anomalies and curiosities of medicine-第142部分

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gravated　by　frequent　attacks　of　glossitis；　and　the　treatment　consists　in　the　removal　of　the　protruding　portions　by　the　knife；　ligation；　the　cautery；　or　ecraseur。

Living　Fish　in　the　Pharynx。Probably　the　most　interesting　cases　of　foreign　bodies　are　those　in　which　living　fish　enter　the　pharynx　and　esophagus。　Chevers　has　collected　five　cases　in　which　death　was　caused　by　living　fish　entering　the　mouth　and　occluding　the　air…passages。　He　has　mentioned　a　case　in　which　a　large　catfish　jumped　into　the　mouth　of　a　Madras　bheestie。　An　operation　on　the　esophagus　was　immediately　commenced；　but　abandoned；　and　an　attempt　made　to　push　the　fish　down　with　a　probang；　which　was；　in　a　measure；　successful。　However；　the　patient　gave　a　convulsive　struggle；　and；　to　all　appearances；　died。　The　trachea　was　immediately　opened；　and　respiration　was　restored。　During　the　course　of　the　night　the　man　vomited　up　pieces　of　fish　bone　softened　by　decomposition。　In　1863　White　mentions　that　the　foregoing　accident　is　not　uncommon　among　the　natives　of　India；　who　are　in　the　habit　of　swimming　with　their　mouths　open　in　tanks　abounding　with　fish。　There　is　a　case　in　which　a　fisherman；　having　both　hands　engaged　in　drawing　a　net；　and　seeing　a　sole…fish　about　eight　inches　long　trying　to　escape　through　the　meshes　of　the　net；　seized　it　with　his　teeth。　A　sudden　convulsive　effort　of　the　fish　enabled　it　to　enter　the　fisherman's　throat；　and　he　was　asphyxiated　before　his　boat　reached　the　shore。　After　death　the　fish　was　found　in　the　cardiac　end　of　the　stomach。　There　is　another　case　of　a　man　named　Durand；　who　held　a　mullet　between　his　teeth　while　rebaiting　his　hook。　The　fish；　in　the　convulsive　struggles　of　death；　slipped　down　the　throat；　and　because　of　the　arrangement　of　its　scales　it　could　be　pushed　down　but　not　up；　asphyxiation；　however；　ensued。　Stewart　has　extensively　described　the　case　of　a　native　〃Puckally〃　of　Ceylon　who　was　the　victim　of　the　most　distressing　symptoms　from　the　impaction　of　a　living　fish　in　his　throat。　The　native　had　caught　the　fish；　and　in　order　to　extract　it　placed　its　head　between　his　teeth；　holding　the　body　with　the　left　hand　and　the　hook　with　the　right。　He　had　hardly　extracted　the　hook；　when　the　fish　pricked　his　palm　with　his　long　and　sharp　dorsal　fin；　causing　him　suddenly　to　release　his　grasp　on　the　fish　and　voluntarily　open　his　mouth　at　the　same　time。　The　fish　quickly　bolted　into　his　mouth；　and；　although　he　grasped　the　tail　with　his　right　hand；　and　squeezed　his　pharynx　with　his　left；　besides　coughing　violently；　the　fish　found　its　way　into　the　esophagus。　Further　attempts　at　extraction　were　dangerous　and　quite　likely　to　fail；　his　symptoms　were　distressing；　he　could　not　hold　his　head　erect　without　the　most　agonizing　pain　and　he　was　almost　prostrated　from　fright　and　asphyxia；　it　was　thought　advisable　to　push　the　fish　into　the　stomach；　and　after　an　impaction　of　sixteen　hours　the　symptoms　were　relieved。　The　fish　in　this　instance　was　the　Anabas　scandens　or　〃walking　perch〃　of　Ceylon；　which　derives　its　name　from　its　power　of　locomotion　on　land　and　its　ability　to　live　out　of　water　for　some　time。　It　is　from　four　to　five　inches　long　and　has　a　dorsal　fin　as　sharp　as　a　knife　and　directed　toward　the　tail；　and　pectoral　fins　following　the　same　direction；　these　would　admit　of　entrance；　but　would　interfere　with　extraction。　MacLauren　reports　the　history　of　a　young　man　who；　after　catching　a　fish；　placed　it　between　his　teeth。　The　fish；　three　inches　long；　by　a　sudden　movement；　entered　the　pharynx。　Immediately　ensued　suffocation；　nausea；　vomiting；　together　with　the　expectoration　of　blood　and　mucus。　There　was　emphysema　of　the　face；　neck；　and　chest。　The　fish　could　be　easily　felt　impacted　in　the　tissues；　but；　after　swallowing　much　water　and　vinegar；　together　with　other　efforts　at　extraction；　the　fins　were　loosenedabout　twenty…four　hours　after　the　accident。　By　this　time　the　emphysema　had　extended　to　the　scrotum。　There　was　much　expectoration　of　muco…purulent　fluid；　and　on　the　third　day　complete　aphonia；　but　the　symptoms　gradually　disappeared；　and　recovery　was　complete　in　eight　days。　Dantra　is　accredited　with　describing　asphyxiation；　accompanied　by　great　agony；　in　a　man　who；　while　swimming；　had　partially　swallowed　a　live　fish。　The　fish　was　about　three　inches　in　length　and　one　in　breadth；　and　was　found　lying　on　the　dorsum　of　his　tongue　and；　together　with　numerous　clots　of　blood；　filled　his　mouth。　Futile　attempts　to　extract　the　fish　by　forceps　were　made。　Examination　showed　that　the　fish　had　firmly　grasped　the　patient's　uvula；　which　it　was　induced　to　relinquish　when　its　head　was　seized　by　the　forceps　and　pressed　from　side　to　side。　After　this　it　was　easily　extracted　and　lived　for　some　time。　There　was　little　hemorrhage　after　the　removal　of　the　offending　object；　and　the　blood　had　evidently　come　from　the　injuries　to　the　sides　of　the　mouth；　caused　by　the　fins。　The　uvula　was　bitten；　not　torn。　There　is　an　interesting　account　of　a　native　of　India；　who；　while　fishing　in　a　stream；　caught　a　flat　eel…like　fish　from　fifteen　to　sixteen　inches　long。　After　the　fashion　of　his　fellows　he　attempted　to　kill　the　eel　by　biting　off　its　head；　in　the　attempt　the　fish　slipped　into　his　gullet；　and　owing　to　its　sharp　fins　could　not　be　withdrawn。　The　man　died　one　hour　later　in　the　greatest　agony；　so　firmly　was　the　eel　impacted　that　even　after　death　it　could　not　be　extracted；　and　the　man　was　buried　with　it　protruding　from　his　mouth。

