Anomalies And Curiosities Of Medicine Part 61

Elephantiasis seldom attacks the upper extremities. Of the older cases Rayer reports four collected by Alard. In one case the hard and permanent swelling of the arm occurred after the application of a blister; in another the arm increased so that it weighed more than 200 Genoese pounds, 40 of which consisted of serum. The swellings of the arm and forearm resembled a distended bladder. The arteries, veins, and nerves had not undergone any alteration, but the lymphatics were very much dilated and loaded with lymph.

The third case was from Fabricius Hilda.n.u.s, and the fourth from Hendy.

Figure 276 represents a remarkable elephantoid change in the hand of an elderly German woman. Unfortunately there is no medical description of the case on record, but the photograph is deemed worthy of reproduction.

Terry describes a French mulatto girl of eleven whose left hand was enormously increased in weight and consistency, the chief enlargement being in the middle finger, which was 6 1/2 inches long, and 5 1/2 inches about the nail, and 8 1/2 around the base of the finger. The index finger was two inches thick and four inches long, twisted and drawn, while the other fingers were dwarfed. The elephantiasis in this case slowly and gradually increased in size until the hand weighed 3 1/2 pounds. The skin of the affected finger, contrary to the general appearance of a part affected with elephantiasis, was of normal color, smooth, s.h.i.+ny, showed no sensibility, and the muscles had undergone fatty degeneration. It was successfully amputated in August, 1894. The accompanying ill.u.s.tration shows a dorsal view of the affected hand.

Magalhaes of Rio Janeiro reports a very interesting case of elephantiasis of the scalp, representing dermatolysis, in which the fold of hypertrophied skin fell over the face like the hide of an elephant, somewhat similar in appearance to the "elephant-man." Figure 279 represents a somewhat similar hypertrophic condition of the scalp and face reported in the Photographic Review of Medicine and Surgery, 1870.

Elephantiasis of the face sometimes only attacks it on one side. Such a case was reported by Alard, in which the elephantiasis seems to have been complicated with eczema of the ear. Willier, also quoted by Alard, describes a remarkable case of elephantiasis of the face. After a debauch this patient experienced violent pain in the left cheek below the zygomatic arch; this soon extended under the chin, and the submaxillary glands enlarged and became painful; the face swelled and became erythematous, and the patient experienced nausea and slight chills. At the end of six months there was another attack, after which the patient perceived that the face continued puffed. This attack was followed by several others, the face growing larger and larger. In similar cases tumefaction a.s.sumes enormous proportions, and Schenck speaks of a man whose head exceeded that of an ox in size, the lower part of the face being entirely covered with the nose, which had to be raised to enable its unhappy owner to breathe.

Rayer cites two instances in which elephantiasis of the breast enlarged these organs to such a degree that they hung to the knees. Salmuth speaks of a woman whose b.r.e.a.s.t.s increased to such a size that they hung down to her knees. At the same time she had in both axillae glandular tumors as large as the head of a fetus. Borellus also quotes the case of a woman whose b.r.e.a.s.t.s became so large that it was necessary to support them by straps, which pa.s.sed over the shoulders and neck.

Elephantiasis is occasionally seen in the genital regions of the female, but more often in the s.c.r.o.t.u.m of the male, in which location it produces enormous tumors, which sometimes reach to the ground and become so heavy as to prevent locomotion. This condition is curious in the fact that these immense tumors have been successfully removed, the t.e.s.t.i.c.l.es and p.e.n.i.s, which had long since ceased to be distinguished, saved, and their function restored. Alibert mentions a patient who was operated upon by Clot-Bey, whose s.c.r.o.t.u.m when removed weighed 110 pounds; the man had two children after the disease had continued for thirteen years, but before it had obtained its monstrous development--a proof that the functions of the t.e.s.t.i.c.l.es had not been affected by the disease.

