Among the peculiar effects of coitus is its deteriorating effect on the healing process of wounds. Boerhaave, Pare, and Fabricius Hildanus all speak of this untoward effect of venery, and in modern times Poncet has made observations at a hospital in Lyons which prove that during the process of healing wounds are unduly and harmfully influenced by coitus, and cites confirmatory instances. Poncet also remarks that he found on nine occasions, by placing a thermometer in the rectum, that the temperature was about 1 degrees F. lower just before than after coitus, and that during the act the temperature gradually rose above normal.

There are many associate conditions which, under the exciting influence of coitus, provoke harmful effects and even a fatal issue. Deguise mentions a man who had coitus 18 times in ten hours with most disastrous effects. Cabrolius speaks of a man who took a potion of aphrodisiac properties, in which, among other things, he put an enormous dose of cantharides. The anticipation of the effect of his dose, that is, the mental influence, in addition to the actual therapeutic effect, greatly distressed and excited him. Almost beyond belief, it is said that he approached his wife eighty-seven times during the night, spilling much sperm on the sleeping-bed. Cabrolius was called to see this man in the morning, and found him in a most exhausted condition, but still having the supposed consecutive ejaculations. Exhaustion progressed rapidly, and death soon terminated this erotic crisis. Lawson is accredited with saying that among the Marquesan tribe he knew of a woman who during a single night had intercourse with 103 men.

Among the older writers there are instances reported in which erection and ejaculation took place without the slightest pleasurable sensation. Claudius exemplifies this fact in his report of a Venetian merchant who had vigorous erections and ejaculations of thick and abundant semen without either tingling or pleasure.

Attila, King of the Huns, and one of the most celebrated leaders of the German hosts which overran the Roman Empire in its decline, and whose enormous army and name inspired such terror that he was called the "Scourge of God," was supposed to have died in coitus. Apoplexy, organic heart disorders, aneurysms, and other like disorders are in such cases generally the direct cause of death, coitus causing the death indirectly by the excitement and exertion accompanying the act.

Bartholinus, Benedictus, Borellus, Pliny, Morgagni, Plater, a Castro, Forestus, Marcellus Donatus, Schurig, Sinibaldus, Schenck, the Ephemerides, and many others mention death during coitus; the older writers in some cases attributed the fatal issue to excessive sexual indulgence, not considering the possibility of the associate direct cause, which most likely would have been found in case of a necropsy.

Suspended Animation.—Various opinions have been expressed as to the length of time compatible with life during which a person can stay under water. Recoveries from drowning furnish interesting examples of the suspension of animation for a protracted period, but are hardly ever reliable, as the subject at short intervals almost invariably rises to the surface of the water, allowing occasional respiration. Taylor mentions a child of two who recovered after ten minutes' submersion; in another case a man recovered after fourteen minutes' submersion. There is a case reported in this country of a woman who was said to have been submerged twenty minutes. Guerard quotes a case happening in 1774, in which there was submersion for an hour with subsequent recovery; but there hardly seems sufficient evidence of this.

Green mentions submersion for fifteen minutes; Douglass, for fourteen minutes; Laub, for fifteen minutes; Povall gives a description of three persons who recovered after a submersion of twenty-five minutes. There is a case in French literature, apparently well authenticated, in which submersion for six minutes was followed by subsequent recovery.

There have been individuals who gave exhibitions of prolonged submersion in large glass aquariums, placed in full view of the audience. Taylor remarks that the person known some years ago in London as "Lurline" could stay under water for three minutes. There have been several exhibitionists of this sort. Some of the more enterprising seat themselves on an artificial coral, and surrounded by fishes of divers hues complacently eat a meal while thus submerged. It is said that quite recently in Detroit there was a performer who accomplished the feat of remaining under water four minutes and eight seconds in full view of the audience. Miss Lurline swam about in her aquarium, which was brilliantly illuminated, ate, reclined, and appeared to be taking a short nap during her short immersion. In Paris, some years since, there was exhibited a creature called "l'homme-poisson," who performed feats similar to Lurline, including the smoking of a cigarette held entirely in his mouth. In all these exhibitions all sorts of artificial means are used to make the submersion appear long. Great ceremony, music, and the counting of the seconds in a loud voice from the stage, all tend to make the time appear much longer than it really is. However, James Finney in London, April 7, 1886, stayed under water four minutes, twenty-nine and one-fourth seconds, and one of his feats was to pick up 70 or 80 gold-plated half-pennies with his mouth, his hands being securely tied behind his back, and never emerging from his tank until his feat was fully accomplished. In company with his sister he played a game of "nap" under water, using porcelain cards and turning them to the view of the audience. "Professor Enochs" recently stayed under water at Lowell, Mass., for four minutes, forty-six and one-fifth seconds. The best previous record was four minutes, thirty-five seconds, made by "Professor Beaumont" at Melbourne on December 16, 1893.

For the most satisfactory examples of prolonged submersion we must look to the divers, particularly the natives who trade in coral, and the pearl fishers. Diving is an ancient custom, and even legendary exploits of this nature are recorded. Homer compares the fall of Hector's chariot to the action of a diver; and specially trained men were employed at the Siege of Syracuse, their mission being to laboriously scuttle the enemy's vessels. Many of the old historians mention diving, and Herodotus speaks of a diver by the name of Scyllias who was engaged by Xerxes to recover some articles of value which had been sunk on some Persian vessels in a tempest. Egyptian divers are mentioned by Plutarch, who says that Anthony was deceived by Cleopatra in a fishing contest by securing expert divers to place the fish upon the hooks. There was a historical or rather legendary character by the name of Didion, who was noted for his exploits in the river Meuse. He had the ability to stay under water a considerable length of time, and even to catch fish while submerged.

There was a famous diver in Sicily at the end of the fifteenth century whose feats are recorded in the writings of Alexander ab Alexandro, Pontanus, and Father Kircher, the Jesuit savant. This man's name was Nicolas, born of poor parents at Catania. From his infancy he showed an extraordinary power of diving and swimming, and from his compatriots soon acquired various names indicative of his capacity. He became very well known throughout Sicily, and for his patron had Frederick, King of Naples. In the present day, the sponge-fishers and pearl-fishers in the West Indies, the Mediterranean, the Indian Seas, and the Gulf of Mexico invite the attention of those interested in the anomalies of suspended animation. There are many marvelous tales of their ability to remain under water for long periods. It is probable that none remain submerged over two minutes, but, what is more remarkable, they are supposed to dive to extraordinary depths, some as much as 150 to 200 feet. Ordinarily they remain under water from a minute to one and a half minutes. Remaining longer, the face becomes congested, the eyes injected; the sputum bloody, due to rupture of some of the minute vessels in the lung. It is said by those who have observed them carefully that few of these divers live to an advanced age. Many of them suffer apoplectic attacks, and some of them become blind from congestion of the ocular vessels. The Syrian divers are supposed to carry weights of considerable size in their hands in order to facilitate the depth and duration of submersion. It is also said that the divers of Oceanica use heavy stones. According to Guyot-Daubes, in the Philippine Isles the native pearl-fishers teach their children to dive to the depth of 25 meters. The Tahitians, who excited the admiration of Cook, are noted for their extraordinary diving. Speaking of the inhabitants of the island of Fakaraya, near Tahiti, de la Quesnerie says that the pearl-fishers do not hesitate to dive to the depth even of 100 feet after their coveted prizes. On the Ceylon coast the mother-of-pearl fishers are under the direction of the English Government, which limits the duration and the practice of this occupation. These divers are generally Cingalese, who practice the exercise from infancy. As many as 500 small boats can be seen about the field of operation, each equipped with divers. A single diver makes about ten voyages under the water, and then rests in the bottom of the boat, when his comrade takes his place. Among other native divers are the Arabs of Algeria and some of the inhabitants of the Mexican coast.

