anomalies and curiosities of medicine-第159部分

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rture　was　filled；　so　as　to　supersede　the　necessity　of　a　compress；　the　protruding　coats　acting　as　a　valve　when　the　stomach　was　filled。　This　valvular　protrusion　was　easily　depressed　by　the　finger。　St。　Martin　suffered　little　pain　except　from　the　depression　of　the　skin。　He　took　his　food　and　drink　like　any　healthy　person；　and　for　eleven　years　remained　under　Dr。　Beaumont's　own　care　in　the　Doctor's　house　as　a　servant。　During　this　time　were　performed　the　experiments　on　digestion　which　are　so　well　known。　St。　Martin　was　at　all　times　willing　to　lend　himself　in　the　interest　of　physiologic　science。　In　August；　1879；　The　Detroit　Lancet　contains　advices　that　St。　Martin　was　living　at　that　time　at　St。　Thomas；　Joliette　County；　Province　of　Quebec；　Canada。　At　the　age　of　seventy…nine　he　was　comparatively　strong　and　well；　and　had　always　been　a　hard　worker。　At　this　time　the　opening　in　the　stomach　was　nearly　an　inch　in　diameter；　and　in　spite　of　its　persistence　his　digestion　had　never　failed　him。

Spizharny　relates　a　remarkable　case　of　gastric　fistula　in　the　loin；　and　collects　61　cases　of　gastric　fistula；　none　of　which　opened　in　the　loin。　The　patient　was　a　girl　of　eighteen；　who　had　previously　had　perityphlitis；　followed　by　abscesses　about　the　navel　and　lumbar　region。　Two　fistulae　were　found　in　the　right　loin；　and　were　laid　open　into　one　canal；　which；　after　partial　resection　of　the　12th　rib；　was　dilated　and　traced　inward　and　upward；　and　found　to　be　in　connection　with　the　stomach。　Food　was　frequently　found　on　the　dressings；　but　with　the　careful　use　of　tampons　a　cure　was　effected。

In　the　olden　times　wounds　of　the　stomach　were　not　always　fatal。　The　celebrated　anatomist；　Fallopius；　successfully　treated　two　cases　in　which　the　stomach　was　penetrated　so　that　food　passed　through　the　wound。　Jacobus　Orthaeus　tells　us　that　in　the　city　of　Fuldana　there　was　a　soldier　who　received　a　wound　of　the　stomach；　through　which　food　passed　immediately　after　being　swallowed；　he　adds　that　two　judicious　surgeons　stitched　the　edges　of　the　wound　to　the　integuments；　thereby　effecting　a　cure。　There　is　another　old　record　of　a　gastric　fistula　through　which　some　aliment　passed　during　the　period　of　eleven　years。

Archer　tells　of　a　man　who　was　stabbed　by　a　negro；　the　knife　entering　the　cartilages　of　the　4th　rib　on　the　right　side；　and　penetrating　the　stomach　to　the　extent　of　two　inches　at　a　point　about　two　inches　below　the　xiphoid　cartilage。　The　stomachal　contents；　consisting　of　bacon；　cabbage；　and　cider；　were　evacuated。　Shortly　after　the　reception　of　the　injury；　an　old　soldier　sewed　up　the　wound　with　an　awl；　needle；　and　wax…thread；　Archer　did　not　see　the　patient　until　forty…eight　hours　afterward；　at　which　time　he　cleansed　and　dressed　the　wound。　After　a　somewhat　protracted　illness　the　patient　recovered；　notwithstanding　the　extent　of　injury　and　the　primitive　mode　of　treatment。

Travers　mentions　the　case　of　a　woman　of　fifty…three　who；　with　suicidal　intent；　divided　her　abdominal　parietes　below　the　navel　with　a　razor；　wounding　the　stomach　in　two　places。　Through　the　wound　protruded　the　greater　part　of　the　larger　curvature　of　the　stomach；　the　arch　of　the　colon　and　the　entire　greater　omentum　were　both　strangulated。　A　small　portion　of　the　coats　of　the　stomach；　including　the　wound；　was　nipped　up；　a　silk　ligature　tied　about　it；　and　the　entrails　replaced。　Two　months　afterward　the　patient　had　quite　recovered；　though　the　ligature　of　the　stomach　had　not　been　seen　in　the　stool。　Clements　mentions　a　robust　German　of　twenty…two　who　was　stabbed　in　the　abdomen　with　a　dirk；　producing　an　incised　wound　of　the　stomach。　The　patient　recovered　and　was　returned　to　duty　the　following　month。