There are several old accounts of scrotal tumors which have evidently been elephantoid in conformation. In the Ephemerides in 1692 there was mentioned a tumor of the s.c.r.o.t.u.m weighing 200 pounds. In the West Indies it was reported that rats have been known to feed on these enormous tumors, while the deserted subjects lay in a most helpless condition. Larrey mentioned a case of elephantiasis of the s.c.r.o.t.u.m in which the tumor weighed over 200 pounds. Sir Astley Cooper removed a tumor of 56 pounds weight from a Chinese laborer. It extended from beneath the umbilicus to the anterior border of the a.n.u.s; it had begun in the prepuce ten years previously. Clot-Bey removed an elephantoid tumor of the s.c.r.o.t.u.m weighing 80 pounds, performing castration at the same time. Alleyne reports a case of elephantiasis, in which he successfully removed a tumor of the integuments of the s.c.r.o.t.u.m and p.e.n.i.s weighing 134 pounds.

Bicet mentions a curious instance of elephantiasis of the p.e.n.i.s and s.c.r.o.t.u.m which had existed for five years. The subject was in great mental misery and alarm at his unsightly condition. The parts of generation were completely buried in the huge ma.s.s. An operation was performed in which all of the diseased structures that had totally unmanned him were removed, the true organs of generation escaping inviolate. Thebaud mentions a tumor of the s.c.r.o.t.u.m, the result of elephantiasis, which weighed 63 1/2 pounds. The weight was ascertained by placing the tumor on the scales, and directing the patient to squat over them without resting any weight of the body on the scales. This man could readily feel his p.e.n.i.s, although his surgeons could not do so. The bladder was under perfect control, the urine flowing over a channel on the exterior of the s.c.r.o.t.u.m, extending 18 inches from the meatus. Despite his infirmity this patient had perfect s.e.xual desire, and occasional erections and emissions. A very interesting operation was performed with a good recovery.

Partridge reports an enormous scrotal tumor which was removed from a Hindoo of fifty-five, with subsequent recovery of the subject. The tumor weighed 111 1/2 pounds. The ingenious technic of this operation is well worth perusal by those interested. Goodman successfully removed an elephantiasis of the s.c.r.o.t.u.m from a native Fiji of forty-five. The tumor weighed 42 pounds, without taking into consideration the weight of the fluid which escaped in abundance during the operation and also after the operation, but before it was weighed.

Van Buren and Keyes mention a tumor of the s.c.r.o.t.u.m of this nature weighing 165 pounds. Quoted by Russell, Hendy describes the case of a negro who had successive attacks of glandular swelling of the s.c.r.o.t.u.m, until finally the s.c.r.o.t.u.m was two feet long and six feet in circ.u.mference. It is mentioned that mortification of the part caused this patient's ultimate death.

Figure 281 is taken from a photograph loaned to the authors by Dr.

James Thorington. The patient was a native of Fiji, and was successfully operated on, with preservation of the testes. The tumor, on removal, weighed 120 pounds.

W. R. Browne, Surgeon-General, reports from the Madras General Hospital an operation on a patient of thirty-five with elephantoid s.c.r.o.t.u.m of six years' duration. The proportions of the s.c.r.o.t.u.m were as follows: Horizontally the circ.u.mference was six feet 6 1/2 inches, and vertically the circ.u.mference was six feet ten inches. The p.e.n.i.s was wholly hidden, and the urine pa.s.sed from an opening two feet 5 1/2 inches from the pubis. The man had complete control of his bladder, but was unable to walk. The operation for removal occupied one hour and twenty minutes, and the tumor removed weighed 124 3/4 pounds. Little blood was lost on account of an elastic cord tied about the neck of the tumor, and secured by successful removal of a scrotal tumor weighing 56 pounds.

Fenger describes a case of the foregoing nature in a German of twenty-three, a resident of Chicago. The growth had commenced eight years previously, and had progressively increased. There was no pain or active inflammation, and although the patient had to have especially constructed trousers he never ceased his occupation as a driver. The s.c.r.o.t.u.m was represented by a hairless tumor weighing 22 pounds, and hanging one inch below the knees. No t.e.s.t.i.c.l.es or p.e.n.i.s could be made out. Fenger removed the tumor, and the man was greatly improved in health. There was still swelling of the inguinal glands on both sides, but otherwise the operation was very successful. The man's mental condition also greatly improved. Fenger also calls especial attention to the importance of preserving the p.e.n.i.s and testes in the operation, as although these parts may apparently be obliterated their functions are undisturbed.

