anomalies and curiosities of medicine-第137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！


ding；　and　struck　a　person　a　few　paces　away。　It　entered　the　head　near　the　root　of　the　zygomatic　arch；　about　a　finger's　breadth　from　the　outer　corner　of　the　right　eye；　passed　through　the　head；　emerging　at　the　posterior　superior　angle　of　the　parietal　bone；　a　finger's　breadth　from　the　sagittal　suture；　and　about　the　same　distance　above　the　superior　angle　of　the　occipital　bone。　The　wounded　man　attempted　to　pull　the　ramrod　out；　but　all　his　efforts　were　ineffectual。　After　the　tolerance　of　this　foreign　body　for　some　time；　one　of　his　companions　managed　to　extract　it；　and　when　it　was　brought　out　it　was　as　straight　as　the　day　it　left　the　maker's　shop。　Little　blood　was　lost；　and　the　wound　healed　rapidly　and　completely；　in　spite　of　this　major　injury　the　patient　recovered。

Carpenter　reports　the　curious　case　of　an　insane　man　who　deliberately　bored　holes　through　his　skull；　and　at　different　times；　at　a　point　above　the　ear；　he　inserted　into　his　brain　five　pieces　of　No。　20　broom　wire　from　2　1/16　to　6　3/4　inches　in　length；　a　fourpenny　nail　2　1/4　inches　long；　and　a　needle　1　5/8　inches　long。　Despite　these　desperate　attempts　at　suicide　he　lived　several　months；　finally　accomplishing　his　purpose　by　taking　an　overdose　of　morphin。　MacQueen　has　given　the　history　of　a　man　of　thirty…five；　who　drove　one　three…inch　nail　into　his　forehead；　another　close　to　his　occiput；　and　a　third　into　his　vertex　an　inch　in　front　and　1/4　inch　to　the　left　of　the　middle　line。　He　had　used　a　hammer　to　effect　complete　penetration；　hoping　that　death　would　result　from　his　injuries。　He　failed　in　this；　as　about　five　weeks　later　he　was　discharged　from　the　Princess　Alice　Hospital　at　Eastbourne；　perfectly　recovered。　There　is　a　record　of　a　man　by　the　name　of　Bulkley　who　was　found；　by　a　police　officer　in　Philadelphia；　staggering　along　the　streets；　and　was　taken　to　the　inebriate　ward　of　the　Blockley　Hospital；　where　he　subsequently　sank　and　died；　after　having　been　transferred　from　ward　to　ward；　his　symptoms　appearing　inexplicable。　A　postmortem　examination　revealed　the　fact　that　an　ordinary　knife…blade　had　been　driven　into　his　brain　on　the　right　side；　just　above　the　ear；　and　was　completely　hidden　by　the　skin。　It　had　evidently　become　loosened　from　the　handle　when　the　patient　was　stabbed；　and　had　remained　in　the　brain　several　days。　No　clue　to　the　assailant　was　found。

Thudicum　mentions　the　case　of　a　man　who　walked　from　Strafford　to　Newcastle；　and　from　Newcastle　to　London；　where　he　died；　and　in　his　brain　was　found　the　breech…pin　of　a　gun。　Neiman　describes　a　severe　gunshot　wound　of　the　frontal　region；　in　which　the　iron　breech…block　of　an　old…fashioned　muzzle…loading　gun　was　driven　into　the　substance　of　the　brain；　requiring　great　force　for　its　extraction。　The　patient；　a　young　man　of　twenty…eight；　was　unconscious　but　a　short　time；　and　happily　made　a　good　recovery。　A　few　pieces　of　bone　came　away；　and　the　wound　healed　with　only　a　slight　depression　of　the　forehead。　Wilson　speaks　of　a　child　who　fell　on　an　upright　copper　paper…file；　which　penetrated　the　right　side　of　the　occipital　bone；　below　the　external　orifice　of　the　ear；　and　entered　the　brain　for　more　than　three　inches；　and　yet　the　child　made　a　speedy　recovery。

Baron　Larrey　knew　of　a　man　whose　head　was　completely　transfixed　by　a　ramrod；　which　extended　from　the　middle　of　the　forehead　to　the　left　side　of　the　nape　of　the　neck；　despite　this　serious　injury　the　man　lived　two　days。

