of parturition or delivery during sleep, lethargies, trances,
and similar conditions are by no means uncommon. Heister speaks of
birth during a convulsive somnolence, and Osiander of a case during
sleep. Montgomery relates the case of a lady, the mother of several
children, who on one occasion was unconsciously delivered in sleep.
Case relates the instance of a French woman residing in the town of
Hopedale, who, though near confinement, attributed her symptoms to
over-fatigue on the previous day. When summoned, the doctor found that
she had severe lumbar pains, and that the os was dilated to the size of
a half-dollar. At ten o'clock he suggested that everyone retire, and
directed that if anything of import occurred he should be called. About
4 A.M. the husband of the girl, in great fright, summoned the
physician, saying: "Monsieur le Medecin, il y a quelque chose entre les
jambes de ma femme," and, to Dr. Case's surprise, he found the head of
a child wholly expelled during a profound sleep of the mother. In
twenty minutes the secundines followed. The patient, who was only
twenty years old, said that she had dreamt that something was the
matter with her, and awoke with a fright, at which instant, most
probably, the head was expelled. She was afterward confined with the
usual labor-pains.

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

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

Samelson says that in 1844 he was sent for in Zabelsdorf, some 30 miles
from Berlin, to attend Hannah Rhode in a case of labor. She had passed
easily through eight parturitions. At about ten o'clock in the morning,
after a partially unconscious night, there was a sudden gush of blood
and water from the vagina; she screamed and lapsed into an unconscious
condition. At 10.35 the face presented, soon followed by the body,
after which came a great flow of blood, welling out in several waves.
The child was a male middle-sized, and was some little time in making
himself heard. Only by degrees did the woman's consciousness return.
She felt weary and inclined to sleep, but soon after she awoke and was
much surprised to know what had happened. She had seven or eight pains
in all. Schultze speaks of a woman who, arriving at the period for
delivery, went into an extraordinary state of somnolence, and in this
condition on the third day bore a living male child.

Berthier in 1859 observed a case of melancholia with delirium which
continued through pregnancy. The woman was apparently unconscious of
her condition and was delivered without pain.  Cripps mentions a case
in which there was absence of pain in parturition. Depaul mentions a
woman who fell in a public street and was delivered of a living child
during a syncope which lasted four hours. Epley reports painless labor
in a patient with paraplegia. Fahnestock speaks of the case of a woman
who was delivered of a son while in a state of artificial somnambulism,
without pain to herself or injury to the child. Among others mentioning
painless or unconscious labor are Behrens (during profound sleep),
Eger, Tempel, Panis, Agnoia, Blanckmeister, Whitehill, Gillette,
Mattei, Murray, Lemoine, and Moglichkeit.

Rapid Parturition Without Usual Symptoms.--Births unattended by
symptoms that are the usual precursors of labor often lead to speedy
deliveries in awkward places. According to Willoughby, in Darby,
February 9, 1667, a poor fool, Mary Baker, while wandering in an open,
windy, and cold place, was delivered by the sole assistance of Nature,
Eve's midwife, and freed of her afterbirth.  The poor idiot had leaned
against a wall, and dropped the child on the cold boards, where it lay
for more than a quarter of an hour with its funis separated from the
placenta. She was only discovered by the cries of the infant. In
"Carpenter's Physiology" is described a remarkable case of instinct in
an idiotic girl in Paris, who had been seduced by some miscreant; the
girl had gnawed the funis in two, in the same manner as is practised by
the lower animals. From her mental imbecility it can hardly be imagined
that she had any idea of the object of this separation, and it must
have been instinct that impelled her to do it. Sermon says the wife of
Thomas James was delivered of a lusty child while in a wood by herself.
She put the child in an apron with some oak leaves, marched stoutly to
her husband's uncle's house a half mile distant, and after two hours'
rest went on her journey one mile farther to her own house; despite all
her exertions she returned the next day to thank her uncle for the two
hours' accommodation. There is related the history of a case of a woman
who was delivered of a child on a mountain during a hurricane, who took
off her gown and wrapped the child up in it, together with the
afterbirth, and walked two miles to her cottage, the funis being
unruptured.

Harvey relates a case, which he learned from the President of Munster,
Ireland, of a woman with child who followed her husband, a soldier in
the army, in daily march. They were forced to a halt by reason of a
river, and the woman, feeling the pains of labor approaching, retired
to a thicket, and there alone brought forth twins. She carried them to
the river, washed them herself, did them up in a cloth, tied them to
her back, and that very day marched, barefooted, 12 miles with the
soldiers, and was none the worse for her experience. The next day the
Deputy of Ireland and the President of Munster, affected by the story,
to repeat the words of Harvey, "did both vouchsafe to be godfathers of
the infants."

Willoughby relates the account of a woman who, having a cramp while in
bed with her sister, went to an outhouse, as if to stool, and was there
delivered of a child. She quickly returned to bed, her going and her
return not being noticed by her sleeping sister. She buried the child,
"and afterward confessed her wickedness, and was executed in the
Stafford Gaol, March 31, 1670." A similar instance is related by the
same author of a servant in Darby in 1647. Nobody suspected her, and
when delivered she was lying in the same room with her mistress. She
arose without awakening anyone, and took the recently delivered child
to a remote place, and hid it at the bottom of a feather tub, covering
it with feathers; she returned without any suspicion on the part of her
mistress. It so happened that it was the habit of the Darby soldiers to
peep in at night where they saw a light, to ascertain if everything was
all right, and they thus discovered her secret doings, which led to her
trial at the next sessions at Darby.

Wagner relates the history of a case of great medicolegal interest. An
unmarried servant, who was pregnant, persisted in denying it, and took
every pains to conceal it. She slept in a room with two other maids,
and, on examination, she stated that on the night in question she got
up toward morning, thinking to relieve her bowels. For this purpose she
secured a wooden tub in the room, and as she was sitting down the child
passed rapidly into the empty vessel. It was only then that she became
aware of the nature of her pains. She did not examine the child
closely, but was certain it neither moved nor cried. The funis was no
doubt torn, and she made an attempt to tie it. Regarding the event as a
miscarriage, she took up the tub with its contents and carried it to a
sand pit about 30 paces distant, and threw the child in a hole in the
sand that she found already made. She covered it up with sand and
packed it firmly so that the dogs could not get it. She returned to her
bedroom, first calling up the man-servant at the stable. She awakened
her fellow-servants, and feeling tired sat down on a stool. Seeing the
blood on the floor, they asked her if she had made way with the child.
She said: "Do you take me for an old sow?" But, having their suspicions
aroused, they traced the blood spots to the sand pit.  Fetching a
spade, they dug up the child, which was about one foot below the
surface. On the access of air, following the removal of the sand and
turf, the child began to cry, and was immediately taken up and carried
to its mother, who washed it and laid it on her bed and soon gave it
the breast. The child was healthy with the exception of a club-foot,
and must have been under ground at least fifteen minutes and no air
could have reached it. It seems likely that the child was born
asphyxiated and was buried in this state, and only began to assume
independent vitality when for the second time exposed to the air. This
curious case was verified to English correspondents by Dr. Wagner, and
is of unquestionable authority; it became the subject of a thorough
criminal investigation in Germany.

During the funeral procession of Marshal MacMahon in Paris an enormous
crowd was assembled to see the cortege pass, and in this crowd was a
woman almost at the time of delivery; the jostling which she received
in her endeavors to obtain a place of vantage was sufficient to excite
contraction, and, in an upright position, she gave birth to a fetus,
which fell at her feet. The crowd pushed back and made way for the
ambulance officials, and mother and child were carried off, the mother
apparently experiencing little embarrassment. Quoted by Taylor,
Anderson speaks of a woman accused of child murder, who walked a
distance of 28 miles on a single day with her two-days-old child on her
back.

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

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

Smith of Madras, in 1862, says he was hastily summoned to see an
English lady who had borne a child without the slightest warning.  He
found the child, which had been born ten minutes, lying close to the
mother's body, with the funis uncut. The native female maid, at the
lady's orders, had left the child untouched, lifting the bed-clothes to
give it air. The lady said that she arose at 5.30 feeling well, and
during the forenoon had walked down a long flight of steps across a
walk to a small summer-house within the enclosure of her grounds.
Feeling a little tired, she had lain down on her bed, and soon
experienced a slight discomfort, and was under the impression that
something solid and warm was lying in contact with her person. She
directed the servant to look below the bed-clothes, and then a female
child was discovered.  Her other labors had extended over six hours,
and were preceded by all the signs distinctive of childbirth, which
fact attaches additional interest to the case. The ultimate fate of the
child is not mentioned. Smith quotes Wilson, who said he was called to
see a woman who was delivered without pain while walking about the
house. He found the child on the floor with its umbilical cord torn
across.

Langston mentions the case of a woman, twenty-three, who, between 4 and
5 A.M., felt griping pains in the abdomen. Knowing her condition she
suspected labor, and determined to go to a friend's house where she
could be confined in safety. She had a distance of about 600 yards to
go, and when she was about half way she was delivered in an upright
position of a child, which fell on the pavement and ruptured its funis
in the fall. Shortly after, the placenta was expelled, and she
proceeded on her journey, carrying the child in her arms. At 5.50 the
physician saw the woman in bed, looking well and free from pain, but
complaining of being cold. The child, which was her first, was healthy,
well nourished, and normal, with the exception of a slight ecchymosis
of the parietal bone on the left side. The funis was lacerated
transversely four inches from the umbilicus. Both mother and child
progressed favorably. Doubtless the intense cold had so contracted the
blood-vessels as to prevent fatal hemorrhage to mother and child. This
case has a legal bearing in the supposition that the child had been
killed in the fall.

There is reported the case of a woman in Wales, who, while walking with
her husband, was suddenly seized with pains, and would have been
delivered by the wayside but for the timely help of Madame Patti, the
celebrated diva, who was driving by, and who took the woman in her
carriage to her palatial residence close by. It was to be christened in
a few days with an appropriate name in remembrance of the occasion.
Coleman met an instance in a married woman, who without the slightest
warning was delivered of a child while standing near a window in her
bedroom. The child fell to the floor and ruptured the cord about one
inch from the umbilicus, but with speedy attention the happiest results
were attained. Twitchell has an example in the case of a young woman of
seventeen, who was suddenly delivered of a child while ironing some
clothes. The cord in this case was also ruptured, but the child
sustained no injury. Taylor quotes the description of a child who died
from an injury to the head caused by dropping from the mother at an
unexpected time, while she was in the erect position; he also speaks of
a parallel case on record.

Unusual Places of Birth.--Besides those mentioned, the other awkward
positions in which a child may be born are so numerous and diversified
that mention of only a few can be made here.  Colton tells of a
painless labor in an Irish girl of twenty-three, who felt a desire to
urinate, and while seated on the chamber dropped a child. She never
felt a labor-pain, and twelve days afterward rode 20 miles over a rough
road to go to her baby's funeral. Leonhard describes the case of a
mother of thirty-seven, who had borne six children alive, who was
pregnant for the tenth time, and who had miscalculated her pregnancy.
During pregnancy she had an attack of small-pox and suffered all
through pregnancy with constipation. She had taken a laxative, and when
returning to bed from stool was surprised to find herself attached to
the stool by a band. The child in the vessel began to cry and was
separated from the woman, who returned to bed and suddenly died
one-half hour later. The mother was entirely unconscious of the
delivery. Westphal mentions a delivery in a water-closet.

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

There is a curious instance on record in which a child was born in a
hip-bath and narrowly escaped drowning. The mother was a European woman
aged forty, who had borne two children, the last nine years before. She
was supposed to have dropsy of the abdomen, and among other treatments
was the use of a speculum and caustic applications for inflammation of
the womb. The escape of watery fluid for two days was considered
evidence of the rupture of an ovarian cyst. At the end of two days,
severe pains set in, and a warm hip-bath and an opiate were ordered.
While in the bath she bore a fully-matured, living, male child, to the
great surprise of herself and her friends. The child might have been
drowned had not assistance been close at hand.

Birth by the Rectum.--In some cases in which there is some obstacle to
the delivery of a child by the natural passages, the efforts of nature
to expel the product of conception lead to an anomalous exit. There are
some details of births by the rectum mentioned in the last century by
Reta and others. Payne cites the instance of a woman of thirty-three,
in labor thirty-six hours, in whom there was a congenital absence of
the vaginal orifice.  The finger, gliding along the perineum, arrived
at a distended anus, just inside of which was felt a fetal head. He
anesthetized the patient and delivered the child with forceps, and
without perineal rupture. There was little hemorrhage, and the placenta
was removed with slight difficulty. Five months later, Payne found an
unaltered condition of the perineum and vicinity; there was absence of
the vaginal orifice, and, on introducing the finger along the anterior
wall of the rectum, a fistula was found, communicating with the vagina;
above this point the arrangement and the situation of the parts were
normal. The woman had given birth to three still-born children, and
always menstruated easily. Coitus always seemed satisfactory, and no
suspicion existed in the patient's mind, and had never been suggested
to her, of her abnormality.

Harrison saw a fetus delivered by the anus after rupture of the uterus;
the membranes came away by the same route. In this case the neck of the
uterus was cartilaginous and firmly adherent to the adjacent parts. In
seven days after the accouchement the woman had completely regained her
health. Vallisneri reports the instance of a woman who possessed two
uteruses, one communicating with the vagina, the other with the rectum.
She had permitted rectal copulation and had become impregnated in this
manner.  Louis, the celebrated French surgeon, created a furore by a
pamphlet entitled "De partium externarum generationi inservientium in
mulieribus naturali vitiosa et morbosa dispositione, etc.," for which
he was punished by the Sorbonne, but absolved by the Pope. He described
a young lady who had no vaginal opening, but who regularly menstruated
by the rectum. She allowed her lover to have connection with her in the
only possible way, by the rectum, which, however, sufficed for
impregnation, and at term she bore by the rectum a well-formed child.
Hunter speaks of a case of pregnancy in a woman with a double vagina,
who was delivered at the seventh month by the rectum. Mekeln and
Andrews give instances of parturition through the anus. Morisani
describes a case of extrauterine pregnancy with tubal rupture and
discharge into the culdesac, in which there was delivery by the rectum.
After an attack of severe abdominal pain, followed by hemorrhage, the
woman experienced an urgent desire to empty the rectum. The fetal
movements ceased, and a recurrence of these symptoms led the patient to
go to stool, at which she passed blood and a seromucoid fluid. She
attempted manually to remove the offending substances from the rectum,
and in consequence grasped the leg of a fetus. She was removed to a
hospital, where a fetus nine inches long was removed from the rectum.
The rectal opening gradually cicatrized, the sac became obliterated,
and the woman left the hospital well.

Birth Through Perineal Perforation.--Occasionally there is perineal
perforation during labor, with birth of the child through the opening.
Brown mentions a case of rupture of the perineum with birth of a child
between the vaginal opening and the anus. Cassidy reports a case of
child-birth through the perineum. A successful operation was performed
fifteen days after the accident. Dupuytren speaks of the passage of an
infant through a central opening of the perineum. Capuron, Gravis, and
Lebrun all report accouchement through a perineal perforation, without
alteration in the sphincter ani or the fourchet. In his "Diseases of
Women" Simpson speaks of a fistula left by the passage of an infant
through the perineum. Wilson, Toloshinoff, Stolz, Argles, Demarquay,
Harley, Hernu, Martyn, Lamb, Morere, Pollock, and others record the
birth of children through perineal perforations.

Birth Through the Abdominal Wall.--Hollerius gives a very peculiar
instance in which the abdominal walls gave way from the pressure
exerted by the fetus, and the uterus ruptured, allowing the child to be
extracted by the hand from the umbilicus; the mother made a speedy
recovery. In such cases delivery is usually by means of operative
interference (which will be spoken of later), but rarely, as here,
spontaneously. Farquharson and Ill both mention rupture of the
abdominal parietes during labor.

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

There is an account of a female who had a tumor projecting between the
vagina and rectum, which was incised through the intestine, and proved
to be a dead child. Saviard reported what he considered a rather unique
case, in which the uterus was ruptured by external violence, the fetus
being thrown forward into the abdomen and afterward extracted from an
umbilical abscess.

Birth of the Fetus Enclosed in the Membranes.--Harvey says that an
infant can rest in its membranes several hours after birth without loss
of life. Schurig eventrated a pregnant bitch and her puppies lived in
their membranes half an hour. Wrisberg cites three observations of
infants born closed in their membranes; one lived seven minutes; the
other two nine minutes; all breathed when the membranes were cut and
air admitted. Willoughby recorded the history of a case which attracted
much comment at the time.  It was the birth of twins enclosed in their
secundines. The sac was opened and, together with the afterbirth, was
laid over some hot coals; there was, however, a happy issue, the
children recovering and living. Since Willoughby's time several cases
of similar interest have been noticed, one in a woman of forty, who had
been married sixteen years, and who had had several pregnancies in her
early married life and a recent abortion. Her last pregnancy lasted
about twenty-eight or twenty-nine weeks, and terminated, after a short
labor, by the expulsion of the ovum entire. The membranes had not been
ruptured, and still enclosed the fetus and the liquor amnii. On
breaking them, the fetus was seen floating on the waters, alive, and,
though very diminutive, was perfectly formed. It continued to live, and
a day afterward took the breast and began to cry feebly. At six weeks
it weighed 2 pounds 2 ounces, and at ten months, 12 pounds, but was
still very weak and ill-nourished. Evans has an instance of a fetus
expelled enveloped in its membranes entire and unruptured. The
membranes were opaque and preternaturally thickened, and were opened
with a pair of scissors; strenuous efforts were made to save the child,
but to no purpose. The mother, after a short convalescence, made a good
recovery. Forman reports an instance of unruptured membranes at birth,
the delivery following a single pain, in a woman of twenty-two,
pregnant for a second time.  Woodson speaks of a case of twins, one of
which was born enveloped in its secundines.

Van Bibber was called in great haste to see a patient in labor.  He
reached the house in about fifteen minutes, and was told by the
midwife, a woman of experience, that she had summoned him because of
the expulsion from the womb of something the like of which she had
never seen before. She thought it must have been some variety of false
conception, and had wrapped it up in some flannel. It proved to be a
fetus enclosed in its sac, with the placenta, all having been expelled
together and intact. He told the nurse to rupture the membranes, and
the child, which had been in the unruptured sac for over twenty
minutes, began to cry. The infant lived for over a month, but
eventually died of bronchitis.

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

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

Delivery After Death of the Mother.--Curious indeed are those anomalous
cases in which the delivery is effected spontaneously after the death
of the mother, or when, by manipulation, the child is saved after the
maternal decease. Wegelin gives the account of a birth in which version
was performed after death and the child successfully delivered.
Bartholinus, Wolff, Schenck, Horstius, Hagendorn, Fabricius Hildanus,
Valerius, Rolfinck, Cornarius, Boener, and other older writers cite
cases of this kind. Pinard gives a most wonderful case. The patient was
a woman of thirty-eight who had experienced five previous normal
labors.  On October 27th she fancied she had labor pains and went to
the Lariboisiere Maternite, where, after a careful examination, three
fetal poles were elicited, and she was told, to her surprise, of the
probability of triplets. At 6 P.M., November 13th, the pains of labor
commenced. Three hours later she was having great dyspnea with each
pain. This soon assumed a fatal aspect and the midwife attempted to
resuscitate the patient by artificial respiration, but failed in her
efforts, and then she turned her attention to the fetuses, and, one by
one, she extracted them in the short space of five minutes; the last
one was born twelve minutes after the mother's death. They all lived
(the first two being females), and they weighed from 4 1/4 to 6 1/2
pounds.

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

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

Aveling states that in 1820 the Council of Cologne sanctioned the
placing of a gag in the mouth of a dead pregnant woman, thereby hoping
to prevent suffocation of the infant, and there are numerous such laws
on record, although most of them pertain to the performance of Cesarean
section immediately after death.

Reiss records the death of a woman who was hastily buried while her
husband was away, and on his return he ordered exhumation of her body,
and on opening the coffin a child's cry was heard. The infant had
evidently been born postmortem. It lived long afterward under the name
of "Fils de la terre." Willoughby mentions the curious instance in
which rumbling was heard from the coffin of a woman during her hasty
burial. One of her neighbors returned to the grave, applied her ear to
the ground, and was sure she heard a sighing noise. A soldier with her
affirmed her tale, and together they went to a clergyman and a justice,
begging that the grave be opened. When the coffin was opened it was
found that a child had been born, which had descended to her knees. In
Derbyshire, to this day, may be seen on the parish register: "April ye
20, 1650, was buried Emme, the wife of Thomas Toplace, who was found
delivered of a child after she had lain two hours in the grave."

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

Other cases of postmortem delivery are less successful, the delivery
being delayed too late for the child to be viable. The first of
Aveling's cases was that of a pregnant woman who was hanged by a
Spanish Inquisitor in 1551 While still hanging, four hours later, two
children were said to have dropped from her womb. The second case was
of a woman of Madrid, who after death was shut in a sepulcher. Some
months after, when the tomb was opened, a dead infant was found by the
side of the corpse.  Rolfinkius tells of a woman who died during
parturition, and her body being placed in a cellar, five days later a
dead boy and girl were found on the bier. Bartholinus is accredited
with the following: Three midwives failing to deliver a woman, she
died, and forty-eight hours after death her abdomen swelled to such an
extent as to burst her grave-clothes, and a male child, dead, was seen
issuing from the vagina. Bonet tells of a woman, who died in Brussels
in 1633, who, undelivered, expired in convulsions on Thursday. On
Friday abdominal movements in the corpse were seen, and on Sunday a
dead child was found hanging between the thighs.  According to Aveling,
Herman of Berne reports the instance of a young lady whose body was far
advanced in putrefaction, from which was expelled an unbroken ovum
containing twins. Even the placenta showed signs of decomposition.
Naumann relates the birth of a child on the second day after the death
of the mother.  Richter of Weissenfels, in 1861, reported the case of a
woman who died in convulsions, and sixty hours after death an eight
months' fetus came away. Stapedius writes to a friend of a fetus being
found dead between the thighs of a woman who expired suddenly of an
acute disease. Schenk mentions that of a woman, dying at 5 P.M., a
child having two front teeth was born at 3 A.M.  Veslingius tells of a
woman dying of epilepsy on June 6, 1630, from whose body, two days
later, issued a child. Wolfius relates the case of a woman dying in
labor in 1677. Abdominal movements being seen six hours after death,
Cesarean section was suggested, but its performance was delayed, and
eighteen hours after a child was spontaneously born. Hoyer of Mulhausen
tells of a child with its mouth open and tongue protruding, which was
born while the mother was on the way to the grave. Bedford of Sydney,
according to Aveling, relates the story of a case in which malpractice
was suspected on a woman of thirty-seven, who died while pregnant with
her seventh child. The body was exhumed, and a transverse rupture of
the womb six inches long above the cervix was found, and the body of a
dead male child lay between the thighs. In 1862, Lanigan tells of a
woman who was laid out for funeral obsequies, and on removal of the
covers for burial a child was found in bed with her. Swayne is credited
with the description of the death of a woman whom a midwife failed to
deliver. Desiring an inquest, the coroner had the body exhumed, when,
on opening the coffin, a well-developed male infant was found parallel
to and lying on the lower limbs, the cord and placenta being entirely
unattached from the mother.

