orrhea. I was called to see her in February, 1897, on account of the severe pain and soreness in the lower part of abdomen, which had almost disabled her from walking. She claims that this trouble began with her first period and has gradually grown worse. She was having an evening temperature varying from 99 to 101 degrees F., with an occasional chill or rigor.

On examination I found a mass on the right side filling the pelvis on that side and fixed. I also found what at that time seemed like a small pedunculated fibroid from the fundus of the uterus.

I opened the abdomen February 17. This tumor that I supposed was attached to the fundus of the uterus, was a dermoid cyst about an inch and a quarter in diameter and was attached to the bladder wall, with a rather thick pedicle. This I dissected off removing a portion of the muscular wall of the bladder. There was no connection between the interior of the bladder and this mass.

The other growth was a dermoid of the right ovary about the size of an orange, and firmly imbedded by inflammatory products. In removing this tumor I accidentally ruptured it, an accident that gave me a little trouble from infection, otherwise she made an uneventful recovery.

ACRANIAL MONSTER: SPECIMEN AND

REPORT OF THE CASE.

BY W. P. WILLIAMS, M.D, BLACKSHEAR, GA.

The case and specimen which I present to the Association. may be more readily understood by a brief clinical history. Mrs. H. R., multipara, aged twenty-three, had had two nor

mal and uneventful pregnancies, giving birth to normal and well-developed children, one of which lives, a fine specimen of healthful and vigorous childhood. Her last menstruation occurred on March 27, 1896. About the last of April nausea and vomiting from her pregnancy set in, and continued with unusual severity for about three months. In

July she suffered a severe fright from a snake.

On November 1st her home was burned at two o'clock in the morning, she being the first to discover the fire, which had gained such headway that the family barely escaped with their lives.

At four and a half months from date of last menstruation she detected the fetal movements, this occurring in first part of August. The movements continued lively until about Christmas and first of January, which should have been her normal term (about January 3d being the term from common methods of calculation.)

From this time fetal movements became less active until they almost ceased until the day before delivery, when they again became unusually lively. In December she experienced a very severe attack of dysentery lasting about two weeks, leaving her in a very debilitated state.

On the morning of March 10, 1897, labor came on, and when I arrived I found on examination a normal face presentation with chin well engaged under pubes. There was a remarkable absence of cranial firmness, which I attributed to the unusual presentation and lack of familiarity on my part with such presentations. While the pains were very short for this stage of labor they were rhythmical, and considering the advance apparently already made, it was unaccountable to me why delivery did not take place. The face had remained almost stationary so long under repeated pains that I finally decided in the interest of the features of the child, to use forceps. It was then that my astonishment reached its climax, for in passing my finger into the vagina to guide the blade of my instrument, I could find no head to guide it around, but massive shoulders seemed to fill every available space and block nature in her efforts at delivery. I grasped the headless face, and tried to bring the right shoulder down upon the perineum, but apparently with no success. In my extremity I sent for my friend,

Dr. Goethe, expecting the necessity of extracting body in sections; but happily for my own satisfaction and the preservation of my specimen, I succeeded in passing a twine in a catheter through the right axilla, and after drawing a strong tape through with it, succeeded in drawing the shoulder down, and with aid of my tape and right forefinger broke humerous and delivered right arm. The remainder was plain sailing, and I was happy in delivering the body without a single tear or bruise to the mother. The placenta was not of unusual size. The patient made a rapid and uneventful recovery without the establishment of active lactation.

I am sorry to weary you with the details of the case, but hope it may prove interesting in connection with the singular points presented for our consideration. The first thing is the brainless monster. How was it produced in a family where on both maternal and paternal sides there had never been a physical anomaly? Those who believe in maternal impression may find in the fright from the snake some resemblance between this monster and that symbol of subtlety and wisdom. And what is more apparent than what was suggested to me, that this mother, laboring under the terror of night, witnessing her home collapse in flame and smoke-what more natural than that she should transmit to her unborn child the wreck and ruin that she saw, and in the very citadel of this divine temple actually duplicate the sorrows and woe of that night? I shall leave this to those inclined to such things, with the suggestion that there is ample room for the imagination.

Possibly there may have been a connection between this anomaly and the poor health, with repeated shocks, which the mother suffered during her pregnancy.

But, leaving the arena of speculation and imagination to those interested in embryology and teratology, I turn to those especially instructive to the obstetrician. I re

fer, in the first place, to the long period of gestation. I believe that while no one attempts to determine definitely the exact number of days in a normal pregnancy, all agree that they are about two hundred and eighty. But here is a case in which, beyond a doubt, gestation lasted for three hundred and forty-five days, or an excess over a normal period of sixty-five days. I am positive of this. The lady is a lady of intelligence, and she is most emphatic as to the period of last menstruation, her morning sickness, and the time of quickening. But this is not all. In the face of two normal pregnancies and normally developed children of a normal size, she gives birth to a headless monster of extraordinary size, weighing at least ten pounds and possibly twelve. Were there a cranium and contents of a proportionate size, this child must have weighed at least fourteen or fifteen pounds-double the size of her former children.

I believe it is an established principle that pelvic abnormalities, causing more or less obstruction to the outlet of the womb, may cause a prolongation of pregnancy; but this case demonstrated a normal pelvis by two normal births, and, with much difficulty, this large body

There are then these two facts that remain, to my mind. at least, associated as cause and effect: the absent cranium and the long period of pregnancy; and we must conclude that the head and calcified cranium of the fetus is a decided factor in closing the term of a gravid uterus.

The factors which are generally accepted as entering into the precipitation of labor may be briefly summarized as follows: The tension to which the muscular fibers of the womb are subjected in the last months of pregnancy, and their reaction therefrom; the increased irritability of the gravid uterus at menstrual epochs; the progressive changes in tissue and the circulation of the blood about the attachment of the decidua, causing its easy response to an irritable womb in separating, and so acting as a foreign