CHAPTER V.

MAJOR TERATA.

Monstrosities have attracted notice from the earliest time, and many of

the ancient philosophers made references to them. In mythology we read

of Centaurs, impossible beings who had the body and extremities of a

beast; the Cyclops, possessed of one enormous eye; or their parallels

in Egyptian myths, the men with pectoral eyes,--the creatures "whose

heads do beneath their shoulders grow;" and the Fauns, those sylvan

deities whose lower extremities bore resemblance to those of a goat.

Monsters possessed of two or more heads or double bodies are found in

the legends and fairy tales of every nation. Hippocrates, his

precursors, Empedocles and Democritus, and Pliny, Aristotle, and Galen,

have all described monsters, although in extravagant and ridiculous

language.

Ballantyne remarks that the occasional occurrence of double monsters

was a fact known to the Hippocratic school, and is indicated by a

passage in De morbis muliebribus, in which it is said that labor is

gravely interfered with when the infant is dead or apoplectic or

double. There is also a reference to monochorionic twins (which are by

modern teratologists regarded as monstrosities) in the treatise De

Superfoetatione, in which it is stated that "a woman, pregnant with

twins, gives birth to them both at the same time, just as she has

conceived them; the two infants are in a single chorion."

Ancient Explanations of Monstrosities.--From the time of Galen to the

sixteenth century many incredible reports of monsters are seen in

medical literature, but without a semblance of scientific truth. There

has been little improvement in the mode of explanation of monstrous

births until the present century, while in the Middle Ages the

superstitions were more ludicrous and observers more ignorant than

before the time of Galen. In his able article on the teratologic

records of Chaldea, Ballantyne makes the following trite statements:

"Credulity and superstition have never been the peculiar possession of

the lower types of civilization only, and the special beliefs that have

gathered round the occurrence of teratologic phenomena have been common

to the cultured Greek and Roman of the past, the ignorant peasant of

modern times, and the savage tribes of all ages. Classical writings,

the literature of the Middle Ages, and the popular beliefs of the

present day all contain views concerning teratologic subjects which so

closely resemble those of the Chaldean magi as to be indistinguishable

from them. Indeed, such works as those of Obsequens, Lycosthenes,

Licetus, and Ambroise Pare only repeat, but with less accuracy of

description and with greater freedom of imagination, the beliefs of

ancient Babylon. Even at the present time the most impossible cases of

so-called 'maternal impressions' are widely scattered through medical

literature; and it is not very long since I received a letter from a

distinguished member of the profession asking me whether, in my

opinion, I thought it possible for a woman to give birth to a dog. Of

course, I do not at all mean to infer that teratology has not made

immense advances within recent times, nor do I suggest that on such

subjects the knowledge of the magi can be compared with that of the

average medical student of the present; but what I wish to emphasize is

that, in the literature of ancient Babylonia, there are indications of

an acquaintance with structural defects and malformations of the human

body which will compare favorably with even the writings of the

sixteenth century of the Christian era."

Many reasons were given for the existence of monsters, and in the

Middle Ages these were as faulty as the descriptions themselves. They

were interpreted as divinations, and were cited as forebodings and

examples of wrath, or even as glorifications of the Almighty. The

semi-human creatures were invented or imagined, and cited as the

results of bestiality and allied forms of sexual perversion prevalent

in those times. We find minute descriptions and portraits of these

impossible results of wicked practices in many of the older medical

books. According to Pare there was born in 1493, as the result of

illicit intercourse between a woman and a dog, a creature resembling in

its upper extremities its mother, while its lower extremities were the

exact counterpart of its canine father. This particular case was

believed by Bateman and others to be a precursor to the murders and

wickedness that followed in the time of Pope Alexander I. Volateranus,

Cardani, and many others cite instances of this kind. Lycosthenes says

that in the year 1110, in the bourg of Liege, there was found a

creature with the head, visage, hands, and feet of a man, and the rest

of the body like that of a pig. Pare quotes this case and gives an

illustration. Rhodiginus mentions a shepherd of Cybare by the name of

Cratain, who had connection with a female goat and impregnated her, so

that she brought forth a beast with a head resembling that of the

father, but with the lower extremities of a goat. He says that the

likeness to the father was so marked that the head-goat of the herd

recognized it, and accordingly slew the goatherd who had sinned so

unnaturally.

In the year 1547, at Cracovia, a very strange monster was born, which

lived three days. It had a head shaped like that of a man; a nose long

and hooked like an elephant's trunk; the hands and feet looking like

the web-foot of a goose; and a tail with a hook on it. It was supposed

to be a male, and was looked upon as a result of sodomy. Rueff says

that the procreation of human beings and beasts is brought about--

(1) By the natural appetite;

(2) By the provocation of nature by delight;

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

is alike.

Plutarch, in his "Lesser Parallels," says that Aristonymus Ephesius,

son of Demonstratus, being tired of women, had carnal knowledge with an

ass, which in the process of time brought forth a very beautiful child,

who became the maid Onoscelin. He also speaks of the origin of the

maiden Hippona, or as he calls her, Hippo, as being from the connection

of a man with a mare. Aristotle mentions this in his paradoxes, and we

know that the patron of horses was Hippona. In Helvetia was reported

the existence of a colt (whose mother had been covered by a bull) that

was half horse and half bull. One of the kings of France was supposed

to have been presented with a colt with the hinder part of a hart, and

which could outrun any horse in the kingdom. Its mother had been

covered by a hart.

Writing in 1557, Lycosthenes reports the mythical birth of a serpent by

a woman. It is quite possible that some known and classified type of

monstrosity was indicated here in vague terms. In 1726 Mary Toft, of

Godalming, in Surrey, England, achieved considerable notoriety

throughout Surrey, and even over all England, by her extensively

circulated statements that she bore rabbits. Even at so late a day as

this the credulity of the people was so great that many persons

believed in her. The woman was closely watched, and being detected in

her maneuvers confessed her fraud. To show the extent of discussion

this case called forth, there are no less than nine pamphlets and books

in the Surgeon-General's library at Washington devoted exclusively to

this case of pretended rabbit-breeding. Hamilton in 1848, and Hard in

1884, both report the births in this country of fetal monstrosities

with heads which showed marked resemblance to those of dogs. Doubtless

many of the older cases of the supposed results of bestiality, if seen

to-day, could be readily classified among some of our known forms of

monsters. Modern investigation has shown us the sterile results of the

connections between man and beast or between beasts of different

species, and we can only wonder at the simple credulity and the

imaginative minds of our ancestors. At one period certain phenomena of

nature, such as an eclipse or comet, were thought to exercise their

influence on monstrous births. Rueff mentions that in Sicily there

happened a great eclipse of the sun, and that women immediately began

to bring forth deformed and double-headed children.

Before ending these preliminary remarks, there might be mentioned the

marine monsters, such as mermaids, sea-serpents, and the like, which

from time to time have been reported; even at the present day there are

people who devoutly believe that they have seen horrible and impossible

demons in the sea. Pare describes and pictures a monster, at Rome, on

November 3, 1520, with the upper portion of a child apparently about

five or six years old, and the lower part and ears of a fish-like

animal. He also pictures a sea-devil in the same chapter, together with

other gruesome examples of the power of imagination.

Early Teratology.--Besides such cases as the foregoing, we find the

medieval writers report likely instances of terata, as, for instance,

Rhodiginus, who speaks of a monster in Italy with two heads and two

bodies; Lycosthenes saw a double monster, both components of which

slept at the same time; he also says this creature took its food and

drink simultaneously in its two mouths. Even Saint Augustine says that

he knew of a child born in the Orient who, from the belly up, was in

all parts double.

The first evidences of a step toward classification and definite

reasoning in regard to the causation of monstrosities were evinced by

Ambroise Pare in the sixteenth century, and though his ideas are crude

and some of his phenomena impossible, yet many of his facts and

arguments are worthy of consideration. Pare attributed the cause of

anomalies of excess to an excessive quantity of semen, and anomalies of

default to deficiency of the same fluid. He has collected many

instances of double terata from reliable sources, but has interspersed

his collection with accounts of some hideous and impossible creatures,

such as are illustrated in the accompanying figure, which shows a

creature that was born shortly after a battle of Louis XII, in 1512; it

had the wings, crest, and lower extremity of a bird and a human head

and trunk; besides, it was an hermaphrodite, and had an extra eye in

the knee. Another illustration represents a monstrous head found in an

egg, said to have been sent for examination to King Charles at Metz in

1569. It represented the face and visage of a man, with small living

serpents taking the place of beard and hair. So credulous were people

at this time that even a man so well informed as Pare believed in the

possibility of these last two, or at least represented them as facts.

At this time were also reported double hermaphroditic terata, seemingly

without latter-day analogues. Rhodiginus speaks of a two-headed monster

born in Ferrari, Italy, in 1540, well formed, and with two sets of

genitals, one male and the other female. Pare gives a picture of twins,

born near Heidelberg in 1486, which had double bodies joined back to

back; one of the twins had the aspect of a female and the other of a

male, though both had two sets of genitals.

Scientific Teratology.--About the first half of the eighteenth century

what might be called the positive period of teratology begins.

Following the advent of this era come Mery, Duverney, Winslow, Lemery,

and Littre. In their works true and concise descriptions are given and

violent attacks are made against the ancient beliefs and prejudices.

From the beginning of the second half of the last century to the

present time may be termed the scientific epoch of teratology. We can

almost with a certainty start this era with the names of Haller,

Morgagni, Geoffroy-Saint-Hilaire, and Meckel, who adduced the

explanations asked for by Harvey and Wolff. From the appearance of the

treatise by Geoffroy-Saint-Hilaire, teratology has made enormous

strides, and is to-day well on the road to becoming a science. Hand in

hand with embryology it has been the subject of much investigation in

this century, and to enumerate the workers of the present day who have

helped to bring about scientific progress would be a task of many

pages. Even in the artificial production of monsters much has been

done, and a glance at the work of Dareste well repays the trouble.

Essays on teratogenesis, with reference to batrachians, have been

offered by Lombardini; and by Lereboullet and Knoch with reference to

fishes. Foll and Warynski have reported their success in obtaining

visceral inversion, and even this branch of the subject promises to

become scientific.

Terata are seen in the lower animals and always excite interest. Pare

gives the history of a sheep with three heads, born in 1577; the

central head was larger than the other two, as shown in the

accompanying illustration. Many of the Museums of Natural History

contain evidences of animal terata. At Hallae is a two-headed mouse;

the Conant Museum in Maine contains the skeleton of an adult sheep with

two heads; there was an account of a two-headed pigeon published in

France in 1734; Leidy found a two-headed snake in a field near

Philadelphia; Geoffroy Saint-Hilaire and Conant both found similar

creatures, and there is one in the Museum at Harvard; Wyman saw a

living double-headed snake in the Jardin des Plantes in Paris in 1853,

and many parallel instances are on record.

Classification.--We shall attempt no scientific discussion of the

causation or embryologic derivation of the monster, contenting

ourselves with simple history and description, adding any associate

facts of interest that may be suggested. For further information, the

reader is referred to the authors cited or to any of the standard

treatises on teratology.

Many classifications of terata have been offered, and each possesses

some advantage. The modern reader is referred to the modification of

the grouping of Geoffroy-Saint-Hilaire given by Hirst and Piersol, or

those of Blanc and Guinard. For convenience, we have adopted the

following classification, which will include only those monsters that

have LIVED AFTER BIRTH, and who have attracted general notice or

attained some fame in their time, as attested by accounts in

contemporary literature.

CLASS 1.--Union of several fetuses. CLASS 2.--Union of two distinct

fetuses by a connecting band. CLASS 3.--Union of two distinct fetuses

by an osseous junction of the cranial bones. CLASS 4.--Union of two

distinct fetuses in which one or more parts are eliminated by the

junction. CLASS 5.--Fusion of two fetuses by a bony union of the

ischii. CLASS 6.--Fusion of two fetuses below the umbilicus into a

common lower extremity. CLASS 7.--Bicephalic monsters. CLASS

8.--Parasitic monsters. CLASS 9.--Monsters with a single body and

double lower extremities. CLASS 10.--Diphallic terata. CLASS

11.--Fetus in fetu, and dermoid cysts. CLASS 12.--Hermaphrodites.