Some time after her decease Harvey found between the thighs of a dead
woman a dead infant which had been expelled postmortem.  Mayer relates
the history of a case of a woman of forty-five who felt the movement of
her child for the fourth time in the middle of November. In the
following March she had hemoptysis, and serious symptoms of
inflammation in the right lung following, led to her apparent death on
the 31st of the month. For two days previous to her death she had
failed to perceive the fetal movements. She was kept on her back in a
room, covered up and undisturbed, for thirty-six hours, the members of
the family occasionally visiting her to sprinkle holy water on her
face.  There was no remembrance of cadaveric distortion of the features
or any odor. When the undertakers were drawing the shroud on they
noticed a half-round, bright-red, smooth-looking body between the
genitals which they mistook for a prolapsed uterus. Early on April 2d,
a few hours before interment, the men thought to examine the swelling
they had seen the day before. A second look showed it to be a dead
female child, now lying between the thighs and connected with the
mother by the umbilical cord. The interment was stopped, and Mayer was
called to examine the body, but with negative results, though the signs
of death were not plainly visible for a woman dead fifty-eight hours.
By its development the body of the fetus confirmed the mother's account
of a pregnancy of twenty-one weeks. Mayer satisfies himself at least
that the mother was in a trance at the time of delivery and died soon
afterward.

Moritz gives the instance of a woman dying in pregnancy, undelivered,
who happened to be disinterred several days after burial. The body was
in an advanced state of decomposition, and a fetus was found in the
coffin. It was supposed that the pressure of gas in the mother's body
had forced the fetus from the uterus.  Ostmann speaks of a woman
married five months, who was suddenly seized with rigors, headache, and
vomiting. For a week she continued to do her daily work, and in
addition was ill-treated by her husband. She died suddenly without
having any abdominal pain or any symptoms indicative of abortion. The
body was examined twenty-four hours after death and was seen to be
dark, discolored, and the abdomen distended. There was no sanguineous
discharge from the genitals, but at the time of raising the body to
place it in the coffin, a fetus, with the umbilical cord, escaped from
the vagina. There seemed to have been a rapid putrefaction in this
ease, generating enough pressure of gas to expel the fetus as well as
the uterus from the body. This at least is the view taken by Hoffman
and others in the solution of these strange cases.

Antepartum Crying of the Child.--There are on record fabulous cases of
children crying in the uterus during pregnancy, and all sorts of
unbelievable stories have been constructed from these reported
occurrences. Quite possible, however, and worthy of belief are the
cases in which the child has been heard to cry during the progress of
parturition--that is, during delivery.  Jonston speaks of infants
crying in the womb, and attempts a scientific explanation of the fact.
He also quotes the following lines in reference to this subject:--

"Mirandum foetus nlaterna clausus in alvo Dicitur insuetos ore dedisse
sonos.  Causa subest; doluit se angusta sede telleri Et cupiit magnae
cernere moliis opus.  Aut quia quaerendi studio vis fessa parentum
Aucupii aptas innuit esse manus."

The Ephemerides gives examples of the child hiccoughing in the uterus.
Cases of crying before delivery, some in the vagina, some just before
the complete expulsion of the head from the os uteri, are very numerous
in the older writers; and it is quite possible that on auscultation of
the pregnant abdomen fetal sounds may have been exaggerated into cries.
Bartholinus, Borellus, Boyle, Buchner, Paullini, Mezger, Riolanus,
Lentillus, Marcellus Donatus, and Wolff all speak of children crying
before delivery; and Mazinus relates the instance of a puppy whose
feeble cries could be heard before expulsion from the bitch. Osiander
fully discusses the subject of infants crying during parturition.

McLean describes a case in which he positively states that a child
cried lustily in utero during application of the forceps.  He compared
the sound as though from a voice in the cellar. This child was in the
uterus, not in the vagina, and continued the crying during the whole of
the five minutes occupied by delivery.

Cesarean Section.--Although the legendary history of Cesarean section
is quite copious, it is very seldom that we find authentic records in
the writings of the older medical observers.  The works of Hippocrates,
Aretxeus, Galen, Celsus, and Aetius contain nothing relative to records
of successful Cesarean sections. However, Pliny says that Scipio
Africanus was the first and Manlius the second of the Romans who owed
their lives to the operation of Cesarean section; in his seventh book
he says that Julius Caesar was born in this way, the fact giving origin
to his name. Others deny this and say that his name came from the thick
head of hair which he possessed. It is a frequent subject in old Roman
sculpture, and there are many delineations of the birth of Bacchus by
Cesarean section from the corpse of Semele. Greek mythology tells us of
the birth of Bacchus in the following manner: After Zeus burnt the
house of Semele, daughter of Cadmus, he sent Hermes in great haste with
directions to take from the burnt body of the mother the fruit of seven
months. This child, as we know, was Bacchus. Aesculapius, according to
the legend of the Romans, had been excised from the belly of his dead
mother, Corinis, who was already on the funeral pile, by his
benefactor, Apollo; and from this legend all products of Cesarean
sections were regarded as sacred to Apollo, and were thought to have
been endowed with sagacity and bravery.

Old records tell us that one of the kings of Navarre was delivered in
this way, and we also have records of the birth of the celebrated Doge,
Andreas Doria, by this method. Jane Seymour was supposed to have been
delivered of Edward VI by Cesarean section, the father, after the
consultation of the physicians was announced to him, replying: "Save
the child by all means, for I shall be able to get mothers enough."
Robert II of Scotland was supposed to have been delivered in this way
after the death of his mother, Margery Bruce, who was killed by being
thrown from a horse. Shakespere's immortal citation of Macduff, "who
was from his mother's womb untimely ripped," must have been such a
case, possibly crudely done, perchance by cattle-horn. Pope Gregory XIV
was said to have been taken from his mother's belly after her death.
The Philosophical Transactions, in the last century contain accounts of
Cesarean section performed by an ignorant butcher and also by a
midwife; and there are many records of the celebrated case performed by
Jacob Nufer, a cattle gelder, at the beginning of the sixteenth century.

By the advent of antisepsis and the improvements of Porro and others,
Cesarean section has come to be a quite frequent event, and a record of
the successful cases would hardly be considered a matter of
extraordinary interest, and would be out of the province of this work,
but a citation of anomalous cases will be given. Baldwin reports a case
of Cesarean section on a typical rachitic dwarf of twenty-four, who
weighed 100 pounds and was only 47 1/2 inches tall. It was the ninth
American case, according to the calculation of Harris, only the third
successful one, and the first successful one in Ohio. The woman had a
uniformly contracted pelvis whose anteroposterior diameter was about 1
1/4 inches. The hygienic surroundings for the operation were not of the
best, as the woman lived in a cellar. Tait's method of performing the
operation was determined upon and successfully performed. Convalescence
was prompt, and in three weeks the case was dismissed. The child was a
female of 7 1/2 pounds which inherited the deformities of its mother.
It thrived for nine and a half months, when it died of angina Ludovici.
Figure 15 represents the mother and child.

Harris gives an account of an operation upon a rachitic dwarf who was
impregnated by a large man, a baby weighing 14 pounds and measuring 20
inches being delivered by the knife. St. Braun gives the account of a
Porro-Cesarean operation in the case of a rachitic dwarf 3 feet 10
inches tall, in which both the mother and child recovered. Munde speaks
of twins being delivered by Cesarean section. Franklin gives the
instance of a woman delivered at full term of a living child by this
means, in whom was also found a dead fetus. It lay behind the stump of
the amputated cervix, in the culdesac of Douglas. The patient died of
hemorrhage.

Croston reports a case of Cesarean section on a primipara of
twenty-four at full term, with the delivery of a double female monster
weighing 12 1/2 pounds. This monster consisted of two females of about
the same size, united from the sternal notch to the navel, having one
cord and one placenta. It was stillborn.  The diagnosis was made before
operation by vaginal examination.  In a communication to Croston,
Harris remarked that this was the first successful Cesarean section for
double monstrous conception in America, and added that in 1881 Collins
and Leidy performed the same operation without success.

Instances of repeated Cesarean section were quite numerous, and the
pride of the operators noteworthy, before the uterus was removed at the
first operation, as is now generally done. Bacque reports two sections
in the same woman, and Bertrandi speaks of a case in which the
operation was successfully executed many times in the same woman.
Rosenberg reports three cases repeated successfully by Leopold of
Dresden. Skutsch reports a case in which it was twice performed on a
woman with a rachitic pelvis, and who the second time was pregnant with
twins; the children and mother recovered. Zweifel cites an instance in
which two Cesarean sections were performed on a patient, both of the
children delivered being in vigorous health. Stolz relates a similar
case.  Beck gives an account of a Cesarean operation twice on the same
woman; in the first the child perished, but in the second it survived.
Merinar cites an instance of a woman thrice opened.  Parravini gives a
similar instance. Charlton gives an account of the performance carried
out successfully four times in the same woman; Chisholm mentions a case
in which it was twice performed.  Michaelis of Kiel gives an instance
in which he performed the same operation on a woman four times, with
successful issues to both mother and children, despite the presence of
peritonitis the last time. He had operated in 1826, 1830, 1832, and
1836. Coe and Gueniot both mention cases in which Cesarean section had
been twice performed with successful terminations as regards both
mothers and children. Rosenberg tabulates a number of similar cases
from medical literature.

Cases of Cesarean section by the patient herself are most curious, but
may be readily believed if there is any truth in the reports of the
operation being done in savage tribes. Felkin gives an account of a
successful case performed in his presence, with preservation of the
lives of both mother and child, by a native African in Kahura, Uganda
Country. The young girl was operated on in the crudest manner, the
hemorrhage being checked by a hot iron. The sutures were made by means
of seven thin, hot iron spikes, resembling acupressure-needles, closing
the peritoneum and skin. The wound healed in eleven days, and the
mother made a complete recovery. Thomas Cowley describes the case of a
negro woman who, being unable to bear the pains of labor any longer,
took a sharp knife and made a deep incision in her belly--deep enough
to wound the buttocks of her child, and extracted the child, placenta
and all. A negro horse-doctor was called, who sewed the wound up in a
manner similar to the way dead bodies are closed at the present time.

Barker gives the instance of a woman who, on being abused by her
husband after a previous tedious labor, resolved to free herself of the
child, and slyly made an incision five inches long on the left side of
the abdomen with a weaver's knife. When Barker arrived the patient was
literally drenched with blood and to all appearance dead. He extracted
a dead child from the abdomen and bandaged the mother, who lived only
forty hours. In his discourses on Tropical Diseases Moseley speaks of a
young negress in Jamaica who opened her uterus and extracted therefrom
a child which lived six days; the woman recovered. Barker relates
another case in Rensselaer County, N.Y., in which the incision was made
with the razor, the woman likewise recovering. There is an interesting
account of a poor woman at Prischtina, near the Servian frontier, who,
suffering greatly from the pains of labor, resolved to open her abdomen
and uterus. She summoned a neighbor to sew up the incision after she
had extracted the child, and at the time of report, several months
later, both the mother and child were doing well.

Madigan cites the case of a woman of thirty-four, in her seventh
confinement, who, while temporarily insane, laid open her abdomen with
a razor, incised the uterus, and brought out a male child.  The
abdominal wound was five inches long, and extended from one inch above
the umbilicus straight downward. There was little or no bleeding and
the uterus was firmly contracted. She did not see a physician for three
hours. The child was found dead and, with the placenta, was lying by
her side. The neighbors were so frightened by the awful sight that they
ran away, or possibly the child might have been saved by ligature of
the funis. Not until the arrival of the clergyman was anything done,
and death ultimately ensued.

A most wonderful case of endurance of pain and heroism was one
occurring in Italy, which attracted much European comment at the time.
A young woman, illegitimately pregnant, at full term, on March 28th, at
dawn, opened her own abdomen on the left side with a common knife such
as is generally used in kitchens. The wound measured five inches, and
was directed obliquely outward and downward. She opened the uterus in
the same direction, and endeavored to extract the fetus. To expedite
the extraction, she drew out an arm and amputated it, and finding the
extraction still difficult, she cut off the head and completely emptied
the womb, including the placenta. She bound a tight bandage around her
body and hid the fetus in a straw mattress. She then dressed herself
and attended to her domestic duties. She afterward mounted a cart and
went into the city of Viterbo, where she showed her sister a cloth
bathed in blood as menstrual proof that she was not pregnant. On
returning home, having walked five hours, she was seized with an attack
of vomiting and fainted. The parents called Drs. Serpieri and Baliva,
who relate the case.  Thirteen hours had elapsed from the infliction of
the wound, through which the bulk of the intestines had been protruding
for the past six hours. The abdomen was irrigated, the toilet made, and
after the eighteenth day the process of healing was well progressed,
and the woman made a recovery after her plucky efforts to hide her
shame.

Cases like the foregoing excite no more interest than those on record
in which an abdominal section has been accidental, as, for instance, by
cattle-horns, and the fetus born through the wound.  Zuboldie speaks of
a case in which a fetus was born from the wound made by a bull's horn
in the mother's abdomen. Deneux describes a case in which the wound
made by the horn was not sufficiently large to permit the child's
escape, but it was subsequently brought through the opening. Pigne
speaks of a woman of thirty-eight, who in the eighth month of her sixth
pregnancy was gored by a bull, the horn effecting a transverse wound 27
inches long, running from one anterior spine to the other. The woman
was found cold and insensible and with an imperceptible pulse. The
small intestines were lying between the thighs and covered with
coagulated blood. In the process of cleansing, a male child was
expelled spontaneously through a rent in the uterus. The woman was
treated with the usual precautions and was conscious at midday. In a
month she was up. She lived twenty years without any inconvenience
except that due to a slight hernia on the left side. The child died at
the end of a fortnight.

In a very exhaustive article Harris of Philadelphia has collected
nearly all the remaining cases on record, and brief extracts from some
of them will be given below. In Zaandam, Holland, 1647, a farmer's wife
was tossed by a furious bull. Her abdomen was ripped open, and the
child and membranes escaped. The child suffered no injuries except a
bruised upper lip and lived nine months. The mother died within forty
hours of her injuries.  Figure 19 taken from an engraving dated 1647,
represents an accouchement by a mad bull, possibly the same case. In
Dillenberg, Germany, in 1779, a multipara was gored by an ox at her
sixth month of pregnancy; the horn entered the right epigastric region,
three inches from the linea alba, and perforated the uterus. The right
arm of the fetus protruded; the wound was enlarged and the fetus and
placenta delivered. Thatcher speaks of a woman who was gored by a cow
in King's Park, and both mother and child were safely delivered and
survived.

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

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

Scott mentions the instance of a woman thirty-four years old who was
gored by an infuriated ox while in the ninth month of her eighth
pregnancy. The horn entered at the anterior superior spinous process of
the ilium, involving the parietes and the uterus. The child was
extruded through the wound about half an hour after the occurrence of
the accident. The cord was cut and the child survived and thrived,
though the mother soon died.  Stalpart tells the almost incredible
story of a soldier's wife who went to obtain water from a stream and
was cut in two by a cannonball while stooping over. A passing soldier
observed something to move in the water, which, on investigation, he
found to be a living child in its membranes. It was christened by order
of one Cordua and lived for some time after.

Postmortem Cesarean Section.--The possibility of delivering a child by
Cesarean section after the death of the mother has been known for a
long time to the students of medicine. In the olden times there were
laws making compulsory the opening of the dead bodies of pregnant women
shortly after death. Numa Pompilius established the first law, which
was called "les regia," and in later times there were many such
ordinances. A full description of these laws is on record. Life was
believed possible after a gestation of six months or over, and, as
stated, some famous men were supposed to have been born in this manner.
Francois de Civile, who on great occasions signed himself "trois fois
enterre et trois fois par le grace de Dieu ressucite," saw the light of
the world by a happy Cesarean operation on his exhumed mother.
Fabricius Hildanus and Boarton report similar instances. Bourton cites
among others the case of an infant who was found living twelve hours
after the death of his mother. Dufour and Mauriceau are two older
French medical writers who discuss this subject.  Flajani speaks of a
case in which a child was delivered at the death of its mother, and
some of the older Italian writers discuss the advisability of the
operation in the moribund state before death actually ensues. Heister
writes of the delivery of the child after the death of the mother by
opening the abdomen and uterus.

Harris relates several interesting examples. In Peru in 1794 a Sambi
woman was killed by lightning, and the next day the abdomen was opened
by official command and a living child was extracted.  The Princess von
Swartzenberg, who was burned to death at a ball in Paris in 1810, was
said to have had a living child removed from her body the next day.
Like all similar instances, this was proved to be false, as her body
was burned beyond the possibility of recognition, and, besides, she was
only four months pregnant.  Harris mentions another case of a young
woman who threw herself from the Pont Neuf into the Seine. Her body was
recovered, and a surgeon who was present seized a knife from a butcher
standing by and extracted a living child in the presence of the curious
spectators. Campbell discusses this subject most thoroughly, though he
advances no new opinions upon it.

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

  Children extracted
  between 1 and 5 minutes after death of the mother, 21
  "   "   10 and 15   "    "    "   "    "    "      13
  "   "   15 and 30   "    "    "   "    "    "       2
  "   "   1 hour      "    "    "   "    "    "       2
  "   "   2 hours     "    "    "   "    "    "       2

Garezky of St. Petersburg collected reports of 379 cases of Cesarean
section after death with the following results: 308 were extracted
dead; 37 showed signs of life; 34 were born alive. Of the 34, only 5
lived for any length of time. He concludes that if extracted within
five or six minutes after death, they may be born alive; if from six to
ten minutes, they may still be born alive, though asphyxiated; if from
ten to twenty-six minutes, they will be highly asphyxiated. In a great
number of these cases the infant was asphyxiated or dead in one minute.
Of course, if the death is sudden, as by apoplexy, accident, or
suicide, the child's chances are better. These statistics seem
conscientious and reliable, and we are safe in taking them as
indicative of the usual result, which discountenances the old reports
of death as taking place some time before extraction.

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

During the Commune of Paris, Tarnier, one night at the Maternite, was
called to an inmate who, while lying in bed near the end of pregnancy,
had been killed by a ball which fractured the base of the skull and
entered the brain. He removed the child by Cesarean section and it
lived for several days. In another case a pregnant woman fell from a
window for a distance of more than 30 feet, instant death resulting;
thirty minutes at least after the death of the mother an infant was
removed, which, after some difficulty, was resuscitated and lived for
thirteen years.  Tarnier states that delivery may take place
three-quarters of an hour or even an hour after the death of the
mother, and he also quotes an extraordinary case by Hubert of a
successful Cesarean operation two hours after the mother's death; the
woman, who was eight months pregnant, was instantly killed while
crossing a railroad track.


Hoffman records the case of a successful Cesarean section done ten
minutes after death. The patient was a woman of thirty-six, in her
eighth month of pregnancy, who was suddenly seized with eclampsia,
which terminated fatally in ten hours. Ten minutes after her last
respiration the Cesarean section was performed and a living male child
delivered. This infant was nourished with the aid of a spoon, but it
died in twenty-five hours in consequence of its premature birth and
enfeebled vitality.

Green speaks of a woman, nine months pregnant, who was run over by a
heavily laden stage-coach in the streets of Southwark. She died in
about twenty minutes, and in about twenty minutes more a living child
was extracted from her by Cesarean section. There was a similar case in
the Hopital St. Louis, in Paris, in 1829; but in this case the child
was born alive five minutes after death. Squire tells of a case in
which the mother died of dilatation of the aorta, and in from twenty to
thirty minutes the child was saved. In comment on this case Aveling is
quoted as saying that he believed it possible to save a child one hour
after the death of the mother. No less an authority than Playfair
speaks of a case in which a child was born half an hour after the death
of the mother. Beckman relates the history of a woman who died suddenly
in convulsions. The incision was made about five minutes after death,
and a male child about four pounds in weight was extracted. The child
exhibited feeble heart-contractions and was despaired of. Happily,
after numerous and persistent means of resuscitation, applied for about
two and a half hours, regular respirations were established and the
child eventually recovered.  Walter reports a successful instance of
removal of the child after the death of the mother from apoplexy.

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

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

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

Rupture of the uterus and recovery does not necessarily prevent
subsequent successful pregnancy and delivery by the natural channels.
Whinery relates an instance of a ruptured uterus in a healthy Irish
woman of thirty-seven from whom a dead child was extracted by abdominal
section and who was safely delivered of a healthy female child about
one year afterward. Analogous to this case is that of Lawrence, who
details the instance of a woman who had been delivered five times of
dead children; she had a very narrow pelvis and labor was always
induced at the eighth month to assure delivery. In her sixth pregnancy
she had miscalculated her time, and, in consequence, her uterus
ruptured in an unexpected parturition, but she recovered and had
several subsequent pregnancies.

Occasionally there is a spontaneous rupture of the vagina during the
process of parturition, the uterus remaining intact.  Wiltshire reports
such a case in a woman who had a most prominent sacrum; the laceration
was transverse and quite extensive, but the woman made a good recovery.
Schauta pictures an exostosis on the promontory of the sacrum.
Blenkinsop cites an instance in which the labor was neither protracted
nor abnormally severe, yet the rupture of the vagina took place with
the escape of the child into the abdomen of the mother, and was from
thence extracted by Cesarean section. A peculiarity of this case was
the easy expulsion from the uterus, no instrumental or other manual
interference being attempted and the uterus remaining perfectly intact.

In some cases there is extensive sloughing of the genitals after
parturition with recovery far beyond expectation. Gooch mentions a case
in which the whole vagina sloughed, yet to his surprise the patient
recovered. Aetius and Benivenius speak of recovery in such cases after
loss of the whole uterus. Cazenave of Bordeaux relates a most marvelous
case in which a primipara suffered in labor from an impacted head. She
was twenty-five, of very diminutive stature, and was in labor a long
time. After labor, sloughing of the parts commenced and progressed to
such an extent that in one month there were no traces of the labia,
nymphae, vagina, perineum, or anus. There was simply a large opening
extending from the meatus urinarius to the coccyx. The rectovaginal
septum, the lower portion of the rectum, and the neck of the bladder
were obliterated. The woman survived, although she always experienced
great difficulty in urination and in entirely emptying the rectum. A
similar instance is reported in a woman of thirty who was thirty-six
hours in labor. The fundus of the uterus descended into the vagina and
the whole uterine apparatus was removed. The lower part of the rectum
depended between the labia; in the presence of the physician the nurse
drew this out and it separated at the sphincter ani. On examining the
parts a single opening was seen, as in the preceding case, from the
pubes to the coccyx. Some time afterward the end of the intestine
descended several inches and hung loosely on the concave surface of the
rectum. A sponge was introduced to support the rectum and prevent
access of air. The destruction of the parts was so complete and the
opening so large as to bring into view the whole inner surface of the
pelvis, in spite of which, after prolonged suppuration, the wound
cicatrized from behind forward and health returned, except as regards
the inconvenience of feces and urine. Milk-secretion appeared late and
lasted two months without influencing the other functions.

