anomalies and curiosities of medicine-第153部分

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d　lay　still　until　his　brother　came　to　his　assistance；　the　latter　with　great　forethought　and　caution　carefully　calculated　the　curvature　of　the　scythe　blade；　and　thus　regulating　his　direction　of　tension；　successfully　withdrew　the　instrument。　There　was　but　little　hemoptysis　and　the　patient　soon　recovered。　Chelius　records　an　instance　of　penetration　of　the　chest　by　a　carriage　shaft；　with　subsequent　recovery。　Hoyland　mentions　a　man　of　twenty…five　who　was　discharging　bar…iron　from　the　hold　of　a　ship；　in　a　stooping　position；　preparatory　to　hoisting　a　bundle　on　deck；　he　was　struck　by　one　of　the　bars　which　pinned　him　to　the　floor　of　the　hold；　penetrating　the　thorax；　and　going　into　the　wood　of　the　flooring　to　the　extent　of　three　inches；　requiring　the　combined　efforts　of　three　men　to　extract　it。　The　bar　had　entered　posteriorly　between　the　9th　and　10th　ribs　of　the　left　side；　and　had　traversed　the　thorax　in　an　upward　and　outward　direction；　coming　out　anteriorly　between　the　5th　and　6th　ribs；　about　an　inch　below　and　slightly　external　to　the　nipple。　There　was　little　constitutional　disturbance；　and　the　man　was　soon　discharged　cured。　Brown　records　a　case　of　impalement　in　a　boy　of　fourteen。　While　running　to　a　fire；　he　struck　the　point　of　the　shaft　of　a　carriage；　which　passed　through　his　left　chest；　below　the　nipple。　There　was；　strangely；　no　hemorrhage；　and　no　symptoms　of　so　severe　an　injury；　the　boy　recovered。

There　is　deposited　in　the　Museum　of　the　Royal　College　of　Surgeons　in　London；　a　mast…pivot；　15　inches　in　length　and　weighing　between　seven　and　eight　pounds；　which　had　passed　obliquely　through　the　body　of　a　sailor。　The　specimen　is　accompanied　by　a　colored　picture　of　the　sufferer　himself　in　two　positions。　The　name　of　the　sailor　was　Taylor；　and　the　accident　occurred　aboard　a　brig　lying　in　the　London　docks。　One　of　Taylor's　mates　was　guiding　the　pivot　of　the　try…sail　into　the　main　boom；　when　a　tackle　gave　way。　The　pivot　instantly　left　the　man's　hand；　shot　through　the　air　point　downward　striking　Taylor　above　the　heart；　passing　out　lower　down　posteriorly；　and　then　imbedded　itself　in　the　deck。　The　unfortunate　subject　was　carried　at　once　to　the　London　Hospital；　and　notwithstanding　his　transfixion　by　so　formidable　an　instrument；　in　five　months　Taylor　had　recovered　sufficiently　to　walk；　and　ultimately　returned　to　his　duties　as　a　seaman。

In　the　same　museum；　near　to　this　spike；　is　the　portion　of　a　shaft　of　the　carriage　which　passed　through　the　body　of　a　gentleman　who　happened　to　be　standing　near　the　vehicle　when　the　horse　plunged　violently　forward；　with　the　result　that　the　off　shaft　penetrated　his　body　under　the　left　arm；　and　came　out　from　under　the　right　arm；　pinning　the　unfortunate　man　to　the　stable　door。　Immediately　after　the　accident　the　patient　walked　upstairs　and　got　in　bed；　his　recovery　progressed　uninterruptedly；　and　his　wounds　were　practically　healed　at　the　end　of　nine　weeks；　he　is　reported　to　have　lived　eleven　years　after　this　terrible　accident。

In　the　Indian　Medical　Gazette　there　is　an　account　of　a　private　of　thirty…　five；　who　was　thrown　forward　and　off　his　horse　while　endeavoring　to　mount。　He　fell　on　a　lance　which　penetrated　his　chest　and　came　out　through　the　scapula。　The　horse　ran　for　about　100　yards；　the　man　hanging　on　and　trying　to　stop　him。　After　the　extraction　of　the　lance　the　patient　recovered。　Longmore　gives　an　instance　of　complete　transfixion　by　a　lance　of　the　right　side　of　the　chest　and　lung；　the　patient　recovering。　Ruddock　mentions　cases　of　penetrating　wounds　of　both　lungs　with　recovery。

