REPORT UPON THE CASE OF THE LATE 
DR. E. A. GR O UX. 
CHARLES JEWETT, M.D., BROOKLYN, N. Y. Figure of Sternum from the late Dr. E. A. Groux. Size. REPORT UPON THE CASE OF THE LATE DR. E. A. 
GROUX, TO THE BROOKLYN ANATOMICAL 
AND SURGICAL CLUB, NOVEMBER 18th, 1878. 
CHARLES JEWETT, M. D. 
(Reprinted from the January Number of the Proceedings of the Medical Society ’of'the 
County of Kings.) 
'De. Ghus.~]ewett-presented the sternum -removed from the body of 
the-late Dr. E. A. Groux, with an account o£his. case, as follows ; 
By imperfect foetal development the sternum may be perforated by a 
small foramen at its lower portion; it may be partially or wholly divided 
by a vertical fissure, or it may be entirely wanting. The occurrence of 
a sternal foramen is by no means rare. Fissures occur oftener in the 
lower than the upper portion of the bone, and are rarely complete. 
These malformations of the sternum are due to failure of the primi- 
tive cartilages to unite in the foetus, and obviously are not explained by 
failure of ossification as stated by Gray and others. 
“The osseous sternum is preceded by a continuous or non-seg- 
mented piece of cartilage; and as the portion of the body in which this 
is developed is formed by the union in the middle line of the two 
‘ventral laminae’ of the embryo, traces of this original median division 
are generally seen in very young sterna, and are often persistent through 
life in the form of fissures or fenestrae in the middle line of the sternum.” 
(W. H. Flower, Osteology of the Mammalia, p. 75.) They accord in 
their order of frequency with the fact that the closure of the thoracic 
cavity in the embryo progresses from above downwards.* 
* Humphrey on the Human Skeleton. 4 
When the bony fissure is complete, the arrest of development usually 
involves also the ovqrlying soft structures, the thorax thus being entirely 
open and the heart exposed—ectopia cordis. 
The rarest of these imperfections of the sternum is a complete median 
fissure of the bone, with no other failure of development. To this class 
belongs the case of the late Dr. E. A. Groux. This case has for many 
years been an object of medical interest throughout the world, and has 
been the subject of numerous publications, both in this country and in 
Europe. 
In the American Medical Monthly, January, 1859, was published the 
Report of a Committee of the New York Pathological Society appointed 
to examine Dr. Groux.* I quote from that report: “There is no defi- 
ciency of bony substance, but simply a median fissure. The clavicles 
are articulated with the lateral halves of the sternum, and the costal car- 
tilages join the bone on each side in the usual manner. The sternal 
attachments of the sterno-mastoid muscles are also in their natural posi- 
tions; but the sterno-hyoid and sterno-thyroid muscles, both right and 
left, are attached below to the left half of the sternum. 
The left half of the sternum is also situated upon a plane somewhat 
anterior to that of the right; so that when the two edges of the fissured 
bone are drawn together by muscular action, the left edge projects in 
front of the right. When Dr. Groux stands erect in an easy position, 
the fissure is one inch wide at the widest part, i. e., about the junction of 
the upper and middle thirds. 
By forcible separation the width at the same point is two inches; by 
forcible approximation, one-quarter inch. 
The impulse of the heart is normal in character, and is felt a little 
above the level of the fifth rib, a little inside the plane of the left nipple. 
In the medio-sternal space, in the ordinary erect position of the body, is 
visible to the eye a pulsating tumor, situated, apparently, just beneath the 
integument. The pulsations of this tumor extend from the second to 
the fourth intercostal space, and from the median line to the left edge of 
the fissure. 
They consist of alternate contractions and dilatations which correspond 
in frequency with the pulsations of the heart and arteries. -The contrac- 
tions of the tumor are synchronous with the impulse of the heart at the 
level of the fifth rib. 
When Mr. G. takes a deep inspiration, followed by a long slow forci- 
ble expiration, the pulsating tumor in the medio-sternal space disappears 
at the time of inspiration, but toward the end of expiration it again shows 
itself, and gradually becomes very much increased in size. 
* This committee consisted of Drs. J. C. Dalton, J. T. Metcalfe, and E. R. Peaslee. 5 
This pulsating tumor has been considered by different observers to be, 
first, the right auricle;* second, the right ventricle; third, the aorta. 
