anomalies and curiosities of medicine-第167部分

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convenience。

Fracture　of　the　lower　part　of　the　spine　is　not　always　fatal；　and　notwithstanding　the　lay…idea　that　a　broken　back　means　certain　death；　patients　with　well…authenticated　cases　of　vertebral　fracture　have　recovered。　Warren　records　the　case　of　a　woman　of　sixty　who；　while　carrying　a　clothes…basket；　made　a　misstep　and　fell　14　feet；　the　basket　of　wet　clothes　striking　the　right　shoulder；　chest；　and　neck。　There　was　fracture　of　the　4th　dorsal　vertebra　at　the　transverse　processes。　By　seizing　the　spinous　process　it　could　be　bent　backward　and　forward；　with　the　peculiar　crepitus　of　fractured　bone。　The　clavicle　was　fractured　two　inches　from　the　acromial　end；　and　the　sternal　end　was　driven　high　up　into　the　muscles　of　the　neck。　The　arm　and　hand　were　paralyzed；　and　the　woman　suffered　great　dyspnea。　There　was　at　first　a　grave　emphysematous　condition　due　to　the　laceration　of　several　broken　ribs。　There　was　also　suffusion　and　ecchymosis　about　the　neck　and　shoulder。　Although　complicated　with　tertiary　syphilis；　the　woman　made　a　fair　recovery；　and　eight　weeks　later　she　walked　into　a　doctor's　office。　Many　similar　and　equally　wonderful　injuries　to　the　spine　are　on　record。

The　results　sometimes　following　the　operation　of　laminectomy　for　fracture　of　the　vertebrae　are　often　marvelous。　One　of　the　most　successful　on　record　is　that　reported　by　Dundore。　The　patient　was　a　single　man　who　lived　in　Mahanoy；　Pa。；　and　was　admitted　to　the　State　Hospital　for　Injured　Persons；　Ashland；　Pa。；　June　17；　1889；　suffering　from　a　partial　dislocation　of　the　9th　dorsal　vertebra。　The　report　is　as　follows〃He　had　been　a　laborer　in　the　mines；　and　while　working　was　injured　March　18；　1889；　by　a　fall　of　top　rock；　and　from　this　date　to　that　of　his　admission　had　been　under　the　care　of　a　local　physician　without　any　sign　of　improvement。　At　the　time　of　his　admission　he　weighed　but　98　pounds；　his　weight　previous　to　the　injury　being　145。　He　exhibited　entire　loss　of　motion　in　the　lower　extremities；　with　the　exception　of　very　slight　movement　in　the　toes　of　the　left　foot；　sensation　was　almost　nil　up　to　the　hips；　above　which　it　was　normal；　he　had　complete　retention　of　urine；　with　a　severe　cystitis。　His　tongue　was　heavily　coated；　the　bowels　constipated；　and　there　was　marked　anorexia；　with　considerable　anemia。　His　temperature　varied　from　99　degrees　to　100　degrees　in　the　morning；　and　from　101　degrees　to　103　degrees　in　the　evening。　The　time　which　had　elapsed　since　the　accident　precluded　any　attempt　at　reduction；　and　his　anemic　condition　would　not　warrant　a　more　radical　method。

〃He　was　put　on　light；　nourishing　diet；　iron　and　strychnin　were　given　internally；　and　electricity　was　applied　to　the　lower　extremities　every　other　day；　the　cystitis　was　treated　by　irrigating　the　bladder　each　day　with　Thiersch's　solution。　By　August　his　appetite　and　general　condition　were　much　improved；　and　his　weight　had　increased　to　125　pounds；　his　temperature　being　99　degrees　or　less　each　morning；　and　seldom　as　high　as　100　degrees　at　night。　The　cystitis　had　entirely　disappeared；　and　he　was　able；　with　some　effort；　to　pass　his　urine　without　the　aid　of　a　catheter。　Sensation　in　both　extremities　had　slightly　improved；　and　he　was　able　to　slightly　move　the　toes　of　the　right　foot。　This　being　his　condition；　an　operation　was　proposed　as　the　only　means　of　further　and　permanent　improvement；　and　to　this　he　eagerly　consented；　and；　accordingly；　on　the　25th　of　August；　the　9th　dorsal　vertebra　was　trephined。