CLASS I.--Triple Monsters.--Haller and Meckel were of the opinion that

no cases of triple monsters worthy of credence are on record, and since

their time this has been the popular opinion. Surely none have ever

lived. Licetus describes a human monster with two feet and seven heads

and as many arms. Bartholinus speaks of a three-headed monster who

after birth gave vent to horrible cries and expired. Borellus speaks of

a three-headed dog, a veritable Cerberus. Blasius published an essay on

triple monsters in 1677. Bordenave is quoted as mentioning a human

monster formed of three fetuses, but his description proves clearly

that it was only the union of two. Probably the best example of this

anomaly that we have was described by Galvagni at Cattania in 1834.

This monster had two necks, on one of which was a single head normal in

dimensions. On the other neck were two heads, as seen in the

accompanying illustration. Geoffroy-Saint-Hilaire mentions several

cases, and Martin de Pedro publishes a description of a case in Madrid

in 1879. There are also on record some cases of triple monster by

inclusion which will be spoken of later. Instances in the lower animals

have been seen, the three-headed sheep of Pare, already spoken of,

being one.

CLASS II.--Double Monsters.--A curious mode of junction, probably the

most interesting, as it admits of longer life in these monstrosities,

is that of a simple cartilaginous band extending between two absolutely

distinct and different individuals. The band is generally in the

sternal region. In 1752 there was described a remarkable monstrosity

which consisted of conjoined twins, a perfect and an imperfect child,

connected at their ensiform cartilages by a band 4 inches in

circumference. The Hindoo sisters, described by Dr. Andrew Berry, lived

to be seven years old; they stood face to face, with their chests 6 1/2

inches and their pubes 8 1/2 inches apart. Mitchell describes the

full-grown female twins, born at Newport, Ky., called the Newport

twins. The woman who gave birth to them became impregnated, it is said,

immediately after seeing the famous Siamese twins, and the products of

this pregnancy took the conformation of those celebrated exhibitionists.

Perhaps the best known of all double monsters were the Siamese twins.

They were exhibited all over the globe and had the additional benefit

and advertisement of a much mooted discussion as to the advisability of

their severance, in which opinions of the leading medical men of all

nations were advanced. The literature on these famous brothers is

simply stupendous. The amount of material in the Surgeon General's

library at Washington would surprise an investigator. A curious volume

in this library is a book containing clippings, advertisements, and

divers portraits of the twins. It will be impossible to speak at all

fully on this subject, but a short history and running review of their

lives will be given: Eng and Chang were born in Siam about May, 1811.

Their father was of Chinese extraction and had gone to Siam and there

married a woman whose father was also a Chinaman. Hence, for the most

part, they were of Chinese blood, which probably accounted for their

dark color and Chinese features. Their mother was about thirty-five

years old at the time of their birth and had borne 4 female children

prior to Chang and Eng. She afterward had twins several times, having

eventually 14 children in all. She gave no history of special

significance of the pregnancy, although she averred that the head of

one and the feet of the other were born at the same time. The twins

were both feeble at birth, and Eng continued delicate, while Chang

thrived. It was only with difficulty that their lives were saved, as

Chowpahyi, the reigning king, had a superstition that such freaks of

nature always presaged evil to the country. They were really discovered

by Robert Hunter, a British merchant at Bangkok, who in 1824 saw them

boating and stripped to the waist. He prevailed on the parents and King

Chowpahyi to allow them to go away for exhibition. They were first

taken out of the country by a certain Captain Coffin. The first

scientific description of them was given by Professor J. C. Warren, who

examined them in Boston, at the Harvard University, in 1829. At that

time Eng was 5 feet 2 inches and Chang 5 feet 1 1/2 inches in height.

They presented all the characteristics of Chinamen and wore long black

queues coiled thrice around their heads, as shown by the accompanying

illustration. After an eight-weeks' tour over the Eastern States they

went to London, arriving at that port November 20, 1829. Their tour in

France was forbidden on the same grounds as the objection to the

exhibition of Ritta-Christina, namely, the possibility of causing the

production of monsters by maternal impressions in pregnant women. After

their European tour they returned to the United States and settled down

as farmers in North Carolina, adopting the name of Bunker. When

forty-four years of age they married two sisters, English women,

twenty-six and twenty-eight years of age, respectively. Domestic

infelicity soon compelled them to keep the wives at different houses,

and they alternated weeks in visiting each wife. Chang had six children

and Eng five, all healthy and strong. In 1869 they made another trip to

Europe, ostensibly to consult the most celebrated surgeons of Great

Britain and France on the advisability of being separated. It was

stated that a feeling of antagonistic hatred after a quarrel prompted

them to seek "surgical separation," but the real cause was most likely

to replenish their depleted exchequer by renewed exhibition and

advertisement.

A most pathetic characteristic of these illustrious brothers was the

affection and forbearance they showed for each other until shortly

before their death. They bore each other's trials and petty maladies

with the greatest sympathy, and in this manner rendered their lives far

more agreeable than a casual observer would suppose possible. They both

became Christians and members or attendants of the Baptist Church.

Figure 31 is a representation of the Siamese twins in old age. On each

side of them is a son. The original photograph is in the Mutter Museum,

College of Physicians, Philadelphia.

The feasibility of the operation of separating them was discussed by

many of the leading men of America, and Thompson, Fergusson, Syme, Sir

J. Y. Simpson, Nelaton, and many others in Europe, with various reports

and opinions after examination. These opinions can be seen in full in

nearly any large medical library. At this time they had diseased and

atheromatous arteries, and Chang, who was quite intemperate, had marked

spinal curvature, and shortly afterward became hemiplegic. They were

both partially blind in their two anterior eyes, possibly from looking

outward and obliquely. The point of junction was about the

sterno-siphoid angle, a cartilaginous band extending from sternum to

sternum. In 1869 Simpson measured this band and made the distance on

the superior aspect from sternum to sternum 4 1/2 inches, though it is

most likely that during the early period of exhibition it was not over

3 inches. The illustration shows very well the position of the joining

band.

The twins died on January 17, 1874, and a committee of surgeons from

the College of Physicians of Philadelphia, consisting of Doctors

Andrews, Allen, and Pancoast, went to North Carolina to perform an

autopsy on the body, and, if possible, to secure it. They made a long

and most interesting report on the results of their trip to the

College. The arteries, as was anticipated, were found to have undergone

calcareous degeneration. There was an hepatic connection through the

band, and also some interlacing diaphragmatic fibers therein. There was

slight vascular intercommunication of the livers and independence of

the two peritoneal cavities and the intestines. The band itself was

chiefly a coalescence of the xyphoid cartilages, surrounded by areolar

tissue and skin.

The "Orissa sisters," or Radica-Doddica, shown in Europe in 1893, were

similar to the Siamese twins in conformation. They were born in Orissa,

India, September, 1889, and were the result of the sixth pregnancy, the

other five being normal. They were healthy girls, four years of age,

and apparently perfect in every respect, except that, from the ensiform

cartilage to the umbilicus, they were united by a band 4 inches long

and 2 inches wide. The children when facing each other could draw their

chests three or four inches apart, and the band was so flexible that

they could sit on either side of the body. Up to the date mentioned it

was not known whether the connecting band contained viscera. A portrait

of these twins was shown at the World's Fair in Chicago.

In the village of Arasoor, district of Bhavany, there was reported a

monstrosity in the form of two female children, one 34 inches and the

other 33 3/4 inches high, connected by the sternum. They were said to

have had small-pox and to have recovered. They seemed to have had

individual nervous systems, as when one was pinched the other did not

feel it, and while one slept the other was awake. There must have been

some vascular connection, as medicine given to one affected both.

Fig. 36 shows a mode of cartilaginous junction by which each component

of a double monster may be virtually independent.

Operations on Conjoined Twins.--Swingler speaks of two girls joined at

the xiphoid cartilage and the umbilicus, the band of union being 1 1/2

inches thick, and running below the middle of it was the umbilical

cord, common to both. They first ligated the cord, which fell off in

nine days, and then separated the twins with the bistoury. They each

made early recovery and lived.

In the Ephemerides of 1690 Konig gives a description of two Swiss

sisters born in 1689 and united belly to belly, who were separated by

means of a ligature and the operation afterward completed by an

instrument. The constricting band was formed by a coalition of the

xiphoid cartilages and the umbilical vessels, surrounded by areolar

tissue and covered with skin. Le Beau says that under the Roman reign,

A. D. 945, two male children were brought from Armenia to

Constantinople for exhibition. They were well formed in every respect

and united by their abdomens. After they had been for some time an

object of great curiosity, they were removed by governmental order,

being considered a presage of evil. They returned, however, at the

commencement of the reign of Constantine VII, when one of them took

sick and died. The surgeons undertook to preserve the other by

separating him from the corpse of his brother, but he died on the third

day after the operation.

In 1866 Boehm gives an account of Guzenhausen's case of twins who were

united sternum to sternum. An operation for separation was performed

without accident, but one of the children, already very feeble, died

three days after; the other survived. The last attempt at an operation

like this was in 1881, when Biaudet and Buginon attempted to separate

conjoined sisters (Marie-Adele) born in Switzerland on June 26th.

Unhappily, they were very feeble and life was despaired of when the

operation was performed, on October 29th. Adele died six hours

afterward, and Marie died of peritonitis on the next day.

CLASS III.--Those monsters joined by a fusion of some of the cranial

bones are sometimes called craniopagi. A very ancient observation of

this kind is cited by Geoffroy-Saint-Hilaire. These two girls were

born in 1495, and lived to be ten years old. They were normal in every

respect, except that they were joined at the forehead, causing them to

stand face to face and belly to belly. When one walked forward, the

other was compelled to walk backward; their noses almost touched, and

their eyes were directed laterally. At the death of one an attempt to

separate the other from the cadaver was made, but it was unsuccessful,

the second soon dying; the operation necessitated opening the cranium

and parting the meninges. Bateman said that in 1501 there was living an

instance of double female twins, joined at the forehead. This case was

said to have been caused in the following manner: Two women, one of

whom was pregnant with the twins at the time, were engaged in an

earnest conversation, when a third, coming up behind them, knocked

their heads together with a sharp blow. Bateman describes the death of

one of the twins and its excision from the other, who died

subsequently, evidently of septic infection. There is a possibility

that this is merely a duplication of the account of the preceding case

with a slight anachronism as to the time of death.

At a foundling hospital in St. Petersburg there were born two living

girls, in good health, joined by the heads. They were so united that

the nose of one, if prolonged, would strike the ear of the other; they

had perfectly independent existences, but their vascular systems had

evident connection.

Through extra mobility of their necks they could really lie in a

straight line, one sleeping on the side and the other on the back.

There is a report a of two girls joined at their vertices, who survived

their birth. With the exception of this junction they were well formed

and independent in existence. There was no communication of the cranial

cavities, but simply fusion of the cranial bones covered by superficial

fascia and skin. Daubenton has seen a case of union at the occiput, but

further details are not quoted.