There are cases in which, through the ignorance of the midwife or the
physician, prolapsed pelvic organs are mistaken for afterbirth and
extracted. There have been instances in which the whole uterus and its
appendages, not being recognized, have been dragged out. Walters cites
the instance of a woman of twenty-two, who was in her third
confinement. The midwife in attendance, finding the afterbirth did not
come away, pulled at the funis, which broke at its attachment. She then
introduced her hand and tore away what proved to be the whole of the
uterus, with the right ovary and fallopian tube, a portion of the round
ligament, and the left tube and ovarian ligament attached to it. A
large quantity of omentum protruded from the vulva and upper part of
the vagina, and an enormous rent was left. Walters saw the woman
twenty-one hours afterward, and ligated and severed the protruding
omentum. On the twenty-eighth day, after a marvelous recovery, she was
able to drive to the Royal Berkshire Hospital, a distance of five
miles. At the time of report, two years and six months after the
mutilation, she was in perfect health.  Walters looked into the
statistics of such cases and found 36 accidental removals of the uterus
in the puerperium with 14 recoveries. All but three of these were
without a doubt attended by previous inversion of the uterus.

A medical man was tried for manslaughter in 1878 because he made a
similar mistake. He had delivered a woman by means of the forceps, and,
after delivery, brought away what he thought a tumor. This "tumor"
consisted of the uterus, with the placenta attached to the fundus, the
funis, a portion of the lateral ligament, containing one ovary and
about three inches of vagina.  The uterus was not inverted. A horrible
case, with similar results, happened in France, and was reported by
Tardieu. A brutal peasant, whose wife was pregnant, dragged out a fetus
of seven months, together with the uterus and the whole intestinal
canal, from within 50 cm. of the pylorus to within 8 cm. of the
ileocecal valve. The woman was seen three-quarters of an hour after the
intestines had been found in the yard (where the brute had thrown
them), still alive and reproaching her murderer.  Hoffman cites an
instance in which a midwife, in her anxiety to extract the afterbirth,
made traction on the cord, brought out the uterus, ovaries, and tubes,
and tore the vulva and perineum as far as the anus.

Woodson tells the story of a negress who was four months pregnant, and
who, on being seized with severe uterine pains in a bath, succeeded in
seizing the fetus and dragging it out, but inverting the uterus in the
operation. There is a case recorded of a girl of eighteen, near her
labor, who, being driven from her house by her father, took refuge in a
neighboring house, and soon felt the pains of child-birth. The
accoucheur was summoned, pronounced them false pains, and went away. On
his return he found the girl dying, with her uterus completely inverted
and hanging between her legs. This unfortunate maiden had been
delivered while standing upright, with her elbows on the back of a
chair. The child suddenly escaped, bringing with it the uterus, but as
the funis ruptured the child fell to the floor. Wagner pictures partial
prolapse of the womb in labor.

It would too much extend this chapter to include the many accidents
incident to labor, and only a few of especial interest will be given.
Cases like rupture of an aneurysm during labor, extensive hemorrhage,
the entrance of air into the uterine veins and sinuses, and common
lacerations will be omitted, together with complicated births like
those of double monsters, etc., but there are several other cases that
deserve mention. Eldridge gives an instance of separation of the
symphysis pubis during labor,--a natural symphysiotomy. A separation of
3/4 inch could be discerned at the symphysis, and in addition the
sacroiliac synchondrosis was also quite movable. The woman had not been
able to walk in the latter part of her pregnancy. The child weighed 10
1/2 pounds and had a large head in a remarkably advanced stage of
ossification, with the fontanelles nearly closed. Delivery was
effected, though during the passage of the head the pubes separated to
such an extent that Eldridge placed two fingers between them. The
mother recovered, and had perfect union and normal locomotion.

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

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

Symphysiotomy is an operation consisting of division of the pubic
symphysis in order to facilitate delivery in narrow pelves. This
operation has undergone a most remarkable revival during the past two
years. It originated in a suggestion by Pineau in his work on surgery
in 1598, and in 1665 was first performed by La Courvee upon a dead body
in order to save the child, and afterward by Plenk, in 1766, for the
same purpose. In 1777 Sigault first proposed the operation on the
living, and Ferrara was the one to carry out, practically, the
proposition,--although Sigault is generally considered to be the first
symphysiotormist, and the procedure is very generally known as the
"Sigaultean operation." From Ferrara's time to 1858, when the operation
had practically died out, it had been performed 85 times, with a
recorded mortality of 33 per cent. In 1866 the Italians, under the
leadership of Morisani of Naples, revived the operation, and in twenty
years had performed it 70 times with a mortality of 24 per cent. Owing
to rigid antiseptic technic, the last 38 of these operations (1886 to
1891) showed a mortality of only 50 per cent, while the
infant-mortality was only 10 2/3 per cent. The modern history of this
operation is quite interesting, and is very completely reviewed by
Hirst and Dorland.

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

Irwin reports a case in which the firm attachment of the fetal head to
the uterine parietes rendered delivery without artificial aid
impossible, and it was necessary to perform craniotomy. The right
temporal region of the child adhered to the internal surface of the
neck of the uterus, being connected by membranes.  The woman was
forty-four years old, and the child was her fourth.

Delay in the Birth of the Second Twin.--In twin pregnancies there is
sometimes a delay of many days in the birth of a second child, even to
such an extent as to give suspicion of superfetation.  Pignot speaks of
one twin two months before the other. De Bosch speaks of a delay of
seventeen days; and there were 2 cases on record in France in the last
century, one of which was delayed ten days, and the other showed an
interval of seven weeks between the delivery of the twins. There is an
old case on record in which there was an interval of six weeks between
deliveries; Jansen gives an account of three births in ten months;
Pinart mentions a case with an interval of ten days; Thilenius, one of
thirteen days; and Ephemerides, one of one week. Wildberg describes a
case in which one twin was born two months after the other, and there
was no secretion of milk until after the second birth. A full
description of Wildberg's case is given in another journal in brief, as
follows: A woman, eighteen months married, was in labor in the eighth
month of pregnancy. She gave birth to a child, which, though not fully
matured, lived. There was no milk-secretion in her breasts, and she
could distinctly feel the movements of another child; her abdomen
increased in size. After two months she had another labor, and a fully
developed and strong child was born, much heavier than the first. On
the third day after, the breasts became enlarged, and she experienced
considerable fever. It was noticeable in this case that a placenta was
discharged a quarter of an hour after the first birth. Irvine relates
an instance of thirty-two days' delay; and Pfau one of seven days'.

Carson cites the instance of a noblewoman of forty, the mother of four
children, who was taken ill about two weeks before confinement was
expected, and was easily delivered of a male child, which seemed well
formed, with perfect nails, but weakly.  After the birth the mother
never became healthy or natural in appearance. She was supposed to be
dying of dropsy, but after forty-four days the mystery was cleared by
the birth of a fine, well-grown, and healthy daughter. Both mother and
child did well.

Addison describes the case of a woman who was delivered of a healthy
male child, and everything was well until the evening of the fourth
day, when intense labor-pains set in, and well-formed twins about the
size of a pigeon's egg were born. In this strange case, possibly an
example of superfetation, the patient made a good recovery and the
first child lived. A similar case is reported by Lumby in which a woman
was delivered on January 18th, by a midwife, of a full-grown and
healthy female child. On the third day she came down-stairs and resumed
her ordinary duties, which she continued until February 4th (seventeen
days after). At this time she was delivered of twins, a boy and a girl,
healthy and well-developed. The placenta was of the consistency of
jelly and had to be scooped away with the hand. The mother and children
did well. This woman was the mother of ten children besides the product
of this conception, and at the latter occurrence had entire absence of
pains and a very easy parturition.

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



CHAPTER IV.

PROLIFICITY.

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

General Law, and the Influence of War.--In the increase of the world's
population, although circumstances may for the time alter it, a general
average of prolificity has, in the long run, been maintained. In the
history of every nation artificial circumstances, such as fashion, war,
poverty, etc., at some period have temporarily lowered the average of
prolificity; but a further search finds another period, under opposite
circumstances, which will more than compensate for it. The effect of a
long-continued war or wars on generation and prolificity has never been
given proper consideration. In such times marriages become much less
frequent; the husbands are separated from their wives for long periods;
many women are left widows; the females become in excess of the males;
the excitement of the times overtops the desire for sexual intercourse,
or, if there is the same desire, the unprolific prostitute furnishes
the satisfaction; and such facts as these, coupled with many similar
ones, soon produce an astonishing effect upon the comparative
birth-rate and death-rate of the country. The resources of a country,
so far as concerns population, become less as the period of
peace-disturbance is prolonged. Mayo-Smith quotes von Mayr in the
following example of the influence of the war of 1870-71 on the
birth-rate in Bavaria,--the figures for births are thrown back nine
months, so as to show the time of conception: Before the war under
normal conception the number of births was about 16,000 per month.
During the war it sank to about 2000 per month.  Immediately on the
cessation of hostilities it arose to its former number, while the
actual return of the troops brought an increase of 2000 per month. The
maximum was reached in March, 1872, when it was 18,450. The war of 1866
seems to have passed over Germany without any great influence, the
birth-rate in 1865 being 39.2; in 1866, 39.4; in 1867, 38.3; in 1868,
38.4. On the other hand, while the birth-rate in 1870 was 40.1, in 1871
it was only 35.9; in 1872 it recovered to 41.1, and remained above 41
down to 1878. Von Mayr believes the war had a depressing influence upon
the rate apart from the mere absence of the men, as shown in the fact
that immediately upon the cessation of hostilities it recovered in
Bavaria, although it was several months before the return of the troops.

Mayo-Smith, in remarking on the influence of war on the marriage-rate,
says that in 1866 the Prussian rate fell from 18.2 to 15.6, while the
Austrian rate fell from 15.5 to 13.0. In the war of 1870-71 the
Prussian rate fell from 17.9 in 1869 to 14.9 in 1870 and 15.9 in 1871;
but in the two years after peace was made it rose to 20.6 and 20.2, the
highest rates ever recorded.  In France the rate fell from 16.5 to 12.1
and 14.4, and then rose to 19.5 and 17.7, the highest rates ever
recorded in France.

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

The effect of climate and race on prolificity, though much spoken of,
is not so great a factor as supposed. The inhabitants of Great Britain
are surpassed by none in the point of prolificity; yet their location
is quite northern. The Swedes have always been noted for their
fecundity. Olaf Rudbeck says that from 8 to 12 was the usual family
number, and some ran as high as 25 or 30.  According to Lord Kames, in
Iceland before the plague (about 1710) families of from 15 to 20 were
quite common. The old settlers in cold North America were always
blessed with large families, and Quebec is still noted for its
prolificity. There is little difference in this respect among nations,
woman being limited about the same everywhere, and the general average
of the range of the productive function remaining nearly identical in
all nations. Of course, exception must be made as to the extremes of
north or south.

Ancient and Modern Prolificity.--Nor is there much difference between
ancient and modern times. We read in the writings of Aristotle, Pliny,
and Albucasis of the wonderful fertility of the women of Egypt, Arabia,
and other warm countries, from 3 to 6 children often being born at once
and living to maturity; but from the wonder and surprise shown in the
narration of these facts, they were doubtless exceptions, of which
parallels may be found in the present day. The ancient Greek and Roman
families were no larger than those of to-day, and were smaller in the
zenith of Roman affluence, and continued small until the period of
decadence.

Legal Encouragement of Prolificity.--In Quebec Province, Canada,
according to a Montreal authority, 100 acres of land are allotted to
the father who has a dozen children by legitimate marriage.  The same
journal states that, stimulated by the premium offered, families of 20
or more are not rare, the results of patriotic efforts. In 1895, 1742
"chefs de famille" made their claim according to the conditions of the
law, and one, Paul Bellanger, of the River du Loup, claimed 300 acres
as his premium, based on the fact that he was the father of 36
children. Another claimant, Monsieur Thioret de Sainte Genevieve, had
been presented by his wife, a woman not yet thirty years old, with 17
children. She had triplets twice in the space of five years and twins
thrice in the mean time. It is a matter of conjecture what the effect
would be of such a premium in countries with a lowering birth-rate, and
a French medical journal, quoting the foregoing, regretfully wishes for
some countrymen at home like their brothers in Quebec.

Old Explanations of Prolificity.--The old explanation of the causation
of the remarkable exceptions to the rules of prolificity was similar to
that advanced by Empedocles, who says that the greater the quantity of
semen, the greater the number of children at birth. Pare, later, uses a
similar reason to explain the causation of monstrosities, grouping them
into two classes, those due to deficiency of semen, such as the
acephalous type, and those due to excess, such as the double monsters.
Hippocrates, in his work on the "Nature of the Infant," tells us that
twins are the result of a single coitus, and we are also informed that
each infant has a chorion; so that both kinds of plural gestation
(monochorionic and dichorionic) were known to the ancients. In this
treatise it is further stated that the twins may be male or female, or
both males or both females; the male is formed when the semen is thick
and strong.

The greatest number of children at a single birth that it is possible
for a woman to have has never been definitely determined. Aristotle
gives it as his opinion that one woman can bring forth no more than 5
children at a single birth, and discredits reports of multiplicity
above this number; while Pliny, who is not held to be so trustworthy,
positively states that there were authentic records of as many as 12 at
a birth.  Throughout the ages in which superstitious distortion of
facts and unquestioning credulity was unchecked, all sorts of
incredible accounts of prolificity are found. Martin Cromerus, a Polish
historian, quoted by Pare, who has done some good work in statistical
research on this subject, says a that Margaret, of a noble and ancient
family near Cracovia, the wife of Count Virboslaus, brought forth 36
living children on January 20, 1296.

The celebrated case of Countess Margaret, daughter of Florent IV, Earl
of Holland, and spouse of Count Hermann of Henneberg, was supposed to
have occurred just before this, on Good Friday, 1278.  She was at this
time forty-two years of age, and at one birth brought forth 365
infants, 182 males, 182 females, and 1 hermaphrodite. They were all
baptized in two large brazen dishes by the Bishop of Treras, the males
being called John, the females Elizabeth. During the last century the
basins were still on exhibition in the village church of Losdun, and
most of the visitors to Hague went out to see them, as they were
reckoned one of the curiosities of Holland. The affliction was ascribed
to the curse of a poor woman who, holding twins in her arms, approached
the Countess for aid. She was not only denied alms, but was insulted by
being told that her twins were by different fathers, whereupon the poor
woman prayed God to send the Countess as many children as there were
days in the year. There is room for much speculation as to what this
case really was. There is a possibility that it was simply a case of
hydatidiform or multiple molar pregnancy, elaborated by an exhaustive
imagination and superstitious awe. As late as 1799 there was a woman of
a town of Andalusia who was reported to have been delivered of 16 male
infants, 7 of which were alive two months later.

Mayo-Smith remarks that the proportion of multiple births is not more
than 1 per cent of the total number of parturitions. The latest
statistics, by Westergaard, give the following averages to number of
cases of 100 births in which there were 2 or more at a birth:--

  Sweden,      1.45
  Germany,     1.24
  Bavaria,     1.38
  Denmark,     1.34
  Holland,     1.30
  Prussia,     1.26
  Scotland,    1.22
  Norway,      1.32
  Saxony,      1.20
  Italy,       1.21
  Austria,     1.17
  Switzerland, 1.16
  France,      0.99
  Belgium,     0.97
  Spain,       0.85


In Prussia, from 1826 to 1880, there were 85 cases of quadruplets and 3
cases of 5 at a birth.

The most extensive statistics in regard to multiple births are those of
Veit, who reviews 13,000,000 births in Prussia.  According to his
deductions, twins occur once in 88 births; triplets, once in 7910; and
quadruplets, once in 371,126. Recent statistics supplied by the Boards
of Health of New York and Philadelphia place the frequency of twin
births in these cities at 1 in every 120 births, while in Bohemia twins
occur once in about 60 births, a proportion just twice as great. Of
150,000 twin pregnancies studied by Veit, in one-third both children
were boys; in slightly less than one-third both were girls; in the
remaining third both sexes were represented.

Authentic records of 5 and 6 at a birth are extremely rare and
infinitesimal in proportion. The reputed births in excess of 6 must be
looked on with suspicion, and, in fact, in the great majority of
reports are apochryphal.

The examples of multiple births of a single pregnancy will be taken up
under their respective numbers, several examples of each being given,
together with the authorities. Many twin and triplet brothers have
figured prominently in history, and, in fact, they seem especially
favored. The instance of the Horatii and the Curatii, and their famous
battle, on which hung the fate of Rome and Alba, is familiar to every
one, their strength and wisdom being legendary with the Romans.

Twins and triplets, being quite common, will not be considered here,
although there are 2 cases of interest of the latter that deserve
citation. Sperling reports 2 instances of triplets; in the first there
was 1 placenta and chorion, 2 amnions, and the sex was the same; in the
second case, in which the sexes were different, there were 3 placentas,
3 chorions, and 3 amnions.  What significance this may have is only a
matter of conjecture.  Petty describes a case of triplets in which one
child was born alive, the other 2 having lost their vitality three
months before. Mirabeau has recently found that triple births are most
common (1 to 6500) in multiparous women between thirty and thirty-four
years of age. Heredity seems to be a factor, and duplex uteruses
predispose to multiple births. Ross reports an instance of double
uterus with triple pregnancy.

Quadruplets are supposed to occur once in about every 400,000 births.
There are 72 instances recorded in the Index Catalogue of the Surgeon
General's Library, U. S. A., up to the time of compilation, not
including the subsequent cases in the Index Medicus. At the Hotel-Dieu,
in Paris, in 108,000 births, covering a period of sixty years, mostly
in the last century, there was only one case of quadruplets. The
following extract of an account of the birth of quadruplets is given by
Dr. De Leon of Ingersoll, Texas:--

"I was called to see Mrs. E. T. Page, January 10, 1890, about 4 o'clock
A.M.; found her in labor and at full time, although she assured me that
her 'time' was six weeks ahead. At 8 o'clock A.M.  I delivered her of a
girl baby; I found there were triplets, and so informed her. At 11 A.M.
I delivered her of the second girl, after having rectified
presentation, which was singular, face, hands, and feet all presented;
I placed in proper position and practised 'version.' This child was
'still-born,' and after considerable effort by artificial respiration
it breathed and came around 'all right.' The third girl was born at
11.40 A.M.  This was the smallest one of the four. In attempting to
take away the placenta, to my astonishment I found the feet of another
child. At 1 P.M. this one was born; the head of this child got firmly
impacted at the lower strait, and it was with a great deal of
difficulty and much patient effort that it was finally disengaged; it
was blocked by a mass of placenta and cords. The first child had its
own placenta; the second and third had their placenta; the fourth had
also a placenta. They weighed at birth in the aggregate 19 1/2 pounds
without clothing; the first weighed 6 pounds; the second 5 pounds; the
third 4 1/2 pounds; the fourth 4 pounds. Mrs. Page is a blonde, about
thirty-six years old, and has given birth to 14 children, twins three
times before this, one pair by her first husband. She has been married
to Page three years, and has had 8 children in that time. I have waited
on her each time. Page is an Englishman, small, with dark hair, age
about twenty-six, and weighs about 115 pounds. They are in St. Joseph,
Mo., now, having contracted with Mr. Uffner of New York to travel and
exhibit themselves in Denver, St. Joseph, Omaha, and Nebraska City,
then on to Boston, Mass., where they will spend the summer."

There is a report from Canada of the birth of 4 living children at one
time. The mother, a woman of thirty-eight, of small stature, weighing
100 pounds, had 4 living children of the ages of twelve, ten, eight,
and seven years, respectively. She had aborted at the second month, and
at full term was delivered of 2 males, weighing, respectively, 4 pounds
9 1/4 ounces and 4 pounds 3 ounces; and of 2 females, weighing 4 pounds
3 ounces and 3 pounds 13 3/4 ounces, respectively. There was but one
placenta, and no more exhaustion or hemorrhage than at a single birth.
The father weighed 169 pounds, was forty-one years old, and was 5 feet
5 inches tall, healthy and robust. The Journal of St.  Petersburg, a
newspaper of the highest standard, stated that at the end of July,
1871, a Jewish woman residing in Courland gave birth to 4 girls, and
again, in May, 1872, bore 2 boys and a girl; the mother and the 7
children, born within a period of ten months, were doing well at the
time of the report. In the village of Iwokina, on May 26, 1854, the
wife of a peasant bore 4 children at a birth, all surviving. Bousquet
speaks of a primiparous mother, aged twenty-four, giving birth to 4
living infants, 3 by the breech and 1 by the vertex, apparently all in
one bag of membranes. They were nourished by the help of 3 wet-nurses.
Bedford speaks of 4 children at a birth, averaging 5 pounds each, and
all nursing the mother.

Quintuplets are quite rare, and the Index Catalogue of the Surgeon
General's Library, U. S. A., gives only 19 cases, reports of a few of
which will be given here, together with others not given in the
Catalogue, and from less scientific though reliable sources. In the
year 1731 there was one case of quintuplets in Upper Saxony and another
near Prague, Bohemia. In both of these cases the children were all
christened and had all lived to maturity. Garthshore speaks of a
healthy woman, Margaret Waddington, giving birth to 5 girls, 2 of which
lived; the 2 that lived weighed at birth 8 pounds 12 ounces and 9
pounds, respectively. He discusses the idea that woman was meant to
bear more than one child at a birth, using as his argument the
existence of the double nipple and mamma, to which might be added the
not infrequent occurrence of polymazia.

In March, 1736, in a dairy cellar in the Strand, London, a poor woman
gave birth to 3 boys and 9 girls. In the same journal was reported the
birth at Wells, Somersetshire, in 1739, of 4 boys and a girl, all of
whom were christened and were healthy. Pare in 1549 gives several
instances of 5 children at a birth, and Pliny reports that in the
peninsula of Greece there was a woman who gave birth to quintuplets on
four different occasions. Petritus, a Greek physician, speaks of the
birth of quintuplets at the seventh month. Two males and one female
were born dead, being attached to the same placenta; the others were
united to a common placenta and lived three days. Chambon mentions an
instance of 5 at a birth. Not far from Berne, Switzerland, the wife of
John Gelinger, a preacher in the Lordship of Berne, brought forth
twins, and within a year after she brought forth quintuplets, 3 sons
and 2 daughters. There is a similar instance reported in 1827 of a
woman of twenty-seven who, having been delivered of twins two years
before, was brought to bed with 5 children, 3 boys and 2 girls. Their
length was from 15 1/2 to 16 1/2 inches.  Although regularly formed,
they did not seem to have reached maturity. The mother was much
exhausted, but recovered. The children appeared old-looking, had
tremulous voices, and slept continually; during sleep their
temperatures seemed very low.

Kennedy showed before the Dublin Pathological Society 5 fetuses with
the involucra, the product of an abortion at the third month. At Naples
in 1839 Giuseppa Califani gave birth to 5 children; and about the same
time Paddock reported the birth in Franklin County, Pa., of
quintuplets. The Lancet relates an account of the birth of quintuplets,
2 boys and 3 girls, by the wife of a peasant on March 1, 1854. Moffitt
records the birth at Monticello, Ill., of quintuplets. The woman was
thirty-five years of age; examination showed a breech presentation; the
second child was born by a foot-presentation, as was the third, but the
last was by a head-presentation. The combined weight was something over
19 pounds, and of the 5, 3 were still-born, and the other 2 died soon
after birth. The Elgin Courant (Scotland), 1858, speaks of a woman
named Elspet Gordon, at Rothes, giving birth to 3 males and 2 females.
Although they were six months' births, the boys all lived until the
following morning. The girls were still-born. One of the boys had two
front teeth when born.  Dr. Dawson of Rothes is the obstetrician
mentioned in this case.

