anomalies and curiosities of medicine-第68部分

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nces；　and　in　all　these　cases　the　clinical　features　were　obstinate　constipation　and　marked　meteorismus。

Imperforate　Anus。Cases　in　which　the　anus　is　imperforate　or　the　rectum　ends　in　a　blind　pouch　are　occasionally　seen。　In　some　instances　the　rectum　is　entirely　absent；　the　colon　being　the　termination　of　the　intestinal　tract。　There　are　cases　on　record　in　which　the　rectum　communicated　with　the　anus　solely　by　a　fibromuscular　cord。　Anorectal　atresia　is　the　ordinary　imperforation　of　the　anus；　in　which　the　rectum　terminates　in　the　middle　of　the　sacral　cavity。　The　rectum　may　be　deficient　from　the　superior　third　of　the　sacrum；　and　in　this　position　is　quite　inaccessible　for　operation。

A　compensatory　coalition　of　the　bowel　with　the　bladder　or　urethra　is　sometimes　present；　and　in　these　cases　the　feces　are　voided　by　the　urinary　passages。　Huxham　mentions　the　fusion　of　the　rectum　and　colon　with　the　bladder；　and　similar　instances　are　reported　by　Dumas　and　Baillie。　Zacutus　Lusitanus　describes　an　infant　with　an　imperforate　membrane　over　its　anus　who　voided　feces　through　the　urethra　for　three　months。　After　puncture　of　the　membrane；　the　discharge　came　through　the　natural　passage　and　the　child　lived；　Morgagni　mentions　a　somewhat　similar　case　in　a　little　girl　living　in　Bologna；　and　other　modern　instances　have　been　reported。　The　rectum　may　terminate　in　the　vagina。　Masters　has　seen　a　child　who　lived　nine　days　in　whom　the　sigmoid　flexure　of　the　colon　terminated　in　the　fundus　of　the　bladder。　Guinard　pictures　a　case　in　which　there　was　communication　between　the　rectum　and　the　bladder。　In　Figure　140　a　represents　the　rectum；　b　the　bladder；　c　the　point　of　communication；　g　shows　the　cellular　tissue　of　the　scrotum。

There　is　a　description　of　a　girl　of　fourteen；　otherwise　well　constituted　and　healthy；　who　had　neither　external　genital　organs　nor　anus。　There　was　a　plain　dermal　covering　over　the　genital　and　anal　region。　She　ate　regularly；　but　every　three　days　she　experienced　pain　in　the　umbilicus　and　much　intestinal　irritation；　followed　by　severe　vomiting　of　stercoraceous　matter；　the　pains　then　ceased　and　she　cleansed　her　mouth　with　aromatic　washes；　remaining　well　until　the　following　third　day。　Some　of　the　urine　was　evacuated　by　the　mammae。　The　examiners　displayed　much　desire　to　see　her　after　puberty　to　note　the　disposition　of　the　menstrual　flow；　but　no　further　observation　of　her　case　can　be　found。

Fournier　narrates　that　he　was　called　by　three　students；　who　had　been　trying　to　deliver　a　woman　for　five　days。　He　found　a　well…constituted　woman　of　twenty…two　in　horrible　agony；　who　they　said　had　not　had　a　passage　of　the　bowels　for　eight　days；　so　he　prescribed　an　enema。　The　student　who　was　directed　to　give　the　enema　found　to　his　surprise　that　there　was　no　anus；　but　by　putting　his　finger　in　the　vagina　he　could　discern　the　floating　end　of　the　rectum；　which　was　full　of　feces。　There　was　an　opening　in　this　suspended　rectum　about　the　size　of　an　undistended　anus。　Lavage　was　practiced　by　a　cannula　introduced　through　the　opening；　and　a　great　number　of　cherry　stones　agglutinated　with　feces　followed　the　water；　and　labor　was　soon　terminated。　The　woman　afterward　confessed　that　she　was　perfectly　aware　of　her　deformity；　but　was　ashamed　to　disclose　it　before。　There　was　an　analogue　of　this　case　found　by　Mercurialis　in　a　child　of　a　Jew　called　Teutonicus。

