PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. 2 page
There is the history of a woman who suffered from metastasis of milk to
the stomach, and who, with convulsive action of the chest and abdomen,
vomited it daily. A peculiar instance of milk in a tumor is that of a
Mrs. Reed, who, when pregnant with twins, developed an abdominal tumor
from which 25 pounds of milk was drawn off.
There is a French report of secretion of milk in the scrotum of a man
of twenty-one. The scrotum was tumefied, and to the touch gave the
sensation of a human breast, and the parts were pigmented similar to an
engorged breast. Analysis showed the secretion to have been true human
milk.
Cases of lactation in the new-born are not infrequent. Bartholinus,
Baricelli, Muraltus, Deusingius, Rhodius, Schenck, and Schurig mention
instances of it. Cardanus describes an infant of one month whose
breasts were swollen and gave milk copiously. Battersby cites a
description of a male child three weeks old whose breasts were full of
a fluid, analysis proving it to have been human milk; Darby, in the
same journal, mentions a child of eight days whose breasts were so
engorged that the nurse had to milk it. Faye gives an interesting paper
in which he has collected many instances of milk in the breasts of the
new-born. Jonston details a description of lactation in an infant.
Variot mentions milk-secretion in the new-born and says that it
generally takes place from the eighth to the fifteenth day and not in
the first week. He also adds that probably mammary abscesses in the
new-born could be avoided if the milk were squeezed out of the breasts
in the first days. Variot says that out of 32 children of both sexes,
aged from six to nine months, all but six showed the presence of milk
in the breasts. Gibb mentions copious milk-secretion in an infant, and
Sworder and Menard have seen young babes with abundant milk-secretion.
Precocious Lactation.--Bochut says that he saw a child whose breasts
were large and completely developed, offering a striking contrast to
the slight development of the thorax. They were as large as a stout
man's fist, pear-shaped, with a rosy areola, in the center of which was
a nipple. These precocious breasts increased in size at the beginning
of the menstrual epoch (which was also present) and remained enlarged
while the menses lasted. The vulva was covered with thick hair and the
external genitalia were well developed. The child was reticent, and
with a doll was inclined to play the role of mother.
Baudelocque mentions a girl of eight who suckled her brother with her
extraordinarily developed breasts. In 1783 this child milked her
breasts in the presence of the Royal Academy at Paris. Belloc spoke of
a similar case. There is another of a young negress who was able to
nourish an infant; and among the older writers we read accounts of
young virgins who induced lactation by applying infants to their
breasts. Bartholinus, Benedictus, Hippocrates, Lentilius, Salmuth, and
Schenck mention lactation in virgins.
De la Coide describes a case in which lactation was present, though
menstruation had always been deficient. Dix, at the Derby Infirmary,
has observed two females in whom there was continued lactation,
although they had never been pregnant. The first was a chaste female of
twenty-five, who for two years had abundant and spontaneous discharge
of milk that wetted the linen; and the other was in a prostitute of
twenty, who had never been pregnant, but who had, nevertheless, for
several months an abundant secretion of healthy milk. Zoologists know
that a nonpregnant bitch may secrete milk in abundance. Delafond and de
Sinnety have cited instances.
Lactation in the aged has been frequently noticed. Amatus Lusitanus and
Schenck have observed lactation in old women; in recent years Dunglison
has collected some instances. Semple relates the history of an elderly
woman who took charge of an infant the mother of which had died of
puerperal infection. As a means of soothing the child she allowed it to
take the nipple, and, strange to say, in thirty-six hours milk appeared
in her breasts, and soon she had a flow as copious as she had ever had
in her early married life. The child thrived on this production of a
sympathetic and spontaneous lactation. Sir Hans Sloane mentions a lady
of sixty-eight who though not having borne a child for twenty years,
nursed her grandchildren one after another.
Montegre describes a woman in the Department of Charente who bore two
male children in 1810. Not having enough milk for both, and being too
poor to secure the assistance of a midwife, in her desperation she
sought an old woman named Laverge, a widow of sixty-five, whose husband
had been dead twenty-nine years. This old woman gave the breast to one
of the children, and in a few days an abundant flow of milk was
present. For twenty-two months she nursed the infant, and it thrived as
well as its brother, who was nursed by their common mother--in fact, it
was even the stronger of the two.
Dargan tells of a case of remarkable rejuvenated lactation in a woman
of sixty, who, in play, placed the child to her breast, and to her
surprise after three weeks' nursing of this kind there appeared an
abundant supply of milk, even exceeding in amount that of the young
mother.
