anomalies and curiosities of medicine-第180部分

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d　venesections。　

The　loss　of　blood　through　spontaneous　hemorrhage　is　sometimes　remarkable。　Fabricius　Hildanus　reports　the　loss　of　27　pounds　of　blood　in　a　few　days；　and　there　is　an　older　record　of　40　pounds　being　lost　in　four　days。　Horstius；　Fabricius　Hildanus；　and　Schenck；　all　record　instances　of　death　from　hemorrhage　of　the　gums。　Tulpius　speaks　of　hemoptysis　lasting　chronically　for　thirty　years；　and　there　is　a　similar　record　of　forty　years'　duration　in　the　Ephemerides。　Chapman　gives　several　instances　of　extreme　hemorrhage　from　epistaxis。　He　remarks　that　Bartholinus　has　recorded　the　loss　of　48　pounds　of　blood　from　the　nose；　and　Rhodius；　18　pounds　in　thirty…six　hours。　The　Ephemerides　contains　an　account　of　epistaxis　without　cessation　for　six　weeks。　Another　writer　in　an　old　journal　speaks　of　75　pounds　of　blood　from　epistaxis　in　ten　days。　Chapman　also　mentions　a　case　in　which；　by　intestinal　hemorrhage；　eight　gallons　of　blood　were　lost　in　a　fortnight；　the　patient　recovering。　In　another　case　a　pint　of　blood　was　lost　daily　for　fourteen　days；　with　recovery。　The　loss　of　eight　quarts　in　three　days　caused　death　in　another　case；　and　Chapman；　again；　refers　to　the　loss　of　three　gallons　of　blood　from　the　bowel　in　twenty…four　hours。　In　the　case　of　Michelotti；　recorded　in　the　Transactions　of　the　Royal　Society；　a　young　man　suffering　from　enlargement　of　the　spleen　vomited　12　pounds　of　blood　in　two　hours；　and　recovered。

In　hemorrhoidal　hemorrhages；　Lieutaud　speaks　of　six　quarts　being　lost　in　two　days；　Hoffman；　of　20　pounds　in　less　than　twenty…four　hours；　and　Panaroli；　of　the　loss　of　one　pint　daily　for　two　years。

Arrow…Wounds。According　to　Otis　the　illustrious　Baron　Percy　was　wont　to　declare　that　military　surgery　had　its　origin　in　the　treatment　of　wounds　inflicted　by　darts　and　arrows；　he　used　to　quote　Book　XI　of　the　Iliad　in　behalf　of　his　belief；　and　to　cite　the　cases　of　the　patients　of　Chiron　and　Machaon；　Menelaus　and　Philoctetes；　and　Eurypiles；　treated　by　Patroclus；　he　was　even　tempted　to　believe　with　Sextus　that　the　name　iatros；　medicus；　was　derived　from　ios；　which　in　the　older　times　signified　〃sagitta；〃　and　that　the　earliest　function　of　our　professional　ancestors　was　the　extraction　of　arrows　and　darts。　An　instrument　called　beluleum　was　invented　during　the　long　Peloponnesian　War；　over　four　hundred　years　before　the　Christian　era。　It　was　a　rude　extracting…forceps；　and　was　used　by　Hippocrates　in　the　many　campaigns　in　which　he　served。　His　immediate　successor；　Diocles；　invented　a　complicated　instrument　for　extracting　foreign　bodies；　called　graphiscos；　which　consisted　of　a　canula　with　hooks。　Otis　states　that　it　was　not　until　the　wars　of　Augustus　that　Heras　of　Cappadocia　designed　the　famous　duck…bill　forceps　which；　with　every　conceivable　modification；　has　continued　in　use　until　our　time。　Celsus　instructs　that　in　extracting　arrow…heads　the　entrance…wound　should　be　dilated；　the　barb　of　the　arrow…head　crushed　by　strong　pliers；　or　protected　between　the　edges　of　a　split　reed；　and　thus　withdrawn　without　laceration　of　the　soft　parts。　According　to　the　same　authority；　Paulus　Aegineta　also　treated　fully　of　wounds　by　arrow…heads；　and　described　a　method　used　in　his　time　to　remove　firmly…impacted　arrows。　Albucasius　and　others　of　the　Arabian　school　did　little　or　nothing　toward　aiding　our　knowledge　of　the　means　of　extracting　foreign　bodies。　After　the　fourteenth　century　the　attention　of　surgeons　was　directed　to　wounds　from　projectiles　impelled　by　gunpowder。　In　the　sixteenth　century　arrows　were　still　considerably　used　in　warfare；　and　we　find　Pare　a　delineating　the　treatment　of　this　class　of　injuries　with　the　sovereign　good　sense　that　characterized　his　writings。　As　the　use　of　firearms　became　prevalent　the　literature　of　wounds　from　arrows　became　meager；　and　the　report　of　an　instance　in　the　present　day　is　very　rare。