It might be well to mention here the divers who work by means of apparatus. The ancients had knowledge of contrivances whereby they could stay under water some time. Aristotle speaks of an instrument by which divers could rest under water in communication with the air, and compares it with the trunk of an elephant wading a stream deeper than his height. In the presence of Charles V diving bells were used by the Greeks in 1540. In 1660 some of the cannon of the sunken ships of the Spanish Armada were raised by divers in diving bells. Since then various improvements in submarine armor have been made, gradually evolving into the present perfected diving apparatus of to-day, by which men work in the holds of vessels sunk in from 120 to 200 feet of water. The enormous pressure of the water at these great depths makes it necessary to have suits strong enough to resist it. Lambert, a celebrated English diver, recovered L90,000 in specie from the steamer Alphonso XII, a Spanish mail boat belonging to the Lopez line, which sank off Point Gando, Grand Canary, in 26 1/2 fathoms of water. For nearly six months the salvage party, despatched by the underwriters in May, 1885, persevered in the operations; two divers lost their lives, the golden bait being in the treasure-room beneath the three decks, but Lambert finished the task successfully.

Deep-sea divers only acquire proficiency after long training. It is said that as a rule divers are indisposed to taking apprentices, as they are afraid of their vocation being crowded and their present ample remuneration diminished. At present there are several schools. At Chatham, England, there is a school of submarine mining, in which men are trained to lay torpedoes and complete harbor defense. Most of these divers can work six hours at a time in from 35 to 50 feet of water. Divers for the Royal Navy are trained at Sheerness. When sufficiently trained to work at the depth of 150 feet seamen-divers are fully qualified, and are drafted to the various ships. They are connected with an air-pump in charge of trustworthy men; they signal for their tools and material, as well as air, by means of a special line for this purpose. At some distance below the water the extraordinary weight of the suits cannot be felt, and the divers work as well in armor as in ordinary laboring clothes. One famous diver says that the only unpleasant experience he ever had in his career as a diver, not excepting the occasion of his first dive, was a drumming in the ears, as a consequence of which, after remaining under water at a certain work for nine hours, he completely lost the use of one ear for three months, during which time he suffered agony with the earache. These men exhibit absolute indifference to the dangers attached to their calling, and some have been known to sleep many fathoms beneath the surface. Both by means of their signal lines and by writing on a slate they keep their associates informed of the progress of their work.

Suspension of the Pulse.—In some cases the pulse is not apparent for many days before actual death, and there have been instances in which, although the pulse ceased for an extended period, the patient made an ultimate recovery. In reviewing the older literature we find that Ballonius mentions an instance in which the pulse was not apparent for fourteen days before complete asphyxia. Ramazzini describes a case of cessation of the pulse four days before death. Schenck details the history of a case in which the pulse ceased for three days and asphyxia was almost total, but the patient eventually recovered. There is a noteworthy observation, in which there was cessation of the pulse for nine days without a fatal issue.

Some persons seem to have a preternatural control over their circulatory system, apparently enabling them to produce suspension of cardiac movement at will. Cheyne speaks of a Colonel Townshend who appeared to possess the power of dying, as it were, at will,—that is, so suspending the heart's action that no pulsation could be detected. After lying in this state of lifelessness for a short period, life would become slowly established without any consciousness or volition on the man's part. The longest period in which he remained in this death-like condition was about thirty minutes. A postmortem examination of this person was awaited with great interest; but after his death nothing was found to explain the power he possessed over his heart.

Saint Augustin knew of a priest named Rutilut who had the power of voluntarily simulating death. Both the pulsation and respiration was apparently abolished when he was in his lifeless condition. Burning and pricking left visible effects on the skin after his recovery, but had no apparent effect on his lethargy. Chaille reports an instance of voluntary suspension of the pulse.

Relative to hibernation, it is well-known that mice, snakes, and some reptiles, as well as bees, sometimes seem to entirely suspend animation for an extended period, and especially in the cold weather. In Russia fish are transported frozen stiff, but return to life after being plunged into cold water. A curious tale is told by Harley, from Sir John Lubbock, of a snail brought from Egypt and thought to be dead. It was placed on a card and put in position on a shelf in the British Museum in March, 1845. In March, 1850 after having been gummed to a label for five years, it was noticed to have an apparent growth on its mouth and was taken out and placed in water, when it soon showed signs of life and ate cabbage leaves offered to it. It has been said, we think with credible evidence, that cereal seeds found in the tombs with mummies have grown when planted, and Harley quotes an instance of a gentleman who took some berries, possibly the remnants of Pharaoh's daughter's last meal, coming as they did from her mummified stomach after lying dormant in an Egyptian tomb many centuries, and planted them in his garden, where they soon grew, and he shortly had a bush as flourishing as any of those emanating from fresh seeds.

Human hibernation is an extremely rare anomaly. Only the fakirs of India seem to have developed this power, and even the gifted ones there are seldom seen. Many theories have been advanced to explain this ability of the fakirs, and many persons have discredited all the stories relative to their powers; on the other hand, all who have witnessed their exhibitions are convinced of their genuineness. Furthermore, these persons are extremely scarce and are indifferent to money; none has been enticed out of his own country to give exhibitions. When one dies in a community, his place is never filled—proving that he had no accomplices who knew any fraudulent secret practices, otherwise the accomplice would soon step out to take his place. These men have undoubtedly some extraordinary mode of sending themselves into a long trance, during which the functions of life are almost entirely suspended. We can readily believe in their ability to fast during their periods of burial, as we have already related authentic instances of fasting for a great length of time, during which the individual exercised his normal functions.

To the fakir, who neither visibly breathes nor shows circulatory movements, and who never moves from his place of confinement, fasting should be comparatively easy, when we consider the number of men whose minds were actively at work during their fasts, and who also exercised much physical power.

Harley says that the fakirs begin their performances by taking a large dose of the powerfully stupefying "bang," thus becoming narcotized. In this state they are lowered into a cool, quiet tomb, which still further favors the prolongation of the artificially induced vital lethargy; in this condition they rest for from six to eight weeks. When resurrected they are only by degrees restored to life, and present a wan, haggard, debilitated, and wasted appearance. Braid is credited, on the authority of Sir Claude Wade, with stating that a fakir was buried in an unconscious state at Lahore in 1837, and when dug up, six weeks later, he presented all the appearances of a dead person. The legs and arms were shrunken and stiff, and the head reclined on the shoulder in a manner frequently seen in a corpse. There was no pulsation of the heart or arteries of the arm or temple—in fact, no really visible signs of life. By degrees this person was restored to life. Every precaution had been taken in this case to prevent the possibility of fraud, and during the period of interment the grave was guarded night and day by soldiers of the regiment stationed at Lahore.

Honigberger, a German physician in the employ of Runjeet Singh, has an account of a fakir of Punjaub who allowed himself to be buried in a well-secured vault for such a long time that grain sown in the soil above the vault sprouted into leaf before he was exhumed. Honigberger affirms that the time of burial was over 40 days, and that on being submitted to certain processes the man recovered and lived many years after. Sir Henry Lawrence verified the foregoing statements. The chest in which the fakir was buried was sealed with the Runjeet stamp on it, and when the man was brought up he was cold and apparently lifeless. Honigberger also states that this man, whose name was Haridas, was four months in a grave in the mountains; to prove the absolute suspension of animation, the chin was shaved before burial, and at exhumation this part was as smooth as on the day of interment. This latter statement naturally calls forth comment when we consider the instances that are on record of the growth of beard and hair after death.

There is another account of a person of the same class who had the power of suspending animation, and who would not allow his coffin to touch the earth for fear of worms and insects, from which he is said to have suffered at a previous burial.

