CHAPTER XIV.

MISCELLANEOUS SURGICAL ANOMALIES. Marvelous Recoveries from Multiple Injuries.--There are injuries so numerous or so great in extent, and so marvelous in their recovery, that they are worthy of record in a section by themselves. They are found particularly in military surgery. In the Medical and Philosophical Commentaries for 1779 is the report of the case of a lieutenant who was wounded through the lungs, liver, and stomach, and in whose armpit lodged a ball. It was said that when the wound in his back was injected, the fluid would immediately be coughed up from his lungs. Food would pass through the wound of the stomach. The man was greatly prostrated, but after eleven months of convalescence he recovered. In the brutal capture of Fort Griswold, Connecticut, in 1781, in which the brave occupants were massacred by the British, Lieutenant Avery had an eye shot out, his skull fractured, the brain-substance scattering on the ground, was stabbed in the side, and left for dead; yet he recovered and lived to narrate the horrors of the day forty years after. A French invalid-artillery soldier, from his injuries and a peculiar mask he used to hide them, was known as "L'homme a la tete de cire." The Lancet gives his history briefly as follows: During the Franco-Prussian War, he was horribly wounded by the bursting of a Prussian shell. His whole face, including his two eyes, were literally blown away, some scanty remnants of the osseous and muscular systems, and the skull covered with hair being left. His wounds healed, giving him such a hideous and ghastly appearance that he was virtually ostracized from the sight of his fellows. For his relief a dentist by the name of Delalain constructed a mask which included a false palate and a set of false teeth. This apparatus was so perfect that the functions of respiration and mastication were almost completely restored to their former condition, and the man was able to speak distinctly, and even to play the flute. His sense of smell also returned. He wore two false eyes simply to fill up the cavities of the orbits, for the parts representing the eyes were closed. The mask was so well-adapted to what remained of the real face, that it was considered by all one of the finest specimens of the prothetic art that could be devised. This soldier, whose name was Moreau, was living and in perfect health at the time of the report, his bizarre face, without expression, and his sobriquet, as mentioned, making him an object of great curiosity. He wore the Cross of Honor, and nothing delighted him more than to talk about the war. To augment his meager pension he sold a pamphlet containing in detail an account of his injuries and a description of the skilfully devised apparatus by which his declining life was made endurable. A somewhat similar case is mentioned on page 585. A most remarkable case of a soldier suffering numerous and almost incredible injuries and recovering and pursuing his vocation with undampened ardor is that of Jacques Roellinger, Company B, 47th New York Volunteers. He appeared before a pension board in New York, June 29, 1865, with the following history: In 1862 he suffered a sabre-cut across the quadriceps extensor of the left thigh, and a sabre-thrust between the bones of the forearm at the middle third. Soon afterward at Williamsburg, Va., he was shot in the thigh, the ball passing through the middle third external to the femur. At Fort Wagner, 1863, he had a sword-cut, severing the spinal muscles and overlying tissue for a distance of six inches. Subsequently he was captured by guerillas in Missouri and tortured by burning splinters of wood, the cicatrices of which he exhibited; he escaped to Florida, where he was struck by a fragment of an exploding shell, which passed from without inward, behind the hamstring on the right leg, and remained embedded and could be plainly felt. When struck he fell and was fired on by the retiring enemy. A ball entered between the 6th and 7th ribs just beneath the apex of the heart, traversed the lungs and issued at the right 9th rib. He fired his revolver on reception of this shot, and was soon bayonetted by his own comrades by mistake, this wound also penetrating the body. He showed a depressed triangular cicatrix on the margin of the epigastrium. If the scars are at all indicative, the bayonet must have passed through the left lobe of the liver and border of the diaphragm. Finally he was struck by a pistol-ball at the lower angle of the left lower jaw, this bullet issuing on the other side of the neck. As exemplary of the easy manner in which he bore his many injuries during a somewhat protracted convalescence, it may be added that he amused his comrades by blowing jets of water through the apertures on both sides of his neck. Beside the foregoing injuries he received many minor ones, which he did not deem worthy of record or remembrance. The greatest disability he suffered at the time of applying for a pension resulted from an ankylosed knee. Not satisfied with his experience in our war, he stated to the pension examiners that he was on his way to join Garibaldi's army. This case is marvelous when we consider the proximity of several of the wounds to a vital part; the slightest deviation of position would surely have resulted in a fatal issue for this apparently charmed life. The following table shows the man's injuries in the order of their reception:-- (1) Sabre-cut across the quadriceps femoris of right leg, dividing the tendinous and muscular structures. (2) Sabre-thrust between the bones in the middle third of the right forearm. (3) Shot in the right thigh, the ball passing through the middle third. (4) A sword-cut across the spinal muscles covering the lower dorsal vertebrae. (5) Tortured by guerillas in Indian fashion by having burning splinters of wood applied to the surface of his right thorax. (6) An exploded shell passed through the hamstring muscles of the right thigh and embedded itself in the ligamentous tissues of the internal condyle of the femur. (7) Shot by a ball between the 6th and 7th ribs of the left side. (8) Bayonetted through the body, the steel passing through the left lobe of the liver and penetrating the posterior border of the diaphragm. (9) Pistol-ball shot through the sternocleido muscle of one side of the neck, emerging through the corresponding muscle of the other side of the neck. (10) Sabre-thrust between the bones of the left forearm. (11) Pistol-shot through the left pectoralis major and left deltoid muscles. (12) Deep cut dividing the commissure between the left thumb and forefinger down to the carpal bones. Somewhat analogous to the foregoing is a case reported in 1834 by McCosh from Calcutta. The patient was a native who had been dreadfully butchered in the Chooar campaign. One of his hands was cut off above the wrist. The remaining stump was nearly amputated by a second blow. A third blow penetrated the shoulder-joint. Beside these and several other slashes, he had a cut across the abdomen extending from the umbilicus to the spine. This cut divided the parietes and severed one of the coats of the colon. The intestines escaped and lay by his side. He was then left on the ground as dead. On arrival at the hospital his wounds were dressed and he speedily convalesced, but the injured colon ruptured and an artificial anus was formed and part of the feces were discharged through the wound. This man was subsequently seen at Midnapore healthy and lusty although his body was bent to one side in consequence of a large cicatrix; a small portion of the feces occasionally passed through the open wound. There is an account of a private soldier, aged twenty-seven, who suffered a gunshot wound of the skull, causing compound fracture of the cranium, and who also received compound fractures of both bones of the leg. He did not present himself for treatment until ten days later. At this time the head-injury caused him no inconvenience, but it was necessary to amputate the leg and remove the necrosed bones from the cranial wounds; the patient recovered. Recovery After Injuries by Machinery, with Multiple Fractures, etc.--Persons accidentally caught in some portions of powerful machinery usually suffer several major injuries, any one of which might have been fatal, yet there are marvelous instances of recovery after wounds of this nature. Phares records the case of a boy of nine who, while playing in the saw-gate of a cotton-press, was struck by the lever in revolution, the blow fracturing both bones of the leg about the middle. At the second revolution his shoulder was crushed; the third passed over him, and the fourth, with maximum momentum struck his head, carrying away a large part of the integument, including one eyebrow, portions of the skull, membranes, and brain-substance. A piece of cranial bone was found sticking in the lever, and there were stains of brain on all the 24 posts around the circumference of the hole. Possibly from 1 1/2 to two ounces of cerebral substance were lost. A physician was called, but thinking the case hopeless he declined to offer surgical interference. Undaunted, the father of the injured lad straightened the leg, adjusted the various fractures, and administered calomel and salts. The boy progressively recovered, and in a few weeks his shoulder and legs were well. About this time a loosened fragment of the skull was removed almost the size and shape of a dessert spoon, with the handle attached, leaving a circular opening directly over the eye as large as a Mexican dollar, through which cerebral pulsation was visible. A peculiar feature of this case was that the boy never lost consciousness, and while one of his playmates ran for assistance he got out of the hole himself, and moved to a spot ten feet distant before any help arrived, and even then he declined proffered aid from a man he disliked. This boy stated that he remembered each revolution of the lever and the individual injuries that each inflicted. Three years after his injury he was in every respect well. Fraser mentions an instance of a boy of fifteen who was caught in the crank of a balance-wheel in a shingle-mill, and was taken up insensible. His skull was fractured at the parietal eminence and the pericranium stripped off, leaving a bloody tumor near the base of the fracture about two inches in diameter. The right humerus was fractured at the external condyle; there was a fracture of the coronoid process of the ulna, and a backward dislocation at the elbow. The annular ligament was ruptured, and the radius was separated from the ulna. On the left side there was a fracture of the anatomic neck of the humerus, and a dislocation downward. The boy was trephined, and the comminuted fragments removed; in about six weeks recovery was nearly complete. Gibson reports the history of a girl of eight who was caught by her clothing in a perpendicular shaft in motion, and carried around at a rate of 150 or 200 times a minute until the machinery could be stopped. Although she was found in a state of shock, she was anesthetized, in order that immediate attention could be given to her injuries, which were found to be as follows:-- (1) An oblique fracture of the middle third of the right femur. (2) A transverse fracture of the middle third of the left femur. (3) A slightly comminuted transverse fracture of the middle third of the left tibia and fibula. (4) A transverse fracture of the lower third of the right humerus. (5) A fracture of the lower third of the right radius. (6) A partial radiocarpal dislocation. (7) Considerable injuries of the soft parts at the seats of fracture, and contusions and abrasions all over the body. During convalescence the little patient suffered an attack of measles, but after careful treatment it was found by the seventy-eighth day that she had recovered without bony deformity, and that there was bony union in all the fractures. There was slight tilting upward in the left femur, in which the fracture had been transverse, but there was no perceptible shortening. Hulke describes a silver-polisher of thirty-six who, while standing near a machine, had his sleeve caught by a rapidly-turning wheel, which drew him in and whirled him round and round, his legs striking against the ceiling and floor of the room. It was thought the wheel had made 50 revolutions before the machinery was stopped. After his removal it was found that his left humerus was fractured at its lower third, and apparently comminuted. There was no pulse in the wrist in either the radial or ulnar arteries, but there was pulsation in the brachial as low as the ecchymosed swelling. Those parts of the hand and fingers supplied by the median and radial nerves were insensible. The right humerus was broken at the middle, the end of the upper fragment piercing the triceps, and almost protruding through the skin. One or more of the middle ribs on the right side were broken near the angle, and there was a large transverse rent in the quadriceps extensor. Despite this terrible accident the man made a perfect recovery, with the single exception of limitation of flexion in the left elbow-joint. Dewey details a description of a girl of six who was carried around the upright shaft of a flour mill in which her clothes became entangled. Some part of the body struck the bags or stones with each revolution. She sustained a fracture of the left humerus near the insertion of the deltoid, a fracture of the middle third of the left femur, a compound fracture of the left femur in the upper third, with protrusion of the upper fragment and considerable venous hemorrhage, and fracture of the right tibia and fibula at the upper third. When taken from the shafting the child was in a moribund state, with scarcely perceptible pulse, and all the accompanying symptoms of shock. Her injuries were dressed, the fractures reduced, and starch bandages applied; in about six weeks there was perfect union, the right leg being slightly shortened. Six months later she was playing about, with only a slight halt in her gait. Miscellaneous Multiple Fractures.--Westmoreland speaks of a man who was pressed between two cars, and sustained a fracture of both collar-bones and of the sternum; in addition, six or eight ribs were fractured, driven into and lacerating the lung. The heart was displaced. In spite of these terrible injuries, the man was rational when picked up, and lived nearly half a day. In comment on this case Battey mentions an instance in which a mill-sawyer was run over by 20 or 30 logs, which produced innumerable fractures of his body, constituting him a surgical curiosity. He afterward completely recovered, and, as a consequence of his miraculous escape, became a soothsayer in his region. West reports a remarkable recovery after a compound fracture of the femur, fracture of the jaw, and of the radius, and possibly injury to the base of the skull, and injury to the spine. There is on record an account of a woman of forty-three who, by muscular action in lifting a stone, fractured her pubes, external to the spine, on the left side. Not realizing her injury she continued hard work all that day, but fell exhausted on the next. She recovered in about a month, and was able to walk as well as ever. Vinnedge reports recovery after concussion of the brain and extreme shock, associated with fracture of the left femur, and comminuted fractures of the left tibia and fibula. Tufnell mentions recovery after compound comminuted fracture of the leg, with simple fracture of both collar-bones, and dislocation of the thumb. Nankivell speaks of a remarkable recovery in an individual who suffered compound comminuted fracture of both legs, and fracture of the skull. It was found necessary to amputate the right thigh and left leg. Erichsen effected recovery by rest alone, in an individual whose ribs and both clavicles were fractured by being squeezed. Gilman records recovery after injuries consisting of fracture of the frontal bone near the junction with the right parietal; fracture of the right radius and ulna at the middle third and at the wrist; and compound fracture of the left radius and ulna, 1 1/4 inches above the wrist. Boulting reports a case of an individual who suffered compound fractures of the skull and humerus, together with extensive laceration of the thigh and chest, and yet recovered. Barwell mentions recovery after amputation of the shoulder-joint, in an individual who had suffered fracture of the base of the skull, fracture of the jaw, and compound fracture of the right humerus. There was high delirium followed by imbecility in this case. Bonnet reports a case of fracture of both thighs, two right ribs, luxation of the clavicle, and accidental club-foot with tenotomy, with good recovery from all the complications. Beach speaks of an individual who suffered fracture of both thighs, and compound comminuted fracture of the tibia, fibula, and tarsal bones into the ankle-joint, necessitating amputation of the leg. The patient not only survived the operation, but recovered with good union in both thighs. As illustrative of the numerous fractures a person may sustain at one time, the London Medical Gazette mentions an injury to a girl of fourteen, which resulted in 31 fractures. Remarkable Falls.--In this connection it is of interest to note from how great a height a person may fall without sustaining serious injury. A remarkable fall of a miner down 100 meters of shaft (about 333 feet) without being killed is recorded by M. Reumeaux in the Bulletin de l'Industrie Minerale. Working with his brother in a gallery which issued on the shaft, he forgot the direction in which he was pushing a truck; so it went over, and he after it, falling into some mud with about three inches of water. As stated in Nature, he seems neither to have struck any of the wood debris, nor the sides of the shaft, and he showed no contusions when he was helped out by his brother after about ten minutes. He could not, however, recall any of his impressions during the fall. The velocity on reaching the bottom would be about 140 feet, and time of fall 4.12 seconds; but it is thought he must have taken longer. It appears strange that he should have escaped simple suffocation and loss of consciousness during a time sufficient for the water to have drowned him. While intoxicated Private Gough of the 42d Royal Highlanders attempted to escape from the castle at Edinburgh. He fell almost perpendicularly 170 feet, fracturing the right frontal sinus, the left clavicle, tibia, and fibula. In five months he had so far recovered as to be put on duty again, and he served as an efficient soldier. There is an account of recovery after a fall of 192 feet, from a cliff in County Antrim, Ireland. Manzini mentions a man who fell from the dome of the Invalides in Paris, without sustaining any serious accident, and there is a record from Madrid of a much higher fall than this without serious consequence. In 1792 a bricklayer fell from the fourth story of a high house in Paris, landing with his feet on the dirt and his body on stone. He bled from the nose, and lost consciousness for about forty-five minutes; he was carried to the Hotel-Dieu where it was found that he had considerable difficulty in breathing; the regions about the external malleoli were contused and swollen, but by the eighth day the patient had recovered. In the recent reparation of the Hotel Raleigh in Washington, D.C., a man fell from the top of the building, which is above the average height, fracturing several ribs and rupturing his lung. He was taken to the Emergency Hospital where he was put to bed, and persistent treatment for shock was pursued; little hope of the man's recovery was entertained. His friends were told of his apparently hopeless condition. There were no external signs of the injury with the exception of the emphysema following rupture of the lung. Respiration was limited and thoracic movement diminished by adhesive straps and a binder; under careful treatment the man recovered. Kartulus mentions an English boy of eight who, on June 1, 1879, while playing on the terrace in the third story of a house in Alexandria, in attempting to fly a kite in company with an Arab servant, slipped and fell 71 feet to a granite pavement below. He was picked up conscious, but both legs were fractured about the middle. He had so far recovered by the 24th of July that he could hobble about on crutches. On the 15th of November of the same year he was seen by Kartulus racing across the playground with some other boys; as he came in third in the race he had evidently lost little of his agility. Parrott reports the history of a man of fifty, weighing 196 pounds, who fell 110 feet from the steeple of a church. In his descent he broke a scaffold pole in two, and fell through the wooden roof of an engine-house below, breaking several planks and two strong joists, and landing upon some sacks of cement inside the house. When picked up he was unconscious, but regained his senses in a short time, and it was found that his injuries were not serious. The left metacarpal bones were dislocated from the carpal bones, the left tibia was fractured, and there were contusions about the back and hips. Twelve days later he left for home with his leg in plaster. Farber and McCassy report a case in which a man fell 50 feet perpendicularly through an elevator shaft, fracturing the skull. Pieces of bone at the superior angle of the occipital bone were removed, leaving the aura exposed for a space one by four inches. The man was unconscious for four days, but entirely recovered in eighteen days, with only a slightly subnormal hearing as an after-effect of his