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Project Gutenberg Etext of Anomalies and Curiosities of Medicine
by George M. Gould
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Walter L. Pyle
December, 1996 [Etext #747]
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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 he a spina bifida in the lower sacral
region. According to Senn, the swelling never caused any pain or
inconvenience until it inflamed, when it opened spontaneously and
suppurated, discharging a large quantity of offensive pus, hair,
and sebaceous material, thus proving it to have been a dermoid.
The cyst was freely incised, and there were found numerous
openings of sweat glands, from which drops of perspiration
escaped when the patient was sweating.
Dermoid cysts of the thorax are rare. Bramann reported a case in
which a dermoid cyst of small size was situated over the sternum
at the junction of the manubrium with the gladiolus, and a
similar cyst in the neck near the left cornu of the hyoid bone.
Chitten removed a dermoid from the sternum of a female of
thirty-nine, the cyst containing 11 ounces of atheromatous
material. In the Museum of St. Bartholomew's Hospital in London
there is a congenital tumor which was removed from the anterior
mediastinum of a woman of twenty one, and contained portions of
skin, fat, sebaceous material, and two pieces of bone similar to
the superior maxilla, and in which several teeth were found.
Dermoids are found in the palate and pharynx, and open dermoids
of the conjunctiva are classified by Sutton with the moles.
According to Senn, Barker collected sixteen dermoid tumors of the
tongue. Bryk successfully removed a tumor of this nature the size
of a fist. Wellington Gray removed an enormous lingual dermoid
from the mouth of a negro. It contained 40 ounces of atheromatous
material. Dermoids of the rectum are reported. Duyse reports the
history of a case of labor during which a rectal dermoid was
expelled. The dermoid contained a cerebral vesicle, a rudimentary
eye, a canine and a molar tooth, and a piece of bone. There is
little doubt that many cases of fetus in fetu reported were
really dermoids of the scrotum.
Ward reports the successful removal of a dermoid cyst weighing 30
pounds from a woman of thirty-two, the mother of two children
aged ten and twelve, respectively. The report is briefly as
follows: "The patient has always been in good health until within
the last year, during which time she has lost flesh and strength
quite rapidly, and when brought to my hospital by her physician,
Dr. James of Williamsburg, Kansas, was quite weak, although able
to walk about the house. A tumor had been growing for a number of
years, but its growth was so gradual that the patient had not
considered her condition critical until quite recently. The tumor
was diagnosed to be cystoma of the left ovary. Upon opening the
sac with the trocar we were confronted by complications entirely
unlooked for, and its use had to be abandoned entirely because
the thick contents of the cyst would not flow freely, and the
presence of sebaceous matter blocked the instrument. As much of
the fluid as possible was removed, and the abdominal incision was
enlarged to allow of the removal of the large tumor. An ovarian
hematoma the size of a large orange was removed from the right
side. We washed the intestines quite as one would wash linen,
since some of the contents of the cyst had escaped into the
abdominal cavity. The abdomen was closed without drainage, and
the patient placed in bed without experiencing the least shock.
Her recovery was rapid and uneventful. She returned to her home
in four weeks after the operation.
"The unusual feature in this case was the nature of the contents
of the sac. There was a large quantity of long straight hair
growing from the cyst wall and an equal amount of loose hair in
short pieces floating through the tumor- contents, a portion of
which formed nuclei for what were called 'moth-balls,' of which
there were about 1 1/2 gallons. These balls, or marbles, varied
from the size of moth-balls, as manufactured and sold by
druggists, to that of small walnuts. They seemed to be composed
of sebaceous matter, and were evidently formed around the short
hairs by the motion of the fluid produced by walking or riding.
There was some tissue resembling true skin attached to the inner
wall of the sac."
There are several cases of multiple dermoid cysts on record, and
they may occur all over the body. Jamieson reports a case in
which there were 250, and in Maclaren's case there were 132.
According to Crocker, Hebra and Rayer also each had a case. In a
case of Sangster, reported by Politzer, although most of the
dermoids, as usual, were like fibroma-nodules and therefore the
color of normal skin, those over the mastoid processes and
clavicle were lemon-yellow, and were generally thought to be
xanthoma until they were excised, and Politzer found they were
typical dermoid cysts with the usual contents of degenerated
epithelium and hair.
Hermaphroditism.--Some writers claim that Adam was the first
hermaphrodite and support this by Scriptural evidence. We find in
some of the ancient poets traces of an Egyptian legend in which
the goddess of the moon was considered to be both male and
female. From mythology we learn that Hermaphroditus was the son
of Hermes, or Mercury, and Venus Aphrodite, and had the powers
both of a father and mother. In speaking of the foregoing
Ausonius writes, "Cujus erat facies in qua paterque materque
cognosci possint, nomen traxit ab illis." Ovid and Virgil both
refer to legendary hermaphrodites, and the knowledge of their
existence was prevalent in the olden times. The ancients
considered the birth of hermaphrodites bad omens, and the
Athenians threw them into the sea, the Romans, into the Tiber.
Livy speaks of an hermaphrodite being put to death in Umbria, and
another in Etruria. Cicero, Aristotle, Strabonius, and Pliny all
speak concerning this subject. Martial and Tertullian noticed
this anomaly among the Romans. Aetius and Paulus Aegineta speak
of females in Egypt with prolonged clitorides which made them
appear like hermaphrodites. Throughout the Middle Ages we
frequently find accounts, naturally exaggerated, of double-sexed
creatures. Harvey, Bartholinus, Paullini, Schenck, Wolff,
Wrisberg, Zacchias, Marcellus Donatus, Haller, Hufeland, de
Graff, and many others discuss hermaphroditism. Many
classifications have been given, as, e.g., real and apparent;
masculine, feminine, or neuter; horizontal and vertical;
unilateral and bilateral, etc. The anomaly in most cases consists
of a malformation of the external genitalia. A prolonged
clitoris, prolapsed ovaries, grossness of figure, and hirsute
appearance have been accountable for many supposed instances of
hermaphrodites. On the other hand, a cleft scrotum, an
ill-developed penis, perhaps hypospadias or epispadias, rotundity
of the mammae, and feminine contour have also provoked accounts
of similar instances. Some cases have been proved by dissection
to have been true hermaphrodites, portions or even entire
genitalia of both sexes having been found.
Numerous accounts, many mythical, but always interesting, are
given of these curious persons. They have been accredited with
having performed the functions of both father and mother,
notwithstanding the statements of some of the best authorities
that they are always sterile. Observation has shown that the
sexual appetite diminishes in proportion to the imperfections in
the genitalia, and certainly many of these persons are sexually
indifferent.
We give descriptions of a few of the most famous or interesting
instances of hermaphroditism. Pare speaks of a woman who, besides
a vulva, from which she menstruated, had a penis, but without
prepuce or signs of erectility. Haller alludes to several cases
in which prolonged clitorides have been the cause of the anomaly.
In commenting on this form of hermaphroditism Albucasiusus
describes a necessary operation for the removal of the clitoris.
Columbus relates the history of an Ethiopian woman who was
evidently a spurious female hermaphrodite. The poor wretch
entreated him to cut off her penis, an enlarged clitoris, which
she said was an intolerable hindrance to her in coitus. De Graff
and Riolan describe similar cases. There is an old record of a
similar creature, supposing herself to be a male, who took a
wife, but previously having had connection with a man, the
outcome of which was pregnancy, was shortly after marriage
delivered of a daughter. There is an account of a person in
Germany who, for the first thirty years of life, was regarded as
feminine, and being of loose morals became a mother. At a certain
period she began to feel a change in her sexual inclinations; she
married and became the father of a family. This is doubtless a
distortion of the facts of the case of Catherine or Charles
Hoffman, born in 1824, and who was considered a female until the
age of forty. At puberty she had the instincts of a woman, and
cohabitated with a male lover for twenty years. Her breasts were
well formed and she menstruated at nineteen. At the age of
forty-six her sexual desires changed, and she attempted coitus as
a man, with such evident satisfaction that she married a woman
soon afterward. Fitch speaks of a house-servant with masculine
features and movements, aged twenty-eight, and 5 feet and 9
inches tall, who was arrested by the police for violating the
laws governing prostitution. On examination, well-developed male
and female organs of generation were found. The labia majora were
normal and flattened on the anterior surface. The labia minora
and hymen were absent. The vagina was spacious and the woman had
a profuse leukorrhea. She stated that several years previously
she gave birth to a normal child. In place of a clitoris she had
a penis which, in erection, measured 5 1/4 inches long and 3 5/8
inches in circumference. The glans penis and the urethra were
perfectly formed. The scrotum contained two testicles, each about
an inch long; the mons veneris was sparsely covered with
straight, black hair. She claimed functional ability with both
sets of genitalia, and said she experienced equal sexual
gratification with either. Semen issued from the penis, and every
three weeks she had scanty menstruation, which lasted but two
days.
Beclard showed Marie-Madeline Lefort, nineteen years of age, 1
1/2 meters in height. Her mammae were well developed, her nipples
erectile and surrounded by a brown areola, from which issued
several hairs. Her feet were small, her pelvis large, and her
thighs like those of a woman. Projecting from the vulva was a
body looking like a penis 7 cm. long and slightly erectile at
times; it was imperforate and had a mobile prepuce. She had a
vulva with two well-shaped labia as shown by the accompanying
illustration. She menstruated slightly and had an opening at the
root of the clitoris. The parotid region showed signs of a beard
and she had hair on her upper lip. On August 20, 1864, a person
came into the Hotel-Dieu, asking treatment for chronic pleurisy.
He said his age was sixty-five, and he pursued the calling of a
mountebank, but remarked that in early life he had been taken for
a woman. He had menstruated at eight and had been examined by
doctors at sixteen. The menstruation continued until 1848, and at
its cessation he experienced the feelings of a male. At this time
he presented the venerable appearance of a long-bearded old man.
At the autopsy, about two months later, all the essentials of a
female were delineated. A Fallopian tube, ovaries, uterus, and
round ligaments were found, and a drawing in cross-section of the
parts was made. There is no doubt but that this individual was
Marie-Madeline Lefort in age.
Worbe speaks of a person who was supposed to be feminine for
twenty-two years. At the age of sixteen she loved a farmer's son,
but the union was delayed for some reason, and three years later
her grace faded and she became masculine in her looks and tastes.
It was only after lengthy discussion, in which the court took
part, that it was definitely settled that this person was a male.
Adelaide Preville, who was married as a female, and as such lived
the last ten years of her life in France, was found on dissection
at the Hotel-Dieu to be a man. A man was spoken of in both France
and Germany a who passed for many years as a female. He had a
cleft scrotum and hypospadias, which caused the deception.
Sleeping with another servant for three years, he constantly had
sexual congress with her during this period, and finally
impregnated her. It was supposed in this case that the posterior
wall of the vagina supplied the deficiency of the lower boundary
of the urethra, forming a complete channel for the semen to
proceed through. Long ago in Scotland a servant was condemned to
death by burial alive for impregnating his master's daughter
while in the guise and habit of a woman. He had always been
considered a woman. We have heard of a recent trustworthy account
of a pregnancy and delivery in a girl who had been impregnated by
a bed-fellow who on examination proved to be a male
pseudohermaphrodite.
Fournier speaks of an individual in Lisbon in 1807 who was in the
highest degree graceful, the voice feminine, the mammae well
developed, The female genitalia were normal except the labia
majora, which were rather diminutive. The thighs and the pelvis.
were not so wide as those of a woman. There was some beard on the
chin, but it was worn close. the male genitalia were of the size
and appearance of a male adult and were covered with the usual
hair. This person had been twice pregnant and aborted at the
third and fifth month. During coitus the penis became erect, etc.
Schrell describes a case in which, independent of the true penis
and testicles, which were well formed, there existed a small
vulva furnished with labia and nymphae, communicating with a
rudimentary uterus provided with round ligaments and imperfectly
developed ovaries. Schrell remarks that in this case we must
notice that the female genitalia were imperfectly developed, and
adds that perfect hermaphroditism is a physical impossibility
without great alterations of the natural connections of the bones
and other parts of the pelvis. Cooper describes a woman with an
enormous development of the clitoris, an imperforate uterus, and
absence of vagina; at first sight of the parts they appeared to
be those of a man.
In 1859 Hugier succeeded in restoring a vagina to a young girl of
twenty who had an hypertrophied clitoris and no signs of a
vagina. The accompanying illustrations show the conformation of
the parts before operation with all the appearance of
ill-developed male genitalia, and the appearance afterward with
restitution of the vaginal opening.
Virchow in 1872, Boddaert in 1875, and Marchand in 1883 report
cases of duplication of the genitalia, and call their cases true
hermaphrodites from an anatomic standpoint. There is a specimen
in St. Bartholomew's Hospital in London from a man of forty-four,
who died of cerebral hemorrhage. He was well formed and had a
beard and a full-sized penis. He was married, and it was stated
that his wife had two children. The bladder and the internal
organs of generation were those of a man in whom neither testis
had descended into the scrotum, and in whom the uterus masculinus
and vagina were developed to an unusual degree. The uterus,
nearly as large as in the adult female, lay between the bladder
and rectum, and was enclosed between two layers of peritoneum, to
which, on either side of the uterus, were attached the testes.
There was also shown in London the pelvic organs from a case of
complex or vertical hermaphroditism occurring in a child of nine
months who died from the effects of an operation for the radical
cure of a right inguinal hernia. The external organs were those
of a male with undescended testes. The bladder was normal and its
neck was surrounded by a prostate gland. Projecting backward were
a vagina, uterus, and broad ligaments, round ligaments, and
Fallopian tubes, with the testes in the position of the ovaries.
There were no seminal vesicles. The child died eleven days after
the operation. The family history states that the mother had had
14 children and eight miscarriages. Seven of the children were
dead and showed no abnormalities. The fifth and sixth children
were boys and had the same sexual arrangement.
Barnes, Chalmers, Sippel, and Litten describe cases of spurious
hermaphroditism due to elongation of the clitoris. In Litten's
case a the clitoris was 3 1/2 inches long, and there was
hydrocele of the processus vaginalis on both sides, making tumors
in the labium on one side and the inguinal canal on the other,
which had been diagnosed as testicles and again as ovaries. There
was associate cystic ovarian disease. Plate 4 is taken from a
case of false external bilateral hermaphroditism. Phillips
mentions four cases of spurious hermaphroditism in one family,
and recently Pozzi tells of a family of nine individuals in whom
this anomaly was observed. The first was alive and had four
children; the second was christened a female but was probably a
male; the third, fourth, and fifth were normal but died young;
the sixth daughter was choreic and feeble-minded, aged
twenty-nine, and had one illegitimate child; the seventh, a boy,
was healthy and married; the eighth was christened a female, but
when seventeen was declared by the Faculty to be a male; the
ninth was christened a female, but at eighteen the genitals were
found to be those of a male, though the mammae were well
developed.
O'Neill speaks of a case in which the clitoris was five inches
long and one inch thick, having a groove in its inferior surface
reaching down to an oblique opening in the perineum. The scrotum
contained two hard bodies thought to be testicles, and the
general appearance was that of hypospadias. Postmortem a complete
set of female genitalia was found, although the ovaries were very
small. The right round ligament was exceedingly thick and reached
down to the bottom of the false scrotum, where it was firmly
attached. The hard bodies proved to be on one side an irreducible
omental hernia, probably congenital, and on the other a hardened
mass having no glandular structure. The patient was an adult. As
we have seen, there seems to be a law of evolution in
hermaphroditism which prevents perfection. If one set of
genitalia are extraordinarily developed, the other set are
correspondingly atrophied. In the case of extreme development of
the clitoris and approximation to the male type we must expect to
find imperfectly developed uterus or ovaries. This would answer
for one of the causes of sterility in these cases.
There is a type of hermaphroditism in which the sex cannot be
definitely declared, and sometimes dissection does not definitely
indicate the predominating sex. Such cases are classed under the
head of neuter hermaphrodites, possibly an analogy of the "genus
epicoenum" of Quintilian. Marie Dorothee, of the age of
twenty-three, was examined and declared a girl by Hufeland and
Mursina, while Stark, Raschig, and Martens maintained that she
was a boy. This formidable array of talent on both sides provoked
much discussion in contemporary publications, and the case
attracted much notice. Marc saw her in 1803, at which time she
carried contradicting certificates as to her sex. He found an
imperforate penis, and on the inferior face near the root an
opening for the passage of urine. No traces of nymphae, vagina,
testicles, nor beard were seen. The stature was small, the form
debilitated, and the voice effeminate. Marc came to the
conclusion that it was impossible for any man to determine either
one sex or the other. Everard Home dissected a dog with apparent
external organs of the female, but discovered that neither sex
was sufficiently pronounced to admit of classification. Home also
saw at the Royal Marine Hospital at Plymouth, in 1779, a marine
who some days after admission was reported to be a girl. On
examination Home found him to possess a weak voice, soft skin,
voluminous breasts, little beard, and the thighs and legs of a
woman. There was fat on the pubis, the penis was short and small
and incapable of erection, the testicles of fetal size; he had no
venereal desires whatever, and as regards sex was virtually
neuter.
The legal aspect of hermaphroditism has always been much
discussed. Many interesting questions arise, and extraordinary
complications naturally occur. In Rome a hermaphrodite could be a
witness to a testament, the exclusive privilege of a man, and the
sex was settled by the predominance. If the male aspect and
traits together with the generative organs of man were most
pronounced, then the individual could call himself a man.
"Hermaphroditus an ad testamentum adhiberi possit qualitas sesus
incalescentis ostendit."
There is a peculiar case on record in which the question of legal
male inheritance was not settled until the individual had lived
as a female for fifty-one years. This person was married when
twenty-one, but finding coitus impossible, separated after ten
years, and though dressing as a female had coitus with other
women. She finally lived with her brother, with whom she
eventually came to blows. She prosecuted him for assault, and the
brother in return charged her with seducing his wife. Examination
ensued, and at this ripe age she was declared to be a male.
The literature on hermaphroditism is so extensive that it is
impossible to select a proper representation of the interesting
cases in this limited space, and the reader is referred to the
modern French works on this subject, in which the material is
exhaustive and the discussion thoroughly scientific.
CHAPTER VI.
MINOR TERATA.
Ancient Ideas Relative to Minor Terata.--The ancients viewed with
great interest the minor structural anomalies of man, and held
them to be divine signs or warnings in much the same manner as
they considered more pronounced monstrosities. In a most
interesting and instructive article, Ballantyne quotes Ragozin in
saying that the Chaldeo-Babylonians, in addition to their other
numerous subdivisions of divination, drew presages and omens for
good or evil from the appearance of the liver, bowels, and
viscera of animals offered for sacrifice and opened for
inspection, and from the natural defects or monstrosities of
babies or the young of animals. Ballantyne names this latter
subdivision of divination fetomancy or teratoscopy, and thus
renders a special chapter as to omens derived from monstrous
births, given by Lenormant:--
"The prognostics which the Chaldeans claimed to draw from
monstrous births in man and the animals are worthy of forming a
class by themselves, insomuch the more as it is the part of their
divinatory science with which, up to the present time, we are
best acquainted. The development that their astrology had given
to 'genethliaque,' or the art of horoscopes of births, had led
them early to attribute great importance to all the teratologic
facts which were there produced. They claimed that an experience
of 470,000 years of observations, all concordant, fully justified
their system, and that in nothing was the influence of the stars
marked in a more indubitable manner than in the fatal law which
determined the destiny of each individual according to the state
of the sky at the moment when he came into the world. Cicero, by
the very terms which he uses to refute the Chaldeans, shows that
the result of these ideas was to consider all infirmities and
monstrosities that new-born infants exhibited as the inevitable
and irremediable consequence of the action of these astral
positions. This being granted, the observation of similar
monstrosities gave, as it were, a reflection of the state of the
sky; on which depended all terrestrial things; consequently, one
might read in them the future with as much certainty as in the
stars themselves. For this reason the greatest possible
importance was attached to the teratologic auguries which occupy
so much space in the fragments of the great treatise on
terrestrial presages which have up to the present time been
published."
The rendering into English of the account of 62 teratologic cases
in the human subject with the prophetic meanings attached to them
by Chaldean diviners, after the translation of Opport, is given
as follows by Ballantyne, some of the words being
untranslatable:--
"When a woman gives birth to an infant--
(1) that has the ears of a lion, there will be a powerful king in
the country;
(2) that wants the right ear, the days of the master (king) will
be prolonged (reach old age);
(3) that wants both ears, there will be mourning in the country,
and the country will be lessened (diminished);
(4) whose right ear is small, the house of the man (in whose
house the birth took place) will be destroyed;
(5) whose ears are both small, the house of the man will be built
of bricks;
(6) whose right ear is mudissu tehaat (monstrous), there will be
an androgyne in the house of the new-born
(7) whose ears are both mudissu (deformed), the country will
perish and the enemy rejoice;
(8) whose right ear is round, there will be an androgyne in the
house of the new-born;
(9) whose right ear has a wound below, and tur re ut of the man,
the house will be estroyed;
(10) that has two ears on the right side and none on the left,
the gods will bring about a stable reign, the country will
flourish, and it will be a land of repose;
(11) whose ears are both closed, sa a au;
(12) that has a bird's beak, the country will be peaceful;
(13) that has no mouth, the mistress of the house will die;
(14) that has no right nostril, the people of the world will be
injured;
(15) whose nostrils are absent, the country will be in
affliction, and the house of the man will be ruined;
(16) whose jaws are absent, the days of the master (king) will be
prolonged, but the house (where the infant is born) will be
ruined.
When a woman gives birth to an infant--
(17) that has no lower jaw, mut ta at mat, the name will not be
effaced;
(20) that has no nose, affliction will seize upon the country,
and the master of the house will die;
(21) that has neither nose nor virile member (penis), the army of
the king will be strong, peace will be in the land, the men of
the king will be sheltered from evil influences, and Lilit (a
female demon) shall not have power over them;
(22) whose upper lip overrides the lower, the people of the world
will rejoice (or good augury for the troops);
(23) that has no lips, affliction will seize upon the land, and
the house of the man will be destroyed;
(24) whose tongue is kuri aat, the man will be spared (?);
(25) that has no right hand, the country will be convulsed by an
earthquake;
(26) that has no fingers, the town will have no births, the bar
shall be lost;
(27) that has no fingers on the right side, the master (king)
will not pardon his adversary (or shall be humiliated by his
enemies);
(28) that has six fingers on the right side, the man will take
the lukunu of the house;
(29) that has six very small toes on both feet, he shall not go
to the lukunu;
(30) that has six toes on each foot, the people of the world will
be injured (calamity to the troops);
(31) that has the heart open and that has no skin, the country
will suffer from calamities;
(32) that has no penis, the master of the house will be enriched
by the harvest of his field;
(33) that wants the penis and the umbilicus, there will be
ill-will in the house, the woman (wife) will have an overbearing
eye (be haughty); but the male descent of the palace will be more
extended.
When a woman gives birth to an infant--
(34) that has no well-marked sex, calamity and affliction will
seize upon the land; the master of the house shall have no
happiness;
(35) whose anus is closed, the country will suffer from want of
nourishment;
(36) whose right testicle (?) is absent, the country of the
master (king) will perish;
(37) whose right foot is absent, his house will be ruined and
there will be abundance in that of the neighbor;
(38) that has no feet, the canals of the country will be cut
(intercepted) and the house ruined;
(39) that has the right foot in the form of a fish's tail, the
booty of the country of the humble will not be imas sa bir;
(40) whose hands and feet are like four fishes' tails (fins), the
master (king) shall perish (?) and his country shall be consumed;
(41) whose feet are moved by his great hunger, the house of the
su su shall be destroyed;
(42) whose foot hangs to the tendons of the body, there will be
great prosperity in the land;
(43) that has three feet, two in their normal position (attached
to the body) and the third between them, there will be great
prosperity in the land;
(44) whose legs are male and female, there will be rebellion;
(45) that wants the right heel, the country of the master (king)
will be destroyed.
When a woman gives birth to an infant--
(46) that has many white hairs on the head, the days of the king
will be prolonged;
(47) that has much ipga on the head, the master of the house will
die, the house will be destroyed;
(48) that has much pinde on the head, joy shall go to meet the
house (that has a head on the head, the good augury shall enter
at its aspect into the house);
(49) that has the head full of hali, there will be ill-will
toward him and the master (king) of the town shall die;
(50) that has the head full of siksi the king will repudiate his
masters;
(51) that has some pieces of flesh (skin) hanging on the head,
there shall be ill-will;
(52) that has some branches (?) (excrescences) of flesh (skin)
hanging on the head, there shall be ill-will, the house will
perish;
(53) that has some formed fingers (horns ?) on the head, the days
of the king will be less and the years lengthened (in the
duration of his old age);
(54) that has some kali on the head, there will be a king of the
land;
(55) that has a ---- of a bird on the head, the master of the
house shall not prosper;
(56) that has some teeth already through (cut), the days of the
king will arrive at old age, the country will show itself
powerful over (against) strange (feeble) lands, but the house
where the infant is born will be ruined;
(57) that has the beard come out, there will be abundant rains;
(58) that has some birta on the head, the country will be
strengthened (reinforced);
(59) that has on the head the mouth of an old man and that foams
(slabbers), there will be great prosperity in the land, the god
Bin will give a magnificent harvest (inundate the land with
fertility), and abundance shall be in the land;
(60) that has on one side of the head a thickened ear, the
first-born of the men shall live a long time (?);
(61) that has on the head two long and thick ears, there will be
tranquility and the pacification of litigation (contests);
(62) that has the figure in horn (like a horn ?) . . ."