CLASS IV.--The next class to be considered is that in which the

individuals are separate and well formed, except that the point of

fusion is a common part, eliminating their individual components in

this location. The pygopagous twins belong in this section. According

to Bateman, twins were born in 1493 at Rome joined back to back, and

survived their birth. The same authority speaks of a female child who

was born with "2 bellies, 4 arms, 4 legs, 2 heads, and 2 sets of

privates, and was exhibited throughout Italy for gain's sake." The

"Biddenden Maids" were born in Biddenden, Kent, in 1100. Their names

were Mary and Eliza Chulkhurst, and their parents were fairly

well-to-do people. They were supposed to have been united at the hips

and the shoulders, and lived until 1134. At the death of one it was

proposed to separate them, but the remaining sister refused, saying,

"As we came together, we will also go together," and, after about six

hours of this Mezentian existence, they died. They bequeathed to the

church-wardens of the parish and their successors land to the extent of

20 acres, at the present time bringing a rental of about $155.00

annually, with the instructions that the money was to be spent in the

distribution of cakes (bearing the impression of their images, to be

given away on each Easter Sunday to all strangers in Biddenden) and

also 270 quartern loaves, with cheese in proportion, to all the poor in

said parish. Ballantyne has accompanied his description of these

sisters by illustrations, one of which shows the cake. Heaton gives a

very good description of these maids; and a writer in "Notes and

Queries" of March 27, 1875, gives the following information relative to

the bequest:--

"On Easter Monday, at Biddenden, near Staplehurst, Kent, there is a

distribution, according to ancient custom, of 'Biddenden Maids' cakes,'

with bread and cheese, the cost of which is defrayed from the proceeds

of some 20 acres of land, now yielding L35 per annum. and known as the

'Bread and Cheese Lands.' About the year 1100 there lived Eliza and

Mary Chulkhurst, who were joined together after the manner of the

Siamese twins, and who lived for thirty-four years, one dying, and then

being followed by her sister within six hours. They left by their will

the lands above alluded to and their memory is perpetuated by

imprinting on the cakes their effigies 'in their habit as they lived.'

The cakes, which are simple flour and water, are four inches long by

two inches wide, and are much sought after as curiosities. These, which

are given away, are distributed at the discretion of the

church-wardens, and are nearly 300 in number. The bread and cheese

amounts to 540 quartern loaves and 470 pounds of cheese. The

distribution is made on land belonging to the charity, known as the Old

Poorhouse. Formerly it used to take place in the Church, immediately

after the service in the afternoon, but in consequence of the unseemly

disturbance which used to ensue the practice was discontinued. The

Church used to be filled with a congregation whose conduct was

occasionally so reprehensible that sometimes the church-wardens had to

use their wands for other purposes than symbols of office. The

impressions of the maids 'on the cakes are of a primitive character,

and are made by boxwood dies cut in 1814. They bear the date 1100, when

Eliza and Mary Chulkhurst are supposed to have been born, and also

their age at death, thirty-four years."

Ballantyne has summed up about all there is to be said on this national

monstrosity, and his discussion of the case from its historic as well

as teratologic standpoint is so excellent that his conclusions will be

quoted--

"It may be urged that the date fixed for the birth of the Biddenden

Maids is so remote as to throw grave doubt upon the reality of the

occurrence. The year 1100 was, it will be remembered, that in which

William Rufus was found dead in the New Forest, 'with the arrow either

of a hunter or an assassin in his breast.' According to the Anglo-Saxon

Chronicle, several 'prodigies' preceded the death of this profligate

and extravagant monarch. Thus it is recorded that 'at Pentecost blood

was observed gushing from the earth at a certain town of Berkshire,

even as many asserted who declared that they had seen it. And after

this, on the morning after Lammas Day, King William was shot.' Now, it

is just possible that the birth of the Biddenden Maids may have

occurred later, but have been antedated by the popular tradition to the

year above mentioned. For such a birth would, in the opinion of the

times, be regarded undoubtedly as a most evident prodigy or omen of

evil. Still, even admitting that the date 1100 must be allowed to

stand, its remoteness from the present time is not a convincing

argument against a belief in the real occurrence of the phenomenon; for

of the dicephalic Scottish brothers, who lived in 1490, we have

credible historic evidence. Further, Lycosthenes, in his "Chronicon

Prodigiorum atque Ostentorum", published in 1557, states, upon what

authority I know not, that in the year 1112 joined twins resembling the

Biddenden phenomenon in all points save in sex were born in England.

The passage is as follows: 'In Anglia natus est puer geminus a clune ad

superiores partes ita divisus, ut duo haberet capita, duo corpora

integra ad renes cum suis brachiis, qui baptizatus triduo supervixit.'

It is just possible that in some way or other this case has been

confounded with the story of Biddenden; at any rate, the occurrence of

such a statement in Lycosthenes' work is of more than passing interest.

Had there been no bequest of land in connection with the case of the

Kentish Maids, the whole affair would probably soon have been forgotten.

"There is, however, one real difficulty in accepting the story handed

down to us as authentic,--the nature of the teratologic phenomenon

itself. All the records agree in stating that the Maids were joined

together at the shoulders and hips, and the impression on the cakes and

the pictures on the 'broadsides' show this peculiar mode of union, and

represent the bodies as quite separate in the space between the

above-named points. The Maids are shown with four feet and two arms,

the right and left respectively, whilst the other arms (left and right)

are fused together at the shoulder according to one illustration, and a

little above the elbow according to another. Now, although it is not

safe to say that such an anomaly is impossible, I do not know of any

case of this peculiar mode of union; but it may be that, as Prof. A. R.

Simpson has suggested, the Maids had four separate arms, and were in

the habit of going about with their contiguous arms round each other's

necks, and that this gave rise to the notion that these limbs were

united. If this be so, then the teratologic difficulty is removed, for

the case becomes perfectly comparable with the well-known but rare type

of double terata known as the pygopagous twins, which is placed by

Taruffi with that of the ischiopagous twins in the group dicephalus

lecanopagus. Similar instances, which are well known to students of

teratology, are the Hungarian sisters (Helen and Judith), the North

Carolina twins (Millie and Christine), and the Bohemian twins (Rosalie

and Josepha Blazek). The interspace between the thoraces may, however,

have simply been the addition of the first artist who portrayed the

Maids (from imagination?); then it may be surmised that they were

ectopagous twins.

"Pygopagous twins are fetuses united together in the region of the

nates and having each its own pelvis. In the recorded cases the union

has been usually between the sacra and coccyges, and has been either

osseous or (more rarely) ligamentous. Sometimes the point of junction

was the middle line posteriorly, at other times it was rather a

posterolateral union; and it is probable that in the Biddenden Maids it

was of the latter kind; and it is likely, from the proposal made to

separate the sisters after the death of one, that it was ligamentous in

nature.

"If it be granted that the Biddenden Maids were pygopagous twins, a

study of the histories of other recorded cases of this monstrosity

serves to demonstrate many common characters. Thus, of the 8 cases

which Taruffi has collected, in 7 the twins were female; and if to

these we add the sisters Rosalie and Josepha Blazek and the Maids, we

have 10 cases, of which 9 were girls. Again, several of the pygopagous

twins, of whom there are scientific records, survived birth and lived

for a number of years, and thus resembled the Biddenden terata. Helen

and Judith, for instance, were twenty-three years old at death; and the

North Carolina twins, although born in 1851, are still alive. There is,

therefore, nothing inherently improbable in the statement that the

Biddenden Maids lived for thirty-four years. With regard also to the

truth of the record that the one Maid survived her sister for six

hours, there is confirmatory evidence from scientifically observed

instances, for Joly and Peyrat (Bull. de l'Acad. Med., iii., pp. 51 and

383, 1874) state that in the case seen by them the one infant lived ten

hours after the death of the other. It is impossible to make any

statement with regard to the internal structure of the Maids or to the

characters of their genital organs, for there is absolutely no

information forthcoming upon these points. It may simply be said, in

conclusion, that the phenomenon of Biddenden is interesting not only on

account of the curious bequest which arose out of it, but also because

it was an instance of a very rare teratologic type, occurring at a very

early period in our national history."

Possibly the most famous example of twins of this type were Helen and

Judith, the Hungarian sisters, born in 1701 at Szony, in Hungary. They

were the objects of great curiosity, and were shown successively in

Holland, Germany, Italy, France, England, and Poland. At the age of

nine they were placed in a convent, where they died almost

simultaneously in their twenty-second year. During their travels all

over Europe they were examined by many prominent physiologists,

psychologists, and naturalists; Pope and several minor poets have

celebrated their existence in verse; Buffon speaks of them in his

"Natural History," and all the works on teratology for a century or

more have mentioned them. A description of them can be best given by a

quaint translation by Fisher of the Latin lines composed by a Hungarian

physician and inscribed on a bronze statuette of them:--

Two sisters wonderful to behold, who have thus grown as one, That

naught their bodies can divide, no power beneath the sun. The town of

Szoenii gave them birth, hard by far-famed Komorn, Which noble fort may

all the arts of Turkish sultans scorn. Lucina, woman's gentle friend,

did Helen first receive; And Judith, when three hours had passed, her

mother's womb did leave. One urine passage serves for both;--one anus,

so they tell; The other parts their numbers keep, and serve their

owners well. Their parents poor did send them forth, the world to

travel through, That this great wonder of the age should not be hid

from view. The inner parts concealed do lie hid from our eyes, alas!

But all the body here you view erect in solid brass.

They were joined back to back in the lumbar region, and had all their

parts separate except the anus between the right thigh of Helen and the

left of Judith and a single vulva. Helen was the larger, better

looking, the more active, and the more intelligent. Judith at the age

of six became hemiplegic, and afterward was rather delicate and

depressed. They menstruated at sixteen and continued with regularity,

although one began before the other. They had a mutual affection, and

did all in their power to alleviate the circumstances of their sad

position. Judith died of cerebral and pulmonary affections, and Helen,

who previously enjoyed good health, soon after her sister's first

indisposition suddenly sank into a state of collapse, although

preserving her mental faculties, and expired almost immediately after

her sister. They had measles and small-pox simultaneously, but were

affected in different degree by the maladies. The emotions,

inclinations, and appetites were not simultaneous. Eccardus, in a very

interesting paper, discusses the physical, moral, and religious

questions in reference to these wonderful sisters, such as the

advisability of separation, the admissibility of matrimony, and,

finally, whether on the last day they would rise as joined in life, or

separated.

There is an account of two united females, similar in conjunction to

the "Hungarian sisters," who were born in Italy in 1700. They were

killed at the age of four months by an attempt of a surgeon to separate

them.

In 1856 there was reported to have been born in Texas, twins after the

manner of Helen and Judith, united back to back, who lived and attained

some age. They were said to have been of different natures and

dispositions, and inclined to quarrel very often.

Pancoast gives an extensive report of Millie-Christine, who had been

extensively exhibited in Europe and the United States. They were born

of slave parents in Columbus County, N.C., July 11, 1851; the mother,

who had borne 8 children before, was a stout negress of thirty-two,

with a large pelvis. The presentation was first by the stomach and

afterward by the breech. These twins were united at the sacra by a

cartilaginous or possibly osseous union. They were exhibited in Paris

in 1873, and provoked as much discussion there as in the United States.

Physically, Millie was the weaker, but had the stronger will and the

dominating spirit. They menstruated regularly from the age of

thirteen. One from long habit yielded instinctively to the other's

movements, thus preserving the necessary harmony. They ate separately,

had distinct thoughts, and carried on distinct conversations at the

same time. They experienced hunger and thirst generally simultaneously,

and defecated and urinated nearly at the same times. One, in tranquil

sleep, would be wakened by a call of nature of the other. Common

sensibility was experienced near the location of union. They were

intelligent and agreeable and of pleasant appearance, although slightly

under size; they sang duets with pleasant voices and accompanied

themselves with a guitar; they walked, ran, and danced with apparent

ease and grace. Christine could bend over and lift Millie up by the

bond of union.

A recent example of the pygopagus type was Rosa-Josepha Blazek, born in

Skerychov, in Bohemia, January 20, 1878. These twins had a broad bony

union in the lower part of the lumbar region, the pelvis being

obviously completely fused. They had a common urethral and anal

aperture, but a double vaginal orifice, with a very apparent septum.

The sensation was distinct in each, except where the pelves joined.

They were exhibited in Paris in 1891, being then on an exhibition tour

around the world. Rosa was the stronger, and when she walked or ran

forward she drew her sister with her, who must naturally have reversed

her steps. They had independent thoughts and separate minds; one could

sleep while the other was awake. Many of their appetites were

different, one preferring beer, the other wine; one relished salad, the

other detested it, etc. Thirst and hunger were not simultaneous.

Baudoin describes their anatomic construction, their mode of life, and

their mannerisms and tastes in a quite recent article. Fig. 42 is a

reproduction of an early photograph of the twins, and Fig. 43

represents a recent photograph of these "Bohemian twins," as they are

now called.

