anomalies and curiosities of medicine-第144部分

按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！



Relative　to　ligature　of　the　common　carotid　artery；　Ashhurst　mentions　the　fact　that　the　artery　has　been　ligated　in　228　instances；　with　94　recoveries。　Ellis　mentions　ligature　of　both　carotids　in　four　and　a　half　days；　as　a　treatment　for　a　gunshot　wound；　with　subsequent　recovery。　Lewtas　reports　a　case　of　ligation　of　the　innominate　and　carotid　arteries　for　traumatic　aneurysm　（likely　a　hematoma　due　to　a　gunshot　injury　of　the　subclavian　artery）。　The　patient　was　in　profound　collapse；　but　steadily　reacted　and　was　discharged　cured　on　the　forty…fifth　day；　with　no　perceptible　pulse　at　the　wrist　and　only　a　feeble　beat　in　the　pulmonary　artery。

Garengeot；　Wirth；　Fine；　and　Evers；　all　mention　perforating　wounds　of　the　trachea　and　esophagus　with　recoveries。　Van　Swieten　and　Hiester　mention　cases　in　which　part　of　the　trachea　was　carried　away　by　a　ball；　with　recovery。　Monro；　Tulpius；　Bartholinus；　and　Pare　report　severance　of　the　trachea　with　the　absence　of　oral　breathing；　in　which　the　divided　portions　were　sutured；　with　successful　results。　In　his　〃Theatro　Naturae；〃　Bodinus　says　that　William；　Prince　of　Orange；　lost　the　sense　of　taste　after　receiving　a　wound　of　the　larynx；　according　to　an　old　authority；　a　French　soldier　became　mute　after　a　similar　accident。　Davies…Colley　mentions　a　boy　of　eighteen　who　fell　on　a　stick　about　the　thickness　of　the　index　finger；　transfixing　his　neck　from　right　to　left；　he　walked　to　a　doctor's　house；　250　yards　away；　with　the　stick　in　situ。　In　about　two　weeks　he　was　discharged　completely　well。　During　treatment　he　had　no　hemorrhage　of　any　importance；　and　his　voice　was　not　affected；　but　for　a　while　he　had　slight　dysphagia。

Barker　gives　a　full　account　of　a　barber　who　was　admitted　to　a　hospital　two　and　a　half　hours　after　cutting　his　throat。　He　had　a　deep　wound　running　transversely　across　the　neck；　from　one　angle　of　the　jaw　to　the　other；　cutting　open　the　floor　of　the　mouth　and　extending　from　the　inner　border　of　the　sternocleido…mastoid　to　the　other；　leaving　the　large　vessels　of　the　neck　untouched。　The　razor　had　passed　through　the　glosso…epiglottidean　fold；　a　tip　of　the　epiglottis；　and　through　the　pharynx　down　to　the　spinal　column。　There　was　little　hemorrhage；　but　the　man　could　neither　swallow　nor　speak。　The　wound　was　sutured；　tracheotomy　done；　and　the　head　kept　fixed　on　the　chest　by　a　copper　splint。　He　was　ingeniously　fed　by　esophageal　tubes　and　rectal　enemata；　in　three　weeks　speech　and　deglutition　were　restored。　Shortly　afterward　the　esophageal　tube　was　removed　and　recovery　was　virtually　complete。　Little　mentions　an　extraordinary　case　of　a　woman　of　thirty…six　who　was　discharged　from　Garland's　asylum；　where　she　had　been　an　inmate　for　three　months。　This　unfortunate　woman　had　attempted　suicide　by　self…decapitation　from　behind　forward。　She　was　found；　knife　in　hand；　with　a　huge　wound　in　the　back　of　the　neck　and　her　head　bobbing　about　in　a　ghastly　manner。　The　incision　had　severed　the　skin；　subcutaneous　tissues　and　muscles；　the　ligaments　and　bone；　opening　the　spinal　canal；　but　not　cutting　the　cord。　The　instrument　used　to　effect　this　major　injury　was　a　blunt　potato…peeling　knife。　Despite　this　terrible　wound　the　patient　lived　to　the　sixth　day。