It has been stated that the fakirs are either eunuchs or hermaphrodites, social outcasts, having nothing in common with the women or men of their neighborhood; but Honigberger mentions one who disproved this ridiculous theory by eloping to the mountains with his neighbor's wife.

Instances of recovery after asphyxia from hanging are to be found, particularly among the older references of a time when hanging was more common than it is to-day. Bartholinus, Blegny, Camerarius, Morgagni, Pechlin, Schenck, Stoll, and Wepfer all mention recovery after hanging. Forestus describes a case in which a man was rescued by provoking vomiting with vinegar, pepper, and mustard seed. There is a case on record in which a person was saved after hanging nineteen minutes. There was a case of a man brought into the Hopital Saint-Louis asphyxiated by strangulation, having been hung for some time. His rectal temperature was only 93.3 degrees F., but six hours after it rose to 101.6 degrees F., and he subsequently recovered. Taylor cites the instance of a stout woman of forty-four who recovered from hanging. When the woman was found by her husband she was hanging from the top of a door, having been driven to suicide on account of his abuse and intemperance. When first seen by Taylor she was comatose, her mouth was surrounded by white froth, and the swollen tongue protruded from it. Her face was bloated, her lips of a darkened hue, and her neck of a brown parchment-color. About the level of the larynx, the epidermis was distinctly abraded, indicating where the rope had been. The conjunctiva was insensible and there was no contractile response of the pupil to the light of a candle. The reflexes of the soles of the feet were tested, but were quite in abeyance. There was no respiratory movement and only slight cardiac pulsation. After vigorous measures the woman ultimately recovered. Recovery is quite rare when the asphyxiation has gone so far, the patients generally succumbing shortly after being cut down or on the following day. Chevers mentions a most curious case, in which cerebral congestion from the asphyxiation of strangling was accidentally relieved by an additional cut across the throat. The patient was a man who was set upon by a band of Thugs in India, who, pursuant to their usual custom, strangled him and his fellow-traveler. Not being satisfied that he was quite dead, one of the band returned and made several gashes across his throat. This latter action effectually relieved the congestion caused by the strangulation and undoubtedly saved his life, while his unmutilated companion was found dead. After the wounds in his throat had healed this victim of the Thugs gave such a good description of the murderous band that their apprehension and execution soon followed.

Premature Burial.—In some instances simulation of death has been so exact that it has led to premature interment. There are many such cases on record, and it is a popular superstition of the laity that all the gruesome tales are true of persons buried alive and returning to life, only to find themselves hopelessly lost in a narrow coffin many feet below the surface of the earth. Among the lower classes the dread of being buried before life is extinct is quite generally felt, and for generations the medical profession have been denounced for their inability to discover an infallible sign of death. Most of the instances on record, and particularly those from lay journals, are vivid exaggerations, drawn from possibly such a trivial sign as a corpse found with the fist tightly clenched or the face distorted, which are the inspiration of the horrible details of the dying struggles of the person in the coffin. In the works of Fontenelle there are 46 cases recorded of the premature interment of the living, in which apparent has been mistaken for real death. None of these cases, however, are sufficiently authentic to be reliable. Moreover, in all modern methods of burial, even if life were not extinct, there could be no possibility of consciousness or of struggling. Absolute asphyxiation would soon follow the closing of the coffin lid.

We must admit, however, that the mistake has been made, particularly in instances of catalepsy or trance, and during epidemics of malignant fevers or plagues, in which there is an absolute necessity of hasty burial for the prevention of contagion. In a few instances on the battle-field sudden syncope, or apparent death, has possibly led to premature interment; but in the present day this is surely a very rare occurrence. There is also a danger of mistake from cases of asphyxiation, drowning, and similar sudden suspensions of the vital functions.

It is said that in the eighty-fourth Olympiad, Empedocles restored to life a woman who was about to be buried, and that this circumstance induced the Greeks, for the future protection of the supposed dead, to establish laws which enacted that no person should be interred until the sixth or seventh day. But even this extension of time did not give satisfaction, and we read that when Hephestion, at whose funeral obsequies Alexander the Great was present, was to be buried his funeral was delayed until the tenth day. There is also a legend that when Acilius Aviola fell a victim to disease he was burned alive, and although he cried out, it was too late to save him, as the fire had become so widespread before life returned.

While returning to his country house Asclepiades, a physician denominated the "God of Physic," and said to have been a descendant of aesculapius, saw during the time of Pompey the Great a crowd of mourners about to start a fire on a funeral pile. It is said that by his superior knowledge he perceived indications of life in the corpse and ordered the pile destroyed, subsequently restoring the supposed deceased to life. These examples and several others of a similar nature induced the Romans to delay their funeral rites, and laws were enacted to prevent haste in burning, as well as in interment. It was not until the eighth day that the final rites were performed, the days immediately subsequent to death having their own special ceremonies. The Turks were also fearful of premature interment and subjected the defunct to every test; among others, one was to examine the contractility of the sphincter and, which shows their keen observation of a well-known modern medical fact.

According to the Memoirs of Amelot de la Houssaye, Cardinal Espinola, Prime Minister to Philip II, put his hand to the embalmer's knife with which he was about to be opened; It is said that Vesalius, sometimes called the "Father of Anatomy," having been sent for to perform an autopsy on a woman subject to hysteric convulsions, and who was supposed to be dead, on making the first incision perceived by her motion and cries that she was still alive. This circumstance, becoming known, rendered him so odious that he had to leave the community in which he practiced, and it is believed that he never entirely recovered from the shock it gave him. The Abbe Prevost, so well known by his works and the singularities of his life, was seized by apoplexy in the Forest of Chantilly on October 23, 1763. His body was carried to the nearest village, and the officers of justice proceeded to open it, when a cry he sent forth frightened all the assistants and convinced the surgeon in charge that the Abbe was not dead; but it was too late to save him, as he had already received a mortal wound.

Massien speaks of a woman living in Cologne in 1571 who was interred living, but was not awakened from her lethargy until a grave-digger opened her grave to steal a valuable ring which she wore. This instance has been cited in nearly every language. There is another more recent instance, coming from Poitiers, of the wife of a goldsmith named Mernache who was buried with all her jewels. During the night a beggar attempted to steal her jewelry, and made such exertion in extracting one ring that the woman recovered and was saved. After this resurrection she is said to have had several children. This case is also often quoted. Zacchias mentions an instance which, from all appearances, is authentic. It was that of a young man, pest-stricken and thought to be dead, who was placed with the other dead for burial. He exhibited signs of life, and was taken back to the pest-hospital. Two days later he entered a lethargic condition simulating death, and was again on his way to the sepulcher, when he once more recovered.

It is said that when the body of William, Earl of Pembroke, who died April 10, 1630, was opened to be embalmed, the hand raised when the first incision was made. There is a story of an occurrence which happened on a return voyage from India. The wife of one of the passengers, an officer in the army, to all appearances died. They were about to resort to sea-burial, when, through the interposition of the husband, who was anxious to take her home, the ship-carpenters started to construct a coffin suitable for a long voyage, a process which took several days, during which time she lay in her berth, swathed in robes and ready for interment. When the coffin was at last ready the husband went to take his last farewell, and removed the wedding-ring, which was quite tightly on her finger. In the effort to do this she was aroused, recovered, and arrived in England perfectly well.

It is said that when a daughter of Henry Laurens, the first President of the American Congress, died of small-pox, she was laid out as dead, and the windows of the room were opened for ventilation. While left alone in this manner she recovered. This circumstance so impressed her illustrious father that he left explicit directions that in case of his death he should be burned. The same journal also contains the case of a maid-servant who recovered thrice on her way to the grave, and who, when really dead, was kept a preposterous length of time before burial.

