ANOMALIES and CURIOSITIES of MEDICINE

Let me turn to my third and last principle for the new global economy: better accountability. The new generation demands transparency. They demand good governance. We must deliver.

Just look at the role of information technology in forcing change. It was the citizen power of social media that sparked a peoples’ transformation in the Middle East, put pressure on U.S. policymakers to compromise on the fiscal cliff, and prompted Chinese policymakers to publish frequent updates of pollution levels.

These forces for greater accountability will only get stronger. Of course, governments can try to push back and restrict access to information technology. But this is like King Canute ordering the tide not to come in!

Accountability is really a two-way street—institutions must be accountable to citizens, but citizens must also have the knowledge, education, and training needed to hold them accountable. It is mutual responsibility.

What does this all mean for economic life—in the public sector, the private sector, and international institutions too?

Beginning with the public sector, we have learned that good governance is the bedrock of economic success. Without strong institutions, good policies cannot be developed and implemented.

Zero tolerance for corruption must be foundational. The state must be the servant rather than the master of the people—meeting their basic needs and providing an enabling environment for the private sector to thrive.

But the private sector also needs to be accountable. The goal of the private sector cannot be only profit; it must also be to add value, create jobs, develop the new ideas that drive an economy forward. Vested interests and arbitrage typically hinder the accountability principle.

One has in mind the financial sector, which turned out to be insufficiently accountable—to its clients, its shareholders, and to society in general. As we all know, the global economic crisis was, in many respects, a governance crisis originating in the financial sector. It hid too much activity in murky and dark corners, and put its own short-term gain ahead of supporting the real economy.

As Plato said long ago, “Excess generally causes reaction, and produces a change in the opposite direction.”

Frankly, we need to see more of that change in 2013. Finishing the job of financial sector reform must be a priority. We can already see too many signs of waning commitment—dilution of reforms, delays in implementation, inconsistency of approaches. And we can see the risks—a further weakening in capital and liquidity standards; and not enough progress on key areas like cross-border resolution, shadow banking, and derivatives. We must also move in the direction of more prudent compensation practices.

Ultimately, again, this is all about accountability: we need a financial sector that is accountable to the real economy—one that adds value, not destroys it.

One final point on accountability: it also relates to international financial institutions like the IMF. We too must respond to the new imperative for greater accountability.


And so we are trying to become more open and transparent, reaching out to all stakeholders. Recognizing the profound changes in the global economy, we are pushing ahead with our governance reforms so that all countries have a fair stake in the running of the institution.

For at the end of the day, our job too is service: for our 188 member countries. We must be accountable to them—but even more than that, to the citizens of those countries who now hold us, rightly, to a new standard of effectiveness.

Conclusion: A New Moment in History

Let me conclude. I believe that if we continue to act, 2013 will be a defining year in terms of finally getting beyond the crisis. But more than that, I believe we are standing in the antechamber of a new global economy, marked by rapidly shifting circumstances and new modes of thinking.

Yes, this new economy will be geographically different, driven more by the dynamic emerging markets and developing countries. But it will also be generationally different, shaped by different values and principles.

What we need today is a “new moment in history” that embraces the values of a new era—more openness and cooperation between nations, more inclusion and solidarity among peoples, and stronger accountability of those responsible for the global economy. That includes many of the people here in this room.

In the final analysis, there are no easy answers to the big burning questions like the sources of future growth and the harnessing of technology to benefit the entire planet. But we can at least say that, together, we are grappling with the right issues—with our intelligence, goodwill, and courage.

Let me assure you that the IMF will always be ready to help in whatever way we can.

Thank you.

ANOMALIES and CURIOSITIES of MEDICINE

Being an encyclopedic collection of rare and extraordinary cases, and

of the most striking instances of abnormality in all branches of

medicine and surgery, derived from an exhaustive research of medical

literature from its origin to the present day, abstracted, classified,

annotated, and indexed.

by GEORGE M. GOULD, A.M., M.D. and WALTER L. PYLE, A.M., M.D.

PREFATORY AND INTRODUCTORY.