A　Leech　in　the　Pharynx。Granger；　a　surgeon　in　Her　Majesty's　Indian　Service；　writes：〃Several　days　ago　I　received　a　note　from　the　political　sirdar；　asking　me　if　I　would　see　a　man　who　said　he　had　a　leech　in　his　throat　which　he　was　unable　to　get　rid　of。　I　was　somewhat　sceptical；　and　thought　that　possibly　the　man　might　be　laboring　under　a　delusion。　On　going　outside　the　fort　to　see　the　case；　I　found　an　old　Pathan　graybeard　waiting　for　me。　On　seeing　me；　he　at　once　spat　out　a　large　quantity　of　dark；　half…clotted　blood　to　assure　me　of　the　serious　nature　of　his　complaint。　His　historymostly　made　out　with　the　aid　of　interpreterswas　that　eleven　days　ago　he　was　drinking　from　a　rain…water　tank　and　felt　something　stick　in　his　throat；　which　he　could　not　reject。　He　felt　this　thing　moving；　and　it　caused　difficulty　in　swallowing；　and　occasionally　vomiting。　On　the　following　day　he　began　to　spit　up　blood；　and　this　continued　until　he　saw　me。　He　stated　that　he　once　vomited　blood；　and　that　he　frequently　felt　that　he　was　going　to　choke。

