anomalies and curiosities of medicine-第66部分

按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！


sting　of　a　coccyx　prolonged　and　covered　with　skin；　and　in　1884　he　saw　the　same　girl；　at　this　time　the　tail　measuring　nearly　13　cm。

Virchow　received　for　examination　a　tail　three　inches　long　amputated　from　a　boy　of　eight　weeks。　Ornstein；　chief　physician　of　the　Greek　army；　describes　a　Greek　of　twenty…six　who　had　a　hairless；　conical　tail；　free　only　at　the　tip；　two　inches　long　and　containing　three　vertebrae。　He　also　remarks　that　other　instances　have　been　observed　in　recruits。　Thirk　of　Broussa　in　1820　described　the　tail　of　a　Kurd　of　twenty…two　which　contained　four　vertebrae。　Belinovski　gives　an　account　of　a　hip…joint　amputation　and　extirpation　of　a　fatty　caudal　extremity；　the　only　one　he　had　ever　observed。

Before　the　Berlin　Anthropological　Society　there　were　presented　two　adult　male　Papuans；　in　good　health　and　spirits；　who　had　been　brought　from　New　Guinea；　their　coccygeal　bones　projected　1　1/2　inches。　Oliver　Wendell　Holmes　in　the　Atlantic　Monthly；　June；　1890；　says　that　he　saw　in　London　a　photograph　of　a　boy　with　a　considerable　tail。　The　〃Moi　Boy〃　was　a　lad　of　twelve；　who　was　found　in　Cochin　China；　with　a　tail　a　foot　long　which　was　simply　a　mass　of　flesh。　Miller　tells　of　a　West　Point　student　who　had　an　elongation　of　the　coccyx；　forming　a　protuberance　which　bulged　very　visibly　under　the　skin。　Exercise　at　the　riding　school　always　gave　him　great　distress；　and　the　protuberance　would　often　chafe　until　the　skin　was　broken；　the　blood　trickling　into　his　boots。

Bartels　presents　a　very　complete　article　in　which　he　describes　21　persons　born　with　tails；　most　of　the　tails　being　merely　fleshy　protuberances。　Darwin　speaks　of　a　person　with　a　fleshy　tail　and　refers　to　a　French　article　on　human　tails。　

Science　contains　a　description　of　a　negro　child　born　near　Louisville；　eight　weeks　old；　with　a　pedunculated　tail　2　1/2　inches　long；　with　a　base　1　1/4　inches　in　circumference。　The　tail　resembled　in　shape　a　pig's　tail　and　had　grown　1/4　inch　since　birth。　It　showed　no　signs　of　cartilage　or　bone；　and　had　its　origin　from　a　point　slightly　to　the　left　of　the　median　line　and　about　an　inch　above　the　end　of　the　spinal　column。

Dickinson　recently　reported　the　birth　of　a　child　with　a　tail。　It　was　a　well…developed　female　between　5　1/2　and　six　pounds　in　weight。　The　coccyx　was　covered　with　the　skin　on　both　the　anterior　and　posterior　surfaces。　It　thus　formed　a　tail　of　the　size　of　the　nail　of　the　little　finger；　with　a　length　of　nearly　3/16　inch　on　the　inner　surface　and　3/8　inch　on　the　rear　surface。　This　little　tip　could　be　raised　from　the　body　and　it　slowly　sank　back。

In　addition　to　the　familiar　caudal　projection　of　the　human　fetus；　Dickinson　mentions　a　group　of　other　vestigial　remains　of　a　former　state　of　things。　Briefly　these　are：

（1）　The　plica　semilunaris　as　a　vestige　of　the　nictitating　membrane　of　certain　birds。

（2）　The　pointed　ear；　or　the　turned…down　tip　of　the　ears　of　many　men。

（3）　The　atrophied　muscles；　such　as　those　that　move　the　ear；　that　are　well　developed　in　certain　people；　or　that　shift　the　scalp；　resembling　the　action　of　a　horse　in　ridding　itself　of　flies。

（4）　The　supracondyloid　foremen　of　the　humerus。

（5）　The　vermiform　appendix。

（6）　The　location　and　direction　of　the　hair　on　the　trunk　and　limbs。

（7）　The　dwindling　wisdom…teeth。

（8）　The　feet　of　the　fetus　strongly　deflected　inward；　as　in　the　apes；　and　persisting　in　the　early　months　of　life；　together　with　great　mobility　and　a　distinct　projection　of　the　great　toe　at　an　angle　from　the　side　of　the　foot。

