anomalies and curiosities of medicine-第139部分

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mposed　of　convolution　as　well　as　white　matter。　The　wound　healed；　there　was　no　hernia；　and　at　the　time　of　report　the　girl　was　conscious　of　no　disturbance；　not　even　a　headache。　There　was　nothing　indicative　of　the　reception　of　the　injury　except　a　scar　near　the　edge　of　the　hair　on　the　upper　part　of　the　right　side　of　the　forehead。　Steele；　in　a　school…boy　of　eight；　mentions　a　case　of　very　severe　injury　to　the　bones　of　the　face　and　head；　with　escape　of　cerebral　substance；　and　recovery。　The　injury　was　caused　by　falling　into　machinery。

There　was　a　seaman　aboard　of　the　U。S。S。　〃Constellation；〃　who　fell　through　a　hatchway　from　the　masthead；　landing　on　the　vertex　of　the　head。　There　was　copious　bleeding　from　the　ears；　50　to　60　fluid…ounces　of　blood　oozing　in　a　few　hours；　mingled　with　small　fragments　of　brain…tissue。　The　next　day　the　discharge　became　watery；　and　in　it　were　found　small　pieces　of　true　brain…substance。　In　five　weeks　the　man　returned　to　duty　complaining　only　of　giddiness　and　of　a　〃stuffed…up〃　head。　In　1846　there　is　a　record　of　a　man　of　forty　who　fell　from　a　scaffold；　erected　at　a　height　of　20　feet；　striking　on　his　head。　He　was　at　first　stunned；　but　on　admission　to　the　hospital　recovered　consciousness。　A　small　wound　was　found　over　the　right　eyebrow；　protruding　from　which　was　a　portion　of　brain…substance。　There　was　slight　hemorrhage　from　the　right　nostril；　and　some　pain　in　the　head；　but　the　pulse　and　respiration　were　undisturbed。　On　the　following　day　a　fragment　of　the　cerebral　substance；　about　the　size　of　a　hazel…nut；　together　with　some　brood…clots；　escaped　from　the　right　nostril。　In　this　case　the　inner　wall　of　the　frontal　sinus　was　broken；　affording　exit　for　the　lacerated　brain。

Cooke　and　Laycock　mention　a　case　of　intracranial　injury　with　extensive　destruction　of　brain…substance　around　the　Rolandic　area；　there　was　recovery　but　with　loss　of　the　so　called　muscular　sense。　The　patient；　a　workman　of　twenty…nine；　while　cutting　down　a　gum…tree；　was　struck　by　a　branch　as　thick　as　a　man's　arm；　which　fell　from　100　feet　overhead；　inflicting　a　compound　comminuted　fracture　of　the　cranium。　The　right　eye　was　contused　but　the　pupils　equal；　the　vertex…wound　was　full　of　brain…substance　and　pieces　of　bone；　ten　of　which　were　removed；　leaving　an　oval　opening　four　by　three　inches。　The　base　of　the　skull　was　fractured　behind　the　orbits；　a　fissure　1/4　inch　wide　was　discernible；　and　the　right　frontal　bone　could　be　easily　moved。　The　lacerated　and　contused　brain…substance　was　removed。　Consciousness　returned　six　days　after　the　operation。　The　accompanying　illustrations　（Figs。　196　and　197）　show　the　extent　of　the　injury。　The　lower　half　of　the　ascending　frontal　convolution；　the　greater　half　of　the　sigmoid　gyrus；　the　posterior　third　of　the　lower　and　middle　frontal　convolutions；　the　base　and　posterior　end　of　the　upper　convolution；　and　the　base　of　the　corresponding　portion　of　the　falciform　lobe　were　involved。　The　sensory　and　motor　functions　of　the　arm　were　retained　in　a　relative　degree。　There　was　power　of　simple　movements；　but　complex　movements　were　awkward。　The　tactile　localization　was　almost　lost。