The statistics of this major operation show a surprisingly small mortality. Fayrer operated on 28 patients with 22 recoveries and six deaths, one from shock and five from pyemia The same surgeon collected 193 cases, and found the general mortality to be 18 per cent. According to Ashhurst, Turner, who practiced as a medical missionary in the Samoan Islands, claims to have operated 136 times with only two deaths.

McLeod, Fayrer's successor in India, reported 129 cases with 23 deaths.

Early in this century Rayer described a case of elephantiasis in a boy of seventeen who, after several attacks of erysipelas, showed marked diminution of the elephantoid change; the fact shows the antagonism of the streptococcus erysipelatis to hypertrophic and malignant processes.

Acromegaly is a term introduced by Marie, and signifies large extremities. It is characterized by an abnormally large development of the extremities and of the features of the face,--the bony as well as the soft parts. In a well-marked case the hands and feet are greatly enlarged, but not otherwise deformed, and the normal functions are not disturbed. The hypertrophy involves all the tissues, giving a curious spade-like appearance to the hands. The feet are similarly enlarged, although the big toe may be relatively much larger. The nails also become broad and large. The face increases in volume and becomes elongated, in consequence of the hypertrophy of the superior and inferior maxillary bones. The latter often projects beyond the upper teeth. The teeth become separated, and the soft parts increase in size.

The nose is large and broad, and the skin of the eyelids and ears is enormously hypertrophied. The tongue is greatly hypertrophied. The disease is of long duration, and late in the history the bones of the spine and thorax may acquire great deformity. As we know little of the influences and sources governing nutrition, the pathology and etiology of acromegaly are obscure. Marie regards the disease as a systemic dystrophy a.n.a.logous to myxedema, due to a morbid condition of the pituitary body, just as myxedema is due to disease of the thyroid. In several of the cases reported the squint and optic atrophy and the amblyopia have pointed to the pituitary body as the seat of a new growth of hypertrophy. Pers.h.i.+ng shows a case of this nature. The enlargement of the face and extremities was characteristic, and the cerebral and ocular symptoms pointed to the pituitary body as the seat of the lesion. Unverricht, Thomas, and Ransom report cases in which the ocular lesions, indicative of pituitary trouble, were quite prominent.

Of 22 cases collected by Tamburini 19 showed some change in the pituitary body, and in the remaining three cases either the diagnosis was uncertain or the disease was of very short duration. Linsmayer reported a case in which there was a softened adenoma in the pituitary body, and the thymus was absent.

Hersman reports an interesting case of progressive enlargement of the hands in a clergyman of fifty. Since youth he had suffered with pains in the joints. About three years before the time of report he noticed enlargement of the phalangeal joint of the third finger of the right hand. A short time later the whole hand became gradually involved and the skin a.s.sumed a darker hue. Sensation and temperature remained normal in both hands; acromegaly was excluded on account of the absence of similar changes elsewhere. Hersman remarks that the change was probably due to increase in growth of the fibrous elements of the subcutaneous lesions about the tendons, caused by rheumatic poison.

Figure 283 shows the palmer and dorsal surfaces of both hands.

Chiromegaly is a term that has been applied by Charcot and Brissaud to the pseudoacromegaly that sometimes occurs in syringomyelia. Most of the cases that have been reported as a combination of these two diseases are now thought to be only a syringomyelia. A recent case is reported by Marie. In this connection it is interesting to notice a case of what might be called acute symptomatic transitory pseudoacromegaly, reported by Potovski: In an insane woman, and without ascertainable cause, there appeared an enlargement of the ankles, wrists, and shoulders, and later of the muscles, with superficial trophic disturbances that gradually disappeared. The author excludes syphilis, tuberculosis, rheumatism, gout, hemophilia, etc., and considers it to have been a trophic affection of cerebral origin.