The following recent instance is given with full details to illustrate
the difficulties attending the births of quintuplets.  Stoker has
reported the case of a healthy woman, thirty-five years old, 5 feet 1
inch high, and of slight build, whom he delivered of 5 fetuses in the
seventh month of pregnancy, none of the children surviving. The
patient's mother had on two occasions given birth to twins. The woman
herself had been married for six years and had borne 4 children at full
term, having no difficulty in labor. When she came under observation
she computed that she had been pregnant for six months, and had had her
attention attracted to the unusually large size of her abdomen. She
complained of fixed pain in the left side of the abdomen on which side
she thought she was larger. Pains set in with regularity and the labor
lasted eight and three-quarter hours. After the rupture of the
membranes the first child presented by the shoulder.  Version was
readily performed; the child was dead (recently).  Examination after
the birth of the first child disclosed the existence of more than one
remaining fetus. The membranes protruded and became tense with each
contraction. The presentation was a transverse one. In this case also
there was little difficulty in effecting internal version. The child
lived a couple of hours. The third fetus was also enclosed in a
separate sac, which had to be ruptured. The child presented by the
breech and was delivered naturally, and lived for an hour. In the
fourth case the membranes had likewise to be ruptured, and alarming
hemorrhage ensued. Version was at once practised, but the chin became
locked with that of the remaining fetus. There was some difficulty and
considerable delay in freeing the children, though the extent of
locking was not at any time formidable. The child was dead (recently).
The fifth fetus presented by the head and was delivered naturally. It
lived for half an hour. The placenta was delivered about five minutes
after the birth of the last child, and consisted of two portions united
by a narrow isthmus. One, the smaller, had two cords attached centrally
and close together; the other, and larger, had two cords attached in a
similar way and one where it was joined to the isthmus. The organ
appeared to be perfectly healthy. The cord of the fourth child was so
short that it had to be ligated in the vagina. The children were all
females and of about the same size, making a total weight of 8 pounds.
The mother rallied quickly and got on well.

Trustworthy records of sextuplets are, of course, extremely scarce.
There are few catalogued at Washington, and but two authentic cases are
on record in the United States. On December 30, 1831, a woman in Dropin
was delivered of 6 daughters, all living, and only a little smaller
than usual in size. The mother was not quite twenty years old, but was
of strong constitution.  The 6 lived long enough to be baptized, but
died the evening of their births. There was a case a of sextuplets in
Italy in 1844.  In Maine, June 27, 1847, a woman was delivered of 6
children, 2 surviving and, together with the mother, doing well. In
1885 there was reported the birth of sextuplets in Lorca, Spain, of
which only one survived. At Dallas, Texas, in 1888, Mrs. George Hirsh
of Navarro County gave birth to 6 children, the mother and the children
all doing well. There were 4 boys and 2 girls, and they were all
perfect, well formed, but rather small.

Valsalli gives an instance which is quoted by the Medical News without
giving the authority. Valsalli's account, which differs slightly from
the account in the Medical News, is briefly as follows: While straining
at stool on the one hundred and fifteenth day of pregnancy the
membranes ruptured and a foot prolapsed, no pain having been felt
before the accident. A fetus was delivered by the midwife. Valsalli was
summoned and found the woman with an enormously distended abdomen,
within which were felt numerous fetal parts; but no fetal heart-sounds
or movements were noticed. The cervix was only slightly dilated, and,
as no pains were felt, it was agreed to wait. On the next day the
membranes were ruptured and 4 more fetuses were delivered.  Traction on
the umbilical cord started hemorrhage, to check which the physician
placed his hand in the uterine cavity. In this most arduous position he
remained four hours until assistance from Lugano came. Then, in the
presence of the three visiting physicians, a sixth amniotic sac was
delivered with its fetus.  The woman had a normal convalescence, and in
the following year gave birth to healthy, living twins. The News says
the children all moved vigorously at birth; there were 4 males and 2
females, and for the 6 there was only one placenta The mother,
according to the same authority, was thirty-six years of age, and was
in her second pregnancy.

Multiple Births over Six.--When we pass sextuplets the records of
multiple births are of the greatest rarity and in modern records there
are almost none. There are several cases mentioned by the older writers
whose statements are generally worthy of credence, which, however
incredible, are of sufficient interest at least to find a place in this
chapter. Albucasis affirms that he knew of the birth of seven children
at one time; and d'Alechampius reports that Bonaventura, the slave of
one Savelli, a gentleman of Siena, gave birth to 7 children, 4 of whom
were baptized. At the Parish of San Ildefonso, Valladolid, Julianna,
wife of Benito Quesada, gave birth to 3 children in one day, and during
the following night to 4 more. Sigebert, in his Chronicles, says that
the mother of the King of Lombardy had borne 7 children at a birth.
Borellus says that in 1650 the lady of the then present Lord Darre gave
birth to eight perfect children at one parturition and that it was the
unusual event of the country.

Mrs. Timothy Bradlee of Trumbull County, Ohio, in 1872 is reported to
have given birth to 8 children at one time. They were healthy and
living, but quite small. The mother was married six years previously
and then weighed 273 pounds. She had given birth to 2 pairs of twins,
and, with these 3 boys and 5 girls, she had borne 12 children in six
years. She herself was a triplet and her father and her mother were of
twin births and one of her grandmothers was the mother of 5 pairs of
twins. This case was most celebrated and was much quoted, several
British journals extracting it.

Watering of Maregnac speaks of the simultaneous birth of 8 children at
one time. When several months pregnant the woman was seized with
colicky pains and thought them a call of nature. She went into a
vineyard to answer it, and there, to her great astonishment, gave birth
to 8 fetuses. Watering found them enclosed in a sac, and thought they
probably had died from mutual pressure during growth. The mother made a
good recovery.

In 1755 Seignette of Dijon reports the simultaneous birth of nine
children. Franciscus Picus Mirandulae, quoted by Pare, says that one
Dorothea, an Italian, bore 20 children at 2 confinements, the first
time bearing 9 and the second time eleven. He gives a picture of this
marvel of prolificity, in which her belly is represented as hanging
down to her knees, and supported by a girdle from the neck. In the
Annals, History, and Guide to Leeds and York, according to Walford,
there is mention of Ann Birch, who in 1781 was delivered of 10
children. One daughter, the sole survivor of the 10, married a market
gardener named Platt, who was well known in Leeds. Jonston quotes
Baytraff as saying that he knew of a case in which 9 children were born
simultaneously; and also says that the Countess of Altdorf gave birth
to twelve at one birth. Albucasis mentions a case of fifteen
well-formed children at a birth. According to Le Brun, Gilles de
Trazegines, who accompanied Saint Louis to Palestine, and who was made
Constable of France, was one of thirteen infants at a simultaneous
accouchement. The Marquise, his mother, was impregnated by her husband
before his departure, and during his absence had 13 living children.
She was suspected by the native people and thought to be an adulteress,
and some of the children were supposed to be the result of
superfetation. They condemned them all to be drowned, but the Marquis
appeared upon the scene about this time and, moved by compassion,
acknowledged all 13.  They grew up and thrived, and took the name of
Trazegines, meaning, in the old language, 13 drowned, although many
commentaries say that "gines" was supposed to mean in the twelfth
century "nes," or, in full, the interpretation would be "13 born."

Cases in which there is a repetition of multiple births are quite
numerous, and sometimes so often repeated as to produce a family the
size of which is almost incredible. Aristotle is credited with saying
that he knew the history of a woman who had quintuplets four times.
Pliny's case of quintuplets four times repeated has been mentioned; and
Pare, who may be believed when he quotes from his own experience, says
that the wife of the last Lord de Maldemeure, who lived in the Parish
of Seaux, was a marvel of prolificity. Within a year after her marriage
she gave birth to twins; in the next year to triplets; in the third
year to quadruplets; in the fourth year to quintuplets, and in the
fifth year bore sextuplets; in this last labor she died. The then
present Lord de Maldemeure, he says, was one of the final sextuplets.
This case attracted great notice at the time, as the family was quite
noble and very well known. Seaux, their home, was near Chambellay.
Picus Mirandulae gathered from the ancient Egyptian inscriptions that
the women of Egypt brought forth sometimes 8 children at a birth, and
that one woman bore 30 children in 4 confinements. He also cites, from
the history of a certain Bishop of Necomus, that a woman named Antonia,
in the Territory of Mutina, Italy, now called Modena, had brought forth
40 sons before she was forty years of age, and that she had had 3 and 4
at a birth. At the auction of the San Donato collection of pictures a
portrait of Dianora Frescobaldi, by one of the Bronzinos in the
sixteenth century, sold for about $3000. At the bottom of this portrait
was an inscription stating that she was the mother of 52 children. This
remarkable woman never had less than 3 at a birth, and tradition gives
her as many as 6.

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

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

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

A woman in Schlossberg, Germany, gave birth to twins; after a year, to
triplets, and again, in another year, to 3 fairly strong boys. In the
State Papers, Domestic Series, Charles I, according to Walford, appears
an extract from a letter from George Garrard to Viscount Conway, which
is as follows: "Sir John Melton, who entertained you at York, hath
buried his wife, Curran's daughter.  Within twelve months she brought
him 4 sons and a daughter, 2 sons last summer, and at this birth 2 more
and a daughter, all alive." Swan mentions a woman who gave birth to 6
children in seventeen months in 2 triple pregnancies. The first
terminated prematurely, 2 children dying at once, the other in five
weeks.  The second was uneventful, the 3 children living at the time of
the report. Rockwell gives the report of a case of a woman of
twenty-eight, herself a twin, who gave birth to twins in January, 1879.
They died after a few weeks, and in March, 1880, she again bore twins,
one living three and the other nine weeks. On March 12, 1881, she gave
birth to triplets. The first child, a male, weighed 7 pounds; the
second, a female, 6 1/4 pounds; the third, a male, 5 1/2 pounds. The
third child lived twenty days, the other two died of cholera infantum
at the sixth month, attributable to the bottle-feeding. Banerjee gives
the history of a case of a woman of thirty being delivered of her
fourth pair of twins. Her mother was dead, but she had 3 sisters
living, of one of which she was a twin, and the other 2 were twins. One
of her sisters had 2 twin terms, 1 child surviving; like her own
children, all were females. A second sister had a twin term, both
males, 1 surviving. The other sister aborted female twins after a fall
in the eighth month of pregnancy. The name of the patient was Mussamat
Somni, and she was the wife of a respectable Indian carpenter.

There are recorded the most wonderful accounts of prolificity, in
which, by repeated multiple births, a woman is said to have borne
children almost beyond belief. A Naples correspondent to a Paris
Journal gives the following: "About 2 or 3 stations beyond Pompeii, in
the City of Nocera, lives Maddalena Granata, aged forty-seven, who was
married at twenty-eight, and has given birth to 52 living and dead
children, 49 being males. Dr. de Sanctis, of Nocera, states that she
has had triplets 15 times."

Peasant Kirilow was presented to the Empress of Russia in 1853, at the
age of seventy years. He had been twice married, and his first wife had
presented him with 57 children, the fruits of 21 pregnancies. She had
quadruplets four times, triplets seven times, and twins thrice. By his
second wife he had 15 children, twins six times, and triplets once.
This man, accordingly, was the father of 72 children, and, to magnify
the wonder, all the children were alive at the time of presentation.
Herman, in some Russian statistics, relates the instance of Fedor
Vassilet, a peasant of the Moscow Jurisdiction, who in 1872, at the age
of seventy-five years, was the father of 87 children. He had been twice
married; his first wife bore him 69 children in 27 accouchements,
having twins sixteen times, triplets seven times, and quadruplets four
times, but never a single birth. His second wife bore him 18 children
in 8 accouchements. In 1872, 83 of the 87 children were living. The
author says this case is beyond all question, as the Imperial Academy
of St. Petersburg, as well as the French Academy, have substantial
proof of it. The family are still living in Russia, and are the object
of governmental favors. The following fact is interesting from the
point of exaggeration, if for nothing else: "The New York Medical
Journal is accredited with publishing the following extract from the
history of a journey to Saragossa, Barcelona, and Valencia, in the year
1585, by Philip II of Spain. The book was written by Henrique Cock, who
accompanied Philip as his private secretary.  On page 248 the following
statements are to be found: At the age of eleven years, Margarita
Goncalez, whose father was a Biscayian, and whose mother was French,
was married to her first husband, who was forty years old. By him she
had 78 boys and 7 girls. He died thirteen years after the marriage,
and, after having remained a widow two years, the woman married again.
By her second husband, Thomas Gchoa, she had 66 boys and 7 girls.
These children were all born in Valencia, between the fifteenth and
thirty-fifth year of the mother's age, and at the time when the account
was written she was thirty-five years old and pregnant again. Of the
children, 47 by the first husband and 52 by the second were baptized;
the other births were still or premature. There were 33 confinements in
all."

Extreme Prolificity by Single Births.--The number of children a woman
may bring forth is therefore not to be accurately stated; there seems
to be almost no limit to it, and even when we exclude those cases in
which remarkable multiplicity at each birth augments the number, there
are still some almost incredible cases on record. The statistics of the
St. Pancras Royal Dispensary, 1853, estimated the number of children
one woman may bear as from 25 to 69. Eisenmenger relates the history of
a case of a woman in the last century bearing 51 children, and there is
another case in which a woman bore 44 children, all boys. Atkinson
speaks of a lady married at sixteen, dying when she was sixty-four, who
had borne 39 children, all at single births, by one husband, whom she
survived. The children, 32 daughters and 7 sons, all attained their
majority. There was a case of a woman in America who in twenty-six
years gave birth to 22 children, all at single births.  Thoresby in his
"History of Leeds," 1715, mentions three remarkable cases--one the wife
of Dr. Phineas Hudson, Chancellor of York, as having died in her
thirty-ninth year of her twenty-fourth child; another of Mrs. Joseph
Cooper, as dying of her twenty-sixth child, and, lastly, of Mrs.
William Greenhill, of a village in Hertford, England, who gave birth to
39 children during her life. Brand, a writer of great repute, in his
"History of Newcastle," quoted by Walford, mentions as a well attested
fact the wife of a Scotch weaver who bore 62 children by one husband,
all of whom lived to be baptized.

A curious epitaph is to be seen at Conway, Carnarvonshire--

"Here lieth the body of Nicholas Hookes, of Conway, gentleman, who was
one-and-fortieth child of his father, William Hookes, Esq., by Alice,
his wife, and the father of 27 children. He died 20th of March, 1637."

On November 21, 1768, Mrs. Shury, the wife of a cooper, in Vine Street,
Westminster, was delivered of 2 boys, making 26 by the same husband.
She had previously been confined with twins during the year.

It would be the task of a mathematician to figure the possibilities of
paternity in a man of extra long life who had married several prolific
women during his prolonged period of virility. A man by the name of
Pearsons of Lexton, Nottingham, at the time of the report had been
married 4 times. By his first 3 wives he had 39 children and by his
last 14, making a total of 53. He was 6 feet tall and lived to his
ninety-sixth year. We have already mentioned the two Russian cases in
which the paternity was 72 and 87 children respectively, and in "Notes
and Queries," June 21, 1856, there is an account of David Wilson of
Madison, Ind., who had died a few years previously at the age of one
hundred and seven. He had been 5 times married and was the father of 47
children, 35 of whom were living at the time of his death.

On a tomb in Ely, Cambridgeshire, there is an inscription saying that
Richard Worster, buried there, died on May 11, 1856, the tomb being in
memory of his 22 sons and 5 daughters.

Artaxerxes was supposed to have had 106 children; Conrad, Duke of
Moscow, 80; and in the polygamous countries the number seems
incredible. Herotinus was said to have had 600; and Jonston also quotes
instances of 225 and even of 650 in the Eastern countries.

Recently there have been published accounts of the alleged experiments
of Luigi Erba, an Italian gentleman of Perugia, whose results have been
announced. About forty years of age and being quite wealthy, this
bizarre philanthropist visited various quarters of the world, securing
women of different races; having secured a number sufficient for his
purposes, he retired with them to Polynesia, where he is accredited
with maintaining a unique establishment with his household of females.
In 1896, just seven years after the experiment commenced, the reports
say he is the father of 370 children.

The following is a report from Raleigh, N.C., on July 28, 1893, to the
New York Evening Post:--

"The fecundity of the negro race has been the subject of much comment
and discussion. A case has come to light in this State that is one of
the most remarkable on record. Moses Williams, a negro farmer, lives in
the eastern section of this State. He is sixty-five years old (as
nearly as he can make out), but does not appear to be over fifty. He
has been married twice, and by the two wives has had born to him 45
children. By the first wife he had 23 children, 20 of whom were girls
and 3 were boys. By the second wife he had 22 children--20 girls and 2
boys. He also has about 50 grand-children. The case is well
authenticated."

We also quote the following, accredited to the "Annals of Hygiene:"--

"Were it not part of the records of the Berks County courts, we could
hardly credit the history of John Heffner, who was accidentally killed
some years ago at the age of sixty-nine. He was married first in 1840.
In eight years his wife bore him 17 children. The first and second
years of their marriage she gave birth to twins. For four successive
years afterward she gave birth to triplets. In the seventh year she
gave birth to one child and died soon afterward. Heffner engaged a
young woman to look after his large brood of babies, and three months
later she became the second Mrs. Heffner. She presented her husband
with 2 children in the first two years of her wedded life. Five years
later she had added 10 more to the family, having twins 5 times.  Then
for three years she added but 1 a year. At the time of the death of the
second wife 12 of the 32 children had died. The 20 that were left did
not appear to be any obstacle to a young widow with one child
consenting to become the third wife of the jolly little man, for he was
known as one of the happiest and most genial of men, although it kept
him toiling like a slave to keep a score of mouths in bread. The third
Mrs. Heffner became the mother of 9 children in ten years, and the
contentment and happiness of the couple were proverbial. One day, in
the fall of 1885, the father of the 41 children was crossing a railroad
track and was run down by a locomotive and instantly killed. His widow
and 24 of the 42 children are still living."

Many Marriages.--In this connection it seems appropriate to mention a
few examples of multimarriages on record, to give an idea of the
possibilities of the extent of paternity. St. Jerome mentions a widow
who married her twenty-second husband, who in his time had taken to
himself 20 loving spouses. A gentleman living in Bordeaux in 1772 had
been married 16 times.  DeLongueville, a Frenchman, lived to be one
hundred and ten years old, and had been joined in matrimony to 10
wives, his last wife bearing him a son in his one hundred and first
year.

Possible Descendants.--When we indulge ourselves as to the possible
number of living descendants one person may have, we soon get
extraordinary figures. The Madrid Estafette states that a gentleman,
Senor Lucas Nequeiras Saez, who emigrated to America seventy years
previously, recently returned to Spain in his own steamer, and brought
with him his whole family, consisting of 197 persons. He had been
thrice married, and by his first wife had 11 children at 7 births; by
his second wife, 19 at 13 births, and by his third wife, 7 at 6 births.
The youngest of the 37 was thirteen years old and the eldest seventy.
This latter one had a son aged forty-seven and 16 children besides. He
had 34 granddaughters, 45 grandsons, 45 great granddaughters, 39 great
grandsons, all living. Senor Saez himself was ninety-three years old
and in excellent health.

At Litchfield, Conn., there is said to be the following inscription:--

"Here lies the body of Mrs. Mary, wife of Dr. John Bull, Esq. She died
November 4, 1778, aetat. ninety, having had 13 children, 101
grandchildren, 274 great grandchildren, and 22 great-great
grandchildren, a total of 410; surviving, 336."

In Esher Church there is an inscription, scarcely legible, which
records the death of the mother of Mrs. Mary Morton on April 18, 1634,
and saying that she was the wonder of her sex and age, for she lived to
see nearly 400 issued from her loins.

The following is a communication to "Notes and Queries," March 21,
1891: "Mrs. Mary Honeywood was daughter and one of the coheiresses of
Robert Waters, Esq., of Lenham, in Kent. She was born in 1527; married
in February, 1543, at sixteen years of age, to her only husband, Robert
Honeywood, Esq., of Charing, in Kent.  She died in the ninety-third
year of her age, in May, 1620. She had 16 children of her own body, 7
sons and 9 daughters, of whom one had no issue, 3 died young--the
youngest was slain at Newport battle, June 20, 1600. Her grandchildren,
in the second generation, were 114; in the third, 228, and in the
fourth, 9; so that she could almost say the same as the distich doth of
one of the Dalburg family of Basil: 'Rise up, daughter and go to thy
daughter, for thy daughter's daughter hath a daughter.'

"In Markshal Church, in Essex, on Mrs. Honeywood's tomb is the
following inscription: 'Here lieth the body of Mary Waters, the
daughter and coheir of Robert Waters, of Lenham, in Kent, wife of
Robert Honeywood, of Charing, in Kent, her only husband, who had at her
decease, lawfully descended from her, 367 children, 16 of her own body,
114 grandchildren, 228 in the third generation, and 9 in the fourth.
She lived a most pious life and died at Markshal, in the ninety-third
year of her age and the forty-fourth of her widowhood, May 11, 1620.'
(From 'Curiosities for the Ingenious,' 1826.)            S. S. R."

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

In illustration we may note the following: In the Illustrated London
News, May 11, 1895, is a portrait of "Lady Millard," a fine St. Bernard
bitch, the property of Mr. Thorp of Northwold, with her litter of 21
puppies, born on February 9, 1896, their sire being a magnificent
dog--"Young York." There is quoted an incredible account of a cow, the
property of J. N. Sawyer of Ohio, which gave birth to 56 calves, one of
which was fully matured and lived, the others being about the size of
kittens; these died, together with the mother. There was a cow in
France, in 1871, delivered of 5 calves.



CHAPTER V.

MAJOR TERATA.

Monstrosities have attracted notice from the earliest time, and many of
the ancient philosophers made references to them. In mythology we read
of Centaurs, impossible beings who had the body and extremities of a
beast; the Cyclops, possessed of one enormous eye; or their parallels
in Egyptian myths, the men with pectoral eyes,--the creatures "whose
heads do beneath their shoulders grow;" and the Fauns, those sylvan
deities whose lower extremities bore resemblance to those of a goat.
Monsters possessed of two or more heads or double bodies are found in
the legends and fairy tales of every nation. Hippocrates, his
precursors, Empedocles and Democritus, and Pliny, Aristotle, and Galen,
have all described monsters, although in extravagant and ridiculous
language.

Ballantyne remarks that the occasional occurrence of double monsters
was a fact known to the Hippocratic school, and is indicated by a
passage in De morbis muliebribus, in which it is said that labor is
gravely interfered with when the infant is dead or apoplectic or
double. There is also a reference to monochorionic twins (which are by
modern teratologists regarded as monstrosities) in the treatise De
Superfoetatione, in which it is stated that "a woman, pregnant with
twins, gives birth to them both at the same time, just as she has
conceived them; the two infants are in a single chorion."

