Chapter XIV · (continued 2)

Nerve-grafting, as a supplementary operation to neurectomy, has been practiced, and Gersung has transplanted the nerves of lower animals to the nerve stumps of man.

Bone-grafting is quite frequently practiced, portions from a recently amputated limb, or portions removed from living animals, or bone-chips, may be used. Senn proposed decalcified bone-plates to be used to fill in the gaps. Shifting of the bone has been done, e.g., by dividing a strip of the hard palate covered with its soft parts, parallel to the fissure in cleft palate, but leaving unsevered the bony attachments in front, and partially fracturing the pedicle, drawing the bony flaps together with sutures; or, when forming a new nose, by turning down with the skin and periosteum the outer table of the frontal bone, split off with a chisel, after cutting around the part to be removed. Trueheart reports a case of partial excision of the clavicle, successfully followed by the grafting of periosteal and osseous material taken from a dog. Robson and Hayes of Rochester, N.Y., have successfully supplemented excision of spina bifida by the transplantation of a strip of periosteum from a rabbit. Poncet hastened a cure in a case of necrosis with partial destruction of the periosteum by inserting grafts taken from the bones of a dead infant and from a kid. Ricketts speaks of bone-grafting and the use of ivory, and remarks that Poncet of Lyons restored a tibia in nine months by grafting to the superior articular surface. Recently amalgam fillings have been used in bone-cavities to supplant grafting.

In destructive injuries of the skin, various materials were formerly used in grafting, none of which, however, have produced the same good effect as the use of skin by the Thiersch Method, which will be described later.

Rodgers, U.S.N., reports the case of a white man of thirty-eight who suffered from gangrene of the skin of the buttocks caused by sitting in a pan of caustic potash. When seen the man was intoxicated, and there was a gangrenous patch four by six inches on his buttocks. Rodgers used grafts from the under wing of a young fowl, as suggested by Redard, with good result. Vanmeter of Colorado describes a boy of fourteen with a severe extensive burn; a portion beneath the chin and lower jaw, and the right arm from the elbow to the fingers, formed a granulating surface which would not heal, and grafting was resorted to. The neck-grafts were supplied by the skin of the father and brother, but the arm-grafts were taken from two young puppies of the Mexican hairless breed, whose soft, white, hairless skin seemed to offer itself for the purpose with good prospect of a successful result. The outcome was all that could be desired. The puppy-grafts took faster and proved themselves to be superior to the skin-grafts. There is a case reported in which the skin of a greyhound seven days old, taken from the abdominal wall and even from the tail, was used with most satisfactory results in grafting an extensive ulcer following a burn on the left leg of a boy of ten. Masterman has grafted with the inner membrane of a hen's egg, and a Mexican surgeon, Altramirano, used the gills of a cock.

Fowler of Brooklyn has grafted with the skin from the back and abdomen of a large frog. The patient was a colored boy of sixteen, who was extensively burned by a kerosene lamp. The burns were on the legs, thighs, buttocks, and right ankle, and the estimated area of burnt surface was 247.95 square inches. The frog skin was transferred to the left buttocks, and on the right buttocks eight long strips of white skin were transferred after the manner of Thiersch. A strip of human skin was placed in one section over the frog skin, but became necrotic in four days, not being attached to the granulating surface. The man was discharged cured in six months. The frog skin was soft, pliable, and of a reddish hue, while the human white skin was firm and rapidly becoming pigmented. Leale cites the successful use of common warts in a case of grafting on a man of twenty who was burned on the foot by a stream of molten metal. Leale remarks that as common warts of the skin are collections of vascular papillae, admitting of separation without injury to their exceptionally thick layer of epidermis, they are probably better for the purposes of skin-grafting than ordinary skin of less vitality or vascularity. Ricketts has succeeded in grafting the skin of a frog to that of a tortoise, and also grafting frog skin to human skin. Ricketts remarks that the prepuce of a boy is remarkably good material for grafting. Sponge-grafts are often used to hasten cicatrization of integumental wounds. There is recorded an instance in which the breast of a crow and the back of a rat were grafted together and grew fast. The crow dragged the rat along, and the two did not seem to care to part company.

Relative to skin-grafting proper, Bartens succeeded in grafting the skin of a dead man of seventy on a boy of fourteen. Symonds reports cases of skin-grafting of large flaps from amputated limbs, and says this method is particularly available in large hospitals where they have amputations and grafts on the same day. Martin has shown that, after many hours of exposure in the open air at a temperature of nearly 32 degrees F., grafts could be successfully applied, but in such temperatures as 82 degrees F., exposure of from six to seven hours destroyed their vitality, so that if kept cool, the limb of a healthy individual amputated for some accident, may be utilized for grafting purposes.

Reverdin originated the procedure of epidermic grafting. Small grafts the size of a pin-head doing quite as well as large ones. Unfortunately but little diminution of the cicatricial contraction is effected by Reverdin's method. Thiersch contends that healing of a granulated surface results first from a conversion of the soft, vascular granulation-papillae, by contraction of some of their elements into young connective-tissue cells, into "dry, cicatricial papillae," actually approximating the surrounding tissues, thus diminishing the area to be covered by epidermis; and, secondly, by the covering of these papillae by epidermic cells. Thiersch therefore recommends that for the prevention of cicatricial contraction, the grafting be performed with large strips of skin.

Harte gives illustrations of a case of extensive skin-grafting on the thigh from six inches above the great trochanter well over the median line anteriorly and over the buttock. This extent is shown in Figure 228, taken five months after the accident, when the granulations had grown over the edge about an inch. Figure 229 shows the surface of the wound, six and one-half months after the accident and three months after the applications of numerous skin-grafts.

Cases of self-mutilation may be divided into three classes:—those in which the injuries are inflicted in a moment of temporary insanity from hallucinations or melancholia; with suicidal intent; and in religious frenzy or emotion. Self-mutilation is seen in the lower animals, and Kennedy, in mentioning the case of a hydrocephalic child who ate off its entire under lip, speaks also of a dog, of cats, and of a lioness who ate off their tails. Kennedy mentions the habit in young children of biting the finger-nails as an evidence of infantile trend toward self-mutilation. In the same discussion Collins states that he knew of an instance in India in which a horse lay down, deliberately exposing his anus, and allowing the crows to pick and eat his whole rectum. In temporary insanity, in fury, or in grief, the lower animals have been noticed by naturalists to mutilate themselves.

Self-mutilation in man is almost invariably the result of meditation over the generative function, and the great majority of cases of this nature are avulsions or amputations of some parts of the genitalia. The older records are full of such instances. Benivenius, Blanchard, Knackstedt, and Schenck cite cases. Smetius mentions castration which was effected by using the finger-nails, and there is an old record in which a man avulsed his own genitals. Scott mentions an instance in which a man amputated his genitals and recovered without subsequent symptoms. Gockelius speaks of self-castration in a ruptured man, and Golding, Guyon, Louis, Laugier, the Ephemerides, Alix, Marstral, and others, record instances of self-castration. In his Essays Montaigne mentions an instance of complete castration performed by the individual himself.

Thiersch mentions a case of a man who circumcised himself when eighteen. He married in 1870, and upon being told that he was a father he slit up the hypogastrium from the symphysis pubis to the umbilicus, so that the omentum protruded; he said his object was to obtain a view of the interior. Although the knife was dirty and blunt, the wound healed after the removal of the extruding omentum. A year later he laid open one side of the scrotum. The prolapsed testicle was replaced, and the wound healed without serious effect. He again laid open his abdomen in 1880, the wound again healing notwithstanding the prolapse of the omentum. In May of the same year he removed the right testicle, and sewed the wound up himself. Four days later the left was treated the same way. The spermatic cord however escaped, and a hematoma, the size of a child's head, formed on account of which he had to go to the hospital. This man acted under an uncontrollable impulse to mutilate himself, and claimed that until he castrated himself he had no peace of mind.

