ARMY MEDICAL LIBRARY WASHINGTON Founded 1836 Section. Number......^.#.P._3. Fobm 113c, W. D.. S. G. O. (Revised June 13, 1936) DUE TWO WEEKS FhOM LAST :ATE tissue ; the peduncle was firmer and not discolored, and the surface was every where smooth except where torn. 1839. Another case of polypus will be hereafter reported, in con- nection with a case of ruptured uterus. 655. Uterine polypus, of a regular, pedunculated form, one inch and a half in length, somewhat fissured upon the surface, and of a dense, white structure. Removed by an operation. The patient had at the time an infant fourteen months old, and had been subject for five years to what she regarded as prolapsus uteri. Did well during her pregnancy and confinement, and continued pretty well until the spring of 1841, when she flowed almost constantly ; from this, however, she was at last relieved. Had also about the same time severe bearing-down pains, and, as she thought, a protrusion of the os uteri exter- nally ; an examination was then made by Dr. John Ware, her attending physician, and the polypus was discovered. In August it was removed by Dr. George Hayward, with the scissors. Very little blood was lost during the operation, but, five or six hours afterwards, on the patient's rising from her bed, profuse haemorrhage took place; this, however, was soon checked, and she has had no further trouble since. Dec. 1842. 656. Prolapsus uteri. The pelvic organs have been removed entire, and the preparation shows a complete prolapsus, the appear- ances, both externally and within the pelvis, being most accu- rately represented in Cruveilhier's figure of a similar case (Liv. xvi. pi. 5); the uterus could very easily be pushed back, and then had the same constricted appearance which is shown in one of the figures. The patient, an octogenarian, died of meningeal apoplexy, under the care of Dr. William P. Dexter, and the date of the prolapsus is unknown. 1844. 208 FEMALE ORGANS OF GENERATION. 657. Fibrous tumors of the uterus. They are so developed throughout its substance that the whole mass appears of a rounded form, and nearly as large as a child's head. The cavity of the uterus is much elongated, and the muscular and vascular structure are developed as in gestation; the enlarge- ment of the blood-vessels is particularly well shown, as the specimen was taken from a dissecting-room subject which had been injected. 658. Several fibrous tumors, more or less pedunculated, and hang- ing, as it were, from the peritoneal surface; the largest, about the size of an orange, has been cut open, and is a very fine specimen of the fibro-cellular structure. The uterus itself is very little enlarged. 659. Portion of a large fibrous tumor of the uterus, in a state of inflammation or disorganization, from a woman who died after an abortion at the seventh month of gestation. The patient was twenty-eight years of age, and had been married for two years. Was first seen by her physician, Dr. M. S. Perry, November 14th, 1838. Reported then as follows:—Health always good, except for dysmenorrhoea, until seven months since, when she became pregnant with her first child. From that time until August she had much vomiting, with pain in the right side of the abdomen; then an attack of dysentery, which lasted for two or three weeks, followed by increased pain in the side, with tenderness on pressure, indigestion, diarrhoea most of the time, nervous symptoms, and prostration of strength which confined her to the room. When seen on the 14th, she was uncommonly large for the seventh month; tenderness ex- treme on right side ; countenance bad; pulse quick and feeble, and skin dry; diarrhoea continued, and, on walking, she suf- fered from bearing down, and from dyspnoea. The pain was relieved by external applications, but the other symptoms con- tinued the same, and on the 26th of the same month she abor- ted. After the placenta came away, a circumscribed tumor was found in the right side of the abdomen, extending from the crest of the ilium to the ribs, and forwards as far as the umbilicus. For the first two days she was very comfortable; on the third there was some appearance of milk, but the lochia FEMALE ORGANS OF GENERATION. 209 diminished and there was considerable heat of the skin; on the fourth day diarrhoea, with some tenderness of the abdomen and meteorism, and in the night delirium. From this time she gradually sank, and died on the eleventh day, with symptoms, as it was supposed, of peritonitis. On dissection, the peritoneum was found healthy, but the inner surface of the uterus was inflamed, as shown by redness, and an extensive deposit of recent, opaque, whitish lymph. The tumor arose from the right side of the fundus by a small pedicle of uterine tissue, was situated in front of the ascending colon, and connected posteriorly with the neighboring parts by old adhesions; it was about six inches in diameter, and une- qually firm, feeling boggy in some parts, and in some encysted. On incision, it was found to consist mainly of the usual fibro- cellular structure, but much broken down, and containing throughout its substance numerous, very irregular cavities, in which was a thin serous fluid such as is often discharged from a scrofulous abscess, the parietes being whitish, opaque, soft, and of a very loose texture. The cavities were not large, and some of them appeared, to use a comparison of Cruveilhier's, like little geodes in the midst of the sound structure. Immedi- ately in the neighborhood of one of the largest cavities the fibrous structure was infiltrated to a considerable extent with an opaque, yellowish lymph, as if preparatory to breaking down, but there was nowhere in the tumor any redness, nor any well formed pus. This change in the fibrous tumor is figured by Cruveilhier. (Liv. xxiii. pi. 6.) As the result of pregnancy, however, it has been particularly described by Dr. Ashwell (Guy's Hospi- tal Reports, No. II.); he thinks that it takes place during the latter months, and that, being highly dangerous to life, prema- ture labor should be induced, but, in the above case, the disease was already quite advanced at the seventh month, and had probably been going on for some time, and in Dr. A.'s first case, in which, judging from his figure, the disease must have been still more extensive, the patient was only advancing towards the sixth month; the change may, perhaps, then, begin in the early months of gestation. It may be remarked that the above case differs from those observed by Dr. A., inasmuch as he found the uterus healthy or very nearly so, and he 27 210 FEMALE ORGANS OF GENERATION. remarks that it has been found so in the majority of cases. 660. A single, rounded tumor, four inches and a half in diameter, and developed entirely in the posterior parietes of the uterus. The structure was very peculiar, being neither fibrous nor cel- lular, but rather resembling in appearance and consistence the fibrinous deposit from the blood, the whole being rather moist, and of a dull, pale red color, as if stained by blood. One regular cavity is seen, about two-thirds of an inch in diameter, quite smooth inside, and partly filled, when recent, with a thick, pasty, reddish substance; cut surface generally rough, with many small holes and fissures, and in one place the tumor had the thin, white, parchment-like envelope, which is sometimes met with in these cases. This was regarded as a fibrous tumor in a state of degeneration. The uterus and tumor, together, in this case, weighed three pounds, and formed a regular, rounded mass, which seemed to fluctuate before being opened. The cavity of the uterus is enlarged, and contained a bloody mucus, and the muscular and vascular structures are seen to be very strongly developed; cervix not involved. Ovaries small, and adhere to the tumor. From a patient of Dr. John Jeffries; an unmarried lady, aged forty-four years, and who died of acute dysentery. Tumor had existed for at least five or six years, the abdomen being quite prominent; never interfered with the pelvic organs, the menstruation being regular, although the general health had rather declined. 1840. 661. Ossification of several fibrous tumors; they hang off from the peritoneal surface, and one of them, which is about the size of a hen's egg, has been sawed open. The organ itself is almost buried by them, but seems otherwise not much affected. From a woman, seventy years of age. 662. Ossified tumors dissected out from the uterus, and dried. One of them, which is about an inch in diameter, hung from the fundus, and was covered only by the peritoneum; the other, about half as large, was imbedded in the substance of the organ. FEMALE ORGANS OF GENERATION. 211 663. Corroding ulcer of the uterus. The os tincae, cervix, and a great part of the body of the organ are entirely destroyed, and the ulceration has proceeded far down the vagina, but the sur- rounding parts are neither indurated nor thickened; ulceration well defined, but not deep. The disease is complicated with several simple, fibrous tumors, which are seen attached to the fundus of the uterus, one of which is cut open to show its structure, and being nearly as large as the fist, had formed a tumor which was felt for some months before death. The other organs of the abdomen and thorax were healthy. From a patient of Dr. D. H. Storer; she was a married woman, forty-nine years of age, but had not lived with her husband for some time, having once received the venereal disease from him; never had children. The uterine symptoms had existed for more than a year; pain very severe; discharge from vagina, which, towards the last, was excessively foetid, but never any haemorrhage; became sallow, very much emaciated, and died worn out by her extreme sufferings. 1835. 664. Greater part of the uterus destroyed by cancerous disease. The patient was about sixty years of age, had had symp- toms of pelvic disease for about eight years, and for the last six months incontinence of urine. 665. Extensive, old adhesions about the appendages of the uterus, obliteration of the extremities of the tubes, and an encysted state of the left ovary; from a woman who had been a prostitute for two years and a half or more. The uterus appears healthy. 1838. 666. Dropsy of the Fallopian tube. The serum having been forced out, the tube has been distended and dried. 1840. 667. Cholesterine from the Fallopian tube. From a patient of Dr. Charles E. Ware ; died in February, 1846, of encephaloid disease of the stomach, the other organs being sufficiently well, except for two biliary calculi in the gall-bladder. The extrem- ity of the right Fallopian tube was dilated into a cavity about the size of a filbert, and was filled with the cholesterine, which appeared in the form of yellowish white, dryish, closely packed FEMALE ORGANS OF GENERATION. scales, having a beautiful pearly lustre, easily rubbed down, and shown to be greasy when heated upon paper before the fire; this was a shut cavity, and was lined by mucous mem- brane. The rest of the tube, having been cut open, was found to be coated with a thin layer of the same deposit, so as to resemble the inside of an oyster shell; this was very readily rubbed off, and then the mucous membrane presented its usual appearance. On examination under the microscope, by Dr. John Bacon, Jr., the deposit presented the appearance of rhomboidal scales, and exhibited colors with the polarizing attachment; a portion of it was afterwards prepared by Dr. M. Gay, and resulted in a delicate white substance, which, being again ex- amined by Dr. B., gave very perfect crystals, and much more brilliant colors than the crude mass. A quantity of the pre- pared cholesterine is preserved in a phial, and some upon a watch-glass. Since the occurrence of this case cholesterine has been shown to the Society, taken, in one instance, from the fluid of a hydrocele, and in another, from the substance of the kidney. 668. Fallopian tube distended by tuberculous matter. The inner surface of the uterus was similarly diseased. From a case of phthisis. May, 1844. n. Vagina and External Organs. 669. The opening from the vagina into the vulva traversed by a firm, fleshy band, so as to be equally divided upon the median line; from a new born child, and otherwise well formed. Dr. Charles G. Putnam. 670. The bowls of two large tea-spoons, with a small portion of the handle, a broad, gold finger-ring, and two pieces of crockery ware. Removed by Dr. S., with a pair of dressing forceps, from the vagina of a patient at the Lunatic Asylum, South Boston; they had probably been there for about four months, and had caused great irritation. February, 1844. Dr. Charles H. Stedman. 671. Several pieces of thick, white, dense, fibrous membrane, four FEMALE ORGANS OF GENERATION. 213 or five inches in length, and which were reported by a patient, who had suffered from dysmenorrhoea, to have been dis- charged from the vagina. In the same jar there have been placed some strips of ligamentum nuchae, and it is evident that they are the same substance. The patient was quite a respectable woman, and the physician, who brought the speci- mens to the city, for a consultation upon the case, seemed to be a man of intelligence, but would not listen to the idea of imposture; about a year afterwards he was again in the city, and was as firm in his belief as before, the membrane, as he said, being still occasionally discharged. 672. A large, warty tumor, removed from the labia. Weighed one pound and a quarter, when recent, is imperfectly lobulated, generally quite dark on the surface, but in one or two places has a smooth, white cicatrized appearance; consistence fleshy, and, in structure, appears as if it might be allied to elephanti- asis. One very distinct lobe, which is about the size of a fig, arose from one of the internal labia, and almost the whole of the remaining mass was a growth from the one upon the other side. It was removed by Dr. William J. Walker, with a por- tion of the clitoris, but the disease returned not long afterwards; haemorrhage moderate during the operation. The patient was an unmarried, respectable female, thirty-three years of age, and was under the care of Dr. George Bartlett; the disease had been forming for about fifteen years, and troubled her only by bulk and weight of the mass. 1839. 673. A second specimen, similar to the last; removed by an opera- tion. The tumor is nearly as large as the two fists, and very firm to the feel; warty appearance strongly marked, deeply lobulated, and surface dark, with one smooth, whitish cicatrix as in the other specimen. The patient was a black girl, of bad habits. Dr. S. D. Townsend. 674. A tumor, which was removed by ligature from one of the labia; attached by a small pedicle, but resembled pretty nearly the last two specimens. It was nearly three inches in length, of a flattened, oval form, dark colored, wrinkled rather than warty upon the surface, quite flaccid to the feel, and, being cut 214 FEMALE ORGANS OF GENERATION. through on one side, appeared to consist of a simple, lax, cel- lular tissue. The patient was a married lady, thirty-seven years of age; the tumor had been forming for about two years, and appeared at first as a small wart; caused no trouble ex- cept from its weight, being six inches in length before removal, and filling with fluid when she was in the erect position. 1842. Dr. John Homans. 675. Foul ulceration of the whole inner surface of the vagina, but without any appearance of malignant deposit. An opening into the rectum is seen, nearly two inches in length, and another was about forming into the bladder. The uterus was rather small, with corroding ulceration of the os tincae, and acute inflammation of the inner surface; this organ and the vagina are shown, cut open. From an Alms-house patient; she was sixty years of age, had been long subject to uterine haemorrhage, and for the last five years to discharge from the vagina, which was sometimes foetid and sanious; towards the last her sufferings were very great, and for some weeks before death a free communication existed between the rectum and bladder. The case had been regarded as one of cancer of the womb. 1834. Dr. J. W. McKean. in. Ovaries. 676. Cretaceous deposit upon the surface of the ovary. It appears in the form of an opaque, white crust, with some small grains, and is scattered over the surface to which they adhere. From a middle-aged woman, who had been married for several years, but had never been pregnant, there being some old adhesions about the ovaries, with an obliteration of the extremity of one of the Fallopian tubes; the peritoneum, otherwise, was healthy. In the preparation, the great mass of the ovary has been dis- sected away, and the portion of the surface upon which the deposit is formed, has been spread upon a black board and dried. This specimen having been very fully examined by Dr. John Bacon, Jr., it appears that the deposit consists of the phosphate of lime, with animal matter, there being no trace of the triple phosphate; under the microscope, it has a waxy lustre, and the surface is mamillated, but there is no crystalline appearance. 1847. Dr. J. B. S. Jackson. FEMALE ORGANS OF GENERATION. 215 677. Encysted disease of the ovary. The tumor is about half as large again as a man's head. Cysts distended and dried, with the uterus attached. Dr. S. D. Townsend. 678. Encysted ovary; about the size of a hen's egg. Hair is seen, which was contained in the cysts, and mixed, as usual, with fatty matter. The patient died of phthisis. Dr. J. W. McKean. 679. Encysted disease of the ovary, with a considerable quantity of hair attached to the interior, as represented by Cruveilhier (Liv. xviii.) The mass was large enough to fill the cavity of the pelvis, and was formed mainly by a single cyst, which was filled with clear serum. The hair was contained in a separate cyst, with fatty matter, and the surface from which it grew consisted apparently of well formed cutis and cuticle, the pores being as distinct as upon any part of the scalp; some of the hairs were free, and without any appearance of a bulb. There are also two small pieces of bone in the parietes of the cyst. A dry specimen. From a patient of Dr. J. M. Whittemore, of Brighton; a lady, twenty-one years of age, who died of inflammation of the articulations of the pelvis, with phlebitis, after her first confinement, having previously enjoyed full health. 1837. 680. Hair from an ovarian cyst; mostly free in the fatty matter, but some was found growing from the interior of the cyst. From a dissecting-room subject. 681. Another specimen, a small portion of the dried cyst having been preserved, with some of the hair attached. The patient, an unmarried woman, thirty-five years of age, had an ovarian tumor of immense size, which had been forming for about seventeen years. The contents of the cysts were various, and in one of them, which was about the size of an orange, was found the hair. 1838. 682. Diseased ovary, from a cancerous subject. It is of a regular, flattened, oval form, six and a half inches in length, and, on incision, after having been in spirit for several years, appears FEMALE ORGANS OF GENERATION. to consist of an uniform, whitish, condensed, cellular tissue, with scarcely any fibrous structure. The uterus is seen attached, and is healthy. As there was cancer of the bones in this case (Nos. 97 and 219), and of the breast (No. 685), it was thought that the disease of the ovary might be of the same nature, but this is doubtful. Dr. S. D. Townsend. 683. Diseased ovary, from a patient of Dr. Charles G. Putnam; a little girl, six years of age, who died of very extensive malig- nant disease of the abdomen. (No. 509.) Both of the organs were greatly enlarged, of a regular, oval form, very soft, and of rather a bright red color externally. That on the right side formed a tumor which was felt three months before death, and measured five and a half inches in length ; on incision, it was found to consist of a coarse, cellular tissue, abundantly infil- trated with serum, and containing some whitish, carcinomatous deposit. The left ovary, which is the one preserved, measured three inches and a half in length, and resembled the other in structure, except that it contained much effused coagulated blood. The Fallopian tube is seen to be thickened, and much elongated by the growth of the ovary, as the neck of the womb sometimes is in case of disease or displacement of that organ. 1840. 684. Both of the ovaries preserved in connection with the uterus. They are about the size of a large orange, of a rounded form, irregular or knobbed on the surface, and solid to the feel. One of them having been cut open, was found to consist of very fine cells, filled with a clear, yellow serum, but without any appearance of distinct cysts, and without carcinomatous deposit or effused blood. The uterus is healthy. The patient was an unmarried female, forty-one years of age, and died at the Mass. Gen. Hospital, of scirrhous stomach (No. 483), with ascites, and a granulated disease of the peritoneum. April, 1832. iv. Breast. 685. Cancer of the breast. The bones were extensively diseased, and one of the ovaries. (No. 682.) Dr. S. D. Townsend. (217) XI. MALE ORGANS OF GENERATION. i. Testicle. 686. Absence of the testicle. The vas deferens, which has been preserved, is of the usual size and pervious, and terminates rather bluntly in a sort of convolution, in the inguinal canal; artery and veins of full size. There was no appearance of a cicatrix, and Dr. C. could not learn from the family that the testicle had ever been removed. Upon the opposite side there was a hydrocele, with slight enlargement of the organ. From a patient of Dr. Henry G. Clark; a man, fifty-five years of age, who died from poisoning by arsenic. 1841. 687. A loose body from the cavity of the tunica vaginalis ; it con- sists of a hard, ossific mass, covered by a thin layer of carti- lage, and is about the size of a pea. From a dissecting-room subject. The testicle and serous membrane were healthy, except that from the last there hung off a slender mass of half organized lymph about a quarter of an inch in length. Dr. Henry J. Bigelow. 688. Several fragments of ossific matter, from the testicle of an old negro, the organ being about three times its usual size. 1834. Dr. Francis W. Cragin, of Surinam. 689. Ossific deposit, about an inch in length, in the substance of the testicle; organ otherwise healthy, although there is seen to have been an universal old adhesion of the tunica vaginalis. From a patient of Dr. A. A. Gould; an old syphilitic case; from the same subject as No. 96. The testicle has been cut open. 690. Scrofulous disease of the testicle; the organ is about twice its usual size, and is converted into a solid, yellowish, curdy sub- stance. Cord healthy. Dr. S. D. Townsend. 691. A second specimen; not cut open. Dr. S. D. Townsend. 28 218 MALE ORGANS OF GENERATION. 692. Fungous disease of the testicle. The organ is considerably enlarged, and presents through the scrotum an extensive, raised, foul, shreddy, ulcerated surface. It was removed at the Alms-house, and the patient did well. Dr. Winslow Lewis. 693. Cancerous disease of the testicle; removed by Dr. Charles T. Jackson, from a patient of Dr. A. A. Gould. The organ was about the size of a large orange, and consisted mainly of a substance like half-organized lymph; the upper portion was semitransparent and indurated, but posteriorly it was soft, and highly vascular. Cord quite healthy. The patient was a laboring man, twenty-five years of age, and had had pain and swelling of the organ for six months, caused by an injury which he received when lifting a barrel of apples. Died about a year after the operation from a return of the disease. 694. Disease of the testicle. The specimen was brought to the Society with the following history, by Dr. Benjamin Cushing, a nephew of Dr. Thaxter, in whose practice the case occurred. The patient, a stout, healthy child, was first seen by Dr. T. in September, 1843; the left testicle was then about the size of a hen's egg, and there was considerable external redness, the disease having been discovered about a fortnight before. Leeches and a saturnine lotion were used without effect, the tumor increased in size, and in November the patient was carried to the Mass. Gen. Hospital for further advice; an ex- ploring needle was passed in, but blood only was discharged; the question then was whether the case was one of hemato- cele or malignant disease, and it was proposed to make an incision, but to this the child's mother would not consent. From this time until the following September the patient was under the care of different practitioners, but was often visited by Dr. C.; the tumor gradually increased in size, until it measured about seven inches in length, and five inches from before backwards, pressing up firmly against the abdomen, and so far involving the penis that the situation of this organ was only indicated by a fold in the skin. About the first of Sep- tember Dr. T. was again called; the surface of the tumor had recently given way, and the integument was destroyed to the MALE ORGANS OF GENERATION. 219 extent of about three inches; haemorrhage had already once or twice occurred, and the blood was issuing in a jet, the tumor, meanwhile, having considerably diminished in size. From this time the bleeding frequently recurred, and the child died, ex- hausted, about the last of September, 1844, aged five years and eleven months. Had no pain in the testicle, nor was his general health affected until towards the last, when he became much emaciated. The testicle is of a regular, oval form, and about as large as the double fist. Being cut through, the body of the organ measures, after having been in spirit, four and a half by two inches; the color is whitish, the consistence fleshy, and the structure close and compact, the appearance throughout being perfectly uniform, except for two or three cavities, half an inch or more in diameter, these last being perfectly defined, smooth and polished upon the inner surface, and, when recent, filled with clear serum. The epididymis is proportionably enlarged, of a purplish color when recent, and now darker than the body of the organ, the limits between the two being well marked. In no part of the mass is there to be seen any trace of the original structure, nor any appearance of malignant disease; the ulcerated surface is covered with a blackish crust, the remains probably of the blood which was discharged during life. The cord is healthy, as was the other testicle, and, so far as seen, the organs of the abdomen. Dr. Robert Thaxter, of Dorchester. \ 695. Encephaloid disease of the testicle, removed by an operation. The patient was a healthy-looking infant, seventeen months old, and the disease was first observed at the age of six months. The organ is about as large as that of an adult, and the body of the gland is completely disorganized, presenting as perfect a specimen of the disease as would ever be seen in an older subject. October, 1846. Dr. Winslow Lewis. ii. Prostate Gland. 696. Lateral lobes of the prostate gland much enlarged, and, as is often the case, the left more than the right; no appearance of a middle lobe. Bladder sacculated. The patient, a healthy- 220 MALE ORGANS OF GENERATION. looking farmer, over seventy years of age, died of disease of the heart, having had dysuria for some years, though not severely. 697. Lateral lobes of the prostate enlarged, but much less so than in the last specimen; middle lobe also enlarged. Bladder sacculated. 698. Enlargement of the lateral and third lobes of the prostate gland; bladder thickened and sacculated. The patient was about sixty-five years of age, and had suffered much from the disease for several years. 1841. Dr. George C. Shattuck. 699. Portion of a prostate gland, showing calculi in situ, many others having been removed. (No. 700.) From a patient of Dr. George C. Shattuck, a gentleman, sixty-five years of age, who had been long subject to dysuria, and died at last from disease of the heart. The ducts of the gland are much en- larged, and crowded with calculi, the substance, also, seeming to be filled with fine particles of the same. 1838. 700. A collection of prostatic calculi from the above case. (No. 699.) They are well characterized, and, having been analyzed by Dr. Charles T. Jackson, were found to contain 64 per cent, of the phosphate of lime, 8 per cent, of the carbonate of lime, and 28 per cent, of xanthic oxide, five grains being the amount that was used. Treated with nitric acid and warmed, a fine lemon-colored solution was rapidly effected, with a disengage- ment of gas, and, when the solution was saturated with liquid ammonia, a fine orpiment yellow precipitate was formed, which was the xanthic oxide mixed with phosphate of lime. 1838. in. Penis. 701. Penis injected and the bladder distended and dried. 702. Corpora cavernosa inflated, dried, and cut open. 703. Penis of a negro, showing an entire absence of the fraenum, as UTERO-GESTATION. 221 seen in the Chimpanse, and without any appearance of its having been destroyed by disease. 1842. Dr. Samuel Parkman. 704. Hypospadias, the urethra terminating beneath the glans penis; from an adult. 705. Venereal warts. The prepuce is much enlarged, and its inner surface nearly covered with the excrescences, the glans itself being healthy. The patient, a young negro, entered the Marine Hospital at Chelsea, in consequence of a severe haemor- rhage from the diseased surface; there was complete phymosis, with several fistulous openings through the prepuce. The patient would not consent to the usual operation, but insisted upon amputation of the organ, which was at last performed. Dr. Charles H Stedman. 706. A very highly finished pencil drawing of the appearances in the last case before the operation ; by Dr. J. Francis Tuckerman. 707. " Penis and scrotum of a subject who was syphilitic for many years before death, but had recovered with the loss of a great portion of the penis; a bougie is in the urethra." Dr. S. D. Townsend. 708. Cancer of the prepuce, the glans being apparently healthy; amputation was performed, but the disease afterwards returned, and proved fatal. Dr. Abel L. Peirson, of Salem. XII. UTERO-GESTATION. i. Parts belonging to the Mother. 709. Uterus at a very early period of impregnation; from a patient of the late Dr. Charles T. Hildreth. Twenty-seven days before her death, the subject of this case passed the evening 222 UTERO-GESTATION. with a man, from whom she had been receiving attentions, and it was ascertained that they had not been alone together for a considerable time before nor after that date. Had not menstruated for six weeks, and on this account, according to her statement, she took half an ounce of the oil of tansy; violent spasms ensued, and she died in rather less than two hours. A full account of the case and of the symptoms which were produced by the poison, were published in the Boston Medical Magazine for November, 1834. The uterus was carefully examined twelve hours after death, and the following appearances were noted: — Length of the organ four inches. Fundus and body doughy to the feel, the first being of a dark red color. Os tincae quite prominent, thick, and fleshy, and upon the inner surface red, as from mechanical irritation. A crucial incision having been made through the anterior face, the cavity of the organ was fully exposed, the parietes being not much thicker than in the unim- pregnated state. The inner surface of the body and fundus, to the depth of two or three lines, had a somewhat fibrous appearance, but was exceedingly soft, and almost pulpy; the line of demarcation between this and the firmer substance beneath being sufficiently defined, although the two could not be separated like two distinct textures; towards the fundus this surface was of a reddish color, but generally it was whitish, though not opaque. Near the centre of the fundus there was a rounded cyst, of a dark reddish color, and about half an inch in diameter. On cutting this open, an ovum soon made its escape, seeming to have little or no connection with its interior. Within the chorion the amnion was seen as a very delicate cyst, and about the size of a robin-shot, and still within this there were distinctly seen the rudiments of the embryo. The cyst which contained the ovum was closely connected with the inner surface of the uterus, although quite different from it in texture, being thin, moderately firm, and upon its inner surface smooth and polished, though rather irregular. Cervix not much changed, and its cavity not closed, except by viscid mucus; the openings into the Fallopian tubes appeared also to be free. The left ovary contained a corpus luteum, about the size of a marble, the yellow portion being more than a line in thickness, and the cavity being filled with coagulated blood. In the UTERO-GESTATION. 223 preparation, the ovum is seen floating at the bottom of the jar, and the structure of the cyst at the fundus of the uterus, and of the softened inner surface of the fundus and body is satis- factorily shown. The softened inner surface of the uterus above described was undoubtedly the decidua vera, and the case is interesting inasmuch as the view which was taken of it at the time was in accordance with what has since become an established fact in science. The decidua has generally been considered as an adventitious membrane thrown out upon the inner surface of the organ, and of which the organization is, to say the least, very questionable; and it was only in the year 1834, the very year when the above case occurred, that Weber promulgated what is probably the true doctrine in regard to this subject, as appears in Miiller's Physiology. When the above case was published, the question was asked, in regard to the softened tissue, " was this the decidua ? or is it the internal surface of the womb in a softened state ?" We did not dare to express our conviction that it was the latter, as it was so opposed to the doctrines of the day, but, in the notes of the case, which were taken at the time, after a description of the tissue in question, it is distinctly stated that there is " no appearance of anything like decidua." 710. Uterus of a woman who died about the third month of preg- nancy, from excessive vomiting. The organ is partially laid open by a crucial incision, and shows the two portions of "the decidua and the chorion; the corpus luteum is also seen in the left ovary. From a patient of Dr. John Ware. 711. Tubular pregnancy. The uterus measured three inches and one-fourth in length, and was changed in structure as usual in gestation; inner surface softened, but without any well marked decidua. The outer half of the right Fallopian tube was enlarged to about the size of the last joint of the thumb, and, having been cut open, the membranes of the ovum are shown, with a well developed foetus, three-fourths of an inch in length. The lady from whom this specimen was taken, was a patient of Dr. John D. Fisher; eighteen years of age, and had been 224 UTERO-GESTATION. married only ten weeks. The catamenia appeared on the day of her marriage; at the end of three weeks it appeared again, as she thought, and in two weeks more it appeared for the third time; discharge unusually profuse, of a bright red color, and continued for a week without much intermission. After the last period it frequently recurred, and, on any considerable exertion, became so profuse as to cause faintness. On the morning of the last day she was unusually cheerful, and had been exercising freely, so as to become somewhat fatigued. At 11 o'clock, A. M. profuse flooding came on, and she be- came excessively faint; at one o'clock Dr. F. found her with symptoms of complete collapse, as from haemorrhage; under the use of stimulants she revived somewhat, but remained in a fluctuating state until nine in the evening, when re-action became pretty fully established; soon after this she fell asleep, and slept until about half past three, when she awoke quite faint, and so continued until seven in the morning, when she died, twenty hours from the time of the attack. There had been slight pain with tenderness just above the right groin, a sense of fulness in the abdomen, and an unusual degree of fulness over the lower part, on examination by the hand. On dissection, there were found three quarts or more of blood in the peritoneal cavity, the right Fallopian tube having ruptured at the point which is marked in the preparation by a reddish brown coagulum. In several other cases of tubular pregnancy which have occurred in this city, there has been observed a tendency to haemorrhage, as in the above case, though not to the same degree, the patient generally regarding the discharge as an irregular flow of the catamenia, and as an evidence that preg- nancy did not exist. 712. Oviduct of a domestic fowl, distended near its upper extrem- ity by the materials of several eggs, which had been arrested in their progress downwards, and form a rounded tumor as large as the fist, and consisting of a solid, opaque, albuminous- looking substance. The organ itself has been preserved throughout its entire length, and appears healthy. One or two other specimens have been shown to the Society, and a similar one is described in the Catalogue of the Hunterian Museum, (Part I. 970.) Dr. J. B. S. Jackson. UTERO-GESTATION. 225 713. A transverse section of the ovary of a Striped Basse (Labrax lineatus), distended by ova, which have been formed upon the inner surface during successive years, three or four distinct, concentric layers being now seen. The section measures about three inches in diameter, the whole mass is quite solid, and the enveloping cyst, or ovary, seems not to be thickened. Dr. D. H. Storer. 714. Extra-uterine foetation; foetus removed through the anterior parietes of the abdomen by Dr. Nathaniel Miller, of Franklin, and presented by him to the Society, May 10th, 1841, with the following history of the case: — The patient was a married woman, thirty-four years of age. Pregnancy occurred about seven years since, but nothing remarkable occurred until she arrived at the full period, when the motions of the child became very active, and continued so for about a month; they then ceased altogether, and she felt a dead weight, becoming also, as she said, thinner about the waist; the lochia came on, and continued for about a week, and for a time there was a flow of milk. From that time she kept about her house, her health being sufficiently good; was perfectly sensible of the presence of the foetus, and imagined that she could feel the bones. In about six months she again became pregnant, and, to sum up the case in a few words, she has borne, during the last seven years, three living children, and carried them to the full period, having had one previously. In December, 1840, she consulted Dr. M. with regard to an operation; for about six weeks there had been considerable pain and tenderness in the abdomen, with loss of appetite and flesh; a very hard tumor was found about the middle of the abdomen, perhaps rather more to the right side, but the parts of the foetus could not be felt. Dr. M. thought the expediency of an operation doubtful, and saw her again in about a fortnight, when she had altered decidedly for the worse. About the first of January the operation was per- formed. A small incision having been made below the umbil- icus, the tumor was punctured with a trocar, and, when the opening was sufficiently enlarged, the foetus appeared, lying coiled up in the most compact form ; the upper extremity pre- sented, but one foot was seized, and by this it was extracted. Something was found which looked like a cord, but nothing 29 226 UTERO-GESTATION. like a placenta. The foetus weighed four pounds and a half after the extraction, and appeared fresh, excepting one foot, which was somewhat decomposed; some of the other small bones of the hands and feet, and some of the cranial bones are seen in the specimen to be more or less denuded, but this, Dr. M. thinks, is owing to decomposition since the removal. On the day after the operation, Dr. M. found some traces of fcecal matter about the wound, and these continued unequivo- cally to be seen so long as she lived; death occurred in about a month, and it was supposed that a communication had formed before the operation between the intestine and the sac which contained the foetus. Body not examined. 