Cases of pneumonia osteoarthropathy simulating acromegaly have been reported by Korn and Murray.

Megalocephaly, or as it was called by Virchow, leontiasis ossea, is due to a hypertrophic process in the bones of the cranium. The cases studied by Virchow were diffuse hyperostoses of the cranium. Starr describes what he supposes to be a case of this disease, and proposes the t.i.tle megalocephaly as preferable to Virchow's term, because the soft parts are also included in the hypertrophic process. A woman of fifty-two, married but having no children, and of negative family history, six years before the time of report showed the first symptoms of the affection, which began with formication in the finger-tips. This gradually extended to the shoulders, and was attended with some uncertainty of tactile sense and clumsiness of movement, but actual anesthesia had never been demonstrated. This numbness had not invaded the trunk or lower extremities, although there was slight uncertainty in the gait. There had been a slowly progressing enlargement of the head, face, and neck, affecting the bone, skin, and subcutaneous tissues, the first to the greatest degree. The circ.u.mference of the neck was 16 inches; the horizontal circ.u.mference of the head was 24 inches; from ear to ear, over the vertex, 16 inches; and from the root of the nose to the occipital protuberance, 16 inches. The cervical vertebrae were involved, and the woman had lost five inches in height.

It may be mentioned here that Brissaud and Meige noticed the same loss in height, only more p.r.o.nounced, in a case of gigantism, the loss being more than 15 inches. In Starr's case the tongue was normal and there was no swelling of the thyroid.

Cretinism is an endemic disease among mountainous people who drink largely of lime water, and is characterized by a condition of physical, physiologic, and mental degeneracy and nondevelopment, and possibly goiter. The subjects of this disease seldom reach five feet in height, and usually not more than four. The word cretin is derived from the Latin creatura. They are found all over the world. In Switzerland it is estimated that in some cantons there is one cretin to every 25 inhabitants. In Styria, the Tyrol, and along the Rhine cretins are quite common, and not long since cases existed in Derbys.h.i.+re. These creatures have been allowed to marry and generate, and thus extend their species. In "Le Medicin de Campagne," Balzac has given a vivid picture of the awe and respect in which they were held and the way in which they were allowed to propagate. Speaking of the endemic cretins, Beaupre says: "I see a head of unusual form and size, a squat and bloated figure, a stupid look, bleared, hollow, and heavy eyes, thick, projecting eyelids, and a flat nose. His face is of a leaden hue, his skin dirty, flabby, covered with tetters, and his thick tongue hangs down over his moist, livid lips; his mouth, always open and full of saliva, shows teeth going to decay. His chest is narrow, his back curved, his breath asthmatic, his limbs short, misshapen, without power. The knees are thick and inclined inward, the feet flat. The large head droops listlessly on the breast; the abdomen is like a bag."

The cretin is generally deaf and dumb, or only able to give a hoa.r.s.e cry. He is indifferent to heat and cold, and even to the most revolting odors. The general opinion has always been that the s.e.xual desire and genital organs are fully developed.

A quotation under our observation credits Colonel Sykes with the following statistics of cretinism, which show how in some locations it may be a decided factor of population. In December, 1845, in a population of 2,558,349 souls (the locality not mentioned), there were 18,462 people with simple goiter. Of the cretins without goiter there were 2089. Of cretins with goiter there were 3909; and cretins in which goiter was not stated 962, making a total of 6960. Of these 2185 had mere animal instincts; 3531 possessed very small intellectual faculties; 196 were almost without any; 1048 not cla.s.sified. Of this number 2483 were born of healthy and sane fathers; 2285 from healthy mothers; 961 from goitrous fathers; 1267 from goitrous mothers; 49 from cretin fathers; 41 from cretin mothers; 106 from cretin fathers with goiter; 66 from cretin mothers with goiter; 438 fathers and 405 mothers were not specified.