[By some the great veins were believed to constitute a portion of the 
pulsating tumor.—J.] 
The committee are of the opinion that the pulsating tumor in the 
medio-sternal space is the right ventricle.” 
Dr. Groux died October 15, 1878, at the age of 45 years. The 
autopsy was made October 17, by Dr. Henry Riedel, of this city. Pro- 
fessor J. C. Dalton, of New York, and a large number of other medical 
gentlemen were present. Our President, Dr. L. S. Pilcher, Dr. G. W. 
Baker, and your reporter were among the number. 
Before opening the thorax, the trachea was ligated, to prevent displace- 
ment of the heart by collapse of the lungs. 
An incision through the skin and superficial fascia opened directly 
into the anterior mediastinum. No other structure bridged the space 
between the lateral halves of the bone.f 
The heart was found normal in size and shape, and normally situated, 
except that the position was slightly higher than usual, the apex pre- 
senting at the level of the upper border of the fifth rib. The right 
auricle lay wholly to the right of the median line. The position of the 
right ventricle corresponded precisely with that of the pulsating tumor 
described in the above report. 
The anatomical appearances of the malformed bone are well displayed 
in the accompanying figure. Were the lateral halves united a slight 
deficiency in width would be seen at the upper portion of the manubri- 
um, perhaps one-half inch. The lower segment of the gladiolus would 
also be found somewhat smaller than usual. Otherwise there is no defi- 
ciency of bony substance. 
It will be seen that the articulations of the fifth, sixth and seventh cos- 
tal cartilages deviate somewhat from their normal relations to the lower 
segment of the gladiolus. While the fissure divides the entire bone, the 
lateral portions of the lower segment of the gladiolus articulate with each 
other. Each articular surface is covered by a cartilage, and the two parts 
of the bone are bound together by external ligamentous bands. The 
articular cartilages of this joint blend below with the ensiform appendix. 
The vertical depth of the fissure from the level of the sterno-clavicular 
articulation to the bottom of the cleft is four inches. 
* Among these, Sappey, Bernard, Magendie, Richet, Verneuil, Hammernik, Pavy, 
and many others. 
t The Committee of the N. V. Patholog. Soc. reported that this space “ was ap- 
parently covered with a strong subcutaneous fibrous sheet of aponeurosis.” 6 
Width at the level of the first costal cartilage, one inch. 
Width at widest part, 1.4 inch. 
The specimen has been carefully prepared by Dr. Pilcher, for the Mu- 
seum of the Anatomical and Surgical Club, to which it has been for- 
mally donated by the widow of Dr. Groux. 
Among similar cases of malformation or absence of the sternum that 
I have been able to collect are the following: 
In the American Practitioner, Oct. 1878, Dr. J. T. Hodgen, of St. 
Louis, reports a case of congenital fissure of the sternum, with exstrophy 
of the heart. The heart was wholly outside of the thorax. The integu- 
ment was continuous over the fissure, except an opening in the median 
line, through which the vessels passed. The child died on the fifth day 
after birth. The sternum in this case presented an U-shaped cleft, ex- 
tending down to a point opposite the articulation of the fourth rib with 
the sternum. Width of the opening, one inch. 
Dr. A. M. Slocum (Trans. Coll, of Phys., Phila., iB6O, 111 N. S., p. 
310), describes a case of congenital fissure of the upper half of the 
sternum in case of a woman twenty-five years of age. Fissure filled up 
with a strong ligament and covered with the common integument. 
Vertical depth, three in. ; ordinary width, one and a half in. 
Professor Abbott (Mem. Soc. de Biologic, tome IV, 1 sen, p. 163) 
relates a case of absence of sternum in an adult negress, married, and 
the mother of three perfectly developed children. 
Dr. Otto Obermeier (Virchow’s Archiv. 1869, XLVI, pp. 209-217) 
says that several cases of bifid sternum are to be found in the literature 
known to him—few in adults—and gives valuable bibliography. 
Prof. C. L. Ford writes that the Museum at Ann Arbor “ contains a 
sternum with an opening in the middle, of small size, and another of 
less width.” 
Dr. Groux is supposed to have possessed the power to arrest the 
action of the heart at will. On taking two or three quick inspirations, 
by an effort the cardiac movements were apparently stopped. The 
writer once witnessed this experiment, though without opportunity for 
personal examination. The duration of the supposed arrest was about 
twenty seconds. The Doctor remarked that he had never deemed it 
prudent to prolong it beyond that time. 
