anomalies and curiosities of medicine-第72部分

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ocervicitis；　but　no　history　of　injury　or　operation　and　no　tendency　to　contraction。　The　two　remaining　cases　occurred　in　patients　seen　by　Dr。　J。　F。　Scott。　In　one　the　septum　was　about　1　3/4　inches　from　the　entrance　to　the　vagina　and　contained　an　orifice　large　enough　to　admit　a　uterine　probe。　During　labor　the　septum　resisted　the　advance　of　the　head　for　several　hours；　until　it　was　slit　in　several　directions。　In　the　other；　menstruation　had　always　been　irregular；　intermissions　being　followed　by　a　profuse　flow　of　black　and　tarry　blood；　which　lasted　sometimes　for　fifteen　days　and　was　accompanied　by　severe　pain。　The　septum　was　1　1/2　inches　from　the　vaginal　orifice　and　contained　an　opening　which　admitted　a　uterine　sound。　It　was　very　dense　and　tight　and　fully　1/8　inch　in　thickness。

Mordie　reported　a　case　of　congenital　deficiency　of　the　rectovaginal　septum　which　was　successfully　remedied　by　operation。

Anomalous　Openings　of　the　Vagina。The　vagina　occasionally　opens　abnormally　into　the　rectum；　into　the　bladder；　the　urethra；　or　upon　the　abdominal　parietes。　Rossi　reports　from　a　hospital　in　Turin　the　case　of　a　Piedmontese　girl　in　whom　there　was　an　enormous　tumor　corresponding　to　the　opening　of　the　vaginal　orifice；　no　traces　of　a　vagina　could　be　found。　The　tumor　was　incised　and　proved　to　be　a　living　infant。　The　husband　of　the　woman　said　that　he　had　coitus　without　difficulty　by　the　rectum；　and　examination　showed　that　the　vagina　opened　into　the　rectum；　by　which　means　impregnation　had　been　accomplished。　Bonnain　and　Payne　have　observed　analogous　cases　of　this　abnormality　of　the　vaginal　opening　and　subsequent　accouchement　by　the　anus。　Payne's　case　was　of　a　woman　of　thirty…five；　well　formed；　who　had　been　in　labor　thirty…six　hours；　when　the　physician　examined　and　looked　in　vain　for　a　vaginal　opening；　the　finger；　gliding　along　the　perineum；　came　in　contact　with　the　distended　anus；　in　which　was　recognized　the　head　of　the　fetus。　The　woman　from　prolongation　of　labor　was　in　a　complete　state　of　prostration；　which　caused　uterine　inertia。　Payne　anesthetized　the　patient；　applied　the　forceps；　and　extracted　the　fetus　without　further　accident。　The　vulva　of　this　woman　five　months　afterward　displayed　all　the　characteristics　of　virginity；　the　vagina　opened　into　the　rectum；　and　menstruation　had　always　been　regular。　This　woman；　as　well　as　her　husband；　averred　that　they　had　no　suspicion　of　the　anomaly　and　that　coitus　（by　the　anus）　had　always　been　satisfactory。

Opening　of　the　vagina　upon　the　parietes；　of　which　Le　Fort　has　collected　a　number　of　cases；　has　never　been　observed　in　connection　with　a　viable　fetus。

Absence　of　the　labia　majora　has　been　observed；　especially　by　Pozzi；　to　the　exclusion　of　all　other　anomalies。　It　is　the　rule　in　exstrophy　of　the　bladder。

Absence　of　the　nymphae　has　also　been　observed；　particularly　by　Auvard　and　by　Perchaux；　and　is　generally　associated　with　imperfect　development　of　the　clitoris。　Constantinedes　reports　absence　of　the　external　organs　of　generation；　probably　also　of　the　uterus　and　its　appendages；　in　a　young　lady。　Van　Haartman；　LeFort；　Magee；　and　Ogle　cite　cases　of　absence　of　the　external　female　organs。　Riolan　in　the　early　part　of　the　seventeenth　century　reported　a　case　of　defective　nymphae；　Neubauer　in　1774　offers　a　contrast　to　this　case　in　an　instance　of　triple　nymphae。