Gerster　reports　a　rare　form　of　imperforate　anus；　with　malposition　of　the　left　ureter；　obliteration　of　the　ostia　of　both　ureters；　with　consequent　hydronephrosis　of　a　confluent　kidney。　There　was　a　minute　opening　into　the　bladder；　which　allowed　the　passage　of　meconium　through　the　urethra。　Burge　mentions　the　case　of　what　he　calls　〃sexless　child；〃　in　which　there　was　an　imperforate　anus　and　no　pubic　arch；　the　ureters　discharged　upon　a　tumor　the　size　of　a　teacup　extending　from　the　umbilicus　to　the　pubes。　A　postmortem　examination　confirmed　the　diagnosis　of　sexless　child。

The　Liver。The　Ephemerides；　Frankenau；　von　Home；　Molinetti；　Schenok；　and　others　speak　of　deficient　or　absent　liver。　Zacutus　Lusitanus　says　that　he　once　found　a　mass　of　flesh　in　place　of　the　liver。　Lieutaud　is　quoted　as　describing　a　postmortem　examination　of　an　adult　who　had　died　of　hydropsy；　in　whom　the　liver　and　spleen　were　entirely　missing。　The　portal　vein　discharged　immediately　into　the　vena　cava；　this　case　is　probably　unique；　as　no　authentic　parallel　could　be　found。

Laget　reports　an　instance　of　supernumerary　lobe　in　the　liver。　Van　Buren　describes　a　supernumerary　liver。　Sometimes　there　is　rotation；　real　or　apparent；　caused　by　transposition　of　the　characteristics　of　the　liver。　Handy　mentions　such　a　case。　Kirmisson　reports　a　singular　anomaly　of　the　liver　which　he　calls　double　displacement　by　interversion　and　rotation　on　the　vertical　axis。　Actual　displacements　of　the　liver　as　well　as　what　is　known　as　wandering　liver　are　not　uncommon。　The　operation　for　floating　liver　will　be　spoken　of　later。

Hawkins　reports　a　case　of　congenital　obliteration　of　the　ductus　communis　choledochus　in　a　male　infant　which　died　at　the　age　of　four　and　a　half　months。　Jaundice　appeared　on　the　eighth　day　and　lasted　through　the　short　life。　The　hepatic　and　cystic　ducts　were　pervious　and　the　hepatic　duct　obliterated。　There　were　signs　of　hepatic　cirrhosis　and　in　addition　an　inguinal　hernia

The　Gall…Bladder。Harle　mentions　the　case　of　a　man　of　fifty；　in　whom　he　could　find　no　gall…bladder；　Patterson　has　seen　a　similar　instance　in　a　men　of　twenty…five。　Purser　describes　a　double　gall…bladder。

The　spleen　has　been　found　deficient　or　wanting　by　Lebby；　Ramsay；　and　others；　but　more　frequently　it　is　seen　doubled。　Cabrolius；　Morgagni；　and　others　have　found　two　spleens　in　one　subject；　Cheselden　and　Fallopius　report　three；　Fantoni　mentions　four　found　in　one　subject；　Guy…Patin　has　seen　five；　none　as　large　as　the　ordinary　organ；　Hollerius；　Kerckringius；　and　others　have　remarked　on　multiple　spleens。　There　is　a　possibility　that　in　some　of　the　cases　of　multiple　spleens　reported　the　organ　is　really　single　but　divided　into　several　lobes。　Albrecht　mentions　a　case　shown　at　a　meeting　of　the　Vienna　Medical　Society　of　a　very　large　number　of　spleens　found　in　the　mesogastrium；　peritoneum；　on　the　mesentery　and　transverse　mesocolon；　in　Douglas'　pouch；　etc。　There　was　a　spleen　〃the　size　of　a　walnut〃　in　the　usual　position；　with　the　splenic　artery　and　vein　in　their　normal　position。　Every　one　of　these　spleens　had　a　capsule；　was　covered　by　peritoneum；　and　exhibited　the　histologic　appearance　of　splenic　tissue。　According　to　the　review　of　this　article；　Toldt　explains　the　case　by　assuming　that　other　parts　of　the　celomic　epithelium；　besides　that　of　the　mesogastrium；　are　capable　of　forming　splenic　tissue。　Jameson　reports　a　case　of　double　spleen　and　kidneys。　Bainbrigge　mentions　a　case　of　supernumerary　spleen　causing　death　from　the　patient　being　placed　in　the　supine　position　in　consequence　of　fracture　of　the　thigh。　Peevor　mentions　an　instance　of　second　spleen。　Beclard　and　Guy…Patin　have　seen　the　spleen　congenitally　misplaced　on　the　right　side　and　the　liver　on　the　left；　Borellus　and　Bartholinus　with　others　have　observed　misplacement　of　the　spleen。

