anomalies and curiosities of medicine-第136部分

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　the　shaft。　The　entire　skull　was　laid　bare　from　the　margin　of　the　eyelids　to　the　neck。　The　nasal　bones　were　uncovered　and　broken；　exposing　the　superior　nasal　meatus。　The　skin　of　the　eyelids　was　removed　from　within　three　mm。　of　their　edges。　The　lower　margin　of　the　wound　was　traceable　from　the　lower　portion　of　the　left　external　process　of　the　frontal　bone；　downward　and　backward　below　the　left　ear　（which　was　entirely　removed）；　thence　across　the　neck；　five　cm。　below　the　superior　curved　line　of　the　occipital　bone；　and　forward　through　the　lower　one…third　of　the　right　auricle　to　the　right　external　angular　process　of　the　frontal　bone　and　margin　of　the　right　upper　eyelid；　across　the　lid；　nose；　and　left　eyelid；　to　the　point　of　commencement。　Every　vessel　and　nerve　supplying　the　scalp　was　destroyed；　and　the　pericranium　was　torn　off　in　three　places；　one　of　the　denuded　spots　measuring　five　by　seven　cm。　and　another　five　by　six　cm。　The　neck　flap　of　the　wound　fell　away　from　the　muscular　structures　beneath　it；　exposing　the　trapezius　muscle　almost　one…half　the　distance　to　the　shoulder　blade。　The　right　ear　was　torn　across　in　its　lower　third；　and　hung　by　the　side　of　the　neck　by　a　piece　of　skin　less　than　five　mm。　wide。　The　exposed　surface　of　the　wound　measured　40　cm。　from　before　back；　and　34　cm。　in　width　near　the　temporal　portion。　The　cranial　sutures　were　distinctly　seen　in　several　places；　and　only　a　few　muscular　fibers　of　the　temporal　were　left　on　each　side。　Hemorrhage　was　profuse　from　the　temporal；　occipital；　and　posterior　auricular　arteries；　which　were　tied。　The　patient　was　seen　three…quarters　of　an　hour　after　the　injury；　and　the　mangled　scalp　was　thoroughly　washed　in　warm　carbolized　water；　and　stitched　back　in　position；　after　the　hair　was　cut　from　the　outer　surface。　Six　weeks　after　the　injury　suppuration　was　still　free；　and　skin…grafting　was　commenced。　In　all；　4800　grafts　were　used；　the　patient　supplying　at　different　times　1800　small　grafts。　Her　own　skin　invariably　did　better　than　foreign　grafts。　In　ten　months　she　had　almost　completely　recovered；　and　sight　and　hearing　had　returned。　Figure　191　shows　the　extent　of　the　injury；　and　the　ultimate　results　of　the　treatment。

Schaeffer　also　reports　the　case　of　a　woman　working　in　a　button　factory　at　Union　City；　Conn。；　in　1871；　who　placed　her　head　under　a　swiftly　turning　shaft　to　pick　up　a　button；　when　her　hair　caught　in　the　shaft；　taking　off　her　scalp　from　the　nape　of　the　neck　to　the　eyebrows。　The　scalp　was　cleansed　by　her　physician；　Dr。　Bartlett；　and　placed　on　her　head　about　two　hours　after　the　accident；　but　it　did　not　stay　in　position。　Then　the　head　was　covered　twice　by　skin…grafts；　but　each　time　the　grafts　were　lost；　but　the　third　time　a　successful　grafting　was　performed　and　she　was　enabled　to　work　after　a　period　of　two　years。　The　same　authority　also　quotes　Wilson　and　Way　of　Bristol；　Conn。；　in　an　account　of　a　complete　avulsion　of　the　scalp；　together　with　tearing　of　the　eyelid　and　ear。　The　result　of　the　skin…grafting　was　not　given。　Powell　of　Chicago　gives　an　account　of　a　girl　of　nineteen　who　lost　her　scalp　while　working　in　the　Elgin　Watch　Factory　at　Elgin；　Illinois。　The　wound　extended　across　the　forehead　above　the　eyebrows；　but　the　ears　were　untouched。　Skin…　grafting　was　tried　in　this　case　but　with　no　result；　and　the　woman　afterward　lost　an　eye　by　exposure；　from　retraction　of　the　eyelid。

