anomalies and curiosities of medicine-第47部分

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matter。　In　lieu　of　one　penis　there　were　two；　situated　near　each　other；　the　right　one　of　natural　size　and　the　left　larger；　but　not　furnished　with　a　prepuce。　Each　penis　had　its　own　urethra；　from　which　dribbled　urine　and　some　meconium。　There　was　a　duplication　of　each　scrotum；　but　only　one　testicle　in　each；　and　several　other　minor　malformations。

Gore；　reported　by　Velpeau；　has　seen　an　infant　of　eight　and　one…half　months　with　two　penises　and　three　lower　extremities。　The　penises　were　4　cm。　apart　and　the　scrotum　divided；　containing　one　testicle　in　each　side。　Each　penis　was　provided　with　a　urethra；　urine　being　discharged　from　both　simultaneously。　In　a　similar　case；　spoken　of　by　Geoffroy…Saint…Hilaire；　the　two　organs　were　also　separate；　but　urine　and　semen　escaped　sometimes　from　one；　sometimes　from　both。

The　most　celebrated　of　all　the　diphallic　terata　was　Jean　Baptista　dos　Santos；　who　when　but　six　months　old　was　spoken　of　by　Acton。　His　father　and　mother　were　healthy　and　had　two　well…formed　children。　He　was　easily　born　after　an　uneventful　pregnancy。　He　was　good…looking；　well　proportioned；　and　had　two　distinct　penises；　each　as　large　as　that　of　a　child　of　six　months。　Urination　proceeded　simultaneously　from　both　penises；　he　had　also　two　scrotums。　Behind　and　between　the　legs　there　was　another　limb；　or　rather　two；　united　throughout　their　length。　It　was　connected　to　the　pubis　by　a　short　stem　1/2　inch　long　and　as　large　as　the　little　finger；　consisting　of　separate　bones　and　cartilages。　There　was　a　patella　in　the　supernumerary　limb　on　the　anal　aspect；　and　a　joint　freely　movable。　This　compound　limb　had　no　power　of　motion；　but　was　endowed　with　sensibility。　A　journal　in　London；　after　quoting　Acton's　description；　said　that　the　child　had　been　exhibited　in　Paris；　and　that　the　surgeons　advised　operation。　Fisher；　to　whom　we　are　indebted　for　an　exhaustive　work　in　Teratology；　received　a　report　from　Havana　in　July；　1865；　which　detailed　a　description　of　Santos　at　twenty…　two　years　of　age；　and　said　that　he　was　possessed　of　extraordinary　animal　passion；　the　sight　of　a　female　alone　being　sufficient　to　excite　him。　He　was　said　to　use　both　penises；　after　finishing　with　one　continuing　with　the　other；　but　this　account　of　him　does　not　agree　with　later　descriptions；　in　which　no　excessive　sexual　ability　had　been　noticed。　Hart　describes　the　adult　Santos　in　full；　and　accompanies　his　article　with　an　illustration。　At　this　time　he　was　said　to　have　developed　double　genitals；　and　possibly　a　double　bladder　communicating　by　an　imperfect　septum。　At　adulthood　the　anus　was　three　inches　anterior　to　the　os　coceygeus。　In　the　sitting　or　lying　posture　the　supernumerary　limb　rested　on　the　front　of　the　inner　surface　of　the　lower　third　of　his　left　thigh。　He　was　in　the　habit　of　wearing　this　limb　in　a　sling；　or　bound　firmly　to　the　right　thigh；　to　prevent　its　unseemly　dangling　when　erect。　The　perineum　proper　was　absent；　the　entire　space　between　the　anus　and　the　posterior　edge　of　the　scrotum　being　occupied　by　the　pedicle。　Santos'　mental　and　physical　functions　were　developed　above　normal；　and　he　impressed　everybody　with　his　accomplishments。　Geoffroy…Saint…Hilaire　records　an　instance　in　which　the　conformation　was　similar　to　that　of　Santos。　There　was　a　third　lower　extremity　consisting　of　two　limbs　fused　into　one　with　a　single　foot　containing　ten　distinct　digits。　He　calls　the　case　one　of　arrested　twin　development。

