GENETIC ANOMALIES.

Menstruation has always been of interest, not only to the student of

medicine, but to the lay-observer as well. In olden times there were

many opinions concerning its causation, all of which, until the era of

physiologic investigation, were of superstitious derivation. Believing

menstruation to be the natural means of exit of the feminine bodily

impurities, the ancients always thought a menstruating woman was to be

shunned; her very presence was deleterious to the whole animal economy,

as, for instance, among the older writers we find that Pliny remarks:

"On the approach of a woman in this state, must will become sour, seeds

which are touched by her become sterile, grass withers away, garden

plants are parched up, and the fruit will fall from the tree beneath

which she sits." He also says that the menstruating women in Cappadocia

were perambulated about the fields to preserve the vegetation from

worms and caterpillars. According to Flemming, menstrual blood was

believed to be so powerful that the mere touch of a menstruating woman

would render vines and all kinds of fruit-trees sterile. Among the

indigenous Australians, menstrual superstition was so intense that one

of the native blacks, who discovered his wife lying on his blanket

during her menstrual period, killed her, and died of terror himself in

a fortnight. Hence, Australian women during this season are forbidden

to touch anything that men use. Aristotle said that the very look of a

menstruating woman would take the polish out of a mirror, and the next

person looking in it would be bewitched. Frommann mentions a man who

said he saw a tree in Goa which withered because a catamenial napkin

was hung on it. Bourke remarks that the dread felt by the American

Indians in this respect corresponds with the particulars recited by

Pliny. Squaws at the time of menstrual purgation are obliged to seclude

themselves, and in most instances to occupy isolated lodges, and in all

tribes are forbidden to prepare food for anyone save themselves. It was

believed that, were a menstruating woman to step astride a rifle, a

bow, or a lance, the weapon would have no utility. Medicine men are in

the habit of making a "protective" clause whenever they concoct a

"medicine," which is to the effect that the "medicine" will be

effective provided that no woman in this condition is allowed to

approach the tent of the official in charge.

Empiricism had doubtless taught the ancient husbands the dangers of

sexual intercourse during this period, and the after-results of many

such connections were looked upon as manifestations of the

contagiousness of the evil excretions issuing at this period. Hence at

one time menstruation was held in much awe and abhorrence.

On the other hand, in some of the eastern countries menstruation was

regarded as sacred, and the first menstrual discharge was considered so

valuable that premenstrual marriages were inaugurated in order that the

first ovum might not be wasted, but fertilized, because it was supposed

to be the purest and best for the purpose. Such customs are extant at

the present day in some parts of India, despite the efforts of the

British Government to suppress them, and descriptions of

child-marriages and their evil results have often been given by

missionaries.

As the advances of physiology enlightened the mind as to the true

nature of the menstrual period, and the age of superstition gradually

disappeared, the intense interest in menstruation vanished, and now,

rather than being held in fear and awe, the physicians of to-day

constantly see the results of copulation during this period. The

uncontrollable desire of the husband and the mercenary aims of the

prostitute furnish examples of modern disregard.

The anomalies of menstruation must naturally have attracted much

attention, and we find medical literature of all times replete with

examples. While some are simply examples of vicarious or compensatory

menstruation, and were so explained even by the older writers, there

are many that are physiologic curiosities of considerable interest.

Lheritier furnishes the oft-quoted history of the case of a young girl

who suffered from suppression of menses, which, instead of flowing

through the natural channels, issued periodically from vesicles on the

leg for a period of six months, when the seat of the discharge changed

to an eruption on the left arm, and continued in this location for one

year; then the discharge shifted to a sore on the thumb, and at the end

of another six months again changed, the next location being on the

upper eyelid; here it continued for a period of two years. Brierre de

Boismont and Meisner describe a case apparently identical with the

foregoing, though not quoting the source.

Haller, in a collection of physiologic curiosities covering a period of

a century and a half, cites 18 instances of menstruation from the skin.

Parrot has also mentioned several cases of this nature. Chambers speaks

of bloody sweat occurring periodically in a woman of twenty-seven; the

intervals, however, were occasionally but a week or a fortnight, and

the exudation was not confined to any one locality. Van Swieten quotes

the history of a case of suppression of the menstrual function in which

there were convulsive contractions of the body, followed by paralysis

of the right arm. Later on, the patient received a blow on the left eye

causing amaurosis; swelling of this organ followed, and one month later

blood issued from it, and subsequently blood oozed from the skin of the

nose, and ran in jets from the skin of the fingers and from the nails.