715. Bones of an extra-uterine foetus, removed from the bladder, by the operation of lithotomy, by the late Dr. Joseph Bossuet, of this city, the following history of the case having been pub- lished by Dr. B. in the sixth volume of the New England Journ. of Med. and Surg.: — In the month of October, 1807, Mrs. C, of Braintree, be- came pregnant, and from that time suffered very great distress, with pains shooting from the hypogastric to the epigastric regions, until the latter part of the following spring, when the signs of labor came on; as the child could not be felt, large doses of opium were given, and in the course of a fortnight the pains abated. For two months afterwards she was much troubled by a disagreeable " drawing" sensation, and the abdo- men was greatly enlarged, but this, after some time, gradually subsided. During the next three years there was not much distress, but, at the end of that time, she began to have very acute pains, with profuse evacuations by the urethra, of a matter, which was sometimes yellow, sometimes bloody, and very foetid, some very small bones being voided at the same time. A communication also took place between the rectum and bladder, so that the urine and faeces would pass either way. During the five years preceding Dr. B.'s first visit to her, the patient suffered excruciating pain, day and night. On the 20th of May, 1816, he was called, and, having ascertained the nature of the case, advised an operation, which, on the 17th of June, was performed, one hundred and forty-six bones of a UTERO-GESTATION. 227 seven months foetus being removed, together with a stone about the size of an olive. Dr. B.'s report of the case was dated March 24th, 1817, at which time the patient had fully regained her health, and was quite free from pain, the communication between the rectum and bladder, however, not being wholly obliterated. The bones were given to Dr. B. by the patient herself, who is now (May, 1841) living in a neighboring town. Since the operation, her general health has continued to be sufficiently good, so that she has attended to her household affairs, although she has never been able to retain her urine. The bones are displayed upon a black board, with the fragments of the cal- culus. Dr. Henry I. Bowditch. 716. An extra-uterine cyst, filled with foetal bones; from a Sheep. A dry specimen. 1842. Dr. J. V. C. Smith. 111. Uterus of a woman who died three days after labor at the full period. Dr. Winslow Lewis. 718. Polypus of the womb; laceration of the organ during a diffi- cult labor; malformation, the cavity of the fundus being divided by a septum. The specimen, being very bulky, has been pre- served in an open jar. From a patient of Dr. George Hayward; a lady, thirty-nine years of age; had had for at least two or three years what she regarded as a prolapsus of the womb, but which was undoubt- edly the polypus, although she had in the meantime borne one if not two children. In March, 1837, labor again came on, and, when Dr. H. saw her, towards evening, the arm was found to protrude; the child was turned about 7 P. M., and the labor soon accomplished, but the woman sank rapidly, and died in about two hours, without any external haemorrhage, although the peritoneal cavity was found, on dissection, to contain a large quantity of blood. Before the delivery a mass was felt in the vagina, which was supposed to be the placenta. On the following day the organs were removed. The poly- pus was of a flattened, pyriform shape, and arose from the posterior parietes of the cervix, leaving about half an inch of the os tincae below it. Before the dissection, it protruded six 228 UTERO-GESTATION. inches, by measurement, from the external organs; after the removal of the parts, the form being, of course, very much altered, it measured six inches in length, four inches and three- fourths in width inferiorly, and two inches and three-fourths at the neck; thickness varied from about one-third of an inch to one inch and three-fourths. The inner surface of the uterus was continued over it to some extent, and, where this was torn, it was shown that the polypus consisted of a coarse, fibrous structure, in the form of irregular bundles, and held together by a loose, cellular tissue; numerous blood-vessels, which could be inflated with the blow pipe, were also seen in the sub- stance, and upon the surface. It formed altogether a relaxed, fleshy mass, and, although described as fibrous, showed no appearances of having originated as a common fibrous tumor; there were, however, four or five small tumors of this nature about the fundus of the organ. The laceration was two inches in length, oblique in its direction, and situated at the posterior part of the cervix, upon the left side; parietes of the organ apparently healthy, except for the polypus. As to the malformation, it did not appear externally, but, within, the cavity of the fundus was found to be divided upon the median line by a septum, which extended downwards three inches, the entire length of the organ being about eleven inches. Cruveilhier figures a case (Liv. iv. pi. 5, fig. 5,) in which the septum extended down to the cervix, but without any appearance of division externally. 719. A very correct, and highly finished colored drawing of a rup- tured uterus. The patient was a healthy Irish woman, twenty- seven years of age, and died in labor with her third child, three hours after the rupture was supposed to have occurred. The uterus itself was eleven inches and a half in length; the laceration was situated in the posterior parietes of the organ, towards the left side, and measured seven inches and a half; peritoneum stripped up extensively. The foetus laid almost entirely in the peritoneal cavity, and the placenta was found near the stomach; there was also much effused blood in the cavity. The case occurred in the practice of Dr. Henry G. Clark, and the drawing was made for him by Mr. H. Billings. 1837. UTERO-GESTATION. 229 720. A separation by sloughing of the whole inner portion of the uterus. The case occurred in the practice of Dr. James M. Whittemore, of Brighton, and the specimen was presented to the Society by Dr. Walter Channing, who gave at the same time a full history of the case. The patient was twenty-five years of age, and was taken in labor with her first child on the 26th of February, 1847. On the 3d of March Dr. C. saw her in consultation. The pains had continued, and she had got but little sleep; abdomen ex- ceedingly hard, and very large, the tumor being divided by a sulcus upon the median line. With great difficulty, from her weight, soreness, and inability to help herself, she was brought to the edge of the bed, and laid upon her left side. Upon examination, it appeared that the foetus was still within the uterus, and in a state of putrefaction, being extremely flaccid, doubled upon itself, presenting by the left side of the trunk, and having in the left side of the chest a large opening, through which the organs of the thorax and abdomen protruded; the organs appeared as a large blackish mass, outside of the ex- ternal organs, and had been down since 4, A. M. A constant discharge of most offensive flatus was passing from her before she was moved, but, during the examination, it came away in volumes. The child was extracted by the feet, and the pla- centa was removed with ease, there having been no haemor- rhage at any time. Alarming collapse followed the delivery, but from this she soon rallied, under the use of stimulants, and was doing well until the 11th of March, when she began to complain of pain in the region of the bladder, and two or three days afterwards something was found to protrude from the vagina, which, in a letter to Dr. C, Dr. Whittemore described as "inflamed, livid, and very offensive;" on the 17th it came away, and, having been sent to Dr. C, it is now in the Society's Cabinet. On examination of this mass it is seen to consist of a nearly perfect sac, its general form resembling that of an uncontracted uterus at the full period of gestation, and its length being about thirteen inches. It is generally from one to two lines in thick- ness, dark colored, and very flaccid, but sufficiently consistent to allow of a full examination, and showing this unequivocal evidence of its being a portion of the uterus itself, that upon 230 UTERO-GESTATION. one of its surfaces are seen the extremities of vessels of con- siderable size. These vessels have all the appearance of ute- rine sinuses, and one of them is traceable to the extent of two inches, and nearly large enough to admit the tip of the little finger. Upon the other surface are several patches of some size of a soft substance, which may have been effused lymph. No appearance of an os tincae. About the close of March, or beginning of April, Dr. C. saw this patient again, and made another examination, but from the extreme soreness of the organs, the prostration, and the unwil- lingness of the patient to submit, the result was unsatisfactory. Posteriorly, the vagina was smooth, and natural to the feel; superiorly, it was entirely closed, so that no portion of the womb could be reached ; anteriorly, a large rough surface was felt, from which the urine was passing in streams, and about which it was depositing an earthy concretion. The parts about the superior commissure, and the urethra seemed to be in a good condition, but the patient would not allow the introduction of a catheter for a full examination of the bladder. On the 25th of June, Dr. Whittemore reported that the patient had gradually recovered her health, and had been, at that period, as well as usual for several weeks, and able to attend to her household affairs. The soreness, however, con- tinued, and the discharge of urine was still involuntary, as it had been from the first, the organs being much excoriated. 721. Corpus luteum, from a woman who died after an abortion at about the fourth month. It is seven lines in diameter, and the yellow portion is from one to two and a half lines in thickness. The cavity is seen to be lined by a firm, smooth cyst, and was filled, when recent, with clear serum. Dr. J. B. S. Jackson. 722. Ossa pubis, showing the relaxation which takes place during gestation; the specimen has been preserved in an open jar, so that it may be removed for examination. From a woman, twenty-eight years of age, who died of meningeal apoplexy at the full period of gestation, and before labor had commenced. Had previously had one child, and for about a month before her confinement, she had suffered from lameness about the UTERO-GESTATION. 231 pelvis, which increased so much for the last eight or ten days, that she was obliged to support herself on going up stairs; recovered perfectly after her confinement, but the same lame- ness was again felt for about a month before her death. The bones could be moved so freely upon each other, after they had been sawed out, as almost to overlap, it being, however, a simple relaxation of the connecting fibro-cellular tissue, and without any redness, oedema, or any other mark of disease. The sacro-iliac synchondroses, also, could be moved very per- ceptibly. A similar relaxation has been observed in several other cases which have occurred here, and not merely towards the close of pregnancy, but, to a certain degree, in the earlier months; the degree, however, varies in different subjects at the same period of gestation. 1839. Dr. J. B. S. Jackson. 723. The pelvis of a Guinea-pig, showing the separation of the bones that takes place so remarkably in this animal during gestation; a dried specimen. The ossa pubis are far apart, and, when recent, the sacro-iliac articulations were much relaxed. The animal died of acute disease some time before the end of gestation. May, 1846. Dr. J. B. S. Jackson. 724. A specimen to show the development of the mammary gland, which takes place during gestation; it very nearly resembles the pancreas, at first sight. 1847. Dr. J. B. S. Jackson. n. Product of Conception. 725-37. Foetuses with the membranes, from the first to the fifth month, the smallest embryo being about the size of a pea. The external development of the foetus, in these specimens, is well shown, and many points in the anatomy of the membranes, both healthy and morbid. An attempt has been made to designate the age of each, but this is only approximative, the history of most of the cases being unknown, and the develop- ment in several of them, having evidently been modified or arrested by disease. Most of the specimens have been cut open, but some of them are entire. 232 UTERO-GESTATION. One only (No. 729) will be especially described, and this more particularly with reference to the uterus, which was also examined. The patient was an unmarried female, who took the oil of Tansy or of Hemlock at about the sixth week of pregnancy, and died in two hours, the case having occurred in the practice of Dr. Charles E. Ware. The uterus was four and a half inches in length, and contained within its cavity about half a drachm of reddish fluid. The decidua vera ex- tended as far as the cervix, but did not close it; the blood- vessels and porous appearance were well marked, and it was evidently, as in No. 709, the inner surface of the organ itself, and not a new formation, the decidua reflexa being directly continuous, though very different in structure. The ovum was about one inch and a half in diameter, and was detached without difficulty, leaving a rough surface, and showing the existence of the decidua upon the corresponding inner surface of the uterus. A large space existed between the amnion and chorion, and was filled with a substance which resembled the vitreous humor of the eye. The umbilical vesicle adhered to the external surface of the amnion, near the root of the cord, and appeared in the form of a very delicate cyst about the size of a pea ; one of its blood-vessels was quite distinct; the duct, however, was not to be seen, but, on a second examination, the specimen having in the mean time been in spirit, there was some appearance of a white line going off from the vesicle. The foetus was about half an inch in length, and developed externally in proportion. The cavity of the corpus luteum contained about half a drachm of serum, and was lined with a soft, flocculent, infiltrated tissue, in which there was some effused blood. In the preparation the umbilical vesicle is shown, with the foetus and membranes. January, 1847. Since the above, the same change has been observed in the inner surface of the uterus in another case, the blood-vessels being in some places of considerable size; the patient died from the effects of long continued vomiting, at about the third month of pregnancy. 738-43. Foetuses without the membranes, from about the age of two and a half to six and a half months. UTERO-GESTATION. 233 744. A foetus affected with kirronosis, as described and figured by Lobstein, (Repertoire general d'Anat. et de Physiol. Vol. I. 1826.) The mother had borne several children, and this was her first miscarriage. She supposed herself to be in the fourth or fifth month of pregnancy, but the foetus is much less devel- oped than it should be at that period, the spine measuring only about two and a half inches in length. About a month before the abortion the abdomen subsided, the breasts became soft, and for the last three weeks there was a yellowish discharge from the vagina. The foetus and placenta were expelled together, and appeared perfectly exsanguine, as if they had been macerated in spirit, but without any sign of putrefaction. The placenta and membranes were not other- wise remarkable, but the cord was observed at once to have a decided tinge of kirronosis, and the foetus was therefore removed for examination. The cavities are fully exposed in the preparation, and the inner surface of the anterior abdomi- nal parietes is seen to be of a deep, rich, yellow color; the membranes of the brain seem to be universally, and quite as deeply colored, the vault of the cranium having been removed upon each side ; the pleurae and pericardium are less generally affected, and in the spinal membranes the color is compara- tively faint. There is nowhere any appearance of icterus. October, 1845. Dr. J. B. S. Jackson. 745. The posterior portion of the occipital bone, from a case of Cephalhaematoma, which occurred in the practice of Dr. S. L. Abbott; a dried specimen. The mother had previously had several children, and one of them was affected with spina bifida. In the present case the labor was easy. The child was a healthy female, and the tumor was observed immediately after birth; it was then quite prominent, rounded, tense, fluctu- ating, and situated over the occiput. For the first two or three days the whole face, scalp, and upper extremities were of a deep red color, and the face was swollen to such a degree as to close the eyes. The prominence and tension of the tumor gradually diminished after the first day, and at the time of death it was flattened, diffused, and quite soft; the hard margi- nal ring was never observed. The child appeared to suffer no inconvenience from this affection, but it soon began to cough, 30 234 UTERO-GESTATION. and died on the fourteenth day, with the symptoms of pneu- monia. On dissection the scalp was found healthy. Pericranium slightly ecchymosed over the right parietal bone, and over the upper half of the superior portion of the occiput it was entirely detached, the cavity thus formed between it and the bone con- taining two or three drachms of very dark, viscid blood, per- fectly inodorous, without a trace of coagulum, and evidently effused some time before death. This cavity was limited mainly by the suture. The pericranium was extensively ossi- fied toward the inferior margin, but was otherwise not remark- able. The outer surface of the bone was completely exposed, except for the thinnest pellicle of lymph, and was perfectly healthy; the corresponding inner surface, however, to the extent of nearly one inch, was elevated, porous, and quite vas- cular, the limits of this change being well defined, and the vascularity extending somewhat through to the outer surface; there was no appearance of caries, and the bone was otherwise healthy. The dura mater was very readily detached from this vascular portion of the bone, but the membrane was healthy and no effused blood was found. In the preparation the thick- ened, porous appearance of the bone is seen, and the ossified condition of the pericranium. 1847. 746. Placenta injected. 747. Uterus, showing a portion of placenta, about an inch in diam- eter, adhering to the fundus; the organ itself is about five inches in length, and otherwise not remarkable. From a patient of Dr. Anson Hooker, of East Cambridge; a woman, forty years of age, of delicate health, and somewhat subject to fainting. Labor natural, excepting that the placenta did not come away for an hour and a half, and it was then found that a portion had been retained. After her confinement she did better than usual, but there was more tenderness and enlarge- ment of the uterine tumor, and towards the last the lochial dis- charge was rather foul. On the twelfth day after her confine- ment she was up and dressed, and expressed herself as quite well, but on the following morning, she rose to the close-stool, swooned several times, and died almost at once. Nothing UTERO-GESTATION. 235 found, on dissection, to explain the suddenness of the death. 1837. 748. Retention of the placenta, causing an extensive destruction of the fundus of the uterus by sloughing. This case occurred in December, 1842, and was published, with remarks, in the New England Quarterly Medical Journal (p. 570.) The patient was twenty-one years of age, and was delivered of her first child on the 7th inst, at 5 o'clock, A. M., and after a labor of a few hours ; child very small. The uterus contracted well, but, the placenta no*t being readily detached, an examination was made, and it was then found to be firmly adherent to the fundus of the organ. After waiting for several hours, an attempt was made by Dr. S. to remove it, but a small portion only was brought away, and in the evening a similar attempt was made by another practitioner, and with the same result. For the first three days there was nothing alarming in the symptoms, the patient, meanwhile, having taken one drachm of ergot, in divided doses, and a cathartic of castor oil; the lochia appeared, and continued to flow, the milk was secreted, and no pain nor other difficulty was complained of. On the morning of the fourth day the pulse had risen from 84 to 140; the abdomen was tympanitic, and pressure upon it produced considerable uneasiness, while distinct pain was caused in the uterus by the application of external force; the lochia and milk had disappeared, the resgjration was hurried, and the countenance distressed, it being evident that peritonitis had supervened. Dr. Channing, having seen the patient in consultation, examined the uterus, but could remove nothing; ten leeches were then applied over this organ, and a poultice to the remainder of the abdomen, and the injections of the chlo- ride of soda, which had previously been used, were continued. In the afternoon she seemed relieved. At night a Dover's powder was given, and on the following morning she was decidedly better; the abdomen was less affected by pressure, and less swollen, the pulse had fallen to 100, and she had slept and perspired freely during the night; at noon she was still more relieved, but in the afternoon her pain gradually returned, and during the night it was mitigated only by opium. On the morning of the sixth day she was found in the greatest distress; 236 UTERO-GESTATION. pain intense, tympanitis greatly increased, and respiration labored. During the whole forenoon the pains were intermit- tent, as in labor, and increased in their severity until they could scarcely be borne, but in the afternoon they suddenly ceased, and did not again return; the distention of the abdomen increased, the respiration became more labored, the pulse rose to 160, and in the evening she died. Upon examining the body after death, the fundus of the uterus was found to have been destroyed, and projecting through it into the abdominal cavity, was seen a large portion of the placenta, the remainder still being contained within the cavity of the uterus; the body and neck of the organ were not disorganized. In the preparation the uterus has not been cut open, and the placenta is seen as above described. Dr. D. H. Storer. 749. Extensive ossific deposit over the uterine surface of the pla- centa ; from a patient of the late Dr. Charles T. Hildreth; a dried preparation. A second case occurred to Dr. H. about the same time, the patient, in both instances, having passed her full period, as she supposed. 1838. 750. Tumor in the placenta, two and a half inches in diameter, well defined, of a regular rounded form, situated two inches from the insertion of the cord, and connected with the outer surface of the chorio*, being in fact buried in the substance of the placenta. Appeared, at first, white, opaque, and elastic, as if encysted, but, on being cut open, it is found to be uniform in its structure, and to resemble condensed cellular tissue; some blood-vessels in it, but nowhere any appearance of effused blood. The placenta was otherwise healthy, and the labor natural. 1839. Dr. Henry I. Bowditch. 751. A blighted ovum. From a patient of Dr. J. Mason Warren; had had several children, and was not subject to miscarriage. The last catamenial period occurred in July. About the last of November she had some discharge of blood, but the abdomen continued to enlarge for two or three weeks afterwards, when it began to diminish in size, and on the 5th of February she called on Dr. W. to know whether she was pregnant or not; during the forenoon she was abroad for some time, and on the UTERO-GESTATION. 237 following night had flowing, which returned on the 14th, when the ovum was discharged in a perfectly fresh state. It was about the size of a goose egg, and fleshy to the feel, the ex- ternal surface being rough, and in part coarsely granulated, much of it seeming to consist of an opaque, white, fibrinous substance, the inner surface of the cavity having the usual botryoidal appearance. The amnion, chorion and decidua were quite distinct, the last having a dead, yellowish color; cord two and a half inches in length, small and much twisted. The foetus was sufficiently plump, but exsanguine in appear- ance, and measured twenty lines from the vertex to the coccyx ; extremities fixed permanently in an unnatural position, and terminated in a knobbed appendage, the fingers and toes not being formed, — most of the above appearances are shown in the preparation. February, 1845. > 752. A blighted ovum, retained for several months, from a patient of Dr. John Homans ; had previously had one miscarriage, and had carried one child to the full period; catamenia quite regu- lar. In January, 1845, she menstruated for the last time, and there was no recurrence until after the first of the following December, on which day the ovum was discharged, with a moderate amount of pain and flowing. There was frequently, however, a slight, pale bloody discharge, lasting from about one to twenty-four hours, and in March there was a discharge which lasted for three or four days, consisting of liquid blood, with at first a small amount of coagulum ; on this last occasion Dr. H. was sent for, but both he and the patient felt confident that no miscarriage had taken place. No bearing down during the above period. Swelling and soreness of the breasts com- menced after cessation of catamenia, and continued throughout the summer, but disappeared before the ovum was discharged. There was also swelling with hardness of the abdomen, and this continued until the termination of the case, although less marked for the last few weeks. This enlargement was generally about as much as it usually is in the fourth or fifth month of pregnancy, but varied much at different times. When first discharged the ovum had a bloodless, macerated look, as usual in cases of retention. On being distended, it is seen to be of a spherical form, and two inches in diameter. 238 UTERO-GESTATION. The placental mass is perfectly defined, and equal in extent to about one-half of the whole ovum ; greatest thickness three lines. The membranes were thin, but sufficiently firm, the amnion having its usual polish, and being readily separated from the chorion. No trace of a foetus or cord. In the pre- paration the placenta has been cut through, and the cavity of the ovum is partially distended, so as to show many of the points above noted, but, when first discharged, the membranes were turned in so as to be in close contact with the placenta, and give to the whole mass the appearance of a cup-shaped cavity. From the outside of the chorion, near the placenta, there is seen hanging a tattered shred of decidua, upon which the characteristic porous appearance is still marked. 1845. 753. A large mass of uterine hydatids, there being some appear- ance of membranes, but nothing like the remains of a foetus. The patient was fifty years of age, and had at the time a healthy living child, only two years old ; menstruated regularly until three months before the mass was expelled; flowing for the last ten days, and for twenty-four hours to a considerable amount, and with much pain. Four days afterwards there came on a severe attack of puerperal mania, which lasted for three or four weeks. 1834. Dr. J. B. S. Jackson. 754. Uterine hydatids. The patient was an Irish woman, had had nine children, and supposed herself to be again pregnant, although some of the symptoms were wanting; the catamenia had ceased for three and a half months, but there had been occasionally slight bleeding from the uterus. Signs of mis- carriage came on, and, after a dose of ergot, about half a wash-basin full of the " hydatids " were discharged ; they were more or less connected by membrane, and in structure and va- riety of size and form corresponded to the description given by Cruveilhier (Liv. 1. pi. 1,) but nothing was seen like the remains of a foetus. 1842. Dr. Henry G. Clark. 755. Umbilical cord about forty-five inches in length; passed twice round the child's neck. 1839. Dr. Charles G. Putnam. 756. A knot in the umbilical cord. 1840. Dr. D. H. Storer. (239 ) XIII. MONSTROSITIES. i. Monstrosities by Deficiency. 757. A lithographic drawing of a specimen which was presented to the Society by Dr. George C. Shattuck. This form of monstrosity has been described by M. Isod. Geoff. St. Hilaire (Histoire des Anomalies, vol. II. p. 469) as the acephalus, and the external appearances, in the present case, are well repre- sented, and perfectly characteristic, the drawing having been made directly upon stone. The mother of this subject was twenty years of age, and had been married three years. On the 25th of June, 1837, she was confined for the second time, being then in the seventh or eighth month of pregnancy; one well formed child had been expelled, when the monstrosity presented by the feet, and was withdrawn, the case being attended by Dr. Ward N. Boylston, then a pupil of Dr. S. When received, it was quite fresh, weighed nearly four pounds, and measured from ten to eleven inches in length. The integuments were excessively oedematous, constituting by far the great bulk of the foetus, and on the back and sides were found, on dissection, several large cysts. Superiorly, it terminated in a regular, rounded mass, and upon the median line, anteriorly, and not far from the above termination, there was the fleshy protuberance which is so often found in these cases. This protuberance, which represented the head, con- sisted of two portions, one above the other, and closely con- nected ; the upper one was of a rounded form, and four or five lines in diameter, the lower one being considerably smaller, and terminating anteriorly in two points; the internal structure of this mass will be described in connection with the skeleton. In place of the upper extremities there appeared externally, upon the right side, two fingers, which looked not unlike the claw of a lobster; on the left side there was but a single finger. Both of the feet were turned in, and each had four toes, those on the right side being equi-distant, but those on the left irregular; otherwise, the lower extremities were well de- 240 MONSTROSITIES. veloped. The anus was imperforate; penis well developed ; umbilical cord very small, and much shrivelled, but sufficiently long, and at its junction with the abdomen the intestines pro- truded, and were covered only by a delicate membrane. On dissection, there were found in the abdomen the intes- tines, the left kidney, two renal capsules, the bladder, and the testicles, the greater part of the intestines being contained in the hernial sac. The stomach, liver, pancreas, spleen, and right kidney were wanting. The small intestine (No. 761) was eleven inches in length, terminated bluntly in a cul de sac, and was nearly filled with a whitish, curdy substance. The large* intestine was eight inches in length, and contained a white, crumbling substance at its upper part; the rectum was filled with mucus, and ter- minated in a cul de sac, except for a very minute opening into the urethra, just in front of the verumontanum. The kidney rested upon the front of the spine, or a little to the left of it, and was sufficiently well developed ; renal capsule very small, and closely attached to its concave edge. On the right side, the renal capsule was much larger. Bladder, prostate gland, and testicles well developed. Vas deferens wanting upon the right side ; upon the left, it was traced very nearly to its termina- tion in the urethra, but the vesiculae seminales could not be found. The heart was entirely wanting. In the American Journ. of Med. Sciences for Feb. 1838, in which this case was pub- lished, there is a sketch of the external appearance of the foetus, and also of the circulation, the course of which was as follows. The umbilical vein divided into two large branches soon after its entrance into the abdomen; one passed down- wards to supply the pelvis and lower extremities; the other passed upwards on the right of the spine, and divided at the upper part of the thorax, to form the right and left subclavian and jugular veins; about the middle of the thorax a large branch was sent off on the right side, and which seemed to correspond to the vena azygos. The aorta divided, at the upper part of the thorax, into the right and left subclavian arteries, from which were sent off two small vessels, that, from their relation to the cervical vertebrae and to the cranial bones, were regarded as carotids, the corresponding veins being, of MONSTROSITIES. 241 course, regarded as the jugulars. The main trunk descended in front of the spine, or a little to the right of it, and gave off the intercostals; inferiorly, it terminated in the left umbilical and the left iliacs, which were distributed as usual; the iliacs and the umbilical artery upon the right side were perfectly distinct from those on the left. In front of the thorax, beneath where the sternum should have been, there was quite a net- work of vessels. The structure of the arteries and veins was apparently normal; the valves in these last, however, were probably wanting, as shown by the experiment of inflating the vessels when the abdomen was first opened. In the thorax was a quantity of condensed cellular membrane, and along the spine several large cells filled with serum, but nothing like a pleural cavity. The spinal marrow was fully exposed by separating the wings of two of the dorsal vertebrae, and was found to be of the usual size, the nerves going off on each side. At its upper extremity it was still more satisfactorily shown ; it there bulged slightly, and measured four lines transversely, then be- coming smaller, and terminating in a blunt point, nerves being sent off from it to form the axillary plexus, which was large on each side. Within the thorax and abdomen were found several ganglia of the sympathetic nerve. Muscles of the trunk and lower extremities sufficiently developed, but else- where imperfect. The skeleton (No. 759) having been prepared, and mounted, has been represented in Fig. 4, at the end of the volume. There are nineteen vertebrae, besides the sacral; three, situ- ated above the upper rib, are partially united, and the bodies of two or three of the upper dorsal are irregularly ossified, but the rest are well developed. Nine ribs on the left side, and ten on the right; these last having hardly a trace of cartilage, but otherwise are not remarkable. The sternum is, of course, cartilaginous, but consists of two lateral portions, which are widely separated, except at the lower extremity, where they are closely approximated but do not unite; the portion which is upon the left side is attached to the clavicle, and to the car- tilages of the ribs, but on the right to the clavicle only. There is a scapula on each side, sufficiently large, although not well formed, the right being the most perfect. The clavicles are 31 242 MONSTROSITIES. short, stout, and bent to somewhat of an angular form. The right upper extremity wants the humerus, but there is a slender bone, about an inch in length, which is evidently the ulna, and attached to this is a small cartilage, which may represent the head of the radius, these being directly attached to the scapula by ligament; the carpus exists, but the distinct parts were not made out. There are two metacarpal bones, about five lines in length ; one is slender, and connected with the long finger above mentioned, and which has three well developed pha- langes ; the other is broad and stout, and bifurcates so as to connect with both fingers, of which the short one has two pha- langes. The left upper extremity consisted of two, small, ir- regular cartilages, followed by a perfectly well developed me- tacarpal bone, and three phalanges. The pelvis and lower extremities are well formed, except that, as appeared exter- nally, the feet are turned in, and have only four metatarsal bones and toes ; one of the cuneiform bones, also, is misplaced, being set back behind the others. Connected with the upper extremity of the spinal column is a row of eight small bones; they are altogether one inch in extent, and, for the most part, exceedingly irregular, but the terminal bone ends distinctly in an alveolus, in which are seen the well developed crowns of two incisor teeth, besides a smaller one, which is connected with one of them laterally. This chain of cranial bones terminated in the external fleshy protuberance above mentioned, and the teeth were contained in a cavity in the lower point, probably the dental sac. The protuberance was generally fleshy to the feel, and had some dark hair about it. Between the upper and lower portions were two small openings, which led backwards into two distinct cavities, three-fourths of an inch in extent, large enough to admit a probe, and ending in a cul de sac, the inner surface being smooth and polished, except just within the openings, where it was thickened and rough; taken in connection with the bones about them, and especially with the teeth, these may fairly be called nasal cavities, the development being altogether very remarkable for this form of monstrosity. 758. Cast in plaster of the above monstrosity, taken, before the dissection, by Dr. O. W. Holmes. MONSTROSITIES. 243 759. Skeleton of the same. 760. Colored drawing, to show the course of the circulation from the same; the sketch in the Medical Journal, above quoted, having been taken from this, as that of the external appear- ances was from the lithographic drawing. Dr. Jeffries Wyman. 761. Small intestine injected, to show the termination in a cul de sac ; from the same. 762. A cast in plaster of a second acephalus; taken by Dr. 0. W. Holmes. The specimen was brought from Salem by Dr. E. B. Peirson, in May, 1842, the case having occurred in the prac- tice of Dr. Samuel Johnson. The mother was a mechanic's wife, and had previously had two well-formed children. Nothing remarkable was noticed in pregnancy, except her great size ; labor took place at the sixth month, and was easy. There were twins, as usual in such cases, and the monster was born first, which, according to St. Hilaire, almost never happens. The second child was well-formed, but died in twelve hours; a large quantity of liquor amnii was discharged with this, but with the first none at all, so far as observed. Placenta single, the cord of the monstrosity being about six inches in length, and inserted near the edge. Externally, this specimen resembled very nearly the one (No. 757) already described. The weight was four pounds and thirteen ounces, the length eleven inches, and the width, at the upper part, six inches. Integuments excessively oede- matous, but there were no cysts, as in the last case. Feet turned in, and the toes imperfect, but the lower extremities were otherwise well developed. There was some vestige of the right hand, but only a pit upon the surface in the place of the left. A small, fleshy protuberance, as usual in these cases, represented the head, and around it was some appearance of hair. Immediately below this protuberance, and almost con- cealing it, was a remarkable development of pia mater; it formed a soft, dark red, circular, flattened, pedunculated mass, sixteen lines in diameter, and about three lines in thickness, the base being about eight lines; it was covered by serous 244 MONSTROSITIES. membrane alone, and consisted of a uniform, dark red, spongy tissue, such as is found upon the base of the cranium, in the common " acephalous foetus." There was nothing between this mass and the cellular tissue which filled the cavity of the thorax, and there was no trace of cerebral substance. This formation is not mentioned by St. Hilaire, but Beclard (Art. Monstruosite, Diet, des Sc. Med.) has described something of the kind. On dissection, there was found no trace of heart, lungs, thy- mus gland, liver, spleen, pancreas, or diaphragm. The umbil- ical vein was fully injected from the trunk (No. 763), and showed no appearance of valves ; it sent branches to the lower extremities, and to the abdomen; then ascended along the spine, and divided to supply the upper extremities and the neighboring parts ; one large branch entered the spinal canal, upon the right side, between two of the lumbar vertebrae. There were two umbilical arteries, which were distributed as in the last case (No. 757), the left being connected with the aorta, which divided at the upper part of the spine like the vein, and at the lower part gave off the usual vessels to the pelvis, and to the left lower extremity ; the umbilical artery upon the right side, and its branches, appeared to be distinct from those on the left. The mode of circulation in these cases has never been satis- factorily determined, from the want of sufficient facts. Sir A. Cooper, however, has shown (Guy's Hosp. Reports, No. xi.) that in one case, at least, it must have been carried on through the monstrosity by the heart of the perfect foetus, the placenta being single, as, according to St. Hilaire, it generally is, and the umbilical arteries of the two foetuses communicating freely, so that the blood entered the monstrosity by these ves- sels, and was returned by the veins, contrary to its usual course. With regard to the absence of valves, in the present case, Sir. A. C. noticed the same fact in one, if not both, of the subjects which he dissected, and St. Hilaire mentions another case, being, as he says, the only one in which, so far as he knows, this point has been examined. The large intestine was ten inches in length ; small intestine fifteen inches, and ending in a cul de sac, there being two dila- tations of the lower part of the ileum, from one of which arose a MONSTROSITIES. 