The literature on this subject is very exhaustive, volumes having been written on the uncertainty of the signs of death, with hundreds of examples cited illustrative of the danger of premature interment. The foregoing instances have been given as indicative of the general style of narration; for further information the reader is referred to the plethora of material on this subject.

Postmortem Anomalies.—Among the older writers startling movements of a corpse have given rise to much discussion, and possibly often led to suspicion of premature burial. Bartholinus describes motion in a cadaver. Barlow says that movements were noticed after death in the victims of Asiatic cholera. The bodies were cold and expressions were death-like, but there were movements simulating natural life. The most common was flexion of the right leg, which would also be drawn up toward the body and resting on the left leg. In some cases the hand was moved, and in one or two instances a substance was grasped as if by reflex action. Some observers have stated that reflex movements of the face were quite noticeable. These movements continued sometimes for upward of an hour, occurring mostly in muscular subjects who died very suddenly, and in whom the muscular irritability or nervous stimulus or both had not become exhausted at the moment of dissolution. Richardson doubts the existence of postmortem movements of respiration.

Snow is accredited with having seen a girl in Soho who, dying of scarlet fever, turned dark at the moment of death, but in a few hours presented such a life-line appearance and color as to almost denote the return of life. The center of the cheeks became colored in a natural fashion, and the rest of the body resumed the natural flesh color. The parents refused to believe that death had ensued. Richardson remarks that he had seen two similar cases, and states that he believes the change is due to oxidation of the blood surcharged with carbon dioxid. The moist tissues suffuse carbonized blood, and there occurs an osmotic interchange between the carbon dioxid and the oxygen of the air resulting in an oxygenation of the blood, and modification of the color from dark venous to arterial red.

A peculiar postmortem anomaly is erection of the penis. The Ephemerides and Morgagni discuss postmortem erection, and Guyon mentions that on one occasion he saw 14 negroes hanged, and states that at the moment of suspension erection of the penis occurred in each; in nine of these blacks traces of this erectile state were perceived an hour after death.

Cadaveric perspiration has been observed and described by several authors, and Paullini has stated that he has seen tears flow from the eyes of a corpse.

The retardation of putrefaction of the body after death sometimes presents interesting changes. Petrifaction or mummification of the body are quite well known, and not being in the province of this work, will be referred to collateral books on this subject; but sometimes an unaccountable preservation takes place. In a tomb recently opened at Canterbury Cathedral, a for the purpose of discovering what Archbishop's body it contained, the corpse was of an extremely offensive and sickening odor, unmistakably that of putrefaction. The body was that of Hubert Walter, who died in 1204 A.D., and the decomposition had been retarded, and was actually still in progress, several hundred years after burial.

Retardation of the putrefactive process has been noticed in bodies some years under water. Konig of Hermannstadt mentions a man who, forty years previous to the time of report, had fallen under the waters of Echoschacht, and who was found in a complete state of preservation.

Postmortem Growth of Hair and Nails.—The hair and beard may grow after death, and even change color. Bartholinus recalls a case of a man who had short, black hair and beard at the time of interment, but who, some time after death, was found to possess long and yellowish hair. Aristotle discusses postmortem growth of the hair, and Garmanus cites an instance in which the beard and hair were cut several times from the cadaver. We occasionally see evidences of this in the dissecting-rooms. Caldwell mentions a body buried four years, the hair from which protruded at the points where the joints of the coffin had given away. The hair of the head measured 18 inches, that of the beard eight inches, and that on the breast from four to six inches. Rosse of Washington mentions an instance in which after burial the hair turned from dark brown to red, and also cites a case in a Washington cemetery of a girl, twelve or thirteen years old, who when exhumed was found to have a new growth of hair all over her body. The Ephemerides contains an account of hair suddenly turning gray after death.

Nails sometimes grow several inches after death, and there is on record the account of an idiot who had an idiosyncrasy for long nails, and after death the nails were found to have grown to such an extent that they curled up under the palms and soles.

The untoward effects of the emotions on the vital functions are quite well exemplified in medical literature. There is an abundance of cases reported in which joy, fear, pride, and grief have produced a fatal issue. In history we have the old story of the Lacedemonian woman who for some time had believed her son was dead, and who from the sudden joy occasioned by seeing him alive, herself fell lifeless. There is a similar instance in Roman history. Aristotle, Pliny, Livy, Cicero, and others cite instances of death from sudden or excessive joy. Fouquet died of excessive joy on being released from prison. A niece of the celebrated Leibnitz immediately fell dead on seeing a casket of gold left to her by her deceased uncle.

Galen mentions death from joy, and in comment upon it he says that the emotion of joy is much more dangerous than that of anger. In discussing this subject, Haller says that the blood is probably sent with such violence to the brain as to cause apoplexy. There is one case on record in which after a death from sudden joy the pericardium was found full of blood. The Ephemerides, Marcellus Donatus, Martini, and Struthius all mention death from joy.

Death from violent laughter has been recorded, but in this instance it is very probable that death was not due to the emotion itself, but to the extreme convulsion and exertion used in the laughter. The Ephemerides mentions a death from laughter, and also describes the death of a pregnant woman from violent mirth. Roy, Swinger, and Camerarius have recorded instances of death from laughter. Strange as it may seem, Saint-Foix says that the Moravian brothers, a sect of Anabaptists having great horror of bloodshed, executed their condemned brethren by tickling them to death.

Powerfully depressing emotions, which are called by Kant "asthenic," such as great and sudden sorrow, grief, or fright, have a pronounced effect on the vital functions, at times even causing death. Throughout literature and history we have examples of this anomaly. In Shakespeare's "Pericles," Thaisa, the daughter to Simonides and wife of Pericles, frightened when pregnant by a threatened shipwreck, dies in premature childbirth.

In Scott's "Guy Mannering," Mrs. Bertram, on suddenly learning of the death of her little boy, is thrown into premature labor, followed by death. Various theories are advanced in explanation of this anomaly. A very plausible one is, that the cardiac palsy is caused by energetic and persistent excitement of the inhibitory cardiac nerves. Strand is accredited with saying that agony of the mind produces rupture of the heart. It is quite common to hear the expression, "Died of a broken heart;" and, strange to say, in some cases postmortem examination has proved the actual truth of the saying. Bartholinus, Fabricius Hildanus, Pliny, Rhodius, Schenck, Marcellus Donatus, Riedlin, and Garengeot speak of death from fright and fear, and the Ephemerides describes a death the direct cause of which was intense shame. Deleau, a celebrated doctor of Paris, while embracing his favorite daughter, who was in the last throes of consumption, was so overcome by intense grief that he fell over her corpse and died, and both were buried together.

The fear of child-birth has been frequently cited as a cause of death McClintock quotes a case from Travers of a young lady, happily married; who entertained a fear of death in child-birth; although she had been safely delivered, she suddenly and without apparent cause died in six hours. Every region of the body was examined with minutest care by an eminent physician, but no signs indicative of the cause of death were found. Mordret cites a similar instance of death from fear of labor. Morgagni mentions a woman who died from the disappointment of bearing a girl baby when she was extremely desirous of a boy.

The following case, quoted from Lauder Brunton, shows the extent of shock which may be produced by fear: Many years ago a janitor of a college had rendered himself obnoxious to the students, and they determined to punish him. Accordingly they prepared a block and an axe, which they conveyed to a lonely place, and having appropriately dressed themselves, some of them prepared to act as judges, and sent others of their company to bring him before them. He first affected to treat the whole affair as a joke, but was solemnly assured by the students that they meant it in real earnest. He was told to prepare for immediate death. The trembling janitor looked all around in the vain hope of seeing some indication that nothing was really meant, but stern looks met him everywhere. He was blindfolded, and made to kneel before the block. The executioner's axe was raised, but, instead of the sharp edge, a wet towel was brought sharply down on the back of the neck. The bandage was now removed from the culprit's eyes, but to the horror and astonishment of the students they found that he was dead. Such a case may be due to heart-failure from fear or excitement.

