anomalies and curiosities of medicine-第165部分

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ave　been　followed　by　recovery；　even　when　associated　with　considerable　loss　of　liver…substance。　In　the　older　records；　Glandorp　and　Scultetus　mention　cures　after　large　wounds　of　the　liver。　Fabricius　Hildanus　reports　a　case　that　ended　happily；　in　which　a　piece　of　liver　was　found　in　the　wound；　having　been　separated　by　a　sword…thrust。　There　is　a　remarkable　example　of　recovery　after　multiple　visceral　wounds；　self…inflicted　by　a　lunatic。　This　man　had　18　wounds；　14　having　penetrated　the　abdomen；　the　liver；　colon；　and　the　jejunum　being　injured；　by　frequent　bleeding；　strict　regimen；　dressing；　etc。；　he　recovered　his　health　and　senses；　but　relapsing　a　year　and　a　half　later；　he　again　attempted　suicide；　which　gave　the　opportunity　for　a　postmortem　to　learn　the　extent　of　the　original　injuries。　Plater；　Schenck；　Cabrolius；　the　Ephemerides；　and　Nolleson　mention　recovery　after　wounds　of　the　liver。　Salmuth　and　the　Ephemerides　report　questionable　instances　in　which　portions　of　the　liver　were　ejected　in　violent　vomiting。　Macpherson　describes　a　wound　of　the　liver　occurring　in　a　Hindoo　of　sixty　who　had　been　struck　by　a　spear。　A　portion　of　the　liver　was　protruding；　and　a　piece　weighing　1　1/4　ounces　was　removed；　complete　recovery　following。

Postempski　mentions　a　case　of　suture　of　the　liver　after　a　stab…wound。　Six　sutures　of　chromicized　cat…gut　were　carefully　tightened　and　fastened　with　a　single　loop。　The　patient　left　his　bed　on　the　sixth　day　and　completely　recovered。　Gann　reports　a　case　of　harpoon…wound　of　the　liver。　While　in　a　dory　spearing　fish　in　the　Rio　Nuevo；　after　a　sudden　lurch　of　the　boat；　a　young　man　of　twenty…eight　fell　on　the　sharp　point　of　a　harpoon；　which　penetrated　his　abdomen。　About　one　inch　of　the　harpoon　was　seen　protruding　from　below　the　tip　of　the　ensiform　cartilage；　the　harpoon　was　seven　inches　long。　It　was　found　that　the　instrument　had　penetrated　the　right　lobe　of　the　liver；　on　passing　the　hand　backward　along　the　inferior　surface　of　the　liver；　the　point　could　be　felt　projecting　through　its　posterior　border。　On　account　of　two　sharp　barbs　on　the　spear…point；　it　was　necessary　to　push　the　harpoon　further　in　to　disengage　the　barbs；　after　which　it　was　easily　removed。　Recovery　followed；　and　the　patient　was　discharged　in　twenty…one　days。

Romme　discusses　the　subject　of　punctured　wounds　of　the　liver；　as　a　special　text　using　the　case　of　the　late　President　Carnot。　He　says　that　in　543　cases　of　traumatism　of　the　liver　collected　by　Elder；　65　were　caused　by　cutting　or　sharp…pointed　instruments。　Of　this　group；　23　recovered　and　42　died。　The　chief　causes　of　death　were　hemorrhage　and　peritonitis。　The　principal　symptoms　of　wounds　of　the　liver；　such　as　traumatic　shock；　collapse；　local　and　radiating　pains；　nausea；　vomiting；　and　respiratory　disturbances　were　all　present　in　the　case　of　President　Carnot。　From　an　experience　gained　in　the　case　of　the　President；　Romme　strongly　recommends　exploratory　celiotomy　in　all　penetrating　wounds　of　the　liver。　Zeidler　reports　three　cases　of　wound　of　the　liver　in　which　recovery　ensued。　The　hemorrhage　in　one　case　was　arrested　by　the　tampon；　and　in　the　other　by　the　Pacquelin　cautery。

