MINOR TERATA. 4 page

perspiration. This is probably the same case quoted in the foregoing

paragraph in regard to the anomalies of hair. Otto, quoted by Sedgwick,

speaks of two brothers who were both totally edentulous. It might be

interesting in this connection to note that Oudet found in a fetus at

term all the dental follicles in a process of suppuration, leaving no

doubt that, if the fetus had been born viable, it would have been

edentulous. Giraldes mentions the absence of teeth in an infant of

sixteen months. Bronzet describes a child of twelve, with only half

its teeth, in whom the alveolar borders receded as in age. Baumes

remarks that he had seen a man who never had any teeth.

The anomalies of excessive dentition are of several varieties, those of

simple supernumerary teeth, double or triple rows, and those in

anomalous positions. Ibbetson saw a child with five incisors in the

inferior maxillary bone, and Fanton-Touvet describes a young lady who

possessed five large incisors of the first dentition in the superior

maxilla. Rayer notes a case of dentition of four canines, which first

made their appearance after pain for eight days in the jaws and

associated with convulsions. In an Ethiopian Soemmering has seen one

molar too many on each side and in each jaw. Ploucquet and Tesmer have

seen five incisors and Fanchard six. Many persons have the

supernumerary teeth parallel with their neighbors, anteriorly or

posteriorly. Costa reports a case in which there were five canine teeth

in the upper jaw, two placed laterally on either side, and one on the

right side behind the other two. The patient was twenty-six years of

age, well formed and in good health.

In some cases there is fusion of the teeth. Pliny, Bartholinus, and

Melanthon pretend to have seen the union of all the teeth, making a

continuous mass. In the "Musee de l'ecole dentaire de Paris" there are

several milk-teeth, both of the superior and inferior maxilla, which

are fused together. Bloch cites a case in which there were two rows of

teeth in the superior maxilla. Hellwig has observed three rows of

teeth, and the Ephemerides contain an account of a similar anomaly.

Extraoral Dentition.--Probably the most curious anomaly of teeth is

that in which they are found in other than normal positions. Albinus

speaks of teeth in the nose and orbit; Borellus, in the palate;

Fabricius Hildanus, under the tongue; Schenck, from the palate; and

there are many similar modern records. Heister in 1743 wrote a

dissertation on extraoral teeth. The following is a recent quotation:--

"In the Norsk Magazin fur Laegevidenskaben, January, 1895, it is

reported that Dr. Dave, at a meeting of the Medical Society in

Christiania, showed a tooth removed from the nose of a woman aged

fifty-three. The patient had consulted him for ear-trouble, and the

tooth was found accidentally during the routine examination. It was

easily removed, having been situated in a small depression at the

junction of the floor and external wall of the nasal cavity, 22 mm.

from the external nares. This patient had all her teeth; they were

placed somewhat far from each other. The tooth resembled a milk canine;

the end of the imperfect root was covered with a fold of mucous

membrane, with stratified epithelium. The speaker suggested that part

of the mucous membrane of the mouth with its tooth-germ had become

impacted between the superior and premaxillary bones and thus cut off

from the cavity of the mouth. Another speaker criticised this fetal

dislocation and believed it to be due to an inversion--a development in

the wrong direction--by which the tooth had grown upward into the nose.

The same speaker also pointed out that the stratified epithelium of the

mucous membrane did not prove a connection with the cavity of the

mouth, as it is known that cylindric epithelium-cells after irritative

processes are replaced by flat ones."

Delpech saw a young man in 1829 who had an opening in the palatine

vault occasioned by the extraction of a tooth. This opening

communicated with the nasal fossa by a fracture of the palatine and

maxillary bones; the employment of an obturator was necessary. It is

not rare to see teeth, generally canine, make their eruption from the

vault of the palate; and these teeth are not generally supernumerary,

but examples of vice and deviation of position. Fanton-Touvet, however,

gives an example of a supernumerary tooth implanted in the palatine

arch. Branch a describes a little negro boy who had two large teeth in

the nose; his dentition was otherwise normal, but a portion of the nose

was destroyed by ulceration. Roy describes a Hindoo lad of fourteen who

had a tooth in the nose, supposed to have been a tumor. It was of the

canine type, and was covered with enamel to the junction with the root,

which was deeply imbedded in the side and upper part of the antrum. The

boy had a perfect set of permanent teeth and no deformity, swelling, or

cystic formation of the jaw. This was clearly a case of

extrafollicular development and eruption of the tooth in an anomalous

position, the peculiarity being that while in other similar cases the

crown of the tooth shows itself at the floor of the nasal cavity from

below upward, in this instance the dental follicle was transposed, the

eruption being from above downward. Hall cites an instance in which the

right upper canine of a girl erupted in the nose. The subject showed

marked evidence of hereditary syphilis. Carver describes a child who

had a tooth growing from the lower right eyelid. The number of

deciduous teeth was perfect; although this tooth was canine it had a

somewhat bulbulous fang.

