VI HUMAN TERATA AND THE SACRAMENTS

Teratology ( , a monster) is a part of biology that treats of deviation from a normal development in man and the lower animals. The name was adopted in 1822 by the elder Saint-Hilaire, who then attempted to separate the results of modern exact methods of research from the myths and loose descriptions of monsters found in the writings of old authors. Cicero (De Divinatione) derives the term monster from the proper preternatural signification looked for in the occurrence of these abnormal beings: "Monstra, ostenta, portenta, prodigia appellantur, quoniam monstrant, ostendunt, portendunt et predicunt."

At the end of the seventeenth century Malpighi and Grew discovered that plant tissue is entirely made up of microscopic spaces enclosing fluid; they called these spaces cells. Different investigators found that animal tissue is also composed of cells; and between 1835 and 1839 Schwann and Schleiden formulated the law that every metazoic organism is made of cells, and starts from a cell.

In 1672 de Graaf discovered the mammalian ovum, in 1675 Ludwig Ham found spermatozoa, in 1827 von Baer recognised the human ovum, but not until 1875 was the important fact established that fertilisation is effected by the fusion of the male and female pronuclei. This was demonstrated by Oscar Hertwig from observation of the ova of starfishes.

Mammalian ova, owing to an almost complete lack of yolk, are all small. The egg of a whale is about the size of a fern-seed, but the yolked eggs of birds are large—that of the great auk was 7.5 inches long. In man the ovum is from 0.18 to 0.2 mm. in diameter, scarcely visible to the {70} naked eye, and the spermatozoon is extremely minute. The human spermatozoon is only fifty-four thousandths of a millimetre in length, and from forty-one to fifty-three thousandths of a millimetre are taken up by its flagellum. The essential part is from four to six thousandths of a millimetre in length (Dr. L. N. Boston, Journ, of Applied Microscopy, vol. iv. p. 1360). A line of 18 human spermatozoa would reach only across the head of an ordinary pin. These spermatozoa have the power of locomotion in alkaline fluid. Henle found they can travel one centimetre in three minutes.

The human ovum and spermatozoon are single cells, and the principal parts of a typical cell are the cytoplasm (called also the protoplasm), and, within this, the nucleus and centrosome. The centrosome is efficient in the process of cell-division. A few cells have also an outer envelope or membrane, and this part is well developed in the ovum. The nucleus is the centre of activity in a cell. In the resting state it is surrounded by a membrane, and within the membrane is an intra-nuclear network made up of chromatin and linin—the chromatin is an important element. The meshes of this network are probably filled with fluid. During the stages preparatory to the mitotic, or indirect, division of a cell into two cells (one of the methods of reproduction) the chromatin segregates in typical cases into two groups of loops, and each group has equal portions of the chromatin. When the chromatin is in this shape, a loop is called a chromosome. The chromosomes are very important. They occur in constant definite numbers in the somatic cells of the various species of many animals and plants, and it is probable that each species of plant and animal has its own characteristic number of chromosomes. Wilson (The Cell in Development and Inheritance, New York, 1890) gives a list of 72 species in which the number has been determined. Man has probably 16 chromosomes in the somatic cell, and the mature male and female germ cells in man contribute eight chromosomes each to the nucleus of the impregnated ovum.

The chromosomes transmit the physical bases of heredity from one generation to the next, and the heritages from the two parents are equal except in cases of prepotency. Every cell {71} in the human body is derived from the father and the mother equally. The fact that the woman carries a child for months in her womb means only that she employs a peculiar method of feeding and protecting it. After its birth she feeds it from her breasts, before birth through its umbilical vessels, but she originally gives only the eight chromosomes as the father does, and the child's vital principle builds up the body from this foundation. The popular notion that the foetus in the womb is formed through some process of literal abstraction from the maternal tissues is no more true than that the infant is so built up while it is suckling; both processes are merely different methods of feeding.

All the chromosomes from the fathers of at least 200 men could fit simultaneously on the head of one pin, yet virtually, not merely potentially, half the bodily substance of that multitude, and all the physical characteristics derived from the 200 fathers, are indubitably contained in those chromosomes and nowhere else, unless by a special creation they are infused with the new soul, which seems to be an altogether unreasonable alternative. This statement concerning the minuteness of the chromosomes is not speculation—they can readily be seen and measured with the aid of the microscope.

