anomalies and curiosities of medicine-第70部分

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an　of　forty…six；　and　there　was　a　septum　ventriculorum　of　an　adult　heart　from　a　woman　of　sixty…three；　who　died　of　carcinoma　of　the　breast；　in　which　the　foremen　ovale　was　still　open　and　would　admit　the　fore…finger。　This　woman　had　shown　no　symptoms　of　the　malformation。　There　were　also　hearts　in　which　the　interventricular　septum　was　deficient；　the　ductus　arteriosus　patent；　or　some　valvular　malformation　present。　All　these　persons　had　reached　puberty。

Displacements　of　the　heart　are　quite　numerous。　Deschamps　of　Laval　made　an　autopsy　on　an　old　soldier　which　justified　the　expression；　〃He　had　a　heart　in　his　belly。〃　This　organ　was　found　in　the　left　lumbar　region；　it　had；　with　its　vessels；　traversed　an　anomalous　opening　in　the　diaphragm。　Franck　observed　in　the　Hospital　of　Colmar　a　woman　with　the　heart　in　the　epigastric　region。　Ramel　and　Vetter　speak　of　the　heart　under　the　diaphragm。

Inversion　of　the　heart　is　quite　frequent；　and　we　often　find　reports　of　cases　of　this　anomaly。　Fournier　describes　a　soldier　of　thirty　years；　of　middle　height；　well　proportioned　and　healthy；　who　was　killed　in　a　duel　by　receiving　a　wound　in　the　abdomen；　postmortem；　the　heart　was　found　in　the　position　of　the　right　lung；　the　two　lungs　were　joined　and　occupied　the　left　chest。

The　anomalies　of　the　vascular　system　are　so　numerous　that　we　shall　dismiss　them　with　a　slight　mention。　Malacarne　in　Torino　in　1784　described　a　double　aorta；　and　Hommelius　mentions　an　analogous　case。　The　following　case　is　quite　an　interesting　anatomic　anomaly：　A　woman　since　infancy　had　difficulty　in　swallowing；　which　was　augmented　at　the　epoch　of　menstruation　and　after　exercise；　bleeding　relieved　her　momentarily；　but　the　difficulty　always　returned。　At　last　deglutition　became　impossible　and　the　patient　died　of　malnutrition。　A　necropsy　revealed　the　presence　of　the　subclavicular　artery　passing　between　the　tracheal　artery　and　the　esophagus；　compressing　this　latter　tube　and　opposing　the　passage　of　food。

Anomalies　of　the　Breasts。The　first　of　the　anomalies　of　the　generative　apparatus　to　be　discussed；　although　not　distinctly　belonging　under　this　head；　will　be　those　of　the　mammae。

Amazia；　or　complete　absence　of　the　breast；　is　seldom　seen。　Pilcher　describes　an　individual　who　passed　for　a　female；　but　who　was　really　a　male；　in　whom　the　breasts　were　absolutely　wanting。　Foerster；　Froriep；　and　Ried　cite　instances　associated　with　thoracic　malformation。　Greenhow　reports　a　case　in　which　the　mammae　were　absent；　although　there　were　depressed　rudimentary　nipples　and　areolae。　There　were　no　ovaries　and　the　uterus　was　congenitally　imperfect。

There　was　a　negress　spoken　of　in　1842　in　whom　the　right　breast　was　missing；　and　there　are　cases　of　but　one　breast；　mentioned　by　King；　Paull；　and　others。　Scanzoni　has　observed　absence　of　the　left　mamma　with　absence　of　the　left　ovary。

Micromazia　is　not　so　rare；　and　is　generally　seen　in　females　with　associate　genital　troubles。　Excessive　development　of　the　mammae；　generally　being　a　pathologic　phenomenon；　will　be　mentioned　in　another　chapter。　However；　among　some　of　the　indigenous　negroes　the　female　breasts　are　naturally　very　large　and　pendulous。　This　is　well　shown　in　Figure　144；　which　represents　a　woman　of　the　Bushman　tribe　nursing　an　infant。　The　breasts　are　sufficiently　pendulous　and　loose　to　be　easily　thrown　over　the　shoulder。