Blanchard mentions milk in the breasts of a woman of sixty, and Krane
cites a similar instance. In the Philosophical Transactions there is an
instance of a woman of sixty-eight having abundant lactation.
Warren, Boring, Buzzi, Stack, Durston, Egan, Scalzi, Fitzpatrick, and
Gillespie mention rejuvenation and renewed lactation in aged women.
Ford has collected several cases in which lactation was artificially
induced by women who, though for some time not having been pregnant
themselves, nursed for others.
Prolonged lactation and galactorrhea may extend through several
pregnancies. Green reports the case of a woman of forty-seven, the
mother of four children, who after each weaning had so much milk
constantly in her breasts that it had to be drawn until the next birth.
At the time of report the milk was still secreting in abundance. A
similar and oft-quoted case was that of Gomez Pamo, who described a
woman in whom lactation seemed indefinitely prolonged; she married at
sixteen, two years after the establishment of menstruation. She became
pregnant shortly after marriage, and after delivery had continued
lactation for a year without any sign of returning menstruation. Again
becoming pregnant, she weaned her first child and nursed the other
without delay or complication. This occurrence took place fourteen
times. She nursed all 14 of her children up to the time that she found
herself pregnant again, and during the pregnancies after the first the
flow of milk never entirely ceased; always after the birth of an infant
she was able to nurse it. The milk was of good quality and always
abundant, and during the period between her first pregnancy to seven
years after the birth of her last child the menses had never
reappeared. She weaned her last child five years before the time of
report, and since then the milk had still persisted in spite of all
treatment. It was sometimes so abundant as to necessitate drawing it
from the breast to relieve painful tension.
Kennedy describes a woman of eighty-one who persistently menstruated
through lactation, and for forty-seven years had uninterruptedly nursed
many children, some of which were not her own. Three years of this time
she was a widow. At the last reports she had a moderate but regular
secretion of milk in her eighty-first year.
In regard to profuse lacteal flow, Remy is quoted as having seen a
young woman in Japan from whom was taken 12 1/2 pints of milk each day,
which is possibly one of the most extreme instance of continued
galactorrhea on record.
Galen refers to gynecomastia or gynecomazia; Aristotle says he has seen
men with mammae a which were as well developed as those of a woman, and
Paulus aegineta recognized the fact in the ancient Greeks. Subsequently
Albucasis discusses it in his writings. Bartholinus, Behr, Benedictus,
Borellus, Bonet, the Ephemerides, Marcellus Donatus, Schenck, Vesalius,
Schacher, Martineau, and Buffon all discuss the anomalous presence of
milk in the male breast. Puech says that this condition is found in one
out of 13,000 conscripts.
To Bedor, a marine surgeon, we owe the first scientific exposition of
this subject, and a little later Villeneuve published his article in
the French dictionary. Since then many observations have been made on
this subject, and quite recently Laurent has published a most
exhaustive treatise upon it.
Robert describes an old man who suckled a child, and Meyer discusses
the case of a castrated man who was said to suckle children. It is said
that a Bishop of Cork, who gave one-half crown to an old Frenchman of
seventy, was rewarded by an exhibition of his breasts, which were
larger than the Bishop had ever seen in a woman. Petrequin speaks of a
male breast 18 inches long which he amputated, and Laurent gives the
photograph of a man whose breasts measured 30 cm. in circumference at
the base, and hung like those of a nursing woman.
In some instances whole families with supernumerary breasts are seen.
Handyside gives two instances of quadruple breasts in brothers.
Blanchard speaks of a father who had a supernumerary nipple on each
breast and his seven sons had the same deformities; it was not noticed
in the daughters. The youngest son transmitted this anomaly to his four
sons. Petrequin describes a man with three mammae, two on the left
side, the third being beneath the others. He had three sons with
accessory mammae on the right side and two daughters with the same
anomaly on the left side. Savitzky reports a case of gynecomazia in a
peasant of twenty-one whose father, elder brother, and a cousin were
similarly endowed. The patient's breasts were 33 cm. in circumference
and 15 cm. from the nipple to the base of the gland; they resembled
normal female mammae in all respects. The penis and the other genitalia
were normal, but the man had a female voice and absence of facial hair.
There was an abundance of subcutaneous fat and a rather broad pelvis.