A human being, then, obtains eight microscopic chromosomes from his father and eight from his mother, positively nothing more except food; yet he develops into a man with a body made up of countless millions of cells which expand into more than 200 bones in the skeleton and over 200 muscles,—into the fascias, ligaments, tendons, the great and small glands, the lymph and blood systems, the respiratory and alimentary tracts, the skin and its appendages, and a nervous system, which alone furnishes material for years of study if we would learn its anatomy fully. Not only all this, but the man commonly closely resembles his father or his mother, or some other ancestor, in personal appearance, in certain physical tendencies, in graces or blemishes; and furthermore, he shows inherited racial characteristics.

If a father is prepotent, he may have a greater effect in producing the formed child than the mother has, and vice versa, as when a son closely resembles his father or his mother. {72} Prepotency, moreover, may extend down through generations and centuries. In the streets of Palermo to-day typical Normans may be seen, despite the intermarriages of centuries, who are the descendants of those male Normans that went down to Sicily with Tancred. There are Romans there, too, and Saracens. When the Belgae—a race of tall, red-bearded men, with elliptical skulls—went from the continent of Europe to Ireland, probably six centuries before our era, they conquered the aborigines, a gentle, brune race of lower stature. These Belgae became the ancestors of the chieftain class, and their physical type persists until to-day; so does that of the Pictish aborigines. Daniel O'Connell had a typical Belgic body. Other big, blond Irishmen are Norse or Danish in remote origin.

How is the extremely complex human body with its various physical characteristics built up from the nucleus of a fecundated cell, the ovum? The endeavour to answer this question has brought out most ingenious speculation from nearly all the great biologists of modern times. The question is the foundation of the theories of heredity, and it is also fundamental in the theories of evolution. The human ovum is a flattened spherical cell, made up of a very delicate cell-wall, called the vitelline membrane; outside this is a comparatively thick membrane, the zona pellucida, which is properly not a part of the cell. Within the vitelline membrane is a granular cytoplasm, the vitellus (yolk), and in this lies the nucleus, which in the old text-books was called the germinal vesicle. This nucleus contains a nucleolus. The human spermatozoon consists of a flattened head which has a thin protoplasmic cap extending down two-thirds of its length. In the head is the nucleus with the chromatin. Beyond the head is the neck, which contains the anterior and posterior centrosomes. Behind the neck is the tail, or flagellum, in three parts,—the middle piece, the principal part, and the end piece. From the neck to the end of the tail centrally runs a bundle of fibrils, the axial filament. In the middle piece these fibrils are wrapped within a single spiral filament which winds from the neck down to the annulus at the beginning of the principal part, and lies in a clear fluid. Without the spiral filament, along the middle piece, is the mitochondria, a finely granular protoplasmic layer. The principal part of the tail consists of the axial {73} filament enclosed in an involucrum, and the end piece is made up of this filament without the involucrum. The head and neck of the spermatozoon, which contain the nucleus and centrosomes, are the essential parts, and the middle piece and the remainder of the tail appear to be used solely for locomotion and penetration. When the head penetrates the ovum, the tail is detached and rejected. Our knowledge of the initial stages in the development of a human embryo is derived indirectly from the observation of other mammals. There are nine early human embryos reported, and the average probable age of these is twelve days. Breuss' specimen was probably ten days old (Wiener med. Wochenblatt, 1877). Peters (Einbettung des mensch. Eies, 1899) found a smaller embryo than this. The Breuss ovum was 5 mm. in length; Peters' was 3 by 1.5 by 1.5 mm., but the probable age was not given. There have been numerous embryos more than twelve days old observed, and since the process after the twelfth day is identical in man and the higher mammals, there is no doubt that the first stages are also the same. The segmentation that makes new cells is complicated, and the outcome of the division is a ball of cells. In eggs which have a large yolk, like those of birds, the cells form a round body resting on the surface of the yolk, but in mammalian ova a hollow ball of cells, or a Morula, results, which lines the internal surface of the cellular envelope. The ovum absorbs moisture by osmosis and enlarges, and about the twelfth day after the germ-nuclei have begun to divide, the Morula, or hollow ball of cells, called also the Blastodermic Vesicle, is formed. The next stage in development is the establishment of two primary germinal layers, called together the Gastrula, The outer layer is the Ectoderm or the Epiblast, and the inner layer is the Endoderm or Hypoblast. In a Morula the smaller cells, which contain less yolk-material, gradually grow around the larger yolk-containing cells to form the Gastrula. Between the Ectoderm and the Endoderm a layer of cells called the Mesoderm or Mesoblast is next formed, and from these three layers all the parts of the embryo are built up. From the outer Ectoderm and the inner Endoderm those organs arise which are in the body, outer and inner,—as the nervous system and the outer skin from the Ectoderm, the inner entrails, the lungs and liver, from the Endoderm. From the Mesoderm come the inner skin, the bones and muscles. By this time the embryo is a minute longitudinal streak at the {74} surface of one pole of the ovum. The "Primitive Trace" is like a long inverted letter U, the legs of which are in apposition. The Primitive Trace becomes a circular flattened disc; and it grows into a cylindrical body by the juncture of the free margins which fold downward and inward and meet in the median line, and this closes in the pelvic, abdominal, thoracic, pharyngeal, and oral cavities. The legs and arms bud from this cylinder later. While the ventral cylinder is growing, another longitudinal cylinder is formed along the upper surface of the embryo, which will contain the brain and the spinal column. The subsequent development of the embryo and foetus need not be known for an understanding of the material considered in treating here of terata.

