(astromelic.—Are very rare. " They are characterized by the pres ence of one or two accessory limbs inserted between the pelvic and the thoracic limbs." (Saint-Hilaire.) Notomelie.—Where there are one or two accessory limbs on the back. In the human race Saint-Hilaire never found a case. He saw it twice in cows.
Ceplialomelic.—W here the supplementary limb is inserted on the head.
Melanzelic. —Where one or more accessory limbs are inserted on one or more of the normal limbs. This variety is not so very uncommon. It may consist in the addition of a complete limb by a scapula or coxal bone near the normal limb; but often the scapula or coxal bone is lacking, and the accessory limb is confounded with the normal and has the same insertion. In certain instances, the superior segment of the limb is sin gle, the division not beginning till the second segment, the forearm or the leg. Again, the excess in development includes only the hands, feet or fingers.
The upper and the lower extremities may both be thus affected at the same time, and we may observe a certain symmetry in the malformation. Total doubling of the limbs is rarer.
[A curious instance of this variety we recently had the pleasure of see ing through the courtesy of Dr. W. J. Burnett of Long Island City, in whose practice the child was born. The following is the description which we wrote out at the time: Child, a female, aged thirteen months, with six teeth, and well-formed except as regards the right arm, forearm and hand. There are two humeri, each articulating with a radius and an ulna. In the forearm are three radii and three ulna), the central possibly articulating with the inner humerus. There are three hands, each can be moved separately. The inner hand has four fingers and one thumb, the latter always flexed in the hand from absence of the extensor muscle, and on its ulnar surface two rudimentary fingers; the middle hand has four fingers, always contracted, and no thumb; the outer hand has five perfect fingers.
Thus then: Two humeri, three radii, three ulnte, sixteen fingers, two rudimentary.—Ed. I Endoeytnie Fceluses.—The parasite is only represented by a mass in which traces of foetal structure may be found. They represent what the ancient writers described under the name of congenital pregnancy, and which to-day are classed among the dermoid cysts.
These deep inclusions have been well described by Verneuil, according to whom there are three periods: 1. A period of stagnation, where its presence is not revea.ed by any symptom physical or rational. This period is not of long duration. 2.
In the second period there are symptoms from the side of neighboring organs, although not suggestive of inclusion. 3. The third period is characterized by purulent inflammation, or by gangrene, and resulting elimination by the intestine, abdomen, etc.
During labor perforation is called for.
The prognosis is not, usually, grave for the mother. In 28 cases Paul noted 4 infantile deaths. In a number of instances, the infants have lived many years. Since the tumor may remain indolent, it is apparent that the real danger to the child depends on the site.
Milliaresis reported a case where the included mass occupied the brain.
Triple Menders.
Only a few instances have been recorded, and of these, some are in all probability apocryphal. The probability is that, in the future, observa tion will prove that even as there exist double monsters, so there also exist triple, only more rarely, even as triplets are rarer than twins.