anomalies and curiosities of medicine-第73部分

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n　of　twenty…five　in　a　reduced　state　of　health　with　an　enormous　clitoris　and　warts　about　the　anus；　there　were　also　manifestations　of　tuberculosis。　On　questioning　her；　it　was　found　that　she　had　formerly　masturbated；　later　she　had　sexual　intercourse　several　times　with　a　young　man；　but　after　his　death　she　commenced　self…abuse　again；　which　brought　on　the　present　enlargement。　The　clitoris　was　ligated　and　came　away　without　leaving　disfigurement。　Cassano　and　Pedretti　of　Naples　reported　an　instance　of　monstrous　clitoris　in　1860　before　the　Academy　of　Medicine。

In　some　cases　ossification　of　the　clitoris　is　observed　Fournier　speaks　of　a　public　woman　in　Venice　who　had　an　osseous　clitoris；　it　was　said　that　men　having　connection　with　her　invariably　suffered　great　pain；　followed　by　inflammation　of　the　penis。

There　are　a　few　instances　recorded　of　bifid　clitoris；　and　Arnaud　cites　the　history　of　a　woman　who　had　a　double　clitoris。　Secretain　speaks　of　a　clitoris　which　was　in　a　permanent　state　of　erection。

Complete　absence　of　the　ovaries　is　seldom　seen；　but　there　are　instances　in　which　one　of　the　ovaries　is　missing。　Hunter；　Vidal；　and　Chaussier　report　in　full　cases　of　the　absence　of　the　ovaries；　and　Thudicum　has　collected　21　cases　of　this　nature。　Morgagni；　Pears；　and　Cripps　have　published　observations　in　which　both　ovaries　were　said　to　have　been　absent。　Cripps　speaks　of　a　young　girl　of　eighteen　who　had　an　infantile　uterus　and　no　ovaries；　she　neither　menstruated　nor　had　any　signs　of　puberty。　Lauth　cites　the　case　of　a　woman　whose　ovaries　and　uterus　were　rudimentary；　and　who　exhibited　none　of　the　principal　physiologic　characteristics　of　her　sex；　on　the　other　hand；　Ruband　describes　a　woman　with　only　rudimentary　ovaries　who　was　very　passionate　and　quite　feminine　in　her　aspect。

At　one　time　the　existence　of　genuine　supernumerary　ovaries　was　vigorously　disputed；　and　the　older　records　contain　no　instances；　but　since　the　researches　of　Beigel；　Puech；　Thudicum；　Winckler；　de　Sinety；　and　Paladino　the　presence　of　multiple　ovaries　is　an　incontestable　fact。　It　was　originally　thought　that　supernumerary　ovaries　as　well　as　supernumerary　kidneys　were　simply　segmentations　of　the　normal　organs　and　connected　to　them　by　portions　of　the　proper　substance；　now；　however；　by　the　recent　reports　we　are　warranted　in　admitting　these　anomalous　structures　as　distinct　organs。　It　has　even　been　suggested　that　it　is　the　persistence　of　these　ovaries　that　causes　the　menstruation　of　which　we　sometimes　hear　as　taking　place　after　ovariotomy。　Sippel　records　an　instance　of　third　ovary；　Mangiagalli　has　found　a　supernumerary　ovary　in　the　body　of　a　still…born　child；　situated　to　the　inner　side　of　the　normal　organ。　Winckel　discovered　a　large　supernumerary　ovary　connected　to　the　uterus　by　its　own　ovarian　ligament。　Klebs　found　two　ovaries　on　one　side；　both　consisting　of　true　ovarian　tissue；　and　connected　by　a　band　3/5　inch　long。

Doran　divides　supernumerary　ovaries　into　three　classes：

（1）　The　ovarium　succentauriatum　of　Beigel。

（2）　Those　cases　in　which　two　masses　of　ovarian　tissue　are　separated　by　ligamentous　bands。

