anomalies and curiosities of medicine-第138部分

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re　explosion　drove　a　tamping…iron；　three　feet　seven　inches　long；　1　1/4　inches　in　diameter；　weighing　13　1/4　pounds；　completely　through　the　man's　head。　The　iron　was　round　and　comparatively　smooth；　the　pointed　end　entered　first。　The　iron　struck　against　the　left　side　of　the　face；　immediately　anterior　to　the　inferior　maxillary　and　passed　under　the　zygomatic　arch；　fracturing　portions　of　the　spheroid　bone　and　the　floor　of　the　left　orbit；　it　then　passed　through　the　left　anterior　lobe　of　the　cerebrum；　and；　in　the　median　line；　made　its　exit　at　the　junction　of　the　coronal　and　sagittal　sutures；　lacerating　the　longitudinal　sinus；　fracturing　the　parietal　and　frontal　bones；　and　breaking　up　considerable　of　the　brain；　the　globe　of　the　left　eye　protruded　nearly　one…half　of　its　diameter。　The　patient　was　thrown　backward　and　gave　a　few　convulsive　movements　of　the　extremities。　He　was　taken　to　a　hotel　3/4　mile　distant；　and　during　the　transportation　seemed　slightly　dazed；　but　not　at　all　unconscious。　Upon　arriving　at　the　hotel　he　dismounted　from　the　conveyance；　and　without　assistance　walked　up　a　long　flight　of　stairs　to　the　hall　where　his　wound　was　to　be　dressed。　Harlow　saw　him　at　about　six　o'clock　in　the　evening；　and　from　his　condition　could　hardly　credit　the　story　of　his　injury；　although　his　person　and　his　bed　were　drenched　with　blood。　His　scalp　was　shaved；　the　coagula　and　debris　removed；　and　among　other　portions　of　bone　was　a　piece　of　the　anterior　superior　angle　of　each　parietal　bone　and　a　semicircular　piece　of　the　frontal　bone；　leaving　an　opening　3　1/2　inches　in　diameter。　At　10　P。M。　on　the　day　of　the　injury　Gage　was　perfectly　rational　and　asked　about　his　work　and　after　his　friends。　After　a　while　delirium　set　in　for　a　few　days；　and　on　the　eleventh　day　he　lost　the　vision　in　the　left　eye。　His　convalescence　was　rapid　and　uneventful。　It　was　said　that　he　discharged　pieces　of　bone　and　cerebral　substance　from　his　mouth　for　a　few　days。　The　iron　when　found　was　smeared　with　blood　and　cerebral　substance。

As　was　most　natural　such　a　wonderful　case　of　cerebral　injury　attracted　much　notice。　Not　only　was　the　case　remarkable　in　the　apparent　innocuous　loss　of　cerebral　substance；　but　in　the　singular　chance　which　exempted　the　brain　from　either　concussion　or　compression；　and　subsequent　inflammation。　Professor　Bigelow　examined　the　patient　in　January；　1850；　and　made　a　most　excellent　report　of　the　case；　and　it　is　due　to　his　efforts　that　the　case　attained　world…wide　notoriety。　Bigelow　found　the　patient　quite　recovered　in　his　faculties　of　body　and　mind；　except　that　he　had　lost　the　sight　of　the　injured　eye。　He　exhibited　a　linear　cicatrix　one　inch　long　near　the　angle　of　the　ramus　of　the　left　lower　jaw。　His　left　eyelid　was　involuntarily　closed　and　he　had　no　power　to　overcome　his　ptosis。　Upon　the　head；　well　covered　by　the　hair；　was　a　large　unequal　depression　and　elevation。　In　order　to　ascertain　how　far　it　might　be　possible　for　a　bar　of　the　size　causing　the　injury　to　traverse　the　skull　in　the　track　assigned　to　it；　Bigelow　procured　a　common　skull　in　which　the　zygomatic　arches　were　barely　visible　from　above；　and　having　entered　a　drill　near　the　left　angle　of　the　inferior　maxilla；　he　passed　it　obliquely　upward　to　the　median　line　of　the　cranium　just　in　front　of　the　junction　of　the　sagittal　and　coronal　sutures。　This　aperture　was　then　enlarged　until　it　allowed　the　passage　of　the　bar　in　question；　and　the　loss　of　substance　strikingly　corresponded　with　the　lesion　said　to　have　been　received　by　the　patient。　From　the　coronoid　process　of　the　inferior　maxilla　there　was　removed　a　fragment　measuring　about　3/4　inch　in　length。　This　fragment；　in　the　patient's　case；　might　have　been　fractured　and　subsequently　reunited。　The　iron　bar；　together　with　a　cast　of　the　patient's　head；　was　placed　in　the　Museum　of　the　Massachusetts　Medical　College。

