anomalies and curiosities of medicine-第151部分

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eal　lines　of　long　bones　and　beneath　the　periosteum。　Figure　213　shows　the　appearance　during　life　of　a　patient　with　the　highest　grade　of　rachitis；　and　it　can　be　easily　understood　what　a　barrier　to　natural　child…birth　it　would　produce。　In　rachitis　epiphyseal　swellings　are　seen　at　the　wrists　and　ankle…joints；　and　in　superior　cases　at　the　ends　of　the　phalanges　of　the　fingers　and　toes。　When　the　shaft　of　a　long　bone　is　affected；　not　only　deformity；　but　even　fracture　may　occur。　Under　these　circumstances　the　humerus　and　femur　appear　to　be　the　bones　most　likely　to　break；　there　is　an　associate　deformity　of　the　head；　known　as　〃craniotabes；〃　together　with　pigeon…breast　and　various　spinal　curvature。　The　accompanying　illustration　is　from　a　drawing　of　a　skeleton　in　the　Warren　Museum　in　Boston。　The　subject　was　an　Indian；　twenty…one　years　of　age；　one　of　the　Six　Nations。　His　mode　of　locomotion　was　by　a　large　wooden　bowl；　in　which　he　sat　and　moved　forward　by　advancing　first　one　side　of　the　bowl　and　then　the　other；　by　means　of　his　hands。　The　nodules　or　〃adventitious　joints〃　were　the　result　of　imperfect　ossification；　or；　in　other　words；　of　motion　before　ossification　was　completed。

Analogous　to　rachitis　is　achondroplasia；　or　the　so　called　fetal　ricketsa　disease　in　which　deformity　results　from　an　arrest；　absence；　or　perversion　of　the　normal　process　of　enchondral　ossification。　It　is　decidedly　an　intrauterine　affection；　and　the　great　majority　of　fetuses　die　in　utero。　Thomson　reports　three　living　cases　of　achondroplasia。　The　first　was　a　child　five　months　of　age；　of　pale　complexion；　bright　and　intelligent；　its　head　measuring　23　inches　in　length。　There　was　a　narrow　thorax　showing　the　distinct　beads　of　rickets；　the　upper　and　lower　limbs　were　very　short；　but　improved　under　antirachitic　treatment。　The　child　died　of　pneumonia。　The　other　two　cases　were　in　adults；　one　thirty…nine　and　the　other　thirty…six。　The　men　were　the　same　height；　49　inches；　and　resembled　each　other　in　all　particulars。　They　both　enjoyed　good　health；　and；　though　somewhat　dwarfed；　were　of　considerable　intelligence。　Neither　had　married。　Both　the　upper　and；　lower　limbs　showed　exaggerations　of　the　normal　curves；　the　hands　and　feet　were　broad　and　short；　the　gait　of　both　of　these　little　men　was　waddling；　the　hunk　swaying　when　they　attempted　to　make　any　rapid　progress。

Osteitis　deformans　is　a　hyperplasia　of　bone　described　by　Paget　in　1856。　Paget's　patient　was　a　gentleman　of　forty…six　who　had　always　enjoyed　good　health；　without　assignable　cause　he　began　to　be　subject　to　aching　pains　in　the　thighs　and　legs。　The　bones　of　the　left　leg　began　to　increase　in　size；　and　a　year　or　two　later　the　left　femur；　also　enlarged　considerably。　During　a　period　of　twenty　years　these　changes　were　followed　by　a　growth　of　other　bones。　The　spine　became　firm　and；　rigid；　the　head　increased　5　1/4　inches　in　circumference。　The　bones　of　the　face　were　not　affected。　When　standing；　the　patient　had　a　peculiar　bowed　condition　of　the　legs；　with　marked　flexure　at　the　knees。　He　finally　died　of　osteosarcoma；　originating　in　the　left　radius；　Paget　collected　eight　cases；　five　of　whom　died　of　malignant　disease。　The　postmortem　of　Paget's　case　showed　extreme　thickening　in　the　bones　affected；　the　femur　and　cranium　particularly　showing　osteoclerosis。　Several　cases　have　been　recorded　in　this　country；　according　to　Warren；　Thieberge　analyzed　43　cases；　21　were　men；　22　women；　the　disease　appeared　usually　after　forty。

