Irwin reports a case in which the firm attachment of the fetal head to the uterine parietes rendered delivery without artificial aid impossible, and it was necessary to perform craniotomy. The right temporal region of the child adhered to the internal surface of the neck of the uterus, being connected by membranes. The woman was forty-four years old, and the child was her fourth.

Delay in the Birth of the Second Twin.—In twin pregnancies there is sometimes a delay of many days in the birth of a second child, even to such an extent as to give suspicion of superfetation. Pignot speaks of one twin two months before the other. De Bosch speaks of a delay of seventeen days; and there were 2 cases on record in France in the last century, one of which was delayed ten days, and the other showed an interval of seven weeks between the delivery of the twins. There is an old case on record in which there was an interval of six weeks between deliveries; Jansen gives an account of three births in ten months; Pinart mentions a case with an interval of ten days; Thilenius, one of thirteen days; and Ephemerides, one of one week. Wildberg describes a case in which one twin was born two months after the other, and there was no secretion of milk until after the second birth. A full description of Wildberg's case is given in another journal in brief, as follows: A woman, eighteen months married, was in labor in the eighth month of pregnancy. She gave birth to a child, which, though not fully matured, lived. There was no milk-secretion in her breasts, and she could distinctly feel the movements of another child; her abdomen increased in size. After two months she had another labor, and a fully developed and strong child was born, much heavier than the first. On the third day after, the breasts became enlarged, and she experienced considerable fever. It was noticeable in this case that a placenta was discharged a quarter of an hour after the first birth. Irvine relates an instance of thirty-two days' delay; and Pfau one of seven days'.

Carson cites the instance of a noblewoman of forty, the mother of four children, who was taken ill about two weeks before confinement was expected, and was easily delivered of a male child, which seemed well formed, with perfect nails, but weakly. After the birth the mother never became healthy or natural in appearance. She was supposed to be dying of dropsy, but after forty-four days the mystery was cleared by the birth of a fine, well-grown, and healthy daughter. Both mother and child did well.

Addison describes the case of a woman who was delivered of a healthy male child, and everything was well until the evening of the fourth day, when intense labor-pains set in, and well-formed twins about the size of a pigeon's egg were born. In this strange case, possibly an example of superfetation, the patient made a good recovery and the first child lived. A similar case is reported by Lumby in which a woman was delivered on January 18th, by a midwife, of a full-grown and healthy female child. On the third day she came down-stairs and resumed her ordinary duties, which she continued until February 4th (seventeen days after). At this time she was delivered of twins, a boy and a girl, healthy and well-developed. The placenta was of the consistency of jelly and had to be scooped away with the hand. The mother and children did well. This woman was the mother of ten children besides the product of this conception, and at the latter occurrence had entire absence of pains and a very easy parturition.

Pincott had a case with an interval of seven weeks between the births; Vale 1 of two months; Bush 1 of seventeen days; and Burke 1 with an interval of two months. Douglas cites an instance of twins being born four days apart. Bessems of Antwerp, in 1866, mentions a woman with a bicornate uterus who bore two twins at fifty-four days' interval.



CHAPTER IV.

PROLIFICITY.

General Historic Observations.—Prolificity is a much discussed subject, for besides its medical and general interest it is of importance in social as well as in political economy. Superfluous population was a question that came to consciousness early; Aristotle spoke of legislation to prevent the increase of population and the physical and mental deterioration of the race,—he believed in a population fixed as regards numbers,—and later Lycurgus transformed these precepts into a terrible law. Strabonius reports that the inhabitants of Cathea brought their infants at the age of two months before a magistrate for inspection. The strong and promising were preserved and the weak destroyed. The founders of the Roman Empire followed a similar usage. With great indignation Seneca, Ovid, and Juvenal reproved this barbarity of the Romans. With the domination of Christianity this custom gradually diminished, and Constantine stopped it altogether, ordering succor to the people too poor to rear their own children. The old Celts were so jealous of their vigor that they placed their babes on a shield in the river, and regarded those that the waves respected as legitimate and worthy to become members of their clans. In many of the Oriental countries, where the population is often very excessive and poverty great, the girl babies of the lower classes were destroyed. At one time the crocodiles, held sacred in the Nile, were given the surplus infants. By destroying the females the breeding necessarily diminished, and the number of the weaker and dependent classes became less. In other countries persons having children beyond their ability to support were privileged to sell them to citizens, who contracted to raise them on condition that they became their slaves.

General Law, and the Influence of War.—In the increase of the world's population, although circumstances may for the time alter it, a general average of prolificity has, in the long run, been maintained. In the history of every nation artificial circumstances, such as fashion, war, poverty, etc., at some period have temporarily lowered the average of prolificity; but a further search finds another period, under opposite circumstances, which will more than compensate for it. The effect of a long-continued war or wars on generation and prolificity has never been given proper consideration. In such times marriages become much less frequent; the husbands are separated from their wives for long periods; many women are left widows; the females become in excess of the males; the excitement of the times overtops the desire for sexual intercourse, or, if there is the same desire, the unprolific prostitute furnishes the satisfaction; and such facts as these, coupled with many similar ones, soon produce an astonishing effect upon the comparative birth-rate and death-rate of the country. The resources of a country, so far as concerns population, become less as the period of peace-disturbance is prolonged. Mayo-Smith quotes von Mayr in the following example of the influence of the war of 1870-71 on the birth-rate in Bavaria,—the figures for births are thrown back nine months, so as to show the time of conception: Before the war under normal conception the number of births was about 16,000 per month. During the war it sank to about 2000 per month. Immediately on the cessation of hostilities it arose to its former number, while the actual return of the troops brought an increase of 2000 per month. The maximum was reached in March, 1872, when it was 18,450. The war of 1866 seems to have passed over Germany without any great influence, the birth-rate in 1865 being 39.2; in 1866, 39.4; in 1867, 38.3; in 1868, 38.4. On the other hand, while the birth-rate in 1870 was 40.1, in 1871 it was only 35.9; in 1872 it recovered to 41.1, and remained above 41 down to 1878. Von Mayr believes the war had a depressing influence upon the rate apart from the mere absence of the men, as shown in the fact that immediately upon the cessation of hostilities it recovered in Bavaria, although it was several months before the return of the troops.

Mayo-Smith, in remarking on the influence of war on the marriage-rate, says that in 1866 the Prussian rate fell from 18.2 to 15.6, while the Austrian rate fell from 15.5 to 13.0. In the war of 1870-71 the Prussian rate fell from 17.9 in 1869 to 14.9 in 1870 and 15.9 in 1871; but in the two years after peace was made it rose to 20.6 and 20.2, the highest rates ever recorded. In France the rate fell from 16.5 to 12.1 and 14.4, and then rose to 19.5 and 17.7, the highest rates ever recorded in France.

Influence of Rural and Urban Life.—Rural districts are always very prolific, and when we hear the wails of writers on "Social Economy," bemoaning the small birth-rates of their large cities, we need have no fear for urban extinction, as emigration from the country by many ambitious sons and daughters, to avail themselves of the superior advantages that the city offers, will not only keep up but to a certain point increase the population, until the reaction of overcrowding, following the self-regulating law of compensation, starts a return emigration.

The effect of climate and race on prolificity, though much spoken of, is not so great a factor as supposed. The inhabitants of Great Britain are surpassed by none in the point of prolificity; yet their location is quite northern. The Swedes have always been noted for their fecundity. Olaf Rudbeck says that from 8 to 12 was the usual family number, and some ran as high as 25 or 30. According to Lord Kames, in Iceland before the plague (about 1710) families of from 15 to 20 were quite common. The old settlers in cold North America were always blessed with large families, and Quebec is still noted for its prolificity. There is little difference in this respect among nations, woman being limited about the same everywhere, and the general average of the range of the productive function remaining nearly identical in all nations. Of course, exception must be made as to the extremes of north or south.

Ancient and Modern Prolificity.—Nor is there much difference between ancient and modern times. We read in the writings of Aristotle, Pliny, and Albucasis of the wonderful fertility of the women of Egypt, Arabia, and other warm countries, from 3 to 6 children often being born at once and living to maturity; but from the wonder and surprise shown in the narration of these facts, they were doubtless exceptions, of which parallels may be found in the present day. The ancient Greek and Roman families were no larger than those of to-day, and were smaller in the zenith of Roman affluence, and continued small until the period of decadence.

Legal Encouragement of Prolificity.—In Quebec Province, Canada, according to a Montreal authority, 100 acres of land are allotted to the father who has a dozen children by legitimate marriage. The same journal states that, stimulated by the premium offered, families of 20 or more are not rare, the results of patriotic efforts. In 1895, 1742 "chefs de famille" made their claim according to the conditions of the law, and one, Paul Bellanger, of the River du Loup, claimed 300 acres as his premium, based on the fact that he was the father of 36 children. Another claimant, Monsieur Thioret de Sainte Genevieve, had been presented by his wife, a woman not yet thirty years old, with 17 children. She had triplets twice in the space of five years and twins thrice in the mean time. It is a matter of conjecture what the effect would be of such a premium in countries with a lowering birth-rate, and a French medical journal, quoting the foregoing, regretfully wishes for some countrymen at home like their brothers in Quebec.