Ancient Explanations of Monstrosities.--From the time of Galen to the
sixteenth century many incredible reports of monsters are seen in
medical literature, but without a semblance of scientific truth. There
has been little improvement in the mode of explanation of monstrous
births until the present century, while in the Middle Ages the
superstitions were more ludicrous and observers more ignorant than
before the time of Galen. In his able article on the teratologic
records of Chaldea, Ballantyne makes the following trite statements:
"Credulity and superstition have never been the peculiar possession of
the lower types of civilization only, and the special beliefs that have
gathered round the occurrence of teratologic phenomena have been common
to the cultured Greek and Roman of the past, the ignorant peasant of
modern times, and the savage tribes of all ages. Classical writings,
the literature of the Middle Ages, and the popular beliefs of the
present day all contain views concerning teratologic subjects which so
closely resemble those of the Chaldean magi as to be indistinguishable
from them. Indeed, such works as those of Obsequens, Lycosthenes,
Licetus, and Ambroise Pare only repeat, but with less accuracy of
description and with greater freedom of imagination, the beliefs of
ancient Babylon.  Even at the present time the most impossible cases of
so-called 'maternal impressions' are widely scattered through medical
literature; and it is not very long since I received a letter from a
distinguished member of the profession asking me whether, in my
opinion, I thought it possible for a woman to give birth to a dog. Of
course, I do not at all mean to infer that teratology has not made
immense advances within recent times, nor do I suggest that on such
subjects the knowledge of the magi can be compared with that of the
average medical student of the present; but what I wish to emphasize is
that, in the literature of ancient Babylonia, there are indications of
an acquaintance with structural defects and malformations of the human
body which will compare favorably with even the writings of the
sixteenth century of the Christian era."

Many reasons were given for the existence of monsters, and in the
Middle Ages these were as faulty as the descriptions themselves.  They
were interpreted as divinations, and were cited as forebodings and
examples of wrath, or even as glorifications of the Almighty. The
semi-human creatures were invented or imagined, and cited as the
results of bestiality and allied forms of sexual perversion prevalent
in those times. We find minute descriptions and portraits of these
impossible results of wicked practices in many of the older medical
books. According to Pare there was born in 1493, as the result of
illicit intercourse between a woman and a dog, a creature resembling in
its upper extremities its mother, while its lower extremities were the
exact counterpart of its canine father. This particular case was
believed by Bateman and others to be a precursor to the murders and
wickedness that followed in the time of Pope Alexander I. Volateranus,
Cardani, and many others cite instances of this kind. Lycosthenes says
that in the year 1110, in the bourg of Liege, there was found a
creature with the head, visage, hands, and feet of a man, and the rest
of the body like that of a pig. Pare quotes this case and gives an
illustration. Rhodiginus mentions a shepherd of Cybare by the name of
Cratain, who had connection with a female goat and impregnated her, so
that she brought forth a beast with a head resembling that of the
father, but with the lower extremities of a goat. He says that the
likeness to the father was so marked that the head-goat of the herd
recognized it, and accordingly slew the goatherd who had sinned so
unnaturally.

In the year 1547, at Cracovia, a very strange monster was born, which
lived three days. It had a head shaped like that of a man; a nose long
and hooked like an elephant's trunk; the hands and feet looking like
the web-foot of a goose; and a tail with a hook on it. It was supposed
to be a male, and was looked upon as a result of sodomy. Rueff says
that the procreation of human beings and beasts is brought about--

(1) By the natural appetite;

(2) By the provocation of nature by delight;

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

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

Writing in 1557, Lycosthenes reports the mythical birth of a serpent by
a woman. It is quite possible that some known and classified type of
monstrosity was indicated here in vague terms.  In 1726 Mary Toft, of
Godalming, in Surrey, England, achieved considerable notoriety
throughout Surrey, and even over all England, by her extensively
circulated statements that she bore rabbits. Even at so late a day as
this the credulity of the people was so great that many persons
believed in her. The woman was closely watched, and being detected in
her maneuvers confessed her fraud. To show the extent of discussion
this case called forth, there are no less than nine pamphlets and books
in the Surgeon-General's library at Washington devoted exclusively to
this case of pretended rabbit-breeding. Hamilton in 1848, and Hard in
1884, both report the births in this country of fetal monstrosities
with heads which showed marked resemblance to those of dogs. Doubtless
many of the older cases of the supposed results of bestiality, if seen
to-day, could be readily classified among some of our known forms of
monsters. Modern investigation has shown us the sterile results of the
connections between man and beast or between beasts of different
species, and we can only wonder at the simple credulity and the
imaginative minds of our ancestors. At one period certain phenomena of
nature, such as an eclipse or comet, were thought to exercise their
influence on monstrous births. Rueff mentions that in Sicily there
happened a great eclipse of the sun, and that women immediately began
to bring forth deformed and double-headed children.

Before ending these preliminary remarks, there might be mentioned the
marine monsters, such as mermaids, sea-serpents, and the like, which
from time to time have been reported; even at the present day there are
people who devoutly believe that they have seen horrible and impossible
demons in the sea. Pare describes and pictures a monster, at Rome, on
November 3, 1520, with the upper portion of a child apparently about
five or six years old, and the lower part and ears of a fish-like
animal. He also pictures a sea-devil in the same chapter, together with
other gruesome examples of the power of imagination.

Early Teratology.--Besides such cases as the foregoing, we find the
medieval writers report likely instances of terata, as, for instance,
Rhodiginus, who speaks of a monster in Italy with two heads and two
bodies; Lycosthenes saw a double monster, both components of which
slept at the same time; he also says this creature took its food and
drink simultaneously in its two mouths. Even Saint Augustine says that
he knew of a child born in the Orient who, from the belly up, was in
all parts double.

The first evidences of a step toward classification and definite
reasoning in regard to the causation of monstrosities were evinced by
Ambroise Pare in the sixteenth century, and though his ideas are crude
and some of his phenomena impossible, yet many of his facts and
arguments are worthy of consideration. Pare attributed the cause of
anomalies of excess to an excessive quantity of semen, and anomalies of
default to deficiency of the same fluid. He has collected many
instances of double terata from reliable sources, but has interspersed
his collection with accounts of some hideous and impossible creatures,
such as are illustrated in the accompanying figure, which shows a
creature that was born shortly after a battle of Louis XII, in 1512; it
had the wings, crest, and lower extremity of a bird and a human head
and trunk; besides, it was an hermaphrodite, and had an extra eye in
the knee. Another illustration represents a monstrous head found in an
egg, said to have been sent for examination to King Charles at Metz in
1569. It represented the face and visage of a man, with small living
serpents taking the place of beard and hair. So credulous were people
at this time that even a man so well informed as Pare believed in the
possibility of these last two, or at least represented them as facts.
At this time were also reported double hermaphroditic terata, seemingly
without latter-day analogues. Rhodiginus speaks of a two-headed monster
born in Ferrari, Italy, in 1540, well formed, and with two sets of
genitals, one male and the other female. Pare gives a picture of twins,
born near Heidelberg in 1486, which had double bodies joined back to
back; one of the twins had the aspect of a female and the other of a
male, though both had two sets of genitals.

Scientific Teratology.--About the first half of the eighteenth century
what might be called the positive period of teratology begins.
Following the advent of this era come Mery, Duverney, Winslow, Lemery,
and Littre. In their works true and concise descriptions are given and
violent attacks are made against the ancient beliefs and prejudices.
From the beginning of the second half of the last century to the
present time may be termed the scientific epoch of teratology. We can
almost with a certainty start this era with the names of Haller,
Morgagni, Geoffroy-Saint-Hilaire, and Meckel, who adduced the
explanations asked for by Harvey and Wolff. From the appearance of the
treatise by Geoffroy-Saint-Hilaire, teratology has made enormous
strides, and is to-day well on the road to becoming a science.  Hand in
hand with embryology it has been the subject of much investigation in
this century, and to enumerate the workers of the present day who have
helped to bring about scientific progress would be a task of many
pages. Even in the artificial production of monsters much has been
done, and a glance at the work of Dareste well repays the trouble.
Essays on teratogenesis, with reference to batrachians, have been
offered by Lombardini; and by Lereboullet and Knoch with reference to
fishes. Foll and Warynski have reported their success in obtaining
visceral inversion, and even this branch of the subject promises to
become scientific.

Terata are seen in the lower animals and always excite interest.  Pare
gives the history of a sheep with three heads, born in 1577; the
central head was larger than the other two, as shown in the
accompanying illustration. Many of the Museums of Natural History
contain evidences of animal terata. At Hallae is a two-headed mouse;
the Conant Museum in Maine contains the skeleton of an adult sheep with
two heads; there was an account of a two-headed pigeon published in
France in 1734; Leidy found a two-headed snake in a field near
Philadelphia; Geoffroy Saint-Hilaire and Conant both found similar
creatures, and there is one in the Museum at Harvard; Wyman saw a
living double-headed snake in the Jardin des Plantes in Paris in 1853,
and many parallel instances are on record.

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

Many classifications of terata have been offered, and each possesses
some advantage. The modern reader is referred to the modification of
the grouping of Geoffroy-Saint-Hilaire given by Hirst and Piersol, or
those of Blanc and Guinard. For convenience, we have adopted the
following classification, which will include only those monsters that
have LIVED AFTER BIRTH, and who have attracted general notice or
attained some fame in their time, as attested by accounts in
contemporary literature.

CLASS 1.--Union of several fetuses.  CLASS 2.--Union of two distinct
fetuses by a connecting band.  CLASS 3.--Union of two distinct fetuses
by an osseous junction of the cranial bones.  CLASS 4.--Union of two
distinct fetuses in which one or more parts are eliminated by the
junction.  CLASS 5.--Fusion of two fetuses by a bony union of the
ischii. CLASS 6.--Fusion of two fetuses below the umbilicus into a
common lower extremity.  CLASS 7.--Bicephalic monsters.  CLASS
8.--Parasitic monsters.  CLASS 9.--Monsters with a single body and
double lower extremities.  CLASS 10.--Diphallic terata. CLASS
11.--Fetus in fetu, and dermoid cysts.  CLASS 12.--Hermaphrodites.

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

CLASS II.--Double Monsters.--A curious mode of junction, probably the
most interesting, as it admits of longer life in these monstrosities,
is that of a simple cartilaginous band extending between two absolutely
distinct and different individuals. The band is generally in the
sternal region. In 1752 there was described a remarkable monstrosity
which consisted of conjoined twins, a perfect and an imperfect child,
connected at their ensiform cartilages by a band 4 inches in
circumference. The Hindoo sisters, described by Dr. Andrew Berry, lived
to be seven years old; they stood face to face, with their chests 6 1/2
inches and their pubes 8 1/2 inches apart. Mitchell describes the
full-grown female twins, born at Newport, Ky., called the Newport
twins. The woman who gave birth to them became impregnated, it is said,
immediately after seeing the famous Siamese twins, and the products of
this pregnancy took the conformation of those celebrated exhibitionists.

Perhaps the best known of all double monsters were the Siamese twins.
They were exhibited all over the globe and had the additional benefit
and advertisement of a much mooted discussion as to the advisability of
their severance, in which opinions of the leading medical men of all
nations were advanced. The literature on these famous brothers is
simply stupendous. The amount of material in the Surgeon General's
library at Washington would surprise an investigator. A curious volume
in this library is a book containing clippings, advertisements, and
divers portraits of the twins. It will be impossible to speak at all
fully on this subject, but a short history and running review of their
lives will be given: Eng and Chang were born in Siam about May, 1811.
Their father was of Chinese extraction and had gone to Siam and there
married a woman whose father was also a Chinaman.  Hence, for the most
part, they were of Chinese blood, which probably accounted for their
dark color and Chinese features.  Their mother was about thirty-five
years old at the time of their birth and had borne 4 female children
prior to Chang and Eng. She afterward had twins several times, having
eventually 14 children in all. She gave no history of special
significance of the pregnancy, although she averred that the head of
one and the feet of the other were born at the same time. The twins
were both feeble at birth, and Eng continued delicate, while Chang
thrived.  It was only with difficulty that their lives were saved, as
Chowpahyi, the reigning king, had a superstition that such freaks of
nature always presaged evil to the country. They were really discovered
by Robert Hunter, a British merchant at Bangkok, who in 1824 saw them
boating and stripped to the waist. He prevailed on the parents and King
Chowpahyi to allow them to go away for exhibition. They were first
taken out of the country by a certain Captain Coffin. The first
scientific description of them was given by Professor J. C. Warren, who
examined them in Boston, at the Harvard University, in 1829. At that
time Eng was 5 feet 2 inches and Chang 5 feet 1 1/2 inches in height.
They presented all the characteristics of Chinamen and wore long black
queues coiled thrice around their heads, as shown by the accompanying
illustration. After an eight-weeks' tour over the Eastern States they
went to London, arriving at that port November 20, 1829.  Their tour in
France was forbidden on the same grounds as the objection to the
exhibition of Ritta-Christina, namely, the possibility of causing the
production of monsters by maternal impressions in pregnant women. After
their European tour they returned to the United States and settled down
as farmers in North Carolina, adopting the name of Bunker. When
forty-four years of age they married two sisters, English women,
twenty-six and twenty-eight years of age, respectively. Domestic
infelicity soon compelled them to keep the wives at different houses,
and they alternated weeks in visiting each wife. Chang had six children
and Eng five, all healthy and strong. In 1869 they made another trip to
Europe, ostensibly to consult the most celebrated surgeons of Great
Britain and France on the advisability of being separated. It was
stated that a feeling of antagonistic hatred after a quarrel prompted
them to seek "surgical separation," but the real cause was most likely
to replenish their depleted exchequer by renewed exhibition and
advertisement.

A most pathetic characteristic of these illustrious brothers was the
affection and forbearance they showed for each other until shortly
before their death. They bore each other's trials and petty maladies
with the greatest sympathy, and in this manner rendered their lives far
more agreeable than a casual observer would suppose possible. They both
became Christians and members or attendants of the Baptist Church.

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

The feasibility of the operation of separating them was discussed by
many of the leading men of America, and Thompson, Fergusson, Syme, Sir
J. Y. Simpson, Nelaton, and many others in Europe, with various reports
and opinions after examination. These opinions can be seen in full in
nearly any large medical library. At this time they had diseased and
atheromatous arteries, and Chang, who was quite intemperate, had marked
spinal curvature, and shortly afterward became hemiplegic. They were
both partially blind in their two anterior eyes, possibly from looking
outward and obliquely. The point of junction was about the
sterno-siphoid angle, a cartilaginous band extending from sternum to
sternum. In 1869 Simpson measured this band and made the distance on
the superior aspect from sternum to sternum 4 1/2 inches, though it is
most likely that during the early period of exhibition it was not over
3 inches. The illustration shows very well the position of the joining
band.

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

The "Orissa sisters," or Radica-Doddica, shown in Europe in 1893, were
similar to the Siamese twins in conformation. They were born in Orissa,
India, September, 1889, and were the result of the sixth pregnancy, the
other five being normal. They were healthy girls, four years of age,
and apparently perfect in every respect, except that, from the ensiform
cartilage to the umbilicus, they were united by a band 4 inches long
and 2 inches wide. The children when facing each other could draw their
chests three or four inches apart, and the band was so flexible that
they could sit on either side of the body. Up to the date mentioned it
was not known whether the connecting band contained viscera. A portrait
of these twins was shown at the World's Fair in Chicago.

In the village of Arasoor, district of Bhavany, there was reported a
monstrosity in the form of two female children, one 34 inches and the
other 33 3/4 inches high, connected by the sternum. They were said to
have had small-pox and to have recovered. They seemed to have had
individual nervous systems, as when one was pinched the other did not
feel it, and while one slept the other was awake. There must have been
some vascular connection, as medicine given to one affected both.

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

Operations on Conjoined Twins.--Swingler speaks of two girls joined at
the xiphoid cartilage and the umbilicus, the band of union being 1 1/2
inches thick, and running below the middle of it was the umbilical
cord, common to both. They first ligated the cord, which fell off in
nine days, and then separated the twins with the bistoury. They each
made early recovery and lived.

In the Ephemerides of 1690 Konig gives a description of two Swiss
sisters born in 1689 and united belly to belly, who were separated by
means of a ligature and the operation afterward completed by an
instrument. The constricting band was formed by a coalition of the
xiphoid cartilages and the umbilical vessels, surrounded by areolar
tissue and covered with skin. Le Beau says that under the Roman reign,
A. D. 945, two male children were brought from Armenia to
Constantinople for exhibition. They were well formed in every respect
and united by their abdomens. After they had been for some time an
object of great curiosity, they were removed by governmental order,
being considered a presage of evil. They returned, however, at the
commencement of the reign of Constantine VII, when one of them took
sick and died. The surgeons undertook to preserve the other by
separating him from the corpse of his brother, but he died on the third
day after the operation.

In 1866 Boehm gives an account of Guzenhausen's case of twins who were
united sternum to sternum. An operation for separation was performed
without accident, but one of the children, already very feeble, died
three days after; the other survived. The last attempt at an operation
like this was in 1881, when Biaudet and Buginon attempted to separate
conjoined sisters (Marie-Adele) born in Switzerland on June 26th.
Unhappily, they were very feeble and life was despaired of when the
operation was performed, on October 29th. Adele died six hours
afterward, and Marie died of peritonitis on the next day.

CLASS III.--Those monsters joined by a fusion of some of the cranial
bones are sometimes called craniopagi. A very ancient observation of
this kind is cited by Geoffroy-Saint-Hilaire.  These two girls were
born in 1495, and lived to be ten years old.  They were normal in every
respect, except that they were joined at the forehead, causing them to
stand face to face and belly to belly. When one walked forward, the
other was compelled to walk backward; their noses almost touched, and
their eyes were directed laterally. At the death of one an attempt to
separate the other from the cadaver was made, but it was unsuccessful,
the second soon dying; the operation necessitated opening the cranium
and parting the meninges. Bateman said that in 1501 there was living an
instance of double female twins, joined at the forehead. This case was
said to have been caused in the following manner: Two women, one of
whom was pregnant with the twins at the time, were engaged in an
earnest conversation, when a third, coming up behind them, knocked
their heads together with a sharp blow. Bateman describes the death of
one of the twins and its excision from the other, who died
subsequently, evidently of septic infection. There is a possibility
that this is merely a duplication of the account of the preceding case
with a slight anachronism as to the time of death.

At a foundling hospital in St. Petersburg there were born two living
girls, in good health, joined by the heads. They were so united that
the nose of one, if prolonged, would strike the ear of the other; they
had perfectly independent existences, but their vascular systems had
evident connection.

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

CLASS IV.--The next class to be considered is that in which the
individuals are separate and well formed, except that the point of
fusion is a common part, eliminating their individual components in
this location. The pygopagous twins belong in this section. According
to Bateman, twins were born in 1493 at Rome joined back to back, and
survived their birth. The same authority speaks of a female child who
was born with "2 bellies, 4 arms, 4 legs, 2 heads, and 2 sets of
privates, and was exhibited throughout Italy for gain's sake." The
"Biddenden Maids" were born in Biddenden, Kent, in 1100. Their names
were Mary and Eliza Chulkhurst, and their parents were fairly
well-to-do people. They were supposed to have been united at the hips
and the shoulders, and lived until 1134. At the death of one it was
proposed to separate them, but the remaining sister refused, saying,
"As we came together, we will also go together," and, after about six
hours of this Mezentian existence, they died. They bequeathed to the
church-wardens of the parish and their successors land to the extent of
20 acres, at the present time bringing a rental of about $155.00
annually, with the instructions that the money was to be spent in the
distribution of cakes (bearing the impression of their images, to be
given away on each Easter Sunday to all strangers in Biddenden) and
also 270 quartern loaves, with cheese in proportion, to all the poor in
said parish. Ballantyne has accompanied his description of these
sisters by illustrations, one of which shows the cake. Heaton gives a
very good description of these maids; and a writer in "Notes and
Queries" of March 27, 1875, gives the following information relative to
the bequest:--

"On Easter Monday, at Biddenden, near Staplehurst, Kent, there is a
distribution, according to ancient custom, of 'Biddenden Maids' cakes,'
with bread and cheese, the cost of which is defrayed from the proceeds
of some 20 acres of land, now yielding L35 per annum. and known as the
'Bread and Cheese Lands.' About the year 1100 there lived Eliza and
Mary Chulkhurst, who were joined together after the manner of the
Siamese twins, and who lived for thirty-four years, one dying, and then
being followed by her sister within six hours. They left by their will
the lands above alluded to and their memory is perpetuated by
imprinting on the cakes their effigies 'in their habit as they lived.'
The cakes, which are simple flour and water, are four inches long by
two inches wide, and are much sought after as curiosities. These, which
are given away, are distributed at the discretion of the
church-wardens, and are nearly 300 in number. The bread and cheese
amounts to 540 quartern loaves and 470 pounds of cheese.  The
distribution is made on land belonging to the charity, known as the Old
Poorhouse. Formerly it used to take place in the Church, immediately
after the service in the afternoon, but in consequence of the unseemly
disturbance which used to ensue the practice was discontinued. The
Church used to be filled with a congregation whose conduct was
occasionally so reprehensible that sometimes the church-wardens had to
use their wands for other purposes than symbols of office. The
impressions of the maids 'on the cakes are of a primitive character,
and are made by boxwood dies cut in 1814. They bear the date 1100, when
Eliza and Mary Chulkhurst are supposed to have been born, and also
their age at death, thirty-four years."

Ballantyne has summed up about all there is to be said on this national
monstrosity, and his discussion of the case from its historic as well
as teratologic standpoint is so excellent that his conclusions will be
quoted--

"It may be urged that the date fixed for the birth of the Biddenden
Maids is so remote as to throw grave doubt upon the reality of the
occurrence. The year 1100 was, it will be remembered, that in which
William Rufus was found dead in the New Forest, 'with the arrow either
of a hunter or an assassin in his breast.' According to the Anglo-Saxon
Chronicle, several 'prodigies' preceded the death of this profligate
and extravagant monarch. Thus it is recorded that 'at Pentecost blood
was observed gushing from the earth at a certain town of Berkshire,
even as many asserted who declared that they had seen it. And after
this, on the morning after Lammas Day, King William was shot.' Now, it
is just possible that the birth of the Biddenden Maids may have
occurred later, but have been antedated by the popular tradition to the
year above mentioned. For such a birth would, in the opinion of the
times, be regarded undoubtedly as a most evident prodigy or omen of
evil. Still, even admitting that the date 1100 must be allowed to
stand, its remoteness from the present time is not a convincing
argument against a belief in the real occurrence of the phenomenon; for
of the dicephalic Scottish brothers, who lived in 1490, we have
credible historic evidence.  Further, Lycosthenes, in his "Chronicon
Prodigiorum atque Ostentorum", published in 1557, states, upon what
authority I know not, that in the year 1112 joined twins resembling the
Biddenden phenomenon in all points save in sex were born in England.
The passage is as follows: 'In Anglia natus est puer geminus a clune ad
superiores partes ita divisus, ut duo haberet capita, duo corpora
integra ad renes cum suis brachiis, qui baptizatus triduo supervixit.'
It is just possible that in some way or other this case has been
confounded with the story of Biddenden; at any rate, the occurrence of
such a statement in Lycosthenes' work is of more than passing interest.
Had there been no bequest of land in connection with the case of the
Kentish Maids, the whole affair would probably soon have been forgotten.