Human terata occur in certain rather definite, types of erroneous development, and the classification of Hirst and Piersol (Human Monstrosities, Philadelphia, 1891), which is a combination and change of the classifications of Geoffrey Saint-Hilaire, Klebs, and Förster, is the most satisfactory. There are four great groups of abnormally developed human beings: (1) Hemiteratic; (2) Heterotaxic; (3) Hermaphroditic; (4) Monstrous.

Hemiterata are giants, dwarfs, persons showing anomalies in shape, in colour, in closure of embryonic clefts, in absence or excess of digits, or having other defects. This group does not come under discussion here, but attention should be called to the fact that women who are dwarfs are to be warned before marriage that they cannot be delivered normally,—that the caesarean section or symphyseotomy will be necessary, or that certain physicians will practise craniotomy in delivering them.

The Heterotaxic group comprises persons whose left or right visceral organs are reversed in position through abnormal embryonic development; the liver is on the left side, the heart points to the right, and so on.

Of the next group, the Hermaphroditic, it may be said that a true hermaphrodite, in the full sense of the term, has not been found; but there have been several examples of individuals who had an ovary and a testicle, and other rudimentary sexual organs that belonged to both male and female. Forms of apparent doubling are common, and in case of doubt as to sex the probability leans toward the {75} masculine side. As to marriage in such cases, questions may arise that are to be settled by the anatomist. In dealing with double monsters it is sometimes difficult or impossible to determine whether we have to do with one or two individuals, and this difficulty has serious weight, especially in the administration of baptism. It is improbable that there is a doubling of personality in hermaphrodites. A striking characteristic of compound terata is that the individuals are always of the same sex; moreover, the embryonal development of reproductive organs in general is such as almost to preclude a question of duality of personality.

Terata, more properly so called, are divided into single, double, and triple monsters. Single monsters may be autositic, or independent of another embryo or foetus; or they may be omphalositic, that is, dependent upon another embryo or foetus, which is commonly well developed, and which supplies blood for both through the umbilical vessels. When an omphalosite exists, the other foetus is called, in this case also, the autosite.

The first order of autositic single monsters contains four genera with eight species, and under these species are thirty-four varieties. They may have imperfect limbs, no limbs, one eye in the middle of the forehead (cyclops), fused lower limbs (siren), and so on. Some of these monsters show a strong resemblance to lower animals, but there is no record that is in any degree scientific of a hybrid between a human being and a lower animal.

There are two genera of the omphalositic single monsters, with four species. One of the twins, the autosite, is commonly a normal child; the other, the omphalosite, may be as small as a child's fist, and be very much deformed. Of these omphalosites the paracephalus has an imperfect head, commonly no heart, and the lungs are absent or rudimentary. The acephalus has no head, and commonly no arms; the asomata is a head more or less developed, with a sac below containing rudiments of the trunk organs. The Acephalus is very rare—the rarest of all monsters except the Tricephalus. There is a fourth kind—the foetus anideus. This is a shapeless mass of flesh covered with skin. There may be a {76} slight prominence with a tuft of hair on it at one end of the mass to indicate the head. In this monster there are more traces of bodily organs than might be expected. These four kinds of omphalosites are either dead when born, or they die as soon as the placental circulation is cut off. If there is any probability of life, the physician should give them baptism before the placental circulation is stopped.