As ancient and as obscure as are these records, Ballantyne has
carefully gone over each, and gives the following lucid
explanatory comments:--
"What 'ears like a lion' (No. 1) may have been it is difficult to
determine; but doubtless the direction and shape of the auricles
were so altered as to give them an animal appearance, and
possibly the deformity was that called 'orechio ad ansa' by
Lombroso. The absence of one or both ears (Nos. 2 and 3) has been
noted in recent times by Virchow (Archiv fur path. Anat. xxx., p.
221), Gradenigo (Taruffi's 'Storia della Teratologia,' vi., p.
552), and others. Generally some cartilaginous remnant is found,
but on this point the Chaldean record is silent. Variations in
the size of the ears (Nos. 4 and 5) are well known at the present
time, and have been discussed at length by Binder (Archiv fur
Psychiatrie und Nervenkrankheiten, xx., 1887) and others. The
exact malformation indicated in Nos. 6 and 7 is, of course, not
to be determined, although further researches in Assyriology may
clear up this point. The 'round ear' (No. 8) is one of Binder's
types, and that with a 'wound below' (No. 9) probably refers to a
case of fistula auris congenita (Toynbee, 'Diseases of the Ear,'
1860). The instance of an infant born with two ears on the right
side (No. 10) was doubtless one of cervical auricle or
preauricular appendage, whilst closure of the external auditory
meatus (No. 11) is a well-known deformity.
"The next thirteen cases (Nos. 12-24) were instances of anomalies
of the mouth and nose. The 'bird's beak' (No. 12) may have been a
markedly aquiline nose; No. 13 was a case of astoma; and Nos. 14
and 15 were instances of stenosis or atresia of the anterior
nares. Fetuses with absence of the maxillae (Nos. 16 and 17) are
in modern terminology called agnathous. Deformities like that
existing in Nos. 20 and 21 have been observed in paracephalic and
cyclopic fetuses. The coincident absence of nose and penis (No.
21) is interesting, especially when taken in conjunction with the
popular belief that the size of the former organ varies with that
of the latter. Enlargement of the upper lip (No. 22), called
epimacrochelia by Taruffi, and absence of the lips (No. 23),
known now under the name of brachychelia, have been not
unfrequently noticed in recent times. The next six cases (Nos.
25-30) were instances of malformations of the upper limb: Nos.
25, 26. and 27 were probably instances of the so-called
spontaneous or intrauterine amputation; and Nos. 28, 29, and 30
were examples of the comparatively common deformity known as
polydactyly. No. 31 was probably a case of ectopia cordis.
"Then follow five instances of genital abnormalities (Nos.
32-36), consisting of absence of the penis (epispadias?), absence
of penis and umbilicus (epispadias and exomphalos?),
hermaphroditism, imperforate anus, and nondescent of one
testicle. The nine following cases (Nos. 37-45) were anomalies of
the lower limbs: Nos. 37, 38, and 42 may have been spontaneous
amputations; Nos. 39 and 40 were doubtless instances of webbed
toes (syndactyly), and the deformity indicated in No. 45 was
presumably talipes equinus. The infant born with three feet (No.
43) was possibly a case of parasitic monstrosity, several of
which have been reported in recent teratologic literature; but
what is meant by the statement concerning 'male and female legs'
it is not easy to determine.
"Certain of the ten following prodigies (Nos. 46-55) cannot in
the present state of our knowledge be identified. The presence of
congenital patches of white or gray hair on the scalp, as
recorded in No. 46, is not an unknown occurrence at the present
time; but what the Chaldeans meant by ipga, pinde, hali riksi,
and kali on the head of the new-born infant it is impossible to
tell. The guess may be hazarded that cephalhematoma,
hydrocephalus, meningocele, nevi, or an excessive amount of
vernix caseosa were the conditions indicated, but a wider
acquaintance with the meaning of the cuneiform characters is
necessary before any certain identification is possible. The
'pieces of skin hanging from the head' (No. 51) may have been
fragments of the membranes; but there is nothing in the
accompanying prediction to help us to trace the origin of the
popular belief in the good luck following the baby born with a
caul. If No. 53 was a case of congenital horns on the head, it
must be regarded as a unique example, unless, indeed, a form of
fetal ichthyosis be indicated.
"The remaining observations (No. 56-62) refer to cases of
congenital teeth (No. 56) to deformity of the ears (Nos. 60 and
61), and a horn (No. 62)."
From these early times almost to the present day similar
significance has been attached to minor structural anomalies. In
the following pages the individual anomalies will be discussed
separately and the most interesting examples of each will be
cited. It is manifestly evident that the object of this chapter
is to mention the most striking instances of abnormism and to
give accompanying descriptions of associate points of interest,
rather than to offer a scientific exposition of teratology, for
which the reader is referred elsewhere.
Congenital defect of the epidermis and true skin is a rarity in
pathology. Pastorello speaks of a child which lived for two and a
half hours whose hands and feet were entirely destitute of
epidermis; the true skin of those parts looked like that of a
dead and already putrefying child. Hanks cites the history of a
case of antepartum desquamation of the skin in a living fetus.
Hochstetter describes a full-term, living male fetus with
cutaneous defect on both sides of the abdomen a little above the
umbilicus. The placenta and membranes were normal, a fact
indicating that the defect was not due to amniotic adhesions; the
child had a club-foot on the left side. The mother had a fall
three weeks before labor.
Abnormal Elasticity of the Skin.--In some instances the skin is
affixed so loosely to the underlying tissues and is possessed of
so great elasticity that it can be stretched almost to the same
extent as India rubber. There have been individuals who could
take the skin of the forehead and pull it down over the nose, or
raise the skin of the neck over the mouth. They also occasionally
have an associate muscular development in the subcutaneous
tissues similar to the panniculus adiposus of quadrupeds, giving
them preternatural motile power over the skin. The man recently
exhibited under the title of the "Elastic-Skin Man" was an
example of this anomaly. The first of this class of
exhibitionists was seen in Buda-Pesth some years since and
possessed great elasticity in the skin of his whole body; even
his nose could be stretched. Figure 70 represents a photograph of
an exhibitionist named Felix Wehrle, who besides having the power
to stretch his skin could readily bend his fingers backward and
forward. The photograph was taken in January, 1888.
In these congenital cases there is loose attachment of the skin
without hypertrophy, to which the term dermatolysis is restricted
by Crocker. Job van Meekren, the celebrated Dutch physician of
the seventeenth century, states that in 1657 a Spaniard, Georgius
Albes, is reported to have been able to draw the skin of the left
pectoral region to the left ear, or the skin under the face over
the chin to the vertex. The skin over the knee could be extended
half a yard, and when it retracted to its normal position it was
not in folds. Seiffert examined a case of this nature in a young
man of nineteen, and, contrary to Kopp's supposition, found that
in some skin from over the left second rib the elastic fibers
were quite normal, but there was transformation of the connective
tissue of the dermis into an unformed tissue like a myxoma, with
total disappearance of the connective-tissue bundles. Laxity of
the skin after distention is often seen in multipara, both in the
breasts and in the abdominal walls, and also from obesity, but in
all such cases the skin falls in folds, and does not have a
normal appearance like that of the true "elastic-skin man."
Occasionally abnormal development of the scalp is noticed.
McDowall of twenty-two. On each side of the median line of the
head there were five deep furrows, more curved and shorter as the
distance from the median line increased. In the illustration the
hair in the furrows is left longer than that on the rest of the
head. The patient was distinctly microcephalic and the right side
of the body was markedly wasted. The folds were due to
hypertrophy of the muscles and scalp, and the same sort of
furrowing is noticed when a dog "pricks his ears." This case may
possibly be considered as an example of reversion to inferior
types. Cowan records two cases of the foregoing nature in idiots.
The first case was a paralytic idiot of thirty-nine, whose
cranial development was small in proportion to the size of the
face and body; the cranium was oxycephalic; the scalp was lax and
redundant and the hair thin; there were 13 furrows, five on each
side running anteroposteriorly, and three in the occipital region
running transversely. The occipitofrontalis muscle had no action
on them. The second case was that of an idiot of forty-four of a
more degraded type than the previous one. The cranium was round
and bullet-shaped and the hair generally thick. The scalp was not
so lax as in the other case, but the furrows were more crooked.
By tickling the scalp over the back of the neck the two median
furrows involuntarily deepened.
Impervious Skin.--There have been individuals who claimed that
their skin was impervious to ordinary puncture, and from time to
time these individuals have appeared in some of the larger
medical clinics of the world for inspection. According to a
recent number of the London Graphic, there is in Berlin a
Singhalese who baffles all investigations by physicians by the
impenetrability of his skin. The bronzed Easterner, a Hercules in
shape, claims to have found an elixir which will render the human
skin impervious to any metal point or sharpened edge of a knife
or dagger, and calls himself the "Man with Iron Skin." He is now
exhibiting himself, and his greatest feat is to pass with his
entire body through a hoop the inside of which is hardly big
enough to admit his body and is closely set with sharp
knife-points, daggers, nails, and similar things. Through this
hoop he squeezes his body with absolute impunity. The physicians
do not agree as to his immunity, and some of them think that
Rhannin, which is his name, is a fakir who has by long practice
succeeded in hardening himself against the impressions of metal
upon his skin. The professors of the Berlin clinic, however,
considered it worth while to lecture about the man's skin,
pronouncing it an inexplicable matter. This individual performed
at the London Alhambra in the latter part of 1895. Besides
climbing with bare feet a ladder whose rungs were sharp-edged
swords, and lying on a bed of nail points with four men seated
upon him, he curled himself up in a barrel, through whose inner
edges nails projected, and was rolled about the stage at a rapid
rate. Emerging from thence uninjured, he gracefully bows himself
off the stage.
Some individuals claim immunity from burns and show many
interesting feats in handling fire. As they are nothing but
skilful "fire jugglers" they deserve no mention here. The
immunity of the participants in the savage fire ceremonies will
be discussed in Chapter IX.
Albinism is characterized by the absolute or relative absence of
pigment of the skin, due to an arrest, insufficiency, or
retardation of this pigment. Following Trelat and Guinard, we may
divide albinism into two classes,-- general and partial.
As to the etiology of albinism, there is no known cause of the
complete form. Heredity plays no part in the number of cases
investigated by the authors. D'Aube, by his observations on white
rabbits, believes that the influence of consanguinity is a marked
factor in the production of albinism; there are, however, many
instances of heredity in this anomaly on record, and this idea is
possibly in harmony with the majority of observers.
Geoffroy-Saint-Hilaire has noted that albinism can also be a
consequence of a pathologic condition having its origin in
adverse surroundings, the circumstances of the parents, such as
the want of exercise, nourishment, light, etc.
Lesser knew a family in which six out of seven were albinos, and
in some tropical countries, such as Loango, Lower Guinea, it is
said to be endemic. It is exceptional for the parents to be
affected; but in a case of Schlegel, quoted by Crocker, the
grandfather was an albino, and Marey describes the case of the
Cape May albinos, in which the mother and father were "fair
emblems of the African race," and of their children three were
black and three were white, born in the following order: two
consecutive black boys, two consecutive white girls, one black
girl, one white boy. Sym of Edinburgh relates the history of a
family of seven children, who were alternately white and black.
All but the seventh were living and in good health and mentally
without defect. The parents and other relatives were dark. Figure
73 portrays an albino family by the name of Cavalier who
exhibited in Minneapolis in 1887.
Examples of the total absence of pigment occur in all races, but
particularly is it interesting when seen in negroes who are found
absolutely white but preserving all the characteristics of their
race, as, for instance, the kinky, woolly hair, flattened nose,
thick lips, etc. Rene Claille, in his "Voyage a Tombouctou," says
that he saw a white infant, the offspring of a negro and negress.
Its hair was white, its eyes blue, and its lashes flaxen. Its
pupils were of a reddish color, and its physiognomy that of a
Mandingo. He says such cases are not at all uncommon; they are
really negro albinos. Thomas Jefferson, in his "History of
Virginia," has an excellent description of these negroes, with
their tremulous and weak eyes; he remarks that they freckle
easily. Buffon speaks of Ethiops with white twins, and says that
albinos are quite common in Africa, being generally of delicate
constitution, twinkling eyes, and of a low degree of
intelligence; they are despised and ill-treated by the other
negroes. Prichard, quoted by Sedgwick, speaks of a case of atavic
transmission of albinism through the male line of the negro race.
The grandfather and the grandchild were albinos, the father being
black. There is a case of a brother and sister who were albinos,
the parents being of ordinary color but the grandfather an
albino. Coinde, quoted by Sedgwick, speaks of a man who, by two
different wives, had three albino children.
A description of the ordinary type of albino would be as follows:
The skin and hair are deprived of pigment; the eyebrows and
eyelashes are of a brilliant white or are yellowish; the iris and
the choroid are nearly or entirely deprived of coloring material,
and in looking at the eye we see a roseate zone and the ordinary
pink pupil; from absence of pigment they necessarily keep their
eyes three-quarters closed, being photophobic to a high degree.
They are amblyopic, and this is due partially to a high degree of
ametropia (caused by crushing of the eyeball in the endeavor to
shut out light) and from retinal exhaustion and nystagmus. Many
authors have claimed that they have little intelligence, but this
opinion is not true. Ordinarily the reproductive functions are
normal, and if we exclude the results of the union of two albinos
we may say that these individuals are fecund.
Partial albinism is seen. The parts most often affected are the
genitals, the hair, the face, the top of the trunk, the nipple,
the back of the hands and fingers. Folker reports the history of
a case of an albino girl having pink eyes and red hair, the rest
of the family having pink eyes and white hair. Partial albinism,
necessarily congenital, presenting a piebald appearance, must not
be confounded with leukoderma, which is rarely seen in the young
and which will be described later.
Albinism is found in the lower animals, and is exemplified
ordinarily by rats, mice, crows, robins, etc. In the Zoologic
Garden at Baltimore two years ago was a pair of pure albino
opossums. The white elephant is celebrated in the religious
history of Oriental nations, and is an object of veneration and
worship in Siam. White monkeys and white roosters are also
worshiped. In the Natural History Museum in London there are
stuffed examples of albinism and melanism in the lower animals.
Melanism is an anomaly, the exact contrary of the preceding. It
is characterized by the presence in the tissues and skin of an
excessive amount of pigment. True total melanism is unknown in
man, in whom is only observed partial melanism, characterized
simply by a pronounced coloration of part of the integument.
Some curious instances have been related of an infant with a
two-colored face, and of others with one side of the face white
and the other black; whether they were cases of partial albinism
or partial melanism cannot be ascertained from the descriptions.
Such epidermic anomalies as ichthyosis, scleroderma, and
molluscum simplex, sometimes appearing shortly after birth, but
generally seen later in life, will be spoken of in the chapter on
Anomalous Skin Diseases.
Human horns are anomalous outgrowths from the skin and are far
more frequent than ordinarily supposed. Nearly all the older
writers cite examples. Aldrovandus, Amatus Lusitanus, Boerhaave,
Dupre, Schenck, Riverius, Vallisneri, and many others mention
horns on the head. In the ancient times horns were symbolic of
wisdom and power. Michael Angelo in his famous sculpture of Moses
has given the patriarch a pair of horns. Rhodius observed a
Benedictine monk who had a pair of horns and who was addicted to
rumination. Fabricius saw a man with horns on his head, whose son
ruminated; the son considered that by virtue of his ruminating
characteristics his father had transmitted to him the peculiar
anomaly of the family. Fabricius Hildanus saw a patient with
horns all over the body and another with horns on the forehead.
Gastaher speaks of a horn from the left temple; Zacutus Lusitanus
saw a horn from the heel; Wroe, one of considerable length from
the scapula; Cosnard, one from the bregma; the Ephemerides, from
the foot; Borellus, from the face and foot, and Ash, horns all
over the body. Home, Cooper, and Treves have collected examples
of horns, and there is one 11 inches long and 2 1/2 in
circumference in a London museum. Lozes collected reports of 71
cases of horns,--37 in females, 31 in males, and three in
infants. Of this number, 15 were on the head, eight on the face,
18 on the lower extremities, eight on the trunk, and three on the
glans penis. Wilson collected reports of 90 cases,--44 females,
39 males, the sex not being mentioned in the remainder. Of these
48 were on the head, four on the face, four on the nose, 11 on
the thigh, three on the leg and foot, six on the back, five on
the glans penis, and nine on the trunk. Lebert's collection
numbered 109 cases of cutaneous horns. The greater frequency
among females is admitted by all authors. Old age is a
predisposing cause. Several patients over seventy have been seen
and one of ninety-seven.
Instances of cutaneous horns, when seen and reported by the
laity, give rise to most amusing exaggerations and descriptions.
The following account is given in New South Wales, obviously
embellished with apocryphal details by some facetious journalist:
The child, five weeks old, was born with hair two inches long all
over the body; his features were fiendish and his eyes shone like
beads beneath his shaggy brows. He had a tail 18 inches long,
horns from the skull, a full set of teeth, and claw-like hands;
he snapped like a dog and crawled on all fours, and refused the
natural sustenance of a normal child. The mother almost became an
imbecile after the birth of the monster. The country people about
Bomballa considered this devil-child a punishment for a rebuff
that the mother gave to a Jewish peddler selling
Crucifixion-pictures. Vexed by his persistence, she said she
would sooner have a devil in her house than his picture.
Lamprey has made a minute examination of the much-spoken-of
"Horned Men of Africa." He found that this anomaly was caused by
a congenital malformation and remarkable development of the
infraorbital ridge of the maxillary bone. He described several
cases, and through an interpreter found that they were
congenital, followed no history of traumatism, caused little
inconvenience, and were unassociated with disturbance of the
sense of smell. He also learned that the deformity was quite rare
in the Cape Coast region, and received no information tending to
prove the conjecture that the tribes in West Africa used
artificial means to produce the anomaly, although such custom is
prevalent among many aborigines.
Probably the most remarkable case of a horn was that of Paul
Rodrigues, a Mexican porter, who, from the upper and lateral part
of his head, had a horn 14 inches in circumference and divided
into three shafts, which he concealed by constantly wearing a
peculiarly shaped red cap. There is in Paris a wax model of a
horn, eight or nine inches in length, removed from an old woman
by the celebrated Souberbielle. Figure 75 is from a wax model
supposed to have been taken from life, showing an enormous
grayish-black horn proceeding from the forehead. Warren mentions
a case under the care of Dubois, in a woman from whose forehead
grew a horn six inches in diameter and six inches in height. It
was hard at the summit and had a fetid odor. In 1696 there was an
old woman in France who constantly shed long horns from her
forehead, one of which was presented to the King. Bartholinus
mentions a horn 12 inches long. Voigte cites the case of an old
woman who had a horn branching into three portions, coming from
her forehead. Sands speaks of a woman who had a horn 6 3/4 inches
long, growing from her head. There is an account of the
extirpation of a horn nearly ten inches in length from the
forehead of a woman of eighty-two. Bejau describes a woman of
forty from whom he excised an excrescence resembling a ram's
horn, growing from the left parietal region. It curved forward
and nearly reached the corresponding tuberosity. It was eight cm.
long, two cm. broad at the base, and 1 1/2 cm. at the apex, and
was quite mobile. It began to grow at the age of eleven and had
constantly increased. Vidal presented before the Academie de
Medecine in 1886 a twisted horn from the head of a woman. This
excrescence was ten inches long, and at the time of presentation
reproduction of it was taking place in the woman. Figure 76 shows
a case of ichthyosis cornea pictured in the Lancet, 1850.
There was a woman of seventy-five, living near York, who had a
horny growth from the face which she broke off and which began to
reproduce, the illustration representing the growth during twelve
months. Lall mentions a horn from the cheek; Gregory reports one
that measured 7 1/2 inches long that was removed from the temple
of a woman in Edinburgh; Chariere of Barnstaple saw a horn that
measured seven inches growing from the nape of a woman's neck;
Kameya Iwa speaks of a dermal horn of the auricle; Saxton of New
York has excised several horns from the tympanic membrane of the
ear; Noyes speaks of one from the eyelid; Bigelow mentions one
from the chin; Minot speaks of a horn from the lower lip, and
Doran of one from the neck.
Gould cites the instance of a horn growing from an
epitheliomatous penis. The patient was fifty-two years of age and
the victim of congenital phimosis. He was circumcised four years
previously, and shortly after the wound healed there appeared a
small wart, followed by a horn about the size of a marble. Jewett
speaks of a penile horn 3 1/2 inches long and 3 3/4 inches in
diameter; Pick mentions one 2 1/2 inches long. There is an
account of a Russian peasant boy who had a horn on his penis from
his earliest childhood. Johnson mentions a case of a horn from
the scrotum, which was of sebaceous origin and was subsequently
supplanted by an epithelioma.
Ash reported the case of a girl named Annie Jackson, living in
Waterford, Ireland, who had horny excrescences from her joints,
arms, axillae, nipples, ears, and forehead. Locke speaks of a boy
at the Hopital de la Charite in Paris, who had horny excrescences
four inches long and 11 inches in circumference growing from his
fingers and toes.
Wagstaffe presents a horn which grew from the middle of the leg
six inches below the knee in a woman of eighty. It was a
flattened spiral of more than two turns, and during forty years'
growth had reached the length of 14.3 inches. Its height was 3.8
inches, its skin-attachment 1.5 inches in diameter, and it ended
in a blunt extremity of 0.5 inch in diameter. Stephens mentions a
dermal horn on the buttocks at the seat of a carcinomatous
cicatrix. Harris and Domonceau speak of horns from the leg.
Cruveilhier saw a Mexican Indian who had a horn four inches long
and eight inches in circumference growing from the left lumbar
region. It had been sawed off twice by the patient's son and was
finally extirpated by Faget. The length of the pieces was 12
inches. Bellamy saw a horn on the clitoris about the size of a
tiger's claw in a its origin from beneath the preputium
clitoridis.
Horns are generally solitary but cases of multiple formation are
known Lewin and Heller record a syphilitic case with eight
cutaneous horns on the palms and soles. A female patient of
Manzuroff had as many as 185 horns.
Pancoast reports the case of a man whose nose, cheeks, forehead,
and lips were covered with horny growths, which had apparently
undergone epitheliomatous degeneration. The patient was a
sea-captain of seventy-eight, and had been exposed to the winds
all his life. He had suffered three attacks of erysipelas from
prolonged exposure. When he consulted Pancoast the horns had
nearly all fallen off and were brought to the physician for
inspection; and the photograph was taken after the patient had
tied the horns in situ on his face.
Anomalies of the Hair.--Congenital alopecia is quite rare, and it
is seldom that we see instances of individuals who have been
totally destitute of hair from birth. Danz knew of two adult sons
of a Jewish family who never had hair or teeth. Sedgwick quotes
the case of a man of fifty-eight who ever since birth was totally
devoid of hair and in whom sensible perspiration and tears were
absent. A cousin on his mother's side, born a year before him,
had precisely the same peculiarity. Buffon says that the Turks
and some other people practised depilatory customs by the aid of
ointments and pomades, principally about the genitals. Atkinson
exhibited in Philadelphia a man of forty who never had any
distinct growth of hair since birth, was edentulous, and
destitute of the sense of smell and almost of that of taste. He
had no apparent perspiration, and when working actively he was
obliged to wet his clothes in order to moderate the heat of his
body. He could sleep in wet clothes in a damp cellar without
catching cold. There was some hair in the axillae and on the
pubes, but only the slightest down on the scalp, and even that
was absent on the skin. His maternal grandmother and uncle were
similarly affected; he was the youngest of 21 children, had never
been sick, and though not able to chew food in the ordinary
manner, he had never suffered from dyspepsia in any form. He was
married and had eight children. Of these, two girls lacked a
number of teeth, but had the ordinary quantity of hair. Hill
speaks of an aboriginal man in Queensland who was entirely devoid
of hair on the head, face, and every part of the body. He had a
sister, since dead, who was similarly hairless. Hill mentions the
accounts given of another black tribe, about 500 miles west of
Brisbane, that contained hairless members. This is very strange,
as the Australian aboriginals are a very hairy race of people.
Hutchinson mentions a boy of three and a half in whom there was
congenital absence of hair and an atrophic condition of the skin
and appendages. His mother was bald from the age of six, after
alopecia areata. Schede reports two cases of congenitally bald
children of a peasant woman (a boy of thirteen and a girl of six
months). They had both been born quite bald, and had remained so.