D'Andrade cites an account of a healthy Parsee lady, eighteen years of

age, who menstruated regularly from thirteen to fifteen and a half

years; the catamenia then became irregular and she suffered occasional

hemorrhages from the gums and nose, together with attacks of

hematemesis. The menstruation returned, but she never became pregnant,

and, later, blood issued from the healthy skin of the left breast and

right forearm, recurring every month or two, and finally additional

dermal hemorrhage developed on the forehead. Microscopic examination of

the exuded blood showed usual constituents present. There are two

somewhat similar cases spoken of in French literature. The first was

that of a young lady, who, after ten years' suppression of the

menstrual discharge, exhibited the flow from a vesicular eruption on

the finger. The other case was quite peculiar, the woman being a

prostitute, who menstruated from time to time through spots, the size

of a five-franc piece, developing on the breasts, buttocks, back,

axilla, and epigastrium. Barham records a case similar to the

foregoing, in which the menstruation assumed the character of periodic

purpura. Duchesne mentions an instance of complete amenorrhea, in which

the ordinary flow was replaced by periodic sweats.

Parrot speaks of a woman who, when seven months old, suffered from

strumous ulcers, which left cicatrices on the right hand, from whence,

at the age of six years, issued a sanguineous discharge with associate

convulsions. One day, while in violent grief, she shed bloody tears.

She menstruated at the age of eleven, and was temporarily improved in

her condition; but after any strong emotion the hemorrhages returned.

The subsidence of the bleeding followed her first pregnancy, but

subsequently on one occasion, when the menses were a few days in

arrears, she exhibited a blood-like exudation from the forehead,

eyelids, and scalp. As in the case under D'Andrade's observation, the

exudation was found by microscopic examination to consist of the true

constituents of blood. An additional element of complication in this

case was the occurrence of occasional attacks of hematemesis.