（3）　Entirely　separate　organs；　as　in　Winckel's　case。

Prolapsus　or　displacement　of　the　ovaries　into　the　culdesac　of　Douglas；　the　vaginal　wall；　or　into　the　rectum　can　be　readily　ascertained　by　the　resulting　sense　of　nausea；　particularly　in　defecation　or　in　coitus。　Munde；　Barnes；　Lentz；　Madden；　and　Heywood　Smith　report　instances；　and　Cloquet　describes　an　instance　of　inguinal　hernia　of　the　ovary　in　which　the　uterus　as　well　as　the　Fallopian　tube　were　found　in　the　inguinal　canal。　Debierre　mentions　that　Puech　has　gathered　88　instances　of　inguinal　hernia　of　the　ovary　and　14　of　the　crural　type；　and　also　adds　that　Otte　cites　the　only　instance　in　which　crural　ovarian　hernia　has　been　found　on　both　sides。　Such　a　condition　with　other　associate　malformations　of　the　genitalia　might　easily　be　mistaken　for　an　instance　of　hermaphroditic　testicles。

The　Fallopian　tubes　are　rarely　absent　on　either　side；　although　Blasius　reports　an　instance　of　deficient　oviducts。　Blot　reports　a　case　of　atrophy；　or　rather　rudimentary　state　of　one　of　the　ovaries；　with　absence　of　the　tube　on　that　side；　in　a　woman　of　forty。

Doran　has　an　instance　of　multiple　Fallopian　tubes；　and　Richard；　in　1861；　says　several　varieties　are　noticed。　These　tubes　are　often　found　fused　or　adherent　to　the　ovary　or　to　the　uterus；　but　Fabricius　describes　the　symphysis　of　the　Fallopian　tube　with　the　rectum。

Absence　of　the　uterus　is　frequently　reported。　Lieutaud　and　Richerand　are　each　said　to　have　dissected　female　subjects　in　whom　neither　the　uterus　nor　its　annexed　organs　were　found。　Many　authors　are　accredited　with　mentioning　instances　of　defective　or　deficient　uteri；　among　them　Bosquet；　Boyer；　Walther；　Le　Fort；　Calori；　Pozzi；　Munde；　and　Strauch。　Balade　has　reported　a　curious　absence　of　the　uterus　and　vagina　in　a　girl　of　eighteen。　Azem；　Bastien；　Bibb；　Bovel；　Warren；　Ward；　and　many　others　report　similar　instances；　and　in　several　cases　all　the　adnexa　as　well　as　the　uterus　and　vagina　were　absent；　and　even　the　kidney　and　bladder　malformed。

Phillips　speaks　of　two　sisters；　both　married；　with　congenital　absence　of　the　uterus。　In　his　masterly　article　on　〃Heredity；〃　Sedgwick　quotes　an　instance　of　total　absence　of　the　uterus　in　three　out　of　five　daughters　of　the　same　family；　two　of　the　three　were　twice　married。

Double　uterus　is　so　frequently　reported　that　an　enumeration　of　the　cases　would　occupy　several　pages。　Bicorn；　bipartite；　duplex；　and　double　uteruses　are　so　called　according　to　the　extent　of　the　duplication。　The　varieties　range　all　the　way　from　slight　increase　to　two　distinct　uteruses；　with　separate　appendages　and　two　vaginae。　Meckel；　Boehmer；　and　Callisen　are　among　the　older　writers　who　have　observed　double　uterus　with　associate　double　vagina。　Figure　150　represents　a　transverse　section　of　a　bipartite　uterus　with　a　double　vagina。　The　so…called　uterus　didelphus　is　really　a　duplex　uterus；　or　a　veritable　double　uterus；　each　segment　having　the　appearance　of　a　complete　unicorn　uterus　more　or　less　joined　to　its　neighbor。　Vallisneri　relates　the　history　of　a　woman　who　was　poisoned　by　cantharides　who　had　two　uteruses；　one　opening　into　the　vagina；　the　other　into　the　rectum。　Morand；　Bartholinus；　Tiedemann；　Ollivier；　Blundell；　and　many　others　relate　instances　of　double　uterus　in　which　impregnation　had　occurred；　the　fetus　being　retained　until　the　full　term。

Purcell　of　Dublin　says　that　in　the　summer　of　1773　he　opened　the　body　of　a　woman　who　died　in　the　ninth　month　of　pregnancy。　He　found　a　uterus　of　ordinary　size　and　form　as　is　usual　at　this　period　of　gestation；　which　contained　a　full…grown　fetus；　but　only　one　ovary　attached　to　a　single　Fallopian　tube。　On　the　left　side　he　found　a　second　uterus；　unimpregnated　and　of　usual　size；　to　which　another　ovary　and　tube　were　attached。　Both　of　these　uteruses　were　distinct　and　almost　entirely　separate。