McMillan　describes　a　man　of　twenty　who　was　kicked　by　a　horse　over　the　liver　and　rupturing　that　organ。　A　large　quantity　of　offensive　fluid　was　drawn　off　from　the　liver；　and　the　man　recovered。　Frazer　reports　a　case　of　rupture　of　liver　and　kidney　in　a　boy　of　thirteen　who　was　squeezed　between　the　tire　and　driving　chain　of　a　mill；　but　who　recovered　despite　his　serious　symptoms。　Allen　mentions　recovery　after　an　extensive　incised　wound　of　the　abdomen；　liver；　and　lung。　Massie　cites　an　instance　of　gunshot　wound　of　the　right　hypochondrium；　with　penetration　and　protrusion　of　the　liver。　The　patient；　a　boy　of　seven；　recovered　after　excision　of　a　small　part　of　the　protruding　liver。　Lawson　Tait　has　incised　the　liver　to　the　extent　of　three　inches；　evacuated　two　gallons　of　hydatids；　and　obtained　successful　recovery　in　ten　weeks。

There　are　several　cases　of　wound　of　the　liver　followed　by　recovery　reported　by　surgeons　of　the　United　States　Army。　Whitehead　mentions　a　man　of　twenty…two　who　on　June　3；　1867；　was　shot　in　the　liver　by　a　slug　from　a　pistol。　At　the　time　of　the　injury　he　bled　freely　from　the　wound　of　entrance　continuing　to　lose　blood　and　bile　until　daylight　the　next　morning；　when　the　hemorrhage　ceased；　but　the　flow　of　bile　kept　on。　By　June　10th　there　was　considerable　improvement；　but　the　wound　discharged　blood…clots；　bile；　and　serum。　When　the　patient　left　the　hospital　on　July　15th　the　wound　was　healthy；　discharging　less　than　1　1/2　ounces　during　the　twenty…four　hours；　of　a　mixture　of　free　bile；　and　bile　mixed　with　thick　material。　When　last　heard　fromJuly　27；　1867the　patient　was　improving　finely　in　flesh　and　strength。　McKee　mentions　a　commissary…sergeant　stationed　at　Santa　Fe；　New　Mexico；　who　recovered　after　a　gunshot　wound　of　the　liver。　Hassig　reports　the　case　of　a　private　of　twenty…six　who　was　wounded　in　a　fray　near　Paducah；　Kentucky；　by　a　conoid　ball；　which　passed　through　the　liver。　The　ball　was　cut　out　the　same　day。　The　patient　recovered　and　was　returned　to　duty　in　May；　1868。　Patzki　mentioned　a　private　in　the　Sixth　Cavalry；　aged　twenty…five；　who　recovered　from　a　gunshot　wound　of　the　abdomen；　penetrating　the　right　lobe　of　the　liver　and　the　gall…bladder。

Resection　of　the　Liver。It　is　remarkable　to　what　extent　portions　of　the　liver　may　be　resected　by　the　knife；　cautery；　or　ligature；　and　the　patient　recover。　Langenbuch　records　a　case　in　which　he　successfully　removed　the　greater　portion　of　the　left　lobe　of　a　woman　of　thirty。　The　lobe　had　been　extensively　deformed　by　tight　lacing；　and　caused　serious　inconvenience。　There　was　considerable　hemorrhage；　but　the　vessels　were　secured；　and　the　woman　made　a　good　recovery。　McWhinnie；　in　The　Lancet；　records　a　case　of　dislodgment　of　an　enlarged　liver　from　tight　lacing。　Terrilon　mentions　an　instance　in　which　a　portion　of　the　liver　was　removed　by　ligature　after　celiotomy。　The　ligature　was　removed　in　seven　days；　and　the　sphacelated　portion　of　the　liver　came　off　with　it。　A　cicatrix　was　completed　at　the　end　of　six　weeks；　and　the　patient；　a　woman　of　fifty…three；　made　an　excellent　recovery。　Bastianelli　discusses　those　cases　in　which　portions　of　the　liver；　having　been　constricted　from　the　general　body　of　the　organ　and　remaining　attached　by　a　pedicle；　give　rise　to　movable　tumors　of　the　abdomen。　He　records　such　a　case　in　a　woman　of　thirty…seven　who　had　five　children。　A　piece　of　liver　weighing　500　grams　was　removed；　and　with　it　the　gall…bladder；　and　the　patient　made　an　uninterrupted　recovery。　Tricomi　reports　a　case　in　which　it　was　found　necessary　to　remove　the　left　lobe　of　the　liver。　An　attempt　had　been　made　to　remove　a　liver…tumor　the　size　of　a　fist　by　constricting　the　base　with　an　elastic　ligature。　This　attempt　was　a　failure；　and　cure　was　also　unsuccessfully　attempted　by　wire　ligature　and　the　thermocautery。　The　growth　was　cut　away；　bleeding　was　arrested　by　the　thermocautery　and　by　iron…solution；　the　wound　entirely　healed；　and　the　patient　recovered。　Valerian　von　Meister　has　proved　that　the　liver　has　marvelous　powers　of　regeneration；　and　that　in　rabbits；　cats；　and　dogs；　even　three…fourths　of　the　organ　may　be　reproduced　in　from　forty…five　to　sixty…five　days。　This　regeneration　is　brought　about　chiefly　by　hypertrophy　of　the　lobules。　