Jewett　records　the　case　of　an　Irish　drayman　who；　without　treatment；　worked　for　forty…seven　days　after　receiving　a　penetrating　wound　of　the　skull　1/4　inch　in　diameter　and　four　inches　deep。　Recovery　ensued　in　spite　of　the　delay　in　treatment。

Gunshot　Injuries。Swain　mentions　a　patient　who　stood　before　a　looking　glass；　and；　turning　his　head　far　around　to　the　left；　fired　a　pistol　shot　into　his　brain　behind　the　right　ear。　The　bullet　passed　into　his　mouth；　and　he　spat　it　out。　Some　bleeding　occurred　from　both　the　internal　and　external　wounds；　the　man　soon　began　to　suffer　with　a　troublesome　cough；　with　bloody　expectoration；　his　tongue　was　coated　and　drawn　to　the　right；　he　became　slightly　deaf　in　his　right　ear　and　dragged　his　left　leg　in　walking。　These　symptoms；　together　with　those　of　congestion　of　the　lung；　continued　for　about　a　week；　when　he　died；　apparently　from　his　pulmonary　trouble。

Ford　quotes　the　case　of　a　lad　of　fifteen　who　was　shot　in　the　head；　3/4　inch　anterior　to　the　summit　of　the　right　ear；　the　ball　escaping　through　the　left　os　frontis；　1　1/4　inch　above　the　center　of　the　brow。　Recovery　ensued；　with　a　cicatrix　on　the　forehead；　through　which　the　pulsations　of　the　brain　could　be　distinctly　seen。　The　senses　were　not　at　all　deteriorated。

Richardson　tells　of　a　soldier　who　was　struck　by　a　Minie　ball　on　the　left　temporal　bone；　the　missile　passed　out　through　the　left　frontal　bone　1/2　inch　to　the　left　of　the　middle　of　the　forehead。　He　was　only　stunned；　and　twenty…　four　hours　later　his　intellect　was　undisturbed。　There　was　no　operation；　free　suppuration　with　discharges　of　fragments　of　skull　and　broken…down　substance　ensued　for　four　weeks；　when　the　wounds　closed　kindly；　and　recovery　followed。

Angle　records　the　case　of　a　cowboy　who　was　shot　by　a　comrade　in　mistake。　The　ball　entered　the　skull　beneath　the　left　mastoid　process　and　passed　out　of　the　right　eye。　The　man　recovered。

Rice　describes　the　case　of　a　boy　of　fourteen　who　was　shot　in　the　head；　the　ball　directly　traversing　the　brain　substance；　some　of　which　protruded　from　the　wound。　The　boy　recovered。　The　ball　entered　one　inch　above　and　in　front　of　the　right　ear　and　made　its　exit　through　the　lambdoidal　suture　posteriorly。

Hall　of　Denver；　Col。；　in　an　interesting　study　of　gunshot　wounds　of　the　brain；　writes　as　follows：

〃It　is　in　regard　to　injuries　involving　the　brain　that　the　question　of　the　production　of　immediate　unconsciousness　assumes　the　greatest　interest。　We　may　state　broadly　that　if　the　medulla　or　the　great　centers　at　the　base　of　the　brain　are　wounded　by　a　bullet；　instant　unconsciousness　must　result；　with　any　other　wounds　involving　the　brain…substance　it　will；　with　very　great　probability；　result。　But　there　is　a　very　broad　area　of　uncertainty。　Many　instances　have　been　recorded　in　which　the　entrance　of　a　small　bullet　into　the　anterior　part　of　the　brain　has　not　prevented　the　firing　of　a　second　shot　on　the　part　of　the　suicide。　Personally；　I　have　not　observed　such　a　case；　however。　But；　aside　from　the　injuries　by　the　smallest　missiles　in　the　anterior　parts　of　the　brain；　we　may　speak　with　almost　absolute　certainty　with　regard　to　the　production　of　unconsciousness；　for　the　jar　to　the　brain　from　the　blow　of　the　bullet　upon　the　skull　would　produce　such　a　result　even　if　the　damage　to　the　brain　were　not　sufficient　to　do　so。

