MISCELLANEOUS SURGICAL ANOMALIES. 5 page

days later. He was placed in an Asylum at Astino where, though closely

watched, he took advantage of the first opportunity and cut off

two-thirds of his penis, when the delirium subsided. Camp describes a

stout German of thirty-five who, while suffering from delirium tremens,

fancied that his enemies were trying to steal his genitals, and seizing

a sharp knife he amputated his penis close to the pubes. He threw the

severed organ violently at his imaginary pursuers. The hemorrhage was

profuse, but ceased spontaneously by the formation of coagulum over the

mouth of the divided vessels. The wound was quite healed in six weeks,

and he was discharged from the hospital, rational and apparently

content with his surgical feat.

Richards reports the case of a Brahman boy of sixteen who had

contracted syphilis, and convinced, no doubt, that "nocit empta dolore

voluptus," he had taken effective means of avoiding injury in the

future by completely amputating his penis at the root. Some days after

his admission to the hospital he asked to be castrated, stating that he

intended to become an ascetic, and the loss of his testes as well as of

his penis appeared to him to be an imperative condition to the

attainment of that happy consummation. Chevers mentions a somewhat

similar case occurring in India.

Sands speaks of a single man of thirty who amputated his penis. He

gave an incomplete history of syphilis. After connection with a woman

he became a confirmed syphilophobe and greatly depressed. While

laboring under the hallucination that he was possessed of two bodies he

tied a string around the penis and amputated the organ one inch below

the glans. On loosening the string, three hours afterward, to enable

him to urinate, he lost three pints of blood, but he eventually

recovered. In the Pennsylvania Hospital Reports there is an account of

a married man who, after drinking several weeks, developed mania a

potu, and was found in his room covered with blood. His penis was

completely cut off near the pubes, and the skin of the scrotum was so

freely incised that the testicles were entirely denuded, but not

injured. A small silver cap was made to cover the sensitive urethra on

a line with the abdominal wall.

There is a record of a tall, powerfully-built Russian peasant of

twenty-nine, of morose disposition, who on April 3d, while reading his

favorite book, without uttering a cry, suddenly and with a single pull

tore away his scrotum together with his testes. He then arose from the

bank where he had been sitting, and quietly handed the avulsed parts to

his mother who was sitting near by, saying to her: "Take that; I do not

want it any more." To all questions from his relatives he asked pardon

and exemption from blame, but gave no reason for his act. This patient

made a good recovery at the hospital. Alexeef, another Russian, speaks

of a similar injury occurring during an attack of delirium tremens.

Black details the history of a young man of nineteen who went to his

bath-room and deliberately placing his scrotum on the edge of the tub

he cut it crossways down to the wood. He besought Black to remove his

testicle, and as the spermatic cord was cut and much injured, and

hemorrhage could only be arrested by ligature, the testicle was

removed. The reason assigned for this act of mutilation was that he had

so frequent nocturnal emissions that he became greatly disgusted and

depressed in spirit thereby. He had practiced self-abuse for two years

and ascribed his emissions to this cause. Although his act was that of

a maniac, the man was perfectly rational. Since the injury he had had

normal and frequent emissions and erections.

Orwin mentions the case of a laborer of forty who, in a fit of remorse

after being several days with a prostitute, atoned for his

unfaithfulness to his wife by opening his scrotum and cutting away his

left testicle with a pocket knife. The missing organ was found about

six yards away covered with dirt. At the time of infliction of this

injury the man was calm and perfectly rational. Warrington relates the

strange case of Isaac Brooks, an unmarried farmer of twenty-nine, who

was found December 5, 1879, with extensive mutilations of the scrotum;

he said that he had been attacked and injured by three men. He swore to

the identity of two out of the three, and these were transported to ten

years' penal servitude. On February 13, 1881, he was again found with

mutilation of the external genitals, and again said he had been set

upon by four men who had inflicted his injury, but as he wished it kept

quiet he asked that there be no prosecution. Just before his death on

December 31, 1881, he confessed that he had perjured himself, and that

the mutilations were self-performed. He was not aware of any morbid

ideas as to his sexual organs, and although he had an attack of

gonorrhea ten years before he seemed to worry very little over it.

There is an account of a Scotch boy who wished to lead a "holy life,"

and on two occasions sought the late Mr. Liston's skilful aid in

pursuance of this idea. He returned for a third time, having himself

unsuccessfully performed castration.

