anomalies and curiosities of medicine-第71部分

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stern　cites　a　case　of　a　mamma　on　the　left　shoulder　nearly　under　the　insertion　of　the　deltoid；　and　Klob　speaks　of　an　acromial　accessory　mamma　situated　on　the　shoulder　over　the　greatest　prominence　of　the　deltoid。　Hall　reports　the　case　of　a　functionally　active　supernumerary　mamma　over　the　costal　cartilage　of　the　8th　rib。　Jussieu　speaks　of　a　woman　who　had　three　breasts；　one　of　which　was　situated　on　the　groin　and　with　which　she　occasionally　suckled；　her　mother　had　three　breasts；　but　they　were　all　situated　on　the　chest。　Saunois　details　an　account　of　a　female　who　had　two　supernumerary　breasts　on　the　back。　Bartholinus　（quoted　by　Meckel）　and　Manget　also　mention　mammae　on　the　back；　but　Geoffroy…Saint…Hilaire　questions　their　existence。　Martin　gives　a　very　clear　illustration　of　a　woman　with　a　supernumerary　breast　below　the　natural　organ。　Sneddon；　who　has　collected　quite　a　number　of　cases　of　polymazia；　quotes　the　case　of　a　woman　who　had　two　swellings　in　each　axilla　in　which　gland…structure　was　made　out；　but　with　no　external　openings；　and　which　had　no　anatomic　connection　with　the　mammary　glands　proper。　Shortly　after　birth　they　varied　in　size　and　proportion；　as　the　breasts　were　full　or　empty；　and　in　five　weeks　all　traces　of　them　were　lost。　Her　only　married　sister　had　similar　enlargements　at　her　third　confinement。

Polymazia　sometimes　seems　to　be　hereditary。　Robert　saw　a　daughter　whose　mother　was　polymastic；　and　Woodman　saw　a　mother　and　eldest　daughter　who　each　had　three　nipples。　Lousier　mentions　a　woman　wanting　a　mamma　who　transmitted　this　vice　of　conformation　to　her　daughter。　Handyside　says　he　knew　two　brothers　in　both　of　whom　breasts　were　wanting。

Supernumerary　nipples　alone　are　also　seen；　as　many　as　five　having　been　found　on　the　same　breast。　Neugebauer　reports　eight　supernumerary　nipples　in　one　case。　Hollerus　has　seen　a　woman　who　had　two　nipples　on　the　same　breast　which　gave　milk　with　the　same　regularity　and　the　same　abundance　as　the　single　nipple。　The　Ephemerides　contains　a　description　of　a　triple　nipple。　Barth　describes　〃mamma　erratica〃　on　the　face　in　front　of　the　right　ear　which　enlarged　during　menstruation。

Cases　of　deficiency　of　the　nipples　have　been　reported　by　the　Ephemerides；　Lentilius；　Severinus；　and　Werckardus。

Cases　of　functional　male　mammae　will　be　discussed　in　Chapter　IX。

Complete　absence　of　the　hymen　is　very　rare；　if　we　may　accept　the　statements　of　Devilliers；　Tardieu；　and　Brouardel；　as　they　have　never　seen　an　example　in　the　numerous　young　girls　they　have　examined　from　a　medico…legal　point　of　view。

Duplication　or　biperforation　of　the　hymen　is　also　a　very　rare　anomaly　of　this　membrane。　In　this　instance　the　hymen　generally　presents　two　lateral　orifices；　more　or　less　irregular　and　separated　by　a　membranous　band；　which　gives　the　appearance　of　duplicity。　Roze　reported　from　Strasburg　in　1866　a　case　of　this　kind；　and　Delens　has　observed　two　examples　of　biperforate　hymen；　which　show　very　well　that　this　disposition　of　the　membrane　is　due　to　a　vice　of　conformation。　The　first　was　in　a　girl　of　eleven；　in　which　the　membrane　was　of　the　usual　size　and　thickness；　but　was　duplicated　on　either　side。　In　her　sister　of　nine　the　hymen　was　normally　conformed。　The　second　case　was　in　a　girl　under　treatment　by　Cornil　in　1876　for　vaginitis。　Her　brother　had　accused　a　young　man　of　eighteen　of　having　violated　her；　and　on　examination　the　hymen　showed　a　biperforate　conformation；　there　were　two　oval　orifices；　their　greatest　diameter　being　in　the　vertical　plane；　the　openings　were　situated　on　each　side　of　the　median　line；　about　five　mm。　apart；　the　dividing　band　did　not　appear　to　be　cicatricial；　but　presented　the　same　roseate　coloration　as　the　rest　of　the　hymen。　Since　this　report　quite　a　number　of　cases　have　been　recorded。

