anomalies and curiosities of medicine-第143部分

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sometimes　alimentary；　sometimes　mucus；　pus；　or　blood；　and　went　into　the　last　stage　of　marasmus。　At　last；　after　this　long…continued　suffering；　following　a　strong　convulsion　and　syncope；　the　coin　descended　to　the　stomach；　and　the　young　man　expectorated　great　quantities　of　pus。　After　thirty…five　years；　the　coin　had　not　been　passed　by　the　rectum。

Instances　of　migration　of　foreign　bodies　from　the　esophagus　are　repeatedly　recorded。　There　is　an　instance　of　a　needle　which　was　swallowed　and　lodged　in　the　esophagus；　but　twenty…one　months　afterward　was　extracted　by　an　incision　at　a　point　behind　the　right　ear。　Kerckring　speaks　of　a　girl　who　swallowed　a　needle　which　was　ultimately　extracted　from　the　muscles　of　her　neck。　Poulet　remarks　that　Vigla　has　collected　the　most　interesting　of　these　cases　of　migration　of　foreign　bodies。　Hevin　mentions　several　cases　of　grains　of　wheat　abstracted　from　abscesses　of　the　thoracic　parietes；　from　thirteen　to　fifteen　days　after　ingestion。　Bonnet　and　Helmontius　have　reported　similar　facts。　Volgnarius　has　seen　a　grain　of　wheat　make　its　exit　from　the　axilla；　and　Polisius　mentions　an　abscess　of　the　back　from　which　was　extracted　a　grain　of　wheat　three　months　after　ingestion。　Bally　reports　a　somewhat　similar　instance；　in　which；　three　months　after　ingestion；　during　an　attack　of　peripneumonia；　a　foreign　body　was　extracted　from　an　abscess　of　the　thorax；　between　the　2d　and　3d　ribs。　Ambrose　found　a　needle　encysted　in　the　heart　of　a　negress。　She　distinctly　stated　that　she　had　swallowed　it　at　a　time　calculated　to　have　been　nine　years　before　her　death。　Planque　speaks　of　a　small　bone　perforating　the　esophagus　and　extracted　through　the　skin。

Abscess　or　ulceration；　consequent　upon　periesophagitis；　caused　by　the　lodgment　of　foreign　bodies　in　the　esophagus；　often　leads　to　the　most　serious　results。　There　is　an　instance　of　a　soldier　who　swallowed　a　bone　while　eating　soup；　who　died　on　the　thirty…first　day　from　the　rupture　internally　of　an　esophageal　abscess。　Grellois　has　reported　the　history　of　a　case　of　a　child　twenty…two　months　old；　who　suffered　for　some　time　with　impaction　of　a　small　bone　in　the　esophagus。　Less　than　three　months　afterward　the　patient　died　with　all　the　symptoms　of　marasmus；　due　to　difficult　deglutition；　and　at　the　autopsy　an　abscess　was　seen　in　the　posterior　wall　of　the　pharynx；　opposite　the　3d　cervical　vertebra；　extensive　caries　was　also　noticed　in　the　bodies　of　the　2d；　3d；　and　4th　cervical　vertebrae。　Guattani　mentions　a　curious　instance　in　which　a　man　playing　with　a　chestnut　threw　it　in　the　air；　catching　it　in　his　mouth。　The　chestnut　became　lodged　in　the　throat　and　caused　death　on　the　nineteenth　day。　At　the　autopsy　it　was　found　that　an　abscess　communicating　with　the　trachea　had　been　formed　in　the　pharynx　and　esophagus。