245 marked diverticulum ; anus open. There was a considerable quantity of nearly colorless mucus, with some white, curdy flakes, and in the small intestine some traces of a greenish color. The renal capsules were small, and united across the spine like a horse-shoe kidney. Left kidney large ; measured thirteen by sixteen lines, and seemed to be distended with urine; right kidney five by nine lines. The bladder was rather small, but contained urine. The testicles, gubernacula, vasa deferentia, prostate, verumontanum and penis were suffi- ciently well. The ganglia of the sympathetic nerve, and the filaments connecting them were unusually developed in the thorax, ab- domen and pelvis ; in the thorax were two ganglia which ex- tended from the upper rib to about the eighth rib upon the right side, and to the sixth on the left. The spinal marrow was sufficiently developed, as were the intercostal nerves, and the nerves in the lower extremities. The right brachial nerve was rather large, and it was one of the most remarkable points in the whole anatomy, that although there was no trace upon the left side either of a clavicle or upper extremity, not even in the cartilaginous state, yet there was a very tolerably developed nerve, artery and vein running down in connection, in the sit- uation and direction which the extremity would have taken if it had existed. The skeleton, having been partially prepared, and preserved in that state, there were found to be eleven ribs on the left side and twelve on the right; all well formed, except the three first on the right side, which were fused anteriorly. The dorsal vertebrae corresponded to the ribs, the fourth being incomplete on the left side; cervical vertebrae about three in number, but not exactly determined, the wings being fused, although the transverse processes were tolerably distinct; ten vertebrae be- low the dorsal, of which five may be regarded as lumbar, and five as sacral; and below these last was a hard, thick, blunt cartilage, in place of a coccyx. The sternum was in two lateral portions, widely separated, sufficiently and about equally developed. The right upper extremity was about three inches in length; there was one metacarpal bone, with its phalanges well developed and ossified, and above these two irregular carti- lages ; upon the left side, as above stated, no clavicle, and no trace 246 MONSTROSITIES. of an upper extremity. Pelvis well formed. Lower extremities sufficiently developed, strongly rotated inwards, and the feet turned in; head of each femur quite prominent anteriorly, as if partially dislocated, and the synovial membrane seemed universally adherent. On the left foot there were four toes, the fourth metatarsal bone being cartilaginous and quite slender; six tarsal, the third cuneiform being wanting. On the right foot, on which there were three toes, there were two metatarsal bones well developed, and two which were very imperfect and cartilaginous ; tarsal as on the left side. 763. Veins of the above monstrosity; injected, dissected out, and displayed upon a black board. 764. Intestinal canal, from the same case, and prepared like the veins. 765. A third specimen of acephalus, preserved entire in spirit. It is smaller than the two others, the length being from six to seven inches. The lower extremities are well developed, but the feet are much distorted, there being only two toes on the left, and three on the right. No trace of upper extremities. Sex female, anus not open. Hernia of intestine into the cord. Just above the cord, and rather to the left of the median line, is a very soft, fleshy, rounded protuberance, about one-third of an inch in diameter. Integuments very cedematous, as usual. One well formed child was born, and afterwards the mon- strosity, which presented by the feet. Quantity of liquor amnii large, there being a separate discharge for each foetus. Pla- centa single ; cord of the monstrosity slender, but that of the child was quite large. Labor occurred at the sixth month, and was otherwise natural; the child living a few hours only. 1842. Dr. M. S. Perry. 766-74. Specimens illustrating one of the varieties of that form of monstrosity which is commonly known as the " Acephalous Foetus." The specimens are so similar, that one general de- scription may answer for the whole, and with these, have been incorporated notes of seven others which have also been ob- served, the cranial bones of several of them having been pre- served in the Cabinet. MONSTROSITIES. 247 Externally, this variety of monstrosity is characterized as follows:—The trunk and extremities were well formed and fully developed; the vault of the cranium was wanting, and the base of the skull was covered by a deep red, smooth, but somewhat irregular, serous surface, this surface extending down the neck, sometimes as low as the middle of the back, and terminating in a point; on the margin of the integument, about the base of the cranium, was a narrow strip of hair; the neck was short, the ears rested on the shoulders, and turned forwards over the meatus, the face was directed upwards in proportion to the malformation of the neck, the mouth was open, and the prominent, staring, frog-like eyes were situated almost upon the top of the head. On cutting through the arachnoid membrane, over the base of the cranium, for so it must be called, a coarse lace-work of vessels was found, consisting of pia mater, and very much congested; but, although the thickness of this vascular sub- stance varied in different subjects, and still more in different parts of the same, there was nothing that could be called a tumor, as described by St. Hilaire (Hist, des Anomalies, vol. ii. p. 336.) In eight of the cases above referred to, there was no trace of brain; in one there was a doubtful trace, but in four there were distinct traces of cerebral substance in the pia mater. St. H. remarks (vol. ii. p. 339) that his father and M. Serres discovered the pituitary gland in one case; in the above cases, I found, no less than six times, a rounded body about the size of that gland, and precisely in its situation, but although some- times soft like brain, it more commonly had almost the fleshy consistence, as it had the color, of a lymphatic gland; and these were not all, for the same was also found three times in the other varieties of this form of monstrosity. The cerebral character of this body being then rather doubtful, it was ex- cluded in speaking of the brain. The spinal marrow terminated about where the serous sur- face began, but could sometimes be traced a little way upon the membranes, as a thin expansion; below this, whenever ex- amined, it was found to be fully developed. Of the nerves about the base of the cranium, the spinal ac- cessory was generally seen after a little dissection, and some- 248 MONSTROSITIES. times at once; branches of the fifth pair were several times found, and in one case there was some appearance of the Casserian ganglion; the other nerves, when seen, were so in- volved in the cellulo-vascular tissue that they could not be traced to their foramina. The internal organs of the thorax and abdomen, in ten of the cases which I examined myself, were well formed, with the following exceptions. The renal capsules, in every one, were very small, and in some they might readily have been dissected away with the fat which was found about the kidneys, as probably happened in some of the published cases, in which they are stated to have been wanting. The same general fact in these cases was noticed by Mr. Hewson (Phil. Trans.'1775), and seems now to be generally known, although I do not find that St. Hilaire refers to it. In one there was a supernumerary artery at the arch of the aorta; in another there was but one umbilical artery; in one the heart was malformed (No. 340), and in one the diaphragm was almost entirely wanting upon the right side, the liver encroaching upon the thorax, and the right lung being no larger than the upper lobe usually is. In one (No. 773) there were several peculiarities that will be no- ticed hereafter. In two, of which I did not see the dissection, the internal organs were well formed, except that the renal capsules were very small, and in one of the subjects one of them was not found. The cranium was very remarkable in these cases, and the general form varied so little that one representation (Figure 5) will suffice for the whole. The frontal bones (a. a.) were very imperfectly developed in all, forming, as it were, a part of an irregular bony circle or ring; the nasal processes, however, were always quite large. In connection with these bones may be mentioned the extreme shallowness of the orbits, causing the eyes to protrude and appear large, as they are generally described, although, when dissected out, they were found to be no larger than usual. The parietals were wanting in every case, excepting one (No. 769), in which they existed in a very rudimentary state. The occipital bone was the most remark- able ; the basilar and lateral portions were sufficiently devel- oped, although not always well formed, and the last two were directed horizontally outwards, and sometimes even a little MONSTROSITIES. 249 downwards ; the posterior portion, as seen in the figure, is di- vided into two equal portions (b. b.,) which are of a very pe- culiar form, and are widely separated, so as to form on each side the lateral margin of the cranium. Tne petrous portion of the temporal bone was always large and quite prominent; passage for the carotid artery sufficiently large, but short and direct in its course, instead of being circuitous as usual; squamous portion very imperfectly developed, and situated rather beneath the cranium than upon its side ; the ossicula were sufficiently de- veloped, but the stapes was often more or less distorted. The great wings of the sphenoid bone are distinct from the body, in a foetus at the term, whereas, in the above cases, the left wing was co-ossified in two, the right in three, and in five they were both united to the body of the bone ; pterygoid processes quite large; small wings scarcely developed, having, in some cases, long slender spines, directed anteriorly, and in others being united posteriorly with the body of the bone, so as to make two distinct foramina behind the optic; these last, and those for the fifth pair of nerves were sufficiently developed. The two superior maxillary bones, which should be distinct, were co-ossified anteriorly in nine of the above cases, and in one of two cases, in which they were separate, the two inferior max- illary bones were co-ossified, this being the only instance in which this unusual condition was observed. The other bones of the head were not remarkable; the inferior maxillary is sometimes spoken of as larger than usual, but it only appears so from the deficiency of the cranial bones. The malformation of the spine, which existed in all, was confined to the neck in some, but extended, in others, as low as the middle of the back, the wings of the vertebrae being widely separated, unequally developed, and often more or less co-ossified; the bodies, also, were very often irregularly de- veloped. Some of the ribs were generally co-ossified when there was much malformation of the spine. Skeleton, other- wise, well formed. The osteology will be fully illustrated in the four following specimens, which are a part of those above described. There are some other interesting circumstances in the his- tory of these cases, which should not be omitted. With regard to the sex, five were males and eight were females. In seven 32 250 MONSTROSITIES. the birth was premature, and one only is stated to have been born at the full term. One presented by the arm, but the child was readily turned, and delivered by the feet; a second pre- sented by the feet'; a third, by the head, but the face was to the pubes ; five by the head, and in these, and all of the others, the presentation must have been natural, or the contrary would have been stated; and a similar observation might be made in regard to many other points, all of the positive facts of any importance having been obtained, in nearly every case. Three were reported still born, and so, I am quite sure, they all were, or that they gasped but a few times at the most. A very curious fact, which was noticed in this, and in another variety of this form of monstrosity, and almost universally, was a profuse discharge of what has been regarded as the liquor amnii; it is recorded, however, only eight times in the first variety; Lallemand has observed the same fact in an analogous case, and attributed it to the dropsical affection which he supposed to have destroyed the brain and spinal marrow. In regard to previous births, one case was that of a first child, but in seven there had been other children, and, for the most part, a large number. St. Hilaire seems to attach much importance to the occurrence of some cause acting upon the mother, in the early months of pregnancy, and tending to produce the monstrosity (II. pp. 345 and 369;) in one of the above cases, the mother attributed it very decidedly to a severe fright; in four others, no cause could be assigned, and in the remainder the fact is not noticed. 766. A mounted skeleton of an " Acephalous Foetus ; " this is the specimen which is represented in Figure No. 5. 1839. Dr. J. C. Hay den. 767. A set of separated bones of the head and part of the spine, of an acephalous foetus ; mounted individually upon pedestals, and placed upon a black board. 1839. Dr. J. D. Fisher. 768. A second specimen, similar to the last, but showing also a fusion of the ribs. 1841. Dr. George C. Shattuck. 769. A third specimen; in this there are two rudimentary and very MONSTROSITIES. 251 irregular bones, that are connected with the frontal, and proba- bly represent the parietal bones. 1842. Dr. William E. Townsend. 770. Drawings, showing the external appearances of an acephalous foetus. Two of them represent in outline a front and side view of the head and shoulders, and the third gives a back view of the whole in India ink, the head being shaded. They were taken by a professed artist, for Dr. Charles T. Hildreth, and, being admirably well done, might be copied here, if this form of monstrosity were not sufficiently well known ; the only repre- sentations, however, that I have seen of it are two wretched figures, one in St. Hilaire's work (Hist, des Anom.,) and the other in a Memoir by V. Portal (Annales des Sciences Nat. vol. xiii.). 771. Cranium of the monstrosity, from which the above drawings were taken ; prepared by Dr. C. T. Hildreth. The skeleton has also been preserved, but, being in an imperfect state, it has not been mounted with the cranium; it, however, shows an extensive fusion of the ribs, and separation of the wings of the vertebrae as low as the eighth dorsal. 1835. 772. A foetus preserved in spirit, and showing the full development and plump condition so often noticed in these cases. Dissected by Dr. Joseph W. McKean. 1828. 773. A foetus preserved in spirit, and which had been in spirit for some time when it was dissected. The case, which is interest- ing from the malformation of the internal organs, and from the circumstances of its birth, occurred in the practice of Dr. Ezra Palmer, Jr., and an account of it was published by him in the Medical Magazine for December, 1833. The deficiency of the vertebrae extended to about opposite the lower angles of the scapulae, the brain being nearly want- ing. Left upper and right lower extremities imperfectly de- veloped ; feet turned in, as in varus. Something like a penis was seen, about one-third of an inch in length, and having the appearance of an urethra, which terminated almost at once in a cul de sac, but there was no prepuce nor scrotum, neither 252 MONSTROSITIES. did the anus exist, nor the sulcus between the nates. Other- wise the foetus externally was well formed. The abdomen was much distended, and, when the specimen was fresh, there was supposed to be ascites; the peritoneal cavity, however, on being opened, was found to contain a few ounces only of a reddish brown fluid. The urinary bladder was as large as a common-sized orange, considerably thick- ened, and filled about one-third of the cavity of the abdomen, the urethra being pervious to the extent of about two-thirds of an inch. Kidneys and renal capsules small, but the ureters were tortuous, and very much dilated. The large intestine opened into the upper back part of the bladder, and upon its left side, being, for the last two inches, distended with meco- nium. At the fundus of the bladder, and connected intimately with its parietes, were the rudiments of a uterus; these con- sisted of three cavities, one of them about two-thirds of an inch in diameter, and the other two about half as large, the largest being situated immediately upon the right side of the intestine, and the two others close to it, but upon the other side; they were about a line in thickness, rugous upon the inner surface, and opened freely into the cavity of the bladder, two of them by distinct openings, and the third indirectly through one of the others; from each side there was sent off a pro- longation, or horn, which terminated in a short Fallopian tube, and beneath which was a well developed ovary. The other or- gans of the abdomen were well formed, and have been removed, except the large intestine ; the thoracic organs were also well formed. In the preparation, the anterior parietes of the abdo- men and of the urinary bladder having been cut away, there are seen the openings from the intestine and from the uterine cavities into the bladder, the appendages of the uterus, and the dilated ureters, these last being injected. This foetus was born in company with two others, which were well formed ; the first, a male, weighed seven pounds, and did well; the second, the subject of the present case, weighed five pounds, and gasped only a few times after it was expelled; the third, a female, weighed six pounds, and lived for ten hours. The two first presented by the breech, but the presentation of the third was natural. They were contained in separate cavi- ties, and the placenta, which was single, weighed two pounds. MONSTROSITIES. 253 The mother was a respectable, middle aged woman, and had four children previously to her confinement with the triplets. 1835. 774. Cast in plaster of the head of an acephalous foetus, taken by Dr. Morrill Wyman, of Cambridge. The child was born at six o'clock, A. M., on the 25th of August, 1843, and died in the course of the forenoon of the 30th, having lived more than five days. During this time it appeared very feeble, and in the most miserable state possible; it, however, opened its eyes, moved its lips, protruded the tongue to the edge of the lips, and took liquids from a sop, but would not suck. It also moved the limbs. It was small, but externally well formed, except for a reddish mass, which exuded serous fluid, and was situated about midway between the eyes and the occiput. The case occurred in the practice of Dr. T. Wellington, of West Cambridge. 775. The cranium of an acephalous foetus, which differed from all of those above described .(p. 246,) in having the spine entire throughout, and in having \he posterior portion of the occipital bone only partially divided, as shown in Figure 6. The pari- etal bones were wanting, and the cranium was otherwise formed as in the above cases, excepting that it was more elongated than usual. Externally, the foetus was well developed, and well formed, excepting the head; the neck being sufficiently long, the ears were not bent forwards as in the other cases; weight five and a half pounds; sex male; born at the full period, and presented by the lower extremities, which moved when they were first felt in the vagina, though the child never breathed ; quantity of liquor amnii very great. The mother had pre- viously had six or seven children, and assigned no cause for the monstrosity. Upon the base of the cranium was an irregular, dark red mass, nearly as large as an English walnut, one rounded, pe- dunculated body hanging down over the left eye ; on dissec- tion, this consisted of a coarse, reticulated structure, with some large blood-vessels, and numerous, small, serous cysts, but without a trace of cerebral substance. The spinal marrow 254 MONSTROSITIES. terminated just above the base of the skull, in four little rounded eminences, and was, at the same time, rather enlarged. Renal capsules exceedingly small, but the internal organs were otherwise well formed. 1838. Dr. George Bartlett. 776-81. The next six specimens belong to another variety of the "Acephalous Foetus," which resembles the one already de- scribed (p. 246,) in its general characters, but differs from it much in the degree of malformation; the spine is open throughout, and is often incurvated so as to add very much to the external deformity; there are also more frequently than in the first variety other malformations, both external and inter- nal ; the cranium, however, remains about the same, although there is more development of brain. 776. A mounted skeleton, being the first specimen in this series. The spine was perfectly straight, except at the upper lumbar vertebra, where there was a slight anterior curvature, but this is not now to be seen; all of the vertebrae are well developed, except the wings of the third cervical, which are quite small; the wings of the dorsal vertebrae, also, not being so widely open as usual in this form of monstrosity. Otherwise the skeleton is well formed, excepting the head, as externally, the subject was well formed, except for the head and spine. A trace of brain only existed, if any at all, but, in the situa- tion of the pituitary gland, there was found a soft, rounded, reddish mass, in this case, and in No. 778; there was some appearance, also, of a thin and superficial layer of medullary substance in place of the spinal marrow; and the same has been sometimes observed in other similar cases; spinal nerves and ganglia well developed, as they usually are in these cases. The internal organs were well formed, except for the small size of the renal capsules, and a fissure of the uvula; this last was also observed in Nos. 781 and 783, and twice in the first variety of the acephalous foetus (p. 246,) the soft palate being otherwise well developed. This case occurred in November, 1844; the mother was a young married woman, and this was her first child ; no acci- dent during pregnancy; considered herself as in the sixth month when labor came on, without any obvious cause ; breech MONSTROSITIES. 255 presentation; child still born; quantity of liquor amnii large. Dr. Benjamin E. Cotting, of Roxbury. 777. A mounted skeleton; the second specimen in this series (p. 254.) Cranium as in the first variety (p. 246,) except that there are two long, slender bones, finely serrated on their edges, closely connected with the frontals, and which may perhaps be rudimentary parietal bones; the same have been figured in the case of No. 781, and also by Lallemand, in his case above referred to (Observations Pathologiques, 1825.) The cervical portion of the spine is bent directly downwards and backwards, so that the upper dorsal vertebra forms the proper summit of the spinal column, and, in the recent speci- men, the posterior edge of the base of the cranium was united by fibrous substance to the wings of the sixth dorsal vertebra; wings of the cervical and dorsal vertebrae extensively co-ossi- fied. Skeleton otherwise well formed. When recent, a large and somewhat lobulated mass of cere- bral substance was found, and there was some appearance of spinal marrow. The specimen was then put in spirit, and after some time was taken out and hastily examined; the internal organs were well formed, except for the renal capsules, which were not found ; the entire absence of these organs is so con- trary to what has been generally observed, that I think there must have been an oversight in this case, the examination having been made under very unfavorable circumstances. When recent, this foetus weighed one pound and a quarter; sex female ; discharge of liquor amnii very great. 1838. Dr. Charles Wild, of Brookline. 778. A mounted skeleton ; the third specimen in this series (p. 254.) Cranium as in the last specimen, except that there is but one so called rudimentary parietal bone, and that is quite small and attached to the left frontal bone. The spine is nearly doubled upon itself, the middle dorsal vertebrae projecting forwards, and the upper lumbar backwards ; there is also a considerable lateral distortion. The wings of the cervical and dorsal ver- tebrae are unequally developed, and extensively fused, espe- cially upon the right side; the bodies also are very irregular. Of the ribs, there are eleven upon the left side, and these are 256 MONSTROSITIES. distinct; on the right, there are ten or eleven, and nearly all of them are fused. Externally, this foetus was more deformed and much smaller than those already described, weighing scarcely twelve ounces (avoird.) In consequence of the strong curvature of the spine, the trunk was much shortened, and the projection of the lum- bar vertebrae was very conspicuous. The parietes of the ab- domen were deficient upon the left side, and the liver and in- testines protruded, forming a large tumor, and covered only by a thin membrane, which was continuous with the integuments. The right hand was strongly flexed, and turned so that its cubi- tal edge came in contact with that of the fore-arm, as shown in the skeleton; the left foot was, also, strongly bent outwards. On dissection, no trace of cerebral substance was found, ex- cepting the pituitary body ; no cysts in the pia mater ; spinal nerves and ganglia distinct, with some appearance of spinal marrow, the parts being considerably injured in the delivery, as they often are. Internally, the diaphragm was wanting. Liver fawn-colored, and the umbilical vein entered on the convexity of the organ, there being no division into lobes; spleen, kidneys, bladder, uterus, ovaries, and vagina well formed. Renal capsules rather larger than usual in the acephalous foetus, and not con- nected with the kidneys, but rather above them and towards the median line. The arch of the aorta gave off the right subclavian and carotid only; the pulmonary artery gave off the usual branch to each lung, and then divided into two main branches, one being the ductus arteriosus, and the other, after running some way upwards, dividing into the left subcla- vian and carotid arteries ; the other vessels, and the heart, ex- ternally, were well formed, as were also the lungs. The mother of this subject was a young woman, and had had one miscarriage, but had never carried a child to the full term. Considered herself as in the seventh month of preg- nancy, when the child was born; the liquor amnii had been coming away for three weeks, and in considerable quantity, the discharge being profuse towards the last; back of the child presented, and thus it came into the world. The placenta was reported by Dr. S. as large, and made up almost entirely of serous cysts; cord exceedingly short. In the course of her MONSTROSITIES. 257 pregnancy, the mother sent for Dr. S., in consequence of her anxiety from what her friends had said, that her child would resemble a certain dog, to which she was much attached, and which had been used to draw her breasts after the previous mis- carriage. This child was born on the 30th of October, 1840, and on the 1st of December, 1841, she was again delivered of another very similar monstrosity, (No. 780.) Dr. Asa B. Snow. 779. This specimen, the fourth of this series (p. 254,) is preserved entire, in spirit, and is interesting in connection with the last, as it resembled it perfectly in size, and its general outline, and in the projection formed by the lumbar vertebrae. There is also the same deficiencies of protrusion of the parietes of the abdomen, with a protrusion of the contents, the only differ- ence being that, in the present case, it is upon the right side, whereas in the other it was on the left; sex male. Dr. Charles Walker. 780. Separated bones of an entire skeleton, the spine only being preserved as a single piece; mounted on pedestals, and dis- played upon a black-board; the fifth specimen of this series. The right wing of the sphenoid is fused with the body of the bone. The spine, which is represented in Figure 8, is four inches in length, and nearly straight, open throughout, of course, but otherwise well developed below the lower dorsal vertebra. The wings are mostly small, and more or less fused as low as the sixth dorsal vertebra, on the left side, and rather lower down, on the right. The bodies of the corresponding vertebrae are generally very irregularly developed ; most of the cervical, with the two upper dorsal, are fused into one mass, and bifid; the two lateral halves being separated so as to leave an open- ing of considerable size (a.), although much less than in the next case. Upon the body of the eleventh dorsal vertebra, posteriorly, is seen what appears to be the wing of a vertebra (b.), inclining to the right side, and resting immediately upon a small bone, which may be a misplaced and undeveloped body. Of the ribs, there are nine upon the left side, and eleven on the right; many of them are fused, and some are very imperfectly developed. Extremities well developed. 33 258 MONSTROSITIES. This child was born on the 1st of December, 1841, and the most remarkable circumstance in the case was, that, thirteen months previously, the mother had been delivered of a similar monstrosity (No. 778.) Labor occurred at the eighth month, and the presentation was natural; weight of the child two pounds and nine ounces. She subsequently had two other, well formed children, one at the full period, and one prema- turely ; and about a fortnight after the last, in February, 1845, died of acute nephritis. Dr. Asa B. Snow. 781. The cranium and trunk of the sixth specimen in this series (p. 254;) represented in Figure 9 ; the extremities, being well formed, have been removed. The head is inclined to the right side, and carried backwards so that the occiput is closely con- nected with the wing of the sixth dorsal vertebra upon the left side, and with the eighth on the right. The rudimentary pa- rietal bones (a. a.) exist, as in No. 777, and there is a consid- erable separation between the palatine bones, extending some- what to the upper maxillaries, and connected with a fissure which was observed in the soft palate. The spinal column is remarkably malformed. A front view of this part of the skeleton has been represented in Figure 10, and an idea may be given of it, by supposing that there had been a longitudinal fissure through the bodies of the vertebrae, from the first cervical to the eighth dorsal, and that the two lateral portions had then been so widely separated as to result, not merely in a coming together, but in an actual fusion of the cervical bodies with the dorsal of the same side ; the fusion being more marked posteriorly than in the front view. The lateral portions do not, however, come perfectly together, but there remains a central opening (a.), about three lines in diam- eter, and surrounded on all sides by the bodies of the vertebrae. Upon the left side the third cervical is in contact with the seventh dorsal (b.), and on the right side, the second, third, fourth, and fifth cervical are fused into a common mass with the eighth dorsal (c.) As to the number of the bodies, there are in the neck, on the left side, six, distinct from each other, and regularly arranged, the last two being fused with the bodies of the dorsal vertebrae; on the right side are seven, much more irregular, and of which four are fused, as above stated. MONSTROSITIES. 259 The body of the first upper dorsal vertebra, on the left side, exists; the two next are wanting; the four next are distinct, and of some size, and two of them certainly are fused with the bodies of the cervical vertebrae; the eighth and ninth form a common large mass, bounding the central opening inferiorly. On the right side, the bodies of the dorsal vertebrae are much more irregular; the first four or five are almost entirely want- ing ; the sixth and seventh are of some size, but are fused with the cervical, and the eighth is fused with four of the cer- vical, as above stated. The bodies of the last three dorsal vertebrae, and of the five lumbar, are well developed, there being, however, a slight lateral curvature. Most of the wings of the cervical vertebrae are fused, and many of the dorsal, especially on the right side. There are twelve pairs of ribs, which are, for the most part, closely compressed, as usual in these cases; three of the lowest are fused on the right side, and on the left, they are generally flattened, but otherwise well developed. This case occurred in December, 1844. The mother had previously had two well formed children, and considered her- self as in the sixth month of pregnancy, when, without any obvious cause, labor came on ; breech presentation; child still born ; sex female ; quantity of liquor amnii very large. The deformity of the trunk was very considerable, but the extremi- ties were well developed. Upon the base of the skull were some traces of brain, and, in place of the spinal marrow, a layer of medullary substance, thin, but of some width, and covered, if at all, by the most delicate membrane ; nerves and ganglia well developed, as usual in these cases. Internally, the diaphragm was pushed very high into the thorax, the lungs being imperfectly developed. Pericardium mostly wanting, so that the heart and lungs laid, as it were, in one common cavity; the heart being well formed. The me- sentery, also, was quite imperfect, appearing more or less per- forated and tattered, although much of it was entire. A fissure was found through the centre of the uvula, and extending somewhat into the soft palate, the bones being separated, as already shown. CEsophagus quite short. The stomach, which, with a portion of the intestine, has been injected (No. 782,) was, perhaps, sufficiently large, but of a very irregular form ; 260 MONSTROSITIES. the right extremity terminating in a cul de sac, and the intes- tine arising at a considerable distance from it. The liver was considerably fissured, and the umbilical vein entered upon the convex face; gall-bladder and ducts apparently well, but the intestine, wherever examined, contained only a light colored, pasty mucus, and without a trace of bile. Renal capsules exceedingly small. The kidneys were united by their lower extremities, across the spine, the two pelves being proved, by inflation, to be separate. The other organs were well formed. Dr. Anson Hooker, of East Cambridge. 782. Malformed stomach, from the above case. 783-88. In the four next cases, constituting the third variety of the " Acephalous Foetus," the spine is open throughout, and much incurvated, as in the last group. The brain, however, is considerably developed, and the form of the cranium is much altered, in regard to the existence of the parietal bones, and a consequent change in the posterior portion of the occiput. 783. Cranium and trunk prepared, and mounted. This is the first specimen in the present series, and has been represented in Figures 10 and 11. The head being thrown very far back- wards, and the upper half of the spine much bent upon itself, the posterior portion of the occipital bone is closely connected with the wings of the ninth, tenth, and eleventh dorsal verte- brae ; this portion of the occiput consists of two broad, flat- tened bones (a. a.), wanting the prolongation which usually extends forwards to the frontal, as the parietals (b. b.) exist in this case ; these last, however, are in a very undeveloped state. The basilar portion of the occiput is large, as also the lateral portions ; the right being fused with the temporal bone. The petrous portion of the temporals is very irregular, the cranium being otherwise formed as usual in these cases. The cervical, and upper half of the dorsal vertebrae, are bent strongly back- wards (Figure 11;) the lower dorsal forwards; and, below these, the spine is straight, there being the usual number of vertebrae, unless one may be wanting in the neck. The bodies of the cervical consist mainly of two broad lateral portions; the two upper dorsal are irregular and fused; the fifth is very MONSTROSITIES. 261 imperfect, but all of the other bodies are well developed. The wings of the cervical are mostly fused ; the seven or eight upper dorsal are small and crowded, although distinct, and the rest are fully developed. The ribs are normal, except for a partial fusion of the tenth and eleventh, upon the right side. Extremities well formed, and have been removed in the pre- paration. The foetus weighed, when recent, three pounds and six ounces (avoird.) and was quite fat; neck most completely wanting, in consequence of the curvature of the spine. A mass of brain existed, equal to more than an inch in diameter, and at its base were several nerves. The spinal marrow ex- isted, although less developed than in the next case. The pa- rietes of the abdomen were deficient about the umbilicus, and a tumor, from which the cord arose, was formed there, two inches in extent, and covered by a transparent membrane. The liver was large, and sent off a considerable lobe between the two others, to form the protrusion at the umbilicus. The heart was malformed, and has been already, described (No. 341.) Each of the lungs consisted of a single lobe, which was deeply fissured at the base. There was also fissure of the uvula. Renal capsules exceedingly small; right hypogastric artery wanting. The other organs were well formed, as were the extremities. Lubor came on at eight and a half months; the child pre- sented by the feet, and was still born ; sex female ; quantity of liquor amnii very large. The mother was a respectable woman, and attributed the monstrosity to a fright which she had received when six weeks pregnant; had had three other child- ren, and all well formed. 1845. Dr. Milton Fuller, of Medford. 