Anomalies And Curiosities Of Medicine Part 9

Garezky of St. Petersburg collected reports of 379 cases of Cesarean section after death with the following results: 308 were extracted dead; 37 showed signs of life; 34 were born alive. Of the 34, only 5 lived for any length of time. He concludes that if extracted within five or six minutes after death, they may be born alive; if from six to ten minutes, they may still be born alive, though asphyxiated; if from ten to twenty-six minutes, they will be highly asphyxiated. In a great number of these cases the infant was asphyxiated or dead in one minute.

Of course, if the death is sudden, as by apoplexy, accident, or suicide, the child's chances are better. These statistics seem conscientious and reliable, and we are safe in taking them as indicative of the usual result, which discountenances the old reports of death as taking place some time before extraction.

Peuch is credited with statistics showing that in 453 operations 101 children gave signs of life, but only 45 survived.

During the Commune of Paris, Tarnier, one night at the Maternite, was called to an inmate who, while lying in bed near the end of pregnancy, had been killed by a ball which fractured the base of the skull and entered the brain. He removed the child by Cesarean section and it lived for several days. In another case a pregnant woman fell from a window for a distance of more than 30 feet, instant death resulting; thirty minutes at least after the death of the mother an infant was removed, which, after some difficulty, was resuscitated and lived for thirteen years. Tarnier states that delivery may take place three-quarters of an hour or even an hour after the death of the mother, and he also quotes an extraordinary case by Hubert of a successful Cesarean operation two hours after the mother's death; the woman, who was eight months pregnant, was instantly killed while crossing a railroad track.

Hoffman records the case of a successful Cesarean section done ten minutes after death. The patient was a woman of thirty-six, in her eighth month of pregnancy, who was suddenly seized with eclampsia, which terminated fatally in ten hours. Ten minutes after her last respiration the Cesarean section was performed and a living male child delivered. This infant was nourished with the aid of a spoon, but it died in twenty-five hours in consequence of its premature birth and enfeebled vitality.

Green speaks of a woman, nine months pregnant, who was run over by a heavily laden stage-coach in the streets of Southwark. She died in about twenty minutes, and in about twenty minutes more a living child was extracted from her by Cesarean section. There was a similar case in the Hopital St. Louis, in Paris, in 1829; but in this case the child was born alive five minutes after death. Squire tells of a case in which the mother died of dilatation of the aorta, and in from twenty to thirty minutes the child was saved. In comment on this case Aveling is quoted as saying that he believed it possible to save a child one hour after the death of the mother. No less an authority than Playfair speaks of a case in which a child was born half an hour after the death of the mother. Beckman relates the history of a woman who died suddenly in convulsions. The incision was made about five minutes after death, and a male child about four pounds in weight was extracted. The child exhibited feeble heart-contractions and was despaired of. Happily, after numerous and persistent means of resuscitation, applied for about two and a half hours, regular respirations were established and the child eventually recovered. Walter reports a successful instance of removal of the child after the death of the mother from apoplexy.

Cleveland gives an account of a woman of forty-seven which is of special interest. The mother had become impregnated five months after the cessation of menstruation, and a uterine sound had been used in ignorance of the impregnation at this late period. The mother died, and one hour later a living child was extracted by Cesarean section. There are two other recent cases recorded of extraction after an hour had expired from the death. One is cited by Veronden in which the extraction was two hours after death, a living child resulting, and the other by Blatner in which one hour had elapsed after death, when the child was taken out alive.

Cases of rupture of the uterus during pregnancy from the pressure of the contents and delivery of the fetus by some unnatural pa.s.sage are found in profusion through medical literature, and seem to have been of special interest to the older observers. Benivenius saw a case in which the uterus ruptured and the intestines protruded from the v.u.l.v.a.

An instance similar to the one recorded by Benivenius is also found in the last century in Germany. Bouillon and Desbois, two French physicians of the last century, both record examples of the uterus rupturing in the last stages of pregnancy and the mother recovering.

Schreiber gives an instance of rupture of the uterus occasioned by the presence of a 13-pound fetus, and there is recorded the account of a rupture caused by a 20-pound fetus that made its way into the abdomen.

We find old accounts of cases of rupture of the uterus with birth by the umbilicus and the recovery of the woman. Vespre describes a case in which the uterus was ruptured by the feet of the fetus.

Farquharson has an account of a singular case in midwifery in which abdomen ruptured from the pressure of the fetus; and quite recently Geoghegan ill.u.s.trates the possibilities of uterine pressure in pregnancy by a postmortem examination after a fatal parturition, in which the stomach was found pushed through the diaphragm and lying under the left clavicle. Heywood Smith narrates the particulars of a case of premature labor at seven months in which rupture of the uterus occurred and, notwithstanding the fact that the case was complicated by placenta praevia, the patient recovered.

Rupture of the uterus and recovery does not necessarily prevent subsequent successful pregnancy and delivery by the natural channels.