There is a similar report in an Italian journal which was quoted in London. It described a student at law, of delicate complexion, who at the age of fourteen gave himself up to masturbation. He continually studied until the age of nineteen, when he fell into a state of dulness, and complained that his head felt as if compressed by a circle of fire. He said that a voice kept muttering to him that his generative organs were abnormally deformed or the seat of disease. After that, he imagined that he heard a cry of "amputation! amputation!" Driven by this hallucination, he made his first attempt at self-mutilation ten days later. He was placed in an Asylum at Astino where, though closely watched, he took advantage of the first opportunity and cut off two-thirds of his penis, when the delirium subsided. Camp describes a stout German of thirty-five who, while suffering from delirium tremens, fancied that his enemies were trying to steal his genitals, and seizing a sharp knife he amputated his penis close to the pubes. He threw the severed organ violently at his imaginary pursuers. The hemorrhage was profuse, but ceased spontaneously by the formation of coagulum over the mouth of the divided vessels. The wound was quite healed in six weeks, and he was discharged from the hospital, rational and apparently content with his surgical feat.

Richards reports the case of a Brahman boy of sixteen who had contracted syphilis, and convinced, no doubt, that "nocit empta dolore voluptus," he had taken effective means of avoiding injury in the future by completely amputating his penis at the root. Some days after his admission to the hospital he asked to be castrated, stating that he intended to become an ascetic, and the loss of his testes as well as of his penis appeared to him to be an imperative condition to the attainment of that happy consummation. Chevers mentions a somewhat similar case occurring in India.

Sands speaks of a single man of thirty who amputated his penis. He gave an incomplete history of syphilis. After connection with a woman he became a confirmed syphilophobe and greatly depressed. While laboring under the hallucination that he was possessed of two bodies he tied a string around the penis and amputated the organ one inch below the glans. On loosening the string, three hours afterward, to enable him to urinate, he lost three pints of blood, but he eventually recovered. In the Pennsylvania Hospital Reports there is an account of a married man who, after drinking several weeks, developed mania a potu, and was found in his room covered with blood. His penis was completely cut off near the pubes, and the skin of the scrotum was so freely incised that the testicles were entirely denuded, but not injured. A small silver cap was made to cover the sensitive urethra on a line with the abdominal wall.

There is a record of a tall, powerfully-built Russian peasant of twenty-nine, of morose disposition, who on April 3d, while reading his favorite book, without uttering a cry, suddenly and with a single pull tore away his scrotum together with his testes. He then arose from the bank where he had been sitting, and quietly handed the avulsed parts to his mother who was sitting near by, saying to her: "Take that; I do not want it any more." To all questions from his relatives he asked pardon and exemption from blame, but gave no reason for his act. This patient made a good recovery at the hospital. Alexeef, another Russian, speaks of a similar injury occurring during an attack of delirium tremens.

Black details the history of a young man of nineteen who went to his bath-room and deliberately placing his scrotum on the edge of the tub he cut it crossways down to the wood. He besought Black to remove his testicle, and as the spermatic cord was cut and much injured, and hemorrhage could only be arrested by ligature, the testicle was removed. The reason assigned for this act of mutilation was that he had so frequent nocturnal emissions that he became greatly disgusted and depressed in spirit thereby. He had practiced self-abuse for two years and ascribed his emissions to this cause. Although his act was that of a maniac, the man was perfectly rational. Since the injury he had had normal and frequent emissions and erections.

Orwin mentions the case of a laborer of forty who, in a fit of remorse after being several days with a prostitute, atoned for his unfaithfulness to his wife by opening his scrotum and cutting away his left testicle with a pocket knife. The missing organ was found about six yards away covered with dirt. At the time of infliction of this injury the man was calm and perfectly rational. Warrington relates the strange case of Isaac Brooks, an unmarried farmer of twenty-nine, who was found December 5, 1879, with extensive mutilations of the scrotum; he said that he had been attacked and injured by three men. He swore to the identity of two out of the three, and these were transported to ten years' penal servitude. On February 13, 1881, he was again found with mutilation of the external genitals, and again said he had been set upon by four men who had inflicted his injury, but as he wished it kept quiet he asked that there be no prosecution. Just before his death on December 31, 1881, he confessed that he had perjured himself, and that the mutilations were self-performed. He was not aware of any morbid ideas as to his sexual organs, and although he had an attack of gonorrhea ten years before he seemed to worry very little over it. There is an account of a Scotch boy who wished to lead a "holy life," and on two occasions sought the late Mr. Liston's skilful aid in pursuance of this idea. He returned for a third time, having himself unsuccessfully performed castration.

A case of self-mutilation by a soldier who was confined in the guard-house for drunkenness is related by Beck. The man borrowed a knife from a comrade and cut off the whole external genital apparatus, remarking as he flung the parts into a corner: "Any——fool can cut his throat, but it takes a soldier to cut his privates off!" Under treatment he recovered, and then he regretted his action.

Sinclair describes an Irishman of twenty-five who, maniacal from intemperance, first cut off one testicle with a wire nail, and then the second with a trouser-buckle. Not satisfied with the extent of his injuries he drove a nail into his temple, first through the skin by striking it with his hand, and then by butting it against the wall,—the latter maneuver causing his death.

There is on record the history of an insane medical student in Dublin who extirpated both eyes and threw them on the grass. He was in a state of acute mania, and the explanation offered was that as a "grinder" before examination he had been diligently studying the surgery of the eye, and particularly that relating to enucleation. Another Dublin case quoted by the same authority was that of a young girl who, upon being arrested and committed to a police-cell in a state of furious drunkenness, tore out both her eyes. In such cases, as a rule, the finger-nails are the only instrument used. There is a French case also quoted of a woman of thirty-nine who had borne children in rapid succession. While suckling a child three months old she became much excited, and even fanatical, in reading the Bible. Coming to the passage, "If thy right eye offend thee, pluck it out, etc.," she was so impressed with the necessity of obeying the divine injunction that she enucleated her eye with a meat-hook. There is mentioned the case of a young woman who cut off her right hand and cast it into the fire, and attempted to enucleate her eyes, and also to hold her remaining hand in the fire. Haslam reports the history of a female who mutilated herself by grinding glass between her teeth.

Channing gives an account of the case of Helen Miller, a German Jewess of thirty, who was admitted to the Asylum for Insane Criminals at Auburn, N.Y., in October, 1872, and readmitted in June, 1875, suffering from simulation of hematemesis. On September 25th she cut her left wrist and right hand; in three weeks she became again "discouraged" because she was refused opium, and again cut her arms below the elbows, cleanly severing the skin and fascia, and completely hacking the muscles in every direction. Six weeks later she repeated the latter feat over the seat of the recently healed cicatrices. The right arm healed, but the left showed erysipelatous inflammation, culminating in edema, which affected the glottis to such an extent that tracheotomy was performed to save her life. Five weeks after convalescence, during which her conduct was exemplary, she again cut her arms in the same place. In the following April, for the merest trifle, she again repeated the mutilation, but this time leaving pieces of glass in the wounds. Six months later she inflicted a wound seven inches in length, in which she inserted 30 pieces of glass, seven long splinters, and five shoe-nails. In June, 1877, she cut herself for the last time. The following articles were taken from her arms and preserved: Ninety-four pieces of glass, 34 splinters, two tacks, five shoe-nails, one pin, and one needle, besides other things which were lost,—making altogether about 150 articles.