The latest record we have of this type of monstrosity is that given by

Tynberg to the County Medical Society of New York, May 27, 1895. The

mother was present with the remarkable twins in her arms, crying at the

top of their voices. These two children were born at midnight on April

15th. Tynberg remarked that he believed them to be distinct and

separate children, and not dependent on a common arterial system; he

also expressed his intention of separating them, but did not believe

the operation could be performed with safety before another year.

Jacobi describes in full Tynberg's instance of pygopagus. He says the

confinement was easy; the head of one was born first, soon followed by

the feet and the rest of the twins. The placenta was single and the

cord consisted of two branches. The twins were united below the third

sacral vertebrae in such a manner that they could lie alongside of each

other. They were females, and had two vaginae, two urethrae four labia

minora, and two labia majora, one anus, but a double rectum divided by

a septum. They micturated independently but defecated simultaneously.

They virtually lived separate lives, as one might be asleep while the

other cried, etc.

CLASS V.--While instances of ischiopagi are quite numerous, few have

attained any age, and, necessarily, little notoriety. Pare speaks of

twins united at the pelves, who were born in Paris July 20, 1570. They

were baptized, and named Louis and Louise. Their parents were well

known in the rue des Gravelliers. According to Bateman, and also Rueff,

in the year 1552 there were born, not far from Oxford, female twins,

who, from the description given, were doubtless of the ischiopagus

type. They seldom wept, and one was of a cheerful disposition, while

the other was heavy and drowsy, sleeping continually. They only lived a

short time, one expiring a day before the other. Licetus speaks of Mrs.

John Waterman, a resident of Fishertown, near Salisbury, England, who

gave birth to a double female monster on October 26, 1664, which

evidently from the description was joined by the ischii. It did not

nurse, but took food by both the mouths; all its actions were done in

concert; it was possessed of one set of genitourinary organs; it only

lived a short while. Many people in the region flocked to see the

wonderful child, whom Licetus called "Monstrum Anglicum." It is said

that at the same accouchement the birth of this monster was followed by

the birth of a well-formed female child, who survived.

Geoffroy-Saint-Hilaire quotes a description of twins who were born in

France on October 7, 1838, symmetrically formed and united at their

ischii. One was christened Marie-Louise, and the other

Hortense-Honorine. Their avaricious parents took the children to Paris

for exhibition, the exposures of which soon sacrificed their lives. In

the year 1841 there was born in the island of Ceylon, of native

parents, a monstrous child that was soon brought to Columbo, where it

lived only two months. It had two heads and seemed to have duplication

in all its parts except the anus and male generative organs.

Montgomery speaks of a double child born in County Roscommon, Ireland,

on the 24th of July, 1827. It had two heads, two chests with arms

complete, two abdominal and pelvic cavities united end to end, and four

legs, placed two on either side. It had only one anus, which was

situated between the thighs. One of the twins was dark haired and was

baptized Mary, while the other was a blonde and was named Catherine.

These twins felt and acted independently of each other; they each in

succession sucked from the breast or took milk from the spoon, and used

their limbs vigorously. One vomited without affecting the other, but

the feces were discharged through a common opening.

Goodell speaks of Minna and Minnie Finley, who were born in Ohio and

examined by him. They were fused together in a common longitudinal

axis, having one pelvis, two heads, four legs, and four arms. One was

weak and puny and the other robust and active; it is probable that they

had but one rectum and one bladder. Goodell accompanies his

description by the mention of several analogous cases. Ellis speaks of

female twins, born in Millville, Tenn., and exhibited in New York in

1868, who were joined at the pelves in a longitudinal axis. Between the

limbs on either side were to be seen well-developed female genitals,

and the sisters had been known to urinate from both sides, beginning

and ending at the same time.

Huff details a description of the "Jones twins," born on June 24, 1889,

in Tipton County, Indiana, whose spinal columns were in apposition at

the lower end. The labor, of less than two hours' duration, was

completed before the arrival of the physician. Lying on their mother's

back, they could both nurse at the same time. Both sets of genitals and

ani were on the same side of the line of union, but occupied normal

positions with reference to the legs on either side. Their weight at

birth was 12 pounds and their length 22 inches. Their mother was a

medium-sized brunette of 19, and had one previous child then living at

the age of two; their father was a finely formed man 5 feet 10 inches

in height. The twins differed in complexion and color of the eyes and

hair. They were publicly exhibited for some time, and died February 19

and 20, 1891, at St. John's Hotel, Buffalo, N.Y. Figure 45 shows their

appearance several months after birth.

CLASS VI.--In our sixth class, the first record we have is from the

Commentaries of Sigbert, which contains a description of a monstrosity

born in the reign of the Emperor Theodosius, who had two heads, two

chests with four arms attached, but a single lower extremity. The

emotions, affections, and appetites were different. One head might be

crying while the other laughed, or one feeding while the other was

sleeping. At times they quarreled and occasionally came to blows. This

monster is said to have lived two years, one part dying four days

before the other, which evinced symptoms of decay like its inseparable

neighbor.

Roger of Wendover says that in Lesser Brittany and Normandy, in 1062,

there was seen a female monster, consisting of two women joined about

the umbilicus and fused into a single lower extremity. They took their

food by two mouths but expelled it at a single orifice. At one time,

one of the women laughed, feasted, and talked, while the other wept,

fasted, and kept a religious silence. The account relates how one of

them died, and the survivor bore her dead sister about for three years

before she was overcome by the oppression and stench of the cadaver.

Batemen describes the birth of a boy in 1529, who had two heads, four

ears, four arms, but only two thighs and two legs. Buchanan speaks at

length of the famous "Scottish Brothers," who were the cynosure of the

eyes of the Court of James III of Scotland. This monster consisted of

two men, ordinary in appearance in the superior extremities, whose

trunks fused into a single lower extremity. The King took diligent care

of their education, and they became proficient in music, languages, and

other court accomplishments. Between them they would carry on animated

conversations, sometimes merging into curious debates, followed by

blows. Above the point of union they had no synchronous sensations,

while below, sensation was common to both. This monster lived

twenty-eight years, surviving the royal patron, who died June, 1488.

One of the brothers died some days before the other, and the survivor,

after carrying about his dead brother, succumbed to "infection from

putrescence." There was reported to have been born in Switzerland a

double headed male monster, who in 1538, at the age of thirty, was

possessed of a beard on each face, the two bodies fused at the

umbilicus into a single lower extremity. These two twins resembled one

another in contour and countenance. They were so joined that at rest

they looked upon one another. They had a single wife, with whom they

were said to have lived in harmony. In the Gentleman's Magazine about

one hundred and fifty years since there was given the portrait and

description of a double woman, who was exhibited all over the large

cities of Europe. Little can be ascertained anatomically of her

construction, with the exception that it was stated that she had two

heads, two necks, four arms, two legs, one pelvis, and one set of

pelvic organs.

The most celebrated monster of this type was Ritta-Christina, who was

born in Sassari, in Sardinia, March 23, 1829. These twins were the

result of the ninth confinement of their mother, a woman of thirty-two.

Their superior extremities were double, but they joined in a common

trunk at a point a little below the mammae. Below this point they had

a common trunk and single lower extremities. The right one, christened

Ritta, was feeble and of a sad and melancholy countenance; the left,

Christina, was vigorous and of a gay and happy aspect. They suckled at

different times, and sensations in the upper extremities were distinct.

They expelled urine and feces simultaneously, and had the indications

in common. Their parents, who were very poor, brought them to Paris for

the purpose of public exhibition, which at first was accomplished

clandestinely, but finally interdicted by the public authorities, who

feared that it would open a door for psychologic discussion and

speculation. This failure of the parents to secure public patronage

increased their poverty and hastened the death of the children by

unavoidable exposure in a cold room. The nervous system of the twins

had little in common except in the line of union, the anus, and the

sexual organs, and Christina was in good health all through Ritta's

sickness; when Ritta died, her sister, who was suckling at the mother's

breast, suddenly relaxed hold and expired with a sigh. At the

postmortem, which was secured with some difficulty on account of the

authorities ordering the bodies to be burned, the pericardium was found

single, covering both hearts. The digestive organs were double and

separate as far as the lower third of the ilium, and the cecum was on

the left side and single, in common with the lower bowel. The livers

were fused and the uterus was double. The vertebral columns, which were

entirely separate above, were joined below by a rudimentary os

innorminatum. There was a junction between the manubrium of each. Sir

Astley Cooper saw a monster in Paris in 1792 which, by his description,

must have been very similar to Ritta-Christina.

The Tocci brothers were born in 1877 in the province of Turin, Italy.

They each had a well-formed head, perfect arms, and a perfect thorax to

the sixth rib; they had a common abdomen, a single anus, two legs, two

sacra, two vertebral columns, one penis, but three buttocks, the

central one containing a rudimentary anus. The right boy was christened

Giovanni-Batista, and the left Giacomo. Each individual had power over

the corresponding leg on his side, but not over the other one. Walking

was therefore impossible. All their sensations and emotions were

distinctly individual and independent. At the time of the report, in

1882, they were in good health and showed every indication of attaining

adult age. Figure 48 represents these twins as they were exhibited

several years ago in Germany.

McCallum saw two female children in Montreal in 1878 named Marie-Rosa

Drouin. They formed a right angle with their single trunk, which

commenced at the lower part of the thorax of each. They had a single

genital fissure and the external organs of generation of a female. A

little over three inches from the anus was a rudimentary limb with a

movable articulation; it measured five inches in length and tapered to

a fine point, being furnished with a distinct nail, and it contracted

strongly to irritation. Marie, the left child, was of fair complexion

and more strongly developed than Rosa. The sensations of hunger and

thirst were not experienced at the same time, and one might be asleep

while the other was crying. The pulsations and the respiratory

movements were not synchronous. They were the products of the second

gestation of a mother aged twenty-six, whose abdomen was of such

preternatural size during pregnancy that she was ashamed to appear in

public. The order of birth was as follows: one head and body, the lower

extremity, and the second body and head.

CLASS VII.--There are many instances of bicephalic monsters on record.

Pare mentions and gives an illustration of a female apparently single

in conformation, with the exception of having two heads and two necks.

The Ephemerides, Haller, Schenck, and Archenholz cite examples, and

there is an old account of a double-headed child, each of whose heads

were baptized, one called Martha and the other Mary. One was of a gay

and the other a sad visage, and both heads received nourishment; they

only lived a couple of days. There is another similar record of a

Milanese girl who had two heads, but was in all other respects single,

with the exception that after death she was found to have had two

stomachs. Besse mentions a Bavarian woman of twenty-six with two heads,

one of which was comely and the other extremely ugly; Batemen quotes

what is apparently the same case--a woman in Bavaria in 1541 with two

heads, one of which was deformed, who begged from door to door, and who

by reason of the influence of pregnant women was given her expenses to

leave the country.

A more common occurrence of this type is that in which there is fusion

of the two heads. Moreau speaks of a monster in Spain which was shown

from town to town. Its heads were fused; it had two mouths and two

noses; in each face an eye well conformed and placed above the nose;

there was a third eye in the middle of the forehead common to both

heads; the third eye was of primitive development and had two pupils.

Each face was well formed and had its own chin. Buffon mentions a cat,

the exact analogue of Moreau's case. Sutton speaks of a photograph sent

to Sir James Paget in 1856 by William Budd of Bristol. This portrays a

living child with a supernumerary head, which had mouth, nose, eyes,

and a brain of its own. The eyelids were abortive, and as there was no

orbital cavity the eyes stood out in the form of naked globes on the

forehead. When born, the corneas of both heads were transparent, but

then became opaque from exposure. The brain of the supernumerary head

was quite visible from without, and was covered by a membrane beginning

to slough. On the right side of the head was a rudimentary external

ear. The nurse said that when the child sucked some milk regurgitated

through the supernumerary mouth. The great physiologic interest in this

case lies in the fact that every movement and every act of the natural

face was simultaneously repeated by the supernumerary face in a

perfectly consensual manner, i.e., when the natural mouth sucked, the

second mouth sucked; when the natural face cried, yawned, or sneezed,

the second face did likewise; and the eyes of the two heads moved in

unison. The fate of the child is not known.