The　different　varieties　of　the　hymen　will　be　left　to　the　works　on　obstetrics。　As　has　already　been　observed；　labor　is　frequently　seriously　complicated　by　a　persistent　and　tough　hymen。

Deficient　vulva　may　be　caused　by　the　persistence　of　a　thick　hymen；　by　congenital　occlusion；　or　by　absolute　absence　in　vulvar　structure。　Bartholinus；　Borellus；　Ephemerides；　Julius；　Vallisneri；　and　Baux　are　among　the　older　writers　who　mention　this　anomaly；　but　as　it　is　generally　associated　with　congenital　occlusion；　or　complete　absence　of　the　vagina；　the　two　will　be　considered　together。

Complete　absence　of　the　vagina　is　quite　rare。　Baux　a　reports　a　case　of　a　girl　of　fourteen　in　whom　〃there　was　no　trace　of　fundament　or　of　genital　organs。〃　Oberteuffer　speaks　of　a　case　of　absent　vagina。　Vicq　d'Azir　is　accredited　with　having　seen　two　females　who；　not　having　a　vagina；　copulated　all　through　life　by　the　urethra；　and　Fournier　sagely　remarks　that　the　extra　large　urethra　may　have　been　a　special　dispensation　of　nature。　Bosquet　describes　a　young　girl　of　twenty　with　a　triple　vice　of　conformationan　obliterated　vulva；　closure　of　the　vagina；　and　absence　of　the　uterus。　Menstrual　hemorrhage　took　place　from　the　gums。　Clarke　has　studied　a　similar　case　which　was　authenticated　by　an　autopsy。

O'Ferral　of　Dublin；　Gooch；　Davies；　Boyd；　Tyler　Smith；　Hancock；　Coste；　Klayskens；　Debrou；　Braid；　Watson；　and　others　are　quoted　by　Churchill　as　having　mentioned　the　absence　of　the　vagina。　Amussat　observed　a　German　girl　who　did　not　have　a　trace　of　a　vagina　and　who　menstruated　regularly。　Griffith　describes　a　specimen　in　the　Museum　of　St。　Bartholomew's　Hospital；　London；　in　which　the　ovaries　lay　on　the　surface　of　the　pelvic　peritoneum　and　there　was　neither　uterus　nor　vagina；　the　pelvis　had　some　of　the　characteristics　of　the　male　type。　Matthews　Duncan　has　observed　a　somewhat　similar　case；　the　vagina　not　measuring　more　than　an　inch　in　length。　Ferguson　describes　a　prostitute　of　eighteen　who　had　never　menstruated。　The　labia　were　found　well　developed；　but　there　was　no　vagina；　uterus；　or　ovaries。　Coitus　had　been　through　the　urethra；　which　was　considerably　distended；　though　not　causing　incontinence　of　urine。　Hulke　reports　a　case　of　congenital　atresia　of　the　vagina　in　a　brunette　of　twenty；　menstruation　occurring　through　the　urethra。　He　also　mentions　the　instance　of　congenital　atresia　of　the　vagina　with　hernia　of　both　ovaries　into　the　left　groin　in　a　servant　of　twenty；　and　the　case　of　an　imperforate　vagina　in　a　girl　of　nineteen　with　an　undeveloped　uterus。

Brodhurst　reports　an　instance　of　absence　of　the　vagina　and　uterus　in　a　girl　of　sixteen　who　at　four　years　of　age　showed　signs　of　approaching　puberty。　At　this　early　age　the　mons　was　covered　with　hair；　and　at　ten　the　clitoris　was　three　inches　long　and　two　inches　in　circumference。　The　mammae　were　well　developed。　The　labia　descended　laterally　and　expanded　into　folds；　resembling　the　scrotum。

