anomalies and curiosities of medicine-第67部分

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muscles；　nipples；　and　breasts；　the　pectorals　and　adjacent　muscles；　the　costal　cartilages　and　anterior　ends　of　ribs；　the　hand　and　forearm；　he　also　adds　that　there　may　be　a　hernia　of　the　lung；　not　hereditary；　but　probably　due　to　the　pressure　of　the　arm　against　the　chest。　De　Marque　gives　a　curious　instance　in　which　the　chin　and　chest　were　congenitally　fastened　together。　Muirhead　cites　an　instance　in　which　a　firm；　broad　strip　of　cartilage　resembling　sternomastoid　extended　from　below　the　left　ear　to　the　left　upper　corner　of　the　sternum；　being　entirely　separate　from　the　jaw。

Some　preliminary　knowledge　of　embryology　is　essential　to　understand　the　formation　of　branchial　fissures；　and　we　refer　the　reader　to　any　of　the　standard　works　on　embryology　for　this　information。　Dzondi　was　one　of　the　first　to　recognize　and　classify　congenital　fistulas　of　the　neck。　The　proper　classification　is　into　lateral　and　median　fissures。　In　a　case　studied　by　Fevrier　the　exploration　of　a　lateral　pharyngeal　fistula　produced　by　the　introduction　of　the　sound　violent　reflex　phenomena；　such　as　pallor　of　the　face　and　irregular；　violent　beating　of　the　heart。　The　rarest　of　the　lateral　class　is　the　preauricular　fissure；　which　has　been　observed　by　Fevrier；　Le　Dentu；　Marchand；　Peyrot；　and　Routier。

The　median　congenital　fissures　of　the　neck　are　probably　caused　by　defective　union　of　the　branchial　arches；　although　Arndt　thinks　that　he　sees　in　these　median　fistulas　a　persistence　of　the　hypobranchial　furrow　which　exists　normally　in　the　amphioxus。　They　are　less　frequent　than　the　preceding　variety。

The　most　typical　form　of　malformation　of　the　esophagus　is　imperforation　or　obliteration。　Van　Cuyck　of　Brussels　in　1824　delivered　a　child　which　died　on　the　third　day　from　malnutrition。　Postmortem　it　was　found　that　the　inferior　extremity　of　the　esophagus　to　the　extent　of　about　two　inches　was　converted　into　a　ligamentous　cord。　Porro　describes　a　case　of　congenital　obliteration　of　the　esophagus　which　ended　in　a　cecal　pouch　about　one　inch　below　the　inferior　portion　of　the　glottidean　aperture　and　from　this　point　to　the　stomach　only　measured　an　inch；　there　was　also　tracheal　communication。　The　child　was　noticed　to　take　to　the　breast　with　avidity；　but　after　a　little　suckling　it　would　cough；　become　livid；　and　reject　most　of　the　milk　through　the　nose；　in　this　way　almost　suffocating　at　each　paroxysm；　it　died　on　the　third　day。

In　some　cases　the　esophagus　is　divided；　one　portion　opening　into　the　bronchial　or　other　thoracic　organs。　Brentano　describes　an　infant　dying　ten　days　after　birth　whose　esophagus　was　divided　into　two　portions；　one　terminating　in　a　culdesac；　the　other　opening　into　the　bronchi；　the　left　kidney　was　also　displaced　downward。　Blasius　describes　an　anomalous　case　of　duplication　of　the　esophagus。　Grashuys；　and　subsequently　Vicq　d'Azir；　saw　a　dilatation　of　the　esophagus　resembling　the　crop　of　a　bird。

Anomalies　of　the　Lungs。Carper　describes　a　fetus　of　thirty…seven　weeks　in　whose　thorax　he　found　a　very　voluminous　thymus　gland　but　no　lungs。　These　organs　were　simply　represented　by　two　little　oval　bodies　having　no　lobes；　with　the　color　of　the　tissue　of　the　liver。　The　heart　had　only　one　cavity　but　all　the　other　organs　were　perfectly　formed。　This　case　seems　to　be　unique。　Tichomiroff　records　the　case　of　a　woman　of　twenty…four　who　died　of　pneumonia　in　whom　the　left　lung　was　entirely　missing。　No　traces　of　a　left　bronchus　existed。　The　subject　was　very　poorly　developed　physically。　Tichomiroff　finds　four　other　cases　in　literature；　in　all　of　which　the　left　lung　was　absent。　Theremin　and　Tyson　record　cases　of　the　absence　of　the　left　lung。