Old Explanations of Prolificity.—The old explanation of the causation of the remarkable exceptions to the rules of prolificity was similar to that advanced by Empedocles, who says that the greater the quantity of semen, the greater the number of children at birth. Pare, later, uses a similar reason to explain the causation of monstrosities, grouping them into two classes, those due to deficiency of semen, such as the acephalous type, and those due to excess, such as the double monsters. Hippocrates, in his work on the "Nature of the Infant," tells us that twins are the result of a single coitus, and we are also informed that each infant has a chorion; so that both kinds of plural gestation (monochorionic and dichorionic) were known to the ancients. In this treatise it is further stated that the twins may be male or female, or both males or both females; the male is formed when the semen is thick and strong.

The greatest number of children at a single birth that it is possible for a woman to have has never been definitely determined. Aristotle gives it as his opinion that one woman can bring forth no more than 5 children at a single birth, and discredits reports of multiplicity above this number; while Pliny, who is not held to be so trustworthy, positively states that there were authentic records of as many as 12 at a birth. Throughout the ages in which superstitious distortion of facts and unquestioning credulity was unchecked, all sorts of incredible accounts of prolificity are found. Martin Cromerus, a Polish historian, quoted by Pare, who has done some good work in statistical research on this subject, says a that Margaret, of a noble and ancient family near Cracovia, the wife of Count Virboslaus, brought forth 36 living children on January 20, 1296.

The celebrated case of Countess Margaret, daughter of Florent IV, Earl of Holland, and spouse of Count Hermann of Henneberg, was supposed to have occurred just before this, on Good Friday, 1278. She was at this time forty-two years of age, and at one birth brought forth 365 infants, 182 males, 182 females, and 1 hermaphrodite. They were all baptized in two large brazen dishes by the Bishop of Treras, the males being called John, the females Elizabeth. During the last century the basins were still on exhibition in the village church of Losdun, and most of the visitors to Hague went out to see them, as they were reckoned one of the curiosities of Holland. The affliction was ascribed to the curse of a poor woman who, holding twins in her arms, approached the Countess for aid. She was not only denied alms, but was insulted by being told that her twins were by different fathers, whereupon the poor woman prayed God to send the Countess as many children as there were days in the year. There is room for much speculation as to what this case really was. There is a possibility that it was simply a case of hydatidiform or multiple molar pregnancy, elaborated by an exhaustive imagination and superstitious awe. As late as 1799 there was a woman of a town of Andalusia who was reported to have been delivered of 16 male infants, 7 of which were alive two months later.

Mayo-Smith remarks that the proportion of multiple births is not more than 1 per cent of the total number of parturitions. The latest statistics, by Westergaard, give the following averages to number of cases of 100 births in which there were 2 or more at a birth:—

Sweden, 1.45 Germany, 1.24 Bavaria, 1.38 Denmark, 1.34 Holland, 1.30 Prussia, 1.26 Scotland, 1.22 Norway, 1.32 Saxony, 1.20 Italy, 1.21 Austria, 1.17 Switzerland, 1.16 France, 0.99 Belgium, 0.97 Spain, 0.85

In Prussia, from 1826 to 1880, there were 85 cases of quadruplets and 3 cases of 5 at a birth.

The most extensive statistics in regard to multiple births are those of Veit, who reviews 13,000,000 births in Prussia. According to his deductions, twins occur once in 88 births; triplets, once in 7910; and quadruplets, once in 371,126. Recent statistics supplied by the Boards of Health of New York and Philadelphia place the frequency of twin births in these cities at 1 in every 120 births, while in Bohemia twins occur once in about 60 births, a proportion just twice as great. Of 150,000 twin pregnancies studied by Veit, in one-third both children were boys; in slightly less than one-third both were girls; in the remaining third both sexes were represented.

Authentic records of 5 and 6 at a birth are extremely rare and infinitesimal in proportion. The reputed births in excess of 6 must be looked on with suspicion, and, in fact, in the great majority of reports are apochryphal.

The examples of multiple births of a single pregnancy will be taken up under their respective numbers, several examples of each being given, together with the authorities. Many twin and triplet brothers have figured prominently in history, and, in fact, they seem especially favored. The instance of the Horatii and the Curatii, and their famous battle, on which hung the fate of Rome and Alba, is familiar to every one, their strength and wisdom being legendary with the Romans.

Twins and triplets, being quite common, will not be considered here, although there are 2 cases of interest of the latter that deserve citation. Sperling reports 2 instances of triplets; in the first there was 1 placenta and chorion, 2 amnions, and the sex was the same; in the second case, in which the sexes were different, there were 3 placentas, 3 chorions, and 3 amnions. What significance this may have is only a matter of conjecture. Petty describes a case of triplets in which one child was born alive, the other 2 having lost their vitality three months before. Mirabeau has recently found that triple births are most common (1 to 6500) in multiparous women between thirty and thirty-four years of age. Heredity seems to be a factor, and duplex uteruses predispose to multiple births. Ross reports an instance of double uterus with triple pregnancy.

Quadruplets are supposed to occur once in about every 400,000 births. There are 72 instances recorded in the Index Catalogue of the Surgeon General's Library, U. S. A., up to the time of compilation, not including the subsequent cases in the Index Medicus. At the Hotel-Dieu, in Paris, in 108,000 births, covering a period of sixty years, mostly in the last century, there was only one case of quadruplets. The following extract of an account of the birth of quadruplets is given by Dr. De Leon of Ingersoll, Texas:—

"I was called to see Mrs. E. T. Page, January 10, 1890, about 4 o'clock A.M.; found her in labor and at full time, although she assured me that her 'time' was six weeks ahead. At 8 o'clock A.M. I delivered her of a girl baby; I found there were triplets, and so informed her. At 11 A.M. I delivered her of the second girl, after having rectified presentation, which was singular, face, hands, and feet all presented; I placed in proper position and practised 'version.' This child was 'still-born,' and after considerable effort by artificial respiration it breathed and came around 'all right.' The third girl was born at 11.40 A.M. This was the smallest one of the four. In attempting to take away the placenta, to my astonishment I found the feet of another child. At 1 P.M. this one was born; the head of this child got firmly impacted at the lower strait, and it was with a great deal of difficulty and much patient effort that it was finally disengaged; it was blocked by a mass of placenta and cords. The first child had its own placenta; the second and third had their placenta; the fourth had also a placenta. They weighed at birth in the aggregate 19 1/2 pounds without clothing; the first weighed 6 pounds; the second 5 pounds; the third 4 1/2 pounds; the fourth 4 pounds. Mrs. Page is a blonde, about thirty-six years old, and has given birth to 14 children, twins three times before this, one pair by her first husband. She has been married to Page three years, and has had 8 children in that time. I have waited on her each time. Page is an Englishman, small, with dark hair, age about twenty-six, and weighs about 115 pounds. They are in St. Joseph, Mo., now, having contracted with Mr. Uffner of New York to travel and exhibit themselves in Denver, St. Joseph, Omaha, and Nebraska City, then on to Boston, Mass., where they will spend the summer."

There is a report from Canada of the birth of 4 living children at one time. The mother, a woman of thirty-eight, of small stature, weighing 100 pounds, had 4 living children of the ages of twelve, ten, eight, and seven years, respectively. She had aborted at the second month, and at full term was delivered of 2 males, weighing, respectively, 4 pounds 9 1/4 ounces and 4 pounds 3 ounces; and of 2 females, weighing 4 pounds 3 ounces and 3 pounds 13 3/4 ounces, respectively. There was but one placenta, and no more exhaustion or hemorrhage than at a single birth. The father weighed 169 pounds, was forty-one years old, and was 5 feet 5 inches tall, healthy and robust. The Journal of St. Petersburg, a newspaper of the highest standard, stated that at the end of July, 1871, a Jewish woman residing in Courland gave birth to 4 girls, and again, in May, 1872, bore 2 boys and a girl; the mother and the 7 children, born within a period of ten months, were doing well at the time of the report. In the village of Iwokina, on May 26, 1854, the wife of a peasant bore 4 children at a birth, all surviving. Bousquet speaks of a primiparous mother, aged twenty-four, giving birth to 4 living infants, 3 by the breech and 1 by the vertex, apparently all in one bag of membranes. They were nourished by the help of 3 wet-nurses. Bedford speaks of 4 children at a birth, averaging 5 pounds each, and all nursing the mother.

Quintuplets are quite rare, and the Index Catalogue of the Surgeon General's Library, U. S. A., gives only 19 cases, reports of a few of which will be given here, together with others not given in the Catalogue, and from less scientific though reliable sources. In the year 1731 there was one case of quintuplets in Upper Saxony and another near Prague, Bohemia. In both of these cases the children were all christened and had all lived to maturity. Garthshore speaks of a healthy woman, Margaret Waddington, giving birth to 5 girls, 2 of which lived; the 2 that lived weighed at birth 8 pounds 12 ounces and 9 pounds, respectively. He discusses the idea that woman was meant to bear more than one child at a birth, using as his argument the existence of the double nipple and mamma, to which might be added the not infrequent occurrence of polymazia.

In March, 1736, in a dairy cellar in the Strand, London, a poor woman gave birth to 3 boys and 9 girls. In the same journal was reported the birth at Wells, Somersetshire, in 1739, of 4 boys and a girl, all of whom were christened and were healthy. Pare in 1549 gives several instances of 5 children at a birth, and Pliny reports that in the peninsula of Greece there was a woman who gave birth to quintuplets on four different occasions. Petritus, a Greek physician, speaks of the birth of quintuplets at the seventh month. Two males and one female were born dead, being attached to the same placenta; the others were united to a common placenta and lived three days. Chambon mentions an instance of 5 at a birth. Not far from Berne, Switzerland, the wife of John Gelinger, a preacher in the Lordship of Berne, brought forth twins, and within a year after she brought forth quintuplets, 3 sons and 2 daughters. There is a similar instance reported in 1827 of a woman of twenty-seven who, having been delivered of twins two years before, was brought to bed with 5 children, 3 boys and 2 girls. Their length was from 15 1/2 to 16 1/2 inches. Although regularly formed, they did not seem to have reached maturity. The mother was much exhausted, but recovered. The children appeared old-looking, had tremulous voices, and slept continually; during sleep their temperatures seemed very low.

