more noticeable in the posterior part of the sagittal and in the coronal suture, particularly on the right side. There are small Wormian bones in the sutures, twelve being found in the coronal. In some of the places where there is overlapping, this appears to have caused the tearing of the fibrous tissue that unites the edges of the bones.

The posterior fontanelle does not exist.

The anterior is not of the usual rhomboidal form, the advanced ossification of the antero-superior angle of both parietal bones. having led to the disappearance of the triangle that would have been formed in its posterior half. In consequence of this loss, this fontanelle has the form of a triangle, two sides of which are curved and its surface thereby further diminished. Its height is 18 mm., and its base 15 mm.

The thickness of the parietal and the frontal bones measures generally 1 mm. The compact consistency of the outer and inner tables is evident. Interiorly we can perceive with the finger shallow cerebral impressions. In the upper and lower jaws the septum that divides the first and second molars is entirely formed, and the one destined to separate the second from the third is half formed. In the inferior maxilla, the mental foramen stands on a level with the first molar.

The other parts of the skeleton that have appeared to us more worthy of notice are the centres of ossification, the dimensions of which we give below, their osseous structure being evident.

Length.

Width.

upper epiphysis of the humerus, 3

4532

I have submitted the reasons that have led me to entertain the belief that a single coition occurred, and that the exact date of its occurrence is known. However, there are so many motives of the greatest delicacy and complexity that might prevail in a woman to induce her to fall into a mistake or to misrepresent in this respect, that there is always some point of doubt or objection left in the mind of the reader of such histories from the most competent authors. Even in cases where the physician has been able to observe the appearance of the earliest signs of pregnancy, there are possible causes leading to error. Any illness may bring about an amenorrhea and the pregnant state might immediately follow. Lusk pointed out a case in the Obstetrical Society of New York. And we cannot affirm that a diagnosis of the real cause of the amenorrhea can be properly pronounced, because we think

right to repeat after Emmet-" it may be questioned if amenorrhea can take place in health."

The justice of the doubts that like cases bring forth is so clearly appreciated by me, that I cannot refrain from admiring the scientific self-denial and fortitude of physicians who, having had the good fortune to have in their own marriage the chronology of such a scientific curiosity as we now study, have published the case. I believe that under such circumstances there would prevail an anxious desire of keeping secret the occurrence, as, even with the support of silence, there might be reason left for uneasiness. Fourdes says in this respect, in his excellent article "Natalité" inserted in the "Dictionnaire Encyclopédique des Sciences Médicales," "Nul n'est temoin dans sa propre cause"-" Nobody can be witness in his own

cause."

In our case we find the diagnosis of pregnancy given by a physician in the month of August, but we cannot attach to it any great reliance, as we do not know the doctor, nor have we the certainty that he perceived the heart-sounds at such an early date, and he might have ventured an affirmation based on signs of mere probability. The pains and contractions suffered when the pregnant woman was at the end of her ninth month, according to her report and calculation, might also be taken into account, even with due regard to the expectant attention that prevailed in her, and to the fact that said pains were never so intense as to constitute a missed labor. On the whole, these antecedents lead us to believe that the labor commenced 317 days after the coition that caused the pregnancy, but we do not consider them such as to allow us to entertain the idea that this case offers a better warrant of certainty than others already published.

The course of labor was that already indicated in cases of dystocia consequent upon excessive volume or advanced ossification of the fetal head. It should not appear strange that the diagnosis should then have been delayed until after the delivery.

Dr. John Ellis Blake, in an article published in this Journal, Vol. XII., 1879, pointed out the deficiency of classical books in this respect and the difficulty of making a diagnosis. Furthermore, it is known that notabilities of so high reputation as Peaslee

have pronounced these as cases of retarted labor, and Thomas, who enjoys the merit of having twice diagnosed an advanced ossification before labor had taken place, did so only after repeating in vain tractions with the forceps. In fact, it was almost impossible to act in our case otherwise than we did. Pajot, in an excellent article upon the excessive retardation of labor and referring to real tedious labor, says: "when a labor progresses slowly it is never delayed." "The pulse, the mother's temperature, the fetal inspection must guide us in deciding whether to act or to remain in expectancy."