Of anomalies of the head the first to be considered will be the

anencephalous monsters who, strange to say, have been known to survive

birth. Clericus cites an example of life for five days in a child

without a cerebrum. Heysham records the birth of a child without a

cerebrum and remarks that it was kept alive for six days. There was a

child born alive in Italy in 1831 without a brain or a cerebellum--in

fact, no cranial cavity--and yet it lived eleven hours. A somewhat

similar case is recorded in the last century. In the Philosophical

Transactions there is mentioned a child virtually born without a head

who lived four days; and Le Duc records a case of a child born without

brain, cerebellum, or medulla oblongata, and who lived half an hour.

Brunet describes an anencephalous boy born at term who survived his

birth. Saviard delivered an anencephalous child at term which died in

thirty-six hours. Lawrence mentions a child with brain and cranium

deficient that lived five days. Putnam speaks of a female

nosencephalous monster that lived twenty-nine hours. Angell and Elsner

in March, 1895, reported a case of anencephaly, or rather

pseudencephaly, associated with double divergent strabismus and limbs

in a state of constant spastic contraction. The infant lived eight

days. Geoffroy-Saint-Hilaire cites an example of anencephaly which

lived a quarter of an hour. Fauvel mentioned one that lived two hours,

and Sue describes a similar instance in which life persisted for seven

hours and distinct motions were noticed. Malacarne saw life in one for

twelve hours, and Mery has given a description of a child born without

brain that lived almost a full day and took nourishment. In the

Hotel-Dieu in Paris in 1812 Serres saw a monster of this type which

lived three days, and was fed on milk and sugared water, as no nurse

could be found who was willing to suckle it.

Fraser mentions a brother and sister, aged twenty and thirty,

respectively, who from birth had exhibited signs of defective

development of the cerebellum. They lacked power of coordination and

walked with a drunken, staggering gait; they could not touch the nose

with the finger when their eyes were shut, etc. The parents of these

unfortunate persons were perfectly healthy, as were the rest of their

family. Cruveilhier cites a case of a girl of eleven who had absolutely

no cerebellum, with the same symptoms which are characteristic in such

cases. There is also recorded the history of a man who was deficient in

the corpus callosum; at the age of sixty-two, though of feeble

intelligence, he presented no signs of nervous disorder. Claude Bernard

made an autopsy on a woman who had no trace of olfactory lobes, and

after a minute inquiry into her life he found that her sense of smell

had been good despite her deficiency.

Buhring relates the history of a case somewhat analogous to viability

of anencephalous monsters. It was a bicephalous child that lived

thirty-two hours after he had ligated one of its heads.

{footnote} The argument that the brain is not the sole organ of the

mind is in a measure substantiated by a wonderful case of a decapitated

rooster, reported from Michigan. A stroke of the knife bad severed the

larynx and removed the whole mass of the cerebrum, leaving the inner

aspect and base of the skull exposed. The cerebrum was partly removed;

the external auditory meatus was preserved. Immediately after the

decapitation the rooster was left to its supposed death struggles, but

it ran headless to the barn, where it was secured and subsequently fed

by pushing corn down its esophagus, and allowing water to trickle into

this tube from the spout of an oil-can. The phenomena exhibited by the

rooster were quite interesting. It made all the motions of pecking,

strutted about, flapped its wings, attempted to crow, but, of course,

without making any sound. It exhibited no signs of incoordination, but

did not seem to hear. A ludicrous exhibition was the absurd, sidelong

pas seul made toward the hens.

Ward mentions an instance of congenital absence of the corpora

callosum. Paget and Henry mention cases in which the corpora callosum,

the fornix, and septum lucidum were imperfectly formed. Maunoir

reports congenital malformation of the brain, consisting of almost

complete absence of the occipital lobe. The patient died at the

twenty-eighth month. Combettes reports the case of a girl who died at

the age of eleven who had complete absence of the cerebellum in

addition to other minor structural defects; this was probably the case

mentioned by Cruveilhier.

