anomalies and curiosities of medicine-第48部分

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tomach；　and　kidneys　has　been　noted；　and　the　lower　limbs　may　be　shorter　than　normal。

CLASS　XI。Cases　of　fetus　in　fetu；　those　strange　instances　in　which　one　might　almost　say　that　a　man　may　be　pregnant　with　his　brother　or　sister；　or　in　which　an　infant　may　carry　its　twin　without　the　fact　being　apparent；　will　next　be　discussed。　The　older　cases　were　cited　as　being　only　a　repetition　of　the　process　by　which　Eve　was　born　of　Adam。　Figure　63　represents　an　old　engraving　showing　the　birth　of　Eve。　Bartholinus；　the　Ephemerides；　Otto；　Paullini；　Schurig；　and　Plot　speak　of　instances　of　fetus　in　fetu。　Ruysch　describes　a　tumor　contained　in　the　abdomen　of　a　man　which　was　composed　of　hair；　molar　teeth；　and　other　evidences　of　a　fetus。　Huxham　reported　to　the　Royal　Society　in　1748　the　history　of　a　child　which　was　born　with　a　tumor　near　the　anus　larger　than　the　whole　body　of　the　child；　this　tumor　contained　rudiments　of　an　embryo。　Young　speaks　of　a　fetus　which　lay　encysted　between　the　laminae　of　the　transverse　mesocolon；　and　Highmore　published　a　report　of　a　fetus　in　a　cyst　communicating　with　the　duodenum。　Dupuytren　gives　an　example　in　a　boy　of　thirteen；　in　whom　was　found　a　fetus。　Gaetano…Nocito；　cited　by　Philipeaux；　has　the　history　of　a　taken　with　a　great　pain　in　the　right　hypochondrium；　and　from　which　issued　subsequently　fetal　bones　and　a　mass　of　macerated　embryo。　His　mother　had　had　several　double　pregnancies；　and　from　the　length　of　the　respective　tibiae　one　of　the　fetuses　seemed　to　be　of　two　months'　and　the　other　of　three　months'　intrauterine　life。　The　man　died　five　years　after　the　abscess　had　burst　spontaneously。

Brodie　speaks　of　a　case　in　which　fetal　remains　were　taken　from　the　abdomen　of　a　girl　of　two　and　one…half　years。　Gaither　describes　a　child　of　two　years　and　nine　months；　supposed　to　be　affected　with　ascites；　who　died　three　hours　after　the　physician's　arrival。　In　its　abdomen　was　found　a　fetus　weighing　almost　two　pounds　and　connected　to　the　child　by　a　cord　resembling　an　umbilical　cord。　This　child　was　healthy　for　about　nine　months；　and　had　a　precocious　longing　for　ardent　spirits；　and　drank　freely　an　hour　before　its　death。

Blundell　says　that　he　knew　〃a　boy　who　was　literally　and　without　evasion　with　child；　for　the　fetus　was　contained　in　a　sac　communicating　with　the　abdomen　and　was　connected　to　the　side　of　the　cyst　by　a　short　umbilical　cord；　nor　did　the　fetus　make　its　appearance　until　the　boy　was　eight　or　ten　years　old；　when　after　much　enlargement　of　pregnancy　and　subsequent　flooding　the　boy　died。〃　The　fetus；　removed　after　death；　on　the　whole　not　very　imperfectly　formed；　was　of　the　size　of　about　six　or　seven　months'　gestation。　Bury　cites　an　account　of　a　child　that　had　a　second　imperfectly　developed　fetus　in　its　face　and　scalp。　There　was　a　boy　by　the　name　of　Bissieu　who　from　the　earliest　age　had　a　pain　in　one　of　his　left　ribs；　this　rib　was　larger　than　the　rest　and　seemed　to　have　a　tumor　under　it。　He　died　of　phthisis　at　fourteen；　and　after　death　there　was　found　in　a　pocket　lying　against　the　transverse　colon　and　communicating　with　it　all　the　evidences　of　a　fetus。