There　are　many　cases　on　record　in　which　injury　of　the　stomach　has　been　due　to　some　mistake　or　accident　in　the　juggling　process　of　knife…swallowing　or　sword…swallowing。　The　records　of　injuries　of　this　nature　extend　back　many　hundred　years；　and　even　in　the　earlier　days　the　delicate　operation　of　gastrotomy；　sometimes　with　a　successful　issue；　was　performed　upon　persons　who　had　swallowed　knives。　Gross　mentions　that　in　1502　Florian　Mathias　of　Bradenberg　removed　a　knife　nine　inches　long　from　the　stomach　of　a　man　of　thirty…six；　followed　by　a　successful　recovery。　Glandorp；　from　whom；　possibly；　Gross　derived　his　information；　relates　this　memorable　case　as　being　under　the　direction　of　Florianus　Matthaesius　of　Bradenburg。　The　patient；　a　native　of　Prague；　had　swallowed　a　knife　eight　or　nine　inches　long；　which　lay　pointing　at　the　superior　portion　of　the　stomach。　After　it　had　been　lodged　in　this　position　for　seven　weeks　and　two　days　gastrotomy　was　performed；　and　the　knife　extracted；　the　patient　recovered。　In　1613　Crollius　reports　the　case　of　a　Bohemian　peasant　who　had　concealed　a　knife　in　his　mouth；　thinking　no　one　would　suspect　he　possessed　the　weapon；　while　he　was　excited　it　slipped　into　the　stomach；　from　whence　it　subsequently　penetrated　through　to　the　skin；　the　man　recovered。　There　is　another　old　case　of　a　man　at　Prague　who　swallowed　a　knife　which　some　few　weeks　afterward　made　its　exit　from　an　abdominal　abscess。　Gooch　quotes　the　case　of　a　man；　belonging　to　the　Court　of　Paris；　who；　nine　months　after　swallowing　a　knife；　voided　it　at　the　groin。　In　the　sixteenth　century　Laurentius　Joubert　relates　a　similar　case；　the　knife　having　remained　in　the　body　two　years。　De　Diemerbroeck　mentions　the　fact　that　a　knife　ten　inches　long　was　extracted　by　gastrotomy；　and　placed　among　the　rarities　in　the　anatomic　chamber　of　the　University　at　Leyden。　The　operation　was　done　in　1635　at　Koenigsberg；　by　Schwaben；　who　for　his　surgical　prowess　was　appointed　surgeon　to　the　King　of　Poland。　The　patient　lived　eight　years　after　the　operation。

It　is　said　that　in　1691；　while　playing　tricks　with　a　knife　6　1/2　inches　long；　a　country　lad　of　Saxony　swallowed　it；　point　first。　He　came　under　the　care　of　Weserern；　physician　to　the　Elector　of　Brandenburgh；　who　successfully　extracted　it；　two　years　and　seven　months　afterward；　from　the　pit　of　the　lad's　stomach。　The　horn　haft　of　the　knife　was　considerably　digested。　In　1720　Hubner　of　Rastembourg　operated　on　a　woman　who　had　swallowed　an　open　knife。　After　the　incision　it　was　found　that　the　knife　had　almost　pierced　the　stomach　and　had　excited　a　slight　suppuration。　After　the　operation　recovery　was　very　prompt。

Bell　of　Davenport；　Iowa；　performed　gastrotomy　on　a　man；　who；　while　attempting　a　feat　of　legerdemain；　allowed　a　bar　of　lead；　10　1/8　inches　long；　1　1/2　inches　wide；　and　9　1/2　ounces　in　weight；　to　slip　into　his　stomach。　The　bar　was　removed　and　the　patient　recovered。　Gussenbauer　gives　an　account　of　a　juggler　who　turned　his　head　to　bow　an　acknowledgment　of　applause　while　swallowing　a　sword；　he　thus　brought　his　upper　incisors　against　the　sword；　which　broke　off　and　slipped　into　his　stomach。　To　relieve　suffocation　the　sword　was　pushed　further　down。　Gastrotomy　was　performed；　and　the　piece　of　sword　11　inches　long　was　extracted；　as　there　was　perforation　of　the　stomach　before　the　operation；　the　patient　died　of　peritonitis。