It is not uncommon that death ensues from the shock alone following blows that cause no visible injury, but administered to vital parts. This is particularly true of blows about the external genital region, or epigastrium, where the solar plexus is an active factor in inhibition. Ivanhoff of Bulgaria in 1886 speaks of a man of forty-five who was dealt a blow on the testicle in a violent street fight, and staggering, he fell insensible. Despite vigorous medical efforts he never regained consciousness and died in forty-five minutes. Postmortem examination revealed everything normal, and death must have been caused by syncope following violent pain. Watkins cites an instance occurring in South Africa. A native shearing sheep for a farmer provoked his master's ire by calling him by some nickname. While the man was in a squatting posture the farmer struck him in the epigastrium. He followed this up by a kick in the side and a blow on the head, neither of which, however, was as severe as the first blow. The man fell unconscious and died. At the autopsy there were no signs indicative of death, which must have been due to the shock following the blow on the epigastrium.

As illustrative of the sensitiveness of the epigastric region, Vincent relates the following case: "A man received a blow by a stick upon the epigastrium. He had an anxious expression and suffered from oppression. Irregular heart-action and shivering were symptoms that gradually disappeared during the day. In the evening his appetite returned and he felt well; during the night he died without a struggle, and at the autopsy there was absolutely nothing abnormal to be found." Blows upon the neck often produce sudden collapse. Prize-fighters are well aware of the effects of a blow on the jugular vein. Maschka, quoted by Warren, reports the case of a boy of twelve, who was struck on the anterior portion of the larynx by a stone. He fell lifeless to the ground, and at autopsy no local lesion was found nor any lesion elsewhere. The sudden death may be attributed in this case partly to shock and partly to cerebral anemia.

Soldiers have been seen to drop lifeless on the battle-field without apparent injury or organic derangement; in the olden times this death was attributed to fear and fright, and later was supposed to be caused by what is called "the wind of a cannon-ball." Tolifree has written an article on this cause of sudden death and others have discussed it. By some it is maintained that the momentum acquired by a cannon-ball generates enough force in the neighboring air to prostrate a person in the immediate vicinity of its path of flight.




CHAPTER X.

SURGICAL ANOMALIES OF THE HEAD AND NECK.

Injuries of such a delicate organ as the eye, in which the slightest accident can produce such disastrous consequences, naturally elicit the interest of all. Examples of exophthalmos, or protrusion of the eye from the orbit from bizarre causes, are of particular interest. Among the older writers we find Ficker and the Ephemerides giving instances of exophthalmos from vomiting. Fabricius Hildanus mentions a similar instance. Salmuth, Verduc, and others mention extrusion of the eyeball from the socket, due to excessive coughing. Ab Heers and Sennert mention instances in which after replacement the sight was uninjured. Tyler relates the case of a man who, after arising in the morning, blew his nose violently, and to his horror his left eye extruded from the orbit. With the assistance of his wife it was immediately replaced and a bandage placed over it. When Tyler saw him the upper lid was slightly swollen and discolored, but there was no hemorrhage.

Hutchinson describes extrusion of the eyeball from the orbit caused by a thrust with a stick. There was paraphymotic strangulation of the globe, entirely preventing replacement and necessitating excision. Reyssie speaks of a patient who, during a fire, was struck in the right eye by a stream of water from a hose, violently thrusting the eye backward. Contracting under the double influence of shock and cold, the surrounding tissues forced the eyeball from the orbit, and an hour later Reyssie saw the patient with the eye hanging by the optic nerve and muscles. Its reduction was easy, and after some minor treatment vision was perfectly restored in the injured organ. Thirty months after the accident the patient had perfect vision, and the eye had never in the slightest way discommoded him.

Bodkin mentions the case of a woman of sixty who fell on the key in a door and completely avulsed her eye. In von Graefe's Archiv there is a record of a man of seventy-five who suffered complete avulsion of the eye by a cart-wheel passing over his head. Verhaeghe records complete avulsion of the eye caused by a man falling against the ring of a sharp-worn key. Hamill describes the case of a young girl whose conjunctiva was pierced by one of the rests of an ordinary gas-bracket. Being hooked at one of its extremities the iron became entangled in either the inferior oblique or external rectus muscles, and completely avulsed the eyeball upon the cheek. The real damage could not be estimated, as the patient never returned after the muscle was clipped off close to its conjunctival insertion. Calhoun mentions an instance of a little Esquimaux dog whose head was seized between the jaws of a large Newfoundland with such force as to press the left eyeball from the socket. The ball rested on the cheek, held by the taut optic nerve; the cornea was opaque. The ball was carefully and gently replaced, and sight soon returned to the eye.

In former days there was an old-fashioned manner of fighting called "gouging." In this brutal contest the combatant was successful who could, with his thumb, press his opponent's eyeball out. Strange to say, little serious or permanently bad results followed such inhuman treatment of the eye. Von Langenbeck of Berlin mentions an instance of fracture of the superior maxilla, in which the eyeball was so much displaced as to lodge in the antrum of Highmore. Von Becker of Heidelberg reports the history of a case in which a blow from the horn of a cow dislocated the eye so far back in the orbit as to present the appearance of enucleation. The conjunctiva hid the organ from view, but when it was pulled aside the eyeball was exposed, and in its remote position still possessed the power of vision. In some cases in which exophthalmos has been seemingly spontaneous, extreme laxity of the lids may serve as an explanation. There is an instance on record in which a Polish dew appeared in a Continental hospital, saying that while turning in bed, without any apparent cause, his eyeball was completely extruded. There have been people who prided themselves on their ability to produce partial exophthalmos.

Rupture of the Eyeball.—Jessop mentions the case of a child of eight who suffered a blow on the eye from a fall against a bedpost, followed by compound rupture of the organ. The wound in the sclerotic was three or four lines in length, and the rent in the conjunctiva was so large that it required three sutures. The chief interest in this case was the rapid and complete recovery of vision.

Adler reports a case of fracture of the superior maxillary in which the dislocated bone-fragment of the lower orbital border, through pressure on the inferior maxillary and counter pressure on the skull, caused rupture of the conjunctiva of the left eye.

Serious Sequelae of Orbital Injuries.—In some instances injuries primarily to the orbit either by extension or implication of the cerebral contents provoke the most serious issues. Pointed instruments thrust into the orbital cavity may by this route reach the brain. There is a record of death caused by a wound of a cavernous sinus through the orbit by the stem of a tobacco-pipe. Bower saw a woman at the Gloucester Infirmary who had been stabbed in the eye by the end of an umbrella. There was profuse hemorrhage from the nostrils and left eye, but no signs indicative of its origin. Death shortly ensued, and at the necropsy a fracture through the roof of the orbit was revealed, the umbrella point having completely severed the optic nerve and divided the ophthalmic artery. The internal carotid artery was wounded in one-half of its circumference at its bend, just before it passes up between the anterior clinoid process and the optic nerve. The cavernous sinus was also opened. In this rare injury, although there was a considerable quantity of clotted blood at the base of the brain, there was no wound to the eyeball nor to the brain itself.

