anomalies and curiosities of medicine-第146部分

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orse；　suddenly　started　and　swallowed　the　seed　of　the　fruit。　After　the　accident　he　had　little　pain　or　oppression；　and　no　coughing；　but　twelve　hours　afterward　he　rejected　the　seed　in　coughing。

A　curious　accident　is　that　in　which　a　foreign　body　thrown　into　the　air　and　caught　in　the　mouth　has　caused　immediate　asphyxiation。　Suetonius　transmits　the　history　of　a　young　man；　a　son　of　the　Emperor　Claudius；　who；　in　sport；　threw　a　small　pear　into　the　air　and　caught　it　in　his　mouth；　and；　as　a　consequence；　was　suffocated。　Guattani　cites　a　similar　instance　of　a　man　who　threw　up　a　chestnut；　which；　on　being　received　in　the　mouth；　lodged　in　the　air…passages；　the　man　died　on　the　nineteenth　day。　Brodie　reported　the　classic　observation　of　the　celebrated　engineer；　Brunel；　who　swallowed　a　piece　of　money　thrown　into　the　air　and　caught　in　his　mouth。　It　fell　into　the　open　larynx；　was　inspired；　causing　asphyxiation；　but　was　removed　by　inversion　of　the　man's　body。

Sennert　says　that　Pope　Adrian　IV　died　from　the　entrance　of　a　fly　into　his　respiratory　passages；　and　Remy　and　Gautier　record　instances　of　the　penetration　of　small　fish　into　the　trachea。　There　are；　again；　instances　of　leeches　in　this　location。

Occasionally　the　impaction　of　artificial　teeth　in　the　neighborhood　of　the　larynx　has　been　unrecognized　for　many　years。　Lennox　Browne　reports　the　history　of　a　woman　who　was　supposed　to　have　either　laryngeal　carcinoma　or　phthisis；　but　in　whom　he　found；　impacted　in　the　larynx；　a　plate　with　artificial　teeth　attached；　which　had　remained　in　this　position　twenty…two　months　unrecognized　and　unknown。　The　patient；　when　questioned；　remembered　having　been　awakened　in　the　night　by　a　violent　attack　of　vomiting；　and　finding　her　teeth　were　missing　assumed　they　were　thrown　away　with　the　ejections。　From　that　time　on　she　had　suffered　pain　and　distress　in　breathing　and　swallowing；　and　became　the　subject。　of　progressive　emaciation。　After　the　removal　of　the　impacted　plate　and　teeth　she　soon　regained　her　health。　Paget　speaks　of　a　gentleman　who　for　three　months；　unconsciously；　carried　at　the　base　of　the　tongue　and　epiglottis；　very　closely　fitted　to　all　the　surface　on　which　it　rested；　a　full　set　of　lost　teeth　and　gold　palate…plate。　From　the　symptoms　and　history　it　was　suspected　that　he　had　swallowed　his　set　of　false　teeth；　but；　in　order　to　prevent　his　worrying；　he　was　never　informed　of　this　suspicion；　and　he　never　once　suspected　the　causes　of　his　symptoms。

Wrench　mentions　a　case　illustrative　of　the　extent　to　which　imagination　may　produce　symptoms　simulating　those　ordinarily　caused　by　the　swallowing　of　false　teeth。　This　man　awoke　one　morning　with　his　nose　and　throat　full　of　blood；　and　noticed　that　his　false　teeth；　which　he　seldom　removed　at　night；　were　missing。　He　rapidly　developed　great　pain　and　tumor　in　the　larynx；　together　with　difficulty　in　deglutition　and　speech。　After　a　fruitless　search；　with　instrumental　and　laryngoscopic　aid；　the　missing　teeth　were　foundin　a　chest　of　drawers；　the　symptoms　immediately　subsided　when　the　mental　illusion　was　relieved。

There　is　a　curious　case　of　a　man　drowned　near　Portsmouth。　After　the　recovery　of　his　body　it　was　seen　that　his　false　teeth　were　impacted　at　the　anterior　opening　of　the　glottis；　and　it　was　presumed　that　the　shock　caused　by　the　plunge　into　the　cold　water　had　induced　a　violent　and　deep　inspiration　which　carried　the　teeth　to　the　place　of　impaction。

