anomalies and curiosities of medicine-第135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！


wo　weeks　after　the　injury　paralysis　began　on　the　right　side；　and　six　weeks　from　the　injury　the　patient　died。　This　case　is　interesting　from　the　novel　mode　of　death；　the　perfect　paralysis　of　the　arm；　paralysis　agitans　of　the　body　（occurring　as　hemorrhage　from　the　ear　came　on；　and　subsiding　with　it）；　and　extensive　caries　of　the　petrous　bone；　without　sensation　of　pain　or　any　indicative　symptoms。

There　is　an　instance　in　a　young　girl　in　which　a　piece　of　pencil　remained　in　the　right　ear　for　seven　years。　Haug　speaks　of　two　beads　lying　in　the　auditory　canal　for　twenty…eight　years　without　causing　any　harm。

A　boy　of　six　introduced　a　carob…nut　kernel　into　each　ear。　On　the　next　day　incompetent　persons　attempted　to　extract　the　kernel　from　the　left　side；　but　only　caused　pain　and　hemorrhage。　The　nut　issued　spontaneously　from　the　right　side。　In　the　afternoon　the　auditory　canal　was　found　excoriated　and　red；　and　deep　in　the　meatus　the　kernel　was　found；　covered　with　blood。　The　patient　had　been　so　excited　and　pained　by　the　bungling　attempts　at　extraction　that　the　employment　of　instruments　was　impossible；　prolonged　employment　of　injections　was　substituted。　Discharge　from　the　ear　commenced；　intense　fever　and　delirium　ensued；　and　the　patient　had　to　be　chloroformed　to　facilitate　the　operation　of　extraction。　The　nut；　when　taken　out；　was　found　to　have　a　consistency　much　larger　than　originally；　caused　by　the　agglutination　of　wax　and　blood。　Unfortunately　the　symptoms　of　meningitis　increased；　three　days　after　the　operation　coma　followed；　and　on　the　next　day　death　ensued。　In　75　cases　collected　by　Mayer；　and　cited　by　Poulet　（whose　work　on　〃Foreign　Bodies〃　is　the　most　extensive　in　existence）；　death　as　a　consequence　of　meningitis　was　found　in　three。

Fleury　de　Clermont　mentions　a　woman　of　twenty…five　who　consulted　him　for　removal　of　a　pin　which　was　in　her　right　ear。　Vain　attempts　by　some　of　her　lay…friends　to　extract　the　pin　had　only　made　matters　worse。　The　pin　was　directed　transversely；　and　its　middle　part　touched　the　membrane　tympanum。　The　mere　touching　of　the　pin　caused　the　woman　intense　pain；　even　after　etherization　it　was　necessary　to　construct　a　special　instrument　to　extract　it。　She　suffered　intense　cephalalgia　and　other　signs　of　meningitis；　despite　vigorous　treatment　she　lost　consciousness　and　died　shortly　after　the　operation。

Winterbotham　reports　an　instance　in　which　a　cherry…stone　was　removed　from　the　meatus　auditorius　after　lodgment　of　upward　of　sixty　years。　Marchal　de　Calvi　mentions　intermittent　deafness　for　forty　years；　caused　by　the　lodgment　of　a　small　foreign　body　in　the　auditory　canal。　There　is　an　instance　in　which　a　carious　molar　tooth　has　been　tolerated　in　the　same　location　for　forty　years。

Albucasius；　Fabricius　Hildanus；　Pare；　and　others；　have　mentioned　the　fact　that　seeds　and　beans　have　been　frequently　seen　to　increase　in　volume　while　lodged　in　the　auditory　canal。　Tulpius　speaks　of　an　infant；　playing　with　his　comrades；　who　put　a　cherry…seed　in　his　ear　which　he　was　not　able　to　extract。　The　seed　increased　in　volume　to　such　an　extent　that　it　was　only　by　surgical　interference　that　it　could　be　extracted；　and　then　such　serious　consequences　followed　that　death　resulted。　Albers　reports　an　instance　in　which　a　pin　introduced　into　the　ear　issued　from　the　pharynx。

