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； 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 coitu