sue, like nerve tissue; extending from this band, on each side, one for each of the above mentioned foramina, is a strand of the same tissue; these strands pass into the several holes. I have not made the dissection sufficiently extensive to find out whether there are nerves branching from this ribbon or not. This is probably the spinal cord; beneath this ribbon is another layer of the arachnoidean tissue and the periosteum, and anterior to this the body of the vertebræ. The transverse processes pass outward and backward terminating in small nodes. At about the site of the seventh dorsal, an attempt has been made on the left side to form the spinous process and posterior arch. This is only on the left side. We count 24 foramina above the sacrum, which is also spread out or wanting in posterior arches, in proportion to the spreading of the spinal column itself. After lifting the scalp the skull is found to consist of the orbital part of the frontal bone, the superciliary ridge being back of the eyeballs and slightly above a longitudinal plane passed through their centres; only a rudimentary part of the frontal plate is present. The nasal bones are correct and in situ. The petrous portions of the mastoid and the posterior part of the squamous portion of the temporal bones are present, and it is to the superior posterior point of this squamous part of the temporal bone that the scalp and membranes or meningocele is attached. These points stand up like horns, so that a posterior view shows the body of the sphenoid, basilar portion of occipital bones supporting these upright bones or bones of the temporal. There is a rudimentary parietal plate on each side, one cm. wide and two cm. long, situated between the squamous portions of the temporal and posterior edge of frontal bones. The frontal and parietal plates meet in the median line; the squamous portion of the temporal is joined by fibrous membrane. The occipital, parietal and squamous plates are down and resting on the base of the skull, leaving only a shallow slit between the anterior base of the skull and the above plates, in which space nothing can be found resembling nerve or brain structure. The cavity of the meningocele led directly into this slit, so that the meningocele, when distended would present the appearance of a large waterfall occasionally worn by our feminine ancestors. From the relation and attachments, this sac is the distended arachnoid of cranium and spine. The skin over the vertebral column is wanting, the line of demarcation between this and the thin wall of the meningocele being just external to the ends of the transverse processes.

I made an incision through the abdominal walls to get my finger on the anterior part of the column, and I found that anterior to the part that presents posteriorly, there is simply the body of the vertebræ, and I verified that by cutting through the spinal column.

There are a few points in connection with this patient that I would like to mention. It seems that the mother of this patient has given birth to a monster also. I simply got the statement from the patient, who said that the doctor who attended her mother said the child was deformed; she was not able to tell me in what the monstrosity consisted. In addition to that, from the time that she had this dream, or from the time she was satisfied that she was pregnant, she was entirely convinced in her own mind that her child would be a monstrosity. I asked her the reason, and of course tried to persuade her that her fears were ill founded. This was before the delivery.

Dr. Coles. Did she mention the fact that her mother had given birth to a monstrosity, before delivery?

Dr. Hulbert.-Yes, sir, and said that she felt satisfied her child would have something the matter with it.

Dr. McPheeters.-Why did she think so?

Dr. Hulbert.-Simply because her mother had given birth to a monster and a good many other women had; and it was a vague impression that she could not get rid of.

Dr. Frank Glasgow.-Had she ever seen such a monster.

Dr. Hulbert.-No: there had been nothing presented to this woman that would be at all startling; she is one of your "stay at homes" and had no unpleasant accident during the time of her gestation.

Now there was another point in regard to this specimen that I would like to call to your attention; that is the fact that this child during the delivery had convulsions, more particularly when there was any pressure brought to bear; that is it would kick and there would be be convulsions in different parts of the body. Upon looking up what little literature I have on the subject I find that Cazeaux makes the statement that he has been able to diagnosticate an anencephalous monster by that one sign, that whenever there was pressure made upon the presenting part (it is not stated whether it was vertex or breech) whenever pressure was brought to bear upon the presenting part the fetus would be thrown into convulsions. This fetus unquestionably had convulsive movements during its

delivery. It may be that the pressure applied through the waters that were left or something of that sort may have caused these convulsions. There does not seem to be enough nerve lesion here to be able to produce a convulsion. From the motion I felt I thought that the child made an attempt at respiration; there was a sudden and large distention of the abdominal walls, filling the cavity of the vagina.

Dr. G. A. Moses.-After birth was there any convulsive attempt or anything of that sort ?

Dr. Hulbert.-No, sir; there was not a movement of any kind. The cord did not pulsate during the delivery of the child.

Dr. Coles.-Did the mother feel the motions of the child before its births?

Dr. Hnlbert.-Yes, sir.

Dr. Coles.-I should say that this was proof positive that there was some functional development of the spinal cord.