"There is, however, one real difficulty in accepting the story handed
down to us as authentic,--the nature of the teratologic phenomenon
itself. All the records agree in stating that the Maids were joined
together at the shoulders and hips, and the impression on the cakes and
the pictures on the 'broadsides' show this peculiar mode of union, and
represent the bodies as quite separate in the space between the
above-named points. The Maids are shown with four feet and two arms,
the right and left respectively, whilst the other arms (left and right)
are fused together at the shoulder according to one illustration, and a
little above the elbow according to another. Now, although it is not
safe to say that such an anomaly is impossible, I do not know of any
case of this peculiar mode of union; but it may be that, as Prof. A. R.
Simpson has suggested, the Maids had four separate arms, and were in
the habit of going about with their contiguous arms round each other's
necks, and that this gave rise to the notion that these limbs were
united. If this be so, then the teratologic difficulty is removed, for
the case becomes perfectly comparable with the well-known but rare type
of double terata known as the pygopagous twins, which is placed by
Taruffi with that of the ischiopagous twins in the group dicephalus
lecanopagus. Similar instances, which are well known to students of
teratology, are the Hungarian sisters (Helen and Judith), the North
Carolina twins (Millie and Christine), and the Bohemian twins (Rosalie
and Josepha Blazek). The interspace between the thoraces may, however,
have simply been the addition of the first artist who portrayed the
Maids (from imagination?); then it may be surmised that they were
ectopagous twins.

"Pygopagous twins are fetuses united together in the region of the
nates and having each its own pelvis. In the recorded cases the union
has been usually between the sacra and coccyges, and has been either
osseous or (more rarely) ligamentous. Sometimes the point of junction
was the middle line posteriorly, at other times it was rather a
posterolateral union; and it is probable that in the Biddenden Maids it
was of the latter kind; and it is likely, from the proposal made to
separate the sisters after the death of one, that it was ligamentous in
nature.

"If it be granted that the Biddenden Maids were pygopagous twins, a
study of the histories of other recorded cases of this monstrosity
serves to demonstrate many common characters. Thus, of the 8 cases
which Taruffi has collected, in 7 the twins were female; and if to
these we add the sisters Rosalie and Josepha Blazek and the Maids, we
have 10 cases, of which 9 were girls.  Again, several of the pygopagous
twins, of whom there are scientific records, survived birth and lived
for a number of years, and thus resembled the Biddenden terata. Helen
and Judith, for instance, were twenty-three years old at death; and the
North Carolina twins, although born in 1851, are still alive. There is,
therefore, nothing inherently improbable in the statement that the
Biddenden Maids lived for thirty-four years. With regard also to the
truth of the record that the one Maid survived her sister for six
hours, there is confirmatory evidence from scientifically observed
instances, for Joly and Peyrat (Bull. de l'Acad. Med., iii., pp. 51 and
383, 1874) state that in the case seen by them the one infant lived ten
hours after the death of the other. It is impossible to make any
statement with regard to the internal structure of the Maids or to the
characters of their genital organs, for there is absolutely no
information forthcoming upon these points. It may simply be said, in
conclusion, that the phenomenon of Biddenden is interesting not only on
account of the curious bequest which arose out of it, but also because
it was an instance of a very rare teratologic type, occurring at a very
early period in our national history."

Possibly the most famous example of twins of this type were Helen and
Judith, the Hungarian sisters, born in 1701 at Szony, in Hungary. They
were the objects of great curiosity, and were shown successively in
Holland, Germany, Italy, France, England, and Poland. At the age of
nine they were placed in a convent, where they died almost
simultaneously in their twenty-second year.  During their travels all
over Europe they were examined by many prominent physiologists,
psychologists, and naturalists; Pope and several minor poets have
celebrated their existence in verse; Buffon speaks of them in his
"Natural History," and all the works on teratology for a century or
more have mentioned them. A description of them can be best given by a
quaint translation by Fisher of the Latin lines composed by a Hungarian
physician and inscribed on a bronze statuette of them:--

Two sisters wonderful to behold, who have thus grown as one, That
naught their bodies can divide, no power beneath the sun.  The town of
Szoenii gave them birth, hard by far-famed Komorn, Which noble fort may
all the arts of Turkish sultans scorn.  Lucina, woman's gentle friend,
did Helen first receive; And Judith, when three hours had passed, her
mother's womb did leave.  One urine passage serves for both;--one anus,
so they tell; The other parts their numbers keep, and serve their
owners well.  Their parents poor did send them forth, the world to
travel through, That this great wonder of the age should not be hid
from view.  The inner parts concealed do lie hid from our eyes, alas!
But all the body here you view erect in solid brass.


They were joined back to back in the lumbar region, and had all their
parts separate except the anus between the right thigh of Helen and the
left of Judith and a single vulva. Helen was the larger, better
looking, the more active, and the more intelligent. Judith at the age
of six became hemiplegic, and afterward was rather delicate and
depressed. They menstruated at sixteen and continued with regularity,
although one began before the other. They had a mutual affection, and
did all in their power to alleviate the circumstances of their sad
position.  Judith died of cerebral and pulmonary affections, and Helen,
who previously enjoyed good health, soon after her sister's first
indisposition suddenly sank into a state of collapse, although
preserving her mental faculties, and expired almost immediately after
her sister. They had measles and small-pox simultaneously, but were
affected in different degree by the maladies. The emotions,
inclinations, and appetites were not simultaneous.  Eccardus, in a very
interesting paper, discusses the physical, moral, and religious
questions in reference to these wonderful sisters, such as the
advisability of separation, the admissibility of matrimony, and,
finally, whether on the last day they would rise as joined in life, or
separated.

There is an account of two united females, similar in conjunction to
the "Hungarian sisters," who were born in Italy in 1700. They were
killed at the age of four months by an attempt of a surgeon to separate
them.

In 1856 there was reported to have been born in Texas, twins after the
manner of Helen and Judith, united back to back, who lived and attained
some age. They were said to have been of different natures and
dispositions, and inclined to quarrel very often.

Pancoast gives an extensive report of Millie-Christine, who had been
extensively exhibited in Europe and the United States. They were born
of slave parents in Columbus County, N.C., July 11, 1851; the mother,
who had borne 8 children before, was a stout negress of thirty-two,
with a large pelvis. The presentation was first by the stomach and
afterward by the breech. These twins were united at the sacra by a
cartilaginous or possibly osseous union. They were exhibited in Paris
in 1873, and provoked as much discussion there as in the United States.
Physically, Millie was the weaker, but had the stronger will and the
dominating spirit.  They menstruated regularly from the age of
thirteen. One from long habit yielded instinctively to the other's
movements, thus preserving the necessary harmony. They ate separately,
had distinct thoughts, and carried on distinct conversations at the
same time. They experienced hunger and thirst generally simultaneously,
and defecated and urinated nearly at the same times. One, in tranquil
sleep, would be wakened by a call of nature of the other. Common
sensibility was experienced near the location of union. They were
intelligent and agreeable and of pleasant appearance, although slightly
under size; they sang duets with pleasant voices and accompanied
themselves with a guitar; they walked, ran, and danced with apparent
ease and grace. Christine could bend over and lift Millie up by the
bond of union.

A recent example of the pygopagus type was Rosa-Josepha Blazek, born in
Skerychov, in Bohemia, January 20, 1878. These twins had a broad bony
union in the lower part of the lumbar region, the pelvis being
obviously completely fused. They had a common urethral and anal
aperture, but a double vaginal orifice, with a very apparent septum.
The sensation was distinct in each, except where the pelves joined.
They were exhibited in Paris in 1891, being then on an exhibition tour
around the world. Rosa was the stronger, and when she walked or ran
forward she drew her sister with her, who must naturally have reversed
her steps. They had independent thoughts and separate minds; one could
sleep while the other was awake. Many of their appetites were
different, one preferring beer, the other wine; one relished salad, the
other detested it, etc. Thirst and hunger were not simultaneous.
Baudoin describes their anatomic construction, their mode of life, and
their mannerisms and tastes in a quite recent article.  Fig. 42 is a
reproduction of an early photograph of the twins, and Fig. 43
represents a recent photograph of these "Bohemian twins," as they are
now called.

The latest record we have of this type of monstrosity is that given by
Tynberg to the County Medical Society of New York, May 27, 1895. The
mother was present with the remarkable twins in her arms, crying at the
top of their voices. These two children were born at midnight on April
15th. Tynberg remarked that he believed them to be distinct and
separate children, and not dependent on a common arterial system; he
also expressed his intention of separating them, but did not believe
the operation could be performed with safety before another year.
Jacobi describes in full Tynberg's instance of pygopagus. He says the
confinement was easy; the head of one was born first, soon followed by
the feet and the rest of the twins. The placenta was single and the
cord consisted of two branches. The twins were united below the third
sacral vertebrae in such a manner that they could lie alongside of each
other. They were females, and had two vaginae, two urethrae four labia
minora, and two labia majora, one anus, but a double rectum divided by
a septum. They micturated independently but defecated simultaneously.
They virtually lived separate lives, as one might be asleep while the
other cried, etc.

CLASS V.--While instances of ischiopagi are quite numerous, few have
attained any age, and, necessarily, little notoriety. Pare speaks of
twins united at the pelves, who were born in Paris July 20, 1570. They
were baptized, and named Louis and Louise. Their parents were well
known in the rue des Gravelliers. According to Bateman, and also Rueff,
in the year 1552 there were born, not far from Oxford, female twins,
who, from the description given, were doubtless of the ischiopagus
type. They seldom wept, and one was of a cheerful disposition, while
the other was heavy and drowsy, sleeping continually. They only lived a
short time, one expiring a day before the other. Licetus speaks of Mrs.
John Waterman, a resident of Fishertown, near Salisbury, England, who
gave birth to a double female monster on October 26, 1664, which
evidently from the description was joined by the ischii. It did not
nurse, but took food by both the mouths; all its actions were done in
concert; it was possessed of one set of genitourinary organs; it only
lived a short while. Many people in the region flocked to see the
wonderful child, whom Licetus called "Monstrum Anglicum." It is said
that at the same accouchement the birth of this monster was followed by
the birth of a well-formed female child, who survived.
Geoffroy-Saint-Hilaire quotes a description of twins who were born in
France on October 7, 1838, symmetrically formed and united at their
ischii. One was christened Marie-Louise, and the other
Hortense-Honorine. Their avaricious parents took the children to Paris
for exhibition, the exposures of which soon sacrificed their lives. In
the year 1841 there was born in the island of Ceylon, of native
parents, a monstrous child that was soon brought to Columbo, where it
lived only two months. It had two heads and seemed to have duplication
in all its parts except the anus and male generative organs.
Montgomery speaks of a double child born in County Roscommon, Ireland,
on the 24th of July, 1827. It had two heads, two chests with arms
complete, two abdominal and pelvic cavities united end to end, and four
legs, placed two on either side. It had only one anus, which was
situated between the thighs. One of the twins was dark haired and was
baptized Mary, while the other was a blonde and was named Catherine.
These twins felt and acted independently of each other; they each in
succession sucked from the breast or took milk from the spoon, and used
their limbs vigorously. One vomited without affecting the other, but
the feces were discharged through a common opening.

Goodell speaks of Minna and Minnie Finley, who were born in Ohio and
examined by him. They were fused together in a common longitudinal
axis, having one pelvis, two heads, four legs, and four arms. One was
weak and puny and the other robust and active; it is probable that they
had but one rectum and one bladder.  Goodell accompanies his
description by the mention of several analogous cases. Ellis speaks of
female twins, born in Millville, Tenn., and exhibited in New York in
1868, who were joined at the pelves in a longitudinal axis. Between the
limbs on either side were to be seen well-developed female genitals,
and the sisters had been known to urinate from both sides, beginning
and ending at the same time.

Huff details a description of the "Jones twins," born on June 24, 1889,
in Tipton County, Indiana, whose spinal columns were in apposition at
the lower end. The labor, of less than two hours' duration, was
completed before the arrival of the physician.  Lying on their mother's
back, they could both nurse at the same time. Both sets of genitals and
ani were on the same side of the line of union, but occupied normal
positions with reference to the legs on either side. Their weight at
birth was 12 pounds and their length 22 inches. Their mother was a
medium-sized brunette of 19, and had one previous child then living at
the age of two; their father was a finely formed man 5 feet 10 inches
in height.  The twins differed in complexion and color of the eyes and
hair.  They were publicly exhibited for some time, and died February 19
and 20, 1891, at St. John's Hotel, Buffalo, N.Y. Figure 45 shows their
appearance several months after birth.

CLASS VI.--In our sixth class, the first record we have is from the
Commentaries of Sigbert, which contains a description of a monstrosity
born in the reign of the Emperor Theodosius, who had two heads, two
chests with four arms attached, but a single lower extremity. The
emotions, affections, and appetites were different. One head might be
crying while the other laughed, or one feeding while the other was
sleeping. At times they quarreled and occasionally came to blows. This
monster is said to have lived two years, one part dying four days
before the other, which evinced symptoms of decay like its inseparable
neighbor.

Roger of Wendover says that in Lesser Brittany and Normandy, in 1062,
there was seen a female monster, consisting of two women joined about
the umbilicus and fused into a single lower extremity. They took their
food by two mouths but expelled it at a single orifice. At one time,
one of the women laughed, feasted, and talked, while the other wept,
fasted, and kept a religious silence. The account relates how one of
them died, and the survivor bore her dead sister about for three years
before she was overcome by the oppression and stench of the cadaver.
Batemen describes the birth of a boy in 1529, who had two heads, four
ears, four arms, but only two thighs and two legs. Buchanan speaks at
length of the famous "Scottish Brothers," who were the cynosure of the
eyes of the Court of James III of Scotland. This monster consisted of
two men, ordinary in appearance in the superior extremities, whose
trunks fused into a single lower extremity. The King took diligent care
of their education, and they became proficient in music, languages, and
other court accomplishments. Between them they would carry on animated
conversations, sometimes merging into curious debates, followed by
blows. Above the point of union they had no synchronous sensations,
while below, sensation was common to both. This monster lived
twenty-eight years, surviving the royal patron, who died June, 1488.
One of the brothers died some days before the other, and the survivor,
after carrying about his dead brother, succumbed to "infection from
putrescence." There was reported to have been born in Switzerland a
double headed male monster, who in 1538, at the age of thirty, was
possessed of a beard on each face, the two bodies fused at the
umbilicus into a single lower extremity. These two twins resembled one
another in contour and countenance. They were so joined that at rest
they looked upon one another. They had a single wife, with whom they
were said to have lived in harmony. In the Gentleman's Magazine about
one hundred and fifty years since there was given the portrait and
description of a double woman, who was exhibited all over the large
cities of Europe. Little can be ascertained anatomically of her
construction, with the exception that it was stated that she had two
heads, two necks, four arms, two legs, one pelvis, and one set of
pelvic organs.

The most celebrated monster of this type was Ritta-Christina, who was
born in Sassari, in Sardinia, March 23, 1829. These twins were the
result of the ninth confinement of their mother, a woman of thirty-two.
Their superior extremities were double, but they joined in a common
trunk at a point a little below the mammae.  Below this point they had
a common trunk and single lower extremities. The right one, christened
Ritta, was feeble and of a sad and melancholy countenance; the left,
Christina, was vigorous and of a gay and happy aspect. They suckled at
different times, and sensations in the upper extremities were distinct.
They expelled urine and feces simultaneously, and had the indications
in common. Their parents, who were very poor, brought them to Paris for
the purpose of public exhibition, which at first was accomplished
clandestinely, but finally interdicted by the public authorities, who
feared that it would open a door for psychologic discussion and
speculation. This failure of the parents to secure public patronage
increased their poverty and hastened the death of the children by
unavoidable exposure in a cold room. The nervous system of the twins
had little in common except in the line of union, the anus, and the
sexual organs, and Christina was in good health all through Ritta's
sickness; when Ritta died, her sister, who was suckling at the mother's
breast, suddenly relaxed hold and expired with a sigh. At the
postmortem, which was secured with some difficulty on account of the
authorities ordering the bodies to be burned, the pericardium was found
single, covering both hearts. The digestive organs were double and
separate as far as the lower third of the ilium, and the cecum was on
the left side and single, in common with the lower bowel. The livers
were fused and the uterus was double. The vertebral columns, which were
entirely separate above, were joined below by a rudimentary os
innorminatum. There was a junction between the manubrium of each. Sir
Astley Cooper saw a monster in Paris in 1792 which, by his description,
must have been very similar to Ritta-Christina.

The Tocci brothers were born in 1877 in the province of Turin, Italy.
They each had a well-formed head, perfect arms, and a perfect thorax to
the sixth rib; they had a common abdomen, a single anus, two legs, two
sacra, two vertebral columns, one penis, but three buttocks, the
central one containing a rudimentary anus. The right boy was christened
Giovanni-Batista, and the left Giacomo. Each individual had power over
the corresponding leg on his side, but not over the other one.  Walking
was therefore impossible. All their sensations and emotions were
distinctly individual and independent. At the time of the report, in
1882, they were in good health and showed every indication of attaining
adult age. Figure 48 represents these twins as they were exhibited
several years ago in Germany.

McCallum saw two female children in Montreal in 1878 named Marie-Rosa
Drouin. They formed a right angle with their single trunk, which
commenced at the lower part of the thorax of each.  They had a single
genital fissure and the external organs of generation of a female. A
little over three inches from the anus was a rudimentary limb with a
movable articulation; it measured five inches in length and tapered to
a fine point, being furnished with a distinct nail, and it contracted
strongly to irritation. Marie, the left child, was of fair complexion
and more strongly developed than Rosa. The sensations of hunger and
thirst were not experienced at the same time, and one might be asleep
while the other was crying. The pulsations and the respiratory
movements were not synchronous. They were the products of the second
gestation of a mother aged twenty-six, whose abdomen was of such
preternatural size during pregnancy that she was ashamed to appear in
public. The order of birth was as follows: one head and body, the lower
extremity, and the second body and head.

CLASS VII.--There are many instances of bicephalic monsters on record.
Pare mentions and gives an illustration of a female apparently single
in conformation, with the exception of having two heads and two necks.
The Ephemerides, Haller, Schenck, and Archenholz cite examples, and
there is an old account of a double-headed child, each of whose heads
were baptized, one called Martha and the other Mary. One was of a gay
and the other a sad visage, and both heads received nourishment; they
only lived a couple of days. There is another similar record of a
Milanese girl who had two heads, but was in all other respects single,
with the exception that after death she was found to have had two
stomachs. Besse mentions a Bavarian woman of twenty-six with two heads,
one of which was comely and the other extremely ugly; Batemen quotes
what is apparently the same case--a woman in Bavaria in 1541 with two
heads, one of which was deformed, who begged from door to door, and who
by reason of the influence of pregnant women was given her expenses to
leave the country.

A more common occurrence of this type is that in which there is fusion
of the two heads. Moreau speaks of a monster in Spain which was shown
from town to town. Its heads were fused; it had two mouths and two
noses; in each face an eye well conformed and placed above the nose;
there was a third eye in the middle of the forehead common to both
heads; the third eye was of primitive development and had two pupils.
Each face was well formed and had its own chin. Buffon mentions a cat,
the exact analogue of Moreau's case. Sutton speaks of a photograph sent
to Sir James Paget in 1856 by William Budd of Bristol. This portrays a
living child with a supernumerary head, which had mouth, nose, eyes,
and a brain of its own. The eyelids were abortive, and as there was no
orbital cavity the eyes stood out in the form of naked globes on the
forehead. When born, the corneas of both heads were transparent, but
then became opaque from exposure. The brain of the supernumerary head
was quite visible from without, and was covered by a membrane beginning
to slough. On the right side of the head was a rudimentary external
ear. The nurse said that when the child sucked some milk regurgitated
through the supernumerary mouth. The great physiologic interest in this
case lies in the fact that every movement and every act of the natural
face was simultaneously repeated by the supernumerary face in a
perfectly consensual manner, i.e., when the natural mouth sucked, the
second mouth sucked; when the natural face cried, yawned, or sneezed,
the second face did likewise; and the eyes of the two heads moved in
unison. The fate of the child is not known.

Home speaks of a child born in Bengal with a most peculiar fusion of
the head. The ordinary head was nearly perfect and of usual volume, but
fused with its vertex and reversed was a supernumerary head. Each head
had its own separate vessels and brain, and each an individual
sensibility, but if one had milk first the other had an abundance of
saliva in its mouth. It narrowly escaped being burned to death at
birth, as the midwife, greatly frightened by the monstrous appearance,
threw it into the fire to destroy it, from whence it was rescued,
although badly burned, the vicious conformation of the accessory head
being possibly due to the accident. At the age of four it was bitten by
a venomous serpent and, as a result, died. Its skull is in the
possession of the Royal College of Surgeons in London.

The following well-known story of Edward Mordake, though taken from lay
sources, is of sufficient notoriety and interest to be mentioned here:--

"One of the weirdest as well as most melancholy stories of human
deformity is that of Edward Mordake, said to have been heir to one of
the noblest peerages in England. He never claimed the title, however,
and committed suicide in his twenty-third year.  He lived in complete
seclusion, refusing the visits even of the members of his own family.
He was a young man of fine attainments, a profound scholar, and a
musician of rare ability.  His figure was remarkable for its grace, and
his face--that is to say, his natural face--was that of an Antinous.
But upon the back of his head was another face, that of a beautiful
girl, 'lovely as a dream, hideous as a devil.' The female face was a
mere mask, 'occupying only a small portion of the posterior part of the
skull, yet exhibiting every sign of intelligence, of a malignant sort,
however.' It would be seen to smile and sneer while Mordake was
weeping. The eyes would follow the movements of the spectator, and the
lips would 'gibber without ceasing.' No voice was audible, but Mordake
avers that he was kept from his rest at night by the hateful whispers
of his 'devil twin,' as he called it, 'which never sleeps, but talks to
me forever of such things as they only speak of in hell. No imagination
can conceive the dreadful temptations it sets before me. For some
unforgiven wickedness of my forefathers I am knit to this fiend--for a
fiend it surely is. I beg and beseech you to crush it out of human
semblance, even if I die for it.' Such were the words of the hapless
Mordake to Manvers and Treadwell, his physicians. In spite of careful
watching he managed to procure poison, whereof he died, leaving a
letter requesting that the 'demon face' might be destroyed before his
burial, 'lest it continues its dreadful whisperings in my grave.' At
his own request he was interred in a waste place, without stone or
legend to mark his grave."

A most curious case was that of a Fellah woman who was delivered at
Alexandria of a bicephalic monster of apparently eight months'
pregnancy. This creature, which was born dead, had one head white and
the other black the change of color commencing at the neck of the black
head. The bizarre head was of negro conformation and fully developed,
and the colored skin was found to be due to the existence of pigment
similar to that found in the black race. The husband of the woman had a
light brown skin, like an ordinary Fellah man, and it was ascertained
that there were some negro laborers in port during the woman's
pregnancy; but no definite information as to her relations with them
could be established, and whether this was a case of maternal
impression or superfetation can only be a matter of conjecture.

Fantastic monsters, such as acephalon, paracephalon, cyclops,
pseudencephalon, and the janiceps, prosopthoracopagus, disprosopus,
etc., although full of interest, will not be discussed here, as none
are ever viable for any length of time, and the declared intention of
this chapter is to include only those beings who have lived.

CLASS VIII.--The next class includes the parasitic terata, monsters
that consist of one perfect body, complete in every respect, but from
the neighborhood of whose umbilicus depends some important portion of a
second body. Pare, Benivenius, and Columbus describe adults with
acephalous monsters attached to them. Schenck mentions 13 cases, 3 of
which were observed by him.  Aldrovandus shows 3 illustrations under
the name of "monstrum bicorpum monocephalon." Bustorf speaks of a case
in which the nates and lower extremities of one body proceeded out of
the abdomen of the other, which was otherwise perfect. Reichel and
Anderson mention a living parasitic monster, the inferior trunk of one
body proceeding from the pectoral region of the other.