Sporadic cretinism, or congenital myzedema, is characterized by a congenital absence of the thyroid, diminutiveness of size, thickness of neck, shortness of arms and legs, prominence of the abdomen, large size of the face, thickness of the lips, large and protruding tongue, and imbecility or idiocy. It is popularly believed that coitus during intoxication is the cause of this condition. Osler was able to collect 11 or 12 cases in this country. The diagnosis is all-important, as the treatment by the thyroid extract produces the most noteworthy results.

There are several remarkable recoveries on record, but possibly the most wonderful is the case of J. P. West of Bellaire, Ohio, the portraits of which are reproduced in Plate 11. At seventeen months the child presented the typical appearance of a sporadic cretin. The astonis.h.i.+ng results of six months' treatment with thyroid extract are shown in the second figure. After a year's treatment the child presents the appearance of a healthy and well-nourished little girl.

Myxedema proper is a const.i.tutional condition due to the loss of the function of the thyroid gland. The disease was first described by Sir William Gull as a cretinoid change, and later by William Ord of London, who suggested the name. It is characterized clinically by a myxedematous condition of the subcutaneous tissues and mental failure, and anatomically by atrophy of the thyroid gland. The symptoms of myxedema, as given by Ord, are marked increase in the general bulk of the body, a firm, inelastic swelling of the skin, which does not pit on pressure; dryness and roughness which tend, with swelling, to obliterate the lines of expression in the face; imperfect nutrition of the hair; local tumefaction of the skin and subcutaneous tissues, particularly in the supraclavicular region. The physiognomy is remarkably altered; the features are coa.r.s.e and broad, the lips thick, the nostrils broad and thick, and the mouth enlarged. There is a striking slowness of thought and of movement; the memory fails, and conditions leading to incipient dementia intervene. The functions of the thoracic and abdominal organs seem to be normal, and death is generally due to some intercurrent disease, possibly tuberculosis. A condition akin to myxedema occurs after operative removal of the thyroid gland.

In a most interesting lecture Brissaud shows the intimate relation between myxedema, endemic cretinism, sporadic cretinism, or myxedematous idiocy, and infantilism. He considers that they are all dependent upon an inherited or acquired deficiency or disease of the thyroid gland, and he presents cases ill.u.s.trating each affection.

Figure 285 shows a case of myxedema, one of myxedema in a case of arrested development--a transition case between myxedema of the adult and sporadic cretinism--and a typical case of sporadic cretinism.

Cagots are an outcast race or clan of dwarfs in the region of the Pyrenees, and formerly in Brittany, whose existence has been a scientific problem since the sixteenth century, at which period they were known as Cagots, Gahets, Gafets, Agotacs, in France; Agotes or Gafos, in Spain; and Cacous, in Lower Brittany. Cagot meant the dog of a Goth; they were of supposed Gothic origin by some, and of Tartar origin by others. These people were formerly supposed to have been the descendants of lepers, or to have been the victims of leprosy themselves. From the descriptions there is a decided difference between the Cagots and the cretins. In a recent issue of Cosmos a writer describes Cagots as follows:--

"They inhabit the valley of the Ribas in the northwestern part of the Spanish province now called Gerona. They never exceed 51 1/2 inches in height, and have short, ill-formed legs, great bellies, small eyes, flat noses, and pale, unwholesome complexions. They are usually stupid, often to the verge of idiocy, and much subject to goiter and scrofulous affections. The chief town of the Ribas Valley is Ribas, a place of 1500 inhabitants, about 800 feet above sea-level. The mountains rise about the town to a height of from 6000 to 8000 feet, and command an amazingly beautiful panorama of mountain, plain, and river, with Spanish cities visible upon the one side and French upon the other. The region is rich, both agriculturally and minerally, and is famous for its medicinal springs. In this paradise dwell the dwarfs, perhaps as degraded a race of men and women as may be found in any civilized community. They are almost without education, and inhabit wretched huts when they have any shelter. The most intelligent are employed as shepherds, and in summer they live for months at an elevation of more than 6000 feet without shelter. Here they see no human creature save some of their own kind, often idiots, who are sent up every fifteen or twenty days with a supply of food.