Whinery relates an instance of a ruptured uterus in a healthy Irish woman of thirty-seven from whom a dead child was extracted by abdominal section and who was safely delivered of a healthy female child about one year afterward. a.n.a.logous to this case is that of Lawrence, who details the instance of a woman who had been delivered five times of dead children; she had a very narrow pelvis and labor was always induced at the eighth month to a.s.sure delivery. In her sixth pregnancy she had miscalculated her time, and, in consequence, her uterus ruptured in an unexpected parturition, but she recovered and had several subsequent pregnancies.

Occasionally there is a spontaneous rupture of the v.a.g.i.n.a during the process of parturition, the uterus remaining intact. Wilts.h.i.+re reports such a case in a woman who had a most prominent sacrum; the laceration was transverse and quite extensive, but the woman made a good recovery.

Schauta pictures an exostosis on the promontory of the sacrum.

Blenkinsop cites an instance in which the labor was neither protracted nor abnormally severe, yet the rupture of the v.a.g.i.n.a took place with the escape of the child into the abdomen of the mother, and was from thence extracted by Cesarean section. A peculiarity of this case was the easy expulsion from the uterus, no instrumental or other manual interference being attempted and the uterus remaining perfectly intact.

In some cases there is extensive sloughing of the genitals after parturition with recovery far beyond expectation. Gooch mentions a case in which the whole v.a.g.i.n.a sloughed, yet to his surprise the patient recovered. Aetius and Benivenius speak of recovery in such cases after loss of the whole uterus. Cazenave of Bordeaux relates a most marvelous case in which a primipara suffered in labor from an impacted head. She was twenty-five, of very diminutive stature, and was in labor a long time. After labor, sloughing of the parts commenced and progressed to such an extent that in one month there were no traces of the l.a.b.i.a, nymphae, v.a.g.i.n.a, perineum, or a.n.u.s. There was simply a large opening extending from the meatus urinarius to the coccyx. The rectov.a.g.i.n.al septum, the lower portion of the r.e.c.t.u.m, and the neck of the bladder were obliterated. The woman survived, although she always experienced great difficulty in urination and in entirely emptying the r.e.c.t.u.m. A similar instance is reported in a woman of thirty who was thirty-six hours in labor. The fundus of the uterus descended into the v.a.g.i.n.a and the whole uterine apparatus was removed. The lower part of the r.e.c.t.u.m depended between the l.a.b.i.a; in the presence of the physician the nurse drew this out and it separated at the sphincter ani. On examining the parts a single opening was seen, as in the preceding case, from the p.u.b.es to the coccyx. Some time afterward the end of the intestine descended several inches and hung loosely on the concave surface of the r.e.c.t.u.m. A sponge was introduced to support the r.e.c.t.u.m and prevent access of air. The destruction of the parts was so complete and the opening so large as to bring into view the whole inner surface of the pelvis, in spite of which, after prolonged suppuration, the wound cicatrized from behind forward and health returned, except as regards the inconvenience of feces and urine. Milk-secretion appeared late and lasted two months without influencing the other functions.

There are cases in which, through the ignorance of the midwife or the physician, prolapsed pelvic organs are mistaken for afterbirth and extracted. There have been instances in which the whole uterus and its appendages, not being recognized, have been dragged out. Walters cites the instance of a woman of twenty-two, who was in her third confinement. The midwife in attendance, finding the afterbirth did not come away, pulled at the funis, which broke at its attachment. She then introduced her hand and tore away what proved to be the whole of the uterus, with the right ovary and fallopian tube, a portion of the round ligament, and the left tube and ovarian ligament attached to it. A large quant.i.ty of omentum protruded from the v.u.l.v.a and upper part of the v.a.g.i.n.a, and an enormous rent was left. Walters saw the woman twenty-one hours afterward, and ligated and severed the protruding omentum. On the twenty-eighth day, after a marvelous recovery, she was able to drive to the Royal Berks.h.i.+re Hospital, a distance of five miles. At the time of report, two years and six months after the mutilation, she was in perfect health. Walters looked into the statistics of such cases and found 36 accidental removals of the uterus in the puerperium with 14 recoveries. All but three of these were without a doubt attended by previous inversion of the uterus.

A medical man was tried for manslaughter in 1878 because he made a similar mistake. He had delivered a woman by means of the forceps, and, after delivery, brought away what he thought a tumor. This "tumor"

consisted of the uterus, with the placenta attached to the fundus, the funis, a portion of the lateral ligament, containing one ovary and about three inches of v.a.g.i.n.a. The uterus was not inverted. A horrible case, with similar results, happened in France, and was reported by Tardieu. A brutal peasant, whose wife was pregnant, dragged out a fetus of seven months, together with the uterus and the whole intestinal ca.n.a.l, from within 50 cm. of the pylorus to within 8 cm. of the ileocecal valve. The woman was seen three-quarters of an hour after the intestines had been found in the yard (where the brute had thrown them), still alive and reproaching her murderer. Hoffman cites an instance in which a midwife, in her anxiety to extract the afterbirth, made traction on the cord, brought out the uterus, ovaries, and tubes, and tore the v.u.l.v.a and perineum as far as the a.n.u.s.