Kennedy showed before the Dublin Pathological Society 5 fetuses with the involucra, the product of an abortion at the third month. At Naples in 1839 Giuseppa Califani gave birth to 5 children; and about the same time Paddock reported the birth in Franklin County, Pa., of quintuplets. The Lancet relates an account of the birth of quintuplets, 2 boys and 3 girls, by the wife of a peasant on March 1, 1854. Moffitt records the birth at Monticello, Ill., of quintuplets. The woman was thirty-five years of age; examination showed a breech presentation; the second child was born by a foot-presentation, as was the third, but the last was by a head-presentation. The combined weight was something over 19 pounds, and of the 5, 3 were still-born, and the other 2 died soon after birth. The Elgin Courant (Scotland), 1858, speaks of a woman named Elspet Gordon, at Rothes, giving birth to 3 males and 2 females. Although they were six months' births, the boys all lived until the following morning. The girls were still-born. One of the boys had two front teeth when born. Dr. Dawson of Rothes is the obstetrician mentioned in this case.

The following recent instance is given with full details to illustrate the difficulties attending the births of quintuplets. Stoker has reported the case of a healthy woman, thirty-five years old, 5 feet 1 inch high, and of slight build, whom he delivered of 5 fetuses in the seventh month of pregnancy, none of the children surviving. The patient's mother had on two occasions given birth to twins. The woman herself had been married for six years and had borne 4 children at full term, having no difficulty in labor. When she came under observation she computed that she had been pregnant for six months, and had had her attention attracted to the unusually large size of her abdomen. She complained of fixed pain in the left side of the abdomen on which side she thought she was larger. Pains set in with regularity and the labor lasted eight and three-quarter hours. After the rupture of the membranes the first child presented by the shoulder. Version was readily performed; the child was dead (recently). Examination after the birth of the first child disclosed the existence of more than one remaining fetus. The membranes protruded and became tense with each contraction. The presentation was a transverse one. In this case also there was little difficulty in effecting internal version. The child lived a couple of hours. The third fetus was also enclosed in a separate sac, which had to be ruptured. The child presented by the breech and was delivered naturally, and lived for an hour. In the fourth case the membranes had likewise to be ruptured, and alarming hemorrhage ensued. Version was at once practised, but the chin became locked with that of the remaining fetus. There was some difficulty and considerable delay in freeing the children, though the extent of locking was not at any time formidable. The child was dead (recently). The fifth fetus presented by the head and was delivered naturally. It lived for half an hour. The placenta was delivered about five minutes after the birth of the last child, and consisted of two portions united by a narrow isthmus. One, the smaller, had two cords attached centrally and close together; the other, and larger, had two cords attached in a similar way and one where it was joined to the isthmus. The organ appeared to be perfectly healthy. The cord of the fourth child was so short that it had to be ligated in the vagina. The children were all females and of about the same size, making a total weight of 8 pounds. The mother rallied quickly and got on well.

Trustworthy records of sextuplets are, of course, extremely scarce. There are few catalogued at Washington, and but two authentic cases are on record in the United States. On December 30, 1831, a woman in Dropin was delivered of 6 daughters, all living, and only a little smaller than usual in size. The mother was not quite twenty years old, but was of strong constitution. The 6 lived long enough to be baptized, but died the evening of their births. There was a case a of sextuplets in Italy in 1844. In Maine, June 27, 1847, a woman was delivered of 6 children, 2 surviving and, together with the mother, doing well. In 1885 there was reported the birth of sextuplets in Lorca, Spain, of which only one survived. At Dallas, Texas, in 1888, Mrs. George Hirsh of Navarro County gave birth to 6 children, the mother and the children all doing well. There were 4 boys and 2 girls, and they were all perfect, well formed, but rather small.

Valsalli gives an instance which is quoted by the Medical News without giving the authority. Valsalli's account, which differs slightly from the account in the Medical News, is briefly as follows: While straining at stool on the one hundred and fifteenth day of pregnancy the membranes ruptured and a foot prolapsed, no pain having been felt before the accident. A fetus was delivered by the midwife. Valsalli was summoned and found the woman with an enormously distended abdomen, within which were felt numerous fetal parts; but no fetal heart-sounds or movements were noticed. The cervix was only slightly dilated, and, as no pains were felt, it was agreed to wait. On the next day the membranes were ruptured and 4 more fetuses were delivered. Traction on the umbilical cord started hemorrhage, to check which the physician placed his hand in the uterine cavity. In this most arduous position he remained four hours until assistance from Lugano came. Then, in the presence of the three visiting physicians, a sixth amniotic sac was delivered with its fetus. The woman had a normal convalescence, and in the following year gave birth to healthy, living twins. The News says the children all moved vigorously at birth; there were 4 males and 2 females, and for the 6 there was only one placenta The mother, according to the same authority, was thirty-six years of age, and was in her second pregnancy.

Multiple Births over Six.—When we pass sextuplets the records of multiple births are of the greatest rarity and in modern records there are almost none. There are several cases mentioned by the older writers whose statements are generally worthy of credence, which, however incredible, are of sufficient interest at least to find a place in this chapter. Albucasis affirms that he knew of the birth of seven children at one time; and d'Alechampius reports that Bonaventura, the slave of one Savelli, a gentleman of Siena, gave birth to 7 children, 4 of whom were baptized. At the Parish of San Ildefonso, Valladolid, Julianna, wife of Benito Quesada, gave birth to 3 children in one day, and during the following night to 4 more. Sigebert, in his Chronicles, says that the mother of the King of Lombardy had borne 7 children at a birth. Borellus says that in 1650 the lady of the then present Lord Darre gave birth to eight perfect children at one parturition and that it was the unusual event of the country.

Mrs. Timothy Bradlee of Trumbull County, Ohio, in 1872 is reported to have given birth to 8 children at one time. They were healthy and living, but quite small. The mother was married six years previously and then weighed 273 pounds. She had given birth to 2 pairs of twins, and, with these 3 boys and 5 girls, she had borne 12 children in six years. She herself was a triplet and her father and her mother were of twin births and one of her grandmothers was the mother of 5 pairs of twins. This case was most celebrated and was much quoted, several British journals extracting it.

Watering of Maregnac speaks of the simultaneous birth of 8 children at one time. When several months pregnant the woman was seized with colicky pains and thought them a call of nature. She went into a vineyard to answer it, and there, to her great astonishment, gave birth to 8 fetuses. Watering found them enclosed in a sac, and thought they probably had died from mutual pressure during growth. The mother made a good recovery.

In 1755 Seignette of Dijon reports the simultaneous birth of nine children. Franciscus Picus Mirandulae, quoted by Pare, says that one Dorothea, an Italian, bore 20 children at 2 confinements, the first time bearing 9 and the second time eleven. He gives a picture of this marvel of prolificity, in which her belly is represented as hanging down to her knees, and supported by a girdle from the neck. In the Annals, History, and Guide to Leeds and York, according to Walford, there is mention of Ann Birch, who in 1781 was delivered of 10 children. One daughter, the sole survivor of the 10, married a market gardener named Platt, who was well known in Leeds. Jonston quotes Baytraff as saying that he knew of a case in which 9 children were born simultaneously; and also says that the Countess of Altdorf gave birth to twelve at one birth. Albucasis mentions a case of fifteen well-formed children at a birth. According to Le Brun, Gilles de Trazegines, who accompanied Saint Louis to Palestine, and who was made Constable of France, was one of thirteen infants at a simultaneous accouchement. The Marquise, his mother, was impregnated by her husband before his departure, and during his absence had 13 living children. She was suspected by the native people and thought to be an adulteress, and some of the children were supposed to be the result of superfetation. They condemned them all to be drowned, but the Marquis appeared upon the scene about this time and, moved by compassion, acknowledged all 13. They grew up and thrived, and took the name of Trazegines, meaning, in the old language, 13 drowned, although many commentaries say that "gines" was supposed to mean in the twelfth century "nes," or, in full, the interpretation would be "13 born."

Cases in which there is a repetition of multiple births are quite numerous, and sometimes so often repeated as to produce a family the size of which is almost incredible. Aristotle is credited with saying that he knew the history of a woman who had quintuplets four times. Pliny's case of quintuplets four times repeated has been mentioned; and Pare, who may be believed when he quotes from his own experience, says that the wife of the last Lord de Maldemeure, who lived in the Parish of Seaux, was a marvel of prolificity. Within a year after her marriage she gave birth to twins; in the next year to triplets; in the third year to quadruplets; in the fourth year to quintuplets, and in the fifth year bore sextuplets; in this last labor she died. The then present Lord de Maldemeure, he says, was one of the final sextuplets. This case attracted great notice at the time, as the family was quite noble and very well known. Seaux, their home, was near Chambellay. Picus Mirandulae gathered from the ancient Egyptian inscriptions that the women of Egypt brought forth sometimes 8 children at a birth, and that one woman bore 30 children in 4 confinements. He also cites, from the history of a certain Bishop of Necomus, that a woman named Antonia, in the Territory of Mutina, Italy, now called Modena, had brought forth 40 sons before she was forty years of age, and that she had had 3 and 4 at a birth. At the auction of the San Donato collection of pictures a portrait of Dianora Frescobaldi, by one of the Bronzinos in the sixteenth century, sold for about $3000. At the bottom of this portrait was an inscription stating that she was the mother of 52 children. This remarkable woman never had less than 3 at a birth, and tradition gives her as many as 6.