Nothing satisfactory is known concerning the etiology of single monsters. Landau, and other authorities as great as he is, reject the theory that maternal impressions from fright or exposure to the sight of hideous deformity are the cause of terata. I think the father is accountable for terata as often as the mother is. Barnes, an English physician, and others claim they find that terata are frequent in consanguineous marriages, but I have not been able to verify the assertion. It seems a theory may be offered to explain the single terata. In 1888 Roux of Breslau by puncturing one blastomere of a frog's egg in the two-cell stage killed the punctured blastomere without affecting the other. The punctured blastomere remained inactive, but the other developed into a complete half embryo. Crampton by separating and isolating the blastomeres in the two-cell stage obtained a half embryo; and Zoja by isolating blastomeres of the medusae, Clytia and Laodice, got dwarfed larvae. Wilson succeeded by the separation through shaking of the blastomeres in the two-cell and four-cell stages in developing Amphioxus larvae, which were half the natural size for the two-cell blastomeres, and commonly half the normal size from the four-cell blastomeres, yet in the latter some of the larvae were of the normal size but imperfect. From the eight-cell stage he got only imperfect larvae. Similar results were obtained by other operators with various eggs. Driesch and Morgan by removing part of the cytoplasm from a fertilized egg of the ctenophore, Beroe, produced imperfect larvae showing certain defects which represent the parts removed. In these cases of injured and isolated blastomeres we have, it seems to me, a plausible theory for the etiology of single terata. The blastomeres in the human ovum may perhaps be injured in part by toxins from the mother, or they may be defective through disease in the ovum or the spermatozoon. They also may possibly be displaced traumatically, but this seems to be doubtful. There are three theories concerning the origin of omphalositic {77} terata. Ahlfeld (Missbildungen des Menschen, Leipsic, 1882) holds that the autosite is stronger than the omphalosite, and as a consequence the foetal circulation in the omphalosite is reversed, and development is thus checked. Dareste (Production artificielle des monstruosités, Paris, 1876), Panum (Beitrag zur Kenntniss der physiol. Bedeut. der angeboren Missbildungen, Virchow's Archiv., 1878), Perls (Lehrbuch der allgem. Pathologie) and Breus (Wiener med. Jahrbuch, 1882) maintain there is an inherent original defect in the omphalositic child which prevents development of the blood-vessels, and that Ahlfeld's theory of an indirect umbilical connection of the omphalosite to the placenta is not probable; if it were, omphalosites would be very common, because one of twins is nearly always stronger than the other. Hirst and Piersol (op. cit) combine these theories. This kind of monster is certainly an imperfectly developed human individual, and even the Foetus Anideus should receive at the least conditional baptism.

The next group comprises the composite monsters. Normal twins may arise from the fertilisation of one ovum and of two distinct ova. In 506 cases examined by Ahlfeld he found that 66 twin births came from single ova. Twins from a single ovum are always of the same sex, and they are not easily distinguished one from the other. Triplets may arise from one, two, or three ova. The elder Saint-Hilaire thought that composite monsters arise from the fusion of two impregnated ova, but this opinion is now generally rejected. Composite terata in every instance arise from a single ovum.