The　nymphae　are　sometimes　enormously　enlarged　by　hypertrophy；　by　varicocele；　or　by　elephantiasis；　of　which　latter　type　Rigal　de　Gaillac　has　observed　a　most　curious　case。　There　is　also　a　variety　o？enlargement　of　the　clitoris　which　seems　to　be　constant　in　some　races；　it　may　be　a　natural　hypertrophy；　or　perhaps　produced　by　artificial　manipulation。

The　peculiar　conditions　under　which　the　Chinese　women　are　obliged　to　live；　particularly　their　mode　of　sitting；　is　said　to　have　the　effect　of　causing　unusual　development　of　the　mons　veneris　and　the　labia　majora。　On　the　other　hand；　some　of　the　lower　African　races　have　been　distinguished　by　the　deficiency　in　development　of　the　labia　majora；　mons　veneris；　and　genital　hair。　In　this　respect　they　present　an　approximation　to　the　genitals　of　the　anthropoid　apes；　among　whom　the　orang…outang　alone　shows　any　tendency　to　formation　of　the　labia　majora。

The　labial　appendages　of　the　Hottentot　female　have　been　celebrated　for　many　years。　Blumenbach　and　others　of　the　earlier　travelers　found　that　the　apron…like　appearance　of　the　genitals　of　the　Hottentot　women　was　due　to　abnormal　hypertrophy　of　the　labia　and　nymphae。　According　to　John　Knott；　the　French　traveler；　Le　Vaillant；　said　that　the　more　coquettish　among　the　Hottentot　girls　are　excited　by　extreme　vanity　to　practice　artificial　elongation　of　the　nympha　and　labia。　They　are　said　to　pull　and　rub　these　parts；　and　even　to　stretch　them　by　hanging　weights　to　them。　Some　of　them　are　said　to　spend　several　hours　a　day　at　this　process；　which　is　considered　one　of　the　important　parts　of　the　toilet　of　the　Hottentot　belle；　this　malformation　being　an　attraction　for　the　male　members　of　the　race。　Merensky　says　that　in　Basutoland　the　elder　women　begin　to　practice　labial　manipulation　on　their　female　children　shortly　after　infancy；　and　Adams　has　found　this　custom　to　prevail　in　Dahomey；　he　says　that　the　King's　seraglio　includes　3000　members；　the　elect　of　his　female　subjects；　all　of　whom　have　labia　up　to　the　standard　of　recognized　length。　Cameron　found　an　analogous　practice　among　the　women　of　the　shores　of　Lake　Tanganyika。　The　females　of　this　nation　manipulated　the　skin　of　the　lower　part　of　the　abdomens　of　the　female　children　from　infancy；　and　at　puberty　these　women　exhibit　a　cutaneous　curtain　over　the　genitals　which　reaches　half…way　down　the　thighs。

A　corresponding　development　of　the　preputian　clitorides；　attaining　the　length　of　18　mm。　or　even　more；　has　been　observed　among　the　females　of　Bechuanaland。　The　greatest　elongation　measured　by　Barrow　was　five　inches；　but　it　is　quite　probable　that　it　was　not　possible　for　him　to　examine　the　longest；　as　the　females　so　gifted　generally　occupied　very　high　social　positions。

Morgagni　describes　a　supernumerary　left　nympha；　and　Petit　is　accredited　with　seeing　a　case　which　exhibited　neither　nymphae；　clitoris；　nor　urinary　meatus。　Mauriceau　performed　nymphotomy　on　a　woman　whose　nymphae　were　so　long　as　to　render　coitus　difficult。　Morand　quotes　a　case　of　congenital　malformation　of　the　nymphae；　to　which　he　attributed　impotency。

There　is　sometimes　coalition　of　the　labia　and　nymphae；　which　may　be　so　firm　and　extensive　as　to　obliterate　the　vulva。　Debout　has　reported　a　case　of　absence　of　the　vulva　in　a　woman　of　twenty　upon　whom　he　operated；　which　was　the　result　of　the　fusion　of　the　labia　minora；　and　this　with　an　enlarged　clitoris　gave　the　external　appearance　of　an　hermaphrodite。

The　absence　of　the　clitoris　coincides　with　epispadias　in　the　male；　and　in　atrophy　of　the　vulva　it　is　common　to　find　the　clitoris　rudimentary；　but　a　more　frequent　anomaly　is　hypertrophy　of　the　clitoris。