----

Since the time when man's mind first busied itself with subjects beyond

his own self-preservation and the satisfaction of his bodily appetites,

the anomalous and curious have been of exceptional and persistent

fascination to him; and especially is this true of the construction and

functions of the human body. Possibly, indeed, it was the anomalous

that was largely instrumental in arousing in the savage the attention,

thought, and investigation that were finally to develop into the body

of organized truth which we now call Science. As by the aid of

collected experience and careful inference we to-day endeavor to pass

our vision into the dim twilight whence has emerged our civilization,

we find abundant hint and even evidence of this truth. To the highest

type of philosophic minds it is the usual and the ordinary that demand

investigation and explanation. But even to such, no less than to the

most naive-minded, the strange and exceptional is of absorbing

interest, and it is often through the extraordinary that the

philosopher gets the most searching glimpses into the heart of the

mystery of the ordinary. Truly it has been said, facts are stranger

than fiction. In monstrosities and dermoid cysts, for example, we seem

to catch forbidden sight of the secret work-room of Nature, and drag

out into the light the evidences of her clumsiness, and proofs of her

lapses of skill,--evidences and proofs, moreover, that tell us much of

the methods and means used by the vital artisan of Life,--the loom, and

even the silent weaver at work upon the mysterious garment of

corporeality.

"La premiere chose qui s'offre a l' Homme quand il se regarde, c'est

son corps," says Pascal, and looking at the matter more closely we find

that it was the strange and mysterious things of his body that occupied

man's earliest as well as much of his later attention. In the

beginning, the organs and functions of generation, the mysteries of

sex, not the routine of digestion or of locomotion, stimulated his

curiosity, and in them he recognized, as it were, an unseen hand

reaching down into the world of matter and the workings of bodily

organization, and reining them to impersonal service and far-off ends.

All ethnologists and students of primitive religion well know the role

that has been played in primitive society by the genetic instincts.

Among the older naturalists, such as Pliny and Aristotle, and even in

the older historians, whose scope included natural as well as civil and

political history, the atypic and bizarre, and especially the

aberrations of form or function of the generative organs, caught the

eye most quickly. Judging from the records of early writers, when

Medicine began to struggle toward self-consciousness, it was again the

same order of facts that was singled out by the attention. The very

names applied by the early anatomists to many structures so widely

separated from the organs of generation as were those of the brain,

give testimony of the state of mind that led to and dominated the

practice of dissection.

In the literature of the past centuries the predominance of the

interest in the curious is exemplified in the almost ludicrously

monotonous iteration of titles, in which the conspicuous words are

curiosa, rara, monstruosa, memorabilia, prodigiosa, selecta, exotica,

miraculi, lusibus naturae, occultis naturae, etc., etc. Even when

medical science became more strict, it was largely the curious and rare

that were thought worthy of chronicling, and not the establishment or

illustration of the common, or of general principles. With all his

sovereign sound sense, Ambrose Pare has loaded his book with references

to impossibly strange, and even mythologic cases.

In our day the taste seems to be insatiable, and hardly any medical

journal is without its rare or "unique" case, or one noteworthy chiefly

by reason of its anomalous features. A curious case is invariably

reported, and the insertion of such a report is generally productive of

correspondence and discussion with the object of finding a parallel for

it.

In view of all this it seems itself a curious fact that there has never

been any systematic gathering of medical curiosities. It would have

been most natural that numerous encyclopedias should spring into

existence in response to such a persistently dominant interest. The

forelying volume appears to be the first thorough attempt to classify

and epitomize the literature of this nature. It has been our purpose

to briefly summarize and to arrange in order the records of the most

curious, bizarre, and abnormal cases that are found in medical

literature of all ages and all languages--a thaumatographia medica. It

will be readily seen that such a collection must have a function far

beyond the satisfaction of mere curiosity, even if that be stigmatized

with the word "idle." If, as we believe, reference may here be found to

all such cases in the literature of Medicine (including Anatomy,

Physiology, Surgery, Obstetrics, etc.) as show the most extreme and

exceptional departures from the ordinary, it follows that the future

clinician and investigator must have use for a handbook that decides

whether his own strange case has already been paralleled or excelled.