Hislop　records　a　case　of　cut…throat　in　a　man　of　seventy…four。　He　had　a　huge　gaping　wound　of　the　neck；　extending　to　within　a　half　inch　of　the　carotids　on　each　side。　The　trachea　was　almost　completely　severed；　the　band　left　was　not　more　than　1/4　inch　wide。　Hislop　tied　four　arteries；　brought　the　ends　of　the　trachea　together　with　four　strong　silk　sutures；　and；　as　the　operation　was　in　the　country；　he　washed　the　big　cavity　of　the　wound　out　with　cold　spring…water。　He　brought　the　superficial　surfaces　together　with　ten　interrupted　sutures；　and；　notwithstanding　the　patient's　age；　the　man　speedily　recovered。　This　emphasizes　the　fact　that　the　old　theory　of　leaving　wounds　of　this　nature　open　was　erroneous。　Solly　reports　the　case　of　a　tailor　of　twenty…two　who　attempted　suicide　by　cutting　through　the　larynx；　entirely　severing　the　epiglottis　and　three…fourths　of　the　pharynx。　No　bleeding　point　was　found；　and　recovery　ensued。

Cowles　describes　the　case　of　a　soldier　of　thirty…five　who；　while　escaping　from　the　patrols；　was　shot　by　the　Officer　of　the　Day　with　a　small　bullet　from　a　pistol。　The　ball　entered　the　right　shoulder；　immediately　over　the　suprascapular　notch；　passed　superficially　upward　and　forward　into　the　neck；　wounding　the　esophagus　posteriorly　at　a　point　opposite　the　thyroid　cartilage；　and　lodged　in　the　left　side　of　the　neck。　The　patient　had　little　hemorrhage；　but　had　expectorated　and　swallowed　much　blood。　He　had　a　constant　desire　to　swallow；　which　continued　several　days。　The　treatment　was　expectant；　and　in　less　than　three　weeks　the　soldier　was　returned　to　duty。　From　the　same　authority　there　is　a　condensation　of　five　reports　of　gunshot　wounds　of　the　neck；　from　all　of　which　the　patients　recovered　and　returned　to　duty。

Braman　describes　the　case　of　a　man　on　whom　several　injuries　were　inflicted　by　a　drunken　companion。　The　first　wound　was　slight；　the　second　a　deep　flesh…wound　over　the　trapezius　muscle；　the　third　extended　from　the　right　sterno…cleido…mastoid　midway　upward　to　the　middle　of　the　jaw　and　down　to　the　rapine　of　the　trachea。　The　external　jugular；　the　external　thyroid；　and　the　facial　arteries　were　severed。　Braman　did　not　find　it　necessary　to　ligate；　but　was　able　to　check　the　hemorrhage　with　lint　and　persulphate　of　iron；　in　powder；　with　pressure。　After　fourteen　hours　the　wound　was　closed；　the　patient　recovered；　and　was　returned　to　duty　in　a　short　time。

Thomas　has　reported　the　case　of　a　man　sixty…five　years　old　who　in　an　attempt　at　suicide　with　a　penknife；　had　made　a　deep　wound　in　the　left　side　of　the　neck。　The　sternohyoid　and　omohyoid　muscles　were　divided；　the　internal　jugular　vein　was　cut　through；　and　its　cut　ends　were　collapsed　and　3/4　inch　apart；　the　common　carotid　artery　was　cut　into；　but　not　divided；　the　thyroid　cartilage　was　notched；　and　the　external　and　anterior　jugular　veins　were　severed。　Clamp…forceps　were　immediately　applied　to　the　cut　vessels　and　one　on　each　side　the　aperture　in　the　common　carotid　from　which　a　small　spurt　of　blood；　certainly　not　half　a　teaspoonful；　came　out。　The　left　median　basilic　vein　was　exposed　by　an　incision；　and　20　ounces　of　warm　saline　solution　were　slowly　perfused；　an　ordinary　glass　syringe　with　a　capacity　of　five　ounces；　with　an　India…rubber　tubing　attached　to　a　canula　in　the　vein　being　employed。　After　seven　ounces　of　fluid　had　been　injected；　the　man　made　a　short；　distinct　inspiration；　at　ten　ounces　a　deeper　one　（the　radial　pulse　could　now　be　felt　beating　feebly）；　at　15　ounces　the　breathing　became　regular　and　deep；　at　18　ounces　the　man　opened　his　eyes；　but　did　not　appear　to　be　conscious。　The　clamped　vessels　were　now　tied　with　catgut　and　the　wound　cleansed　with　phenol　lotion　and　dressed　with　cyanid…gauze。　The　man　was　surrounded　by　hot…water　bottles　and　the　foot　of　the　bed　elevated　18　inches。　In　the　course　of　an　hour　the　patient　had　recovered　sufficiently　to　answer　in　a　squeaky　voice　to　his　name　when　called　loudly。　Improvement　proceeded　rapidly　until　the　twenty…second　day；　when　violent　hemorrhage　occurred；　preceded　a　few　hours　previously　by　a　small　trickle；　easily　controlled　by　pressure。　The　wound　was　at　once　opened　and　blood　found　oozing　from　the　distal　extremities　of　the　carotid　artery　and　jugular　vein；　which　were　promptly　clamped。　The　common　carotid　artery　was　not　sound；　so　that　ligatures　were　applied　to　the　internal　and　external　carotids　and　to　the　internal　jugular　with　a　small　branch　entering　into　it。　The　patient　was　in　great　collapse；　but　quickly　rallied；　only　to　suffer　renewed　hemorrhage　from　the　internal　carotid　nine　days　later。　This　was　controlled　by　pressure　with　sponges；　and　a　quart　of　hot　water　was　injected　into　the　rectum。　From　this　time　on　the　patient　made　a　slow　recovery；　a　small　sinus　in　the　lower　part　of　the　neck　disappearing　on　the　removal　of　the　catgut　ligature。

