anomalies and curiosities of medicine-第140部分

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　　　　　　　　　　96　　　　18　　Total；　114。

In　a　paper　on　nonmortal　fractures　of　the　base　of　the　skull；　Lidell　gives　an　account　of　135　cases。　MacCormac　reports　a　case　of　a　boy　of　nine　who　was　run　over　by　a　carriage　drawn　by　a　pair　of　horses。　He　suffered　fracture　of　the　base　of　the　skull；　of　the　bones　of　the　face；　and　of　the　left　ulna；　and　although　suppuration　at　the　points　of　fracture　ensued；　followed　by　an　optic　neuritis；　an　ultimate　recovery　was　effected。　Ball；　an　Irish　surgeon；　has　collected　several　instances　in　which　the　base　of　the　skull　has　been　driven　in　and　the　condyle　of　the　jaw　impacted　in　the　opening　by　force　transmitted　through　the　lower　maxilla。

The　tolerance　of　foreign　bodies　in　the　brain　is　most　marvelous。　In　the　ancient　chronicles　of　Koenigsberg　there　is　recorded　the　history　of　a　man　who　for　fourteen　years　carried　in　his　head　a　piece　of　iron　as　large　as　his　finger。　After　its　long　lodgment；　during　which　the　subject　was　little　discommoded；　it　finally　came　out　by　the　palatine　arch。　There　is　also　an　old　record　of　a　ball　lodging　near　the　sella　turcica　for　over　a　year；　the　patient　dying　suddenly　of　an　entirely　different　accident。　Fabricius　Hildanus　relates　the　history　of　an　injury；　in　which；　without　causing　any　uncomfortable　symptoms；　a　ball　rested　between　the　skull　and　dura　for　six　months。

Amatus　Lusitanus　speaks　of　a　drunken　courtesan　who　was　wounded　in　a　fray　with　a　long；　sharp…pointed　knife　which　was　driven　into　the　head。　No　apparent　injury　resulted；　and　death　from　fever　took　place　eight　years　after　the　reception　of　the　injury。　On　opening　the　head　a　large　piece　of　knife　was　found　between　the　skull　and　dura。　It　is　said　that　Benedictus　mentions　a　Greek　who　was　wounded；　at　the　siege　of　Colchis；　in　the　right　temple　by　a　dart　and　taken　captive　by　the　Turks；　he　lived　for　twenty　years　in　slavery；　the　wound　having　completely　healed。　Obtaining　his　liberty；　he　came　to　Sidon；　and　five　years　after；　as　he　was　washing　his　face；　he　was　seized　by　a　violent　fit　of　sneezing；　and　discharged　from　one　of　his　nostrils　a　piece　of　the　dart　having　an　iron　point　of　considerable　length。

In　about　1884　there　died　in　the　Vienna　Hospital　a　bookbinder　of　forty…　five；　who　had　always　passed　as　an　intelligent　man；　but　who　had　at　irregular　intervals　suffered　from　epileptic　convulsions。　An　iron　nail　covered　with　rust　was　discovered　in　his　brain；　from　the　history　of　his　life　and　from　the　appearances　of　the　nail　it　had　evidently　been　lodged　in　the　cerebrum　since　childhood。

Slee　mentions　a　case　in　which；　after　the　death　of　a　man　from　septic　peritonitis　following　a　bullet…wound　of　the　intestines；　he　found　postmortem　a　knife…blade　5/16　inch　in　width　projecting　into　the　brain　to　the　depth　of　one　inch。　The　blade　was　ensheathed　in　a　strong　fibrous　capsule　1/2　inch　thick；　and　the　adjacent　brain…structure　was　apparently　normal。　The　blade　was　black　and　corroded；　and　had　evidently　passed　between　the　sutures　during　boyhood　as　there　was　no　depression　or　displacement　of　the　cranial　bones。　The　weapon　had　broken　off　just　on　a　level　with　the　skull；　and　had　remained　in　situ　until　the　time　of　death　without　causing　any　indicative　symptoms。　Slee　does　not　state　the　man's　age；　but　remarks　that　he　was　a　married　man　and　a　father　at　the　time　of　his　death；　and　had　enjoyed　the　best　of　health　up　to　the　time　he　was　shot　in　the　abdomen。　Callaghan；　quoted　in　Erichsen's　〃Surgery；〃　remarks　that　he　knew　of　an　officer　who　lived　seven　years　with　a　portion　of　a　gun…breech　weighing　three　ounces　lodged　in　his　brain。

