anomalies and curiosities of medicine-第69部分

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hy　of　one　kidney；　he　finds　213　cases　of　complete　absence　of　one　kidney；　upon　which　he　bases　the　following　conclusions：　Such　deficiency　occurs　almost　twice　as　often　in　males　as　in　females；　a　fact；　however；　which　may　be　partly　accounted　for　by　the　greater　frequency　of　necropsies　on　males。　As　to　age；　23　occurred　in　the　fetus　or　newly　born；　most　having　some　other　congenital　deformity；　especially　imperforate　anus；　the　rest　were　about　evenly　distributed　up　to　seventy　years　of　age；　after　which　only　seven　cases　occurred。　Taking　all　cases　together；　the　deficiency　is　more　common　on　the　left　than　on　the　right　side；　but　while　in　males　the　left　kidney　is　far　more　commonly　absent　than　the　right；　in　females　the　two　sides　show　the　defect　equally。　The　renal　vessels　were　generally　absent；　as　also　the　ureter；　on　the　abnormal　side　（the　latter　in　all　except　15　cases）；　the　suprarenal　was　missing　in　31　cases。　The　solitary　kidney　was　almost　always　normal　in　shape　and　position；　but　much　enlarged。　Microscopically　the　enlargement　would　seem　to　be　due　rather　to　hyperplasia　than　to　hypertrophy。　The　bladder；　except　for　absence　of　the　opening　of　one　ureter；　was　generally　normal。　In　a　large　number　of　cases　there　were　associated　deformities　of　the　organs　of　generation；　especially　of　the　female　organs；　and　these　were　almost　invariably　on　the　side　of　the　renal　defect；　they　affected　the　conducting　portion　much　more　than　the　glandular　portionthat　is；　uterus；　vagina；　and　Fallopian　tubes　in　the　female；　and　vas　deferens　or　vesiculae　seminales　in　the　male；　rather　than　the　ovaries　or　testicles。　Finally；　he　points　out　the　practical　bearing　of　the　subjectfor　example；　the　probability　of　calculus　causing　sudden　suppression　of　urine　in　such　casesand　also　the　danger　of　surgical　interference；　and　suggests　the　possibility　of　diagnosing　the　condition　by　ascertaining　the　absence　of　the　opening　of　one　ureter　in　the　bladder　by　means　of　the　cystoscope；　and　also　the　likelihood　of　its　occurring　where　any　abnormality　of　the　genital　organs　is　found；　especially　if　this　be　unilateral。〃

Green　reports　the　case　of　a　female　child　in　which　the　right　kidney　and　right　Fallopian　tube　and　ovary　were　absent　without　any　rudimentary　structures　in　their　place。　Guiteras　and　Riesman　have　noted　the　absence　of　the　right　kidney；　right　ureter；　and　right　adrenal　in　an　old　woman　who　had　died　of　chronic　nephritis。　The　left　kidney　although　cirrhotic　was　very　much　enlarged。

Tompsett　describes　a　necropsy　made　on　a　coolie　child　of　nearly　twelve　months；　in　which　it　was　seen　that　in　the　place　of　a　kidney　there　were　two　left　organs　connected　at　the　apices　by　a　prolongation　of　the　cortical　substance　of　each；　the　child　had　died　of　neglected　malarial　fever。　Sandifort　speaks　of　a　case　of　double　kidneys　and　double　ureters；　and　cases　of　supernumerary　kidney　are　not　uncommon；　generally　being　segmentation　of　one　of　the　normal　kidneys。　Rayer　has　seen　three　kidneys　united　and　formed　like　a　horseshoe。　We　are　quite　familiar　with　the　ordinary　〃horseshoe　kidney；〃　in　which　two　normal　kidneys　are　connected。

There　are　several　forms　of　displacement　of　the　kidneys；　the　most　common　being　the　〃floating　kidney；〃　which　is　sometimes　successfully　removed　or　fixed；　Rayer　has　made　an　extensive　study　of　this　anomaly。