Dr. Hulbert.-Another point that Cazeaux mentioned in regard to this is the quantity of amniotic fluid. There was an enormous quantity of it compared with the period of gestation; and there was another feature that struck me the first time I saw the woman; she did not seem to be large enough for a full seven months gestation; and making the examination I thought she did not have the dimensions of a woman in that stage of pregnancy; the abdominal walls were very tense, hard and contracted, so much so that she seemed to have a tendency to flatten out-to flatten the projecting portion or rotundity of the uterine globe. She was a primipara, and this, according to some authorities, may have some influence upon these monstrosities.

Dr. G. A. Moses.-What was the nativity of the woman?

Dr. Hulbert.-She was an American, and there was no history of syphilis in this case.

Dr. Papin.-This thing is not so uncommon, though fortunately not very frequent.

MATERNAL IMPRESSIONS.

Dr. Scott.-What are your views upon maternal impressions upon the fetus ?

Dr. Papin. They have so little to do with the development and growth of the child in most instances that I pay no attention to them. There is a coincidence occasionally that may lead us to be

lieve that there must be some maternal impression producing these monstrosities, but then when a woman will declare from morning to night and night to morning that there is a man in the house and look under the bed every night to find one, it is to be expected that she will sometime find one there. Certainly the headless fetus is a much less common thing than an armless or legless one, as far as the record is concerned, and here we may have a fair explanation of the amputation of the limb in the earlier stages of gestation. I remember one notable case in which a woman was strongly impressed that her child was to be born without a leg, and it was born without a leg. In that case there seemed to have been a moral influence which imposed this penalty as a punishment for some rather harsh treatment which she had witnessed. These mulberry and strawberry marks and all those things, the result of mere accident in the birth or prior to the birth, and when the child is born the mother remembers that she trampled on a mulberry or wanted a strawberry very badly or something of that kind; it is all nonsense. I certainly have not seen enough in my own personal observation to induce me to change my ideas about the matter. Dr. Boisliniere who has had a much larger experience could probably tell us some very extraordinary things in regard to this matter.

Dr. Boisliniere.-I think that Dr. Papin has had as much experience as any obstetrician in this city; still it falls to the lot of some men to see a series of peculiar cases. I have perhaps seen more of these cases than some other obstetricians, who have had a larger practice than I.

The etiology of these cases is very obscure. I do not think maternal impressions have anything to do with it. It may be due to malnutrition. Sometimes syphilis is mentioned as the cause, but syphilis has nothing to do with these malformations; it produces other mischiefs, but not these deformities.

They are not very common. I have seen perhaps a half dozen or more cases. One of the first cases that I saw was one like this where there was an arrest of growth-spina bifida, extending from the sacrum to the occipital bone; it was a cross presentation; I felt the external irregularities, the transverse processes of the vertebræ, but no spinous processes, and I ran my fingers along and felt something soft. But these cases are very difficult to diagnose; you may confound them with a great many things. Sometimes the presenting sac is very soft or you may take it for a placenta previa

or a placenta dislodged from its moorings. Of course if enough of the body of the child is delivered, the diagnosis may be easy enough. I have cases such as that, and also cases where there was an arrest of the growth of the occipital bone, and a hernia of the cerebellum also a case where there was a large portion of parietal bone wanting. Hernia of the brain and encephaloma are difficult to differentiate. I remember a case which I saw with Dr. Pope. I thought it was hernia of the brain, but he said it was an encepha latoma. I have seen cases of hernia of the brain where there was a large piece of parietal bone wanting. I remember a case of encephalocele which struck me as being remarkable because it was simply a case of arrest of the growth of the vault of the cranium. Really I was at sea to know what it was, and only after the child was born did I recognize the condition of affairs. The rest of the column was perfect, not wanting in any of its elements, but the whole vault of the cranium was wanting. The child lived thirty-six hours, moaning all the time, showing the independence of organic life from the brain, the child never had any convulsions: it died gradually, from what cause I do not know. The child was very large. The mother vomited a good deal during the third and fourth month, when the osseous formation of the child becomes perfect; she had constant vomiting and was really starved almost to death, but we finally controlled the vomiting, but this malnutrition during the period when the bones of the child were being formed may have caused the malformation. I cannot tell. There was no history of heredity in her family, and she was a very healthy woman, and the only thing I can refer it to is the want of nutrition during the three or four months when she was nearly starved.

Dr. Frank Glasgow.-Did the mother have any premonition that the child would be deformed?

Dr. Boisliniere.-No, Sir, she had no maternal impressions.

Dr. Papin I do not think the doctor intended to convey the idea that the mere vomiting during her pregnancy-the want of proper nutrition on the part of the mother would cause this malformation.

Dr. Boisliniere.-No, Sir, we frequently have this vomiting without any malformation of the child. In the cases that I have seen, the mother's recovery has been very good. I think the fact