"It is said that formal marriage is almost unknown among them. The women in some instances are employed in the village of Ribas as nurses for children, and as such are found tender and faithful. Before communication throughout the region was as easy as it is now, it was thought lucky to have one of these dwarfs in a family, and the dwarfs were hired out and even sold to be used in beggary in neighboring cities. There are somewhat similar dwarfs in other valleys of the Pyrenees, but the number is decreasing, and those of the Ribas Valley are reduced to a few individuals."

Hiccough is a symptom due to intermittent, sudden contraction of the diaphragm. Obstinate cases are most peculiar, and sometimes exhaust the physician's skill. Symes divides these cases into four groups:--

(1) Inflammatory, seen particularly in inflammatory diseases of the viscera or abdominal membranes, and in severe cases of typhoid fever.

(2) Irritative, as in direct stimulus of the diaphragm in swallowing some very hot substance; local disease of the esophagus near the diaphragm, and in many conditions of gastric and intestinal disorder, more particularly those a.s.sociated with flatus.

(3) Specific or idiopathic, in which there are no evident causes present; it is sometimes seen in cases of nephritis and diabetes.

(4) Neurotic, in which the primary cause is in the nervous system,--hysteria, epilepsy, shock, or cerebral tumors.

The obstinacy of continued hiccough has long been discussed. Osler calls to mind that in Plato's "Symposium" the physician, Eryximachus, recommended to Aristophanes, who had hiccough from eating too much, either to hold his breath or to gargle with a little water; but if it still continued, "tickle your nose with something and sneeze, and if you sneeze once or twice even the most violent hiccough is sure to go."

The attack must have been a severe one, as it is stated subsequently that the hiccough did not disappear until Aristophanes had excited the sneezing.

Among the older medical writers Weber speaks of singultus lasting for five days; Tulpius, for twelve days; Eller and Schenck, for three months; Taranget, for eight months; and Bartholinus, for four years.

At the present day it is not uncommon to read in the newspapers accounts of prolonged hiccoughing. These cases are not mythical, and are paralleled by a number of instances in reliable medical literature.

The cause is not always discernible, and cases sometimes resist all treatment.

Holston reports a case of chronic singultus of seven years' standing.

It had followed an attack of whooping-cough, and was finally cured apparently by the administration of strychnin. Cowan speaks of a shoemaker of twenty-two who experienced an attack of constant singultus for a week, and then intermittent attacks for six years. Cowan also mentions instances of prolonged hiccough related by Heberden, Good, Hoffman, and Wartmouth. Barrett is accredited with reporting a case of persistent hiccough in a man of thirty-five. Rowland speaks of a man of thirty-five who hiccoughed for twelve years. The paroxysms were almost constant, and occurred once or twice a minute during the hours when the man was not sleeping. There was no noise with the cough. There is another case related in the same journal of a man who died on the fourth day of an attack of singultus, probably due to abscess of the diaphragm, which no remedy would relieve. Moore records a case of a child, injured when young, who hiccoughed until about twenty years of age (the age at the time of report). Foot mentions a lad of fifteen who, except when asleep, hiccoughed incessantly for twenty-two weeks, and who suffered two similar, but less severe, attacks in the summer of 1879, and again in 1880. The disease was supposed to be due to the habit of pressing the chest against the desk when at school. Dexter reports a case of long-continued singultus in an Irish girl of eighteen, ascribed to habitual masturbation. There was no intermission in the paroxysm, which increased in force until general convulsions ensued. The patient said that the paroxysm could be stopped by firm pressure on the upper part of the external genital organs. Dexter applied firm pressure on her c.l.i.toris, and the convulsions subsided, and the patient fell asleep. They could be excited by firm pressure on the lower vertebrae. Corson speaks of a man of fifty-seven who, after exposure to cold, suffered exhausting hiccough for nine days; and also records the case of an Irish servant who suffered hiccough for four months; the cause was ascribed to fright. Stevenson cites a fatal instance of hiccough in a stone-mason of forty-four who suffered continuously from May 14th to May 28th. The only remedy that seemed to have any effect in this case was castor-oil in strong purgative doses.