Woodson tells the story of a negress who was four months pregnant, and who, on being seized with severe uterine pains in a bath, succeeded in seizing the fetus and dragging it out, but inverting the uterus in the operation. There is a case recorded of a girl of eighteen, near her labor, who, being driven from her house by her father, took refuge in a neighboring house, and soon felt the pains of child-birth. The accoucheur was summoned, p.r.o.nounced them false pains, and went away. On his return he found the girl dying, with her uterus completely inverted and hanging between her legs. This unfortunate maiden had been delivered while standing upright, with her elbows on the back of a chair. The child suddenly escaped, bringing with it the uterus, but as the funis ruptured the child fell to the floor. Wagner pictures partial prolapse of the womb in labor.

It would too much extend this chapter to include the many accidents incident to labor, and only a few of especial interest will be given.

Cases like rupture of an aneurysm during labor, extensive hemorrhage, the entrance of air into the uterine veins and sinuses, and common lacerations will be omitted, together with complicated births like those of double monsters, etc., but there are several other cases that deserve mention. Eldridge gives an instance of separation of the symphysis pubis during labor,--a natural symphysiotomy. A separation of 3/4 inch could be discerned at the symphysis, and in addition the sacroiliac synchondrosis was also quite movable. The woman had not been able to walk in the latter part of her pregnancy. The child weighed 10 1/2 pounds and had a large head in a remarkably advanced stage of ossification, with the fontanelles nearly closed. Delivery was effected, though during the pa.s.sage of the head the p.u.b.es separated to such an extent that Eldridge placed two fingers between them. The mother recovered, and had perfect union and normal locomotion.

Sanders reports a case of the separation of the pubic bones in labor.

Studley mentions a case of fracture of the pelvis during instrumental delivery. Humphreys cites a most curious instance. The patient, it appears, had a large exostosis on the body of the p.u.b.es which, during parturition, was forced through the walls of the uterus and bladder, resulting in death. Kilian reports four cases of death from perforation of the uterus in this manner. Schauta pictures such an exostosis.

Chandler relates an instance in which there was laceration of the liver during parturition; and Hubbard records a case of rupture of the spleen after labor.

Symphysiotomy is an operation consisting of division of the pubic symphysis in order to facilitate delivery in narrow pelves. This operation has undergone a most remarkable revival during the past two years. It originated in a suggestion by Pineau in his work on surgery in 1598, and in 1665 was first performed by La Courvee upon a dead body in order to save the child, and afterward by Plenk, in 1766, for the same purpose. In 1777 Sigault first proposed the operation on the living, and Ferrara was the one to carry out, practically, the proposition,--although Sigault is generally considered to be the first symphysiotormist, and the procedure is very generally known as the "Sigaultean operation." From Ferrara's time to 1858, when the operation had practically died out, it had been performed 85 times, with a recorded mortality of 33 per cent. In 1866 the Italians, under the leaders.h.i.+p of Morisani of Naples, revived the operation, and in twenty years had performed it 70 times with a mortality of 24 per cent. Owing to rigid antiseptic technic, the last 38 of these operations (1886 to 1891) showed a mortality of only 50 per cent, while the infant-mortality was only 10 2/3 per cent. The modern history of this operation is quite interesting, and is very completely reviewed by Hirst and Dorland.

In November, 1893, Hirst reported 212 operations since 1887, with a maternal mortality of 12.73 per cent and a fetal mortality of 28 per cent. In his later statistics Morisani gives 55 cases with 2 maternal deaths and 1 infantile death, while Zweifel reports 14 cases from the Leipzig clinic with no maternal death and 2 fetal deaths, 1 from asphyxia and 1 from pneumonia, two days after birth. All the modern statistics are correspondingly encouraging.

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 b.r.e.a.s.t.s, 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 b.r.e.a.s.t.s 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 n.o.blewoman 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 s.h.i.+eld 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 cla.s.ses 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 cla.s.ses 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 circ.u.mstances 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 circ.u.mstances, such as fas.h.i.+on, war, poverty, etc., at some period have temporarily lowered the average of prolificity; but a further search finds another period, under opposite circ.u.mstances, 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 s.e.xual intercourse, or, if there is the same desire, the unprolific prost.i.tute furnishes the satisfaction; and such facts as these, coupled with many similar ones, soon produce an astonis.h.i.+ng 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 pa.s.sed 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 surpa.s.sed 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 s.p.a.ce 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 quant.i.ty of s.e.m.e.n, the greater the number of children at birth. Pare, later, uses a similar reason to explain the causation of monstrosities, grouping them into two cla.s.ses, those due to deficiency of s.e.m.e.n, 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 s.e.m.e.n 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 superst.i.tious 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 n.o.ble 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 G.o.d 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 superst.i.tious 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 s.e.xes 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.