There　is　a　most　remarkable　instance　of　recovery　after　major　thoracic　wounds　recorded　by　Brokaw。　In　a　brawl；　a　shipping　clerk　received　a　thoracic　wound　extending　from　the　3d　rib　to　within　an　inch　of　the　navel；　13　1/2　inches　long；　completely　severing　all　the　muscular　and　cartilaginous　structures；　including　the　cartilages　of　the　ribs　from　the　4th　to　the　9th；　and　wounding　the　pleura　and　lung。　In　addition　there　was　an　abdominal　wound　6　1/2　inches　long；　extending　from　the　navel　to　about　two　inches　above　Poupart's　ligament；　causing　almost　complete　intestinal　evisceration。　The　lung　was　partially　collapsed。　The　cartilages　were　ligated　with　heavy　silk；　and　the　hemorrhage　checked　by　ligature　and　by　packing　gauze　in　the　inter…chondral　spaces。　The　patient　speedily　recovered；　and　was　discharged　in　a　little　over　a　month；　the　only　disastrous　result　of　his　extraordinary　injuries　being　a　small　ventral　hernia。

In　wounds　of　the　diaphragm；　particularly　those　from　stabs　and　gunshot　injuries；　death　is　generally　due　to　accompanying　lesions　rather　than　to　injury。　Hollerius；　and　Alexander　Benedictus；　made　a　favorable　diagnosis　of　wounds　made　in　the　fleshy　portions　of　the　diaphragm；　but　despaired　of　those　in　the　tendinous　portions。　Bertrand；　Fabricius　Hildanus；　la　Motte；　Ravaton；　Valentini；　and　Glandorp；　record　instances　of　recovery　from　wounds　of　the　diaphragm。

There　are　some　peculiar　causes　of　diaphragmatic　injuries　on　record；　laughter；　prolonged　vomiting；　excessive　eating；　etc。；　being　mentioned。　On　the　other　hand；　in　his　〃Essay　on　Laughter　（du　Ris）；〃　Joubert　quotes　a　case　in　which　involuntary　laughter　was　caused　by　a　wound　of　the　diaphragm；　the　laughter　mentioned　in　this　instance　was　probably　caused　by　convulsive　movements　of　the　diaphragm；　due　to　some　unknown　irritation　of　the　phrenic　nerve。　Bremuse　gives　an　account　of　a　man　who　literally　split　his　diaphragm　in　two　by　the　ingestion　of　four　plates　of　potato　soup；　numerous　cups　of　tea　and　milk；　followed　by　a　large　dose　of　sodium　bicarbonate　to　aid　digestion。　After　this　meal　his　stomach　swelled　to　an　enormous　extent　and　tore　the　diaphragm　on　the　right　side；　causing　immediate　death。

The　diaphragm　may　be　ruptured　by　external　violence　（a　fall　on　the　chest　or　abdomen）；　or　by　violent　squeezing　（railroad　accidents；　etc。）；　or　according　to　Ashhurst；　by　spasmodic　contraction　of　the　part　itself。　If　the　injury　is　unaccompanied　by　lesion　of　the　abdominal　or　thoracic　viscera；　the　prognosis　is　not　so　unfavorable　as　might　be　supposed。　Unless　the　laceration　is　extremely　small；　protrusion　of　the　stomach　or　some　other　viscera　into　the　thoracic　cavity　will　almost　invariably　result；　constituting　the　condition　known　as　internal　or　diaphragmatic　hernia。　Pare　relates　the　case　of　a　Captain　who　was　shot　through　the　fleshy　portion　of　the　diaphragm；　and　though　the　wound　was　apparently　healed；　the　patient　complained　of　a　colicky　pain。　Eight　months　afterward　the　patient　died　in　a　violent　paroxysm　of　this　pain。　At　the　postmortem　by　Guillemeau；　a　man　of　great　eminence　and　a　pupil　of　Pare；　a　part　of　the　colon　was　found　in　the　thorax；　having　passed　through　a　wound　in　the　diaphragm。　Gooch　saw　a　similar　case；　but　no　history　of　the　injury　could　be　obtained。　Bausch　mentions　a　case　in　which　the　omentum；　stomach；　and　pancreas　were　found　in　the　thoracic　cavity；　having　protruded　through　an　extensive　opening　in　the　diaphragm。　Muys；　Bonnet；　Blancard；　Schenck；　Sennert；　Fantoni；　and　Godefroy　record　instances　in　which；　after　rupture　of　the　diaphragm；　the　viscera　have　been　found　in　the　thorax；　there　are　many　modern　cases　on　record。　Internal　hernia　through　the　diaphragm　is　mentioned　by　Cooper；　Bowles；　Fothergill；　Monro；　Ballonius；　Derrecagiax；　and　Schmidt。　Sir　Astley　Cooper　mentioned　a　case　of　hernia　ventriculi　from　external　violence；　wherein　the　diaphragm　was　lacerated　without　any　fracture　of　the　ribs。　The　man　was　aged　twenty…seven；　and　being　an　outside　passenger　on　a　coach　（and　also　intoxicated）；　when　it　broke　down　he　was　projected　some　distance；　striking　the　ground　with　considerable　force。　He　died　on　the　next　day；　and　the　diagnosis　was　verified　at　the　necropsy；　the　opening　in　the　diaphragm　causing　stricture　of　the　bowel。

