THE LANCET  VOLUME 2  1840 Page 637

 EXTRAORDINARY DEVELOPMENT OF THE

MAMMÆ IN THE MALE

 

Letter to the Editor

The Lancet

 

Sir,

 

The exceedingly rare occurrence of a similar case similar to the following has induced me to forward a report of it to you.  I am Sir, your obedient servant.

John Gorham. Tonbridge, Kent, July 1840

 William Rogers, age 61, a native of Chatham and by trade a fisherman, states, that he has generally enjoyed good health.  He married at the age of thirty-three and has had three children, the last being thirteen years old.

Four years and a half ago he went into the Queen of Spain’s service, having been previously examined in the ordinary way and pronounced quite fit for service, being a strong hale man in every respect.  

On attempting to jump over an entrenchment in a retreat, and not being able to clear it, the anterior part of the body in the situation of the xyphoid cartilage, or thereabouts, was projected with great force against the upper and sharp edge of a wall; he was driven backwards and fell on his back.    While lying as if dead, one of the Carlists stabbed him with a bayonet a little below the orbit on the left side, and immediately afterwards he received a sabre wound over the frontal bone on the same side.  On regaining his senses he was able to walk for a short distance, and was immediately put to bed.  The symptoms induced by the accidents are referable to the following parts:- the spine; lower extremities; bladder; rectum; the testicles; the mammae and the hair.

Spine – When in Bilboa Hospital he had a great pain in the vertebral column and for this he was cupped repeatedly.  He now has a complete angular, or Potts’ curvature; the trunk is bent forwards and the spines processes of the vertebrae backwards; pain is complained of, and this, on percussing, appears to be most evident at the centre of the dorsal region, and also of the lumbar; there is a constriction of the upper part of the abdomen.

Lower Extremities – The right lower extremity is constantly affected with cramps and, as he describes it, “pins and needles” and is generally colder than the left; he can walk a distance of five or six miles a day.

Bladder – His urine was drawn off for about fourteen days after the accident; a complete paralysis of the bladder apparently then existing, but since that time he has been able to retain it. 

Rectum – The alvine dejections were passed at first and with great difficulty, sometimes involuntarily, and at others with pain.  Since the collapse of the diseased bones, however, and the recovery of the patient, with the consequent deformity, all these symptoms, more immediately dependent on the spinal lesion, have disappeared.

The most remarkable alterations produced are to be found in the three last named parts: the testicles, the mammary glands, and the hair.

Testes - Ever since the accident these glands have wasted; that on the right side is soft, pulpy, and the size of a small nutmeg; it is drawn upwards, close to the external abdominal ring.

The left testicle is somewhat larger, but still atrophied, and, as in health, is more pendulous than its fellow.  As regards their function, the poor fellow has not had the slightest sexual desire since the receipt of the injury.

Breasts – About three weeks after the accident, the integuments around each nipple became painful and swollen, and a tumour, analogous, as I image, to the areolar of Sir A. Cooper, was formed.  Leeches and poultices were applied.  However, the increase of substance did not stop there, for, as the testicles decreased in size, hypertrophy of the whole mammary region became more and more evident; each breast is, at this period, the size of an orange, glandular to the touch and pendulous.

Hair – This, on the face, is of a very tardy growth, so that he is obliged to shave much less frequently than formerly.

As far as I can judge from seeing him, only for a short time, he is a quiet and inoffensive person; his countenance struck me as being not effeminate, yet certainly devoid of that roughness and harsh appearance which so often predominate in the military, who have been chosen from the lower orders of people.  His voice was subdued, and he received a small trifle placed in his hands, as a compensation for allowing me to make a few remarks upon him, with apparent gratitude.  His spinal affection, it is true, might have caused all this, and therefore, the few circumstances here noticed I could not wish to be looked upon as a part of the narrative of the case.  It was thought at the Westminster Hospital that a lacteal secretion might possibly exist, and a cupping-glass was had recourse to, but, on producing a partial vacuum, no milk issued.

A cast of the head has been taken and he informs me, by Dr Elliotson, and one of the head unshaven, together with the bust, and other parts of his body, by Mr Deville; the occiput is very flat; but as the function over which the cerebellum partly presides was quite normal, and active before the injury, little weight must be attached to this circumstance.  The pulse was 56, and the respiration 20.