anomalies and curiosities of medicine-第164部分

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athing　the　wound　with　a　decoction　of　the　leaves　of　the　red…gum　tree。　Notwithstanding　that　the　spear　measured　seven　inches；　and　the　interference　of　treatment；　the　abdominal　wound　closed　on　the　sixth　day；　and　recovery　was　uninterrupted。　Gilkrist　mentions　an　instance　in　which　a　ramrod　was　fired　into　a　soldier's　abdomen；　its　extremity　lodging　in　the　spinal　column；　without　causing　the　slightest　evidence　of　wounds　of　the　intestines　or　viscera。　A　minute　postmortem　examination　was　held　some　time　afterward；　the　soldier　having　died　by　drowning；　but　the　results　were　absolutely　negative　as　regards　any　injury　done　by　the　passage　of　the　ramrod。

Humphreys　says　that　a　boy　of　eleven；　while　〃playing　soldier〃　with　another　boy；　accidentally　fell　on　a　rick…stake。　The　stake　was　slightly　curved　at　its　upper　part；　being　43　inches　long　and　three　inches　in　circumference；　and　sharp…pointed　at　its　extremity。　As　much　as　17　1/2　inches　entered　the　body　of　the　lad。　The　stake　entered　just　in　front　of　the　right　spermatic　cord；　passed　beneath　Poupart's　ligament　into　the　cavity　of　the　abdomen；　traversed　the　whole　cavity　across　to　the　left　side；　it　then　entered　the　thorax　by　perforating　the　diaphragm；　displaced　the　heart　by　pushing　it　to　the　right　of　the　sternum；　and　pierced　the　left　lung。　It　then　passed　anteriorly　under　the　muscles　and　integument　in　the　axillary　space；　along　the　upper　third　of　the　humerus；　which　was　extended　beyond　the　head；　the　external　skin　not　being　ruptured。　The　stick　remained　in　situ　for　four　hours　before　attempts　at　extraction　were　made。　On　account　of　the　displacement　of　the　heart　it　was　decided　not　to　give　chloroform。　The　boy　was　held　down　by　four　men；　and　Humphreys　and　his　assistant　made　all　the　traction　in　their　power。　After　removal　not　more　than　a　teaspoonful　of　blood　followed。　The　heart　still　remained　displaced；　and　a　lump　of　intestine　about　the　size　of　an　orange　protruded　from　the　wound　and　was　replaced。　The　boy　made　a　slow　and　uninterrupted　recovery；　and　in　six　weeks　was　able　to　sit　up。　The　testicle　sloughed；　but　five　months　later；　when　the　boy　was　examined；　he　was　free　from　pain　and　able　to　walk。　There　was　a　slight　enlargement　of　the　abdomen　and　a　cicatrix　of　the　wound　in　the　right　groin。　The　right　testicle　was　absent；　and　the　apex　of　the　heart　was　displaced　about　an　inch。

Woodbury　reports　the　case　of　a　girl　of　fourteen；　who　fell　seven　or　eight　feet　directly　upon　an　erect　stake　in　a　cart；　the　tuberosity　was　first　struck；　and　then　the　stake　passed　into　the　anus；　up　the　rectum　for　two　inches；　thence　through　the　rectal　wall；　and　through　the　body　in　an　obliquely　upward　direction。　Striking　the　ribs　near　the　left　nipple　it　fractured　three；　and　made　its　exit。　The　stake　was　three　inches　in　circumference；　and　27　inches　of　its　length　passed　into　the　body；　six　or　seven　inches　emerging　from　the　chest。　This　girl　recovered　so　rapidly　that　she　was　able　to　attend　school　six　weeks　afterward。　In　a　case　reported　by　Bailey　a　middle…aged　woman；　while　sliding　down　a　hay…stack；　struck　directly　upon　a　pitchfork　handle　which　entered　the　vagina；　the　whole　weight　of　the　woman　was　successfully　maintained　by　the　cellular　tissue　of　the　uterovaginal　culdesac。

Minot　speaks　of　the　passage　of　one　prong　of　a　pitchfork　through　the　body　of　a　man　of　twenty…one；　from　the　perineum　to　the　umbilicus；　the　man　recovered。