Pare says that there was a man in Paris in 1530, quite forty years of
age, who carried about a parasite without a head, which hung pendant
from his belly. This individual was exhibited and drew great crowds.
Pare appends an illustration, which is, perhaps, one of the most
familiar in all teratology. He also gives a portrait of a man who had a
parasitic head proceeding from his epigastrium, and who was born in
Germany the same year that peace was made with the Swiss by King
Francis. This creature lived to manhood and both heads were utilized in
alimentation.  Bartholinus details a history of an individual named
Lazarus-Joannes Baptista Colloredo, born in Genoa in 1617, who
exhibited himself all over Europe. From his epigastrium hung an
imperfectly developed twin that had one thigh, hands, body, arms, and a
well-formed head covered with hair, which in the normal position hung
lowest. There were signs of independent existence in the parasite,
movements of respiration, etc., but its eyes were closed, and, although
saliva constantly dribbled from its open mouth, nothing was ever
ingested. The genitals were imperfect and the arms ended in badly
formed hands. Bartholinus examined this monster at twenty-two, and has
given the best report, although while in Scotland in 1642 he was again
examined, and accredited with being married and the father of several
children who were fully and admirably developed. Moreau quotes a case
of an infant similar in conformation to the foregoing monster, who was
born in Switzerland in 1764, and whose supernumerary parts were
amputated by means of a ligature.  Winslow reported before the Academie
Royale des Sciences the history of a girl of twelve who died at the
Hotel-Dieu in 1733.  She was of ordinary height and of fair
conformation, with the exception that hanging from the left flank was
the inferior half of another girl of diminutive proportions. The
supernumerary body was immovable, and hung so heavily that it was said
to be supported by the hands or by a sling. Urine and feces were
evacuated at intervals from the parasite, and received into a diaper
constantly worn for this purpose. Sensibility in the two was common, an
impression applied to the parasite being felt by the girl. Winslow
gives an interesting report of the dissection of this monster, and
mentions that he had seen an Italian child of eight who had a small
head proceeding from under the cartilage of the third left rib.
Sensibility was common, pinching the ear of the parasitic head causing
the child with the perfect head to cry. Each of the two heads received
baptism, one being named John and the other Matthew. A curious question
arose in the instance of the girl, as to whether the extreme unction
should be administered to the acephalous fetus as well as to the child.

In 1742, during the Ambassadorship of the Marquis de l'Hopital at
Naples, he saw in that city an aged man, well conformed, with the
exception that, like the little girl of Winslow, he had the inferior
extremities of a male child growing from his epigastric region. Haller
and Meckel have also observed cases like this.  Bordat described before
the Royal Institute of France, August, 1826, a Chinaman, twenty-one
years of age, who had an acephalous fetus attached to the surface of
his breast (possibly "A-ke").

Dickinson describes a wonderful child five years old, who, by an
extraordinary freak of nature, was an amalgamation of two children.
From the body of an otherwise perfectly formed child was a
supernumerary head protruding from a broad base attached to the lower
lumbar and sacral region. This cephalic mass was covered with hair
about four or five inches long, and showed the rudiments of an eye,
nose, mouth, and chin. This child was on exhibition when Dickinson saw
it. Montare and Reyes were commissioned by the Academy of Medicine of
Havana to examine and report on a monstrous girl of seven months,
living in Cuba. The girl was healthy and well developed, and from the
middle line of her body between the xiphoid cartilage and the
umbilicus, attached by a soft pedicle, was an accessory individual,
irregular, of ovoid shape, the smaller end, representing the head,
being upward. The parasite measured a little over 1 foot in length, 9
inches about the head, and 7 3/4 inches around the neck. The cranial
bones were distinctly felt, and the top of the head was covered by a
circlet of hair. There were two rudimentary eyebrows; the left eye was
represented by a minute perforation encircled with hair; the right eye
was traced by one end of a mucous groove which ran down to another
transverse groove representing the mouth; the right third of this
latter groove showed a primitive tongue and a triangular tooth, which
appeared at the fifth month. There was a soft, imperforate nose, and
the elements of the vertebral column could be distinguished beneath the
skin; there were no legs; apparently no vascular sounds; there was
separate sensation, as the parasite could be pinched without attracting
the perfect infant's notice. The mouth of the parasite constantly
dribbled saliva, but showed no indication of receiving aliment.

Louise L., known as "La dame a quatre jambes," was born in 1869, and
had attached to her pelvis another rudimentary pelvis and two atrophied
legs of a parasite, weighing 8 kilos. The attachment was effected by
means of a pedicle 33 cm. in diameter, having a bony basis, and being
fixed without a joint. The attachment almost obliterated the vulva and
the perineum was displaced far backward. At the insertion of the
parasite were two rudimentary mammae, one larger than the other. No
genitalia were seen on the parasite and it exhibited no active
movements, the joints of both limbs being ankylosed. The woman could
localize sensations in the parasite except those of the feet. She had
been married five years, and bore, in the space of three years, two
well-formed daughters.

Quite recently there was exhibited in the museums of the United States
an individual bearing the name "Laloo," who was born in Oudh, India,
and was the second of four children. At the time of examination he was
about nineteen years of age. The upper portion of a parasite was firmly
attached to the lower right side of the sternum of the individual by a
bony pedicle, and lower by a fleshy pedicle, and apparently contained
intestines. The anus of the parasite was imperforate; a well-developed
penis was found, but no testicles; there was a luxuriant growth of hair
on the pubes. The penis of the parasite was said to show signs of
erection at times, and urine passed through it without the knowledge of
the boy. Perspiration and elevation of temperature seemed to occur
simultaneously in both. To pander to the morbid curiosity of the
curious, the "Dime Museum" managers at one time shrewdly clothed the
parasite in female attire, calling the two brother and sister; but
there is no doubt that all the traces of sex were of the male type. An
analogous case was that of "A-Ke," a Chinaman, who was exhibited in
London early in the century, and of whom and his parasite anatomic
models are seen in our museums.  Figure 58 represents an epignathus, a
peculiar type parasitic monster, in which the parasite is united to the
inferior maxillary bone of the autosite.

CLASS IX.--Of "Lusus naturae" none is more curious than that of
duplication of the lower extremities. Pare says that on January 9,
1529, there was living in Germany a male infant having four legs and
four arms. In Paris, at the Academie des Sciences, on September 6,
1830, there was presented by Madame Hen, a midwife, a living male child
with four legs, the anus being nearly below the middle of the third
buttock; and the scrotum between the two left thighs, the testicles not
yet descended. There was a well-formed and single pelvis, and the
supernumerary legs were immovable. Aldrovandus mentions several similar
instances, and gives the figure of one born in Rome; he also describes
several quadruped birds. Bardsley speaks of a male child with one head,
four arms, four legs, and double generative organs. He gives a portrait
of the child when it was a little over a year old.  Heschl published in
Vienna in 1878 a description of a girl of seventeen, who instead of
having a duplication of the superior body, as in "Millie-Christine, the
two-headed nightingale," had double parts below the second lumbar
vertebra. Her head and upper body resembled a comely, delicate girl of
twelve.

Wells a describes Mrs. B., aged twenty, still alive and healthy.  The
duplication in this case begins just above the waist, the spinal column
dividing at the third lumbar vertebra, below this point everything
being double. Micturition and defecation occur at different times, but
menstruation occurs simultaneously. She was married at nineteen, and
became pregnant a year later on the left side, but abortion was induced
at the fourth month on account of persistent nausea and the expectation
of impossible delivery. Whaley, in speaking of this case, said Mrs. B.
utilized her outside legs for walking; he also remarks that when he
informed her that she was pregnant on the left side she replied, "I
think you are mistaken; if it had been on my right side I would come
nearer believing it;"--and after further questioning he found, from the
patient's observation, that her right genitals were almost invariably
used for coitus. Bechlinger of Para, Brazil, describes a woman of
twenty-five, a native of Martinique, whose father was French and mother
a quadroon, who had a modified duplication of the lower body. There was
a third leg attached to a continuation of the processus coceygeus of
the sacrum, and in addition to well developed mammae regularly
situated, there were two rudimentary ones close together above the
pubes. There were two vaginae and two well-developed vulvae, both
having equally developed sensations. The sexual appetite was markedly
developed, and coitus was practised in both vaginae. A somewhat similar
case, possibly the same, is that of Blanche Dumas, born in 1860.  She
had a very broad pelvis, two imperfectly developed legs, and a
supernumerary limb attached to the symphysis, without a joint, but with
slight passive movement. There was a duplication of bowel, bladder, and
genitalia. At the junction of the rudimentary limb with the body, in
front, were two rudimentary mammary glands, each containing a nipple.

Other instances of supernumerary limbs will be found in Chapter VI.

CLASS X.--The instances of diphallic terata, by their intense interest
to the natural bent of the curious mind, have always elicited much
discussion. To many of these cases have been attributed exaggerated
function, notwithstanding the fact that modern observation almost
invariably shows that the virile power diminishes in exact proportion
to the extent of duplication.  Taylor quotes a description of a
monster, exhibited in London, with two distinct penises, but with only
one distinct testicle on either side. He could exercise the function of
either organ.

Schenck, Schurig, Bartholinus, Loder, and Ollsner report instances of
diphallic terata; the latter case a was in a soldier of Charles VI,
twenty-two years old, who applied to the surgeon for a bubonic
affection, and who declared that he passed urine from the orifice of
the left glans and also said that he was incapable of true coitus.
Valentini mentions an instance in a boy of four, in which the two
penises were superimposed. Bucchettoni speaks of a man with two penises
placed side by side. There was an anonymous case described of a man of
ninety-three with a penis which was for more than half its length
divided into two distinct members, the right being somewhat larger than
the left. From the middle of the penis up to the symphysis only the
lower wall of the urethra was split. Jenisch describes a diphallic
infant, the offspring of a woman of twenty-five who had been married
five years. Her first child was a well-formed female, and the second,
the infant in question, cried much during the night, and several times
vomited dark-green matter. In lieu of one penis there were two,
situated near each other, the right one of natural size and the left
larger, but not furnished with a prepuce. Each penis had its own
urethra, from which dribbled urine and some meconium.  There was a
duplication of each scrotum, but only one testicle in each, and several
other minor malformations.

Gore, reported by Velpeau, has seen an infant of eight and one-half
months with two penises and three lower extremities. The penises were 4
cm. apart and the scrotum divided, containing one testicle in each
side. Each penis was provided with a urethra, urine being discharged
from both simultaneously. In a similar case, spoken of by
Geoffroy-Saint-Hilaire, the two organs were also separate, but urine
and semen escaped sometimes from one, sometimes from both.

The most celebrated of all the diphallic terata was Jean Baptista dos
Santos, who when but six months old was spoken of by Acton.  His father
and mother were healthy and had two well-formed children. He was easily
born after an uneventful pregnancy. He was good-looking, well
proportioned, and had two distinct penises, each as large as that of a
child of six months.  Urination proceeded simultaneously from both
penises; he had also two scrotums. Behind and between the legs there
was another limb, or rather two, united throughout their length. It was
connected to the pubis by a short stem 1/2 inch long and as large as
the little finger, consisting of separate bones and cartilages. There
was a patella in the supernumerary limb on the anal aspect, and a joint
freely movable. This compound limb had no power of motion, but was
endowed with sensibility. A journal in London, after quoting Acton's
description, said that the child had been exhibited in Paris, and that
the surgeons advised operation.  Fisher, to whom we are indebted for an
exhaustive work in Teratology, received a report from Havana in July,
1865, which detailed a description of Santos at twenty-two years of
age, and said that he was possessed of extraordinary animal passion,
the sight of a female alone being sufficient to excite him. He was said
to use both penises, after finishing with one continuing with the
other; but this account of him does not agree with later descriptions,
in which no excessive sexual ability had been noticed. Hart describes
the adult Santos in full, and accompanies his article with an
illustration. At this time he was said to have developed double
genitals, and possibly a double bladder communicating by an imperfect
septum. At adulthood the anus was three inches anterior to the os
coceygeus. In the sitting or lying posture the supernumerary limb
rested on the front of the inner surface of the lower third of his left
thigh. He was in the habit of wearing this limb in a sling, or bound
firmly to the right thigh, to prevent its unseemly dangling when erect.
The perineum proper was absent, the entire space between the anus and
the posterior edge of the scrotum being occupied by the pedicle.
Santos' mental and physical functions were developed above normal, and
he impressed everybody with his accomplishments.
Geoffroy-Saint-Hilaire records an instance in which the conformation
was similar to that of Santos. There was a third lower extremity
consisting of two limbs fused into one with a single foot containing
ten distinct digits. He calls the case one of arrested twin development.

Van Buren and Keyes describe a case in a man of forty-two, of good,
healthy appearance. The two distinct penises of normal size were
apparently well formed and were placed side by side, each attached at
its root to the symphysis. Their covering of skin was common as far as
the base of the glans; at this point they seemed distinct and perfect,
but the meatus of the left was imperforate.  The right meatus was
normal, and through it most of the urine passed, though some always
dribbled through an opening in the perineum at a point where the root
of the scrotum should have been. On lifting the double-barreled penis
this opening could be seen and was of sufficient size to admit the
finger. On the right side of the aperture was an elongated and rounded
prominence similar in outline to a labium majus. This prominence
contained a testicle normal in shape and sensibility, but slightly
undersized, and surrounded, as was evident from its mobility, by a
tunica vaginalis. The left testicle lay on the tendon of the adductor
longus in the left groin; it was not fully developed, but the patient
had sexual desires, erections, and emissions.  Both penises became
erect simultaneously, the right more vigorously. The left leg was
shorter than the right and congenitally smaller; the mammae were of
normal dimensions.

Sangalli speaks of a man of thirty-five who had a supernumerary penis,
furnished with a prepuce and capable of erection. At the apex of the
glans opened a canal about 12 cm. long, through which escaped monthly a
serous fluid. Smith mentions a man who had two penises and two
bladders, on one of which lithotomy was performed. According to
Ballantyne, Taruffi, the scholarly observer of terata, mentions a child
of forty-two months and height of 80 cm. who had two penises, each
furnished with a urethra and well-formed scrotal sacs which were
inserted in a fold of the groin. There were two testicles felt in the
right scrotum and one in the left. Fecal evacuations escaped through
two anal orifices. There is also another case mentioned similar to the
foregoing in a man of forty; but here there was an osseous projection
in the middle line behind the bladder. This patient said that erection
was simultaneous in both penises, and that he had not married because
of his chagrin over his deformity. Cole speaks of a child with two
well-developed male organs, one to the left and the other to the right
of the median line, and about 1/4 or 1/2 inch apart at birth. The
urethra bifurcated in the perineal region and sent a branch to each
penis, and urine passed from each meatus. The scrotum was divided into
three compartments by two raphes, and each compartment contained a
testicle. The anus at birth was imperforate, but the child was
successfully operated on, and at its sixtieth day weighed 17 pounds.

Lange says that an infant was brought to Karg for relief of anal
atresia when fourteen days old. It was found to possess duplicate
penises, which communicated each to its distinct half of the bladder as
defined by a median fold. The scrotum was divided into three portions
by two raphes, and each lateral compartment contained a fully formed
testicle. This child died because of its anal malformation, which we
notice is a frequent associate of malformations or duplicity of the
penis. There is an example in an infant described in which there were
two penises, each about 1/2 inch long, and a divided scrotal sac 21
inches long. Englisch speaks of a German of forty who possessed a
double penis of the bifid type.

Ballantyne and his associates define diphallic terata as individuals
provided with two more or less well-formed and more or less separate
penises, who may show also other malformations of the adjoining parts
and organs (e.g., septate bladder), but who are not possessed of more
than two lower limbs. This definition excludes, therefore, the cases in
which in addition to a double penis there is a supernumerary lower
extremity--such a case, for example, as that of Jean Baptista dos
Santos, so frequently described by teratologists. It also excludes the
more evident double terata, and, of course, the cases of duplication of
the female genital organs (double clitoris, vulva, vagina, and uterus).
Although Schurig, Meckel, Himly, Taruffi, and others give bibliographic
lists of diphallic terata, even in them erroneous references are
common, and there is evidence to show that many cases have been
duplicated under different names.  Ballantyne and Skirving have
consulted all the older original references available and eliminated
duplications of reports and, adhering to their original definition,
have collected and described individually 20 cases; they offer the
following conclusions:--

1. Diphallus, or duplication of the penis in an otherwise apparently
single individual, is a very rare anomaly, records of only 20 cases
having been found in a fairly exhaustive search through teratologic
literature. As a distinct and well-authenticated type it has only quite
recently been recognized by teratologists.

2. It does not of itself interfere with intrauterine or extrauterine
life; but the associated anomalies (e.g., atresia ani) may be sources
of danger. If not noticed at birth, it is not usually discovered till
adult life, and even then the discovery is commonly accidental.

3. With regard to the functions of the pelvic viscera, urine may be
passed by both penises, by one only, or by neither. In the last
instance it finds exit by an aperture in the perineum. There is reason
to believe that semen may be passed in the same way; but in most of the
recorded cases there has been sterility, if not inability to perform
the sexual act.

4. All the degrees of duplication have been met with, from a fissure of
the glans penis to the presence of two distinct penises inserted at
some distance from each other in the inguinal regions.

5. The two penises are usually somewhat defective as regards prepuce,
urethra, etc.; they may lie side by side, or more rarely may be
situated anteroposteriorly; they may be equal in size, or less commonly
one is distinctly larger than the other; and one or both may be
perforate or imperforate.

6. The scrotum may be normal or split; the testicles, commonly two in
number, may be normal or atrophic, descended or undescended; the
prostate may be normal or imperfectly developed, as may also the vasa
deferentia and vesiculae seminales.

7. The commonly associated defects are: More or less completely septate
bladder, atresia ani, or more rarely double anus, double urethra,
increased breadth of the bony pelvis with defect of the symphysis
pubis, and possibly duplication of the lower end of the spine, and
hernia of some of the abdominal contents into a perineal pouch. Much
more rarely, duplication of the heart, lungs, stomach, and kidneys has
been noted, and the lower limbs may be shorter than normal.

CLASS XI.--Cases of fetus in fetu, those strange instances in which one
might almost say that a man may be pregnant with his brother or sister,
or in which an infant may carry its twin without the fact being
apparent, will next be discussed. The older cases were cited as being
only a repetition of the process by which Eve was born of Adam. Figure
63 represents an old engraving showing the birth of Eve. Bartholinus,
the Ephemerides, Otto, Paullini, Schurig, and Plot speak of instances
of fetus in fetu. Ruysch describes a tumor contained in the abdomen of
a man which was composed of hair, molar teeth, and other evidences of a
fetus. Huxham reported to the Royal Society in 1748 the history of a
child which was born with a tumor near the anus larger than the whole
body of the child; this tumor contained rudiments of an embryo. Young
speaks of a fetus which lay encysted between the laminae of the
transverse mesocolon, and Highmore published a report of a fetus in a
cyst communicating with the duodenum.  Dupuytren gives an example in a
boy of thirteen, in whom was found a fetus. Gaetano-Nocito, cited by
Philipeaux, has the history of a taken with a great pain in the right
hypochondrium, and from which issued subsequently fetal bones and a
mass of macerated embryo. His mother had had several double
pregnancies, and from the length of the respective tibiae one of the
fetuses seemed to be of two months' and the other of three months'
intrauterine life. The man died five years after the abscess had burst
spontaneously.

Brodie speaks of a case in which fetal remains were taken from the
abdomen of a girl of two and one-half years. Gaither describes a child
of two years and nine months, supposed to be affected with ascites, who
died three hours after the physician's arrival. In its abdomen was
found a fetus weighing almost two pounds and connected to the child by
a cord resembling an umbilical cord. This child was healthy for about
nine months, and had a precocious longing for ardent spirits, and drank
freely an hour before its death.

Blundell says that he knew "a boy who was literally and without evasion
with child, for the fetus was contained in a sac communicating with the
abdomen and was connected to the side of the cyst by a short umbilical
cord; nor did the fetus make its appearance until the boy was eight or
ten years old, when after much enlargement of pregnancy and subsequent
flooding the boy died." The fetus, removed after death, on the whole
not very imperfectly formed, was of the size of about six or seven
months' gestation. Bury cites an account of a child that had a second
imperfectly developed fetus in its face and scalp. There was a boy by
the name of Bissieu who from the earliest age had a pain in one of his
left ribs; this rib was larger than the rest and seemed to have a tumor
under it. He died of phthisis at fourteen, and after death there was
found in a pocket lying against the transverse colon and communicating
with it all the evidences of a fetus.

At the Hopital de la Charite in Paris, Velpeau startled an audience of
500 students and many physicians by saying that he expected to find a
rudimentary fetus in a scrotal tumor placed in his hands for operation.
His diagnosis proved correct, and brought him resounding praise, and
all wondered as to his reasons for expecting a fetal tumor. It appears
that he had read with care a report by Fatti of an operation on the
scrotum of a child which had increased in size as the child grew, and
was found to contain the ribs, the vertebral column, the lower
extremities as far as the knees, and the two orbits of a fetus; and
also an account of a similar operation performed by Wendt of Breslau on
a Silesian boy of seven. The left testicle in this case was so swollen
that it hung almost to the knee, and the fetal remains removed weighed
seven ounces.

Sulikowski relates an instance of congenital fetation in the umbilicus
of a girl of fourteen, who recovered after the removal of the anomaly.
Aretaeos described to the members of the medical fraternity in Athens
the case of a woman of twenty-two, who bore two children after a seven
months' pregnancy. One was very rudimentary and only 21 inches long,
and the other had an enormous head resembling a case of hydrocephalus.
On opening the head of the second fetus, another, three inches long,
was found in the medulla oblongata, and in the cranial cavity with it
were two additional fetuses, neither of which was perfectly formed.

Broca speaks of a fetal cyst being passed in the urine of a man of
sixty-one; the cyst contained remnants of hair, bone, and cartilage.
Atlee submits quite a remarkable case of congenital ventral gestation,
the subject being a girl of six, who recovered after the discharge of
the fetal mass from the abdomen. McIntyre speaks of a child of eleven,
playing about and feeling well, but whose abdomen progressively
increased in size 1 1/2 inches each day. After ten days there was a
large fluctuating mass on the right side; the abdomen was opened and
the mass enucleated; it was found to contain a fetal mass weighing
nearly five pounds, and in addition ten pounds of fluid were removed.
The child made an early recovery. Rogers mentions a fetus that was
found in a man's bladder. Bouchacourt reports the successful
extirpation of the remains of a fetus from the rectum of a child of
six. Miner describes a successful excision of a congenital gestation.

Modern literature is full of examples, and nearly every one of the
foregoing instances could be paralleled from other sources.  Rodriguez
is quoted as reporting that in July, 1891, several newspapers in the
city of Mexico published, under the head of "A Man-mother," a wonderful
story, accompanied by wood-cuts, of a young man from whose body a great
surgeon had extracted a "perfectly developed fetus." One of these
wood-cuts represented a tumor at the back of a man opened and
containing a crying baby.  In commenting upon this, after reviewing
several similar cases of endocymian monsters that came under his
observation in Mexico, Rodriguez tells what the case which had been so
grossly exaggerated by the lay journals really was: An Indian boy, aged
twenty-two, presented a tumor in the sacrococcygeal region measuring 53
cm. in circumference at the base, having a vertical diameter of 17 cm.
and a transverse diameter of 13 cm. It had no pedicle and was fixed,
showing unequal consistency. At birth this tumor was about the size of
a pigeon's egg. A diagnosis of dermoid cyst was made and two operations
were performed on the boy, death following the second. The skeleton
showed interesting conditions; the rectum and pelvic organs were
natural, and the contents of the cyst verified the diagnosis.