784. Cranium and trunk prepared, and mounted. This is the second specimen of the present series, and is represented in Figure 12. The spine is so strongly bent upon itself, as to bring the occipital bone in close connection with the two last dorsal ver- tebrae. The parietal bones (a. a.) are developed very much as in No. 787, and extend transversely across the base of the cranium, upon which they are depressed, and with which, to a certain extent, they come in contact, the right being rather the 262 MONSTROSITIES. largest; their external surface is quite concave, and the suture between them runs obliquely towards the right side. The pos- terior portions of the occipital bone (b. b.) are connected with the parietals, and pretty well developed, so as nearly to meet from the two sides; superior edge quite dentated, the inferior being thicker and smooth ; on the right side it is fused with the lateral portion, and with the temporal bone. The frontal bones (c. c.) are considerably developed, but strongly depressed upon the base of the cranium. The bodies of the vertebrae, in the cervical portion, consist of five or six pieces irregularly devel- oped ; two or three of the upper dorsal are also irregular, as well as the sixth, but the rest are sufficiently well. The cer- vical wings are imperfect, and mostly fused ; those on the right side forming one mass with the first six dorsal; the six upper dorsal, on the left side, are also fused, but not with the cervi- cal ; otherwise the wings are well developed. On the left side there are eleven ribs, which are not remarkable except for a fusion, to a small extent, between the fourth and fifth ; on the right side, there are twelve, but they are pretty extensively fused. The subject of this case was a first child, and born of re- spectable parents. Labor came on in the night, at the seventh month; and the child was born half an hour before Dr. D. ar- rived ; quantity of liquor amnii large. The heart was seen to beat about thirty times in a minute, for nearly two hours after the birth, but without any other sign of life. Sex female. A mass of brain was found, equal to §ij, or more, and divided upon the median line, almost equally; the right lobe being again subdivided; something like a ventricle was also found upon the left side, and at the base were several nerves. The spinal marrow appeared as a thin, flattened ribband of distinct medullary substance, of a reddish color, and, as ob- served in some other cases, divided into two lateral portions. The parietes of the trunk were extensively deficient; the liver, stomach and intestines, spleen, heart, and left lung pro- truding. The placenta, which was born with the child, was not remarkable. The cord was but five inches in length, and sent off a duplicature of the amnion, from half an inch to one inch in width, which was expanded over the organs, and could be stripped up nearly to the surrounding integument. Other- MONSTROSITIES. 263 wise the foetus was well formed externally, except for a varus of the left foot. On dissection, a thin, dense, fibro-cellular membrane was found to invest the protruded organs, when the amnion was raised, the muscles, of course, being wanting. The heart was fully and regularly developed, some elongation only being ob- served of the vessels, which were put upon the stretch by the unnatural position of the organ; pericardium well. In the right cavity of the thorax there was nothing very remarkable. Upon the left side there was no pleural cavity, and nothing in place of the lung but a coarse cellular tissue ; the lung itself appeared just beneath the transparent membranes, not unlike a thin muscular expansion, the bronchus being small in propor- tion to the undeveloped condition of the organ. The liver was somewhat irregularly developed; ascending colon situated in the middle of the abdomen, as in the earlier months; the renal capsules were larger than usual in such cases, and the left hypogastric artery was wanting, the organs being otherwise well formed. 1845. Dr. Henry Dyer. 785. A colored drawing of a monstrosity, an account of which was published by the late Dr. Charles T. Hildreth, in the Medical Magazine for July, 1834. The third specimen in this series (p. 254.) This drawing was made by a professed artist, and was afterwards engraved on copper, and published with the case ; engravings being also made of the skeleton. The whole was done at the expense of Dr. H., and, the plates having been preserved, have been used for the present work. The case is particularly mentioned by St. Hilaire (Hist, des Anom. II. 313,) and the drawing of the monstrosity has been repre- sented in one of his plates. The external appearances of the foetus are so well repre- sented in Figure No. 13, as to render a general description unnecessary. The weight was three pounds and one ounce, and the length thirteen inches. Sex female. The brain rested upon the expanded dorsal and lumbar ver- tebrae, and upon the integument which covered the depressed cranial bones, sending a prolongation, however, beneath these last. After dissection, it was carefully collected, and found to weigh three ounces. It was divided into two equal hemi- 264 MONSTROSITIES. spheres, and imperfectly into convolutions, the arachnoid membrane being continuous about the base with the common integument. The whole mass was very soft, and of a dusky red color, from congestion, and effused blood ; there being in each hemisphere a cavity which was filled with coagula. No other parts of the brain were recognized, and no connection was traced between this mass and any of the nerves, either cerebral or spinal. The spinal marrow was wanting, and, the spinal column be- ing open throughout, the nerves terminated, as usual, in the membrane upon its posterior face. A very small bundle of nervous fibres was seen passing down over five or six of the processes upon the left side, and a few of the cranial nerves were found, among which, it was thought, was the par vagum. Nerves of the trunk and extremities well developed. The internal organs were well formed, except for the kid- neys ; these were united across the spine (No. 787,) and the left was not more than half as large as the right; upon the right side were two ureters, which were distinct throughout; renal capsules sufficiently developed. There was also but one umbilical artery. The development of the renal capsules is interesting as an exception to the general law, and it should be observed, that, in the last case, these organs were larger than usual in the " acephalous foetus." The history of this case was as follows: The mother was a married woman, thirty-five years of age, of excitable tem- perament, and had previously had two well formed children. In the present case, the motions of the child were not felt until about the end of the fifth month, and were always feeble and peculiar. The uterine tumor was uniformly tense, and, towards the end of the seventh month, increased very rapidly, so as to fill the epigastrium, and cause a very painful distention. De- cember 20th, being called hastily, in the night, to attend a sick child, she felt a remarkable subsidence of the tumor, the change in her form being very apparent; this was soon fol- lowed by paroxysms of pain in the right hip, with vomiting and constipation, which continued more or less for five or six days, but were relieved after free evacuations, although the sense of painful distention continued. On the 9th of January, whilst walking across the room, she had a slight uterine pain, MONSTROSITIES. 265 and, suddenly, a most profuse discharge of liquor amnii; slight pains continued through the day, and with them considerable discharges of water; but, in a day or two, she was about again, and much more comfortable than before ; slight motions of the child being still occasionally felt. On the 15th of Jan- uary labor came on, and was accomplished with very little pain ; the child was born alive, but completely enveloped in the membranes, the mother having felt its motions for fifteen or twenty minutes after it was expelled. On the arrival of Dr. H., half an hour afterwards, the lower extremities were still in the vagina, and, from its position, the child had probably de- scended with the face to the pubes. 1834. Dr. Charles T. Hildreth. 786. Skeleton of the specimen above described, and of which a back and a side view are represented in Figures 14 and 15. The head is bent strongly backwards, and there is also a lateral inclination of the head and spine. The frontal and parietal bones (a. a. and b. b.) are much more developed than in any of the preceding specimens, but are depressed towards the base of the cranium; posteriorly, or rather inferiorly, how- ever, there is a broad, open cavity, which readily admits the ends of three fingers. The basilar and lateral portions of the occiput are sufficiently developed, but the basilar has a pecu- liar hexagonal form, and the lateral portions are seen to en- croach much upon the petrous portion of the temporal bones. The posterior portion of the occiput consists of two bones (c. c), one upon each side, of a somewhat rhomboidal form, and tolerably developed; that upon the right side is curved upon itself, and forms a part of the cranial cavity, a small portion of it only, above the curve, being seen in Figure 15; the one upon the opposite side is rather behind or below the cavity, but they both serve to connect the parietal bones with the spinous processes of the dorsal vertebrae. There is also another distinct bone, which is marked c, and may perhaps be considered as a part of the occiput; it is a long and narrow bone, situated behind the right parietal and posterior occipital; resting, like the occiput, upon the extremity of the spinous processes of the vertebrae, and forming, with the left parietal, the posterior edge of the cranial cavity. The other bones of 34 266 MONSTROSITIES. the head are not particularly remarkable; palatines not sepa- rated, as in some of the cases. The spinal column, as before stated, is open throughout; otherwise, the vertebrae are well developed, from below up- wards to the twelfth dorsal. Above this, the bodies are well developed as high as the sixth dorsal, above which they be- come more and more irregular. The dorsal wings, on the right side, are generally well, except for a fusion of the first two; upon the left side, the last six are sufficiently well, although less regular than those on the right, but above these are four others which are fused and much compressed, in con- sequence of the curvature of the spine towards that side ; upon the ninth is a distinct bone, marked k. in the figure, and which appears not unlike a rudimentary wing; something of the same kind having been observed in No. 780. The cervi- cal vertebrae are very irregular; the bodies consist, for the most part, of two lateral rows of small bones; the first pair of wings are small and distinct, but below these are four others which are fused together, and with the dorsal, those upon the left side being shown (I.) in Figure 14. The ribs upon the right side are of the usual number, and fully developed; the second, third, and fourth, however, are fused at their angles, and the eleventh becomes very broad near its anterior extremity, as seen in the figure. On the left side, the twelfth only is normal; the first is quite small, and between this and the next is a large, open space, the ribs be- low this being much compressed, fused, and irregularly de- veloped ; as to the number, there may be one or two wanting, but this is doubtful. The pelvis and extremities are well de- veloped. 787. Kidneys and renal capsules from the above case (p. 264.) 788. Head and trunk of the fourth and last specimen in this series (p. 254); the deformity is excessive, as is shown in Figure No. 16. The occipital bones are united with the spinous pro- cesses as far down as the first lumbar vertebra, except upon the left side, where there is a deficiency to a considerable ex- tent between the lateral portion of the occiput and the spine ; the antero-posterior curvature of the spine is very strong, the MONSTROSITIES. 267 upper dorsal and the middle lumbar vertebrae forming the prominent points, and, as a consequence, the pelvis and the anterior extremities of the ribs are brought into close contact. The cranial cavity is quite capacious. The frontal bones (a.) are fully as large as in the last specimen, and the parietals (b.) are considerably larger and convex outwardly, there being a considerable space between the frontals and the base of the skull. The basilar and lateral portions of the occiput are well developed ; the posterior portion (c.) consists upon each side of one piece, the one upon the left being more rectangular, but the one upon the opposite side sending out a long and slender portion which is connected, as in the preceding cases, with the parietal bone, and forms the posterior boundary of the cranial cavity. Orbital cavities deep, as a consequence of the devel- opment of the frontal bones ; upper maxillaries not co-ossified ; the palatine fossa being deep and narrow, and the palatine bones themselves small. The spinal column has some lateral distortion, besides the strong curvature above reported ; the wings of the first cervi- cal vertebra separate ; otherwise, the wings of all of the cer- vical vertebrae, of which there are six or seven, and of the first seven dorsal, upon the left side, are co-ossified, except for two linear divisions; upon the right side, the cervical and first dorsal wings, and below these two or three others are co-os- sified, the wings of the other vertebrae being separate. An additional wing is seen, resting upon the wings of the second and third lumbar vertebrae upon the left side, and, upon the same side, the wings of two or three of the upper sacral ver- tebrae have produced a growth of bone, which extends, as one continuous piece, to about the median line, and forms, thus far, something like a spinal canal. There is also seen a very anomalous bone, larger and thicker than the wing of a verte- bra, besides differing from one in form; it is attached at one extremity, by fibrous substance, to the back of the first lumbar vertebra, and at the other, to the inner surface of the posterior portion of the occipital bone, upon the right side, thus forming an arch over a portion of the spinal column. The cervical portion of the spine is of considerable length, broad and flat- tened. Some obliquity of coccyx, but pelvis otherwise well. Thorax exceedingly prominent. The sternum is fully de- 268 MONSTROSITIES. veloped, but the anterior half has no connection with the ribs, and appears perfectly naked. Upon the right side there are seven ribs; the cartilage of the first joins the sternum about midway; the second, third, and fourth are fused posteriorly, and the cartilage of the second is to a certain extent wanting; the fifth, sixth and seventh are also fused posteriorly, and, instead of terminating as usual, send out a broad, thin, but strong expansion of bone, which stretches, like a diaphragm, across the front of the spine, and even to some distance beyond it upon the left side, where it is connected again with the body of the vertebra, and appears as one of the ribs. The above remarkable appearance has been represented in Figure 17. Upon the left side, there are twelve ribs, including the one which is fused with, or which is sent off from those upon the opposite side, this being the tenth in order; the first two are disconnected with the sternum, as in birds; a rudimentary cartilage, however, being sent off as if to meet the second; the first is very small; from the third to the eighth, inclusive, the ribs are well developed; the ninth and eleventh are broad and flattened ; the eleventh having a slender attachment, which connects it, near its head, with the front of the body of the vertebra, midway; the twelfth is normal. The extremities, being well formed, except for the club- feet, have been removed. Externally, this foetus was quite fleshy, and would probably have weighed four or five pounds. Deformity very great, the neck being absolutely wanting, and the upper extremities ap- parently much elongated; circumference about thorax four- teen inches ; both feet affected with varus, as so often happens where the nervous centres are imperfectly developed. The frontal and parietal bones evidently existed, but were much depressed, and covered by scalp and hair; the brain appeared, with a quantity of deep red vascular tissue, and formed a mass about the size of an English walnut, the deficiency of the spine appearing below. About this deficiency, was an appear- ance of cicatrization, the cuticle being continued, to some ex- tent, beyond the limits of the cutis; this appearance is usually seen, to a greater or less extent, and the cuticle has often been separated from the subjacent parts by maceration. On dissection, a mass of brain was removed from the era- MONSTROSITIES. 269 nial cavity, equal in bulk, by estimate, to giijss.; convolutions distinct; one portion was firmer than the rest, and showed some appearance of a pons, and medulla oblongata. Upon the bodies of the lumbar, and a few of the dorsal vertebrae, there were seen two large parallel nervous cords, which be- came united at the lower extremity, and, upon raising up the brain, there was seen beneath it a thin expansion of medullary substance, which was probably connected with the cords just mentioned ; nerves and ganglia distinct, as usual. In the roof of the mouth there was the very deceptive ap- pearance, which is so often seen in these cases, as of a fissure through the palate ; the uvula, however, was divided upon the median line ; thymus gland quite large ; lungs irregularly fis- sured ; alimentary canal well, except that the coecum and as- cending colon were found in the middle of the abdomen ; liver large, and irregularly divided. The kidneys were in the usual situation, and separate, but rather small, and seemed to be made up of thin and delicate cysts, apparently containing a thin liquid, and being about a line in diameter (No. 789.) The right ureter was of some size and firmness, from the bladder upwards, to about the brim of the pelvis; and the left ureter was in the same condition, nearly to the kidneys; they then became abruptly so small and filiform, that they could scarcely be traced, and continued without any further change as far as the kidneys. Bladder small. The renal capsules were as large, in proportion to the size of the kidneys, as in a well formed foetus, but were broadly and intimately united across the spine, like a horse- shoe kidney (No. 789.) The same condition was found in No. 762. St. Hilaire (I. 543) quotes a case of fusion of the testicles, kidneys, and renal capsules, and remarks that there is no other case of this last on record. The other organs were well formed. This case occurred in the practice of Dr. S. W. Drew. The mother was a respectable woman, and this was her first child. When about two and a half months pregnant, she at- tended an operation upon the eye, when she became very faint and remained so for some time. Labor occurred at eight and a half months, and was short; liquor amnii discharged before Dr. D. arrived, but nothing was said of the amount; head pre- 270 MONSTROSITIES. sented, and the child lived about half an hour. Sex female. 1847. 789-95. The four next cases may be grouped together as a fourth and last variety of the " Acephalus Foetus." The spine is en- tire, except in the first, in which the deficiency may be con- sidered as an accidental complication; the cranial cavity is closed posteriorly by the occiput, and the parietals exist, but there is very little appearance of brain, and the same was ob- served in a similar case, which was dissected some years since. Superiorly, the cranial cavity is, of course, open, and, in most of the cases, largely so. 789. An entire skeleton, being the first specimen in this series. The posterior portion of the occiput consists of a single piece, that extends from side to side, and rises perpendicularly from the spine, the upper edge being thick, smooth, and rounded, and the lower edge deeply notched upon the median line. As a rudimentary parietal, there is, upon the right side, a long, narrow, flattened bone, reaching from the frontal to the occip- ital, and depressed upon the base of the skull, there being nothing of the kind upon the other side. The frontal bones are not much more developed than in the first variety of this form of monstrosity. Otherwise, the cranium is not remarka- ble, except for the vertical direction of the base of the skull posteriorly. The spine is perfect in its cervical portion, but below this it is open throughout. The wings of the two last dorsal, and first lumbar vertebrae are fused, and the body of the tenth dorsal is imperfect, so as to cause a considerable lateral curvature. From the bodies of the second and third lumbar vertebrae, pos- teriorly, there arises a mass of bone, apparently formed by the fusion of three or four rudimentary wings, uniting with the proper wings upon the left side, and forming the passage for a large nerve that went to the sciatic. Sacrum very imperfect; three distinct wings upon the right side, and two on the left, these last being fused ; at its lower extremity, anteriorly, is an anomalous bone, about one line in diameter, and extending transversely from side to side. Coccyx entirely wanting. The pelvis is well formed, in itself, but the antero-posterior MONSTROSITIES. 271 diameter is much elongated, and it seems to be attached to the front of the sacrum rather than to the sides. Ribs well formed, and of the usual number, except upon the left side, where the last two are wanting, and the tenth becomes abruptly widened, about midway, as in Figure 15. Externally, this foetus was well formed, except for the head and back; neck not shortened, and the ears inclined but little forwards. Weight two pounds and two ounces. Upon the base of the skull was a prominent, irregular, lobulated mass of pia mater, equal to an inch or more in diameter, and containing a few serous cysts, but no trace of brain. The spinal marrow was somewhat enlarged just at its termination, and gave origin to the portio dura and mollis, and to the par vagum ; the fifth pair of nerves, with its Casserian ganglion, and the spinal accessory were also distinct. In the neck, the spinal marrow seemed to be perfectly developed, but below this, it was altogether wanting; a cavity, however, was found, as usual, on cutting through the membranes, and the nerves were seen going off upon each side, one large branch passing through the adventitious passage in the lumbar region, as above stated. Internal organs well formed, except for the small size of the renal capsules (No. 792,) and a small diverticulum from the intestine (No. 791.) The mother was a young married woman, and this was her first child. Labor natural; head presented ; quantity of liquor amnii very great. The child gasped for about five hours after it was born, and bled freely from the head and back, but showed no other signs of life. Sex male. 1838. Dr. George Hayward. 790. Two drawings of the above specimen, as it appeared in the recent state ; a back and side view. Dr. Jeffries Wyman. 791. A diverticulum, from the above case. 792. Kidney and renal capsule, from the same. 793. A mounted cranium, represented in Figure 18, and forming the second specimen in this series. The posterior portion of the occipital bone (a.) consists of a single, thick, solid piece of 272 MONSTROSITIES. bone, extending across from side to side, and rising perpen- dicularly from the spine, the upper edge being smooth, round- ed, and almost eburnated ; it is firmly anchylosed to the lateral portions, and, in part, apparently, to the temporal bones. The frontal and parietal bones (b. and c.) are very considerably de- veloped, but depressed entirely down upon the base of the cra- nium ; upper surface of the parietals concave. The opening in the vault of the cranium, formed by the occipital and two parietal bones, is not far from the size and form of the thumb- nail ; posteriorly, the whole base of the cranium is inclined upon the portion that is anterior to it, so as to come into a ver- tical position, the basilar and posterior portions of the occiput being parallel to each other, as remarked by St. Hilaire (II. 322,) in a form of monstrosity, which, in some respects, resembled the present case ; this appearance was observed in three cases, at least, of the present series. The foetus was sent to Dr. C. from the country. It lived nine hours after it was born, and weighed seven pounds and a half. Sex female. In the recent state, the top of the cranium was flattened from the orbits backwards, but was covered by integument and brain, except towards the back part, where it was deficient to the extent of two-thirds of an inch or more. From this part, there projected or hung off two or three soft, dark red masses, having a serous surface, one being about as large as the top of the finger, and the others much smaller, the integu- ment stopping abruptly about their base. Just behind the large mass there was seen a small opening which led in the direction of the spinal cavity, but this was not traced. On cutting through these masses, they were found to consist of a dark red, flaccid, oedematous, apparently cellular tissue, con- taining a serous cyst, about the size of a pea, but no trace of brain; on removing this tissue, however, from between the vault and base of the cranium, a small mass of cerebral sub- stance was found, and which was apparently in the situation of the pituitary gland. The spinal marrow terminated in an ex- pansion in the membranes, between the basilar and posterior portions of the occipital bone, the nerves being sent off on each side. Otherwise the foetus was well formed, externally and internally, except for the small size of the renal capsules. 1842. Dr. Walter Channing. MONSTROSITIES. 273 794. The cranial bones, in this specimen, have been separated by maceration, mounted separately upon pedestals, and placed in a small glass case ; the third in the present series. The posterior portion of the occipital bone is seen to con- sist of two broad pieces, which are deficient, so as in the re- cent state to greatly enlarge the foramen magnum, although superiorly they nearly met. The upper edge of these two bones is thin, rough, and inclined forwards ; the surface pos- teriorly is somewhat convex, and they are strongly anchylosed both with the lateral portions of the occiput and with the tem- poral bones ; differing much, then, from the last two speci- mens. The lateral portions are distinguished by their outward direction, and large foramina ; and the basilar, by its unusual breadth. The frontal bones are very considerably developed, as in the last case, and partially anchylosed, the orbital and frontal por- tions being almost compressed into one broad flat piece. The parietals consist, as in the same specimen, of two, broad, flat, irregular bones, which were depressed so as nearly to touch the base of the cranium ; upper face concave. Large wings of the sphenoid bone co-ossified with the body, and very im- perfectly and irregularly developed; foramina large ; body large, and terminates, in front of the small wings, in a strong point. The squamous portion of the temporal bones is larger than in the first form of the " acephalous foetus" (p. 249,) and the carotid foramen is long and circuitous, but otherwise, there is no marked difference ; ring large, irregular, and co-ossified. The lower maxillary bone is rather short, but stout; posteri- orly, it is broad and flaring ; anteriorly, it is pointed, and the two portions are strongly co-ossified. There is one anomalous bone, of a triangular form, and equal to about five lines in ex- tent, but this was not seen until after the bones had been sepa- rated by maceration. St. Hilaire remarks (II. 302) upon the very compact and almost eburnated condition of many of the bones, and especially of the occipital, in a certain form of monstrosity, to which, osteologically, the present specimen and the last seem to be allied, and in both of which, this structure, in nearly all of the larger bones, is strongly marked. The form of monstrosity referred to, however, is characterized, according to St. Llilaire, by a pedunculated brain, resting upon 35 274 MONSTROSITIES. the depressed vault of the cranium, apparently somewhat de- veloped, and covered, for the most part, by integument; whereas, in these two cases, the quantity of cerebral substance was very small, and it was covered only by serous membrane. The cervical vertebrae have been preserved, the wings being irregu- larly developed, and somewhat fused; the two upper ribs of each side are also seen to be fused. The subject of this case, which occurred in the practice of the late Dr. Henry G. Wiley, was an illegitimate child; and this was the only instance of the kind that was observed in all of the cases of " acephalous foetus " that are here referred to, so far as was ascertained. With regard to another point, the mother was said to have carried her child ten months; and St. Hilaire refers to a similar occurrence in a form of monstrosity to which the present case is nearly allied (II. 346.) Weight nearly six pounds. Sex female. Top of head quite flat, even with the brows, and covered by integument, on which was some hair. On the back part, and about over the occipital foramen, was a dark red mass, covered by serous membrane, about one inch and a quarter in diameter, and consisting partly of cere- bral substance. All of the joints of the lower extremities were more or less distorted, and also the hands ; the fingers being strongly flexed, and the points bent permanently back- wards. Internal organs well formed, except for the small size of the renal capsules, and for the existence of two ureters upon the left side. 1842. 795. A mounted cranium; the fourth and last case in this series. The frontal bones are not much more developed than in No. 789, and are more irregular than in any other specimen. The parietals, also, are represented by two very irregular little bones, from three to four lines in length, and situated behind the frontals. The posterior portion of the occipital bone con- sists of two broad pieces, which meet upon the median line, and slightly overlap, except inferiorly, where there is some de- ficiency ; upper edge arched forwards, as in the last case, and somewhat eburnated ; not co-ossified with the lateral portions, nor with the temporal bones; the basilar portion is almost parallel with the posterior, as above stated (p. 272.) The mastoid portion of the temporal bone is imperfectly dc- MONSTROSITIES. 275 veloped, and the three pieces of the sphenoid are co-ossified, as are also the two superior maxillary bones. The spine was entire throughout, and the skeleton was otherwise well formed. The child, in this case, was fully developed, and would probably have weighed seven pounds. Born at the full period, before Dr. W.'s arrival, and lived ten hours. Sex male. The mother had had several well formed children, and attributed the malformation, in the present case, to a very direct and strong moral impression, the explanation being given since her delivery. The tumor upon the top of the head was about the size of an English walnut, and somewhat flattened, the arach- noid being apparently covered by a very delicate membrane, which resembled the cuticle, as seen about the base of the tu- mor, and when detached by putrefaction. The tumor con- sisted almost entirely of serous cysts, from two to six lines in diameter, and connected, as usual, by a greatly congested cel- lulo-vascular tissue, and at the base there was some appear- ance of an arachnoid cavity. One mass of rather doubtful cerebral substance was found, about five lines in diameter, and two and a half lines in thickness, of a greyish color, ecchy- mosed, and having almost the consistence of a lymphatic gland. The spinal marrow terminated just above the foramen magnum, in a broad, thin expansion. Internally, the renal capsules were quite small, the kidneys large, and each of the ureters formed two separate ducts for some distance after leaving the organs ; in the uvula there was also the trace of a division along the median line. Otherwise, the organs were well formed, the thymus gland appearing rather large, as it often does. In the stomach were six or eight distinct ulcera- tions, from half a line to a line in diameter, and with some ap- pearances of inflammation; this being the only case in which anything like acute disease was found in the internal organs. 1845. Dr. Abner B. Wheeler. 796. Spina bifida ; a wet preparation. The malformation reached, externally, from the sacral into the dorsal region, and measured three inches and one-fourth. Integuments immedi- ately about it cicatrized, as in the " acephalous foetus." Sur- face at first rather depressed, but before death considerably 276 MONSTROSITIES. elevated by the effusion which took place ; it was also excori- ated from the time of birth, and discharged a thin, purulent matter. On cutting through the membranes, the cavity be- neath was found in a state of intense inflammation, as shown by the effusion of serum, and a large quantity of recent lymph. This last being removed, the spinal marrow was seen terminating, as usual in these cases, where the malformation commenced, and adhering to the inner surface of the cavity ; below this, the nerves went off from the membranes upon each side; the anterior and posterior branches, and the ganglia connected with these last, being perfectly distinct, and of full size, as shown in the preparation. Upon each side there was another cavity, which was apparently distinct from the first, but in the same state of inflammation. The subject of this case was a twin-child, and otherwise well formed, except for a strong eversion of the right foot; the other child was well formed, but had died, apparently, before labor began ; both were males. Frequent and ineffectual at- tempts were made to induce motion in the lower extremities; urine and feces discharged about once in two days, and it was never observed to make any expulsive effort. Much distressed on the first night, but was afterwards kept constantly under the influence of paregoric, and it died, without any material change of symptoms, on the tenth day. Inflammation of the membranes, as a cause of death in these cases, is described and figured by Cruveilhier (Anat. Path.), and the same has been several times observed here. In one case, the lymph not merely invested the whole spinal marrow, and extended to the base of the brain, but the brain itself was completely and very peculiarly disorganized; and, throughout the spinal marrow, there was the appearance of a central canal, which was filled with thick yellow pus. 1839. Dr. James B. Gregerson. 797. A dry preparation, to show the condition of the bones, in a case of spina bifida. The wings of the last three lumbar ver- tebrae, as well as the sacral, are separated from each other, though, individually, they are seen to be fully developed. When recent, there existed, at this part, a soft, red tumor, two inches in diameter, the edges projecting over the base; this MONSTROSITIES. 277 ruptured probably at the time of birth, and, so long as the child lived, discharged abundantly, the surface having, to some ex- tent, an opaque, and somewhat sloughing appearance. In- ternally, the sac was highly inflamed, as in the last case, and, above this, there was an imperfect cavity in which the spinal marrow was seen to terminate, the nerves being connected, as usual, with the membranes. This was also a male child ; otherwise well formed, and lived about two weeks. Had a perfect use of the lower ex- tremities, and seemed to be doing well until the eighth day, when there came on convulsions of the head and upper ex- tremities, which recurred very frequently, and were constantly becoming worse as long as it lived. The lower extremities were not convulsed, but, when the change occurred, became paralyzed, and there was some rigid contraction of the muscles of the feet and toes, the system generally becoming affected. Dr. Z. B. Adams. 798. A second specimen, similar to the last. The subject of this case was a first child, and hydrocephalic; presented by the feet, and was still-born. Sex female. Labor occurred at eight, or eight and a half months; quantity of liquor amnii very large. The head was eighteen inches in circumference, and the ventricles of the brain were large in proportion; cra- nial bones widely separated, with some perforations through their substance. The preparation shows an open condition of the spinal ca- nal, from the eighth dorsal vertebra downwards, the bodies and wings of the vertebrae being in no way remarkable, except for a fusion of the wings of the seventh and eighth upon the right side. In the recent state, the corresponding part of the sur- face of the back presented the usual appearance, being de- pressed rather than otherwise ; membranes thickened towards the median line, and gave origin, as it were, to the nerves, both branches of which, with their ganglia, were of full size; no distinct appearance of medullary substance ; cavity not inflamed. 1847. Dr. Stephen Ball. 799. Spina bifida in a boy, sixteen years of age ; the spinal mar- row terminating at the fourth dorsal vertebra; the spine was 278 MONSTROSITIES. removed as low down as the sacrum, and has been prepared to show the condition of the bones. At birth, there was observed a small tumor in the middle of the back, the surface having much the appearance of an old cicatrix, and below this, in the lumbar region, was an " ulcer" about half as large as the hand ; paralysis complete below the ribs. Nursed as well as any child, and appeared to enjoy perfect health, the "ulcer" discharging for about six months, and then healing entirely. Generally quite costive, and the feces were passed involun- tarily. Urine also discharged involuntarily ; always perfectly limpid, without sediment or odor, and, until a short time before death, much more copious than natural; the character of the excretion being very different from what is generally observed in cases of paraplegia. Appetite generally good, and he was not troubled with indigestion. When he was between thirteen and fourteen years old, hair appeared upon the pubes, but he never showed any sexual propensities, so far as could be ascer- tained. The tumor, in the middle of the back, was exceed- ingly tender, but in the ulcer there never appeared to be the least sensibility, not even on the application of caustics. Right leg often oedematous, but the left never; both were always of a natural temperature, and not liable to become cold. Mind active ; upper half of the body unaffected. About two years before his death, the ulcer in the lumbar region broke out again, and he gradually sank under the profuse discharge which took place from the surface. On dissection, the surface of the tumor over the middle of the back appeared as if cicatrized; beneath this was a coarse, white, cellular tissue, which contained no fat, like the sur- rounding integuments, and beneath this a serous cavity, formed by the expansion of the spinal membranes, and partly filled with serum. The wings of the dorsal vertebrae, from the fourth to the ninth, inclusive, were separated so that, midway, the little finger could be passed freely about within the cavity, at the upper extremity of which the spinal marrow was dis- tinctly felt to terminate in the membranes posteriorly, as usual in spina bifida, and from this point downwards it was satisfac- torily ascertained that the spinal marrow did not exist. Below this fissure the spinal canal was again completed by the union of the wings of the two next vertebrae, those of the last dorsal MONSTROSITIES. 279 and first lumbar being also closely approximated. The four last lumbar and first sacral were open posteriorly, the wings upon the right side being very imperfectly developed, and partly fused, whilst those on the left side could hardly be said to exist; the foramina for the nerves, however, were sufficiently large. Throughout the lumbar region there was found, in the situation of the spinal cavity, a coarse, white, cellular tissue, surrounded, for the most part, by a firm membrane, which ap- peared to be an extension of the dura mater, and upon this last, the nerves appeared to terminate. The wings of the dorsal vertebrae, from the third downwards, were extensively fused, the last being also very irregular; bodies of the fifth, seventh and eighth formed throughout in two lateral portions. The spine, at the dorsal region, was strongly bent towards the right side, the bodies of the vertebrae at that part being nar- rower on that side than on the other. There was also a dis- ease of the first two lumbar vertebrae, about one-half of the bodies of these bones having been destroyed by caries, with their intervertebral substance ; some new bone was thrown out upon them anteriorly, and a very considerable quantity of the same upon most of the rudimentary wings of the lumbar ver- tebrae upon the left side, this new bone lying immediately be- neath the ulcerated surface, so as to be covered by little more than the granulations. The thoracic and abdominal organs appeared sufficiently healthy; the liver was rather large and of a pale fawn color, but the lungs were not tuberculous. 