A case of self-mutilation by a soldier who was confined in the

guard-house for drunkenness is related by Beck. The man borrowed a

knife from a comrade and cut off the whole external genital apparatus,

remarking as he flung the parts into a corner: "Any----fool can cut his

throat, but it takes a soldier to cut his privates off!" Under

treatment he recovered, and then he regretted his action.

Sinclair describes an Irishman of twenty-five who, maniacal from

intemperance, first cut off one testicle with a wire nail, and then the

second with a trouser-buckle. Not satisfied with the extent of his

injuries he drove a nail into his temple, first through the skin by

striking it with his hand, and then by butting it against the

wall,--the latter maneuver causing his death.

There is on record the history of an insane medical student in Dublin

who extirpated both eyes and threw them on the grass. He was in a state

of acute mania, and the explanation offered was that as a "grinder"

before examination he had been diligently studying the surgery of the

eye, and particularly that relating to enucleation. Another Dublin case

quoted by the same authority was that of a young girl who, upon being

arrested and committed to a police-cell in a state of furious

drunkenness, tore out both her eyes. In such cases, as a rule, the

finger-nails are the only instrument used. There is a French case also

quoted of a woman of thirty-nine who had borne children in rapid

succession. While suckling a child three months old she became much

excited, and even fanatical, in reading the Bible. Coming to the

passage, "If thy right eye offend thee, pluck it out, etc.," she was so

impressed with the necessity of obeying the divine injunction that she

enucleated her eye with a meat-hook. There is mentioned the case of a

young woman who cut off her right hand and cast it into the fire, and

attempted to enucleate her eyes, and also to hold her remaining hand in

the fire. Haslam reports the history of a female who mutilated herself

by grinding glass between her teeth.

Channing gives an account of the case of Helen Miller, a German Jewess

of thirty, who was admitted to the Asylum for Insane Criminals at

Auburn, N.Y., in October, 1872, and readmitted in June, 1875, suffering

from simulation of hematemesis. On September 25th she cut her left

wrist and right hand; in three weeks she became again "discouraged"

because she was refused opium, and again cut her arms below the elbows,

cleanly severing the skin and fascia, and completely hacking the

muscles in every direction. Six weeks later she repeated the latter

feat over the seat of the recently healed cicatrices. The right arm

healed, but the left showed erysipelatous inflammation, culminating in

edema, which affected the glottis to such an extent that tracheotomy

was performed to save her life. Five weeks after convalescence, during

which her conduct was exemplary, she again cut her arms in the same

place. In the following April, for the merest trifle, she again

repeated the mutilation, but this time leaving pieces of glass in the

wounds. Six months later she inflicted a wound seven inches in length,

in which she inserted 30 pieces of glass, seven long splinters, and

five shoe-nails. In June, 1877, she cut herself for the last time. The

following articles were taken from her arms and preserved: Ninety-four

pieces of glass, 34 splinters, two tacks, five shoe-nails, one pin, and

one needle, besides other things which were lost,--making altogether

about 150 articles.

"Needle-girls," etc.--A peculiar type of self-mutilation is the habit

sometimes seen in hysteric persons of piercing their flesh with

numerous needles or pins. Herbolt of Copenhagen tells of a young Jewess

from whose body, in the course of eighteen months, were extracted 217

needles. Sometime after 100 more came from a tumor on the shoulder. As

all the symptoms in this case were abdominal, it was supposed that

during an epileptic seizure this girl had swallowed the needles; but as

she was of an hysteric nature it seems more likely they had entered the

body through the skin. There is an instance in which 132 needles were

extracted from a young lady's person. Caen describes a woman of

twenty-six, while in prison awaiting trial, succeeding in committing

suicide by introducing about 30 pins and needles in the chest region,

over the heart. Her method was to gently introduce them, and then to

press them deeper with a prayer-book. An autopsy showed that some of

the pins had reached the lungs, some were in the mediastinum, on the

back part of the right auricle; the descending vena cave was

perforated, the anterior portion of the left ventricle was transfixed

by a needle, and several of the articles were found in the liver.

Andrews removed 300 needles from the body of an insane female. The

Lancet records an account of a suicide by the penetration of a

darning-needle in the epigastrium. There were nine punctures in this

region, and in the last the needle was left in situ and fixed by

worsted. In 1851 the same journal spoke of an instance in which 30 pins

were removed from the limbs of a servant girl. It was said that while

hanging clothes, with her mouth full of pins, she was slapped on the

shoulder, causing her to start and swallow the pins. There is another

report of a woman who swallowed great numbers of pins. On her death one

pound and nine ounces of pins were found in her stomach and duodenum.

