anomalies and curiosities of medicine-第168部分

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on　readily　yielded　to　a　clyster　and　laxative。　The　rupture　had　a　transverse　diameter　of　14　1/2　inches；　with　a　vertical　diameter　of　11　1/2　inches。　The　opening　was　in　the　abdominal　walls　outside　of　the　internal　inguinal　ring。　The　writhings　of　the　intestines　were　very　conspicuous　through　the　walls　of　the　pouch。

Dade　reports　a　case　of　prodigious　umbilical　hernia。　The　patient　was　a　widow　of　fifty…eight；　a　native　of　Ireland。　Her　family　history　was　good；　and　she　had　never　borne　any　children。　The　present　dimensions　of　the　tumor；　which　for　fifteen　years　had　been　accompanied　with　pain；　and　had　progressively　increased　in　size；　are　as　follows：　Circumference　at　the　base；　19　1/2　inches；　circumference　at　the　extremity；　11　1/4　inches；　distance　of　extremity　from　abdominal　wall；　12　3/4　inches。　Inspection　showed　a　large　lobulated　tumor　protruding　from　the　abdominal　wall　at　the　umbilicus。　The　veins　covering　it　were　prominent　and　distended。　The　circulation　of　the　skin　was　defective；　giving　it　a　blue　appearance。　Vermicular　contractions　of　the　small　intestines　could　be　seen　at　the　distance　of　ten　feet。　The　tumor　was　soft　and　velvety　to　the　touch；　and　could　only　partially　be　reduced。　Borborygmus　could　be　easily　heard。　On　percussion　the　note　over　the　bulk　was　tympanitic；　and　dull　at　the　base。　The　distal　extremity　contained　a　portion　of　the　small　intestine　instead　of　the　colon；　which　Wood　considered　the　most　frequent　occupant。　The　umbilicus　was　completely　obliterated。　Dade　believed　that　this　hernia　was　caused　by　the　weakening　of　the　abdominal　walls　from　a　blow；　and　considered　that　the　protrusion　came　from　an　aperture　near　the　umbilicus　and　not　through　it；　in　this　manner　differing　from　congenital　umbilical　hernia。

A　peculiar　form　of　hernia　is　spontaneous　rupture　of　the　abdominal　walls；　which；　however；　is　very　rare。　There　is　an　account　of　such　a　case　in　a　woman　of　seventy…two　living　in　Pittsburg；　who；　after　a　spasmodic　cough；　had　a　spontaneous　rupture　of　the　parietes。　The　rent　was　four　inches　in　length　and　extended　along　the　linea　alba；　and　through　it　protruded　a　mass　of　omentum　about　the　size　of　a　child's　head。　It　was　successfully　treated　and　the　woman　recovered。　Wallace　reports　a　case　of　spontaneous　rupture　of　the　abdominal　wall；　following　a　fit　of　coughing。　The　skin　was　torn　and　a　large　coil　of　ileum　protruded；　uncovered　by　peritoneum。　After　protracted　exposure　of　the　bowel　it　was　replaced；　the　rent　was　closed；　and　the　patient　recovered。