In addition there were neither eyebrows nor eyelashes and nowhere
a trace of lanugo. The children were otherwise healthy and well
formed. The parents and brothers were healthy and possessed a
full growth of hair. Thurman reports a case of a man of
fifty-eight, who was almost devoid of hair all his life and
possessed only four teeth. His skin was very delicate and there
was absence of sensible perspiration and tears. The skin was
peculiar in thinness, softness, and absence of pigmentation. The
hair on the crown of the head and back was very fine, short, and
soft, and not more in quantity than that of an infant of three
months. There was a similar peculiarity in his cousin-german.
Williams mentions the case of a young lady of fifteen with
scarcely any hair on the eyebrows or head and no eyelashes. She
was edentulous and had never sensibly perspired. She improved
under tonic treatment.
Rayer quotes the case of Beauvais, who was a patient in the
Hopital de la Charite in 1827. The skin of this man's cranium was
apparently completely naked, although in examining it narrowly it
was found to be beset with a quantity of very white and silky
hair, similar to the down that covers the scalp of infants; here
and there on the temples there were a few black specks,
occasioned by the stumps of several hairs which the patient had
shaved off. The eyebrows were merely indicated by a few fine and
very short hairs; the free edges of the eyelids were without
cilia, but the bulb of each of these was indicated by a small,
whitish point. The beard was so thin and weak that Beauvais
clipped it off only every three weeks. A few straggling hairs
were observed on the breast and pubic region, as in young people
on the approach of puberty. There was scarcely any under the
axillae. It was rather more abundant on the inner parts of the
legs. The voice was like that of a full-grown and
well-constituted man. Beauvais was of an amorous disposition and
had had syphilis twice. His mother and both sisters had good
heads of hair, but his father presented the same defects as
Beauvais.
Instances are on record of women devoid of hair about the genital
region. Riolan says that he examined the body of a female
libertine who was totally hairless from the umbilical region
down.
Congenital alopecia is seen in animals. There is a species of
dog, a native of China but now bred in Mexico and in the United
States, which is distinguished for its congenital alopecia. The
same fact has been observed occasionally in horses, cattle, and
dogs. Heusner has seen a pigeon destitute of feathers, and which
engendered a female which in her turn transmitted the same
characteristic to two of her young.
Sexualism and Hair Growth.--The growth or development of the hair
may be accelerated by the state of the organs of generation. This
is peculiarly noticeable in the pubic hairs and the beard, and is
fully exemplified in the section on precocious development
(Chapter VII); however, Moreau de la Sarthe showed a child to the
Medical Faculty of Paris in whom precocious development of the
testicles had influenced that of the hair to such a degree that,
at the age of six, the chest of this boy was as thickly set with
hair as is usually seen in adults. It is well known that eunuchs
often lose a great part of their beards, and after removal of the
ovaries women are seen to develop an extra quantity of hair.
Gerberon tells of an infant with a beard, and Paullini and the
Ephemerides mention similar instances.
Bearded women are not at all infrequent. Hippocrates mentions a
female who grew a beard shortly after menstruation had ceased. It
is a well-recognized fact that after the menopause women become
more hirsute, the same being the case after removal of any of the
functional generative apparatus. Vicat saw a virgin who had a
beard, and Joch speaks of "foeminis barbati." Leblond says that
certain women of Ethiopia and South America have beards and
little or no menstruation. He also says that sterility and
excessive chastity are causes of female beards, and cites the
case of Schott of a young widow who secluded herself in a
cloister, and soon had a beard.
Barbara Urster, who lived in the 16th century, had a beard to her
girdle. The most celebrated "bearded woman" was Rosine-Marguerite
Muller, who died in a hospital in Dresden in 1732, with a thick
beard and heavy mustache. Julia Pastrana had her face covered
with thick hair and had a full beard and mustache. She exhibited
defective dentition in both jaws, and the teeth present were
arranged in an irregular fashion. She had pronounced prognathism,
which gave her a simian appearance. Ecker examined in 1876 a
woman who died at Fribourg, whose face contained a full beard and
a luxuriant mustache.
Harris reports several cases of bearded women, inmates of the
Coton Hill Lunatic Asylum. One of the patients was eighty-three
years of age and had been insane forty-four years following a
puerperal period. She would not permit the hair on her face to be
cut, and the curly white hairs had attained a length of from
eight to ten inches on the chin, while on the upper lip the hairs
were scarcely an inch. This patient was quite womanly in all her
sentiments. The second case was a woman of thirty-six, insane
from emotional melancholia. She had tufts of thick, curly hair on
the chin two inches long, light yellowish in color, and a few
straggling hairs on the upper lip. The third case was that of a
woman of sixty-four, who exhibited a strong passion for the male
sex. Her menstruation had been regular until the menopause. She
plaited her beard, and it was seven or eight inches long on the
chin and one inch on the lip. This woman had extremely hairy
legs. Another case was that of a woman of sixty-two, who, though
bald, developed a beard before the climacteric. Her structural
proportions were feminine in character, and it is said that her
mother, who was sane, had a beard also. A curious case was that
of a woman of twenty-three (Mrs. Viola M.), who from the age of
three had a considerable quantity of hair on the side of the
cheek which eventually became a full beard. She was quite
feminine was free from excessive hair elsewhere, her nose and
forehead being singularly bare. Her voice was very sweet; she was
married at seventeen and a half, having two normal children, and
nursed each for one month. "The bearded woman" of every circus
side-show is an evidence of the curious interest in which these
women are held. The accompanying illustration is a representation
of a "bearded woman" born in Bracken County, Ky. Her beard
measured 15 inches in length.
There is a class of anomalies in which there is an exaggerated
development of hair. We would naturally expect to find the
primitive peoples, who are not provided with artificial
protection against the wind, supplied with an extra quantity of
hair or having a hairy coat like animals; but this is sometimes
found among civilized people. This abnormal presence of hair on
the human body has been known for many years; the description of
Esau in the Bible is an early instance. Aldrovandus says that in
the sixteenth century there came to the Canary Islands a family
consisting of a father, son, and two daughters, who were covered
all over their bodies by long hair, and their portrait, certainly
reproduced from life, resembles the modern instances of "dog
men."
In 1883 there was shown in England and France, afterward in
America, a girl of seven named "Krao," a native of Indo-China.
The whole body of this child was covered with black hair. Her
face was of the prognathic type, and this, with her extraordinary
prehensile powers of feet and lips, gave her the title of
"Darwin's missing link." In 1875 there was exhibited in Paris,
under the name of "l'homme-chien" Adrien Jeftichew, a Russian
peasant of fifty-five, whose face, head, back, and limbs were
covered with a brown hairy coat looking like wool and several
centimeters long. The other parts of the body were also covered
with hair, but less abundantly. This individual had a son of
three, Theodore, who was hairy like himself.
A family living in Burmah (Shive-Maon, whose history is told by
Crawford and Yule), consisting of a father, a daughter, and a
granddaughter, were nearly covered with hair. Figure 84
represents a somewhat similar family who were exhibited in this
country.
Teresa Gambardella, a young girl of twelve, mentioned by
Lombroso, was covered all over the body, with the exception of
the hands and feet, by thick, bushy hair. This hypertrichosis was
exemplified in this country only a few months since by a person
who went the rounds of the dime museums under the euphonious name
of "Jo-Jo, the dog-face boy." His face was truly that of a
skye-terrier.
Sometimes the hairy anomalies are but instances of naevus
pilosus. The Indian ourang-outang woman examined at the office of
the Lancet was an example of this kind. Hebra, Hildebrandt,
Jablokoff, and Klein describe similar cases. Many of the older
"wild men" were individuals bearing extensive hairy moles.
Rayer remarks that he has seen a young man of sixteen who
exhibited himself to the public under the name of a new species
of wild man whose breast and back were covered with light brown
hair of considerable length.
The surface upon which it grew was of a brownish hue, different
from the color of the surrounding integument. Almost the whole of
the right arm was covered in the same manner. On the lower
extremity several tufts of hair were observed implanted upon
brown spots from seven to eight lines in diameter symmetrically
disposed upon both legs. The hair was brown, of the same color as
that of the head. Bichat informs us that he saw at Paris an
unfortunate man who from his birth was afflicted with a hairy
covering of his face like that of a wild boar, and he adds that
the stories which were current among the vulgar of individuals
with a boar's head, wolf's head, etc., undoubtedly referred to
cases in which the face was covered to a greater or less degree
with hair. Villerme saw a child of six at Poitiers in 1808 whose
body, except the feet and hands, was covered with a great number
of prominent brown spots of different dimensions, beset with hair
shorter and not so strong as that of a boar, but bearing a
certain resemblance to the bristles of that animal. These spots
occupied about one-fifth of the surface of this child's skin.
Campaignac in the early part of this century exhibited a case in
which there was a large tuft of long black hair growing from the
shoulder. Dufour has detailed a case of a young man of twenty
whose sacral region contained a tuft of hair as long and black,
thick and pliant, as that of the head, and, particularly
remarkable in this case, the skin from which it grew was as fine
and white as the integument of the rest of the body. There was a
woman exhibited recently, under the advertisement of "the lady
with a mane," who had growing from the center of her back between
the shoulders a veritable mane of long, black hair, which
doubtless proceeded from a form of naevus.
Duyse reports a case of extensive hypertrichosis of the back in a
girl aged nine years; her teeth were normal; there was
pigmentation of the back and numerous pigmentary nevi on the
face. Below each scapula there were tumors of the nature of
fibroma molluscum. In addition to hairy nevi on the other parts
of the body there was localized ichthyosis.
Ziemssen figures an interesting case of naevus pilosus resembling
"bathing tights". There were also present several benign tumors
(fibroma molluscum) and numerous smaller nevi over the body.
Schulz first observed the patient in 1878. This individual's name
was Blake, and he stated that he was born with a large naevus
spreading over the upper parts of the thighs and lower parts of
the trunk, like bathing-tights, and resembling the pelt of an
animal. The same was true of the small hairy parts and the larger
and smaller tumors. Subsequently the altered portions of the skin
had gradually become somewhat larger. The skin of the large hairy
naevus, as well as that of the smaller ones, was stated by Schulz
to have been in the main thickened, in part uneven, verrucose,
from very light to intensely dark brown in color; the consistency
of the larger mammiform and smaller tumors soft, doughy, and
elastic. The case was really one of large congenital naevus
pilosus and fibroma molluscum combined.
A Peruvian boy was shown at the Westminster Aquarium with a dark,
hairy mole situated in the lower part of the trunk and on the
thighs in the position of bathing tights. Nevins Hyde records two
similar cases with dermatolytic growths. A sister of the Peruvian
boy referred to had a still larger growth, extending from the
nucha all over the back. Both she and her brother had hundreds of
smaller hairy growths of all sizes scattered irregularly over the
face, trunk, and limbs. According to Crocker, a still more
extraordinary case, with extensive dermatolytic growths all over
the back and nevi of all sizes elsewhere, is described and
engraved in "Lavater's Physiognomy," 1848. Baker describes an
operation in which a large mole occupying half the forehead was
removed by the knife.
In some instances the hair and beard is of an enormous length.
Erasmus Wilson of London saw a female of thirty-eight, whose hair
measured 1.65 meters long. Leonard of Philadelphia speaks of a
man in the interior of this country whose beard trailed on the
ground when he stood upright, and measured 2.24 meters long. Not
long ago there appeared the famous so-called "Seven Sutherland
Sisters," whose hair touched the ground, and with whom nearly
every one is familiar through a hair tonic which they extensively
advertised. In Nature, January 9, 1892, is an account of a
Percheron horse whose mane measured 13 feet and whose tail
measured almost ten feet, probably the greatest example of
excessive mane development on record. Figure 88 represents Miss
Owens, an exhibitionist, whose hair measured eight feet three
inches. In Leslie's Weekly, January 2, 1896, there is a portrait
of an old negress named Nancy Garrison whose woolly hair was
equally as long.
The Ephemerides contains the account of a woman who had hair from
the mons veneris which hung to the knees; it was affected with
plica polonica, as was also the other hair of the body.
Rayer saw a Piedmontese of twenty-eight, with an athletic build,
who had but little beard or hair on the trunk, but whose scalp
was covered with a most extraordinary crop. It was extremely fine
and silky, was artificially frizzled, dark brown in color, and
formed a mass nearly five feet in circumference.
Certain pathologic conditions may give rise to accidental growths
of hair. Boyer was accustomed to quote in his lectures the case
of a man who, having an inflamed tumor in the thigh, perceived
this part becoming covered in a short time with numerous long
hairs. Rayer speaks of several instances of this kind. In one the
part affected by a blister in a child of two became covered with
hair. Another instance was that of a student of medicine, who
after bathing in the sea for a length of time, and exposing
himself to the hot sun, became affected with coppery patches,
from which there sprang a growth of hair. Bricheteau, quoted by
the same authority, speaks of a woman of twenty-four, having
white skin and hair of deep black, who after a long illness
occasioned by an affection analogous to marasmus became covered,
especially on the back, breast, and abdomen, with a multitude of
small elevations similar to those which appear on exposure to
cold. These little elevations became brownish at the end of a few
days, and short, fair, silky hair was observed on the summit of
each, which grew so rapidly that the whole surface of the body
with the exception of the hands and face became velvety. The hair
thus evolved was afterward thrown out spontaneously and was not
afterward reproduced.
Anomalies of the Color of the Hair.--New-born infants sometimes
have tufts of hair on their heads which are perfectly white in
color. Schenck speaks of a young man whose beard from its first
appearance grew white. Young men from eighteen to twenty
occasionally become gray; and according to Rayer, paroxysms of
rage, unexpected and unwelcome news, diseases of the scalp such
as favus, wounds of the head, habitual headache, over-indulgence
of the sexual appetite, mercurial courses too frequently
repeated, too great anxiety, etc., have been known to blanch the
hair prematurely.
The well-accepted fact of the sudden changing of the color of the
hair from violent emotions or other causes has always excited
great interest, and many ingenious explanations have been devised
to account for it. There is a record in the time of Charles V of
a young man who was committed to prison in 1546 for seducing his
girl companion, and while there was in great fear and grief,
expecting a death-sentence from the Emperor the next day. When
brought before his judge, his face was wan and pale and his hair
and beard gray, the change having taken place in the night. His
beard was filthy with drivel, and the Emperor, moved by his
pitiful condition, pardoned him. There was a clergyman of
Nottingham whose daughter at the age of thirteen experienced a
change from jet-blackness of the hair to white in a single night,
but this was confined to a spot on the back of the head 1 1/2
inches in length. Her hair soon became striped, and in seven
years was totally white. The same article speaks of a girl in
Bedfordshire, Maria Seeley, aged eight, whose face was swarthy,
and whose hair was long and dark on one side and light and short
on the other. One side of her body was also brown, while the
other side was light and fair. She was seen by the faculty in
London, but no cause could be established.
Voigtel mentions the occurrence of canities almost suddenly.
Bichat had a personal acquaintance whose hair became almost
entirely gray in consequence of some distressing news that
reached him. Cassan records a similar case. According to Rayer, a
woman by the name of Perat, summoned before the Chamber of Peers
to give evidence in the trial of the assassin Louvel, was so much
affected that her hair became entirely white in a single night
Byron makes mention of this peculiar anomaly in the opening
stanzas of the "Prisoner of Chillon:"--
"My hair is gray, but not with years,
Nor grew it white
In a single night.
As men's have grown from sudden fears."
The commentators say that Byron had reference to Ludovico Sforza
and others. The fact of the change is asserted of Marie
Antoinette, the wife of Louis XVI, though in not quite so short a
period, grief and not fear being the cause. Ziemssen cites
Landois' case of a compositor of thirty-four who was admitted to
a hospital July 9th with symptoms of delirium tremens; until
improvement began to set in (July 13th) he was continually
tormented by terrifying pictures of the imagination. In the night
preceding the day last mentioned the hair of the head and beard
of the patient, formerly blond, became gray. Accurate examination
by Landois showed the pigment contents of the hair to be
unchanged, and led him to believe that the white color was solely
due to the excessive development of air-bubbles in the hair
shaft. Popular belief brings the premature and especially the
sudden whitening into connection with depressing mental emotions.
We might quote the German expression--"Sich graue Haare etwas
wachsen lassen" ("To worry one's self gray"). Brown-Sequard
observed on several occasions in his own dark beard hairs which
had turned white in a night and which he epileptoid. He closes
his brief communication on the subject with the belief that it is
quite possible for black hair to turn white in one night or even
in a less time, although Hebra and Kaposi discredit sudden
canities (Duhring). Raymond and Vulpian observed a lady of
neurotic type whose hair during a severe paroxysm of neuralgia
following a mental strain changed color in five hours over the
entire scalp except on the back and sides; most of the hair
changed from black to red, but some to quite white, and in two
days all the red hair became white and a quantity fell off. The
patient recovered her general health, but with almost total loss
of hair, only a few red, white, and black hairs remaining on the
occipital and temporal regions. Crocker cites the case of a
Spanish cock which was nearly killed by some pigs. The morning
after the adventure the feathers of the head had become
completely white, and about half of those on the back of the neck
were also changed.
Dewees reports a case of puerperal convulsions in a patient under
his care which was attended with sudden canities. From 10 A.M. to
4 P.M. 50 ounces of blood were taken. Between the time of Dr.
Dewees' visits, not more than an hour, the hair anterior to the
coronal suture turned white. The next day it was less light, and
in four or five days was nearly its natural color. He also
mentions two cases of sudden blanching from fright.
Fowler mentions the case of a healthy girl of sixteen who found
one morning while combing her hair, which was black, that a strip
the whole length of the back hair was white, starting from a
surface about two inches square around the occipital
protuberance. Two weeks later she had patches of ephelis over the
whole body.
Prentiss, in Science, October 3, 1890, has collected numerous
instances of sudden canities, several of which will be given:--
"In the Canada Journal of Medical Science, 1882, p. 113, is
reported a case of sudden canities due to business-worry. The
microscope showed a great many air-vesicles both in the medullary
substance and between the medullary and cortical substance.
"In the Boston Medical and Surgical Journal, 1851, is reported a
case of a man thirty years old, whose hair 'was scared' white in
a day by a grizzly bear. He was sick in a mining camp, was left
alone, and fell asleep. On waking he found a grizzly bear
standing over him.
"A second case is that of a man of twenty-three years who was
gambling in California. He placed his entire savings of $1100 on
the turn of a card. He was under tremendous nervous excitement
while the cards were being dealt. The next day his hair was
perfectly white.
"In the same article is the statement that the jet-black hair of
the Pacific Islanders does not turn gray gradually, but when it
does turn it is sudden, usually the result of fright or sudden
emotions."
D'Alben, quoted by Fournier, describes a young man of
twenty-four, an officer in the regiment of Touraine in 1781, who
spent the night in carnal dissipation with a mulatto, after which
he had violent spasms, rendering flexion of the body impossible.
His beard and hair on the right side of the body was found as
white as snow, the left side being unchanged. He appeared before
the Faculte de Montpelier, and though cured of his nervous
symptoms his hair was still white, and no suggestion of relief
was offered him.
Louis of Bavaria, who died in 1294, on learning of the innocence
of his wife, whom he had put to death on a suspicion of her
infidelity, had a change of color in his hair, which became white
almost immediately. Vauvilliers, the celebrated Hellenist, became
white-haired almost immediately after a terrible dream, and
Brizard, the comedian, experienced the same change after a narrow
escape from drowning in the Rhone. The beard and the hair of the
Duke of Brunswick whitened in twenty-four hours after hearing
that his father had been mortally wounded at the battle of
Auerstadt.
De Schweinitz speaks of a well-formed and healthy brunette of
eighteen in whom the middle portion of the cilia of the right
upper eyelid and a number of the hairs of the lower lid turned
white in a week. Both eyes were myopic, but no other cause could
be assigned. Another similar case is cited by Hirshberg, and the
authors have seen similar cases. Thornton of Margate records the
case of a lady in whom the hair of the left eyebrow and eyelashes
began to turn white after a fortnight of sudden grief, and within
a week all the hair of these regions was quite white and remained
so. No other part was affected nor was there any other symptom.
After a traumatic ophthalmitis of the left and sympathetic
inflammation of the right eye in a boy of nine, Schenck observed
that a group of cilia of the right upper lid and nearly all the
lashes of the upper lid of the left eye, which had been
enucleated, turned silvery-white in a short time. Ludwig has
known the eyelashes to become white after small-pox.
Communications are also on record of local decolorization of the
eyebrows and lashes in neuralgias of isolated branches of the
trigeminus, especially of the supraorbital nerve.
Temporary and Partial Canities.--Of special interest are those
cases in which whiteness of the hair is only temporary. Thus,
Compagne mentions a case in which the black hair of a woman of
thirty-six began to fade on the twenty-third day of a malignant
fever, and on the sixth day following was perfectly white, but on
the seventh day the hairs became darker again, and on the
fourteenth day after the change they had become as black as they
were originally. Wilson records a case in which the hair lost its
color in winter and regained it in summer. Sir John Forbes,
according to Crocker, had gray hair for a long time, then
suddenly it all turned white, and after remaining so for a year
it returned to its original gray.
Grayness of the hair is sometimes only partial. According to
Crocker an adult whose hair was generally brown had a tuft of
white hair over the temple, and several like cases are on record.
Lorry tells us that grayness of one side only is sometimes
occasioned by severe headache. Hagedorn has known the beard to be
black in one place and white in another. Brandis mentions the
hair becoming white on one side of the face while it continued of
its former color on the other. Rayer quotes cases of canities of
the whole of one side of the body.
Richelot observed white mottling of hair in a girl sick with
chlorosis. The whitening extended from the roots to a distance of
two inches. The probable cause was a temporary alteration of the
pigment-forming function. When the chlorosis was cured the
natural color returned. Paullini and Riedlin, as well as the
Ephemerides, speak of different colored hair in the same head,
and it is not at all rare to see individuals with an anomalously
colored patch of hair on the head. The members of the ancient
house of Rohan were said to possess a tuft of white hair on the
front of their heads.
Michelson of Konigsberg describes a curious case in a barrister
of twenty-three affected with partial canities. In the family of
both parents there was stated to be congenital premature
canities, and some white hairs had been observed even in
childhood. In the fifteenth year, after a grave attack of scarlet
fever, the hair to a great extent fell out. The succeeding growth
of hair was stated to have been throughout lighter in tissue and
color and fissured at the points. Soon after bunches of white
hair appeared on the occiput, and in the succeeding years small
patches of decolored hairs were observed also on the anterior and
lateral portions of the scalp. In the spring of 1880 the patient
exhibited signs of infiltration of the apex of the right lung,
and afterward a violent headache came on. At the time of the
report the patient presented the appearance shown in Figure 89.
The complexion was delicate throughout, the eyelashes and eyelids
dark brown, the moustache and whiskers blond, and in the latter
were a few groups of white hair. The white patches were chiefly
on the left side of the head. The hairs growing on them were
unpigmented, but otherwise normal. The patient stated that his
head never sweated. He was stout and exhibited no signs of
internal disease, except at the apex of the right lung.
Anomalous Color Changes of the Hair.--The hair is liable to
undergo certain changes of color connected with some modification
of that part of the bulb secreting its coloring-matter. Alibert,
quoted by Rayer, gives us a report of the case of a young lady
who, after a severe fever which followed a very difficult labor,
lost a fine head of hair during a discharge of viscid fluid,
which inundated the head in every part. He tells us, further,
that the hair grew again of a deep black color after the recovery
of the patient. The same writer tells of the case of James B--,
born with brown hair, who, having lost it all during the course
of a sickness, had it replaced with a crop of the brightest red.
White and gray hair has also, under peculiar circumstances, been
replaced by hair of the same color as the individual had in
youth. We are even assured by Bruley that in 1798 the white hair
of a woman sixty years of age changed to black a few days before
her death. The bulbs in this case were found of great size, and
appeared gorged with a substance from which the hair derived its
color. The white hairs that remained, on the contrary, grew from
shriveled bulbs much smaller than those producing the black. This
patient died of phthisis.
A very singular case, published early in the century, was that of
a woman whose hair, naturally fair, assumed a tawny red color as
often as she was affected with a certain fever, and returned to
its natural hue as soon as the symptoms abated. Villerme alludes
to the case of a young lady, sixteen years of age, who had never
suffered except from trifling headaches, and who, in the winter
of 1817, perceived that the hair began to fall out from several
parts of her head, so that before six months were over she became
entirely bald. In the beginning of January, 1819, her head became
covered with a kind of black wool over those places that were
first denuded, and light brown hair began to develop from the
rest of the scalp. Some of this fell out again when it had grown
from three to four inches; the rest changed color at different
distances from its end and grew of a chestnut color from the
roots. The hair, half black, half chestnut, had a very singular
appearance.
Alibert and Beigel relate cases of women with blond hair which
all came off after a severe fever (typhus in one case), and when
it grew again it was quite black. Alibert also saw a young man
who lost his brown hair after an illness, and after restoration
it became red. According to Crocker, in an idiotic girl of
epileptic type (in an asylum at Edinburgh), with alternating
phases of stupidity and excitement, the hair in the stupid phase
was blond and in the excited condition red. The change of color
took place in the course of two or three days, beginning first at
the free ends, and remaining of the same tint for seven or eight
days. The pale hairs had more air-spaces than the darker ones.