A　peculiarly　fatal　accident　in　this　connection　is　that　in　which　a　foreign　body　in　the　esophagus　ulcerates；　and　penetrates　one　of　the　neighboring　major　vessels。　Colles　mentions　a　man　of　fifty…six　who；　while　eating；　perceived　a　sensation　as　of　a　rent　in　the　chest。　The　pain　was　augmented　during　deglutition；　and　almost　immediately　afterward　he　commenced　to　expectorate　great　quantities　of　blood。　On　the　following　day　he　vomited　a　bone　about　an　inch　long　and　died　on　the　same　day。　At　the　autopsy　it　was　found　that　there　was　a　rent　in　the　posterior　wall　of　the　esophagus；　about　1/2　inch　long；　and　a　corresponding　wound　of　the　aorta。　There　was　blood　in　the　pleura；　pericardium；　stomach；　and　intestines。　There　is　one　case　in　which　a　man　of　forty…seven　suddenly　died；　after　vomiting　blood；　and　at　the　autopsy　it　was　demonstrated　that　a　needle　had　perforated　the　posterior　wall　of　the　esophagus　and　wounded　the　aorta。　Poulet　has　collected　31　cases　in　which　ulceration　caused　by　foreign　bodies　in　the　esophagus　has　resulted　in　perforation　of　the　walls　of　some　of　the　neighboring　vessels。　The　order　of　frequency　was　as　follows：　aorta；　17；　carotids；　four；　vena　cava；　two；　and　one　case　each　of　perforation　of　the　inferior　thyroid　artery；　right　coronary　vein；　demi…azygos　vein；　the　right　subclavicular　artery　（abnormal）；　and　the　esophageal　artery。　In　three　of　the　cases　collected　there　was　no　autopsy　and　the　vessel　affected　was　not　known。

In　a　child　of　three　years　that　had　swallowed　a　half…penny；　Atkins　reports　rupture　of　the　innominate　artery。　No　symptoms　developed；　but　six　weeks　later；　the　child　had　an　attack　of　ulcerative　stomatitis；　from　which　it　seemed　to　be　recovering　nicely；　when　suddenly　it　ejected　two　ounces　of　bright　red　blood　in　clots；　and　became　collapsed　out　of　proportion　to　the　loss　of　blood。　Under　treatment；　it　rallied　somewhat；　but　soon　afterward　it　ejected　four　ounces　more　of　blood　and　died　in　a　few　minutes。　At　the　autopsy　3/4　pint　of　blood　was　found　in　the　stomach；　and　a　perforation　was　discovered　on　the　right　side　of　the　esophagus；　leading　into　a　cavity；　in　which　a　blackened　half…penny　was　found。　A　probe　passed　along　the　aorta　into　the　innominate　protruded　into　the　same　cavity　about　the　bifurcation　of　the　vessel。

Denonvilliers　has　described　a　perforation　of　the　esophagus　and　aorta　by　a　five…franc　piece。　A　preserved　preparation　of　this　case；　showing　the　coin　in　situ；　is　in　the　Musee　Dupuytren。　Blaxland　relates　the　instance　of　a　woman　of　forty…five　who　swallowed　a　fish　bone；　was　seized　with　violent　hematemesis；　and　died　in　eight　hours。　The　necropsy　revealed　a　penetration　of　the　aorta　through　the　thoracic　portion　of　the　esophagus。　There　is　also　in　the　Musee　Dupuytren　a　preparation　described　by　Bousquet；　in　which　the　aorta　and　the　esophagus　were　perforated　by　a　very　irregular　piece　of　bone。　Mackenzie　mentions　an　instance　of　death　from　perforation　of　the　aorta　by　a　fish…bone。

In　some　cases　penetration　of　the　esophagus　allows　the　further　penetration　of　some　neighboring　membrane　or　organ　in　the　same　manner　as　the　foregoing　cases。　Dudley　mentions　a　case　in　which　fatal　hemorrhage　was　caused　by　penetration　of　the　esophagus　and　lung　by　a　chicken…bone。　Buist　speaks　of　a　patient　who　swallowed　two　artificial　teeth。　On　the　following　day　there　was　pain　in　the　epigastrium；　and　by　the　fourth　day　the　pain　extended　to　the　vertebrae；　with　vomiting；　delirium；　and　death　on　the　fifth　day。　At　the　autopsy　it　was　found　that　a　foreign　body；　seven　cm。　long　had　perforated　the　pericardium；　causing　a　suppurative　pericarditis。　Dagron　reports　a　unique　instance　of　death　by　purulent　infection　arising　from　perforation　of　the　esophagus　by　a　pin。　The　patient　was　a　man　of　forty…two；　and；　some　six　weeks　before　he　presented　himself　for　treatment；　before　swallowing　had　experienced　a　severe　pain　low　down　in　the　neck。　Five　days　before　admission　he　had　had　a　severe　chill；　followed　by　sweating　and　delirium。　He　died　of　a　supraclavicular　abscess　on　the　fifth　day；　a　black　steel　pin　was　found　against　the　esophagus　and　trachea。

