anomalies and curiosities of medicine-第149部分

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e　was　the　usual　depression　immediately　above　the　upper　margin　of　the　patella；　and　the　other　distinctive　signs　of　the　accident。　In　three　months　both　tendons　had　united　to　such　an　extent　that　the　patient　was　able　to　walk　slowly。　Gibney　records　a　case　in　which　the　issue　was　not　so　successful；　his　patient　being　a　man　who；　in　a　fall　ten　years　previously；　had　ruptured　the　right　quadriceps　tendon；　and　four　years　later　had　suffered　the　same　accident　on　the　opposite　side。　As　a　result　of　his　injuries；　at　the　time　Gibney　saw　him；　he　had　completely　lost　all　power　of　extending　the　knee…joint。　Partridge　mentions　an　instance；　in　a　strong　and　healthy　man；　of　rupture　of　the　tendon　of　the　left　triceps　cubiti；　caused　by　a　fall　on　the　pavement。　There　are　numerous　cases　in　which　the　tendo　Achillis　has　recovered　after　rupture；in　fact；　it　is　unhesitatingly　severed　when　necessity　demands　it；　sufficient　union　always　being　anticipated。　None　of　these　cases　of　rupture　of　the　tendon　are　unique；　parallel　instances　existing　in　medical　literature　in　abundance。

Marshall　had　under　his　observation　a　case　in　which　the　femoral　artery　was　ruptured　by　a　cart　wheel　passing　over　the　thigh；　and　death　ensued　although　there　were　scarcely　any　external　signs　of　contusion　and　positively　no　fracture。　Boerhaave　cites　a　curious　instance　in　which　a　surgeon　attempted　to　stop　hemorrhage　from　a　wounded　radial　artery　by　the　application　of　a　caustic；　but　the　material　applied　made　such　inroads　as　to　destroy　the　median　artery　and　thus　brought　about　a　fatal　hemorrhage。

Spontaneous　fractures　are　occasionally　seen；　but　generally　in　advanced　age；　although　muscular　action　may　be　the　cause。　There　are　several　cases　on　record　in　which　the　muscular　exertion　in　throwing　a　stone　or　ball；　or　in　violently　kicking　the　leg；　has　fractured　one　or　both　of　the　bones　of　an　extremity。　In　old　persons　intracapsular　fracture　may　be　caused　by　such　a　trivial　thing　as　turning　in　bed；　and　even　a　sudden　twist　of　the　ankle　has　been　sufficient　to　produce　this　injury。　In　a　boy　of　thirteen　Storrs　has　reported　fracture　of　the　femur　within　the　acetabulum。　In　addition　to　the　causes　enumerated；　inflammation　of　osseous　tissue；　or　osteoid　carcinoma；　has　been　found　at　the　seat　of　a　spontaneous　fracture。

One　of　the　most　interesting　subjects　in　the　history　of　surgery　is　the　gradual　evolution　of　the　rational　treatment　of　dislocations。　Possibly　no　portion　of　the　whole　science　was　so　backward　as　this。　Thirty…five　centuries　ago　Darius；　son　of　Hydaspis；　suffered　a　simple　luxation　of　the　foot；　it　was　not　diagnosed　in　this　land　of　Apis　and　of　the　deified　discoverer　of　medicine。　Among　the　wise　men　of　Egypt；　then　in　her　acme　of　civilization；　there　was　not　one　to　reduce　the　simple　luxation　which　any　student　of　the　present　day　would　easily　diagnose　and　successfully　treat。　Throughout　the　dark　ages　and　down　to　the　present　century；　the　hideous　and　unnecessary　apparatus　employed；　each　decade　bringing　forth　new　types；　is　abundantly　pictured　in　the　older　books　on　surgery；　in　some　almost　recent　works　there　are　pictures　of　windlasses　and　of　individuals　making　superhuman　efforts　to　pull　the　luxated　member　backall　of　which　were　given　to　the　student　as　advisable　means　of　treatment。

Relative　to　anomalous　dislocations　the　field　is　too　large　to　be　discussed　here；　but　there　are　two　recent　ones　worthy　of　mention。　Bradley　relates　an　instance　of　death　following　a　subluxation　of　the　right　humerus　backward　on　the　scapula　It　could　not　be　reduced　because　the　tendon　of　the　biceps　lay　between　the　head　of　the　humerus　and　a　piece　of　the　bone　which　was　chipped　off。