Diminution in volume of the head is called microcephaly. Probably the

most remarkable case on record is that mentioned by Lombroso. The

individual was called "l'homme-oiseau," or the human bird, and his

cranial capacity was only 390 c.c. Lombroso speaks of another

individual called "l'homme-lapin," or man-rabbit, whose cranium was

only slightly larger than that of the other, measuring 490 mm. in

circumference. Castelli alludes to endemic microcephaly among some of

the peoples of Asia. We also find it in the Caribbean Islands, and from

the skulls and portraits of the ancient Aztecs we are led to believe

that they were also microcephalic.

Two creatures of celebrity were Maximo and Bartola, who for twenty-five

years have been shown in America and in Europe under the name of the

"Aztecs" or the "Aztec children". They were male and female and very

short, with heads resembling closely the bas-reliefs on the ancient

Aztec temples of Mexico. Their facial angle was about 45 degrees, and

they had jutting lips and little or no chin. They wore their hair in an

enormous bunch to magnify the deformity. These curiosities were born in

Central America and were possibly half Indian and Negro. They were

little better than idiots in point of intelligence.

Figure 92 represents a microcephalic youth known as the "Mexican wild

boy," who was shown with the Wallace circus.

Virchow exhibited a girl of fourteen whose face was no larger than that

of a new-born child, and whose head was scarcely as large as a man's

fist. Magitot reported a case of a microcephalic woman of thirty who

weighed 70 pounds.

Hippocrates and Strabonius both speak of head-binding as a custom

inducing artificial microcephaly, and some tribes of North American

Indians still retain this custom.

As a rule, microcephaly is attended with associate idiocy and arrested

development of the rest of the body. Ossification of the fontanelles in

a mature infant would necessarily prevent full development of the

brain. Osiander and others have noticed this anomaly. There are cases

on record in which the fontanelles have remained open until adulthood.

Augmentation of the volume of the head is called macrocephaly, and

there are a number of curious examples related. Benvenuti describes an

individual, otherwise well formed, whose head began to enlarge at

seven. At twenty-seven it measured over 37 inches in circumference and

the man's face was 15 inches in height; no other portion of his body

increased abnormally; his voice was normal and he was very intelligent.

He died of apoplexy at the age of thirty.

Fournier speaks of a cranium in the cabinet of the Natural History

Museum of Marseilles of a man by the name of Borghini, who died in

1616. At the time he was described he was fifty years old, four feet in

height; his head measured three feet in circumference and one foot in

height. There was a proverb in Marseilles, "Apas mai de sen que

Borghini," meaning in the local dialect, "Thou hast no more wit than

Borghini." This man, whose fame became known all over France, was not

able, as he grew older, to maintain the weight of his head, but carried

a cushion on each shoulder to prop it up. Fournier also quotes the

history of a man who died in the same city in 1807 at the age of

sixty-seven. His head was enormous, and he never lay on a bed for

thirty years, passing his nights in a chair, generally reading or

writing. He only ate once in twenty-four or thirty hours, never warmed

himself, and never used warm water. His knowledge was said to have been

great and encyclopedic, and he pretended never to have heard the

proverb of Borghini. There is related the account of a Moor, who was

seen in Tunis early in this century, thirty-one years of age, of middle

height, with a head so prodigious in dimensions that crowds flocked

after him in the streets. His nose was quite long, and his mouth so

large that he could eat a melon as others would an apple. He was an

imbecile. William Thomas Andrews was a dwarf seventeen years old,

whose head measured in circumference 35 inches; from one external

auditory meatus to another, 27 1/4 inches; from the chin over the

cranial summit to the suboccipital protuberance, 37 1/2 inches; the

distance from the chin to the pubes was 20 inches; and from the pubes

to the soles of the feet, 16; he was a monorchid. James Cardinal, who

died in Guy's Hospital in 1825, and who was so celebrated for the size

of his head, only measured 32 1/2 inches in head-circumference.

The largest healthy brains on record, that is, of men of prominence,

are those of Cuvier, weighing 64 1/3 ounces; of Daniel Webster,

weighing 63 3/4 ounces (the circumference of whose head was 23 3/4

inches); of Abercrombie, weighing 63 ounces, and of Spurzheim, weighing

55 1/16 ounces. Byron and Cromwell had abnormally heavy brains, showing

marked evidence of disease.

A curious instance in this connection is that quoted by Pigne, who

gives an account of a double brain found in an infant. Keen reports

finding a fornix which, instead of being solid from side to side,

consisted of two lateral halves with a triangular space between them.

When the augmentation of the volume of the cranium is caused by an

abundant quantity of serous fluid the anomaly is known as hydrocephaly.