fall. For many years there have been persons who have given exhibitions of high jumps, either landing in a net or in the water. Some of these hazardous individuals do not hesitate to dive from enormous heights, being satisfied to strike head first or to turn a somersault in their descent. Nearly all the noted bridges in this country have had their "divers." The death of Odlum in his attempt to jump from Brooklyn bridge is well known. Since then it has been claimed that the feat has been accomplished without any serious injury. It is reported that on June 20, 1896, a youth of nineteen made a headlong dive from the top of the Eads bridge at St. Louis, Mo., a distance of 125 feet. He is said to have swum 250 feet to a waiting tug, and was taken on board without having been hurt. Probably the most interesting exhibition of this kind that was ever seen was at the Royal Aquarium, London, in the summer of 1895. A part of the regular nightly performance at this Hall, which is familiar on account of its immensity, was the jump of an individual from the rafters of the large arched roof into a tank of water about 15 by 20 feet, and from eight to ten feet deep, sunken in the floor of the hall. Another performer, dressed in his ordinary street clothes, was tied up in a bag and jumped about two-thirds of this height into the same tank, breaking open the bag and undressing himself before coming to the surface. In the same performance a female acrobat made a backward dive from the topmost point of the building into a net stretched about ten feet above the floor. Nearly every large acrobatic entertainment has one of these individuals who seem to experience no difficulty in duplicating their feats night after night. It is a common belief that people falling from great heights die in the act of descent. An interview with the sailor who fell from the top-gallant of an East Indiaman, a height of 120 feet, into the water, elicited the fact that during the descent in the air, sensation entirely disappeared, but returned in a slight degree when he reached the water, but he was still unable to strike out when rising to the surface. By personal observation this man stated that he believed that if he had struck a hard substance his death would have been painless, as he was sure that he was entirely insensible during the fall. A writer in the Pall Mall Gazette, in speaking of the accidents which had happened in connection with the Forth Bridge, tells of a man who trusted himself to work at the height of 120 feet above the waters of the Firth, simply grasping a rope. His hands became numb with cold, his grasp relaxed, and he fell backward down into the water, but was brought out alive. In another instance a spanner fell a distance of 300 feet, knocked off a man's cap, and broke its way through a four-inch plank. Again, another spanner fell from a great height, actually tearing off a man's clothes, from his waistcoat to his ankle, but leaving him uninjured. On another occasion a staging with a number of workmen thereon gave way. Two of the men were killed outright by striking some portion of the work in their descent; two others fell clear of the girders, and were rescued from the Firth little worse for their great fall. Resistance of Children to Injuries.--It is a remarkable fact that young children, whose bones, cartilages, and tissues are remarkably elastic, are sometimes able to sustain the passage over their bodies of vehicles of great weight without apparent injury. There is a record early in this century of a child of five who was run over across the epigastrium by a heavy two-wheeled cart, but recovered without any bad symptoms. The treatment in this case is quite interesting, and was as follows: venesection to faintness, castor oil in infusion of senna until there was a free evacuation of the bowels, 12 leeches to the abdomen and spine, and a saline mixture every two hours! Such depleting therapeutics would in themselves seem almost sufficient to provoke a fatal issue, and were given in good faith as the means of effecting a recovery in such a case. In a similar instances a wagon weighing 1200 pounds passed over a child of five, with no apparent injury other than a bruise near the ear made by the wheel. Infant-vitality is sometimes quite remarkable, a newly-born child sometimes surviving extreme exposure and major injuries. There was a remarkable instance of this kind brought to light in the Mullings vs. Mullings divorce-case, recorded in The Lancet. It appeared that Mrs. Mullings, a few hours after her confinement at Torquay, packed her newly-born infant boy in a portmanteau, and started for London. She had telegraphed Dr. J. S. Tulloch to meet her at Paddington, where he found his patient apparently in good condition, and not weak, as he expected in a woman shortly to be confined. On the way to her apartments, which had been provided by Dr. Tulloch, Mrs. Mullings remarked to the Doctor that she had already borne her child. Dr. Tulloch was greatly surprised, and immediately inquired what she had done with the baby. She replied that it was in a box on top of the cab. When the box was opened the child was found alive. The Lancet comments on the remarkable fact that, shortly after confinement, a woman can travel six or seven hours in a railroad train, and her newly-born babe conveyed the same distance in a portmanteau, without apparent injury, and without attracting attention. Booth reports a remarkable case of vitality of a newly-born child which came under his observation in October, 1894. An illegitimate child, abandoned by its mother, was left at the bottom of a cesspool vault; she claimed that ten hours before Booth's visit it had been accidentally dropped during an attempt to micturate. The infant lived despite the following facts: Its delivery from an ignorant, inexperienced, unattended negress; its cord not tied; its fall of 12 feet down the pit; its ten hours' exposure in the cesspool; its smothering by foul air, also by a heavy covering of rags, paper, and straw; its pounding by three bricks which fell in directly from eight feet above (some loose bricks were accidentally dislodged from the sides of the vault, in the maneuvers to extricate the infant); its lowered temperature previous to the application of hot bottles, blankets, and the administration of cardiac stimulants. Booth adds that the morning after its discovery the child appeared perfectly well, and some two months afterward was brought into court as evidence in the case. A remarkable case of infant vitality is given on page 117. Operations in the Young and Old.--It might be of interest to mention that such a major operation as ovariotomy has been successfully performed in an infant. In a paper on infant ovariotomy, several instances of this nature are mentioned. Roemer successfully performed ovariotomy on a child one year and eight months old; Swartz, on a child of four; Barker, on a child of four; Knowsley Thornton, on a child of seven, and Spencer Wells Cupples, and Chenoweth, on children of eight. Rein performed ovariotomy on a girl of six, suffering from a multilocular cyst of the left ovary. He expresses his belief that childhood and infancy are favorable to laparotomy. Kidd removed a dermoid from a child of two years and eleven months; Hooks performed the same operation on a child of thirty months. Chiene extirpated an ovary from a child of three; Neville duplicated this operation in a child one month younger; and Alcock performed ovariotomy on a child of three. Successful ovariotomies are infrequent in the extremely aged. Bennett mentions an instance in a woman of seventy-five, and Davies records a similar instance. Borsini and Terrier cite instances of successful ovariotomy in patients of seventy-seven. Carmichael performed the operation at seventy-four. Owens mentions it at eighty; and Homans at eighty-two years and four months. Dewees records a successful case of ovariotomy in a woman over sixty-seven; McNutt reports a successful instance in a patient of sixty-seven years and six months; the tumor weighed 60 pounds, and there were extensive adhesions. Maury removed a monocystic ovarian tumor from a woman of seventy-four, his patient recovering. Pippingskold mentions an ovariotomy at eighty. Terrier describes double ovariotomy for fibromata in a woman of seventy-seven. Aron speaks of an operation for pilous dermoid of the ovary in a woman of seventy-five. Shepherd reports a case of recurrent proliferous cyst in a woman of sixty-three, on whom successful ovariotomy was performed twice within nine months. Wells mentions an ovarian cyst in a woman of sixty-five, from which 72 pints of fluid were removed. Hawkins describes the case of a musician, M. Rochard, who at the age of one hundred and seven was successfully operated on for strangulated hernia of upward of thirty hours' duration. The wound healed by first intention, and the man was well in two weeks. Fowler operated successfully for strangulated umbilical hernia on a patient of sixty-eight. Repeated Operations.--Franzolini speaks of a woman of fifty on whom he performed six celiotomies between June, 1879, and April, 1887. The first operation was for fibrocystic disease of the uterus. Since the last operation the woman had had remarkably good health, and there was every indication that well-merited recovery had been effected. The Ephemerides contains an account of a case in which cystotomy was repeated four times, and there is another record of this operation having been done five times on a man. Instances of repeated Cesarean section are mentioned on page 130. Before leaving this subject, we mention a marvelous operation performed by Billroth on a married woman of twenty-nine, after her sixth pregnancy. This noted operator performed, synchronously, double ovariotomy and resections of portions of the bladder and ileum, for a large medullary carcinomatous growth of the ovary, with surrounding involvement. Menstruation returned three months after the operation, and in fifteen months the patient was in good health in every way, with no apparent danger of recurrence of the disease. Self-performed Surgical Operations.--There have been instances in which surgeons and even laymen have performed considerable operations upon themselves. On the battlefield men have amputated one of their own limbs that had been shattered. In such cases there would be little pain, and premeditation would not be brought into play in the same degree as in the case of M. Clever de Maldigny, a surgeon in the Royal Guards of France, who successfully performed a lithotomy on himself before a mirror. He says that after the operation was completed the urine flowed in abundance; he dressed the wound with lint dipped in an emollient solution, and, being perfectly relieved from pain, fell into a sound sleep. On the following day, M. Maldigny says, he was as tranquil and cheerful as if he had never been a sufferer. A Dutch blacksmith and a German cooper each performed lithotomy on themselves for the intense pain caused by a stone in the bladder. Tulpius, Walther, and the Ephemerides each report an instance of self-performed cystotomy. The following case is probably the only instance in which the patient, suffering from vesical calculus, tried to crush and break the stone himself. J. B., a retired draper, born in 1828, while a youth of seventeen, sustained a fracture of the leg, rupture of the urethra, and laceration of the perineum, by a fall down a well, landing astride an iron bar. A permanent perineal fistula was established, but the patient was averse to any operative remedial measure. In the year 1852 he became aware of the presence of a calculus, but not until 1872 did he ask for medical assistance. He explained that he had introduced a chisel through his perineal fistula to the stone, and attempted to comminute it himself and thus remove it, and by so doing had removed about an ounce of the calculus. The physician started home for his forceps, but during the interval, while walking about in great pain, the man was relieved by the stone bursting through the perineum, falling to the floor, and breaking in two. Including the ounce already chiselled off, the stone weighed 14 1/2 ounces, and was 10 5/8 inches in its long circumference. B. recovered and lived to December, 1883, still believing that he had another piece of stone in his bladder. In Holden's "Landmarks" we are told that the operation of dividing the Achilles tendon was first performed by an unfortunate upon himself, by means of a razor. According to Patterson, the late Mr. Symes told of a patient in North Scotland who, for incipient hip-disease, had the cautery applied at the Edinburgh Infirmary with resultant great relief. After returning home to the country he experienced considerable pain, and despite his vigorous efforts he was unable to induce any of the men to use the cautery upon him; they termed it "barbarous treatment." In desperation and fully believing in the efficacy of this treatment as the best means of permanently alleviating his pain, the crippled Scotchman heated a poker and applied the cautery himself. We have already mentioned the marvelous instances of Cesarean sections self-performed, and in the literature of obstetric operations many of the minor type have been done by the patient herself. In the foregoing cases it is to be understood that the operations have been performed solely from the inability to secure surgical assistance or from the incapacity to endure the pain any longer. These operations were not the self-mutilations of maniacs, but were performed by rational persons, driven to desperation by pain. Possibly the most remarkable instances of extensive loss of blood, with recoveries, are to be found in the older records of venesection. The chronicles of excessive bleeding in the olden days are well known to everybody. Perhaps no similar practice was so universally indulged in. Both in sickness and in health, depletion was indicated, and it is no exaggeration to say that about the hospital rooms at times the floors were covered with blood. The reckless way in which venesection was resorted to, led to its disuse, until to-day it has so vanished from medical practice that even its benefits are overlooked, and depletion is brought about in some other manner. Turning to the older writers, we find Burton describing a patient from whom he took 122 ounces of blood in four days. Dover speaks of the removal of 111 and 190 ounces; Galen, of six pounds; and Haen, of 114 ounces. Taylor relates the history of a case of asphyxia in which he produced a successful issue by extracting one gallon of blood from his patient during twelve hours. Lucas speaks of 50 venesections being practiced during one pregnancy. Van der Wiel performed venesection 49 times during a single pregnancy. Balmes mentions a case in which 500 venesections were performed in twenty-five years. Laugier mentions 300 venesections in twenty-six months. Osiander speaks of 8000 ounces of blood being taken away in thirty-five years. Pechlin reports 155 venesections in one person in sixteen years, and there is a record of 1020 repeated venesections. The loss of blood through spontaneous hemorrhage is sometimes remarkable. Fabricius Hildanus reports the loss of 27 pounds of blood in a few days; and there is an older record of 40 pounds being lost in four days. Horstius, Fabricius Hildanus, and Schenck, all record instances of death from hemorrhage of the gums. Tulpius speaks of hemoptysis lasting chronically for thirty years, and there is a similar record of forty years' duration in the Ephemerides. Chapman gives several instances of extreme hemorrhage from epistaxis. He remarks that Bartholinus has recorded the loss of 48 pounds of blood from the nose; and Rhodius, 18 pounds in thirty-six hours. The Ephemerides contains an account of epistaxis without cessation for six weeks. Another writer in an old journal speaks of 75 pounds of blood from epistaxis in ten days. Chapman also mentions a case in which, by intestinal hemorrhage, eight gallons of blood were lost in a fortnight, the patient recovering. In another case a pint of blood was lost daily for fourteen days, with recovery. The loss of eight quarts in three days caused death in another case; and Chapman, again, refers to the loss of three gallons of blood from the bowel in twenty-four hours. In the case of Michelotti, recorded in the Transactions of the Royal Society, a young man suffering from enlargement of the spleen vomited 12 pounds of blood in two hours, and recovered. In hemorrhoidal hemorrhages, Lieutaud speaks of six quarts being lost in two days; Hoffman, of 20 pounds in less than twenty-four hours, and Panaroli, of the loss of one pint daily for two years. Arrow-Wounds.--According to Otis the illustrious Baron Percy was wont to declare that military surgery had its origin in the treatment of wounds inflicted by darts and arrows; he used to quote Book XI of the Iliad in behalf of his belief, and to cite the cases of the patients of Chiron and Machaon, Menelaus and Philoctetes, and Eurypiles, treated by Patroclus; he was even tempted to believe with Sextus that the name iatros, medicus, was derived from ios, which in the older times signified "sagitta," and that the earliest function of our professional ancestors was the extraction of arrows and darts. An instrument called beluleum was invented during the long Peloponnesian War, over four hundred years before the Christian era. It was a rude extracting-forceps, and was used by Hippocrates in the many campaigns in which he served. His immediate successor, Diocles, invented a complicated instrument for extracting foreign bodies, called graphiscos, which consisted of a canula with hooks. Otis states that it was not until the wars of Augustus that Heras of Cappadocia designed the famous duck-bill forceps which, with every conceivable modification, has continued in use until our time. Celsus instructs that in extracting arrow-heads the entrance-wound should be dilated, the barb of the arrow-head crushed by strong pliers, or protected between the edges of a split reed, and thus withdrawn without laceration of the soft parts. According to the same authority, Paulus Aegineta also treated fully of wounds by arrow-heads, and described a method used in his time to remove firmly-impacted arrows. Albucasius and others of the Arabian school did little or nothing toward aiding our knowledge of the means of extracting foreign bodies. After the fourteenth century the attention of surgeons was directed to wounds from projectiles impelled by gunpowder. In the sixteenth century arrows were still considerably used in warfare, and we find Pare a delineating the treatment of this class of injuries with the sovereign good sense that characterized his writings. As the use of firearms became prevalent the literature of wounds from arrows became meager, and the report of an instance in the present day is very rare. Bill has collected statistics and thoroughly discussed this subject, remarking upon the rapidity with which American Indians discharge their arrows, and states that it is exceptional to meet with only a single wound. It is commonly believed that the Indian tribes make use of poisoned arrows, but from the reports of Bill and others, this must be a very rare custom. Ashhurst states that he was informed by Dr. Schell, who was stationed for some time at Fort Laramie, that it is the universal custom to dip the arrows in blood, which is allowed to dry on them; it is not, therefore, improbable that septic material may thus be inoculated through a wound. Many savage tribes still make use of the poisonous arrow. The Dyak uses a sumpitan, or blow-tube, which is about seven feet long, and having a bore of about half an inch. Through this he blows his long, thin dart, anointed on the head with some vegetable poison. Braidwood speaks of the physiologic action of Dajaksch, an arrow-poison used in Borneo. Arnott has made observations relative to a substance produced near Aden, which is said to be used by the Somalies to poison their arrows. Messer of the British Navy has made inquiries into the reputed poisonous nature of the arrows of the South Sea Islanders. Otis has collected reports of arrow-wounds from surgical cases occurring in the U. S. Army. Of the multiple arrow-wounds, six out of the seven cases were fatal. In five in which the cranial cavity was wounded, four patients perished. There were two remarkable instances of recovery after penetration of the pleural cavity by arrows. The great fatality of arrow-wounds of the abdomen is well known, and, according to Bill, the Indians always aim at the umbilicus; when fighting Indians, the Mexicans are accustomed to envelop the abdomen, as the most vulnerable part, in many folds of a blanket. Of the arrow-wounds reported, nine were fatal, with one exception, in which the lesion implicated the soft parts only. The regions injured were the scalp, face, and neck, in three instances; the parietes of the chest in six; the long muscles of the back in two; the abdominal muscles in two; the hip or buttocks in three; the testis in one; the shoulder or arm in 13; forearm or hand in six; the thigh or leg in seven. The force with which arrows are projected by Indians is so great that it has been estimated that the initial velocity nearly equals that of a musket-ball. At a short distance an arrow will perforate the larger bones without comminuting them, causing a slight fissure only, and resembling the effect of a pistol-ball fired through a window-glass a few yards off. Among extraordinary cases of recovery from arrow-wounds, several of the most striking will be