On　examining　his　throat；　a　large　clot　of　blood　was　found　to　be　adherent　to　the　posterior　wall　of　the　pharynx。　On　removing　this　clot　of　blood；　no　signs　of　the　presence　of　a　leech　could　be　detected。　However；　on　account　of　the　symptoms　complained　of　by　the　patient　I　introduced　a　polypus　forceps　into　the　lower　part　of　the　pharynx　and　toward　the　esophagus；　where　a　body；　distinctly　moving；　was　felt。　This　body　I　seized　with　the　forceps；　and　with　considerable　force　managed　to　remove　it。　It　was　a　leech　between　2　1/2　and　three　inches　in　length；　and　with　a　body　of　the　size　of　a　Lee…Metford　bullet。　No　doubt　during　the　eleven　days　it　had　remained　in　the　man's　throat　the　leech　had　increased　in　size。　Nevertheless　it　must　have　been　an　animal　of　considerable　size　when　the　man　attempted　to　swallow　it。　I　send　this　case　as　a　typical　example　of　the　carelessness　of　natives　of　the　class　from　which　we　enlist　our　Sepoys；　as　to　the　nature　of　the　water　they　drink。　This　man　had　drunk　the　pea…soup　like　water　of　a　tank　dug　in　the　side　of　the　hill；　rather　than　go　a　few　hundred　yards　to　a　spring　where　the　water　is　perfectly　clear　and　pure。　Though　I　have　not　met　with　another　case　of　leeches　being　taken　with　drinking　water；　I　am　assured　that　such　cases　are　occasionally　met　with　about　Agra　and　other　towns　in　the　North…West　Provinces。　This　great　carelessness　as　to　the　purity　or　impurity　of　their　drinking　water　shows　the　difficulty　medical　officers　must　experience　in　their　endeavors　to　prevent　the　Sepoys　of　a　regiment　from　drinking　water　from　condemned　or　doubtful　sources　during　a　cholera　or　typhoid　epidemic。〃

Foreign　Bodies　in　the　Pharynx　and　Esophagus。Aylesbury　mentions　a　boy　who　swallowed　a　fish…hook　while　eating　gooseberries。　He　tried　to　pull　it　up；　but　it　was　firmly　fastened；　and　a　surgeon　was　called。　By　ingeniously　passing　a　leaden　bullet　along　the　line；　the　weight　of　the　lead　loosened　the　hook；　and　both　bullet　and　hook　were　easily　drawn　up。　Babbit　and　Battle　report　an　ingenious　method　of　removing　a　piece　of　meat　occluding　the　esophagusthe　application　of　trypsin。　Henry　speaks　of　a　German　officer　who　accidentally　swallowed　a　piece　of　beer　bottle；　3/8　x　1/8　inch；　which　subsequently　penetrated　the　esophagus；　and　in　its　course　irritated　the　recurrent　laryngeal　and　vagi；　giving　rise　to　the　most　serious　phlegmonous　inflammation　and　distressing　respiratory　symptoms。　A　peculiar　case　is　that　of　the　man　who　died　after　a　fire　at　the　Eddystone　Lighthouse。　He　was　endeavoring　to　extinguish　the　flames　which　were　at　a　considerable　distance　above　his　head；　and　was　looking　up　with　his　mouth　open；　when　the　lead　of　a　melting　lantern　dropped　down　in　such　quantities　as　not　only　to　cover　his　face　and　enter　his　mouth；　but　run　over　his　clothes。　The　esophagus　and　tunica　in　the　lower　part　of　the　stomach　were　burned；　and　a　great　piece　of　lead；　weighing　over　7　1/2　ounces；　was　taken　from　the　stomach　after　death。

Evans　relates　the　history　of　a　girl　of　twenty…one　who　swallowed　four　artificial　teeth；　together　with　their　gold　plate；　two　years　and　eight　days　afterward　she　ejected　them　after　a　violent　attack　of　retching。　Gauthier　speaks　of　a　young　girl　who；　while　eating　soup；　swallowed　a　fragment　of　bone。　For　a　long　time　she　had　symptoms　simulating　phthisis；　but　fourteen　years　afterward　the　bone　was　dislodged；　and；　although　the　young　woman　was　considered　in　the　last　stages　of　phthisis；　she　completely　recovered　in　six　weeks。　Gastellier　has　reported　the　case　of　a　young　man　of　sixteen　who　swallowed　a　crown　piece；　which　became　lodged　in　the　middle　portion　of　the　esophagus　and　could　not　be　removed。　For　ten　months　the　piece　of　money　remained　in　this　position；　during　which　the　young　man　was　never　without　acute　pain　and　often　had　convulsions。　He　vomited　material；　sometimes　alimentary；　sometimes　mucus；　pus；　or　blood；　and　went　into　the　last　stage　of　marasmus。　At　l