There is a divergence of opinion, however, as to the origin of a composite monster in the single ovum. Some authorities maintain that these monsters arise from the union of two originally separate primitive traces. This supposes primitive duality followed by fusion (Verwachsungstheorie). Other writers hold that there is originally one primitive trace, and that composite terata are the product of a more or less extensive cleavage of this single blastoderm. This supposes primitive unity followed by fission (Spaltungstheorie). Here, as in the case of normal development, the argument is founded on analogy. The earliest stage in the development of a human double monster observed was at the fourth week after fertilisation—Ahlfeld's case. B. Schultze (U. anomale Duplicität der Axenorgane, Virchow's Archiv.) and Panum and Dareste (op. cit.) hold the fusion theory— {78} the fusion of two separate blastoderms in one ovum. Panum and Dareste have seen two separate normal blastoderms on one ovum. Allen Thompson in 1844 (London and Edinburgh Monthly Journal of Medical Science), Wolff, von Baer, and Reichert also observed two embryos in one ovum. Dareste is of the opinion that the fusion of two separate ova is impossible. The fission theory—the fission of a single blastoderm to make a composite monster—is supported by Wolff, J. F. Meckel, von Baer, J. Müller, Valentine, Bischoff, and others, especially by Ahlfeld. Ahlfeld says that this single blastoderm is split by pressure. Gerlach also (Die Entstehungsweise der Doppelmissbildungen, etc., Stuttgart, 1882) admits fission, but he contends that it is not so simple a process as Ahlfeld thinks it is. It is not a passive cleavage, but a result of a force in the cell-mass existing before differentiation. Gerlach calls fission at the anterior or head-end of the single blastoderm, bifurcation; and he has actually observed such bifurcation in a chick embryo of sixteen hours (U. d. Entstehungsweise der vorderen Verdoppelung. Deutsche Archiv. f. klin, Med., 1887). In this case the first change noticed was a broadening of the anterior end of the primitive streak; next a forked divergence appeared, and this became more pronounced; until by the twenty-sixth hour the bifurcation was half as long as the undivided posterior part. From each anterior end of the diverging branches a distinct head-process extended. Allen Thompson (loc. cit.) in 1844 saw a goose-egg, which had been incubated for five days, in which was a double monster divided to the neck. Beyond this observation by Gerlach we have the fact, which seems to make for the fission theory, that no matter how unequally nourished or how variable in extent, the union between the halves of double monsters is always symmetric—exactly the same parts of each twin are joined. This seems to exclude a fortuitous growing together of dissimilar areas or cell-masses, for non-parasitic double terata at the least. Born ( U. d. Furchung des Eies bei Doppelbildungen, Breslauer Aerztl. Zeitschr., 1887), in a study of fish ova, found that ova which produce double monsters begin with a segmentation like that of the single normal ovum. If fission is complete homogeneous twins are the result; these twins are of the same sex and very similar in appearance. Incomplete fission, as has been said, gives rise to double or triple terata. If one of the teratic twin embryos is stronger than the other, the various combinations of enclosure and parasitism may result, although the origin of parasitic double terata is not convincingly clear. A triple {79} monster, according to the fission theory, arises from a double incomplete cleavage of the primitive trace. Dr. Ephraim Cutter has observed teratic composite spermatozoa which, he thinks, probably have influence in producing composite monsters.

There are three orders of the double autositic monsters: Terata Katadidyma, in which the embryonal fission was at the cerebral end; the Terata Anadidyma, divided below; the Terata Anakatadidyma, divided above and below, but joined at the middle of the body. There are four genera of the Terata Katadidyma with many species. The first genus is the Diprosopus, the double-faced. The doubling varies from the finding of two complete faces to a slight trace of duplex formation in one head. Förster in 500 human monsters observed 29 cases of diprosopi.

There are six species of diprosopi: 1. D. Diophthalmus, which has only two eyes, but there is a doubling of the nose. 2. D. Distomus, which has two mouths, two lower jaws, two tongues, one pharynx, and one oesophagus. 3. D. Triophthalmus, which has three eyes, and the doubling of the face is more complete. There are only two ears. 4. D. Tetrophthalmus, which has four eyes and two well-separated faces. 5. D. Triotus is like the last, but it has three ears. 6. D. Tetrotus has four ears, four eyes, and there is some doubling at the pharynx. Two oesophaguses enter one stomach in this species commonly. D. Tetrotus is rare—only one example in man is known. In all diprosopi there is only one trunk, one pair of arms, and one pair of legs. Sir James Paget had a photograph, made in 1856, of a living diprosopus, the second face of which had a mouth, nose, eye, part of an ear, and a brain (?) of its own. The two faces acted simultaneously, suckled, sneezed, yawned together.

Are diprosopi twins? An answer to this question will be clearer after a description of other composite terata.

The second genus of the Terata Katadidyma is the Dicephalus. This genus comprises five species, which have in each case two heads, with separate necks commonly. There are two vertebral columns, which usually are separate down to the sacrum, and they converge at the lower end. {80} In the interior organs doubling will be found corresponding to the degree of separation of the trunks. In all the species of this genus there are one umbilicus and one cord.

The first species of the Dicephalus is the Dicephalus Dibrachius—a two-armed, double-headed monster. In this species most of the viscera are single, but the right and left halves of each viscus are supplied by the respective foetuses, and the entrail does not become indistinguishably single until near the lower end of the ileum. There may be two ordinary kidneys and a third smaller one, two pancreatic glands, and two gall-bladders. Such a monster may be monauchenous or diauchenous.