1836. Dr. Asa B. Snow. 800. Cast in plaster of the nates and lower part of the back, show- ing the size and form of the tumor, in a case of spina bifida, which may be compared with the following dissected specimen. The patient is a bright, healthy-looking little girl, four years of age; walked as early as other children, and is disposed to play, but soon becomes tired, and often falls, the lower extrem- ities being turned much inwards, and deficient, to a certain extent, in the power of motion ; the urine and faeces are often discharged involuntarily, the bowels being always costive. The tumor is of a regular rounded form, like a female breast, about as large as the fist, and situated over the very lower part 280 MONSTROSITIES. of the spine ; it is perfectly covered by cutis and integument, and resembles to the feel, not an encysted, but rather a com- mon fatty tumor, so that excision has often been suggested; upon the surface there is nothing remarkable, excepting a mi- nute, warty-looking body, and some appearance, as of a small naevus; the separation of the wings of the sacrum is not dis- tinctly felt. The tumor, which was small at the time of birth, has grown rather faster in proportion than the child itself. January 27th, 1845. Dr. Charles E. Ware. 801. A specimen which is preserved in spirit, and shows the con- dition of the parts in a case similar to the last. The tumor was rather towards the left side, about three inches in diame- ter, fleshy to the feel, and covered by integument, with a small naevus upon the surface, as in the other case. On dissection, it was found to consist mainly of fat, but near the surface was a cavity of some size, formed by an expansion of the spinal membranes, and in which the spinal marrow itself terminated, about half an inch within the sac. The wings of the sacral vertebrae are separated, excepting perhaps the first, and upon the left side two or three are fused into a separate mass of considerable size, and are connected with the ilium and ischi- um. The bodies of the same vertebrae are also irregularly developed, and upon the left side there is quite a deficiency of bone, leaving a circumscribed cavity, at the bottom of which the theca is seen, and the nerves arising, as it were, from it. The patient was a male child, fourteen months old, always feeble, and subject to diarrhoea, under which it at last sank, ^•October 10th, 1843. The power of motion in the lower ex- tremities was imperfect, so that it could never stand alone, and there was a want of control of the sphincters of the rectum and bladder. The tumor was congenital, and grew with the child, and the case was particularly interesting in connection with the one last described, as the two patients lived for a time in the same neighborhood, and were observed together. Dr. Henry G. Wiley. 802. The trunk and lower extremities of a malformed, seven months foetus. When recent, a large, rounded, uniform, en- cysted tumor was situated over the sacrum, and apparently MONSTROSITIES. 281 just ready to burst; it was formed by common integument, and so far differed from the ordinary cases of spina bifida. On being laid open, it was found to contain §x of serum, though far from being distended, and was lined by a smooth, polished, and highly vascular membrane. Through an opening, one- fourth of an inch in diameter, there protruded a small portion of spinal marrow, which adhered to the inner surface of the sac, and may still be seen in the preparation; this continuation of the spinal marrow in substance into the lower part of the canal, and below where the cauda equina usually forms, has been observed in certain cases of spina bifida since the time of Morgagni. The external organs of generation and the anus were wanting. Both feet turned inwards, and the left also up- wards. Otherwise, the foetus was well formed externally. On examination of the internal organs, the uterus was found to be of some size, but the cavity terminated below in a cul de sac, and the vagina was wanting; left Fallopian tube and ovary normal. The right Fallopian tube and ovary, also, seemed to be well developed, but the tube, instead of uniting with the uterus, took the course of the round ligament, and was lost towards the groin. The kidneys were entirely wanting, but the renal capsules were of full size, and in their proper place ; so, in a specimen that was exhibited to the Society by Dr. Samuel Parkman, one of the kidneys was wanting, but the renal cap- sules were equally and fully developed; and in a case that was observed by Dr. Lewis, at his dissecting-room, the left kidney was situated in the cavity of the pelvis, but the renal capsule was in its usual place. The bladder, of course, was very small, but communicated with the rectum by a capillary open- ing, as in the cases of imperforate anus, above described (p. 129.) All of the above points, excepting the last, are shown in the preparation; the rectum is also seen, much dis- tended, the rest of the intestine being cut away. Gall-bladder wanting, the ducts being traced directly from the liver into the intestine. The liver itself, and the other abdominal organs were well formed, and have been removed. In the thorax there was nothing remarkable excepting a deep yellow stain upon the external surface of the ventricles of the heart; this was another instance of kirronosis, of which so marked a case has already been recorded (No. 744.) 1836. 36 Dr. D. H. Storer. 282 MONSTROSITIES. 803. A mounted cranium, in which there is seen, near the centre of the posterior portion of the occipital bone, an oval, defined opening, about two lines in diameter, and extending quite through the bone; there is also a considerable deficiency of the frontal bones, commencing at the anterior fontanelle, and terminating rather abruptly some way above the orbits. The subject was a female child, born rather prematurely, and lived but a few hours. Upon the back of the head was a soft tu- mor, about the size of a large filbert, sufficiently defined, but flattened, and covered by healthy integument; on incision, there was found a small cavity within, lined by a delicate, vas- cular, serous membrane, which seemed to penetrate the open- ing in the occiput, and to be connected within the cranium, but this last point was not examined. Otherwise, the child was well formed externally and internally. 1846. Dr. John Homans. 804. A mounted cranium, showing a deficiency in the occiput, and upper part of the spine. The child was born with a cyst at- tached to the back of the head, covered by integument, and nearly as large as the head itself. The cyst presented in the delivery, and, as it caused some delay, it was burst, and dis- charged a considerable quantity of bloody serum. Labor oc- curred at six and a half months, and the child lived four days and a half. During this time it appeared very feeble, and only one attempt was made to give it nourishment, this causing much distress ; there were frequent but slight convulsions from the time of birth, and, towards the last, the hands were strongly and rigidly flexed. The cyst contracted much in size after the child was born, and became dark and quite offensive. On dissection, the inner surface of the cyst appeared to be lined by a serous membrane, and was of a dark red color. Through the deficiency in the occiput, which was at once ob- served, the brain protruded somewhat, and was covered by its proper membranes, and by the dura mater, and, having been carefully removed, it seemed pretty certain that the cerebellum was wanting, and the pons Varolii very imperfectly developed. The organs of the thorax and abdomen were well formed. Sex male. The cranium is generally well formed, but some of the MONSTROSITIES. 283 bones are imperfectly developed. The anterior fontanelle is large, the frontal bones considerably separated, and in several places the bone is very thin, or even not yet formed. This is more remarkable along the upper and back part of the parie- tals, and also along their inferior border, large and irregular deficiencies in the bone being there supplied by membrane ; towards the vertex, and along the sutures, the fibres, which shoot out from the edge of the bone, are very marked, but about the membranous patches the edges of the bone are de- fined. The place of the bone is also supplied by membrane, upon each side, between the temporal and the occipital bones, and also at the base of the skull, between the petrous portion of the temporal and the sphenoid. The deficiency in the oc- cipital bone, above referred to, enlarges, as it were, the fora- men magnum, measuring three-fourths of an inch transversely, and an inch and two-thirds antero-posteriorly, from the junc- tion of the basilar with the spine, the opening posteriorly being well defined, and of a regular, oval form. The separation of the lateral portions of the occiput is just equal to the width of the deficiency in the posterior, so that the regular form of the opening is preserved. Otherwise, the cranium is well formed. Several of the cervical vertebrae having been prepared, in connection with the cranium, the wings of three or four of them are seen to be separated so as to enlarge the opening in the occiput, and there is one wing more upon the right side than on the left, causing a lateral inclination which was as marked in the recent state as it is now; most of the bodies also are imperfectly or irregularly developed. 1846. Dr. Z. B. Adams. 805. A mounted cranium, in which the upper back part of the skull is largely open and greatly malformed. The posterior portion of the occiput consists of two parts, one behind the other, and there is a second large foramen, with several, small, irregular bones about it, which suggest the idea of a second occipital bone. Otherwise, the cranium is well formed, except that the vault is altogether larger than usual. When recent, there existed upon the back of the head a very large tumor, formed by a protrusion of the scalp, and lined by dura mater. Otherwise, the foetus, externally, was 284 MONSTROSITIES. well formed. Sex female. In consequence of the great size of the head, an extensive rupture of the uterus took place, and the patient died in the course of the day. After the oc- currence of the accident, the child was turned, and the lower extremities and body came away readily, but the head re- mained fixed in the pelvis until it was perforated through the frontal bone, after which there was a copious discharge of water, and it was at once born. 1843. Dr. J. C. Hayden. 806. A foetal cranium, showing the effects of hydrocephalus, and the condition of the bones in fissure of the palate. It is much enlarged, measuring seven inches in length, and four inches and one-fourth between the parietal protuberances; the sagittal suture varies in width from two inches to two and three-fourths, and the whole posterior portion of the cranium is largely open. Between the frontal bones, anteriorly, are several ossa Wormi- iana, two of which are quite large ; none being found about the occiput. The nasal bones are one inch apart, and directed upwards and outwards. The left superior maxillary bone is imperfectly developed, and contains the rudiments of the ca- nine and two bicuspid teeth only ; it is widely separated from the vomer, which last is quite broad, and altogether larger than usual. The right superior maxillary is well developed, except in its palatine portion, there being a deficiency from behind forwards nearly to the alveoli; the separation from the vomer, however, is much less than upon the other side. The distance between the palatine bones is ten and a half lines. Con- nected with the right superior maxillary is a portion of alveo- lus, or intermaxillary bone, which contains the first incisor tooth of the left side. The brain was tolerably developed, and some appearance of convolutions was seen, but it was not in a state for any fur- ther examination. Internally, the organs were well formed. Externally, and before dissection, the fissure in the lip, upon the left side, and the double fissure in the palate corresponded with the condition of the bones, the cavity of the left nostril and that of the mouth being directly continuous, and the left ala nasi being carried apparently off into the middle of the cheek, so that, at first sight, the nose upon this side seemed to be wanting. Otherwise, the foetus was well formed, MONSTROSITIES. 285 Labor came on at the end of the eighth month, and was ter- minated in twenty-four hours. The membranes ruptured quite early, as Dr. D. supposed at the time, and there was at once a discharge of water, which he estimated at two quarts, after which the pains subsided for some hours. The child, when born, had an extensive laceration in the posterior part of the scalp, and a direct communication with the cavity of the cra- nium, but the scalp itself appeared to be well developed, and perfectly sound in structure. 1844. Dr. Horace Dupee. 807. A highly finished and very correct drawing, by Dr. James F. Colman; showing the external appearances of a monstrosity which was presented to the Society by Dr. H. B. C. Greene. The foetus weighed eight pounds and two ounces, and, from its size, the labor was very difficult. The most conspicuous ob- ject was a cyst, which arose from the top of the head, rather to one side, and was more than half as large as the head itself; consisted mainly of integument, and seemed to be connected with the membranes of the brain, having burst during labor, and discharged one or two pints of fluid. The convolutions of the brain were seen, but the organ was not examined. The situation of the eyes was marked externally by a slight linear depression, the orbits being filled with adipose substance ; there was, however, something like a membrane, with a black sub- stance upon it, and which was probably the choroid coat; no trace of optic nerves. The nose consisted of two slightly pro- jecting alae, and a small intermediate prominence ; nasal cavi- ties distinct, but terminated posteriorly in a cul de sac. About the mouth, there was a double hare-lip, the appearance of a deep fissure of the palate, as above noticed (p. 269), and an adhesion of the under surface of the tongue, quite to the tip. The sex was apparently female, but, on separating the labia, which were large and well developed, there was found nothing, except the opening of the urethra at the upper part of the fis- sure, to show that they were anything more than a simple fold of the integuments. At the umbilicus there was a hernial protrusion of the intestines, and otherwise the trunk was well formed. The lower extremities (No. 810) were quite short; the feet, however, were of the full size, but extended so as to form a 286 MONSTROSITIES. continuous line with the front of the leg. Each foot has six perfect toes. On dissection of one of these extremities, there were found six metatarsal bones, three of them resting upon the cuboid, and the remainder on three cuneiform bones, one of which last was supernumerary, the large cuneiform pro- jecting so far beyond the edge of the foot as not to support any one of the metatarsal bones. The bones of the thigh and leg were short, but broad and stout. One of the upper extremi- ties (No. 810) had five perfect fingers, besides the thumb, but upon the other, the supernumerary finger arises from the cu- bital edge of the hand, and is directed backwards towards the fore-arm, as in a case quoted by St Hilaire (I. 686.) On dissection, the epiglottis was found to be wanting, except for three little shreds; glottis large and very prominent; vocal cords wanting; body of the hyoid bone very broad, and the thyroid cartilage malformed. Thoracic organs well developed. Stomach, intestines, liver and pancreas well. Spleen very much fissured and lobulated (No. 812.) Kidneys very large, and much altered in structure (No. 811,) the renal capsules being as small as in the " acephalous foetus." Testicles and vasa deferentia well formed, these last opening freely into two distinct cavities, that were situated in a body, which seemed to partake of the character of a prostate gland, of the vesiculae seminales, and perhaps of the uterus; these cavities opened upon each side of the verumontanum, like the vesiculae, but differed from them in structure. In front of these, but still in the same organ, was a third cavity of considerable size, rough upon the inner surface, but quite different in structure, as it was distinct from the first two, and opening largely upon the top of the verumontanum. The inner surface of the urinary bladder, to the extent of about half an inch, had a strongly marked arborescent appearance, as usual in the cervix uteri; neck large; urethra pervious throughout, and opened as above stated, but without any appearance of a penis or clitoris. 808. Cranium of the specimen above described. The vault is en- tirely open, as represented in Figure 19, the bones which form the sides being tolerably, though irregularly developed, and deeply serrated upon their edges. Parietals wanting. The basilar and two lateral portions of the occipital bone are suffi- MONSTROSITIES. 287 cicntly well formed; the posterior portion consists of two pieces, that are distinct, and, for the most part, widely sepa- rated, though they meet to a small extent superiorly. Upon the right side, and connected with this last part of the occiput, is a small, triangular bone, two or three lines in diameter, which would perhaps be regarded by some as a rudimentary parietal, and upon the opposite side there seems to have been a corresponding one. This posterior portion of the occiput is, moreover, distinguished by a considerable lateral distortion. Temporal bones sufficiently well, the passage for the carotid forming a deep groove. The sphenoid bone is sufficiently large, but very irregularly developed ; the small wings are separated from the body to the extent of two or three lines, and are connected with the orbital portion of the frontal bone and the aethmoid ; the body of the bone being connected anteri- orly with the united maxillaries ; large wings sufficiently well developed. The superior maxillary bones are very broad an- teriorly, and short in their antero-posterior diameter; the-alve- oli being for the most part very large, and the palatine fossa deep and much compressed; posteriorly, the orbital portion inclines directly backwards, and the two are united by a broad suture below the aethmoid bone. The palatine bones are small, and unite so as completely to close the posterior nares. The nasal cavity is large, broad, directed upwards, and termi- nates in a cul de sac, the orbital cavities being small, irregu- larly developed, and opening largely into the cavity of the cra- nium. The aethmoid seems to be imperfectly developed, and the vomer is probably wanting. The inferior maxillary bone, as shown in the figure, is very irregular, and without any ap- pearance of an angle ; the two pieces are intimately united, the chin is much elongated, and from beneath it there projects a large, thick spine, for the insertion of muscles; in the situa- tion of the angles it flares off on each side in a broad spine, and, upon the inside, there is a strong ridge of bone, which terminates in a very prominent spine, about where the nerve enters; the coronoid process is comparatively small, and the alveoli are quite large, as in the upper maxillary bones. The other cranial bones are not remarkable, neither were those of the trunk. 1838. Dr. H B. C. Greene. 288 MONSTROSITIES. 809. The two upper and one of the lower extremities of the speci- men last described. 810. One of the kidneys, from the above specimen ; length two inches and ten-twelfths, and otherwise large in proportion; surface unequal and irregular, but not lobulated, and having nothing like an external tunic that can be raised. The other kidney, which perfectly resembled it externally, having been cut open in the recent state, there was found no trace of cor- tical nor tubular portions, except for two very small and doubt- ful mamillary processes; consisted of a close, tough, but very flaccid tissue, and contained an immense number of small cysts, from half a line to one line in diameter. These cysts were collapsed, as if the fluid, if they ever contained any, had been absorbed ; their parietes were firm and moderately thick, and they could be very readily detached from the substance in which they were imbedded. The same appearance was found in the kidneys of a patient from whom a malformed uterus (No. 652) was taken, and something of the kind also in No. 788. 811. Spleen from the above case. 812. Skeleton of a monstrous Calf. The animal was born at Wrentham, March 15th, 1839, at the full period, and was re- ceived on the following day in a perfectly fresh state. It was regarded in the neighborhood as a " calf changed into a bull- dog," and the supposed resemblance, as well as the fact of the malformation, was attributed to a particular fright which the cow had received during the early months of gestation. The head was full and rounded, the line of the face was abrupt, the muzzle was short and square, and the under lip was some- what projecting. The extremities were very short, but of full size, and this was one of the most remarkable peculiarities in the case; the anterior being turned directly backwards, the posterior backwards and inwards. The measurements were, from the muzzle to the root of the tail twenty-seven inches, and to the top of the head seven inches and three-fourths; cir- cumference of body twenty-six inches; extremities six inches in length, the anterior being six inches and three-fourths, and MONSTROSITIES. 289 the posterior seven-inches in circumference. On dissection of the thorax and abdomen, nothing unusual was found. The cranium is represented in Figure 20, and presents the following peculiarities, as compared with a standard specimen of about the same age. The cranial portion is sufficiently large, but quite broad and rounded; no indications of hydro- cephalus, which, according to St. Hilaire, (II. 212) has been so often observed in animals affected with this form of mon- strosity, the bones being sufficiently thick, and the structure healthy. The sagittal and lambdoidal sutures exist, but with a slight deficiency of bone at their junction. The superior and lateral portions of the occiput are co-ossified, as also the basi- lar portion and the sphenoid bone. Foramen magnum small and irregular. Basilar portion of occiput thick, quite irregular, and with a well marked longitudinal fissure upon the under surface. The facial portion of the skull is also quite broad, with a flaring of the upper and lower jaws; the shortness, however, is the most striking peculiarity, the distance from the posterior extremity of the vomer to the extremity of the inter- maxillary bones being three inches and one-fourth, whilst in the other cranium, which could have been very little older, it was five inches and three-fourths. A broad fissure in the palate is also observed, not involving the intermaxillary bones, but ex- tending quite through the maxillaries, the separation between these last being one inch and two-thirds, and the palatine por- tion of course very imperfectly developed. Orbits large. Nasal bones short, and very broad. The trunk is separately preserved, and also the individual extremities, as ligamentary preparations; the first is well formed, excepting the pelvis. The feet, also, with the carpus and tarsus, are well formed, but the other parts are exceedingly imperfect; the scapulae, humerus, radius and ulna, femur, tibia and fibula consisting of very short, thick, and irregular bones, measuring generally from one inch and a fourth to two inches in length. Each of the ossa innominata consisted of a single piece, and were quite as imperfectly developed as the bones of the extremities, the cavity of the pelvis being very small. The extremities of the femur and humerus were formed by very large, rounded, cartilaginous masses, but are now, of course, quite dried up. 1839. Dr. J. B. S. Jackson. 37 290 MONSTROSITIES. 813. A drawing, to show the external appearances in the above case; by Dr. Jeffries Wyman. 814. A foetal skeleton, showing an imperfect development of the extremities, &c. The subject was a male child, premature and still-born. It was quite plump, and generally well developed, externally and internally; the hands and feet, also, as in the last case, were of full size and well formed, but the limbs were very short, and the bones thick and stout. Before the skeleton was dried, the humerus and ulna measured, each, one inch and a fourth in length, and the hand one inch and a half; the femur one inch and a fourth, the tibia one inch and a third, and the foot nearly two inches ; the femur being considerably curved, and some of the other bones more or less so. The cranium is generally well formed; the parietal bones, how- ever, are deficient on each side of the vertex, so as to leave a defined opening, which measures one inch and three-fourths transversely, and one inch in the opposite direction, with two ossa Wormiana at the posterior fontanelle, and a third about the middle of the sagittal suture. The ribs also are shorter than usual. The spine is perfect, and measures eight inches in length. 1846. Dr. John Homans. 815. Cast in plaster of the above specimen. Dr. William E. Coale. 816. Imperfectly developed extremities, in connection with hydro- cephalus, and malformation of the cranial bones (No. 817.) This case occurred in the practice of Dr. E. T. Learned, of Weymouth; the child presented by the breech, and in about an hour the head was removed. The head was quite large, and discharged, on being tapped, about five or six ounces of serum; external ears malformed and very imperfect; lower jaw also very imperfect, and evidently disconnected with the base of the skull. The right upper extremity, before dissection, consisted of an arm and hand which were well developed, except for an ab- sence of the thumb; the hand, however, formed a right angle with the arm; the fore-arm is wanting, and the carpus is seen, in the preparation, to be directly attached to the humerus. MONSTROSITIES. 291 The left upper extremity consisted of a hand having only three fingers, but otherwise well developed; seemed to be attached almost directly to the shoulder; a short bone, however, could be felt, and this, on dissection, proved to be an imperfectly de- veloped humerus. The right lower extremity consisted of a foot, having four toes, but otherwise well developed, though arising directly from the groin; on dissection, the fourth me- tatarsal bone was found to be entirely wanting, except for its very anterior extremity ; the tarsus was developed in propor- tion to the number of toes. The left lower extremity also arose directly from the groin, was an inch and a quarter in length, consisted of a single, well developed toe, and terminated posteriorly in a proper heel, the bones and cartilages being de- veloped in accordance with the external appearances. The muscles, nerves, and blood-vessels were not examined. In place of the pelvic bones, there are seen on the right of the sacrum two small cartilages, one above the other, and upon the left side a third, which is still smaller. The pelvis, and the right upper and left lower extremities are preserved together in one jar in spirit, and the left upper and right lower extremities are preserved in a second jar, as dry specimens. The internal organs were well formed, and the spine was six inches and a quarter in length. Dr. Winslow Lewis. 817. Some of the cranial bones, from the above case, mounted separately, and displayed upon a black-board. The lower jaw consists of two small bones, of the usual width, and united by a proper symphisis, but developed only to the extent of the alveoli for the incisor and canine teeth. The two upper max- illary bones are united, and in these also the alveolar portion is very deficient. Between the petrous portion of the tempo- ral bone and the body of the sphenoid is a large, thick, and exceedingly irregular bone, nearly equal in extent to the body and wings of the sphenoid; upon the right side it is separate, but upon the left it is anchylosed to the sphenoid and temporal bones. 1845. Dr. Winslow Lewis. 818. A drawing, in India ink, of Mr. Benoni T. Bachelder, who exhibited himself in this city not long since, and an account of whose case was published, with remarks, by Dr. O. W. Holmes, 292 MONSTROSITIES. in the Boston Med. and Surg. Journal (March 3d, 1847.) Ac- cording to Dr. H., Mr. B. is twenty-eight years of age, and has one perfect extremity, the others being abortive stumps, and much like those left after amputation. The right humerus is a foot or more in length. The deltoid and pectoral muscles are well developed ; the biceps has a well marked fleshy belly, but tapers rapidly, in common with the other muscles of the arm, towards the lower extremity, which is rounded off without anything like a cicatrix, and has a small, wart-like excrescence upon one side near its termina- tion. This, Mr. B. says, made its appearance some years since, and was not a part of the original conformation. The humerus is felt to be somewhat flattened, so as to spread a little transversely at the lower end, as if there were an effort at the formation of condyles. All the movements of the shoulder-joint are perfect, and the muscular power is very con- siderable. The thigh-bones are about a third of the natural length. The extremity of each of the stumps has a little, mushroom- like appendix or fleshy pad attached to it; that on the right the largest, bearing a certain resemblance to a flattened and boneless great toe, and capable of slight voluntary motions. The left is smaller, and can be retracted by a voluntary effort of the muscles of the stump. The pelvis is said to be narrow. The left upper extremity is well formed and exceedingly muscular. Supporting himself upon this, he is able to move freely about, going up and down stairs, crossing the room in a rapid series of bounds, and throwing himself into a chair with the most perfect ease. Otherwise, Mr. B. seems to be fully developed, and he is one of a large family, all of whom are well formed. His general health is quite good, and his weight is at present ninety-two pounds, but, at the age of twenty-three, was, as he says, one hundred and seventeen. The drawing was made by Dr. William T. Parker. 819. Drawing of a monstrosity, which was presented to the Society by Dr. Abner B. Wheeler. The parietes of the abdomen were wanting upon the right side and in front, so that the intestines and a large part of the liver protruded, forming a mass as MONSTROSITIES. 293 large as the fist. The intestines were very much matted together, had a thickened, fleshy look and feel, and were of a deep red color, there being also a considerable effusion of greenish yellow lymph over the peritoneal surface. The right lower extremity, as shown in the drawing, was entirely wanting, but the left was well developed. This last stood off at a right angle from the trunk, the knee was strongly flexed, and the foot turned inwards; the toes were malformed, the first being sufficiently large, but scarcely separated from the second, the second and third fused, the fourth distinct, and the fifth large and widely separated from the rest. Otherwise, the foetus was well formed externally, except for some lateral compression of the thorax. Sex female. Weight two pounds and a quarter. On dissection, the right internal iliac artery was found to be no larger than a small thread, the left being of full size. The right sacral nerves were also exceedingly small, excepting the first. The uterus was of a conical form, the apex being in- clined towards the left side, and giving off the Fallopian tube ; left ovary well developed ; right tube and ovary wanting. The other abdominal organs were not remarkable except for what is said above of the liver and intestines. In the thorax there was considerable serous effusion, and the arch of the aorta gave off four vessels of about equal size, but otherwise nothing unusual was observed. The mother had previously had one well formed child, and felt the motions of this last as much as she did those of the first. Labor came on at the end of the seventh month; the head presented, the quantity of liquor amnii was smaller than usual, and the child and placenta were expelled together. The heart beat for about ten minutes, and the child gasped a few times after it was born, a general convulsion being produced whenever it was moved. The drawing was made by Dr. Jeffries Wyman. 820. Skeleton of the above monstrosity. A small bone, measuring about two by three lines, is connected with the right side of the sacrum, and upon this there was, when recent, a rounded car- tilage, about a line in diameter, but otherwise there is no trace of a right lower extremity. The left lower extremity is in the 294 MONSTROSITIES. position in which it is above described, the os innominatum be- ing well developed, as is the rest of the skeleton. 1839. Dr. Abner B. Wheeler. 821. Placenta from the above case ; injected and dried. The mem- branes are connected with the cord throughout, which, in the recent state, was but three inches and a quarter in length; they were also continuous with the integuments of the foetus about the right hypochondrium, and adhered slightly to the left lobe of the liver. 822. Cast in plaster of an upper extremity. The arm was well formed; the fore-arm was pretty well developed, but bent to a right angle upon the arm, and measured but seven inches in length ; the hand was bent to a right angle upon the fore-arm, and sufficiently developed, except for the thumb, which was in a very rudimentary state, and connected with the integument by a small peduncle. The subject of this malformation was a man, thirty-five years of age, who died at the Almshouse, October 21st, 1844, and was known during life to have had a good use of the limb. The dissection was made by Dr. B., who found the muscles developed in accordance with the condition of the bones (No. 823); the biceps was attached to the ligament which usually connects the radius and ulna; the nerves ran in a perfectly straight course, but the arteries were much contorted. The cast was taken by Dr. Henry J. Bigelow. 823. A ligamentary preparation of the upper extremity just de- scribed ; by Dr. Samuel Cabot. The radius is seen to be en- tirely wanting. The ulna is strongly developed, but curved upon itself, and measures six inches and three-fourths in a straight line. The inferior articulating surface of the humerus is narrow, as it receives only the ulna, but that portion is most developed with which the radius is usually connected; other- wise this bone is well formed. The bones of the hand are well developed, except for the thumb, which consists of two rudimentary phalanges, upon the last of which is a small nail; the trapezium also is wanting. Dr. Winslow Lewis. MONSTROSITIES. 295 824. A rhinencephalous pig; preserved in spirit. The eyes are contained in a common orbit, but the fusion is not complete ; the proboscis is directly above them, and is about one inch and three-fourths in length, and one-fourth of an inch in diameter. 825. A second specimen. This subject was older than the last; the fusion of the eyes is less complete, and between them and the proboscis the cranium appears to be deficient, or, at least, the integuments are wanting. This last complication is very unusual. 826 - 30. The following specimens of " Blighted Foetus " had the flattened, bloodless, macerated look, which is generally seen in these cases, and, as usual, they were all cases of twins, the other foetus being well formed. 826. The first specimen is shown in Fig. 27, and weighs only ninety- two grains. The trunk is one and a half inches in length, smooth on the surface and quite firm, and terminates bluntly, without any trace of a head or upper extremities. The pelvis, however, exists, and the lower extremities are tolerably devel- oped ; legs crossed, and strongly flexed, so as to come in con- tact with the body, the left foot being also bent into contact with the leg; right foot very imperfect. Labor occurred at seven and a half months, and the perfect child was born first. 1838. Dr. William J. Walker. 827. The second specimen (Fig. 28) is four inches in length, two in width, and was enclosed in a distinct cavity attached to the placenta of a full grown foetus. In this case the lower ex- tremities are wanting, but the head exists; also, the spinal column, the ribs, the scapulae, and one of the upper extremi- ties are seen ; this last adhering to the trunk. 1834. Dr. John Odin. 828. The third specimen is about the size of a five months foetus, the external parts generally being well developed ; enclosed in a sac, which was connected with the placenta of a large and vigorous foetus ; cord fourteen inches in length. 1830. Dr. Joseph W. McKean. 296 MONSTROSITIES. 829. The fourth specimen is less developed than the last, the weight being less than five ounces ; connected with the placenta of a mature foetus. This case is remarkable for the strong flexion of the limbs, and for being enveloped in an abundant, soft, ragged, adventitious deposit. 1829. Dr. John Ware. 830. A cranium, prepared to show the great overlapping of the bones which takes place in the blighted foetus, when the de- velopment is sufficiently advanced. In the recent state, the subject of this case resembled No. 828, and a healthy eight months foetus was born at the same time. Dr. D. H. Storer. 831. A human foetus, between two and three months old, and affected with hare-lip upon the left side. 1830. Dr. J. H. Lane. 832. The superior maxillary bones of a six months foetus, that was affected with hare-lip. That on the left side wants the two first alveoli, but is otherwise well formed ; the alveolus for the first incisor, however, exists as an intermaxillary bone, and is connected by a slender process with the vomer. The right superior maxillary is sufficiently developed. 833. A drawing of the right hand of a child between two and three years old. The fingers are closely united, and there is a sin- gle, continuous nail extending across the whole, the outline of the fingers being distinctly felt. The thumb is well developed, and the hand is otherwise sufficiently well, except that the ar- ticulation of the middle finger with the metacarpus is not in a line with the rest. The case occurred (1847) in the practice of Dr. Anson Hooker, of East Cambridge, and the drawing was made by Dr. Jeffries Wyman. A somewhat similar case was reported not long since to the Society, but in which the deformity was considerably greater, the right hand being here also affected. The thumb was wanting ; three fingers only could be felt, and these, with three metacarpal bones, were more or less imperfect; nail not per- fectly continuous, but divided towards one of the edges into two portions. The subject of this case was a well formed MONSTROSITIES. 297 child, about two years old, and a patient of Dr. Edward Jarvis, of Dorchester. n. Monstrosities by excess. 834. " Two male children, well grown, united from the shoulders on one side to the navel; there is but one umbilical cord ; the thorax is common to both, having no partition, and but one heart; the aortas have an arch from two ascending arteries, arising, apparently, from each superior corner of the heart." The above account of this specimen is from the Boston Med- ical Intelligencer, for August 19th, 1823. The union seems now to be rather anterior than lateral. Dr. George Parkman. 835. Skeleton of two female children, that were united face to face from the top of the sternum to the umbilicus, being otherwise well formed, as is the last specimen, which, in the recent state, it very perfectly resembled. Weighed nine pounds and two ounces, and was quite fresh when received, but died probably during the delivery, there being some laceration of the soft parts, with fracture of some of the bones ; the mother also died in conse- quence of the difficulty of the labor. The thorax forms one large, continuous cavity, and has a sternum upon each side, but these last, instead of being dis- tinct, as, according to St. Hilaire, they usually are in these cases (III. 95,) are united so as to form an arch above the common cavity. On dissection of this foetus, the alimentary canal, the pan- creas, the spleen, the urinary and genital organs, the thymus gland, and the vocal and respiratory organs were found to be in double sets and well formed ; some adhesions only existing between the intestines and the other parts. The principal nerves were also dissected. The diaphragm formed one large and continuous arch be- tween the two foetuses. The two livers were united, but appeared to be no larger than the single organ in a foetus at the term. A single broad ligament extended from the umbilicus along each face of the organ to the diaphragm, making the two abdominal cavities 38" 298 MONSTROSITIES. quite distinct. There were two umbilical veins and a gall- bladder upon each face of the organ, the ducts being distributed as usual. The two hearts were united to form one common organ, the ventricular portion resembling somewhat, in its breadth, the heart of a tortoise. There was but a single auricle, irregular on the inner surface, and having a band running across it mid- way, but with nothing that could be called a septum ; two ap- pendices were found at each extremity, with the pulmonary veins and the superior vena cava of each foetus. The ven- tricular portion consisted of two cavities, the septum being perfect, except for a small opening at the upper part; auriculo- ventricular valves well developed. At one extremity of this ventricular portion there arose an aorta which was in every way normal, and by its side a pulmonary artery, smaller than itself, and having but two valves; at the other extremity there was another aorta, which gave off the pulmonary artery. The only peculiarity noticed in the vessels was the existence of but one umbilical artery in one of the foetuses. 