Bigelow　appends　an　engraving　to　his　paper。　In　the　illustration　the　parts　are　as　follows：

（1）　Lateral　view　of　a　prepared　cranium　representing　the　iron　bar　traversing　its　cavity。

（2）　Front　view　of　same。

（3）　Plan　of　the　base　seen　from　within。　In　these　three　figures　the　optic　foramina　are　seen　to　be　intact　and　are　occupied　by　small　white　rods。

（4）　Cast　taken　from　the　shaved　head　of　the　patient　representing　the　appearance　of　the　fracture　in　1850；　the　anterior　fragment　being　considerably　elevated　in　the　profile　view。

（5）　The　iron　bar　with　length　and　diameter　in　proportion　to　the　size　of　the　other　figures。

Heaton　reports　a　case　in　which；　by　an　explosion；　a　tamping…iron　was　driven　through　the　chin　of　a　man　into　the　cerebrum。　Although　there　was　loss　of　brain…substance；　the　man　recovered　with　his　mental　faculties　unimpaired。　A　second　case　was　that　of　a　man　who；　during　an　explosion；　was　wounded　in　the　skull。　There　was　visible　a　triangular　depression；　from　which；　possibly；　an　ounce　of　brain…substance　issued。　This　man　also　recovered。

Jewett　mentions　a　case　in　which　an　injury　somewhat　similar　to　that　in　Bigelow's　case　was　produced　by　a　gas…pipe。

Among　older　writers；　speaking　of　loss　of　brain…substance　with　subsequent　recovery；　Brasavolus　saw　as　much　brain　evacuated　as　would　fill　an　egg　shell；　the　patient　afterward　had　an　impediment　of　speech　and　grew　stupid。　Franciscus　Arcaeus　gives　the　narrative　of　a　workman　who　was　struck　on　the　head　by　a　stone　weighing　24　pounds　falling　from　a　height。　The　skull　was　fractured；　fragments　of　bone　were　driven　into　the　brain。　For　three　days　the　patient　was　unconscious　and　almost　lifeless。　After　the　eighth　day　a　cranial　abscess　spontaneously　opened；　from　the　sinciput　to　the　occiput；　and　a　large　quantity　of　〃corruption〃　was　evacuated。　Speech　returned　soon　after；　the　eyes　opened；　and　in　twenty　days　the　man　could　distinguish　objects。　In　four　months　recovery　was　entire。　Bontius　relates　a　singular　accident　to　a　sailor；　whose　head　was　crushed　between　a　ship　and　a　small　boat；　the　greater　part　of　the　occipital　bone　was　taken　away　in　fragments；　the　injury　extending　almost　to　the　foremen　magnum。　Bontius　asserts　that　the　patient　was　perfectly　cured　by　another　surgeon　and　himself。　Galen　mentions　an　injury　to　a　youth　in　Smyrna；　in　whom　the　brain　was　so　seriously　wounded　that　the　anterior　ventricles　were　opened；　and　vet　the　patient　recovered。　Glandorp　mentions　a　case　of　fracture　of　the　skull　out　of　which　his　father　took　large　portions　of　brain　and　some　fragments　of　bone。　He　adds　that　the　man　was　afterward　paralyzed　an　the　opposite　side　and　became　singularly　irritable。　In　his　〃Chirurgical　Observations；〃　Job　van　Meek'ren　tells　the　story　of　a　Russian　nobleman　who　lost　part　of　his　skull；　and　a　dog's　skull　was　supplied　in　its　place。　The　bigoted　divines　of　the　country　excommunicated　the　man；　and　would　not　annul　his　sentence　until　he　submitted　to　have　the　bit　of　foreign　bone　removed。