The　Pancreas。Lieutaud　has　seen　the　pancreas　missing　and　speaks　of　a　double　pancreatic　duct　that　he　found　in　a　man　who　died　from　starvation；　Bonet　speaks　of　a　case　similar　to　this　last。

There　are　several　cases　of　complete　transposition　of　the　viscera　on　record。　This　bizarre　anomaly　was　probably　observed　first　in　1650　by　Riolanus；　but　the　most　celebrated　case　was　that　of　Morand　in　1660；　and　Mery　described　the　instance　later　which　was　the　subject　of　the　following　quatrain：

〃La　nature；　peu　sage　et　sans　douse　en　debauche　Placa　le　foie　au　cote　gauche；　Et　de　meme；　vice　versa　Le　coeur　a　le　droite　placa。〃

Young　cites　an　example　in　a　woman　of　eighty…five　who　died　at　Hammersmith；　London。　She　was　found　dead　in　bed；　and　in　a　postmortem　examination；　ordered　to　discover　if　possible　the　cause　of　death；　there　was　seen　complete　transposition　of　the　viscera。　The　heart　lay　with　its　base　toward　the　left；　its　apex　toward　the　right；　reaching　the　lower　border　of　the　4th　rib；　under　the　right　mamma。　The　vena　cava　was　on　the　left　side　and　passed　into　the　pulmonary　cavity　of　the　heart；　which　was　also　on　the　left　side；　the　aorta　and　systemic　ventricle　being　on　the　right。　The　left　splenic　vein　was　lying　on　the　superior　vena　cava；　the　liver　under　the　left　ribs；　and　the　spleen　on　the　right　side　underneath　the　heart。　The　esophagus　was　on　the　right　of　the　aorta；　and　the　location　of　the　two　ends　of　the　stomach　was　reversed；　the　sigmoid　flexure　was　on　the　right　side。　Davis　describes　a　similar　instance　in　a　man。

Herrick　mentions　transposition　of　viscera　in　a　man　of　twenty…five。　Barbieux　cites　a　case　of　transposition　of　viscera　in　a　man　who　was　wounded　in　a　duel。　The　liver　was　to　the　left　and　the　spleen　and　heart　to　the　right　etc。　Albers；　Baron；　Beclard；　Boyer；　Bull；　Mackensie；　Hutchinson；　Hunt；　Murray；　Dareste；　Curran；　Duchesne；　Musser；　Sabatier；　Shrady；　Vulpian；　Wilson；　and　Wehn　are　among　others　reporting　instances　of　transposition　and　inversion　of　the　viscera。

Congenital　extroversion　or　eventration　is　the　result　of　some　congenital　deficiency　in　the　abdominal　wall；　instances　are　not　uncommon；　and　some　patients　live　as　long　as　do　cases　of　umbilical　hernia　proper。　Ramsey　speaks　of　entire　want　of　development　of　the　abdominal　parietes。　Robertson；　Rizzoli；　Tait；　Hamilton；　Brodie；　Denis；　Dickie；　Goyrand；　and　many　others　mention　extroversion　of　viscera　from　parietal　defects。　The　different　forms　of　hernia　will　be　considered　in　another　chapter。

There　seem　to　be　no　authentic　cases　of　complete　absence　of　the　kidney　except　in　the　lowest　grades　of　monstrosities。　Becker；　Blasius；　Rhodius；　Baillie；　Portal；　Sandifort；　Meckel；　Schenck；　and　Stoll　are　among　the　older　writers　who　have　observed　the　absence　of　one　kidney。　In　a　recent　paper　Ballowitz　has　collected　213　cases；　from　which　the　following　extract　has　been　made　by　the　British　Medical　Journal：

〃Ballowitz　（Virchow's　Archiv；　August　5；　1895）　has　collected　as　far　as　possible　all　the　recorded　cases　of　congenital　absence　of　one　kidney。　Excluding　cases　of　fused　kidney　and　of　partial　atrophy　of　one　kidney；　he　finds　213　cases　of　complete　absence　of　one　kidney；　upon　which　he　bases　the　foll