Azema　reports　an　instance　of　complete　absence　of　the　vagina　and　impermeability　and　probable　absence　of　the　col　uterinus。　The　deficiencies　were　remedied　by　operation。　Berard　mentions　a　similar　deformity　and　operation　in　a　girl　of　eighteen。　Gooding　cites　an　instance　of　absent　vagina　in　a　married　woman；　the　uterus　discharging　the　functions。　Gosselin　reports　a　case　in　which　a　voluminous　tumor　was　formed　by　the　retained　menstrual　fluid　in　a　woman　without　a　vagina。　An　artificial　vagina　was　created；　but　the　patient　died　from　extravasation　of　blood　into　the　peritoneal　cavity。　Carter；　Polaillon；　Martin；　Curtis；　Worthington；　Hall；　Hicks；　Moliere；　Patry；　Dolbeau；　Desormeaux；　and　Gratigny　also　record　instances　of　absence　of　the　vagina。

There　are　some　cases　reported　in　extramedical　literature　which　might　be　cited。　Bussy　Rabutin　in　his　Memoires　in　1639　speaks　of　an　instance。　The　celebrated　Madame　Recamier　was　called　by　the　younger　Dumas　an　involuntary　virgin；　and　in　this　connection　could　be　cited　the　malicious　and　piquant　sonnet

Chateaubriand　et　Madame　Recamier。

〃Juliette　et　Rene　s'aimaient　d'amour　si　tendre　　Que　Dien；　sans　les　punir；　a　pu　leur　pardonner：　　Il　n'avait　pas　voulu　que　l'une　put　donner　　Ce　que　l'autre　ne　pouvait　prendre。〃

Duplex　vagina　has　been　observed　by　Bartholinus；　Malacarne；　Asch；　Meckel；　Osiander；　Purcell；　and　other　older　writers。　In　more　modern　times　reports　of　this　anomaly　are　quite　frequent。　Hunter　reports　a　case　of　labor　at　the　seventh　month　in　a　woman　with　a　double　vagina；　and　delivery　through　the　rectum。　Atthill　and　Watts　speak　of　double　vagina　with　single　uterus。

Robb　of　Johns　Hopkins　Hospital　reports　a　case　of　double　vagina　in　a　patient　of　twenty　suffering　from　dyspareunia。　The　vaginal　orifice　was　contracted；　the　urethra　was　dilated　and　had　evidently　been　used　for　coitus。　A　membrane　divided　the　vagina　into　two　canals；　the　cervix　lying　in　the　right　half；　the　septum　was　also　divided。　Both　the　thumbs　of　the　patient　were　so　short　that　their　tips　could　scarcely　meet　those　of　the　little　fingers。　Double　vagina　is　also　reported　by　Anway；　Moulton；　Freeman；　Frazer；　Haynes；　Lemaistre；　Boardman；　Dickson；　Dunoyer；　and　Rossignol。　This　anomaly　is　usually　associated　with　bipartite　or　double　uterus。　Wilcox　mentions　a　primipara；　three　months　pregnant；　with　a　double　vagina　and　a　bicornate　uterus；　who　was　safely　delivered　of　several　children。　Haller　and　Borellus　have　seen　double　vagina；　double　uterus；　and　double　ovarian　supply；　in　the　latter　case　there　was　also　a　double　vulva。　Sanger　speaks　of　a　supernumerary　vagina　connecting　with　the　other　vagina　by　a　fistulous　opening；　and　remarks　that　this　was　not　a　case　of　patent　Gartner's　duct。

Cullingworth　cites　two　cases　in　which　there　were　transverse　septa　of　the　vagina。　Stone　reports　five　cases　of　transverse　septa　of　the　vagina。　Three　of　the　patients　were　young　women　who　had　never　borne　children　or　suffered　injury。　Pregnancy　existed　in　each　case。　In　the　first　the　septum　was　about　two　inches　from　the　introitus；　and　contained　an　opening　about　1/2　inch　in　diameter　which　admitted　the　tip　of　the　finger。　The　membrane　was　elastic　and　thin　and　showed　no　signs　of　inflammation。　Menstruation　had　always　been　regular　up　to　the　time　of　pregnancy。　The　second　was　a　duplicate　of　the　first；　excepting　that　a　few　bands　extended　from　the　cervix　to　the　membranous　septum。　In　the　third　the　lumen　of　the　vagina；　about　two　inches　from　the　introitus；　was　distinctly　narrowed　by　a　ridge　of　tissue。　There　was　uterine　displacement　and　some　endocervicitis；　but　no　history　of　injury　or　operation　and　no　tendency　to　contraction。　The　two　remaining