Supplementary　pulmonary　lobes　are　occasionally　seen　in　man　and　are　taken　by　some　authorities　to　be　examples　of　retrogressive　anomalies　tending　to　prove　that　the　derivation　of　the　human　race　is　from　the　quadrupeds　which　show　analogous　pulmonary　malformation。　Eckley　reports　an　instance　of　supernumerary　lobe　of　the　right　lung　in　close　connection　with　the　vena　azygos　major。　Collins　mentions　a　similar　case。　Bonnet　and　Edwards　speak　of　instances　of　four　lobes　in　the　right　lung。　Testut　and　Marcondes　report　a　description　of　a　lung　with　six　lobes。

Anomalies　of　the　Diaphragm。Diemerbroeck　is　said　to　have　dissected　a　human　subject　in　whom　the　diaphragm　and　mediastinum　were　apparently　missing；　but　such　cases　must　be　very　rare；　although　we　frequently　find　marked　deficiency　of　this　organ。　Bouchand　reports　an　instance　of　absence　of　the　right　half　of　the　diaphragm　in　an　infant　born　at　term。　Lawrence　mentions　congenital　deficiency　of　the　muscular　fibers　of　the　left　half　of　the　diaphragm　with　displacement　of　the　stomach。　The　patient　died　of　double　pneumonia。　Carruthers；　McClintock；　Polaillon；　and　van　Geison　also　record　instances　of　congenital　deficiency　of　part　of　the　diaphragm。　Recently　Dittel　reported　unilateral　defect　in　the　diaphragm　of　an　infant　that　died　soon　after　birth。　The　stomach；　small　intestines；　and　part　of　the　large　omentum　lay　in　the　left　pleural　cavity；　both　the　phrenic　nerves　were　normal。　Many　similar　cases　of　diaphragmatic　hernia　have　been　observed。　In　such　cases　the　opening　may　be　large　enough　to　allow　a　great　part　of　the　visceral　constituents　to　pass　into　the　thorax；　sometimes　seriously　interfering　with　respiration　and　circulation　by　the　pressure　which　ensues。　Alderson　reports　a　fatal　case　of　diaphragmatic　hernia　with　symptoms　of　pneumothorax。　The　stomach；　spleen；　omentum；　and　transverse　colon　were　found　lying　in　the　left　pleura。　Berchon　mentions　double　perforation　of　the　diaphragm　with　hernia　of　the　epiploon。　The　most　extensive　paper　on　this　subject　was　contributed　by　Bodwitch；　who；　besides　reporting　an　instance　in　the　Massachusetts　General　Hospital；　gives　a　numerical　analysis　of　all　the　cases　of　this　affection　found　recorded　in　the　writings　of　medical　authors　between　the　years　1610　and　1846。　Hillier　speaks　of　an　instance　of　congenital　diaphragmatic　hernia　in　which　nearly　all　the　small　intestines　and　two…thirds　of　the　large　passed　into　the　right　side　of　the　thorax。　Macnab　reports　an　instance　in　which　three　years　after　the　cure　of　empyema　the　whole　stomach　constituted　the　hernia。　Recently　Joly　described　congenital　hernia　of　the　stomach　in　a　man　of　thirty…seven；　who　died　from　collapse　following　lymphangitis；　persistent　vomiting；　and　diarrhea。　At　the　postmortem　there　was　found　a　defect　in　the　diaphragm　on　the　left　side；　permitting　herniation　of　the　stomach　and　first　part　of　the　duodenum　into　the　left　pleural　cavity。　There　was　no　history　of　traumatism　to　account　for　strangulation。　Longworth　cites　an　instance　of　inversion　of　the　diaphragm　in　a　human　subject。　Bartholinus　mentions　coalition　of　the　diaphragm　and　liver；　and　similar　cases　are　spoken　of　by　Morgagni　and　the　Ephemerides。　Hoffman　describes　diaphragmatic　junction　with　the　lung。