Merriman quotes a case of a woman, a shopkeeper named Blunet, who had 21 children in 7 successive births. They were all born alive, and 12 still survived and were healthy. As though to settle the question as to whom should be given the credit in this case, the father or the mother, the father experimented upon a female servant, who, notwithstanding her youth and delicateness, gave birth to 3 male children that lived three weeks. According to despatches from Lafayette, Indiana, investigation following the murder, on December 22, 1895, of Hester Curtis, an aged woman of that city, developed the rather remarkable fact that she had been the mother of 25 children, including 7 pairs of twins.

According to a French authority the wife of a medical man at Fuentemajor, in Spain, forty-three years of age, was delivered of triplets 13 times. Puech read a paper before the French Academy in which he reports 1262 twin births in Nimes from 1790 to 1875, and states that of the whole number in 48 cases the twins were duplicated, and in 2 cases thrice repeated, and in one case 4 times repeated.

Warren gives an instance of a lady, Mrs. M——, thirty-two years of age, married at fourteen, who, after the death of her first child, bore twins, one living a month and the other six weeks. Later she again bore twins, both of whom died. She then miscarried with triplets, and afterward gave birth to 12 living children, as follows: July 24, 1858, 1 child; June 30, 1859, 2 children; March 24, 1860, 2 children; March 1, 1861, 3 children; February 13, 1862, 4 children; making a total of 21 children in eighteen years, with remarkable prolificity in the later pregnancies. She was never confined to her bed more than three days, and the children were all healthy.

A woman in Schlossberg, Germany, gave birth to twins; after a year, to triplets, and again, in another year, to 3 fairly strong boys. In the State Papers, Domestic Series, Charles I, according to Walford, appears an extract from a letter from George Garrard to Viscount Conway, which is as follows: "Sir John Melton, who entertained you at York, hath buried his wife, Curran's daughter. Within twelve months she brought him 4 sons and a daughter, 2 sons last summer, and at this birth 2 more and a daughter, all alive." Swan mentions a woman who gave birth to 6 children in seventeen months in 2 triple pregnancies. The first terminated prematurely, 2 children dying at once, the other in five weeks. The second was uneventful, the 3 children living at the time of the report. Rockwell gives the report of a case of a woman of twenty-eight, herself a twin, who gave birth to twins in January, 1879. They died after a few weeks, and in March, 1880, she again bore twins, one living three and the other nine weeks. On March 12, 1881, she gave birth to triplets. The first child, a male, weighed 7 pounds; the second, a female, 6 1/4 pounds; the third, a male, 5 1/2 pounds. The third child lived twenty days, the other two died of cholera infantum at the sixth month, attributable to the bottle-feeding. Banerjee gives the history of a case of a woman of thirty being delivered of her fourth pair of twins. Her mother was dead, but she had 3 sisters living, of one of which she was a twin, and the other 2 were twins. One of her sisters had 2 twin terms, 1 child surviving; like her own children, all were females. A second sister had a twin term, both males, 1 surviving. The other sister aborted female twins after a fall in the eighth month of pregnancy. The name of the patient was Mussamat Somni, and she was the wife of a respectable Indian carpenter.

There are recorded the most wonderful accounts of prolificity, in which, by repeated multiple births, a woman is said to have borne children almost beyond belief. A Naples correspondent to a Paris Journal gives the following: "About 2 or 3 stations beyond Pompeii, in the City of Nocera, lives Maddalena Granata, aged forty-seven, who was married at twenty-eight, and has given birth to 52 living and dead children, 49 being males. Dr. de Sanctis, of Nocera, states that she has had triplets 15 times."

Peasant Kirilow was presented to the Empress of Russia in 1853, at the age of seventy years. He had been twice married, and his first wife had presented him with 57 children, the fruits of 21 pregnancies. She had quadruplets four times, triplets seven times, and twins thrice. By his second wife he had 15 children, twins six times, and triplets once. This man, accordingly, was the father of 72 children, and, to magnify the wonder, all the children were alive at the time of presentation. Herman, in some Russian statistics, relates the instance of Fedor Vassilet, a peasant of the Moscow Jurisdiction, who in 1872, at the age of seventy-five years, was the father of 87 children. He had been twice married; his first wife bore him 69 children in 27 accouchements, having twins sixteen times, triplets seven times, and quadruplets four times, but never a single birth. His second wife bore him 18 children in 8 accouchements. In 1872, 83 of the 87 children were living. The author says this case is beyond all question, as the Imperial Academy of St. Petersburg, as well as the French Academy, have substantial proof of it. The family are still living in Russia, and are the object of governmental favors. The following fact is interesting from the point of exaggeration, if for nothing else: "The New York Medical Journal is accredited with publishing the following extract from the history of a journey to Saragossa, Barcelona, and Valencia, in the year 1585, by Philip II of Spain. The book was written by Henrique Cock, who accompanied Philip as his private secretary. On page 248 the following statements are to be found: At the age of eleven years, Margarita Goncalez, whose father was a Biscayian, and whose mother was French, was married to her first husband, who was forty years old. By him she had 78 boys and 7 girls. He died thirteen years after the marriage, and, after having remained a widow two years, the woman married again. By her second husband, Thomas Gchoa, she had 66 boys and 7 girls. These children were all born in Valencia, between the fifteenth and thirty-fifth year of the mother's age, and at the time when the account was written she was thirty-five years old and pregnant again. Of the children, 47 by the first husband and 52 by the second were baptized; the other births were still or premature. There were 33 confinements in all."

Extreme Prolificity by Single Births.—The number of children a woman may bring forth is therefore not to be accurately stated; there seems to be almost no limit to it, and even when we exclude those cases in which remarkable multiplicity at each birth augments the number, there are still some almost incredible cases on record. The statistics of the St. Pancras Royal Dispensary, 1853, estimated the number of children one woman may bear as from 25 to 69. Eisenmenger relates the history of a case of a woman in the last century bearing 51 children, and there is another case in which a woman bore 44 children, all boys. Atkinson speaks of a lady married at sixteen, dying when she was sixty-four, who had borne 39 children, all at single births, by one husband, whom she survived. The children, 32 daughters and 7 sons, all attained their majority. There was a case of a woman in America who in twenty-six years gave birth to 22 children, all at single births. Thoresby in his "History of Leeds," 1715, mentions three remarkable cases—one the wife of Dr. Phineas Hudson, Chancellor of York, as having died in her thirty-ninth year of her twenty-fourth child; another of Mrs. Joseph Cooper, as dying of her twenty-sixth child, and, lastly, of Mrs. William Greenhill, of a village in Hertford, England, who gave birth to 39 children during her life. Brand, a writer of great repute, in his "History of Newcastle," quoted by Walford, mentions as a well attested fact the wife of a Scotch weaver who bore 62 children by one husband, all of whom lived to be baptized.

A curious epitaph is to be seen at Conway, Carnarvonshire—

"Here lieth the body of Nicholas Hookes, of Conway, gentleman, who was one-and-fortieth child of his father, William Hookes, Esq., by Alice, his wife, and the father of 27 children. He died 20th of March, 1637."

On November 21, 1768, Mrs. Shury, the wife of a cooper, in Vine Street, Westminster, was delivered of 2 boys, making 26 by the same husband. She had previously been confined with twins during the year.

It would be the task of a mathematician to figure the possibilities of paternity in a man of extra long life who had married several prolific women during his prolonged period of virility. A man by the name of Pearsons of Lexton, Nottingham, at the time of the report had been married 4 times. By his first 3 wives he had 39 children and by his last 14, making a total of 53. He was 6 feet tall and lived to his ninety-sixth year. We have already mentioned the two Russian cases in which the paternity was 72 and 87 children respectively, and in "Notes and Queries," June 21, 1856, there is an account of David Wilson of Madison, Ind., who had died a few years previously at the age of one hundred and seven. He had been 5 times married and was the father of 47 children, 35 of whom were living at the time of his death.

On a tomb in Ely, Cambridgeshire, there is an inscription saying that Richard Worster, buried there, died on May 11, 1856, the tomb being in memory of his 22 sons and 5 daughters.

Artaxerxes was supposed to have had 106 children; Conrad, Duke of Moscow, 80; and in the polygamous countries the number seems incredible. Herotinus was said to have had 600; and Jonston also quotes instances of 225 and even of 650 in the Eastern countries.

Recently there have been published accounts of the alleged experiments of Luigi Erba, an Italian gentleman of Perugia, whose results have been announced. About forty years of age and being quite wealthy, this bizarre philanthropist visited various quarters of the world, securing women of different races; having secured a number sufficient for his purposes, he retired with them to Polynesia, where he is accredited with maintaining a unique establishment with his household of females. In 1896, just seven years after the experiment commenced, the reports say he is the father of 370 children.

