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.

TABLE OF CONTENTS.

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.