An　hour　after　ingestion；　Bernays　of　St。　Louis　successfully　removed　a　knife　9　1/2　inches　long。　By　means　of　an　army…bullet　forceps　the　knife　was　extracted　easily　through　an　incision　5/8　inch　long　in　the　walls　of　the　stomach。　Gross　speaks　of　a　man　of　thirty　who　was　in　the　habit　of　giving　exhibitions　of　sword…swallowing　in　public　houses；　and　who　injured　his　esophagus　to　such　an　extent　as　to　cause　abscess　and　death。　In　the　Journal　of　the　American　Medical　Association；　March　1；　1896；　there　is　an　extensive　list　of　gastrotomies　performed　for　the　removal　of　knives　and　other　foreign　bodies；　from　the　seventeenth　century　to　the　present　time。

The　physiologic　explanation　of　sword…swallowing　is　quite　interesting。　We　know　that　when　we　introduce　the　finger；　a　spoon；　brush；　etc。；　into　the　throat　of　a　patient；　we　cause　extremely　disagreeable　symptoms。　There　is　nausea；　gagging；　and　considerable　hindrance　with　the　function　of　respiration。　It　therefore　seems　remarkable　that　there　are　people　whose　physiologic　construction　is　such　that；　without　apparent　difficulty；　they　are　enabled　to　swallow　a　sword　many　inches　long。　Many　of　the　exhibitionists　allow　the　visitors　to　touch　the　stomach　and　outline　the　point　of　the　sabre　through　the　skin。　The　sabre　used　is　usually　very　blunt　and　of　rounded　edges；　or　if　sharp；　a　guiding　tube　of　thin　metal　is　previously　swallowed。　The　explanation　of　these　exhibitions　is　as　follows：　The　instrument　enters　the　mouth　and　pharynx；　then　the　esophagus；　traverses　the　cardiac　end　of　the　stomach；　and　enters　the　latter　as　far　as　the　antrum　of　the　pylorus；　the　small　culdesac　of　the　stomach。　In　their　normal　state　in　the　adult　these　organs　are　not　in　a　straight　line；　but　are　so　placed　by　the　passage　of　the　sword。　In　the　first　place　the　head　is　thrown　back；　so　that　the　mouth　is　in　the　direction　of　the　esophagus；　the　curves　of　which　disappear　or　become　less　as　the　sword　proceeds；　the　angle　that　the　esophagus　makes　with　the　stomach　is　obliterated；　and　finally　the　stomach　is　distended　in　the　vertical　diameter　and　its　internal　curve　disappears；　thus　permitting　the　blade　to　traverse　the　greater　diameter　of　the　stomach。　According　to　Guyot…Daubes；　these　organs；　in　a　straight　line；　extend　a　distance　of　from　55　to　62　cm。；　and　consequently　the　performer　is　enabled　to　swallow　an　instrument　of　this　length。　The　length　is　divided　as　follows：

Mouth　and　pharynx；　。　。　。　。　。　。　。　。　。　。　。　。　10　to　12　cm。　　Esophagus；　。　。　。　。　。　。　。　。　。　。　。　。　。　。　。　。　25　to　28　cm。　　Distended　stomach；　。　。　。　。　。　。　。　。　。　。　。　。　20　to　22　cm。　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　…　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　55　to　62　cm。

These　acrobats　with　the　sword　have　rendered　important　service　to　medicine。　It　was　through　the　good　offices　of　a　sword…swallower　that　the　Scotch　physician；　Stevens；　was　enabled　to　make　his　experiments　on　digestion。　He　caused　this　assistant　to　swallow　small　metallic　tubes　pierced　with　holes。　They　were　filled；　according　to　Reaumur's　method；　with　pieces　of　meat。　After　a　certain　length　of　time　he　would　have　the　acrobat　disgorge　the　tubes；　and　in　this　way　he　observed　to　what　degree　the　process　of　digestion　had　taken　place。　It　was　also　probably　the　sword…swallower　who　showed　the　physicians　to　what　extent　the　pharynx　could　be　habituated　to