1837. Dr. Nathaniel Miller, of Franklin. 836. Drawing of a monstrosity that was sent to the Society by Dr. E. T. Learned, of Weymouth. The subject of this case consisted of two foetuses, which were united from above downwards, but separate below the umbilicus; having two perfect faces, four upper extremities, and being well formed externally, except for the fusion. Sex male. Weight twenty- four ounces, and length of the spines three inches and a fourth. The mouth of each foetus opened posteriorly into a common pharynx, from which descended the oesophagus (Figure 22.) Below the diaphragm there was seen the stomach, which, when distended, was about the size of a large cherry (No. 838); this communicated with a portion of intestine, about one inch and a quarter in length, and this opened into a cavity which sent off a separate intestine to each foetus, the small intestine being seven inches in length, and the large eight inches, with- out including the rectum. The liver was decomposed, and unfit for examination. Urinary and genital organs double, and well- formed ; the respiratory organs were also double, with the thy- roid and thymus glands. MONSTROSITIES. 299 There were two separate hearts. Each had, at least, one auricle, and in one of them there was an appearance of a second; each had also two ventricles, which communicated freely, and gave off from their common cavity an aorta and a pulmonary artery, the vessels being distributed as follows. Each aorta gave off two carotids, after which the arch became very small. One of the pulmonary arteries gave its branches to the lungs, and its ductus arteriosus to the aorta, which after- wards sent off the two subclavians. The other pulmonary artery gave its branches to the lungs, and then a large branch which formed the second descending aorta, from which one subclavian artery was seen to arise; the second having proba- bly been cut off; the ductus arteriosus was then given off, and, after having joined the arch of the aorta, opened at once into the first descending aorta, and thus formed a free communica- tion between the two. The drawing was made by Dr. Jeffries Wyman. 837. Skeleton of the above monstrosity ; not mounted. The head contains two entire sets of bones, which are sufficiently devel- oped for the age of the subject, though somewhat crowded; most of them have been detached, but those of the base still remain in connection, and are represented in Figure 21. The sphenoids are the only ones that require any particular notice; the body of each of these bones is divided longitudinally into two equal portions, and each revolves one-quarter of a circle, so as to bring the posterior edges of the two corresponding portions into opposition; the inner lateral edges of each sphe- noid, then, are opposed to those of the opposite sphenoid, whilst the outer lateral edges are opposed to the basilar portion of the occiput and to the temporal bone. This is certainly very different from a figure of a similar case by Serres, in the Memoirs of the Institute (vol. 55.) The large and small wings are sufficiently well, except that three of the last retain their early foetal condition of being dis- tinct bones. The other bones are not remarkable, except for some difference in the size of the parietals in the two subjects, and a fusion of the two portions of each frontal bone. The thorax is double, as usual in these cases, and the two skeletons are otherwise well formed. 1836. Dr. E. T. Learned, of Weymouth. 300 MONSTROSITIES. 838. A model, in wax, of the oesophagus, stomach, and upper part of the intestine, from the above monstrosity; as already described. 839. A foetal Calf, preserved in spirit, the age of the subject being perhaps two or three months. Malformation as in the last case, except that one of the faces is somewhat imperfect. 840. A double Pig, similar to No. 836, except that instead of a second face, an ear only is found, perhaps a fusion of two. A stuffed specimen. Some years since, a human subject, showing this same form of monstrosity, was brought from Siam, and was in the Socie- ty's cabinet for a time, but was afterwards removed. 841. A double Guinea-pig, preserved entire in spirit. Malforma- tion as in the last case. Dr. George B. Doane. 842. A double Chicken, preserved entire in spirit, and malformed like the last specimen; there is also a lateral distortion of the upper mandible. This form of monstrosity is common in the mammalia, but St. Hilaire does not mention its occurrence in birds. 1845. Dr. Francis W. Cragin, of Surinam. A second specimen has lately been received, and resembles the one just described, except that the upper mandible is not dis- torted. Upon the back of the head there is seen the external open- ing of the central ear, or perhaps, from the size, a fusion of two. 843. A double Kitten, preserved entire in spirit. Malformation as in No. 840, except that the ear on the back of the head is wanting. 844. Skeleton of a double Lamb ; not mounted. Externally, this subject resembled the last, as a monstrosity, except for some peculiarities about the head. Below the angle of the jaw, upon the right side, was a narrow fissure, one and a half inches in length, opening largely into the pharynx, and at its posterior extremity, on separating its edges, was seen a malformed in- ternal ear. The external ear, upon the left side, was well formed, but the right, which was situated not far from the fis- MONSTROSITIES. 301 sure, terminated in a cul de sac, though otherwise well devel- oped. Secondly, there were beneath the anterior extremity of the lower jaw, and inclining to the left side, two incisor teeth, the relations of which will be-hereafter described. On dissection, there was seen on the back of the pharynx a fold of membrane, which was evidently the rudiment of a second palate, and beneath this some appearance of the root of a second tongue. Oesophagus single, and well formed. The stomach was formed by the fusion of two organs. The fourth, or digestive cavity, was single, but very large, measur- ing, in a collapsed state and before being opened, four and a half inches in length, and one and a half inches transversely. Of each of the three other cavities there was a double set, those which corresponded being equally developed. The first ex- tended off two inches from the lower extremity of the oeso- phagus upon each side, and was about two-thirds of an inch in diameter. Where these two opened into the fourth cavity there were seen, closely grouped together, four others, each of which was about one-third of an inch in diameter; these, of course, were the second and third cavities, and one of each of them was situated, side by side, on each face of the stomach, or between the two first cavities. The intestine continued single for seven feet and a half, and then divided, one portion consisting of thirty inches, each, of small and large intestine, and the other of about thirty-four inches, each, of the same. Just at the division there was a sort of diverticulum, six and a half inches in length, termi- nating in a cul de sac, and lying free in the cavity of the ab- domen ; this appendage was not uniform in size, but was in some parts considerably smaller, though nowhere larger than the intestine itself. There were two distinct livers, one being somewhat larger than the other, and each having its gall-bladder, ducts and ves- sels ; the umbilical vein entering upon the convexity of the organ. There were also two distinct sets of urinary and ge- nital organs. The lungs, trachea, and thymus gland were in double sets and well-formed. The larynx, which corresponded to the face of the animal, was also normal, though the cornu of the hyoid bone on the right side, and in connection with the fissure in the 302 MONSTROSITIES. neck, was imperfectly developed. The other larynx was alto- gether small, and the cornua of the hyoid bone, which were otherwise not remarkable, were so closely connected as to ap- pear like one bone before they were separated. Two distinct hearts were found ; one was decidedly larger than the other, but both of them sufficiently developed, and, seeming to be externally well formed, were not cut open. An aorta and pulmonary artery arose from each, and communi- cated, as usual, by the ductus arteriosus. The arch of each aorta gave off a single vessel which very soon divided into the two carotids; one of these vessels being proportioned to the size of the head of the animal, but the other quite small. At some distance beyond the arch each aorta gave off two sub- clavians, directly opposite to each other. At the arch the two aortas communicated by a vessel which was about the size of either of the ascending portions. Of the skeleton. — The cranium is single in front, but is not well formed, there being a want of symmetry between the two sides; posteriorly, it is quite broad, and formed by the fusion of two. There are two occipital foramina, two-thirds of an inch apart, one being of full size and well formed, the other considerably larger and somewhat irregular. The lateral and two basilar portions of the occiput are quite distinct, these last being connected with a common but broad sphenoid bone, and also with each other through nearly half their extent; the pos- terior portions are less distinct, being partially fused with the parietals. Of these last there seem to be two sets, and con- nected with each an interparietal. Between the lateral por- tions of the occiput are a few, small and very irregular bones upon the median line, to represent the face of the second foe- tus. Upon the left side the temporal bone is well developed, but on the right the bony cavity connected with the tympanum is very imperfect, its internal structure being exposed in the form of a very irregular surface, which, when recent, was covered by a thin, delicate membrane, and was seen in this state at the bottom of the fissure which opened externally be- neath the lower jaw. There is much lateral distortion of the lower jaw, especially on the right side, and connected with the posterior inferior portion of the symphisis is a small, distinct bone which contains two incisor teeth, (Fig. 23,) the atrophy MONSTROSITIES. 303 of the lower jaw being much greater than in any case referred to by M. St. Hilaire, where he treats of this form of mon- strosity (III. 257.) The bodies are connected as usual in these cases, the ster- num and ribs corresponding to the face of the animal being well developed, but not those upon the opposite side. To distin- guish the two bodies, that may be called A which corresponds to the right side of the face of the animal, and the other B. The spines are distinct throughout, and have the usual number of vertebra?. The spine of A has, in the cervical and upper half of the dorsal portion, a strong, double lateral curvature, there being a considerable atrophy of the dorsal wings upon the concave side, but with less difference in the neck, where the curvature is less marked; the atlas, however, is thrown quite to one side ; the spinous processes and wings of the first six dorsal vertebrae are fused, and also the seventh and eighth. The spine of B. is less curved in its dorsal portion, and the cervical very little if at all; the first four dorsal wings are fused, also the fifth and sixth, and the seventh and eighth. B. has thirteen well developed ribs on each side. A. has a re- markable development of the right transverse process of the vertebra in place of the thirteenth rib, and, as it seems intend- ed to represent a rib, this vertebra has been regarded as one of the dorsal; the fourth, fifth, sixth and seventh ribs on the left side are very closely fused posteriorly, but anteriorly divide into two portions, otherwise the two bodies appear to be well formed, as are also the eight extremities. The subject of the above case was sent to the Society in May, 1843, by Dr. Henry C. Perkins, of Newburyport. 845. Skeleton of a double Pig; not mounted. — Externally, this monstrosity resembled No. 841, except for a deficiency of the vault of the cranium, and that there was no additional ear upon the back of the head. How far the brain was developed, if at all, could not be ascertained, as the spinal marrow had been cut off at its upper extremity, being there of about the proper size ; the specimen had been in spirit, but was otherwise in a state of good preservation. The posterior portion of the occi- put is very imperfectly developed, but connected as usual with the lateral portions, and forms with them a high wall perpen- MONSTROSITIES. dicular to the base of the cranium. The cranial portion of the frontal bones is wanting, and the parietals are very imperfectly developed; these last being separated by the whole width of the base of the cranium. The palatine, the maxillary, and, to a certain extent, the intermaxillary bones, are separated, as usual, in fissure of the palate. Otherwise, the cranium is sufficiently well formed. The two spines are united in the cervical portion. Posteri- orly, the first three vertebrae are single ; the fourth is double, having two sets of wings, and something like a rudimentary one between them, and from the fifth downwards the two col- umns are separate throughout. Anteriorly, the fusion is much less complete, the two rows of bodies being distinct throughout; the first body in each spine consists of two bones, one above the other, and between those of the second vertebrae there is an additional bone of considerable size ; the fourth, and all be- low, are well formed. The spinal canal is single to the fourth vertebrae. The thorax is formed, as usual, by a fusion of the two, the side corresponding to the back of the head being im- perfectly developed. The extremities which correspond to the imperfect side have the scapulae united by their upper edges, and also by their spines (Figures 33 and 33'), but are otherwise well formed, as are the two other upper extremities, and both sets of the lower. On dissection, the oesophagus was found to be single, but communicated largely throughout with the larynx and trachea, as has been observed in some analogous cases (Anom. des Org. III. 144.) The stomach (Fig. 34) was single, but formed by the union of two. The small intestine was single for the first thirty-two inches; it then became dilated, as shown in Figure 24, and from this second cavity there arose a double set of intestines, the small measuring between five and six inches, and the large about twenty-four inches. Two inches above the dilatation there was a diverticulum, ten lines in length, and situated parallel to the intestine, to which it closely adhered, except near the extremity. Both subjects were males, and there was nothing unusual in the genital or urinary organs, excepting that one set of kidneys was somewhat smaller than the other. The hyoid bone, epiglottis, larynx and trachea, corresponding to the face of the monstrosity, appeared to be MONSTROSITIES. 305 well developed, except that the two last, as above stated, opened freely into the oesophagus; the primary bronchia and the lungs were also sufficiently developed. About opposite to the lower part of the trachea, and in the parietes, as it were, of the oesophagus, there was found a second, small, rudiment- ary larynx, below which was a trachea of corresponding de- velopment, two bronchia, and a pair of lungs, these last being about one-third or one-half as large as the first pair. A large blood-vessel passed down between the cartilage of the larynx and its mucous surface, running parallel to and in front of the trachea, and dividing to send a branch to each lung, as it were a pulmonary artery; its origin, however, could not be deter- mined, as it had been cut off about half an inch above the larynx. The heart was single, and appeared externally well formed, except that no vessels were found to enter the left auricle ; a large branch, however, entered the right auricle, and, from its situation, was probably the common trunk of the pulmonary veins. Internal structure normal. The aorta divided almost at once into two large trunks, one for each foetus; and these gave off branches, which must have been the carotids and sub- clavians. The pulmonary artery gave off two small pulmo- nary branches, and sent to each aorta a ductus arteriosus, these two last vessels being of unequal size. 846. A portion of small intestine, from the above case, injected, and represented in Fig. 24. St. Hilaire (II. pp. 102 and 132) remarks upon dilatation of the intestine at the point of division as very rare, but refers to three cases. 847. Skeleton of a double Pig; mounted. The cranium is malformed very nearly as in the last case, the vault being open superiorly, and the cavity quite shallow. The parietal bones form the lateral boundary; the cranial por- tion of the frontals is entirely wanting, as is also the posterior portion of the occiput, the lateral portions being well devel- oped, but widely separated, and not anchylosed' with the tem- porals, as in No. 845. There was also a fissure through the palate, and double harelip, the maxillary and palatine bones being separated as usual, with a deficiency of the facial por- tion of the intermaxillaries. 39 306 MONSTROSITIES. The seven cervical and first dorsal vertebrae are single, and then the spines divide. As in No. 844, the subject which cor- responds to the right side of the face of the animal may be called A, and the other B. The spine of B is sufficiently developed to about the tenth dorsal vertebra, but with a con- siderable lateral curvature, and a fusion of two or three wings upon each side ; at this point there was an antero-posterior curvature, and below this it is open as far as the sacrum, as in a case of spina bifida, the bodies and expanded wings forming a broad, flat surface ; there are five lumbar vertebrae, and the sacral and coccygeal are probably normal. Upon the right side the wings of the vertebrae of A seemed to be well devel- oped as low as the sixth dorsal, but with a partial fusion of the first three ; upon the left side there are seen two very broad and irregular wings, which are fused with those of the right side. Below the sixth dorsal vertebra the spine is open throughout as far as the sacrum, and most irregularly and strongly curved or rather twisted upon itself, producing a de- gree of shortening such that in the recent state the ilium came nearly into contact with the ribs; upon the right side there are the wings of five lumbar vertebrae, and with these are con- nected the bodies, which consist of two broad and irregular bones, but upon the left side the wings are entirely wanting; the sacral vertebrae are imperfect, and the coccygeal entirely wanting. The thorax, which corresponds to the face of the animal, is sufficiently developed; the ribs on the left side of A, are fully so, except for a fusion of the first two, the whole number being fourteen; upon the right side of B there are thirteen, and they are more compressed. The thorax, which corresponds to the occiput of the animal, is represented by fourteen ribs, all of which are separate but much compressed, the first one or two belonging to the left side of A, and the others to the right side of B. The pelves and extremities are well formed. Before dissection the condition of the head and of the spines corresponded with that of the skeleton as above described ; there were but two upper extremities, and the two lower of each of the subjects were united by integument as far down as the middle of the leg. The organs of the abdomen had been mostly removed, but there remained for B an intestine, MONSTROSITIES. 307 left kidney, bladder, testicles and penis; in A there, was the right kidney, the testicles, and an imperfect bladder, but no intestine. The thoracic organs had not been disturbed, and were found normal, the aorta dividing for the two subjects just above the diaphragm. 1834. Dr. Francis W. Cragin, of Surinam. 848. The cranium of a double Pig; mounted. This specimen differs from any in the present series (p. 298), inasmuch as there is a common central orbit, and the anterior as well as the posterior portion is composed of the parts of two individuals. The occipital foramina, the basilar and posterior portions of the occiput, the parietal, frontal, and nasal bones are double and well developed, though somewhat irregular ; the anterior portion of the two faces being not merely approximated, but to some extent overlapping ; one of the parietals also consists of two pieces. Upon the outer half of each cranium the lateral portion of the occiput, the temporal, the os unguis, the malar, and the intermaxillary bones are well developed; the upper maxillary of each, however, is deficient throughout in its palatine portion, there being a fissure of the palate as in the last case. Upon the inner half of each cranium the temporal bones are very imperfectly developed and completely fused ; the tympanic cavities are much compressed, situated di- rectly between the two occipital foramina, and show no trace of a division ; the squamous portions consist of a single broadly expanded bone, bounded by the parietals and the occiput, and having in its centre a common meatus, the vaginal process of each bone being well marked; the petrous portions are situ- ated between the two basilars. The central orbital cavity is formed mainly by the frontal bones and the anterior sphenoids ; each of these last is perforated by a large optic foramen, and the two bones are intimately fused together, and also with the posterior sphenoid of the subject which may be called A, with the vomer of A, and with a bone of some size which may perhaps be the ascending portion of the palatine of B, there being nothing corresponding to this last in the other subject. Between the central orbit and the base of the skull there is now seen to be a free opening, and this is divided by a bony partition which seems to be formed by the internal wings 308 MONSTROSITIES. of the posterior sphenoids, that of B, however, being detached from the body of the bone ; there are, of course, two basilar bones, and a posterior sphenoid connected with each. In front of the central orbit the os unguis of each subject is largely developed, but the superior maxillary bones are in the most rudimentary state, and show no trace of alveoli; the nasal cavity is open throughout; the intermaxillaries are very im- perfect, and particularly that of A, which contains only one incisor tooth. The lower jaw is single, the branch correspond- ing to A being shorter than the other, and flaring outward. The rest of the skeleton has been preserved separately, but not fully prepared ; there are four upper and four lower ex- tremities, and the thorax is formed, as usual in these cases, by a fusion of the two. As this subject was in a state of advanced putrefaction, when received, the dissection was hastily made, and those parts only will be mentioned which were particularly exam- ined. In the central orbit were two distinct eyes, and upon the back of the head a large double ear. The oesophagus was single, and situated between the two tracheae ; stomach formed as in No. 845; small intestine well developed, and single to within nine inches of its lower extremity, where it divided, but without any dilatation at this part; at the umbili- cus was a considerable hernia. The respiratory organs were double, but both sets of lungs were very imperfectly developed ; one larynx also being imperfect, and the cornua of the hyoid bone closely compressed, as in No. 844. The two hearts were widely separated, and each had its pericardium ; internal structure of both normal; the vessels, entering and leaving the organs, were all of them traced, excepting the pulmonary veins, which, owing probably to the undeveloped state of the lungs, must have been very small and were not found. The two aortas communicated at the arch by a vessel which was of considerable length, and fully equal in size to either trunk; one aorta passed over the left primary bronchus, and the other over the right of the other set of lungs, as in No. 850, and, lastly, each aorta sent off at the arch two vessels, one of which soon divided. 1847. Dr. John C. Warren. 849-57. In the present series, which is the reverse of the last MONSTROSITIES. 309 (836-48), the duplication commences with the head, and the fusion goes on from above downwards. 849. A double-headed Fish, preserved in spirit.—The two heads are about equally developed, and the fusion commences just behind the pectoral fins, the spines being traced separately to behind the anus. Each individual has a dorsal fin, and two pectorals, but the anus and a single pair of ventral fins are common to the two. The specimen belongs to the genus Pi- melodus, and measures one inch and three-fourths in length, and one-third of an inch from the anterior extremity to the point of fusion. It was taken in the Gulf of Mexico, by Lieut. White of the U. S. Navy, he having caught it in his hand. 1846. Epes S. Dixwell, Esq. 850. A drawing of the alimentary canal of a monstrosity that was born in the practice of Dr. Nathaniel Ruggles, of Nantucket, in June, 1846, and was subsequently examined in this city. It has been represented in Fig. 26, and the following account of the case, as it was reported to the Society, is here given, by the permission of Dr. R. The subject of this case had two heads and necks, which were distinct throughout, one pair of upper and lower ex- tremities, and a trunk which was formed by the fusion of two. Sex male. The mother was a middle-aged woman, and this, which was her first labor, occurred about the end of the eighth month. One of the heads presented, but Dr. R. brought down the feet, and after three hours accomplished the delivery, much force being required; the children lived about twenty- five minutes. Weight five pounds and a half. A hasty ex- amination of the organs was made at the time by Dr. C. T. Collins, of New York, and Dr. Ruggles, and a short account of the case was published by Dr. C. in the New York Med. and Surg. Reporter, of which he was at that time the editor. The body was then sewed up, but the organs, which had been removed in a mass, were preserved separately, and a few weeks afterwards the specimen was sent to this city, where it remained for a short time ; here it was again examined, and very recently the whole has been returned to Nantucket and buried. 310 MONSTROSITIES. With regard to the external appearances, it may be stated that there was no trace of a third upper extremity, and that the two spines, being traceable to the middle of the back, would probably have met about at the sacrum. On examination of the organs, there were found two hearts within a common pericardium. One was perfectly normal. The other was somewhat smaller; consisted of a single, large, ventricular cavity, from which there arose an aorta of full size, and a small pulmonary artery, the ductus arteriosus being very slender; the left auricle was very much larger than the right, the limits between them being well defined, though there was only the trace of a septum. The lower vena cava was com- mon to the two organs, and divided just above the diaphragm. Each aorta gave off a large vessel, which immediately divided, and just beyond this a second, undoubtedly the two carotids and a subclavian, the subclavian arteries arising from different aortas, as each of the two upper extremities belonged to a different subject. The aorta of the largest heart passed, as usual, over the corresponding left primary bronchus, but the other over the right primary bronchus of the second set of lungs, and somewhere between the arch and the diaphragm the two formed a common trunk. The respiratory organs and thymus gland were in double sets, the lungs being small, irregular, and much fissured, ex- cept the one which corresponded to the malformed heart, and was upon the right side. The alimentary canal, having been washed out and inflated, a drawing was made of it by Dr. Jeffries Wyman, and has been represented in Figure 25. The two stomachs were well formed, and one of them was of full size ; the other was about half as large as the first, and buried, as it were, in a cavity in the liver. The duodenum of each was about three-fourths of an inch in length ; the two then united to form a single intes- tine, which was three inches and a half in length, half an inch or more in diameter, and much contorted. Near the termina- tion of this irregular portion of intestine was a diverticulum, three-fourths of an inch in length, and adherent to the intes- tine, its cul-de-sac being directed towards the great dilatation, into which the intestine now opened. The dilatation was three inches and a half in length in a straight line, and one and a MONSTROSITIES. 311 half inches in diameter; considerably curved upon itself, and upon its large curvature sacculated, as the large intestine of an adult often is. The dilatation was followed by ten inches of small intestine, which arose quite abruptly, and eight and a half inches of large intestine, besides what may have been left in the body. The liver was single ; lobes irregular. One well developed gall-bladder, with its ducts, corresponded to the largest stomach, and near it there was seen the situation for the second, if it had existed. According to the statement of Dr. R. there was one spleen and two kidneys. In the mass examined here, there were found two rudimentary spleens connected with the large stom- ach, and about a line or more in diameter; one kidney with its renal capsule, and a second renal capsule without its kidney. 851. A double-headed Lamb. The two heads are united at an ob- tuse angle, and the central ears appear to be fused at the base. The animal is otherwise well formed, and, from its size, may have lived for some time after birth. A stuffed specimen. 852. A double-headed Kitten. There are no central ears, but the eyes are somewhat far apart. A stuffed specimen. 853. A second specimen, preserved in spirit. The central eyes are not fused, though they are in a common orbit, there being two perfect sets of lids. 1844. Mr. Kimball, Proprietor of the Boston Museum. 854. A double-headed Chicken. The central eyes are probably fused, there being but one set of lids. The upper portion of the spinal canal seems to be open, as in the next case. 855. A double-headed Duck; said to have lived for a short time. The two heads form a more acute angle than in the last speci- men, but the central eyes are equally far apart. The top of the cranium may have been injured by violence, but the upper portion of the spinal canal seems to be open, as from conge- nital deficiency. Dr. J. B. S. Jackson. 856. A small double-headed Snake, from South America. The 312 MONSTROSITIES. two heads appear to be equally developed, and form with each other a right angle as in St. Hilaire's figure, (PI. xv.) the cen- tral eyes being widely separated. Boston Society of Natural History. 857. Cranium of a double-headed Lamb. The animal was carried to the full period, and well formed, except for the head, which was sent to Dr. J. by Dr. L. W. Briggs, of Bristol, R. I. There were two perfect eyes, and upon the median line two others which were fused, the two cavities of the vitreous humor being separated by a common sclerotic coat. The cavity of the mouth was single, and the tongue and lower jaw showed no trace of duplication, in which respect this specimen resembled one already described (No. 848), and differed from what has been generally observed in this form of monstrosity. (Hist, des Anom. III. 200.) The cranium, having been pre- pared, is seen to be divided anteriorly into two portions, which are symmetrical; each has two frontal bones, two ungues, one nasal and intermaxillary, and upon the outside a well devel- oped maxillary, but upon the inside this last is entirely want- ing ; the outer nasal cavity is perfect, but the inner is not so, there being a deficiency of bone between the intermaxillary and os unguis. At the bottom of the large common orbit are seen the two optic foramina about one-third of an inch apart; superiorly the orbit is mostly membranous, but inferiorly it is in part formed by an irregular, imperfectly developed, bony plate. The posterior sphenoid, where it is connected with the basilar, is double, this last and the whole occipital region being single and well formed. 1846. Dr. J. B. S. Jackson. 858 — 69. The following specimens may be grouped in one series. 858. A model of Ake, the well known Chinese monstrosity (Hist. des Anom. PI. xviii. Fig. 4); sent to Dr. Reynolds by a gen- tleman in Canton, and with it a manuscript copy of Dr. John K. Mitchell's description of the individual as observed by him- self ; the manuscript is deposited with the specimen. Dr. M.'s description was published, with an engraving, in the Philadel- phia Journ. of the Med. and Phys. Sciences, in 1821, and is, of course, much more to be relied upon than that of Dr. MONSTROSITIES. 313 Livingstone's account of the case which was sent to England from Canton, and has been published in the Catalogue of the Hunterian Museum, Dr. L. himself never having seen the individual. It is remarkable that Dr. M.'s description, which is so very full and satisfactory, is not mentioned in the Hunt. Catalogue, nor by St. Hilaire. Dr. Edward Reynolds. 859. A Kitten, preserved in spirit, and showing two pairs of ex- tremities growing from about the epigastric region; the ante- rior are united by integument as far as the carpus, the paws are clubbed, and there are but four toes on each ; the posterior extremities are more developed, and there is an anus and some appearance of genitals, but no tail. 860. A stuffed specimen, very similar to the last, except that the anterior extremities are not united. 861. A third specimen ; preserved in spirit, and resembles No. 859, except that there is only one pair of supernumerary extremi- ties, and these are the posterior. 862. A Chicken preserved in spirit, and having two supernumerary extremities growing from the back of the pelvis ; they are not fully developed, and the thigh bones are united by integu- ment. A similar specimen has also been sent to the Society by Dr. Jarvis, of Dorchester. 1840. Dr. Robert W. Hooper. 863. The skeleton of a Chicken, that resembled the last specimen; mounted. The supernumerary extremities have a very slen- der attachment to the coccyx upon the left side, but are toler- ably developed ; a small, irregular bone, which represents the pelvis, being connected with the upper extremity of the two femora. Otherwise, it is well developed. 1847. Dr. D. H Storer. 864. A portion of the skeleton of a Fowl. Upon the right side there is an additional ischium, somewhat developed, and situ- ated between the sacrum and the true ischium, with which last it is fused, the sacrum and coccyx being much inclined towards the left side. From this additional bone there arises an ex- 40 314 MONSTROSITIES. tremity which is considerably and permanently distorted. The tibia is a short, thick, stout bone, about one inch in length, the femur and metatarsal bones being tolerably developed; the toes are five in number, and one of these is bifurcated. 1835. Dr. Winslow Lewis, Jr. 865. Skeleton of a Chicken that lived three months; mounted. The left femur, which is formed by the union of two, is very broad, has two distinct trochanters, and terminates inferiorly in two extremities, one of which is sufficiently well developed. The supernumerary member has in the place of a tibia and fibula two bones, that look not unlike tibiae, being largely and about equally developed, separate above, but soon becom- ing fused, and connected with the femur by two additional and distinct articulating surfaces; the metatarsal bone is short, slender, and very much bent upon itself, and beneath it there was during life a considerable callus, this division of the ex- tremity being as much or more used in progression than the other; the whole terminates in three very imperfectly devel- oped toes. In the pelvis there is some appearance of duplica- tion upon the left side, but, otherwise, the skeleton is well formed, as were the internal organs, except that the intestine had four caeca, two of them being large, one small, and one of intermediate size. 1840. Dr. J. B. S. Jackson. 866. The fore-foot of an adult Pig; preserved in spirit. One of the small toes is normal, but in place of the other are two large toes, giving altogether the appearance of a double foot, the supernumerary, however, being less developed than the principal. Where the foot was cut off there are seen to be five metatarsal bones. « 867. The hind feet of a young Pig; one has been dried, and the other prepared to show the condition of the bones, the mal- formation being apparently the same in both. In the dissected specimen, the two principal toes, and the small one upon the outside, are perfect in all their parts; upon the inside there are two other toes, nearly as large as the first two, and con- nected with the tarsus by a single large metatarsal bone ; be- tween these two feet, for so they appear to be, is a small un- MONSTROSITIES. 315 developed toe, that belongs rather to the supernumerary foot than to the principal. The tarsus has additional bones or rather cartilages in connection with the supernumerary meta- tarsal. This specimen, with the following others, was purchased by subscription amongst the members of the Society, at the New England Museum : — Nos. 537, 636, 824, 825,839, 840,845, 851, 852, 854, 859, 860, 861, and 866. 868. A series to show the development of the supernumerary thumb so often observed in the domestic Fowl. In the first specimen there is a very imperfectly developed additional phalanx, besides the terminal one, the nail only ap- pearing externally. In the next, the first phalanx of the proper thumb bifurcates, the additional phalanges being well devel- oped and directed upwards ; these two specimens are mates, as are also the fourth and fifth. The third essentially resembles the second, the fusion at the bifurcation being more complete. In the fourth specimen the additional thumb is in all its parts fully developed, curved upwards, and situated directly above the principal. The fifth resembles the fourth. In all of these, excepting the fifth, the development of the bones has been fully shown by removing the soft parts from the under surface of the thumb. The last specimen consists of a set of bones, separated by maceration, and in which the bone that sup- ported the two thumbs consists of a single broad piece. 1845. 869. A preparation to show the development of the bone in a su- pernumerary thumb; there are two phalanges, connected by fibrous substance, the first about two lines in diameter, the second nearly an inch in length, and supporting a well formed nail. It was attached to the integuments over the metacarpal bone of the thumb, and was removed as an incumbrance, the patient being a young mechanic. 1837. Dr. J. B. S. Jackson. 870. A cast in plaster of the right hand of a little girl, showing a thumb with three phalanges. The thumb is long and slender, and reaches about as far forwards as the little finger. 1846. Dr. Benjamin E. Cotting, of Roxbury. 316 MONSTROSITIES. 871. Two Hen's eggs, united by a short thick band ; they are toler- ably developed in regard to size, though there is only a trace of shell. Boston Society of Natural History. 