anomalies and curiosities of medicine-第145部分

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t　as　large　a　proportion　as　18　per　cent　of　injuries　of　the　cervical　vertebrae　occurring　in　civil　practice；　recover。　However；　the　chances　of　a　fatal　issue　in　injuries　of　the　vertebrae　vary　inversely　with　the　distance　of　the　point　of　injury　from　the　brain。　Keen　has　recorded　a　case　in　which　a　conoidal　ball　lodged　in　the　body　of　the　third　cervical　vertebra；　from　which　it　was　extracted　six　weeks　later。　The　paralysis；　which；　up　to　the　time　of　extraction；　had　affected　all　four　limbs；　rapidly　diminished。　In　about　five　weeks　after　the　removal　of　the　bullet　nearly　the　entire　body　of　the　3d　cervical　vertebra；　including　the　anterior　half　of　the　transverse　process　and　vertebral　foremen；　was　spontaneously　discharged。　Nearly　eight　years　afterward　Keen　saw　the　man　still　living；　but　with　his　right　shoulder　and　arm　diminished　in　size　and　partly　paralyzed。

Doyle　reports　a　case　of　dislocated　neck　with　recovery。　During　a　runaway　the　patient　was　thrown　from　his　wagon；　and　was　soon　after　found　on　the　roadside　apparently　dead。　Physicians　who　were　quickly　summoned　from　the　immediate　neighborhood　detected　faint　signs　of　life；　they　also　found　a　deformity　of　the　neck；　which　led　them　to　suspect　dislocation。　An　ambulance　was　called；　and　without　any　effort　being　made　to　relieve　the　deformity　the　man　was　placed　in　it　and　driven　to　his　home　about　a　mile　distant。　The　jolting　over　the　rough　roads　greatly　aggravated　his　condition。　When　Doyle　saw　the　patient；　his　general　appearance　presented　a　hopeless　condition；　but　being　satisfied　that　a　dislocation　existed；　Doyle　immediately　prepared　to　reduce　it。　Two　men　were　told　to　grasp　the　feet　and　two　more　the　head；　and　were　directed　to　make　careful　but　strong　extension。　At　the　same　time　the　physician　placed　his　right　hand　against　the　neck　just　over　the　pomum　Adami；　and　his　left　against　the　occiput；　and；　while　extension　was　being　made；　he　flexed　the　head　forward　until　the　chin　nearly　touched　the　breast；　after　which　the　head　was　returned　to　its　normal　position。　The　manipulation　was　accompanied　by　a　clicking　sensation；　caused　by　the　replacement　of　the　dislocated　vertebra。　The　patient　immediately　showed　signs　of　relief　and　improved　rapidly。　Perceptible　but　feeble　movements　were　made　by　all　the　limbs　except　the　right　arm。　The　patient　remained　in　a　comatose　condition　for　eight　or　nine　days；　during　which　he　had　enuresis　and　intestinal　torpor。　He　suffered　from　severe　concussion　of　the　brain；　which　accounted　for　his　prolonged　coma。　Delirium　was　present；　but　he　was　carefully　watched　and　not　allowed　to　injure　himself。　His　recovery　was　tedious　and　was　delayed　by　several　relapses。　His　first　complaint　after　consciousness　returned　（on　the　tenth　day）　was　of　a　sense　of　constriction　about　the　neck；　us　if　he　were　being　choked。　This　gradually　passed　off；　and　his　improvement　went　on　without　development　of　any　serious　symptoms。　At　the　time　of　report　he　appeared　in　the　best　of　health　and　was　quite　able　to　attend　to　his　daily　avocations。　Doyle　appends　to　his　report　the　statement　that　among　394　cases　embraced　in　Ashhurst's　statistics；　in　treatment　of　dislocations　in　the　cervical　region；　the　mortality　has　been　nearly　four　times　greater　when　constitutional　or　general　treatment　has　been　relied　on　exclusively　than　when　attempts　had　been　made　to　reduce　the　dislocation　by　extension；　rotation；　etc。　Doyle　strongly　advocates　attempts　at　reduction　in　such　cases。

Figure　205　represents　a　photograph　of　Barney　Baldwin；　a　switchman　of　the　Louisville　and　Nashville　Railroad；　who；　after　recovery　from　cervical　dislocation；　exhibited　himself　about　the　country；　never　appearing　without　his　suspensory　apparatus。