〃Many　injuries　to　the　brain　from　bullets　of　moderate　size　and　low　velocity　do　not　cause　more　than　a　temporary　loss　of　consciousness；　and　the　subjects　are　seen　by　the　surgeon；　after　the　lapse　of　half　an　hour　or　more；　apparently　sound　of　mind。　These　are　the　cases　in　which　the　ball　has　lost　its　momentum　in　passing　through　the　skull；　and　has　consequently　done　little　damage　to　the　brain…substance；　excepting　to　make　a　passage　for　itself　for　a　short　distance　into　the　brain。　It　is　apparently　well　established　that；　in　the　case　of　the　rifle…bullet　of　high　velocity；　and　especially　if　fired　from　the　modern　military　weapons　using　nitro…powders；　and　giving　an　enormous　initial　velocity　to　the　bullet；　the　transmission　of　the　force　from　the　displaced　particles　of　brain　（and　this　rule　applies　to　any　other　of　the　soft　organs　as　well）　to　the　adjacent　parts　is　such　as　to　disorganize　much　of　the　tissue　surrounding　the　original　track　of　the　missile。　Under　these　circumstances　a　much　slighter　wound　would　be　necessary　to　produce　unconsciousness　or　death　than　in　the　case　of　a　bullet　of　low　velocity；　especially　if　it　were　light　in　weight。　Thus　I　have　recorded　elsewhere　an　instance　of　instant　death　in　a　grizzly　bear；　an　animal　certainly　as　tenacious　of　life　as　any　we　have；　from　a　mere　furrow；　less　than　a　quarter　of　an　inch　in　depth；　through　the　cortex　of　the　brain；　without　injury　of　the　skull　excepting　the　removal　of　the　bone　necessary　for　the　production　of　this　furrow。　The　jar　to　the　brain　from　a　bullet　of　great　velocity；　as　in　this　case；　was　alone　sufficient　to　injure　the　organ　irreparably。　In　a　similar　manner　I　have　known　a　deer　to　be　killed　by　the　impact　of　a　heavy　rifle…ball　against　one　horn；　although　there　was　no　evidence　of　fracture　of　the　skull。　On　the　other　hand；　game　animals　often　escape　after　such　injuries　not　directly　involving　the　brain；　although　temporarily　rendered　unconscious；　as　I　have　observed　in　several　instances；　the　diagnosis　undoubtedly　being　concussion　of　the　brain。

〃Slight　injury　to　the　brain；　and　especially　if　it　be　unilateral；　then；　may　not　produce　unconsciousness。　It　is　not　very　uncommon　for　a　missile　from　a　heavy　weapon　to　strike　the　skull；　and　be　deflected　without　the　production　of　such　a　state。　Near　the　town　in　which　I　formerly　practiced；　the　town…marshal　shot　at　a　negro；　who　resisted　arrest；　at　a　distance　of　only　a　few　feet；　with　a　44…　caliber　revolver；　striking　the　culprit　on　the　side　of　the　head。　The　wound　showed　that　the　ball　struck　the　skull　and　plowed　along　under　the　scalp　for　several　inches　before　emerging；　but　it　did　not　even　knock　the　negro　down；　and　no　unconsciousness　followed　later。　I　once　examined　an　express…messenger　who　had　been　shot　in　the　occipital　region　by　a　weapon　of　similar　size；　while　seated　at　his　desk　in　the　car。　The　blow　was　a　very　glancing　one　and　did　not　produce　unconsciousness；　and　probably；　as　in　the　case　of　the　negro；　because　it　did　not　strike　with　sufficient　directness。〃

Head　Injuries　with　Loss　of　Cerebral　Substance。The　brain　and　its　membranes　may　be　severely　wounded；　portions　of　the　cranium　or　cerebral　substance　destroyed　or　lost；　and　yet　recovery　ensue。　Possibly　the　most　noted　injury　of　this　class　was　that　reported　by　Harlow　and　commonly　known　as　〃Bigelow's　Case〃　or　the　〃American　Crow…bar　Case。〃　Phineas　P。　Gage；　aged　twenty…five；　a　foreman　on　the　Rutland　and　Burlington　Railroad；　was　employed　September　13；　1847；　in　charging　a　hole　with　powder　preparatory　to　blasting。　A　premature　explosion　drove　a　tamping…iron；　three　feet　seven　inches　long；　1　1/4　inches　in　diameter；　weighing