〃The　cord　was　found　to　be　compressed　and　greatly　congested；　but　there　was　no　evidence　of　laceration。　The　laminae　and　spinous　processes　of　the　8th　and　9th　dorsal　vertebrae　were　cut　away；　thus　relieving　all　pressure　on　the　cord；　the　wound　was　drained　and　sutured；　and　a　plaster…of…Paris　jacket　applied；　a　hole　being　cut　out　over　the　wound　for　the　purpose　of　changing　the　dressing　when　necessary。　By　September　1st　union　was　perfect；　and　for　the　next　month　the　patient　remained　in　excellent　condition；　but　without　any　sign　of　improvement　as　to　sensation　and　motion。　Early　in　October　he　was　able　to　slightly　move　both　legs；　and　had　full　control　of　urination；　from　this　time　on　his　paralysis　rapidly　improved；　the　battery　was　applied　daily；　with　massage　morning　and　evening；　and　in　November　the　plaster…of…Paris　jacket　was　removed；　and　he　propelled　himself　about　the　ward　in　a　rolling　chair；　and　shortly　after　was　able　to　get　about　slowly　on　crutches。　He　was　discharged　December　23d；　and　when　I　saw　him　six　months　later　he　walked　very　well　and　without　effort；　he　carried　a　cane；　but　this　seemed　more　from　habit　than　from　necessity。　At　present　date　he　weighs　150　pounds；　and　drives　a　huckster　wagon　for　a　living；　showing　very　little　loss　of　motion　in　his　lower　extremities。〃

Although　few　cases　show　such　wonderful　improvement　as　this　one；　statistics　prove　that　the　results　of　this　operation　are　sometimes　most　advantageous。　Thorburn　collects　statistics　of　50　operations　from　1814　to　1885；　undertaken　for　relief　of　injuries　of　the　spinal　cord。　Lloyd　has　compiled　what　is　possibly　the　most　extensive　collection　of　cases　of　spinal　surgery；　his　cases　including　operations　for　both　disease　and　injury。　White　has　collected　37　cases　of　recent　date；　and　Chipault　reports　two　cases；　and　collected　33　cases。　Quite　a　tribute　to　the　modern　treatment　by　antisepsis　is　shown　in　the　results　of　laminectomy。　Of　his　non…antiseptic　cases　Lloyd　reports　a　mortality　of　65　per　cent；　those　surviving　the　operation　are　distributed　as　follows：　Cured；　one；　partially　cured；　seven；　unknown；　two；　no　improvement；　five。　Of　those　cases　operated　upon　under　modern　antiseptic　principles；　the　mortality　was　50　per　cent；　those　surviving　were　distributed　as　follows：　Cured；　four；　partially　cured；　15；　no　improvement；　11。　The　mortality　in　White's　cases；　which　were　all　done　under　antiseptic　precautions；　was　38　per　cent。　Of　those　surviving；　there　were　six　complete　recoveries；　six　with　benefit；　and　11　without　marked　benefit。　Pyle　collects　52　cases　of　spinal　disease　and　injury；　in　which　laminectomy　was　performed。　All　the　cases　were　operated　upon　since　1890。　Of　the　52　cases　there　were　15　deaths　（a　mortality　of　29。4　per　cent）；　26　recoveries　with　benefit；　and　five　recoveries　in　which　the　ultimate　result　has　not　been　observed。　It　must　be　mentioned　that　several　of　the　fatal　cases　reported　were　those　of　cervical　fracture；　which　is　by　far　the　most　fatal　variety。

Injury　to　the　spinal　cord　does　not　necessarily　cause　immediate　death。　Mills　and　O'Hara；　both　of　Philadelphia；　have　recorded　instances　of　recovery　after　penetrating　wound　of　the　spinal　marrow。　Eve　reports　three　cases　of　gunshot　wound　in　which　the　balls　lodged　in　the　vertebral　canal；　two　of　the　patients　recovering。　He　adds　some　remarks　on　the　division　of　the　spinal　cord　without　immediate　death。