Lawson　mentions　the　impaction　of　a　portion　of　a　breech　of　a　gun　in　the　forehead　of　a　man　for　twelve　years；　with　subsequent　removal　and　recovery。　Waldon　speaks　of　a　similar　case　in　which　a　fragment　of　the　breech　weighing　three　ounces　penetrated　the　cranium；　and　was　lodged　in　the　brain　for　two　months　previous　to　the　death　of　the　patient。

Huppert　tells　of　the　lodgment　of　a　slate…pencil　three　inches　long　in　the　brain　during　lifetime；　death　ultimately　being　caused　by　a　slight　head…injury。　Larry　mentions　a　person　who　for　some　time　carried　a　six　ounce　ball　in　the　brain　and　ultimately　recovered。　Peter　removed　a　musket…ball　from　the　frontal　sinus　after　six　years'　lodgment；　with　successful　issue。　Mastin　has　given　an　instance　in　which　the　blade　of　a　pen…knife　remained　in　the　brain　six　months；　recovery　following　its　removal。　Camden　reports　a　case　in　which　a　ball　received　in　a　gunshot　wound　of　the　brain　remained　in　situ　for　thirteen　years；　Cronyn　mentions　a　similar　case　in　which　a　bullet　rested　in　the　brain　for　eight　years。　Doyle　successfully　removed　an　ounce　Minie　ball　from　the　brain　after　a　fifteen　years'　lodgment。

Pipe…stems；　wires；　shot；　and　other　foreign　bodies；　are　from　time　to　time　recorded　as　remaining　in　the　brain　for　some　time。　Wharton　has　compiled　elaborate　statistics　on　this　subject；　commenting　on　316　cases　in　which　foreign　bodies　were　lodged　in　the　brain；　and　furnishing　all　the　necessary　information　to　persons　interested　in　this　subject。

Injuries　of　the　nose；　with　marked　deformity；　are　in　a　measure　combated　by　devices　invented　for　restoring　the　missing　portions　of　the　injured　member。　Taliacotius；　the　distinguished　Italian　surgeon　of　the　sixteenth　century；　devised　an　operation　which　now　bears　his　name；　and　consists　in　fashioning　a　nose　from　the　fleshy　tissues　of　the　arm。　The　arm　is　approximated　to　the　head　and　held　in　this　position　by　an　apparatus　or　system　of　bandages　for　about　ten　days；　at　which　time　it　is　supposed　that　it　can　be　severed；　and　further　trimming　and　paring　of　the　nose　is　then　practiced。　A　column　is　subsequently　made　from　the　upper　lip。　In　the　olden　days　there　was　a　timorous　legend　representing　Taliacotius　making　noses　for　his　patients　from　the　gluteal　regions　of　other　persons；　which　statement；　needless　to　say；　is　not　founded　on　fact。　Various　modifications　and　improvements　on　the　a　Talicotian　method　have　been　made；　but　in　recent　years　the　Indian　method；　introduced　by　Carpue　into　England　in　1816；　is　generally　preferred。　Syme　of　Edinburgh；　Wood；　and　Ollier　have　devised　methods　of　restoring　the　nose；　which　bear　their　names。

Ohmann…Dumesnil　reports　a　case　of　rhinophyma　in　a　man　of　seventy…two；　an　alcoholic；　who　was　originally　affected　with　acne　rosacea；　on　whom　he　performed　a　most　successful　operation　for　restoration。　The　accompanying　illustration　shows　the　original　deformitya　growth　weighing　two　poundsand　also　pictures　the　appearance　shortly　after　the　operation。　This　case　is　illustrative　of　the　possibilities　of　plastic　surgery　in　the　hands　of　a　skilful　and　ingenious　operator。

About　1892　Dr。　J。　P。　Parker　then　of　Kansas　City；　Mo。；　restored　the　missing　bridge　of　a　patient's　nose　by　laying　the　sunken　part　open　in　two　long　flaps；　denuding　the　distal　extremity　of　the　little　finger　of　the　patient's　right　hand　of　nail；　flesh；　tendons；　etc。；　and　binding　it　into　the　wound　of　the　nose　until　firm　union　had　taken　place。　The　finger　was　then　amputated　at　the　second　joint　and　the　plastic　operation　completed；　with　a　result　pleasing　both　to　patient　and　operator。