Perrin　reports　a　case　of　an　old　man　of　eighty…two　who　lost　his　life　from　the　impaction　of　a　small　piece　of　meat　in　the　trachea　and　glottis。　In　the　Musee　Valde…Grace　is　a　prepared　specimen　of　this　case　showing　the　foreign　body　in　situ。　In　the　same　museum　Perrin　has　also　deposited　a　preparation　from　the　body　of　a　man　of　sixty…two；　who　died　from　the　entrance　of　a　morsel　of　beef　into　the　respiratory　passages。　At　the　postmortem　a　mobile　mass　of　food　about　the　size　of　a　hazel…nut　was　found　at　the　base　of　the　larynx　at　the　glossoepiglottic　fossa。　About　the　5th　ring　of　the　trachea　the　caliber　of　this　organ　was　obstructed　by　a　cylindric　alimentary　bolus　about　six　inches　long；　extending　almost　to　the　bronchial　division。　Ashhurst　shows　a　fibrinous　cast；　similar　to　that　found　in　croup；　caused　by　a　foreign　body　removed　by　Wharton；　together　with　a　shawl…pin；　from　a　patient　at　the　Children's　Hospital　seven　hours　after　the　performance　of　tracheotomy。　Search　for　the　foreign　body　at　the　time　of　the　operation　was　prevented　by　profuse　hemorrhage。

The　ordinary　instances　of　foreign　bodies　in　the　larynx　and　trachea　are　so　common　that　they　will　not　be　mentioned　here。　Their　variety　is　innumerable　and　it　is　quite　possible　for　more　than　two　to　be　in　the　same　location　simultaneously。　In　his　treatise　on　this　subject　Gross　says　that　he　has　seen　two；　three；　and　even　four　substances　simultaneously　or　successively　penetrate　the　same　location。　Berard　presented　a　stick　of　wood　extracted　from　the　vocal　cords　of　a　child　of　ten；　and　a　few　other　similar　instances　are　recorded。

The　Medical　Press　and　Circular　finds　in　an　Indian　contemporary　some　curious　instances　of　misapplied　ingenuity　on　the　part　of　certain　habitual　criminals　in　that　country。　The　discovery　on　a　prisoner　of　a　heavy　leaden　bullet　about　3/4　inch　in　diameter　led　to　an　inquiry　as　to　the　object　to　which　it　was　applied。　It　was　ascertained　that　it　served　to　aid　in　the　formation　of　a　pouch…like　recess　at　the　base　of　the　epiglottis。　The　ball　is　allowed　to　slide　down　to　the　desired　position；　and　it　is　retained　there　for　about　half　an　hour　at　a　time。　This　operation　is　repeated　many　times　daily　until　a　pouch　the　desired　size　results；　in　which　criminals　contrive　to　secrete　jewels；　money；　etc。；　in　such　a　way　as　to　defy　the　most　careful　search；　and　without　interfering　in　any　way　with　speech　or　respiration。　Upward　of　20　prisoners　at　Calcutta　were　found　to　be　provided　with　this　pouch…formation。　The　resources　of　the　professional　malingerer　are　exceedingly　varied；　and　testify　to　no　small　amount　of　cunning。　The　taking　of　internal　irritants　is　very　common；　but　would…be　in…patients　very　frequently　overshoot　the　mark　and　render　recovery　impossible。　Castor…oil　seeds；　croton　beans；　and　sundry　other　agents　are　employed　with　this　object　in　view；　and　the　medical　officers　of　Indian　prisons　have　to　be　continually　on　the　lookout　for　artificially　induced　diseases　that　baffle　diagnosis　and　resist　treatment。　Army　surgeons　are　not　altogether　unfamiliar　with　these　tricks；　but　compared　with　the　artful　Hindoos　the　British　soldier　is　a　mere　child　in　such　matters。

Excision　of　the　larynx　has　found　its　chief　indication　in　carcinoma；　but　has　been　employed　in　sarcoma；　polyp）；　tuberculosis；　enchondroma；　stenosis；　and　necrosis。　Whatever　the　procedure　chosen　for　the　operation；　preliminary　tracheotomy　is　a　prerequisite。　It　should　be　made　well　below　the　isthmus　of　the　thyroid　gland；　and　from　three　to　fifteen　days　before　the　laryngectomy。　This　affords　time　for　the　lungs　to　become　accustomed　to　the　new　manner　of　breathing；　and　the　trachea　becomes　fixed　to　the　anterior　wall　of　the　neck。