Confusion　of　diagnosis　is　occasionally　noticed　in　terrified　or　hysteric　persons。　Lowenberg　was　called　to　see　a　child　of　five　who　had　introduced　a　button　into　his　left　ear。　When　he　saw　the　child　it　complained　of　all　the　pain　in　the　right　ear；　and　he　naturally　examined　this　ear　first　but　found　nothing　to　indicate　the　presence　of　a　foreign　body。　He　examined　the　ear　supposed　to　be　healthy　and　there　found　the　button　lying　against　the　tympanum。　This　was　explained　by　the　fact　that　the　child　was　so　pained　and　terrified　by　the　previous　explorations　of　the　affected　ear　that　rather　than　undergo　them　again　he　presented　the　well　ear　for　examination。　In　the　British　Medical　Journal　for　1877　is　an　account　of　an　unjustified　exploration　of　an　ear　for　a　foreign　body　by　an　incompetent　physician；　who　spent　a　half　hour　in　exploration　and　manipulation；　and　whose　efforts　resulted　in　the　extraction　of　several　pieces　of　bone。　The　child　died　in　one　and　a　half　hours　afterward　from　extreme　hemorrhage；　and　the　medical　bungler　was　compelled　to　appear　before　a　coroner's　jury　in　explanation　of　his　ignorance。

In　the　external　ear　of　a　child　Tansley　observed　a　diamond　which　he　removed　under　chloroform。　The　mother　of　the　child　had　pushed　the　body　further　inward　in　her　endeavors　to　remove　it　and　had　wounded　the　canal。　Schmiegelow　reports　a　foreign　body　forced　into　the　drum…cavity；　followed　by　rough　extraction；　great　irritation；　tetanus；　and　death；　and　there　are　on　record　several　cases　of　fatal　meningitis；　induced　by　rough　endeavors　to　extract　a　body　from　the　external　ear。

In　the　Therapeutic　Gazette；　August　15；　1896；　there　is　a　translation　of　the　report　of　a　case　by　Voss；　in　which　a　child　of　five　pushed　a　dry　pea　in　his　ear。　Four　doctors　spent　several　days　endeavoring　to　extract　it；　but　only　succeeded　in　pushing　it　in　further。　It　was　removed　by　operation　on　the　fifth　day；　but　suppuration　of　the　tympanic　cavity　caused　death　on　the　ninth　day。

Barclay　reports　a　rare　case　of　ensnared　aural　foreign　body　in　a　lady；　aged　about　forty　years；　who；　while　〃picking〃　her　left　ear　with　a　so…called　〃invisible　hair…pin〃　several　hours　before　the　consultation；　had　heard　a　sudden　〃twang〃　in　the　ear；　as　if　the　hair…pin　had　broken。　And　so；　indeed；　it　had；　for　on　the　instant　she　had　attempted　to　jerk　it　quickly　from　the　ear　the　sharp　extremity　of　the　inner　portion　of　its　lower　prong　sprang　away　from　its　fellow；　penetrated　the　soft　tissues　of　the　floor　of　the　external　auditory　canal；　and　remained　imbedded　there；　the　separated　end　of　this　prong　only　coming　away　in　her　grasp。　Every　attempt　on　her　part　to　remove　the　hair…pin　by　traction　on　its　projecting　prongshe　durst　not　force　it　INWARD　for　fear　of　wounding　the　drumheadhad　served　but　to　bury　the　point　of　the　broken　prong　more　deeply　into　the　flesh　of　the　canal；　thereby　increasing　her　suffering。　Advised　by　her　family　physician　not　to　delay；　she　forthwith　sought　advice　and　aid。　On　examination；　it　was　found　that　the　lower　prong　of　the　〃invisible　hair…pin〃　had　broken　at　the　outer　end　of　its　wavy　portion；　and　seemed　firmly　imbedded　in　the　floor　of　the　auditory　canal；　now　quite　inflamed；　at　a　point　about　one…third　of　its　depth　from　the　outlet　of　the　canal。　The　loop　or　turn　of　the　hair…pin　was　about　1/2　inch　from　the　flaccid　portion　of　the　drumhead；　and；　together　with　the　unbroken　prong；　it　lay　closely　against　the　roof　of　the　canal。　Projecting　from　the　meatus　there　was　enough　of　this　prong　to　be　easily　grasped　between　one's　thumb　and　finger。　Removal　of　the　hair…pin　was　effected　by　first　inserting　within　the　meatus　a　Gruber　speculum；　encircling　the　unbroken　projecting　prong；　and　then　raising　the　end　of　the　broken　one　with　a　long…shanked　aural　hook；　when　the　hair…pin　was　readily　withdrawn。　The　wound　of　the　canal…floor　promptly　healed。