Pepper records a case in which a knife was thrust through the spheroidal fissure, wounding a large meningeal vein, causing death from intracranial hemorrhage. Nelaton describes an instance in which the point of an umbrella wounded the cavernous sinus and internal carotid artery of the opposite side, causing the formation of an arteriovenous aneurysm which ultimately burst, and death ensued. Polaillon saw a boy of eighteen who was found in a state of coma. It was stated that an umbrella stick had been thrust up through the roof of the orbit and had been withdrawn with much difficulty. The anterior lobe of the brain was evidently much wounded; an incision was made in the forehead and a portion of the frontal bone chiseled away entrance being thus effected, the aura was incised, and some blood and cerebrospinal fluid escaped. Five splinters were removed and a portion of the damaged brain-substance, and a small artery was tied with catgut. The debris of the eyeball was enucleated and a drain was placed in the frontal wound, coming out through the orbit. The patient soon regained consciousness and experienced no bad symptoms afterward. The drains were gradually withdrawn, the process of healing advanced rapidly, and recovery soon ensued.

Annandale mentions an instance in which a knitting-needle penetrated the brain through the orbit. Hewett speaks of perforation of the roof of the orbit and injury to the brain by a lead-pencil.

Gunshot Injuries of the Orbit.—Barkan recites the case in which a leaden ball 32/100 inch in diameter was thrown from a sling into the left orbital cavity, penetrating between the eyeball and osseous wall of the orbit without rupturing the tunics of the eye or breaking the bony wall of the cavity. It remained lodged two weeks without causing any pain or symptoms, and subsequently worked itself forward, contained in a perfect conjunctival sac, in which it was freely movable.

Buchanan recites the case of a private in the army who was shot at a distance of three feet away, the ball entering the inner canthus of the right eye and lodging under the skin of the opposite side. The eye was not lost, and opacity of the lower part of the cornea alone resulted. Cold water and purging constituted the treatment.

It is said a that an old soldier of one of Napoleon's armies had a musket-ball removed from his left orbit after twenty-four years' lodgment. He was struck in the orbit by a musket-ball, but as at the same time a companion fell dead at his side he inferred that the bullet rebounded from his orbit and killed his comrade. For twenty-four years he had suffered from cephalalgia and pains and partial exophthalmos of the left eye. After removal of the ball the eye partially atrophied.

Warren reports a case of a man of thirty-five whose eyeball was destroyed by the explosion of a gun, the breech-pin flying off and penetrating the head. The orbit was crushed; fourteen months afterward the man complained of soreness on the hard palate, and the whole breech-pin, with screw attached, was extracted. The removal of the pin was followed by fissure of the hard palate, which, however, was relieved by operation. The following is an extract of a report by Wenyon of Fatshan, South China:—

"Tang Shan, Chinese farmer, thirty-one years of age, was injured in the face by the bursting of a shot-gun. After being for upward of two months under the treatment of native practitioners, he came to me on December 4, 1891. I observed a cicatrix on the right side of his nose, and above this a sinus, still unhealed, the orifice of which involved the inner canthus of the right eye, and extended downward and inward for about a centimeter. The sight of the right eye was entirely lost, and the anterior surface of the globe was so uniformly red that the cornea could hardly be distinguished from the surrounding conjunctiva. There was no perceptible enlargement or protrusion of the eyeball, and it did not appear to have sustained any mechanical injury or loss of tissue. The ophthalmia and keratitis were possibly caused by the irritating substances applied to the wound by the Chinese doctors. The sinus on the side of the nose gave exit to a continuous discharge of slightly putrid pus, and the patient complained of continuous headache and occasional dizziness, which interfered with his work. The pain was referred to the right frontal and temporal regions, and the skin on this part of the head had a slight blush, but there was no superficial tenderness. The patient had been told by his native doctors, and he believed it himself, that there was no foreign body in the wound; but on probing it I easily recognized the lower edge of a hard metallic substance at a depth of about one inch posteriorly from the orifice of the sinus. Being unable to obtain any reliable information as to the probable size or shape of the object, I cautiously made several attempts to remove it through a slightly enlarged opening, but without success. I therefore continued the incision along the side of the nose to the nostril, thus laying open the right nasal cavity; then, seizing the foreign body with a pair of strong forceps, I with difficulty removed the complete breech-pin of a Chinese gun. Its size and shape are accurately represented by the accompanying drawing. The breech-pin measures a little over three inches in length, and weighs 21 ounces, or 75.6 grams. It had evidently lain at the back of the orbit, inclined upward and slightly backward from its point of entrance, at an angle of about 45 degrees. On its removal the headache was at once relieved and did not return. In ten days the wound was perfectly healed and the patient went back to his work. A somewhat similar case, but which terminated fatally, is recorded in the American Journal of the Medical Sciences of July, 1882."

The extent of permanent injury done by foreign bodies in the orbit is variable. In some instances the most extensive wound is followed by the happiest result, while in others vision is entirely destroyed by a minor injury.

Carter reports a case in which a hat-peg 3 3/10 inches long and about 1/4 inch in diameter (upon one end of which was a knob nearly 1/2 inch in diameter) was impacted in the orbit for from ten to twenty days, and during this time the patient was not aware of the fact. Recovery followed its extraction, the vision and movements of the eye being unimpaired.

According to the Philosophical Transactions a laborer thrust a long lath with great violence into the inner canthus of the left eye of his fellow workman, Edward Roberts. The lath broke off short, leaving a piece two inches long, 1/2 inch wide, and 1/4 inch thick, in situ. Roberts rode about a mile to the surgery of Mr. Justinian Morse, who extracted it with much difficulty; recovery followed, together with restoration of the sight and muscular action. The lath was supposed to have passed behind the eyeball. Collette speaks of an instance in which 186 pieces of glass were extracted from the left orbit, the whole mass weighing 186 Belgian grains. They were blown in by a gust of wind that broke a pane of glass; after extraction no affection of the brain or eye occurred. Watson speaks of a case in which a chip of steel 3/8 inch long was imbedded in cellular tissue of the orbit for four days, and was removed without injury to the eye. Wordsworth reports a case in which a foreign body was deeply imbedded in the orbit for six weeks, and was removed with subsequent recovery. Chisholm has seen a case in which for five weeks a fly was imbedded in the culdesac between the lower lid and the eyeball.

Foreign bodies are sometimes contained in the eyeball for many years. There is an instance on record in which a wooden splinter, five mm. long and two mm. broad, remained in the eye forty-seven years. It was extracted, with the lens in which it was lodged, to relieve pain and other distressing symptoms. Snell reports a case in which a piece of steel was imbedded and encapsulated in the ciliary process twenty-nine years without producing sympathetic irritation of its fellow, but causing such pain as to warrant enucleation of this eye. Gunning speaks of a piece of thorn 5/8 inch long, imbedded in the left eyeball of an old man for six years, causing total loss of vision; he adds that, after its removal, some improvement was noticed.

Williams mentions a stone-cutter whose left eye was put out by a piece of stone. Shortly after this his right eye was wounded by a knife, causing traumatic cataract, which was extracted by Sir William Wilde, giving the man good sight for twelve years, after which iritis attacked the right eye and produced a false membrane over the pupil so that the man could not work. It was in this condition that he consulted Williams, fourteen years after the loss of the left eye. The eye was atrophied, and on examination a piece of stone was seen projecting from it directly between the lids. The visible portion was 1/4 inch long, and the end in the shrunken eye was evidently longer than the end protruding. The sclera was incised, and, after fourteen years' duration in the eye, the stone was removed.

Taylor reports the removal of a piece of bone which had remained quiescent in the eye for fourteen years; after the removal of the eye the bone was found adherent to the inner tunics. It resembled the lens in size and shape. Williams mentions continual tolerance of foreign bodies in the eyeball for fifteen and twenty-two years; and Chisholm reports the lodgment of a fragment of metal in the iris for twenty-three years. Liebreich extracted a piece of steel from the interior of the eye where it had been lodged twenty-two years. Barkar speaks of a piece of steel which penetrated through the cornea and lens, and which, five months later, was successfully removed by the extraction of the cataractous lens. Critchett gives an instance of a foreign body being loose in the anterior chamber for sixteen years. Rider speaks of the lodgment of a fragment of a copper percussion cap in the left eye, back of the inner ciliary margin of the iris, for thirty-five years; and Bartholinus mentions a thorn in the canthus for thirty years. Jacob reports a case in which a chip of iron remained in the eyeball twenty-eight years without giving indications for removal. It was clearly visible, protruding into the anterior surface of the iris, and although it was rusted by its long lodgment, sight in the eye was fairly good, and there was no sign of irritation.

