great pain and the development of a profusion of fungoid granulations which were very suggestive of malignant disease, but which finally yielded to persistent treatment with solid nitrate of silver. It may be proper to add that the pain produced by the caustic was greatly relieved by applications of a four-per-cent solution of cocaine made directly to the wound. The patient has not been seen professionally since the 1st of August, but at that time she seemed to have recovered entirely from her operation, and any consequences which may have followed from it.

NOTE. The patient has been seen within a few weeks by Dr. Castle, and he was informed by her that she felt perfectly well.

A few words may be added in regard to the unique specimen which developed from the left ovary, a drawing of which (very accurately made by Dr. A. P. Doty) accompanies this article. The body of the tumor presents nothing especially peculiar, but from its lower border springs the diverticulum, which resembles a pigeon's egg in shape, size, and color. From or near the lower extremity of the diverticulum projects, as may be plainly seen, a tuft of hair three inches long. The fecal matter which covered this when it was removed from the abdominal cavity gave rise to the unpleasant suggestion that the lumen of the intestine had been invaded. This, however, did not prove to be so serious an accident as was feared. Several interesting questions arise in connection with this peculiar specimen pertaining to the field of the embryologist and pathologist rather than to that of the surgeon. My own idea is this, that the diverticulum was pushed through the anterior wall of the rectum by a process of ulceration, and absorption. of that wall during the growth of the tumor, the diverticulum evidently being a portion of the dermoid tumor of the left

ovary.

2

A CASE OF PROLONGED GESTATION, WITH AUTOPSY OF THE FETUS.

BY

M. NUÑEZ ROSSIÉ, M.D.,

Havana, Cuba.

(With three cuts.)

"HIPPOCRATES was a natural philosopher, and he said that the utmost time that pregnant women could preserve in their womb the product of conception was ten months. Wherefore, if the woman gives birth ten months after death of the husband, the new-born should be acknowledged as his child. But if the birth occurs on a day of the eleventh month after the death of the father, it should not be considered as his son."

The "Partidas," Spanish laws of the twelfth century, decreed the above. The Roman laws had already prescribed the following: "Post decem menses mortis natus non admittitur ad legitimam hæreditatem" (Digesto, lib. xxxviii., tit. vi.). The laws of modern Spain, France, Prussia, Austria, Scotland, and other countries are well known as leaving in doubt or rejecting the legitimacy of children born three hundred days after the last possibility of sexual intercourse in married life.

These beliefs, indorsed by law since such ancient date, are in our times supported by many scientific men. In the medical literature of the countries mentioned, there prevails amongst tocologists and medical experts a general opinion which repudiates the possibility of gestations prolonged beyond the time designed by law. As an ample proof, we have merely to refer to the assertions inserted upon the subject in the two excellent modern treatises on obstetrics published in Paris by Tarnier and Chantreuil, and by Charpentier. Even in England and in the United States, where the silence of legislation in this respect has called for an assiduous study thereon, and the consequent acknowledgment of prolonged gestation, nevertheless, authorities of so high standing as Matthews Duncan still repel that belief.

In consideration of the foregoing reasons, I have deemed it my duty to report the following case:

Maria X., native of the Canary Islands, of white race, 22 years of age, of low stature, well formed, strong and healthy, unmarried. Menstruation began in her fourteenth year and was always regular and painless. Her first act of coition took place on the 6th of May, 1884, on which day she was raped. Without any other intercourse, from that period her menstruation ceased. In August she was sure of her condition, having consulted a physician, who confirmed her suspicions of pregnancy, and anxiously desiring to hide her shame, she fled in October to Cuba.

These facts were gathered by my old friend and teacher, Dr. Valencia, Professor of Obstetrics in the Havana University, who was in charge of the clinic when the patient was admitted to the hospital. He placed reliance on her statements, and I also considered them true, in view of the sincerity and integrity of her behavior; and, on the other hand, I cannot see that she had any special interest in deceiving us, as she was entirely unknown in Cuba, and nobody had any relation with or knowledge of her family.

She enjoyed good health during her pregnancy.

At the end of January, Dr. Valencia took a leave of absence, and I was put in charge of the obstetrical clinic; Maria was presented to me as the case nearest to labor, and I was earnestly requested to avoid, as much as possible, explorations by the students, particularly vaginal examinations, which would be morally most painful to her. This latter means of exploration was, therefore, only once resorted to. We then found narrowness of the vagina, particularly of the fornix; the cervix, high up and pointing backwards, was large, of a conical form, and of unusually firm consistence, the external os being closed. The pelvic diameters were normal. Palpation showed the fetus to occupy the left occipitoanterior position, the head being entirely above the brim, and the whole child easily movable. Heart-sounds, 140 to 160 a minute, were heard, as usual, to the left.