Hamilton　reports　a　case　of　laceration　of　the　perineum　with　penetration　of　the　pelvic　cavity　to　the　depth　of　ten　inches　by　a　stick　3/4　inch　thick。　Prowse　mentions　the　history　of　a　case　of　impalement　in　a　man　of　thirty…four；　who；　coming　down　a　hay…stack；　alighted　on　the　handle　of　a　pitchfork　which　struck　him　in　the　middle　of　the　scrotum；　and　passed　up　between　the　skin　and　fascia　to　the　10th　rib。　Recovery　was　prompt。

There　are　several　cases　on　record　in　which　extensive　wounds　of　the　abdominal　parietes　with　protrusion　and　injury　to　the　intestine　have　not　been　followed　by　death。　Injuries　to　the　intestines　themselves　have　already　been　spoken　of；　but　there　are　several　cases　of　evisceration　worthy　of　record。

Doughty　says　that　at　midnight　on　June　7；　1868；　he　was　called　to　see　a　man　who　had　been　stabbed　in　a　street　altercation　with　a　negro。　When　first　seen　in　the　street；　the　patient　was　lying　on　his　back　with　his　abdomen　exposed；　from　which　protruded　an　enormous　mass　of　intestines；　which　were　covered　with　sand　and　grit；　the　small　intestine　（ileum）　was　incised　at　one　point　and　scratched　at　another　by　the　passing　knife。　The　incision；　about　an　inch　in　length；　was　closed　with　a　single　stitch　of　silk　thread；　and　after　thorough　cleansing　the　whole　mass　was　returned　to　the　abdominal　cavity。　In　this　hernial　protrusion　were　recognized　four　or　five　feet　of　the　ileum；　the　cecum　with　its　appendix；　part　of　the　ascending　colon　with　corresponding　portions　of　the　mesentery；　the　distribution　of　the　superior　mesentery；　made　more　apparent　by　its　living　pulsation；　was　more　beautifully　displayed　in　its　succession　of　arches　than　in　any　dissection　that　Doughty　had　ever　witnessed。　Notwithstanding　the　extent　of　his　injuries　the　patient　recovered；　and　at　last　reports　was　doing　finely。

Barnes　reports　the　history　of　a　negro　of　twenty…five　who　was　admitted　to　the　Freedmen's　Hospital；　New　Orleans；　May　15；　1867；　suffering　from　an　incised　wound　of　the　abdomen；　from　which　protruded　eight　inches　of　colon；　all　of　the　stomach；　and　nearly　the　whole　of　the　small　intestines。　About　2　1/2　feet　of　the　small　intestine；　having　a　whitish　color；　appeared　to　be　filled　with　food　and　had　much　of　the　characteristic　feeling　of　a　sausage。　The　rest　of　the　small　intestine　had　a　dark…brown　color；　and　the　stomach　and　colon；　distended　with　gas；　were　leaden…colored。　The　viscera　had　been　exposed　to　the　atmosphere　for　over　an　hour。　Having　nothing　but　cold　Mississippi　water　to　wash　them　with；　Barnes　preferred　returning　the　intestines　without　any　attempt　at　removing　blood　and　dirt　further　than　wiping　with　a　cambric　handkerchief　and　the　stripping　they　would　naturally　be　subjected　to　in　being　returned　through　the　opening。　In　ten　minutes　they　were　returned；　they　were　carefully　examined　inch　by　inch　for　any　wound；　but　none　was　found。　Three　silver　sutures　were　passed　through　the　skin；　and　a　firm　compress　applied。　The　patient　went　to　sleep　shortly　after　his　wound　was　dressed；　and　never　had　a　single　subsequent　bad　symptom；　he　was　discharged　on　May　24th；　the　wound　being　entirely　healed；　with　the　exception　of　a　cartilage　of　a　rib　which　had　not　reunited。

Rogers　mentions　the　case　of　a　carpenter　of　thirty…six　who　was　struck　by　a　missile　thrown　by　a　circular　saw；　making　a　wound　two　inches　above　the　umbilicus　and　to　the　left。　Through　the　opening　a　mass　of　intestines　and　a　portion　of　the　liver；　attached　by　a　pedicle；　protruded。　A　portion　of　the　liver　was　detached；　and　the　liver；　as　well　as　the　intestines；　were　replaced；　and　the　man　recovered。