Polymazia　is　of　much　more　frequent　occurrence　than　is　supposed。　Julia；　the　mother　of　Alexander　Severus；　was　surnamed　〃Mammea〃　because　she　had　supernumerary　breasts。　Anne　Boleyn；　the　unfortunate　wife　of　Henry　VIII　of　England；　was　reputed　to　have　had　six　toes；　six　fingers；　and　three　breasts。　Lynceus　says　that　in　his　time　there　existed　a　Roman　woman　with　four　mammae；　very　beautiful　in　contour；　arranged　in　two　lines；　regularly；　one　above　the　other；　and　all　giving　milk　in　abundance。　Rubens　has　pictured　a　woman　with　four　breasts；　the　painting　may　be　seen　in　the　Louvre　in　Paris。

There　was　a　young　and　wealthy　heiress　who　addressed　herself　to　the　ancient　faculty　at　Tubingen；　asking；　as　she　displayed　four　mammary；　whether；　should　she　marry；　she　would　have　three　or　four　children　at　a　birth。　This　was　a　belief　with　which　some　of　her　elder　matron　friends　had　inspired　her；　and　which　she　held　as　a　hindrance　to　marriage。

Leichtenstern；　who　has　collected　70　cases　of　polymazia　in　females　and　22　in　males；　thinks　that　accessory　breasts　or　nipples　are　due　to　atavism；　and　that　our　most　remote　inferiorly　organized　ancestors　had　many　breasts；　but　that　by　constantly　bearing　but　one　child；　from　being　polymastic；　females　have　gradually　become　bimastic。　Some　of　the　older　philosophers　contended　that　by　the　presence　of　two　breasts　woman　was　originally　intended　to　bear　two　children。

Hirst　says：　〃Supernumerary　breasts　and　nipples　are　more　common　than　is　generally　supposed。　Bruce　found　60　instances　in　3956　persons　examined　（1。56　per　cent）。　Leichtenstern　places　the　frequency　at　one　in　500。　Both　observers　declare　that　men　present　the　anomaly　about　twice　as　frequently　as　women。　It　is　impossible　to　account　for　the　accessory　glands　on　the　theory　of　reversion；　as　they　occur　with　no　regularity　in　situation；　but　may　develop　at　odd　places　on　the　body。　The　most　frequent　position　is　on　the　pectoral　surface　below　the　true　mammae　and　somewhat　nearer　the　middle　line；　but　an　accessory　gland　has　been　observed　on　the　left　shoulder　over　the　prominence　of　the　deltoid；　on　the　abdominal　surface　below　the　costal　cartilages；　above　the　umbilicus；　in　the　axilla；　in　the　groin；　on　the　dorsal　surface；　on　the　labium　majus；　and　on　the　outer　aspect　of　the　left　thigh。　Ahlfeld　explains　the　presence　of　mammae　on　odd　parts　of　the　body　by　the　theory　that　portions　of　the　embryonal　material　entering　into　the　composition　of　the　mammary　gland　are　carried　to　and　implanted　upon　any　portion　of　the　exterior　of　the　body　by　means　of　the　amnion。〃

Possibly　the　greatest　number　of　accessory　mammae　reported　is　that　of　Neugebauer　in　1886；　who　found　ten　in　one　person。　Peuch　in　1876　collected　77　cases；　and　since　then　Hamy；　Quinqusud；　Whiteford；　Engstrom；　and　Mitchell　Bruce　have　collected　cases。　Polymazia　must　have　been　known　in　the　olden　times；　and　we　still　have　before　us　the　old　images　of　Diana；　in　which　this　goddess　is　portrayed　with　numerous　breasts；　indicating　her　ability　to　look　after　the　growing　child。　Figure　145　shows　an　ancient　Oriental　statue　of　Artemisia　or　Diana　now　at　Naples。

