anomalies and curiosities of medicine-第132部分

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it　without　rupturing　the　tunics　of　the　eye　or　breaking　the　bony　wall　of　the　cavity。　It　remained　lodged　two　weeks　without　causing　any　pain　or　symptoms；　and　subsequently　worked　itself　forward；　contained　in　a　perfect　conjunctival　sac；　in　which　it　was　freely　movable。

Buchanan　recites　the　case　of　a　private　in　the　army　who　was　shot　at　a　distance　of　three　feet　away；　the　ball　entering　the　inner　canthus　of　the　right　eye　and　lodging　under　the　skin　of　the　opposite　side。　The　eye　was　not　lost；　and　opacity　of　the　lower　part　of　the　cornea　alone　resulted。　Cold　water　and　purging　constituted　the　treatment。

It　is　said　a　that　an　old　soldier　of　one　of　Napoleon's　armies　had　a　musket…ball　removed　from　his　left　orbit　after　twenty…four　years'　lodgment。　He　was　struck　in　the　orbit　by　a　musket…ball；　but　as　at　the　same　time　a　companion　fell　dead　at　his　side　he　inferred　that　the　bullet　rebounded　from　his　orbit　and　killed　his　comrade。　For　twenty…four　years　he　had　suffered　from　cephalalgia　and　pains　and　partial　exophthalmos　of　the　left　eye。　After　removal　of　the　ball　the　eye　partially　atrophied。

Warren　reports　a　case　of　a　man　of　thirty…five　whose　eyeball　was　destroyed　by　the　explosion　of　a　gun；　the　breech…pin　flying　off　and　penetrating　the　head。　The　orbit　was　crushed；　fourteen　months　afterward　the　man　complained　of　soreness　on　the　hard　palate；　and　the　whole　breech…pin；　with　screw　attached；　was　extracted。　The　removal　of　the　pin　was　followed　by　fissure　of　the　hard　palate；　which；　however；　was　relieved　by　operation。　The　following　is　an　extract　of　a　report　by　Wenyon　of　Fatshan；　South　China：

〃Tang　Shan；　Chinese　farmer；　thirty…one　years　of　age；　was　injured　in　the　face　by　the　bursting　of　a　shot…gun。　After　being　for　upward　of　two　months　under　the　treatment　of　native　practitioners；　he　came　to　me　on　December　4；　1891。　I　observed　a　cicatrix　on　the　right　side　of　his　nose；　and　above　this　a　sinus；　still　unhealed；　the　orifice　of　which　involved　the　inner　canthus　of　the　right　eye；　and　extended　downward　and　inward　for　about　a　centimeter。　The　sight　of　the　right　eye　was　entirely　lost；　and　the　anterior　surface　of　the　globe　was　so　uniformly　red　that　the　cornea　could　hardly　be　distinguished　from　the　surrounding　conjunctiva。　There　was　no　perceptible　enlargement　or　protrusion　of　the　eyeball；　and　it　did　not　appear　to　have　sustained　any　mechanical　injury　or　loss　of　tissue。　The　ophthalmia　and　keratitis　were　possibly　caused　by　the　irritating　substances　applied　to　the　wound　by　the　Chinese　doctors。　The　sinus　on　the　side　of　the　nose　gave　exit　to　a　continuous　discharge　of　slightly　putrid　pus；　and　the　patient　complained　of　continuous　headache　and　occasional　dizziness；　which　interfered　with　his　work。　The　pain　was　referred　to　the　right　frontal　and　temporal　regions；　and　the　skin　on　this　part　of　the　head　had　a　slight　blush；　but　there　was　no　superficial　tenderness。　The　patient　had　been　told　by　his　native　doctors；　and　he　believed　it　himself；　that　there　was　no　foreign　body　in　the　wound；　but　on　probing　it　I　easily　recognized　the　lower　edge　of　a　hard　metallic　substance　at　a　depth　of　about　one　inch　posteriorly　from　the　orifice　of　the　sinus。　Being　unable　to　obtain　any　reliable　information　as　to　the　probable　size　or　shape　of　the　object；　I　cautiously　made　several　attempts　to　remove　it　through　a　slightly　enlarged　opening；　but　without　success。　I　therefore　continued　the　incision　along　the　side　of　the　nose　to　the　nostril；　thus　laying　open　the　right　nasal　cavity；　then；　seizing　the　foreign　body　with　a　pair　of　strong　forceps；　I　with　difficulty　removed　the　complete　breech…pin　of　a　Chinese　gun。　Its　size　and　shape　are　accurately　represented　by　the　accompanying　drawing。　The　breech…pin　measures　a　little　over　three　inches　in　length；　and　weighs　21　ounces；　or　75。6　grams。　It　had　evidently　lain　at　the　back　of　the　orbit；　inclined　upward　and　slightly　backward　from　its　point　of　entrance；　at　an　angle　of　about　45　degrees。　On　its　removal　the　headache　was　at　once　relieved　and　did　not　return。　In　ten　days　the　wound　was　perfectly　healed　and　the　patient　went　back　to　his　work。　A　somewhat　similar　case；　but　which　terminated　fatally；　is　recorded　in　the　American　Journal　of　the　Medical　Sciences　of　July；　1882。〃