recorded. Tremaine mentions a sergeant of thirty-four who, in a fray with some hostile Indians, received seven arrow-wounds: two on the anterior surface of the right arm; one in the right axilla; one on the right side of the chest near the axillary border; two on the posterior surface of the left arm near the elbow-joint, and one on the left temple. On June 1st he was admitted to the Post Hospital at Fort Dodge, Kan. The wound on the right arm near the deltoid discharged, and there was slight exfoliation of the humerus. The patient was treated with simple dressings, and was returned to duty in July, 1870. Goddard mentions an arrow-wound by which the body was transfixed. The patient was a cutler's helper at Fort Rice, Dakota Territory. He was accidentally wounded in February, 1868, by an arrow which entered the back three inches to the right of the 5th lumbar vertebra, and emerged about two inches to the right of the ensiform cartilage. During the following evening the patient lost about eight ounces of blood externally, with a small amount internally. He was confined to his bed some two weeks, suffering from circumscribed peritonitis with irritative fever. In four weeks he was walking about, and by July 1st was actively employed. The arrow was deposited in the Army Medical Museum. Muller gives a report of an arrow-wound of the lung which was productive of pleurisy but which was followed by recovery. Kugler recites the description of the case of an arrow-wound of the thorax, complicated by frightful dyspnea and blood in the pleural cavity and in the bronchi, with recovery. Smart extracted a hoop-iron arrow-head, 1 3/4 inches long and 1/2 inch in breadth, from the brain of a private, about a month after its entrance. About a dram of pus followed the exit of the arrow-head. After the operation the right side was observed to be paralyzed, and the man could not remember his name. He continued in a varying condition for a month, but died on May 13, 1866, fifty-two days after the injury. At the postmortem it was found that the brain-tissue, to the extent of 3/4 inch around the track of the arrow as a center, was softened and disorganized. The track itself was filled with thick pus which extended into the ventricles. Peabody reports a most remarkable case of recovery from multiple arrow-wounds. In a skirmish with some Indians on June 3, 1863, the patient had been wounded by eight distinct arrows which entered different parts of the body. They were all extracted with the exception of one, which had entered at the outer and lower margin of the right scapula, and had passed inward and upward through the upper lobe of the right lung or trachea. The hemorrhage at this time was so great that all hope was abandoned. The patient, however, rallied, but continued to experience great pain on swallowing, and occasionally spat blood. In July, 1866, more than three years after the injury, he called on Dr. Peabody to undergo an examination with a view of applying for a pension, stating that his health was affected from the presence of an arrow-head. He was much emaciated, and expressed himself as tired of life. Upon probing through a small fistulous opening just above the superior end of the sternum, the point of the arrow was found resting against the bone, about 1 1/2 inches below, the head lying against the trachea and esophagus, with the carotid artery, jugular vein, and nerves overlying. After some little difficulty the point of the arrow was raised above the sternum, and it was extracted without the loss of an ounce of blood. The edge grazed against the sheath of the innominate artery during the operation. The missile measured an inch at the base, and was four inches long. The health of the patient underwent remarkable improvement immediately after the operation. Serious Insect-stings.--Although in this country the stings of insects are seldom productive of serious consequences, in the tropic climates death not unfrequently results from them. Wounds inflicted by large spiders, centipedes, tarantulae, and scorpions have proved fatal. Even in our country deaths, preceded by gangrene, have sometimes followed the bite of a mosquito or a bee, the location of the bite and the idiosyncrasy of the individual probably influencing the fatal issue. In some cases, possibly, some vegetable poison is introduced with the sting. Hulse, U.S.N., reports the case of a man who was bitten on the penis by a spider, and who subsequently exhibited violent symptoms simulating spinal meningitis, but ultimately recovered. Kunst mentions a man of thirty-six who received several bee-stings while taking some honey from a tree, fell from the tree unconscious, and for some time afterward exhibited signs of cerebral congestion. Chaumeton mentions a young man who did not perceive a wasp in a glass of sweet wine, and swallowed the insect. He was stung in the throat, followed by such intense inflammation that the man died asphyxiated in the presence of his friends, who could do nothing to relieve him. In connection with this case there is mentioned an English agriculturist who saved the life of one of his friends who had inadvertently swallowed a wasp with a glass of beer. Alarming symptoms manifested themselves at the moment of the sting. The farmer made a kind of paste from a solution of common salt in as little water as possible, which he gave to the young man, and, after several swallows of the potion, the symptoms disappeared as if by enchantment. There is a recent account from Bridgeport, Conn., of a woman who, while eating a pear, swallowed a hornet that had alighted on the fruit. In going down the throat the insect stung her on the tonsil. Great pain and inflammation followed, and in a short time there was complete deprivation of the power of speech. Mease relates the case of a corpulent farmer who, in July, 1835, was stung upon the temple by a common bee. He walked to a fence a short distance away, thence to his house, 20 yards distant, lay down, and expired in ten minutes. A second case, which occurred in June, 1811, is also mentioned by Mease. A vigorous man was stung in the septum of the nose by a bee. Supported by a friend he walked to his house, a few steps distant, and lay down. He rose immediately to go to the well, stepped a few paces, fell, and expired. It was thirty minutes from the time of the accident to the man's death. A third case is reported by the same author from Kentucky. A man of thirty-five was stung on the right superior palpebrum, and died in twenty minutes. Mease reports a fourth ease from Connecticut, in which a man of twenty-six was stung by a bee on the tip of the nose. He recovered after treatment with ten-grain doses of Dover's Powder, and persistent application of plantain leaves. A fifth case was that of a farmer in Pennsylvania who was stung in the left side of the throat by a wasp which he had swallowed in drinking cider. Notwithstanding medical treatment, death ensued twenty-seven hours afterward. A sixth case, which occurred in October, 1834, is given by the same author. A middle-aged man was stung by a yellow wasp on the middle finger of the right hand, and died in less than twenty minutes after having received his wound. A seventh case was that of a New York farmer who, while hoeing, was bitten on the foot by a spider. Notwithstanding medical treatment, principally bleeding, the man soon expired. Desbrest mentions the sting of a bee above the eyebrow followed by death. Zacutus saw a bee-sting which was followed by gangrene. Delaistre mentions death from a hornet-sting in the palate. Nivison relates the case of a farmer of fifty who was stung in the neck by a bee. The usual swelling and discoloration did not follow, but notwithstanding vigorous medical treatment the man died in six days. Thompson relates three cases of bee-sting, in all of which death supervened within fifteen minutes,--one in a farmer of fifty-eight who was stung in the neck below the right ear; a second in an inn-keeper of fifty who was stung in the neck, and a third of a woman of sixty-four who was stung on the left brow. "Chirurgus" recalls the details of a case of a wasp-sting in the middle finger of the right hand of a man of forty, depriving him of all sense and of muscular power. Ten minutes after receiving it he was unconscious, his heart-beats were feeble, and his pulse only perceptible. Syphilis from a Flea-bite.--Jonathan Hutchinson, in the October, 1895, number of his unique and valuable Archives of Surgery, reports a primary lesion of most unusual origin. An elderly member of the profession presented himself entirely covered with an evident syphilitic eruption, which rapidly disappeared under the use of mercury. The only interest about the case was the question as to how the disease had been acquired. The doctor was evidently anxious to give all the information in his power, but was positive that he had never been exposed to any sexual risk, and as he had retired from practice, no possibility of infection in that manner existed. He willingly stripped, and a careful examination of his entire body surface revealed no trace of lesion whatever on the genitals, or at any point, except a dusky spot on one leg, which looked like the remains of a boil. This, the doctor stated, had been due to a small sore, the dates of the appearance and duration of which were found to fit exactly with those of a primary lesion. There had also been some enlargement of the femoral glands. He had never thought of the sore in this connection, but remembered most distinctly that it followed a flea-bite in an omnibus, and had been caused, as he supposed, by his scratching the place, though he could not understand why it lasted so long. Mr. Hutchinson concludes that all the evidence tends to show that the disease had probably been communicated from the blood of an infected person through the bite of the insect. It thus appears that even the proverbially trivial fleabite may at times prove a serious injury. Snake-bites.--A writer in an Indian paper asserts that the traditional immunity of Indian snake-charmers is due to the fact that having been accidentally bitten by poisonous serpents or insects more than once, and having survived the first attack, they are subsequently immune. His assertion is based on personal acquaintance with Madari Yogis and Fakirs, and an actual experiment made with a Mohammedan Fakir who was immune to the bites of scorpions provided by the writer. The animals were from five to seven inches long and had lobster-like claws. Each bite drew blood, but the Fakir was none the worse. The venom of poisonous snakes may be considered the most typical of animal poisons, being unrivaled in the fatality and rapidity of its action. Fortunately in our country there are few snake-bites, but in the tropic countries, particularly India, the mortality from this cause is frightful. Not only are there numerous serpents in that country, but the natives are lightly dressed and unshod, thus being exposed to the bites of the reptiles. It is estimated by capable authorities that the deaths in India each year from snake-bites exceed 20,000. It is stated that there were 2893 human beings killed by tigers, leopards, hyenas, and panthers in India during the year 1894, and in the same year the same species of beasts, aided by snakes, killed 97,371 head of cattle. The number of human lives destroyed by snakes in India in 1894 was 21,538. The number of wild beasts killed in the same year was 13,447, and the number of snakes killed was 102,210. Yarrow of Washington, who has been a close student of this subject, has found in this country no less than 27 species of poisonous snakes, belonging to four genera. The first genus is the Crotalus, or rattlesnake proper; the second is the Caudisona, or ground-rattlesnake; the third is the Ancistrodon, or moccasin, one of the species of which is a water-snake; and the fourth is the Elaps, or harlequin snake. There is some dispute over the exact degree of the toxic qualities of the venom of the Heloderma suspectum, or Gila monster. In India the cobra is the most deadly snake. It grows to the length of 5 1/2 feet, and is most active at night. The Ophiophagus, or hooded cobra, is one of the largest of venomous snakes, sometimes attaining a length of 15 feet; it is both powerful, active, and aggressive. The common snakes of the deadly variety in the United States are the rattlesnake, the "copperhead," and the moccasin; and it is from the bites of one of these varieties that the great majority of reported deaths are caused. But in looking over medical literature one is struck with the scarcity of reports of fatal snake-bites. This is most likely attributable to the fact that, except a few army-surgeons, physicians rarely see the cases. The natural abode of the serpents is in the wild and uninhabited regions. The venom is delivered to the victim through the medium of a long fang which is connected with a gland in which the poison is stored. The supply may be readily exhausted; for a time the bite would then be harmless. Contrary to the general impression, snake-venom when swallowed is a deadly poison, as proved by the experiments of Fayrer, Mitchell, and Reichert. Death is most likely caused by paralysis of the vital centers through the circulation. In this country the wounds invariably are on the extremities, while in India the cobra sometimes strikes on the shoulder or neck. If called on to describe accurately the symptoms of snake-venom poisoning, few medical men could respond correctly. In most cases the wound is painful, sometimes exaggerated by the mental condition, which is wrought up to a pitch rarely seen in other equally fatal injuries. It is often difficult to discern the exact point of puncture, so minute is it. There is swelling due to effusion of blood, active inflammation, and increasing pain. If the poison has gained full entrance into the system, in a short time the swelling extends, vesicles soon form, and the disorganization of the tissues is so rapid that gangrene is liable to intervene before the fatal issue. The patient becomes prostrated immediately after the infliction of the wound, and his condition strongly indicates the use of stimulants, even if the medical attendant were unfamiliar with the history of the snake-bite. There may be a slight delirium; the expression becomes anxious, the pulse rapid and feeble, the respiration labored, and the patient complains of a sense of suffocation. Coma follows, and the respirations become slower and slower until death results. If the patient lives long enough, the discoloration of the extremity and the swelling may spread to the neck, chest and back. Loss of speech after snake-bite is discussed in Chapter XVII, under the head of Aphasia. A peculiar complication is a distressing inflammation of the mouth of individuals that have sucked the wounds containing venom. This custom is still quite common, and is preferred by the laity to the surer and much wiser method of immediate cauterization by fire. There is a curious case reported of a young man who was bitten on the ankle by a viper; he had not sucked the wound, but he presented such an enormous swelling of the tongue as to be almost provocative of a fatal issue. In this case the lingual swelling was a local effect of the general constitutional disturbance. Cases of Snake-bite.--The following case illustrative of the tenacity of virulence of snake-venom was reported by Mr. Temple, Chief Justice of Honduras, and quoted by a London authority. While working at some wood-cutting a man was struck on a heavy boot by a snake, which he killed with an axe. He imagined that he had been efficiently protected by the boot, and he thought little of the incident. Shortly afterward he began to feel ill, sank into a stupor, and succumbed. His boots were sold after his death, as they were quite well made and a luxury in that country. In a few hours the purchaser of the boots was a corpse, and every one attributed his death to apoplexy or some similar cause. The boots were again sold, and the next unfortunate owner died in an equally short time. It was then thought wise to examine the boots, and in one of them was found, firmly embedded, the fang of the serpent. It was supposed that in pulling on the boots each of the subsequent owners had scratched himself and became fatally inoculated with the venom, which was unsuspected and not combated. The case is so strange as to appear hypothetic, but the authority seems reliable. The following are three cases of snake-bite reported by surgeons of the United States Army, two followed by recovery, and the other by death: Middleton mentions a private in the Fourth Cavalry, aged twenty-nine, who was bitten by a rattlesnake at Fort Concho, Texas, June 27, 1866. The bite opened the phalangeal joint of the left thumb, causing violent inflammation, and resulted in the destruction of the joint. Three years afterward the joint swelled and became extremely painful, and it was necessary to amputate the thumb. Campbell reports the case of a private of the Thirteenth Infantry who was bitten in the throat by a large rattlesnake. The wound was immediately sucked by a comrade, and the man reported at the Post Hospital, at Camp Cooke, Montana, three hours after the accident. The only noticeable appearance was a slightly wild look about the eyes, although the man did not seem to be the least alarmed. The region of the wound was hard and somewhat painful, probably from having been bruised by the teeth of the man who sucked the wound; it remained so for about three hours. The throat was bound up in rancid olive oil (the only kind at hand) and no internal remedy was administered. There were no other bad consequences, and the patient soon returned to duty. Le Carpentier sends the report of a fatal case of rattlesnake-bite: A private, aged thirty-seven, remarkable for the singularity of his conduct, was known in his Company as a snake-charmer, as he had many times, without injury, handled poisonous snakes. On the morning of July 13, 1869, he was detailed as guard with the herd at Fort Cummings, New Mexico, when, in the presence of the herders, he succeeded in catching a rattlesnake and proving his power as a sorcerer. The performance being over and the snake killed, he caught sight of another of the same class, and tried to duplicate his previous feat; but his dexterity failed, and he was bitten in the middle finger of the right hand. He was immediately admitted to the Post Hospital, complaining only of a little pain, such as might follow the sting of a bee or wasp. A ligature was applied above the wound; the two injuries made by the fangs were enlarged by a bistoury; ammonia and the actual cautery were applied; large doses of whiskey were repeated frequently, the constitution of the patient being broken and poor. Vomiting soon came on but was stopped without trouble, and there were doubts from the beginning as to his recovery. The swelling of the hand and arm gradually increased, showing the particular livid and yellowish tint following the bites of poisonous snakes. A blister was applied to the bitten finger, tincture of iodin used, and two ounces of whiskey given every two hours until inebriety was induced. The pulse, which was very much reduced at first, gained gradually under the influence of stimulants; two grains of opium were given at night, the patient slept well, and on the next day complained only of numbness in the arm. The swelling had extended as far as the shoulder-joint, and the blood, which was very fluid, was incessantly running from the wound. Carbolic acid and cerate were applied to the arm, with stimulants internally. On the 15th his condition was good, the swelling had somewhat augmented, there was not so much lividity, but the yellowish hue had increased. On the 16th the man complained of pain in the neck, on the side of the affected limb, but his general condition was good. Examining his genitals, an iron ring 3/4 inch in diameter was discovered, imbedded in the soft tissues of the penis, constricting it to such a degree as to have produced enormous enlargement of the parts. Upon inquiry it seemed that the ring had been kept on the parts very long, as a means of preservation of chastity; but under the influence of the snake's venom the swelling had increased, and the patient having much trouble in passing water was obliged to complain. The ring was filed off with some difficulty. Gangrene destroyed the extremity of the bitten finger. From this date until the 30th the man's condition improved somewhat. The progress of the gangrene was stopped, and the injured finger was disarticulated at the metacarpal articulation. Anesthesia was readily obtained, but the appearance of the second stage was hardly perceptible. Le Carpentier was called early on the next morning, the patient having been observed to be sinking; there was stertorous respiration, the pulse was weak and slow, and the man was only partly conscious. Electricity was applied to the spine, and brandy and potassium bromid were given, but death occurred about noon. A necropsy was made one hour after death. There was general softening of the tissues, particularly on the affected side. The blood was black and very fluid,--not coagulable. The ventricles of the brain were filled with a large amount of serum; the brain was somewhat congested. The lungs were healthy, with the exception of a few crude tubercles of recent formation on the left side. The right ventricle of the heart was empty, and the left filled with dark blood, which had coagulated. The liver and kidneys were healthy, and the gall-bladder very much distended with bile. The intestines presented a few livid patches on the outside. Hydrophobia.