The　kidney　may　be　displaced　to　the　pelvis；　and　Guinard　quotes　an　instance　in　which　the　left　kidney　was　situated　in　the　pelvis；　to　the　left　of　the　rectum　and　back　of　the　bladder。　The　ureter　of　the　left　side　was　very　short。　The　left　renal　artery　came　from　the　bifurcation　of　the　aorta　and　the　primitive　iliacs。　The　right　kidney　was　situated　normally；　and　received　from　the　aorta　two　arteries；　whose　volume　did　not　surpass　the　two　arteries　supplying　the　left　suprarenal　capsule；　which　was　in　its　ordinary　place。　Displacements　of　the　kidney　anteriorly　are　very　rare。

The　ureters　have　been　found　multiple；　Griffon　reports　the　history　of　a　male　subject　in　whom　the　ureter　on　the　left　side　was　double　throughout　its　whole　length；　there　were　two　vesical　orifices　on　the　left　side　one　above　the　other；　and　Morestin；　in　the　same　journal；　mentions　ureters　double　on　both　sides　in　a　female　subject。　Molinetti　speaks　of　six　ureters　in　one　person。　Littre　in　1705　described　a　case　of　coalition　of　the　ureters。　Allen　describes　an　elongated　kidney　with　two　ureters。　Coeyne　mentions　duplication　of　the　ureters　on　both　sides。　Lediberder　reports　a　case　in　which　the　ureter　had　double　origin。　Tyson　cites　an　instance　of　four　ureters　in　an　infant。　Penrose　mentions　the　absence　of　the　upper　two…thirds　of　the　left　ureter；　with　a　small　cystic　kidney；　and　there　are　parallel　cases　on　record。

The　ureters　sometimes　have　anomalous　terminations　either　in　the　rectum；　vagina；　or　directly　in　the　urethra。　This　latter　disposition　is　realized　normally　in　a　number　of　animals　and　causes　the　incessant　flow　of　urine；　resulting　in　a　serious　inconvenience。　Flajani　speaks　of　the　termination　of　the　ureters　in　the　pelvis；　Nebel　has　seen　them　appear　just　beneath　the　umbilicus；　and　Lieutaud　describes　a　man　who　died　at　thirty…five；　from　another　cause；　whose　ureters；　as　large　as　intestines；　terminated　in　the　urethral　canal；　causing　him　to　urinate　frequently；　the　bladder　was　absent。　In　the　early　part　of　this　century　there　was　a　young　girl　examined　in　New　York　whose　ureters　emptied　into　a　reddish　carnosity　on　the　mons　veneris。　The　urine　dribbled　continuously；　and　if　the　child　cried　or　made　any　exertion　it　came　in　jets。　The　genital　organs　participated　but　little　in　the　deformity；　and　with　the　exception　that　the　umbilicus　was　low　and　the　anus　more　anterior　than　natural；　the　child　was　well　formed　and　its　health　good。　Colzi　reports　a　case　in　which　the　left　ureter　opened　externally　at　the　left　side　of　the　hymen　a　little　below　the　normal　meatus　urinarius。　There　is　a　case　described　of　a　man　who　evidently　suffered　from　a　patent　urachus；　as　the　urine　passed　in　jets　as　if　controlled　by　a　sphincter　from　his　umbilicus。　Littre　mentions　a　patent　urachus　in　a　boy　of　eighteen。　Congenital　dilatation　of　the　ureters　is　occasionally　seen　in　the　new…born。　Shattuck　describes　a　male　fetus　showing　reptilian　characters　in　the　sexual　ducts。　There　was　ectopia　vesicae　and　prolapse　of　the　intestine　at　the　umbilicus；　the　right　kidney　was　elongated；　the　right　vas　deferens　opened　into　the　ureter。　There　was　persistence　in　a　separate　condition　of　the　two　Mullerian　ducts　which　opened　externally　inferiorly；　and　there　were　two　ducts　near　the　openings　which　represented　anal　pouches。　Both　testicles　were　in　the　abdomen。　Ord　describes　a　man　in　whom　one　of　the　Mullerian　ducts　was　persistent。