Ford　mentions　a　gunshot　wound　of　the　spinal　cord；　the　patient　living　ten　days；　after　death　the　ball　was　found　in　the　ascending　aorta。　Henley　speaks　of　a　mulatto　of　twenty…four　who　was　stabbed　in　the　back　with　a　knife。　The　blade　entered　the　body　of　the　6th　dorsal　vertebra；　and　was　so　firmly　embedded　that　the　patient　could　be　raised　entirely　clear　of　the　bed　by　the　knife　alone。　An　ultimate　recovery　ensued。

Although　the　word　hernia　can　be　construed　to　mean　the　protrusion　of　any　viscus　from　its　natural　cavity　through　normal　or　artificial　openings　in　the　surrounding　structures；　the　usual　meaning　of　the　word　is　protrusion　of　the　abdominal　contents　through　the　parieteswhat　is　commonly　spoken　of　as　rupture。　Hernia　may　be　congenital　or　acquired；　or　may　be　single　or　multipleas　many　as　five　having　been　seen　in　one　individual。　More　than　two…thirds　of　cases　of　rupture　suffer　from　inguinal　hernia　In　the　oblique　form　of　inguinal　hernia　the　abdominal　contents　descend　along　the　inguinal　canal　to　the　outer　side　of　the　epigastric　artery；　and　enter　the　scrotum　in　the　male；　and　the　labium　majus　in　the　female。　In　this　form　of　hernia　the　size　of　the　sac　is　sometimes　enormous；　the　accompanying　illustration　showing　extreme　cases　of　both　scrotal　and　labial　hernia。　Umbilical　hernia　may　be　classed　under　three　heads：　congenital；　infantile；　and　adult。　Congenital　umbilical　hernia　occurs　most　frequently　in　children；　and　is　brought　about　by　the　failure　of　the　abdominal　walls　to　close。　When　of　large　size　it　may　contain　not　only　the　intestines；　but　various　other　organs；　such　as　the　spleen；　liver；　etc。　In　some　monsters　all　the　abdominal　contents　are　contained　in　the　hernia。　Infantile　umbilical　hernia　is　common；　and　appears　after　the　separation　of　the　umbilical　cord；　it　is　caused　by　the　yielding　of　the　cicatrix　in　this　situation。　It　never　reaches　a　large　size；　and　shows　a　tendency　to　spontaneous　cure。　Adult　umbilical　hernia　rarely　commences　in　infancy。　It　is　most　commonly　seen　in　persons　with　pendulous　bellies；　and　is　sometimes　of　enormous　size；　in　addition　to　the　ordinary　abdominal　contents；　containing　even　the　stomach　and　uterus。　A　few　years　since　there　was　a　man　in　Philadelphia　past　middle　age；　the　victim　of　adult　umbilical　hernia　so　pendulous　that　while　walking　he　had　to　support　it　with　his　arms　and　hands。　It　was　said　that　this　hernia　did　not　enlarge　until　after　his　service　as　a　soldier　in　the　late　war。

Abbott　recites　the　case　of　an　Irish　woman　of　thirty…five　who　applied　to　know　if　she　was　pregnant。　No　history　of　a　hernia　could　be　elicited。　No　pregnancy　existed；　but　there　was　found　a　ventral　hernia　of　the　abdominal　viscera　through　an　opening　which　extended　the　entire　length　of　the　linea　alba；　and　which　was　four　inches　wide　in　the　middle　of　the　abdomen。

Pim　saw　a　colored　woman　of　twenty…four　who；　on　December　29；　1858；　was　delivered　normally　of　her　first　child；　and　who　died　in　bed　at　3　A。M。　on　February　12；　1859。　The　postmortem　showed　a　tumor　from　the　ensiform　cartilage　to　the　symphysis　pubis；　which　contained　the　omentum；　liver　（left　lobe）；　small　intestines；　and　colon。　It　rested　upon　the　abdominal　muscles　of　the　right　side。　The　pelvic　viscera　were　normally　placed　and　there　was　no　inguinal　nor　femoral　hernia。

Hulke　reports　a　case　remarkable　for　the　immense　size　of　the　rupture　which　protruded　from　a　spot　weakened　by　a　former　abscess。　There　was　a　partial　absence　of　the　peritoneal　sac；　and　the　obstruction　readily　yielded　to　a　clyster　and　laxative。　The　rupture　had　a　transverse　diameter　of　14　1/2　inches