There was much structural change in the brain and spinal cord.
Smyly of Dublin reported a case of suppurative disease of the
temporal bone, in which the hair changed from a mouse-color to a
reddish-brown; and Squire records a congenital case in a deaf
mute, in whom the hair on the left side was in light patches of
true auburn and dark patches of dark brown like a tortoise-shell
cap; on the other side the hair was a dark brown. Crocker
mentions the changes which have occurred in rare instances after
death from dark brown to red.
Chemic colorations of various tints occur. Blue hair is seen in
workers in cobalt mines and indigo works; green hair in copper
smelters; deep red-brown hair in handlers of crude anilin; and
the hair is dyed a purplish-brown whenever chrysarobin
applications used on a scalp come in contact with an alkali, as
when washed with soap. Among such cases in older literature
Blanchard and Marcellus Donatus speak of green hair; Rosse saw
two instances of the same, for one of which he could find no
cause; the other patient worked in a brass foundry.
Many curious causes are given for alopecia. Gilibert and Merlet
mention sexual excess; Marcellus Donatus gives fear; the
Ephemerides speaks of baldness from fright; and Leo Africanus, in
his description of Barbary, describes endemic baldness. Neyronis
makes the following observation: A man of seventy-three,
convalescent from a fever, one morning, about six months after
recovery perceived that he had lost all his hair, even his
eyelashes, eyebrows, nostril-hairs, etc. Although his health
continued good, the hair was never renewed.
The principal anomalies of the nails observed are absence,
hypertrophy, and displacement of these organs. Some persons are
born with finger-nails and toe-nails either very rudimentary or
entirely absent; in others they are of great length and
thickness. The Chinese nobility allow their finger-nails to grow
to a great length and spend much time in the care of these nails.
Some savage tribes have long and thick nails resembling the claws
of beasts, and use them in the same way as the lower animals.
There is a description of a person with finger-nails that
resembled the horns of a goat.
Neuhof, in his books on Tartary and China, says that many
Chinamen have two nails on the little toe, and other instances of
double nails have been reported.
The nails may be reversed or arise from anomalous positions.
Bartholinus speaks of nails from the inner side of the digits; in
another case, in which the fingers were wanting, he found the
nails implanted on the stumps. Tulpius says he knew of a case in
which nails came from the articulations of three digits; and many
other curious arrangements of nails are to be found.
Rouhuot sent a description and drawing of some monstrous nails to
the Academie des Sciences de Paris. The largest of these was the
left great toe-nail, which, from its extremity to its root,
measured 4 3/4 inches; the laminae of which it consisted were
placed one over the other, like the tiles on a roof, only
reversed. This nail and several of the others were of unequal
thickness and were variously curved, probably on account of the
pressure of the shoe or the neighboring digits. Rayer mentions
two nails sent to him by Bricheteau, physician of the Hopital
Necker, belonging to an old woman who had lived in the
Salpetriere. They were very thick and spirally twisted, like the
horns of a ram. Saviard informs us that he saw a patient at the
Hotel Dieu who had a horn like that of a ram, instead of a nail,
on each great toe, the extremities of which were turned to the
metatarsus and overlapped the whole of the other toes of each
foot. The skeleton of Simore, preserved in Paris, is remarkable
for the ankylosis of all the articulations and the considerable
size of all the nails. The fingers and toes, spread out and
ankylosed, ended in nails of great length and nearly of equal
thickness. A woman by the name of Melin, living in the last
century in Paris, was surnamed "the woman with nails;" according
to the description given by Saillant in 1776 she presented
another and not less curious instance of the excessive growth of
the nails.
Musaeus gives an account of the nails of a girl of twenty, which
grew to such a size that some of those of the fingers were five
inches in length. They were composed of several layers, whitish
interiorly, reddish-gray on the exterior, and full of black
points. These nails fell off at the end of four months and were
succeeded by others. There were also horny laminae on the knees
and shoulders and elbows which bore a resemblance to nails, or
rather talons. They were sensitive only at the point of insertion
into the skin. Various other parts of the body, particularly the
backs of the hands, presented these horny productions. One of
them was four inches in length. This horny growth appeared after
small-pox. Ash, in the Philosophical Transactions, records a
somewhat similar case in a girl of twelve.
Anomalies of the Teeth.--Pliny, Colombus, van Swieten, Haller,
Marcellus Donatus, Baudelocque, Soemmering, and Gardien all cite
instances in which children have come into the world with several
teeth already erupted. Haller has collected 19 cases of children
born with teeth. Polydorus Virgilus describes an infant who was
born with six teeth. Some celebrated men are supposed to have
been born with teeth; Louis XIV was accredited with having two
teeth at birth. Bigot, a physician and philosopher of the
sixteenth century; Boyd, the poet; Valerian, Richard III, as well
as some of the ancient Greeks and Romans, were reputed to have
had this anomaly. The significance of the natal eruption of teeth
is not always that of vigor, as many of the subjects succumb
early in life. There were two cases typical of fetal dentition
shown before the Academie de Medecine de Paris. One of the
subjects had two middle incisors in the lower jaw and the other
had one tooth well through. Levison saw a female born with two
central incisors in the lower jaw.
Thomas mentions a case of antenatal development of nine teeth.
Puech, Mattei, Dumas, Belluzi, and others report the eruption of
teeth in the newborn. In Dumas' case the teeth had to be
extracted on account of ulceration of the tongue. Instances of
triple dentition late in life are quite numerous, many occurring
after a hundred years. Mentzelius speaks of a man of one hundred
and ten who had nine new teeth. Lord Bacon cites the case of a
Countess Desmond, who when over a century old had two new teeth;
Hufeland saw an instance of dentition at one hundred and sixteen;
Nitzsch speaks of one at one hundred, and the Ephemerides contain
an account of a triple dentition at one hundred and twenty. There
is an account of a country laborer who lost all his teeth by the
time he arrived at his sixtieth year of age, but about a half
year afterward a new set made their appearance. Bisset mentions
an account of an old woman who acquired twelve molar teeth at the
age of ninety-eight. Carre notes a case of dental eruption in an
individual of eighty-five. Mazzoti speaks of a third dentition,
and Ysabeau writes of dentition of a molar at the age of
ninety-two. There is a record of a physician of the name of Slave
who retained all his second teeth until the age of eighty, when
they fell out; after five years another set appeared, which he
retained until his death at one hundred. In the same report there
is mentioned an old Scotchman who died at one hundred and ten,
whose teeth were renewed at an advanced age after he had lost his
second teeth. One of the older journals speaks of dentition at
seventy, eighty-four, ninety, and one hundred and fourteen. The
Philosophical Transactions of London contain accounts of
dentition at seventy-five and eighty-one. Bassett tells of an old
woman who had twelve molar teeth at the age of eighty-eight. In
France there is recorded dentition at eighty-five and an account
of an old man of seventy-three who had six new teeth. Von Helmont
relates an instance of triple dentition at the same age. There is
recorded in Germany an account of a woman of ninety who had
dentition at forty-seven and sixty-seven, each time a new set of
teeth appearing; Hunter and Petrequin have observed similar
cases. Carter describes an example of third dentition. Lison
makes a curious observation of a sixth dentition.
Edentulousness.--We have already noticed the association of
congenital alopecia with edentulousness, but, strange to say,
Magitot has remarked that "l'homme-chien," was the subject of
defective dentition. Borellus found atrophy of all the dental
follicles in a woman of sixty who never had possessed any teeth.
Fanton-Touvet saw a boy of nine who had never had teeth, and Fox
a woman who had but four in both jaws; Tomes cites several
similar instances. Hutchinson speaks of a child who was perfectly
edentulous as to temporary teeth, but who had the permanent teeth
duly and fully erupted. Guilford describes a man of forty-eight,
who was edentulous from birth, who also totally lacked the sense
of smell, and was almost without the sense of taste; the surface
of his body was covered with fine hairs and he had never had
visible perspiration. This is probably the same case quoted in
the foregoing paragraph in regard to the anomalies of hair. Otto,
quoted by Sedgwick, speaks of two brothers who were both totally
edentulous. It might be interesting in this connection to note
that Oudet found in a fetus at term all the dental follicles in a
process of suppuration, leaving no doubt that, if the fetus had
been born viable, it would have been edentulous. Giraldes
mentions the absence of teeth in an infant of sixteen months.
Bronzet describes a child of twelve, with only half its teeth, in
whom the alveolar borders receded as in age. Baumes remarks that
he had seen a man who never had any teeth.
The anomalies of excessive dentition are of several varieties,
those of simple supernumerary teeth, double or triple rows, and
those in anomalous positions. Ibbetson saw a child with five
incisors in the inferior maxillary bone, and Fanton-Touvet
describes a young lady who possessed five large incisors of the
first dentition in the superior maxilla. Rayer notes a case of
dentition of four canines, which first made their appearance
after pain for eight days in the jaws and associated with
convulsions. In an Ethiopian Soemmering has seen one molar too
many on each side and in each jaw. Ploucquet and Tesmer have seen
five incisors and Fanchard six. Many persons have the
supernumerary teeth parallel with their neighbors, anteriorly or
posteriorly. Costa reports a case in which there were five canine
teeth in the upper jaw, two placed laterally on either side, and
one on the right side behind the other two. The patient was
twenty-six years of age, well formed and in good health.
In some cases there is fusion of the teeth. Pliny, Bartholinus,
and Melanthon pretend to have seen the union of all the teeth,
making a continuous mass. In the "Musee de l'ecole dentaire de
Paris" there are several milk-teeth, both of the superior and
inferior maxilla, which are fused together. Bloch cites a case in
which there were two rows of teeth in the superior maxilla.
Hellwig has observed three rows of teeth, and the Ephemerides
contain an account of a similar anomaly.
Extraoral Dentition.--Probably the most curious anomaly of teeth
is that in which they are found in other than normal positions.
Albinus speaks of teeth in the nose and orbit; Borellus, in the
palate; Fabricius Hildanus, under the tongue; Schenck, from the
palate; and there are many similar modern records. Heister in
1743 wrote a dissertation on extraoral teeth. The following is a
recent quotation: --
"In the Norsk Magazin fur Laegevidenskaben, January, 1895, it is
reported that Dr. Dave, at a meeting of the Medical Society in
Christiania, showed a tooth removed from the nose of a woman aged
fifty-three. The patient had consulted him for ear-trouble, and
the tooth was found accidentally during the routine examination.
It was easily removed, having been situated in a small depression
at the junction of the floor and external wall of the nasal
cavity, 22 mm. from the external nares. This patient had all her
teeth; they were placed somewhat far from each other. The tooth
resembled a milk canine; the end of the imperfect root was
covered with a fold of mucous membrane, with stratified
epithelium. The speaker suggested that part of the mucous
membrane of the mouth with its tooth-germ had become impacted
between the superior and premaxillary bones and thus cut off from
the cavity of the mouth. Another speaker criticised this fetal
dislocation and believed it to be due to an inversion--a
development in the wrong direction--by which the tooth had grown
upward into the nose. The same speaker also pointed out that the
stratified epithelium of the mucous membrane did not prove a
connection with the cavity of the mouth, as it is known that
cylindric epithelium-cells after irritative processes are
replaced by flat ones."
Delpech saw a young man in 1829 who had an opening in the
palatine vault occasioned by the extraction of a tooth. This
opening communicated with the nasal fossa by a fracture of the
palatine and maxillary bones; the employment of an obturator was
necessary. It is not rare to see teeth, generally canine, make
their eruption from the vault of the palate; and these teeth are
not generally supernumerary, but examples of vice and deviation
of position. Fanton-Touvet, however, gives an example of a
supernumerary tooth implanted in the palatine arch. Branch a
describes a little negro boy who had two large teeth in the nose;
his dentition was otherwise normal, but a portion of the nose was
destroyed by ulceration. Roy describes a Hindoo lad of fourteen
who had a tooth in the nose, supposed to have been a tumor. It
was of the canine type, and was covered with enamel to the
junction with the root, which was deeply imbedded in the side and
upper part of the antrum. The boy had a perfect set of permanent
teeth and no deformity, swelling, or cystic formation of the jaw.
This was clearly a case of extrafollicular development and
eruption of the tooth in an anomalous position, the peculiarity
being that while in other similar cases the crown of the tooth
shows itself at the floor of the nasal cavity from below upward,
in this instance the dental follicle was transposed, the eruption
being from above downward. Hall cites an instance in which the
right upper canine of a girl erupted in the nose. The subject
showed marked evidence of hereditary syphilis. Carver describes a
child who had a tooth growing from the lower right eyelid. The
number of deciduous teeth was perfect; although this tooth was
canine it had a somewhat bulbulous fang.
Of anomalies of the head the first to be considered will be the
anencephalous monsters who, strange to say, have been known to
survive birth. Clericus cites an example of life for five days in
a child without a cerebrum. Heysham records the birth of a child
without a cerebrum and remarks that it was kept alive for six
days. There was a child born alive in Italy in 1831 without a
brain or a cerebellum--in fact, no cranial cavity--and yet it
lived eleven hours. A somewhat similar case is recorded in the
last century. In the Philosophical Transactions there is
mentioned a child virtually born without a head who lived four
days; and Le Duc records a case of a child born without brain,
cerebellum, or medulla oblongata, and who lived half an hour.
Brunet describes an anencephalous boy born at term who survived
his birth. Saviard delivered an anencephalous child at term which
died in thirty-six hours. Lawrence mentions a child with brain
and cranium deficient that lived five days. Putnam speaks of a
female nosencephalous monster that lived twenty-nine hours.
Angell and Elsner in March, 1895, reported a case of anencephaly,
or rather pseudencephaly, associated with double divergent
strabismus and limbs in a state of constant spastic contraction.
The infant lived eight days. Geoffroy-Saint-Hilaire cites an
example of anencephaly which lived a quarter of an hour. Fauvel
mentioned one that lived two hours, and Sue describes a similar
instance in which life persisted for seven hours and distinct
motions were noticed. Malacarne saw life in one for twelve hours,
and Mery has given a description of a child born without brain
that lived almost a full day and took nourishment. In the
Hotel-Dieu in Paris in 1812 Serres saw a monster of this type
which lived three days, and was fed on milk and sugared water, as
no nurse could be found who was willing to suckle it.
Fraser mentions a brother and sister, aged twenty and thirty,
respectively, who from birth had exhibited signs of defective
development of the cerebellum. They lacked power of coordination
and walked with a drunken, staggering gait; they could not touch
the nose with the finger when their eyes were shut, etc. The
parents of these unfortunate persons were perfectly healthy, as
were the rest of their family. Cruveilhier cites a case of a girl
of eleven who had absolutely no cerebellum, with the same
symptoms which are characteristic in such cases. There is also
recorded the history of a man who was deficient in the corpus
callosum; at the age of sixty-two, though of feeble intelligence,
he presented no signs of nervous disorder. Claude Bernard made an
autopsy on a woman who had no trace of olfactory lobes, and after
a minute inquiry into her life he found that her sense of smell
had been good despite her deficiency.
Buhring relates the history of a case somewhat analogous to
viability of anencephalous monsters. It was a bicephalous child
that lived thirty-two hours after he had ligated one of its
heads.
{footnote} The argument that the brain is not the sole organ of
the mind is in a measure substantiated by a wonderful case of a
decapitated rooster, reported from Michigan. A stroke of the
knife bad severed the larynx and removed the whole mass of the
cerebrum, leaving the inner aspect and base of the skull exposed.
The cerebrum was partly removed; the external auditory meatus was
preserved. Immediately after the decapitation the rooster was
left to its supposed death struggles, but it ran headless to the
barn, where it was secured and subsequently fed by pushing corn
down its esophagus, and allowing water to trickle into this tube
from the spout of an oil-can. The phenomena exhibited by the
rooster were quite interesting. It made all the motions of
pecking, strutted about, flapped its wings, attempted to crow,
but, of course, without making any sound. It exhibited no signs
of incoordination, but did not seem to hear. A ludicrous
exhibition was the absurd, sidelong pas seul made toward the
hens.
Ward mentions an instance of congenital absence of the corpora
callosum. Paget and Henry mention cases in which the corpora
callosum, the fornix, and septum lucidum were imperfectly formed.
Maunoir reports congenital malformation of the brain, consisting
of almost complete absence of the occipital lobe. The patient
died at the twenty-eighth month. Combettes reports the case of a
girl who died at the age of eleven who had complete absence of
the cerebellum in addition to other minor structural defects;
this was probably the case mentioned by Cruveilhier.
Diminution in volume of the head is called microcephaly. Probably
the most remarkable case on record is that mentioned by Lombroso.
The individual was called "l'homme-oiseau," or the human bird,
and his cranial capacity was only 390 c.c. Lombroso speaks of
another individual called "l'homme-lapin," or man-rabbit, whose
cranium was only slightly larger than that of the other,
measuring 490 mm. in circumference. Castelli alludes to endemic
microcephaly among some of the peoples of Asia. We also find it
in the Caribbean Islands, and from the skulls and portraits of
the ancient Aztecs we are led to believe that they were also
microcephalic.
Two creatures of celebrity were Maximo and Bartola, who for
twenty-five years have been shown in America and in Europe under
the name of the "Aztecs" or the "Aztec children". They were male
and female and very short, with heads resembling closely the
bas-reliefs on the ancient Aztec temples of Mexico. Their facial
angle was about 45 degrees, and they had jutting lips and little
or no chin. They wore their hair in an enormous bunch to magnify
the deformity. These curiosities were born in Central America and
were possibly half Indian and Negro. They were little better than
idiots in point of intelligence.
Figure 92 represents a microcephalic youth known as the "Mexican
wild boy," who was shown with the Wallace circus.
Virchow exhibited a girl of fourteen whose face was no larger
than that of a new-born child, and whose head was scarcely as
large as a man's fist. Magitot reported a case of a microcephalic
woman of thirty who weighed 70 pounds.
Hippocrates and Strabonius both speak of head-binding as a custom
inducing artificial microcephaly, and some tribes of North
American Indians still retain this custom.
As a rule, microcephaly is attended with associate idiocy and
arrested development of the rest of the body. Ossification of the
fontanelles in a mature infant would necessarily prevent full
development of the brain. Osiander and others have noticed this
anomaly. There are cases on record in which the fontanelles have
remained open until adulthood.
Augmentation of the volume of the head is called macrocephaly,
and there are a number of curious examples related. Benvenuti
describes an individual, otherwise well formed, whose head began
to enlarge at seven. At twenty-seven it measured over 37 inches
in circumference and the man's face was 15 inches in height; no
other portion of his body increased abnormally; his voice was
normal and he was very intelligent. He died of apoplexy at the
age of thirty.
Fournier speaks of a cranium in the cabinet of the Natural
History Museum of Marseilles of a man by the name of Borghini,
who died in 1616. At the time he was described he was fifty years
old, four feet in height; his head measured three feet in
circumference and one foot in height. There was a proverb in
Marseilles, "Apas mai de sen que Borghini," meaning in the local
dialect, "Thou hast no more wit than Borghini." This man, whose
fame became known all over France, was not able, as he grew
older, to maintain the weight of his head, but carried a cushion
on each shoulder to prop it up. Fournier also quotes the history
of a man who died in the same city in 1807 at the age of
sixty-seven. His head was enormous, and he never lay on a bed for
thirty years, passing his nights in a chair, generally reading or
writing. He only ate once in twenty-four or thirty hours, never
warmed himself, and never used warm water. His knowledge was said
to have been great and encyclopedic, and he pretended never to
have heard the proverb of Borghini. There is related the account
of a Moor, who was seen in Tunis early in this century,
thirty-one years of age, of middle height, with a head so
prodigious in dimensions that crowds flocked after him in the
streets. His nose was quite long, and his mouth so large that he
could eat a melon as others would an apple. He was an imbecile.
William Thomas Andrews was a dwarf seventeen years old, whose
head measured in circumference 35 inches; from one external
auditory meatus to another, 27 1/4 inches; from the chin over the
cranial summit to the suboccipital protuberance, 37 1/2 inches;
the distance from the chin to the pubes was 20 inches; and from
the pubes to the soles of the feet, 16; he was a monorchid. James
Cardinal, who died in Guy's Hospital in 1825, and who was so
celebrated for the size of his head, only measured 32 1/2 inches
in head-circumference.
The largest healthy brains on record, that is, of men of
prominence, are those of Cuvier, weighing 64 1/3 ounces; of
Daniel Webster, weighing 63 3/4 ounces (the circumference of
whose head was 23 3/4 inches); of Abercrombie, weighing 63
ounces, and of Spurzheim, weighing 55 1/16 ounces. Byron and
Cromwell had abnormally heavy brains, showing marked evidence of
disease.
A curious instance in this connection is that quoted by Pigne,
who gives an account of a double brain found in an infant. Keen
reports finding a fornix which, instead of being solid from side
to side, consisted of two lateral halves with a triangular space
between them.
When the augmentation of the volume of the cranium is caused by
an abundant quantity of serous fluid the anomaly is known as
hydrocephaly. In this condition there is usually no change in the
size of the brain-structure itself, but often the cranial bones
are rent far asunder. Minot speaks of a hydrocephalic infant
whose head measured 27 1/2 inches in circumference; Bright
describes one whose head measured 32 inches; and Klein, one 43
inches. Figure 93 represents a child of six whose head
circumference was 36 inches. Figure 94 shows a hydrocephalic
adult who was exhibited through this country.
There is a record of a curious monster born of healthy half-caste
African parents. The deformity was caused by a deficiency of
osseous material of the bones of the head. There was considerable
arrest of development of the parietal, temporal, and superior
maxillary bones, in consequence of which a very small amount of
the cerebral substance could be protected by the membranous
expansion of the cranial centers. The inferior maxilla and the
frontal bone were both perfect; the ears were well developed and
the tongue strong and active; the nostrils were imperforate and
there was no roof to the mouth nor floor to the nares. The eyes
were curiously free from eyelashes, eyelids, or brows. The cornea
threatened to slough. There was double harelip on the left side;
the second and third fingers of both hands were webbed for their
whole length; the right foot wanted the distal phalanx of the
great toe and the left foot was clubbed and drawn inward. The
child swallowed when fed from a spoon, appeared to hear, but
exhibited no sense of light. It died shortly after the
accompanying sketch was made.
Occasionally a deficiency in the osseous material of the cranium
or an abnormal dilatation of the fontanelles gives rise to a
hernia of the meninges, which, if accompanied by cerebrospinal
fluid in any quantity, causes a large and peculiarly shaped tumor
called meningocele. If there is a protrusion of brain-substance
itself, a condition known as hernia cerebri results.
Complete absence of the inferior maxilla is much rarer in man
than in animals. Nicolas and Prenant have described a curious
case of this anomaly in a sheep. Gurlt has named subjects
presenting the total or partial absence of the inferior maxilla,
agnathes or hemiagnathes. Simple atrophy of the inferior maxilla
has been seen in man as well as in the lower animals, but is much
less frequent than atrophy of the superior maxilla. Langenbeck
reports the case of a young man who had the inferior maxilla so
atrophied that in infancy it was impossible for him to take milk
from the breast. He had also almost complete immobility of the
jaws. Boullard reports a deformity of the visage, resulting in a
deficiency of the condyles of the lower jaw. Maurice made an
observation on a vice of conformation of the lower jaw which
rendered lactation impossible, probably causing the death of the
infant on this account. Tomes gives a description of a lower jaw
the development of the left ramus of which had been arrested.
Canton mentions arrest of development of the left perpendicular
ramus of the lower jaw combined with malformation of the external
ear.
Exaggerated prominence of the maxillaries is called prognathism;
that of the superior maxilla is seen in the North American
Indians. Inferior prognathism is observed in man as well as in
animals. The bull-dog, for example, displays this, but in this
instance the deformity is really superior brachygnathism, the
superior maxilla being arrested in development.
Congenital absence of the nose is a very rare anomaly.
Maisonneuve has seen an example in an individual in which, in
place of the nasal appendix, there was a plane surface perforated
by two small openings a little less than one mm. in diameter and
three mm. apart.
Exaggeration in volume of the nose is quite frequent. Ballonius
speaks of a nose six times larger than ordinary. Viewing the
Roman celebrities, we find that Numa, to whom was given the
surname Pompilius, had a nose which measured six inches.
Plutarch, Lyourgus, and Solon had a similar enlargement, as had
all the kings of Italy except Tarquin the Superb.
Early in the last century a man, Thomas Wedders (or Wadhouse),
with a nose 7 1/2 inches long, was exhibited throughout
Yorkshire. This man expired as he had lived, in a condition of
mind best described as the most abject idiocy. The accompanying
illustration is taken from a reproduction of an old print and is
supposed to be a true likeness of this unfortunate individual.