The　extent　of　permanent　injury　done　by　foreign　bodies　in　the　orbit　is　variable。　In　some　instances　the　most　extensive　wound　is　followed　by　the　happiest　result；　while　in　others　vision　is　entirely　destroyed　by　a　minor　injury。

Carter　reports　a　case　in　which　a　hat…peg　3　3/10　inches　long　and　about　1/4　inch　in　diameter　（upon　one　end　of　which　was　a　knob　nearly　1/2　inch　in　diameter）　was　impacted　in　the　orbit　for　from　ten　to　twenty　days；　and　during　this　time　the　patient　was　not　aware　of　the　fact。　Recovery　followed　its　extraction；　the　vision　and　movements　of　the　eye　being　unimpaired。

According　to　the　Philosophical　Transactions　a　laborer　thrust　a　long　lath　with　great　violence　into　the　inner　canthus　of　the　left　eye　of　his　fellow　workman；　Edward　Roberts。　The　lath　broke　off　short；　leaving　a　piece　two　inches　long；　1/2　inch　wide；　and　1/4　inch　thick；　in　situ。　Roberts　rode　about　a　mile　to　the　surgery　of　Mr。　Justinian　Morse；　who　extracted　it　with　much　difficulty；　recovery　followed；　together　with　restoration　of　the　sight　and　muscular　action。　The　lath　was　supposed　to　have　passed　behind　the　eyeball。　Collette　speaks　of　an　instance　in　which　186　pieces　of　glass　were　extracted　from　the　left　orbit；　the　whole　mass　weighing　186　Belgian　grains。　They　were　blown　in　by　a　gust　of　wind　that　broke　a　pane　of　glass；　after　extraction　no　affection　of　the　brain　or　eye　occurred。　Watson　speaks　of　a　case　in　which　a　chip　of　steel　3/8　inch　long　was　imbedded　in　cellular　tissue　of　the　orbit　for　four　days；　and　was　removed　without　injury　to　the　eye。　Wordsworth　reports　a　case　in　which　a　foreign　body　was　deeply　imbedded　in　the　orbit　for　six　weeks；　and　was　removed　with　subsequent　recovery。　Chisholm　has　seen　a　case　in　which　for　five　weeks　a　fly　was　imbedded　in　the　culdesac　between　the　lower　lid　and　the　eyeball。

Foreign　bodies　are　sometimes　contained　in　the　eyeball　for　many　years。　There　is　an　instance　on　record　in　which　a　wooden　splinter；　five　mm。　long　and　two　mm。　broad；　remained　in　the　eye　forty…seven　years。　It　was　extracted；　with　the　lens　in　which　it　was　lodged；　to　relieve　pain　and　other　distressing　symptoms。　Snell　reports　a　case　in　which　a　piece　of　steel　was　imbedded　and　encapsulated　in　the　ciliary　process　twenty…nine　years　without　producing　sympathetic　irritation　of　its　fellow；　but　causing　such　pain　as　to　warrant　enucleation　of　this　eye。　Gunning　speaks　of　a　piece　of　thorn　5/8　inch　long；　imbedded　in　the　left　eyeball　of　an　old　man　for　six　years；　causing　total　loss　of　vision；　he　adds　that；　after　its　removal；　some　improvement　was　noticed。