Home speaks of a child born in Bengal with a most peculiar fusion of

the head. The ordinary head was nearly perfect and of usual volume, but

fused with its vertex and reversed was a supernumerary head. Each head

had its own separate vessels and brain, and each an individual

sensibility, but if one had milk first the other had an abundance of

saliva in its mouth. It narrowly escaped being burned to death at

birth, as the midwife, greatly frightened by the monstrous appearance,

threw it into the fire to destroy it, from whence it was rescued,

although badly burned, the vicious conformation of the accessory head

being possibly due to the accident. At the age of four it was bitten by

a venomous serpent and, as a result, died. Its skull is in the

possession of the Royal College of Surgeons in London.

The following well-known story of Edward Mordake, though taken from lay

sources, is of sufficient notoriety and interest to be mentioned here:--

"One of the weirdest as well as most melancholy stories of human

deformity is that of Edward Mordake, said to have been heir to one of

the noblest peerages in England. He never claimed the title, however,

and committed suicide in his twenty-third year. He lived in complete

seclusion, refusing the visits even of the members of his own family.

He was a young man of fine attainments, a profound scholar, and a

musician of rare ability. His figure was remarkable for its grace, and

his face--that is to say, his natural face--was that of an Antinous.

But upon the back of his head was another face, that of a beautiful

girl, 'lovely as a dream, hideous as a devil.' The female face was a

mere mask, 'occupying only a small portion of the posterior part of the

skull, yet exhibiting every sign of intelligence, of a malignant sort,

however.' It would be seen to smile and sneer while Mordake was

weeping. The eyes would follow the movements of the spectator, and the

lips would 'gibber without ceasing.' No voice was audible, but Mordake

avers that he was kept from his rest at night by the hateful whispers

of his 'devil twin,' as he called it, 'which never sleeps, but talks to

me forever of such things as they only speak of in hell. No imagination

can conceive the dreadful temptations it sets before me. For some

unforgiven wickedness of my forefathers I am knit to this fiend--for a

fiend it surely is. I beg and beseech you to crush it out of human

semblance, even if I die for it.' Such were the words of the hapless

Mordake to Manvers and Treadwell, his physicians. In spite of careful

watching he managed to procure poison, whereof he died, leaving a

letter requesting that the 'demon face' might be destroyed before his

burial, 'lest it continues its dreadful whisperings in my grave.' At

his own request he was interred in a waste place, without stone or

legend to mark his grave."

A most curious case was that of a Fellah woman who was delivered at

Alexandria of a bicephalic monster of apparently eight months'

pregnancy. This creature, which was born dead, had one head white and

the other black the change of color commencing at the neck of the black

head. The bizarre head was of negro conformation and fully developed,

and the colored skin was found to be due to the existence of pigment

similar to that found in the black race. The husband of the woman had a

light brown skin, like an ordinary Fellah man, and it was ascertained

that there were some negro laborers in port during the woman's

pregnancy; but no definite information as to her relations with them

could be established, and whether this was a case of maternal

impression or superfetation can only be a matter of conjecture.

Fantastic monsters, such as acephalon, paracephalon, cyclops,

pseudencephalon, and the janiceps, prosopthoracopagus, disprosopus,

etc., although full of interest, will not be discussed here, as none

are ever viable for any length of time, and the declared intention of

this chapter is to include only those beings who have lived.

CLASS VIII.--The next class includes the parasitic terata, monsters

that consist of one perfect body, complete in every respect, but from

the neighborhood of whose umbilicus depends some important portion of a

second body. Pare, Benivenius, and Columbus describe adults with

acephalous monsters attached to them. Schenck mentions 13 cases, 3 of

which were observed by him. Aldrovandus shows 3 illustrations under

the name of "monstrum bicorpum monocephalon." Bustorf speaks of a case

in which the nates and lower extremities of one body proceeded out of

the abdomen of the other, which was otherwise perfect. Reichel and

Anderson mention a living parasitic monster, the inferior trunk of one

body proceeding from the pectoral region of the other.

Pare says that there was a man in Paris in 1530, quite forty years of

age, who carried about a parasite without a head, which hung pendant

from his belly. This individual was exhibited and drew great crowds.

Pare appends an illustration, which is, perhaps, one of the most

familiar in all teratology. He also gives a portrait of a man who had a

parasitic head proceeding from his epigastrium, and who was born in

Germany the same year that peace was made with the Swiss by King

Francis. This creature lived to manhood and both heads were utilized in

alimentation. Bartholinus details a history of an individual named

Lazarus-Joannes Baptista Colloredo, born in Genoa in 1617, who

exhibited himself all over Europe. From his epigastrium hung an

imperfectly developed twin that had one thigh, hands, body, arms, and a

well-formed head covered with hair, which in the normal position hung

lowest. There were signs of independent existence in the parasite,

movements of respiration, etc., but its eyes were closed, and, although

saliva constantly dribbled from its open mouth, nothing was ever

ingested. The genitals were imperfect and the arms ended in badly

formed hands. Bartholinus examined this monster at twenty-two, and has

given the best report, although while in Scotland in 1642 he was again

examined, and accredited with being married and the father of several

children who were fully and admirably developed. Moreau quotes a case

of an infant similar in conformation to the foregoing monster, who was

born in Switzerland in 1764, and whose supernumerary parts were

amputated by means of a ligature. Winslow reported before the Academie

Royale des Sciences the history of a girl of twelve who died at the

Hotel-Dieu in 1733. She was of ordinary height and of fair

conformation, with the exception that hanging from the left flank was

the inferior half of another girl of diminutive proportions. The

supernumerary body was immovable, and hung so heavily that it was said

to be supported by the hands or by a sling. Urine and feces were

evacuated at intervals from the parasite, and received into a diaper

constantly worn for this purpose. Sensibility in the two was common, an

impression applied to the parasite being felt by the girl. Winslow

gives an interesting report of the dissection of this monster, and

mentions that he had seen an Italian child of eight who had a small

head proceeding from under the cartilage of the third left rib.

Sensibility was common, pinching the ear of the parasitic head causing

the child with the perfect head to cry. Each of the two heads received

baptism, one being named John and the other Matthew. A curious question

arose in the instance of the girl, as to whether the extreme unction

should be administered to the acephalous fetus as well as to the child.

In 1742, during the Ambassadorship of the Marquis de l'Hopital at

Naples, he saw in that city an aged man, well conformed, with the

exception that, like the little girl of Winslow, he had the inferior

extremities of a male child growing from his epigastric region. Haller

and Meckel have also observed cases like this. Bordat described before

the Royal Institute of France, August, 1826, a Chinaman, twenty-one

years of age, who had an acephalous fetus attached to the surface of

his breast (possibly "A-ke").

Dickinson describes a wonderful child five years old, who, by an

extraordinary freak of nature, was an amalgamation of two children.

From the body of an otherwise perfectly formed child was a

supernumerary head protruding from a broad base attached to the lower

lumbar and sacral region. This cephalic mass was covered with hair

about four or five inches long, and showed the rudiments of an eye,

nose, mouth, and chin. This child was on exhibition when Dickinson saw

it. Montare and Reyes were commissioned by the Academy of Medicine of

Havana to examine and report on a monstrous girl of seven months,

living in Cuba. The girl was healthy and well developed, and from the

middle line of her body between the xiphoid cartilage and the

umbilicus, attached by a soft pedicle, was an accessory individual,

irregular, of ovoid shape, the smaller end, representing the head,

being upward. The parasite measured a little over 1 foot in length, 9

inches about the head, and 7 3/4 inches around the neck. The cranial

bones were distinctly felt, and the top of the head was covered by a

circlet of hair. There were two rudimentary eyebrows; the left eye was

represented by a minute perforation encircled with hair; the right eye

was traced by one end of a mucous groove which ran down to another

transverse groove representing the mouth; the right third of this

latter groove showed a primitive tongue and a triangular tooth, which

appeared at the fifth month. There was a soft, imperforate nose, and

the elements of the vertebral column could be distinguished beneath the

skin; there were no legs; apparently no vascular sounds; there was

separate sensation, as the parasite could be pinched without attracting

the perfect infant's notice. The mouth of the parasite constantly

dribbled saliva, but showed no indication of receiving aliment.

Louise L., known as "La dame a quatre jambes," was born in 1869, and

had attached to her pelvis another rudimentary pelvis and two atrophied

legs of a parasite, weighing 8 kilos. The attachment was effected by

means of a pedicle 33 cm. in diameter, having a bony basis, and being

fixed without a joint. The attachment almost obliterated the vulva and

the perineum was displaced far backward. At the insertion of the

parasite were two rudimentary mammae, one larger than the other. No

genitalia were seen on the parasite and it exhibited no active

movements, the joints of both limbs being ankylosed. The woman could

localize sensations in the parasite except those of the feet. She had

been married five years, and bore, in the space of three years, two

well-formed daughters.

Quite recently there was exhibited in the museums of the United States

an individual bearing the name "Laloo," who was born in Oudh, India,

and was the second of four children. At the time of examination he was

about nineteen years of age. The upper portion of a parasite was firmly

attached to the lower right side of the sternum of the individual by a

bony pedicle, and lower by a fleshy pedicle, and apparently contained

intestines. The anus of the parasite was imperforate; a well-developed

penis was found, but no testicles; there was a luxuriant growth of hair

on the pubes. The penis of the parasite was said to show signs of

erection at times, and urine passed through it without the knowledge of

the boy. Perspiration and elevation of temperature seemed to occur

simultaneously in both. To pander to the morbid curiosity of the

curious, the "Dime Museum" managers at one time shrewdly clothed the

parasite in female attire, calling the two brother and sister; but

there is no doubt that all the traces of sex were of the male type. An

analogous case was that of "A-Ke," a Chinaman, who was exhibited in

London early in the century, and of whom and his parasite anatomic

models are seen in our museums. Figure 58 represents an epignathus, a

peculiar type parasitic monster, in which the parasite is united to the

inferior maxillary bone of the autosite.

CLASS IX.--Of "Lusus naturae" none is more curious than that of

duplication of the lower extremities. Pare says that on January 9,

1529, there was living in Germany a male infant having four legs and

four arms. In Paris, at the Academie des Sciences, on September 6,

1830, there was presented by Madame Hen, a midwife, a living male child

with four legs, the anus being nearly below the middle of the third

buttock; and the scrotum between the two left thighs, the testicles not

yet descended. There was a well-formed and single pelvis, and the

supernumerary legs were immovable. Aldrovandus mentions several similar

instances, and gives the figure of one born in Rome; he also describes

several quadruped birds. Bardsley speaks of a male child with one head,

four arms, four legs, and double generative organs. He gives a portrait

of the child when it was a little over a year old. Heschl published in

Vienna in 1878 a description of a girl of seventeen, who instead of

having a duplication of the superior body, as in "Millie-Christine, the

two-headed nightingale," had double parts below the second lumbar

vertebra. Her head and upper body resembled a comely, delicate girl of

twelve.

Wells a describes Mrs. B., aged twenty, still alive and healthy. The

duplication in this case begins just above the waist, the spinal column

dividing at the third lumbar vertebra, below this point everything

being double. Micturition and defecation occur at different times, but

menstruation occurs simultaneously. She was married at nineteen, and

became pregnant a year later on the left side, but abortion was induced

at the fourth month on account of persistent nausea and the expectation

of impossible delivery. Whaley, in speaking of this case, said Mrs. B.

utilized her outside legs for walking; he also remarks that when he

informed her that she was pregnant on the left side she replied, "I

think you are mistaken; if it had been on my right side I would come

nearer believing it;"--and after further questioning he found, from the

patient's observation, that her right genitals were almost invariably

used for coitus. Bechlinger of Para, Brazil, describes a woman of

twenty-five, a native of Martinique, whose father was French and mother

a quadroon, who had a modified duplication of the lower body. There was

a third leg attached to a continuation of the processus coceygeus of

the sacrum, and in addition to well developed mammae regularly

situated, there were two rudimentary ones close together above the

pubes. There were two vaginae and two well-developed vulvae, both

having equally developed sensations. The sexual appetite was markedly

developed, and coitus was practised in both vaginae. A somewhat similar

case, possibly the same, is that of Blanche Dumas, born in 1860. She

had a very broad pelvis, two imperfectly developed legs, and a

supernumerary limb attached to the symphysis, without a joint, but with

slight passive movement. There was a duplication of bowel, bladder, and

genitalia. At the junction of the rudimentary limb with the body, in

front, were two rudimentary mammary glands, each containing a nipple.