Anomalies　of　the　Bladder。Blanchard；　Blasius；　Haller；　Nebel；　and　Rhodius　mention　cases　in　which　the　bladder　has　been　found　absent　and　we　have　already　mentioned　some　cases；　but　the　instances　in　which　the　bladder　has　been　duplex　are　much　more　frequent。　Bourienne；　Oberteuffer；　Ruysch；　Bartholinus；　Morgagni；　and　Franck　speak　of　vesical　duplication。　There　is　a　description　of　a　man　who　had　two　bladders；　each　receiving　a　ureter。　Bussiere　describes　a　triple　bladder；　and　Scibelli　of　Naples　mentions　an　instance　in　a　subject　who　died　at　fifty…seven　with　symptoms　of　retention　of　urine。　In　the　illustration；　B　represents　the　normal　bladder；　A　and　C　the　supplementary　bladders；　with　D　and　E　their　respective　points　of　entrance　into　B。　As　will　be　noticed；　the　ureters　terminate　in　the　supplementary　bladders。　Fantoni　and　Malgetti　cite　instances　of　quintuple　bladders。

The　Ephemerides　speaks　of　a　case　of　coalition　of　the　bladder　with　the　os　pubis　and　another　case　of　coalition　with　the　omentum。　Prochaska　mentions　vesical　fusion　with　the　uterus；　and　we　have　already　described　union　with　the　rectum　and　intestine。

Exstrophy　of　the　bladder　is　not　rare；　and　is　often　associated　with　hypospadias；　epispadias；　and　other　malformations　of　the　genitourinary　tract。　It　consists　of　a　deficiency　of　the　abdominal　wall　in　the　hypogastric　region；　in　which　is　seen　the　denuded　bladder。　It　is　remedied　by　many　different　and　ingenious　plastic　operations。

In　an　occasional　instance　in　which　there　is　occlusion　at　the　umbilicus　and　again　at　the　neck　of　the　bladder　this　organ　becomes　so　distended　as　to　produce　a　most　curious　deformity　in　the　fetus。　Figure　143　shows　such　a　case。

The　Heart。Absence　of　the　heart　has　never　been　recorded　in　human　beings　except　in　the　case　of　monsters；　as；　for　example；　the　omphalosites；　although　there　was　a　case　reported　and　firmly　believed　by　the　ancient　authors；a　Roman　soldier　in　whom　Telasius　said　he　could　discover　no　vestige　of　a　heart。

The　absence　of　one　ventricle　has　been　recorded。　Schenck　has　seen　the　left　ventricle　deficient；　and　the　Ephemerides；　Behr；　and　Kerckring　speak　of　a　single　ventricle　only　in　the　heart。　Riolan　mentions　a　heart　in　which　both　ventricles　were　absent。　Jurgens　reported　in　Berlin；　February　1；　1882；　an　autopsy　on　a　child　who　had　lived　some　days　after　birth；　in　which　the　left　ventricle　of　the　heart　was　found　completely　absent。　Playfair　showed　the　heart　of　a　child　which　had　lived　nine　months　in　which　one　ventricle　was　absent。　In　King's　College　Hospital　in　London　there　is　a　heart　of　a　boy　of　thirteen　in　which　the　cavities　consist　of　a　single　ventricle　and　a　single　auricle。

Duplication　of　the　heart；　notwithstanding　the　number　of　cases　reported；　has　been　admitted　with　the　greatest　reserve　by　Geoffroy…Saint…Hilaire　and　by　a　number　of　authors。　Among　the　celebrated　anatomists　who　describe　duplex　heart　are　Littre；　Meckel；　Collomb；　Panum；　Behr；　Paullini；　Rhodins；　Winslow；　and　Zacutus　Lusitanus。

The　Ephemerides　cites　an　instance　of　triple　heart；　and　Johnston　has　seen　a　triple　heart　in　a　goose。

The　phenomenon　of　〃blue…disease；〃　or　congenital　cyanosis；　is　due　to　the　patency　of　the　foremen　ovale；　which；　instead　of　closing　at　birth；　persists　sometimes　to　adult　life。

Perhaps　the　most　unique　collection　of　congenital　malformations　of　the　heart　from　persons　who　have　reached　the　age　of　puberty　was　to　be　seen　in　London　in　1895。　In　this　collection　there　was　an　adult　heart　in　which　the　foremen　ovale　remained　open　until　the　age　of　thirty…seven；　there　were　but　two　pulmonary　valves；　there　was　another　heart　showing　a　large　patent　foramen　ovale　from　a　man　of　forty…six；　and　there　was　a　septum　ventriculorum　of　an　adult　heart　from　a　woman　of　sixty…three；