Acromegaly　is　distinguished　from　osteitis　deformans　in　that　it　is　limited　to　hypertrophy　of　the　hands；　feet；　and　face；　and　it　usually　begins　earlier。　In　gigantism　the　so…called　〃giant　growth　of　bones〃　is　often　congenital　in　character；　and　is　unaccompanied　by　inflammatory　symptoms。

The　deformities　of　the　articulations　may　be　congenital　but　in　most　cases　are　acquired。　When　these　are　of　extreme　degree；　locomotion　is　effected　in　most　curious　ways。　Ankylosis　at　unnatural　angles　and　even　complete　reversion　of　the　joints　has　been　noticed。　Pare　gives　a　case　of　reversion；　and　of　crooked　hands　and　feet；　and　Barlow　speaks　of　a　child　of　two　and　three…quarter　years　with　kyphosis；　but　mobility　of　the　lumbar　region；　which　walked　on　its　elbows　and　knees。　The　pathology　of　this　deformity　is　obscure；　but　there　might　have　been　malposition　in　utero。　Wilson　presented　a　similar　case　before　the　Clinical　Society　of　London；　in　1888。　The　〃Camel…boy；〃　exhibited　some　years　ago　throughout　the　United　States；　had　reversion　of　the　joints；　which　resembled　those　of　quadrupeds。　He　walked　on　all　fours；　the　mode　of　progression　resembling　that　of　a　camel。

Figure　216　represents　Orloff；　〃the　transparent　man；〃　an　exhibitionist；　showing　curious　deformity　of　the　long　bones　and　atrophy　of　the　extremities。　He　derived　his　name　from　the　remarkable　transparency　of　his　deformed　members　to　electric　light；　due　to　porosity　of　the　bones　and　deficiency　of　the　overlying　tissues。

Figure　217；　taken　from　Hutchinson's　〃Archives　of　Surgery；〃　represents　an　extreme　case　of　deformity　of　the　knee…joints　in　a　boy　of　seven；　the　result　of　severe　osteoarthritis。　The　knees　and　elbows　were　completely　ankylosed。

Infantile　spinal　paralysis　is　often　the　cause　of　distressing　deformities；　forbidding　locomotion　in　the　ordinary　manner。　In　a　paper　on　the　surgical　and　mechanical　treatment　of　such　deformities　Willard　mentions　a　boy　of　fourteen；　the　victim　of　infantile　paralysis；　who　at　the　age　of　eleven　had　never　walked；　but　dragged　his　legs　along。　His　legs　were　greatly　twisted；　and　there　was　flexion　at　right　angles　at　the　hips　and　knees。　There　was　equinovarus　in　the　left　foot　and　equinovalgus　in　the　right。　By　an　operation　of　subcutaneous　section　at　the　hips；　knees；　and　feet；　with　application　of　plaster…of…Paris　and　extension；　this　hopeless　cripple　walked　with　crutches　in　two　months；　and　with　an　apparatus　consisting　of　elastic　straps　over　the　quadriceps　femoris；　peroneals；　and　weakened　muscles；　the　valgus…foot　being　supported　beneath　the　sole。　In　six　months　he　was　walking　long　distances；　in　one　year　he　moved　speedily　on　crutches。　Willard　also　mentions　another　case　of　a　girl　of　eleven　who　was　totally　unable　to　support　the　body　in　the　erect　position；　but　could　move　on　all　fours；　as　shown　in　figure　219。　There　was　equinovarus　in　the　right　foot　and　valgus　in　the　left。　The　left　hip　was　greatly　distorted；　not　only　in　the　direction　of　flexion；　but　there　was　also　twisting　of　the　femoral　neck；　simulating　dislocation。　This　patient　was　also　operated　on　in　the　same　manner　as　the　preceding　one。

