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stern cites a case of a mamma on the left shoulder nearly under the insertion of the deltoid； and Klob speaks of an acromial accessory mamma situated on the shoulder over the greatest prominence of the deltoid。 Hall reports the case of a functionally active supernumerary mamma over the costal cartilage of the 8th rib。 Jussieu speaks of a woman who had three breasts； one of which was situated on the groin and with which she occasionally suckled； her mother had three breasts； but they were all situated on the chest。 Saunois details an account of a female who had two supernumerary breasts on the back。 Bartholinus （quoted by Meckel） and Manget also mention mammae on the back； but Geoffroy…Saint…Hilaire questions their existence。 Martin gives a very clear illustration of a woman with a supernumerary breast below the natural organ。 Sneddon； who has collected quite a number of cases of polymazia； quotes the case of a woman who had two swellings in each axilla in which gland…structure was made out； but with no external openings； and which had no anatomic connection with the mammary glands proper。 Shortly after birth they varied in size and proportion； as the breasts were full or empty； and in five weeks all traces of them were lost。 Her only married sister had similar enlargements at her third confinement。
Polymazia sometimes seems to be hereditary。 Robert saw a daughter whose mother was polymastic； and Woodman saw a mother and eldest daughter who each had three nipples。 Lousier mentions a woman wanting a mamma who transmitted this vice of conformation to her daughter。 Handyside says he knew two brothers in both of whom breasts were wanting。
Supernumerary nipples alone are also seen； as many as five having been found on the same breast。 Neugebauer reports eight supernumerary nipples in one case。 Hollerus has seen a woman who had two nipples on the same breast which gave milk with the same regularity and the same abundance as the single nipple。 The Ephemerides contains a description of a triple nipple。 Barth describes 〃mamma erratica〃 on the face in front of the right ear which enlarged during menstruation。
Cases of deficiency of the nipples have been reported by the Ephemerides； Lentilius； Severinus； and Werckardus。
Cases of functional male mammae will be discussed in Chapter IX。
Complete absence of the hymen is very rare； if we may accept the statements of Devilliers； Tardieu； and Brouardel； as they have never seen an example in the numerous young girls they have examined from a medico…legal point of view。
Duplication or biperforation of the hymen is also a very rare anomaly of this membrane。 In this instance the hymen generally presents two lateral orifices； more or less irregular and separated by a membranous band； which gives the appearance of duplicity。 Roze reported from Strasburg in 1866 a case of this kind； and Delens has observed two examples of biperforate hymen； which show very well that this disposition of the membrane is due to a vice of conformation。 The first was in a girl of eleven； in which the membrane was of the usual size and thickness； but was duplicated on either side。 In her sister of nine the hymen was normally conformed。 The second case was in a girl under treatment by Cornil in 1876 for vaginitis。 Her brother had accused a young man of eighteen of having violated her； and on examination the hymen showed a biperforate conformation； there were two oval orifices； their greatest diameter being in the vertical plane； the openings were situated on each side of the median line； about five mm。 apart； the dividing band did not appear to be cicatricial； but presented the same roseate coloration as the rest of the hymen。 Since this report quite a number of cases have been recorded。
The different varieties of the hymen will be left to the works on obstetrics。 As has already been observed； labor is frequently seriously complicated by a persistent and tough hymen。
Deficient vulva may be caused by the persistence of a thick hymen； by congenital occlusion； or by absolute absence in vulvar structure。 Bartholinus； Borellus； Ephemerides； Julius； Vallisneri； and Baux are among the older writers who mention this anomaly； but as it is generally associated with congenital occlusion； or complete absence of the vagina； the two will be considered together。
Complete absence of the vagina is quite rare。 Baux a reports a case of a girl of fourteen in whom 〃there was no trace of fundament or of genital organs。〃 Oberteuffer speaks of a case of absent vagina。 Vicq d'Azir is accredited with having seen two females who； not having a vagina； copulated all through life by the urethra； and Fournier sagely remarks that the extra large urethra may have been a special dispensation of nature。 Bosquet describes a young girl of twenty with a triple vice of conformationan obliterated vulva； closure of the vagina； and absence of the uterus。 Menstrual hemorrhage took place from the gums。 Clarke has studied a similar case which was authenticated by an autopsy。
O'Ferral of Dublin； Gooch； Davies； Boyd； Tyler Smith； Hancock； Coste； Klayskens； Debrou； Braid； Watson； and others are quoted by Churchill as having mentioned the absence of the vagina。 Amussat observed a German girl who did not have a trace of a vagina and who menstruated regularly。 Griffith describes a specimen in the Museum of St。 Bartholomew's Hospital； London； in which the ovaries lay on the surface of the pelvic peritoneum and there was neither uterus nor vagina； the pelvis had some of the characteristics of the male type。 Matthews Duncan has observed a somewhat similar case； the vagina not measuring more than an inch in length。 Ferguson describes a prostitute of eighteen who had never menstruated。 The labia were found well developed； but there was no vagina； uterus； or ovaries。 Coitus had been through the urethra； which was considerably distended； though not causing incontinence of urine。 Hulke reports a case of congenital atresia of the vagina in a brunette of twenty； menstruation occurring through the urethra。 He also mentions the instance of congenital atresia of the vagina with hernia of both ovaries into the left groin in a servant of twenty； and the case of an imperforate vagina in a girl of nineteen with an undeveloped uterus。
Brodhurst reports an instance of absence of the vagina and uterus in a girl of sixteen who at four years of age showed signs of approaching puberty。 At this early age the mons was covered with hair； and at ten the clitoris was three inches long and two inches in circumference。 The mammae were well developed。 The labia descended laterally and expanded into folds； resembling the scrotum。
Azema reports an instance of complete absence of the vagina and impermeability and probable absence of the col uterinus。 The deficiencies were remedied by operation。 Berard mentions a similar deformity and operation in a girl of eighteen。 Gooding cites an instance of absent vagina in a married woman； the uterus discharging the functions。 Gosselin reports a case in which a voluminous tumor was formed by the retained menstrual fluid in a woman without a vagina。 An artificial vagina was created； but the patient died from extravasation of blood into the