In　some　cases　extensive　wounds　of　the　scalp　heal　without　artificial　aid　by　simply　cicatrizing　over。　Gross　mentions　such　a　case　in　a　young　lady；　who；　in　1869；　lost　her　scalp　in　a　factory。　There　is　reported　an　account　of　a　conductor　on　the　Union　Pacific　Railroad；　who；　near　Cheyenne；　in　1869；　was　scalped　by　Sioux　Indians。　He　suffered　an　elliptic　wound；　ten　by　eight　cm。；　a　portion　of　the　outer　table　of　the　cranium　being　removed；　yet　the　wound　healed　over。

Cerebral　Injuries。The　recent　advances　in　brain…surgery　have；　in　a　measure；　diminished　the　interest　and　wonder　of　some　of　the　older　instances　of　major　injuries　of　the　cerebral　contents　with　unimportant　after…results；　and　in　reviewing　the　older　cases　we　must　remember　that　the　recoveries　were　made　under　the　most　unfavorable　conditions；　and　without　the　slightest　knowledge　of　all　important　asepsis　and　antisepsis。

Penetration　or　even　complete　transfixion　of　the　brain　is　not　always　attended　with　serious　symptoms。　Dubrisay　is　accredited　with　the　description　of　a　man　of　forty…four；　who；　with　suicidal　intent；　drove　a　dagger　ten　cm。　long　and　one　cm。　wide　into　his　brain。　He　had　deliberately　held　the　dagger　in　his　left　hand。　and　with　a　mallet　in　his　right　hand　struck　the　steel　several　blows。　When　seen　two　hours　later　he　claimed　that　he　experienced　no　pain；　and　the　dagger　was　sticking　out　of　his　head。　For　half　an　hour　efforts　at　extraction　were　made；　but　with　no　avail。　He　was　placed　on　the　ground　and　held　by　two　persons　while　traction　was　made　with　carpenter's　pliers。　This　failing；　he　was　taken　to　a　coppersmith's；　where　he　was　fastened　by　rings　to　the　ground；　and　strong　pinchers　were　placed　over　the　dagger　and　attached　to　a　chain　which　was　fastened　to　a　cylinder　revolved　by　steam　force。　At　the　second　turn　of　the　cylinder　the　dagger　came　out。　During　all　the　efforts　at　extraction　the　patient　remained　perfectly　cool　and　complained　of　no　pain。　A　few　drops　of　blood　escaped　from　the　wound　after　the　removal　of　the　dagger；　and　in　a　few　minutes　the　man　walked　to　a　hospital　where　he　remained　a　few　days　without　fever　or　pain。　The　wound　healed；　and　he　soon　returned　to　work。　By　experiments　on　the　cadaver　Dubrisay　found　that　the　difficulty　in　extraction　was　due　to　rust　on　the　steel；　and　by　the　serrated　edges　of　the　wound　in　the　bone。