Bill　has　collected　statistics　and　thoroughly　discussed　this　subject；　remarking　upon　the　rapidity　with　which　American　Indians　discharge　their　arrows；　and　states　that　it　is　exceptional　to　meet　with　only　a　single　wound。　It　is　commonly　believed　that　the　Indian　tribes　make　use　of　poisoned　arrows；　but　from　the　reports　of　Bill　and　others；　this　must　be　a　very　rare　custom。　Ashhurst　states　that　he　was　informed　by　Dr。　Schell；　who　was　stationed　for　some　time　at　Fort　Laramie；　that　it　is　the　universal　custom　to　dip　the　arrows　in　blood；　which　is　allowed　to　dry　on　them；　it　is　not；　therefore；　improbable　that　septic　material　may　thus　be　inoculated　through　a　wound。

Many　savage　tribes　still　make　use　of　the　poisonous　arrow。　The　Dyak　uses　a　sumpitan；　or　blow…tube；　which　is　about　seven　feet　long；　and　having　a　bore　of　about　half　an　inch。　Through　this　he　blows　his　long；　thin　dart；　anointed　on　the　head　with　some　vegetable　poison。　Braidwood　speaks　of　the　physiologic　action　of　Dajaksch；　an　arrow…poison　used　in　Borneo。　Arnott　has　made　observations　relative　to　a　substance　produced　near　Aden；　which　is　said　to　be　used　by　the　Somalies　to　poison　their　arrows。　Messer　of　the　British　Navy　has　made　inquiries　into　the　reputed　poisonous　nature　of　the　arrows　of　the　South　Sea　Islanders。

Otis　has　collected　reports　of　arrow…wounds　from　surgical　cases　occurring　in　the　U。　S。　Army。　Of　the　multiple　arrow…wounds；　six　out　of　the　seven　cases　were　fatal。　In　five　in　which　the　cranial　cavity　was　wounded；　four　patients　perished。　There　were　two　remarkable　instances　of　recovery　after　penetration　of　the　pleural　cavity　by　arrows。　The　great　fatality　of　arrow…wounds　of　the　abdomen　is　well　known；　and；　according　to　Bill；　the　Indians　always　aim　at　the　umbilicus；　when　fighting　Indians；　the　Mexicans　are　accustomed　to　envelop　the　abdomen；　as　the　most　vulnerable　part；　in　many　folds　of　a　blanket。

Of　the　arrow…wounds　reported；　nine　were　fatal；　with　one　exception；　in　which　the　lesion　implicated　the　soft　parts　only。　The　regions　injured　were　the　scalp；　face；　and　neck；　in　three　instances；　the　parietes　of　the　chest　in　six；　the　long　muscles　of　the　back　in　two；　the　abdominal　muscles　in　two；　the　hip　or　buttocks　in　three；　the　testis　in　one；　the　shoulder　or　arm　in　13；　forearm　or　hand　in　six；　the　thigh　or　leg　in　seven。

The　force　with　which　arrows　are　projected　by　Indians　is　so　great　that　it　has　been　estimated　that　the　initial　velocity　nearly　equals　that　of　a　musket…ball。　At　a　short　distance　an　arrow　will　perforate　the　larger　bones　without　comminuting　them；　causing　a　slight　fissure　only；　and　resembling　the　effect　of　a　pistol…ball　fired　through　a　window…glass　a　few　yards　off。