Baxter…Tyrie　reports　a　dislocation　of　the　shoulder…joint；　of　unusual　origin；　in　a　man　who　was　riding　a　horse　that　ran　away　up　a　steep　hill。　After　going　a　few　hundred　yards　the　animal　abated　its　speed；　when　the　rider　raised　his　hand　to　strike。　Catching　sight　of　the　whip；　the　horse　sprang　forward；　while　the　man　felt　an　acute　pain　and　a　sense　of　something　having　given　way　at　his　shoulder。　He　did　not　fall　off；　but　rode　a　little　further　and　was　helped　to　dismount。　On　examination　a　subcoracoid　dislocation　of　the　head　of　the　humerus　was　found。　The　explanation　is　that　as　the　weight　of　the　whip　was　inconsiderable　（four　ounces）　the　inertia　of　the　arm　converted　it　into　a　lever　of　the　first　order。　Instead　of　fulfilling　its　normal　function　of　preventing　displacement；　the　coraco…acromial　arch　acted　as　a　fulcrum。　The　limb　from　the　fingers　to　that　point　acted　as　the　〃long　arm；〃　and　the　head　and　part　of　the　neck　of　the　humerus　served　as　the　〃short　arm。〃　The　inertia　of　the　arm；　left　behind　as　it　were；　supplied　the　power；　while　the　ruptured　capsular　ligament　and　displacement　of　the　head　of　the　bone　would　represent　the　work　done。

Congenital　Dislocations。The　extent　and　accuracy　of　the　knowledge　possessed　by　Hippocrates　on　the　subject　of　congenital　dislocations　have　excited　the　admiration　of　modern　writers；　and　until　a　comparatively　recent　time　examples　of　certain　of　the　luxations　described　by　him　had　not　been　recorded。　With　regard；　for　instance；　to　congenital　dislocations　at　the　shoulder…joint；　little　or　nothing　was　known　save　what　was　contained　in　the　writings　of　Hippocrates；　till　R。　M。　Smith　and　Guerin　discussed　the　lesion　in　their　works。

Among　congenital　dislocations；　those　of　the　hips　are　most　commonin　fact；　90　per　cent　of　all。　They　are　sometimes　not　recognizable　until　after　the　lapse　of　months　and　sometimes　for　years；　but　their　causesfaulty　developments　of　the　joint；　paralysis；　etc。are　supposed　to　have　existed　at　birth。　One　or　both　joints　may　be　involved；　and　according　to　the　amount　of　involvement　the　gait　is　peculiar。　As　to　the　reduction　of　such　a　dislocation；　the　most　that　can　be　done　is　to　diminish　the　deformity　and　functional　disability　by　traction　and　palliative　measures　with　apparatus。　The　normal　structure　of　the　joint　does　not　exist；　and　therefore　the　dislocation　admits　of　no　reduction。　Congenital　dislocations　of　the　shoulder　are　also　seen；　owing　to　faulty　development　of　the　glenoid　fossa；　and　at　the　knee；　the　leg　generally　being　in　extreme　hyperextension；　the　foot　sometimes　resting　on　the　abdomen。　Congenital　luxation　of　the　femora；　when　it　appears　in　adult　women　is　a　prominent　factor　in　dystocia。　There　is　a　dislocation　found　at　birth；　or　occurring　shortly　after；　due　to　dropsy　of　the　joint　in　utero；　and　another　form　due　to　succeeding　paralysis　of　groups　of　muscles　about　the　joint。

The　interesting　instances　of　major　amputations　are　so　numerous　and　so　well　known　as　to　need　no　comment　here。　Amputation　of　the　hip　with　recovery　is　fast　becoming　an　ordinary　operation；　at　Westminster　Hospital　in　London；　there　is　preserved　the　right　humerus　and　scapula；　presenting　an　enormous　bulk；　which　was　removed　by　amputation　at　the　shoulder…joint；　for　a　large　lymphosarcoma　growing　just　above　the　clavicle。　The　patient　was　a　man　of　twenty…two；　and　made　a　good　recovery。　Another　similar　preparation　is　to　be　seen　in　London　at　St。　Bartholomew's　Hospital。