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

CLASS X.--The instances of diphallic terata, by their intense interest

to the natural bent of the curious mind, have always elicited much

discussion. To many of these cases have been attributed exaggerated

function, notwithstanding the fact that modern observation almost

invariably shows that the virile power diminishes in exact proportion

to the extent of duplication. Taylor quotes a description of a

monster, exhibited in London, with two distinct penises, but with only

one distinct testicle on either side. He could exercise the function of

either organ.

Schenck, Schurig, Bartholinus, Loder, and Ollsner report instances of

diphallic terata; the latter case a was in a soldier of Charles VI,

twenty-two years old, who applied to the surgeon for a bubonic

affection, and who declared that he passed urine from the orifice of

the left glans and also said that he was incapable of true coitus.

Valentini mentions an instance in a boy of four, in which the two

penises were superimposed. Bucchettoni speaks of a man with two penises

placed side by side. There was an anonymous case described of a man of

ninety-three with a penis which was for more than half its length

divided into two distinct members, the right being somewhat larger than

the left. From the middle of the penis up to the symphysis only the

lower wall of the urethra was split. Jenisch describes a diphallic

infant, the offspring of a woman of twenty-five who had been married

five years. Her first child was a well-formed female, and the second,

the infant in question, cried much during the night, and several times

vomited dark-green matter. In lieu of one penis there were two,

situated near each other, the right one of natural size and the left

larger, but not furnished with a prepuce. Each penis had its own

urethra, from which dribbled urine and some meconium. There was a

duplication of each scrotum, but only one testicle in each, and several

other minor malformations.

Gore, reported by Velpeau, has seen an infant of eight and one-half

months with two penises and three lower extremities. The penises were 4

cm. apart and the scrotum divided, containing one testicle in each

side. Each penis was provided with a urethra, urine being discharged

from both simultaneously. In a similar case, spoken of by

Geoffroy-Saint-Hilaire, the two organs were also separate, but urine

and semen escaped sometimes from one, sometimes from both.

The most celebrated of all the diphallic terata was Jean Baptista dos

Santos, who when but six months old was spoken of by Acton. His father

and mother were healthy and had two well-formed children. He was easily

born after an uneventful pregnancy. He was good-looking, well

proportioned, and had two distinct penises, each as large as that of a

child of six months. Urination proceeded simultaneously from both

penises; he had also two scrotums. Behind and between the legs there

was another limb, or rather two, united throughout their length. It was

connected to the pubis by a short stem 1/2 inch long and as large as

the little finger, consisting of separate bones and cartilages. There

was a patella in the supernumerary limb on the anal aspect, and a joint

freely movable. This compound limb had no power of motion, but was

endowed with sensibility. A journal in London, after quoting Acton's

description, said that the child had been exhibited in Paris, and that

the surgeons advised operation. Fisher, to whom we are indebted for an

exhaustive work in Teratology, received a report from Havana in July,

1865, which detailed a description of Santos at twenty-two years of

age, and said that he was possessed of extraordinary animal passion,

the sight of a female alone being sufficient to excite him. He was said

to use both penises, after finishing with one continuing with the

other; but this account of him does not agree with later descriptions,

in which no excessive sexual ability had been noticed. Hart describes

the adult Santos in full, and accompanies his article with an

illustration. At this time he was said to have developed double

genitals, and possibly a double bladder communicating by an imperfect

septum. At adulthood the anus was three inches anterior to the os

coceygeus. In the sitting or lying posture the supernumerary limb

rested on the front of the inner surface of the lower third of his left

thigh. He was in the habit of wearing this limb in a sling, or bound

firmly to the right thigh, to prevent its unseemly dangling when erect.

The perineum proper was absent, the entire space between the anus and

the posterior edge of the scrotum being occupied by the pedicle.

Santos' mental and physical functions were developed above normal, and

he impressed everybody with his accomplishments.

Geoffroy-Saint-Hilaire records an instance in which the conformation

was similar to that of Santos. There was a third lower extremity

consisting of two limbs fused into one with a single foot containing

ten distinct digits. He calls the case one of arrested twin development.

Van Buren and Keyes describe a case in a man of forty-two, of good,

healthy appearance. The two distinct penises of normal size were

apparently well formed and were placed side by side, each attached at

its root to the symphysis. Their covering of skin was common as far as

the base of the glans; at this point they seemed distinct and perfect,

but the meatus of the left was imperforate. The right meatus was

normal, and through it most of the urine passed, though some always

dribbled through an opening in the perineum at a point where the root

of the scrotum should have been. On lifting the double-barreled penis

this opening could be seen and was of sufficient size to admit the

finger. On the right side of the aperture was an elongated and rounded

prominence similar in outline to a labium majus. This prominence

contained a testicle normal in shape and sensibility, but slightly

undersized, and surrounded, as was evident from its mobility, by a

tunica vaginalis. The left testicle lay on the tendon of the adductor

longus in the left groin; it was not fully developed, but the patient

had sexual desires, erections, and emissions. Both penises became

erect simultaneously, the right more vigorously. The left leg was

shorter than the right and congenitally smaller; the mammae were of

normal dimensions.

Sangalli speaks of a man of thirty-five who had a supernumerary penis,

furnished with a prepuce and capable of erection. At the apex of the

glans opened a canal about 12 cm. long, through which escaped monthly a

serous fluid. Smith mentions a man who had two penises and two

bladders, on one of which lithotomy was performed. According to

Ballantyne, Taruffi, the scholarly observer of terata, mentions a child

of forty-two months and height of 80 cm. who had two penises, each

furnished with a urethra and well-formed scrotal sacs which were

inserted in a fold of the groin. There were two testicles felt in the

right scrotum and one in the left. Fecal evacuations escaped through

two anal orifices. There is also another case mentioned similar to the

foregoing in a man of forty; but here there was an osseous projection

in the middle line behind the bladder. This patient said that erection

was simultaneous in both penises, and that he had not married because

of his chagrin over his deformity. Cole speaks of a child with two

well-developed male organs, one to the left and the other to the right

of the median line, and about 1/4 or 1/2 inch apart at birth. The

urethra bifurcated in the perineal region and sent a branch to each

penis, and urine passed from each meatus. The scrotum was divided into

three compartments by two raphes, and each compartment contained a

testicle. The anus at birth was imperforate, but the child was

successfully operated on, and at its sixtieth day weighed 17 pounds.

Lange says that an infant was brought to Karg for relief of anal

atresia when fourteen days old. It was found to possess duplicate

penises, which communicated each to its distinct half of the bladder as

defined by a median fold. The scrotum was divided into three portions

by two raphes, and each lateral compartment contained a fully formed

testicle. This child died because of its anal malformation, which we

notice is a frequent associate of malformations or duplicity of the

penis. There is an example in an infant described in which there were

two penises, each about 1/2 inch long, and a divided scrotal sac 21

inches long. Englisch speaks of a German of forty who possessed a

double penis of the bifid type.

Ballantyne and his associates define diphallic terata as individuals

provided with two more or less well-formed and more or less separate

penises, who may show also other malformations of the adjoining parts

and organs (e.g., septate bladder), but who are not possessed of more

than two lower limbs. This definition excludes, therefore, the cases in

which in addition to a double penis there is a supernumerary lower

extremity--such a case, for example, as that of Jean Baptista dos

Santos, so frequently described by teratologists. It also excludes the

more evident double terata, and, of course, the cases of duplication of

the female genital organs (double clitoris, vulva, vagina, and uterus).

Although Schurig, Meckel, Himly, Taruffi, and others give bibliographic

lists of diphallic terata, even in them erroneous references are

common, and there is evidence to show that many cases have been

duplicated under different names. Ballantyne and Skirving have

consulted all the older original references available and eliminated

duplications of reports and, adhering to their original definition,

have collected and described individually 20 cases; they offer the

following conclusions:--

1. Diphallus, or duplication of the penis in an otherwise apparently

single individual, is a very rare anomaly, records of only 20 cases

having been found in a fairly exhaustive search through teratologic

literature. As a distinct and well-authenticated type it has only quite

recently been recognized by teratologists.

2. It does not of itself interfere with intrauterine or extrauterine

life; but the associated anomalies (e.g., atresia ani) may be sources

of danger. If not noticed at birth, it is not usually discovered till

adult life, and even then the discovery is commonly accidental.

3. With regard to the functions of the pelvic viscera, urine may be

passed by both penises, by one only, or by neither. In the last

instance it finds exit by an aperture in the perineum. There is reason

to believe that semen may be passed in the same way; but in most of the

recorded cases there has been sterility, if not inability to perform

the sexual act.

4. All the degrees of duplication have been met with, from a fissure of

the glans penis to the presence of two distinct penises inserted at

some distance from each other in the inguinal regions.

5. The two penises are usually somewhat defective as regards prepuce,

urethra, etc.; they may lie side by side, or more rarely may be

situated anteroposteriorly; they may be equal in size, or less commonly

one is distinctly larger than the other; and one or both may be

perforate or imperforate.

6. The scrotum may be normal or split; the testicles, commonly two in

number, may be normal or atrophic, descended or undescended; the

prostate may be normal or imperfectly developed, as may also the vasa

deferentia and vesiculae seminales.

7. The commonly associated defects are: More or less completely septate

bladder, atresia ani, or more rarely double anus, double urethra,

increased breadth of the bony pelvis with defect of the symphysis

pubis, and possibly duplication of the lower end of the spine, and

hernia of some of the abdominal contents into a perineal pouch. Much

more rarely, duplication of the heart, lungs, stomach, and kidneys has

been noted, and the lower limbs may be shorter than normal.

CLASS XI.--Cases of fetus in fetu, those strange instances in which one

might almost say that a man may be pregnant with his brother or sister,

or in which an infant may carry its twin without the fact being

apparent, will next be discussed. The older cases were cited as being

only a repetition of the process by which Eve was born of Adam. Figure

63 represents an old engraving showing the birth of Eve. Bartholinus,

the Ephemerides, Otto, Paullini, Schurig, and Plot speak of instances

of fetus in fetu. Ruysch describes a tumor contained in the abdomen of

a man which was composed of hair, molar teeth, and other evidences of a

fetus. Huxham reported to the Royal Society in 1748 the history of a

child which was born with a tumor near the anus larger than the whole

body of the child; this tumor contained rudiments of an embryo. Young

speaks of a fetus which lay encysted between the laminae of the

transverse mesocolon, and Highmore published a report of a fetus in a

cyst communicating with the duodenum. Dupuytren gives an example in a

boy of thirteen, in whom was found a fetus. Gaetano-Nocito, cited by

Philipeaux, has the history of a taken with a great pain in the right

hypochondrium, and from which issued subsequently fetal bones and a

mass of macerated embryo. His mother had had several double

pregnancies, and from the length of the respective tibiae one of the

fetuses seemed to be of two months' and the other of three months'

intrauterine life. The man died five years after the abscess had burst

spontaneously.

Brodie speaks of a case in which fetal remains were taken from the

abdomen of a girl of two and one-half years. Gaither describes a child

of two years and nine months, supposed to be affected with ascites, who

died three hours after the physician's arrival. In its abdomen was

found a fetus weighing almost two pounds and connected to the child by

a cord resembling an umbilical cord. This child was healthy for about

nine months, and had a precocious longing for ardent spirits, and drank

freely an hour before its death.

Blundell says that he knew "a boy who was literally and without evasion

with child, for the fetus was contained in a sac communicating with the

abdomen and was connected to the side of the cyst by a short umbilical

cord; nor did the fetus make its appearance until the boy was eight or

ten years old, when after much enlargement of pregnancy and subsequent

flooding the boy died." The fetus, removed after death, on the whole

not very imperfectly formed, was of the size of about six or seven

months' gestation. Bury cites an account of a child that had a second

imperfectly developed fetus in its face and scalp. There was a boy by

the name of Bissieu who from the earliest age had a pain in one of his

left ribs; this rib was larger than the rest and seemed to have a tumor

under it. He died of phthisis at fourteen, and after death there was

found in a pocket lying against the transverse colon and communicating

with it all the evidences of a fetus.