The following is a report from Raleigh, N.C., on July 28, 1893, to the New York Evening Post:—

"The fecundity of the negro race has been the subject of much comment and discussion. A case has come to light in this State that is one of the most remarkable on record. Moses Williams, a negro farmer, lives in the eastern section of this State. He is sixty-five years old (as nearly as he can make out), but does not appear to be over fifty. He has been married twice, and by the two wives has had born to him 45 children. By the first wife he had 23 children, 20 of whom were girls and 3 were boys. By the second wife he had 22 children—20 girls and 2 boys. He also has about 50 grand-children. The case is well authenticated."

We also quote the following, accredited to the "Annals of Hygiene:"—

"Were it not part of the records of the Berks County courts, we could hardly credit the history of John Heffner, who was accidentally killed some years ago at the age of sixty-nine. He was married first in 1840. In eight years his wife bore him 17 children. The first and second years of their marriage she gave birth to twins. For four successive years afterward she gave birth to triplets. In the seventh year she gave birth to one child and died soon afterward. Heffner engaged a young woman to look after his large brood of babies, and three months later she became the second Mrs. Heffner. She presented her husband with 2 children in the first two years of her wedded life. Five years later she had added 10 more to the family, having twins 5 times. Then for three years she added but 1 a year. At the time of the death of the second wife 12 of the 32 children had died. The 20 that were left did not appear to be any obstacle to a young widow with one child consenting to become the third wife of the jolly little man, for he was known as one of the happiest and most genial of men, although it kept him toiling like a slave to keep a score of mouths in bread. The third Mrs. Heffner became the mother of 9 children in ten years, and the contentment and happiness of the couple were proverbial. One day, in the fall of 1885, the father of the 41 children was crossing a railroad track and was run down by a locomotive and instantly killed. His widow and 24 of the 42 children are still living."

Many Marriages.—In this connection it seems appropriate to mention a few examples of multimarriages on record, to give an idea of the possibilities of the extent of paternity. St. Jerome mentions a widow who married her twenty-second husband, who in his time had taken to himself 20 loving spouses. A gentleman living in Bordeaux in 1772 had been married 16 times. DeLongueville, a Frenchman, lived to be one hundred and ten years old, and had been joined in matrimony to 10 wives, his last wife bearing him a son in his one hundred and first year.

Possible Descendants.—When we indulge ourselves as to the possible number of living descendants one person may have, we soon get extraordinary figures. The Madrid Estafette states that a gentleman, Senor Lucas Nequeiras Saez, who emigrated to America seventy years previously, recently returned to Spain in his own steamer, and brought with him his whole family, consisting of 197 persons. He had been thrice married, and by his first wife had 11 children at 7 births; by his second wife, 19 at 13 births, and by his third wife, 7 at 6 births. The youngest of the 37 was thirteen years old and the eldest seventy. This latter one had a son aged forty-seven and 16 children besides. He had 34 granddaughters, 45 grandsons, 45 great granddaughters, 39 great grandsons, all living. Senor Saez himself was ninety-three years old and in excellent health.

At Litchfield, Conn., there is said to be the following inscription:—

"Here lies the body of Mrs. Mary, wife of Dr. John Bull, Esq. She died November 4, 1778, aetat. ninety, having had 13 children, 101 grandchildren, 274 great grandchildren, and 22 great-great grandchildren, a total of 410; surviving, 336."

In Esher Church there is an inscription, scarcely legible, which records the death of the mother of Mrs. Mary Morton on April 18, 1634, and saying that she was the wonder of her sex and age, for she lived to see nearly 400 issued from her loins.

The following is a communication to "Notes and Queries," March 21, 1891: "Mrs. Mary Honeywood was daughter and one of the coheiresses of Robert Waters, Esq., of Lenham, in Kent. She was born in 1527; married in February, 1543, at sixteen years of age, to her only husband, Robert Honeywood, Esq., of Charing, in Kent. She died in the ninety-third year of her age, in May, 1620. She had 16 children of her own body, 7 sons and 9 daughters, of whom one had no issue, 3 died young—the youngest was slain at Newport battle, June 20, 1600. Her grandchildren, in the second generation, were 114; in the third, 228, and in the fourth, 9; so that she could almost say the same as the distich doth of one of the Dalburg family of Basil: 'Rise up, daughter and go to thy daughter, for thy daughter's daughter hath a daughter.'

"In Markshal Church, in Essex, on Mrs. Honeywood's tomb is the following inscription: 'Here lieth the body of Mary Waters, the daughter and coheir of Robert Waters, of Lenham, in Kent, wife of Robert Honeywood, of Charing, in Kent, her only husband, who had at her decease, lawfully descended from her, 367 children, 16 of her own body, 114 grandchildren, 228 in the third generation, and 9 in the fourth. She lived a most pious life and died at Markshal, in the ninety-third year of her age and the forty-fourth of her widowhood, May 11, 1620.' (From 'Curiosities for the Ingenious,' 1826.) S. S. R."

Animal prolificity though not finding a place in this work, presents some wonderful anomalies.

In illustration we may note the following: In the Illustrated London News, May 11, 1895, is a portrait of "Lady Millard," a fine St. Bernard bitch, the property of Mr. Thorp of Northwold, with her litter of 21 puppies, born on February 9, 1896, their sire being a magnificent dog—"Young York." There is quoted an incredible account of a cow, the property of J. N. Sawyer of Ohio, which gave birth to 56 calves, one of which was fully matured and lived, the others being about the size of kittens; these died, together with the mother. There was a cow in France, in 1871, delivered of 5 calves.



CHAPTER V.

MAJOR TERATA.

Monstrosities have attracted notice from the earliest time, and many of the ancient philosophers made references to them. In mythology we read of Centaurs, impossible beings who had the body and extremities of a beast; the Cyclops, possessed of one enormous eye; or their parallels in Egyptian myths, the men with pectoral eyes,—the creatures "whose heads do beneath their shoulders grow;" and the Fauns, those sylvan deities whose lower extremities bore resemblance to those of a goat. Monsters possessed of two or more heads or double bodies are found in the legends and fairy tales of every nation. Hippocrates, his precursors, Empedocles and Democritus, and Pliny, Aristotle, and Galen, have all described monsters, although in extravagant and ridiculous language.

Ballantyne remarks that the occasional occurrence of double monsters was a fact known to the Hippocratic school, and is indicated by a passage in De morbis muliebribus, in which it is said that labor is gravely interfered with when the infant is dead or apoplectic or double. There is also a reference to monochorionic twins (which are by modern teratologists regarded as monstrosities) in the treatise De Superfoetatione, in which it is stated that "a woman, pregnant with twins, gives birth to them both at the same time, just as she has conceived them; the two infants are in a single chorion."

Ancient Explanations of Monstrosities.—From the time of Galen to the sixteenth century many incredible reports of monsters are seen in medical literature, but without a semblance of scientific truth. There has been little improvement in the mode of explanation of monstrous births until the present century, while in the Middle Ages the superstitions were more ludicrous and observers more ignorant than before the time of Galen. In his able article on the teratologic records of Chaldea, Ballantyne makes the following trite statements: "Credulity and superstition have never been the peculiar possession of the lower types of civilization only, and the special beliefs that have gathered round the occurrence of teratologic phenomena have been common to the cultured Greek and Roman of the past, the ignorant peasant of modern times, and the savage tribes of all ages. Classical writings, the literature of the Middle Ages, and the popular beliefs of the present day all contain views concerning teratologic subjects which so closely resemble those of the Chaldean magi as to be indistinguishable from them. Indeed, such works as those of Obsequens, Lycosthenes, Licetus, and Ambroise Pare only repeat, but with less accuracy of description and with greater freedom of imagination, the beliefs of ancient Babylon. Even at the present time the most impossible cases of so-called 'maternal impressions' are widely scattered through medical literature; and it is not very long since I received a letter from a distinguished member of the profession asking me whether, in my opinion, I thought it possible for a woman to give birth to a dog. Of course, I do not at all mean to infer that teratology has not made immense advances within recent times, nor do I suggest that on such subjects the knowledge of the magi can be compared with that of the average medical student of the present; but what I wish to emphasize is that, in the literature of ancient Babylonia, there are indications of an acquaintance with structural defects and malformations of the human body which will compare favorably with even the writings of the sixteenth century of the Christian era."

Many reasons were given for the existence of monsters, and in the Middle Ages these were as faulty as the descriptions themselves. They were interpreted as divinations, and were cited as forebodings and examples of wrath, or even as glorifications of the Almighty. The semi-human creatures were invented or imagined, and cited as the results of bestiality and allied forms of sexual perversion prevalent in those times. We find minute descriptions and portraits of these impossible results of wicked practices in many of the older medical books. According to Pare there was born in 1493, as the result of illicit intercourse between a woman and a dog, a creature resembling in its upper extremities its mother, while its lower extremities were the exact counterpart of its canine father. This particular case was believed by Bateman and others to be a precursor to the murders and wickedness that followed in the time of Pope Alexander I. Volateranus, Cardani, and many others cite instances of this kind. Lycosthenes says that in the year 1110, in the bourg of Liege, there was found a creature with the head, visage, hands, and feet of a man, and the rest of the body like that of a pig. Pare quotes this case and gives an illustration. Rhodiginus mentions a shepherd of Cybare by the name of Cratain, who had connection with a female goat and impregnated her, so that she brought forth a beast with a head resembling that of the father, but with the lower extremities of a goat. He says that the likeness to the father was so marked that the head-goat of the herd recognized it, and accordingly slew the goatherd who had sinned so unnaturally.