Morton　mentions　a　patient　of　forty…seven；　who　was　injured　in　a　railroad　accident　near　Phoenixville；　Pa。；　there　was　a　compound　comminuted　fracture　of　the　skull　involving　the　left　temporal；　spheroid；　and　superior　maxillary　bones。　The　side　of　the　head　and　the　ear　were　considerably　lacerated；　several　teeth　were　broken；　and　besides　this　there　was　injury　to　the　aura　and　cerebral　substance。　There　was　profound　coma　for　ten　days　and　paralysis　of　the　1st；　2d；　3d；　4th；　6th；　and　7th　cranial　nerves；　particularly　affecting　the　left　side　of　the　face。　There　was　scarcely　enough　blood…supply　left　to　the　orbit　to　maintain　life　in　the　globe。　The　man　primarily　recovered；　but　ninety…one　days　from　the　injury　he　died　of　cerebral　abscess。

There　is　the　record　of　a　curious　brain…injury　in　a　man　of　twenty…two；　who　was　struck　on　the　skull　by　a　circular　saw。　The　saw　cut　directly　down　into　the　brain；　severing　the　superior　longitudinal　sinus；　besides　tearing　a　branch　of　the　meningeal　artery。　The　wound　was　filled　with　sawdust　left　by　the　saw　while　it　was　tearing　through　the　parts。　After　ordinary　treatment　the　man　recovered。

Bird　reports　a　compound　comminuted　fracture　of　the　left　temporal　region；　with　loss　of　bone；　together　with　six　drams　of　brain…substance；　which；　however；　was　followed　by　recovery。　Tagert　gives　an　instance　of　compound　depressed　fracture　of　the　skull；　with　loss　of　brain…substance；　in　which　recovery　was　effected　without　operative　interference。　Ballou；　Bartlett；　Buckner；　Capon；　Carmichael；　Corban；　Maunder　and　many　others；　cite　instances　of　cranial　fracture　and　loss　of　brain…substance；　with　subsequent　recovery。　Halsted　reports　the　history　of　a　boy　of　seventeen；　who；　while　out　fowling；　had　the　breech…pin　of　a　shot…gun　blown　out；　the　sharp　point　striking　the　forehead　in　the　frontal　suture；　crushing　the　os　frontis；　destroying　1　3/4　inches　of　the　longitudinal　sinus；　and　causing　severe　hemorrhage　from　both　the　longitudinal　and　frontal　sinuses。　The　pin　was　pulled　out　by　the　boy；　who　washed　his　own　face；　and　lay　down；　he　soon　became　semi…comatose；　in　which　condition　he　remained　for　some　days；　but；　after　operation；　he　made　complete　recovery。

Loss　of　Brain…substance　from　Cerebral　Tumor。Koser　is　accredited　with　reporting　results　of　a　postmortem　held　on　a　young　man　of　twenty　who　suffered　from　a　cerebral　tumor　of　considerable　duration。　It　was　stated　that；　although　there　was　a　cavity　in　the　brain　at　least　five　inches　in　length；　the　patient；　almost　up　to　the　time　of　death；　was　possessed　of　the　senses　of　touch；　taste；　hearing；　and　smell；　showed　considerable　control　over　his　locomotor　muscles；　and　could　talk。　In　fact；　he　was　practically　discommoded　in　no　other　way　than　by　loss　of　vision；　caused　by　pressure　on　the　optic　centers。　It　was　also　stated　that　the　retention　of　memory　was　remarkable；　and；　up　to　within　two　weeks　of　his　death；　the　patient　was　able　to　memorize　poems。　The　amount　of　involvement　discovered　postmortem　in　cases　similar　to　the　preceding　is　astonishing。　At　a　recent　pathologic　display　in　London　several　remarkable　specimens　were　shown。