In　connection　with　foreign　bodies　in　the　esophagus；　it　might　be　interesting　to　remark　that　Ashhurst　has　collected　129　cases　of　esophagotomy　for　the　removal　of　foreign　bodies；　resulting　in　95　recoveries　and　34　deaths。　Gaudolphe　collected　142　cases　with　110　recoveries。

Injuries　of　the　neck　are　usually　inflicted　with　suicidal　intent　or　in　battle。　Cornelius　Nepos　says　that　while　fighting　against　the　Lacedemonians；　Epaminondas　was　sensible　of　having　received　a　mortal　wound；　and　apprehending　that　the　lance　was　stopping　a　wound　in　an　important　vessel；　remarked　that　he　would　die　when　it　was　withdrawn。　When　he　was　told　that　the　Boeotians　had　conquered；　exclaiming　〃I　die　unconquered；〃　he　drew　out　the　lance　and　perished。　Petrus　de　Largenta　speaks　of　a　man　with　an　arrow　in　one　of　his　carotids；　who　was　but　slightly　affected　before　its　extraction；　but　who　died　immediately　after　the　removal　of　the　arrow。　Among　the　remarkable　recoveries　from　injuries　of　the　neck　is　that　mentioned　by　Boerhaave；　of　a　young　man　who　lived　nine　or　ten　days　after　receiving　a　sword…thrust　through　the　neck　between　the　4th　and　5th　vertebrae；　dividing　the　vertebral　artery。　Benedictus；　Bonacursius；　and　Monroe；　all　mention　recovery　after　cases　of　cut…throat　in　which　the　esophagus　as　well　as　the　trachea　was　wounded；　and　food　protruded　from　the　external　cut。　Warren　relates　the　history　of　a　case　in　which　the　vertebral　artery　was　wounded　by　the　discharge　of　a　pistol　loaded　with　pebbles。　The　hemorrhage　was　checked　by　compression　and　packing；　and　after　the　discharge　of　a　pebble　and　a　piece　of　bone　from　the　wound；　the　man　was　seen　a　month　afterward　in　perfect　health。　Corson　of　Norristown；　Pa。；　has　reported　the　case　of　a　quarryman　who　was　stabbed　in　the　neck　with　a　shoemaker's　knife；　severing　the　left　carotid　one　inch　below　its　division。　He　was　seen　thirty　minutes　later　in　an　apparently　lifeless　condition；　but　efforts　at　resuscitation　were　successfully　made。　The　hemorrhage　ceased　spontaneously；　and　at　the　time　of　report；　the　man　presented　the　symptoms　of　one　who　had　had　his　carotid　ligated　（facial　atrophy　on　one　side；　no　pulse；　etc。）。　Baron　Larrey　mentions　a　case　of　gunshot　wound　in　which　the　carotid　artery　was　open　at　its　division　into　internal　and　external　branches；　and　says　that　the　wound　was　plugged　by　an　artilleryman　until　ligation；　and　in　this　primitive　manner　the　patient　was　saved。　Sale　reports　the　case　of　a　girl　of　nineteen；　who　fell　on　a　china　bowl　that　she　had　shattered；　and　wounded　both　the　right　common　carotid　artery　and　internal　jugular　vein。　There　was　profuse　and　continuous　hemorrhage　for　a　time；　and　subsequently　a　false　aneurysm　developed；　which　ruptured　in　about　three　months；　giving　rise　to　enormous　momentary　hemorrhage；　notwithstanding　the　severity　of　the　injury　and　the　extent　of　the　hemorrhage；　complete　recovery　ensued。　Amos　relates　the　instance　of　a　woman　named　Mary　Green　who；　after　complete　division　of　all　the　vessels　of　the　neck；　walked　23　yards　and　climbed　over　an　ordinary　bar…gate　nearly　four　feet　high。

Cholmeley　reports　the　instance　of　a　Captain　of　the　First　Madras　Fusileers；　who　was　wounded　at　Pegu　by　a　musket…ball　penetrating　his　neck。　The　common　carotid　was　divided　and　for　five　minutes　there　was　profuse　hemorrhage　which；　however；　strange　to　say；　spontaneously　ceased。　The　patient　died　in　thirty…eight　hours；　supposedly　from　spinal　concussion　or　shock。　

Relative　to　ligature　of　the　common　carotid　artery；　Ashhurst　mentions　the　fact　that　the　artery　has　bee