In the year 1547, at Cracovia, a very strange monster was born, which lived three days. It had a head shaped like that of a man; a nose long and hooked like an elephant's trunk; the hands and feet looking like the web-foot of a goose; and a tail with a hook on it. It was supposed to be a male, and was looked upon as a result of sodomy. Rueff says that the procreation of human beings and beasts is brought about—

(1) By the natural appetite;

(2) By the provocation of nature by delight;

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

Plutarch, in his "Lesser Parallels," says that Aristonymus Ephesius, son of Demonstratus, being tired of women, had carnal knowledge with an ass, which in the process of time brought forth a very beautiful child, who became the maid Onoscelin. He also speaks of the origin of the maiden Hippona, or as he calls her, Hippo, as being from the connection of a man with a mare. Aristotle mentions this in his paradoxes, and we know that the patron of horses was Hippona. In Helvetia was reported the existence of a colt (whose mother had been covered by a bull) that was half horse and half bull. One of the kings of France was supposed to have been presented with a colt with the hinder part of a hart, and which could outrun any horse in the kingdom. Its mother had been covered by a hart.

Writing in 1557, Lycosthenes reports the mythical birth of a serpent by a woman. It is quite possible that some known and classified type of monstrosity was indicated here in vague terms. In 1726 Mary Toft, of Godalming, in Surrey, England, achieved considerable notoriety throughout Surrey, and even over all England, by her extensively circulated statements that she bore rabbits. Even at so late a day as this the credulity of the people was so great that many persons believed in her. The woman was closely watched, and being detected in her maneuvers confessed her fraud. To show the extent of discussion this case called forth, there are no less than nine pamphlets and books in the Surgeon-General's library at Washington devoted exclusively to this case of pretended rabbit-breeding. Hamilton in 1848, and Hard in 1884, both report the births in this country of fetal monstrosities with heads which showed marked resemblance to those of dogs. Doubtless many of the older cases of the supposed results of bestiality, if seen to-day, could be readily classified among some of our known forms of monsters. Modern investigation has shown us the sterile results of the connections between man and beast or between beasts of different species, and we can only wonder at the simple credulity and the imaginative minds of our ancestors. At one period certain phenomena of nature, such as an eclipse or comet, were thought to exercise their influence on monstrous births. Rueff mentions that in Sicily there happened a great eclipse of the sun, and that women immediately began to bring forth deformed and double-headed children.

Before ending these preliminary remarks, there might be mentioned the marine monsters, such as mermaids, sea-serpents, and the like, which from time to time have been reported; even at the present day there are people who devoutly believe that they have seen horrible and impossible demons in the sea. Pare describes and pictures a monster, at Rome, on November 3, 1520, with the upper portion of a child apparently about five or six years old, and the lower part and ears of a fish-like animal. He also pictures a sea-devil in the same chapter, together with other gruesome examples of the power of imagination.

Early Teratology.—Besides such cases as the foregoing, we find the medieval writers report likely instances of terata, as, for instance, Rhodiginus, who speaks of a monster in Italy with two heads and two bodies; Lycosthenes saw a double monster, both components of which slept at the same time; he also says this creature took its food and drink simultaneously in its two mouths. Even Saint Augustine says that he knew of a child born in the Orient who, from the belly up, was in all parts double.

The first evidences of a step toward classification and definite reasoning in regard to the causation of monstrosities were evinced by Ambroise Pare in the sixteenth century, and though his ideas are crude and some of his phenomena impossible, yet many of his facts and arguments are worthy of consideration. Pare attributed the cause of anomalies of excess to an excessive quantity of semen, and anomalies of default to deficiency of the same fluid. He has collected many instances of double terata from reliable sources, but has interspersed his collection with accounts of some hideous and impossible creatures, such as are illustrated in the accompanying figure, which shows a creature that was born shortly after a battle of Louis XII, in 1512; it had the wings, crest, and lower extremity of a bird and a human head and trunk; besides, it was an hermaphrodite, and had an extra eye in the knee. Another illustration represents a monstrous head found in an egg, said to have been sent for examination to King Charles at Metz in 1569. It represented the face and visage of a man, with small living serpents taking the place of beard and hair. So credulous were people at this time that even a man so well informed as Pare believed in the possibility of these last two, or at least represented them as facts. At this time were also reported double hermaphroditic terata, seemingly without latter-day analogues. Rhodiginus speaks of a two-headed monster born in Ferrari, Italy, in 1540, well formed, and with two sets of genitals, one male and the other female. Pare gives a picture of twins, born near Heidelberg in 1486, which had double bodies joined back to back; one of the twins had the aspect of a female and the other of a male, though both had two sets of genitals.

Scientific Teratology.—About the first half of the eighteenth century what might be called the positive period of teratology begins. Following the advent of this era come Mery, Duverney, Winslow, Lemery, and Littre. In their works true and concise descriptions are given and violent attacks are made against the ancient beliefs and prejudices. From the beginning of the second half of the last century to the present time may be termed the scientific epoch of teratology. We can almost with a certainty start this era with the names of Haller, Morgagni, Geoffroy-Saint-Hilaire, and Meckel, who adduced the explanations asked for by Harvey and Wolff. From the appearance of the treatise by Geoffroy-Saint-Hilaire, teratology has made enormous strides, and is to-day well on the road to becoming a science. Hand in hand with embryology it has been the subject of much investigation in this century, and to enumerate the workers of the present day who have helped to bring about scientific progress would be a task of many pages. Even in the artificial production of monsters much has been done, and a glance at the work of Dareste well repays the trouble. Essays on teratogenesis, with reference to batrachians, have been offered by Lombardini; and by Lereboullet and Knoch with reference to fishes. Foll and Warynski have reported their success in obtaining visceral inversion, and even this branch of the subject promises to become scientific.

Terata are seen in the lower animals and always excite interest. Pare gives the history of a sheep with three heads, born in 1577; the central head was larger than the other two, as shown in the accompanying illustration. Many of the Museums of Natural History contain evidences of animal terata. At Hallae is a two-headed mouse; the Conant Museum in Maine contains the skeleton of an adult sheep with two heads; there was an account of a two-headed pigeon published in France in 1734; Leidy found a two-headed snake in a field near Philadelphia; Geoffroy Saint-Hilaire and Conant both found similar creatures, and there is one in the Museum at Harvard; Wyman saw a living double-headed snake in the Jardin des Plantes in Paris in 1853, and many parallel instances are on record.

Classification.—We shall attempt no scientific discussion of the causation or embryologic derivation of the monster, contenting ourselves with simple history and description, adding any associate facts of interest that may be suggested. For further information, the reader is referred to the authors cited or to any of the standard treatises on teratology.

Many classifications of terata have been offered, and each possesses some advantage. The modern reader is referred to the modification of the grouping of Geoffroy-Saint-Hilaire given by Hirst and Piersol, or those of Blanc and Guinard. For convenience, we have adopted the following classification, which will include only those monsters that have LIVED AFTER BIRTH, and who have attracted general notice or attained some fame in their time, as attested by accounts in contemporary literature.

CLASS 1.—Union of several fetuses. CLASS 2.—Union of two distinct fetuses by a connecting band. CLASS 3.—Union of two distinct fetuses by an osseous junction of the cranial bones. CLASS 4.—Union of two distinct fetuses in which one or more parts are eliminated by the junction. CLASS 5.—Fusion of two fetuses by a bony union of the ischii. CLASS 6.—Fusion of two fetuses below the umbilicus into a common lower extremity. CLASS 7.—Bicephalic monsters. CLASS 8.—Parasitic monsters. CLASS 9.—Monsters with a single body and double lower extremities. CLASS 10.—Diphallic terata. CLASS 11.—Fetus in fetu, and dermoid cysts. CLASS 12.—Hermaphrodites.

CLASS I.—Triple Monsters.—Haller and Meckel were of the opinion that no cases of triple monsters worthy of credence are on record, and since their time this has been the popular opinion. Surely none have ever lived. Licetus describes a human monster with two feet and seven heads and as many arms. Bartholinus speaks of a three-headed monster who after birth gave vent to horrible cries and expired. Borellus speaks of a three-headed dog, a veritable Cerberus. Blasius published an essay on triple monsters in 1677. Bordenave is quoted as mentioning a human monster formed of three fetuses, but his description proves clearly that it was only the union of two. Probably the best example of this anomaly that we have was described by Galvagni at Cattania in 1834. This monster had two necks, on one of which was a single head normal in dimensions. On the other neck were two heads, as seen in the accompanying illustration. Geoffroy-Saint-Hilaire mentions several cases, and Martin de Pedro publishes a description of a case in Madrid in 1879. There are also on record some cases of triple monster by inclusion which will be spoken of later. Instances in the lower animals have been seen, the three-headed sheep of Pare, already spoken of, being one.

CLASS II.—Double Monsters.—A curious mode of junction, probably the most interesting, as it admits of longer life in these monstrosities, is that of a simple cartilaginous band extending between two absolutely distinct and different individuals. The band is generally in the sternal region. In 1752 there was described a remarkable monstrosity which consisted of conjoined twins, a perfect and an imperfect child, connected at their ensiform cartilages by a band 4 inches in circumference. The Hindoo sisters, described by Dr. Andrew Berry, lived to be seven years old; they stood face to face, with their chests 6 1/2 inches and their pubes 8 1/2 inches apart. Mitchell describes the full-grown female twins, born at Newport, Ky., called the Newport twins. The woman who gave birth to them became impregnated, it is said, immediately after seeing the famous Siamese twins, and the products of this pregnancy took the conformation of those celebrated exhibitionists.