Acheson　records　a　case　of　luxation　of　the　cervical　spine　with　recovery　after　the　use　of　a　jury…mast。　The　patient　was　a　man　of　fifty…five；　by　trade　a　train…conductor。　On　July　10；　1889；　he　fell　backward　in　front　of　a　train；　his　head　striking　between　the　ties；　the　brake…body　caught　his　body；　pushing　it　forward　on　his　head；　and　turned　him　completely　over。　Three　trucks　passed　over　him。　When　dragged　from　beneath　the　train；　his　upper　extremities　were　paralyzed。　At　noon　the　next　day；　nineteen　hours　after　the　accident；　examination　revealed　bruises　over　the　body；　and　he　suffered　intense　pain　at　the　back　of　the　neck　and　base　of　the　skull。　Posteriorly；　the　neck　presented　a　natural　appearance；　but　anteriorly；　to　use　the　author's　description；　his　neck　resembled　a　combined　case　of　mumps　and　goiter。　The　sternomastoid　muscle　bulged　at　the　angle　of　the　jaw；　and　was　flaccid；　and　his　〃Adam's　apple〃　was　on　a　level　with　the　chin。　Sensation　in　the　upper　extremities　was　partially　restored；　and；　although　numb；　he　now　had　power　of　movement　in　the　arms　and　hands；　but　could　not　rotate　his　neck。　A　diagnosis　of　cervical　dislocation　was　made；　and　violent　extension；　with　oscillation　forward　and　backward；　was　practiced；　and　the　abnormal　appearance　subsided　at　once。　No　crepitus　was　noticed。　On　the　fourth　day　there　was　slight　hemorrhage　from　the　mouth；　which　was　more　severe　on　the　fifth　and　sixth　days。　The　lower　jaw　had　been　forced　past　the　upper；　until　the　first　molar　had　penetrated　the　tissues　beneath　the　tongue。　A　plaster…of…Paris　apparatus　was　applied；　and　in　two　months　was　exchanged　for　one　of　sole…leather。　In　rising　from　the　recumbent　position　the　man　had　to　lift　his　head　with　his　hands。　Fifty　days　after　the　accident　he　suffered　excruciating　pain　at　the　change　of　the　weather；　and　at　the　approach　of　a　storm　the　joints；　as　well　as　the　neck；　were　involved。　It　was　believed　（one　hundred　and　seven　days　after　the　accident）　that　both　fracture　and　luxation　existed。　His　voice　had　become　guttural；　but　examination　of　the　fauces　was　negative。　The　only　evidence　of　paralysis　was　in　the　fingers；　which；　when　applied　to　anything；　experienced　the　sensation　of　touching　gravel。　The　mottling　of　the　tissues　of　the　neck；　which　appeared　about　the　fiftieth　day；　had　entirely　disappeared。

According　to　Thorburn；　Hilton　had　a　patient　who　lived　fourteen　years　with　paraplegia　due　to　fracture　of　the　5th；　6th；　and　7th　cervical　vertebrae。　Shaw　is　accredited　with　a　case　in　which　the　patient　lived　fifteen　months；　the　fracture　being　above　the　4th　cervical　vertebra。