Relative　to　anomalous　increase　or　hypertrophy　of　the　bones　of　the　extremities；　Fischer　shows　that　an　increase　in　the　length　of　bone　may　follow　slight　injuries。　He　mentions　a　boy　of　twelve；　who　was　run　over　by　a　wagon　and　suffered　a　contusion　of　the　bones　of　the　right　leg。　In　the　course　of　a　year　this　leg　became　4　1/2　cm。　longer　than　the　other；　and　the　bones　were　also　much　thicker　than　in　the　other。　Fischer　also　reports　several　cases　of　abnormal　growth　of　bone　following　necrosis。　A　case　of　shortening　3　3/4　cm。；　after　a　fracture；　was　reduced　to　one　cm。　by　compensatory　growth。　Elongation　of　the　bone　is　also　mentioned　as　the　result　of　the　inflammation　of　the　joint。　Warren　also　quotes　Taylor's　case　of　a　lady　who　fell；　injuring；　but　not　fracturing；　the　thigh。　Gradual　enlargement；　with　an　outward　curving　of　the　bone；　afterward　took　place。



CHAPTER　XII。

SURGICAL　ANOMALIES　OF　THE　THORAX　AND　ABDOMEN。

Injuries　of　the　lung　or　bronchus　are　always　serious；　but　contrary　to　the　general　idea；　recovery　after　extensive　wound　of　the　lung　is　quite　a　common　occurrence。　Even　the　older　writers　report　many　instances　of　remarkable　recoveries　from　lung…injuries；　despite　the　primitive　and　dirty　methods　of　treatment。　A　review　of　the　literature　previous　to　this　century　shows　the　names　of　Arcaeus；　Brunner；　Collomb；　Fabricius　Hildanus；　Vogel；　Rhodius；　Petit；　Guerin；　Koler；　Peters；　Flebbe；　and　Stalpart；　as　authorities　for　instances　of　this　nature。　In　one　of　the　journals　there　is　a　description　of　a　man　who　was　wounded　by　a　broad…sword　thrust　in　the　mediastinum。　After　death　it　was　found　that　none　of　the　viscera　were　wounded；　and　death　was　attributed　to　the　fact　that　the　in…rush　of　air　counterbalancing　the　pressure　within　the　lungs　left　them　to　their　own　contractile　force；　with　resultant　collapse；　obstruction　to　the　circulation；　and　death。　It　is　said　that　Vesalius　demonstrated　this　condition　on　the　thorax　of　a　pig。

Gooch　gives　an　instance　of　a　boy　of　thirteen　who　fell　from　the　top　of　a　barn　upon　the　sharp　prow　of　a　plough；　inflicting　an　oblique　wound　from　the　axilla　to　below　the　sternum；　slightly　above　the　insertion　of　the　diaphragm。　Several　ribs　were　severed；　and　the　left　thoracic　cavity　was　wholly　exposed　to　view；　showing　the　lungs；　diaphragm；　and　pericardium　all　in　motion。　The　lungs　soon　became　gangrenous；　and　in　this　horrible　state　the　patient　lived　twelve　days。　One　of　the　curious　facts　noticed　by　the　ancient　writers　was　the　amelioration　of　the　symptoms　caused　by　thoracic　wounds　after　hemorrhage　from　other　locations；　and　naturally；　in　the　treatment　of　such　injuries；　this　circumstance　was　used　in　advocacy　of　depletion。　Monro　speaks　of　a　gentleman　who　was　wounded　in　a　duel；　and　who　had　all　the　symptoms　of　hemothorax；　his　condition　was　immediately　relieved　by　the　evacuation　of　a　considerable　quantity　of　bloody　matter　with　the　urine。　Swammerdam　records　a　similar　case；　and　Fabricius　ab　Aquapendente　noticed　a　case　in　which　the　opening　in　the　thorax　showed　immediate　signs　of　improvement　after　the　patient　voided　large　quantities　of　bloody　urine。　Glandorp　also　calls　attention　to　the　foregoing　facts。　Nicolaus　Novocomensis　narrates　the　details　of　the　case　of　one　of　his　friends；　suffering　from　a　penetrating　wound　of　the　thorax；　who　was　relieved　and　ultimately　cured　by　a　bloody　evacuation　with　the　stool。

There　is　an　extraordinary　recovery　reported　in　a　boy　of　fifteen　who；　by　falling　into　the　machinery　of　an　elevator；　was　severely　injured　about　the　chest。　There　were　six　extensive　lacerations；　five　through　the　skin　about　six　inches　long；　and　one　through　the　chest　about　eight　inches　long。　The　3d；　4th；　5th；　and　6th　ribs　were　fractured　and　torn　apart；　and　about　an　inch　of　the　substance　of　the　4th　rib　was　lost。　Several　jagged　fragments　were　removed；　a　portion　of　the