--The bite of an enraged animal is always of great danger to man, and death has followed a wound inflicted by domestic animals or even fowls; a human bite has also caused a fatal issue. Rabies is frequently observed in herbivorous animals, such as the ox, cow, or sheep, but is most commonly found in the carnivore, such as the dog, wolf, fox, jackal, hyena, and cat and other members of the feline tribe. Fox reports several cases of death from symptoms resembling those of hydrophobia in persons who were bitten by skunks. Swine, birds, and even domestic poultry have caused hydrophobia by their bites. Le Cat speaks of the bite of an enraged duck causing death, and Thiermeyer mentions death shortly following the bite of a goose, as well as death in three days from a chicken-bite. Camerarius describes a case of epilepsy which he attributed to a horse-bite. Among the older writers speaking of death following the bite of an enraged man, are van Meek'ren, Wolff, Zacutus Lusitanus, and Glandorp. The Ephemerides contains an account of hydrophobia caused by a human bite. Jones reports a case of syphilitic inoculation from a human bite on the hand. Hydrophobia may not necessarily be from a bite; a previously-existing wound may be inoculated by the saliva alone, conveyed by licking. Pliny, and some subsequent writers, attributed rabies to a worm under the animal's tongue which they called "lytta." There is said to be a superstition in India that, shortly after being bitten by a mad dog, the victim conceives pups in his belly; at about three months these move rapidly up and down the patient's intestines, and being mad like their progenitor, they bite and bark incessantly, until they finally kill the unfortunate victim. The natives of Nepaul firmly believe this theory. All sorts of curious remedies have been suggested for the cure of hydrophobia. Crabs-claws, Spanish fly, and dragon roots, given three mornings before the new or full moon, was suggested as a specific by Sir Robert Gordon. Theodore De Vaux remarks that the person bitten should immediately pluck the feathers from the breech of an old cock and apply them bare to the bites. If the dog was mad the cock was supposed to swell and die. If the dog was not mad the cock would not swell; in either case the person so treated was immune. Mad-stones, as well as snake-stones, are believed in by some persons at the present day. According to Curran, at one time in Ireland the fear of hydrophobia was so great that any person supposed to be suffering from it could be legally smothered. According to French statistics, hydrophobia is an extremely fatal disease, although the proportion of people bitten and escaping without infection is overwhelmingly greater than those who acquire the disease. The mortality of genuine hydrophobia is from 30 to 80 per cent, influenced by efficient and early cauterization and scientific treatment. There is little doubt that many of the cases reported as hydrophobia are merely examples of general systemic infection from a local focus of sepsis, made possible by some primitive and uncleanly treatment of the original wound. There is much superstition relative to hydrophobia; the majority of wounds seen are filled with the hair of the dog, soot, ham-fat, and also with particles of decayed food and saliva from the mouth of some person who has practiced sucking the wound. Ordinarily, the period of incubation of hydrophobia in man is before the end of the second month, although rarely cases are seen as many as six months from the reception of the bite. The first symptoms of the disease are melancholia, insomnia, loss of appetite, and occasionally shooting pains, radiating from the wound. There may be severe pain at the back of the head and in the neck. Difficulty in swallowing soon becomes a marked symptom. The speech assumes a sobbing tone, and occasionally the expression of the face is wild and haggard. As regards the crucial diagnostic test of a glass of water, the following account of a patient's attempt to drink is given by Curtis and quoted by Warren: "A glass of water was offered the patient, which he refused to take, saying that he could not stand so much as that, but would take it from a teaspoon. On taking the water from the spoon he evinced some discomfort and agitation, but continued to raise the spoon. As it came within a foot of his lips, he gagged and began to gasp violently, his features worked, and his head shook. He finally almost tossed the water into his mouth, losing the greater part of it, and staggered about the room gasping and groaning. At this moment the respirations seemed wholly costal, and were performed with great effort, the elbows being jerked upward with every inspiration. The paroxysm lasted about half a minute. The act of swallowing did not appear to cause distress, for he could go through the motions of deglutition without any trouble. The approach of liquid toward the mouth would, however, cause distress." It is to be remarked that the spasm affects the mechanism of the respiratory apparatus, the muscles of mastication and deglutition being only secondarily contracted. Pasteur discovered that the virulence of the virus of rabies could be attenuated in passing it through different species of animals, and also that inoculation of this attenuated virus had a decided prophylactic effect on the disease; hence, by cutting the spinal cord of inoculated animals into fragments a few centimeters long, and drying them, an emulsion could be made containing the virus. The patients are first inoculated with a cord fourteen days old, and the inoculation is repeated for nine days, each time with a cord one day fresher. The intensive method consists in omitting the weakest cords and giving the inoculations at shorter intervals. As a curious coincidence, Pliny and Pasteur, the ancient and modern, both discuss the particular virulence of saliva during fasting. There is much discussion over the extent of injury a shark-bite can produce. In fact some persons deny the reliability of any of the so-called cases of shark-bites. Ensor reports an interesting case occurring at Port Elizabeth, South Africa. While bathing, an expert swimmer felt a sharp pain in the thigh, and before he could cry out, felt a horrid crunch and was dragged below the surface of the water. He struggled for a minute, was twisted about, shaken, and then set free, and by a supreme effort, reached the landing stairs of the jetty, where, to his surprise, he found that a monstrous shark had bitten his leg off. The leg had been seized obliquely, and the teeth had gone across the joints, wounding the condyles of the femur. There were three marks on the left side showing where the fish had first caught him. The amputation was completed at once, and the man recovered. Macgrigor reports the case of a man at a fishery, near Manaar, who was bitten by a shark. The upper jaw of the animal was fixed in the left side of the belly, forming a semicircular wound of which a point one inch to the left of the umbilicus was the upper boundary, and the lower part of the upper third of the thigh, the lower boundary. The abdominal and lumbar muscles were divided and turned up, exposing the colon in its passage across the belly. Several convolutions of the small intestines were also laid bare, as were also the three lowest ribs. The gluteal muscles were lacerated and torn, the tendons about the trochanter divided, laying the bone bare, and the vastus externus and part of the rectus of the thigh were cut across. The wound was 19 inches in length and four or five inches in breadth. When Dr. Kennedy first saw the patient he had been carried in a boat and then in a palanquin for over five miles, and at this time, three hours after the reception of the wound, Kennedy freed the abdominal cavity of salt water and blood, thoroughly cleansed the wound of the hair and the clots, and closed it with adhesive strips. By the sixteenth day the abdominal wound had perfectly closed, the lacerations granulated healthily, and the man did well. Boyle reports recovery from extensive lacerated wounds from the bite of a shark. Both arms were amputated as a consequence of the injuries. Fayrer mentions shark-bites in the Hooghley. Leprosy from a Fish-bite.--Ashmead records the curious case of a man that had lived many years in a leprous country, and while dressing a fish had received a wound of the thumb from the fin of the fish. Swelling of the arm followed, and soon after bullae upon the chest, head, and face. In a few months the blotches left from this eruption became leprous tubercles, and other well-marked signs of the malady followed. The author asked if in this case we have to do with a latent leprosy which was evoked by the wound, or if it were a case of inoculation from the fish? Cutliffe records recovery after amputation at the elbow-joint, as a consequence of an alligator-bite nine days before admission to the hospital. The patient exhibited a compound comminuted fracture of the right radius and ulna in their lower thirds, compound comminuted fractures of the bones of the carpus and metacarpus, with great laceration of the soft parts, laying bare the wrist-joint, besides several penetrating wounds of the arm and fore-arm. Mourray gives some notes on a case of crocodile-bite with removal of a large portion of omentum. Sircar speaks of recovery from a crocodile-bite. Dudgeon reports two cases of animal-bites, both fatal, one by a bear, and the other by a camel. There is mention of a compound dislocation of the wrist-joint from a horse-bite. Fayrer speaks of a wolf-bite of the forearm, followed by necrosis and hemorrhage, necessitating ligature of the brachial artery and subsequent excision of the elbow-joint. Injuries from Lightning.--The subject of lightning-stroke, with its diverse range of injuries, is of considerable interest, and, though not uncommon, the matter is surrounded by a veil of superstition and mystery. It is well known that instantaneous or temporary unconsciousness may result from lightning-stroke. Sometimes superficial or deep burns may be the sole result, and again paralysis of the general nerves, such as those of sensation and motion, may be occasioned. For many years the therapeutic effect of a lightning-stroke has been believed to be a possibility, and numerous instances are on record. The object of this article will be to record a sufficient number of cases of lightning-stroke to enable the reader to judge of its various effects, and form his own opinion of the good or evil of the injury. It must be mentioned here that half a century ago Le Conte wrote a most extensive article on this subject, which, to the present time, has hardly been improved upon. The first cases to be recorded are those in which there has been complete and rapid recovery from lightning-stroke. Crawford mentions a woman who, while sitting in front of her fireplace on the first floor of a two-story frame building, heard a crash about her, and realized that the house had been struck by lightning. The lightning had torn all the weather-boarding off the house, and had also followed a spouting which terminated in a wooden trough in a pig-sty, ten feet back of the house, and killed a pig. Another branch of the fluid passed through the inside of the building and, running along the upper floor to directly over where Mrs. F. was sitting, passed through the floor and descended upon the top of her left shoulder. Her left arm was lying across her abdomen at the time, the points of the fingers resting on the crests of the ilium. There was a rent in the dress at the top of the shoulder, and a red line half an inch wide running from thence along the inside of the arm and fore-arm. In some places there was complete vesication, and on its palmer surface the hand lying on the abdomen was completely denuded. The abdomen, for a space of four inches in length and eight inches in breadth, was also blistered. The fluid then passed from the fingers to the crest of the ilium, and down the outside of the leg, bursting open the shoes, and passing then through the floor. Again a red line half an inch wide could be traced from the ilium to the toes. The clothing was not scorched, but only slightly rent at the point of the shoulder and where the fingers rested. This woman was neither knocked off her chair nor stunned, and she felt no shock at the time. After ordinary treatment for her burns she made rapid and complete recovery. Halton reports the history of a case of a woman of sixty-five who, about thirty-five minutes before he saw her, had been struck by lightning. While she was sitting in an outbuilding a stroke of lightning struck and shattered a tree about a foot distant. Then, leaving the tree about seven feet from the ground, it penetrated the wall of the building, which was of unplastered frame, and struck Mrs. P. on the back of the head, at a point where her hair was done up in a knot and fastened by two ordinary hair-pins. The hair was much scorched, and under the knot the skin of the scalp was severely burned. The fluid crossed, burning her right ear, in which was a gold ear-ring, and then passed over her throat and down the left sternum, leaving a burn three inches wide, covered by a blister. There was another burn, 12 inches long and three inches wide, passing from just above the crest of the ilium forward and downward to the symphysis pubis. The next burn began at the patella of the right knee, extending to the bottom of the heel, upon reaching which it wound around the inner side of the leg. About four inches below the knee a sound strip of cuticle, about 1 1/2 inches, was left intact. The lightning passed off the heel of the foot, bursting open the heel of a strongly sewed gaiter-boot. The woman was rendered unconscious but subsequently recovered. A remarkable feature of a lightning-stroke is the fact that it very often strips the affected part of its raiment, as in the previous case in which the shoe was burst open. In a discussion before the Clinical Society of London, October 24 1879, there were several instances mentioned in which clothes had been stripped off by lightning. In one case mentioned by Sir James Paget, the clothes were wet and the man's skin was reeking with perspiration. In its course the lightning traveled down the clothes, tearing them posteriorly, and completely stripping the patient. The boots were split up behind and the laces torn out. This patient, however, made a good recovery. Beatson mentions an instance in which an explosion of a shell completely tore off the left leg of a sergeant instructor, midway between the knee and ankle. It was found that the foot and lower third of the leg had been completely denuded of a boot and woolen stocking, without any apparent abrasion or injury to the skin. The stocking was found in the battery and the boot struck a person some distance off. The stocking was much torn, and the boot had the heel missing, and in one part the sole was separated from the upper. The laces in the upper holes were broken but were still present in the lower holes. The explanation offered in this case is similar to that in analogous cases of lightning-stroke, that is, that the gas generated by the explosion found its way between the limb and the stocking and boot and stripped them off. There is a curious collection of relics, consisting of the clothes of a man struck by lightning, artistically hung in a glass case in the Museum of the Royal College of Surgeons, London, and the history of the injury, of which these remnants are the result, is given by Professor Stewart, the curator, as follows: At half past four on June 8, 1878, James Orman and others were at work near Snave, in Romney Marsh, about eight miles from Ashford. The men were engaged in lopping willows, when the violence of the rain compelled them to take refuge under a hedge. Three of the men entered a shed near by, but Orman remained by the willow, close to the window of the shed. Scarcely were the three inside when a lightning-stroke entered the door, crossed the shed, and passed out the window, which it blew before it into the field. The men noticed that the tree under which Orman stood was stripped of its bark. Their companion's boots stood close to the foot of the tree, while the man himself lay almost perfectly naked a few yards further on, calling for help. When they left him a few moments previously, he was completely clad in a cotton shirt, cotton jacket, flannel vest, and cotton trousers, secured at the waist with leather straps and buckles. Orman also wore a pair of stout hobnail boots, and had a watch and chain. After the lightning-stroke, however, all he had on him was the left arm of his flannel vest. The field was strewn for some distance with fragments of the unfortunate man's clothing. Orman was thrown down, his eyebrows burned off, and his whiskers and beard much scorched. His chest was covered with superficial burns, and he had sustained a fracture of the leg. His strong boots were torn from his feet, and his watch had a hole burned right through it, as if a soldering iron had been used. The watch-chain was almost completely destroyed, only a few links remaining. Together with some fused coins, these were found close by, and are deposited in a closed box in the Museum. According to Orman's account of the affair, he first felt a violent blow on the chest and shoulders, and then he was involved in a blinding light and hurled into the air. He said he never lost consciousness; but when at the hospital he seemed very deaf and stupid. He was discharged perfectly cured twenty weeks after the occurrence. The scientific explanation of this amazing escape from this most eccentric vagary of the electric fluid is given,--the fact that the wet condition of the man's clothing increased its power of conduction, and in this way saved his life. It is said that the electric current passed down the side of Orman's body, causing everywhere a sudden production of steam, which by its expansion tore the clothing off and hurled it away. It is a curious fact that where the flannel covered the man's skin the burns were merely superficial, whereas in those parts touched by the cotton trousers they were very much deeper. This case is also quoted and described by Dr. Wilks. There was a curious case of lightning-stroke reported at Cole Harbor, Halifax. A diver, while at work far under the surface of the water, was seriously injured by the transmission of a lightning-stroke, which first struck the communicating air pump to which the diver was attached. The man was brought to the surface insensible, but he afterward recovered. Permanent Effect of Lightning on the Nervous System.