There are individuals known as "human pin-cushions," who publicly

introduce pins and needles into their bodies for gain's sake.

The wanderings of pins and needles in the body are quite well known.

Schenck records the finding of a swallowed pin in the liver. Haller

mentions one that made its way to the hand. Silvy speaks of a case in

which a quantity of swallowed pins escaped through the muscles, the

bladder, and vagina; there is another record in which the pins escaped

many years afterward from the thigh. The Philosophical Transactions

contain a record of the escape of a pin from the skin of the arm after

it had entered by the mouth. Gooch, Ruysch, Purmann, and Hoffman speak

of needle-wanderings. Stephenson gives an account of a pin which was

finally voided by the bladder after forty-two years' sojourn in a

lady's body. On November 15, 1802, the celebrated Dr. Lettsom spoke of

an old lady who sat on a needle while riding in a hackney coach; it

passed from the injured leg to the other one, whence it was extracted.

Deckers tells of a gentleman who was wounded in the right

hypochondrium, the ball being taken thirty years afterward from the

knee. Borellus gives an account of a thorn entering the digit and

passing out of the body by the anus.

Strange as it may seem, a prick of a pin not entering a vital center or

organ has been the indirect cause of death. Augenius writes of a tailor

who died in consequence of a prick of a needle between the nail and

flesh of the end of the thumb. Amatus Lusitanus mentions a similar

instance in an old woman, although, from the symptoms given, the direct

cause was probably tetanus. In modern times Cunninghame, Boring, and

Hobart mention instances in which death has followed the prick of a

pin: in Boring's case the death occurred on the fifth day.

Manufacture of Crippled Beggars.--Knowing the sympathy of the world in

general for a cripple, in some countries low in the moral scale,

voluntary mutilation is sometimes practiced by those who prefer begging

to toiling. In the same manner artificial monstrosities have been

manufactured solely for gain's sake. We quite often read of these

instances in lay-journals, but it is seldom that a case comes under the

immediate observation of a thoroughly scientific mind. There is,

however, on record a remarkable instance accredited to Jamieson of

Shanghai who presented to the Royal College of Surgeons a pair of feet

with the following history: Some months previously a Chinese beggar had

excited much pity and made a good business by showing the mutilated

stumps of his legs, and the feet that had belonged to them slung about

his neck. While one day scrambling out of the way of a constable who

had forbidden this gruesome spectacle, he was knocked down by a

carriage in the streets of Shanghai, and was taken to the hospital,

where he was questioned about the accident which deprived him of his

feet. After selling the medical attendant his feet he admitted that he

had purposely performed the amputations himself, starting about a year

previously. He had fastened cords about his ankles, drawing them as

tightly as he could bear them, and increasing the pressure every two or

three days. For a fortnight his pain was extreme, but when the bones

were bared his pains ceased. At the end of a month and a half he was

able to entirely remove his feet by partly snapping and partly cutting

the dry bone. Such cases appear to be quite common in China, and by

investigation many parallels could elsewhere be found.

The Chinese custom of foot-binding is a curious instance of

self-mutilation. In a paper quoted in the Philadelphia Medical Times,

January 31, 1880, a most minute account of the modus operandi, the

duration, and the suffering attendant on this process are given.

Strapping of the foot by means of tight bandages requires a period of

two or three years' continuance before the desired effect is produced.

There is a varying degree of pain, which is most severe during the

first year and gradually diminishes after the binding of all the joints

is completed. During the binding the girl at night lies across the

bed, putting her legs on the edge of the bed-stead in such a manner as

to make pressure under the knees, thus benumbing the parts below and

avoiding the major degree of pain. In this position, swinging their

legs backward and forward, the poor Chinese girls pass many a weary

night. During this period the feet are unbound once a month only. The

operation is begun by placing the end of a long, narrow bandage on the

inside of the instep and carrying it over the four smaller toes,

securing them under the foot. After several turns the bandage is

reversed so as to compress the foot longitudinally. The young girl is

then left for a month, and when the bandage is removed the foot is

often found gangrenous and ulcerated, one or two toes not infrequently

being lost. If the foot is thus bound for two years it becomes

virtually dead and painless. By this time the calf disappears from lack

of exercise, the bones are attenuated, and all the parts are dry and

shrivelled. In after-life the leg frequently regains its muscles and

adipose tissue, but the foot always remains small. The binding process

is said to exert a markedly depressing influence upon the emotional

character of the subject, which lasts through life, and is very

characteristic.