At　the　Hopital　de　la　Charite　in　Paris；　Velpeau　startled　an　audience　of　500　students　and　many　physicians　by　saying　that　he　expected　to　find　a　rudimentary　fetus　in　a　scrotal　tumor　placed　in　his　hands　for　operation。　His　diagnosis　proved　correct；　and　brought　him　resounding　praise；　and　all　wondered　as　to　his　reasons　for　expecting　a　fetal　tumor。　It　appears　that　he　had　read　with　care　a　report　by　Fatti　of　an　operation　on　the　scrotum　of　a　child　which　had　increased　in　size　as　the　child　grew；　and　was　found　to　contain　the　ribs；　the　vertebral　column；　the　lower　extremities　as　far　as　the　knees；　and　the　two　orbits　of　a　fetus；　and　also　an　account　of　a　similar　operation　performed　by　Wendt　of　Breslau　on　a　Silesian　boy　of　seven。　The　left　testicle　in　this　case　was　so　swollen　that　it　hung　almost　to　the　knee；　and　the　fetal　remains　removed　weighed　seven　ounces。

Sulikowski　relates　an　instance　of　congenital　fetation　in　the　umbilicus　of　a　girl　of　fourteen；　who　recovered　after　the　removal　of　the　anomaly。　Aretaeos　described　to　the　members　of　the　medical　fraternity　in　Athens　the　case　of　a　woman　of　twenty…two；　who　bore　two　children　after　a　seven　months'　pregnancy。　One　was　very　rudimentary　and　only　21　inches　long；　and　the　other　had　an　enormous　head　resembling　a　case　of　hydrocephalus。　On　opening　the　head　of　the　second　fetus；　another；　three　inches　long；　was　found　in　the　medulla　oblongata；　and　in　the　cranial　cavity　with　it　were　two　additional　fetuses；　neither　of　which　was　perfectly　formed。

Broca　speaks　of　a　fetal　cyst　being　passed　in　the　urine　of　a　man　of　sixty…　one；　the　cyst　contained　remnants　of　hair；　bone；　and　cartilage。　Atlee　submits　quite　a　remarkable　case　of　congenital　ventral　gestation；　the　subject　being　a　girl　of　six；　who　recovered　after　the　discharge　of　the　fetal　mass　from　the　abdomen。　McIntyre　speaks　of　a　child　of　eleven；　playing　about　and　feeling　well；　but　whose　abdomen　progressively　increased　in　size　1　1/2　inches　each　day。　After　ten　days　there　was　a　large　fluctuating　mass　on　the　right　side；　the　abdomen　was　opened　and　the　mass　enucleated；　it　was　found　to　contain　a　fetal　mass　weighing　nearly　five　pounds；　and　in　addition　ten　pounds　of　fluid　were　removed。　The　child　made　an　early　recovery。　Rogers　mentions　a　fetus　that　was　found　in　a　man's　bladder。　Bouchacourt　reports　the　successful　extirpation　of　the　remains　of　a　fetus　from　the　rectum　of　a　child　of　six。　Miner　describes　a　successful　excision　of　a　congenital　gestation。

Modern　literature　is　full　of　examples；　and　nearly　every　one　of　the　foregoing　instances　could　be　paralleled　from　other　sources。　Rodriguez　is　quoted　as　reporting　that　in　July；　1891；　several　newspapers　in　the　city　of　Mexico　published；　under　the　head　of　〃A　Man…mother；〃　a　wonderful　story；　accompanied　by　wood…cuts；　of　a　young　man　from　whose　body　a　great　surgeon　had　extracted　a　〃perfectly　developed　fetus。〃　One　of　these　wood…cuts　represented　a　tumor　at　the　back　of　a　man　opened　and　containing　a　crying　baby。　In　commenting　upon　this；　after　reviewing　several　similar　cases　of　endocymian　monsters　that　came　under　his　observation　in　Mexico；　Rodriguez　tells　what　the　case　which　had　been　so　grossly　exaggerated　by　the　lay　journals　really　was：　An　Indian　boy；　aged　twenty…two；　presented　a　tumor　in　the　sacrococcygeal　region　measuring　53　cm。　in　circumference　at　the　base；　having　a　vertical　diameter　of　17　cm。　and　a　transverse　diameter　of　13　cm。　It　had　no　pedicle　and　was　fixed；　showing　unequal　consistency。　At　birth　this　tumor　was　about　the　size　of　a　pigeon's　egg。　A　diagnosis　of　dermoid　cyst　was　made　and　two　operations　were　performed　on　the　boy；　death　following　the　second。　The　skeleton　showed　interesting　conditions；　the　rectum　and　pelvic　organs　were　natural；　and　the　contents　of　the　cyst　verified　the　diagnosis。