Bartholinus　has　observed　a　Danish　woman　with　three　mammae；　two　ordinarily　formed　and　a　third　forming　a　triangle　with　the　others　and　resembling　the　breasts　of　a　fat　man。　In　the　village　of　Phullendorf　in　Germany　early　in　this　century　there　was　an　old　woman　who　sought　alms　from　place　to　place；　exhibiting　to　the　curious　four　symmetrical　breasts；　arranged　parallel。　She　was　extremely　ugly；　and　when　on　all　fours；　with　her　breasts　pendulous；　she　resembled　a　beast。　The　authors　have　seen　a　man　with　six　distinct　nipples；　arranged　as　regularly　as　those　of　a　bitch　or　sow。　The　two　lower　were　quite　small。　This　man's　body　was　covered　with　heavy；　long　hair；　making　him　a　very　conspicuous　object　when　seen　naked　during　bathing。　The　hair　was　absent　for　a　space　of　nearly　an　inch　about　the　nipples。　Borellus　speaks　of　a　woman　with　three　mammae；　two　as　ordinarily；　the　third　to　the　left　side；　which　gave　milk；　but　not　the　same　quantity　as　the　others。　Gardiner　describes　a　mulatto　woman　who　had　four　mammae；　two　of　which　were　near　the　axillae；　about　four　inches　in　circumference；　with　proportionate　sized　nipples。　She　became　a　mother　at　fourteen；　and　gave　milk　from　all　her　breasts。　In　his　〃Dictionnaire　Philosophique〃　Voltaire　gives　the　history　of　a　woman　with　four　well…formed　and　symmetrically　arranged　breasts；　she　also　exhibited　an　excrescence；　covered　with　a　nap…like　hair；　looking　like　a　cow…tail。　Percy　thought　the　excrescence　a　prolongation　of　the　coccyx；　and　said　that　similar　instances　were　seen　in　savage　men　of　Borneo。

Percy　says　that　among　some　prisoners　taken　in　Austria　was　found　a　woman　of　Valachia；　near　Roumania；　exceedingly　fatigued；　and　suffering　intensely　from　the　cold。　It　was　January；　and　the　ground　was　covered　with　three　feet　of　snow。　She　had　been　exposed　with　her　two　infants；　who　had　been　born　twenty　days；　to　this　freezing　temperature；　and　died　on　the　next　day。　An　examination　of　her　body　revealed　five　mammae；　of　which　four　projected　as　ordinarily；　while　the　fifth　was　about　the　size　of　that　of　a　girl　at　puberty。

They　all　had　an　intense　dark　ring　about　them；　the　fifth　was　situated　about　five　inches　above　the　umbilicus。　Percy　injected　the　subject　and　dissected　and　described　the　mammary　blood…supply。　Hirst　mentions　a　negress　of　nineteen　who　had　nine　mammae；　all　told；　and　as　many　nipples。　The　two　normal　glands　were　very　large。　Two　accessory　glands　and　nipples　below　them　were　small　and　did　not　excrete　milk。　All　the　other　glands　and　nipples　gave　milk　in　large　quantities。　There　were　five　nipples　on　the　left　and　four　on　the　right　side。　The　patient's　mother　had　an　accessory　mamma　on　the　abdomen　that　secreted　milk　during　the　period　of　lactation。

Charpentier　has　observed　in　his　clinic　a　woman　with　two　supplementary　axillary　mammae　with　nipples。　They　gave　milk　as　the　ordinary　mammae。　Robert　saw　a　woman　who　nourished　an　infant　by　a　mamma　on　the　thigh。　Until　the　time　of　pregnancy　this　mamma　was　taken　for　an　ordinary　nevus；　but　with　pregnancy　it　began　to　develop　and　acquired　the　size　of　a　citron。　Figure　147　is　from　an　old　wood…cut　showing　a　child　suckling　at　a　supernumerary　mamma　on　its　mother's　thigh　while　its　brother　is　at　the　natural　breast。　Jenner　speaks　of　a　breast　on　the　outer　side　of　the　thigh　four　inches　below　the　great　trochanter。　Hare　describes　a　woman　of　thirty…seven　who　secreted　normal　milk　from　her　axillae。　Lee　mentions　a　woman　of　thirty…five　with　four　mammae　and　four　nipples；　she　suckled　with　the　pectoral　and　not　the　axillary　breasts。　McGillicudy　describes　a　pair　of　rudimentary　abdominal　mammae；　and　there　is　another　similar　case　recorded。　Hartung　mentions　a　woman　of　thirty　who　while　suckling　had　a　mamma　on　the　left　labium　majus。　It　was　excised；　and　microscopic　examination　showed　its　structure　to　be　that　of　a　rudimentary　nipple　and　mammary　gland。　Leichtenstern　cites　a　case　of　a　mamma　on　the　left　shoulder　nearly　under　the　insertion　of　the　deltoid；　and　Kl