872. A double Peach, preserved in spirit; the two are fully devel- oped, and united intimately, though to a small extent, near the common stem. Dr. J. B. S. Jackson. 873. A cast in plaster of two Apples, united like the above. Dr. Henry 1. Bowditch. 874. A cast in plaster of two Cucumbers, that had a linear union throughout almost their entire length ; these two casts were taken by Dr. William E. Coale. Dr. Charles Bertody. m. Monstrosities by distortion. 875. Cranium of a Fowl, showing a strong incurvation of the upper mandible to one side, as in No. 842. Mr. Charles K. Whipple. 876. Cranium of a Canary bird, showing a similar deformity. Dr. William T. Parker. 877. A Hen's egg, quite small, and contracted at one extremity, so as to resemble in form a certain kind of gourd; shell for the most part well developed. 1844. Dr. Benjamin E. Cotting, of Roxbury. 878. Deformity of the lower extremity; removed at the hip-joint, and preserved in spirit. The knee appears to be dislocated, the head of the tibia resting upon the outside of the femur; the leg, in the recent state, was strongly flexed upon the thigh, the foot very strongly flexed, and twisted so that its inner edge was in contact with the leg, and its sole with the thigh, the outer condyle being quite prominent, and forming the proper termination of the extremity. From a child that was born with imperforate anus, and died on the fifth day, being otherwise well formed, except for some trifling deviations in the arteries. October, 1841. Dr. E. 0. Phinney. PARASITES. 317 879. Cranium of a six months foetus; mounted. There is great deformity of the vault, and such as may possibly have been caused by external pressure, the bones being compressed laterally, and the right parietal doubled upon itself; the ver- tical diameter, on the other hand, is proportionately increased, and the whole occipital region much depressed. Otherwise the foetus was well developed; presented by the knees. The mother has aborted several times at the same period, and thinks she has a uterine tumor, though none has ever been dis- covered on examination. 1847. Dr. Enoch Hale. XIV. PARASITES. 880. A jar containing a large number of lumbrici (Asc. lumbri- coides.) The patient was a little girl, four years old, and had passed one hundred and twenty of these worms within the course of a few weeks, twenty being the greatest number passed at any one time. She lived almost wholly upon animal food ; appetite diminished, but general health sufficiently good. Dr. D. H Storer. 881. Dissection of a male lumbricus. Dr. Jeffries Wyman. 882. Lumbricus from the gall-bladder of a man who died of acute dysentery. Nov. 1836. Mass. Gen. Hospital. 883. Intestinal worms (Asc. marginata, Lamarck) from a young dog. The animal was found in the road in a fit, and carried into the house of a physician, where he was kept under obser- vation for three days and then drowned. The paroxysms fre- quently recurred, though lasting but a few minutes at a time ; they began with a twitching of the face, then the left side, and at last the whole body being affected ; after the convulsions he appeared for a time quite delirious. On the most careful ex- amination of all the organs of the abdomen, thorax and head, no disease was discovered, but, about the middle of the small intestine, five worms were found coiled up in a knot, and 318 PARASITES. measuring from three and a half to seven and a half inches in length. Dr. Jeffries Wyman. 884. A Guinea-worm, (Filaria med.) nine and a half inches in length; removed from the integuments of the abdomen, where it had caused much local inflammation. The patient was a sailor, and had been troubled by the worm since he was on the coast of Africa about a year before ; he had also another re- moved from the foot. Dr. Charles H. Stedman. 885. A portion of the lung of a Porpoise (Phoc. communis,) con- taining Filariae, great numbers being found in the air-passages, or in the fluid which had drained from them (No. 886.) They were generally about one inch and a half in length. Ascari- des were also found in the stomach. The animal was har- pooned off Nahant, and the organs were sent here for dissec- tion by Mr. William H. Johnson, of Nahant. 886. Filariae from the air-tubes of a Porpoise (No. 885.) 887. Several worms, probably Filariae, from the peritoneal cavity of a Horse ; they are about three and a half inches in length, quite attenuated at one extremity, blunt at the other, and with- out any appearance of papillae. A similar specimen has been also presented by Dr. H. I. Bowditch. Dr. Morrill Wyman, of Cambridge. 888. A portion of the parietes of the abdomen of a Sculpin, in which were found a considerable number of worms, probably Filariae; they are half an inch or more in length, and were coiled up beneath the peritoneum, which has been removed to expose them, one being still covered by the membrane. 1845. Dr. Jeffries Wyman. 889. Strongylus gigas; six specimens from the kidney of a Mink (No. 598); length from nine to twenty-one inches. Dr. Erasmus D. Miller, of Dorchester. 890. Several parasites (Echinorynchus gigas) attached to the in- testine of a Hog, with depressions in the mucous membrane • PARASITES. 319 showing where others have been attached, and a thickening of the corresponding portion of the intestine externally. Dr. Jeffries Wyman. 891. One of the parasites (No. 890,) in a separate phial; they are generally about five inches in length. 892. A portion of intestine from a Striped Basse (Labrax lineatus,) with numerous Echinorynchi attached, several of them having perforated the parietes. 1845. Dr. Jeffries Wyman. 893-900. Eleven specimens of Taenia solium from the human sub- ject are in the Cabinet, of which the following may be noticed. 893. The first is six feet in length. The patient was a gentleman, about twenty-five years of age, and had been in Canton for several years, when he began to pass fragments of the worm; this happened frequently, and also for a considerable time after his return to this country, when, under the use of turpentine, preceded by a rigid diet and an active cathartic, the worm was expelled, and he has passed none since, twenty months having now elapsed. 1843. Dr. Charles G. Putnam. 894. The second specimen is much broken, but the fragments altogether measure several feet in length. The joints are very regular, but vary much in size and form; some are quite remarkable for their shortness, and for the union between them being almost confined to the median line, as shown in a drawing by Dr. Wyman. The patient was a little girl, nine years old, who had been sick for about a year, having pre- viously enjoyed good health; her symptoms were loss of flesh and strength, with an enlarged abdomen, and very strong ap- petite. Having taken a common cathartic, some joints of the worm came away ; an active cathartic was then given, and the whole was expelled, when she at once regained her health. 1843. Dr. James B. Forsyth, of Chelsea. 895. The third specimen is remarkable for the great irregularity in the form of many of the joints, for having many of the lateral pores successively upon the same side, and for being the only « 320 PARASITES. one in the Cabinet from the human subject in which the head is to be seen; this last, as it appeared under the microscope, has been figured by Dr. Jeffries Wyman. The patient was a man about forty years of age, and the worm was expelled without medicine. 1843. Dr. John Homans. 896. A portion of the above specimen, showing the remarkable irregularity of some of the joints (Fig. 26.) 897. A fourth specimen, from a middle-aged woman who had been complaining for four or five years; discharged after a dose of turpentine; a few months afterwards she died of phthisis. Dr. M. S. Perry. 898. A fifth specimen, nearly thirty-two feet in length. Dr. D. H. Storer. 899. A portion of Taenia solium dried upon glass, to show the ge- nital apparatus. 900. Several specimens of Taenia from a Porcupine (Hystrix dor- sata.) They are mostly about one inch and a quarter in length ; anterior extremity pointed, with a well marked head, but without any appearance of hooks; the posterior extrem- ity being broad, thick and quite blunt, as shown in a drawing by Dr. Wyman. The joints are very short, and the pores are sometimes seen not merely upon the same side of several suc- cessive joints, but occasionally upon both sides or edges of the same joint. A few of the specimens are longer than the above, more uniformly narrow and thin, and have but very few lateral pores. This is the second instance in which Dr. W. has found a large collection of these parasites in the Porcupine. 1845. Dr. Jeffries Wyman. 901. A specimen of Bothriocephalus, or Taenia lata, as it is usually called. It is seven feet in length, and is about one-half of what was discharged. The patient was a healthy, middle- aged Englishman, and the case occurred during the last winter at Richmond, Va. The pores are seen upon the flat surface of the joints, and not upon the edges, as in the taenia solium; PARASITES. 321 and, a portion of the worm having been dried upon glass, the outline of the genital organs is very distinct. 1847. Dr. Jeffries Wyman. 902. A portion of the above parasite dried upon glass. 903. A second specimen of Bothryocephalus, three feet in length, and from half a line to one line and a quarter in width; from an infant The joints are very regular, except at one extrem- ity, where they approach the triangular form, are very delicate, and but slightly connected, as shown in a drawing by Dr. Wyman. From a very healthy infant nineteen months old; it had been weaned about six months, and had had the usual diet from that time ; the worm was discharged without medi- cine, its presence having never been suspected. 1842. Dr. Ezra Palmer, Jr. 904. Cysticercus cellulosae. From a woman about fifty years of age, who died of phthisis; a dissecting-room subject, at Rich- mond, Va. In the phial are contained a piece of muscle with the cyst in it; secondly a detached cyst, and thirdly one of the parasites removed from its cyst. Accompanying the specimen is a drawing by Dr. W. of the parasite, &c, as it appeared in the recent state under the microscope. About a dozen or fif- teen of the cysts were found in the cellular membrane of the muscles and in the integuments, besides one which hung free from the inner surface of the dura mater near the crista galli. In the same subject there were also numerous specimens of trichina spiralis. 1845. Dr. Jeffries Wyman. 905. Cysticercus from the mesentery of a Sheep. 1840. Dr. Jeffries Wyman. 906. A Linguatula from the intestine of an African Serpent (Ce- rastes —) which was sent to the Soc. of Nat. History, by Dr. Thomas S. Savage, of Cape Palmas, the individual having been dissected by Dr. S. There were also sent several specimens of the parasite, all of them females, and from three and a half to four inches in length. Boston Society of Natural History. 41 322 PARASITES. 907. Linguatulae from the inner surface of the lung of a South American Boa. There were altogether four or five ; one of them, a female, was three and a half inches in length; the rest were males, and did not exceed one inch and a half. This and the last specimen have been figured and fully de- scribed by Dr. W. in the Journal of the Boston Soc. of Nat. History (Vol. V. No. 2 — 1845.) Dr. Jeffries Wyman. 908. Entozoa from the gall-ducts of a young East-Indian Elephant, that died in this city. They are of two kinds, the Distoma hepaticum, and a small species of Ascaris; immense numbers were found in the ducts, and of the ascarides, a few were found in the duodenum. In the same jar are several larvae from the stomach and duodenum. There was ascites, with disease of the liver, and in the stomach near the pylorus a large, deep, chronic ulcer, of a circular form and perfectly defined. 1835. Dr. J. B. S. Jackson. 909. Trichina spiralis. A portion of one of the voluntary mus- cles has been picked apart, so as to form a thin extended sheet; having then been dried and varnished, it is seen to be filled with the cysts, and with the microscope the parasite itself may be shown. From a middle-aged man, a patient of Dr. M. S. Perry, who died of malignant disease of the abdomen. This case was published by Dr. Henry I. Bowditch, in a full paper upon the subject, and accompanied with drawings, in the Boston Med. and Surg. Journ., March 30, 1842. Several other instances have been observed here, and also in Richmond, Va., by Dr. Jeffries Wyman, and one deserves especial notice, in which Dr. W. found one or two of the parasites about the middle of the oesophagus. 910. Small crustacean parasites (Chondracanthus) from the mouth of the Whiting (Merlucius albidus); from Cape Cod. 1847. Dr. Jeffries Wyman. 911. Larvae of the Bot-fly (GEstrus equi) from the stomach of a Horse. Dr. Morrill Wyman, of Cambridge. 912. Larvae of the Bot-fly (CEstrus ovis) from the frontal sinuses of MISCELLANEOUS SPECIMENS. 323 a Sheep. Dr. W. has met with them frequently in this situa- tion in the month of February, when preparing for his anatom- ical lectures at Richmond, Va. 1847. Dr. Jeffries Wyman. XV. MISCELLANEOUS SPECIMENS. 913. Chinese Paintings. A collection of twenty-eight highly finished oil paintings, that were presented to the Society by Dr. Robert W. Hooper, April 14, 1845. They were executed by a native artist at the hospital in Canton, under the charge of Dr. Peter Parker, and represent various forms of external disease, but chiefly tumors ; many of these are of great size, and this development of the diseased masses is one of the most striking features in the collection, as was shown in an article by Dr. Holmes in the Boston Med. and* Surg. Journ., May 21, 1845. The healthy appearance of most of the subjects is also remarkable, for, as in Alibert's plates of the skin, the individual is repre- sented as fully as the disease. A descriptive catalogue of most of the cases has also been presented to the Society with the paintings; copied from the'Reports of the Hospital, which were published in the Chinese Repository. 914. Three drawings in water colors, admirably executed, and representing different views of a malignant tumor of immense size that formed about the shoulder. They were taken by a professed artist, Mr. J. R. Penniman, for Dr. John Homans, in whose practice the case occurred, and were presented by him to the Society, with a full history of the case. The patient died in June, 1831, aged fifty-four years. In August, 1816, he fell, and broke the left humerus just below the shoulder joint. Union took place, but in the winter he be- gan to have pain, and in the course of the following year a tumor appeared in the axilla. This tumor gradually increased, and in 1825 was as large as the head of a child of six months. In the autumn of 1829 the growth became more rapid; his health, which had previously been perfectly good, began to fail, and he gave up his business as a stage-driver, 324 MISCELLANEOUS SPECIMENS. which until that time he had pursued regularly ; in the spring, however, he resumed his occupation, and continued it until the autumn, from which time the enlargement of the tumor and the failure of his health went on rapidly. A few weeks before death, sloughing commenced, profuse discharge followed, with severe pain, and the tumor diminished greatly in size. The tumor extended, as shown in the drawings, from the top of the shoulder nearly to the ilium, and from the anterior ex- tremity of the ribs to the base of the scapula, the upper half of the humerus being also involved ; weighed sixty-two pounds, with the scapula and clavicle, after being dissected from the arm. " The only attachment to the body was by condensed cellular tissue ; the mass itself consisted mainly of a sort of cartilaginous substance, whilst other portions were very soft, and the whole was held together by fibrous membrane." 1844. 915. A collection of thirty-two casts in plaster, representing dislo- cations, fractures, deformities of the feet, and some other cases of external disease; presented to the "Society by Dr. Nathan R. Smith, of Baltimore, through his colleague, Dr. Joseph Roby, the original moulds having been made by Dr. S., March 23, 1846. 916. An adipose tumor, about three inches in diameter. Dr. A. L. Peirson, of Salem. 917-8. Two other specimens of the same. Dr. S. D. Townsend. 919. A large, glandular tumor, removed from the axilla. The pa- tient was a lad, thirteen years of age, and otherwise quite healthy. The tumor had existed for a year, and weighed nearly two pounds after its removal, the skin being much dis- colored, with enlargement of the veins; external surface lobu- lated, and internally it consisted of a firm, whitish, nearly uni- form structure. The boy recovered. Dr. S. D. Townsend. 920. A "scirrhous tumor" removed from under the pectoral mus- cle. It is of a flattened, oval form, about the size of a small orange, somewhat irregular upon the surface, and having a MISCELLANEOUS SPECIMENS. 325 uniform, dense, whitish structure, as shown on incision. The patient was a middle-aged female, and had been aware of the existence of the tumor for four months previously to the opera- tion, during which time it had grown rapidly, but without pain. In the operation it was readily detached, the pectoral muscle not being involved ; no disease existed in the breasts, but there was some enlargement of the axillary glands. Dr. George Hayward. 921. A cellular tumor removed by Dr. L.; the patient was a fe- male, thirty-four years of age, and did well, though in the seventh month of pregnancy when the operation was per- formed. The mass hung pendulous from behind the knee, and weighed about thirteen pounds; it had been forming for about eleven years, and had begun to ulcerate, but was not painful. Internally it is seen to consist of a coarse, cellular structure, some of the cells being as large as a hazel-nut, and filled, when recent, with a thin, ropy fluid. Dr. Winslow Lewis, Jr. 922. An encysted tumor from the scalp; size of an English walnut. Dr. S. D. Townsend. 923. Four encysted tumors from the scalp ; from the size of a pea to that of a nutmeg. Dr. S. D. Townsend. 924. A cyst removed from the outer edge of the orbit. The pa- tient was a young woman, and the tumor had been observed in infancy; gradually increased in size, but for the last three years had grown more rapidly. When removed, it was about the size of a filbert, and contained an oily fluid, in which were short, stiff hairs, resembling those of the eyebrow. The cyst has been dried, and many of the hairs are seen £o adhere to the interior of the cyst, though they are mostly free. 1843. Dr. Robert W. Hooper. 925. Hair discharged from the umbilicus. The patient, a middle- aged female, had had pain and tenderness in the part for nearly two years, and for some months a fistulous opening; two other small pellets of hair were discharged about the same time, and the opening then closed. Dr. Edward Reynolds. 326 MISCELLANEOUS SPECIMENS. 926. Cancerous disease of the thigh, removed by excision. The patient was a female, about sixty years of age. For ten years or more she had had a small, indolent, subcutaneous tumor, that for the last two years had become painful, and resulted, at last, in a deep, cancerous ulceration about an inch in diam- eter. The wound healed in about a week, but the disease re- appeared in the same place, and the patient died six weeks after the operation, the inguinal glands having become diseased, and also those in the abdomen. Dr. M. S. Perry. 927. Enlargement, with induration of the thymus gland. The pa- tient was a stout, fleshy woman, sixty years of age, and had suffered somewhat from dyspnoea with febrile symptoms for three or four months before death. Dr. Winsloio Lewis, Jr. 928. A Frog, which was found at Mount Auburn, in good condi- tion, and quite active in all its motions. It had lost the greater part of one of the posterior extremities, and shows a most per- fectly formed stump. Another was some time afterwards found by Dr. W., which had lost the leg below the knee, the stump in this case being equally perfect. Dr. Jeffries Wyman. 929. A Frog, showing the entire loss of one of the anterior ex- tremities ; from the gardens at Versailles. 1844. Dr. Jeffries Wyman. 930. A cast in plaster of the stump after a sloughing off of the leg below the knee. This case occurred about six years since in a miserable Irish family, and during a severely cold winter. The patient, a little girl, eleven years of age, was attacked with purpura, and the effusion of blood being very extensive, hemi- plegia came on, and the paralyzed limb mortified, having been frozen, as it was supposed, without the knowledge of the child; in a year or more it was separated by the natural processes. A conspicuous object in the cast is an enlarged bursa over the patella, but this has since disappeared. 1842. Dr. William E. Coale. MISCELLANEOUS SPECIMENS. 327 931. A small Lizard (Anolis—Cuv.) from Surinam, showing a bifid condition of the tail about midway ; the two form a very acute angle, and the additional one, which seems to contain no bone, is rather shorter and smaller than the principal. This was the result probably of a wound, and the tendency which there is in these reptiles to reproduce the part when lost by ac- cident. 1839. Boston Society of Natural History. 932. A piece of bone from the fat about the kidney of a Hog; it is five inches in length, from nine to fifteen lines in width, and from two to three lines in thickness ; the surfaces are smooth, but the edges are quite irregular, and the structure is rather light. 1843. Dr. Nathaniel B. Shurtleff. 933. A rough, three:cornered piece of stone, about half an inch in diameter, removed from the integuments beneath the jaw. The patient was a laboring man, and had been blown up about two years before, whilst blasting rocks ; several pieces of stone were driven into the flesh, and all of them had been removed excepting the one in the neck, which he had allowed to remain, as it never troubled him, the parts about it being much con- densed. 934. A phial, containing several pieces of bone that, with a great many more, were said to have been discharged from the nose and ear. The pretended sufferer was an intelligent and inter- esting little girl, eleven years of age, and the deception was carried on for several months, while under various methods of treatment. 935. Hands of a Guanche Indian, from the Isle of Teneriffe ; they are clasped together, and dried in this position, with the flesh on, the bones of the fore-arm being preserved in connection. The size is not remarkable. Boston Society of Natural History. 936. Fore-arm and hand of an Egyptian Mummy; the flesh is dried on, and remarkably well preserved; the subject was a child. Also the fore-arm of an older subject, in the same condition. Francis C. Lowell, Esq. APPENDIX. Of the following specimens, four were accidentally omitted in preparing the Catalogue, and the rest were received too late for in- sertion in their proper place. 937. Extensive and deep absorption of the bodies of three of the dorsal vertebrae, upon the left side ; the result of an aneurism. A larger sac existed at the arch, of the aorta, that had de- stroyed the upper portion of the sternum, and foraged a prom- inent tumor externally, when first seen more than two years and a half before death. The patient was a laboring man, forty- four years of age, and was in the habit of wearing a copper plate over the tumor, to protect it from external injury when at work; he was once exhibited to the Society, and his case was published in detail in the New England Quarterly Journ. of Med. and Surg., Oct. 1842. Dr. M. S. Perry. 938. An old and extensive fracture of the crest of the ilium; the union is strong and regular, but there is a considerable deposit of new bone upon both surfaces. From an Irish laborer, who had been at work upon one of the railroads, and died probably in a drunken affray. 1847. Mr. Calvin Ellis. 939. Bony anchylosis of the hip-joint, the femur being bent to about a right angle with the trunk. The union is strong, though a considerable opening is seen through the ischium. From a middle-aged man, who had an attack of apoplexy in the street in New York; was carried into a Hospital, and died soon after entrance. Presented to the Society, June, 1847, by Dr. William T. Thurston, of St. Kitts, W. I. APPENDIX. 329 940. Extensive caries of the knee-joint, with an abundant deposit of new bone about the articular surface of the femur. The following is an abstract of a full history of the case, that was given by Mr. Edwin Leigh, a student of medicine. The pa- tient was a carpenter, fifty-three years of age ; general health good, and habits always temperate. In the year 1822 he wounded the right knee-joint with an axe, upon the inside of the patella, and severe inflammation followed, which confined him for three months or more. For nearly a year, the knee remained permanently flexed, but, after an accidental fall, by which the adhesions seemed to have been broken up, the mo- tions became very much more free; it was, however, occa- sionally troublesome, and the patient was always more or less lame, there being much deformity of the joint, and in the situ- ation of the wound a hard tumor as large as " half an orange." March 16, 1847, the same knee was again cut in the same place with a broad-axe. The wound bled freely, was tightly bandaged, and the patient walked home, half a mile. His physician, Dr. Charles F. Chaplin, of Cambridgeport, being called to visit him, passed a probe through a thick mass of condensed cellular tissue, and into the joint. The accident was followed at once by very severe inflammation of the joint and neighboring soft parts ; the suppuration was abundant, and he became so exceedingly reduced that it was thought hardly possible for him to survive an amputation. On the 13th of June, however, the limb was removed by Dr. Lewis, at the up- per third of the thigh, the patient having first been put under the influence of ether; immediately after the operation he be- gan to rally, and from that time rapidly improved, so that about the middle of July he was able to go out, and his health is now fully restored. On dissection of the limb, which for one or two days re- tained the odor of the ether, very extensive abscesses were found above the knee, having upon the inner surface a dark, gangrenous appearance, and communicating freely with the joint; below the knee, they were less extensive. The inside of the joint, for the most part, resembled the abscesses in its dark, shreddy appearance, the bone being denuded and rough, and only a trace of cartilage remaining. Between the patella and the anterior portion of the femur, however, there were old 42 330 APPENDIX. cellular adhesions, probably the result of the first injury, and to this part of the joint the recent inflammation did not extend, the outline of the two portions being quite marked in the pre- pared specimen. Sept. 1, 1847. Dr. Winsloio Lewis, Jr. 941. Section of an anchylosed knee-joint. (See next specimen.) Dr. Charles F. Heywood. 942. Disease of the tibia, the result of necrosis. The patient was a physician, fifty years of age, and entered the Massachusetts General Hospital May 31, 1847. When he was ten years old a large abscess formed in consequence of an injury of the leg ; in two months the bone began to exfoliate, and in the course of a year he thinks the whole of the tibia came away, ex- cepting the epiphyses. In five or six years the openings closed, and he had a useful limb, except for an anchylosis of the knee and ancle-joints, his general health being good. Four years ago, as he stated on admission, the surface was abraded just above the ancle, and an ulcer formed, which never after- wards healed; fourteen months ago, dead bone began to be discharged from the ulcerated surface, and for the last eight months the leg had been exceedingly painful with much loss of flesh and strength. The above is an abstract of the case from the records of the hospital. On examination, a large ulcer was found to occupy the lower anterior half of the leg, the bone being exposed, and the surface surrounded by a peculiar fungous growth. On the 5th of June the thigh was amputated by Dr. S. D. Town- send, and on the 4th of July the patient died, having gradually sunk from the time of the operation. The stump had healed perfectly, but there was found, on dissection, a separation of the periosteum about the end of the bone, with some small ab- scesses, and an inflammation of the femoral vein. The bones having been prepared by Dr. Heywood, the house-surgeon of the hospital, the tibia is seen to be much en- larged, and its lower portion occupied by a large and very irregular cavity, the structure of the bone being much altered. The lower extremity of the fibula, and the astragalus and os calcis are firmly anchylosed with the tibia. Complete bony anchylosis of the knee-joint also existed, except for the central APPENDIX. 331 opening which so often exists; and, through this opening a longitudinal section of the bones has been made, the tibia having first been sawed across below the joint. Dr. Charles F. Heywood. 943. Melanosis of the eye (Fig. 36.) An account of this case, and of another of colloid tumor of the orbit, was published by Dr. Bethune, with remarks, in the Boston Med. and Surg. Journal, July 28, 1847 ; it was accompanied with a lithographic drawing of the specimen, and, by the permission of Dr. B., the stone has been used for the present volume. The following is an abstract of the case : Mrs. G., forty- three years of age, entered the Massachusetts Eye and Ear Infirmary, June 9, 1847, with disease of the right eye. In the autumn of 1842, after an exposure, she began to have pain and redness in the eye, with gradual loss of sight, which at the end of three months, became total. Pain occasionally re- curred, and at one time the operation for cataract was per- formed, this being followed by severe inflammation, which never entirely subsided. About eight or nine months before her admission she perceived a " sore place " in the centre of the ball, and a few months afterwards the eye began to project at this point, and the projection constantly increased from that time ; during the last winter there were frequent darting pains through the eye. On admission, the anterior half of the globe projected, in the form of an irregular fungous mass, to the ex- tent of half an inch through the lids ; in front, it was of a car- tilaginous hardness, and of a mixed white and red color; be- hind this the color was red and black, and still further back there was seen a small mass, which had a livid tint, and was nearly black; the globe was much injected, but not enlarged, and a sanious discharge exuded from the surface. On the 18th of June the organ was removed, and on the 20th of July the patient was doing quite well. The general appearance of the eye is well shown in Fig. 36. The interior of the globe is filled with a dark brown, moder- ately firm substance, and the sclerotic coat being traceable to a considerable extent, there is seen externally to it a thick mass, which has almost a scirrhous hardness, and is of a whitish 332 APPENDIX. color, with some intermixture of brown; the optic nerve is much enlarged, and similarly diseased. Dr. George A. Bethune. 944. Change of color of the hair. From an old gentleman, in his eighty-sixth year. For a long time his hair had been perfectly white, as shown in the smallest of two locks that have been preserved. His health having been failing for some time, it was observed about a month before his death that some of his hairs had turned black in their whole length; of this change there is a specimen in the largest lock. Behind the ears, on each side, was a lock that was entirely black, but elsewhere the white and black hairs were mingled, as in the specimen. The change occurred within a very few days, and within a week of this time the eyes changed from a blue grey to a dark grey color, this last being, it was said, their natural color when he was a child. 1842. Dr. James Jackson. 945. Imperforation of the small intestine (Fig. 29.) The patient was a finely developed infant, and lived for three days, vomiting most of the time ; the case occurred in the practice of Dr. George Hubbard. For the first thirty-seven inches the intestine was greatly distended, measuring in some parts, on being inflated, one inch and a quarter in diameter, and contain- ing a considerable quantity of brownish red liquid, but very little if any trace of mucus or bile; it then terminated abruptly in a cul de sac. Below this, the small intestine was directly continu- ous with the dilated portion, measured seventy-two inches in length, and was about two and a half lines in diameter when distended. The large intestine measured twenty-one inches, and from three to four lines in diameter; both of these por- tions were filled with thick mucus, which was generally color- less, but in many parts had a decidedly yellow tinge. Six or seven inches below the imperforation there adhered to the intestine a reddish fleshy body, somewhat larger than a pea, and having upon the surface a cretaceous deposit such as was found upon the diaphragm (No. 946.) Otherwise, the organs were well formed. In the preparation, a portion of the intes- tine, having been distended and dried, has been cut open to show the imperforation. 1847. APPENDIX. 333 946. A cretaceous deposit from the peritoneal surface of a new born infant (No. 945.) It appeared as a very conspicuous ob- ject upon the under surface of the diaphragm, and, with one exception, which has been referred to in connection with the last specimen, it was found in no other part. This deposit consisted of a number of opaque, white, irregular crusts, the largest being about two lines in diameter, and all of them con- nected with the peritoneum by a very delicate membrane. One of the crusts having been examined by Dr. John Bacon, Jr., was found to be uncrystallized, and to consist of about equal parts of the carbonate and phosphate of lime. In the preparation, the peritoneum has been stripped off from the diaphragm, and dried upon a black board ; a small portion of intestine show- ing the fleshy body above referred to, with the cretaceous de- posit, has also been preserved. 947. A deposit of the phosphate of ammonia and magnesia upon the peritoneal surface, the preparation consisting of a portion of the membrane, which has been stripped off and dried. From a dissecting-room subject; a middle-aged man, who, from the appearance of the intestines, must have died about the fifth or sixth week of typhoid fever. On opening the ab- domen, the viscera seemed to be almost universally, though slightly adherent, and, on separating them, the surface was at once observed to be roughened, like fine sand-paper. A portion of this membrane was sent to Dr. John Bacon, Jr., and the following is the result of his examination. The de- posit appears in the form of white, and firmly adherent grains. Under the microscope, it is seen to consist partly of isolated prismatic crystals scattered over the surface, the largest not exceeding the one-hundredth of an inch in diameter; they are semi-transparent, and become colored in polarized light, the faces being considerably modified, and not well defined, and the forms very similar to those in which the triple phos- phate occurs. There are also seen little masses, composed of radiating acicular crystals ; these are more opaque, a few be- ing entirely so, and showing no crystalline structure. The two forms of deposit agree in the reactions which they afford, and consist of the phosphate of ammonia and magnesia, as in the cases reported by Dr. Robert Harrison, in the Dublin 334 APPENDIX. Journal, for May, 1836. (Am. Journ. Med. Science, Vol. XX. p. 207.) No. 502 was from the same subject. 948. Encephaloid disease of the testicle. The patient was a per- fectly healthy looking infant, aged three months, and had no hereditary tendency to carcinoma, so far as could be ascer- tained. When it was eight days old, the mother noticed an enlargement of the organ, and from that time it has been in- creasing in size but without any pain. August 7, 1847, it en- tered the hospital, and on the 11th the organ was removed by Dr. Henry J. Bigelow. A few weeks previously it had been punctured, and discharged, by report, blood and water. The sense of fluctuation was very strongly marked, and after its admission into the hospital, the growth was considerable, and the surface became discolored, which it had not been before. The organ was greatly enlarged, measuring, after its removal, two and a quarter by one and a half inches; and presented a fair specimen of encephaloid disease ; cord healthy. 949. A hen's egg, about the size of a small olive ; it is well formed, and the shell is fully developed, but of the yolk there was only a trace. 1845. Dr. Henry J. Bigelow. 950. The cranium and trunk of a malformed foetus; mounted. The cranium differs from any of those already described; the frontal, parietal and occipital bones are very imperfectly devel- oped, but, instead of flaring outwards, they rise perpendicu- larly from the base of the skull, and give to the cavity a horse- shoe form ; the posterior portion of the occiput consisting of two pieces which are widely separated. The trunk is pre- served on account of a strong lateral curvature of the spine, and a narrowing of the right side of the thorax, several of the last ribs upon this side lying in close contact with the spine ; the sixth, seventh and eighth ribs are fused, the second wants its cartilage, and the sternum, which is very short, is con- nected with the first three ribs only. Upon the left side the cavity of the thorax is well developed, and the sternum is con- nected with the usual number of ribs. The skeleton was otherwise well formed, and the extremities were therefore re- moved. APPENDIX. 335 In the recent state, the foetus was sufficiently developed for the age. The cavity of the cranium was entirely open, and contained a small quantity of brain, from the base of which several of the nerves were traced. The parietes of the abdo- men were almost entirely wanting, and to some extent those of the thorax ; the liver, stomach, small and large intestines, kidneys and left testicle lying completely exposed. The heart was covered only by its pericardium. The whole peritoneal surface and the left pleural cavity were inflamed, and the lung much compressed. There was fissure of the uvula, as in so many of the acephalous foetuses; the gall-bladder and ducts contained a very little colorless secretion; the renal cap- sules were nearly or quite as large as in a well-formed foetus ; the left umbilical artery was wanting; organs otherwise not remarkable. The mother was a respectable, young married woman, and this was her first child; no cause assigned for monstrosity. Labor occurred at about the eighth month, and was easy; head presented ; quantity of liquor amnii large ; the cord was only a few inches in length, doubled upon itself and adherent, and broke in the delivery ; placenta exceedingly large. Child still-born, though the motions had been felt, as so often hap- pens, only a few hours before. Sex male. 1847. Dr. Asa B. Snow. 951. Tuberculous disease of the spinal marrow. It was situated opposite the sixth cervical vertebra, and involved almost the entire substance of the organ at that part, forming an opaque, yellowish, solid, well defined and uniform mass about as large as the top of the little finger; spinal marrow somewhat en- larged at the seat of disease, and a little softened just above and below it, but elsewhere quite healthy. The membranes, also, were healthy, except for some thickening of the dura mater at the upper part. In the preparation a portion of the organ is shown, cut open longitudinally. In the brain there was a copious effusion of serum, with complete softening of the septum. Extensive tuberculous disease was found in both lungs and in the intestines, besides similar disease in the pros- tate gland, and in the kidneys. The patient was an Irish laborer, forty-two years of age, and 336 APPENDIX. died at the Massachusetts General Hospital, Sept. 25, 1842. Health quite good previously to the last year, and since then no local trouble except a disease of the ankle joint. The symptoms of spinal disease came on about three and a half months before death, and, when examined on the 13th of August, were as follows : diminished sensation, with hardly a trace of voluntary motion in the lower extremities, the upper being very much less affected ; very frequent and involuntary contractions of the right lower extremity, tending to draw the limb up into a strongly flexed position, and attended with very severe pain; some contractions also of the left lower ex- tremity, but without pain. Even on moving the bed-clothes, the muscles of the lower extremities would be strongly ex- cited, and, on attempting to straighten them when they were drawn up, his suffering was very great. In the upper ex- tremities these spasms were very much less. The bladder was completely paralyzed, so that the catheter had been used daily for the last three weeks. These symptoms continued with but little change until his death, the spasms being on one occasion so violent that the patient was fairly jerked out of bed, and fell upon the floor, though fortunately with but little injury. He suffered much also from a morbid sensibility, and from neuralgic pains in the right lower extremity, passing up into the abdomen. Respiration was carried on by the dia- phragm, the intercostal muscles being paralyzed. The cathe- ter was used until the last month, after which the urine became involuntary; the dejections, also, were for the most part in- voluntary, whenever procured, the bowels being very costive. The spine was often examined, but the patient scarcely ever allowed any pain or tenderness there, neither was there any trouble in the head worth mentioning. When first seen his general aspect was sufficiently well, but as the disease ad- vanced, he became exceedingly emaciated, and for some time before death was very much sunken, with sloughs about the sacrum. As to his pulmonary disease, he had no symptoms that led to a suspicion of it; there was occasionally some dyspnoea, but, as it was generally accompanied with a feeling as of a cord about the lower part of the chest, it was attributed to the paralysis; the nurse, on being questioned after the death of the patient, mentioned an occasional, very slight cough during the last few days, but never before. APPENDIX. 