These were the prevailing conditions up to the morning of the 21st, and our behavior can be described after the expression of Pajot-" surveillance, expectation." I am firmly convinced that there was no reason to interfere until, after the rupture of the bag of waters, we obtained the confirmation of the position; and the labor, instead of being more speedy, became more slow. Some advantages could have been derived from craniotomy: the death of the fetus as well as the ulterior sufferings of the mother allow us to say so. Moreover, even if the fetus had been saved, its life would have been worthless, on account of the deep lesions of the nervous system consequent on such dystocia, as has been so well demonstrated by Jacobi and Blake. We call attention to the fact that the suboccipitobregmatic diameter could make its way through the pelvis, whilst the suboccipito-frontal did not pass, as is shown by the position of the frontal depression. This confirms the importance given by Duncan to said suboccipito-frontal diameter, and shows us that labor would have terminated quite naturally if the overlapping in the coronal suture could have been possible.

The repeated careful examinations of the genital organs of this woman after labor allow us to conclude that none of the parts had any vice of conformation or any other pathological condition, except those that are generally consequent upon cervical and perineal laceration. We specially watched in this respect, from the commencement, the uterine cervix, because during labor we came to the belief that the upper part of the cervical canal had not expanded during pregnancy, nor had it become part of the uterine cavity, as usually happens when the formation of Braune's canal takes place.

The fetus' weight, length, and all the diameters of its head are excessive. A study of comparative or statistical data, however numerous, confirms this assertion. Pinard says

that out of the 20,000 children born at the Paris Maternity there was only one weighing up to 5,300. Of the 208 cases that Ribemont and Budin have taken as the basis in their investigations upon the fetal head, there is not any one of such a weight as ours, and only two or three reached equal dimensions in length of body or size of head.

The excess of volume has not been of constant occurrence in like cases, and we must add that the small size has been pointed out as the cause of prolonged gestation by two ancient and renowned expert physicians (P. Zacchias and Foderé) who believed that they had observed cases of prolonged gestation in their own wives. But the excess of volume has been observed in other cases referred to by Klein, Rob, Siebold, Liegard, Feltz and Rate, Cailletet, Leishman, Delore, Henderson, etc.

The epidermic desquamation commencing in a living fetus still in the uterine cavity is very rare. The desquamation usually begins in the newborn after the second day, and reaches its maximum on the tenth day (Depaul), and at times it is not properly completed until the thirtieth or fortieth day. Briande and Chaude and Billard do not admit the ante-partum desquamation; there are, however, authentic cases thereof. Depaul has seen it seven or eight times, and gives full details of one of them; Charrière published another one in 1878; Hanks also reported a case in the Obstetrical Society of New York, and Parrot mentions another case of Baer, in which the exfoliation was completed on the first day. It would appear that of these cases we should exclude Hanks', in which a pathological condition seems to have existed, as the dermis, entirely denuded, was besides congested and had a dark-red appearance. Charrière's case would appear, at first reading of his narrative, as a case similar to Hanks', because he states that the epidermis came off as in a macerated fetus; but surely the new-born must have merely lost the superficial layers of the epidermis, so long as he remained alive, in spite of the exfoliation having extended to the whole body; otherwise under such an extensive loss of the total thickness of the epidermis, death would have inevitably taken place, for the very same reasons that

burns of the second degree of an extensive tegumental surface are necessarily mortal.

Depaul asserts that these cases of premature desquamation are due to the action of the amniotic fluid under some alteration, rendering it irritating, acrid, and corrosive, and he adds that this alteration might be caused by its mixture with urine or meconium. The meconium has in fact been expelled in some of the cases of Depaul, in Charrière's, and in our case under review, but this simultaneous occurrence of both facts does not permit us to admit the theory, because the expulsion of meconium, the fetus remaining more or less time immersed in the amniotic fluid mixed with the meconium, is of quite frequent occurrence, whilst the premature desquamation is certainly very rare.

At all events, and leaving aside the conclusions that may be arrived at upon the foregoing hypothesis, it is our principal aim to establish the fact that the phenomenon of desquamation that generally takes place when the new-born is already several days old, occurred in my case when the fetus was still in the uterine cavity.

The excessive size and growth of the nails and the loss of their free ends is also a fact of an importance similar to that of the phenomenon of the skin. Kölliker has demonstrated that the most outjutting and thinnest part of the nail which normally drops after birth has a different structure than the rest of the nail because it corresponds to a previous period of embryonic life.

On referring to the examination of the osseous system, we have to say that its importance to enable us to determine a fixed age in the new-born has been admitted already as a basis for medico-legal investigations. We have not, however, found in the observations, that we have been able to read relative to prolonged pregnancy, that any of them has afforded the opportunity of giving minute details and measurements on this point. Authors generally limit themselves to reporting that the fontanelles and sutures have been found closer than usual, and that the cranial bones were of excessive hardness.

I deem of importance the following comparative statement kindly afforded to us by Dr. Montané, in which he gives the anthropological measures of nineteen fetal craniums at term,