Perhaps the best known of all double monsters were the Siamese twins. They were exhibited all over the globe and had the additional benefit and advertisement of a much mooted discussion as to the advisability of their severance, in which opinions of the leading medical men of all nations were advanced. The literature on these famous brothers is simply stupendous. The amount of material in the Surgeon General's library at Washington would surprise an investigator. A curious volume in this library is a book containing clippings, advertisements, and divers portraits of the twins. It will be impossible to speak at all fully on this subject, but a short history and running review of their lives will be given: Eng and Chang were born in Siam about May, 1811. Their father was of Chinese extraction and had gone to Siam and there married a woman whose father was also a Chinaman. Hence, for the most part, they were of Chinese blood, which probably accounted for their dark color and Chinese features. Their mother was about thirty-five years old at the time of their birth and had borne 4 female children prior to Chang and Eng. She afterward had twins several times, having eventually 14 children in all. She gave no history of special significance of the pregnancy, although she averred that the head of one and the feet of the other were born at the same time. The twins were both feeble at birth, and Eng continued delicate, while Chang thrived. It was only with difficulty that their lives were saved, as Chowpahyi, the reigning king, had a superstition that such freaks of nature always presaged evil to the country. They were really discovered by Robert Hunter, a British merchant at Bangkok, who in 1824 saw them boating and stripped to the waist. He prevailed on the parents and King Chowpahyi to allow them to go away for exhibition. They were first taken out of the country by a certain Captain Coffin. The first scientific description of them was given by Professor J. C. Warren, who examined them in Boston, at the Harvard University, in 1829. At that time Eng was 5 feet 2 inches and Chang 5 feet 1 1/2 inches in height. They presented all the characteristics of Chinamen and wore long black queues coiled thrice around their heads, as shown by the accompanying illustration. After an eight-weeks' tour over the Eastern States they went to London, arriving at that port November 20, 1829. Their tour in France was forbidden on the same grounds as the objection to the exhibition of Ritta-Christina, namely, the possibility of causing the production of monsters by maternal impressions in pregnant women. After their European tour they returned to the United States and settled down as farmers in North Carolina, adopting the name of Bunker. When forty-four years of age they married two sisters, English women, twenty-six and twenty-eight years of age, respectively. Domestic infelicity soon compelled them to keep the wives at different houses, and they alternated weeks in visiting each wife. Chang had six children and Eng five, all healthy and strong. In 1869 they made another trip to Europe, ostensibly to consult the most celebrated surgeons of Great Britain and France on the advisability of being separated. It was stated that a feeling of antagonistic hatred after a quarrel prompted them to seek "surgical separation," but the real cause was most likely to replenish their depleted exchequer by renewed exhibition and advertisement.

A most pathetic characteristic of these illustrious brothers was the affection and forbearance they showed for each other until shortly before their death. They bore each other's trials and petty maladies with the greatest sympathy, and in this manner rendered their lives far more agreeable than a casual observer would suppose possible. They both became Christians and members or attendants of the Baptist Church.

Figure 31 is a representation of the Siamese twins in old age. On each side of them is a son. The original photograph is in the Mutter Museum, College of Physicians, Philadelphia.

The feasibility of the operation of separating them was discussed by many of the leading men of America, and Thompson, Fergusson, Syme, Sir J. Y. Simpson, Nelaton, and many others in Europe, with various reports and opinions after examination. These opinions can be seen in full in nearly any large medical library. At this time they had diseased and atheromatous arteries, and Chang, who was quite intemperate, had marked spinal curvature, and shortly afterward became hemiplegic. They were both partially blind in their two anterior eyes, possibly from looking outward and obliquely. The point of junction was about the sterno-siphoid angle, a cartilaginous band extending from sternum to sternum. In 1869 Simpson measured this band and made the distance on the superior aspect from sternum to sternum 4 1/2 inches, though it is most likely that during the early period of exhibition it was not over 3 inches. The illustration shows very well the position of the joining band.

The twins died on January 17, 1874, and a committee of surgeons from the College of Physicians of Philadelphia, consisting of Doctors Andrews, Allen, and Pancoast, went to North Carolina to perform an autopsy on the body, and, if possible, to secure it. They made a long and most interesting report on the results of their trip to the College. The arteries, as was anticipated, were found to have undergone calcareous degeneration. There was an hepatic connection through the band, and also some interlacing diaphragmatic fibers therein. There was slight vascular intercommunication of the livers and independence of the two peritoneal cavities and the intestines. The band itself was chiefly a coalescence of the xyphoid cartilages, surrounded by areolar tissue and skin.

The "Orissa sisters," or Radica-Doddica, shown in Europe in 1893, were similar to the Siamese twins in conformation. They were born in Orissa, India, September, 1889, and were the result of the sixth pregnancy, the other five being normal. They were healthy girls, four years of age, and apparently perfect in every respect, except that, from the ensiform cartilage to the umbilicus, they were united by a band 4 inches long and 2 inches wide. The children when facing each other could draw their chests three or four inches apart, and the band was so flexible that they could sit on either side of the body. Up to the date mentioned it was not known whether the connecting band contained viscera. A portrait of these twins was shown at the World's Fair in Chicago.

In the village of Arasoor, district of Bhavany, there was reported a monstrosity in the form of two female children, one 34 inches and the other 33 3/4 inches high, connected by the sternum. They were said to have had small-pox and to have recovered. They seemed to have had individual nervous systems, as when one was pinched the other did not feel it, and while one slept the other was awake. There must have been some vascular connection, as medicine given to one affected both.

Fig. 36 shows a mode of cartilaginous junction by which each component of a double monster may be virtually independent.

Operations on Conjoined Twins.—Swingler speaks of two girls joined at the xiphoid cartilage and the umbilicus, the band of union being 1 1/2 inches thick, and running below the middle of it was the umbilical cord, common to both. They first ligated the cord, which fell off in nine days, and then separated the twins with the bistoury. They each made early recovery and lived.

In the Ephemerides of 1690 Konig gives a description of two Swiss sisters born in 1689 and united belly to belly, who were separated by means of a ligature and the operation afterward completed by an instrument. The constricting band was formed by a coalition of the xiphoid cartilages and the umbilical vessels, surrounded by areolar tissue and covered with skin. Le Beau says that under the Roman reign, A. D. 945, two male children were brought from Armenia to Constantinople for exhibition. They were well formed in every respect and united by their abdomens. After they had been for some time an object of great curiosity, they were removed by governmental order, being considered a presage of evil. They returned, however, at the commencement of the reign of Constantine VII, when one of them took sick and died. The surgeons undertook to preserve the other by separating him from the corpse of his brother, but he died on the third day after the operation.

In 1866 Boehm gives an account of Guzenhausen's case of twins who were united sternum to sternum. An operation for separation was performed without accident, but one of the children, already very feeble, died three days after; the other survived. The last attempt at an operation like this was in 1881, when Biaudet and Buginon attempted to separate conjoined sisters (Marie-Adele) born in Switzerland on June 26th. Unhappily, they were very feeble and life was despaired of when the operation was performed, on October 29th. Adele died six hours afterward, and Marie died of peritonitis on the next day.

CLASS III.—Those monsters joined by a fusion of some of the cranial bones are sometimes called craniopagi. A very ancient observation of this kind is cited by Geoffroy-Saint-Hilaire. These two girls were born in 1495, and lived to be ten years old. They were normal in every respect, except that they were joined at the forehead, causing them to stand face to face and belly to belly. When one walked forward, the other was compelled to walk backward; their noses almost touched, and their eyes were directed laterally. At the death of one an attempt to separate the other from the cadaver was made, but it was unsuccessful, the second soon dying; the operation necessitated opening the cranium and parting the meninges. Bateman said that in 1501 there was living an instance of double female twins, joined at the forehead. This case was said to have been caused in the following manner: Two women, one of whom was pregnant with the twins at the time, were engaged in an earnest conversation, when a third, coming up behind them, knocked their heads together with a sharp blow. Bateman describes the death of one of the twins and its excision from the other, who died subsequently, evidently of septic infection. There is a possibility that this is merely a duplication of the account of the preceding case with a slight anachronism as to the time of death.

At a foundling hospital in St. Petersburg there were born two living girls, in good health, joined by the heads. They were so united that the nose of one, if prolonged, would strike the ear of the other; they had perfectly independent existences, but their vascular systems had evident connection.

Through extra mobility of their necks they could really lie in a straight line, one sleeping on the side and the other on the back. There is a report a of two girls joined at their vertices, who survived their birth. With the exception of this junction they were well formed and independent in existence. There was no communication of the cranial cavities, but simply fusion of the cranial bones covered by superficial fascia and skin. Daubenton has seen a case of union at the occiput, but further details are not quoted.