In　speaking　of　foreign　bodies　in　the　larynx　and　trachea；　the　first　to　be　considered　will　be　liquids。　There　is　a　case　on　record　of　an　infant　who　was　eating　some　coal；　and　being　discovered　by　its　mother　was　forced　to　rapidly　swallow　some　water。　In　the　excitement；　part　of　the　fluid　swallowed　fell　into　the　trachea；　and　death　rapidly　ensued。　It　is　hardly　necessary　to　mention　the　instances　in　which　pus　or　blood　from　ruptured　abscesses　entered　the　trachea　and　caused　subsequent　asphyxiation。　A　curious　instance　is　reported　by　Gaujot　of　Val…de…Grace　of　a　soldier　who　was　wounded　in　the　Franco…Prussian　war；　and　into　whose　wound　an　injection　of　the　tincture　of　iodin　was　made。　The　wound　was　of　such　an　extent　as　to　communicate　with　a　bronchus；　and　by　this　means　the　iodin　entered　the　respiratory　tract；　causing　suffocation。　According　to　Poulet；　Vidal　de　Cassis　mentions　an　inmate　of　the　Charite　Hospital；　in　Paris；　who；　full　of　wine；　had　started　to　vomit；　he　perceived　Corvisart；　and　knew　he　would　be　questioned；　therefore　he　quickly　closed　his　mouth　to　hide　the　proofs　of　his　forbidden　ingestion。　The　materials　in　his　mouth　were　forced　into　the　larynx；　and　he　was　immediately　asphyxiated。　Laennec；　Merat；　and　many　other　writers　have　mentioned　death　caused　by　the　entrance　of　vomited　materials　into　the　air…passages。　Parrot　has　observed　a　child　who　died　by　the　penetration　of　chyme　into　the　air…passages。　The　bronchial　mucous　and　underlying　membrane　were　already　in　a　process　of　digestion。　Behrend；　Piegu；　and　others　cite　analogous　instances。

The　presence　of　a　foreign　body　in　the　larynx　is　at　all　times　the　cause　of　distressing　symptoms；　and；　sometimes；　a　substance　of　the　smallest　size　will　cause　death。　There　is　a　curious　accident　recorded　that　happened　to　a　young　man　of　twenty…three；　who　was　anesthetized　in　order　to　extract　a　tooth。　A　cork　had　been　placed　between　the　teeth　to　keep　the　mouth　open。　The　tooth　was　extracted　but　slipped　from　the　forceps；　and；　together　with　the　cork；　fell　into　the　pharynx。　The　tooth　was　ejected　in　an　effort　at　vomiting；　but　the　cork　entered　the　larynx；　and；　after　violent　struggles；　asphyxiation　caused　death　in　an　hour。　The　autopsy　demonstrated　the　presence　of　the　cork　in　the　larynx。　A　somewhat　analogous　case；　though　not　ending　fatally；　was　reported　by　Hertz　of　a　woman　of　twenty…six；　who　was　anesthetized　for　the　extraction　of　the　right　second　inferior　molar。　The　crown　broke　off　during　the　operation；　and　immediately　after　the　extraction　she　had　a　fit　of　coughing。　About　fifteen　days　later　she　experienced　pain　in　the　lungs。　Her　symptoms　increased　to　the　fifth　week；　when　she　became　so　feeble　as　to　be　confined　to　her　bed。　A　body　seemed　to　be　moving　in　the　trachea；　synchronously　with　respiration。　At　the　end　of　the　fifth　week　the　missing　crown　of　the　tooth　was　expelled　after　a　violent　fit　of　coughing；　the　symptoms　immediately　ameliorated；　and　recovery　was　rapid　thereafter。　Aronsohn　speaks　of　a　child　who　was　playing　with　a　toy　wind…instrument；　and　in　his　efforts　to　forcibly　aspirate　air　through　it；　the　child　drew　the　detached　reed　into　the　respiratory　passages；　causing　asphyxiation。　At　the　autopsy　the　foreign　body　was　found　at　the　superior　portion　of　the　left　bronchus。　There　are　other　cases　in　which；　while　sucking　oranges　or　lemons；　seeds　have　been　aspirated；　and　there　is　a　case　in　which；　in　a　like　manner；　the　claw　of　a　crab　was　drawn　into　the　air…passages。　There　are　two　cases　mentioned　in　which　children　playing　with　toy　balloons；　which　they　inflated　with　their　breath；　have；　by　inspiration；　reversed　them　and　drawn　the　rubber　of　the　balloon　into　the　opening　of　the　glottis；　causing　death。　Aronsohn；　who　has　already　been　quoted；　and　whose　collection　of　instances　of　this　nature　is　probably　the　most　extensive；　speaks　of　a　child　in　the　street　who　was　eating　an　almond；　a　carriage　threw　the　child　down　and　he　suddenly　inspired　the　nut　into　the　air…passages；　causing　immediate　asphyxia　The　same　author　also　mentions　a　soldier　walking　in　the　street　eating　a　plum；　who；　on　being　struck　by　a　horse；　suddenly　started　and　swallowed　the　seed　of　the　fruit。　After　the　accident　he　had　little　pain　or