Some years ago Dr. Groux was examined at the Long Island College 
Hospital. Dr. J. H. Raymond, Professor of Physiology in that institu- 
tion, writes : “ The experiments of Dr. Groux were made while stand- 
ing. The time during which the heart’s action was arrested was very 
brief, but sufficiently long to satisfy several (medical gentlemen) of the 7 
fact. I was myself convinced that he could voluntarily arrest the action 
of the heart, and I am still of that opinion.” 
Dr. S. G. Armor, Professor of the Practice of Medicine in the same 
college, says : 
“While my ear was applied to the chest the heart ceased to beat. The 
time of suspended action was very short, and I was not satisfied as to the 
immediate cause. lam inclined to the opinion, however, that it was 
mechanical rather than mental. He claimed, I believe, that it was 
purely mental, the result of his volition. But the volitional act appeared 
to always immediately follow two or three deep inspirations. I have no 
reason to suppose that the Doctor himself attached any importance to the 
deep and forcible breathing, other than as security during the temporary 
suspension of the heart’s action. But that the heart did cease to beat for 
a time, there cannot, I think, be any doubt. 
Dr. Middleton Michel, Prof. Physiol, and Histol., Medical College of 
State of South Carolina, in a recent paper (Boston Medical and Surgical 
Journal, Oct. 31, 1878), describes the case of a negro, who, he says, 
could arrest the action of the heart at will. Prof. Michel had personally 
examined the negro and witnessed the experiment. He states that he 
had also examined “a Mr. Grew, in whom there was an arrest of de- 
velopment of the sternum.” (The person meant is, undoubtedly, the 
subject of this report.) He testifies that, in the case of Mr. G., “ there 
was temporarily no pulse throughout the system,” and that “the experi- 
ment lasted almost two minutes. ” In the case of the negro, the act was 
not so prolonged. 
In answer to inquiry as to the authenticity of alleged cases of volun- 
tary control over the heart’s action, Dr. Austin Flint, Jr., says: “I have 
never seen a report of a case that has been satisfactory to me. ” 
In reply to a similar question, Prof. J. C. Dalton writes: “The im- 
pression which they give me is that there are none of them of any real 
value. 
I suppose the earliest reported case of this kind is that about the year 
420, by Saint Augustine, who speaks of a certain elder of the church in 
Calamo, named Restitutus, who could at will pass into a state of syn- 
cope or apparent death, and come out of it again. But Saint Augustine 
does not pretend to have seen the case himself, or even to have known 
the man. Pie only reports it as something which many of the brethren 
recollected (quod plerique fratres memoridj recentissimd experti sunt.)” 
The entire quotation is given in D. H. Tuke, M. D.: Influence of the 
Mind upon the Body. London, 1872, p. 345 
The case mentioned by Dr. Darwin (Darwin’s Zodnomia, 1794, vol. I, 
p. 39), says Professor Dalton, is without satisfactory authority. 8 
The performances of the East Indian Fakirs (Observations on Trance, 
James Braid, M.R.C.S., London and Edinburgh, '1850), who, weeks 
after burial, were exhumed alive, he shows to be “pure deceptions” 
comparable to the “tricks of the Davenport Brothers.” Of the only 
recorded case that has been almost universally accepted as authentic, he 
says: “ After all, the most authentic case of this kind is that of Col. 
Townshend, reported by Dr. Geo. Cheyne. This case has been fre- 
quently referred to, and is quoted in many medical works. It is often 
stated in such a way as to give the impression that it was of tolerably re- 
cent occurrence and well attested : that Col. Townshend was a man in 
the prime of life and in fair health, but having the power to stop the ac- 
tion of his heart at will, and that he was in the habit of doing this when- 
ever he pleased, and of returning to his usual condition afterward. The 
facts were very different. The case happened nearly 150 years ago. 
Col. Townshend, when seen by Dr. Cheyne, was in the last stages of 
a chronic disease of the kidney. Early one morning he sent for the doc- 
tor and his assistants in order to ask them about an ‘ odd sensation ’ which 
he had felt, as he said, for ‘some time.’ Presumably this was during the 
previous twenty-four hours, or less, as he had been visited regularly by his 
medical attendants every day, and had said nothing about it before. 