Snell gives an instance in which a piece of steel was imbedded close to the optic disc with retention of sight. It was plainly visible by the opthalmoscope eighteen months after the accident, when as yet no diminution of sight was apparent. Smyly speaks of a portion of a tobacco pipe which was successfully removed from the anterior chamber by an incision through the cornea. Clark mentions a case in which molten lead in the eye caused no permanent injury; and there are several cases mentioned in confirmation of the statement that the eye seems to be remarkably free from disastrous effects after this injury.

Williamson mentions eyelashes in the anterior chamber of the eye, the result of a stab wound of this organ.

Contusion of the eyeball may cause dislocation of the lens into the anterior chamber, and several instances have been recorded. We regret our inability to give the reference or authority for a report that we have seen, stating that by one kick of a horse the lenses of both eyes of a man were synchronously knocked through the eyeballs by the calkins of the horseshoe. Oliver mentions extraction of a lens by a thrust of a cow's horn.

Lowe speaks of rupture of the anterior capsule of the lens from violent sneezing, with subsequent absorption of the lenticular substance and restoration of vision. Trioen mentions a curious case of expulsion of the crystalline lens from the eye in ophthalmia, through the formation of a corneal fissure. The authors have personal knowledge of a case of spontaneous extrusion of the lens through a corneal ulcer, in a case of ophthalmia of the new-born.

Injury of the Eyeball by Birds.—There are several instances in which birds have pierced the eyeball with their bills, completely destroying vision. Not long since a prominent taxidermist winged a crane, picked it up, and started to examine it, when it made one thrust with its bill and totally destroyed his eyeball. In another instance a man was going from the railroad station to his hotel in a gale of wind, when, as he turned the corner of the street, an English sparrow was blown into his face. Its bill penetrated his eyeball and completely ruined his sight. There are several instances on record in which game fowls have destroyed the eyes of their owners. In one case a game cock almost completed the enucleation of the eye of his handler by striking him with his gaff while preparing in a cock-pit.

Moorehead explains a rare accident to an eye as follows:—

"Mr. S. B. A., while attending to his bees, was stung by one upon the right upper eyelid near its center. An employee, who was assisting in the work, immediately discovered the sting driven in the lid and cautiously extracted it, stating that he made sufficient traction to lift the lid well away from the globe. In a few hours the lid became much swollen, but the pain experienced at first had disappeared. Before retiring for the night he began gentle massage of the lid, stroking it horizontally with his finger. The edematous condition was by this means much reduced in a short time. While thus engaged in stroking the lid he suddenly experienced intense pain in the eye as if it had been pierced by a sharp instrument. The suffering was very severe, and he passed a wretched night, constantly feeling 'something in his eye.'

"The next morning, the trouble continuing, he came to me for relief. Upon examination of the lid, no opening could be made out where the sting had penetrated, and a minute inspection of the conjunctival surface with a good glass failed to reveal any foreign substance. Cleansing the lid thoroughly, and carefully inspecting with a lens under strong light, a minute dark point was made out about the center of the lid. Feeling that this might be the point of the sting, I had recourse to several expedients for its removal, but without success. Finally, with a fine knife, I succeeded in cutting down by the side of the body and tilting it out. Examination with a 1/5 inch objective confirmed my opinion that it was the point of the bee-sting.

"The barbed formation of the point explains how, under the stroking with the finger, it was forced through the dense tarsal cartilage and against the cornea of the eye."

There is a story told in La Medecine Moderne of a seamstress of Berlin who was in the habit of allowing her dog to lick her face. She was attacked with a severe inflammation of the right eye, which had to be enucleated, and was found full of tenia echinococcus, evidently derived from the dog's tongue.

Gabb mentions a case of epistaxis in which the blood welled up through the lacrimal ducts and suffused into the eye so that it was constantly necessary to wipe the lower eyelid, and the discharge ceased only when the nose stopped bleeding. A brief editorial note on epistaxis through the eyes, referring to a case in the Medical News of November 30, 1895, provoked further reports from numerous correspondents. Among others, the following:—

"Dr. T. L. Wilson of Bellwood, Pa., relates the case of an old lady of seventy-eight whom he found with the blood gushing from the nostrils. After plugging the nares thoroughly with absorbent cotton dusted with tannic acid he was surprised to see the blood ooze out around the eyelids and trickle down the cheeks. This oozing continued for the greater part of an hour, being controlled by applications of ice to both sides of the nose."

"Dr. F. L. Donlon of New York City reports the case of a married woman, about fifty years old, in whom epistaxis set in suddenly at 11 P.M., and had continued for several hours, when the anterior nares were plugged. In a short time the woman complained that she could scarcely see, owing to the welling up of blood in the eyes and trickling down her face. The bleeding only ceased when the posterior nares also were plugged."

"Dr. T. G. Wright of Plainville, Conn., narrates the case of a young man whom he found in the night, bleeding profusely, and having already lost a large amount of blood. Shortly after plugging both anterior and posterior nares the blood found its way through the lacrimal ducts to the eyes and trickled down the cheeks."

"Dr. Charles W. Crumb cites the case of a man, sixty-five years old, with chronic nephritis, in whom a slight bruise of the nose was followed by epistaxis lasting twenty-four hours. When the nares were plugged blood escaped freely from the eyes. A cone-shaped bit of sponge, saturated with ferrous sulphate, was passed into each anterior naris, and another piece of sponge, similarly medicated, into either posterior naris. The patient had been taking various preparations of potassium, and it was thought that his blood contained a deficiency of fibrin. Upon removal of the nasal plugs a catarrhal inflammation developed which lasted a long time and was attended with considerable purulent discharge."

Late Restoration of Sight.—There are some marvelous cases on record in which, after many years of blindness, the surgeon has been able, by operation, to restore the sight. McKeown gives the history of a blind fiddler of sixty-three, who, when one and a half years old, had lost the sight of both eyes after an attack of small-pox. Iridectomy was performed, and after over sixty years of total blindness his sight was restored; color-perception was good. Berncastle mentions a case of extraction of double cataract and double iridectomy for occluded pupils, which, after thirty years of blindness, resulted in the recovery of good sight. The patient was a blind beggar of Sydney.

To those interested in this subject, Jauffret has a most interesting description of a man by the name of Garin, who was born blind, who talked at eight or nine months, showed great intelligence, and who was educated at a blind asylum. At the age of twenty-four he entered the hospital of Forlenze, to be operated upon by that famous oculist. Garin had never seen, but could distinguish night or darkness by one eye only, and recognized orange and red when placed close to that eye. He could tell at once the sex and age of a person approximately by the voice and tread, and formed his conclusions more rapidly in regard to females than males. Forlenze diagnosed cataract, and, in the presence of a distinguished gathering, operated with the happiest result. The description that follows, which is quoted by Fournier and is readily accessible to any one, is well worth reading, as it contains an account of the first sensations of light, objects, distance, etc., and minor analogous thoughts, of an educated and matured mind experiencing its first sensations of sight.

Hansell and Clark say that the perplexities of learning to see after twenty-six years of blindness from congenital disease, as described by a patient of Franke, remind one of the experience of Shelley's Frankenstein. Franke's patient was successfully operated on for congenital double cataract, at twenty-six years of age. The author describes the difficulties the patient had of recognizing by means of vision the objects he had hitherto known through his other senses, and his slowness in learning to estimate distances and the comparative size of objects.