--MacDonald mentions a woman of seventy-eight who, some forty-two years previous, while ironing a cap with an Italian iron, was stunned by an extremely vivid flash of lightning and fell back unconscious into a chair. On regaining consciousness she found that the cap which she had left on the table, remote from the iron, was reduced to cinders. Her clothes were not burned nor were there any marks on the skin. After the stroke she felt a creeping sensation and numbness, particularly in the arm which was next to the table. She stated positively that in consequence of this feeling she could predict with the greatest certainty when the atmosphere was highly charged with electricity, as the numbness increased on these occasions. The woman averred that shortly before or during a thunder storm she always became nauseated. MacDonald offers as a physiologic explanation of this case that probably the impression produced forty-two years before implicated the right brachial plexus and the afferent branches of the pneumogastric, and to some degree the vomiting center in the medulla; hence, when the atmosphere was highly charged with electricity the structures affected became more readily impressed. Camby relates the case of a neuropathic woman of thirty-eight, two of whose children were killed by lightning in her presence. She herself was unconscious for four days, and when she recovered consciousness, she was found to be hemiplegic and hemianesthetic on the left side. She fully recovered in three weeks. Two years later, during a thunder storm, when there was no evidence of a lightning-stroke, she had a second attack, and three years later a third attack under similar circumstances. There are some ocular injuries from lightning on record. In these cases the lesions have consisted of detachment of the retina, optic atrophy, cataract, hemorrhages into the retina, and rupture of the choroid, paralysis of the oculomotor muscles, and paralysis of the optic nerve. According to Buller of Montreal, such injuries may arise from the mechanic violence sustained by the patient rather than by the thermal or chemic action of the current. Buller describes a case of lightning-stroke in which the external ocular muscles, the crystalline lens, and the optic nerve were involved. Godfrey reports the case of Daniel Brown, a seaman on H.M.S. Cambrian. While at sea on February 21, 1799, he was struck both dumb and blind by a lightning-stroke. There was evidently paralysis of the optic nerve and of the oculomotor muscles; and the muscles of the glottis were also in some manner deprived of motion. That an amputation can be perfectly performed by a lightning-stroke is exemplified in the case of Sycyanko of Cracow, Poland. The patient was a boy of twelve, whose right knee was ankylosed. While riding in a field in a violent storm, a loud peal of thunder caused the horse to run away, and the child fell stunned to the ground. On coming to his senses the boy found that his right leg was missing, the parts having been divided at the upper end of the tibia. The wound was perfectly round and the patella and femur were intact. There were other signs of burns about the body, but the boy recovered. Some days after the injury the missing leg was found near the place where he was first thrown from the horse. The therapeutic effect of lightning-stroke is verified by a number of cases, a few of which will be given. Tilesius mentions a peculiar case which was extensively quoted in London. Two brothers, one of whom was deaf, were struck by lightning. It was found that the inner part of the right ear near the tragus and anti-helix of one of the individuals was scratched, and on the following day his hearing returned. Olmstead quotes the history of a man in Carteret County, N.C., who was seized with a paralytic affection of the face and eyes, and was quite unable to close his lids. While in his bedroom, he was struck senseless by lightning, and did not recover until the next day, when it was found that the paralysis had disappeared, and during the fourteen years which he afterward lived his affection never returned. There is a record of a young collier in the north of England who lost his sight by an explosion of gunpowder, utterly destroying the right eye and fracturing the frontal bone. The vision of the left eye was lost without any serious damage to the organ, and this was attributed to shock. On returning from Ettingshall in a severe thunder storm, he remarked to his brother that he had seen light through his spectacles, and had immediately afterward experienced a piercing sensation which had passed through the eye to the back of the head. The pain was brief, and he was then able to see objects distinctly. From this occasion he steadily improved until he was able to walk about without a guide. Le Conte mentions the case of a negress who was struck by lightning August 19, 1842, on a plantation in Georgia. For years before the reception of the shock her health had been very bad, and she seemed to be suffering from a progressive emaciation and feebleness akin to chlorosis. The difficulty had probably followed a protracted amenorrhea, subsequent to labor and a retained placenta In the course of a week she had recovered from the effects of lightning and soon experienced complete restoration to health; and for two years had been a remarkably healthy and vigorous laborer. Le Conte quotes five similar cases, and mentions one in which a lightning-shock to a woman of twenty-nine produced amenorrhea, whereas she had previously suffered from profuse menstruation, and also mentions another case of a woman of seventy who was struck unconscious; the catamenial discharge which had ceased twenty years before, was now permanently reestablished, and the shrunken mammae again resumed their full contour. A peculiar feature or superstition as to lightning-stroke is its photographic properties. In this connection Stricker of Frankfort quotes the case of Raspail of a man of twenty-two who, while climbing a tree to a bird's nest, was struck by lightning, and afterward showed upon his breast a picture of the tree, with the nest upon one of its branches. Although in the majority of cases the photographs resembled trees, there was one case in which it resembled a horse-shoe; another, a cow; a third, a piece of furniture; a fourth, the whole surrounding landscape. This theory of lightning-photographs of neighboring objects on the skin has probably arisen from the resemblance of the burns due to the ramifications of the blood-vessels as conductors, or to peculiar electric movements which can be demonstrated by positive charges on lycopodium powder. A lightning-stroke does not exhaust its force on a few individuals or objects, but sometimes produces serious manifestations over a large area, or on a great number of people. It is said that a church in the village of Chateauneuf, in the Department of the Lower Alps, in France, was struck by three successive lightning strokes on July 11, 1819, during the installation of a new pastor. The company were all thrown down, nine were killed and 82 wounded. The priest, who was celebrating mass, was not affected, it is believed, on account of his silken robe acting as an insulator. Bryant of Charlestown, Mass., has communicated the particulars of a stroke of lightning on June 20, 1829, which shocked several hundred persons. The effect of this discharge was felt over an area of 172,500 square feet with nearly the same degree of intensity. Happily, there was no permanent injury recorded. Le Conte reports that a person may be killed when some distance--even as far as 20 miles away from the storm--by what Lord Mahon calls the "returning stroke." Skin-grafting is a subject which has long been more or less familiar to medical men, but which has only recently been developed to a practically successful operation. The older surgeons knew that it was possible to reunite a resected nose or an amputated finger, and in Hunter's time tooth-replantation was quite well known. Smellie has recorded an instance in which, after avulsion of a nipple in suckling, restitution was effected. It is not alone to the skin that grafting is applicable; it is used in the cornea, nerves, muscles, bones, tendons, and teeth. Wolfer has been successful in transplanting the mucous membranes of frogs, rabbits, and pigeons to a portion of mucous membrane previously occupied by cicatricial tissue, and was the first to show that on mucous surfaces, mucous membrane remains mucous membrane, but when transplanted to skin, it becomes skin. Attempts have been made to transplant a button of clear cornea of a dog, rabbit, or cat to the cornea of a human being, opaque as the result of ophthalmia, and von Hippel has devised a special method of doing this. Recently Fuchs has reported his experience in cornea-grafting in sections, as a substitute for von Hippel's method, in parenchymatous keratitis and corneal staphyloma, and though not eminently successful himself, he considers the operation worthy of trial in cases that are without help, and doomed to blindness. John Hunter was the first to perform the implantation of teeth; and Younger the first to transplant the teeth of man in the jaws of man; the initial operation should be called replantation, as it was merely the replacement of a tooth in a socket from which it had accidentally or intentionally been removed. Hunter drilled a hole in a cock's comb and inserted a tooth, and held it by a ligature. Younger drilled a hole in a man's jaw and implanted a tooth, and proved that it was not necessary to use a fresh tooth. Ottolengni mentions the case of a man who was struck by a ruffian and had his two central incisors knocked out. He searched for them, washed them in warm water, carefully washed the teeth-sockets, and gently placed the teeth back in their position, where they remained firmly attached. At the time of report, six years after the accident, they were still firmly in position. Pettyjohn reports a successful case of tooth-replantation in his young daughter of two, who fell on the cellar stairs, completely excising the central incisors. The alveolar process of the right jaw was fractured, and the gum lacerated to the entire length of the root. The teeth were placed in a tepid normal saline solution, and the child chloroformed, narcosis being induced in sleep; the gums were cleaned antiseptically, and 3 1/2 hours afterward the child had the teeth firmly in place. They had been out of the mouth fully an hour. Four weeks afterward they were as firm as ever. By their experiments Gluck and Magnus prove that there is a return of activity after transplantation of muscle. After excision of malignant tumors of muscles, Helferich of Munich, and Lange of New York, have filled the gap left by the excision of the muscle affected by the tumor with transplanted muscles from dogs. Gluck has induced reproduction of lost tendons by grafting them with cat-gut, and according to Ashhurst, Peyrot has filled the gaps in retracted tendons by transplanting tendons, taken in one case from a dog, and in another from a cat. Nerve-grafting, as a supplementary operation to neurectomy, has been practiced, and Gersung has transplanted the nerves of lower animals to the nerve stumps of man. Bone-grafting is quite frequently practiced, portions from a recently amputated limb, or portions removed from living animals, or bone-chips, may be used. Senn proposed decalcified bone-plates to be used to fill in the gaps. Shifting of the bone has been done, e.g., by dividing a strip of the hard palate covered with its soft parts, parallel to the fissure in cleft palate, but leaving unsevered the bony attachments in front, and partially fracturing the pedicle, drawing the bony flaps together with sutures; or, when forming a new nose, by turning down with the skin and periosteum the outer table of the frontal bone, split off with a chisel, after cutting around the part to be removed. Trueheart reports a case of partial excision of the clavicle, successfully followed by the grafting of periosteal and osseous material taken from a dog. Robson and Hayes of Rochester, N.Y., have successfully supplemented excision of spina bifida by the transplantation of a strip of periosteum from a rabbit. Poncet hastened a cure in a case of necrosis with partial destruction of the periosteum by inserting grafts taken from the bones of a dead infant and from a kid. Ricketts speaks of bone-grafting and the use of ivory, and remarks that Poncet of Lyons restored a tibia in nine months by grafting to the superior articular surface. Recently amalgam fillings have been used in bone-cavities to supplant grafting. In destructive injuries of the skin, various materials were formerly used in grafting, none of which, however, have produced the same good effect as the use of skin by the Thiersch Method, which will be described later. Rodgers, U.S.N., reports the case of a white man of thirty-eight who suffered from gangrene of the skin of the buttocks caused by sitting in a pan of caustic potash. When seen the man was intoxicated, and there was a gangrenous patch four by six inches on his buttocks. Rodgers used grafts from the under wing of a young fowl, as suggested by Redard, with good result. Vanmeter of Colorado describes a boy of fourteen with a severe extensive burn; a portion beneath the chin and lower jaw, and the right arm from the elbow to the fingers, formed a granulating surface which would not heal, and grafting was resorted to. The neck-grafts were supplied by the skin of the father and brother, but the arm-grafts were taken from two young puppies of the Mexican hairless breed, whose soft, white, hairless skin seemed to offer itself for the purpose with good prospect of a successful result. The outcome was all that could be desired. The puppy-grafts took faster and proved themselves to be superior to the skin-grafts. There is a case reported in which the skin of a greyhound seven days old, taken from the abdominal wall and even from the tail, was used with most satisfactory results in grafting an extensive ulcer following a burn on the left leg of a boy of ten. Masterman has grafted with the inner membrane of a hen's egg, and a Mexican surgeon, Altramirano, used the gills of a cock. Fowler of Brooklyn has grafted with the skin from the back and abdomen of a large frog. The patient was a colored boy of sixteen, who was extensively burned by a kerosene lamp. The burns were on the legs, thighs, buttocks, and right ankle, and the estimated area of burnt surface was 247.95 square inches. The frog skin was transferred to the left buttocks, and on the right buttocks eight long strips of white skin were transferred after the manner of Thiersch. A strip of human skin was placed in one section over the frog skin, but became necrotic in four days, not being attached to the granulating surface. The man was discharged cured in six months. The frog skin was soft, pliable, and of a reddish hue, while the human white skin was firm and rapidly becoming pigmented. Leale cites the successful use of common warts in a case of grafting on a man of twenty who was burned on the foot by a stream of molten metal. Leale remarks that as common warts of the skin are collections of vascular papillae, admitting of separation without injury to their exceptionally thick layer of epidermis, they are probably better for the purposes of skin-grafting than ordinary skin of less vitality or vascularity. Ricketts has succeeded in grafting the skin of a frog to that of a tortoise, and also grafting frog skin to human skin. Ricketts remarks that the prepuce of a boy is remarkably good material for grafting. Sponge-grafts are often used to hasten cicatrization of integumental wounds. There is recorded an instance in which the breast of a crow and the back of a rat were grafted together and grew fast. The crow dragged the rat along, and the two did not seem to care to part company. Relative to skin-grafting proper, Bartens succeeded in grafting the skin of a dead man of seventy on a boy of fourteen. Symonds reports cases of skin-grafting of large flaps from amputated limbs, and says this method is particularly available in large hospitals where they have amputations and grafts on the same day. Martin has shown that, after many hours of exposure in the open air at a temperature of nearly 32 degrees F., grafts could be successfully applied, but in such temperatures as 82 degrees F., exposure of from six to seven hours destroyed their vitality, so that if kept cool, the limb of a healthy individual amputated for some accident, may be utilized for grafting purposes. Reverdin originated the procedure of epidermic grafting. Small grafts the size of a pin-head doing quite as well as large ones. Unfortunately but little diminution of the cicatricial contraction is effected by Reverdin's method. Thiersch contends that healing of a granulated surface results first from a conversion of the soft, vascular granulation-papillae, by contraction of some of their elements into young connective-tissue cells, into "dry, cicatricial papillae," actually approximating the surrounding tissues, thus diminishing the area to be covered by epidermis; and, secondly, by the covering of these papillae by epidermic cells. Thiersch therefore recommends that for the prevention of cicatricial contraction, the grafting be performed with large strips of skin. Harte gives illustrations of a case of extensive skin-grafting on the thigh from six inches above the great trochanter well over the median line anteriorly and over the buttock. This extent is shown in Figure 228, taken five months after the accident, when the granulations had grown over the edge about an inch. Figure 229 shows the surface of the wound, six and one-half months after the accident and three months after the applications of numerous skin-grafts. Cases of self-mutilation may be divided into three classes:--those in which the injuries are inflicted in a moment of temporary insanity from hallucinations or melancholia; with suicidal intent; and in religious frenzy or emotion. Self-mutilation is seen in the lower animals, and Kennedy, in mentioning the case of a hydrocephalic child who ate off its entire under lip, speaks also of a dog, of cats, and of a lioness who ate off their tails. Kennedy mentions the habit in young children of biting the finger-nails as an evidence of infantile trend toward self-mutilation. In the same discussion Collins states that he knew of an instance in India in which a horse lay down, deliberately exposing his anus, and allowing the crows to pick and eat his whole rectum. In temporary insanity, in fury, or in grief, the lower animals have been noticed by naturalists to mutilate themselves. Self-mutilation in man is almost invariably the result of meditation over the generative function, and the great majority of cases of this nature are avulsions or amputations of some parts of the genitalia. The older records are full of such instances. Benivenius, Blanchard, Knackstedt, and Schenck cite cases. Smetius mentions castration which was effected by using the finger-nails, and there is an old record in which a man avulsed his own genitals. Scott mentions an instance in which a man amputated his genitals and recovered without subsequent symptoms. Gockelius speaks of self-castration in a ruptured man, and Golding, Guyon, Louis, Laugier, the Ephemerides, Alix, Marstral, and others, record instances of self-castration. In his Essays Montaigne mentions an instance of complete castration performed by the individual himself. Thiersch mentions a case of a man who circumcised himself when eighteen. He married in 1870, and upon being told that he was a father he slit up the hypogastrium from the symphysis pubis to the umbilicus, so that the omentum protruded; he said his object was to obtain a view of the interior. Although the knife was dirty and blunt, the wound healed after the removal of the extruding omentum. A year later he laid open one side of the scrotum. The prolapsed testicle was replaced, and the wound healed without serious effect. He again laid open his abdomen in 1880, the wound again healing notwithstanding the prolapse of the omentum. In May of the same year he removed the right testicle, and sewed the wound up himself. Four days later the left was treated the same way. The spermatic cord however escaped, and a hematoma, the size of a child's head, formed on account of which he had to go to the hospital. This man acted under an uncontrollable impulse to mutilate himself, and claimed that until he castrated himself he had no peace of mind. There is a similar report in an Italian journal which was quoted in London. It described a student at law, of delicate complexion, who at the age of fourteen gave himself up to masturbation. He continually studied until the age of nineteen, when he fell into a state of dulness, and complained that his head felt as if compressed by a circle of fire. He said that a voice kept muttering to him that his generative organs were abnormally deformed or the seat of disease. After that, he imagined that he heard a cry of "amputation! amputation!" Driven by this hallucination, he made his first attempt at self-mutilation ten days later. He was placed in an Asylum at Astino where, though closely watched, he took advantage of the first opportunity and cut off two-thirds of his penis, when the delirium subsided. Camp describes a stout German of thirty-five who, while suffering from delirium tremens, fancied that his enemies were trying to steal his genitals, and seizing a sharp knife he amputated his penis close to the pubes. He threw the severed organ violently at his imaginary pursuers. The hemorrhage was profuse, but ceased spontaneously by the formation of coagulum over the mouth of the divided vessels. The wound was quite healed in six weeks, and he was discharged from the hospital, rational and apparently content with his surgical feat. Richards reports the case of a Brahman boy of sixteen who had contracted syphilis, and convinced, no doubt, that "nocit empta dolore voluptus," he had taken effective means of avoiding injury in the future by completely amputating his penis at the root. Some days after his admission to the hospital he asked to be castrated, stating that he intended to become an ascetic, and the loss of his testes as well as of his penis appeared to him to be an imperative condition to the attainment of that happy consummation. Chevers mentions a somewhat similar case occurring in India. Sands speaks of a single man of thirty who amputated his penis. He gave an incomplete history of syphilis. After connection with a woman he became a confirmed syphilophobe and greatly depressed. While laboring under the hallucination that he was possessed of two bodies he tied a string around the penis and amputated the organ one inch below the glans. On loosening the string, three hours afterward, to enable him to urinate, he lost three pints of blood, but he eventually recovered. In the Pennsylvania Hospital Reports there is an account of a married man who, after drinking several weeks, developed mania a potu, and was found in his room covered with blood. His penis was completely cut off near the pubes, and the skin of the scrotum was so freely incised that the testicles were entirely denuded, but not injured. A small silver cap was made to cover the sensitive urethra on a line with the abdominal wall. There is a record of a tall, powerfully-built Russian peasant of twenty-nine, of morose disposition, who on April 3d, while reading his favorite book, without uttering a cry, suddenly and with a single pull tore away his scrotum together with his testes. He then arose from the bank where he had been sitting, and quietly handed the avulsed parts to his mother who was sitting near by, saying to her: "Take that; I do not want it any more." To all questions from his relatives he asked pardon and exemption from blame, but gave no reason for his act. This patient made a good recovery at the hospital. Alexeef, another Russian, speaks of a similar injury occurring during an attack of delirium tremens. Black details the history of a young man of nineteen who went to his bath-room and deliberately placing his scrotum on the edge of the tub he cut it crossways down to the wood. He besought Black to remove his testicle, and as the spermatic cord was cut and much injured, and hemorrhage could only be arrested by ligature, the testicle was removed. The reason assigned for this act of mutilation was that he had so frequent nocturnal emissions that he