Among　the　older　authorities　quoting　instances　of　enlarged　clitorides　are　Bartholinus；　Schenck；　Hellwig；　Rhodius；　Riolanus；　and　Zacchias。　Albucasis　describes　an　operation　for　enlarged　clitoris；　Chabert　ligated　one；　and　Riedlin　gives　an　instance　of　an　enlarged　clitoris；　in　which　there　appeared　a　tumor　synchronous　with　the　menstrual　epoch。

We　learn　from　the　classics　that　there　were　certain　females　inhabiting　the　borders　of　the　Aegean　Sea　who　had　a　sentimental　attachment　for　one　another　which　was　called　〃Lesbian　love；〃　and　which　carried　them　to　the　highest　degree　of　frenzy。　The　immortal　effusions　of　Sappho　contain　references　to　this　passion。　The　solution　of　this　peculiar　ardor　is　found　in　the　fact　that　some　of　the　females　had　enlarged　clitorides；　strong　voices；　robust　figures；　and　imitated　men。　Their　manner　was　imperative　and　authoritative　to　their　sex；　who　worshiped　them　with　perverted　devotion。　We　find　in　Martial　mention　of　this　perverted　love；　and　in　the　time　of　the　dissolute　Greeks　and　Romans　ridiculous　jealousies　for　unfaithfulness　between　these　women　prevailed。　Aetius　said　that　the　Egyptians　practiced　amputation　of　the　clitoris；　so　that　enlargement　of　this　organ　must　have　been　a　common　vice　of　conformation　along　the　Nile。　It　was　also　said　that　the　Egyptian　women　practiced　circumcision　on　their　females　at　the　age　of　seven　or　eight；　the　time　chosen　being　when　the　Nile　was　in　flood。　Bertherand　cites　examples　of　enlarged　clitorides　in　Arab　women；　Bruce　testifies　to　this　circumstance　in　Abyssinia；　and　Mungo　Park　has　observed　it　in　the　Mandingos　and　the　Ibbos。

Sonnini　says　that　the　women　of　Egypt　had　a　natural　excrescence；　fleshy　in　consistency；　quite　thick　and　pendulous；　coming　from　the　skin　of　the　mons　veneris。　Sonnini　says　that　in　a　girl　of　eight　he　saw　one　of　these　caruncles　which　was　1/2　inch　long；　and　another　on　a　woman　of　twenty　which　was　four　inches　long；　and　remarks　that　they　seem　peculiar　only　to　women　of　distinct　Egyptian　origin。

Duhouset　says　that　in　circumcision　the　Egyptian　women　not　only　remove　a　great　part　of　the　body　of　the　clitoris　with　the　prepuce；　but　also　adjacent　portions　of　the　nymphae；　Gallieni　found　a　similar　operation　customary　on　the　upper　banks　of　the　Niger。

Otto　at　Breslau　in　1824　reports　seeing　a　negress　with　a　clitoris　4　1/2　inches　long　and　1　1/2　inches　in　the　transverse　diameter；　it　projected　from　the　vulva　and　when　supine　formed　a　complete　covering　for　the　vaginal　orifice。　The　clitoris　may　at　times　become　so　large　as　to　prevent　coitus；　and　in　France　has　constituted　a　legitimate　cause　for　divorce。　This　organ　is　very　sensitive；　and　it　is　said　that　in　cases　of　supposed　catalepsy　a　woman　cannot　bear　titillation　of　the　clitoris　without　some　visible　movement。

Columbus　cites　an　example　of　a　clitoris　as　long　as　a　little　finger；　Haller　mentions　one　which　measured　seven　inches；　and　there　is　a　record　of　an　enlarged　clitoris　which　resembled　the　neck　of　a　goose　and　which　was　12　inches　long。　Bainbridge　reports　a　case　of　enlarged　clitoris　in　a　woman　of　thirty…two　who　was　confined　with　her　first　child。　This　organ　was　five　inches　in　length　and　of　about　the　diameter　of　a　quiescent　penis。　Figure　149　shows　a　well…marked　case　of　hypertrophy　of　the　clitoris。　Rogers　describes　a　woman　of　twenty…five　in　a　reduced　state　of　health　with　an　enormous　clitoris　and　warts　about　the　anus；　th