CLASS IV.—The next class to be considered is that in which the individuals are separate and well formed, except that the point of fusion is a common part, eliminating their individual components in this location. The pygopagous twins belong in this section. According to Bateman, twins were born in 1493 at Rome joined back to back, and survived their birth. The same authority speaks of a female child who was born with "2 bellies, 4 arms, 4 legs, 2 heads, and 2 sets of privates, and was exhibited throughout Italy for gain's sake." The "Biddenden Maids" were born in Biddenden, Kent, in 1100. Their names were Mary and Eliza Chulkhurst, and their parents were fairly well-to-do people. They were supposed to have been united at the hips and the shoulders, and lived until 1134. At the death of one it was proposed to separate them, but the remaining sister refused, saying, "As we came together, we will also go together," and, after about six hours of this Mezentian existence, they died. They bequeathed to the church-wardens of the parish and their successors land to the extent of 20 acres, at the present time bringing a rental of about $155.00 annually, with the instructions that the money was to be spent in the distribution of cakes (bearing the impression of their images, to be given away on each Easter Sunday to all strangers in Biddenden) and also 270 quartern loaves, with cheese in proportion, to all the poor in said parish. Ballantyne has accompanied his description of these sisters by illustrations, one of which shows the cake. Heaton gives a very good description of these maids; and a writer in "Notes and Queries" of March 27, 1875, gives the following information relative to the bequest:—

"On Easter Monday, at Biddenden, near Staplehurst, Kent, there is a distribution, according to ancient custom, of 'Biddenden Maids' cakes,' with bread and cheese, the cost of which is defrayed from the proceeds of some 20 acres of land, now yielding L35 per annum. and known as the 'Bread and Cheese Lands.' About the year 1100 there lived Eliza and Mary Chulkhurst, who were joined together after the manner of the Siamese twins, and who lived for thirty-four years, one dying, and then being followed by her sister within six hours. They left by their will the lands above alluded to and their memory is perpetuated by imprinting on the cakes their effigies 'in their habit as they lived.' The cakes, which are simple flour and water, are four inches long by two inches wide, and are much sought after as curiosities. These, which are given away, are distributed at the discretion of the church-wardens, and are nearly 300 in number. The bread and cheese amounts to 540 quartern loaves and 470 pounds of cheese. The distribution is made on land belonging to the charity, known as the Old Poorhouse. Formerly it used to take place in the Church, immediately after the service in the afternoon, but in consequence of the unseemly disturbance which used to ensue the practice was discontinued. The Church used to be filled with a congregation whose conduct was occasionally so reprehensible that sometimes the church-wardens had to use their wands for other purposes than symbols of office. The impressions of the maids 'on the cakes are of a primitive character, and are made by boxwood dies cut in 1814. They bear the date 1100, when Eliza and Mary Chulkhurst are supposed to have been born, and also their age at death, thirty-four years."

Ballantyne has summed up about all there is to be said on this national monstrosity, and his discussion of the case from its historic as well as teratologic standpoint is so excellent that his conclusions will be quoted—

"It may be urged that the date fixed for the birth of the Biddenden Maids is so remote as to throw grave doubt upon the reality of the occurrence. The year 1100 was, it will be remembered, that in which William Rufus was found dead in the New Forest, 'with the arrow either of a hunter or an assassin in his breast.' According to the Anglo-Saxon Chronicle, several 'prodigies' preceded the death of this profligate and extravagant monarch. Thus it is recorded that 'at Pentecost blood was observed gushing from the earth at a certain town of Berkshire, even as many asserted who declared that they had seen it. And after this, on the morning after Lammas Day, King William was shot.' Now, it is just possible that the birth of the Biddenden Maids may have occurred later, but have been antedated by the popular tradition to the year above mentioned. For such a birth would, in the opinion of the times, be regarded undoubtedly as a most evident prodigy or omen of evil. Still, even admitting that the date 1100 must be allowed to stand, its remoteness from the present time is not a convincing argument against a belief in the real occurrence of the phenomenon; for of the dicephalic Scottish brothers, who lived in 1490, we have credible historic evidence. Further, Lycosthenes, in his "Chronicon Prodigiorum atque Ostentorum", published in 1557, states, upon what authority I know not, that in the year 1112 joined twins resembling the Biddenden phenomenon in all points save in sex were born in England. The passage is as follows: 'In Anglia natus est puer geminus a clune ad superiores partes ita divisus, ut duo haberet capita, duo corpora integra ad renes cum suis brachiis, qui baptizatus triduo supervixit.' It is just possible that in some way or other this case has been confounded with the story of Biddenden; at any rate, the occurrence of such a statement in Lycosthenes' work is of more than passing interest. Had there been no bequest of land in connection with the case of the Kentish Maids, the whole affair would probably soon have been forgotten.

"There is, however, one real difficulty in accepting the story handed down to us as authentic,—the nature of the teratologic phenomenon itself. All the records agree in stating that the Maids were joined together at the shoulders and hips, and the impression on the cakes and the pictures on the 'broadsides' show this peculiar mode of union, and represent the bodies as quite separate in the space between the above-named points. The Maids are shown with four feet and two arms, the right and left respectively, whilst the other arms (left and right) are fused together at the shoulder according to one illustration, and a little above the elbow according to another. Now, although it is not safe to say that such an anomaly is impossible, I do not know of any case of this peculiar mode of union; but it may be that, as Prof. A. R. Simpson has suggested, the Maids had four separate arms, and were in the habit of going about with their contiguous arms round each other's necks, and that this gave rise to the notion that these limbs were united. If this be so, then the teratologic difficulty is removed, for the case becomes perfectly comparable with the well-known but rare type of double terata known as the pygopagous twins, which is placed by Taruffi with that of the ischiopagous twins in the group dicephalus lecanopagus. Similar instances, which are well known to students of teratology, are the Hungarian sisters (Helen and Judith), the North Carolina twins (Millie and Christine), and the Bohemian twins (Rosalie and Josepha Blazek). The interspace between the thoraces may, however, have simply been the addition of the first artist who portrayed the Maids (from imagination?); then it may be surmised that they were ectopagous twins.

"Pygopagous twins are fetuses united together in the region of the nates and having each its own pelvis. In the recorded cases the union has been usually between the sacra and coccyges, and has been either osseous or (more rarely) ligamentous. Sometimes the point of junction was the middle line posteriorly, at other times it was rather a posterolateral union; and it is probable that in the Biddenden Maids it was of the latter kind; and it is likely, from the proposal made to separate the sisters after the death of one, that it was ligamentous in nature.

"If it be granted that the Biddenden Maids were pygopagous twins, a study of the histories of other recorded cases of this monstrosity serves to demonstrate many common characters. Thus, of the 8 cases which Taruffi has collected, in 7 the twins were female; and if to these we add the sisters Rosalie and Josepha Blazek and the Maids, we have 10 cases, of which 9 were girls. Again, several of the pygopagous twins, of whom there are scientific records, survived birth and lived for a number of years, and thus resembled the Biddenden terata. Helen and Judith, for instance, were twenty-three years old at death; and the North Carolina twins, although born in 1851, are still alive. There is, therefore, nothing inherently improbable in the statement that the Biddenden Maids lived for thirty-four years. With regard also to the truth of the record that the one Maid survived her sister for six hours, there is confirmatory evidence from scientifically observed instances, for Joly and Peyrat (Bull. de l'Acad. Med., iii., pp. 51 and 383, 1874) state that in the case seen by them the one infant lived ten hours after the death of the other. It is impossible to make any statement with regard to the internal structure of the Maids or to the characters of their genital organs, for there is absolutely no information forthcoming upon these points. It may simply be said, in conclusion, that the phenomenon of Biddenden is interesting not only on account of the curious bequest which arose out of it, but also because it was an instance of a very rare teratologic type, occurring at a very early period in our national history."

Possibly the most famous example of twins of this type were Helen and Judith, the Hungarian sisters, born in 1701 at Szony, in Hungary. They were the objects of great curiosity, and were shown successively in Holland, Germany, Italy, France, England, and Poland. At the age of nine they were placed in a convent, where they died almost simultaneously in their twenty-second year. During their travels all over Europe they were examined by many prominent physiologists, psychologists, and naturalists; Pope and several minor poets have celebrated their existence in verse; Buffon speaks of them in his "Natural History," and all the works on teratology for a century or more have mentioned them. A description of them can be best given by a quaint translation by Fisher of the Latin lines composed by a Hungarian physician and inscribed on a bronze statuette of them:—

Two sisters wonderful to behold, who have thus grown as one, That naught their bodies can divide, no power beneath the sun. The town of Szoenii gave them birth, hard by far-famed Komorn, Which noble fort may all the arts of Turkish sultans scorn. Lucina, woman's gentle friend, did Helen first receive; And Judith, when three hours had passed, her mother's womb did leave. One urine passage serves for both;—one anus, so they tell; The other parts their numbers keep, and serve their owners well. Their parents poor did send them forth, the world to travel through, That this great wonder of the age should not be hid from view. The inner parts concealed do lie hid from our eyes, alas! But all the body here you view erect in solid brass.

They were joined back to back in the lumbar region, and had all their parts separate except the anus between the right thigh of Helen and the left of Judith and a single vulva. Helen was the larger, better looking, the more active, and the more intelligent. Judith at the age of six became hemiplegic, and afterward was rather delicate and depressed. They menstruated at sixteen and continued with regularity, although one began before the other. They had a mutual affection, and did all in their power to alleviate the circumstances of their sad position. Judith died of cerebral and pulmonary affections, and Helen, who previously enjoyed good health, soon after her sister's first indisposition suddenly sank into a state of collapse, although preserving her mental faculties, and expired almost immediately after her sister. They had measles and small-pox simultaneously, but were affected in different degree by the maladies. The emotions, inclinations, and appetites were not simultaneous. Eccardus, in a very interesting paper, discusses the physical, moral, and religious questions in reference to these wonderful sisters, such as the advisability of separation, the admissibility of matrimony, and, finally, whether on the last day they would rise as joined in life, or separated.