CHAPTER　XIII。

SURGICAL　ANOMALIES　OF　THE　GENITO…URINARY　SYSTEM。

Wounds　of　the　kidney　may　be　very　severe　without　causing　death；　and　even　one　entire　kidney　may　be　lost　without　interfering　with　the　functions　of　life。　Marvand；　the　Surgeon…Major　of　an　Algerian　regiment；　reports　the　case　of　a　young　Arab　woman　who　had　been　severely　injured　in　the　right　lumbar　region　by　a　weapon　called　a　〃yataghan；〃　an　instrument　which　has　only　one　cutting　edge。　On　withdrawing　this　instrument　the　right　kidney　was　extruded；　became　strangulated　between　the　lips　of　the　wound；　and　caused　considerable　hemorrhage。　A　ligature　was　put　around　the　base　of　the　organ；　and　after　some　weeks　the　mass　separated。　The　patient　continued　in　good　health　the　whole　time；　and　her　urinary　secretion　was　normal。　She　was　discharged　in　two　months　completely　recovered。　Price　mentions　the　case　of　a　groom　who　was　kicked　over　the　kidney　by　a　horse；　and　eighteen　months　later　died　of　dropsy。　Postmortem　examination　showed　traces　of　a　line　of　rupture　through　the　substance　of　the　gland；　the　preparation　was　deposited　in　St。　George's　Hospital　Museum　in　London。　The　case　is　singular　in　that　this　man；　with　granular　degeneration　of　the　kidney；　recovered　from　so　extensive　a　lesion；　and；　moreover；　that　he　remained　in　perfect　health　for　over　a　year　with　his　kidney　in　a　state　of　destructive　disease。　Borthwick　mentions　a　dragoon　of　thirty　who　was　stabbed　by　a　sword…thrust　on　the　left　side　under　the　short　rib；　the　sword　penetrating　the　pelvis　and　wounding　the　kidney。　There　was　no　hemorrhage　from　the　external　wound；　nor　pain　in　the　spermatic　cord　or　testicle。　Under　expectant　treatment　the　man　recovered。　Castellanos　mentions　a　case　of　recovery　from　punctured　wound　of　the　kidney　by　a　knife　that　penetrated　the　tubular　and　cortical　substance；　and　entered　the　pelvis　of　the　organ。　The　case　was　peculiar　in　the　absence　of　two　symptoms；　viz。；　the　escape　of　urine　from　the　wound；　and　retraction　of　the　corresponding　testicle。　Dusenbury　reports　the　case　of　a　corporal　in　the　army　who　was　wounded　on　April　6；　1865；　the　bullet　entering　both　the　liver　and　kidney。　Though　there　was　injury　to　both　these　important　organs；　there　was　no　impairment　of　the　patient's　health；　and　he　recovered。

Bryant　reports　four　cases　of　wound　of　the　kidney；　with　recovery。　All　of　these　cases　were　probably　extraperitoneal　lacerations　or　ruptures。　Cock　found　a　curious　anomaly　in　a　necropsy　on　the　body　of　a　boy　of　eighteen；　who　had　died　after　a　fall　from　some　height。　There　was　a　compound；　transverse　rupture　of　the　left　kidney；　which　was　twice　as　large　as　usual；　the　ureter　also　being　of　abnormal　size。　Further　search　showed　that　the　right　kidney　was　rudimentary；　and　had　no　vein　or　artery。

Ward　mentions　a　case　of　ruptured　kidney；　caused　by　a　fall　of　seven　feet；　the　man　recovering　after　appropriate　treatment。　Vernon　reports　a　case　of　serious　injury　to　the　kidney；　resulting　in　recovery　in　nine　weeks。　The　patient　fell　40　feet；　landing　on　some　rubbish　and　old　iron；　and　received　a　wound　measuring　six　inches　over　the　right　iliac　crest；　through　which　the　lower　end　of　the　right　kidney　protruded；　a　piece　of　the　kidney　was　lost。　The　case　was　remarkable　because　of　the　slight　amount　of　hemorrhage。

Nephrorrhaphy　is　an　operation　in　which　a　movable　or　floating　kidney　is　fixed　by　suture　through　its　capsule；　including　a　portion　of　kidney…substance；　and　then　through　the　adjacent　lumbar　fascia　and　muscles。　The　ultimate　results　of　this　operation　have　been　most　successful。

Nephrolithotomy　is　an　operation　for　the　removal　of　stone　from　the　kidney。　The　operation　may　be　a　very　difficult　one；　owing　to　the　adhesions　and　thickening　of　all　the　perinephric　tissues；　or　to　the　small　size　or　remote　location　of　the　stone。

There　was　a　recent　exhibition　in　London；　in　which　were　shown　the　results　of　a　number　of　recent　operations　on　the　kidney。　There　was　one…half　of　a　kidney　that　had　been　removed　on　account　of　a　rapidly…growing　sarcoma　from　a　young　man　of　nineteen；　who　had　known　of　the　tumor　for　six　months；　there　was　a　good　recovery；　and　the　man　was　quite　well　in　eighteen　months　afterward。　Another　specimen　was　a　right　kidney　removed　at　St。　Bartholomew's　Hospital。　It　was　much　dilated；　and　only　a　small　amount　of　the　kidney…substance　remained。　A　calculus　blocked　the　ureter　at　its　commencement。　The　patient　was　a　woman　of　thirty…one；　and　made　a　good　recovery。　From　the　Middlesex　Hospital　was　a　kidney　containing　a　uric　acid　calculus　which　was　successfully　removed　from　a　man　of　thirty…five。　From　the　Cancer　Hospital　at　Brompton　there　were　two　kidneys　which　had　been　removed　from　a　man　and　a　woman　respectively；　both　of　whom　made　a　good　recovery。　From　the　King's　College　Hospital　there　was　a　kidney　with　its　pelvis　enlarged　and　occupied　by　a　large　calculus；　and　containing　little　secreting　substance；　which　was　removed　from　a　man　of　forty…nine；　who　recovered。　These　are　only　a　few　of　the　examples　of　this　most　interesting　collection。　Large　calculi　of　the　kidney　are　mentioned　in　Chapter　XV。