To show how minute some of the feet of the Chinese women are, Figure I

of the accompanying plate, taken from a paper by Kenthughes on the

"Feet of Chinese Ladies" is from a photograph of a shoe that measured

only 3 1/4 inches anteroposteriorly. The foot which it was intended to

fill must have been smaller still, for the bandage would take up a

certain amount of space. Figure II is a reproduction of a photograph of

a foot measuring 5 1/2 inches anteroposteriorly, the wrinkled

appearance of the skin being due to prolonged immersion in spirit. This

photograph shows well the characteristics of the Chinese foot--the

prominent and vertically placed heel, which is raised generally about

an inch from the level of the great toe; the sharp artificial cavus,

produced by the altered position of the os calcis, and the downward

deflection of the foot in front of the mediotarsal joint; the straight

and downward pointing great toe, and the infolding of the smaller toes

underneath the great toe. In Figure III we have a photograph of the

skeleton of a Chinese lady's foot about five inches in anteroposterior

diameter. The mesial axis of the os calcis is almost directly vertical,

with a slight forward inclination, forming a right angle with the bones

in front of the mediotarsal joint. The upper three-quarters of the

anterior articular surface of the calcis is not in contact with the

cuboid, the latter being depressed obliquely forward and downward, the

lower portion of the posterior facet on the cuboid articulating with a

new surface on the under portion of the bone. The general shape of the

bone closely resembles that of a normal one--a marked contrast to its

wasted condition and tapering extremity in paralytic calcaneus.

Extension and flexion at the ankle are only limited by the shortness of

the ligaments; there is no opposition from the conformation of the

bones. The astragalus is almost of normal shape; the trochlea is

slightly prolonged anteriorly, especially on the inner side, from

contact with the tibial articular surface. The cartilage on the exposed

posterior portion of the trochlea seems healthy. The head of the

astragalus is very prominent on the outer side, the scaphoid being

depressed downward and inward away from it. The anterior articular

surface is prolonged in the direction of the displaced scaphoid. The

scaphoid, in addition to its displacement, is much compressed on the

planter surface, being little more than one-half the width of the

dorsal surface. The cuboid is displaced obliquely downward and forward,

so that the upper part of the posterior articular surface is not in

contact with the calcis.

A professional leg-breaker is described in the Weekly Medical Review of

St. Louis, April, 1890. This person's name was E. L. Landers, and he

was accredited with earning his living by breaking or pretending to

break his leg in order to collect damages for the supposed injury.

Moreover, this individual had but one leg, and was compelled to use

crutches. At the time of report he had succeeded in obtaining damages

in Wichita, Kansas, for a supposed fracture. The Review quotes a

newspaper account of this operation as follows.--

"According to the Wichita Dispatch he represented himself as a

telegraph operator who was to have charge of the postal telegraph

office in that city as soon as the line reached there. He remained

about town for a month until he found an inviting piece of defective

sidewalk, suitable for his purpose, when he stuck his crutch through

the hole and fell screaming to the ground, declaring that he had broken

his leg. He was carried to a hospital, and after a week's time, during

which he negotiated a compromise with the city authorities and

collected $1000 damages, a confederate, claiming to be his nephew,

appeared and took the wounded man away on a stretcher, saying that he

was going to St. Louis. Before the train was fairly out of Wichita,

Landers was laughing and boasting over his successful scheme to beat

the town. The Wichita story is in exact accord with the artistic

methods of a one-legged sharper who about 1878 stuck his crutch through

a coal-hole here, and, falling heels over head, claimed to have

sustained injuries for which he succeeded in collecting something like

$1500 from the city. He is described as a fine-looking fellow, well

dressed, and wearing a silk hat. He lost one leg in a railroad

accident, and having collected a good round sum in damages for it,

adopted the profession of leg-breaking in order to earn a livelihood.

He probably argued that as he had made more money in that line than in

any other he was especially fitted by natural talents to achieve

distinction in this direction. But as it would be rather awkward to

lose his remaining leg altogether he modified the idea and contents

himself with collecting the smaller amounts which ordinary fractures of

the hip-joint entitle such an expert 'fine worker' to receive.