Wiltshire said that he knew a gynecomast in the person of a
distinguished naturalist who since the age of puberty observed activity
in his breasts, accompanied with secretion of milky fluid which lasted
for a period of six weeks and occurred every spring. This authority
also mentions that the French call husbands who have well-developed
mammae "la couvade;" the Germans call male supernumerary breasts
"bauchwarze," or ventral nipples. Hutchinson describes several cases
of gynecomazia, in which the external genital organs decreased in
proportion to the size of the breast and the manners became effeminate.
Cameron, quoted by Snedden, speaks of a fellow-student who had a
supernumerary nipple, and also says he saw a case in a little boy who
had an extra pair of nipples much wider than the ordinary ones.
Ansiaux, surgeon of Liege, saw a conscript of thirteen whose left mamma
was well developed like that of a woman, and whose nipple was
surrounded by a large areola. He said that this breast had always been
larger than the other, but since puberty had grown greatly; the genital
organs were well formed. Morgan examined a seaman of twenty-one,
admitted to the Royal Naval Hospital at Hong Kong, whose right mamma,
in size and conformation, had the appearance of the well developed
breast of a full-grown woman. It was lobulated and had a large,
brown-colored areola; the nipple, however, was of the same size as that
on the left breast. The man stated that he first observed the breast to
enlarge at sixteen and a half years; since that time it had steadily
increased, but there was no milk at any time from the nipple; the
external genital organs were well and fully developed. He complained of
no pain or uneasiness except when in drilling aloft his breast came in
contact with the ropes.
Gruger of St. Petersburg divides gynecomazia into three classes:--
(1) That in which the male generative organs are normal;
(2) In which they are deformed;
(3) In which the anomaly is spurious, the breast being a mass of fat or
a new growth.
The same journal quotes an instance (possibly Morgan's case) in a young
man of twenty-one with a deep voice, excellent health, and genitals
well developed, and who cohabited with his wife regularly. When sixteen
his right breast began to enlarge, a fact that he attributed to the
pressure of a rope. Glandular substance could be distinctly felt, but
there was no milk-secretion. The left breast was normal. Schuchardt has
collected 272 cases of gynecomazia.
Instances of Men Suckling Infants.--These instances of gynecomazia are
particularly interesting when the individuals display ability to suckle
infants. Hunter refers to a man of fifty who shared equally with his
wife the suckling of their children. There is an instance of a sailor
who, having lost his wife, took his son to his own breast to quiet him,
and after three or four days was able to nourish him. Humboldt
describes a South American peasant of thirty-two who, when his wife
fell sick immediately after delivery, sustained the child with his own
milk, which came soon after the application to the breast; for five
months the child took no other nourishment. In Franklin's "Voyages to
the Polar Seas" he quotes the instance of an old Chippewa who, on
losing his wife in childbirth, had put his infant to his breast and
earnestly prayed that milk might flow; he was fortunate enough to
eventually produce enough milk to rear the child. The left breast, with
which he nursed, afterward retained its unusual size. According to
Mehliss some missionaries in Brazil in the sixteenth century asserted
that there was a whole Indian nation whose women had small and withered
breasts, and whose children owed their nourishment entirely to the
males. Hall exhibited to his class in Baltimore a negro of fifty-five
who had suckled all his mistress' family. Dunglison reports this case
in 1837, and says that the mammae projected seven inches from the
chest, and that the external genital organs were well developed.
Paullini and Schenck cite cases of men suckling infants, and Blumenbach
has described a male-goat which, on account of the engorgement of the
mammae, it was necessary to milk every other day of the year.
Ford mentions the case of a captain who in order to soothe a child's
cries put it to his breast, and who subsequently developed a full
supply of milk. He also quotes an instance of a man suckling his own
children, and mentions a negro boy of fourteen who secreted milk in one
breast. Hornor and Pulido y Fernandez also mention similar instances of
gynecomazia.
Human Odors.--Curious as it may seem, each individual as well as each
species is in life enveloped with an odor peculiarly its own, due to
its exhaled breath, its excretions, and principally to its insensible
perspiration. The faculty of recognizing an odor in different
individuals, although more developed in savage tribes, is by no means
unknown in civilized society. Fournier quotes the instance of a young
man who, like a dog, could smell the enemy by scent, and who by smell
alone recognized his own wife from other persons.