became greatly disgusted and depressed in spirit thereby. He had practiced self-abuse for two years and ascribed his emissions to this cause. Although his act was that of a maniac, the man was perfectly rational. Since the injury he had had normal and frequent emissions and erections. Orwin mentions the case of a laborer of forty who, in a fit of remorse after being several days with a prostitute, atoned for his unfaithfulness to his wife by opening his scrotum and cutting away his left testicle with a pocket knife. The missing organ was found about six yards away covered with dirt. At the time of infliction of this injury the man was calm and perfectly rational. Warrington relates the strange case of Isaac Brooks, an unmarried farmer of twenty-nine, who was found December 5, 1879, with extensive mutilations of the scrotum; he said that he had been attacked and injured by three men. He swore to the identity of two out of the three, and these were transported to ten years' penal servitude. On February 13, 1881, he was again found with mutilation of the external genitals, and again said he had been set upon by four men who had inflicted his injury, but as he wished it kept quiet he asked that there be no prosecution. Just before his death on December 31, 1881, he confessed that he had perjured himself, and that the mutilations were self-performed. He was not aware of any morbid ideas as to his sexual organs, and although he had an attack of gonorrhea ten years before he seemed to worry very little over it. There is an account of a Scotch boy who wished to lead a "holy life," and on two occasions sought the late Mr. Liston's skilful aid in pursuance of this idea. He returned for a third time, having himself unsuccessfully performed castration. A case of self-mutilation by a soldier who was confined in the guard-house for drunkenness is related by Beck. The man borrowed a knife from a comrade and cut off the whole external genital apparatus, remarking as he flung the parts into a corner: "Any----fool can cut his throat, but it takes a soldier to cut his privates off!" Under treatment he recovered, and then he regretted his action. Sinclair describes an Irishman of twenty-five who, maniacal from intemperance, first cut off one testicle with a wire nail, and then the second with a trouser-buckle. Not satisfied with the extent of his injuries he drove a nail into his temple, first through the skin by striking it with his hand, and then by butting it against the wall,--the latter maneuver causing his death. There is on record the history of an insane medical student in Dublin who extirpated both eyes and threw them on the grass. He was in a state of acute mania, and the explanation offered was that as a "grinder" before examination he had been diligently studying the surgery of the eye, and particularly that relating to enucleation. Another Dublin case quoted by the same authority was that of a young girl who, upon being arrested and committed to a police-cell in a state of furious drunkenness, tore out both her eyes. In such cases, as a rule, the finger-nails are the only instrument used. There is a French case also quoted of a woman of thirty-nine who had borne children in rapid succession. While suckling a child three months old she became much excited, and even fanatical, in reading the Bible. Coming to the passage, "If thy right eye offend thee, pluck it out, etc.," she was so impressed with the necessity of obeying the divine injunction that she enucleated her eye with a meat-hook. There is mentioned the case of a young woman who cut off her right hand and cast it into the fire, and attempted to enucleate her eyes, and also to hold her remaining hand in the fire. Haslam reports the history of a female who mutilated herself by grinding glass between her teeth. Channing gives an account of the case of Helen Miller, a German Jewess of thirty, who was admitted to the Asylum for Insane Criminals at Auburn, N.Y., in October, 1872, and readmitted in June, 1875, suffering from simulation of hematemesis. On September 25th she cut her left wrist and right hand; in three weeks she became again "discouraged" because she was refused opium, and again cut her arms below the elbows, cleanly severing the skin and fascia, and completely hacking the muscles in every direction. Six weeks later she repeated the latter feat over the seat of the recently healed cicatrices. The right arm healed, but the left showed erysipelatous inflammation, culminating in edema, which affected the glottis to such an extent that tracheotomy was performed to save her life. Five weeks after convalescence, during which her conduct was exemplary, she again cut her arms in the same place. In the following April, for the merest trifle, she again repeated the mutilation, but this time leaving pieces of glass in the wounds. Six months later she inflicted a wound seven inches in length, in which she inserted 30 pieces of glass, seven long splinters, and five shoe-nails. In June, 1877, she cut herself for the last time. The following articles were taken from her arms and preserved: Ninety-four pieces of glass, 34 splinters, two tacks, five shoe-nails, one pin, and one needle, besides other things which were lost,--making altogether about 150 articles. "Needle-girls," etc.--A peculiar type of self-mutilation is the habit sometimes seen in hysteric persons of piercing their flesh with numerous needles or pins. Herbolt of Copenhagen tells of a young Jewess from whose body, in the course of eighteen months, were extracted 217 needles. Sometime after 100 more came from a tumor on the shoulder. As all the symptoms in this case were abdominal, it was supposed that during an epileptic seizure this girl had swallowed the needles; but as she was of an hysteric nature it seems more likely they had entered the body through the skin. There is an instance in which 132 needles were extracted from a young lady's person. Caen describes a woman of twenty-six, while in prison awaiting trial, succeeding in committing suicide by introducing about 30 pins and needles in the chest region, over the heart. Her method was to gently introduce them, and then to press them deeper with a prayer-book. An autopsy showed that some of the pins had reached the lungs, some were in the mediastinum, on the back part of the right auricle; the descending vena cave was perforated, the anterior portion of the left ventricle was transfixed by a needle, and several of the articles were found in the liver. Andrews removed 300 needles from the body of an insane female. The Lancet records an account of a suicide by the penetration of a darning-needle in the epigastrium. There were nine punctures in this region, and in the last the needle was left in situ and fixed by worsted. In 1851 the same journal spoke of an instance in which 30 pins were removed from the limbs of a servant girl. It was said that while hanging clothes, with her mouth full of pins, she was slapped on the shoulder, causing her to start and swallow the pins. There is another report of a woman who swallowed great numbers of pins. On her death one pound and nine ounces of pins were found in her stomach and duodenum. There are individuals known as "human pin-cushions," who publicly introduce pins and needles into their bodies for gain's sake. The wanderings of pins and needles in the body are quite well known. Schenck records the finding of a swallowed pin in the liver. Haller mentions one that made its way to the hand. Silvy speaks of a case in which a quantity of swallowed pins escaped through the muscles, the bladder, and vagina; there is another record in which the pins escaped many years afterward from the thigh. The Philosophical Transactions contain a record of the escape of a pin from the skin of the arm after it had entered by the mouth. Gooch, Ruysch, Purmann, and Hoffman speak of needle-wanderings. Stephenson gives an account of a pin which was finally voided by the bladder after forty-two years' sojourn in a lady's body. On November 15, 1802, the celebrated Dr. Lettsom spoke of an old lady who sat on a needle while riding in a hackney coach; it passed from the injured leg to the other one, whence it was extracted. Deckers tells of a gentleman who was wounded in the right hypochondrium, the ball being taken thirty years afterward from the knee. Borellus gives an account of a thorn entering the digit and passing out of the body by the anus. Strange as it may seem, a prick of a pin not entering a vital center or organ has been the indirect cause of death. Augenius writes of a tailor who died in consequence of a prick of a needle between the nail and flesh of the end of the thumb. Amatus Lusitanus mentions a similar instance in an old woman, although, from the symptoms given, the direct cause was probably tetanus. In modern times Cunninghame, Boring, and Hobart mention instances in which death has followed the prick of a pin: in Boring's case the death occurred on the fifth day. Manufacture of Crippled Beggars.--Knowing the sympathy of the world in general for a cripple, in some countries low in the moral scale, voluntary mutilation is sometimes practiced by those who prefer begging to toiling. In the same manner artificial monstrosities have been manufactured solely for gain's sake. We quite often read of these instances in lay-journals, but it is seldom that a case comes under the immediate observation of a thoroughly scientific mind. There is, however, on record a remarkable instance accredited to Jamieson of Shanghai who presented to the Royal College of Surgeons a pair of feet with the following history: Some months previously a Chinese beggar had excited much pity and made a good business by showing the mutilated stumps of his legs, and the feet that had belonged to them slung about his neck. While one day scrambling out of the way of a constable who had forbidden this gruesome spectacle, he was knocked down by a carriage in the streets of Shanghai, and was taken to the hospital, where he was questioned about the accident which deprived him of his feet. After selling the medical attendant his feet he admitted that he had purposely performed the amputations himself, starting about a year previously. He had fastened cords about his ankles, drawing them as tightly as he could bear them, and increasing the pressure every two or three days. For a fortnight his pain was extreme, but when the bones were bared his pains ceased. At the end of a month and a half he was able to entirely remove his feet by partly snapping and partly cutting the dry bone. Such cases appear to be quite common in China, and by investigation many parallels could elsewhere be found. The Chinese custom of foot-binding is a curious instance of self-mutilation. In a paper quoted in the Philadelphia Medical Times, January 31, 1880, a most minute account of the modus operandi, the duration, and the suffering attendant on this process are given. Strapping of the foot by means of tight bandages requires a period of two or three years' continuance before the desired effect is produced. There is a varying degree of pain, which is most severe during the first year and gradually diminishes after the binding of all the joints is completed. During the binding the girl at night lies across the bed, putting her legs on the edge of the bed-stead in such a manner as to make pressure under the knees, thus benumbing the parts below and avoiding the major degree of pain. In this position, swinging their legs backward and forward, the poor Chinese girls pass many a weary night. During this period the feet are unbound once a month only. The operation is begun by placing the end of a long, narrow bandage on the inside of the instep and carrying it over the four smaller toes, securing them under the foot. After several turns the bandage is reversed so as to compress the foot longitudinally. The young girl is then left for a month, and when the bandage is removed the foot is often found gangrenous and ulcerated, one or two toes not infrequently being lost. If the foot is thus bound for two years it becomes virtually dead and painless. By this time the calf disappears from lack of exercise, the bones are attenuated, and all the parts are dry and shrivelled. In after-life the leg frequently regains its muscles and adipose tissue, but the foot always remains small. The binding process is said to exert a markedly depressing influence upon the emotional character of the subject, which lasts through life, and is very characteristic. To show how minute some of the feet of the Chinese women are, Figure I of the accompanying plate, taken from a paper by Kenthughes on the "Feet of Chinese Ladies" is from a photograph of a shoe that measured only 3 1/4 inches anteroposteriorly. The foot which it was intended to fill must have been smaller still, for the bandage would take up a certain amount of space. Figure II is a reproduction of a photograph of a foot measuring 5 1/2 inches anteroposteriorly, the wrinkled appearance of the skin being due to prolonged immersion in spirit. This photograph shows well the characteristics of the Chinese foot--the prominent and vertically placed heel, which is raised generally about an inch from the level of the great toe; the sharp artificial cavus, produced by the altered position of the os calcis, and the downward deflection of the foot in front of the mediotarsal joint; the straight and downward pointing great toe, and the infolding of the smaller toes underneath the great toe. In Figure III we have a photograph of the skeleton of a Chinese lady's foot about five inches in anteroposterior diameter. The mesial axis of the os calcis is almost directly vertical, with a slight forward inclination, forming a right angle with the bones in front of the mediotarsal joint. The upper three-quarters of the anterior articular surface of the calcis is not in contact with the cuboid, the latter being depressed obliquely forward and downward, the lower portion of the posterior facet on the cuboid articulating with a new surface on the under portion of the bone. The general shape of the bone closely resembles that of a normal one--a marked contrast to its wasted condition and tapering extremity in paralytic calcaneus. Extension and flexion at the ankle are only limited by the shortness of the ligaments; there is no opposition from the conformation of the bones. The astragalus is almost of normal shape; the trochlea is slightly prolonged anteriorly, especially on the inner side, from contact with the tibial articular surface. The cartilage on the exposed posterior portion of the trochlea seems healthy. The head of the astragalus is very prominent on the outer side, the scaphoid being depressed downward and inward away from it. The anterior articular surface is prolonged in the direction of the displaced scaphoid. The scaphoid, in addition to its displacement, is much compressed on the planter surface, being little more than one-half the width of the dorsal surface. The cuboid is displaced obliquely downward and forward, so that the upper part of the posterior articular surface is not in contact with the calcis. A professional leg-breaker is described in the Weekly Medical Review of St. Louis, April, 1890. This person's name was E. L. Landers, and he was accredited with earning his living by breaking or pretending to break his leg in order to collect damages for the supposed injury. Moreover, this individual had but one leg, and was compelled to use crutches. At the time of report he had succeeded in obtaining damages in Wichita, Kansas, for a supposed fracture. The Review quotes a newspaper account of this operation as follows.-- "According to the Wichita Dispatch he represented himself as a telegraph operator who was to have charge of the postal telegraph office in that city as soon as the line reached there. He remained about town for a month until he found an inviting piece of defective sidewalk, suitable for his purpose, when he stuck his crutch through the hole and fell screaming to the ground, declaring that he had broken his leg. He was carried to a hospital, and after a week's time, during which he negotiated a compromise with the city authorities and collected $1000 damages, a confederate, claiming to be his nephew, appeared and took the wounded man away on a stretcher, saying that he was going to St. Louis. Before the train was fairly out of Wichita, Landers was laughing and boasting over his successful scheme to beat the town. The Wichita story is in exact accord with the artistic methods of a one-legged sharper who about 1878 stuck his crutch through a coal-hole here, and, falling heels over head, claimed to have sustained injuries for which he succeeded in collecting something like $1500 from the city. He is described as a fine-looking fellow, well dressed, and wearing a silk hat. He lost one leg in a railroad accident, and having collected a good round sum in damages for it, adopted the profession of leg-breaking in order to earn a livelihood. He probably argued that as he had made more money in that line than in any other he was especially fitted by natural talents to achieve distinction in this direction. But as it would be rather awkward to lose his remaining leg altogether he modified the idea and contents himself with collecting the smaller amounts which ordinary fractures of the hip-joint entitle such an expert 'fine worker' to receive. "He first appeared here in 1874 and succeeded, it is alleged, in beating the Life Association of America. After remaining for some time in the hospital he was removed on a stretcher to an Illinois village, from which point the negotiations for damages were conducted by correspondence, until finally a point of agreement was reached and an agent of the company was sent to pay him the money. This being accomplished the agent returned to the depot to take the train back to St. Louis when he was surprised to see the supposed sufferer stumping around on his crutches on the depot platform, laughing and jesting over the ease with which he had beaten the corporation. "He afterward fell off a Wabash train at Edwardsville and claimed to have sustained serious injuries, but in this case the company's attorneys beat him and proved him to be an impostor. In 1879 he stumbled into the telegraph office at the Union Depot here, when Henry C. Mahoney, the superintendent, catching sight of him, put him out, with the curt remark that he didn't want him to stick that crutch into a cuspidor and fall down, as it was too expensive a performance for the company to stand. He beat the Missouri Pacific and several other railroads and municipalities at different times, it is claimed, and manages to get enough at each successful venture to carry him along for a year or eighteen months, by which time the memory of his trick fades out of the public mind, when he again bobs up serenely." Anomalous Suicides.--The literature on suicide affords many instances of self-mutilations and ingenious modes of producing death. In the Dublin Medical Press for 1854 there is an extraordinary case of suicide, in which the patient thrust a red-hot poker into his abdomen and subsequently pulled it out, detaching portions of the omentum and 32 inches of the colon. Another suicide in Great Britain swallowed a red-hot poker. In commenting on suicides, in 1835, Arntzenius speaks of an ambitious Frenchman who was desirous of leaving the world in a distinguished manner, and who attached himself to a rocket of enormous size which he had built for the purpose, and setting fire to it, ended his life. On September 28, 1895, according to the Gaulois and the New York Herald (Paris edition) of that date, there was admitted to the Hopital St. Louis a clerk, aged twenty-five, whom family troubles had rendered desperate and who had determined to seek death as a relief from his misery. Reviewing the various methods of committing suicide he found none to his taste, and resolved on something new. Being familiar with the constituents of explosives, he resolved to convert his body into a bomb, load it with explosives, and thus blow himself to pieces. He procured some powdered sulphur and potassium chlorate, and placing each in a separate wafer he swallowed both with the aid of water. He then lay down on his bed, dressed in his best clothes, expecting that as soon as the two explosive materials came into contact he would burst like a bomb and his troubles would be over. Instead of the anticipated result the most violent collicky pains ensued, which finally became so great that he had to summon his neighbors, who took him to the hospital, where, after vigorous application with the stomach-pump, it was hoped that his life would be saved. Sankey mentions an epileptic who was found dead in his bed in the Oxford County Asylum; the man had accomplished his end by placing a round pebble in each nostril, and thoroughly impacting in his throat a strip of flannel done up in a roll. In his "Institutes of Surgery" Sir Charles Bell remarks that his predecessor at the Middlesex Hospital entered into a conversation with his barber over an attempt at suicide in the neighborhood, during which the surgeon called the "would-be suicide" a fool, explaining to the barber how clumsy his attempts had been at the same time giving him an extempore lecture on the anatomic construction of the neck, and showing him how a successful suicide in this region should be performed. At the close of the conversation the unfortunate barber retired into the back area of his shop, and following minutely the surgeon's directions, cut his throat in such a manner that there was no hope of saving him. It is supposed that one could commit suicide by completely gilding or varnishing the body, thus eliminating the excretory functions of the skin. There is an old story of an infant who was gilded to appear at a Papal ceremony who died shortly afterward from the suppression of the skin-function. The fact is one well established among animals, but after a full series of actual experiments, Tecontjeff of St. Petersburg concludes that in this respect man differs from animals. This authority states that in man no tangible risk is entailed by this process, at least for any length of time required for therapeutic purposes. "Tarred and feathered" persons rarely die of the coating of tar they receive. For other instances of peculiar forms of suicide reference may be made to numerous volumes on this subject, prominent among which is that by Brierre de Boismont, which, though somewhat old, has always been found trustworthy, and also to the chapters on this subject written by various authors on medical jurisprudence. Religious and Ceremonial Mutilations.