"He first appeared here in 1874 and succeeded, it is alleged, in

beating the Life Association of America. After remaining for some time

in the hospital he was removed on a stretcher to an Illinois village,

from which point the negotiations for damages were conducted by

correspondence, until finally a point of agreement was reached and an

agent of the company was sent to pay him the money. This being

accomplished the agent returned to the depot to take the train back to

St. Louis when he was surprised to see the supposed sufferer stumping

around on his crutches on the depot platform, laughing and jesting over

the ease with which he had beaten the corporation.

"He afterward fell off a Wabash train at Edwardsville and claimed to

have sustained serious injuries, but in this case the company's

attorneys beat him and proved him to be an impostor. In 1879 he

stumbled into the telegraph office at the Union Depot here, when Henry

C. Mahoney, the superintendent, catching sight of him, put him out,

with the curt remark that he didn't want him to stick that crutch into

a cuspidor and fall down, as it was too expensive a performance for the

company to stand. He beat the Missouri Pacific and several other

railroads and municipalities at different times, it is claimed, and

manages to get enough at each successful venture to carry him along for

a year or eighteen months, by which time the memory of his trick fades

out of the public mind, when he again bobs up serenely."

Anomalous Suicides.--The literature on suicide affords many instances

of self-mutilations and ingenious modes of producing death. In the

Dublin Medical Press for 1854 there is an extraordinary case of

suicide, in which the patient thrust a red-hot poker into his abdomen

and subsequently pulled it out, detaching portions of the omentum and

32 inches of the colon. Another suicide in Great Britain swallowed a

red-hot poker. In commenting on suicides, in 1835, Arntzenius speaks of

an ambitious Frenchman who was desirous of leaving the world in a

distinguished manner, and who attached himself to a rocket of enormous

size which he had built for the purpose, and setting fire to it, ended

his life. On September 28, 1895, according to the Gaulois and the New

York Herald (Paris edition) of that date, there was admitted to the

Hopital St. Louis a clerk, aged twenty-five, whom family troubles had

rendered desperate and who had determined to seek death as a relief

from his misery. Reviewing the various methods of committing suicide

he found none to his taste, and resolved on something new. Being

familiar with the constituents of explosives, he resolved to convert

his body into a bomb, load it with explosives, and thus blow himself to

pieces. He procured some powdered sulphur and potassium chlorate, and

placing each in a separate wafer he swallowed both with the aid of

water. He then lay down on his bed, dressed in his best clothes,

expecting that as soon as the two explosive materials came into contact

he would burst like a bomb and his troubles would be over. Instead of

the anticipated result the most violent collicky pains ensued, which

finally became so great that he had to summon his neighbors, who took

him to the hospital, where, after vigorous application with the

stomach-pump, it was hoped that his life would be saved. Sankey

mentions an epileptic who was found dead in his bed in the Oxford

County Asylum; the man had accomplished his end by placing a round

pebble in each nostril, and thoroughly impacting in his throat a strip

of flannel done up in a roll. In his "Institutes of Surgery" Sir

Charles Bell remarks that his predecessor at the Middlesex Hospital

entered into a conversation with his barber over an attempt at suicide

in the neighborhood, during which the surgeon called the "would-be

suicide" a fool, explaining to the barber how clumsy his attempts had

been at the same time giving him an extempore lecture on the anatomic

construction of the neck, and showing him how a successful suicide in

this region should be performed. At the close of the conversation the

unfortunate barber retired into the back area of his shop, and

following minutely the surgeon's directions, cut his throat in such a

manner that there was no hope of saving him. It is supposed that one

could commit suicide by completely gilding or varnishing the body, thus

eliminating the excretory functions of the skin. There is an old story

of an infant who was gilded to appear at a Papal ceremony who died

shortly afterward from the suppression of the skin-function. The fact

is one well established among animals, but after a full series of

actual experiments, Tecontjeff of St. Petersburg concludes that in

this respect man differs from animals. This authority states that in

man no tangible risk is entailed by this process, at least for any

length of time required for therapeutic purposes. "Tarred and

feathered" persons rarely die of the coating of tar they receive. For

other instances of peculiar forms of suicide reference may be made to

numerous volumes on this subject, prominent among which is that by

Brierre de Boismont, which, though somewhat old, has always been found

trustworthy, and also to the chapters on this subject written by

various authors on medical jurisprudence.

Religious and Ceremonial Mutilations.--Turning now to the subject of

self-mutilation and self-destruction from the peculiar customs or

religious beliefs of people, we find pages of information at our

disposal. It is not only among the savage or uncivilized tribes that

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