Simultaneous；　synchronous；　or　consecutive　amputations　of　all　the　limbs　have　been　repeatedly　performed。　Champeuois　reports　the　case　of　a　Sumatra　boy　of　seven；　who　was　injured　to　such　an　extent　by　an　explosion　as　to　necessitate　the　amputation　of　all　his　extremities；　and；　despite　his　tender　age　and　the　extent　of　his　injuries；　the　boy　completely　recovered。　Jackson；　quoted　by　Ashhurst；　had　a　patient　from　whom　he　simultaneously　amputated　all　four　limbs　for　frost…bite。

Muller　reports　a　case　of　amputation　of　all　four　limbs　for　frost…bite；　with　recovery。　The　patient；　aged　twenty…six；　while　traveling　to　his　home　in　Northern　Minnesota；　was　overtaken　by　a　severe　snow　storm；　which　continued　for　three　days；　on　December　13th　he　was　obliged　to　leave　the　stage　in　a　snow…drift　on　the　prairie；　about　110　miles　distant　from　his　destination。　He　wandered　over　the　prairie　that　day　and　night；　and　the　following　four　days；　through　the　storm；　freezing　his　limbs；　nose；　ears；　and　cheeks；　taking　no　food　or　water　until；　on　December　16th；　he　was　found　in　a　dying　condition　by　Indian　scouts；　and　taken　to　a　station…house　on　the　road。　He　did　not　reach　the　hospital　at　Fort　Ridgely　until　the　night　of　December　24theleven　days　after　his　first　exposure。　He　was　almost　completely　exhausted；　and；　after　thawing　the　ice　from　his　clothes；　stockings；　and　boots；which　had　not　been　removed　since　December　13th；it　was　found　that　both　hands　and　forearms　were　completely　mortified　up　to　the　middle　third；　and　both　feet　and　legs　as　far　as　the　upper　third；　both　knees　over　and　around　the　patellae；　and　the　alae　and　tip　of　the　nose　all　presented　a　dark　bluish　appearance　and　fairly　circumscribed　swelling。　No　evacuation　of　the　bowels　had　taken　place　for　over　two　weeks；　and　as　the　patient　suffered　from　singultus　and　constant　pain　over　the　epigastric　region；　a　light　cathartic　was　given；　which；　in　twenty…four　hours；　gave　relief。　The　four　frozen　limbs　were　enveloped　in　a　solution　of　zinc　chlorid。　The　frozen　ears　and　cheeks　healed　in　due　time；　and　the　gangrenous　parts　of　the　nose　separated　and　soon　healed；　with　the　loss　of　the　tip　and　parts　of　the　alae；　leaving　the　septum　somewhat　exposed。　On　January　10th　the　lines　of　demarcation　were　distinct　and　deep　on　all　four　limbs；　though　the　patient；　seconded　by　his　wife；　at　first　obstinately　opposed　operative　interference；　on　January　13th；　after　a　little　hesitancy；　the　man　consented　to　an　amputation　of　the　arms。　This　was　successfully　carried　out　on　both　forearms；　at　the　middle　third；　the　patient　losing　hardly　any　blood　and　complaining　of　little　pain。　The　great　relief　afforded　by　this　operation　so　changed　his　aversion　to　being　operated　upon　that　on　the　next　day　he　begged　to　have　both　legs　amputated　in　the　same　manner；　which　was　done；　three　days　afterward；　with　the　same　favorable　result。　After　some　minor　complications　the　patient　left　for　his　home；　perfectly　recovered；　June　9；　1866。

Begg　of　Dundee　successfully　performed　quadruple　amputation　on　a　woman；　the　victim　of　idiopathic　gangrene。　With　artificial　limbs　she　was　able　to　earn　a　livelihood　by　selling　fancy　articles　which　she　made　herself。　This　woman　died　in　1885；　and　the　four　limbs；　mounted　on　a　lay　figure；　were　placed　in　the　Royal　College　of　Surgeons；　in　London。　Wallace；　of　Rock　Rapids；　Iowa；　has　successfully　removed　both　forearms；　one　leg；　and