In this condition there is usually no change in the size of the

brain-structure itself, but often the cranial bones are rent far

asunder. Minot speaks of a hydrocephalic infant whose head measured 27

1/2 inches in circumference; Bright describes one whose head measured

32 inches; and Klein, one 43 inches. Figure 93 represents a child of

six whose head circumference was 36 inches. Figure 94 shows a

hydrocephalic adult who was exhibited through this country.

There is a record of a curious monster born of healthy half-caste

African parents. The deformity was caused by a deficiency of osseous

material of the bones of the head. There was considerable arrest of

development of the parietal, temporal, and superior maxillary bones, in

consequence of which a very small amount of the cerebral substance

could be protected by the membranous expansion of the cranial centers.

The inferior maxilla and the frontal bone were both perfect; the ears

were well developed and the tongue strong and active; the nostrils were

imperforate and there was no roof to the mouth nor floor to the nares.

The eyes were curiously free from eyelashes, eyelids, or brows. The

cornea threatened to slough. There was double harelip on the left side;

the second and third fingers of both hands were webbed for their whole

length; the right foot wanted the distal phalanx of the great toe and

the left foot was clubbed and drawn inward. The child swallowed when

fed from a spoon, appeared to hear, but exhibited no sense of light. It

died shortly after the accompanying sketch was made.

Occasionally a deficiency in the osseous material of the cranium or an

abnormal dilatation of the fontanelles gives rise to a hernia of the

meninges, which, if accompanied by cerebrospinal fluid in any quantity,

causes a large and peculiarly shaped tumor called meningocele. If there

is a protrusion of brain-substance itself, a condition known as hernia

cerebri results.

Complete absence of the inferior maxilla is much rarer in man than in

animals. Nicolas and Prenant have described a curious case of this

anomaly in a sheep. Gurlt has named subjects presenting the total or

partial absence of the inferior maxilla, agnathes or hemiagnathes.

Simple atrophy of the inferior maxilla has been seen in man as well as

in the lower animals, but is much less frequent than atrophy of the

superior maxilla. Langenbeck reports the case of a young man who had

the inferior maxilla so atrophied that in infancy it was impossible for

him to take milk from the breast. He had also almost complete

immobility of the jaws. Boullard reports a deformity of the visage,

resulting in a deficiency of the condyles of the lower jaw. Maurice

made an observation on a vice of conformation of the lower jaw which

rendered lactation impossible, probably causing the death of the infant

on this account. Tomes gives a description of a lower jaw the

development of the left ramus of which had been arrested. Canton

mentions arrest of development of the left perpendicular ramus of the

lower jaw combined with malformation of the external ear.

Exaggerated prominence of the maxillaries is called prognathism; that

of the superior maxilla is seen in the North American Indians. Inferior

prognathism is observed in man as well as in animals. The bull-dog, for

example, displays this, but in this instance the deformity is really

superior brachygnathism, the superior maxilla being arrested in

development.

Congenital absence of the nose is a very rare anomaly. Maisonneuve has

seen an example in an individual in which, in place of the nasal

appendix, there was a plane surface perforated by two small openings a

little less than one mm. in diameter and three mm. apart.

Exaggeration in volume of the nose is quite frequent. Ballonius speaks

of a nose six times larger than ordinary. Viewing the Roman

celebrities, we find that Numa, to whom was given the surname

Pompilius, had a nose which measured six inches. Plutarch, Lyourgus,

and Solon had a similar enlargement, as had all the kings of Italy

except Tarquin the Superb.

Early in the last century a man, Thomas Wedders (or Wadhouse), with a

nose 7 1/2 inches long, was exhibited throughout Yorkshire. This man

expired as he had lived, in a condition of mind best described as the

most abject idiocy. The accompanying illustration is taken from a

reproduction of an old print and is supposed to be a true likeness of

this unfortunate individual.

There are curious pathologic formations about the nose which increase

its volume so enormously as to interfere with respiration and even with

alimentation; but these will be spoken of in another chapter.

There have been some celebrities whose noses were undersized. The Duc

de Guise, the Dauphin d'Auvergne, and William of Orange, celebrated in

the romances of chivalry, had extremely short noses.

There are a few recorded cases of congenital division of the nose.

Bartholinus, Borellus, and the Ephemerides speak of duplex noses.

Thomas of Tours has observed congenital fissure of the nose. Rikere

reports the case of an infant of three weeks who possessed a

supernumerary nose on the right nasal bone near the inner canthus of

the eye. It was pear-shaped, with its base down, and was the size of

the natural nose of an infant of that age, and air passed through it.

Hubbell, Ronaldson, and Luscha speak of congenital occlusion of the

posterior nares. Smith and Jarvis record cases of congenital occlusion

of the anterior nares.