"Needle-girls," etc.—A peculiar type of self-mutilation is the habit sometimes seen in hysteric persons of piercing their flesh with numerous needles or pins. Herbolt of Copenhagen tells of a young Jewess from whose body, in the course of eighteen months, were extracted 217 needles. Sometime after 100 more came from a tumor on the shoulder. As all the symptoms in this case were abdominal, it was supposed that during an epileptic seizure this girl had swallowed the needles; but as she was of an hysteric nature it seems more likely they had entered the body through the skin. There is an instance in which 132 needles were extracted from a young lady's person. Caen describes a woman of twenty-six, while in prison awaiting trial, succeeding in committing suicide by introducing about 30 pins and needles in the chest region, over the heart. Her method was to gently introduce them, and then to press them deeper with a prayer-book. An autopsy showed that some of the pins had reached the lungs, some were in the mediastinum, on the back part of the right auricle; the descending vena cave was perforated, the anterior portion of the left ventricle was transfixed by a needle, and several of the articles were found in the liver. Andrews removed 300 needles from the body of an insane female. The Lancet records an account of a suicide by the penetration of a darning-needle in the epigastrium. There were nine punctures in this region, and in the last the needle was left in situ and fixed by worsted. In 1851 the same journal spoke of an instance in which 30 pins were removed from the limbs of a servant girl. It was said that while hanging clothes, with her mouth full of pins, she was slapped on the shoulder, causing her to start and swallow the pins. There is another report of a woman who swallowed great numbers of pins. On her death one pound and nine ounces of pins were found in her stomach and duodenum. There are individuals known as "human pin-cushions," who publicly introduce pins and needles into their bodies for gain's sake.

The wanderings of pins and needles in the body are quite well known. Schenck records the finding of a swallowed pin in the liver. Haller mentions one that made its way to the hand. Silvy speaks of a case in which a quantity of swallowed pins escaped through the muscles, the bladder, and vagina; there is another record in which the pins escaped many years afterward from the thigh. The Philosophical Transactions contain a record of the escape of a pin from the skin of the arm after it had entered by the mouth. Gooch, Ruysch, Purmann, and Hoffman speak of needle-wanderings. Stephenson gives an account of a pin which was finally voided by the bladder after forty-two years' sojourn in a lady's body. On November 15, 1802, the celebrated Dr. Lettsom spoke of an old lady who sat on a needle while riding in a hackney coach; it passed from the injured leg to the other one, whence it was extracted. Deckers tells of a gentleman who was wounded in the right hypochondrium, the ball being taken thirty years afterward from the knee. Borellus gives an account of a thorn entering the digit and passing out of the body by the anus.

Strange as it may seem, a prick of a pin not entering a vital center or organ has been the indirect cause of death. Augenius writes of a tailor who died in consequence of a prick of a needle between the nail and flesh of the end of the thumb. Amatus Lusitanus mentions a similar instance in an old woman, although, from the symptoms given, the direct cause was probably tetanus. In modern times Cunninghame, Boring, and Hobart mention instances in which death has followed the prick of a pin: in Boring's case the death occurred on the fifth day.

Manufacture of Crippled Beggars.—Knowing the sympathy of the world in general for a cripple, in some countries low in the moral scale, voluntary mutilation is sometimes practiced by those who prefer begging to toiling. In the same manner artificial monstrosities have been manufactured solely for gain's sake. We quite often read of these instances in lay-journals, but it is seldom that a case comes under the immediate observation of a thoroughly scientific mind. There is, however, on record a remarkable instance accredited to Jamieson of Shanghai who presented to the Royal College of Surgeons a pair of feet with the following history: Some months previously a Chinese beggar had excited much pity and made a good business by showing the mutilated stumps of his legs, and the feet that had belonged to them slung about his neck. While one day scrambling out of the way of a constable who had forbidden this gruesome spectacle, he was knocked down by a carriage in the streets of Shanghai, and was taken to the hospital, where he was questioned about the accident which deprived him of his feet. After selling the medical attendant his feet he admitted that he had purposely performed the amputations himself, starting about a year previously. He had fastened cords about his ankles, drawing them as tightly as he could bear them, and increasing the pressure every two or three days. For a fortnight his pain was extreme, but when the bones were bared his pains ceased. At the end of a month and a half he was able to entirely remove his feet by partly snapping and partly cutting the dry bone. Such cases appear to be quite common in China, and by investigation many parallels could elsewhere be found.

The Chinese custom of foot-binding is a curious instance of self-mutilation. In a paper quoted in the Philadelphia Medical Times, January 31, 1880, a most minute account of the modus operandi, the duration, and the suffering attendant on this process are given. Strapping of the foot by means of tight bandages requires a period of two or three years' continuance before the desired effect is produced. There is a varying degree of pain, which is most severe during the first year and gradually diminishes after the binding of all the joints is completed. During the binding the girl at night lies across the bed, putting her legs on the edge of the bed-stead in such a manner as to make pressure under the knees, thus benumbing the parts below and avoiding the major degree of pain. In this position, swinging their legs backward and forward, the poor Chinese girls pass many a weary night. During this period the feet are unbound once a month only. The operation is begun by placing the end of a long, narrow bandage on the inside of the instep and carrying it over the four smaller toes, securing them under the foot. After several turns the bandage is reversed so as to compress the foot longitudinally. The young girl is then left for a month, and when the bandage is removed the foot is often found gangrenous and ulcerated, one or two toes not infrequently being lost. If the foot is thus bound for two years it becomes virtually dead and painless. By this time the calf disappears from lack of exercise, the bones are attenuated, and all the parts are dry and shrivelled. In after-life the leg frequently regains its muscles and adipose tissue, but the foot always remains small. The binding process is said to exert a markedly depressing influence upon the emotional character of the subject, which lasts through life, and is very characteristic.

To show how minute some of the feet of the Chinese women are, Figure I of the accompanying plate, taken from a paper by Kenthughes on the "Feet of Chinese Ladies" is from a photograph of a shoe that measured only 3 1/4 inches anteroposteriorly. The foot which it was intended to fill must have been smaller still, for the bandage would take up a certain amount of space. Figure II is a reproduction of a photograph of a foot measuring 5 1/2 inches anteroposteriorly, the wrinkled appearance of the skin being due to prolonged immersion in spirit. This photograph shows well the characteristics of the Chinese foot—the prominent and vertically placed heel, which is raised generally about an inch from the level of the great toe; the sharp artificial cavus, produced by the altered position of the os calcis, and the downward deflection of the foot in front of the mediotarsal joint; the straight and downward pointing great toe, and the infolding of the smaller toes underneath the great toe. In Figure III we have a photograph of the skeleton of a Chinese lady's foot about five inches in anteroposterior diameter. The mesial axis of the os calcis is almost directly vertical, with a slight forward inclination, forming a right angle with the bones in front of the mediotarsal joint. The upper three-quarters of the anterior articular surface of the calcis is not in contact with the cuboid, the latter being depressed obliquely forward and downward, the lower portion of the posterior facet on the cuboid articulating with a new surface on the under portion of the bone. The general shape of the bone closely resembles that of a normal one—a marked contrast to its wasted condition and tapering extremity in paralytic calcaneus. Extension and flexion at the ankle are only limited by the shortness of the ligaments; there is no opposition from the conformation of the bones. The astragalus is almost of normal shape; the trochlea is slightly prolonged anteriorly, especially on the inner side, from contact with the tibial articular surface. The cartilage on the exposed posterior portion of the trochlea seems healthy. The head of the astragalus is very prominent on the outer side, the scaphoid being depressed downward and inward away from it. The anterior articular surface is prolonged in the direction of the displaced scaphoid. The scaphoid, in addition to its displacement, is much compressed on the planter surface, being little more than one-half the width of the dorsal surface. The cuboid is displaced obliquely downward and forward, so that the upper part of the posterior articular surface is not in contact with the calcis.