Menstruation from the Breasts.--Being in close sympathy with the

generative function, we would naturally expect to find the female

mammae involved in cases of anomalous menstruation, and the truth of

this supposition is substantiated in the abundance of such cases on

record. Schenck reports instances of menstruation from the nipple; and

Richter, de Fontechia, Laurentius, Marcellus Donatus, Amatus Lusitanus,

and Bierling are some of the older writers who have observed this

anomaly. Pare says the wife of Pierre de Feure, an iron merchant,

living at Chasteaudun, menstruated such quantities from the breasts

each month that several serviettes were necessary to receive the

discharge. Cazenave details the history of a case in which the mammary

menstruation was associated with a similar exudation from the face, and

Wolff saw an example associated with hemorrhage from the fauces. In the

Lancet (1840-1841) is an instance of monthly discharge from beneath the

left mamma. Finley also writes of an example of mammary hemorrhage

simulating menstruation. Barnes saw a case in St. George's Hospital,

London, 1876, in which the young girl menstruated vicariously from the

nipple and stomach. In a London discussion there was mentioned the case

of a healthy woman of fifty who never was pregnant, and whose

menstruation had ceased two years previously, but who for twelve months

had menstruated regularly from the nipples, the hemorrhage being so

profuse as to require constant change of napkins. The mammae were large

and painful, and the accompanying symptoms were those of ordinary

menstruation. Boulger mentions an instance of periodic menstrual

discharge from beneath the left mamma. Jacobson speaks of habitual

menstruation by both breasts. Rouxeau describes amenorrhea in a girl of

seventeen, who menstruated from the breast; and Teufard reports a case

in which there was reestablishment of menstruation by the mammae at the

age of fifty-six. Baker details in full the description of a case of

vicarious menstruation from an ulcer on the right mamma of a woman of

twenty. At the time he was called to see her she was suffering with

what was called "green-sickness." The girl had never menstruated

regularly or freely. The right mamma was quite well developed, flaccid,

the nipple prominent, and the superficial veins larger and more

tortuous than usual. The patient stated that the right mamma had always

been larger than the left. The areola was large and well marked, and

1/4 inch from its outer edge, immediately under the nipple, there was

an ulcer with slightly elevated edges measuring about 1 1/4 inches

across the base, and having an opening in its center 1/4 inch in

diameter, covered with a thin scab. By removing the scab and making

pressure at the base of the ulcer, drops of thick, mucopurulent matter

were made to exude. This discharge, however, was not offensive to the

smell. On March 17, 1846, the breast became much enlarged and

congested, as portrayed in Plate 1. The ulcer was much inflamed and

painful, the veins corded and deep colored, and there was a free

discharge of sanguineous yellowish matter. When the girl's general

health improved and menstruation became more natural, the vicarious

discharge diminished in proportion, and the ulcer healed shortly

afterward. Every month this breast had enlarged, the ulcer became

inflamed and discharged vicariously, continuing in this manner for a

few days, with all the accompanying menstrual symptoms, and then dried

up gradually. It was stated that the ulcer was the result of the girl's

stooping over some bushes to take an egg from a hen's nest, when the

point of a palmetto stuck in her breast and broke off. The ulcer

subsequently formed, and ultimately discharged a piece of palmetto.

This happened just at the time of the beginning of the menstrual epoch.

The accompanying figures, Plate 1, show the breast in the ordinary

state and at the time of the anomalous discharge.

Hancock relates an instance of menstruation from the left breast in a

large, otherwise healthy, Englishwoman of thirty-one, who one and a

half years after the birth of the youngest child (now ten years old)

commenced to have a discharge of fluid from the left breast three days

before the time of the regular period. As the fluid escaped from the

nipple it became changed in character, passing from a whitish to a

bloody and to a yellowish color respectively, and suddenly terminating

at the beginning of the real flow from the uterus, to reappear again at

the breast at the close of the flow, and then lasting two or three days

longer. Some pain of a lancinating type occurred in the breast at this

time. The patient first discovered her peculiar condition by a stain of

blood upon the night-gown on awakening in the morning, and this she

traced to the breast. From an examination it appeared that a neglected

lacerated cervix during the birth of the last child had given rise to

endometritis, and for a year the patient had suffered from severe

menorrhagia, for which she was subsequently treated. At this time the

menses became scanty, and then supervened the discharge of bloody fluid

from the left breast, as heretofore mentioned. The right breast

remained always entirely passive. A remarkable feature of the case was

that some escape of fluid occurred from the left breast during coitus.

As a possible means of throwing light on this subject it may be added

that the patient was unusually vigorous, and during the nursing of her

two children she had more than the ordinary amount of milk

(galactorrhea), which poured from the breast constantly. Since this

time the breasts had been quite normal, except for the tendency

manifested in the left one under the conditions given.

Cases of menstruation through the eyes are frequently mentioned by the

older writers. Bellini, Hellwig, and Dodonaeus all speak of

menstruation from the eye. Jonston quotes an example of ocular

menstruation in a young Saxon girl, and Bartholinus an instance

associated with bloody discharge of the foot. Guepin has an example in

a case of a girl of eighteen, who commenced to menstruate when three

years old. The menstruation was tolerably regular, occurring every

thirty-two or thirty-three days, and lasting from one to six days. At

the cessation of the menstrual flow, she generally had a supplementary

epistaxis, and on one occasion, when this was omitted, she suffered a

sudden effusion into the anterior chamber of the eye. The discharge had

only lasted two hours on this occasion. He also relates an example of

hemorrhage into the vitreous humor in a case of amenorrhea.

Conjunctival hemorrhage has been noticed as a manifestation of

vicarious menstruation by several American observers. Liebreich found

examples of retinal hemorrhage in suppressed menstruation, and Sir

James Paget says that he has seen a young girl at Moorfields who had a

small effusion of blood into the anterior chamber of the eye at the

menstrual period, which became absorbed during the intervals of

menstruation. Blair relates the history of a case of vicarious

menstruation attended with conjunctivitis and opacity of the cornea.

Law speaks of a plethoric woman of thirty who bled freely from the

eyes, though menstruating regularly.

Relative to menstruation from the ear, Spindler, Paullini, and Alibert

furnish examples. In Paullini's case the discharge is spoken of as very

foul, which makes it quite possible that this was a case of middle-ear

disease associated with some menstrual disturbance, and not one of true

vicarious menstruation. Alibert's case was consequent upon suppression

of the menses. Law cites an instance in a woman of twenty-three, in

whom the menstrual discharge was suspended several months. She

experienced fulness of the head and bleeding (largely from the ears),

which subsequently occurred periodically, being preceded by much

throbbing; but the patient finally made a good recovery. Barnes,

Stepanoff, and Field adduce examples of this anomaly. Jouilleton

relates an instance of menstruation from the right ear for five years,

Date: 2014-12-29; view: 876