Baillie；　Bhadoory；　Barker；　Edmundson；　Johnson；　and　others；　record　instances　of　abdominal　wounds　accompanied　by　extensive　protrusion　of　the　intestines；　and　recovery。　Shah　mentions　an　abdominal　wound　with　protrusion　of　three　feet　of　small　intestine。　By　treatment　with　ice；　phenol；　and　opium；　recovery　was　effected　without　peritonitis。

Among　nonfatal　perforating　gunshot　wounds　of　the　abdomen；　Loring：　reports　the　case　of　a　private　in　the　First　Artillery　who　recovered　after　a　double　gunshot　perforation　of　the　abdomen。　One　of　the　balls　entered　5　1/2　inches　to　the　left　of　the　umbilicus；　and　two　inches　above　the　crest　of　the　ilium；　making　its　exit　two　inches　above　the　crest　of　the　ilium；　on　a　line　with　and　two　inches　from　the　4th　lumbar　vertebra。　The　other　ball　entered　four　inches　below　and　to　the　rear　of　the　left　nipple；　making　its　exit　four　inches　directly　below　the　point　of　entrance。　In　their　passages　these　balls　did　not　wound　any　of　the　viscera；　and　with　the　exception　of　traumatic　fever　there　was　no　disturbance　of　the　health　of　the　patient。　Schell　records　the　case　of　a　soldier　who　was　wounded　July　3；　1867；　by　a　conoid　ball　from　a　Remington　revolver　of　the　Army　pattern。　The　ball　entered　on　the　left　side　of　the　abdomen；　its　lower　edge　grazing　the　center　of　Poupart's　ligament；　and　passing　backward；　inward；　and　slightly　upward；　emerged　one　inch　to　the　left　of　the　spinous　process　of　the　sacrum。　On　July　6th　all　the　symptoms　of　peritonitis　made　their　appearance。　On　July　11th　there　was　free　discharge　of　fecal　matter　from　both　anterior　and　posterior　wounds。　This　discharge　continued　for　three　days　and　then　ceased。　By　August　12th　both　wounds　were　entirely　healed。　Mineer　reports　a　case　of　a　wound　from　a　revolver…ball　entering　the　abdomen；　passing　through　the　colon；　and　extracted　just　above　the　right　ilium。　Under　simple　treatment　the　patient　recovered　and　was　returned　to　duty　about　ten　weeks　afterward。

There　are　a　number　of　cases　on　record　in　which　a　bullet　entering　the　abdominal　cavity　is　subsequently　voided　either　by　the　bladder　or　by　the　bowel。　Ducachet　mentions　two　cases　at　the　Georgetown　Seminary　Hospital　during　the　late　war　in　which　Minie　balls　entering　the　abdominal　wall　were　voided　by　the　anus　in　a　much　battered　condition。　Bartlett　reports　the　case　of　a　young　man　who　was　accidentally　shot　in　the　abdomen　with　a　Colt's　revolver。　Immediately　after　the　accident　he　complained　of　constant　and　pressing　desire　to　void　his　urine。　While　urinating　on　the　evening　of　the　third　day；　the　ball　escaped　from　the　urethra　and　fell　with　a　click　into　the　chamber。　After　the　discharge　of　the　ball　the　intolerable　symptoms　improved；　and　in　two　or　three　weeks　there　was　complete　recovery。　Hoag　mentions　a　man　who　was　wounded　by　a　round　musket…ball　weighing　400　grains。　It　had　evidently　passed　through　the　lung　and　diaphragm　and　entered　the　alimentary　canal；　it　was　voided　by　the　rectum　five　days　after　the　injury。　Lenox　mentions　the　fact　of　a　bullet　entering　the　abdominal　wall　and　subsequently　being　passed　from　the　rectum。　Day　and　Judkins　report　similar　cases。　Rundle　speaks　of　the　lodgment　of　a　bullet；　and　its　escape；　after　a　period　of　seven　and　one…half　years；　into　the　alimentary　canal；　causing　internal　strangulation　and　death。

Wounds　of　the　liver　often　end　very　happily；　and　there　are　many　cases　on　record　in　which　such　injuries　have　been　followed　by　recovery；　even　when　associated　with　considerable　loss　of　liver…substance。　In　th