Anomalies in size of the mouth are not uncommon. Fournier quotes the

history of a man who had a mouth so large that when he opened it all

his back teeth could be seen. There is a history of a boy of seventeen

who had a preternaturally-sized mouth, the transverse diameter being 6

1/2 inches. The mother claimed that the boy was born with his foot in

his mouth and to this fact attributed his deformity. The negro races

are noted for their large mouths and thick lips. A negro called "Black

Diamond," recently exhibited in Philadelphia, could put both his fists

in his mouth.

Morgan reports two cases of congenital macrostoma accompanied by

malformation of the auricles and by auricular appendages. Van Duyse

mentions congenital macrostoma with preauricular tumors and a dermoid

of the eye. Macrostoma is sometimes produced by lateral fissures. In

other cases this malformation is unilateral and the fissure ascends, in

which instance the fissure may be accompanied by a fistula of the duct

of Stensen. Sometimes there is associated with these anomalies curious

terminations of the salivary ducts, either through the cheek by means

of a fistula or on the anterior part of the neck.

Microstoma.--There are a few cases on record in which the mouth has

been so small or ill-defined as not to admit of alimentation. Molliere

knew an individual of forty whose mouth was the exact size of a

ten-centime piece.

Buchnerus records a case of congenital atresia of the mouth. Cayley,

Smith, Sourrouille, and Stankiewiez of Warsaw discuss atresia of the

mouth. Cancrum oris, scarlet fever, burns, scurvy, etc., are occasional

causes that have been mentioned, the atresia in these instances taking

place at any time of life.

Anomalies of the Lips.--The aboriginal tribes are particularly noted

for their large and thick lips, some of which people consider enormous

lips signs of adornment. Elephantiasis or other pathologic hypertrophy

of the labial tissues can produce revolting deformity, such as is seen

in Figure 100, representing an individual who was exhibited several

years ago in Philadelphia. We have in English the expression, "pulling

a long lip." Its origin is said to date back to a semimythical hero of

King Arthur's time, who, "when sad at heart and melancholic," would let

one of his lips drop below his waist, while he turned the other up like

a cap on his head.

Blot records a case of monstrous congenital hypertrophy of the superior

lip in an infant of eight months. Buck successfully treated by surgical

operations a case of congenital hypertrophy of the under lip, and

Detmold mentions a similar result in a young lady with hypertrophy of

the lip and lower part of the nose. Murray reports an undescribed

malformation of the lower lip occurring in one family.

Hare-lip may be unilateral or double, and may or may not include the

palatine arch. In the worst cases it extends in fissures on both sides

to the orbit. In other cases the minimum degree of this deformity is

seen.

Congenital absence of the tongue does not necessarily make speech,

taste, or deglutition impossible. Jussieu cites the case of a girl who

was born without a tongue but who spoke very distinctly. Berdot

describes a case in which the tongue was deficient, without apparent

disturbance of any of the functions. Riolan mentions speech after loss

of the tongue from small-pox.

Boddington gives an account of Margaret Cutting, who spoke readily and

intelligibly, although she had lost her tongue. Saulquin has an

observation of a girl without a tongue who spoke, sang, and swallowed

normally. Aurran, Bartholinus, Louis, Parsons, Tulpius, and others

mention speech without the presence of a tongue.

Philib reports a case in which mutism, almost simulating that of one

congenitally deaf, was due to congenital adhesions of the tongue to the

floor of the buccal cavity. Speech was established after removal of the

abnormal adhesion. Routier speaks of ankylosis of the tongue of

seventeen years' duration.

Jurist records such abnormal mobility of the tongue that the patient

was able to project the tongue into the nasopharynx. Wherry and

Winslow record similar instances.

There have been individuals with bifid tongues, after the normal type

of serpents and saurians, and others who possessed a supernumerary

tongue. Rev. Henry Wharton, Chaplain to Archbishop Sancroft, in his

journal, written in the seventeenth century, says that he was born with

two tongues and passed through life so, one, however, gradually

atrophying. In the polyclinic of Schnitzer in Vienna in 1892 Hajek

observed in a lad of twelve an accessory tongue 2.4 cm. in length and

eight mm. in breadth, forming a tumor at the base of the normal tongue.

It was removed by scissors, and on histologic examination proved to be

a true tongue with the typical tissues and constituents. Borellus,

Ephemerides, Eschenbach, Mortimer, Penada, and Schenck speak of double

tongues, and Avicenna and Schenck have seen fissured tongues. Dolaeus

records an instance of double tongue in a paper entitled "De puella

bilingui," and Beaudry and Brothers speak of cleft tongue. Braine

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