A professional leg-breaker is described in the Weekly Medical Review of St. Louis, April, 1890. This person's name was E. L. Landers, and he was accredited with earning his living by breaking or pretending to break his leg in order to collect damages for the supposed injury. Moreover, this individual had but one leg, and was compelled to use crutches. At the time of report he had succeeded in obtaining damages in Wichita, Kansas, for a supposed fracture. The Review quotes a newspaper account of this operation as follows.—

"According to the Wichita Dispatch he represented himself as a telegraph operator who was to have charge of the postal telegraph office in that city as soon as the line reached there. He remained about town for a month until he found an inviting piece of defective sidewalk, suitable for his purpose, when he stuck his crutch through the hole and fell screaming to the ground, declaring that he had broken his leg. He was carried to a hospital, and after a week's time, during which he negotiated a compromise with the city authorities and collected $1000 damages, a confederate, claiming to be his nephew, appeared and took the wounded man away on a stretcher, saying that he was going to St. Louis. Before the train was fairly out of Wichita, Landers was laughing and boasting over his successful scheme to beat the town. The Wichita story is in exact accord with the artistic methods of a one-legged sharper who about 1878 stuck his crutch through a coal-hole here, and, falling heels over head, claimed to have sustained injuries for which he succeeded in collecting something like $1500 from the city. He is described as a fine-looking fellow, well dressed, and wearing a silk hat. He lost one leg in a railroad accident, and having collected a good round sum in damages for it, adopted the profession of leg-breaking in order to earn a livelihood. He probably argued that as he had made more money in that line than in any other he was especially fitted by natural talents to achieve distinction in this direction. But as it would be rather awkward to lose his remaining leg altogether he modified the idea and contents himself with collecting the smaller amounts which ordinary fractures of the hip-joint entitle such an expert 'fine worker' to receive.

"He first appeared here in 1874 and succeeded, it is alleged, in beating the Life Association of America. After remaining for some time in the hospital he was removed on a stretcher to an Illinois village, from which point the negotiations for damages were conducted by correspondence, until finally a point of agreement was reached and an agent of the company was sent to pay him the money. This being accomplished the agent returned to the depot to take the train back to St. Louis when he was surprised to see the supposed sufferer stumping around on his crutches on the depot platform, laughing and jesting over the ease with which he had beaten the corporation.

"He afterward fell off a Wabash train at Edwardsville and claimed to have sustained serious injuries, but in this case the company's attorneys beat him and proved him to be an impostor. In 1879 he stumbled into the telegraph office at the Union Depot here, when Henry C. Mahoney, the superintendent, catching sight of him, put him out, with the curt remark that he didn't want him to stick that crutch into a cuspidor and fall down, as it was too expensive a performance for the company to stand. He beat the Missouri Pacific and several other railroads and municipalities at different times, it is claimed, and manages to get enough at each successful venture to carry him along for a year or eighteen months, by which time the memory of his trick fades out of the public mind, when he again bobs up serenely."

Anomalous Suicides.—The literature on suicide affords many instances of self-mutilations and ingenious modes of producing death. In the Dublin Medical Press for 1854 there is an extraordinary case of suicide, in which the patient thrust a red-hot poker into his abdomen and subsequently pulled it out, detaching portions of the omentum and 32 inches of the colon. Another suicide in Great Britain swallowed a red-hot poker. In commenting on suicides, in 1835, Arntzenius speaks of an ambitious Frenchman who was desirous of leaving the world in a distinguished manner, and who attached himself to a rocket of enormous size which he had built for the purpose, and setting fire to it, ended his life. On September 28, 1895, according to the Gaulois and the New York Herald (Paris edition) of that date, there was admitted to the Hopital St. Louis a clerk, aged twenty-five, whom family troubles had rendered desperate and who had determined to seek death as a relief from his misery. Reviewing the various methods of committing suicide he found none to his taste, and resolved on something new. Being familiar with the constituents of explosives, he resolved to convert his body into a bomb, load it with explosives, and thus blow himself to pieces. He procured some powdered sulphur and potassium chlorate, and placing each in a separate wafer he swallowed both with the aid of water. He then lay down on his bed, dressed in his best clothes, expecting that as soon as the two explosive materials came into contact he would burst like a bomb and his troubles would be over. Instead of the anticipated result the most violent collicky pains ensued, which finally became so great that he had to summon his neighbors, who took him to the hospital, where, after vigorous application with the stomach-pump, it was hoped that his life would be saved. Sankey mentions an epileptic who was found dead in his bed in the Oxford County Asylum; the man had accomplished his end by placing a round pebble in each nostril, and thoroughly impacting in his throat a strip of flannel done up in a roll. In his "Institutes of Surgery" Sir Charles Bell remarks that his predecessor at the Middlesex Hospital entered into a conversation with his barber over an attempt at suicide in the neighborhood, during which the surgeon called the "would-be suicide" a fool, explaining to the barber how clumsy his attempts had been at the same time giving him an extempore lecture on the anatomic construction of the neck, and showing him how a successful suicide in this region should be performed. At the close of the conversation the unfortunate barber retired into the back area of his shop, and following minutely the surgeon's directions, cut his throat in such a manner that there was no hope of saving him. It is supposed that one could commit suicide by completely gilding or varnishing the body, thus eliminating the excretory functions of the skin. There is an old story of an infant who was gilded to appear at a Papal ceremony who died shortly afterward from the suppression of the skin-function. The fact is one well established among animals, but after a full series of actual experiments, Tecontjeff of St. Petersburg concludes that in this respect man differs from animals. This authority states that in man no tangible risk is entailed by this process, at least for any length of time required for therapeutic purposes. "Tarred and feathered" persons rarely die of the coating of tar they receive. For other instances of peculiar forms of suicide reference may be made to numerous volumes on this subject, prominent among which is that by Brierre de Boismont, which, though somewhat old, has always been found trustworthy, and also to the chapters on this subject written by various authors on medical jurisprudence.

Religious and Ceremonial Mutilations.—Turning now to the subject of self-mutilation and self-destruction from the peculiar customs or religious beliefs of people, we find pages of information at our disposal. It is not only among the savage or uncivilized tribes that such ideas have prevailed, but from the earliest times they have had their influence upon educated minds. In the East, particularly in India, the doctrines of Buddhism, that the soul should be without fear, that it could not be destroyed, and that the flesh was only its resting-place, the soul several times being reincarnated, brought about great indifference to bodily injuries and death. In the history of the Brahmans there was a sect of philosophers called the Gymnosophists, who had the extremest indifference to life. To them incarnation was a positive fact, and death was simply a change of residence. One of these philosophers, Calanus, was burned in the presence of Alexander; and, according to Plutarch, three centuries later another Gymnosophist named Jarmenochegra, was similarly burned before Augustus. Since this time, according to Brierre de Boismont, the suicides from indifference to life in this mystic country are counted by the thousands. Penetrating Japan the same sentiment, according to report, made it common in the earlier history of that country to see ships on its coasts, filled with fanatics who, by voluntary dismantling, submerged the vessels little by little, the whole multitude sinking into the sea while chanting praises to their idols. The same doctrines produced the same result in China. According to Brucker it is well known that among the 500 philosophers of the college of Confucius, there were many who disdained to survive the loss of their books (burned by order of the savage Emperor Chi-Koung-ti), and throwing themselves into the sea, they disappeared under the waves. According to Brierre de Boismont, voluntary mutilation or death was very rare among the Chaldeans, the Persians, or the Hebrews, their precepts being different from those mentioned. The Hebrews in particular had an aversion to self-murder, and during a period in their history of 4000 years there were only eight or ten suicides recorded. Josephus shows what a marked influence on suicides the invasion of the Romans among the Hebrews had.

In Africa, as in India, there were Gymnosophists. In Egypt Sesostris, the grandest king of the country, having lost his eyesight in his old age, calmly and deliberately killed himself. About the time of Mark Anthony and Cleopatra, particularly after the battle of Actium, suicide was in great favor in Egypt. In fact a great number of persons formed an academy called The Synapothanoumenes, who had for their object the idea of dying together. In Western Europe, as shown in the ceremonies of the Druids, we find among the Celts a propensity for suicide and an indifference to self-torture. The Gauls were similarly minded, believing in the dogma of immortality and eternal repose. They thought little of bodily cares and ills. In Greece and Rome there was always an apology for suicide and death in the books of the philosophers. "Nil igitur mors est, ad nos neque pertinet hilum; quando quidem natura animi mortalis habetur!" cries Lucretius. With the advent of Christianity, condemning as it did the barbarous customs of self-mutilation and self-murder, these practices seem to disappear gradually; but stoicism and indifference to pain were exhibited in martyrdom. Toward the middle ages, when fanaticism was at its height and the mental malady of demoniacal possession was prevalent, there was something of a reversion to the old customs. In the East the Juggernaut procession was still in vogue, but this was suppressed by civilized authorities; outside of a few minor customs still prevalent among our own people we must to-day look to the savage tribes for the perpetuation of such practices.

