anomalies and curiosities of medicine-第4部分

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Relative　to　menstruation　from　the　ear；　Spindler；　Paullini；　and　Alibert　furnish　examples。　In　Paullini's　case　the　discharge　is　spoken　of　as　very　foul；　which　makes　it　quite　possible　that　this　was　a　case　of　middle…ear　disease　associated　with　some　menstrual　disturbance；　and　not　one　of　true　vicarious　menstruation。　Alibert's　case　was　consequent　upon　suppression　of　the　menses。　Law　cites　an　instance　in　a　woman　of　twenty…three；　in　whom　the　menstrual　discharge　was　suspended　several　months。　She　experienced　fulness　of　the　head　and　bleeding　（largely　from　the　ears）；　which　subsequently　occurred　periodically；　being　preceded　by　much　throbbing；　but　the　patient　finally　made　a　good　recovery。　Barnes；　Stepanoff；　and　Field　adduce　examples　of　this　anomaly。　Jouilleton　relates　an　instance　of　menstruation　from　the　right　ear　for　five　years；　following　a　miscarriage。

Hemorrhage　from　the　mouth　of　a　vicarious　nature　has　been　frequently　observed　associated　with　menstrual　disorders。　The　Ephemerides；　Meibomius；　and　Rhodius　mention　instances。　The　case　of　Meibomius　was　that　of　an　infant；　and　the　case　mentioned　by　Rhodius　was　associated　with　hemorrhages　from　the　lungs；　umbilicus；　thigh；　and　tooth…cavity。　Allport　reports　the　history　of　a　case　in　which　there　was　recession　of　the　gingival　margins　and　alveolar　processes；　the　consequence　of　amenorrhea。　Caso　has　an　instance　of　menstruation　from　the　gums；　and　there　is　on　record　the　description　of　a　woman；　aged　thirty…two；　who　had　bleeding　from　the　throat　preceding　menstruation；　later　the　menstruation　ceased　to　be　regular；　and　four　years　previously；　after　an　unfortunate　and　violent　connection；　the　menses　ceased；　and　the　woman　soon　developed　hemorrhoids　and　hemoptysis。　Henry　speaks　of　a　woman　who　menstruated　from　the　mouth；　at　the　necropsy　207　stones　were　found　in　the　gall…bladder。　Krishaber　speaks　of　a　case　of　lingual　menstruation　at　the　epoch　of　menstruation。

Descriptions　of　menstruation　from　the　extremities　are　quite　numerous。　Pechlin　offers　an　example　from　the　foot；　Boerhaave　from　the　skin　of　the　hand；　Ephemerides　from　the　knee；　Albertus　from　the　foot；　Zacutus　Lusitanus　from　the　left　thumb；　Bartholinus　a　curious　instance　from　the　hand；　and　the　Ephemerides　another　during　pregnancy　from　the　ankle。

Post　speaks　of　a　very　peculiar　case　of　edema　of　the　arm　alternating　with　the　menstrual　discharge。　Sennert　writes　of　menstruation　from　the　groin　associated　with　hemorrhage　from　the　umbilicus　and　gums。　Moses　offers　an　example　of　hemorrhage　from　the　umbilicus；　doubtless　vicarious。　Verduc　details　the　history　of　two　cases　from　the　top　of　the　head；　and　Kerokring　cites　three　similar　instances；　one　of　which　was　associated　with　hemorrhage　from　the　hand。

A　peculiar　mode　is　vicarious　menstrual　hemorrhage　through　old　ulcers；　wounds；　or　cicatrices；　and　many　examples　are　on　record；　a　few　of　which　will　be　described。　Calder　gives　an　excellent　account　of　menstruation　at　an　ankle…ulcer；　and　Brincken　says　he　has　seen　periodical　bleeding　from　the　cicatrix　of　a　leprous　ulcer。　In　the　Lancet　is　an　account　of　a　case　in　the　Vienna　Hospital　of　simulated　stigmata；　the　scar　opened　each　month　and　a　menstrual　flow　proceeded　therefrom；　but　by　placing　a　plaster…of…Paris　bandage　about　the　wound；　sealing　it　so　that　tampering　with　the　wound　could　be　easily　detected；　healing　soon　ensued；　and　the　imposture　was　thus　exposed。　Such　would　likely　be　the　result　of　the　investigation　of　most　cases　of　〃bleeding　wounds〃　which　are　exhibited　to　the　ignorant　and　superstitious　for　religious　purposes。