Willard speaks of a man of thirty-four who began to hiccough after an attack of pneumonia, and continued for eighty-six hours. The treatment consisted of the application of belladonna and cantharides plasters, bis.m.u.th, and lime-water, camphor, and salts of white h.e.l.lebore inhaled through the nose in finest powder. Two other cases are mentioned by the same author. Gapper describes the case of a young man who was seized with loud and distressing hiccough that never ceased for a minute during eighty hours. Two ounces of laudanum were administered in the three days without any decided effect, producing only slight languor.

Ranney reports the case of an unmarried woman of forty-four who suffered from paroxysms of hiccough that persisted for four years. A peculiarity of this attack was that it invariably followed movements of the upper extremities. Tenderness and hyperesthesia over the spinous processes of the 4th, 5th, and 6th cervical vertebrae led to the application of the thermocautery, which, in conjunction with the administration of ergot and bromide, was attended with marked benefit, though not by complete cure. Barlow mentions a man with a rheumatic affection of the shoulder who hiccoughed when he moved his joints.

Barlow also recites a case of hiccough which was caused by pressure on the cicatrix of a wound in the left hand.

Beilby reports a peculiar case in a girl of seventeen who suffered an anomalous affection of the respiratory muscle, producing a sound like a cough, but shriller, almost resembling a howl. It was repeated every five or six seconds during the whole of the waking moments, and subsided during sleep. Under rest and free purgation the patient recovered, but the paroxysms continued during prolonged intervals, and in the last six years they only lasted from twenty-four to forty-eight hours.

Parker reports four rebellious cases of singultus successfully treated by dry cups applied to the abdomen. In each case it was necessary to repeat the operation after two hours, but recovery was then rapid.

Tatevosoff reports a brilliant cure in a patient with chronic chest trouble, by the use of common snuff, enough being given several times to induce lively sneezing. Griswold records a successful treatment of one case in a man of fifty, occurring after a debauch, by the administration of glonoin, 1/150 of a grain every three hours.

Heidenhain records a very severe and prolonged case caused, as shown later at the operation and postmortem examination, by carcinoma of the pancreas. The spasms were greatly relieved by cocain administered by the mouth, as much as 15 grains being given in twelve hours. Laborde and Lepine report the case of a young girl who was relieved of an obstinate case of hiccough lasting four days by traction on her tongue.

After the tongue had been held out of the mouth for a few minutes the hiccoughs ceased. Laborde referred to two cases of a similar character reported by Viand.

Anomalous Sneezing.--In the olden times sneezing was considered a good omen, and was regarded as a sacred sign by nearly all of the ancient peoples. This feeling of reverence was already ancient in the days of Homer. Aristotle inquired into the nature and origin of the superst.i.tion, somewhat profanely wondering why sneezing had been deified rather than coughing. The Greeks traced the origin of the sacred regard for sneezing to the days of Prometheus, who blessed his man of clay when he sneezed. According to Seguin the rabbinical account says that only through Jacob's struggle with the angel did sneezing cease to be an act fatal to man. Not only in Greece and Rome was sneezing revered, but also by races in Asia and Africa, and even by the Mexicans of remote times. Xenophon speaks of the reverence as to sneezing, in the court of the King of Persia. In Mesopotamia and some of the African towns the populace rejoiced when the monarch sneezed. In the present day we frequently hear "G.o.d bless you" addressed to persons who have just sneezed, a perpetuation of a custom quite universal in the time of Gregory the Great, in whose time, at a certain season, the air was filled with an unwholesome vapor or malaria which so affected the people that those who sneezed were at once stricken with death-agonies. In this strait the pontiff is said to have devised a form of prayer to be uttered when the paroxysm was seen to be coming on, and which, it was hoped, would avert the stroke of the death-angel.