In an excellent article on the evolution of ceremonial institutions Herbert Spencer mentions the Fuegians, Veddahs, Andamanese, Dyaks, Todas, Gonds, Santals, Bodos, and Dhimals, Mishmis, Kamchadales, and Snake Indians, as among people who form societies to practice simple mutilations in slight forms. Mutilations in somewhat graver forms, but still in moderation, are practiced by the Tasmanians, Tamaese, the people of New Guinea, Karens, Nagas, Ostiaks, Eskimos, Chinooks, Comanches, and Chippewas. What might be called mixed or compound mutilations are practiced by the New Zealanders, East Africans, Kondes, Kukas, and Calmucks. Among those practising simple but severe mutilations are the New Caledonians, the Bushmen, and some indigenous Australians. Those tribes having for their customs the practice of compound major mutilations are the Fiji Islanders, Sandwich Islanders, Tahitians, Tongans, Samoans, Javanese, Sumatrans, natives of Malagasy, Hottentots, Damaras, Bechuanas, Kaffirs, the Congo people, the Coast Negroes, Inland Negroes, Dahomeans, Ashantees, Fulahs, Abyssinians, Arabs, and Dakotas. Spencer has evidently made a most extensive and comprehensive study of this subject, and his paper is a most valuable contribution to the subject. In the preparation of this section we have frequently quoted from it.

The practice of self-bleeding has its origin in other mutilations, although the Aztecs shed human blood in the worship of the sun. The Samoiedes have a custom of drinking the blood of warm animals. Those of the Fijians who were cannibals drank the warm blood of their victims. Among the Amaponda Kaffirs there are horrible accounts of kindred savage customs. Spencer quotes:—"It is usual for the ruling chief on his accession to be washed in the blood of a near relative, generally a brother, who is put to death for the occasion." During a Samoan marriage-ceremony the friends of the bride "took up stones and beat themselves until their heads were bruised and bleeding." In Australia a novitiate at the ceremony of manhood drank a mouthful of blood from the veins of the warrior who was to be his sponsor.

At the death of their kings the Lacedemonians met in large numbers and tore the flesh from their foreheads with pins and needles. It is said that when Odin was near his death he ordered himself to be marked with a spear; and Niort, one of his successors, followed the example of his predecessor. Shakespeare speaks of "such as boast and show their scars." In the olden times it was not uncommon for a noble soldier to make public exhibition of his scars with the greatest pride; in fact, on the battlefield they invited the reception of superficial disfiguring injuries, and to-day some students of the learned universities of Germany seem prouder of the possession of scars received in a duel of honor than in awards for scholastic attainments.

Lichtenstein tells of priests among the Bechuanas who made long cuts from the thigh to the knee of each warrior who slew an enemy in battle. Among some tribes of the Kaffirs a kindred custom was practiced; and among the Damaras, for every wild animal a young man destroyed his father made four incisions on the front of his son's body. Speaking of certain Congo people, Tuckey says that they scar themselves principally with the idea of rendering themselves agreeable to the women of their tribe. Among the Itzaex Indians of Yucatan, a race with particularly handsome features, some are marked with scarred lines, inflicted as signs of courage.

Cosmetic Mutilations.—In modern times there have been individuals expert in removing facial deformities, and by operations of various kinds producing pleasing dimples or other artificial signs of beauty. We have seen an apparatus advertised to be worn on the nose during the night for the purpose of correcting a disagreeable contour of this organ. A medical description of the artificial manufacture of dimples is as follows:—"The modus operandi was to make a puncture in the skin where the dimple was required, which would not be noticed when healed, and, with a very delicate instrument, remove a portion of the muscle. Inflammation was then excited in the skin over the subcutaneous pit, and in a few days the wound, if such it may be called, was healed, and a charming dimple was the result." It is quite possible that some of our modern operators have overstepped the bounds of necessity, and performed unjustifiable plastic operations to satisfy the vanity of their patients.

Dobrizhoffer says of the Abipones that boys of seven pierce their little arms in imitation of their parents. Among some of the indigenous Australians it is quite customary for ridged and linear scars to be self-inflicted. In Tanna the people produce elevated scars on the arms and chests. Bancroft recites that family-marks of this nature existed among the Cuebas of Central America, refusal being tantamount to rebellion. Schomburgk tells that among the Arawaks, after a Mariquawi dance, so great is their zeal for honorable scars, the blood will run down their swollen calves, and strips of skin and muscle hang from the mangled limbs. Similar practices rendered it necessary for the United States Government to stop some of the ceremonial dances of the Indians under their surveillance.

A peculiar custom among savages is the amputation of a finger as a sacrifice to a deity. In the tribe of the Dakotas the relatives of a dead chief pacified his spirit by amputating a finger. In a similar way, during his initiation, the young Mandan warrior, "holding up the little finger of his left hand to the Great Spirit," ... "expresses his willingness to give it as a sacrifice, and he lays it on the dried buffalo skull, when another chops it off near the hand with a blow of the hatchet." According to Mariner the natives of Tonga cut off a portion of the little finger as a sacrifice to the gods for the recovery of a superior sick relative. The Australians have a custom of cutting off the last joint of the little finger of females as a token of submission to powerful beings alive and dead. A Hottentot widow who marries a second time must have the distal joint of her little finger cut off; another joint is removed each time she remarries.

Among the mutilations submitted to on the death of a king or chief in the Sandwich Islands, Cook mentions in his "Voyages" the custom of knocking out from one to four front teeth.

Among the Australian tribes the age of virility and the transition into manhood is celebrated by ceremonial customs, in which the novices are subjected to minor mutilations. A sharp bone is used for lancing their gums, while the throw-stick is used for knocking out a tooth. Sometimes, in addition to this crude dentistry, the youth is required to submit to cruel gashes cut upon his back and shoulders, and should he flinch or utter any cry of pain he is always thereafter classed with women. Haygarth writes of a semi-domesticated Australian who said one day, with a look of importance, that he must go away for a few days, as he had grown to man's estate, and it was high time he had his teeth knocked out. It is an obligatory rite among various African tribes to lose two or more of their front teeth. A tradition among certain Peruvians was that the Conqueror Huayna Coapae made a law that they and their descendants should have three front teeth pulled out in each jaw. Cieza speaks of another tradition requiring the extraction of the teeth of children by their fathers as a very acceptable service to their gods. The Damaras knock out a wedge-shaped gap between two of their front teeth; and the natives of Sierra Leone file or chip their teeth after the same fashion.

Depilatory customs are very ancient, and although minor in extent are still to be considered under the heading of mutilations. The giving of hair to the dead as a custom, has been perpetuated through many tribes and nations. In Euripides we find Electra admonishing Helen for sparing her locks, and thereby defrauding the dead. Alexander the Great shaved his locks in mourning for his friend, Hephaestion, and it was supposed that his death was hastened by the sun's heat on his bare head after his hat blew off at Babylon. Both the Dakota Indians and the Caribs maintain the custom of sacrificing hair to the dead. In Peru the custom was varied by pulling out eyelashes and eyebrows and presenting them to the sun, the hills, etc. It is said this custom is still in continuance. When Clovis was visited by the Bishop of Toulouse he gave him a hair from his beard and was imitated by his followers. In the Arthurian legends we find "Then went Arthur to Caerleon; and thither came messages from King Ryons who said, 'even kings have done me homage, and with their beards I have trimmed a mantle. Send me now thy beard, for there lacks yet one to the finishing of the mantle.'" The association between short hair and slavery arose from the custom of taking hair from the slain. It existed among the Greeks and Romans, and was well known among the indigenous tribes of this continent. Among the Shoshones he who took the most scalps gained the most glory.