Floating　liver　is　a　rare　malady　in　which　the　liver　forms　an　abdominal　prominence　that　may　be　moved　about；　and　which　changes　its　situation　as　the　patient　shifts　the　attitude。　The　condition　usually　arises　from　a　lax　abdominal　wall　following　repeated　pregnancies。　The　accompanying　illustration　exhibits　a　typical　case　verified　by　postmortem　examination。

Hypertrophy　of　the　Liver。The　average　weight　of　the　normal　liver　is　from　50　to　55　ounces；　but　as　noted　by　Powell；　it　may　become　so　hypertrophic　as　to　weigh　as　much　as　40　pounds。　Bonet　describes　a　liver　weighing　18　pounds；　and　in　his　〃Medical　and　Surgical　Observations；〃　Gooch　speaks　of　a　liver　weighing　28　pounds。　Vieussens；　the　celebrated　anatomist；　reports　an　instance　in　which　the　liver　weighed　20　pounds；　and　in　his　〃Aphorisms；〃　Vetter　cites　a　similar　instance。　In　1811　Kraus　of　Germany　describes　a　liver　weighing　25　pounds；　modern　instances　of　enlarged　liver　are　too　numerous　to　be　quoted　here。

Rupture　of　the　gall…bladder；　although　generally　followed　by　death；　is　not　always　fatal。　In　such　cases　bile　is　usually　found　in　the　abdominal　cavity。　Fergus　mentions　a　case　in　which；　after　this　accident；　the　patient　was　considered　convalescent　and　was　walking　about；　when；　on　the　seventh　day；　peritonitis　suddenly　developed　and　proved　fatal　in　two　days。　Several　cases　of　this　accident　have　been　reported　as　treated　successfully　by　incision　and　drainage　（Lane）　or　by　inspiration　（Bell）。　In　these　cases　large　quantities　of　bile　escaped　into　the　abdominal　cavity。　Peritonitis　does　not　necessarily　follow。　Cholecystotomy　for　the　relief　of　the　distention　of　the　gall…　bladder　from　obstruction　of　the　common　or　cystic　duct　and　for　the　removal　of　gall…stones　was　first　performed　in　1867　by　Bobbs　of　Indianapolis；　but　it　is　to　Marion　Sims；　in　1878；　that　perfection　of　the　operation　is　due。　It　has　been　gradually　improved　and　developed；　until　today　it　is　a　most　successful　operation。　Tait　reports　54　cases　with　52　perfect　recoveries。　Cholyecystectomy；　or　excision　of　the　gall…bladder；　was　first　practiced　in　1880　by　Langenbuch　of　Berlin；　and　is　used　in　cases　in　which　gall…stones　are　repeatedly　forming。　Ashhurst's　statistics　show　only　four　deaths　in　28　cases。

At　St。　Bartholomew's　Hospital；　in　London；　is　a　preserved　specimen　of　a　gall…bladder　which　had　formed　the　contents　of　a　hernial　sac；　and　which；　near　the　fundus；　shows　a　constriction　caused　by　the　femoral　ring。　It　was　taken　from　a　woman　of　forty…five　who　was　admitted　into　the　hospital　with　a　strangulated　femoral　hernia。　The　sac　was　opened　and　its　contents　were　returned。　The　woman　died　in　a　few　days　from　peritonitis。　The　gall…bladder　was　found　close　to　the　femoral　ring；　and　showed　a　marked　constriction。　The　liver　was　misshapen　from　tight　lacing；　elongated　and　drawn　downward　toward　the　ring。　There　was　no　evidence　that　any　portion　of　intestine　or　other　structure　besides　the　gall…bladder　had　passed　through　the　ring。　

The　fatality　of　rupture　of