Anomalies and Curiosities of Medicine. George M. Gould
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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, following a miscarriage.
Hemorrhage from the mouth of a vicarious nature has been frequently observed associated with menstrual disorders. The Ephemerides, Meibomius, and Rhodius mention instances. The case of Meibomius was that of an infant, and the case mentioned by Rhodius was associated with hemorrhages from the lungs, umbilicus, thigh, and tooth-cavity. Allport reports the history of a case in which there was recession of the gingival margins and alveolar processes, the consequence of amenorrhea. Caso has an instance of menstruation from the gums, and there is on record the description of a woman, aged thirty-two, who had bleeding from the throat preceding menstruation; later the menstruation ceased to be regular, and four years previously, after an unfortunate and violent connection, the menses ceased, and the woman soon developed hemorrhoids and hemoptysis. Henry speaks of a woman who menstruated from the mouth; at the necropsy 207 stones were found in the gall-bladder. Krishaber speaks of a case of lingual menstruation at the epoch of menstruation.
Descriptions of menstruation from the extremities are quite numerous. Pechlin offers an example from the foot; Boerhaave from the skin of the hand; Ephemerides from the knee; Albertus from the foot; Zacutus Lusitanus from the left thumb; Bartholinus a curious instance from the hand; and the Ephemerides another during pregnancy from the ankle.
Post speaks of a very peculiar case of edema of the arm alternating with the menstrual discharge. Sennert writes of menstruation from the groin associated with hemorrhage from the umbilicus and gums. Moses offers an example of hemorrhage from the umbilicus, doubtless vicarious. Verduc details the history of two cases from the top of the head, and Kerokring cites three similar instances, one of which was associated with hemorrhage from the hand.
A peculiar mode is vicarious menstrual hemorrhage through old ulcers, wounds, or cicatrices, and many examples are on record, a few of which will be described. Calder gives an excellent account of menstruation at an ankle-ulcer, and Brincken says he has seen periodical bleeding from the cicatrix of a leprous ulcer. In the Lancet is an account of a case in the Vienna Hospital of simulated stigmata; the scar opened each month and a menstrual flow proceeded therefrom; but by placing a plaster-of-Paris bandage about the wound, sealing it so that tampering with the wound could be easily detected, healing soon ensued, and the imposture was thus exposed. Such would likely be the result of the investigation of most cases of "bleeding wounds" which are exhibited to the ignorant and superstitious for religious purposes.
Hogg publishes a report describing a young lady who injured her leg with the broken steel of her crinoline. The wound healed nicely, but always burst out afresh the day preceding the regular period. Forster speaks of a menstrual ulcer of the face, and Moses two of the head. White, quoted by Barnes, cites an instance of vicarious hemorrhage from five deep fissures of the lips in a girl of fourteen; the hemorrhage was periodical and could not be checked. At the advent of each menstrual period the lips became much congested, and the recently-healed menstrual scars burst open anew.
Knaggs relates an interesting account of a sequel to an operation for ovarian disease. Following the operation, there was a regular, painless menstruation every month, at which time the lower part of the wound re-opened, and blood issued forth during the three days of the catamenia. McGraw illustrates vicarious menstruation by an example, the discharge issuing from an ovariotomy-scar, and Hooper cites an instance in which the vicarious function was performed by a sloughing ulcer. Buchanan and Simpson describe "amenorrheal ulcers." Dupuytren speaks of denudation of the skin from a burn, with the subsequent development of vicarious catamenia from the seat of the injury.
There are cases on record in which the menstruation occurs by the rectum or the urinary tract. Barbee illustrates this by a case in which cholera morbus occurred monthly in lieu of the regular menstrual discharge. Barrett speaks of a case of vicarious menstruation by the rectum. Astbury says he has seen a case of menstruation by the hemorrhoidal vessels, and instances of relief from plethora by vicarious menstruation in this manner are quite common. Rosenbladt cites an instance of menstruation by the bladder, and Salmuth speaks of a pregnant woman who had her monthly flow by the urinary tract. Ford illustrates this anomaly by the case of a woman of thirty-two, who began normal menstruation at fourteen; for quite a period she had vicarious menstruation from the urinary tract, which ceased after the birth of her last child. The coexistence of a floating kidney in this case may have been responsible for this hemorrhage, and in reading reports of so-called menstruation due consideration must be given to the existence of any other than menstrual derangement before we can accept the cases as true vicarious hemorrhage. Tarnier cites an instance of a girl without a uterus, in whom menstruation proceeded from the vagina. Zacutus Lusitanus relates the history of a case of uterine occlusion, with the flow from the lips of the cervix. There is mentioned an instance of menstruation from the labia.
The occurrence of menstruation after removal of the uterus or ovaries is frequently reported. Storer, Clay, Tait, and the British and Foreign Medico-Chirurgical Review report cases in which menstruation took place with neither uterus nor ovary. Doubtless