Mendenhall　reports　the　history　of　an　injury　to　a　laborer　nineteen　years　old。　While　sitting　on　a　log　a　few　feet　from　a　comrade　who　was　chopping　wood；　the　axe　glanced　and；　slipping　from　the　woodman's　grasp；　struck　him　just　above　the　ear；　burying　the　〃bit〃　of　the　axe　in　his　skull。　Two　hours　afterward　he　was　seen　almost　pulseless；　and　his　clothing　drenched　with　blood　which　was　still　oozing　from　the　wound　with　mixed　brain…substance　and　fragments　of　bone。　The　cut　was　horizontal　on　a　level　with　the　orbit；　5　1/2　inches　long　externally；　and；　owing　to　the　convex　shape　of　the　axe；　a　little　less　internally。　Small　spicules　of　bone　were　removed；　and　a　cloth　was　placed　on　the　battered　skull　to　receive　the　discharges　for　the　inspection　of　the　surgeon；　who　on　his　arrival　saw　at　least　two　tablespoonfuls　of　cerebral　substance　on　this　cloth。　Contrary　to　all　expectation　this　man　recovered；　but；　strangely；　he　had　a　marked　and　peculiar　change　of　voice；　and　this　was　permanent。　From　the　time　of　the　reception　of　the　injury　his　whole　mental　and　moral　nature　had　undergone　a　pronounced　change。　Before　the　injury；　the　patient　was　considered　a　quiet；　unassuming；　and　stupid　boy；　but　universally　regarded　as　honest。　Afterward　he　became　noisy；　self…asserting；　sharp；　and　seemingly　devoid　of　moral　sense　or　honesty。　These　new　traits　developed　immediately；　and　more　strikingly　so　soon　as　convalescence　was　established。

Bergtold　quotes　a　case　reported　in　1857　of　extreme　injury　to　the　cranium　and　its　contents。　While　sleeping　on　the　deck　of　a　canal　boat；　a　man　at　Highspire　was　seriously　injured　by　striking　his　head　against　a　bridge。　When　seen　by　the　surgeon　his　hair　was　matted　and　his　clothes　saturated　with　blood。　There　was　a　terrible　gap　in　the　scalp　from　the　superciliary　ridge　to　the　occipital　bone；　and；　though　full　of　clots；　the　wound　was　still　oozing。　In　a　cloth　on　a　bench　opposite　were　rolled　up　a　portion　of　the　malar　bone；　some　fragments　of　the　os　frontis；　one　entire　right　parietal　bone；　detached　from　its　fellow　along　the　sagittel　suture；　and　from　the　occipital　along　the　lambdoidal　suture；　perhaps　taking　with　it　some　of　the　occipital　bone　together　with　some　of　the　squamous　portion　of　the　temporal　bone。　This　bone　was　as　clean　of　soft　parts　as　if　it　had　been　removed　from　a　dead　subject　with　a　scalpel　and　saw。　No　sight　of　the　membranes　or　of　the　substance　of　the　brain　was　obtained。　The　piece　of　cranium　removed　was　6　3/4　inches　in　the　longitudinal　diameter；　and　5　3/4　inches　in　the　short　oval　diameter。　The　dressing　occupied　an　hour；　at　the　end　of　which　the　patient　arose　to　his　feet　and　changed　his　clothes　as　though　nothing　had　happened。　Twenty…six　years　after　the　accident　there　was　slight　unsteadiness　of　gait；　and　gradual　paralysis　of　the　left　leg　and　arm　and　the　opposite　side　of　the　face；　but　otherwise　the　man　was　in　good　condition。　In　place　of　the　parietal　bone　the　head　presented　a　marked　deficiency　as　though　a　slice　of　the　skull　were　cut　out。　The　depressed　area　measured　five　by　six　inches。　In　1887　the　man　left　the　hospital　in　Buffalo　with　the　paralysis　improved；　but　his　mental　equilibrium　could　be　easily　disturbed。　He　became　hysteric　and　sobbed　when　scolded。

Buchanan　mentions　the　history　of　a　case　in　a　woman　of　twenty…one；　who；　while　working　in　a　mill；　was　struck　by　a　bolt。　Her　skull　was　fractured　and　driven　into　the　brain　comminuted。　Hanging　from　the　wound　was　a　bit　of　brain…substance；　the　size　of　a　finger；　composed　of　convolution　as　well　as　white　matter。　The　wound　healed；　there　was　no　hernia；　and　at　the　tim