The sensation in question was that he ‘ could die or expire when he pleas- 
ed, and yet by an effort or somehow, he could come to life again/ This 
he tried before Dr. Cheyne, and actually became, to all appearance, 
dead, without pulsation or respiration, remaining so for half an hour, 
and then returning to consciousness. This was the only occasion on 
which Dr. Cheyne either saw the phenomenon or heard anything about 
it. It took place about nine o’clock in the morning, and Col. Towns- 
hend died on the evening of the same day; the autopsy being performed 
on the day following. This is the whole of the celebrated Townshend 
case. It is related in Dr. Cheyne's treatise on the English Malady or 
Nervous Diseases. London and Dublin, 1733, p. 209. 
However, 1 do not think that any of these cases have much bearing on 
that of Dr. Groux. In all of them the subjects were supposed to * in- 
duce in themselves, by voluntary effort, a state of trance, or cataleptic in- 
sensibility, in which all the functions of life were apparently suspended 
together. 
With regard to Dr. Groux, as I understand it, it is claimed that he 
could, at any time, arrest the heart’s action, without producing insensi- 
bility, unconsciousness, or any other disturbance of his usual condition, 
beside the stoppage of the circulation. 
If true, this would be very different from any of the previous alleged 
cases. When Dr. Groux was examined, some years ago, by Dr. Peaslee, 9 
Dr. Metcalfe and myself, we were not able to see that he did anything else 
than to stop the pulse at the left wrist, the circulation continuing every- 
where else.” 
In their report, the Committee of the N. Y. Path. Soc. attributed the 
power to stop the pulse at the wrist to the unusual mobility of the clavi- 
cle, by which the subclavian artery was compressed at the top of the chest. 
As bearing upon the question of ability to arrest the heart at will, I 
quote the following; “The heart may be stopped indirectly by a 
voluntary effort. This is effected first, by the lungs, stop- 
ping the mouth and nose, and making a strong i«spiratory effort; second, 
by partially emptying the lungs, stopping the mouth and nose, and mak- 
ing a strong inspiratory effort. These are dangerous experiments.” 
(Physiology of the Circulation, J. B. Pettigrew, Lect. on Physiol., at 
Surgeon’s Hall, Edinburgh.) 
Prof. Michel attributes the arrest of the heart to voluntary suspension 
of respiration. (Boston Med. and Surg. Journal, Oct. 31, ’78.) 
In experiments upon animals the effect of suspending the respiration 
is as follows (Flint’s Text Book of Physiology, p. 54): The obstruction 
to the circulation begins in the systemic capillaries, and is propagated 
back to the heart through the arteries. After about one minute the fre- 
quency of pulsation begins to diminish. Later the cavities of the heart 
become engorged with blood, its muscular fibres paralyzed, and (after 
perhaps four or five minutes) it ceases to beat. “Itis in this manner,” 
Dr. Michel declares, “ that a temporary interruption to the circulation 
and heart’s action is effected ” in cases like that of Dr. Groux. 
This theory is clearly untenable, for the following reasons: 
I, In the examination of Dr. Groux, held at the Long Island Coll. 
Hospital, the arrest of the heart was immediately preceded by deep inspi- 
rations. 
11. In suspended respiration consciousness and voluntary motion are 
abolished by dark blood in the cerebral capillaries before the stoppage of 
the heart. 
HI. When the action of the heart is once arrested by interrupting res- 
piration, its irritability being exhausted and the nervous system narco- 
tized by unaerated blood, the circulation is never restored. (Vide Works 
of Sir B. C. Brodie, vol. I, Effects of Strangulation.) 
It has been suggested that possibly in the experiments of Dr. Groux, 
the cardiac movements were not arrested, but simply rendered inaudible 
by the protrusion of the lung into the fissure, and over the heart, during 
forced inspiration. But, were this possible, so good observers as the 
gentlemen who conducted the examination at the Long Island College 
Hospital could not have omitted to eliminate this source of error. 10 
The method stated by Pettigrew, I assume, does not explain suspension 
of the cardiac movements for twenty seconds. 
mitted to the physiologists for further investigation. 
The subject of alleged ability to control the heart’s action must be com- 
The literature of fissured sternum not already given is chiefly em- 
braced in the following 
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1851. 
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jio Gates Ave., Brooklyn, N. V.