Rupture　of　the　ureter　is　a　very　rare　injury。　Poland　has　collected　the　histories　of　four　cases；　one　of　which　ended　in　recovery　after　the　evacuation　by　puncture；　at　intervals；　of　about　two　gallons　of　fluid　resembling　urine。　The　other　cases　terminated　in　death　during　the　first；　fourth；　and　tenth　weeks　respectively。　Peritonitis　was　apparently　not　present　in　any　of　the　cases；　the　urinary　extravasation　having　occurred　into　the　cellular　tissue　behind　the　peritoneum。

There　are　a　few　recorded　cases　of　uncomplicated　wounds　of　the　ureters。　The　only　well　authenticated　case　in　which　the　ureter　alone　was　divided　is　the　historic　injury　of　the　Archbishop　of　Paris；　who　was　wounded　during　the　Revolution　of　1848；　by　a　ball　entering　the　upper　part　of　the　lumbar　region　close　to　the　spine。　Unsuccessful　attempts　were　made　to　extract　the　ball；　and　as　there　was　no　urine　in　the　bladder；　but　a　quantity　escaping　from　the　wound；　a　diagnosis　of　divided　ureter　was　made。　The　Archbishop　died　in　eighteen　hours；　and　the　autopsy　showed　that　the　ball　had　fractured　the　transverse　process　of　the　3d　lumbar　vertebra；　and　divided　the　cauda　equina　just　below　its　origin；　it　had　then　changed　direction　and　passed　up　toward　the　left　kidney；　dividing　the　ureter　near　the　pelvis；　and　finally　lodged　in　the　psoas　muscle。

It　occasionally　happens　that　the　ureter　is　wounded　in　the　removal　of　uterine；　ovarian；　or　other　abdominal　tumors。　In　such　event；　if　it　is　impossible　to　transplant　to　the　bladder；　the　divided　or　torn　end　should　be　brought　to　the　surface　of　the　loin　or　vagina；　and　sutured　there。　In　cases　of　malignant　growth；　the　ureter　has　been　purposely　divided　and　transplanted　into　the　bladder。　Penrose；　assisted　by　Baldy；　has　performed　this　operation　after　excision　of　an　inch　of　the　left　ureter　for　carcinomatous　involvement。　The　distal　end　of　the　ureter　was　ligated；　and　the　proximal　end　implanted　in　the　bladder　according　to　Van　Hook's　method；　which　consists　in　tying　the　lowered　end　of　the　ureter；　then　making　a　slit　into　it；　and　invaginating　the　upper　end　into　the　lower　through　this　slit。　A　perfect　cure　followed。　Similar　cases　have　been　reported　by　Kelly；　Krug；　and　Bache　Emmet。　Reed　reports　a　most　interesting　series　in　which　he　has　successfully　transplanted　ureters　into　the　rectum。

Ureterovaginal　fistulae　following　total　extirpation　of　the　uterus；　opening　of　pelvic　abscesses；　or　ulcerations　from　foreign　bodies；　are　repaired　by　an　operation　termed　by　Bazy　of　Paris　ureterocystoneostomy；　and　suggested　by　him　as　a　substitute　for　nephrectomy　in　those　cases　in　which　the　renal　organs　are　unaffected。　In　the　repair　of　such　a　case　after　a　vaginal　hysterectomy　Mayo　reports　a　successful　reimplantation　of　the　ureter　into　the　bladder。

Stricture　of　the　ureter　is　also　a　very　rare　occurrence　except　as　a　result　of　compression　of　abdominal　or　pelvic　n