Postempski　successfully　treated　a　wound　of　the　diaphragm　complicated　with　a　wound　of　the　omentum；　which　protruded　between　the　external　opening　between　the　10th　and　11th　ribs；　he　enlarged　the　wound；　forced　the　ribs　apart；　ligated　and　cut　off　part　of　the　omentum；　returned　its　stump　to　the　abdomen；　and　finally　closed　both　the　wound　in　the　diaphragm　and　the　external　wound　with　sutures。　Quoted　by　Ashhurst；　Hunter　recorded　a　case　of　gunshot　wound；　in　which；　after　penetrating　the　stomach；　bowels；　and　diaphragm　the　ball　lodged　in　the　thoracic　cavity；　causing　no　difficulty　in　breathing　until　shortly　before　death；　and　even　then　the　dyspnea　was　mechanicalfrom　gaseous　distention　of　the　intestines。

Peritonitis　in　the　thoracic　cavity　is　a　curious　condition　which　may　be　brought　about　by　a　penetrating　wound　of　the　diaphragm。　In　1872　Sargent　communicated　to　the　Boston　Society　for　Medical　Improvement　an　account　of　a　postmortem　examination　of　a　woman　of　thirty…seven；　in　whom　he　had　observed　major　injuries　twenty　years　before。　At　that　time；　while　sliding　down　some　hay　from　a　loft；　she　was　impaled　on　the　handle　of　a　pitchfork　which　entered　the　vagina；　penetrated　22　inches；　and　was　arrested　by　an　upper　left　rib；　which　it　fractured；　further　penetration　was　possibly　prevented　by　the　woman's　feet　striking　the　floor。　Happily　there　was　no　injury　to　the　bladder；　uterus；　or　intestines。　The　principal　symptoms　were　hemorrhage　from　the　vagina　and　intense　pain　near　the　fractured　rib；　followed　by　emphysema。　The　pitchfork…handle　was　withdrawn；　and　was　afterward　placed　in　the　museum　of　the　Society；　the　abrupt　bloody　stain；　22　inches　from　the　rounded　end；　being　plainly　shown。　During　twenty　years　the　woman　could　never　lie　on　her　right　side　or　on　her　back；　and　for　half　of　this　time　she　spent　most　of　the　night　in　the　sitting　position。　Her　last　illness　attracted　little　attention　because　her　life　had　been　one　of　suffering。　After　death　it　was　found　that　the　cavity　in　the　left　side　of　the　chest　was　entirely　filled　with　abdominal　viscera。　The　opening　in　the　diaphragm　was　four　inches　in　diameter；　and　through　it　had　passed　the　stomach；　transverse　colon；　a　few　inches　of　the　descending　colon；　and　a　considerable　portion　of　the　small　intestines。　The　heart　was　crowded　to　the　right　of　the　sternum　and　was　perfectly　healthy；　as　was　also　the　right　lung。　The　left　lung　was　compressed　to　the　size　of　a　hand。　There　were　marked　signs　of　peritonitis；　and　in　the　absence　of　sufficient　other　symptoms；　it　could　be　said　that　this　woman　had　died　of　peritonitis　in　the　left　thoracic　cavity。

Extended　toleranc