In speaking of the prisoners of the Chicimecs Bancroft says they were often scalped while yet alive, and the bloody trophies placed on the heads of their tormentors. In this manner we readily see that long hair among the indigenous tribes and various Orientals, Ottomans, Greeks, Franks, Goths, etc., was considered a sign of respect and honor. The respect and preservation of the Chinese queue is well known in the present day. Wishing to divide their brother's kingdom, Clothair and Childebert consulted whether to cut off the hair of their nephews, the rightful successors, so as to reduce them to the rank of subjects, or to kill them. The gods of various people, especially the greater gods, were distinguished by their long beards and flowing locks. In all pictures Thor and Samson were both given long hair, and the belief in strength and honor from long hair is proverbial. Hercules is always pictured with curls. According to Goldzhier, long locks of hair and a long beard are mythologic attributes of the sun. The sun's rays are compared to long locks or hairs on the face of the sun. When the sun sets and leaves his place to the darkness, or when the powerful summer sun is succeeded by the weak rays of the winter sun, then Samson's long locks, through which alone his strength remains, are cut off by the treachery of his deceitful concubine Delilah (the languishing, according to the meaning of the name). The beaming Apollo was, moreover, called the "Unshaven;" and Minos cannot conquer the solar hero, Nisos, until the latter loses his golden hair. In Arabic "Shams-on" means the sun, and Samson had seven locks of hair, the number of the planetary bodies. In view of the foregoing facts it seems quite possible that the majority of depilatory processes on the scalp originated in sun-worship, and through various phases and changes in religions were perpetuated to the Middle Ages. Charles Martel sent Pepin, his son, to Luithprand, king of the Lombards, that he might cut his first locks, and by this ceremony hold for the future the place of his illustrious father. To make peace with Alaric, Clovis became his adopted son by offering his beard to be cut. Among the Caribs the hair constituted their chief pride, and it was considered unequivocal proof of the sincerity of their sorrow, when on the death of a relative they cut their hair short. Among the Hebrews shaving of the head was a funeral rite, and among the Greeks and Romans the hair was cut short in mourning, either for a relative or for a celebrated personage. According to Krehl the Arabs also had such customs. Spencer mentions that during an eruption in Hawaii, "King Kamahameha cut off part of his own hair" ... "and threw it into the torrent (of lava)."

The Tonga regarded the pubic hairs as under the special care of the devil, and with great ceremony made haste to remove them. The female inhabitants of some portions of the coast of Guinea remove the pubic hairs as fast as they appear. A curious custom of Mohammedan ladies after marriage is to rid themselves of the hirsute appendages of the pubes. Depilatory ointments are employed, consisting of equal parts of slaked lime and arsenic made into a paste with rose-water. It is said that this important ceremony is not essential in virgins. One of the ceremonies of assuming the toga virilis among the indigenous Australians consists in submitting to having each particular hair plucked singly from the body, the candidate being required not to display evidences of pain during the operation. Formerly the Japanese women at marriage blackened their teeth and shaved or pulled out their eyebrows.

The custom of boring the ear is very old, mention of it being made in Exodus xxi., 5 and 6, in which we find that if a Hebrew servant served for six years, his freedom was optional, but if he plainly said that he loved his master, and his wife and children, and did not desire to leave their house, the master should bring him before the judges; and according to the passage in Exodus, "he shall also bring him to the door or unto the doorpost, and his master shall bore his ear through with an awl; and he shall serve him forever." All the Burmese, says Sangermano, without exception, have the custom of boring their ears. The days when the operations were performed were kept as festivals. The ludicrous custom of piercing the ears for the wearing of ornaments, typical of savagery and found in all indigenous African tribes, is universally prevalent among our own people.

The extremists in this custom are the Botocudos, who represent the most cruel and ferocious of the Brazilian tribes, and who especially cherish a love for cannibalism. They have a fondness for disfiguring themselves by inserting in the lower parts of their ears and in their under lips variously shaped pieces of wood ornaments called peleles, causing enormous protrusion of the under lip and a repulsive wide mouth, as shown in Figure 230.

Tattooing is a peculiar custom originating in various ways. The materials used are vermilion, indigo, carbon, or gunpowder. At one time this custom was used in the East to indicate caste and citizenship. Both sexes of the Sandwich Islanders have a peculiar tattooed mark indicative of their tribe or district. Among the Uapes, one tribe, the Tucanoes, have three vertical blue lines. Among other people tattooed marks indicated servility, and Boyle says the Kyans, Pakatans, and Kermowits alone, among the Borneo people, practised tattooing, and adds that these races are the least esteemed for bravery. Of the Fijians the women alone are tattooed, possibly as a method of adornment.

The tattooing of the people of Otaheite, seen by Cook, was surmised by him to have a religious significance, as it presented in many instances "squares, circles, crescents, and ill-designed representations of men and dogs." Every one of these people was tattooed upon reaching majority. According to Carl Bock, among the Dyaks of Borneo all of the married women were tattooed on the hands and feet, and sometimes on the thighs. The decoration is one of the privileges of matrimony, and is not permitted to unmarried girls. Andrew Lang says of the Australian tribes that the Wingong or the Totem of each man is indicated by a tattooed representation of it on his flesh. The celebrated American traveler, Carpenter, remarks that on his visit to a great prison in Burmah, which contains more than 3000 men, he saw 6000 tattooed legs. The origin of the custom he was unable to find out, but in Burmah tattooing was a sign of manhood, and professional tattooers go about with books of designs, each design warding off some danger. Bourke quotes that among the Apaches-Yumas of Arizona the married women are distinguished by several blue lines running from the lower lip to the chin; and he remarks that when a young woman of this tribe is anxious to become a mother she tattoos the figure of a child on her forehead. After they marry Mojave girls tattoo the chin with vertical blue lines; and when an Eskimo wife has her face tattooed with lamp-black she is regarded as a matron in society. The Polynesians have carried this dermal art to an extent which is unequaled by any other people, and it is universally practiced among them. Quoted by Burke, Sullivan states that the custom of tattooing continued in England and Ireland down to the seventh century. This was the tattooing with the woad. Fletcher remarks that at one time, about the famous shrine of Our Lady of Loretto, were seen professional tattooers, who for a small sum of money would produce a design commemorative of the pilgrim's visit to the shrine. A like profitable industry is pursued in Jerusalem.

Universal tattooing in some of the Eastern countries is used as a means of criminal punishment, the survival of the persecuted individual being immaterial to the torturers, as he would be branded for life and ostracized if he recovered. Illustrative of this O'Connell tells of a case in Hebra's clinic. The patient, a man five feet nine inches in height, was completely tattooed from head to foot with all sorts of devices, such as elephants, birds, lions, etc., and across his forehead, dragons. Not a square of even a quarter inch had been exempt from the process. According to his tale this man had been a leader of a band of Greek robbers, organized to invade Chinese Tartary, and, together with an American and a Spaniard, was ordered by the ruler of the invaded province to be branded in this manner as a criminal. It took three months' continuous work to carry out this sentence, during which his comrades succumbed to the terrible agonies. During the entire day for this extended period indigo was pricked in this unfortunate man's skin. Accounts such as this have been appropriated by exhibitionists, who have caused themselves to be tattooed merely for mercenary purposes. The accompanying illustration represents the appearance of a "tattooed man" who exhibited himself. He claimed that his tattooing was done by electricity. The design showing on his back is a copy of a picture of the Virgin Mary surrounded by 31 angels.

The custom of tattooing the arms, chest, or back is quite prevalent, and particularly among sailors and soldiers. The sequences of this custom are sometimes quite serious. Syphilis has been frequently contracted in this manner, and Maury and Dulles have collected 15 cases of syphilis acquired in tattooing. Cheinisse reports the case of a young blacksmith who had the emblems of his trade tattooed upon his right forearm. At the end of forty days small, red, scaly elevations appeared at five different points in the tattooed area. These broke down and formed ulcers. When examined these ulcers presented the peculiarities of chancres, and there was upon the body of the patient a well-marked syphilitic roseola. It was ascertained that during the tattooing the operator had moistened the ink with his own saliva.