There are curious pathologic formations about the nose which
increase its volume so enormously as to interfere with
respiration and even with alimentation; but these will be spoken
of in another chapter.
There have been some celebrities whose noses were undersized. The
Duc de Guise, the Dauphin d'Auvergne, and William of Orange,
celebrated in the romances of chivalry, had extremely short
noses.
There are a few recorded cases of congenital division of the
nose. Bartholinus, Borellus, and the Ephemerides speak of duplex
noses. Thomas of Tours has observed congenital fissure of the
nose. Rikere reports the case of an infant of three weeks who
possessed a supernumerary nose on the right nasal bone near the
inner canthus of the eye. It was pear-shaped, with its base down,
and was the size of the natural nose of an infant of that age,
and air passed through it. Hubbell, Ronaldson, and Luscha speak
of congenital occlusion of the posterior nares. Smith and Jarvis
record cases of congenital occlusion of the anterior nares.
Anomalies in size of the mouth are not uncommon. Fournier quotes
the history of a man who had a mouth so large that when he opened
it all his back teeth could be seen. There is a history of a boy
of seventeen who had a preternaturally-sized mouth, the
transverse diameter being 6 1/2 inches. The mother claimed that
the boy was born with his foot in his mouth and to this fact
attributed his deformity. The negro races are noted for their
large mouths and thick lips. A negro called "Black Diamond,"
recently exhibited in Philadelphia, could put both his fists in
his mouth.
Morgan reports two cases of congenital macrostoma accompanied by
malformation of the auricles and by auricular appendages. Van
Duyse mentions congenital macrostoma with preauricular tumors and
a dermoid of the eye. Macrostoma is sometimes produced by lateral
fissures. In other cases this malformation is unilateral and the
fissure ascends, in which instance the fissure may be accompanied
by a fistula of the duct of Stensen. Sometimes there is
associated with these anomalies curious terminations of the
salivary ducts, either through the cheek by means of a fistula or
on the anterior part of the neck.
Microstoma.--There are a few cases on record in which the mouth
has been so small or ill-defined as not to admit of alimentation.
Molliere knew an individual of forty whose mouth was the exact
size of a ten-centime piece.
Buchnerus records a case of congenital atresia of the mouth.
Cayley, Smith, Sourrouille, and Stankiewiez of Warsaw discuss
atresia of the mouth. Cancrum oris, scarlet fever, burns, scurvy,
etc., are occasional causes that have been mentioned, the atresia
in these instances taking place at any time of life.
Anomalies of the Lips.--The aboriginal tribes are particularly
noted for their large and thick lips, some of which people
consider enormous lips signs of adornment. Elephantiasis or other
pathologic hypertrophy of the labial tissues can produce
revolting deformity, such as is seen in Figure 100, representing
an individual who was exhibited several years ago in
Philadelphia. We have in English the expression, "pulling a long
lip." Its origin is said to date back to a semimythical hero of
King Arthur's time, who, "when sad at heart and melancholic,"
would let one of his lips drop below his waist, while he turned
the other up like a cap on his head.
Blot records a case of monstrous congenital hypertrophy of the
superior lip in an infant of eight months. Buck successfully
treated by surgical operations a case of congenital hypertrophy
of the under lip, and Detmold mentions a similar result in a
young lady with hypertrophy of the lip and lower part of the
nose. Murray reports an undescribed malformation of the lower lip
occurring in one family.
Hare-lip may be unilateral or double, and may or may not include
the palatine arch. In the worst cases it extends in fissures on
both sides to the orbit. In other cases the minimum degree of
this deformity is seen.
Congenital absence of the tongue does not necessarily make
speech, taste, or deglutition impossible. Jussieu cites the case
of a girl who was born without a tongue but who spoke very
distinctly. Berdot describes a case in which the tongue was
deficient, without apparent disturbance of any of the functions.
Riolan mentions speech after loss of the tongue from small-pox.
Boddington gives an account of Margaret Cutting, who spoke
readily and intelligibly, although she had lost her tongue.
Saulquin has an observation of a girl without a tongue who spoke,
sang, and swallowed normally. Aurran, Bartholinus, Louis,
Parsons, Tulpius, and others mention speech without the presence
of a tongue.
Philib reports a case in which mutism, almost simulating that of
one congenitally deaf, was due to congenital adhesions of the
tongue to the floor of the buccal cavity. Speech was established
after removal of the abnormal adhesion. Routier speaks of
ankylosis of the tongue of seventeen years' duration.
Jurist records such abnormal mobility of the tongue that the
patient was able to project the tongue into the nasopharynx.
Wherry and Winslow record similar instances.
There have been individuals with bifid tongues, after the normal
type of serpents and saurians, and others who possessed a
supernumerary tongue. Rev. Henry Wharton, Chaplain to Archbishop
Sancroft, in his journal, written in the seventeenth century,
says that he was born with two tongues and passed through life
so, one, however, gradually atrophying. In the polyclinic of
Schnitzer in Vienna in 1892 Hajek observed in a lad of twelve an
accessory tongue 2.4 cm. in length and eight mm. in breadth,
forming a tumor at the base of the normal tongue. It was removed
by scissors, and on histologic examination proved to be a true
tongue with the typical tissues and constituents. Borellus,
Ephemerides, Eschenbach, Mortimer, Penada, and Schenck speak of
double tongues, and Avicenna and Schenck have seen fissured
tongues. Dolaeus records an instance of double tongue in a paper
entitled "De puella bilingui," and Beaudry and Brothers speak of
cleft tongue. Braine records a case in which there was a large
hypertrophied fold of membrane coming from each side of the upper
lip.
In some cases there is marked augmentation of the volume of the
tongue. Fournier has seen a juggler with a tongue so long that he
could extrude it six inches from his mouth. He also refers to a
woman in Berlin with a long tongue, but it was thinner than that
of a cat. When she laughed it hung over her teeth like a curtain,
and was always extremely cold to the touch. In the same article
there is a description of a man with a very long neck who could
touch his tongue to his chest without reclining his head.
Congenital and acquired hypertrophy of the tongue will be
discussed later.
Amatus Lusitanus and Portal refer to the presence of hair on the
tongue, and later there was an account of a medical student who
complained of dyspepsia and a sticky sensation in the mouth. On
examination a considerable growth of hair was found on the
surface of the tongue. The hairs would be detached in vomiting
but would grow again, and when he was last seen they were one
inch long. Such are possibly nevoid in formation.
The ordinary anomalies of the palate are the fissures,
unilateral, bilateral, median, etc.: they are generally
associated with hare-lip. The median fissure commencing between
the middle incisors is quite rare.
Many curious forms of obturator or artificial palate are employed
to remedy congenital defects. Sercombe mentions a case in which
destruction of the entire palate was successfully relieved by
mechanical means. In some instances among the lower classes these
obturators are simple pieces of wood, so fashioned as to fit into
the palatine cleft, and not infrequently the obturator has been
swallowed, causing obstruction of the air-passages or occluding
the esophagus.
Abnormalism of the Uvula.--Examples of double uvula are found in
the older writers, and Hagendorn speaks of a man who was born
without a uvula. The Ephemerides and Salmuth describe uvulae so
defective as to be hardly noticeable. Bolster, Delius, Hodges,
Mackenzie of Baltimore, Orr, Riedel, Schufeldt, and Tidyman are
among observers reporting bifurcated and double uvula, and they
are quite common. Ogle records instances of congenital absence of
the uvula.
Anomalies of the Epiglottis.--Morgagni mentions a man without an
epiglottis who ate and spoke without difficulty. He thought the
arytenoids were so strongly developed that they replaced the
functions of the missing organ. Enos of Brooklyn in 1854 reported
absence of the epiglottis without interference with deglutition.
Manifold speaks of a case of bifurcated epiglottis. Debloisi
records an instance of congenital web of the vocal bands.
Mackenzie removed a congenital papillomatous web which had united
the vocal cords until the age of twenty-three, thus establishing
the voice. Poore also recorded a case of congenital web in the
larynx. Elsberg and Scheff mention occlusion of the rima
glottidis by a membrane.
Instances of duplication of the epiglottis attended with a
species of double voice possess great interest. French described
a man of thirty, by occupation a singer and contortionist, who
became possessed of an extra voice when he was sixteen. In high
and falsetto tones he could run the scale from A to F in an upper
and lower range. The compass of the low voice was so small that
he could not reach the high notes of any song with it, and in
singing he only used it to break in on the falsetto and produce a
sensation. He was supposed to possess a double epiglottis.
Roe describes a young lady who could whistle at will with the
lower part of her throat and without the aid of her lips.
Laryngeal examination showed that the fundamental tones were
produced by vibrations of the edges of the vocal cords, and the
modifications were effected by a minute adjustment of the
ventricular bands, which regulated the laryngeal opening above
the cord, and pressing firmly down closed the ventricle and acted
as a damper preventing the vibrations of the cords except in
their middle third. Morgan in the same journal mentions the case
of a boy of nineteen, who seemed to be affected with laryngeal
catarrh, and who exhibited distinct diphthongia. He was seen to
have two glottic orifices with associate bands. The treatment was
directed to the catarrh and consequent paresis of the posterior
bands, and he soon lost his evidences of double voice.
{footnote} The following is a description of the laryngeal
formation of a singer who has recently acquired considerable
notice by her ability to sing notes of the highest tones and to
display the greatest compass of voice. It is extracted from a
Cleveland, Ohio, newspaper: "She has unusual development of the
larynx, which enables her to throw into vibration and with
different degrees of rapidity the entire length of the vocal
cords or only a part thereof. But of greatest interest is her
remarkable control over the muscles which regulate the division
and modification of the resonant cavities, the laryngeal,
pharyngeal, oral, and nasal, and upon this depends the quality of
her voice. The uvula is bifurcated, and the two divisions
sometimes act independently. The epiglottis during the production
of the highest notes rises upward and backward against the
posterior pharyngeal wall in such a way as almost entirely to
separate the pharyngeal cavities, at the same time that it gives
an unusual conformation to those resonant chambers."
Complete absence of the eyes is a very rare anomaly. Wordsworth
describes a baby of seven weeks, otherwise well formed and
healthy, which had congenital absence of both eyes. The parents
of this child were in every respect healthy. There are some cases
of monstrosities with closed, adherent eyelids and absence of
eyes. Holmes reports a case of congenital absence of both eyes,
the child otherwise being strong and perfect. The child died of
cholera infantum. He also reports a case very similar in a female
child of American parents. In a girl of eight, of German parents,
he reports deficiency of the external walls of each orbit, in
addition to great deformity of the side of the head. He also
gives an instance of congenital paralysis of the levator
palpebrae muscles in a child whose vision was perfect and who was
otherwise perfect. Holmes also reports a case of enormous
congenital exophthalmos, in which the right eye protruded from
the orbit and was no longer covered by the cornea. Kinney has an
account of a child born without eyeballs. The delivery was
normal, and there was no history of any maternal impression; the
child was otherwise healthy and well formed.
Landes reports the case of an infant in which both eyes were
absent. There were six fingers on each hand and six toes on each
foot. The child lived a few weeks. In some instances of supposed
absence of the eyeball the eye is present but diminutive and in
the posterior portion of the orbit. There are instances of a
single orbit with no eyes and also a single orbit containing two
eyes. Again we may have two orbits with an absence of eyes but
the presence of the lacrimal glands, or the eyes may be present
or very imperfectly developed. Mackenzie mentions cases in which
the orbit was more or less completely wanting and a mass of
cellular tissue in each eye.
Cases of living cyclopia, or individuals with one eye in the
center of the forehead after the manner of the mythical Cyclops,
are quite rare. Vallentini in 1884 reports a case of a male
cyclopic infant which lived for seventy-three hours. There were
median fissures of the upper lip, preauricular appendages, oral
deformity, and absence of the olfactory proboscis The fetus was
therefore a cyclops arrhynchus, or cyclocephalus. Blok describes
a new-born infant which lived for six or seven hours, having but
one eye and an extremely small mouth.
The "Four-eyed Man of Cricklade" was a celebrated English
monstrosity of whom little reliable information is obtainable. He
was visited by W. Drury, who is accredited with reporting the
following--
" 'So wondrous a thing, such a lusus naturae, such a scorn and
spite of nature I have never seen. It was a dreadful and shocking
sight.' This unfortunate had four eyes placed in pairs, 'one eye
above the other and all four of a dull brown, encircled with red,
the pupils enormously large.' The vision in each organ appeared
to be perfect. 'He could shut any particular eye, the other three
remaining open, or, indeed, as many as he chose, each several eye
seeming to be controlled by his will and acting independently of
the remainder. He could also revolve each eye separately in its
orbit, looking backward with one and forward with another, upward
with one and downward with another simultaneously.' He was of a
savage, malignant disposition, delighting in ugly tricks, teasing
children, torturing helpless animals, uttering profane and
blasphemous words, and acting altogether like the monster, mental
and physical, that he was. 'He could play the fiddle, though in a
silly sort, having his notes on the left side, while closing the
right pair of eyes. He also sang, but in a rough, screeching
voice not to be listened to without disgust.'"
There is a recent report of a child born in Paris with its eyes
in the top of its head. The infant seemed to be doing well and
crowds of people have flocked to see it. Recent reports speak of
a child born in Portland, Oregon, which had a median rudimentary
eye between two normal eyes. Fournier describes an infant born
with perfectly formed eyes, but with adherent eyelids and closed
ocular aperture. Forlenze has seen the pupils adherent to the
conjunctiva, and by dissection has given sight to the subject.
Dubois cites an instance of supernumerary eyelid. At the external
angle of the eyelid was a fold of conjunctiva which extended 0.5
cm. in front of the conjunctiva, to which it did not adhere,
therefore constituting a fourth eyelid. Fano presents a similar
case in a child of four months, in whom no other anomaly, either
of organs or of vision, was observed. On the right side, in front
of the external half of the sclerotic, was observed a semilunar
fold with the concavity inward, and which projected much more
when the lower lid was depressed. When the eyelid rolled inward
the fold rolled with the globe, but never reached so far as the
circumference of the cornea and did not interfere with vision.
Total absence of both irides has been seen in a man of eighteen.
Dixon reports a case of total aniridia with excellent sight in a
woman of thirty-seven. In Guy's Hospital there was seen a case of
complete congenital absence of the iris. Hentzschel speaks of a
man with congenital absence of the iris who had five children,
three of whom exhibited the same anomaly while the others were
normal. Benson, Burnett, Demaux, Lawson, Morison, Reuling,
Samelson, and others also report congenital deficiency of the
irides in both eyes.
Jeaffreson describes a female of thirty, living in India, who was
affected with complete ossification of the iris. It was immovable
and quite beautiful when seen through the transparent cornea; the
sight was only slightly impaired. No cause was traceable.
Multiple Pupils.--More than one pupil in the eye has often been
noticed, and as many as six have been seen. They may be
congenital or due to some pathologic disturbance after birth.
Marcellus Donatus speaks of two pupils in one eye. Beer,
Fritsche, and Heuermann are among the older writers who have
noticed supernumerary pupils. Higgens in 1885 described a boy
whose right iris was perforated by four pupils,--one above, one
to the inner side, one below, and a fourth to the outer side. The
first three were slit-shaped; the fourth was the largest and had
the appearance as of the separation of the iris from its
insertion. There were two pupils in the left eye, both to the
outer side of the iris, one being slit-like and the other
resembling the fourth pupil in the right eye. All six pupils
commenced at the periphery, extended inward, and were of
different sizes. The fundus could be clearly seen through all of
the pupils, and there was no posterior staphyloma nor any
choroidal changes. There was a rather high degree of myopia. This
peculiarity was evidently congenital, and no traces of a central
pupil nor marks of a past iritis could be found. Clinical
Sketches a contains quite an extensive article on and several
illustrations of congenital anomalies of the iris.
Double crystalline lenses are sometimes seen. Fritsch and
Valisneri have seen this anomaly and there are modern references
to it. Wordsworth presented to the Medical Society of London six
members of one family, all of whom had congenital displacement of
the crystalline lens outward and upward. The family consisted of
a woman of fifty, two sons, thirty-five and thirty-seven, and
three grandchildren--a girl of ten and boys of five and seven.
The irides were tremulous.
Clark reports a case of congenital dislocation of both
crystalline lenses. The lenses moved freely through the pupil
into the anterior chambers. The condition remained unchanged for
four years, when glaucoma supervened.
Differences in Color of the Two Eyes.--It is not uncommon to see
people with different colored eyes. Anastasius I had one black
eye and the other blue, from whence he derived his name "Dicore,"
by which this Emperor of the Orient was generally known. Two
distinct colors have been seen in an iris. Berry gives a colored
illustration of such a case.
The varieties of strabismus are so common that they will be
passed without mention. Kuhn presents an exhaustive analysis of
73 cases of congenital defects of the movements of the eyes,
considered clinically and didactically. Some or all of the
muscles may be absent or two or more may be amalgamated, with
anomalies of insertion, false, double, or degenerated, etc.
The influence of heredity in the causation of congenital defects
of the eye is strikingly illustrated by De Beck. In three
generations twelve members of one family had either coloboma
iridis or irideremia. He performed two operations for the cure of
cataract in two brothers. The operations were attended with
difficulty in all four eyes and followed by cyclitis. The result
was good in one eye of each patient, the eye most recently blind.
Posey had a case of coloboma in the macular region in a patient
who had a supernumerary tooth. He believes the defects were
inherited, as the patient's mother also had a supernumerary
tooth.
Nunnely reports cases of congenital malformation in three
children of one family. The globes of two of them (a boy and a
girl) were smaller than natural, and in the boy in addition were
flattened by the action of the recti muscles and were soft; the
sclera were very vascular and the cornea, conical, the irides
dull, thin, and tremulous; the pupils were not in the axis of
vision, but were to the nasal side. The elder sister had the same
congenital condition, but to a lesser degree. The other boy in
the family had a total absence of irides, but he could see fairly
well with the left eye.
Anomalies of the Ears.--Bilateral absence of the external ears is
quite rare, although there is a species of sheep, native of
China, called the "Yungti," in which this anomaly is constant.
Bartholinus, Lycosthenes, Pare, Schenck, and Oberteuffer have
remarked on deficient external ears. Guys, the celebrated
Marseilles litterateur of the eighteenth century, was born with
only one ear. Chantreuil mentions obliteration of the external
auditory canal in the new-born. Bannofont reports a case of
congenital imperforation of the left auditory canal existing near
the tympanic membrane with total deafness in that ear. Lloyd
described a fetus showing absence of the external auditory meatus
on both sides. Munro reports a case of congenital absence of the
external auditory meatus of the right ear; and Richardson speaks
of congenital malformation of the external auditory apparatus of
the right side. There is an instance of absence of the auditory
canal with but partial loss of hearing. Mussey reports several
cases of congenitally deficient or absent aural appendages. One
case was that in which there was congenital absence of the
external auditory meatus of both ears without much impairment of
hearing. In neither ear of N. W. Goddard, aged twenty-seven, of
Vermont, reported in 1834, was there a vestige of an opening or
passage in the external ear, and not even an indentation. The
Eustachian tube was closed. The integuments of the face and scalp
were capable of receiving acoustic impressions and of
transmitting them to the organs of hearing. The authors know of a
student of a prominent New York University who is congenitally
deficient in external ears, yet his hearing is acute. He hides
his deformity by wearing his hair long and combed over his ears.
The knowledge of anomalous auricles is lost in antiquity. Figure
103 represents the head of an aegipan in the British Museum
showing a supernumerary auricle. As a rule, supernumerary
auricles are preauricular appendages. Warner, in a report of the
examination of 50,000 children, quoted by Ballantyne, describes
33 with supernumerary auricles, represented by sessile or
pedunculated outgrowths in front of the tragus. They are more
commonly unilateral, always congenital, and can be easily
removed, giving rise to no unpleasant symptoms. They have a soft
and elastic consistency, and are usually composed of a hyaline or
reticular cartilaginous axis covered with connective or adipose
tissue and skin bearing fine hairs; sometimes both cartilage and
fat are absent. They are often associated with some form of
defective audition--harelip, ocular disturbance, club-feet,
congenital hernia, etc. These supernumerary members vary from one
to five in number and are sometimes hereditary. Reverdin
describes a man having a supernumerary nipple on the right side
of his chest, of whose five children three had preauricular
appendages. Figure 104 represents a girl with a supernumerary
auricle in the neck, described in the Lancet, 1888. A little girl
under Birkett's care in Guy's Hospital more than answered to
Macbeth's requisition, "Had I three ears I'd hear thee!" since
she possessed two superfluous ones at the sides of the neck,
somewhat lower than the angle of the jaw, which were well
developed as to their external contour and made up of
fibrocartilage. There is mentioned the case of a boy of six
months on the left side of whose neck, over the middle anterior
border of the sternocleidomastoid muscle, was a nipple-like
projection 1/2 inch in length; a rod of cartilage was prolonged
into it from a thin plate, which was freely movable in the
subcutaneous tissue, forming a striking analogue to an auricle.
Moxhay cites the instance of a mother who was frightened by the
sight of a boy with hideous contractions in the neck, and who
gave birth to a child with two perfect ears and three rudimentary
auricles on the right side, and on the left side two rudimentary
auricles.
In some people there is an excessive development of the auricular
muscles, enabling them to move their ears in a manner similar to
that of the lower animals. Of the celebrated instances the Abbe
de Marolles, says Vigneul-Marville, bears witness in his
"Memoires" that the Regent Crassot could easily move his ears.
Saint Augustine mentions this anomaly.
Double tympanitic membrane is spoken of by Loeseke. There is
sometimes natural perforation of the tympanum in an otherwise
perfect ear, which explains how some people can blow
tobacco-smoke from the ear. Fournier has seen several Spaniards
and Germans who could perform this feat, and knew one man who
could smoke a whole cigar without losing any smoke, since he made
it leave either by his mouth, his ears, or in both ways. Fournier
in the same article mentions that he has seen a woman with ears
over four inches long.
Strange to say, there have been reports of cases in which the
ossicles were deficient without causing any imperfection of
hearing. Caldani mentions a case with the incus and malleus
deficient, and Scarpa and Torreau quote instances of deficient
ossicles. Thomka in 1895 reported a case of supernumerary
tympanic ossicle, the nature of which was unknown, although it
was neither an inflammatory product nor a remnant of Meckel's
cartilage.
Absence of the Limbs.--Those persons born without limbs are
either the subjects of intrauterine amputation or of embryonic
malformation. Probably the most celebrated of this class was Marc
Cazotte, otherwise known as "Pepin," who died in Paris in the
last century at the age of sixty-two of a chronic intestinal
disorder. He had no arms, legs, or scrotum, but from very jutting
shoulders on each side were well-formed hands. His abdomen ended
in a flattened buttock with badly-formed feet attached. He was
exhibited before the public and was celebrated for his dexterity.
He performed nearly all the necessary actions, exhibited
skilfulness in all his movements, and was credited with the
ability of coitus. He was quite intellectual, being able to write
in several languages. His skeleton is preserved in the Musee
Dupuytren. Flachsland speaks of a woman who three times had borne
children without arms and legs. Hastings describes a living child
born without any traces of arms or legs. Garlick has seen a child
with neither upper nor lower extremities. In place of them were
short stumps three or four inches long, closely resembling the
ordinary stumps after amputation. The head, chest, body, and male
genitals were well formed, and the child survived. Hutchinson
reports the history of a child born without extremities, probably
the result of intrauterine amputation. The flaps were healed at
the deltoid insertion and just below the groin. Pare says he saw
in Paris a man without arms, who by means of his head and neck
could crack a whip or hold an axe. He ate by means of his feet,
dealt and played cards, and threw dice with the same members,
exhibiting such dexterity that finally his companions refused to
play with him. He was proved to be a thief and a murderer and was
finally hanged at Gueldres. Pare also relates having seen a woman
in Paris who sewed, embroidered, and did other things with her
feet. Jansen speaks of a man in Spain, born without arms, who
could use his feet as well as most people use their arms. Schenck
and Lotichius give descriptions of armless people.
Hulke describes a child of four whose upper limbs were absent, a
small dimple only being in their place. He had free movement of
the shoulders in every direction. and could grasp objects between
his cheeks and his acromian process; the prehensile power of the
toes was well developed, as he could pick up a coin thrown to
him. A monster of the same conformation was the celebrated
painter, Ducornet, who was born at Lille on the 10th of January,
1806. He was completely deprived of arms, but the rest of the
body was well formed with the exception of the feet, of which the
second toe was faulty. The deformity of the feet, however, had
the happiest result, as the space between the great toe and its
neighbor was much larger than ordinary and the toes much more
mobile. He became so skilful in his adopted profession that he
finally painted a picture eleven feet in height (representing
Mary Magdalene at the feet of Christ after the resurrection),
which was purchased by the Government and given to the city of
Lille. Broca describes James Leedgwood, who was deprived of his
arms and had only one leg. He exhibited great dexterity with his
single foot, wrote, discharged a pistol, etc.; he was said to
have been able to pick up a sewing-needle on a slippery surface
with his eyes blindfolded. Capitan described to the Societe
d'anthropologie de Paris a young man without arms, who was said
to play a violin and cornet with his feet. He was able to take a
kerchief from his pocket and to blow his nose; he could make a
cigarette, light it, and put it in his mouth, play cards, drink
from a glass, and eat with a fork by the aid of his dexterous
toes. There was a creature exhibited some time since in the
principal cities of France, who was called the "l'homme tronc."