At the Hopital de la Charite in Paris, Velpeau startled an audience of

500 students and many physicians by saying that he expected to find a

rudimentary fetus in a scrotal tumor placed in his hands for operation.

His diagnosis proved correct, and brought him resounding praise, and

all wondered as to his reasons for expecting a fetal tumor. It appears

that he had read with care a report by Fatti of an operation on the

scrotum of a child which had increased in size as the child grew, and

was found to contain the ribs, the vertebral column, the lower

extremities as far as the knees, and the two orbits of a fetus; and

also an account of a similar operation performed by Wendt of Breslau on

a Silesian boy of seven. The left testicle in this case was so swollen

that it hung almost to the knee, and the fetal remains removed weighed

seven ounces.

Sulikowski relates an instance of congenital fetation in the umbilicus

of a girl of fourteen, who recovered after the removal of the anomaly.

Aretaeos described to the members of the medical fraternity in Athens

the case of a woman of twenty-two, who bore two children after a seven

months' pregnancy. One was very rudimentary and only 21 inches long,

and the other had an enormous head resembling a case of hydrocephalus.

On opening the head of the second fetus, another, three inches long,

was found in the medulla oblongata, and in the cranial cavity with it

were two additional fetuses, neither of which was perfectly formed.

Broca speaks of a fetal cyst being passed in the urine of a man of

sixty-one; the cyst contained remnants of hair, bone, and cartilage.

Atlee submits quite a remarkable case of congenital ventral gestation,

the subject being a girl of six, who recovered after the discharge of

the fetal mass from the abdomen. McIntyre speaks of a child of eleven,

playing about and feeling well, but whose abdomen progressively

increased in size 1 1/2 inches each day. After ten days there was a

large fluctuating mass on the right side; the abdomen was opened and

the mass enucleated; it was found to contain a fetal mass weighing

nearly five pounds, and in addition ten pounds of fluid were removed.

The child made an early recovery. Rogers mentions a fetus that was

found in a man's bladder. Bouchacourt reports the successful

extirpation of the remains of a fetus from the rectum of a child of

six. Miner describes a successful excision of a congenital gestation.

Modern literature is full of examples, and nearly every one of the

foregoing instances could be paralleled from other sources. Rodriguez

is quoted as reporting that in July, 1891, several newspapers in the

city of Mexico published, under the head of "A Man-mother," a wonderful

story, accompanied by wood-cuts, of a young man from whose body a great

surgeon had extracted a "perfectly developed fetus." One of these

wood-cuts represented a tumor at the back of a man opened and

containing a crying baby. In commenting upon this, after reviewing

several similar cases of endocymian monsters that came under his

observation in Mexico, Rodriguez tells what the case which had been so

grossly exaggerated by the lay journals really was: An Indian boy, aged

twenty-two, presented a tumor in the sacrococcygeal region measuring 53

cm. in circumference at the base, having a vertical diameter of 17 cm.

and a transverse diameter of 13 cm. It had no pedicle and was fixed,

showing unequal consistency. At birth this tumor was about the size of

a pigeon's egg. A diagnosis of dermoid cyst was made and two operations

were performed on the boy, death following the second. The skeleton

showed interesting conditions; the rectum and pelvic organs were

natural, and the contents of the cyst verified the diagnosis.

Quite similar to the cases of fetus in fetu are the instances of

dermoid cysts. For many years they have been a mystery to

physiologists, and their origin now is little more than hypothetic. At

one time the fact of finding such a formation in the ovary of an

unmarried woman was presumptive evidence that she was unchaste; but

this idea was dissipated as soon as examples were reported in children,

and to-day we have a well-defined difference between congenital and

extrauterine pregnancy. Dermoid cysts of the ovary may consist only of

a wall of connective tissue lined with epidermis and containing

distinctly epidermic scales which, however, may be rolled up in firm

masses of a more or less soapy consistency; this variety is called by

Orth epidermoid cyst; or, according to Warren, a form of cyst made up

of skin containing small and ill-defined papillae, but rich in hair

follicles and sebaceous glands. Even the erector pili muscle and the

sudoriparous gland are often found. The hair is partly free and rolled

up into thick balls or is still attached to the walls. A large mass of

sebaceous material is also found in these cysts. Thomson reports a case

of dermoid cyst of the bladder containing hair, which cyst he removed.

It was a pedunculated growth, and it was undoubtedly vesical and not

expelled from some ovarian source through the urinary passage, as

sometimes occurs.

The simpler forms of the ordinary dermoid cysts contain bone and teeth.

The complicated teratoma of this class may contain, in addition to the

previously mentioned structures, cartilage and glands, mucous and

serous membrane, muscle, nerves, and cerebral substance, portions of

eyes, fingers with nails, mammae, etc. Figure 64 represents a cyst

containing long red hair that was removed from a blonde woman aged

forty-four years who had given birth to six children. Cullingworth

reports the history of a woman in whom both ovaries were apparently

involved by dermoids, who had given birth to 12 children and had three

miscarriages--the last, three months before the removal of the growths.

The accompanying illustration, taken from Baldy, pictures a dermoid

cyst of the complicated variety laid open and exposing the contents in

situ. Mears of Philadelphia reports a case of ovarian cyst removed from

a girl of six and a half by Bradford of Kentucky in 1875. From this age

on to adult life many similar cases are recorded. Nearly every medical

museum has preserved specimens of dermoid cysts, and almost all

physicians are well acquainted with their occurrence. The curious

formations and contents and the bizarre shapes are of great variety.

Graves mentions a dermoid cyst containing the left side of a human

face, an eye, a molar tooth, and various bones. Dermoid cysts are found

also in regions of the body quite remote from the ovary. The so-called

"orbital wens" are true inclusion of the skin of a congenital origin,

as are the nasal dermoids and some of the cysts of the neck.

Weil reported the case of a man of twenty-two years who was born with

what was supposed to be a spina bifida in the lower sacral region.

According to Senn, the swelling never caused any pain or inconvenience

until it inflamed, when it opened spontaneously and suppurated,

discharging a large quantity of offensive pus, hair, and sebaceous

material, thus proving it to have been a dermoid. The cyst was freely

incised, and there were found numerous openings of sweat glands, from

which drops of perspiration escaped when the patient was sweating.

Dermoid cysts of the thorax are rare. Bramann reported a case in which

a dermoid cyst of small size was situated over the sternum at the

junction of the manubrium with the gladiolus, and a similar cyst in the

neck near the left cornu of the hyoid bone. Chitten removed a dermoid

from the sternum of a female of thirty-nine, the cyst containing 11

ounces of atheromatous material. In the Museum of St. Bartholomew's

Hospital in London there is a congenital tumor which was removed from

the anterior mediastinum of a woman of twenty one, and contained

portions of skin, fat, sebaceous material, and two pieces of bone

similar to the superior maxilla, and in which several teeth were found.

Dermoids are found in the palate and pharynx, and open dermoids of the

conjunctiva are classified by Sutton with the moles. According to

Senn, Barker collected sixteen dermoid tumors of the tongue. Bryk

successfully removed a tumor of this nature the size of a fist.

Wellington Gray removed an enormous lingual dermoid from the mouth of a

negro. It contained 40 ounces of atheromatous material. Dermoids of the

rectum are reported. Duyse reports the history of a case of labor

during which a rectal dermoid was expelled. The dermoid contained a

cerebral vesicle, a rudimentary eye, a canine and a molar tooth, and a

piece of bone. There is little doubt that many cases of fetus in fetu

reported were really dermoids of the scrotum.

Ward reports the successful removal of a dermoid cyst weighing 30

pounds from a woman of thirty-two, the mother of two children aged ten

and twelve, respectively. The report is briefly as follows: "The

patient has always been in good health until within the last year,

during which time she has lost flesh and strength quite rapidly, and

when brought to my hospital by her physician, Dr. James of

Williamsburg, Kansas, was quite weak, although able to walk about the

house. A tumor had been growing for a number of years, but its growth

was so gradual that the patient had not considered her condition

critical until quite recently. The tumor was diagnosed to be cystoma of

the left ovary. Upon opening the sac with the trocar we were confronted

by complications entirely unlooked for, and its use had to be abandoned

entirely because the thick contents of the cyst would not flow freely,

and the presence of sebaceous matter blocked the instrument. As much of

the fluid as possible was removed, and the abdominal incision was

enlarged to allow of the removal of the large tumor. An ovarian

hematoma the size of a large orange was removed from the right side. We

washed the intestines quite as one would wash linen, since some of the

contents of the cyst had escaped into the abdominal cavity. The abdomen

was closed without drainage, and the patient placed in bed without

experiencing the least shock. Her recovery was rapid and uneventful.

She returned to her home in four weeks after the operation.

"The unusual feature in this case was the nature of the contents of the

sac. There was a large quantity of long straight hair growing from the

cyst wall and an equal amount of loose hair in short pieces floating

through the tumor-contents, a portion of which formed nuclei for what

were called 'moth-balls,' of which there were about 1 1/2 gallons.

These balls, or marbles, varied from the size of moth-balls, as

manufactured and sold by druggists, to that of small walnuts. They

seemed to be composed of sebaceous matter, and were evidently formed

around the short hairs by the motion of the fluid produced by walking

or riding. There was some tissue resembling true skin attached to the

inner wall of the sac."

There are several cases of multiple dermoid cysts on record, and they

may occur all over the body. Jamieson reports a case in which there

were 250, and in Maclaren's case there were 132. According to Crocker,

Hebra and Rayer also each had a case. In a case of Sangster, reported

by Politzer, although most of the dermoids, as usual, were like

fibroma-nodules and therefore the color of normal skin, those over the

mastoid processes and clavicle were lemon-yellow, and were generally

thought to be xanthoma until they were excised, and Politzer found they

were typical dermoid cysts with the usual contents of degenerated

epithelium and hair.

Hermaphroditism.--Some writers claim that Adam was the first

hermaphrodite and support this by Scriptural evidence. We find in some

of the ancient poets traces of an Egyptian legend in which the goddess

of the moon was considered to be both male and female. From mythology

we learn that Hermaphroditus was the son of Hermes, or Mercury, and

Venus Aphrodite, and had the powers both of a father and mother. In

speaking of the foregoing Ausonius writes, "Cujus erat facies in qua

paterque materque cognosci possint, nomen traxit ab illis." Ovid and

Virgil both refer to legendary hermaphrodites, and the knowledge of

their existence was prevalent in the olden times. The ancients

considered the birth of hermaphrodites bad omens, and the Athenians

threw them into the sea, the Romans, into the Tiber. Livy speaks of an

hermaphrodite being put to death in Umbria, and another in Etruria.

Cicero, Aristotle, Strabonius, and Pliny all speak concerning this

subject. Martial and Tertullian noticed this anomaly among the Romans.

Aetius and Paulus Aegineta speak of females in Egypt with prolonged

clitorides which made them appear like hermaphrodites. Throughout the

Middle Ages we frequently find accounts, naturally exaggerated, of

double-sexed creatures. Harvey, Bartholinus, Paullini, Schenck, Wolff,

Wrisberg, Zacchias, Marcellus Donatus, Haller, Hufeland, de Graff, and

many others discuss hermaphroditism. Many classifications have been

given, as, e.g., real and apparent; masculine, feminine, or neuter;

horizontal and vertical; unilateral and bilateral, etc. The anomaly in

most cases consists of a malformation of the external genitalia. A

prolonged clitoris, prolapsed ovaries, grossness of figure, and hirsute

appearance have been accountable for many supposed instances of

hermaphrodites. On the other hand, a cleft scrotum, an ill-developed

penis, perhaps hypospadias or epispadias, rotundity of the mammae, and

feminine contour have also provoked accounts of similar instances. Some

cases have been proved by dissection to have been true hermaphrodites,

portions or even entire genitalia of both sexes having been found.