Pregnancy　with　Double　Uterus。Hollander　describes　the　following　anomaly　of　the　uterus　which　he　encountered　during　the　performance　of　a　celiotomy：

〃There　were　found　two　uteruses；　the　posterior　one　being　a　normal　organ　with　its　adnexa；　connected　with　this　uterus　was　another　one；　anterior　to　it。　The　two　uteruses　had　a　common　cervix；　the　anterior　of　the　two　organs　had　no　adnexa；　though　there　were　lateral　peritoneal　ligaments；　it　had　become　pregnant。〃　Hollander　explains　the　anomaly　by　stating　that　probably　the　Mullerian　ducts　or　one　of　them　had　grown　excessively；　leading　to　a　folding　off　of　a　portion　which　developed　into　the　anterior　uterus。

Other　cases　of　double　uterus　with　pregnancy　are　mentioned　on　page　49。

When　there　is　simultaneous　pregnancy　in　each　portion　of　a　double　uterus　a　complication　of　circumstances　arises。　Debierre　quotes　an　instance　of　a　woman　who　bore　one　child　on　July　16；　1870；　and　another　on　October　31st　of　the　same　year；　and　both　at　full　term。　She　had　only　had　three　menstrual　periods　between　the　confinements。　The　question　as　to　whether　a　case　like　this　would　be　one　of　superfetation　in　a　normal　uterus；　or　whether　the　uterus　was　double；　would　immediately　arise。　There　would　also　be　the　possibility　that　one　of　the　children　was　of　protracted　gestation　or　that　the　other　was　of　premature　birth。　Article　312　of　the　Civil　Code　of　France　accords　a　minimum　of　one　hundred　and　eighty　and　a　maximum　of　three　hundred　days　for　the　gestation　of　a　viable　child。　（See　Protracted　Gestation。）

Voight　is　accredited　with　having　seen　a　triple　uterus；　and　there　are　several　older　parallels　on　record。　Thilow　mentions　a　uterus　which　was　divided　into　three　small　portions。

Of　the　different　anomalous　positions　of　the　uterus；　most　of　which　are　acquired；　the　only　one　that　will　be　mentioned　is　that　of　complete　prolapse　of　the　uterus。　In　this　instance　the　organ　may　hang　entirely　out　of　the　body　and　even　forbid　locomotion。

Of　19　cases　of　hernia　of　the　uterus　quoted　by　Debierre　13　have　been　observed　in　the　inguinal　region；　five　on　the　right　and　seven　on　the　left　side。　In　the　case　of　Roux　in　1891　the　hernia　existed　on　both　sides。　The　uterus　has　been　found　twice　only　in　crural　hernia　and　three　times　in　umbilical　hernia。　There　is　one　case　recorded；　according　to　Debierre；　in　which　the　uterus　was　one　of　the　constituents　of　an　obturator　hernia。　Sometimes　its　appendages　are　found　with　it。　Doring；　Ledesma；　Rektorzick；　and　Scazoni　have　found　the　uterus　in　the　sac　of　an　inguinal　hernia；　Leotaud；　Murray；　and　Hagner　in　an　umbilical　hernia。　The　accompanying　illustration　represents　a　hernia　of　the　gravid　womb　through　the　linea　alba。

Absence　of　the　penis　is　an　extremely　rare　anomaly；　although　it　has　been　noted　by　Schenck；　Borellus；　Bouteiller；　Nelaton；　and　others。　Fortunatus　Fidelis　and　Revolat　describe　a　newly　born　child　with　absence　of　external　genitals；　with　spina　bifida　and　umbilical　hernia。　Nelaton　describes　a　child　of　two　entirely　without　a　penis；　but　both　testicles　were　found　in　the　scrotum；　the　boy　urinated　by　the　rectum。　Ashby　and　Wright　mention　complete　absence　of　the　penis；　the　urethra　opening　at　the　margin　of　the　anus　outside　the　external　sphincter；　the　scrotum　and　testicles　were　well　developed。　Murphy　gives　the　description　of　a　well…formed　infant　apparently　without　a　penis；　the　child　passed　urine　through　an　opening　in　the　l