Sight is popularly supposed to be occasionally restored without the aid of art, after long years of blindness. Benjamin Rush saw a man of forty-five who, twelve years before, became blind without ascertainable cause, and recovered his sight equally without reason. St. Clair mentions Marshal Vivian, who at the age of one hundred regained sight that for nearly forty years had gradually been failing almost to blindness, and preserved this new sight to the time of his death.

There are many superstitions prevalent among uneducated people as to "second sight," recovery of vision, etc., which render their reports of such things untrustworthy. The real explanations of such cases are too varied for discussion here.

Nyctalopia etymologically means night blindness, but the general usage, making the term mean night-vision, is so strongly intrenched that it is useless and confusing to attempt any reinstatement of the old significance. The condition in which one sees better by night, relatively speaking, than by day is due to some lesion of the macular region, rendering it blind. At night the pupil dilates more than in the day-time, and hence vision with the extramacular or peripheral portions of the retina is correspondingly better. It is, therefore, a symptom of serious retinal disease. All night-prowling animals have widely dilatable pupils, and in addition to this they have in the retina a special organ called the tapetum lucidum, the function of which is to reflect to a focus in front of them the relatively few rays of light that enter the widely-dilated pupil and thus enable them the better to see their way. Hence the luminous appearance of the eyes of such animals in the dark.

Hemeralopia (etymologically day-blindness, but by common usage meaning day-vision or night-blindness) is a symptom of a peculiar degenerative disease of the retina, called retinitis pigmentosa. It also occurs in some cases of extreme denutrition, numerous cases having been reported among those who make the prolonged fasts customary in the Russian church. In retinitis pigmentosa the peripheral or extramacular portions of the retina are subject to a pigmentary degeneration that renders them insensitive to light, and patients so afflicted are consequently incapable of seeing at night as well as others. They stumble and run against objects easily seen by the normal eye.

Snow-blindness occurs from prolonged exposure of the eyes to snow upon which the sun is shining. Some years ago, some seventy laborers, who were clearing away snow-drifts in the Caucasus, were seized, and thirty of them could not find their way home, so great was the photophobia, conjunctivitis, and lacrimation. Graddy reports six cases, and many others are constantly occurring.

Other forms of retinal injury from too great or too prolonged exposure to light are "moon-blindness," due to sleeping with the eyes exposed to bright moonlight, and that due to lightning—a case, e.g., being reported by Knies. Silex also reports such a case and reviews the reported cases, 25 in number, in ten of which cataract ensued. In the Annual of the Universal Medical Sciences, 1888, there is a report of seven cases of retinal injury with central scotoma, amblyopia, etc., in Japanese medical students, caused by observation of the sun in eclipse.

In discussing the question of electric-light injuries of the eyes Gould reviews the literature of the subject and epitomizes the cases reported up to that time. They numbered 23. No patient was seriously or permanently injured, and none was in a person who used the electric light in a proper manner as an illuminant. All were in scientific investigators or workmen about the light, who approached it too closely or gazed at it too long and without the colored protecting spectacles now found necessary by such workers.

Injuries to the Ear.—The folly of the practice of boxing children's ears, and the possible disastrous results subsequent to this punishment, are well exemplified throughout medical literature. Stewart quotes four cases of rupture of the tympanum from boxing the ears, and there is an instance of a boy of eight, who was boxed on the ear at school, in whom subsequent brain-disease developed early, and death followed. Roosa of New York mentions the loss of hearing following a kiss on the ear.

Dalby, in a paper citing many different causes of rupture of the tympanic membrane, mentions the following: A blow in sparring; violent sneezing; blowing the nose; forcible dilatation of the Eustachian canal; a thorn or twig of a tree accidentally thrust into the head; picking the ear with a toothpick. In time of battle soldiers sometimes have their tympanums ruptured by the concussion caused by the firing of cannon. Dalby mentions an instance of an officer who was discharged for deafness acquired in this manner during the Crimean War. He was standing beside a mortar which, unexpectedly to him, was fired, causing rupture of the tympanic membrane, followed by hemorrhage from the ear. Similar cases were reported in the recent naval engagements between the Chinese and Japanese. Wilson reports two cases of rupture of the membrane tympani caused by diving. Roosa divides the causes into traumatic, hemorrhagic, and inflammatory, and primary lesions of the labyrinth, exemplifying each by numerous instances. Under traumatic causes he mentions severe falls, blows about the head or face, constant listening to a telegraphic instrument, cannonading, and finally eight cases of boiler-makers' deafness. Roosa cites a curious case of sudden and profound deafness in a young man in perfect health, while calling upon the parents of his lady-love to ask her hand in marriage. Strange to say that after he had had a favorable reply he gradually recovered his hearing! In the same paper there is an instance of a case of deafness due to the sudden cessation of perspiration, and an instance of tinnitus due to the excessive use of tobacco; Roosa also mentions a case of deafness due to excessive mental employment.

Perforation of the Tympanum.—Kealy relates an instance in which a pin was introduced into the left ear to relieve an intolerable itching. It perforated the tympanum, and before the expiration of twenty-four hours was coughed up from the throat with a small quantity of blood. The pin was bent at an angle of about 120 degrees. Another similar case was that of a girl of twenty-two who, while pricking her ear with a hair-pin, was jerked or struck on the arm by a child, and the pin forced into the ear; great pain and deafness followed, together with the loss of taste on the same side of the tongue; after treatment both of the disturbed senses were restored. A man of twenty was pricked in the ear by a needle entering the meatus. He uttered a cry, fell senseless, and so continued until the fourth day when he died. The whole auditory meatus was destroyed by suppuration. Gamgee tells of a constable who was stabbed in the left ear, severing the middle meningeal artery, death ensuing. In this instance, after digital compression, ligature of the common carotid was practiced as a last resort. There is an account of a provision-dealer's agent who fell asleep at a public house at Tottenham. In sport an attendant tickled his ear with a wooden article used as a pipe light. A quick, unconscious movement forced the wooden point through the tympanum, causing cerebral inflammation and subsequent death. There is a record of death, in a child of nine, caused by the passage of a knitting-needle into the auditory meatus.

Kauffmann reports a case of what he calls objective tinnitus aurium, in which the noise originating in the patient's ears was distinctly audible by others. The patient was a boy of fourteen, who had fallen on the back of his head and had remained unconscious for nearly two weeks. The noises were bilateral, but more distinct on the left than on the right side. The sounds were described as crackling, and seemed to depend on movements of the arch of the palate. Kauffmann expresses the opinion that the noises were due to clonic spasm of the tensor velum palati, and states that under appropriate treatment the tinnitus gradually subsided.

The introduction of foreign bodies in the ear is usually accidental, although in children we often find it as a result of sport or curiosity. There is an instance on record of a man who was accustomed to catch flies and put them in his ear, deriving from them a pleasurable sensation from the tickling which ensued. There have been cases in which children, and even adults, have held grasshoppers, crickets, or lady-birds to their ears in order to more attentively listen to the noise, and while in this position the insects have escaped and penetrated the auditory canal. Insects often enter the ears of persons reposing in the fields with the ear to the ground. Fabricius Hildanus speaks of a cricket penetrating the ear during sleep. Calhoun mentions an instance of disease of the ear which he found was due to the presence of several living maggots in the interior of the ear. The patient had been sleeping in a horse stall in which were found maggots similar to those extracted from his ear. An analogous instance was seen in a negro in the Emergency Hospital, Washington, D.C., in the summer of 1894; and many others are recorded. The insects are frequently removed only after a prolonged lodgment.