337 952. The seventh cervical vertebra, from which the spinous pro- cess was broken off, and removed by an operation two years and three months before death ; for the history of the case, sec specimen No. 141. From the time the above history was given, the power of motion somewhat increased, and the cramps diminished, but without any other change in the condition of the patient, until the last fortnight, when he was attacked with diarrhoea, of which he died on the 19th of September. On dissection, the space left in the canal by the removal of the spinous process was found to be filled by dense fibrous sub- stance ; the theca adhered posteriorly for a small extent to the vertebrae, and internally to the arachnoid membrane, by slight, filiform attachments; there was also some serous effusion, but otherwise the membranes were healthy. The spinal marrow, having been removed to the extent of several inches, appeared healthy, except just at the seat of injury, where there was found, in its centre, a cavity about the size of a pea, and filled with serum, the surrounding substance being completely dis- organized. The vertebra is seen, in the preparation, to be uninjured, except for the loss of its spinous process and a por- tion of the laminae, the upper half of the ring being entire. 1847. Dr. John B. Walker. 953. Indian Skull; dug up, with a considerable part of the skele- ton, in making an excavation near the city for the Brookline branch of the Worcester railroad, and presented to the So- ciety, Sept. 27, 1847, by Dr. H. B. Inches. 954. A calculus from a Neat's tongue ; of a regular cylindrical form, with rounded ends, white, slightly roughened upon the surface, very heavy, and as compact as the hardest marble. It is one inch and two thirds in length, three fourths of an inch in diameter, and, a portion having been removed by Dr. M. Gay for analysis, was found to consist mostly of the carbonate of lime. 1847. Dr. James W. Stone. 43 INDEX. Abdomen. Deficiency of the parietes, 778, 783-4, 819, 950 ; peritoneal surface inflamed in the last two. Acephalus. Preserved entire inspirit, 765; drawing of, 757; cast, 758, 762; skeleton, 759 ; circulation, 760; intestine injected, 761, 761, and veins, 763. Blighted foetus, 826. Acephalous foetus. General description of the first variety, with an analy- sis of cases, 766 - 74 ; second variety, 776 - 81; third, 783 - 8 ; fourth, 789 - 95. Preserved in spirit, 772 - 3, 779 ; drawings of, 770 ; osteo- logy, 706 - 74, 775, 776-81, 783 - 8, 789 - 95, 950 ; similar malforma- tion in a double monstrosity, 845, 847 ; case of triplets, 773 ; lived for several days, 774. Air passages. Foreign bodies, 436 -.7 ; parasites, 885, 907 ; malforma- tion, 815, 456 - 7, 807, 848 ; ossification, 422 - 8 ; old suicidal wound of larynx, 428 ; croup, 430 - 1, 468; bronchial polypus, 432 ; ulceration, 433 - 4. Amputation. Changes which occur in the bones, 185, 189 - 90, 220, 273 -5. Natural stump in a frog, 928 - 9 ; in the human subject, 930. Anchylosis, of the vertebrae, 122, 130-3; hip-joint, 206-7, 937; knee, 247-9, 941; ankle, 276, 292-3, 942; tarsus, 295-6, 299; ossified cartilages of the larynx, 428. False anchylosis of the knee- joint, 318. Aneurism, of the aorta, 367 - 70, 372 - 4 ; common carotid, 376 ; sub- clavian, 375. Dissecting aneurism, 366 - 7 ; dilatation, 371; oblitera- tion of vessels where they arise from the sac, 372 ; bones affected, 128, 937 ; ulceration of oesophagus, 373 ; fibrinous clot in bronchus, to pre- vent a rupture, 372 ; sloughing of external surface, without rupture, 374, 937. Rupture into the pericardium, and involving the pulmonary artery, 368 ; into the left primary bronchus, 372-3; into the lung, 128. Aorta. Impervious at its origin, 340 ; arises from right ventricle, 336. Communication between two aortas, in a double fetus, 83R, 844, 848; division of a single aorta, 845, 847; union of two aortas, 850. Lace- ration of aorta, 366; rupture into pericardium, from chronic disease, 361-5. See Aneurism. 340 INDEX. Appendix Cceci. Unusual length, 459 ; foreign bodies from, 513, 527. Inflammation and perforation, 511 - 3 ; recovery from, 499; cause of internal strangulation, 498 - 9. Arteries. See Aneurism. Injected preparations, 323-5 ; supernumerary from the arch, 344, 339, 342, 766, 819. Umbilical artery distinct from the aorta, 757, 762; absence of one, 766, 783 - 5, 819, 835, 878, 950. Right subclavian passes behind the oesophagus, 345. Origin from the pulmonary artery, 778. Inflammation. 361 ; coagulum after amputation, 360. Ossification, 362-3. Articulations. See Anchylosis and Dislocations. Ligaments of shoulder and knee joints, 304 - 5 ; relaxation of ligaments of pelvis during ges- tation, 722-3; false joint between exostoses, 153, 156; loose bodies from knee-joint, 311, and from a ganglion, 312 - 3 ; fleshy excrescen- ces from knee-joint, 314-6. Bursa containing fibrinous masses, 309 ; greatly thickened, 310. Change in the form of the articulation from mechanical causes, 297, 250 ; wound of knee-joint, old and recent, 940. Chronic disease of the shoulder-joint, 167, 174-5; elbow, 186, and neighboring parts, 187; hip, 201-5; knee, 242-6; ankle, 276, 293. Arsenic. Effect in preventing decomposition, 455. Atrophy. Of the bones; interstitial, from old age, 22, 89, 224 ; from dis- use, 229, 297-8, 185, 189-90, 220, 273 ; and from disease, 77, 202, 293, 168, 277, 290 ; of the femur, in anchylosis of the hip-joint, but not interstitial, 206 ; of the occiput, 87. Of the spleen, 584 ; kidney, 591. Biliary Calculi. From the gall-bladder, 567 - 72; ducts, 562; abscess in the liver, 563; encephaloid mass in the region of the gall-bladder, 564 ; discharged from the bowels, 565; from the umbilicus, 566. Biliary Ducts. Spiral valve of the cystic, 551; parasites from, 908 ; dila- tation, 556-7, 561; obstruction by calculi, 561, 556; ulceration, 556; opening into the pancreatic, 557, 576. Blighted Ovum. Retained, 751-2. Brain and membranes. Formed independently of the spinal marrow, 785, 788; fibrous structure, 388; in the acephalous fetus, 766 - 74, 775, 776-81, 783-8, 789-95; development of the pituitary gland, 766-74, 776, 778, 793; tubercle, 389-90. Development of pia mater in an acephalus, 762, and in the acephalous foetus 766-74 ; serous effusion in monstrosities, 804 - 7. Dura mater ; anatomy, 381; ossification, 382- 5 ; tumor, 386. Meningitis, following the closure of a fistula, 109. Breast. Development during gestation, 724; cancer, 685. Bronchial glands. Ossification, 446 ; abscess opening into the oesophagus, 447. Cancer. See Malignant Disease. Caries. Of the vertebrae, 112-3, 115-9, 124-5; sternum, 145-6; INDEX. 341 lower fragment of a fractured femur, 236. Of an ossified cartilage, 427 ; aortal valve, 352. Casts in plaster. A collection of thirty-two, presented by Dr. Nathan R. Smith of Baltimore, 915. Cephalahmatoma. Tumor over the occiput; pericranium ossified, 745. Chinese paintings. A collection of twenty-eight, presented by Dr. Robert W. Hooper, 913. Chol^erine. In a gall stone, 565; in various organs, 667. Club foot. Casts of 915 ; frequent occurrence in monstrosities, 757, 762, 773, 778, 784, 783 ; condition of the bones, 297. Cranium. See National Skulls. Anatomy of, 11, 13, 7; varieties, 28, 43; 56, 59 ; 30, 63, 952. Malformation, in the acephalus, 757; acephalous fetus, 766-74, 775, 776-81, 783-8, 789-95, 845, 950; in case of ex- ternal hydrocephalus, 803 -6, 808 ; in case of deficiency of the extremi- ties, 812, 817, 814 ; blighted fetus, 830; the result, perhaps of me- chanical cause, 879 ; fusion of two crania, 837, S44, 848, 857. Old fracture, 102-4; epilepsy, 103-4; recent fracture through the base of the skull, 105-6; old sabre wound, 107-8; a cranium showing a leaden ball in the frontal bone, and which had been there for twenty- five years, 109 ; atrophy, 22, 87 - 9 , thickening, 84 - 6 ; exostosis, 90 ; appearance that might be mistaken for the closure of a trephine open- ing, 94; result of syphilis, 95-6; cancer, 97; other disease, 78, 93, 386. Cuticle. Original difference in thickness in different parts of the body, 417 ; continued over a serous membrane, 795, 788. Diabetes. Saccharine extract from the urine, 646, 648; nitrate of urea, 647. Diaphragm. Deficiency, 766, 778; fusion of the two in a double fastus, as in 835 ; hernia through, 493. Dislocation, of the shoulder, 172 -3 ; clavicle, 162 ; hip, at time of birth, 200; vertebrae, without fracture, 135; casts of, 915; reduction fol- lowed by inflammation of joint, 172. Double Monstrosities. Union by the thorax, 834; skeleton, 835. Fusion above, and duplication below the umbilicus: human, 836 ; calf, 839 ; pig, 840, 845, 847-8; Guinea pig, 811; chicken, 842; kitten, 843; lamb, 844: osteology, 835, 837, 844-5, 847-8. Duplication com- mencing with the head : fish, 849 ; human, 850 ; lamb, 851, 857 ; kit- ten, S52-3; chicken, 851; duck, S55; serpent, 856: osteology, 857. Additional extremities : human, 853 ; kitten, 859-61; chicken, 862-5 ; osteology, 863 - 5. Additional phalanges, 866 - 71. Two eggs united by a band, 871. Union in the case of fruit and vegetables, 872-4. Ear. Anatomy, 17, 397-9; fusion of two, externally, 848, 840-1, 851 ; malformation internally, 844 ; polypus, 400 : caries, 401-3. 342 INDEX. Eburnation, of the articular surfaces, 203, 229, 245. Epiglottis. Absence of, 807; destroyed by ulceration, 433. Exostosis, of the cranium, 90, 104 ; antler of a deer, 91; lower jaw of a cod-fish, 92; vertebrae, 122, 124, 129-32; vertebrae of a horse, 133; scapula, 159 ; humerus, 171; carpus of a sheep, 196 ; os innominatum, 197; femur, 213-5; patella, 251 ; tibia, 287 ; fibula, 289 ; tarsus, 294 ; tarsus of a horse, 299. Ivory exostosis, 90; fibious, 159, 197. Result of a blow, 171; of fracture, 104, 153, 268. Extra-uterine gestation. Foetus removed through the parietes of the abdo- men, having been carried seven years, and the woman, meanwhile, hav- ing borne three living children, 714. Foetal bones removed by an opera- tion from the urinary bladder, 715. Cyst filled with foetal bones, from a sheep, 716. Tubular pregnancy ; external hcemorrhage observed as a symptom, 711 ; ova retained in the oviduct of a fowl, 712, and in the ovary of a striped basse, 713. Extremities. Remains of a Guanche Indian, 935; an Egyptian, 936. Ab- sence of one or more, 819; in the acephalus, 762, 765 ; blighted fetus, 826- 7 ; consists of a foot, 816 ; a single finger, 757-62 ; a toe, 816 ; an undeveloped humerus and femur, 818 ; ulna formed without the hu- merus, 757, and the humerus without the ulna, 816; absence of the ra- dius in an adult subject, 823; feet and hands fully developed, the ex- tremities being otherwise imperfect, 814, 812, 809. Blood vessels and nerves developed, when the extremity is wanting, 762. Additional ex- tremities, phalanges, &c, 858-71, 809. Distortion, 778, 794, 878, 819, 822, 826. Fusion of fingers, 833 ; Finger torn off, 307-8 ; skin and nail torn off, 411. See Club-foot. Eyes. Undeveloped, 807 ; two in one orbit, 853, 848; fusion, 857, 854, 824 - 5. Ossification, 393 - 4 ; malignant disease, 395 - 6, 943. Fallopian tube. Absence of one, 819; formed independently of the uterus, 802 ; old adhesions, as observed in prostitutes, 665; dropsy of, 666 ; cholesterine from, 667; tubercular disease, 668; ovum developed in, 711. Feigned disease. Pieces of bone from the nostrils and ears, 934 ; strips of ligamentum nuchae from the vagina, 671. Femur. See Articulations, Dislocation, and Anchylosis. Of a child, 9 ; sections, 19; changes in old age, 213; after amputation, 220 ; fracture, 221-41; exostosis about the neck, mistaken for united fracture, 214 ; inflammation 208 - 9 ; exostosis, 215 ; curvature just above the condyles, 216; malignant disease, 217-9. Foetus. Series to show the development, 725-43 ; osteology, 1 - 8 ; cir- culation, 321 - 3 ; injection of skin, 406, and intestine, 453 ; cuticle, 417 ; development of stomach, 450; ccecum, 451, and bladder, 602. Kirrono- sis, 741, 802 ; cephalhaematoma, 715 ; cretaceous deposit upon the peri- INDEX. 343 toneal surface, 946 ; ulceration of the stomach, 795; softening, as by the gastric juice, 457. Foreign substances. From the alimentary canal, 522-33; air passages, 435-7; nostrils, 934; urinary organs, 609-12, 634, 715; vagina, 670- 1; integument, 933. Fractures. Of the cranium, 102-6; vertebrae, 136-43,951; scapula, 160-1; claviele, 163-4, 166; humerus, 176-84; radius and ulna, 192-5; pelvis, 198, 938; femur, 221-41; patella, 252-3; tibia and fibula, 261 -9, 271-2, 288 ; metatarsus of a deer, 300. Casts in plaster of,915. Fractures in birds, 111, 193, 238-41, 176-9, 271, 301-2; in a tortoise, 157 ; in a crab, 158. Partial fracture, 152; 165, 269-70? into the joints, 180-1, 235; excision of the bone, 181 ; removal of a fractured spinous process, 952; gun-shot injury, 199, 222 ; spontaneous, 219, 230, 223 ; 224 1 changes in the interior of old fractured bones, 234, 262 ; strength of united fracture, 267; lateral union, 192, 264-6; union in case of rickets, 77; ununited fracture, 182-4, 228-9, 237, 252-3, 301; absorption of lower fragment, 184 ; caries of the lower fragment, 236 ; disease of the joints with old fracture, 245 - 6, 174; separation of dead bone, in compound fracture, 235. Gall bladder. Wanting in a fetus, 802 ; in an adult, 552; lumbricus from, 882 ; filled with calculi, 558- 9 ; calculi adherent, 560 ; dilatation, 554 ; ulceration, 556; opening into the colon, 565 ; ossification, 555; atrophy, 553 ; eneephaloid disease, 564. Gangrene. Extensive gangrenopsis, with recovery, 83 ; of the lungs, 441 ; of the lungs and Peyer's patches in typhoid fever, 500 ; of the bladder in fracture of the spine, 604; of the appendix caeci, from a for- eign body, 511 - 3 ; of the extremities, from ossification of the arteries, 363 ; from paralysis and other causes, 930. Hair. Change of color in old age, 944 ; from an Albino negro, 421 ; from a naevus upon the scalp, 420 ; formed in cysts, 678-81, 924-5. Hare-lip. Single, in a fetus of two or three months, 831; condition of the bones in a fetus, 832; double, 847, 807. Heart. Anatomy, 321-3, 326-7. Malformation : absence in the aceph- alus, 757, 762 ; foramen ovale open, 328 -31, 334, 336 ; interventricu- lar opening, 332-6, 339, 341, 836,850; right ventricle, 332-6, and deficiency of the pulmonary valves, 332-5, in interventricular opening ; death from haemorrhage, 332, 334 ; one ventricle undeveloped, the other quite large, 340, 342 ; ductus arteriosus open, 343, 332 ; protrusion ex- ternally, 784, 950. In a double foetus : a single organ, 845 ; a fusion of two organs, 834-5 ; two separate organs, 836, 844, 848, 850. Wound, 346; fibrinous deposit, 357 ; polypiform mass, 358; dilatation, 353-4; aneurism, 355; tubercles, 356,581; valvular disease, 347- 52 ; coro- nary artery ossified, 359. 344 INDEX. Humerus. See Articulations and Dislocation. Anatomy, 9, 10, 19 ; frac- ture, 171, 176-84; after amputation, 185; absorption of cartilage, 167; hyperostosis in a partridge, 170; exostosis, 171; result of old disease, probably caries, 169. Imperforate Anus, 460-1, 757, 802, 87S; minute opening from the rec- tum into the urethra, in male subjects, as a general rule, 460 ; opening of the intestine into the vagina, 466; into the bladder, 773. Imperforate Rectum, 462- 5 ; dilatation of intestine, 463 ; vagina wounded in an operation for, 465. Intestine. See Imperforate Anus, and Rectum, Internal Strangulation, Intussusception, Typhoid Fever, Peyer^s Glands, and Appendix Coeci. Anatomy, 451 -3 ; situated as in early fetal life, 784, 788 ; imperfora- tion of jejunum, 915 ; upper portion wanting in the acephalus, 757, 762 ; diverticula, 458. 762, 791, 844-5, 850. Dilatation, in a double fetus, before the division of a single intestine, 836, 815 ; before the fusion of a double set of intestines, 850. Protrusion from a deficiency of the abdom- inal parietes, 950, 778-9, 783-4, 819; at umbilicus, 848, 757, 765, 807. Parasites : lumbrici, 880, 883 ; echinorynchi, 890-2 ; taeniae, 893, 900 ; bothriocephalus, 901, 903 ; linguatula, 906. Foreign bodies, 527-33. Chyle in the villosities. 485. Fatty dejections, in a case of disease of the pancreas, 576. Rupture from violence, 485 ; perforation in a fish, by parasites, 892 ; hernia of the mucous membrane of the duodenum, 486, and of the large intestine, 508 ; polypus, 487. Acute inflammation in dysentery, 514; ileus, 515; the result of obstruction, 464, 518, perfo- ration occurring in the last case. Chronic ulceration of duodenum, with perforation, 506 ; of large intestine, 516-7; rectovaginal fistula, 675, 519; opening into a fistula, in case of disease of the spine, 117; open- ing from a mesenteric abscess, 541 ; discharge of a tubular membrane, 505. Malignant disease : of the small intestine, with abrupt dilatation, 507; of the large intestine, 518-20. Intussusception. At the junction of the small and large intestines, 488 - 92 ; of the rectum, 509. Kidneys. Absence of both, 802; of one, 757; protrusion of, from defi- ciency of the abdominal parietes, 950; fusion, 585, 781, 787; lacera- tion, 578 ; inflammation, 586 ; tubercular disease ; renal phthisis, 592 ; disease in dropsy, 590. Encysted, 587 - 9 ; in a monstrosity, 788, 810 ; congenital in 589 and 652 1 Atrophy, 591; from dilatation of the pel- vis, 598-9; malignant disease, 593-4. Pelvis dilated, 597-9 ; dis- tended by strongyli, 598; inflamed, 605. Ureters imperfectly developed, 788; two upon one side, 785, 794 ; divided, 795 ; dilated, 599-601,773. Kirronosis. 744, 802. Lowcr jaw. Imperfectly developed, 816; single in a "double-headed fetus," 857, 848 ; additional development, 844 ; shot away, 110 ; caries in a mink and skunk, 79, 80; necrosis, S2 ; malignant disuise, t!8 - 100. INDEX. 345 Liquor amnii. Profuse discharge, in cases of acephalous foetus, 766-74, 778, 784, 950 ; in a case of spina bifida, 798. Liver. Wanting in the acephalus, 757, 762 ; irregular development, 781, 783, 788 : two organs in a double fetus, 844 ; fusion of the two, 835, 850: protrusion from a deficiency of the parietes, 778, 783-4, 819, 950. Laceration, and yellowness of the surface, as a sign of, 545 ; cica- trization, 550 ; abscess, 549 ; tubercular disease, 548 ; cirrhosis, 546-7. Lizard. Bifid tail, 931. Lungs. Wanting in the acephalus, 757, 762 ; imperfect, or irregular development, 766, 781, 783-4, 788, 845, 848,850; protrusion of, from a deficiency of the parietes, 781. Emphysema, 438; apoplexy, 439, 457; gangrene, 441 ; spurious melanosis, 440; arrest of tubercular dis- ease, 442 ; carcinoma, 358. Malignant disease. Of the bones, 97-8, 101, 148, 217-9, 230; antrum, 101 ; shoulder, 914; thigh, 926; ankle joint, 317; eye, 395-6, 943; lungs, 358 ; oesophagus, 471-2, 179; stomach, 479-84; small intes- tine, 507; large intestine, 518-20; pancreas, 573-4; gall-bladder, 564; kidneys, 593-4; prepuce, 708; testicle, 693, 695, 948-694? Congenital, 185; in young subjects, 948, 695, 507 ; abscesses, in con- "'nection with disease of the ribs, 148. Mastodon. Animal matter in the bones and teeth, 26. Melanosis, of the eye, 396, 943 ; spurious, of the lung, 440. Mesentery. Imperfect development, 781 ; cysticercus from, in a sheep, 905; mass of concrete chyle, 378 ; abscess, opening into the intestine, 541. Ossified glands, 512 ; tumor, 543. Nails. Fusion, 833. Hypertrophy, 418-9. National Skulls. From Scio, 39 ; Maltese, 40 ; French soldier from Malta, 41; Egyptian, with most of the skeleton, 42; two Theban, 43-4; from the Ganges, 45-8; Chinese, 49-51; Celebes Islander, 52; Sandwich Islander, 53-8 ; African, 59-61; North American Indian, from the New England States, 62-7, 953; from the Columbia river, 68-9; cast of a Carib head, 70; from California, 71-2. Peruvian; Inca race, 73-5; ancient race, 76. Necrosis, of the lower jaw, 82 ; sternum, 147 ; tibia, 276, 942, and follow- ed in the last case by anchylosis of the knee and ankle joints ; os calcis, 303. Sequestrum from the ulna, 191 ; femur, 210- 1; tibia, 279 ; exfo- liation from the femur after amputation, 212 ; portion of the upper max- illary bone thrown off in case of gangrenopsis, 83; portions of the hyoid bone expectorated, 435. Nerves. Maxillary, 14. Formed independently of the brain and spinal marrow, 706 - 74, 776 ; and also of the extremity which they are to sup- ply, 762 ; ganglia of the sympathetic nerve large in an acephalus, 7G2. 44 346 INDEX. Nostrils. Rudimentary in an acephalus, 757 ; imperfectly developed in an acephalous fetus, 807. Polypus, 404 - 5. Oesophagus. Opening into the larynx and trachea, 845 ; lower portion opening into trachea, the upper terminating in a cul de sac, 456-7. Dilatation, 469; contraction, the effect of an alkali, 470. Malignant disease, 471, 479 ; opening into the trachea, 472. Ossification. Of the cartilages of the ribs, 306; larynx and trachea, 422-6; gall-bladder, 555; pericardium, 320 ; pleura, 448-9; valves of the heart, 347-50, 352; arteries, 362-3; fibrin upon the inner sur- face of the heart, 357, and in the veins, 380; bronchial and mesenteric glands, 446, 542; renal capsules, 595; dura mater, 382-5; eye, 393-4; spleen, 579-80; testicle, 688-9; placenta, 749; fibrous tumors, 661 - 2 ; upon the inner surface of a dilated kidney, 598, and in the fat about the kidney, 932 ; cretaceous deposit upon the surface of the diaphragm, 946, and upon the ovary, 676. Caries of an ossified cricoid cartilage, 427 ; aortal valve, 352. Osteosarcoma. Of the thigh, 217- 18. Ovary. Absence of one, 819 ; situated in the groin, 652 ; surface smooth after puberty, the uterus being impervious, 652 ; corpus luteum, 721. Cretaceous deposit upon the surface, 676; encysted disease, 677-81. Malignant disease, 683 ; 682, and 684? Palate. Condition of the bones in fissure, 806, 812, 845, 847-8, 781; deceptive appearance of fissure in the acephalous fetus, 788. Fissure of the uvula in the acephalous fetus, 776,781, 783, 788, 950; trace of, 795. Pancreas. Absence of, in the acephalus, 757, 762 ; cavity in the organ filled with blood, 557; malignant disease, 573-4; calculi, 575-6. Duct dilated, 575 - 6, 557 ; obliterated at its opening into the intestine, 557, 576; opening into the hepatic duct, 557. Parasites, 880-913. Lumbrici, 880-3; anatomy, 881 ; large number from a child, 880 ; from an epileptic dog, 883 ; from the gall-bladder, 882, and from the ducts, 908. Filariae, from the integuments, 884 ; air tubes of a porpoise, 885 ; peritoneal cavity of a horse, 887 ; from beneath the peritoneum of a fish, 888. Strongyli from the kidney of a mink, 889. Echinorynchi from the intestine of a hog, 890, and fish, 892. Taeniae from the human subject, 893 - 99 ; from a porcupine, 900. Bot- riocephalus, 901-3. Cysticercus cell, from the human subject, 904 ; from a sheep, 905. Linguatulse from the intestine, and from the lung of a serpent, 906-7. Distoma hep. from an elephant, 908. Trichina spiralis, 909. Chondracanthus from the mouth of a whiting, 910. Bot- fly ; larvae from the stomach of a horse, 911, and from the frontal sin- uses of a sheep, 912. Pelvis. Anatomy, 9, 19 ; imperfect development, 816, 820, 812 ; relaxa- ation of ligaments during gestation, 722-3; fracture, 198, 938; gun- shot wound, 199; fibrous exostosis, 197. INDEX. 347 Penis. Anatomy, 701-2 ; absence of the fraenum in a negro, 703; hy- pospadias, 704 ; venereal warts, 705 ; destroyed by venereal disease, 707 ; cancer, 708. Pericardium. Deficiency, 781 : pneumopericardium, 363 ; adhesion, 319, 347-8 ; ossification, 320; rupture into, 361-5, 368. Peritoneum. Parasites from the cavity, 887 ; inflammation in monstrosi- ties, from a deficiency of the parietes, 819, 950; cretaceous and crys- talline deposite, 676, 946-7 ; carcinoma, 544. Peyer's Glands. Redness during the process of digestion, 454, and in acute disease, 430, 504. Inflammation in typhoid fever, 500-1; in dysen- tery, 503. Pharynx. External fissure below the jaw, 844 ; ulceration in scarlatina, 468 ; constriction from the cicatrisation of venereal ulcers, 467. Placenta. Injected, 746; ossification, 749; encysted, 778; tumor in, 750 ; a small portion adherent, 747 ; the whole mass adherent to the uterus, and causing a sloughing of the fundus, 748. Pneumothorax, 443-4. Polypus. Of the nose, 404-5 ; ear, 400 ; intestine, 487 ; womb, 651-5, 718. Prostate Gland. Enlarged, 696-8. Calculi in situ, 699; removed and analyzed, 700. Pulmonary Artery. Two valves, 333, 335, 835; four valves, 337-8; valves imperfect in interventricular opening, 332-5 ; impervious at its origin, 342; arises from aorta, 339, 341 ; gives origin to the right ca- rotid and subclavian arteries, 778. Opening into a tubercular cavity, 445 ; involved in aneurism of the aorta, 368 ; haemorrhage from, into a tubercular cavity, 445. Radius and Ulna. Anatomy, 9, 10, 19; radius wanting in an adult, 823 ; fracture of both bones, 192-3, and of one, 194-5 ; changes after ampu- tation, 190; disease, connected with scrofulous ulcers, 188; seques- trum, 191. Renal Capsules. Independent of the kidneys, 802, 757. Small in the acephalous foetus, 766-74, 776, 781, 783, 789, 793-5; sufficiently developed, 785, 788, 950; small in another form of monstrosity, 807; fusion, 762, 788. Encysted disease, 596 ; ossification, 595. Ribs. Thirteen pairs, 4 ; bifurcation, 34 ; fusion and other anomalies in monstrosities, 762, 766-74, .778, 780-1, 783-5, 788, 844, 950; 757, 762, 778, 789, 847. Fracture, 152-4, 160; exostosis, 156; lateral union, 155 ; carcinomatous deposit, 148. Rickets. Changes in the skeleton, 77. Rhinencephalous Pig, 824 -5. Sacrum. Open posteriorly, 33 ; malformation, 801; curvature, 104; ca- ries, 124-5. 348 INDEX. Salivary Calculus, 954. Scapula. Anatomy, 9, 38 ; fusion of two, 845 ; fracture, 160-1. Skeleton. Fcetal, 1-5; adult, 12; of monstrosities, 759, 766,776-8 781, 783-4, 786,788-9,812, 814, 820, 835, 837, 844-5, 847, 863-5, 950 ; of a child affected with rickets, 77. Skin. Injected, 406 ; tanned, 407- 8 ; tattoed, 409-10 ; torn from finger, with the nail, 411; excrescences, 412 ; models, &c. of disease, 413-16. Spina bifida. Preparations of the soft parts, 796, 801-2; osteology, 797-9, 789, 847; unusual form, 800-2 ; in an acephalous foetus, 789 ; in a double pig, 847 ; complicated with hydrocephalus, 798 ; in a patient sixteen years of age, the spinal marrow terminating at the fourth dorsal vertebra, 799 ; death from meningitis, 796. Spinal Marroiv. Formed independently of the brain, 757; deficiency or absence in the acephalous foetus, 766-74, 776-8, 781, 783-5, 788-9, 847 ; prolongation in spina bifida, 802 ; from a case of backward curva- ture of the spine, 392; tubercle, 951; cartilaginous deposit in the arach- noid, 391. Spleen. Structure, 577; wanting in the acephalus, 757, 762 ; lobulated, 811 ; protrusion from a deficiency of the parietes, 784, 950; laceration, 578; ossification upon the surface, 579-80 ; tuberculous, 581 -2 ; pe- culiar disease, with analysis of cases, 583 ; atrophy, 584. Sternum. Sections, 19; imperfectly developed, 950 ; consists of two lateral portions, 757, 762 ; perforation in the adult, 36-7,151; episternal bones, 35 ; union of the two, in a double foetus, 835. Fracture, 149 - 50 ; laceration of the substance between the bones, 151; caries, 145-6; necrosis, 147 ; carcinomatous deposit, 148. Stomach. Development, 450 ; wanting in the acephalus, 757, 762 ; form irregular, 781 ; fusion of the two organs in a double fetus, 836, 844-5, 848 — two organs separate, 850; protrusion from a deficiency of the parietes, 784, 950. Larvae of the bot-fly, 911 ; foreign substances, 522-6; fatal haemorrhage, from the rupture of a vessel without ulcera- tion, 575 ; effects of elaterium, 473. Chronic ulcer, 474-8 ; perforation in, 475-6; hemorrhage in, 477; hemorrhage and perforation in, 478. Malignant disease, 479-84. Strangulation of the intestine. By a band of false membrane, 494-5 ; by a diverticulum, 496-7; by the appendix caeci, 498-9; diaphragmatic hernia, 493; occurrence of previous attacks important in diagnosis, 498. Teeth. Anatomy, 14, 534-5 ; animal matter in the mastodon, 26 ; three upper incisors upon one side, 75; development in an acephalus, 757 ; preternatural growth of the incisors in a marmot, 537-8; incrusted with tartar, 539 ; disease, 540. Testicle. Absence of, 686 ; protrusion from a deficiency of the parietes, 950 ; organs fully developed, the external appearances being those of a INDEX. 349 female, 807. Ossification, 688 - 9 ; scrofulous disease, 690-1 ; fungous, 692 ; malignant, 693, 695, 948 ; 694 ? Vas deferens wanting,'757." Thymus Gland. Absence of, in an acephalus, 762. Enlargement, 927. Thyroid Gland. Ossified cyst from, 429. Tibia and Fibula. Anatomy, 9, 19; fracture, 261-9, 271-2, 288; changes after amputation, 273-5; sequestrum, 279; exostosis, 289, 287. Disease in connection with old ulcer of the leg, 254-9 ; 260? ca- ries, 278 ; necrosis, 279, 276; scrofulous disease, 277, 290- 11 syphi- litic, 280-5; fungous growth, 286; result of former disease of tibia and ankle joint, 293. Tumors. Adipose, 916-18; glandular, 919; scirrhous, 920; cellular, 921; encysted, 922-4. Paintings of, 913-4. Tunica Vaginalis. Inflammation, 139; ossific body, 687; cast in plaster of hydrocele, 667. Typhoid Fever. Disease of Peyer's glands, 500 - 1 ; haemorrhage from an ulcer, 510; occurrence of intussusception, 492 ; crystals upon the mu- cous membrane, and in the cavity of the intestine, 502. Umbilical Cord. Forty-five inches in length, 755 ; very short sometimes in monstrosities, 762, 778, 784, 821, 950 ; knot in the cord, 756. Umbilical Vesicle. At about the sixth week, 729. Urinary Bladder. Development, 602 ; peculiar form, 603; thickened and dilated in a monstrosity, the urethra being impervious, 773 ; imperfectly developed, the kidneys being wanting, 802; sacculated, 606, 696-8, the sac being larger than the bladder itself in 606; inflammation and gangrene in fracture of the spine, 604; chronic disease, the result of calculus, 605 ; fungous excrescences, 607 ; carcinoma, 608. Urinary Calculi. Formed upon a broken catheter, 611 ; quill, 612 ; sus- pender buckle, 634 ; sealing wax, 642. Composed of uric acid, 613 - 16, 620 ; uric acid and urates, 617 -19 ; urate of ammonia, 639; uric acid and the mixed phosphates, 622-3 ; urate of ammonia and the mixed phos- phates, 638 ; uric acid and the urates, with the mixed phosphates, 624 ; urate of ammonia and oxalate of lime, 626 ; phosphate of lime, 630, 627, 632 ; phosphate of lime and the urates, 628-9 ; mixed phosphates, 634-7; mixed phosphates, with a nucleus of oxalate of lime, 641; with a nu- cleus of urate of ammonia and uric acid, 640 ; oxalate of lime, 644; oxalate of lime, with a thin crust of uric acid, 643; xanthic oxide upon a calculus of the phosphate of lime, 632 ; triple phosphate deposited from the urine, 633. Urine of a serpent, 625. Calculi from the kidney, 618, 621, 626, 645; from the ureter, to which it was adherent, 630; passed from the urethra, 613,615, 631-2,644,637; from under the prepuce of a hog, 637 : the rest were from the bladder. Removed by an operation, 623- 7, 629, 642. From a case of fractured spine, 638-9. Uterine Hydatids, 753-4. 350 INDEX. Uterus. Relations to the other pelvic organs, 649; imperfect develop- ment, S19; consists of three cavities, that open into the bladder, 773 ; divided by a septum throughout, 650 ; fundus divided, 718 ; bilobated, 651, with other malformations, 652. Gravid at an early period, 709, 729 ; third month, 710 ; full period, 717. Anatomy of the decidua, 709 ; 729. Rupture, 718-9, 805. Sloughing of the inner surface, after a te- dious labor, 720 ; of the fundus, from a retention of the placenta, 748. Hernia, 652; prolapsus, 656; inversion, 653; polypus, 654-5, 718. Fibrous tumors, 657-63; injected, and shows the enlargement of the blood-vessels, 657 ; development of the muscular structure, 660 ; disor- ganization, 659 -60 ; ossification, 661 - 2 ; cause of abortion, 659. Ma- lignant disease, 663-4, 675. Vagina. Absence of, 652, 457, 802 ; longitudinal septum, 650 - 1 ; band across the outlet, 669 ; foreign bodies from, 670 - 1 ; elephantiasis of the external organs, 672-4 ; ulceration, opening into the rectum, 519. Veins. Absence of valves in the acephalus, 763, 757 ; left subclavian and jugular open into the right auricle separately from the upper vena cava, 457. Inflammation, 377; inferior vena cava distended by fibrin, 378; iliac vein, after recovery from inflammation, 379 ; phlebolites, 380. Vertebra. Anatomy, 9, 19 ; transverse process developed to represent a rib, 844 ; spinal column in the acephalus, 759, 762, in the acephalous fetus, 766-74, 775, 776-81, 7S3-8, 789-95, and in spina bifida, 797-9, 801, 847 ; fissure of the bodies of the vertebrae, 780-1 ; fusion of two spinal columns in a double monstrosity, 845, 847, 849-50. Fracture of the cervical vertebrae, 136-7; dorsal, 138, 140, 142-3; lumbar, 139; spinous process removed by an operation, 952 ; partial recovery, 952, 142 - 3 ; formation of urinary calculi, 142 - 3 ; dislocation, without frac- ture, 135; obscure injury, 144. Caries without curvature, 112, 113, 124-5, 128, 937, the two last being the result of aneurism; with curvature, 116-19; intervertebral substance primarily affected, 117; a second invasion of caries, 117; opening of a fistula into the intestine, 117 ; recovery, with complete anchylosis, 114, 120-1 ; occurrence in a case of spina bifida, 799 ; symptoms of phthisis in case of extensive ca- ries, 115 ; lateral curvature of the spine of a pickerel, from an absorption of one of the vertebrae, 123. Atlas separated into two lateral halves, 126 ; separation of the wings from the body of a lumbar vertebra, 127. Exostosis from the edges of the vertebrae, resulting in anchylosis, 130-3. Vomiting. Fatal, as a symptom of pregnancy, 710, and note to 729. EXPLANATION OF THE FIGURES. PI. I. No. 329. Foramen ovale open in the adult. PI. I. No 330. The same. PL 1. No. 331. The same. PL III. No. 759, Skeleton of a monstrosity (acephalus.) PI. III. No. 766. Skeleton of an acephalous foetus; a. a. the frontal bones ; b. b, the posterior portions of the occiput. PL III. No. 775. The posterior portion of the occiput of an acephalous foetus. PL IX. No. 844. Lower jaw of a double lamb, showing additional alveoli and teeth beneath the symphisis. PL III. No. 780. Spine of an acephalous foetus; a. a fissure through the bodies of the cervical vertebrae ; 6. an additional wing upon the body of the eleventh dorsal vertebra. PI. V. No. 781. Skeleton of an acephalous foetus; a. a. rudimentary parietal bones. PL V. No. 781. A front view of the upper portion of the spine, show- ing an extensive fissure through the bodies of the vertebrae ; a. the cen- tral opening ; b. union of the body of tke third cervical vertebra with that of the seventh dorsal, upon the left side ; c. union of the bodies of the second, third, fourth and fifth cervical vertebrae with that of the eighth dorsal upon the right side. PL IV. No. 783. Skeleton of an acephalous foetus ; posterior view; a. a. the posterior portions of the occipital bone : 6. 6. the parietals. PL IV. No. 783. A lateral view of the skeleton last referred to ; a. the posterior portion of the occipital, and b. the parietal bone. PL IV. No. 784. Skeleton of an acephalous foetus; a. a. the parietal bones ; b. b. the posterior portions of the occiput; c. c. the frontal bones. PL VI. No. 785. External view of an acephalous foetus, the brain being developed, but situated outside of the cranial cavity. PL VII. No. 786. A posterior view of the skeleton of the monstrosity last referred to ; a. a. the frontal, and b. b. the parietal bones; c. c. the pos- terior portions of the occiput; d. the temporal, and e. the styloid process of the temporal bone; ./. the malar, g. the nasal, h. the ungual, i. the superior maxillary, and j. the inferior maxillary bones ; k. an additional wing connected with the ninth dorsal vertebra. PL VII. No. 786. A lateral view of the skeleton of the monstrosity last referred to : I. a fusion of the wings of the cervical vertebrae ; m. m. the wings, and n. n. the bodies of tne vertebrae. The other letters corres- pond with those in the last figure. PL V. No. 7S8. Skeleton of an acephalous foetus ; a. the frontal, and b. the parietal bones ; c. the posterior portion of the occiput. PL V. No. 788. Fusion, with irregular development of three of the ribs, from the skeleton last referred to. PI. VIII. No. 793. Cranium of an acephalous foetus; a. the posterior portion of the occiput ; 6. the frontal, and c. the parietal bones. PL VIII. No. 808. Cranium of a monstrosity. PL VITI. No. 812. Cranium of a monstrous calf. PL VIII. No. 837. Base of the skull, with a portion of the skeleton of a double foetus. PL X. No. 836. Stomach and portion of the intestine of the double foetus last referred to. PL IX. No. 849. A double fish. 352 EXPLANATION OF THE FIGURES. Fig 24. " 25. (i 26. [< 27. n 2S. " 29. 11 30. u 31. ii 32. ii 33. it 34. PL X. No. 846. A portion of the intestine of a double pig. PL X. No. 850. Alimentary canal of a double foetus. PL I. No. 896. Taenia sol. showing a great irregularity of the joints. PL IX. No. 826. A blighted foetus. PL IX. No. 827. A second blighted foetus. PL I. No. 945. Imperforation of the small intesLne. PL I. No. 612. Urinary calculus formed upon a quill. PI. II. No. 770. Sketch of an acephalous foetus ; front view. PI. II. No. 770. A side view of the same. PL X. No. 845. Fusion of the scapula of a double foetus. 33'. Another view of the same. PL X. No. 845. Fusion of two stomachs in a double pig. Figures 7. 23. 30. 31. and 32. it should be remarked, have been added since the text was prepared for the press, and the figure of specimen No. 943, which it was intended to introduce, has been omitted. ERRATA. Page 214, 19th line from top; for "bladder," read " vagina." " 3, 9th line from bottom, for "frontal," read parietal." Page 1, 9, 12, 37, 66, 216, 258, 261, 263, 269, 235, 302, 305, 309, 8th line from bottom, for an intermaxillary read a maxillary. last line, for are read were. 8th line from the top, for 109 read 120. 14th line from the top, for m. read iv. ; and, upon the 45th page, for iv. read v. 7th line from the top, for anchyloted read anchylosed. 9th line from the top, for 509 read 507. 19th line from the bottom, for 10 read 9'. 3d line from the bottom, for 787 read 786. and 266, for 254 read 260. 12th and 21st line from the bottom, omit (No. 789.) 2d line from the bottom, for 810 read 809; and on the 286th page, for 810, 812 and 811, read 809, 811 and 810. last line, for 23 read 7. 11th line from the bottom, for mounted read not mounted. 17th line from the top, for 26 read 25. ^i^s^A r ^—^ir Is ^2 p: 'j v-o .M NATIONAL LIBRARY OF MEDICINE NLM010015895