Quite　similar　to　the　cases　of　fetus　in　fetu　are　the　instances　of　dermoid　cysts。　For　many　years　they　have　been　a　mystery　to　physiologists；　and　their　origin　now　is　little　more　than　hypothetic。　At　one　time　the　fact　of　finding　such　a　formation　in　the　ovary　of　an　unmarried　woman　was　presumptive　evidence　that　she　was　unchaste；　but　this　idea　was　dissipated　as　soon　as　examples　were　reported　in　children；　and　to…day　we　have　a　well…defined　difference　between　congenital　and　extrauterine　pregnancy。　Dermoid　cysts　of　the　ovary　may　consist　only　of　a　wall　of　connective　tissue　lined　with　epidermis　and　containing　distinctly　epidermic　scales　which；　however；　may　be　rolled　up　in　firm　masses　of　a　more　or　less　soapy　consistency；　this　variety　is　called　by　Orth　epidermoid　cyst；　or；　according　to　Warren；　a　form　of　cyst　made　up　of　skin　containing　small　and　ill…defined　papillae；　but　rich　in　hair　follicles　and　sebaceous　glands。　Even　the　erector　pili　muscle　and　the　sudoriparous　gland　are　often　found。　The　hair　is　partly　free　and　rolled　up　into　thick　balls　or　is　still　attached　to　the　walls。　A　large　mass　of　sebaceous　material　is　also　found　in　these　cysts。　Thomson　reports　a　case　of　dermoid　cyst　of　the　bladder　containing　hair；　which　cyst　he　removed。　It　was　a　pedunculated　growth；　and　it　was　undoubtedly　vesical　and　not　expelled　from　some　ovarian　source　through　the　urinary　passage；　as　sometimes　occurs。

The　simpler　forms　of　the　ordinary　dermoid　cysts　contain　bone　and　teeth。　The　complicated　teratoma　of　this　class　may　contain；　in　addition　to　the　previously　mentioned　structures；　cartilage　and　glands；　mucous　and　serous　membrane；　muscle；　nerves；　and　cerebral　substance；　portions　of　eyes；　fingers　with　nails；　mammae；　etc。　Figure　64　represents　a　cyst　containing　long　red　hair　that　was　removed　from　a　blonde　woman　aged　forty…four　years　who　had　given　birth　to　six　children。　Cullingworth　reports　the　history　of　a　woman　in　whom　both　ovaries　were　apparently　involved　by　dermoids；　who　had　given　birth　to　12　children　and　had　three　miscarriagesthe　last；　three　months　before　the　removal　of　the　growths。　The　accompanying　illustration；　taken　from　Baldy；　pictures　a　dermoid　cyst　of　the　complicated　variety　laid　open　and　exposing　the　contents　in　situ。　Mears　of　Philadelphia　reports　a　case　of　ovarian　cyst　removed　from　a　girl　of　six　and　a　half　by　Bradford　of　Kentucky　in　1875。　From　this　age　on　to　adult　life　many　similar　cases　are　recorded。　Nearly　every　medical　museum　has　preserved　specimens　of　dermoid　cysts；　and　almost　all　physicians　are　well　acquainted　with　their　occurrence。　The　curious　formations　and　contents　and　the　bizarre　shapes　are　of　great　variety。　Graves　mentions　a　dermoid　cyst　containing　the　left　side　of　a　human　face；　an　eye；　a　molar　tooth；　and　various　bones。　Dermoid　cysts　are　found　also　in　regions　of　the　body　quite　remote　from　the　ovary。　The　so…called　〃orbital　wens〃　are　true　inclusion　of　the　skin　of　a　congenital　origin；　as　are　the　nasal　dermoids　and　some　of　the　cysts　of　the　neck。

Weil　reported　the　case　of　a　man　of　twenty…two　years　who　was　born　with　what　was　supposed　to　he　a　spina　bifida　in　the　lower　sacral　region。　According　to　Senn；　the　swelling　never　caused　any　pain　or　inconvenience　until　it　inflamed；　when　it　opened　spontaneously　and　suppurated；　discharging　a　large　quantity　of　offensive　pus；　hair；　and　sebaceous　material；　thus　proving　it　to　have　been　a　dermoid。　The　cyst　was　freely　incised；　and　there　were　found　numerous　openings　of　sweat　glands；　from　which　drops　of　perspiration　escape