The next species is the Dicephalus Tribrachius Dipus—two heads, three arms, and two legs. There is also a Dicephalus Tribrachius Tripus (three arms and three legs), D. Tetrabrachius Dipus (four arms and two legs), and D. Tetrabrachius Tripus (four arms and three legs). In all these cases there is no doubt of the presence of twins, unless there might be some doubt as to dual personality in the Dicephalus Dibrachius. In the Dicephalus Tetrabrachius Dipus and the Dicephalus Tetrabrachius Tripus there is almost complete duplication of the internal organs, and the halves of the composite body belong evidently to individuals distinct in thought, volition, and character. Each brain controls only its own half of the body. There are four lungs, two hearts (sometimes in one pericardium), two stomachs, two intestinal canals down to the colon or lower, two livers (sometimes joined), four kidneys (or three, one of which is small), two bladders, emptied at different times through a common urethra.

Dicephali are somewhat common. Förster found 140 among 500 specimens of monsters. They are rarely born alive. The best known cases of dicephali that lived for any length of time are:

1. Peter and Paul, of Florence, born in 1316, lived thirty days.

2. The Scotch Brothers, born in 1490, lived twenty-eight years. They were at the court of James III. Above the point of union the twins were independent in sensation and action, but below the point all sensation and action were {81} common. One died before the other, and the second "succumbed to infection from putrefaction" a few days later.

3. The Würtemberg Sisters, born in 1498.

4. The twins, Justina and Dorothea, born in 1627, lived six weeks.

5. Boy twins at Padua, born in 1691, lived to be baptised.

6. Rita-Cristina, born at Sassari in Sardinia in 1829. They lived eight months. These children had a common trunk below the breast, one pelvis, and one pair of legs. Rita was feeble and quiet, Cristina vigorous and lively. They suckled at different times; and sensation in the heads and arms was individual, but below the junction it was common. Rita died of bronchitis, and during Rita's final illness Cristina was healthy; but when Rita died, Cristina, who was suckling at the time, suddenly expired. They had two hearts in one pericardium, the digestive tracts did not fuse until the lowest third of the ileum was reached. The livers were fused, the vertebral columns were distinct throughout. These twins were baptised separately.

7. Marie-Rose Drouin, born in Montreal in 1878. They lived seven months. Marie died of cholera infantum; and Rose then died, although she had not been directly affected by the disease. These twins were like Rita-Cristina anatomically except that they had no legs. The respirations and heart-pulsations differed, and one child slept while the other child cried.

8. The Tocci boys, born in Turin in 1877. In 1882 they were strong and healthy, and they may be living still. They resembled Rita-Cristina anatomically in every respect. Each boy had control of the leg on his own side, but not of the other leg, consequently they could not walk. Their sensations above the juncture were distinct, and their thoughts and emotions differed.

In the Paris L'union médicale there is an account of a bicephalic still-born monster, born at Alexandria in 1848, which, according to the report, had on one side a typical negro head and on the other side a typical Egyptian fellah head. This report is probably not authentic; but if it is, it would be difficult to reconcile it with the fission theory. {82} Supposing the report true, the case would have to be one (1) of superimpregnation wherein (2) a spermatozoon from each source penetrated the same ovum, (3) a bicephalic monster resulted, with (4) distinct racial characteristics. All this is extremely improbable.

Superimpregnation has happened. There are cases where negresses have given birth to twins, one of which was a negro and the other a mulatto. Instances are cited in books on Legal Medicine like those of Tidy and Beck. In Flint's Physiology a case is recorded in which a mulatto woman in Kent County, Virginia, married to a negro, gave birth to twins, in 1867, one of which was a negro much blacker than the mother, and the other a white child, with long, light, silky hair, and a "brilliant complexion." The white child's nose was shaped like the mother's, but there was no other resemblance. Even supposing this to be a case of superimpregnation, that does not fully explain the extreme whiteness of one child and the extreme blackness of the other.

Superfoetation is also possible. Tidy (Legal Medicine) gives a case: "Mary Anne Bigaud, at thirty-seven, on April 30th, 1748, gave birth to a full-term mature boy, which survived its birth two and a half months, and to a second mature child (girl) on September 16th, 1748, which lived for one year." The second child was born four and a half months after the first, and both were "nine-months" children. It was proved after death in this case that the mother had not a double uterus, and the report is vouched for by Professor Eisenman, and by Leriche, surgeon-major of the Strasburg Military Hospital. Several other cases of superfoetation are given by Bonnar (Edin. Med. Journ., January, 1865).