--Turning now to the subject of self-mutilation and self-destruction from the peculiar customs or religious beliefs of people, we find pages of information at our disposal. It is not only among the savage or uncivilized tribes that such ideas have prevailed, but from the earliest times they have had their influence upon educated minds. In the East, particularly in India, the doctrines of Buddhism, that the soul should be without fear, that it could not be destroyed, and that the flesh was only its resting-place, the soul several times being reincarnated, brought about great indifference to bodily injuries and death. In the history of the Brahmans there was a sect of philosophers called the Gymnosophists, who had the extremest indifference to life. To them incarnation was a positive fact, and death was simply a change of residence. One of these philosophers, Calanus, was burned in the presence of Alexander; and, according to Plutarch, three centuries later another Gymnosophist named Jarmenochegra, was similarly burned before Augustus. Since this time, according to Brierre de Boismont, the suicides from indifference to life in this mystic country are counted by the thousands. Penetrating Japan the same sentiment, according to report, made it common in the earlier history of that country to see ships on its coasts, filled with fanatics who, by voluntary dismantling, submerged the vessels little by little, the whole multitude sinking into the sea while chanting praises to their idols. The same doctrines produced the same result in China. According to Brucker it is well known that among the 500 philosophers of the college of Confucius, there were many who disdained to survive the loss of their books (burned by order of the savage Emperor Chi-Koung-ti), and throwing themselves into the sea, they disappeared under the waves. According to Brierre de Boismont, voluntary mutilation or death was very rare among the Chaldeans, the Persians, or the Hebrews, their precepts being different from those mentioned. The Hebrews in particular had an aversion to self-murder, and during a period in their history of 4000 years there were only eight or ten suicides recorded. Josephus shows what a marked influence on suicides the invasion of the Romans among the Hebrews had. In Africa, as in India, there were Gymnosophists. In Egypt Sesostris, the grandest king of the country, having lost his eyesight in his old age, calmly and deliberately killed himself. About the time of Mark Anthony and Cleopatra, particularly after the battle of Actium, suicide was in great favor in Egypt. In fact a great number of persons formed an academy called The Synapothanoumenes, who had for their object the idea of dying together. In Western Europe, as shown in the ceremonies of the Druids, we find among the Celts a propensity for suicide and an indifference to self-torture. The Gauls were similarly minded, believing in the dogma of immortality and eternal repose. They thought little of bodily cares and ills. In Greece and Rome there was always an apology for suicide and death in the books of the philosophers. "Nil igitur mors est, ad nos neque pertinet hilum; quando quidem natura animi mortalis habetur!" cries Lucretius. With the advent of Christianity, condemning as it did the barbarous customs of self-mutilation and self-murder, these practices seem to disappear gradually; but stoicism and indifference to pain were exhibited in martyrdom. Toward the middle ages, when fanaticism was at its height and the mental malady of demoniacal possession was prevalent, there was something of a reversion to the old customs. In the East the Juggernaut procession was still in vogue, but this was suppressed by civilized authorities; outside of a few minor customs still prevalent among our own people we must to-day look to the savage tribes for the perpetuation of such practices. In an excellent article on the evolution of ceremonial institutions Herbert Spencer mentions the Fuegians, Veddahs, Andamanese, Dyaks, Todas, Gonds, Santals, Bodos, and Dhimals, Mishmis, Kamchadales, and Snake Indians, as among people who form societies to practice simple mutilations in slight forms. Mutilations in somewhat graver forms, but still in moderation, are practiced by the Tasmanians, Tamaese, the people of New Guinea, Karens, Nagas, Ostiaks, Eskimos, Chinooks, Comanches, and Chippewas. What might be called mixed or compound mutilations are practiced by the New Zealanders, East Africans, Kondes, Kukas, and Calmucks. Among those practising simple but severe mutilations are the New Caledonians, the Bushmen, and some indigenous Australians. Those tribes having for their customs the practice of compound major mutilations are the Fiji Islanders, Sandwich Islanders, Tahitians, Tongans, Samoans, Javanese, Sumatrans, natives of Malagasy, Hottentots, Damaras, Bechuanas, Kaffirs, the Congo people, the Coast Negroes, Inland Negroes, Dahomeans, Ashantees, Fulahs, Abyssinians, Arabs, and Dakotas. Spencer has evidently made a most extensive and comprehensive study of this subject, and his paper is a most valuable contribution to the subject. In the preparation of this section we have frequently quoted from it. The practice of self-bleeding has its origin in other mutilations, although the Aztecs shed human blood in the worship of the sun. The Samoiedes have a custom of drinking the blood of warm animals. Those of the Fijians who were cannibals drank the warm blood of their victims. Among the Amaponda Kaffirs there are horrible accounts of kindred savage customs. Spencer quotes:--"It is usual for the ruling chief on his accession to be washed in the blood of a near relative, generally a brother, who is put to death for the occasion." During a Samoan marriage-ceremony the friends of the bride "took up stones and beat themselves until their heads were bruised and bleeding." In Australia a novitiate at the ceremony of manhood drank a mouthful of blood from the veins of the warrior who was to be his sponsor. At the death of their kings the Lacedemonians met in large numbers and tore the flesh from their foreheads with pins and needles. It is said that when Odin was near his death he ordered himself to be marked with a spear; and Niort, one of his successors, followed the example of his predecessor. Shakespeare speaks of "such as boast and show their scars." In the olden times it was not uncommon for a noble soldier to make public exhibition of his scars with the greatest pride; in fact, on the battlefield they invited the reception of superficial disfiguring injuries, and to-day some students of the learned universities of Germany seem prouder of the possession of scars received in a duel of honor than in awards for scholastic attainments. Lichtenstein tells of priests among the Bechuanas who made long cuts from the thigh to the knee of each warrior who slew an enemy in battle. Among some tribes of the Kaffirs a kindred custom was practiced; and among the Damaras, for every wild animal a young man destroyed his father made four incisions on the front of his son's body. Speaking of certain Congo people, Tuckey says that they scar themselves principally with the idea of rendering themselves agreeable to the women of their tribe. Among the Itzaex Indians of Yucatan, a race with particularly handsome features, some are marked with scarred lines, inflicted as signs of courage. Cosmetic Mutilations.--In modern times there have been individuals expert in removing facial deformities, and by operations of various kinds producing pleasing dimples or other artificial signs of beauty. We have seen an apparatus advertised to be worn on the nose during the night for the purpose of correcting a disagreeable contour of this organ. A medical description of the artificial manufacture of dimples is as follows:--"The modus operandi was to make a puncture in the skin where the dimple was required, which would not be noticed when healed, and, with a very delicate instrument, remove a portion of the muscle. Inflammation was then excited in the skin over the subcutaneous pit, and in a few days the wound, if such it may be called, was healed, and a charming dimple was the result." It is quite possible that some of our modern operators have overstepped the bounds of necessity, and performed unjustifiable plastic operations to satisfy the vanity of their patients. Dobrizhoffer says of the Abipones that boys of seven pierce their little arms in imitation of their parents. Among some of the indigenous Australians it is quite customary for ridged and linear scars to be self-inflicted. In Tanna the people produce elevated scars on the arms and chests. Bancroft recites that family-marks of this nature existed among the Cuebas of Central America, refusal being tantamount to rebellion. Schomburgk tells that among the Arawaks, after a Mariquawi dance, so great is their zeal for honorable scars, the blood will run down their swollen calves, and strips of skin and muscle hang from the mangled limbs. Similar practices rendered it necessary for the United States Government to stop some of the ceremonial dances of the Indians under their surveillance. A peculiar custom among savages is the amputation of a finger as a sacrifice to a deity. In the tribe of the Dakotas the relatives of a dead chief pacified his spirit by amputating a finger. In a similar way, during his initiation, the young Mandan warrior, "holding up the little finger of his left hand to the Great Spirit," ... "expresses his willingness to give it as a sacrifice, and he lays it on the dried buffalo skull, when another chops it off near the hand with a blow of the hatchet." According to Mariner the natives of Tonga cut off a portion of the little finger as a sacrifice to the gods for the recovery of a superior sick relative. The Australians have a custom of cutting off the last joint of the little finger of females as a token of submission to powerful beings alive and dead. A Hottentot widow who marries a second time must have the distal joint of her little finger cut off; another joint is removed each time she remarries. Among the mutilations submitted to on the death of a king or chief in the Sandwich Islands, Cook mentions in his "Voyages" the custom of knocking out from one to four front teeth. Among the Australian tribes the age of virility and the transition into manhood is celebrated by ceremonial customs, in which the novices are subjected to minor mutilations. A sharp bone is used for lancing their gums, while the throw-stick is used for knocking out a tooth. Sometimes, in addition to this crude dentistry, the youth is required to submit to cruel gashes cut upon his back and shoulders, and should he flinch or utter any cry of pain he is always thereafter classed with women. Haygarth writes of a semi-domesticated Australian who said one day, with a look of importance, that he must go away for a few days, as he had grown to man's estate, and it was high time he had his teeth knocked out. It is an obligatory rite among various African tribes to lose two or more of their front teeth. A tradition among certain Peruvians was that the Conqueror Huayna Coapae made a law that they and their descendants should have three front teeth pulled out in each jaw. Cieza speaks of another tradition requiring the extraction of the teeth of children by their fathers as a very acceptable service to their gods. The Damaras knock out a wedge-shaped gap between two of their front teeth; and the natives of Sierra Leone file or chip their teeth after the same fashion. Depilatory customs are very ancient, and although minor in extent are still to be considered under the heading of mutilations. The giving of hair to the dead as a custom, has been perpetuated through many tribes and nations. In Euripides we find Electra admonishing Helen for sparing her locks, and thereby defrauding the dead. Alexander the Great shaved his locks in mourning for his friend, Hephaestion, and it was supposed that his death was hastened by the sun's heat on his bare head after his hat blew off at Babylon. Both the Dakota Indians and the Caribs maintain the custom of sacrificing hair to the dead. In Peru the custom was varied by pulling out eyelashes and eyebrows and presenting them to the sun, the hills, etc. It is said this custom is still in continuance. When Clovis was visited by the Bishop of Toulouse he gave him a hair from his beard and was imitated by his followers. In the Arthurian legends we find "Then went Arthur to Caerleon; and thither came messages from King Ryons who said, 'even kings have done me homage, and with their beards I have trimmed a mantle. Send me now thy beard, for there lacks yet one to the finishing of the mantle.'" The association between short hair and slavery arose from the custom of taking hair from the slain. It existed among the Greeks and Romans, and was well known among the indigenous tribes of this continent. Among the Shoshones he who took the most scalps gained the most glory. In speaking of the prisoners of the Chicimecs Bancroft says they were often scalped while yet alive, and the bloody trophies placed on the heads of their tormentors. In this manner we readily see that long hair among the indigenous tribes and various Orientals, Ottomans, Greeks, Franks, Goths, etc., was considered a sign of respect and honor. The respect and preservation of the Chinese queue is well known in the present day. Wishing to divide their brother's kingdom, Clothair and Childebert consulted whether to cut off the hair of their nephews, the rightful successors, so as to reduce them to the rank of subjects, or to kill them. The gods of various people, especially the greater gods, were distinguished by their long beards and flowing locks. In all pictures Thor and Samson were both given long hair, and the belief in strength and honor from long hair is proverbial. Hercules is always pictured with curls. According to Goldzhier, long locks of hair and a long beard are mythologic attributes of the sun. The sun's rays are compared to long locks or hairs on the face of the sun. When the sun sets and leaves his place to the darkness, or when the powerful summer sun is succeeded by the weak rays of the winter sun, then Samson's long locks, through which alone his strength remains, are cut off by the treachery of his deceitful concubine Delilah (the languishing, according to the meaning of the name). The beaming Apollo was, moreover, called the "Unshaven;" and Minos cannot conquer the solar hero, Nisos, until the latter loses his golden hair. In Arabic "Shams-on" means the sun, and Samson had seven locks of hair, the number of the planetary bodies. In view of the foregoing facts it seems quite possible that the majority of depilatory processes on the scalp originated in sun-worship, and through various phases and changes in religions were perpetuated to the Middle Ages. Charles Martel sent Pepin, his son, to Luithprand, king of the Lombards, that he might cut his first locks, and by this ceremony hold for the future the place of his illustrious father. To make peace with Alaric, Clovis became his adopted son by offering his beard to be cut. Among the Caribs the hair constituted their chief pride, and it was considered unequivocal proof of the sincerity of their sorrow, when on the death of a relative they cut their hair short. Among the Hebrews shaving of the head was a funeral rite, and among the Greeks and Romans the hair was cut short in mourning, either for a relative or for a celebrated personage. According to Krehl the Arabs also had such customs. Spencer mentions that during an eruption in Hawaii, "King Kamahameha cut off part of his own hair" ... "and threw it into the torrent (of lava)." The Tonga regarded the pubic hairs as under the special care of the devil, and with great ceremony made haste to remove them. The female inhabitants of some portions of the coast of Guinea remove the pubic hairs as fast as they appear. A curious custom of Mohammedan ladies after marriage is to rid themselves of the hirsute appendages of the pubes. Depilatory ointments are employed, consisting of equal parts of slaked lime and arsenic made into a paste with rose-water. It is said that this important ceremony is not essential in virgins. One of the ceremonies of assuming the toga virilis among the indigenous Australians consists in submitting to having each particular hair plucked singly from the body, the candidate being required not to display evidences of pain during the operation. Formerly the Japanese women at marriage blackened their teeth and shaved or pulled out their eyebrows. The custom of boring the ear is very old, mention of it being made in Exodus xxi., 5 and 6, in which we find that if a Hebrew servant served for six years, his freedom was optional, but if he plainly said that he loved his master, and his wife and children, and did not desire to leave their house, the master should bring him before the judges; and according to the passage in Exodus, "he shall also bring him to the door or unto the doorpost, and his master shall bore his ear through with an awl; and he shall serve him forever." All the Burmese, says Sangermano, without exception, have the custom of boring their ears. The days when the operations were performed were kept as festivals. The ludicrous custom of piercing the ears for the wearing of ornaments, typical of savagery and found in all indigenous African tribes, is universally prevalent among our own people. The extremists in this custom are the Botocudos, who represent the most cruel and ferocious of the Brazilian tribes, and who especially cherish a love for cannibalism. They have a fondness for disfiguring themselves by inserting in the lower parts of their ears and in their under lips variously shaped pieces of wood ornaments called peleles, causing enormous protrusion of the under lip and a repulsive wide mouth, as shown in Figure 230. Tattooing is a peculiar custom originating in various ways. The materials used are vermilion, indigo, carbon, or gunpowder. At one time this custom was used in the East to indicate caste and citizenship. Both sexes of the Sandwich Islanders have a peculiar tattooed mark indicative of their tribe or district. Among the Uapes, one tribe, the Tucanoes, have three vertical blue lines. Among other people tattooed marks indicated servility, and Boyle says the Kyans, Pakatans, and Kermowits alone, among the Borneo people, practised tattooing, and adds that these races are the least esteemed for bravery. Of the Fijians the women alone are tattooed, possibly as a method of adornment. The tattooing of the people of Otaheite, seen by Cook, was surmised by him to have a religious significance, as it presented in many instances "squares, circles, crescents, and ill-designed representations of men and dogs." Every one of these people was tattooed upon reaching majority. According to Carl Bock, among the Dyaks of Borneo all of the married women were tattooed on the hands and feet, and sometimes on the thighs. The decoration is one of the privileges of matrimony, and is not permitted to unmarried girls. Andrew Lang says of the Australian tribes that the Wingong or the Totem of each man is indicated by a tattooed representation of it on his flesh. The celebrated American traveler, Carpenter, remarks that on his visit to a great prison in Burmah, which contains more than 3000 men, he saw 6000 tattooed legs. The origin of the custom he was unable to find out, but in Burmah tattooing was a sign of manhood, and professional tattooers go about with books of designs, each design warding off some danger. Bourke quotes that among the Apaches-Yumas of Arizona the married women are distinguished by several blue lines running from the lower lip to the chin; and he remarks that when a young woman of this tribe is anxious to become a mother she tattoos the figure of a child on her forehead. After they marry Mojave girls tattoo the chin with vertical blue lines; and when an Eskimo wife has her face tattooed with lamp-black she is regarded as a matron in society. The Polynesians have carried this dermal art to an extent which is unequaled by any other people, and it is universally practiced among them. Quoted by Burke, Sullivan states that the custom of tattooing continued in England and Ireland down to the seventh century. This was the tattooing with the woad. Fletcher remarks that at one time, about the famous shrine of Our Lady of Loretto, were seen professional tattooers, who for a small sum of money would produce a design commemorative of the pilgrim's visit to the shrine. A like profitable industry is pursued in Jerusalem. Universal tattooing in