Van　Buren　and　Keyes　describe　a　case　in　a　man　of　forty…two；　of　good；　healthy　appearance。　The　two　distinct　penises　of　normal　size　were　apparently　well　formed　and　were　placed　side　by　side；　each　attached　at　its　root　to　the　symphysis。　Their　covering　of　skin　was　common　as　far　as　the　base　of　the　glans；　at　this　point　they　seemed　distinct　and　perfect；　but　the　meatus　of　the　left　was　imperforate。　The　right　meatus　was　normal；　and　through　it　most　of　the　urine　passed；　though　some　always　dribbled　through　an　opening　in　the　perineum　at　a　point　where　the　root　of　the　scrotum　should　have　been。　On　lifting　the　double…barreled　penis　this　opening　could　be　seen　and　was　of　sufficient　size　to　admit　the　finger。　On　the　right　side　of　the　aperture　was　an　elongated　and　rounded　prominence　similar　in　outline　to　a　labium　majus。　This　prominence　contained　a　testicle　normal　in　shape　and　sensibility；　but　slightly　undersized；　and　surrounded；　as　was　evident　from　its　mobility；　by　a　tunica　vaginalis。　The　left　testicle　lay　on　the　tendon　of　the　adductor　longus　in　the　left　groin；　it　was　not　fully　developed；　but　the　patient　had　sexual　desires；　erections；　and　emissions。　Both　penises　became　erect　simultaneously；　the　right　more　vigorously。　The　left　leg　was　shorter　than　the　right　and　congenitally　smaller；　the　mammae　were　of　normal　dimensions。

Sangalli　speaks　of　a　man　of　thirty…five　who　had　a　supernumerary　penis；　furnished　with　a　prepuce　and　capable　of　erection。　At　the　apex　of　the　glans　opened　a　canal　about　12　cm。　long；　through　which　escaped　monthly　a　serous　fluid。　Smith　mentions　a　man　who　had　two　penises　and　two　bladders；　on　one　of　which　lithotomy　was　performed。　According　to　Ballantyne；　Taruffi；　the　scholarly　observer　of　terata；　mentions　a　child　of　forty…two　months　and　height　of　80　cm。　who　had　two　penises；　each　furnished　with　a　urethra　and　well…formed　scrotal　sacs　which　were　inserted　in　a　fold　of　the　groin。　There　were　two　testicles　felt　in　the　right　scrotum　and　one　in　the　left。　Fecal　evacuations　escaped　through　two　anal　orifices。　There　is　also　another　case　mentioned　similar　to　the　foregoing　in　a　man　of　forty；　but　here　there　was　an　osseous　projection　in　the　middle　line　behind　the　bladder。　This　patient　said　that　erection　was　simultaneous　in　both　penises；　and　that　he　had　not　married　because　of　his　chagrin　over　his　deformity。　Cole　speaks　of　a　child　with　two　well…developed　male　organs；　one　to　the　left　and　the　other　to　the　right　of　the　median　line；　and　about　1/4　or　1/2　inch　apart　at　birth。　The　urethra　bifurcated　in　the　perineal　region　and　sent　a　branch　to　each　penis；　and　urine　passed　from　each　meatus。　The　scrotum　was　divided　into　three　compartments　by　two　raphes；　and　each　compartment　contained　a　testicle。　The　anus　at　birth　was　imperforate；　but　the　child　was　successfully　operated　on；　and　at　its　sixtieth　day　weighed　17　pounds。

Lange　says　that　an　infant　was　brought　to　Karg　for　relief　of　anal　atresia　when　fourteen　days　old。　It　was　found　to　possess　duplicate　penises；　which　communicated　each　to　its　distinct　half　of　the　bladder　as　defined　by　a　median　fold。　The　scrotum　was　divided　into　three　portions　by　two　raphes；　and　each　lateral　compartment　contained　a　fully　formed　testicle。　This　child　died　because　of　its　anal　malformation；　which　we　notice　is　a　frequent　associate　of　malformations　or　duplicity　of　the　penis。　There　is　an　example　in　an　infant　described　in　which　there　were　two　penises；　each　about　1/2　inch　long；　and　a　divided　scrotal　sac　21　inches　long。　Englisch　speaks　of　a　German　of　forty　who　possessed　a　double　penis　of　the　bifid　type。