Quite similar to the cases of fetus in fetu are the instances of
dermoid cysts. For many years they have been a mystery to
physiologists, and their origin now is little more than hypothetic. At
one time the fact of finding such a formation in the ovary of an
unmarried woman was presumptive evidence that she was unchaste; but
this idea was dissipated as soon as examples were reported in children,
and to-day we have a well-defined difference between congenital and
extrauterine pregnancy. Dermoid cysts of the ovary may consist only of
a wall of connective tissue lined with epidermis and containing
distinctly epidermic scales which, however, may be rolled up in firm
masses of a more or less soapy consistency; this variety is called by
Orth epidermoid cyst; or, according to Warren, a form of cyst made up
of skin containing small and ill-defined papillae, but rich in hair
follicles and sebaceous glands. Even the erector pili muscle and the
sudoriparous gland are often found. The hair is partly free and rolled
up into thick balls or is still attached to the walls. A large mass of
sebaceous material is also found in these cysts. Thomson reports a case
of dermoid cyst of the bladder containing hair, which cyst he removed.
It was a pedunculated growth, and it was undoubtedly vesical and not
expelled from some ovarian source through the urinary passage, as
sometimes occurs.

The simpler forms of the ordinary dermoid cysts contain bone and teeth.
The complicated teratoma of this class may contain, in addition to the
previously mentioned structures, cartilage and glands, mucous and
serous membrane, muscle, nerves, and cerebral substance, portions of
eyes, fingers with nails, mammae, etc.  Figure 64 represents a cyst
containing long red hair that was removed from a blonde woman aged
forty-four years who had given birth to six children. Cullingworth
reports the history of a woman in whom both ovaries were apparently
involved by dermoids, who had given birth to 12 children and had three
miscarriages--the last, three months before the removal of the growths.
The accompanying illustration, taken from Baldy, pictures a dermoid
cyst of the complicated variety laid open and exposing the contents in
situ. Mears of Philadelphia reports a case of ovarian cyst removed from
a girl of six and a half by Bradford of Kentucky in 1875. From this age
on to adult life many similar cases are recorded. Nearly every medical
museum has preserved specimens of dermoid cysts, and almost all
physicians are well acquainted with their occurrence. The curious
formations and contents and the bizarre shapes are of great variety.
Graves mentions a dermoid cyst containing the left side of a human
face, an eye, a molar tooth, and various bones. Dermoid cysts are found
also in regions of the body quite remote from the ovary. The so-called
"orbital wens" are true inclusion of the skin of a congenital origin,
as are the nasal dermoids and some of the cysts of the neck.

Weil reported the case of a man of twenty-two years who was born with
what was supposed to be a spina bifida in the lower sacral region.
According to Senn, the swelling never caused any pain or inconvenience
until it inflamed, when it opened spontaneously and suppurated,
discharging a large quantity of offensive pus, hair, and sebaceous
material, thus proving it to have been a dermoid.  The cyst was freely
incised, and there were found numerous openings of sweat glands, from
which drops of perspiration escaped when the patient was sweating.

Dermoid cysts of the thorax are rare. Bramann reported a case in which
a dermoid cyst of small size was situated over the sternum at the
junction of the manubrium with the gladiolus, and a similar cyst in the
neck near the left cornu of the hyoid bone.  Chitten removed a dermoid
from the sternum of a female of thirty-nine, the cyst containing 11
ounces of atheromatous material. In the Museum of St. Bartholomew's
Hospital in London there is a congenital tumor which was removed from
the anterior mediastinum of a woman of twenty one, and contained
portions of skin, fat, sebaceous material, and two pieces of bone
similar to the superior maxilla, and in which several teeth were found.
Dermoids are found in the palate and pharynx, and open dermoids of the
conjunctiva are classified by Sutton with the moles.  According to
Senn, Barker collected sixteen dermoid tumors of the tongue. Bryk
successfully removed a tumor of this nature the size of a fist.
Wellington Gray removed an enormous lingual dermoid from the mouth of a
negro. It contained 40 ounces of atheromatous material. Dermoids of the
rectum are reported. Duyse reports the history of a case of labor
during which a rectal dermoid was expelled. The dermoid contained a
cerebral vesicle, a rudimentary eye, a canine and a molar tooth, and a
piece of bone. There is little doubt that many cases of fetus in fetu
reported were really dermoids of the scrotum.

Ward reports the successful removal of a dermoid cyst weighing 30
pounds from a woman of thirty-two, the mother of two children aged ten
and twelve, respectively. The report is briefly as follows: "The
patient has always been in good health until within the last year,
during which time she has lost flesh and strength quite rapidly, and
when brought to my hospital by her physician, Dr. James of
Williamsburg, Kansas, was quite weak, although able to walk about the
house. A tumor had been growing for a number of years, but its growth
was so gradual that the patient had not considered her condition
critical until quite recently. The tumor was diagnosed to be cystoma of
the left ovary. Upon opening the sac with the trocar we were confronted
by complications entirely unlooked for, and its use had to be abandoned
entirely because the thick contents of the cyst would not flow freely,
and the presence of sebaceous matter blocked the instrument. As much of
the fluid as possible was removed, and the abdominal incision was
enlarged to allow of the removal of the large tumor. An ovarian
hematoma the size of a large orange was removed from the right side. We
washed the intestines quite as one would wash linen, since some of the
contents of the cyst had escaped into the abdominal cavity. The abdomen
was closed without drainage, and the patient placed in bed without
experiencing the least shock.  Her recovery was rapid and uneventful.
She returned to her home in four weeks after the operation.

"The unusual feature in this case was the nature of the contents of the
sac. There was a large quantity of long straight hair growing from the
cyst wall and an equal amount of loose hair in short pieces floating
through the tumor-contents, a portion of which formed nuclei for what
were called 'moth-balls,' of which there were about 1 1/2 gallons.
These balls, or marbles, varied from the size of moth-balls, as
manufactured and sold by druggists, to that of small walnuts. They
seemed to be composed of sebaceous matter, and were evidently formed
around the short hairs by the motion of the fluid produced by walking
or riding.  There was some tissue resembling true skin attached to the
inner wall of the sac."

There are several cases of multiple dermoid cysts on record, and they
may occur all over the body. Jamieson reports a case in which there
were 250, and in Maclaren's case there were 132.  According to Crocker,
Hebra and Rayer also each had a case. In a case of Sangster, reported
by Politzer, although most of the dermoids, as usual, were like
fibroma-nodules and therefore the color of normal skin, those over the
mastoid processes and clavicle were lemon-yellow, and were generally
thought to be xanthoma until they were excised, and Politzer found they
were typical dermoid cysts with the usual contents of degenerated
epithelium and hair.

Hermaphroditism.--Some writers claim that Adam was the first
hermaphrodite and support this by Scriptural evidence. We find in some
of the ancient poets traces of an Egyptian legend in which the goddess
of the moon was considered to be both male and female. From mythology
we learn that Hermaphroditus was the son of Hermes, or Mercury, and
Venus Aphrodite, and had the powers both of a father and mother. In
speaking of the foregoing Ausonius writes, "Cujus erat facies in qua
paterque materque cognosci possint, nomen traxit ab illis." Ovid and
Virgil both refer to legendary hermaphrodites, and the knowledge of
their existence was prevalent in the olden times. The ancients
considered the birth of hermaphrodites bad omens, and the Athenians
threw them into the sea, the Romans, into the Tiber.  Livy speaks of an
hermaphrodite being put to death in Umbria, and another in Etruria.
Cicero, Aristotle, Strabonius, and Pliny all speak concerning this
subject. Martial and Tertullian noticed this anomaly among the Romans.
Aetius and Paulus Aegineta speak of females in Egypt with prolonged
clitorides which made them appear like hermaphrodites. Throughout the
Middle Ages we frequently find accounts, naturally exaggerated, of
double-sexed creatures. Harvey, Bartholinus, Paullini, Schenck, Wolff,
Wrisberg, Zacchias, Marcellus Donatus, Haller, Hufeland, de Graff, and
many others discuss hermaphroditism. Many classifications have been
given, as, e.g., real and apparent; masculine, feminine, or neuter;
horizontal and vertical; unilateral and bilateral, etc. The anomaly in
most cases consists of a malformation of the external genitalia. A
prolonged clitoris, prolapsed ovaries, grossness of figure, and hirsute
appearance have been accountable for many supposed instances of
hermaphrodites. On the other hand, a cleft scrotum, an ill-developed
penis, perhaps hypospadias or epispadias, rotundity of the mammae, and
feminine contour have also provoked accounts of similar instances. Some
cases have been proved by dissection to have been true hermaphrodites,
portions or even entire genitalia of both sexes having been found.

Numerous accounts, many mythical, but always interesting, are given of
these curious persons. They have been accredited with having performed
the functions of both father and mother, notwithstanding the statements
of some of the best authorities that they are always sterile.
Observation has shown that the sexual appetite diminishes in proportion
to the imperfections in the genitalia, and certainly many of these
persons are sexually indifferent.

We give descriptions of a few of the most famous or interesting
instances of hermaphroditism. Pare speaks of a woman who, besides a
vulva, from which she menstruated, had a penis, but without prepuce or
signs of erectility. Haller alludes to several cases in which prolonged
clitorides have been the cause of the anomaly.  In commenting on this
form of hermaphroditism Albucasiusus describes a necessary operation
for the removal of the clitoris.

Columbus relates the history of an Ethiopian woman who was evidently a
spurious female hermaphrodite. The poor wretch entreated him to cut off
her penis, an enlarged clitoris, which she said was an intolerable
hindrance to her in coitus. De Graff and Riolan describe similar cases.
There is an old record of a similar creature, supposing herself to be a
male, who took a wife, but previously having had connection with a man,
the outcome of which was pregnancy, was shortly after marriage
delivered of a daughter. There is an account of a person in Germany
who, for the first thirty years of life, was regarded as feminine, and
being of loose morals became a mother. At a certain period she began to
feel a change in her sexual inclinations; she married and became the
father of a family. This is doubtless a distortion of the facts of the
case of Catherine or Charles Hoffman, born in 1824, and who was
considered a female until the age of forty. At puberty she had the
instincts of a woman, and cohabitated with a male lover for twenty
years. Her breasts were well formed and she menstruated at nineteen. At
the age of forty-six her sexual desires changed, and she attempted
coitus as a man, with such evident satisfaction that she married a
woman soon afterward. Fitch speaks of a house-servant with masculine
features and movements, aged twenty-eight, and 5 feet and 9 inches
tall, who was arrested by the police for violating the laws governing
prostitution. On examination, well-developed male and female organs of
generation were found. The labia majora were normal and flattened on
the anterior surface. The labia minora and hymen were absent. The
vagina was spacious and the woman had a profuse leukorrhea. She stated
that several years previously she gave birth to a normal child. In
place of a clitoris she had a penis which, in erection, measured 5 1/4
inches long and 3 5/8 inches in circumference. The glans penis and the
urethra were perfectly formed. The scrotum contained two testicles,
each about an inch long; the mons veneris was sparsely covered with
straight, black hair. She claimed functional ability with both sets of
genitalia, and said she experienced equal sexual gratification with
either. Semen issued from the penis, and every three weeks she had
scanty menstruation, which lasted but two days.

Beclard showed Marie-Madeline Lefort, nineteen years of age, 1 1/2
meters in height. Her mammae were well developed, her nipples erectile
and surrounded by a brown areola, from which issued several hairs. Her
feet were small, her pelvis large, and her thighs like those of a
woman. Projecting from the vulva was a body looking like a penis 7 cm.
long and slightly erectile at times; it was imperforate and had a
mobile prepuce. She had a vulva with two well-shaped labia as shown by
the accompanying illustration. She menstruated slightly and had an
opening at the root of the clitoris. The parotid region showed signs of
a beard and she had hair on her upper lip. On August 20, 1864, a person
came into the Hotel-Dieu, asking treatment for chronic pleurisy.  He
said his age was sixty-five, and he pursued the calling of a
mountebank, but remarked that in early life he had been taken for a
woman. He had menstruated at eight and had been examined by doctors at
sixteen. The menstruation continued until 1848, and at its cessation he
experienced the feelings of a male. At this time he presented the
venerable appearance of a long-bearded old man.  At the autopsy, about
two months later, all the essentials of a female were delineated. A
Fallopian tube, ovaries, uterus, and round ligaments were found, and a
drawing in cross-section of the parts was made. There is no doubt but
that this individual was Marie-Madeline Lefort in age.


Worbe speaks of a person who was supposed to be feminine for twenty-two
years. At the age of sixteen she loved a farmer's son, but the union
was delayed for some reason, and three years later her grace faded and
she became masculine in her looks and tastes.  It was only after
lengthy discussion, in which the court took part, that it was
definitely settled that this person was a male.

Adelaide Preville, who was married as a female, and as such lived the
last ten years of her life in France, was found on dissection at the
Hotel-Dieu to be a man. A man was spoken of in both France and Germany
a who passed for many years as a female. He had a cleft scrotum and
hypospadias, which caused the deception.  Sleeping with another servant
for three years, he constantly had sexual congress with her during this
period, and finally impregnated her. It was supposed in this case that
the posterior wall of the vagina supplied the deficiency of the lower
boundary of the urethra, forming a complete channel for the semen to
proceed through. Long ago in Scotland a servant was condemned to death
by burial alive for impregnating his master's daughter while in the
guise and habit of a woman. He had always been considered a woman. We
have heard of a recent trustworthy account of a pregnancy and delivery
in a girl who had been impregnated by a bed-fellow who on examination
proved to be a male pseudohermaphrodite.

Fournier speaks of an individual in Lisbon in 1807 who was in the
highest degree graceful, the voice feminine, the mammae well developed,
The female genitalia were normal except the labia majora, which were
rather diminutive. The thighs and the pelvis.  were not so wide as
those of a woman. There was some beard on the chin, but it was worn
close. the male genitalia were of the size and appearance of a male
adult and were covered with the usual hair. This person had been twice
pregnant and aborted at the third and fifth month. During coitus the
penis became erect, etc.

Schrell describes a case in which, independent of the true penis and
testicles, which were well formed, there existed a small vulva
furnished with labia and nymphae, communicating with a rudimentary
uterus provided with round ligaments and imperfectly developed ovaries.
Schrell remarks that in this case we must notice that the female
genitalia were imperfectly developed, and adds that perfect
hermaphroditism is a physical impossibility without great alterations
of the natural connections of the bones and other parts of the pelvis.
Cooper describes a woman with an enormous development of the clitoris,
an imperforate uterus, and absence of vagina; at first sight of the
parts they appeared to be those of a man.

In 1859 Hugier succeeded in restoring a vagina to a young girl of
twenty who had an hypertrophied clitoris and no signs of a vagina. The
accompanying illustrations show the conformation of the parts before
operation with all the appearance of ill-developed male genitalia, and
the appearance afterward with restitution of the vaginal opening.

Virchow in 1872, Boddaert in 1875, and Marchand in 1883 report cases of
duplication of the genitalia, and call their cases true hermaphrodites
from an anatomic standpoint. There is a specimen in St. Bartholomew's
Hospital in London from a man of forty-four, who died of cerebral
hemorrhage. He was well formed and had a beard and a full-sized penis.
He was married, and it was stated that his wife had two children. The
bladder and the internal organs of generation were those of a man in
whom neither testis had descended into the scrotum, and in whom the
uterus masculinus and vagina were developed to an unusual degree. The
uterus, nearly as large as in the adult female, lay between the bladder
and rectum, and was enclosed between two layers of peritoneum, to
which, on either side of the uterus, were attached the testes.  There
was also shown in London the pelvic organs from a case of complex or
vertical hermaphroditism occurring in a child of nine months who died
from the effects of an operation for the radical cure of a right
inguinal hernia. The external organs were those of a male with
undescended testes. The bladder was normal and its neck was surrounded
by a prostate gland. Projecting backward were a vagina, uterus, and
broad ligaments, round ligaments, and Fallopian tubes, with the testes
in the position of the ovaries.  There were no seminal vesicles. The
child died eleven days after the operation. The family history states
that the mother had had 14 children and eight miscarriages. Seven of
the children were dead and showed no abnormalities. The fifth and sixth
children were boys and had the same sexual arrangement.

Barnes, Chalmers, Sippel, and Litten describe cases of spurious
hermaphroditism due to elongation of the clitoris. In Litten's case a
the clitoris was 3 1/2 inches long, and there was hydrocele of the
processus vaginalis on both sides, making tumors in the labium on one
side and the inguinal canal on the other, which had been diagnosed as
testicles and again as ovaries. There was associate cystic ovarian
disease. Plate 4 is taken from a case of false external bilateral
hermaphroditism. Phillips mentions four cases of spurious
hermaphroditism in one family, and recently Pozzi tells of a family of
nine individuals in whom this anomaly was observed. The first was alive
and had four children; the second was christened a female but was
probably a male; the third, fourth, and fifth were normal but died
young; the sixth daughter was choreic and feeble-minded, aged
twenty-nine, and had one illegitimate child; the seventh, a boy, was
healthy and married; the eighth was christened a female, but when
seventeen was declared by the Faculty to be a male; the ninth was
christened a female, but at eighteen the genitals were found to be
those of a male, though the mammae were well developed.

O'Neill speaks of a case in which the clitoris was five inches long and
one inch thick, having a groove in its inferior surface reaching down
to an oblique opening in the perineum. The scrotum contained two hard
bodies thought to be testicles, and the general appearance was that of
hypospadias. Postmortem a complete set of female genitalia was found,
although the ovaries were very small. The right round ligament was
exceedingly thick and reached down to the bottom of the false scrotum,
where it was firmly attached. The hard bodies proved to be on one side
an irreducible omental hernia, probably congenital, and on the other a
hardened mass having no glandular structure. The patient was an adult.
As we have seen, there seems to be a law of evolution in
hermaphroditism which prevents perfection. If one set of genitalia are
extraordinarily developed, the other set are correspondingly atrophied.
In the case of extreme development of the clitoris and approximation to
the male type we must expect to find imperfectly developed uterus or
ovaries. This would answer for one of the causes of sterility in these
cases.

There is a type of hermaphroditism in which the sex cannot be
definitely declared, and sometimes dissection does not definitely
indicate the predominating sex. Such cases are classed under the head
of neuter hermaphrodites, possibly an analogy of the "genus epicoenum"
of Quintilian. Marie Dorothee, of the age of twenty-three, was examined
and declared a girl by Hufeland and Mursina, while Stark, Raschig, and
Martens maintained that she was a boy. This formidable array of talent
on both sides provoked much discussion in contemporary publications,
and the case attracted much notice. Marc saw her in 1803, at which time
she carried contradicting certificates as to her sex. He found an
imperforate penis, and on the inferior face near the root an opening
for the passage of urine. No traces of nymphae, vagina, testicles, nor
beard were seen. The stature was small, the form debilitated, and the
voice effeminate. Marc came to the conclusion that it was impossible
for any man to determine either one sex or the other. Everard Home
dissected a dog with apparent external organs of the female, but
discovered that neither sex was sufficiently pronounced to admit of
classification. Home also saw at the Royal Marine Hospital at Plymouth,
in 1779, a marine who some days after admission was reported to be a
girl. On examination Home found him to possess a weak voice, soft skin,
voluminous breasts, little beard, and the thighs and legs of a woman.
There was fat on the pubis, the penis was short and small and incapable
of erection, the testicles of fetal size; he had no venereal desires
whatever, and as regards sex was virtually neuter.

The legal aspect of hermaphroditism has always been much discussed.
Many interesting questions arise, and extraordinary complications
naturally occur. In Rome a hermaphrodite could be a witness to a
testament, the exclusive privilege of a man, and the sex was settled by
the predominance. If the male aspect and traits together with the
generative organs of man were most pronounced, then the individual
could call himself a man.  "Hermaphroditus an ad testamentum adhiberi
possit qualitas sesus incalescentis ostendit."

There is a peculiar case on record in which the question of legal male
inheritance was not settled until the individual had lived as a female
for fifty-one years. This person was married when twenty-one, but
finding coitus impossible, separated after ten years, and though
dressing as a female had coitus with other women. She finally lived
with her brother, with whom she eventually came to blows. She
prosecuted him for assault, and the brother in return charged her with
seducing his wife. Examination ensued, and at this ripe age she was
declared to be a male.

The literature on hermaphroditism is so extensive that it is impossible
to select a proper representation of the interesting cases in this
limited space, and the reader is referred to the modern French works on
this subject, in which the material is exhaustive and the discussion
thoroughly scientific.



CHAPTER VI.

MINOR TERATA.

Ancient Ideas Relative to Minor Terata.--The ancients viewed with great
interest the minor structural anomalies of man, and held them to be
divine signs or warnings in much the same manner as they considered
more pronounced monstrosities. In a most interesting and instructive
article, Ballantyne quotes Ragozin in saying that the
Chaldeo-Babylonians, in addition to their other numerous subdivisions
of divination, drew presages and omens for good or evil from the
appearance of the liver, bowels, and viscera of animals offered for
sacrifice and opened for inspection, and from the natural defects or
monstrosities of babies or the young of animals. Ballantyne names this
latter subdivision of divination fetomancy or teratoscopy, and thus
renders a special chapter as to omens derived from monstrous births,
given by Lenormant:--

"The prognostics which the Chaldeans claimed to draw from monstrous
births in man and the animals are worthy of forming a class by
themselves, insomuch the more as it is the part of their divinatory
science with which, up to the present time, we are best acquainted. The
development that their astrology had given to 'genethliaque,' or the
art of horoscopes of births, had led them early to attribute great
importance to all the teratologic facts which were there produced. They
claimed that an experience of 470,000 years of observations, all
concordant, fully justified their system, and that in nothing was the
influence of the stars marked in a more indubitable manner than in the
fatal law which determined the destiny of each individual according to
the state of the sky at the moment when he came into the world. Cicero,
by the very terms which he uses to refute the Chaldeans, shows that the
result of these ideas was to consider all infirmities and monstrosities
that new-born infants exhibited as the inevitable and irremediable
consequence of the action of these astral positions. This being
granted, the observation of similar monstrosities gave, as it were, a
reflection of the state of the sky; on which depended all terrestrial
things; consequently, one might read in them the future with as much
certainty as in the stars themselves. For this reason the greatest
possible importance was attached to the teratologic auguries which
occupy so much space in the fragments of the great treatise on
terrestrial presages which have up to the present time been published."

The rendering into English of the account of 62 teratologic cases in
the human subject with the prophetic meanings attached to them by
Chaldean diviners, after the translation of Opport, is given as follows
by Ballantyne, some of the words being untranslatable:--

"When a woman gives birth to an infant--

(1) that has the ears of a lion, there will be a powerful king in the
country;

(2) that wants the right ear, the days of the master (king) will be
prolonged (reach old age);

(3) that wants both ears, there will be mourning