Extensive　Fractures　of　the　Skull。　Jennings　mentions　an　instance　of　extensive　fracture　of　the　skull；　14　pieces　of　the　cranium　being　found。　The　patient　lived　five　weeks　and　two　days　after　the　injury；　the　immediate　cause　of　death　being　edema　of　the　lungs。　His　language　was　incoherent　and　full　of　oaths。　Belloste；　in　his　〃Hospital　Surgeon；〃　states　that　he　had　under　has　care　a　most　dreadful　case　of　a　girl　of　eleven　or　twelve　years；　who　received　18　or　19　cutlass　wounds　of　the　head；　each　so　violent　as　to　chip　out　pieces　of　bone；　but；　notwithstanding　her　severe　injuries；　she　made　recovery。　At　the　Emergency　Hospital　in　Washington；　D。C。；　there　was　received　a　negress　with　at　least　six　gaping　wounds　of　the　head；　in　some　cases　denuding　the　periosteum　and　cutting　the　cranium。　During　a　debauch　the　night　before　she　had　been　engaged　in　a　quarrel　with　a　negro　with　whom　she　lived；　and　was　struck　by　him　several　times　on　the　head　with　an　axe。　She　lay　all　night　unconscious；　and　was　discovered　the　next　morning　with　her　hair　and　clothes　and　the　floor　on　which　she　lay　drenched　with　blood。　The　ambulance　was　summoned　to　take　her　to　the　morgue；　but　on　the　arrival　of　the　police　it　was　seen　that　feeble　signs　of　life　still　existed。　On　admission　to　the　hospital　she　was　semi…comatose；　almost　pulseless；　cold；　and　exhibiting　all　the　signs　of　extreme　hemorrhage　and　shock。　Her　head　was　cleaned　up；　but　her　condition　would　not　permit　of　any　other　treatment　than　a　corrosive…sublimate　compress　and　a　bandage　of　Scultetus。　She　was　taken　to　the　hospital　ward；　where　warmth　and　stimulants　were　applied；　after　which　she　completely　reacted。　She　progressed　so　well　that　it　was　not　deemed　advisable　to　remove　the　head…bandage　until　the　fourth　day；　when　it　was　seen　that　the　wounds　had　almost　entirely　healed　and　suppuration　was　virtually　absent。　The　patient　rapidly　and　completely　recovered；　and　her　neighbors；　on　her　return　home；　could　hardly　believe　that　she　was　the　same　woman　whom；　a　few　days　before；　they　were　preparing　to　take　to　the　morgue。

A　serious　injury；　which　is　not　at　all　infrequent；　is　that　caused　by　diving　into　shallow　water；　or　into　a　bath　from　which　water　has　been　withdrawn。　Curran　mentions　a　British　officer　in　India　who；　being　overheated；　stopped　at　a　station　bath　in　which　the　previous　night　he　had　had　a　plunge；　and　without　examining；　took　a　violent　〃header〃　into　the　tank；　confidently　expecting　to　strike　from　eight　to　ten　feet　of　water。　He　dashed　his　head　against　the　concrete　bottom　12　feet　below　（the　water　two　hours　previously　having　been　withdrawn）　and　crushed　his　brain　and　skull　into　an　indistinguishable　mass。

There　are　many　cases　on　record　in　which　an　injury；　particularly　a　gunshot　wound　of　the　skull；　though　showing　no　external　wound；　has　caused　death　by　producing　a　fracture　of　the　internal　table　of　the　cranium。　Pare　gives　details　of　the　case　of　a　nobleman　whose　head　was　guarded　by　a　helmet　and　who　was　struck　by　a　ball；　leaving　no　external　sign　of　injury；　but　it　was　subsequently　found　that　there　was　an　internal　fracture　of　the　cranium。　Tulpius　and　Scultetus　are　among　the　older　writers　reporting　somewhat　similar　instances；　and　there　are　several　analogous　cases　reported　as　having　occurred　during　the　War　of　the　Rebellion。　Boling　reports　a　case　in　which　the　internal　table　was　splintered　to　a　much　greater　extent　than　the　external。

Fracture　of　the　base　of　the　skull　is　ordinarily　spoken　of　as　a　fatal　injury；　reported　instances　of　recovery　being　extremely　rare；　but　Battle；　in　a　paper　on　this　subject；　has　collected　numerous　statistics　of　nonfatal　fracture　of　the　base　of　the　brain；　viz。：

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　Male。　Female。　　　Anterior　fossa；　。　。　。　。　。　。　。　。　。　。　。　16　　　　5　　Middle　fossa；　。　。　。　。　。　。　。　。　。　。　。　。　50　　　　6　　Posterior　fossa；。　。　。　。　。　。　。　。　。　。　。　10　　　　1　　Middle　and　anterior　fossae；　。　。　。　。　。　15　　　　5　　Middle　and　posterior　fossae；。　。　。　。　。　　4　　　　1　　　Anterior；　middle；　and　posterior　fossae；1　　　　0　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　96　　　　18　　Total；　114。

In　a　paper　on　nonmortal　fractures　of　the　base　of　the　skull；　Lidel