（9）　The　remarkable　grasping　power　of　the　hand　at　birth　and　for　a　few　weeks　thereafter；　that　permits　young　babies　to　suspend　their　whole　weight　on　a　cane　for　a　period　varying　from　half　a　minute　to　two　minutes。

Horrocks　ascribes　to　these　anal　tags　a　pathologic　importance。　He　claims　that　they　may　be　productive　of　fistula　in　ano；　superficial　ulcerations；　fecal　concretions；　fissure　in　ano；　and　that　they　may　hypertrophy　and　set　up　tenesmus　and　other　troubles。　The　presence　of　human　tails　has　given　rise　to　discussion　between　friends　and　opponents　of　the　Darwinian　theory。　By　some　it　is　considered　a　reversion　to　the　lower　species；　while　others　deny　this　and　claim　it　to　be　simply　a　pathologic　appendix。

Anomalies　of　the　Spinal　Canal　and　Contents。When　there　is　a　default　in　the　spinal　column；　the　vice　of　conformation　is　called　spina　bifida。　This　is　of　two　classes：　first；　a　simple　opening　in　the　vertebral　canal；　and；　second；　a　large　cleft　sufficient　to　allow　the　egress　of　spinal　membranes　and　substance。　Figure　130　represents　a　large　congenital　sacral　tumor。

Achard　speaks　of　partial　duplication　of　the　central　canal　of　the　spinal　cord。　De　Cecco　reports　a　singular　case　of　duplication　of　the　lumbar　segment　of　the　spinal　cord。　Wagner　speaks　of　duplication　of　a　portion　of　the　spinal　cord。

Foot　records　a　case　of　amyelia；　or　absence　of　the　spinal　cord；　in　a　fetus　with　hernia　cerebri　and　complete　fissure　of　the　spinal　column。　Nicoll　and　Arnold　describe　an　anencephalous　fetus　with　absence　of　spinal　marrow；　and　Smith　also　records　the　birth　of　an　amyelitic　fetus。　

In　some　persons　there　are　exaggerated　curvatures　of　the　spine。　The　first　of　these　curvatures　is　called　kyphosis；　in　which　the　curvature　is　posterior；　second；　lordosis；　in　which　the　curvature　is　anterior；　third；　scoliosis；　in　which　it　is　lateral；　to　the　right　or　left。

Kyphosis　is　the　most　common　of　the　deviations　in　man　and　is　most　often　found　in　the　dorsal　region；　although　it　may　be　in　the　lumbar　region。　Congenital　kyphosis　is　very　rare　in　man；　is　generally　seen　in　monsters；　and　when　it　does　exist　is　usually　accompanied　by　lordosis　or　spine　bifida。　We　sometimes　observe　a　condition　of　anterior　curvature　of　the　lumbar　and　sacral　regions；　which　might　be　taken　for　a　congenital　lordosis；　but　this　is　really　a　deformity　produced　after　birth　by　the　physiologic　weight　of　the　body。　Figure　131　represents　a　case　of　lordosis　caused　by　paralysis　of　the　spinal　muscles。

Analogous　to　this　is　what　the　accoucheurs　call　spondylolisthesis。　Scoliosis　may　be　a　cervicodorsal；　dorsolumbar；　or　lumbosacral　curve；　and　the　inclination　of　the　vertebral　column　may　be　to　the　right　or　left。　The　pathologists　divide　scoliosis　into　a　myopathic　variety；　in　which　the　trouble　is　a　physiologic　antagonism　of　the　muscles；　or　osteopathic；　ordinarily　associated　with　rachitis；　which　latter　variety　is　generally　accountable　for　congenital　scoliosis。　In　some　cases　the　diameter　of　the　chest　is　shortened　to　an　almost　incredible　degree；　but　may　yet　be　compatible　with　life。　Glover　speaks　of　an　extraordinary　deformity　of　the　chest　with　lateral　curvature　of　the　spine；　in　which　the　diameter　from　the　pit　of　the　stomach　to　the　spinal　integument　was　only　5　1/2　inches。