some of the Eastern countries is used as a means of criminal punishment, the survival of the persecuted individual being immaterial to the torturers, as he would be branded for life and ostracized if he recovered. Illustrative of this O'Connell tells of a case in Hebra's clinic. The patient, a man five feet nine inches in height, was completely tattooed from head to foot with all sorts of devices, such as elephants, birds, lions, etc., and across his forehead, dragons. Not a square of even a quarter inch had been exempt from the process. According to his tale this man had been a leader of a band of Greek robbers, organized to invade Chinese Tartary, and, together with an American and a Spaniard, was ordered by the ruler of the invaded province to be branded in this manner as a criminal. It took three months' continuous work to carry out this sentence, during which his comrades succumbed to the terrible agonies. During the entire day for this extended period indigo was pricked in this unfortunate man's skin. Accounts such as this have been appropriated by exhibitionists, who have caused themselves to be tattooed merely for mercenary purposes. The accompanying illustration represents the appearance of a "tattooed man" who exhibited himself. He claimed that his tattooing was done by electricity. The design showing on his back is a copy of a picture of the Virgin Mary surrounded by 31 angels. The custom of tattooing the arms, chest, or back is quite prevalent, and particularly among sailors and soldiers. The sequences of this custom are sometimes quite serious. Syphilis has been frequently contracted in this manner, and Maury and Dulles have collected 15 cases of syphilis acquired in tattooing. Cheinisse reports the case of a young blacksmith who had the emblems of his trade tattooed upon his right forearm. At the end of forty days small, red, scaly elevations appeared at five different points in the tattooed area. These broke down and formed ulcers. When examined these ulcers presented the peculiarities of chancres, and there was upon the body of the patient a well-marked syphilitic roseola. It was ascertained that during the tattooing the operator had moistened the ink with his own saliva. Hutchinson exhibited drawings and photographs showing the condition of the arms of two boys suffering from tuberculosis of the skin, who had been inoculated in the process of tattooing. The tattooing was done by the brother of one of the lads who was in the last stages of phthisis, and who used his own saliva to mix the pigment. The cases were under the care of Murray of Tottenham, by whom they had been previously reported. Williams has reported the case of a militiamen of seventeen who, three days after an extensive tattooing of the left forearm, complained of pain, swelling, and tenderness of the left wrist. A day later acute left-sided pneumonia developed, but rapidly subsided. The left shoulder, knee, and ankle were successively involved in the inflammation, and a cardiac bruit developed. Finally chorea developed as a complication, limited for a time to the left side, but shortly spreading to the right, where rheumatic inflammation was attacking the joints. The last, however, quickly subsided, leaving a general, though mild chorea and a permanently damaged heart. Infibulation of the male and female external genital organs for the prevention of sexual congress is a very ancient custom. The Romans infibulated their singers to prevent coitus, and consequent change in the voice, and pursued the same practice with their actors and dancers. According to Celsus, Mercurialis, and others, the gladiators were infibulated to guard against the loss of vigor by sexual excesses. In an old Italian work there is a figure of an infibulated musician--a little bronze statue representing a lean individual tortured or deformed by carrying an enormous ring through the end of the penis. In one of his pleasantries Martial says of these infibulated singers that they sometimes break their rings and fail to place them back--"et cujus refibulavit turgidum faber peruem." Heinsius considers Agamemnon cautious when he left Demodocus near Clytemnestra, as he remarks that Demodocus was infibulated. For such purposes as the foregoing infibulation offered a more humane method than castration. Infibulation by a ring in the prepuce was used to prevent premature copulation, and was in time to be removed, but in some cases its function was the preservation of perpetual chastity. Among some of the religious mendicants in India there were some who were condemned to a life of chastity, and, in the hotter climates, where nudity was the custom, these persons traveled about exposing an enormous preputial ring, which was looked upon with adoration by devout women. It is said these holy persons were in some places so venerated that people came on their knees, and bowing below the ring, asked forgiveness--possibly for sexual excesses. Rhodius mentions the usage of infibulation in antiquity, and Fabricius d'Aquapendente remarks that infibulation was usually practiced in females for the preservation of chastity. No Roman maiden was able to preserve her virginity during participation in the celebrations in the Temples of Venus, the debauches of Venus and Mars, etc., wherein vice was authorized by divine injunction; for this reason the lips of the vagina were closed by rings of iron, copper, or silver, so joined as to hinder coitus, but not prevent evacuation. Different sized rings were used for those of different ages. Although this device provided against the coitus, the maiden was not free from the assaults of the Lesbians. During the Middle Ages, in place of infibulation, chastity-girdles were used, and in the Italian girdles, such as the one exhibited in the Musee Cluny in Paris, both the anus and vulva were protected by a steel covering perforated for the evacuations. In the Orient, particularly in India and Persia, according to old travelers, the labia were sewed together, allowing but a small opening for excretions. Buffon and Brown mention infibulation in Abyssinia, the parts being separated by a bistoury at the time of marriage. In Circassia the women were protected by a copper girdle or a corset of hide and skin which, according to custom, only the husband could undo. Peney speaks of infibulation for the preservation of chastity, as observed by him in the Soudan. Among the Nubians this operation was performed at about the age of eight with great ceremony, and when the time for marriage approached the vulva had to be opened by incision. Sir Richard Buxton, a distinguished traveler, also speaks of infibulation, and, according to him, at the time of the marriage ceremony the male tries to prove his manhood by using only Nature's method and weapon to consummate the marriage, but if he failed he was allowed artificial aid to effect entrance. Sir Samuel Baker is accredited in The Lancet with giving an account in Latin text of the modus operandi of a practice among the Nubian women of removing the clitoris and nymphae in the young girl, and abrading the adjacent walls of the external labia so that they would adhere and leave only a urethral aperture. This ancient custom of infibulation is occasionally seen at the present day in civilized countries, and some cases of infibulation from jealousy are on record. There is mentioned, as from the Leicester Assizes, the trial of George Baggerly for execution of a villainous design on his wife. In jealousy he "had sewed up her private parts." Recently, before the New York Academy of Medicine, Collier reported a case of pregnancy in a woman presenting nympha-infibulation. The patient sought the physician's advice in the summer of 1894, while suffering from uterine disease, and being five weeks pregnant. She was a German woman of twenty-eight, had been married several years, and was the mother of several children. Collier examined her and observed two holes in the nymphae. When he asked her concerning these, she reluctantly told him that she had been compelled by her husband to wear a lock in this region. Her mother, prior to their marriage, sent her over to the care of her future husband (he having left Germany some months before). On her arrival he perforated the labia minora, causing her to be ill several weeks; after she had sufficiently recovered he put on a padlock, and for many years he had practiced the habit of locking her up after each intercourse. Strange to relate, no physician, except Collier, had ever inquired about the openings. In this connection the celebrated Harvey mentions a mare with infibulated genitals, but these did not prevent successful labor. Occasionally infibulation has been used as a means of preventing masturbation. De la Fontaine has mentioned this fact, and there is a case in this country in which acute dementia from masturbation was cured by infibulation. In this instance the prepuce was perforated in two opposite places by a trocar, and two pewter sounds (No. 2) were introduced into the wounds and twisted like rings. On the eleventh day one of the rings was removed, and a fresh one introduced in a new place. A cure was effected in eight weeks. There is recent mention made of a method of preventing masturbation by a cage fastened over the genitals by straps and locks. In cases of children the key was to be kept by the parents, but in adults to be put in some part of the house remote from the sleeping apartment, the theory being that the desire would leave before the key could be obtained. Among some peoples the urethra was slit up as a means of preventing conception, making a meatus near the base of the penis. Herodotus remarks that the women of a certain portion of Egypt stood up while they urinated, while the men squatted. Investigation has shown that the women were obliged to stand up on account of elongated nymphae and labia, while the men sought a sitting posture on account of the termination of the urethra being on the inferior side of the base of the penis, artificially formed there in order to prevent conception. In the Australian Medical Gazette, May, 1883, there is an account of some of the methods of the Central Australians of preventing conception. One was to make an opening into the male urethra just anterior to the scrotum, and another was to slit up the entire urethra so far as to make but a single canal from the scrotum to the glans penis. Bourke quotes Palmer in mentioning that it is a custom to split the urethra of the male of the Kalkadoon tribe, near Cloncurry, Queensland, Australia Mayer of Vienna describes an operation of perforation of the penis among the Malays; and Jagor and Micklucho-Maclay report similar customs among the Dyaks and other natives of Borneo, Java, and Phillipine Islands. Circumcision is a rite of great antiquity. The Bible furnishes frequent records of this subject, and the bas-reliefs on some of the old Egyptian ruins represent circumcised children. Labat has found traces of circumcision and excision of nymphae in mummies. Herodotus remarks that the Egyptians practiced circumcision rather as a sanitary measure than as a rite. Voltaire stated that the Hebrews borrowed circumcision from the Egyptians; but the Jews claimed that the Phoenicians borrowed this rite from the Israelites. Spencer and others say that in the early history of the Christian religion, St. Paul and his Disciples did not believe in circumcision, while St. Peter and his followers practiced it. Spencer mentions that the Abyssinians take a phallic trophy by circumcision from the enemy's dead body. In his "History of Circumcision," Remondino says that among the modern Berbers it is not unusual for a warrior to exhibit virile members of persons he has slain; he also says that, according to Bergman, the Israelites practiced preputial mutilations; David brought 200 prepuces of the Philistines to Saul. Circumcision is practiced in nearly every portion of the world, and by various races, sometimes being a civil as well as a religious custom. Its use in surgery is too well known to be discussed here. It might be mentioned, however, that Rake of Trinidad, has performed circumcision 16 times, usually for phimosis due to leprous tuberculation of the prepuce. Circumcision, as practiced on the clitoris in the female, is mentioned on page 308. Ceremonial Ovariotomy.--In the writings of Strabonius and Alexander ab Alexandro, allusion is made to the liberties taken with the bodies of females by the ancient Egyptians and Lydians. Knott says that ablation of the ovaries is a time-honored custom in India, and that he had the opportunity of physically examining some of the women who had been operated on in early life. At twenty-five he found them strong and muscular, their mammary glands wholly undeveloped, and the normal growth of pubic hairs absent. The pubic arch was narrow, and the vaginal orifice practically obliterated. The menses had never appeared, and there seemed to be no sexual desire. Micklucho-Maclay found that one of the most primitive of all existing races--the New Hollanders--practiced ovariotomy for the utilitarian purpose of creating a supply of prostitutes, without the danger of burdening the population by unnecessary increase. MacGillibray found a native ovariotomized female at Cape York who had been subjected to the operation because, having been born dumb, she would be prevented from bearing dumb children,--a wise, though primitive, method of preventing social dependents. Castration has long been practiced, either for the production of eunuchs, or castrata, through vengeance or jealousy, for excessive cupidity, as a punishment for crime, in fanaticism, in ignorance, and as a surgical therapeutic measure (recently, for the relief of hypertrophied prostate). The custom is essentially Oriental in origin, and was particularly used in polygamous countries, where the mission of eunuchs was to guard the females of the harem. They were generally large, stout men, and were noted for their vigorous health. The history of eunuchism is lost in antiquity. The ancient Book of Job speaks of eunuchs, and they were in vogue before the time of Semiramis; the King of Lydia, Andramytis, is said to have sanctioned castration of both male and female for social reasons. Negro eunuchs were common among the Romans. All the great emperors and conquerors had their eunuchs. Alexander the Great had his celebrated eunuch, Bagoas, and Nero, his Sporus, etc. Chevers says that the manufacture of eunuchs still takes place in the cities of Delhi, Lucknow, and Rajpootana. So skilful are the traveling eunuch-makers that their mortality is a small fraction of one per cent. Their method of operation is to encircle the external genital organs with a tight ligature, and then sweep them off at one stroke. He also remarks that those who retain their penises are of but little value or trusted. He divided the Indian eunuchs into three classes: those born so, those with a penis but no testicles, and those minus both testicles and penis. Curran describes the traveling eunuch-makers in Central India, and remarks upon the absence of death after the operation, and invites the attention of gynecologists and operators to the successful, though crude, methods used. Curran says that, except those who are degraded by practices of sexual perversions, these individuals are vigorous bodily, shrewd, and sagacious, thus proving the ancient descriptions of them. Jamieson recites a description of the barbarous methods of making eunuchs in China. The operators follow a trade of eunuch-making, and keep it in their families from generation to generation; they receive the monetary equivalent of about $8.64 for the operation. The patient is grasped in a semi-prone position by an assistant, while two others hold the legs. After excision the wounded parts are bathed three times with a hot decoction of pepper-pods, the wound is covered with paper soaked in cold water, and bandages applied. Supported by two men the patient is kept walking for two or three hours and then tied down. For three days he is allowed nothing to drink, and is not allowed to pass his urine, the urethra being filled with a pewter plug. It generally takes about one hundred days for the wound to heal, and two per cent of the cases are fatal. There is nocturnal incontinence of urine for a long time after the operation. Examples of castration because of excessive cupidity, etc.,--a most unwarranted operation,--are quite rare and are usually found among ecclesiastics. The author of "Faustin, or le Siecle Philosophique," remarked that there were more than 4000 castrated individuals among the ecclesiastics and others of Italy. The virtuous Pope Clement XIV forbade this practice, and describes it as a terrible abuse; but in spite of the declaration of the Pope the cities of Italy, for some time, still continued to contain great numbers of these victims. In France an article was inserted into the penal code providing severe punishment for such mutilations. Fortunately castration for the production of "castrata," or tenor singers, has almost fallen into disuse. Among the ancient Egyptians and Persians amputation of the virile member was inflicted for certain crimes of the nature of rape. Castration as a religious rite has played a considerable role. With all their might the Emperors Constantine and Justinian opposed the delirious religion of the priests of Cybele, and rendered their offence equivalent to homicide. At the annual festivals of the Phrygian Goddess Amma (Agdistis) it was the custom of young men to make eunuchs of themselves with sharp shells, and a similar rite was recorded among Phoenicians. Brinton names severe self-mutilators of this nature among the ancient Mexican priests. Some of the Hottentots and indigenous Australians enforced semicastration about the age of eight or nine. The Skoptzies, religious castrators in Russia, are possibly the most famous of the people of this description. The Russian government has condemned members of this heresy to hard labor in Siberia, but has been unable to extinguish the sect. Pelikan, Privy Counsel of the government, has exhaustively considered this subject. Articles have appeared in Le Progres Medical, December. 1876. and there is an account in the St. Louis Clinical Record, 1877-78. The name Skoptzy means "the castrated," and they call themselves the "White Doves." They arose about 1757 from the Khlish or flagellants. Paul I caused Sseliwanow, the true founder, to return from Siberia, and after seeing him had him confined in an insane asylum. After an interview, Alexander I transferred him to a hospital. Later the Councillor of State, Jelansky, converted by Sseliwanow, set the man free and soon the Skoptzies were all through Russia and even at the Court. The principal argument of these people is the nonconformity of orthodox believers, especially the priests, to the doctrines professed, and they contrast the lax morals of these persons with the chaste lives, the abstinence from liquor, and the continual fasts of the "White Doves." For the purpose of convincing novices of the Scriptural foundation of their rites and belief they are referred to Matthew xix., 12: "and there be eunuchs which have made themselves for the kingdom of Heaven's sake," etc.; and Mark ix., 43-47; Luke xxiii., 29: "blessed are the barren," etc., and others of this nature. As to the operation itself, pain is represented as voluntary martyrdom, and persecution as the struggle of the spirit of darkness with that of light. They got persons to join the order by monetary offers. Another method was to take into service young boys, who soon became lost to society, and lied with effrontery and obstinacy. They had secret methods of communicating with one another, and exhibited a passion for riches, a fact that possibly accounts for their extended influence. The most perfect were those "worthy of mounting the white horse," the "bearers of the Imperial seal," who were deprived of the testicles, penis, and scrotum. The operation of castration among these people was performed at one stroke or at two different times, in the former case one cicatrix being left, and in the latter two. The greater number--those who had submitted to the "first purification," conferring upon them the "lesser seal"--had lost testicles and scrotum. These people are said to have lost the "keys of hell," but to retain the "key of the abyss" (female genitals). As instruments of excision the hot iron, pieces of glass, old wire, sharpened bone, and old razors are used. Only nine fatal cases resulting from the operation are known. At St. Petersburg Liprandi knew a rich Skoptzy who constantly kept girls--mostly Germans--for his own gratification, soon after having entered into the "first purification." Few of them were able to remain with him over a year, and they always returned to their homes with health irretrievably lost. Women members of the order do not have their ovaries removed, but mutilation is practiced upon the external genitals, the mammae, and nipples. The first ablation is obtained by applying fire or caustics to the nipples, the second by amputation of the breasts, one or both, the third by diverse gashes, chiefly across the breast, and the fourth by resection of the nymphae or of the nymphae and clitoris, and the superior major labia, the cicatrices of which would deform the vulva. Figure 232 represents the appearance of the external genital organs of a male Skoptzy after mutilation; Figure 233 those of a female. Battey speaks of Skoptzies in Roumania who numbered at the time of report 533 persons. They came from Russia and practiced the same ceremonies as the heretics there.