Numerous accounts, many mythical, but always interesting, are given of

these curious persons. They have been accredited with having performed

the functions of both father and mother, notwithstanding the statements

of some of the best authorities that they are always sterile.

Observation has shown that the sexual appetite diminishes in proportion

to the imperfections in the genitalia, and certainly many of these

persons are sexually indifferent.

We give descriptions of a few of the most famous or interesting

instances of hermaphroditism. Pare speaks of a woman who, besides a

vulva, from which she menstruated, had a penis, but without prepuce or

signs of erectility. Haller alludes to several cases in which prolonged

clitorides have been the cause of the anomaly. In commenting on this

form of hermaphroditism Albucasiusus describes a necessary operation

for the removal of the clitoris.

Columbus relates the history of an Ethiopian woman who was evidently a

spurious female hermaphrodite. The poor wretch entreated him to cut off

her penis, an enlarged clitoris, which she said was an intolerable

hindrance to her in coitus. De Graff and Riolan describe similar cases.

There is an old record of a similar creature, supposing herself to be a

male, who took a wife, but previously having had connection with a man,

the outcome of which was pregnancy, was shortly after marriage

delivered of a daughter. There is an account of a person in Germany

who, for the first thirty years of life, was regarded as feminine, and

being of loose morals became a mother. At a certain period she began to

feel a change in her sexual inclinations; she married and became the

father of a family. This is doubtless a distortion of the facts of the

case of Catherine or Charles Hoffman, born in 1824, and who was

considered a female until the age of forty. At puberty she had the

instincts of a woman, and cohabitated with a male lover for twenty

years. Her breasts were well formed and she menstruated at nineteen. At

the age of forty-six her sexual desires changed, and she attempted

coitus as a man, with such evident satisfaction that she married a

woman soon afterward. Fitch speaks of a house-servant with masculine

features and movements, aged twenty-eight, and 5 feet and 9 inches

tall, who was arrested by the police for violating the laws governing

prostitution. On examination, well-developed male and female organs of

generation were found. The labia majora were normal and flattened on

the anterior surface. The labia minora and hymen were absent. The

vagina was spacious and the woman had a profuse leukorrhea. She stated

that several years previously she gave birth to a normal child. In

place of a clitoris she had a penis which, in erection, measured 5 1/4

inches long and 3 5/8 inches in circumference. The glans penis and the

urethra were perfectly formed. The scrotum contained two testicles,

each about an inch long; the mons veneris was sparsely covered with

straight, black hair. She claimed functional ability with both sets of

genitalia, and said she experienced equal sexual gratification with

either. Semen issued from the penis, and every three weeks she had

scanty menstruation, which lasted but two days.

Beclard showed Marie-Madeline Lefort, nineteen years of age, 1 1/2

meters in height. Her mammae were well developed, her nipples erectile

and surrounded by a brown areola, from which issued several hairs. Her

feet were small, her pelvis large, and her thighs like those of a

woman. Projecting from the vulva was a body looking like a penis 7 cm.

long and slightly erectile at times; it was imperforate and had a

mobile prepuce. She had a vulva with two well-shaped labia as shown by

the accompanying illustration. She menstruated slightly and had an

opening at the root of the clitoris. The parotid region showed signs of

a beard and she had hair on her upper lip. On August 20, 1864, a person

came into the Hotel-Dieu, asking treatment for chronic pleurisy. He

said his age was sixty-five, and he pursued the calling of a

mountebank, but remarked that in early life he had been taken for a

woman. He had menstruated at eight and had been examined by doctors at

sixteen. The menstruation continued until 1848, and at its cessation he

experienced the feelings of a male. At this time he presented the

venerable appearance of a long-bearded old man. At the autopsy, about

two months later, all the essentials of a female were delineated. A

Fallopian tube, ovaries, uterus, and round ligaments were found, and a

drawing in cross-section of the parts was made. There is no doubt but

that this individual was Marie-Madeline Lefort in age.

Worbe speaks of a person who was supposed to be feminine for twenty-two

years. At the age of sixteen she loved a farmer's son, but the union

was delayed for some reason, and three years later her grace faded and

she became masculine in her looks and tastes. It was only after

lengthy discussion, in which the court took part, that it was

definitely settled that this person was a male.

Adelaide Preville, who was married as a female, and as such lived the

last ten years of her life in France, was found on dissection at the

Hotel-Dieu to be a man. A man was spoken of in both France and Germany

a who passed for many years as a female. He had a cleft scrotum and

hypospadias, which caused the deception. Sleeping with another servant

for three years, he constantly had sexual congress with her during this

period, and finally impregnated her. It was supposed in this case that

the posterior wall of the vagina supplied the deficiency of the lower

boundary of the urethra, forming a complete channel for the semen to

proceed through. Long ago in Scotland a servant was condemned to death

by burial alive for impregnating his master's daughter while in the

guise and habit of a woman. He had always been considered a woman. We

have heard of a recent trustworthy account of a pregnancy and delivery

in a girl who had been impregnated by a bed-fellow who on examination

proved to be a male pseudohermaphrodite.

Fournier speaks of an individual in Lisbon in 1807 who was in the

highest degree graceful, the voice feminine, the mammae well developed,

The female genitalia were normal except the labia majora, which were

rather diminutive. The thighs and the pelvis. were not so wide as

those of a woman. There was some beard on the chin, but it was worn

close. the male genitalia were of the size and appearance of a male

adult and were covered with the usual hair. This person had been twice

pregnant and aborted at the third and fifth month. During coitus the

penis became erect, etc.

Schrell describes a case in which, independent of the true penis and

testicles, which were well formed, there existed a small vulva

furnished with labia and nymphae, communicating with a rudimentary

uterus provided with round ligaments and imperfectly developed ovaries.

Schrell remarks that in this case we must notice that the female

genitalia were imperfectly developed, and adds that perfect

hermaphroditism is a physical impossibility without great alterations

of the natural connections of the bones and other parts of the pelvis.

Cooper describes a woman with an enormous development of the clitoris,

an imperforate uterus, and absence of vagina; at first sight of the

parts they appeared to be those of a man.

In 1859 Hugier succeeded in restoring a vagina to a young girl of

twenty who had an hypertrophied clitoris and no signs of a vagina. The

accompanying illustrations show the conformation of the parts before

operation with all the appearance of ill-developed male genitalia, and

the appearance afterward with restitution of the vaginal opening.

Virchow in 1872, Boddaert in 1875, and Marchand in 1883 report cases of

duplication of the genitalia, and call their cases true hermaphrodites

from an anatomic standpoint. There is a specimen in St. Bartholomew's

Hospital in London from a man of forty-four, who died of cerebral

hemorrhage. He was well formed and had a beard and a full-sized penis.

He was married, and it was stated that his wife had two children. The

bladder and the internal organs of generation were those of a man in

whom neither testis had descended into the scrotum, and in whom the

uterus masculinus and vagina were developed to an unusual degree. The

uterus, nearly as large as in the adult female, lay between the bladder

and rectum, and was enclosed between two layers of peritoneum, to

which, on either side of the uterus, were attached the testes. There

was also shown in London the pelvic organs from a case of complex or

vertical hermaphroditism occurring in a child of nine months who died

from the effects of an operation for the radical cure of a right

inguinal hernia. The external organs were those of a male with

undescended testes. The bladder was normal and its neck was surrounded

by a prostate gland. Projecting backward were a vagina, uterus, and

broad ligaments, round ligaments, and Fallopian tubes, with the testes

in the position of the ovaries. There were no seminal vesicles. The

child died eleven days after the operation. The family history states

that the mother had had 14 children and eight miscarriages. Seven of

the children were dead and showed no abnormalities. The fifth and sixth

children were boys and had the same sexual arrangement.

Barnes, Chalmers, Sippel, and Litten describe cases of spurious

hermaphroditism due to elongation of the clitoris. In Litten's case a

the clitoris was 3 1/2 inches long, and there was hydrocele of the

processus vaginalis on both sides, making tumors in the labium on one

side and the inguinal canal on the other, which had been diagnosed as

testicles and again as ovaries. There was associate cystic ovarian

disease. Plate 4 is taken from a case of false external bilateral

hermaphroditism. Phillips mentions four cases of spurious

hermaphroditism in one family, and recently Pozzi tells of a family of

nine individuals in whom this anomaly was observed. The first was alive

and had four children; the second was christened a female but was

probably a male; the third, fourth, and fifth were normal but died

young; the sixth daughter was choreic and feeble-minded, aged

twenty-nine, and had one illegitimate child; the seventh, a boy, was

healthy and married; the eighth was christened a female, but when

seventeen was declared by the Faculty to be a male; the ninth was

christened a female, but at eighteen the genitals were found to be

those of a male, though the mammae were well developed.

O'Neill speaks of a case in which the clitoris was five inches long and

one inch thick, having a groove in its inferior surface reaching down

to an oblique opening in the perineum. The scrotum contained two hard

bodies thought to be testicles, and the general appearance was that of

hypospadias. Postmortem a complete set of female genitalia was found,

although the ovaries were very small. The right round ligament was

exceedingly thick and reached down to the bottom of the false scrotum,

where it was firmly attached. The hard bodies proved to be on one side

an irreducible omental hernia, probably congenital, and on the other a

hardened mass having no glandular structure. The patient was an adult.

As we have seen, there seems to be a law of evolution in

hermaphroditism which prevents perfection. If one set of genitalia are

extraordinarily developed, the other set are correspondingly atrophied.

In the case of extreme development of the clitoris and approximation to

the male type we must expect to find imperfectly developed uterus or

ovaries. This would answer for one of the causes of sterility in these

cases.

There is a type of hermaphroditism in which the sex cannot be

definitely declared, and sometimes dissection does not definitely

indicate the predominating sex. Such cases are classed under the head

of neuter hermaphrodites, possibly an analogy of the "genus epicoenum"

of Quintilian. Marie Dorothee, of the age of twenty-three, was examined

and declared a girl by Hufeland and Mursina, while Stark, Raschig, and

Martens maintained that she was a boy. This formidable array of talent

on both sides provoked much discussion in contemporary publications,

and the case attracted much notice. Marc saw her in 1803, at which time

she carried contradicting certificates as to her sex. He found an

imperforate penis, and on the inferior face near the root an opening

for the passage of urine. No traces of nymphae, vagina, testicles, nor

beard were seen. The stature was small, the form debilitated, and the

voice effeminate. Marc came to the conclusion that it was impossible

for any man to determine either one sex or the other. Everard Home

dissected a dog with apparent external organs of the female, but

discovered that neither sex was sufficiently pronounced to admit of

classification. Home also saw at the Royal Marine Hospital at Plymouth,

in 1779, a marine who some days after admission was reported to be a

girl. On examination Home found him to possess a weak voice, soft skin,

voluminous breasts, little beard, and the thighs and legs of a woman.

There was fat on the pubis, the penis was short and small and incapable

of erection, the testicles of fetal size; he had no venereal desires

whatever, and as regards sex was virtually neuter.

The legal aspect of hermaphroditism has always been much discussed.

Many interesting questions arise, and extraordinary complications

naturally occur. In Rome a hermaphrodite could be a witness to a

testament, the exclusive privilege of a man, and the sex was settled by

the predominance. If the male aspect and traits together with the

generative organs of man were most pronounced, then the individual

could call himself a man. "Hermaphroditus an ad testamentum adhiberi

possit qualitas sesus incalescentis ostendit."

There is a peculiar case on record in which the question of legal male

inheritance was not settled until the individual had lived as a female

for fifty-one years. This person was married when twenty-one, but

finding coitus impossible, separated after ten years, and though

dressing as a female had coitus with other women. She finally lived

with her brother, with whom she eventually came to blows. She

prosecuted him for assault, and the brother in return charged her with

seducing his wife. Examination ensued, and at this ripe age she was

declared to be a male.

The literature on hermaphroditism is so extensive that it is impossible

to select a proper representation of the interesting cases in this

limited space, and the reader is referred to the modern French works on

this subject, in which the material is exhaustive and the discussion

thoroughly scientific.