Hogg　publishes　a　report　describing　a　young　lady　who　injured　her　leg　with　the　broken　steel　of　her　crinoline。　The　wound　healed　nicely；　but　always　burst　out　afresh　the　day　preceding　the　regular　period。　Forster　speaks　of　a　menstrual　ulcer　of　the　face；　and　Moses　two　of　the　head。　White；　quoted　by　Barnes；　cites　an　instance　of　vicarious　hemorrhage　from　five　deep　fissures　of　the　lips　in　a　girl　of　fourteen；　the　hemorrhage　was　periodical　and　could　not　be　checked。　At　the　advent　of　each　menstrual　period　the　lips　became　much　congested；　and　the　recently…healed　menstrual　scars　burst　open　anew。

Knaggs　relates　an　interesting　account　of　a　sequel　to　an　operation　for　ovarian　disease。　Following　the　operation；　there　was　a　regular；　painless　menstruation　every　month；　at　which　time　the　lower　part　of　the　wound　re…opened；　and　blood　issued　forth　during　the　three　days　of　the　catamenia。　McGraw　illustrates　vicarious　menstruation　by　an　example；　the　discharge　issuing　from　an　ovariotomy…scar；　and　Hooper　cites　an　instance　in　which　the　vicarious　function　was　performed　by　a　sloughing　ulcer。　Buchanan　and　Simpson　describe　〃amenorrheal　ulcers。〃　Dupuytren　speaks　of　denudation　of　the　skin　from　a　burn；　with　the　subsequent　development　of　vicarious　catamenia　from　the　seat　of　the　injury。

There　are　cases　on　record　in　which　the　menstruation　occurs　by　the　rectum　or　the　urinary　tract。　Barbee　illustrates　this　by　a　case　in　which　cholera　morbus　occurred　monthly　in　lieu　of　the　regular　menstrual　discharge。　Barrett　speaks　of　a　case　of　vicarious　menstruation　by　the　rectum。　Astbury　says　he　has　seen　a　case　of　menstruation　by　the　hemorrhoidal　vessels；　and　instances　of　relief　from　plethora　by　vicarious　menstruation　in　this　manner　are　quite　common。　Rosenbladt　cites　an　instance　of　menstruation　by　the　bladder；　and　Salmuth　speaks　of　a　pregnant　woman　who　had　her　monthly　flow　by　the　urinary　tract。　Ford　illustrates　this　anomaly　by　the　case　of　a　woman　of　thirty…two；　who　began　normal　menstruation　at　fourteen；　for　quite　a　period　she　had　vicarious　menstruation　from　the　urinary　tract；　which　ceased　after　the　birth　of　her　last　child。　The　coexistence　of　a　floating　kidney　in　this　case　may　have　been　responsible　for　this　hemorrhage；　and　in　reading　reports　of　so…called　menstruation　due　consideration　must　be　given　to　the　existence　of　any　other　than　menstrual　derangement　before　we　can　accept　the　cases　as　true　vicarious　hemorrhage。　Tarnier　cites　an　instance　of　a　girl　without　a　uterus；　in　whom　menstruation　proceeded　from　the　vagina。　Zacutus　Lusitanus　relates　the　history　of　a　case　of　uterine　occlusion；　with　the　flow　from　the　lips　of　the　cervix。　There　is　mentioned　an　instance　of　menstruation　from　the　labia。

The　occurrence　of　menstruation　after　removal　of　the　uterus　or　ovaries　is　frequently　reported。　Storer；　Clay；　Tait；　and　the　British　and　Foreign　Medico…Chirurgical　Review　report　cases　in　which　menstruation　took　place　with　neither　uterus　nor　ovary。　Doubtless　many　authentic　instances　like　the　preceding　could　be　found　to…day。　Menstruation　after　hysterectomy　and　ovariotomy　has　been　attributed　to　the　incomplete　removal　of　the　organs　in　question；　yet　upon　postmortem　examination　of　some　cases　no　vestige　of　the　functional　organs　in　question　has　been　found。