He will thus be aided in determining the truth of his statements and

the accuracy of his diagnoses. Moreover, to know extremes gives

directly some knowledge of means, and by implication and inference it

frequently does more. Remarkable injuries illustrate to what extent

tissues and organs may be damaged without resultant death, and thus the

surgeon is encouraged to proceed to his operation with greater

confidence and more definite knowledge as to the issue. If a mad cow

may blindly play the part of a successful obstetrician with her horns,

certainly a skilled surgeon may hazard entering the womb with his

knife. If large portions of an organ,--the lung, a kidney, parts of the

liver, or the brain itself,--may be lost by accident, and the patient

still live, the physician is taught the lesson of nil desperandum, and

that if possible to arrest disease of these organs before their total

destruction, the prognosis and treatment thereby acquire new and more

hopeful phases.

Directly or indirectly many similar examples have also clear

medicolegal bearings or suggestions; in fact, it must be acknowledged

that much of the importance of medical jurisprudence lies in a thorough

comprehension of the anomalous and rare cases in Medicine. Expert

medical testimony has its chief value in showing the possibilities of

the occurrence of alleged extreme cases, and extraordinary deviations

from the natural. Every expert witness should be able to maintain his

argument by a full citation of parallels to any remarkable theory or

hypothesis advanced by his clients; and it is only by an exhaustive

knowledge of extremes and anomalies that an authority on medical

jurisprudence can hope to substantiate his testimony beyond question.

In every poisoning case he is closely questioned as to the largest dose

of the drug in question that has been taken with impunity, and the

smallest dose that has killed, and he is expected to have the cases of

reported idiosyncrasies and tolerance at his immediate command. A widow

with a child of ten months' gestation may be saved the loss of

reputation by mention of the authentic cases in which pregnancy has

exceeded nine months' duration; the proof of the viability of a seven

months' child may alter the disposition of an estate; the proof of

death by a blow on the epigastrium without external marks of violence

may convict a murderer; and so it is with many other cases of a

medicolegal nature.

It is noteworthy that in old-time medical literature--sadly and

unjustly neglected in our rage for the new--should so often be found

parallels of our most wonderful and peculiar modern cases. We wish,

also, to enter a mild protest against the modern egotism that would set

aside with a sneer as myth and fancy the testimonies and reports of

philosophers and physicians, only because they lived hundreds of years

ago. We are keenly appreciative of the power exercised by the

myth-making faculty in the past, but as applied to early physicians, we

suggest that the suspicion may easily be too active. When Pare, for

example, pictures a monster, we may distrust his art, his artist, or

his engraver, and make all due allowance for his primitive knowledge of

teratology, coupled with the exaggerations and inventions of the

wonder-lover; but when he describes in his own writing what he or his

confreres have seen on the battle-field or in the dissecting room, we

think, within moderate limits, we owe him credence. For the rest, we

doubt not that the modern reporter is, to be mild, quite as much of a

myth-maker as his elder brother, especially if we find modern instances

that are essentially like the older cases reported in reputable

journals or books, and by men presumably honest. In our collection we

have endeavored, so far as possible, to cite similar cases from the

older and from the more recent literature.

This connection suggests the question of credibility in general. It

need hardly be said that the lay-journalist and newspaper reporter have

usually been ignored by us, simply because experience and investigation

have many times proved that a scientific fact, by presentation in most

lay-journals, becomes in some mysterious manner, ipso facto, a

scientific caricature (or worse!), and if it is so with facts, what

must be the effect upon reports based upon no fact whatsoever? It is

manifestly impossible for us to guarantee the credibility of chronicles

given. If we have been reasonably certain of unreliability, we may not

even have mentioned the marvelous statement. Obviously, we could do no

more with apparently credible cases, reported by reputable medical men,

than to cite author and source and leave the matter there, where our

responsibility must end.

But where our proper responsibility seemed likely never to end was in

carrying out the enormous labor requisite for a reasonable certainty

that we had omitted no searching that might lead to undiscovered facts,

ancient or modern. Choice in selection is always, of course, an affair

de gustibus, and especially when, like the present, there is

considerable embarrassment of riches, coupled with the purpose of

compressing our results in one handy volume. In brief, it may be said

that several years of exhaustive research have been spent by us in the

great medical libraries of the United States and Europe in collecting

the material herewith presented. If, despite of this, omissions and

errors are to be found, we shall be grateful to have them pointed out.