Hutchinson exhibited drawings and photographs showing the condition of the arms of two boys suffering from tuberculosis of the skin, who had been inoculated in the process of tattooing. The tattooing was done by the brother of one of the lads who was in the last stages of phthisis, and who used his own saliva to mix the pigment. The cases were under the care of Murray of Tottenham, by whom they had been previously reported. Williams has reported the case of a militiamen of seventeen who, three days after an extensive tattooing of the left forearm, complained of pain, swelling, and tenderness of the left wrist. A day later acute left-sided pneumonia developed, but rapidly subsided. The left shoulder, knee, and ankle were successively involved in the inflammation, and a cardiac bruit developed. Finally chorea developed as a complication, limited for a time to the left side, but shortly spreading to the right, where rheumatic inflammation was attacking the joints. The last, however, quickly subsided, leaving a general, though mild chorea and a permanently damaged heart.

Infibulation of the male and female external genital organs for the prevention of sexual congress is a very ancient custom. The Romans infibulated their singers to prevent coitus, and consequent change in the voice, and pursued the same practice with their actors and dancers. According to Celsus, Mercurialis, and others, the gladiators were infibulated to guard against the loss of vigor by sexual excesses. In an old Italian work there is a figure of an infibulated musician—a little bronze statue representing a lean individual tortured or deformed by carrying an enormous ring through the end of the penis. In one of his pleasantries Martial says of these infibulated singers that they sometimes break their rings and fail to place them back—"et cujus refibulavit turgidum faber peruem." Heinsius considers Agamemnon cautious when he left Demodocus near Clytemnestra, as he remarks that Demodocus was infibulated. For such purposes as the foregoing infibulation offered a more humane method than castration.

Infibulation by a ring in the prepuce was used to prevent premature copulation, and was in time to be removed, but in some cases its function was the preservation of perpetual chastity. Among some of the religious mendicants in India there were some who were condemned to a life of chastity, and, in the hotter climates, where nudity was the custom, these persons traveled about exposing an enormous preputial ring, which was looked upon with adoration by devout women. It is said these holy persons were in some places so venerated that people came on their knees, and bowing below the ring, asked forgiveness—possibly for sexual excesses.

Rhodius mentions the usage of infibulation in antiquity, and Fabricius d'Aquapendente remarks that infibulation was usually practiced in females for the preservation of chastity. No Roman maiden was able to preserve her virginity during participation in the celebrations in the Temples of Venus, the debauches of Venus and Mars, etc., wherein vice was authorized by divine injunction; for this reason the lips of the vagina were closed by rings of iron, copper, or silver, so joined as to hinder coitus, but not prevent evacuation. Different sized rings were used for those of different ages. Although this device provided against the coitus, the maiden was not free from the assaults of the Lesbians. During the Middle Ages, in place of infibulation, chastity-girdles were used, and in the Italian girdles, such as the one exhibited in the Musee Cluny in Paris, both the anus and vulva were protected by a steel covering perforated for the evacuations. In the Orient, particularly in India and Persia, according to old travelers, the labia were sewed together, allowing but a small opening for excretions. Buffon and Brown mention infibulation in Abyssinia, the parts being separated by a bistoury at the time of marriage. In Circassia the women were protected by a copper girdle or a corset of hide and skin which, according to custom, only the husband could undo. Peney speaks of infibulation for the preservation of chastity, as observed by him in the Soudan. Among the Nubians this operation was performed at about the age of eight with great ceremony, and when the time for marriage approached the vulva had to be opened by incision. Sir Richard Buxton, a distinguished traveler, also speaks of infibulation, and, according to him, at the time of the marriage ceremony the male tries to prove his manhood by using only Nature's method and weapon to consummate the marriage, but if he failed he was allowed artificial aid to effect entrance. Sir Samuel Baker is accredited in The Lancet with giving an account in Latin text of the modus operandi of a practice among the Nubian women of removing the clitoris and nymphae in the young girl, and abrading the adjacent walls of the external labia so that they would adhere and leave only a urethral aperture.

This ancient custom of infibulation is occasionally seen at the present day in civilized countries, and some cases of infibulation from jealousy are on record. There is mentioned, as from the Leicester Assizes, the trial of George Baggerly for execution of a villainous design on his wife. In jealousy he "had sewed up her private parts." Recently, before the New York Academy of Medicine, Collier reported a case of pregnancy in a woman presenting nympha-infibulation. The patient sought the physician's advice in the summer of 1894, while suffering from uterine disease, and being five weeks pregnant. She was a German woman of twenty-eight, had been married several years, and was the mother of several children. Collier examined her and observed two holes in the nymphae. When he asked her concerning these, she reluctantly told him that she had been compelled by her husband to wear a lock in this region. Her mother, prior to their marriage, sent her over to the care of her future husband (he having left Germany some months before). On her arrival he perforated the labia minora, causing her to be ill several weeks; after she had sufficiently recovered he put on a padlock, and for many years he had practiced the habit of locking her up after each intercourse. Strange to relate, no physician, except Collier, had ever inquired about the openings. In this connection the celebrated Harvey mentions a mare with infibulated genitals, but these did not prevent successful labor.

Occasionally infibulation has been used as a means of preventing masturbation. De la Fontaine has mentioned this fact, and there is a case in this country in which acute dementia from masturbation was cured by infibulation. In this instance the prepuce was perforated in two opposite places by a trocar, and two pewter sounds (No. 2) were introduced into the wounds and twisted like rings. On the eleventh day one of the rings was removed, and a fresh one introduced in a new place. A cure was effected in eight weeks. There is recent mention made of a method of preventing masturbation by a cage fastened over the genitals by straps and locks. In cases of children the key was to be kept by the parents, but in adults to be put in some part of the house remote from the sleeping apartment, the theory being that the desire would leave before the key could be obtained.

Among some peoples the urethra was slit up as a means of preventing conception, making a meatus near the base of the penis. Herodotus remarks that the women of a certain portion of Egypt stood up while they urinated, while the men squatted. Investigation has shown that the women were obliged to stand up on account of elongated nymphae and labia, while the men sought a sitting posture on account of the termination of the urethra being on the inferior side of the base of the penis, artificially formed there in order to prevent conception. In the Australian Medical Gazette, May, 1883, there is an account of some of the methods of the Central Australians of preventing conception. One was to make an opening into the male urethra just anterior to the scrotum, and another was to slit up the entire urethra so far as to make but a single canal from the scrotum to the glans penis. Bourke quotes Palmer in mentioning that it is a custom to split the urethra of the male of the Kalkadoon tribe, near Cloncurry, Queensland, Australia Mayer of Vienna describes an operation of perforation of the penis among the Malays; and Jagor and Micklucho-Maclay report similar customs among the Dyaks and other natives of Borneo, Java, and Phillipine Islands.

Circumcision is a rite of great antiquity. The Bible furnishes frequent records of this subject, and the bas-reliefs on some of the old Egyptian ruins represent circumcised children. Labat has found traces of circumcision and excision of nymphae in mummies. Herodotus remarks that the Egyptians practiced circumcision rather as a sanitary measure than as a rite. Voltaire stated that the Hebrews borrowed circumcision from the Egyptians; but the Jews claimed that the Phoenicians borrowed this rite from the Israelites.

Spencer and others say that in the early history of the Christian religion, St. Paul and his Disciples did not believe in circumcision, while St. Peter and his followers practiced it. Spencer mentions that the Abyssinians take a phallic trophy by circumcision from the enemy's dead body. In his "History of Circumcision," Remondino says that among the modern Berbers it is not unusual for a warrior to exhibit virile members of persons he has slain; he also says that, according to Bergman, the Israelites practiced preputial mutilations; David brought 200 prepuces of the Philistines to Saul. Circumcision is practiced in nearly every portion of the world, and by various races, sometimes being a civil as well as a religious custom. Its use in surgery is too well known to be discussed here. It might be mentioned, however, that Rake of Trinidad, has performed circumcision 16 times, usually for phimosis due to leprous tuberculation of the prepuce. Circumcision, as practiced on the clitoris in the female, is mentioned on page 308.