The third genus of Terata Katadidyma is the Ischiopagus. These twins are divided so much from above downward that the heads are at almost opposite ends of the double body. They are joined at the coccyges and sacra, and the spinal columns have nearly the same axis. The trunk organs are complete and separate, except that they are commonly fused in the pelvis. There may be two, three, or four legs, given off at right angles to the pelvis. This kind of monster is not rare. Förster collected twenty cases, and nine new examples {83} were reported in the Index Medicus between 1879 and 1893. Ischiopagic twins were born in County Roscommon, Ireland, in 1827, and baptised separately. The Jones Twins, born in Typhon County, Indiana, in 1889, lived for about two years; they were ischiopagi, and they had the very unusual quality, it is said, that they differed in complexion and the colour of eyes and hair. A case was reported in American Medicine, September, 1903.

Classed with the Katadidyma is the genus Pygopagus, although it has four legs. This form is very rare. The twins are joined only by the latero-posterior aspects of the sacra and coccyges, so that the two individuals are placed almost back to back. The trunk organs are independent, except for some fusion near the point of juncture. Examples of this class are the Hungarian Sisters, born at Szony in 1701, who lived to womanhood; the negresses Millie-Christine, born in 1851, and who were recently living in North Carolina; and the Blazek Sisters of Bohemia. The negresses had common sensation in the legs, but Millie could not localise what part of Christine's legs was touched, and vice versa.

The second group of the double autositic monsters are Terata Anadidyma—terata divided from below upward. The first genus is the Dipygus. This has a single body above, but a double pelvis with double lower extremities in the typical cases. There is an exact description of a double monster of this kind in the Gaelic Annals of the Four Masters as early as the year 727 of this era. The chronicler says in that year on Dalkey Island near Dublin, "There was a cow seen which had one head and one body as far as her shoulders, two bodies from her shoulders hindward, and two tails. She had eight legs, and she was milked three times a day."

A perfect human Dipygus with two equally developed pairs of legs is unknown. Catherine Kaufmann, who was born in 1876, and who died in 1878, had a double pelvis with double pelvic organs in part, but she had only one pair of legs. There is a similar anomaly said to be living in Philadelphia at present. Blanche Dumas, born in 1860, had a double pelvis, double pelvic organs, and three legs. Mrs. B., born in 1868, {84} had four legs—the two inner ones were smaller than the outer pair. Her spinal column was divided up to the third lumbar vertebra. Her double pelvic organs acted independently. There are living male examples of this form of monster.

The next genus is the Syncephalus, called also Janus and Janiceps. Its lower body is double up to the umbilicus, the trunk single above that point; the head shows signs of doubling, and there are four legs and four arms; the bodies grow front to front. The head usually is large, therefore this monster is born dead.

Another genus is the Craniopagus—twins joined only by the skull or scalp. There are three species, named from the place of union—Craniopagus Frontalis, C. Parietalis, and C. Occipitalis.

A third group of double autositic monsters are the Terata Anakatadidyma, which are divided above and below, but joined from the navel to the head. There are three genera. The first, the Prosopothoracopagus, is joined at the upper abdomen, the chest, and the faces; the spinal columns are separate. The faces are imperfect, the jaws are united; there is a broad neck with one oesophagus, and there is one stomach and one duodenum. This is a rare form, and it can not exist out of the uterus.

A second genus, the Thoracopagus, has a thorax in common, and the inner legs may be united. It is, as a rule, still-born.

The next genus is the Omphalopagus, in which the twins are joined from the navel to the bottom of the chest. This double monster has the slightest union of all, and it is very rare. The Siamese Twins were omphalopagi. They quarrelled; one became a drunkard and the other remained temperate. They married two women, and Chang had ten children, and Eng twelve. Chang died while Eng was asleep, and the latter died two hours after he had waked and learned of his brother's death.

There is a genus, the Rachipagus, the examples of which are joined behind like the class Terata Anakatadidyma that are joined in front.

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Four known attempts have been made to separate double monsters surgically, but all failed owing to crude surgery; modern methods might be successful in some cases.

The second order of double monsters comprises the parasitic class. There are three genera of these terata, with five species and seventeen varieties. The chief of these only will be mentioned. The Heterotypus is a parasitic child which hangs from the abdominal wall of the principal subject. Varieties of this species are the Heteropagus, which is a parasite with head and arms; the Heterodelphus, which has no head; the Heterodymus, which has a head, neck, and thorax. The Heteralitis is a second species, in which the parasite is inserted at a distance from the navel of the autosite. The Epicomus is the only example, and it consists of a parasitic supernumerary head. The Polypnathus is a parasite attached to the jaw of the autosite. When fastened to the upper jaw, it is an Epignathus; at the lower jaw it is an Hypognathns. Another group is made up of terata having parasitic legs which are attached to different parts of the autosite,—to the pelvis, the head, the abdomen, and so on. Finally, there is the Endocyma, which is a parasite enclosed within the body of an autosite.