Supernumerary　ribs　are　not　at　all　uncommon　in　man；　nearly　every　medical　museum　having　some　examples。　Cervical　ribs　are　not　rare。　Gordon　describes　a　young　man　of　seventeen　in　whom　there　was　a　pair　of　supernumerary　ribs　attached　to　the　cervical　vertebrae。　Bernhardt　mentions　an　instance　in　which　cervical　ribs　caused　motor　and　sensory　disturbances。　Dumerin　of　Lyons　showed　an　infant　of　eight　days　which　had　an　arrested　development　of　the　2d；　3d；　4th；　and　5th　ribs。　Cases　of　deficient　ribs　are　occasionally　met。　Wistar　in　1818　gives　an　account　of　a　person　in　whom　one　side　of　the　thorax　was　at　rest　while　the　other　performed　the　movements　of　breathing　in　the　usual　manner。

In　some　cases　we　see　fissure　of　the　sternum；　caused　either　by　deficient　union　or　absence　of　one　of　its　constituent　parts。　In　the　most　exaggerated　cases　these　fissures　permit　the　exit　of　the　heart；　and　as　a　general　rule　ectopies　of　the　heart　are　thus　caused。　Pavy　has　given　a　most　remarkable　case　of　sternal　fissure　in　a　young　man　of　twenty…five；　a　native　of　Hamburg。　He　exhibited　himself　in　one　medical　clinic　after　another　all　over　Europe；　and　was　always　viewed　with　the　greatest　interest。　In　the　median　line；　corresponding　to　the　absence　of　sternum；　was　a　longitudinal　groove　bounded　on　either　side　by　a　continuous　hard　ridge　which　articulated　with　the　costal　cartilages。　The　skin　passed　naturally　over　the　chest　from　one　side　to　another；　but　was　raised　at　one　part　of　the　groove　by　a　pulsatile　swelling　which　occupied　the　position　of　the　right　auricle。　The　clavicle　and　the　two　margins　of　the　sternum　had　no　connections　whatever；　and　below　the　groove　was　a　hard　substance　corresponding　to　the　ensiform　cartilage；　which；　however；　was　very　elastic；　and　allowed　the　patient；　under　the　influence　of　the　pectoral　muscles；　when　the　upper　extremity　was　fixed；　to　open　the　groove　to　nearly　the　extent　of　three　inches；　which　was　more　than　twice　its　natural　width。　By　approximating　his　arms　he　made　the　ends　of　his　clavicles　overlap。　When　he　coughed；　the　right　lung　suddenly　protruded　from　the　chest　through　the　groove　and　ascended　a　considerable　distance　above　the　clavicle　into　the　neck。　Between　the　clavicles　another　pulsatile　swelling　was　easily　felt　but　hardly　seen；　which　was　doubtless　the　arch　of　the　aorta；　as　by　putting　the　fingers　on　it　one　could　feel　a　double　shock；　synchronous　with　distention　and　recoil　of　a　vessel　or　opening　and　closing　of　the　semilunar　valves。

Madden　pictures　（Figs。　134　and　135）　a　Swede　of　forty　with　congenital　absence　of　osseous　structure　in　the　middle　line　of　the　sternum；　leaving　a　fissure　5　3/8　X　1　3/16　X　2　inches；　the　longest　diameter　being　vertical。　Madden　also　mentions　several　analogous　instances　on　record。　Groux's　case　was　in　a　person　of　forty…five；　and　the　fissure　had　the　vertical　length　of　four　inches。　Hodgen　of　St。　Louis　reports　a　case　in　which　there　was　exstrophy　of　the　heart　through　the　fissure。　Slocum　reports　the　occurrence　of　a　sternal　fissure　3　X　1　1/2　inches　in　an　Irishman　of　twenty…five。　Madden　also　cites　the　case　of　Abbott　in　an　adult　negress　and　a　mother。　Obermeier　mentions　several　cases。　Gibson　and　Malet　describe　a　presternal　fissure　uncovering　the　base　of　the　heart。　Ziemssen；　Wrany；　and　Williams　also　record　congenital　fissures　of　the　sternum。

Thomson　has　collected　86　cases　of　thoracic　defects　and　summarizes　his　paper　by　saying　that　the　structures　deficient　are　generally　the　hair　in　the　mammary　and　axillary　regions；　the　subcutaneous　fat　over　the　muscles；　nipples；　and　breasts；　the　pectorals　and　adjacent　muscles；　the　costal　cartilages　and　anterio