Ceremonial Ovariotomy.—In the writings of Strabonius and Alexander ab Alexandro, allusion is made to the liberties taken with the bodies of females by the ancient Egyptians and Lydians. Knott says that ablation of the ovaries is a time-honored custom in India, and that he had the opportunity of physically examining some of the women who had been operated on in early life. At twenty-five he found them strong and muscular, their mammary glands wholly undeveloped, and the normal growth of pubic hairs absent. The pubic arch was narrow, and the vaginal orifice practically obliterated. The menses had never appeared, and there seemed to be no sexual desire. Micklucho-Maclay found that one of the most primitive of all existing races—the New Hollanders—practiced ovariotomy for the utilitarian purpose of creating a supply of prostitutes, without the danger of burdening the population by unnecessary increase. MacGillibray found a native ovariotomized female at Cape York who had been subjected to the operation because, having been born dumb, she would be prevented from bearing dumb children,—a wise, though primitive, method of preventing social dependents.

Castration has long been practiced, either for the production of eunuchs, or castrata, through vengeance or jealousy, for excessive cupidity, as a punishment for crime, in fanaticism, in ignorance, and as a surgical therapeutic measure (recently, for the relief of hypertrophied prostate). The custom is essentially Oriental in origin, and was particularly used in polygamous countries, where the mission of eunuchs was to guard the females of the harem. They were generally large, stout men, and were noted for their vigorous health. The history of eunuchism is lost in antiquity. The ancient Book of Job speaks of eunuchs, and they were in vogue before the time of Semiramis; the King of Lydia, Andramytis, is said to have sanctioned castration of both male and female for social reasons. Negro eunuchs were common among the Romans. All the great emperors and conquerors had their eunuchs. Alexander the Great had his celebrated eunuch, Bagoas, and Nero, his Sporus, etc. Chevers says that the manufacture of eunuchs still takes place in the cities of Delhi, Lucknow, and Rajpootana. So skilful are the traveling eunuch-makers that their mortality is a small fraction of one per cent. Their method of operation is to encircle the external genital organs with a tight ligature, and then sweep them off at one stroke. He also remarks that those who retain their penises are of but little value or trusted. He divided the Indian eunuchs into three classes: those born so, those with a penis but no testicles, and those minus both testicles and penis. Curran describes the traveling eunuch-makers in Central India, and remarks upon the absence of death after the operation, and invites the attention of gynecologists and operators to the successful, though crude, methods used. Curran says that, except those who are degraded by practices of sexual perversions, these individuals are vigorous bodily, shrewd, and sagacious, thus proving the ancient descriptions of them.

Jamieson recites a description of the barbarous methods of making eunuchs in China. The operators follow a trade of eunuch-making, and keep it in their families from generation to generation; they receive the monetary equivalent of about $8.64 for the operation. The patient is grasped in a semi-prone position by an assistant, while two others hold the legs. After excision the wounded parts are bathed three times with a hot decoction of pepper-pods, the wound is covered with paper soaked in cold water, and bandages applied. Supported by two men the patient is kept walking for two or three hours and then tied down. For three days he is allowed nothing to drink, and is not allowed to pass his urine, the urethra being filled with a pewter plug. It generally takes about one hundred days for the wound to heal, and two per cent of the cases are fatal. There is nocturnal incontinence of urine for a long time after the operation.

Examples of castration because of excessive cupidity, etc.,—a most unwarranted operation,—are quite rare and are usually found among ecclesiastics. The author of "Faustin, or le Siecle Philosophique," remarked that there were more than 4000 castrated individuals among the ecclesiastics and others of Italy. The virtuous Pope Clement XIV forbade this practice, and describes it as a terrible abuse; but in spite of the declaration of the Pope the cities of Italy, for some time, still continued to contain great numbers of these victims. In France an article was inserted into the penal code providing severe punishment for such mutilations. Fortunately castration for the production of "castrata," or tenor singers, has almost fallen into disuse. Among the ancient Egyptians and Persians amputation of the virile member was inflicted for certain crimes of the nature of rape.

Castration as a religious rite has played a considerable role. With all their might the Emperors Constantine and Justinian opposed the delirious religion of the priests of Cybele, and rendered their offence equivalent to homicide. At the annual festivals of the Phrygian Goddess Amma (Agdistis) it was the custom of young men to make eunuchs of themselves with sharp shells, and a similar rite was recorded among Phoenicians. Brinton names severe self-mutilators of this nature among the ancient Mexican priests. Some of the Hottentots and indigenous Australians enforced semicastration about the age of eight or nine.

The Skoptzies, religious castrators in Russia, are possibly the most famous of the people of this description. The Russian government has condemned members of this heresy to hard labor in Siberia, but has been unable to extinguish the sect. Pelikan, Privy Counsel of the government, has exhaustively considered this subject. Articles have appeared in Le Progres Medical, December. 1876. and there is an account in the St. Louis Clinical Record, 1877-78. The name Skoptzy means "the castrated," and they call themselves the "White Doves." They arose about 1757 from the Khlish or flagellants. Paul I caused Sseliwanow, the true founder, to return from Siberia, and after seeing him had him confined in an insane asylum. After an interview, Alexander I transferred him to a hospital. Later the Councillor of State, Jelansky, converted by Sseliwanow, set the man free and soon the Skoptzies were all through Russia and even at the Court. The principal argument of these people is the nonconformity of orthodox believers, especially the priests, to the doctrines professed, and they contrast the lax morals of these persons with the chaste lives, the abstinence from liquor, and the continual fasts of the "White Doves." For the purpose of convincing novices of the Scriptural foundation of their rites and belief they are referred to Matthew xix., 12: "and there be eunuchs which have made themselves for the kingdom of Heaven's sake," etc.; and Mark ix., 43-47; Luke xxiii., 29: "blessed are the barren," etc., and others of this nature. As to the operation itself, pain is represented as voluntary martyrdom, and persecution as the struggle of the spirit of darkness with that of light. They got persons to join the order by monetary offers. Another method was to take into service young boys, who soon became lost to society, and lied with effrontery and obstinacy. They had secret methods of communicating with one another, and exhibited a passion for riches, a fact that possibly accounts for their extended influence. The most perfect were those "worthy of mounting the white horse," the "bearers of the Imperial seal," who were deprived of the testicles, penis, and scrotum. The operation of castration among these people was performed at one stroke or at two different times, in the former case one cicatrix being left, and in the latter two. The greater number—those who had submitted to the "first purification," conferring upon them the "lesser seal"—had lost testicles and scrotum. These people are said to have lost the "keys of hell," but to retain the "key of the abyss" (female genitals). As instruments of excision the hot iron, pieces of glass, old wire, sharpened bone, and old razors are used. Only nine fatal cases resulting from the operation are known. At St. Petersburg Liprandi knew a rich Skoptzy who constantly kept girls—mostly Germans—for his own gratification, soon after having entered into the "first purification." Few of them were able to remain with him over a year, and they always returned to their homes with health irretrievably lost. Women members of the order do not have their ovaries removed, but mutilation is practiced upon the external genitals, the mammae, and nipples. The first ablation is obtained by applying fire or caustics to the nipples, the second by amputation of the breasts, one or both, the third by diverse gashes, chiefly across the breast, and the fourth by resection of the nymphae or of the nymphae and clitoris, and the superior major labia, the cicatrices of which would deform the vulva. Figure 232 represents the appearance of the external genital organs of a male Skoptzy after mutilation; Figure 233 those of a female.

Battey speaks of Skoptzies in Roumania who numbered at the time of report 533 persons. They came from Russia and practiced the same ceremonies as the heretics there.