He was totally deprived of all his members. Curran describes a
Hindoo, a prostitute of forty, with congenital absence of both
upper extremities. A slight fleshy protuberance depended from the
cicatrix of the humerus and shoulder-joint of the left side, and
until the age of ten there was one on the right side. She
performed many tricks with her toes. Caldani speaks of a monster
without arms, Davis mentions one, and Smith describes a boy of
four with his upper limbs entirely absent. Breschet has seen a
child of nine with only portions of the upper arms and deformity
of lower extremities and pelvis. Pare says that he saw in Paris
in 1573, at the gate of St. Andrew des Arts, a boy of nine, a
native of a small village near Guise, who had no legs and whose
left foot was represented by a fleshy body hanging from the
trunk; he had but two fingers hanging on his right hand, and had
between his legs what resembled a virile penis. Pare attributes
this anomaly to a default in the quantity of semen.
The figure and skeleton of Harvey Leach, called "Hervio Nono," is
in the museum of the University College in London. The pelvis was
comparatively weak, the femurs hardly to be recognized, and the
right tibia and foot defective; the left foot was better
developed, although far from being in due proportion to the trunk
above. He was one of the most remarkable gymnasts of his day, and
notwithstanding the distortion of his lower limbs had marvelous
power and agility in them. As an arena-horseman, either standing
or sitting, he was scarcely excelled. He walked and even ran
quite well, and his power of leaping, partly with his feet and
partly with his hands, was unusual. His lower limbs were so short
that, erect, he touched the floor with his fingers, but he earned
his livelihood as much with his lower as with his upper limbs. In
his skeleton his left lower limb, between the hip and heel,
measured 16 inches, while the right, between the same points,
measured nine inches. Hare mentions a boy of five and a half
whose head and trunk were the same as in any other child of like
age. He was 22 1/2 inches high, had no spinal curvature, but was
absolutely devoid of lower extremities. The right arm was two
inches long and the left 2 1/4. Each contained the head and a
small adjoining portion of the humerus. The legs were represented
by masses of cellular tissue and fat covered by skin which
projected about an inch. He was intelligent, had a good memory,
and exhibited considerable activity. He seemed to have had more
than usual mobility and power of flexion of the lower lumbar
region. When on his back he was unable to rise up, but resting on
the lower part of the pelvis he was able to maintain himself
erect. He usually picked up objects with his teeth, and could
hold a coin in the axilla as he rolled from place to place. His
rolling was accomplished by a peculiar twisting of the thorax and
bending of the pelvis. There was no history of maternal
impression during pregnancy, no injury, and no hereditary
disposition to anomalous members. Figure 112 represents a boy
with congenital deficiency of the lower extremities. who was
exhibited a few years ago in Philadelphia. In Figure 113, which
represents a similar case in a girl whose photograph is deposited
in the Mutter Museum of the College of Physicians, Philadelphia,
we see how cleverly the congenital defect may be remedied by
mechanical contrivance. With her crutches and artificial legs
this girl was said to have moved about easily.
Parvin describes a "turtle-man" as an ectromelian, almost
entering the class of phocomelians or seal-like monsters; the
former term signifies abortive or imperfect formation of the
members. The hands and feet were normally developed, but the
arms, forearms, and legs are much shortened.
The "turtle-woman" of Demerara was so called because her mother
when pregnant was frightened by a turtle, and also from the
child's fancied resemblance to a turtle. The femur was six inches
long, the woman had a foot of six bones, four being toes, viz.,
the first and second phalanges of the first and second toes. She
had an acetabulum, capsule, and ligamentum teres, but no tibia or
fibula; she also had a defective right forearm. She was never the
victim of rachitis or like disease, but died of syphilis in the
Colonial Hospital. In her twenty-second year she was delivered of
a full-grown child free of deformity.
There was a woman living in Bavaria, under the observation of
Buhl, who had congenital absence of both femurs and both fibulas.
Almost all the muscles of the thigh existed, and the main
attachment to the pelvis was by a large capsular articulation.
Charpentier gives the portrait of a woman in whom there was a
uniform diminution in the size of the limbs. Debout portrays a
young man with almost complete absence of the thigh and leg, from
whose right hip there depended a foot. Accrell describes a
peasant of twenty-six, born without a hip, thigh, or leg on the
right side. The external genital organs were in their usual
place, but there was only one testicle in the scrotum. The man
was virile. The rectum instead of opening outward and underneath
was deflected to the right.
Supernumerary Limbs.--Haller reports several cases of
supernumerary extremities. Plancus speaks of an infant with a
complete third leg, and Dumeril cites a similar instance.
Geoffroy-Saint-Hilaire presented to the Academie des Sciences in
1830 a child with four legs and feet who was in good health.
Amman saw a girl with a large thigh attached to her nates. Below
the thigh was a single leg made by the fusion of two legs. No
patella was found and the knee was anchylosed. One of the feet of
the supernumerary limb had six toes, while the other, which was
merely an outgrowth, had two toes on it.
According to Jules Guerin, the child named Gustav Evrard was born
with a thigh ending in two legs and two imperfect feet depending
from the left nates.
Tucker describes a baby born in the Sloane Maternity in New York,
October 1, 1894, who had a third leg hanging from a bony and
fleshy union attached to the dorsal spine. The supernumerary leg
was well formed and had a left foot attached to it. Larkin and
Jones mention the removal of a meningocele and a supernumerary
limb from an infant of four months. This limb contained three
fingers only, one of which did not have a bony skeleton.
Pare says that on the day the Venetians and the Genevois made
peace a monster was born in Italy which had four legs of equal
proportions, and besides had two supernumerary arms from the
elbows of the normal limbs. This creature lived and was baptized.
Anomalies of the Feet.--Hatte has seen a woman who bore a child
that had three feet. Bull gives a description of a female infant
with the left foot double or cloven. There was only one heel, but
the anterior portion consisted of an anterior and a posterior
part. The anterior foot presented a great toe and four smaller
ones, but deformed like an example of talipes equinovarus.
Continuous with the outer edge of the anterior part and curving
beneath it was a posterior part, looking not unlike a second
foot, containing six well-formed toes situated directly beneath
the other five. The eleven toes were all perfect and none of them
were webbed.
There is a class of monsters called "Sirens" on account of their
resemblance to the fabulous creatures of mythology of that name.
Under the influence of compression exercised in the uterus during
the early period of gestation fusion of the inferior extremities
is effected. The accompanying illustration shows the appearance
of these monsters, which are thought to resemble the
enchantresses celebrated by Homer.
Anomalies of the Hand.--Blumenbach speaks of an officer who,
having lost his right hand, was subsequently presented by his
wife with infants of both sexes showing the same deformity.
Murray cites the instance of a woman of thirty-eight, well
developed, healthy, and the mother of normal children, who had a
double hand. The left arm was abnormal, the flexion of the elbow
imperfect, and the forearm terminated in a double hand with only
rudimentary thumbs. In working as a charwoman she leaned on the
back of the flexed carpus. The double hand could grasp firmly,
though the maximum power was not so great as that of the right
hand. Sensation was equally acute in all three of the hands. The
middle and ring fingers of the supernumerary hand were webbed as
far as the proximal joints, and the movements of this hand were
stiff and imperfect. No single finger of the two hands could be
extended while the other seven were flexed. Giraldes saw an
infant in 1864 with somewhat the same deformity, but in which the
disposition of the muscles and tendons permitted the ordinary
movements.
Absence of Digits.--Maygrier describes a woman of twenty-four who
instead of having a hand on each arm had only one finger, and
each foot had but two toes. She was delivered of two female
children in 1827 and one in 1829, each having exactly the same
deformities. Her mother was perfectly formed, but the father had
but one toe on his foot and one finger on his left hand.
Kohler gives photographs of quite a remarkable case of
suppression and deformity of the digits of both the fingers and
toes.
Figure 123 shows a man who was recently exhibited in
Philadelphia. He had but two fingers on each hand and two toes on
each foot, and resembles Kohler's case in the anomalous digital
conformation.
Figure 124 represents an exhibitionist with congenital
suppression of four digits on each hand.
Tubby has seen a boy of three in whom the first, second, and
third toes of each foot were suppressed, the great toe and the
little toe being so overgrown that they could be opposed. In this
family for four generations 15 individuals out of 22 presented
this defect of the lower extremity. The patient's brothers and a
sister had exactly the same deformity, which has been called
"lobster-claw foot."
Falla of Jedburgh speaks of an infant who was born without
forearms or hands; at the elbow there was a single finger
attached by a thin string of tissue. This was the sixth child,
and it presented no other deformity. Falla also says that
instances of intrauterine digital amputation are occasionally
seen.
According to Annandale, supernumerary digits may be classified as
follows:--
(1) A deficient organ, loosely attached by a narrow pedicle to
the hand or foot (or to another digit).
(2) A more or less developed organ, free at its extremity, and
articulating with the head or sides of a metacarpal, metatarsal,
or phalangeal bone.
(3) A fully developed separate digit.
(4) A digit intimately united along its whole length with another
digit, and having either an additional metacarpal or metatarsal
bone of its own, or articulating with the head of one which is
common to it and another digit.
Superstitions relative to supernumerary fingers have long been
prevalent. In the days of the ancient Chaldeans it was for those
of royal birth especially that divinations relative to extra
digits were cast. Among the ancients we also occasionally see
illustrations emblematic of wisdom in an individual with many
fingers, or rather double hands, on each arm.
Hutchinson, in his comments on a short-limbed, polydactylous
dwarf which was dissected by Ruysch, the celebrated Amsterdam
anatomist, writes as follows.--
"This quaint figure is copied from Theodore Kerckring's
'Spicilegium Anatomicum,' published in Amsterdam in 1670. The
description states that the body was that of an infant found
drowned in the river on October 16, 1668. It was dissected by the
renowned Ruysch. A detailed description of the skeleton is given.
My reason for now reproducing the plate is that it offers an
important item of evidence in reference to the development of
short-limbed dwarfs. Although we must not place too much reliance
on the accuracy of the draughtsman, since he has figured some
superfluous lumbar vertebrae, yet there can be no doubt that the
limbs are much too short for the trunk and head. This remark
especially applies to the lower limbs and pelvis. These are
exactly like those of the Norwich dwarf and of the skeleton in
the Heidelberg Museum which I described in a recent number of the
'Archives.' The point of extreme interest in the present case is
that this dwarfing of the limbs is associated with polydactylism.
Both the hands have seven digits. The right foot has eight and
the left nine. The conditions are not exactly symmetrical, since
in some instances a metacarpal or metatarsal bone is wanting; or,
to put it otherwise, two are welded together. It will be seen
that the upper extremities are so short that the tips of the
digits will only just touch the iliac crests.
"This occurrence of short limbs with polydactylism seems to prove
conclusively that the condition may be due to a modification of
development of a totally different nature from rickets. It is
probable that the infant was not at full term. Among the points
which the author has noticed in his description are that the
fontanelle was double its usual size; that the orbits were
somewhat deformed; that the two halves of the lower jaw were
already united; and that the ribs were short and badly formed. He
also, of course, draws attention to the shortness of the limbs,
the stoutness of the long bones, and the supernumerary digits. I
find no statement that the skeleton was deposited in any museum,
but it is very possible that it is still in existence in
Amsterdam, and if so it is very desirable that it should be more
exactly described,"
In Figure 126, A represents division of thumb after Guyot-Daubes,
shows a typical case of supernumerary fingers, and C pictures
Morand's case of duplication of several toes.
Forster gives a sketch of a hand with nine fingers and a foot
with nine toes. Voight records an instance of 13 fingers on each
hand and 12 toes on each foot. Saviard saw an infant at the
Hotel-Dieu in Paris in 1687 which had 40 digits, ten on each
member. Annandale relates the history of a woman who had six
fingers and two thumbs on each hand, and another who had eight
toes on one foot.
Meckel tells of a case in which a man had 12 fingers and 12 toes,
all well formed, and whose children and grandchildren inherited
the deformity. Mason has seen nine toes on the left foot. There
is recorded the account of a child who had 12 toes and six
fingers on each hand, one fractured. Braid describes talipes
varus in a child of a few months who had ten toes. There is also
on record a collection of cases of from seven to ten fingers on
each hand and from seven to ten toes on each foot. Scherer gives
an illustration of a female infant, otherwise normally formed,
with seven fingers on each hand, all united and bearing claw-like
nails. On each foot there was a double halux and five other
digits, some of which were webbed.
The influence of heredity on this anomaly is well demonstrated.
Reaumur was one of the first to prove this, as shown by the
Kelleia family of Malta, and there have been many corroboratory
instances reported; it is shown to last for three, four, and even
five generations; intermarriage with normal persons finally
eradicates it.
It is particularly in places where consanguineous marriages are
prevalent that supernumerary digits persist in a family. The
family of Foldi in the tribe of Hyabites living in Arabia are
very numerous and confine their marriages to their tribe. They
all have 24 digits, and infants born with the normal number are
sacrificed as being the offspring of adultery. The inhabitants of
the village of Eycaux in France, at the end of the last century,
had nearly all supernumerary digits either on the hands or feet.
Being isolated in an inaccessible and mountainous region, they
had for many years intermarried and thus perpetuated the anomaly.
Communication being opened, they emigrated or married strangers
and the sexdigitism vanished. Maupertuis recalls the history of a
family living in Berlin whose members had 24 digits for many
generations. One of them being presented with a normal infant
refused to acknowledge it. There is an instance in the Western
United States in which supernumerary digits have lasted through
five generations. Cameron speaks of two children in the same
family who were polydactylic, though not having the same number
of supernumerary fingers.
Smith and Norwell report the case of a boy of fifteen both of
whose hands showed webbing of the middle and ring fingers and
accessory nodules of bone between the metacarpals, and six toes
on each foot. The boy's father showed similar malformations, and
in five generations 21 out of 28 individuals were thus malformed,
ten females and 11 males. The deformity was especially
transmitted in the female line.
Instances of supernumerary thumbs are cited by Panaroli,
Ephemerides, Munconys, as well as in numerous journals since.
This anomaly is not confined to man alone; apes, dogs, and other
lower animals possess it. Bucephalus, the celebrated horse of
Alexander, and the horse of Caesar were said to have been
cloven-hoofed.
Hypertrophy of the digits is the result of many different
processes, and true hypertrophy or gigantism must be
differentiated from acromegaly, elephantiasis, leontiasis, and
arthritis deformans, for which distinction the reader is referred
to an article by Park. Park also calls attention to the
difference between acquired gigantism, particularly of the finger
and toes, and another condition of congenital gigantism, in which
either after or before birth there is a relatively
disproportionate, sometimes enormous, overgrowth of perhaps one
finger or two, perhaps of a limited portion of a hand or foot, or
possibly of a part of one of the limbs. The best collection of
this kind of specimens is in the College of Surgeons in London.
Curling quotes a most peculiar instance of hypertrophy of the
fingers in a sickly girl. The middle and ring fingers of the
right hand were of unusual size, the middle finger measuring 5
1/2 inches in length four inches in circumference. On the left
hand the thumb and middle fingers were hypertrophied and the
index finger was as long as the middle one of the right hand. The
middle finger had a lateral curvature outward, due to a
displacement of the extensor tendon. This affection resembled
acromegaly. Curling cites similar cases, one in a Spanish
gentleman, Governor of Luzon, in the Philippine Islands, in 1850,
who had an extraordinary middle finger, which he concealed by
carrying it in the breast of his coat.
Hutchinson exhibited a photograph showing the absence of the
radius and thumb, with shortening of the forearm. Conditions more
or less approaching this had occurred in several members of the
same family. In some they were associated with defects of
development in the lower extremities also.
The varieties of club-foot--talipes varus, valgus, equinus,
equino-varus, etc.--are so well known that they will be passed
with mention only of a few persons who have been noted for their
activity despite their deformity. Tyrtee, Parini, Byron, and
Scott are among the poets who were club-footed; some writers say
that Shakespeare suffered in a slight degree from this deformity.
Agesilas, Genserie, Robert II, Duke of Normandy, Henry II,
Emperor of the West, Otto II, Duke of Brunswick, Charles II, King
of Naples, and Tamerlane were victims of deformed feet. Mlle.
Valliere, the mistress of Louis XIV, was supposed to have both
club-foot and hip-disease. Genu valgum and genu varum are
ordinary deformities and quite common in all classes.
Transpositions of the character of the vertebrae are sometimes
seen. In man the lumbar vertebrae have sometimes assumed the
character of the sacral vertebrae, the sacral vertebrae
presenting the aspect of lumbar vertebrae, etc. It is quite
common to see the first lumbar vertebra presenting certain
characteristics of the dorsal.
Numerical anomalies of the vertebrae are quite common, generally
in the lumbar and dorsal regions, being quite rare in the
cervical, although there have been instances of six or eight
cervical vertebrae. In the lower animals the vertebrae are
prolonged into a tail, which, however, is sometimes absent,
particularly when hereditary influence exists. It has been
noticed in the class of dogs whose tails are habitually amputated
to improve their appearance that the tail gradually decreases in
length. Some breeders deny this fact.
Human Tails.--The prolongation of the coccyx sometimes takes the
shape of a caudal extremity in man. Broca and others claim that
the sacrum and the coccyx represent the normal tail of man, but
examples are not infrequent in which there has been a fleshy or
bony tail appended to the coccygeal region. Traditions of tailed
men are old and widespread, and tailed races were supposed to
reside in almost every country. There was at one time an ancient
belief that all Cornishmen had tails, and certain men of Kent
were said to have been afflicted with tails in retribution for
their insults to Thomas a Becket. Struys, a Dutch traveler in
Formosa in the seventeenth century, describes a wild man caught
and tied for execution who had a tail more than a foot long,
which was covered with red hair like that of a cow.
The Niam Niams of Central Africa are reported to have tails
smooth and hairy and from two to ten inches long. Hubsch of
Constantinople remarks that both men and women of this tribe have
tails. Carpus, or Berengarius Carpensis, as he is called, in one
of his Commentaries said that there were some people in Hibernia
with long tails, but whether they were fleshy or cartilaginous
could not be known, as the people could not be approached.
Certain supposed tailed races which have been described by
sea-captains and voyagers are really only examples of people who
wear artificial appendages about the waists, such as palm-leaves
and hair. A certain Wesleyan missionary, George Brown, in 1876
spoke of a formal breeding of a tailed race in Kali, off the
coast of New Britain. Tailless children were slain at once, as
they would be exposed to public ridicule. The tailed men of
Borneo are people afflicted with hereditary malformation
analogous to sexdigitism. A tailed race of princes have ruled
Rajoopootana, and are fond of their ancestral mark. There are
fabulous stories told of canoes in the East Indies which have
holes in their benches made for the tails of the rowers. At one
time in the East the presence of tails was taken as a sign of
brute force.
There was reported from Caracas the discovery of a tribe of
Indians in Paraguay who were provided with tails. The narrative
reads somewhat after this manner: One day a number of workmen
belonging to Tacura Tuyn while engaged in cutting grass had their
mules attacked by some Guayacuyan Indians. The workmen pursued
the Indians but only succeeded in capturing a boy of eight. He
was taken to the house of Senor Francisco Galeochoa at Posedas,
and was there discovered to have a tail ten inches long. On
interrogation the boy stated that he had a brother who had a tail
as long as his own, and that all the tribe had tails.
Aetius, Bartholinus, Falk, Harvey, Kolping, Hesse, Paulinus,
Strauss, and Wolff give descriptions of tails. Blanchard says he
saw a tail fully a span in length: and there is a description in
1690 of a man by the name of Emanuel Konig, a son of a doctor of
laws who had a tail half a span long, which grew directly
downward from the coccyx and was coiled on the perineum, causing
much discomfort. Jacob describes a pouch of skin resembling a
tail which hung from the tip of the coccyx to the length of six
inches. It was removed and was found to be thicker than the
thumb, consisted of distinctly jointed portions with synovial
capsules. Gosselin saw at his clinic a caudal appendix in an
infant which measured about ten cm. Lissner says that in 1872 he
assisted in the delivery of a young girl who had a tail
consisting of a coccyx prolonged and covered with skin, and in
1884 he saw the same girl, at this time the tail measuring nearly
13 cm.
Virchow received for examination a tail three inches long
amputated from a boy of eight weeks. Ornstein, chief physician of
the Greek army, describes a Greek of twenty-six who had a
hairless, conical tail, free only at the tip, two inches long and
containing three vertebrae. He also remarks that other instances
have been observed in recruits. Thirk of Broussa in 1820
described the tail of a Kurd of twenty-two which contained four
vertebrae. Belinovski gives an account of a hip-joint amputation
and extirpation of a fatty caudal extremity, the only one he had
ever observed.
Before the Berlin Anthropological Society there were presented
two adult male Papuans, in good health and spirits, who had been
brought from New Guinea; their coccygeal bones projected 1 1/2
inches. Oliver Wendell Holmes in the Atlantic Monthly, June,
1890, says that he saw in London a photograph of a boy with a
considerable tail. The "Moi Boy" was a lad of twelve, who was
found in Cochin China, with a tail a foot long which was simply a
mass of flesh. Miller tells of a West Point student who had an
elongation of the coccyx, forming a protuberance which bulged
very visibly under the skin. Exercise at the riding school always
gave him great distress, and the protuberance would often chafe
until the skin was broken, the blood trickling into his boots.
Bartels presents a very complete article in which he describes 21
persons born with tails, most of the tails being merely fleshy
protuberances. Darwin speaks of a person with a fleshy tail and
refers to a French article on human tails.
Science contains a description of a negro child born near
Louisville, eight weeks old, with a pedunculated tail 2 1/2
inches long, with a base 1 1/4 inches in circumference. The tail
resembled in shape a pig's tail and had grown 1/4 inch since
birth. It showed no signs of cartilage or bone, and had its
origin from a point slightly to the left of the median line and
about an inch above the end of the spinal column.
Dickinson recently reported the birth of a child with a tail. It
was a well-developed female between 5 1/2 and six pounds in
weight. The coccyx was covered with the skin on both the anterior
and posterior surfaces. It thus formed a tail of the size of the
nail of the little finger, with a length of nearly 3/16 inch on
the inner surface and 3/8 inch on the rear surface. This little
tip could be raised from the body and it slowly sank back.
In addition to the familiar caudal projection of the human fetus,
Dickinson mentions a group of other vestigial remains of a former
state of things. Briefly these are:--
(1) The plica semilunaris as a vestige of the nictitating
membrane of certain birds.
(2) The pointed ear, or the turned-down tip of the ears of many
men.
(3) The atrophied muscles, such as those that move the ear, that
are well developed in certain people, or that shift the scalp,
resembling the action of a horse in ridding itself of flies.
(4) The supracondyloid foremen of the humerus.
(5) The vermiform appendix.
(6) The location and direction of the hair on the trunk and
limbs.
(7) The dwindling wisdom-teeth.
(8) The feet of the fetus strongly deflected inward, as in the
apes, and persisting in the early months of life, together with
great mobility and a distinct projection of the great toe at an
angle from the side of the foot.
(9) The remarkable grasping power of the hand at birth and for a
few weeks thereafter, that permits young babies to suspend their
whole weight on a cane for a period varying from half a minute to
two minutes.
Horrocks ascribes to these anal tags a pathologic importance. He
claims that they may be productive of fistula in ano, superficial
ulcerations, fecal concretions, fissure in ano, and that they may
hypertrophy and set up tenesmus and other troubles. The presence
of human tails has given rise to discussion between friends and
opponents of the Darwinian theory. By some it is considered a
reversion to the lower species, while others deny this and claim
it to be simply a pathologic appendix.
Anomalies of the Spinal Canal and Contents.--When there is a
default in the spinal column, the vice of conformation is called
spina bifida. This is of two classes: first, a simple opening in
the vertebral canal, and, second, a large cleft sufficient to
allow the egress of spinal membranes and substance. Figure 130
represents a large congenital sacral tumor.
Achard speaks of partial duplication of the central canal of the
spinal cord. De Cecco reports a singular case of duplication of
the lumbar segment of the spinal cord. Wagner speaks of
duplication of a portion of the spinal cord.
Foot records a case of amyelia, or absence of the spinal cord, in
a fetus with hernia cerebri and complete fissure of the spinal
column. Nicoll and Arnold describe an anencephalous fetus with
absence of spinal marrow; and Smith also records the birth of an
amyelitic fetus.
In some persons there are exaggerated curvatures of the spine.
The first of these curvatures is called kyphosis, in which the
curvature is posterior; second, lordosis, in which the curvature
is anterior; third, scoliosis, in which it is lateral, to the
right or left.