Warren　describes　a　case　of　epilepsy　of　seven　months'　standing；　from　depression　of　the　skull　caused　by　a　red　hot　poker　thrown　at　the　subject's　head。　Striking　the　frontal　bone　just　above　the　orbit；　it　entered　three　inches　into　the　cerebral　substance。　Kesteven　reports　the　history　of　a　boy　of　thirteen　who；　while　holding　a　fork　in　his　hand；　fell　from　the　top　of　a　load　of　straw。　One　of　the　prongs　entered　the　head　one　inch　behind　and　on　a　line　with　the　lobe　of　the　left　ear　and　passed　upward　and　slightly　backward　to　almost　its　entire　length。　With　some　difficulty　it　was　withdrawn　by　a　fellow　workman；　the　point　was　bent　on　itself　to　the　extent　of　two　inches。　The　patient　lived　nine　days。　Abel　and　Colman　have　reported　a　case　of　puncture　of　the　brain　with　loss　of　memory；　of　which　the　following　extract　is　an　epitome：　〃A　railway…fireman；　thirty…six　years　old；　while　carrying　an　oil…feeder　in　his　hand；　slipped　and　fell　forward；　the　spout　of　the　can　being　driven　forcibly　into　his　face。　There　was　transitory　loss　of　consciousness；　followed　by　twitching　and　jerking　movements　of　the　limbs；　most　marked　on　the　left　side；　the　legs　being　drawn　up　and　the　body　bent　forward。　There　was　no　hemorrhage　from　mouth；　nose；　or　ears。　The　metallic　spout　of　the　oil…can　was　firmly　fixed　in　the　base　of　the　skull；　and　was　only　removed　from　the　grasp　of　the　bone　by　firm　traction　with　forceps。　It　had　passed　upward　and　toward　the　middle　line；　with　its　concavity　directed　from　the　middle　line。　Its　end　was　firmly　plugged　by　bone　from　the　base　of　the　skull。　No　hemorrhage　followed　its　removal。　The　wound　was　cleansed　and　a　simple　iodoform…dressing　applied。　The　violent　jerking　movements　were　replaced　by　a　few　occasional　twitchings。　It　was　now　found　that　the　left　side　of　the　face　and　the　left　arm　were　paralyzed；　with　inability　to　close　the　left　eye　completely。　The　man　became　drowsy　and　confused；　and　was　unable　to　give　replies　to　any　but　the　simplest　questions。　The　temperature　rose　to　102　degrees；　the　pupils　became　contracted；　the　right　in　a　greater　degree　than　the　left；　both　reacted　to　light。　The　left　leg　began　to　lose　power。　There　was　complete　anesthesia　of　the　right　eyebrow　and　of　both　eyelids　and　of　the　right　cheek　for　an　uncertain　distance　below　the　lower　eyelid。　The　conjunctiva　of　the　right　eye　became　congested；　and　a　small　ulcer　formed　on　the　right　cornea；　which　healed　without　much　trouble。　In　the　course　of　a　few　days　power　began　to　return；　first　in　the　left　leg　and　afterward；　though　to　a　much　less　extent；　in　the　left　arm。　For　two　weeks　there　was　drowsiness；　and　the　man　slept　considerably。　He　was　apathetic；　and　for　many　days　passed　urine　in　bed。　He　could　not　recognize　his　wife　or　old　comrades；　and　had　also　difficulty　in　recognizing　common　objects　and　their　uses。　The　most　remarkable　feature　was　the　loss　of　all　memory　of　his　life　for　twenty　years　before　the　accident。　As　time　went　on；　the　period　included　in　this　loss　of　memory　was　reduced　to　five　years　preceding　the　accident。　The　hemiplegia　persisted；　although　the　man　was　able　to　get　about。　Sensibility　was　lost　to　all　forms　of　stimuli　in　the　right　upper　eyelid；　forehead；　and　anterior　part　of　the　scalp；　corresponding　with　the　distribution　of　the　supraorbital　and　nasal　nerves。　The　cornea　was　completely　anesthetic；　and　the　right　cheek；　an　inch　and　a　half　external　to　the　angle　of　the　nose；　presented　a　small　patch　of　anesthesia。　There　was　undue　emotional　mobility；　the　patient　laughing　or　crying　on　slight　provocation。　The　condition　of　mind…blindness　remained。　It　is　believed　that　the　spout　of　the　oil…can　must　have　passed　under　the　zygoma　to　the　base　of　the　skull；　perforating　the　great　wing　of　the　spheroid　bone　and　penetrating　the　centrum　ovale；　injuring　the　anterior　fibers　of　the　motor　tract　in　the　internal　capsule　near　the　genu。〃

Figures　192　and　193　show　the　outline　and　probable　course　of　the　spout。

Beaumont　reports　the　history　of　an　injury　in　a　man　of　forty…five；　who；　standing　but　12　yards　away；　was　struck　in　the　orbit　by　a　rocket；　which　penetrated　through　the　spheroidal　fissure　into　the　middle　and　posterior　lobes　of　the　left　hemisphere。　He　did　not　fall　at　the　time　he　was　struck；　and　fifteen　minutes　after　the　stick　was　removed　he　arose　without　help　and　walked　away。　Apparently　no　extensive　cerebral　lesion　had　been　caused；　and　the　man　suffered　no　subsequent　cerebral　symptoms　except；　three　years　afterward；　impairment　of　memory。

There　is　an　account　given　by　Chelius　of　an　extraordinary　wound　caused　by　a　ramrod。　The　rod　was　accidentally　discharged　while　being　employed　in　loading；　and　struck　a　person　a　few　paces　away。　It　entered　the　head　near　the　root　of　the　zygomatic　arch；