Fournier also mentions a French woman, an inhabitant of Naples, who had
an extreme supersensitiveness of smell. The slightest odor was to her
intolerable; sometimes she could not tolerate the presence of certain
individuals. She could tell in a numerous circle which women were
menstruating. This woman could not sleep in a bed which any one else
had made, and for this reason discharged her maid, preparing her own
toilet and her sleeping apartments. Cadet de Gassieourt witnessed this
peculiar instance, and in consultation with several of the physicians
of Paris attributed this excessive sensitiveness to the climate. There
is a tale told of a Hungarian monk who affirmed that he was able to
decide the chastity of females by the sense of smell alone. It is well
known that some savage tribes with their large, open nostrils not only
recognize their enemies but also track game the same as hounds.
Individual Odors.--Many individuals are said to have exhaled
particularly strong odors, and history is full of such instances. We
are told by Plutarch that Alexander the Great exhaled an odor similar
to that of violet flowers, and his undergarments always smelled of this
natural perfume. It is said that Cujas offered a particular analogy to
this. On the contrary, there are certain persons spoken of who exhaled
a sulphurous odor. Martial said that Thais was an example of the class
of people whose odor was insupportable. Schmidt has inserted in the
Ephemerides an account of a journeyman saddler, twenty-three years of
age, of rather robust constitution, whose hands exhaled a smell of
sulphur so powerful and penetrating as to rapidly fill any room in
which he happened to be. Rayer was once consulted by a valet-de-chambre
who could never keep a place in consequence of the odor he left behind
him in the rooms in which he worked.
Hammond is quoted with saying that when the blessed Venturni of
Bergamons officiated at the altar people struggled to come near him in
order to enjoy the odor he exhaled. It was said that St. Francis de
Paul, after he had subjected himself to frequent disciplinary
inflictions, including a fast of thirty-eight to forty days, exhaled a
most sensible and delicious odor. Hammond attributes the peculiar odors
of the saints of earlier days to neglect of washing and, in a measure,
to affections of the nervous system. It may be added that these odors
were augmented by aromatics, incense, etc., artificially applied. In
more modern times Malherbe and Haller were said to diffuse from their
bodies the agreeable odor of musk. These "human flowers," to use
Goethe's expression, are more highly perfumed in Southern latitudes.
Modifying Causes.--According to Brieude, sex, age, climate, habits,
ailments, the passions, the emotions, and the occupations modify the
difference in the humors exhaled, resulting in necessarily different
odors. Nursing infants have a peculiar sourish smell, caused by the
butyric acid of the milk, while bottle-fed children smell like strong
butter. After being weaned the odors of the babies become less decided.
Boys when they reach puberty exhibit peculiar odors which are similar
to those of animals when in heat. These odors are leading symptoms of
what Borden calls "seminal fever" and are more strongly marked in those
of a voluptuous nature. They are said to be caused by the absorption of
spermatic fluid into the circulation and its subsequent elimination by
the skin. This peculiar circumstance, however, is not seen in girls, in
whom menstruation is sometimes to be distinguished by an odor somewhat
similar to that of leather. Old age produces an odor similar to that of
dry leaves, and there have been persons who declared that they could
tell approximately the age of individuals by the sense of smell.
Certain tribes and races of people have characteristic odors. Negroes
have a rank ammoniacal odor, unmitigated by cleanliness; according to
Pruner-Bey it is due to a volatile oil set free by the sebaceous
follicles. The Esquimaux and Greenlanders have the odors of their
greasy and oily foods, and it is said that the Cossacks, who live much
with their horses, and who are principally vegetarians, will leave the
atmosphere charged with odors several hours after their passage in
numbers through a neighborhood. The lower race of Chinamen are
distinguished by a peculiar musty odor, which may be noticed in the
laundry shops of this country. Some people, such as the low grade of
Indians, have odors, not distinctive, and solely due to the filth of
their persons. Food and drink, as have been mentioned, markedly
influence the odor of an individual, and those perpetually addicted to
a special diet or drink have a particular odor.
Odor after Coitus.--Preismann in 1877 makes the statement that for six
hours after coitus there is a peculiar odor noticeable in the breath,
owing to a peculiar secretion of the buccal glands. He says that this
odor is most perceptible in men of about thirty-five, and can be
discerned at a distance of from four to six feet. He also adds that
this fact would be of great medicolegal value in the early arrest of
those charged with rape. In this connection the analogy of the breath
immediately after coitus to the odor of chloroform has been mentioned.
The same article states that after coitus naturally foul breath becomes
sweet.
The emotions are said to have a decided influence on the odor of an
individual. Gambrini, quoted by Monin, mentions a young man,
unfortunate in love and violently jealous, whose whole body exhaled a
sickening, pernicious, and fetid odor. Orteschi met a young lady who,
without any possibility of fraud, exhaled the strong odor of vanilla
from the commissures of her fingers.