In　the　severest　forms　of　scalp…injuries；　such　as　avulsion　of　the　scalp　from　the　entangling　of　the　hair　in　machinery；　skin…grafting　or　replantation　is　of　particular　value。　Ashhurst　reports　a　case　which　he　considers　the　severest　case　of　scalp…wound　that　he　had　ever　seen；　followed　by　recovery。　The　patient　was　a　girl　of　fifteen；　an　operative　in　a　cotton…mill；　who　was　caught　by　her　hair　between　two　rollers　which　were　revolving　in　opposite　directions；　her　scalp　being　thus；　as　it　were；　squeezed　off　from　her　head；　forming　a　large　horseshoe　flap。　The　linear　extent　of　the　wound　was　14　inches；　the　distance　between　the　two　extremities　being　but　four　inches。　This　large　flap　was　thrown　backward；　like　the　lid　of　a　box；　the　skull　being　denuded　of　its　pericranium　for　the　space　of　2　1/2　by　one　inch　in　extent。　The　anterior　temporal　artery　was　divided　and　bled　profusely；　and　when　admitted　to　the　hospital　the　patient　was　extremely　depressed　by　shock　and　hemorrhage。　A　ligature　was　applied　to　the　bleeding　vessel；　and　after　it　had　been　gently　but　carefully　cleansed　the　flap　was　replaced　and　held　in　place　with　gauze　and　collodion　dressing。　A　large　compress　soaked　in　warm　olive　oil　was　then　placed　over　the　scalp；　covered　with　oiled　silk　and　with　a　recurrent　bandage。　A　considerable　portion　of　the　wound　healed　by　adhesions；　and　the　patient　was　discharged；　cured；　in　fifty…four　days。　No　exfoliation　of　bone　occurred。　Reverdin；　a　relative　of　the　discoverer　of　transplantation　of　skin；　reported　the　case　of　a　girl　of　twenty…one　whose　entire　scalp　was　detached　by　her　hair　being　caught　in　machinery；　leaving　a　wound　measuring　35　cm。　from　the　root　of　the　nose　to　the　nape　of　the　neck；　28　cm。　from　one　ear　to　the　other；　and　57　cm。　in　circumference。　Grafts　from　the　rabbit　and　dog　failed；　and　the　skin　from　the　amputated　stump　of　a　boy　was　employed；　and　the　patient　was　able　to　leave　the　hospital　in　seven　months。　Cowley　speaks　of　a　girl　of　fourteen　whose　hair　was　caught　in　the　revolving　shaft　of　a　steam…engine；　which　resulted　in　the　tearing　off　of　her　whole　scalp。　A　triangular　portion　of　the　skin　was　hanging　over　her　face；　the　apex　of　the　triangle　containing　short　hair；　from　which　the　long　hair　had　been　detached。　Both　ears　were　hanging　down　the　neck；　having　been　detached　above。　The　right　pinna　was　entire；　and　the　upper　half　of　the　left　pinna　had　disappeared。　The　whole　of　the　head　and　back　of　the　neck　was　denuded　of　skin。　One　of　the　temporal　arteries　was　ligated；　and　the　scalp　cleansed　and　reapplied。　The　hanging　ears　and　the　skin　of　the　forehead　were　successfully　restored　to　their　proper　position。　The　patient　had　no　bad　symptoms　and　little　pain；　and　the　shock　was　slight。　Where　the　periosteum　had　sloughed　the　bone　was　granulating；　and　at　the　time　of　the　report　skin…grafting　was　shortly　to　be　tried。

Schaeffer　has　presented　quite　an　extensive　article　on　scalp…injuries　in　which　grafting　and　transplantation　has　been　used；　and　besides　reporting　his　own　he　mentions　several　other　cases。　One　was　that　of　a　young　lady　of　twenty…　four。　While　at　work　under　a　revolving　shaft　in　a　laundry　the　wind　blew　her　hair　and　it　was　caught　in　the　shaft。　The　entire　skull　was　laid　bare　from　the　margin　of　the　eyelids　to　the　neck。　The　nasal　bon