Among　extraordinary　cases　of　recovery　from　arrow…wounds；　several　of　the　most　striking　will　be　recorded。　Tremaine　mentions　a　sergeant　of　thirty…four　who；　in　a　fray　with　some　hostile　Indians；　received　seven　arrow…wounds：　two　on　the　anterior　surface　of　the　right　arm；　one　in　the　right　axilla；　one　on　the　right　side　of　the　chest　near　the　axillary　border；　two　on　the　posterior　surface　of　the　left　arm　near　the　elbow…joint；　and　one　on　the　left　temple。　On　June　1st　he　was　admitted　to　the　Post　Hospital　at　Fort　Dodge；　Kan。　The　wound　on　the　right　arm　near　the　deltoid　discharged；　and　there　was　slight　exfoliation　of　the　humerus。　The　patient　was　treated　with　simple　dressings；　and　was　returned　to　duty　in　July；　1870。

Goddard　mentions　an　arrow…wound　by　which　the　body　was　transfixed。　The　patient　was　a　cutler's　helper　at　Fort　Rice；　Dakota　Territory。　He　was　accidentally　wounded　in　February；　1868；　by　an　arrow　which　entered　the　back　three　inches　to　the　right　of　the　5th　lumbar　vertebra；　and　emerged　about　two　inches　to　the　right　of　the　ensiform　cartilage。　During　the　following　evening　the　patient　lost　about　eight　ounces　of　blood　externally；　with　a　small　amount　internally。　He　was　confined　to　his　bed　some　two　weeks；　suffering　from　circumscribed　peritonitis　with　irritative　fever。　In　four　weeks　he　was　walking　about；　and　by　July　1st　was　actively　employed。　The　arrow　was　deposited　in　the　Army　Medical　Museum。

Muller　gives　a　report　of　an　arrow…wound　of　the　lung　which　was　productive　of　pleurisy　but　which　was　followed　by　recovery。　Kugler　recites　the　description　of　the　case　of　an　arrow…wound　of　the　thorax；　complicated　by　frightful　dyspnea　and　blood　in　the　pleural　cavity　and　in　the　bronchi；　with　recovery。

Smart　extracted　a　hoop…iron　arrow…head；　1　3/4　inches　long　and　1/2　inch　in　breadth；　from　the　brain　of　a　private；　about　a　month　after　its　entrance。　About　a　dram　of　pus　followed　the　exit　of　the　arrow…head。　After　the　operation　the　right　side　was　observed　to　be　paralyzed；　and　the　man　could　not　remember　his　name。　He　continued　in　a　varying　condition　for　a　month；　but　died　on　May　13；　1866；　fifty…two　days　after　the　injury。　At　the　postmortem　it　was　found　that　the　brain…tissue；　to　the　extent　of　3/4　inch　around　the　track　of　the　arrow　as　a　center；　was　softened　and　disorganized。　The　track　itself　was　filled　with　thick　pus　which　extended　into　the　ventricles。

Peabody　reports　a　most　remarkable　case　of　recovery　from　multiple　arrow…wounds。　In　a　skirmish　with　some　Indians　on　June　3；　1863；　the　patient　had　been　wounded　by　eight　distinct　arrows　which　entered　different　parts　of　the　body。　They　were　all　extracted　with　the　exception　of　one；　which　had　entered　at　the　outer　and　lower　margin　of　the　right　scapula；　and　had　passed　inward　and　upward　through　the　upper　lobe　of　the　right　lung　or　trachea。　The　hemorrhage　at　this　time　was　so　great　that　all　hope　was　abandoned。　The　patient；　however；　rallied；　but　continued　to　experience　great　pain　on　swallowing；　and　occasionally　spat　blood。　In　July；　1866；　more　than　three　years　after　the　injury；　he　called　on　Dr。　Peabody　to　undergo　an　examination　with　a　view　of　applying　for　a　pension；　stating　that　his　health　was　affected　from　the　presence　of　an　arrow…head。　He　was　much　emaciated；　and　expressed　himself　as　tired　of　life。　Upon　probing　through　a　small　fistulous　opening　just　above　the　superior　end　of　the　sternum；　the　point　of　the　arrow　was　found　resting　against　the　bone；　about　1　1/2　inches　below；　the　head　lying　against　the　trachea　and　esophagus；　with　the　carotid　artery；　jugular　vein；　and　nerves　overlying。　After　some　little　difficulty　the　point　of　the　arrow　was　raised　above　the　sternum；　and　it　was　extracted　without　the　loss　of　an　ounce　of　blood。　The　edge　grazed　against　the　sheath　of　the　innominate　artery　during　the　operation。　The　missile　measured　an　inch　at　the　base；　and　was　four　inches　lon