Rayer speaks of a woman under his care at the Hopital de la Charite
affected with chronic peritonitis, who some time before her death
exhaled a very decided odor of musk. The smell had been noticed several
days, but was thought to be due to a bag of musk put purposely into the
bed to overpower other bad smells. The woman, however, gave full
assurance that she had no kind of perfume about her and that her
clothes had been frequently changed. The odor of musk in this case was
very perceptible on the arms and other portions of the body, but did
not become more powerful by friction. After continuing for about eight
days it grew fainter and nearly vanished before the patient's death.
Speranza relates a similar case.
Complexion.--Pare states that persons of red hair and freckled
complexion have a noxious exhalation; the odor of prussic acid is said
to come from dark individuals, while blondes exhale a secretion
resembling musk. Fat persons frequently have an oleaginous smell.
The disorders of the nervous system are said to be associated with
peculiar odors. Fevre says the odor of the sweat of lunatics resembles
that of yellow deer or mice, and Knight remarks that the absence of
this symptom would enable him to tell whether insanity was feigned or
not. Burrows declares that in the absence of further evidence he would
not hesitate to pronounce a person insane if he could perceive certain
associate odors. Sir William Gull and others are credited with
asserting that they could detect syphilis by smell. Weir Mitchell has
observed that in lesions of nerves the corresponding cutaneous area
exhaled the odor of stagnant water. Hammond refers to three cases under
his notice in which specific odors were the results of affections of
the nervous system. One of these cases was a young woman of hysterical
tendencies who exhaled the odor of violets, which pervaded her
apartments. This odor was given off the left half of the chest only and
could be obtained concentrated by collecting the perspiration on a
handkerchief, heating it with four ounces of spirit, and distilling the
remaining mixture. The administration of the salicylate of soda
modified in degree this violaceous odor. Hammond also speaks of a young
lady subject to chorea whose insensible perspiration had an odor of
pineapples; a hypochondriac gentleman under his care smelled of
violets. In this connection he mentions a young woman who, when
suffering from intense sick headache, exhaled an odor resembling that
of Limburger cheese.
Barbier met a case of disordered innervation in a captain of infantry,
the upper half of whose body was subject to such offensive perspiration
that despite all treatment he had to finally resign his commission.
In lethargy and catalepsy the perspiration very often has a cadaverous
odor, which has probably occasionally led to a mistaken diagnosis of
death. Schaper and de Meara speak of persons having a cadaveric odor
during their entire life.
Various ingesta readily give evidence of themselves by their influence
upon the breath. It has been remarked that the breath of individuals
who have recently performed a prolonged necropsy smells for some hours
of the odor of the cadaver. Such things as copaiba, cubebs, sandalwood,
alcohol, coffee, etc., have their recognizable fragrance. There is an
instance of a young woman taking Fowler's solution who had periodic
offensive axillary sweats that ceased when the medicine was
discontinued.
Henry of Navarre was a victim of bromidrosis; proximity to him was
insufferable to his courtiers and mistresses, who said that his odor
was like that of carrion. Tallemant says that when his wife, Marie de
Medicis, approached the bridal night with him she perfumed her
apartments and her person with the essences of the flowers of her
country in order that she might be spared the disgusting odor of her
spouse. Some persons are afflicted with an excessive perspiration of
the feet which often takes a disgusting odor. The inguinoscrotal and
inguinovulvar perspirations have an aromatic odor like that of the
genitals of either sex.
During menstruation, hyperidrosis of the axillae diffuses an aromatic
odor similar to that of acids or chloroform, and in suppression of
menses, according to the Ephemerides, the odor is as of hops.
Odors of Disease.--The various diseases have their own peculiar odors.
The "hospital odor," so well known, is essentially variable in
character and chiefly due to an aggregation of cutaneous exhalations.
The wards containing women and children are perfumed with butyric acid,
while those containing men are influenced by the presence of alkalies
like ammonia.
Gout, icterus, and even cholera (Drasch and Porker) have their own
odors. Older observers, confirmed by Doppner, say that all the
plague-patients at Vetlianka diffused an odor of honey. In diabetes
there is a marked odor of apples. The sweat in dysentery unmistakably
bears the odor of the dejecta. Behier calls the odor of typhoid that of
the blood, and Berard says that it attracts flies even before death.
Typhus has a mouse-like odor, and the following diseases have at
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