Parasites are nourished through the blood supply of the autosite, and the parasites usually are incapable of motion. The autosite can feel when the parasite is touched, and in some cases the autosite can localise the touch. In India, in 1783, a child was born which had a supernumerary head attached to the autositic head, crown to crown; it lived four years. The parasite's eyes were always partly open, but they appeared to be incapable of intelligent vision. They contracted under strong light, and when the autosite was suddenly awakened both sets of eyes moved.

Gould and Pyle (Anomalies and Curiosities of Medicine) give an account of an Italian boy, aged eight years, who had a small parasitic head protruding from near the left third rib. Sensibility was common. Each of the heads received baptism (one was called John and the other Matthew), and there was question as to whether extreme unction should be administered to the parasitic head. A similar case occurred in {86} England in 1880 (British Med. Journal), and the parasitic head could be pinched without attracting the attention of the autosite.

Teratologists now exclude Dermoid Cysts from the lists of terata. The hair, teeth, and particles of bone found in these cysts are looked upon as the development of abnormal ectodermic and endodermic cells, rather than as evidence of a separate personality.

There is only one well-authenticated case of a triple monster, and this happened in Italy in 1831. The monster had a single broad body with three distinct heads and two necks. It was killed in delivery.

In Katadidyma (terata divided from above downward), when we have dicephali, ischiopagi, or pygopagi, there are evidently two individuals present. Is the Diprosopus, however, the two-faced monster, possessed of one or two souls? The cases vary, as we said, from examples with two distinct faces and four ears to cases that have merely two noses. What portion of a human body is required to contain a new soul? That is an interesting question for the psychologist and a very practical one for the moralist, and no moralist has yet attempted to solve it. The presence of a brain is not essential, because acephalous monsters develop without brain, and they are born alive; they have a vital principle which is identical with the soul.

Among the Terata Anadidyma (divided from below upward) the Syncephalus and the Craniopagus are unquestionably two persons. Is the Dipygus (single down to the navel, double below) one or two persons? Mrs. B., the example already given, was as double below the navel as any Dicephalus is above that point. She had features so well ordered in unity that she was a pretty woman, but that unity ceased at her waist. Was her husband unknowingly a bigamist? I think he was. After a consideration of the fission of terata, and the non-essential quality of the brain, why should fission that started at the feet differ from fission that started at the head?

In the Rituale Romanum Pauli V. (tit. ii. cap. i. nn. 18, 19, 20, 21), the following directions for the baptising of terata are given:

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18. In monstris vero baptizandis, si casus eveniat, magna cautio adhibenda est, de quo si opus fuerit, Ordinarius loci; vel alii periti consulantur, nisi mortis periculum immineat. 19. Monstrum, quod humanam speciem non praeseferat, baptizari non debet; de quo si dubium fuerit, baptizetur sub hac conditione: Si tu es homo, ego te baptizo, etc. 20. lllud vero, de quo dubium est, una ne, aut plures sint personae, non baptizetur, donec id discernatur: discerni autem potest, si habeat unum vel plura capita, unum vel plura pectora; tunc enim totidem erunt corda et animae, hominesque distincti, et eo casu singuli seorsum sunt baptizandi, unicuique dicendo: Ego te baptizo, etc Si vero periculum mortis immineat, tempusque non suppetat, ut singuli separatim baptizentur, potent minister singulorum capitibus aquam infundens omnes simul baptizari, dicendo: Ego vos baptizo, in nomine Patris, et Filii, et Spiritus sancti. Quam tamen formam in iis solum, et in aliis similibus mortis periculis, ad plures simul baptizandos, et ubi tempus non patitur, ut singuli separatim baptizentur, alias numquam, licet adhibere. 21. Quando vero non est certum in monstro esse duas personas, ut quia duo capita et duo pectora non habet distincta; tunc debet primum unus absolute baptizari, et postea alter sub conditione, hoc modo: Si non es baptizatus, ego te baptizo in nomine Patris, et Filii, et Spiritus sancti.

AUSTIN ÓMALLEY.

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