Kyphosis is the most common of the deviations in man and is most
often found in the dorsal region, although it may be in the
lumbar region. Congenital kyphosis is very rare in man, is
generally seen in monsters, and when it does exist is usually
accompanied by lordosis or spine bifida. We sometimes observe a
condition of anterior curvature of the lumbar and sacral regions,
which might be taken for a congenital lordosis, but this is
really a deformity produced after birth by the physiologic weight
of the body. Figure 131 represents a case of lordosis caused by
paralysis of the spinal muscles.
Analogous to this is what the accoucheurs call spondylolisthesis.
Scoliosis may be a cervicodorsal, dorsolumbar, or lumbosacral
curve, and the inclination of the vertebral column may be to the
right or left. The pathologists divide scoliosis into a myopathic
variety, in which the trouble is a physiologic antagonism of the
muscles; or osteopathic, ordinarily associated with rachitis,
which latter variety is generally accountable for congenital
scoliosis. In some cases the diameter of the chest is shortened
to an almost incredible degree, but may yet be compatible with
life. Glover speaks of an extraordinary deformity of the chest
with lateral curvature of the spine, in which the diameter from
the pit of the stomach to the spinal integument was only 5 1/2
inches.
Supernumerary ribs are not at all uncommon in man, nearly every
medical museum having some examples. Cervical ribs are not rare.
Gordon describes a young man of seventeen in whom there was a
pair of supernumerary ribs attached to the cervical vertebrae.
Bernhardt mentions an instance in which cervical ribs caused
motor and sensory disturbances. Dumerin of Lyons showed an infant
of eight days which had an arrested development of the 2d, 3d,
4th, and 5th ribs. Cases of deficient ribs are occasionally met.
Wistar in 1818 gives an account of a person in whom one side of
the thorax was at rest while the other performed the movements of
breathing in the usual manner.
In some cases we see fissure of the sternum, caused either by
deficient union or absence of one of its constituent parts. In
the most exaggerated cases these fissures permit the exit of the
heart, and as a general rule ectopies of the heart are thus
caused. Pavy has given a most remarkable case of sternal fissure
in a young man of twenty-five, a native of Hamburg. He exhibited
himself in one medical clinic after another all over Europe, and
was always viewed with the greatest interest. In the median line,
corresponding to the absence of sternum, was a longitudinal
groove bounded on either side by a continuous hard ridge which
articulated with the costal cartilages. The skin passed naturally
over the chest from one side to another, but was raised at one
part of the groove by a pulsatile swelling which occupied the
position of the right auricle. The clavicle and the two margins
of the sternum had no connections whatever, and below the groove
was a hard substance corresponding to the ensiform cartilage,
which, however, was very elastic, and allowed the patient, under
the influence of the pectoral muscles, when the upper extremity
was fixed, to open the groove to nearly the extent of three
inches, which was more than twice its natural width. By
approximating his arms he made the ends of his clavicles overlap.
When he coughed, the right lung suddenly protruded from the chest
through the groove and ascended a considerable distance above the
clavicle into the neck. Between the clavicles another pulsatile
swelling was easily felt but hardly seen, which was doubtless the
arch of the aorta, as by putting the fingers on it one could feel
a double shock, synchronous with distention and recoil of a
vessel or opening and closing of the semilunar valves.
Madden pictures (Figs. 134 and 135) a Swede of forty with
congenital absence of osseous structure in the middle line of the
sternum, leaving a fissure 5 3/8 X 1 3/16 X 2 inches, the longest
diameter being vertical. Madden also mentions several analogous
instances on record. Groux's case was in a person of forty-five,
and the fissure had the vertical length of four inches. Hodgen of
St. Louis reports a case in which there was exstrophy of the
heart through the fissure. Slocum reports the occurrence of a
sternal fissure 3 X 1 1/2 inches in an Irishman of twenty-five.
Madden also cites the case of Abbott in an adult negress and a
mother. Obermeier mentions several cases. Gibson and Malet
describe a presternal fissure uncovering the base of the heart.
Ziemssen, Wrany, and Williams also record congenital fissures of
the sternum.
Thomson has collected 86 cases of thoracic defects and summarizes
his paper by saying that the structures deficient are generally
the hair in the mammary and axillary regions, the subcutaneous
fat over the muscles, nipples, and breasts, the pectorals and
adjacent muscles, the costal cartilages and anterior ends of
ribs, the hand and forearm; he also adds that there may be a
hernia of the lung, not hereditary, but probably due to the
pressure of the arm against the chest. De Marque gives a curious
instance in which the chin and chest were congenitally fastened
together. Muirhead cites an instance in which a firm, broad strip
of cartilage resembling sternomastoid extended from below the
left ear to the left upper corner of the sternum, being entirely
separate from the jaw.
Some preliminary knowledge of embryology is essential to
understand the formation of branchial fissures, and we refer the
reader to any of the standard works on embryology for this
information. Dzondi was one of the first to recognize and
classify congenital fistulas of the neck. The proper
classification is into lateral and median fissures. In a case
studied by Fevrier the exploration of a lateral pharyngeal
fistula produced by the introduction of the sound violent reflex
phenomena, such as pallor of the face and irregular, violent
beating of the heart. The rarest of the lateral class is the
preauricular fissure, which has been observed by Fevrier, Le
Dentu, Marchand, Peyrot, and Routier.
The median congenital fissures of the neck are probably caused by
defective union of the branchial arches, although Arndt thinks
that he sees in these median fistulas a persistence of the
hypobranchial furrow which exists normally in the amphioxus. They
are less frequent than the preceding variety.
The most typical form of malformation of the esophagus is
imperforation or obliteration. Van Cuyck of Brussels in 1824
delivered a child which died on the third day from malnutrition.
Postmortem it was found that the inferior extremity of the
esophagus to the extent of about two inches was converted into a
ligamentous cord. Porro describes a case of congenital
obliteration of the esophagus which ended in a cecal pouch about
one inch below the inferior portion of the glottidean aperture
and from this point to the stomach only measured an inch; there
was also tracheal communication. The child was noticed to take to
the breast with avidity, but after a little suckling it would
cough, become livid, and reject most of the milk through the
nose, in this way almost suffocating at each paroxysm; it died on
the third day.
In some cases the esophagus is divided, one portion opening into
the bronchial or other thoracic organs. Brentano describes an
infant dying ten days after birth whose esophagus was divided
into two portions, one terminating in a culdesac, the other
opening into the bronchi; the left kidney was also displaced
downward. Blasius describes an anomalous case of duplication of
the esophagus. Grashuys, and subsequently Vicq d'Azir, saw a
dilatation of the esophagus resembling the crop of a bird.
Anomalies of the Lungs.--Carper describes a fetus of thirty-seven
weeks in whose thorax he found a very voluminous thymus gland but
no lungs. These organs were simply represented by two little oval
bodies having no lobes, with the color of the tissue of the
liver. The heart had only one cavity but all the other organs
were perfectly formed. This case seems to be unique. Tichomiroff
records the case of a woman of twenty-four who died of pneumonia
in whom the left lung was entirely missing. No traces of a left
bronchus existed. The subject was very poorly developed
physically. Tichomiroff finds four other cases in literature, in
all of which the left lung was absent. Theremin and Tyson record
cases of the absence of the left lung.
Supplementary pulmonary lobes are occasionally seen in man and
are taken by some authorities to be examples of retrogressive
anomalies tending to prove that the derivation of the human race
is from the quadrupeds which show analogous pulmonary
malformation. Eckley reports an instance of supernumerary lobe of
the right lung in close connection with the vena azygos major.
Collins mentions a similar case. Bonnet and Edwards speak of
instances of four lobes in the right lung. Testut and Marcondes
report a description of a lung with six lobes.
Anomalies of the Diaphragm.--Diemerbroeck is said to have
dissected a human subject in whom the diaphragm and mediastinum
were apparently missing, but such cases must be very rare,
although we frequently find marked deficiency of this organ.
Bouchand reports an instance of absence of the right half of the
diaphragm in an infant born at term. Lawrence mentions congenital
deficiency of the muscular fibers of the left half of the
diaphragm with displacement of the stomach. The patient died of
double pneumonia. Carruthers, McClintock, Polaillon, and van
Geison also record instances of congenital deficiency of part of
the diaphragm. Recently Dittel reported unilateral defect in the
diaphragm of an infant that died soon after birth. The stomach,
small intestines, and part of the large omentum lay in the left
pleural cavity; both the phrenic nerves were normal. Many similar
cases of diaphragmatic hernia have been observed. In such cases
the opening may be large enough to allow a great part of the
visceral constituents to pass into the thorax, sometimes
seriously interfering with respiration and circulation by the
pressure which ensues. Alderson reports a fatal case of
diaphragmatic hernia with symptoms of pneumothorax. The stomach,
spleen, omentum, and transverse colon were found lying in the
left pleura. Berchon mentions double perforation of the diaphragm
with hernia of the epiploon. The most extensive paper on this
subject was contributed by Bodwitch, who, besides reporting an
instance in the Massachusetts General Hospital, gives a numerical
analysis of all the cases of this affection found recorded in the
writings of medical authors between the years 1610 and 1846.
Hillier speaks of an instance of congenital diaphragmatic hernia
in which nearly all the small intestines and two-thirds of the
large passed into the right side of the thorax. Macnab reports an
instance in which three years after the cure of empyema the whole
stomach constituted the hernia. Recently Joly described
congenital hernia of the stomach in a man of thirty-seven, who
died from collapse following lymphangitis, persistent vomiting,
and diarrhea. At the postmortem there was found a defect in the
diaphragm on the left side, permitting herniation of the stomach
and first part of the duodenum into the left pleural cavity.
There was no history of traumatism to account for strangulation.
Longworth cites an instance of inversion of the diaphragm in a
human subject. Bartholinus mentions coalition of the diaphragm
and liver; and similar cases are spoken of by Morgagni and the
Ephemerides. Hoffman describes diaphragmatic junction with the
lung.
Anomalies of the Stomach.--The Ephemerides contains the account
of a dissection in which the stomach was found wanting, and also
speaks of two instances of duplex stomach. Bartholinus, Heister,
Hufeland, Morgagni, Riolan, and Sandifort cite examples of duplex
stomach. Bonet speaks of a case of vomiting which was caused by a
double stomach. Struthers reports two cases in which there were
two cavities to the stomach. Struthers also mentions that
Morgagni, Home, Monro, Palmer, Larry, Blasius, Hufeland, and
Walther also record instances in which there was contraction in
the middle of the stomach, accounting for their instances of
duplex stomach. Musser reports an instance of hour-glass
contraction of the stomach. Hart dissected the stomach of a woman
of thirty which resembled the stomach of a predaceous bird, with
patches of tendon on its surface. The right extremity instead of
continuously contracting ended in a culdesac one-half as large as
the greater end of the stomach. The duodenum proceeded from the
depression marking the lesser arch of the organ midway between
the cardiac orifice and the right extremity. Crooks speaks of a
case in which the stomach of an infant terminated in a culdesac.
Hernia of the stomach is not uncommon, especially in
diaphragmatic or umbilical deficiency. There are many cases on
record, some terminating fatally from strangulation or exposure
to traumatism. Paterson reports a case of congenital hernia of
the stomach into the left portion of the thoracic cavity. It was
covered with fat and occupied the whole left half of the thoracic
cavity. The spleen, pancreas, and transverse colon were also
superior to the diaphragm. Death was caused by a well-defined
round perforation at the cardiac curvature the size of a
sixpence.
Anomalies of the Intestines.--The Ephemerides contains the
account of an example of double cecum, and Alexander speaks of a
double colon, and there are other cases of duplication of the
bowel recorded. There is an instance of coalition of the jejunum
with the liver, and Treuner parallels this case. Aubery, Charrier
Poelman, and others speak of congenital division of the
intestinal canal. Congenital occlusion is quite frequently
reported.
Dilatation of the colon frequently occurs as a transient
affection, and by its action in pushing up the diaphragm may so
seriously interfere with the action of the heart and lungs as to
occasionally cause heart-failure. Fenwick has mentioned an
instance of this nature. According to Osler there is a chronic
form of dilatation of the colon in which the gut may reach an
enormous size. The coats may be hypertrophied without evidence of
any special organic change in the mucosa. The most remarkable
instance has been reported by Formad. The patient, known as the
"balloon-man," aged twenty-three at the time of his death, had
had a distended abdomen from infancy. Postmortem the colon was
found as large as that of an ox, the circumference ranging from
15 to 30 inches. The weight of the contents was 47 pounds. Cases
are not uncommon in children. Osler reports three well-marked
cases under his care. Chapman mentions a case in which the liver
was displaced by dilatation of the sigmoid flexure. Mya reports
two cases of congenital dilatation and hypertrophy of the colon
(megacolon congenito). Hirsohsprung, Genersich, Faralli, Walker,
and Griffiths all record similar instances, and in all these
cases the clinical features were obstinate constipation and
marked meteorismus.
Imperforate Anus.--Cases in which the anus is imperforate or the
rectum ends in a blind pouch are occasionally seen. In some
instances the rectum is entirely absent, the colon being the
termination of the intestinal tract. There are cases on record in
which the rectum communicated with the anus solely by a
fibromuscular cord. Anorectal atresia is the ordinary
imperforation of the anus, in which the rectum terminates in the
middle of the sacral cavity. The rectum may be deficient from the
superior third of the sacrum, and in this position is quite
inaccessible for operation.
A compensatory coalition of the bowel with the bladder or urethra
is sometimes present, and in these cases the feces are voided by
the urinary passages. Huxham mentions the fusion of the rectum
and colon with the bladder, and similar instances are reported by
Dumas and Baillie. Zacutus Lusitanus describes an infant with an
imperforate membrane over its anus who voided feces through the
urethra for three months. After puncture of the membrane, the
discharge came through the natural passage and the child lived;
Morgagni mentions a somewhat similar case in a little girl living
in Bologna, and other modern instances have been reported. The
rectum may terminate in the vagina. Masters has seen a child who
lived nine days in whom the sigmoid flexure of the colon
terminated in the fundus of the bladder. Guinard pictures a case
in which there was communication between the rectum and the
bladder. In Figure 140 a represents the rectum; b the bladder; c
the point of communication; g shows the cellular tissue of the
scrotum.
There is a description of a girl of fourteen, otherwise well
constituted and healthy, who had neither external genital organs
nor anus. There was a plain dermal covering over the genital and
anal region. She ate regularly, but every three days she
experienced pain in the umbilicus and much intestinal irritation,
followed by severe vomiting of stercoraceous matter; the pains
then ceased and she cleansed her mouth with aromatic washes,
remaining well until the following third day. Some of the urine
was evacuated by the mammae. The examiners displayed much desire
to see her after puberty to note the disposition of the menstrual
flow, but no further observation of her case can be found.
Fournier narrates that he was called by three students, who had
been trying to deliver a woman for five days. He found a
well-constituted woman of twenty-two in horrible agony, who they
said had not had a passage of the bowels for eight days, so he
prescribed an enema. The student who was directed to give the
enema found to his surprise that there was no anus, but by
putting his finger in the vagina he could discern the floating
end of the rectum, which was full of feces. There was an opening
in this suspended rectum about the size of an undistended anus.
Lavage was practiced by a cannula introduced through the opening,
and a great number of cherry stones agglutinated with feces
followed the water, and labor was soon terminated. The woman
afterward confessed that she was perfectly aware of her
deformity, but was ashamed to disclose it before. There was an
analogue of this case found by Mercurialis in a child of a Jew
called Teutonicus.
Gerster reports a rare form of imperforate anus, with malposition
of the left ureter, obliteration of the ostia of both ureters,
with consequent hydronephrosis of a confluent kidney. There was a
minute opening into the bladder, which allowed the passage of
meconium through the urethra. Burge mentions the case of what he
calls "sexless child," in which there was an imperforate anus and
no pubic arch; the ureters discharged upon a tumor the size of a
teacup extending from the umbilicus to the pubes. A postmortem
examination confirmed the diagnosis of sexless child.
The Liver.--The Ephemerides, Frankenau, von Home, Molinetti,
Schenok, and others speak of deficient or absent liver. Zacutus
Lusitanus says that he once found a mass of flesh in place of the
liver. Lieutaud is quoted as describing a postmortem examination
of an adult who had died of hydropsy, in whom the liver and
spleen were entirely missing. The portal vein discharged
immediately into the vena cava; this case is probably unique, as
no authentic parallel could be found.
Laget reports an instance of supernumerary lobe in the liver. Van
Buren describes a supernumerary liver. Sometimes there is
rotation, real or apparent, caused by transposition of the
characteristics of the liver. Handy mentions such a case.
Kirmisson reports a singular anomaly of the liver which he calls
double displacement by interversion and rotation on the vertical
axis. Actual displacements of the liver as well as what is known
as wandering liver are not uncommon. The operation for floating
liver will be spoken of later.
Hawkins reports a case of congenital obliteration of the ductus
communis choledochus in a male infant which died at the age of
four and a half months. Jaundice appeared on the eighth day and
lasted through the short life. The hepatic and cystic ducts were
pervious and the hepatic duct obliterated. There were signs of
hepatic cirrhosis and in addition an inguinal hernia
The Gall-Bladder.--Harle mentions the case of a man of fifty, in
whom he could find no gall-bladder; Patterson has seen a similar
instance in a men of twenty-five. Purser describes a double
gall-bladder.
The spleen has been found deficient or wanting by Lebby, Ramsay,
and others, but more frequently it is seen doubled. Cabrolius,
Morgagni, and others have found two spleens in one subject;
Cheselden and Fallopius report three; Fantoni mentions four found
in one subject; Guy-Patin has seen five, none as large as the
ordinary organ; Hollerius, Kerckringius, and others have remarked
on multiple spleens. There is a possibility that in some of the
cases of multiple spleens reported the organ is really single but
divided into several lobes. Albrecht mentions a case shown at a
meeting of the Vienna Medical Society of a very large number of
spleens found in the mesogastrium, peritoneum, on the mesentery
and transverse mesocolon, in Douglas' pouch, etc. There was a
spleen "the size of a walnut" in the usual position, with the
splenic artery and vein in their normal position. Every one of
these spleens had a capsule, was covered by peritoneum, and
exhibited the histologic appearance of splenic tissue. According
to the review of this article, Toldt explains the case by
assuming that other parts of the celomic epithelium, besides that
of the mesogastrium, are capable of forming splenic tissue.
Jameson reports a case of double spleen and kidneys. Bainbrigge
mentions a case of supernumerary spleen causing death from the
patient being placed in the supine position in consequence of
fracture of the thigh. Peevor mentions an instance of second
spleen. Beclard and Guy-Patin have seen the spleen congenitally
misplaced on the right side and the liver on the left; Borellus
and Bartholinus with others have observed misplacement of the
spleen.
The Pancreas.--Lieutaud has seen the pancreas missing and speaks
of a double pancreatic duct that he found in a man who died from
starvation; Bonet speaks of a case similar to this last.
There are several cases of complete transposition of the viscera
on record. This bizarre anomaly was probably observed first in
1650 by Riolanus, but the most celebrated case was that of Morand
in 1660, and Mery described the instance later which was the
subject of the following quatrain:--
"La nature, peu sage et sans douse en debauche
Placa le foie au cote gauche,
Et de meme, vice versa
Le coeur a le droite placa."
Young cites an example in a woman of eighty-five who died at
Hammersmith, London. She was found dead in bed, and in a
postmortem examination, ordered to discover if possible the cause
of death, there was seen complete transposition of the viscera.
The heart lay with its base toward the left, its apex toward the
right, reaching the lower border of the 4th rib, under the right
mamma. The vena cava was on the left side and passed into the
pulmonary cavity of the heart, which was also on the left side,
the aorta and systemic ventricle being on the right. The left
splenic vein was lying on the superior vena cava, the liver under
the left ribs, and the spleen on the right side underneath the
heart. The esophagus was on the right of the aorta, and the
location of the two ends of the stomach was reversed; the sigmoid
flexure was on the right side. Davis describes a similar instance
in a man.
Herrick mentions transposition of viscera in a man of
twenty-five. Barbieux cites a case of transposition of viscera in
a man who was wounded in a duel. The liver was to the left and
the spleen and heart to the right etc. Albers, Baron, Beclard,
Boyer, Bull, Mackensie, Hutchinson, Hunt, Murray, Dareste,
Curran, Duchesne, Musser, Sabatier, Shrady, Vulpian, Wilson, and
Wehn are among others reporting instances of transposition and
inversion of the viscera.
Congenital extroversion or eventration is the result of some
congenital deficiency in the abdominal wall; instances are not
uncommon, and some patients live as long as do cases of umbilical
hernia proper. Ramsey speaks of entire want of development of the
abdominal parietes. Robertson, Rizzoli, Tait, Hamilton, Brodie,
Denis, Dickie, Goyrand, and many others mention extroversion of
viscera from parietal defects. The different forms of hernia will
be considered in another chapter.
There seem to be no authentic cases of complete absence of the
kidney except in the lowest grades of monstrosities. Becker,
Blasius, Rhodius, Baillie, Portal, Sandifort, Meckel, Schenck,
and Stoll are among the older writers who have observed the
absence of one kidney. In a recent paper Ballowitz has collected
213 cases, from which the following extract has been made by the
British Medical Journal:--
"Ballowitz (Virchow's Archiv, August 5, 1895) has collected as
far as possible all the recorded cases of congenital absence of
one kidney. Excluding cases of fused kidney and of partial
atrophy of one kidney, he finds 213 cases of complete absence of
one kidney, upon which he bases the following conclusions: Such
deficiency occurs almost twice as often in males as in females, a
fact, however, which may be partly accounted for by the greater
frequency of necropsies on males. As to age, 23 occurred in the
fetus or newly born, most having some other congenital deformity,
especially imperforate anus; the rest were about evenly
distributed up to seventy years of age, after which only seven
cases occurred. Taking all cases together, the deficiency is more
common on the left than on the right side; but while in males the
left kidney is far more commonly absent than the right, in
females the two sides show the defect equally. The renal vessels
were generally absent, as also the ureter, on the abnormal side
(the latter in all except 15 cases); the suprarenal was missing
in 31 cases. The solitary kidney was almost always normal in
shape and position, but much enlarged. Microscopically the
enlargement would seem to be due rather to hyperplasia than to
hypertrophy. The bladder, except for absence of the opening of
one ureter, was generally normal. In a large number of cases
there were associated deformities of the organs of generation,
especially of the female organs, and these were almost invariably
on the side of the renal defect; they affected the conducting
portion much more than the glandular portion--that is, uterus,
vagina, and Fallopian tubes in the female, and vas deferens or
vesiculae seminales in the male, rather than the ovaries or
testicles. Finally, he points out the practical bearing of the
subject--for example, the probability of calculus causing sudden
suppression of urine in such cases--and also the danger of
surgical interference, and suggests the possibility of diagnosing
the condition by ascertaining the absence of the opening of one
ureter in the bladder by means of the cystoscope, and also the
likelihood of its occurring where any abnormality of the genital
organs is found, especially if this be unilateral."
Green reports the case of a female child in which the right
kidney and right Fallopian tube and ovary were absent without any
rudimentary structures in their place. Guiteras and Riesman have
noted the absence of the right kidney, right ureter, and right
adrenal in an old woman who had died of chronic nephritis. The
left kidney although cirrhotic was very much enlarged.
Tompsett describes a necropsy made on a coolie child of nearly
twelve months, in which it was seen that in the place of a kidney
there were two left organs connected at the apices by a
prolongation of the cortical substance of each; the child had
died of neglected malarial fever. Sandifort speaks of a case of
double kidneys and double ureters, and cases of supernumerary
kidney are not uncommon, generally being segmentation of one of
the normal kidneys. Rayer has seen three kidneys united and
formed like a horseshoe. We are quite familiar with the ordinary
"horseshoe kidney," in which two normal kidneys are connected.
There are several forms of displacement of the kidneys, the most
common being the "floating kidney," which is sometimes
successfully removed or fixed; Rayer has made an extensive study
of this anomaly.
The kidney may be displaced to the pelvis, and Guinard quotes an
instance in which the left kidney was situated in the pelvis, to
the left of the rectum and back of the bladder. The ureter of the
left side was very short. The left renal artery came from the
bifurcation of the aorta and the primitive iliacs. The right
kidney was situated normally, and received from the aorta two
arteries, whose volume did not surpass the two arteries supplying
the left suprarenal capsule, which was in its ordinary place.
Displacements of the kidney anteriorly are very rare.
The ureters have been found multiple; Griffon reports the history
of a male subject in whom the ureter on the left side was double
throughout its whole length; there were two vesical orifices on
the left side one above the other; and Morestin, in the same
journal, mentions ureters double on both sides in a female
subject. Molinetti speaks of six ureters in one person. Littre in
1705 described a case of coalition of the ureters. Allen
describes an elongated kidney with two ureters. Coeyne mentions
duplication of the ureters on both sides. Lediberder reports a
case in which the ureter had double origin. Tyson cites an
instance of four ureters in an infant. Penrose mentions the
absence of the upper two-thirds of the left ureter, with a small
cystic kidney, and there are parallel cases on record.