About the middle of February, Maria suffered slight uterine pains, which appeared to be preliminary to labor; and although they acquired intensity at times, there never occurred a true commencement of labor. During the following days of February, and the first fortnight of March, we hardly paid any special attention to her, and we were led to infer, in spite of the reasons I had to believe the truth of her story, that she had mistaken the date of the

coition.

At 3 A.M. on the 19th of March, labor began and proceeded very slowly, the os not being fully dilated until 4.30 A.M. of the 21st, the patient being at this time in good condition, vagina moist and temperature normal, no nervous depression, patient merely feeling a little tired. Membranes ruptured at 5.30 A.M. Amniotic fluid normal.

The occiput at this time was nearly on a level with the subpubic arch, and after about an hour, the pains growing weaker and no progress being made, forceps were applied by Dr. Valencia, and after strong traction the child was delivered, the perineum being extensively ruptured in spite of the greatest care in support, and the performance of episiotomy. Placenta and membranes expelled naturally. Serre-fines were applied to the perineum, but did not secure union. The temperature or pulse never reached 100, either during labor or after, convalescence being normal. After the patient was up and about, symptoms of subinvolution and prolapsus appeared. Examination revealed, besides the laceration of the perineum which had healed without uniting, a bilateral laceration of the cervix, extending on the left side nearly to the vaginal junction, with considerable eversion and thickening of the mucous membrane. About the middle of April I did trachelorrhaphy and perineorrhaphy, and on the 26th of July the patient left the hospital in good health, and so strong that she was employed as a wet-nurse.

The child was a male, of extraordinary dimensions, measuring 54 cm. in length, and weighing 5,300 gms.

The diameters of the fetal head were as follows:

No measures were taken of the circumferences of the head. The blades of the forceps had caused strong marks of depression on a level with the left temporal and on the posterior part of the right parietal bones. There was a large hematoma at the occiput, and another over the right frontal bone; a depression of the bone being very evident.

The skin was free from sebaceous material, and the epidermic coating of the whole body was in a state of desquamation, which took place in very large semi-transparent scales. On the parts where the desquamation was more evident, the dermic mucous coat was not denuded, as the deeper corneal layer of the epidermic coating was always preserved. There was no blistering, softness, or maceration, nor any other pathological condition of the skin.

The nails greatly overtopped the ends of the fingers, and their tips were thin and getting loose on several of the fingers. The thumb-nails measured six millimetres from the root to the top, with an equal measure in their width.

The child was born partially asphyxiated, but was recuscitated; it, however, remained in a semi-tetanic state, and slowly passing into a condition of coma, died six hours after birth.

Many difficulties having to be overcome, the autopsy could not be made for several days, the fetus being meanwhile kept in alcohol. The external appearance has been already described.

The histological examination of the skin was performed, and confirmed our previous statement that the desquamation had only caused the loss of the superficial part of the corneal layer. In the abdominal and thoracic cavities, we only found congestion. of both lungs and a slight degree of putrid decomposition of the viscera. The scalp being lifted up, the hematomata of the parts indicated were confirmed, the sanguineous effusion staining the bones markedly. Over the right frontal bone the periosteum was loose. Upon extracting the brains, a remarkable extravasation of blood in the interior of the cranium also became evident. In our necroscopic examination I have aimed to be most particularly descriptive of those parts of the skeleton from which I could derive a more accurate idea of the age of the fetus.

Dry skull.-Its large size was noticeable, its form was very regular, although some partial deformations could be perceived. On handling the cranium, its little compressibility, heavy weight, and firmness were at once striking.

My esteemed friend and colleague Dr. Montané, a favorite pupil of Broca, has enabled me to be more exact and to give more ample details in this respect, as he has had the kindness to take the anthropological measures of the cranium, and has also furnished me with original unedited data which will allow me to make comparative studies in the reflections accompanying this relation.

The excesses in the dimensions of this cranium are relatively greater in the antero-posterior and transversal diameters than in the vertical, which gives to it a flattened form. The regularity of its whole can be well appreciated by taking a view of its upper part.

The cranial dome is more depressed on the right side than on the left. This discrepancy of height, in the places where it is more remarkable, scarcely equals the thickness of the internal border of the bones, and therefore there is not a real overlapping in the sagittal suture.

The aforementioned depression in the right frontal is of a gutter form (rinnenförmig), commencing at about half a centimetre from the central line and one and one-half centimetre from the anterior angle of the great fontanelle, and reaching the frontal eminence. This furrow is two and one-half centimetres in length, and one and one-half in its greater width, and of such depth that, besides the disappearance of the remarkable natural convexity of this region, it has caused a concavity of two and one-half millimetres. The outer table in this place is not fractured, but the inner one shows a fracture which follows the direction of one of the nutrient vessels of the bone.

The overlapping of the parietals upon the occipital bone is very considerable, being 7 mm.

The sutures are almost serrated, the bones being frequently dovetailed and presenting projecting points and recesses, so that the joints show little or no motion. This arrangement is by far