Adams　describes　the　case　of　a　woman　who　attempted　suicide　with　a　common　table…knife；　severing　the　thyroid；　cricoid；　and　first　three　rings　of　the　trachea；　and　lacerating　the　sternohyoid　and　thyroid　arteries；　she　finally　recovered。

There　is　a　curious　case　of　suicide　of　a　woman　who；　while　under　the　effects　of　opium；　forced　the　handle　of　a　mirror　into　her　mouth。　From　all　appearances；　the　handle　had　broken　off　near　the　junction　and　she　had　evidently　fallen　forward　with　the　remaining　part　in　her　mouth；　driving　it　forcibly　against　the　spine；　and　causing　the　point　of　the　handle　to　run　downward　in　front　of　the　cervical　vertebrae。　On　postmortem　examination；　a　sharp　piece　of　wood　about　two　inches　long；　corresponding　to　the　missing　portion　of　the　broken　mirror　handle；　was　found　lying　between　the　posterior　wall　of　the　esophagus　and　the　spine。　Hennig　mentions　a　case　of　gunshot　wound　of　the　neck　in　which　the　musket　ball　was　lodged　in　the　posterior　portion　of　the　neck　and　was　subsequently　discharged　by　the　anus。

Injuries　of　the　cervical　vertebrae；　while　extremely　grave；　and　declared　by　some　authors　to　be　inevitably　fatal；　are；　however；　not　always　followed　by　death　or　permanently　bad　results。　Barwell　mentions　a　man　of　sixty…three　who；　in　a　fit　of　despondency；　threw　himself　from　a　window；　having　fastened　a　rope　to　his　neck　and　to　the　window…sill。　He　fell　11　or　12　feet；　and　in　doing　so　suffered　a　subluxation　of　the　4th　cervical　vertebra。　It　slowly　resumed　the　normal　position　by　the　elasticity　of　the　intervertebral　fibrocartilage；　and　there　was　complete　recovery　in　ten　days。　Lazzaretto　reports　the　history　of　the　case　of　a　seaman　whose　atlas　was　dislocated　by　a　blow　from　a　falling　sail…yard。　The　dislocation　was　reduced　and　held　by　adhesive　strips；　and　the　man　made　a　good　recovery。　Vanderpool　of　Bellevue　Hospital；　N。Y。；　describes　a　fracture　of　the　odontoid　process　caused　by　a　fall　on　the　back　of　the　head；　death；　however；　did　not　ensue　until　six　months　later。　According　to　Ashhurst；　Philips；　the　elder　Cline；　Willard　Parker；　Bayard；　Stephen　Smith；　May；　and　several　other　surgeons；　have　recorded　complete　recovery　after　fracture　of　the　atlas　and　axis。　The　same　author　also　adds　that　statistic　investigation　shows　that　as　large　a　proportion　as　18　per　cent　of　injuries　of　the　cervical　vertebrae　occurring　in　civil　p