Williams　mentions　a　stone…cutter　whose　left　eye　was　put　out　by　a　piece　of　stone。　Shortly　after　this　his　right　eye　was　wounded　by　a　knife；　causing　traumatic　cataract；　which　was　extracted　by　Sir　William　Wilde；　giving　the　man　good　sight　for　twelve　years；　after　which　iritis　attacked　the　right　eye　and　produced　a　false　membrane　over　the　pupil　so　that　the　man　could　not　work。　It　was　in　this　condition　that　he　consulted　Williams；　fourteen　years　after　the　loss　of　the　left　eye。　The　eye　was　atrophied；　and　on　examination　a　piece　of　stone　was　seen　projecting　from　it　directly　between　the　lids。　The　visible　portion　was　1/4　inch　long；　and　the　end　in　the　shrunken　eye　was　evidently　longer　than　the　end　protruding。　The　sclera　was　incised；　and；　after　fourteen　years'　duration　in　the　eye；　the　stone　was　removed。

Taylor　reports　the　removal　of　a　piece　of　bone　which　had　remained　quiescent　in　the　eye　for　fourteen　years；　after　the　removal　of　the　eye　the　bone　was　found　adherent　to　the　inner　tunics。　It　resembled　the　lens　in　size　and　shape。　Williams　mentions　continual　tolerance　of　foreign　bodies　in　the　eyeball　for　fifteen　and　twenty…two　years；　and　Chisholm　reports　the　lodgment　of　a　fragment　of　metal　in　the　iris　for　twenty…three　years。　Liebreich　extracted　a　piece　of　steel　from　the　interior　of　the　eye　where　it　had　been　lodged　twenty…two　years。　Barkar　speaks　of　a　piece　of　steel　which　penetrated　through　the　cornea　and　lens；　and　which；　five　months　later；　was　successfully　removed　by　the　extraction　of　the　cataractous　lens。　Critchett　gives　an　instance　of　a　foreign　body　being　loose　in　the　anterior　chamber　for　sixteen　years。　Rider　speaks　of　the　lodgment　of　a　fragment　of　a　copper　percussion　cap　in　the　left　eye；　back　of　the　inner　ciliary　margin　of　the　iris；　for　thirty…five　years；　and　Bartholinus　mentions　a　thorn　in　the　canthus　for　thirty　years。　Jacob　reports　a　case　in　which　a　chip　of　iron　remained　in　the　eyeball　twenty…eight　years　without　giving　indications　for　removal。　It　was　clearly　visible；　protruding　into　the　anterior　surface　of　the　iris；　and　although　it　was　rusted　by　its　long　lodgment；　sight　in　the　eye　was　fairly　good；　and　there　was　no　sign　of　irritation。

Snell　gives　an　instance　in　which　a　piece　of　steel　was　imbedded　close　to　the　optic　disc　with　retention　of　sight。　It　was　plainly　visible　by　the　opthalmoscope　eighteen　months　after　the　accident；　when　as　yet　no　diminution　of　sight　was　apparent。　Smyly　speaks　of　a　portion　of　a　tobacco　pipe　which　was　successfully　removed　from　the　anterior　chamber　by　an　incision　through　the　cornea。　Clark　mentions　a　case　in　which　molten　lead　in　the　eye　caused　no　permanent　injury；　and　there　are　several　cases　mentioned　in　confirmation　of　the　statement　that　the　eye　seems　to　be　remarkably　free　from　disastrous　effects　after　this　injury。

Williamson　mentions　eyelashes　in　the　anterior　chamber　of　the　eye；　the　result　of　a　stab　wound　of　this　organ。

Contusion　of　the　eyeball　may　cause　dislocation　of　the　lens　into　the　anterior　chamber；　and　several　instances　have　been　recorded。　We　regret　our　inability　to　give　the　reference　or　authority　for　a　report　that　we　have　seen；　stating　that　by　one　kick　of　a　horse　the　lenses　of　both　eyes　of　a　man　were　synchronously　knocked　through　the　eyeballs　by　the　calkins　of　the　horseshoe。　Oliver　mentions　extraction　of　a　lens　by　a　thrust　of　a　cow's　horn。

Lowe　speaks　of　rupture　of　the　anterior　capsule　of　the　lens　from　violent　sneezing；　with　subsequent　absorption　of　the　lenticular　substance　and　restoration　of　vision。　Trioen　mentions　a　curious　case　of　expulsion　of　the　crystalline　lens　from　the　eye　in　ophthalmia；　through　the　formation　of　a