It must be remembered that limits of space have forbidden satisfactory

discussion of the cases, and the prime object of the whole work has

been to carefully collect and group the anomalies and curiosities, and

allow the reader to form his own conclusions and make his own

deductions.

As the entire labor in the preparation of the forelying volume, from

the inception of the idea to the completion of the index, has been

exclusively the personal work of the authors, it is with full

confidence of the authenticity of the reports quoted that the material

is presented.

Complete references are given to those facts that are comparatively

unknown or unique, or that are worthy of particular interest or further

investigation. To prevent unnecessary loading of the book with

foot-notes, in those instances in which there are a number of cases of

the same nature, and a description has not been thought necessary, mere

citation being sufficient, references are but briefly given or omitted

altogether. For the same reason a bibliographic index has been added at

the end of the text. This contains the most important sources of

information used, and each journal or book therein has its own number,

which is used in its stead all through the book (thus, 476 signifies

The Lancet, London; 597, the New York Medical Journal; etc.). These

bibliographic numbers begin at 100.

Notwithstanding that every effort has been made to conveniently and

satisfactorily group the thousands of cases contained in the book (a

labor of no small proportions in itself), a complete general index is a

practical necessity for the full success of what is essentially a

reference-volume, and consequently one has been added, in which may be

found not only the subjects under consideration and numerous

cross-references, but also the names of the authors of the most

important reports. A table of contents follows this preface.

We assume the responsibility for innovations in orthography, certain

abbreviations, and the occasional substitution of figures for large

numerals, fractions, and decimals, made necessary by limited space, and

in some cases to more lucidly show tables and statistics. From the

variety of the reports, uniformity of nomenclature and numeration is

almost impossible.

As we contemplate constantly increasing our data, we shall be glad to

receive information of any unpublished anomalous or curious cases,

either of the past or in the future.

For many courtesies most generously extended in aiding our

research-work we wish, among others, to acknowledge our especial

gratitude and indebtedness to the officers and assistants of the

Surgeon-General's Library at Washington, D.C., the Library of the Royal

College of Surgeons of London, the Library of the British Museum, the

Library of the British Medical Association, the Bibliotheque de Faculte

de Medecine de Paris, the Bibliotheque Nationale, and the Library of

the College of Physicians of Philadelphia.

GEORGE M. GOULD.

PHILADELPHIA, October, 1896. WALTER L. PYLE.

TABLE OF CONTENTS.

CHAPTER PAGES

I. GENETIC ANOMALIES . . . . . . . . . . . . . . . . . 17-49

II. PRENATAL ANOMALIES . . . . . . . . . . . . . . . . 50-112

III. OBSTETRIC ANOMALIES . . . . . . . . . . . . . . . 113-143

IV. PROLIFICITY . . . . . . . . . . . . . . . . . . . 144-160

V. MAJOR TERATA . . . . . . . . . . . . . . . . . . . 161-212

VI. MINOR TERATA . . . . . . . . . . . . . . . . . . . 213-323

VII. ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT . . . 324-364

VIII. LONGEVITY . . . . . . . . . . . . . . . . . . . 365-382

IX. PHYSIOLOGIC AND FUNCTIONAL ANOMALIES . . . . . . . 383-526

X. SURGICAL ANOMALIES OF THE HEAD AND NECK . . . . . . 527-587

XI. SURGICAL ANOMALIES OF THE EXTREMITIES . . . . . . 588-605

XII. SURGICAL ANOMALIES OF THE THORAX AND ABDOMEN . . 606-666

XIII. SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM . 667-696

XIV. MISCELLANEOUS SURGICAL ANOMALIES . . . . . . . . 697-758

XV. ANOMALOUS TYPES AND INSTANCES OF DISEASE . . . . . 759-822

XVI. ANOMALOUS SKIN-DISEASES . . . . . . . . . . . . . 823-851

XVII. ANOMALOUS NERVOUS AND MENTAL DISEASES . . . . . 852-890

XVIII. HISTORIC EPIDEMICS . . . . . . . . . . . . . . 891-914

ANOMALIES AND CURIOSITIES OF MEDICINE.

CHAPTER I.

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