Ballantyne　and　his　associates　define　diphallic　terata　as　individuals　provided　with　two　more　or　less　well…formed　and　more　or　less　separate　penises；　who　may　show　also　other　malformations　of　the　adjoining　parts　and　organs　（e。g。；　septate　bladder）；　but　who　are　not　possessed　of　more　than　two　lower　limbs。　This　definition　excludes；　therefore；　the　cases　in　which　in　addition　to　a　double　penis　there　is　a　supernumerary　lower　extremitysuch　a　case；　for　example；　as　that　of　Jean　Baptista　dos　Santos；　so　frequently　described　by　teratologists。　It　also　excludes　the　more　evident　double　terata；　and；　of　course；　the　cases　of　duplication　of　the　female　genital　organs　（double　clitoris；　vulva；　vagina；　and　uterus）。　Although　Schurig；　Meckel；　Himly；　Taruffi；　and　others　give　bibliographic　lists　of　diphallic　terata；　even　in　them　erroneous　references　are　common；　and　there　is　evidence　to　show　that　many　cases　have　been　duplicated　under　different　names。　Ballantyne　and　Skirving　have　consulted　all　the　older　original　references　available　and　eliminated　duplications　of　reports　and；　adhering　to　their　original　definition；　have　collected　and　described　individually　20　cases；　they　offer　the　following　conclusions：

1。　Diphallus；　or　duplication　of　the　penis　in　an　otherwise　apparently　single　individual；　is　a　very　rare　anomaly；　records　of　only　20　cases　having　been　found　in　a　fairly　exhaustive　search　through　teratologic　literature。　As　a　distinct　and　well…authenticated　type　it　has　only　quite　recently　been　recognized　by　teratologists。

2。　It　does　not　of　itself　interfere　with　intrauterine　or　extrauterine　life；　but　the　associated　anomalies　（e。g。；　atresia　ani）　may　be　sources　of　danger。　If　not　noticed　at　birth；　it　is　not　usually　discovered　till　adult　life；　and　even　then　the　discovery　is　commonly　accidental。

3。　With　regard　to　the　functions　of　the　pelvic　viscera；　urine　may　be　passed　by　both　penises；　by　one　only；　or　by　neither。　In　the　last　instance　it　finds　exit　by　an　aperture　in　the　perineum。　There　is　reason　to　believe　that　semen　may　be　passed　in　the　same　way；　but　in　most　of　the　recorded　cases　there　has　been　sterility；　if　not　inability　to　perform　the　sexual　act。

4。　All　the　degrees　of　duplication　have　been　met　with；　from　a　fissure　of　the　glans　penis　to　the　presence　of　two　distinct　penises　inserted　at　some　distance　from　each　other　in　the　inguinal　regions。

5。　The　two　penises　are　usually　somewhat　defective　as　regards　prepuce；　urethra；　etc。；　they　may　lie　side　by　side；　or　more　rarely　may　be　situated　anteroposteriorly；　they　may　be　equal　in　size；　or　less　commonly　one　is　distinctly　larger　than　the　other；　and　one　or　both　may　be　perforate　or　imperforate。

6。　The　scrotum　may　be　normal　or　split；　the　testicles；　commonly　two　in　number；　may　be　normal　or　atrophic；　descended　or　undescended；　the　prostate　may　be　normal　or　imperfectly　developed；　as　may　also　the　vasa　deferentia　and　vesiculae　seminales。

7。　The　commonly　associated　defects　are：　More　or　less　completely　septate　bladder；　atresia　ani；　or　more　rarely　double　anus；　double　urethra；　increased　breadth　of　the　bony　pelvis　with　defect　of　the　symphysis　pubis；　and　possibly　duplication　of　the　lower　end　of　the　spine；　and　hernia　of　some　of　the　abdominal　contents　into　a　perineal　pouch。　Much　more　rarely；　duplication　of　the　heart；　lungs；　stomach；　and　kidneys　has　been　noted；　and　the　lower　limbs　may　be　shorter　than　normal。

CLASS　XI。Case