There　is　a　case　quoted　of　a　young　man　who；　when　first　seen　by　his　medical　attendant；　had　all　the　soft　parts　of　the　nose　gone；　except　one…third　of　the　left　ala　and　a　thin　flap　of　the　septum　which　was　lying　on　the　upper　lip。　The　missing　member　was　ferreted　out　and　cleansed；　and　after　an　hour's　separation　sutured　on。　The　nostrils　were　daily　syringed　with　a　corrosive　sublimate　solution；　and　on　the　tenth　day　the　dressing　was　removed；　the　nose　was　found　active　and　well；　with　the　single　exception　of　a　triangular　notch　on　the　right　side；　which　was　too　greatly　bruised　by　the　violence　of　the　blow　to　recover。　When　we　consider　the　varicosity　of　this　organ　we　can　readily　believe　the　possibility　of　the　foregoing　facts；　and　there　is　little　doubt　that　more　precaution　in　suturing　severed　portions　of　the　nose　would　render　the　operation　of　nose　making　a　very　rare　one。

Maxwell　mentions　a　curious　case　of　attempted　suicide　in　which　the　ball；　passing　through　the　palatine　process　of　the　superior　maxillary　bone；　crushing　the　vomer　to　the　extent　of　its　own　diameter；　fell　back　through　the　right　nostril　into　the　pharynx；　was　swallowed；　and　discharged　from　the　anus。

Deformities　of　the　nose　causing　enormous　development；　or　the　condition　called　〃double…nose〃　by　Bartholinus；　Borellus；　Bidault；　and　others；　are　ordinarily　results　of　a　pathologic　development　of　the　sebaceous　glands。　In　some　cases　tumors　develop　from　the　root　of　the　nose；　forming　what　appears　to　be　a　second　nose。　In　other　cases　monstrous　vegetations　divide　the　nose　into　many　tumors。　In　the　early　portion　of　this　century　much　was　heard　about　a　man　who　was　a　daily　habitue　of　the　Palais…Royal　Gardens。　His　nose　was　divided　into　unequally　sized　tumors；　covering　nearly　his　entire　face。　Similar　instances　have　been　observed　in　recent　years。　Hey　mentions　a　case　in　which　the　tumor　extended　to　the　lower　part　of　the　under　lip；　which　compressed　the　patient's　mouth　and　nostrils　to　such　an　extent　that　while　sleeping；　in　order　to　insure　sufficient　respiration；　he　had　to　insert　a　tin…tube　into　one　of　his　nostrils。　Imbert　de　Lannes　is　quoted　as　operating　on　a　former　Mayor　of　Angouleme。　This　gentleman's　nose　was　divided　into　five　lobes　by　sarcomatous　tumors　weighing　two　pounds；　occupying　the　external　surface　of　the　face；　adherent　to　the　buccinator　muscles　to　which　they　extended；　and　covering　the　chin。　In　the　upright　position　the　tumors　sealed　the　nostrils　and　mouth；　and　the　man　had　to　bend　his　head　before　and　after　respiration。　In　eating；　this　unfortunate：　person　had　to　lift　his　tumors　away　from　his　mouth；　and　during　sleep　the　monstrous　growths　were　supported　in　a　sling　attached　to　his　night　cap。　He　presented　such　a　hideous　aspect　that　he　was　virtually　ostracized　from　society　The　growth　had　been　in　progress　for　twelve　years；　but　during　twenty…two　months'　confinement　in　Revolutionary　prisons　the　enlargement　had　been　very　rapid。　Fournier　says　that　the　most　beautiful　result　followed　the　operation　which　was　considered　quite　hazardous。

Foreign　bodies　in　the　nose　present　phenomena　as　interesting　as　wounds　of　this　organ。　Among　the　living　objects　which　have　been　found　in　the　nose　may　be　mentioned　flies；　maggots；　worms；　leeches；　centipedes；　and　even　lizards。　Zacutus　Lusitanus　tells　of　a　person　who　died　in　t