Anomalies　of　the　Stomach。The　Ephemerides　contains　the　account　of　a　dissection　in　which　the　stomach　was　found　wanting；　and　also　speaks　of　two　instances　of　duplex　stomach。　Bartholinus；　Heister；　Hufeland；　Morgagni；　Riolan；　and　Sandifort　cite　examples　of　duplex　stomach。　Bonet　speaks　of　a　case　of　vomiting　which　was　caused　by　a　double　stomach。　Struthers　reports　two　cases　in　which　there　were　two　cavities　to　the　stomach。　Struthers　also　mentions　that　Morgagni；　Home；　Monro；　Palmer；　Larry；　Blasius；　Hufeland；　and　Walther　also　record　instances　in　which　there　was　contraction　in　the　middle　of　the　stomach；　accounting　for　their　instances　of　duplex　stomach。　Musser　reports　an　instance　of　hour…glass　contraction　of　the　stomach。　Hart　dissected　the　stomach　of　a　woman　of　thirty　which　resembled　the　stomach　of　a　predaceous　bird；　with　patches　of　tendon　on　its　surface。　The　right　extremity　instead　of　continuously　contracting　ended　in　a　culdesac　one…half　as　large　as　the　greater　end　of　the　stomach。　The　duodenum　proceeded　from　the　depression　marking　the　lesser　arch　of　the　organ　midway　between　the　cardiac　orifice　and　the　right　extremity。　Crooks　speaks　of　a　case　in　which　the　stomach　of　an　infant　terminated　in　a　culdesac。

Hernia　of　the　stomach　is　not　uncommon；　especially　in　diaphragmatic　or　umbilical　deficiency。　There　are　many　cases　on　record；　some　terminating　fatally　from　strangulation　or　exposure　to　traumatism。　Paterson　reports　a　case　of　congenital　hernia　of　the　stomach　into　the　left　portion　of　the　thoracic　cavity。　It　was　covered　with　fat　and　occupied　the　whole　left　half　of　the　thoracic　cavity。　The　spleen；　pancreas；　and　transverse　colon　were　also　superior　to　the　diaphragm。　Death　was　caused　by　a　well…defined　round　perforation　at　the　cardiac　curvature　the　size　of　a　sixpence。

Anomalies　of　the　Intestines。The　Ephemerides　contains　the　account　of　an　example　of　double　cecum；　and　Alexander　speaks　of　a　double　colon；　and　there　are　other　cases　of　duplication　of　the　bowel　recorded。　There　is　an　instance　of　coalition　of　the　jejunum　with　the　liver；　and　Treuner　parallels　this　case。　Aubery；　Charrier　Poelman；　and　others　speak　of　congenital　division　of　the　intestinal　canal。　Congenital　occlusion　is　quite　frequently　reported。

Dilatation　of　the　colon　frequently　occurs　as　a　transient　affection；　and　by　its　action　in　pushing　up　the　diaphragm　may　so　seriously　interfere　with　the　action　of　the　heart　and　lungs　as　to　occasionally　cause　heart…failure。　Fenwick　has　mentioned　an　instance　of　this　nature。　According　to　Osler　there　is　a　chronic　form　of　dilatation　of　the　colon　in　which　the　gut　may　reach　an　enormous　size。　The　coats　may　be　hypertrophied　without　evidence　of　any　special　organic　change　in　the　mucosa。　The　most　remarkable　instance　has　been　reported　by　Formad。　The　patient；　known　as　the　〃balloon…man；〃　aged　twenty…three　at　the　time　of　his　death；　had　had　a　distended　abdomen　from　infancy。　Postmortem　the　colon　was　found　as　large　as　that　of　an　ox；　the　circumference　ranging　from　15　to　30　inches。　The　weight　of　the　contents　was　47　pounds。　Cases　are　not　uncommon　in　children。　Osler　reports　three　well…marked　cases　under　his　care。　Chapman　mentions　a　case　in　which　the　liver　was　displaced　by　dilatation　of　the　sigmoid　flexure。　Mya　reports　two　cases　of　congenital　dilatation　and　hypertrophy　of　the　colon　（megacolon　congenito）。　Hirsohsprung；　Genersich；　Faralli；　Walker；　and　Griffiths　all　record　similar　instances；　and　in　all　these　cases　the　clinical　features　were　obstinate　constipation　and　marked　meteorismu