Powers　and　White　have　gathered　69　cases　of　either　total　or　partial　extirpation　of　the　larynx；　to　which　the　240　cases　collected　and　analyzed　by　Eugene　Kraus；　in　1890；　have　been　added。　The　histories　of　six　new　cases　are　given。　Of　the　309　operations；　101；　or　32　per　cent　of　the　patients；　died　within　the　first　eight　weeks　from　shock；　hemorrhage；　pneumonia；　septic　infection；　or　exhaustion。　The　cases　collected　by　these　authors　show　a　decrease　in　the　death　ratio　in　the　total　excision；29　per　cent　as　against　36　per　cent　in　the　Kraus　tables。　The　mortality　in　the　partial　operation　is　increased；　being　38　per　cent　as　opposed　to　25　per　cent。　Cases　reported　as　free　from　the　disease　before　the　lapse　of　three　years　are　of　little　value；　except　in　that　they　diminish；　by　so　much；　the　operative　death…rate。　Of　180　laryngectomies　for　carcinoma　prior　to　January　1；　1892；　72；　or　40　per　cent；　died　as　a　result　of　the　operation；　51　of　the　remaining　108　had　recurrence　during　the　first　year；　and　11；　or　ten　per　cent　of　the　survivors；　were　free　from　relapse　three　or　more　years　after　operation。　In　77　cases　of　partial　laryngectomy　for　cancer；　26；　or　33　per　cent；　died　during　the　first　two　months；　of　the　remaining　51；　seven　cases；　or　13　per　cent；　are　reported　as　free　from　the　disease　three　or　more　years　after　the　operation。

Injuries　destroying　great　portions　of　the　face　or　jaw；　but　not　causing　death；　are　seldom　seen；　except　on　the　battle…field；　and　it　is　to　military　surgery　that　we　must　look　for　the　most　striking　instances　of　this　kind。　Ribes　mentions　a　man　of　thirty…three　who；　in　the　Spanish　campaign　in　1811；　received　an　injury　which　carried　away　the　entire　body　of　the　lower　jaw；　half　of　each　ramus；　and　also　mangled　in　a　great　degree　the　neighboring　soft　parts。　He　was　transported　from　the　field　of　battle；　and；　despite　enormous　hemorrhage　and　suppuration；　in　two　months　recovered。　At　the　time　of　report　the　wounded　man　presented　no　trace　of　the　inferior　maxillary　bone；　but　by　carrying　the　finger　along　the　side　of　the　pharynx　in　the　direction　of　the　superior　dental　arch　the　coronoid　apophyses　could　be　recognized；　and　about　six　lines　nearer　the　temporal　extremity　the　ramus　could　be　discovered。　The　tongue　was　missing　for　about　one…third　its　length；　and　was　thicker　than　natural　and　retracted　on　the　hyoid　bone。　The　sublingual　glands　were　adherent　to　the　under　part　of　the　tongue　and　were　red　and　over…developed。　The　inferior　parts　of　the　cheeks　were　cicatrized　with　the　lateral　and　superior　regions　of　the　neck；　and　with　the　base　of　the　tongue　and　the　hyoid　bone。　The　tongue　was　free　under　and　in　front　of　the　larynx。　The　patient　used　a　gilded　silver　plate　to　fix　the　tongue　so　that　deglutition　could　be　carried　on。　He　was　not　able　to　articulate　sounds；　but　made　himself　understood　through　the　intervention　of　this　plate；　which　was　fixed　to　a　silver　chin。　The　chin　he　used　to　maintain　the　tongue…plate；　to　diminish　the　deformity；　and　to　retain　the　saliva；　which　was　constantly　dribbling　on　the　neck。　The　same　author　quotes　the　instance　of　a　man　of　fifty；　who；　during　the　siege　of　Alexandria　in　1801；　was　struck　in　the　middle　of　his　face；　obliquely；　by　a　cannonball；　from　below　upward　and　from　right　to　left。　A　part　of　the　right　malar　bone；　the　two　superior　maxillary　bones；　the　n