Hematemesis　is　a　means　of　anomalous　menstruation；　and　several　instances　are　recorded。　Marcellus　Donatus　and　Benivenius　exemplify　this　with　cases。　Instances　of　vicarious　and　compensatory　epistaxis　and　hemoptysis　are　so　common　that　any　examples　would　be　superfluous。　There　is　recorded　an　inexplicable　case　of　menstruation　from　the　region　of　the　sternum；　and　among　the　curious　anomalies　of　menstruation　must　be　mentioned　that　reported　by　Parvin　seen　in　a　woman；　who；　at　the　menstrual　epoch；　suffered　hemoptysis　and　oozing　of　blood　from　the　lips　and　tongue。　Occasionally　there　was　a　substitution　of　a　great　swelling　of　the　tongue；　rendering　mastication　and　articulation　very　difficult　for　four　or　five　days。　Parvin　gives　portraits　showing　the　venous　congestion　and　discoloration　of　the　lips。

Instances　of　migratory　menstruation；　the　flow　moving　periodically　from　the　ordinary　passage　to　the　breasts　and　mammae；　are　found　in　the　older　writers。　Salmuth　speaks　of　a　woman　on　whose　hands　appeared　spots　immediately　before　the　establishment　of　the　menses。　Cases　of　semimonthly　menstruation　and　many　similar　anomalies　of　periodicity　are　spoken　of。

The　Ephemerides　contains　an　instance　of　the　simulation　of　menstruation　after　death；　and　Testa　speaks　of　menstruation　lasting　through　a　long　sleep。　Instances　of　black　menstruation　are　to　be　found；　described　in　full；　in　the　Ephemerides；　by　Paullini　and　by　Schurig；　and　in　some　of　the　later　works；　it　is　possible　that　an　excess　of　iron；　administered　for　some　menstrual　disorder；　may　cause　such　an　alteration　in　the　color　of　the　menstrual　fluid。

Suppression　of　menstruation　is　brought　about　in　many　peculiar　ways；　and　sometimes　by　the　slightest　of　causes；　some　authentic　instances　being　so　strange　as　to　seem　mythical。　Through　the　Ephemerides　we　constantly　read　of　such　causes　as　contact　with　a　corpse；　the　sight　of　a　serpent　or　mouse；　the　sight　of　monsters；　etc。　Lightning　stroke　and　curious　neuroses　have　been　reported　as　causes。　Many　of　the　older　books　on　obstetric　subjects　are　full　of　such　instances；　and　modern　illustrations　are　constantly　reported。

Menstruation　in　Man。Periodic　discharges　of　blood　in　man；　constituting　what　is　called　〃male　menstruation；〃　have　been　frequently　noticed　and　are　particularly　interesting　when　the　discharge　is　from　the　penis　or　urethra；　furnishing　a　striking　analogy　to　the　female　function　of　menstruation。　The　older　authors　quoted　several　such　instances；　and　Mehliss　says　that　in　the　ancient　days　certain　writers　remarked　that　catamenial　lustration　from　the　penis　was　inflicted　on　the　Jews　as　a　divine　punishment。　Bartholinus　mentions　a　case　in　a　youth；　the　Ephemerides　several　instances；　Zacutus　Lusitanus；　Salmuth；　Hngedorn；　Fabricius　Hildanus；　Vesalius；　Mead；　and　Acta　Eruditorum　all　mention　instances。　Forel　saw　menstruation　in　a　man。　Gloninger　tells　of　a　man　of　thirty…six；　who；　since　the　age　of　seventeen　years　and　five　months；　had　had　lunar　manifestations　of　menstruation。　Each　attack　was　accompanied　by　pains　in　the　back　and　hypogastric　region；　febrile　disturbance；　and　a　sanguineous　discharge　from　the　urethra；　which　resembled　in　color；　consistency；　etc。；　the　menstrual　flux。　King　relates　that　while　attending　a　course　of　medical　lectures　at　the　University　of　Louisiana　he　formed　the　acquaintance　of　a　young　student　who　possessed　the　normal　male　generative　organs；　but　in　whom　the　simulated　function　of　menstruation　was　periodically　performed。　The　cause　was　inexplicable；　and　the　unfortunate　victim　was　the　subject　of　deep　chagrin；　and　was　afflicted　with　melancholia。　He　had　menstruat