The ureters sometimes have anomalous terminations either in the
rectum, vagina, or directly in the urethra. This latter
disposition is realized normally in a number of animals and
causes the incessant flow of urine, resulting in a serious
inconvenience. Flajani speaks of the termination of the ureters
in the pelvis; Nebel has seen them appear just beneath the
umbilicus; and Lieutaud describes a man who died at thirty-five,
from another cause, whose ureters, as large as intestines,
terminated in the urethral canal, causing him to urinate
frequently; the bladder was absent. In the early part of this
century there was a young girl examined in New York whose ureters
emptied into a reddish carnosity on the mons veneris. The urine
dribbled continuously, and if the child cried or made any
exertion it came in jets. The genital organs participated but
little in the deformity, and with the exception that the
umbilicus was low and the anus more anterior than natural, the
child was well formed and its health good. Colzi reports a case
in which the left ureter opened externally at the left side of
the hymen a little below the normal meatus urinarius. There is a
case described of a man who evidently suffered from a patent
urachus, as the urine passed in jets as if controlled by a
sphincter from his umbilicus. Littre mentions a patent urachus in
a boy of eighteen. Congenital dilatation of the ureters is
occasionally seen in the new-born. Shattuck describes a male
fetus showing reptilian characters in the sexual ducts. There was
ectopia vesicae and prolapse of the intestine at the umbilicus;
the right kidney was elongated; the right vas deferens opened
into the ureter. There was persistence in a separate condition of
the two Mullerian ducts which opened externally inferiorly, and
there were two ducts near the openings which represented anal
pouches. Both testicles were in the abdomen. Ord describes a man
in whom one of the Mullerian ducts was persistent.
Anomalies of the Bladder.--Blanchard, Blasius, Haller, Nebel, and
Rhodius mention cases in which the bladder has been found absent
and we have already mentioned some cases, but the instances in
which the bladder has been duplex are much more frequent.
Bourienne, Oberteuffer, Ruysch, Bartholinus, Morgagni, and Franck
speak of vesical duplication. There is a description of a man who
had two bladders, each receiving a ureter. Bussiere describes a
triple bladder, and Scibelli of Naples mentions an instance in a
subject who died at fifty-seven with symptoms of retention of
urine. In the illustration, B represents the normal bladder, A
and C the supplementary bladders, with D and E their respective
points of entrance into B. As will be noticed, the ureters
terminate in the supplementary bladders. Fantoni and Malgetti
cite instances of quintuple bladders.
The Ephemerides speaks of a case of coalition of the bladder with
the os pubis and another case of coalition with the omentum.
Prochaska mentions vesical fusion with the uterus, and we have
already described union with the rectum and intestine.
Exstrophy of the bladder is not rare, and is often associated
with hypospadias, epispadias, and other malformations of the
genitourinary tract. It consists of a deficiency of the abdominal
wall in the hypogastric region, in which is seen the denuded
bladder. It is remedied by many different and ingenious plastic
operations.
In an occasional instance in which there is occlusion at the
umbilicus and again at the neck of the bladder this organ becomes
so distended as to produce a most curious deformity in the fetus.
Figure 143 shows such a case.
The Heart.--Absence of the heart has never been recorded in human
beings except in the case of monsters, as, for example, the
omphalosites, although there was a case reported and firmly
believed by the ancient authors,--a Roman soldier in whom
Telasius said he could discover no vestige of a heart.
The absence of one ventricle has been recorded. Schenck has seen
the left ventricle deficient, and the Ephemerides, Behr, and
Kerckring speak of a single ventricle only in the heart. Riolan
mentions a heart in which both ventricles were absent. Jurgens
reported in Berlin, February 1, 1882, an autopsy on a child who
had lived some days after birth, in which the left ventricle of
the heart was found completely absent. Playfair showed the heart
of a child which had lived nine months in which one ventricle was
absent. In King's College Hospital in London there is a heart of
a boy of thirteen in which the cavities consist of a single
ventricle and a single auricle.
Duplication of the heart, notwithstanding the number of cases
reported, has been admitted with the greatest reserve by
Geoffroy-Saint-Hilaire and by a number of authors. Among the
celebrated anatomists who describe duplex heart are Littre,
Meckel, Collomb, Panum, Behr, Paullini, Rhodins, Winslow, and
Zacutus Lusitanus.
The Ephemerides cites an instance of triple heart, and Johnston
has seen a triple heart in a goose.
The phenomenon of "blue-disease," or congenital cyanosis, is due
to the patency of the foremen ovale, which, instead of closing at
birth, persists sometimes to adult life.
Perhaps the most unique collection of congenital malformations of
the heart from persons who have reached the age of puberty was to
be seen in London in 1895. In this collection there was an adult
heart in which the foremen ovale remained open until the age of
thirty-seven; there were but two pulmonary valves; there was
another heart showing a large patent foramen ovale from a man of
forty-six; and there was a septum ventriculorum of an adult heart
from a woman of sixty-three, who died of carcinoma of the breast,
in which the foremen ovale was still open and would admit the
fore-finger. This woman had shown no symptoms of the
malformation. There were also hearts in which the
interventricular septum was deficient, the ductus arteriosus
patent, or some valvular malformation present. All these persons
had reached puberty.
Displacements of the heart are quite numerous. Deschamps of Laval
made an autopsy on an old soldier which justified the expression,
"He had a heart in his belly." This organ was found in the left
lumbar region; it had, with its vessels, traversed an anomalous
opening in the diaphragm. Franck observed in the Hospital of
Colmar a woman with the heart in the epigastric region. Ramel and
Vetter speak of the heart under the diaphragm.
Inversion of the heart is quite frequent, and we often find
reports of cases of this anomaly. Fournier describes a soldier of
thirty years, of middle height, well proportioned and healthy,
who was killed in a duel by receiving a wound in the abdomen;
postmortem, the heart was found in the position of the right
lung; the two lungs were joined and occupied the left chest.
The anomalies of the vascular system are so numerous that we
shall dismiss them with a slight mention. Malacarne in Torino in
1784 described a double aorta, and Hommelius mentions an
analogous case. The following case is quite an interesting
anatomic anomaly: A woman since infancy had difficulty in
swallowing, which was augmented at the epoch of menstruation and
after exercise; bleeding relieved her momentarily, but the
difficulty always returned. At last deglutition became impossible
and the patient died of malnutrition. A necropsy revealed the
presence of the subclavicular artery passing between the tracheal
artery and the esophagus, compressing this latter tube and
opposing the passage of food.
Anomalies of the Breasts.--The first of the anomalies of the
generative apparatus to be discussed, although not distinctly
belonging under this head, will be those of the mammae.
Amazia, or complete absence of the breast, is seldom seen.
Pilcher describes an individual who passed for a female, but who
was really a male, in whom the breasts were absolutely wanting.
Foerster, Froriep, and Ried cite instances associated with
thoracic malformation. Greenhow reports a case in which the
mammae were absent, although there were depressed rudimentary
nipples and areolae. There were no ovaries and the uterus was
congenitally imperfect.
There was a negress spoken of in 1842 in whom the right breast
was missing, and there are cases of but one breast, mentioned by
King, Paull, and others. Scanzoni has observed absence of the
left mamma with absence of the left ovary.
Micromazia is not so rare, and is generally seen in females with
associate genital troubles. Excessive development of the mammae,
generally being a pathologic phenomenon, will be mentioned in
another chapter. However, among some of the indigenous negroes
the female breasts are naturally very large and pendulous. This
is well shown in Figure 144, which represents a woman of the
Bushman tribe nursing an infant. The breasts are sufficiently
pendulous and loose to be easily thrown over the shoulder.
Polymazia is of much more frequent occurrence than is supposed.
Julia, the mother of Alexander Severus, was surnamed "Mammea"
because she had supernumerary breasts. Anne Boleyn, the
unfortunate wife of Henry VIII of England, was reputed to have
had six toes, six fingers, and three breasts. Lynceus says that
in his time there existed a Roman woman with four mammae, very
beautiful in contour, arranged in two lines, regularly, one above
the other, and all giving milk in abundance. Rubens has pictured
a woman with four breasts; the painting may be seen in the Louvre
in Paris.
There was a young and wealthy heiress who addressed herself to
the ancient faculty at Tubingen, asking, as she displayed four
mammary, whether, should she marry, she would have three or four
children at a birth. This was a belief with which some of her
elder matron friends had inspired her, and which she held as a
hindrance to marriage.
Leichtenstern, who has collected 70 cases of polymazia in females
and 22 in males, thinks that accessory breasts or nipples are due
to atavism, and that our most remote inferiorly organized
ancestors had many breasts, but that by constantly bearing but
one child, from being polymastic, females have gradually become
bimastic. Some of the older philosophers contended that by the
presence of two breasts woman was originally intended to bear two
children.
Hirst says: "Supernumerary breasts and nipples are more common
than is generally supposed. Bruce found 60 instances in 3956
persons examined (1.56 per cent). Leichtenstern places the
frequency at one in 500. Both observers declare that men present
the anomaly about twice as frequently as women. It is impossible
to account for the accessory glands on the theory of reversion,
as they occur with no regularity in situation, but may develop at
odd places on the body. The most frequent position is on the
pectoral surface below the true mammae and somewhat nearer the
middle line, but an accessory gland has been observed on the left
shoulder over the prominence of the deltoid, on the abdominal
surface below the costal cartilages, above the umbilicus, in the
axilla, in the groin, on the dorsal surface, on the labium majus,
and on the outer aspect of the left thigh. Ahlfeld explains the
presence of mammae on odd parts of the body by the theory that
portions of the embryonal material entering into the composition
of the mammary gland are carried to and implanted upon any
portion of the exterior of the body by means of the amnion."
Possibly the greatest number of accessory mammae reported is that
of Neugebauer in 1886, who found ten in one person. Peuch in 1876
collected 77 cases, and since then Hamy, Quinqusud, Whiteford,
Engstrom, and Mitchell Bruce have collected cases. Polymazia must
have been known in the olden times, and we still have before us
the old images of Diana, in which this goddess is portrayed with
numerous breasts, indicating her ability to look after the
growing child. Figure 145 shows an ancient Oriental statue of
Artemisia or Diana now at Naples.
Bartholinus has observed a Danish woman with three mammae, two
ordinarily formed and a third forming a triangle with the others
and resembling the breasts of a fat man. In the village of
Phullendorf in Germany early in this century there was an old
woman who sought alms from place to place, exhibiting to the
curious four symmetrical breasts, arranged parallel. She was
extremely ugly, and when on all fours, with her breasts
pendulous, she resembled a beast. The authors have seen a man
with six distinct nipples, arranged as regularly as those of a
bitch or sow. The two lower were quite small. This man's body was
covered with heavy, long hair, making him a very conspicuous
object when seen naked during bathing. The hair was absent for a
space of nearly an inch about the nipples. Borellus speaks of a
woman with three mammae, two as ordinarily, the third to the left
side, which gave milk, but not the same quantity as the others.
Gardiner describes a mulatto woman who had four mammae, two of
which were near the axillae, about four inches in circumference,
with proportionate sized nipples. She became a mother at
fourteen, and gave milk from all her breasts. In his
"Dictionnaire Philosophique" Voltaire gives the history of a
woman with four well-formed and symmetrically arranged breasts;
she also exhibited an excrescence, covered with a nap-like hair,
looking like a cow-tail. Percy thought the excrescence a
prolongation of the coccyx, and said that similar instances were
seen in savage men of Borneo.
Percy says that among some prisoners taken in Austria was found a
woman of Valachia, near Roumania, exceedingly fatigued, and
suffering intensely from the cold. It was January, and the ground
was covered with three feet of snow. She had been exposed with
her two infants, who had been born twenty days, to this freezing
temperature, and died on the next day. An examination of her body
revealed five mammae, of which four projected as ordinarily,
while the fifth was about the size of that of a girl at puberty.
They all had an intense dark ring about them; the fifth was
situated about five inches above the umbilicus. Percy injected
the subject and dissected and described the mammary blood-supply.
Hirst mentions a negress of nineteen who had nine mammae, all
told, and as many nipples. The two normal glands were very large.
Two accessory glands and nipples below them were small and did
not excrete milk. All the other glands and nipples gave milk in
large quantities. There were five nipples on the left and four on
the right side. The patient's mother had an accessory mamma on
the abdomen that secreted milk during the period of lactation.
Charpentier has observed in his clinic a woman with two
supplementary axillary mammae with nipples. They gave milk as the
ordinary mammae. Robert saw a woman who nourished an infant by a
mamma on the thigh. Until the time of pregnancy this mamma was
taken for an ordinary nevus, but with pregnancy it began to
develop and acquired the size of a citron. Figure 147 is from an
old wood-cut showing a child suckling at a supernumerary mamma on
its mother's thigh while its brother is at the natural breast.
Jenner speaks of a breast on the outer side of the thigh four
inches below the great trochanter. Hare describes a woman of
thirty-seven who secreted normal milk from her axillae. Lee
mentions a woman of thirty-five with four mammae and four
nipples; she suckled with the pectoral and not the axillary
breasts. McGillicudy describes a pair of rudimentary abdominal
mammae, and there is another similar case recorded. Hartung
mentions a woman of thirty who while suckling had a mamma on the
left labium majus. It was excised, and microscopic examination
showed its structure to be that of a rudimentary nipple and
mammary gland. Leichtenstern cites a case of a mamma on the left
shoulder nearly under the insertion of the deltoid, and Klob
speaks of an acromial accessory mamma situated on the shoulder
over the greatest prominence of the deltoid. Hall reports the
case of a functionally active supernumerary mamma over the costal
cartilage of the 8th rib. Jussieu speaks of a woman who had three
breasts, one of which was situated on the groin and with which
she occasionally suckled; her mother had three breasts, but they
were all situated on the chest. Saunois details an account of a
female who had two supernumerary breasts on the back. Bartholinus
(quoted by Meckel) and Manget also mention mammae on the back,
but Geoffroy-Saint-Hilaire questions their existence. Martin
gives a very clear illustration of a woman with a supernumerary
breast below the natural organ. Sneddon, who has collected quite
a number of cases of polymazia, quotes the case of a woman who
had two swellings in each axilla in which gland-structure was
made out, but with no external openings, and which had no
anatomic connection with the mammary glands proper. Shortly after
birth they varied in size and proportion, as the breasts were
full or empty, and in five weeks all traces of them were lost.
Her only married sister had similar enlargements at her third
confinement.
Polymazia sometimes seems to be hereditary. Robert saw a daughter
whose mother was polymastic, and Woodman saw a mother and eldest
daughter who each had three nipples. Lousier mentions a woman
wanting a mamma who transmitted this vice of conformation to her
daughter. Handyside says he knew two brothers in both of whom
breasts were wanting.
Supernumerary nipples alone are also seen, as many as five having
been found on the same breast. Neugebauer reports eight
supernumerary nipples in one case. Hollerus has seen a woman who
had two nipples on the same breast which gave milk with the same
regularity and the same abundance as the single nipple. The
Ephemerides contains a description of a triple nipple. Barth
describes "mamma erratica" on the face in front of the right ear
which enlarged during menstruation.
Cases of deficiency of the nipples have been reported by the
Ephemerides, Lentilius, Severinus, and Werckardus.
Cases of functional male mammae will be discussed in Chapter IX.
Complete absence of the hymen is very rare, if we may accept the
statements of Devilliers, Tardieu, and Brouardel, as they have
never seen an example in the numerous young girls they have
examined from a medico-legal point of view.
Duplication or biperforation of the hymen is also a very rare
anomaly of this membrane. In this instance the hymen generally
presents two lateral orifices, more or less irregular and
separated by a membranous band, which gives the appearance of
duplicity. Roze reported from Strasburg in 1866 a case of this
kind, and Delens has observed two examples of biperforate hymen,
which show very well that this disposition of the membrane is due
to a vice of conformation. The first was in a girl of eleven, in
which the membrane was of the usual size and thickness, but was
duplicated on either side. In her sister of nine the hymen was
normally conformed. The second case was in a girl under treatment
by Cornil in 1876 for vaginitis. Her brother had accused a young
man of eighteen of having violated her, and on examination the
hymen showed a biperforate conformation; there were two oval
orifices, their greatest diameter being in the vertical plane;
the openings were situated on each side of the median line, about
five mm. apart; the dividing band did not appear to be
cicatricial, but presented the same roseate coloration as the
rest of the hymen. Since this report quite a number of cases have
been recorded.
The different varieties of the hymen will be left to the works on
obstetrics. As has already been observed, labor is frequently
seriously complicated by a persistent and tough hymen.
Deficient vulva may be caused by the persistence of a thick
hymen, by congenital occlusion, or by absolute absence in vulvar
structure. Bartholinus, Borellus, Ephemerides, Julius,
Vallisneri, and Baux are among the older writers who mention this
anomaly, but as it is generally associated with congenital
occlusion, or complete absence of the vagina, the two will be
considered together.
Complete absence of the vagina is quite rare. Baux a reports a
case of a girl of fourteen in whom "there was no trace of
fundament or of genital organs." Oberteuffer speaks of a case of
absent vagina. Vicq d'Azir is accredited with having seen two
females who, not having a vagina, copulated all through life by
the urethra, and Fournier sagely remarks that the extra large
urethra may have been a special dispensation of nature. Bosquet
describes a young girl of twenty with a triple vice of
conformation--an obliterated vulva, closure of the vagina, and
absence of the uterus. Menstrual hemorrhage took place from the
gums. Clarke has studied a similar case which was authenticated
by an autopsy.
O'Ferral of Dublin, Gooch, Davies, Boyd, Tyler Smith, Hancock,
Coste, Klayskens, Debrou, Braid, Watson, and others are quoted by
Churchill as having mentioned the absence of the vagina. Amussat
observed a German girl who did not have a trace of a vagina and
who menstruated regularly. Griffith describes a specimen in the
Museum of St. Bartholomew's Hospital, London, in which the
ovaries lay on the surface of the pelvic peritoneum and there was
neither uterus nor vagina; the pelvis had some of the
characteristics of the male type. Matthews Duncan has observed a
somewhat similar case, the vagina not measuring more than an inch
in length. Ferguson describes a prostitute of eighteen who had
never menstruated. The labia were found well developed, but there
was no vagina, uterus, or ovaries. Coitus had been through the
urethra, which was considerably distended, though not causing
incontinence of urine. Hulke reports a case of congenital atresia
of the vagina in a brunette of twenty, menstruation occurring
through the urethra. He also mentions the instance of congenital
atresia of the vagina with hernia of both ovaries into the left
groin in a servant of twenty, and the case of an imperforate
vagina in a girl of nineteen with an undeveloped uterus.
Brodhurst reports an instance of absence of the vagina and uterus
in a girl of sixteen who at four years of age showed signs of
approaching puberty. At this early age the mons was covered with
hair, and at ten the clitoris was three inches long and two
inches in circumference. The mammae were well developed. The
labia descended laterally and expanded into folds, resembling the
scrotum.
Azema reports an instance of complete absence of the vagina and
impermeability and probable absence of the col uterinus. The
deficiencies were remedied by operation. Berard mentions a
similar deformity and operation in a girl of eighteen. Gooding
cites an instance of absent vagina in a married woman, the uterus
discharging the functions. Gosselin reports a case in which a
voluminous tumor was formed by the retained menstrual fluid in a
woman without a vagina. An artificial vagina was created, but the
patient died from extravasation of blood into the peritoneal
cavity. Carter, Polaillon, Martin, Curtis, Worthington, Hall,
Hicks, Moliere, Patry, Dolbeau, Desormeaux, and Gratigny also
record instances of absence of the vagina.
There are some cases reported in extramedical literature which
might be cited. Bussy Rabutin in his Memoires in 1639 speaks of
an instance. The celebrated Madame Recamier was called by the
younger Dumas an involuntary virgin; and in this connection could
be cited the malicious and piquant sonnet--
Chateaubriand et Madame Recamier.
"Juliette et Rene s'aimaient d'amour si tendre
Que Dien, sans les punir, a pu leur pardonner:
Il n'avait pas voulu que l'une put donner
Ce que l'autre ne pouvait prendre."
Duplex vagina has been observed by Bartholinus, Malacarne, Asch,
Meckel, Osiander, Purcell, and other older writers. In more
modern times reports of this anomaly are quite frequent. Hunter
reports a case of labor at the seventh month in a woman with a
double vagina, and delivery through the rectum. Atthill and Watts
speak of double vagina with single uterus.
Robb of Johns Hopkins Hospital reports a case of double vagina in
a patient of twenty suffering from dyspareunia. The vaginal
orifice was contracted; the urethra was dilated and had evidently
been used for coitus. A membrane divided the vagina into two
canals, the cervix lying in the right half; the septum was also
divided. Both the thumbs of the patient were so short that their
tips could scarcely meet those of the little fingers. Double
vagina is also reported by Anway, Moulton, Freeman, Frazer,
Haynes, Lemaistre, Boardman, Dickson, Dunoyer, and Rossignol.
This anomaly is usually associated with bipartite or double
uterus. Wilcox mentions a primipara, three months pregnant, with
a double vagina and a bicornate uterus, who was safely delivered
of several children. Haller and Borellus have seen double vagina,
double uterus, and double ovarian supply; in the latter case
there was also a double vulva. Sanger speaks of a supernumerary
vagina connecting with the other vagina by a fistulous opening,
and remarks that this was not a case of patent Gartner's duct.
Cullingworth cites two cases in which there were transverse septa
of the vagina. Stone reports five cases of transverse septa of
the vagina. Three of the patients were young women who had never
borne children or suffered injury. Pregnancy existed in each
case. In the first the septum was about two inches from the
introitus, and contained an opening about 1/2 inch in diameter
which admitted the tip of the finger. The membrane was elastic
and thin and showed no signs of inflammation. Menstruation had
always been regular up to the time of pregnancy. The second was a
duplicate of the first, excepting that a few bands extended from
the cervix to the membranous septum. In the third the lumen of
the vagina, about two inches from the introitus, was distinctly
narrowed by a ridge of tissue. There was uterine displacement and
some endocervicitis, but no history of injury or operation and no
tendency to contraction. The two remaining cases occurred in
patients seen by Dr. J. F. Scott. In one the septum was about 1
3/4 inches from the entrance to the vagina and contained an
orifice large enough to admit a uterine probe. During labor the
septum resisted the advance of the head for several hours, until
it was slit in several directions. In the other, menstruation had
always been irregular, intermissions being followed by a profuse
flow of black and tarry blood, which lasted sometimes for fifteen
days and was accompanied by severe pain. The septum was 1 1/2
inches from the vaginal orifice and contained an opening which
admitted a uterine sound. It was very dense and tight and fully
1/8 inch in thickness.
Mordie reported a case of congenital deficiency of the
rectovaginal septum which was successfully remedied by operation.
Anomalous Openings of the Vagina.--The vagina occasionally opens
abnormally into the rectum, into the bladder, the urethra, or
upon the abdominal parietes. Rossi reports from a hospital in
Turin the case of a Piedmontese girl in whom there was an
enormous tumor corresponding to the opening of the vaginal
orifice; no traces of a vagina could be found. The tumor was
incised and proved to be a living infant. The husband of the
woman said that he had coitus without difficulty by the rectum,
and examination showed that the vagina opened into the rectum, by
which means impregnation had been accomplished. Bonnain and Payne
have observed analogous cases of this abnormality of the vaginal
opening and subsequent accouchement by the anus. Payne's case was
of a woman of thirty-five, well formed, who had been in labor
thirty-six hours, when the physician examined and looked in vain
for a vaginal opening; the finger, gliding along the perineum,
came in contact with the distended anus, in which was recognized
the head of the fetus. The woman from prolongation of labor was
in a complete state of prostration, which caused uterine inertia.
Payne anesthetized the patient, applied the forceps, and
extracted the fetus without further accident. The vulva of this
woman five months afterward displayed all the characteristics of
virginity, the vagina opened into the rectum, and menstruation
had always been regular. This woman, as well as her husband,
averred that they had no suspicion of the anomaly and that coitus
(by the anus) had always been satisfactory.
Opening of the vagina upon the parietes, of which Le Fort has
collected a number of cases, has never been observed in
connection with a viable fetus.
Absence of the labia majora has been observed, especially by
Pozzi, to the exclusion of all other anomalies. It is the rule in
exstrophy of the bladder.
Absence of the nymphae has also been observed, particularly by
Auvard and by Perchaux, and is generally associated with
imperfect development of the clitoris. Constantinedes reports
absence of the external organs of generation, probably also of
the uterus and its appendages, in a young lady. Van Haartman,
LeFort, Magee, and Ogle cite cases of absence of the external
female organs. Riolan in the early part of the seventeenth
century reported a case of defective nymphae; Neubauer in 1774
offers a contrast to this case in an instance of triple nymphae.
The nymphae are sometimes enormously enlarged by hypertrophy, by
varicocele, or by elephantiasis, of which latter type Rigal de
Gaillac has observed a most curious case. There is also a variety