anomalies and curiosities of medicine-第147部分

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ward　and　from　right　to　left。　A　part　of　the　right　malar　bone；　the　two　superior　maxillary　bones；　the　nasal　bones；　the　cartilage；　the　vomer；　the　middle　lamina　of　the　ethmoid；　the　left　maxillary　bone；　a　portion　of　the　left　zygomatic　arch；　and　a　great　portion　of　the　inferior　maxilla　were　carried　away；　or　comminuted；　and　all　the　soft　parts　correspondingly　lacerated。　Several　hours　afterward　this　soldier　was　counted　among　the　number　of　dead；　but　Larrey；　the　surgeon…in…chief　of　the　army；　with　his　typical　vigilance　and　humanity；　remarked　that　the　patient　gave　signs　of　life；　and　that；　despite　the　magnitude　of　his　wound；　he　did　not　despair　of　his　recovery。　Those　portions　in　which　attrition　was　very　great　were　removed；　and　the　splinters　of　bone　taken　out；　showing　an　enormous　wound。　Three　months　were　necessary　for　cicatrization；　but　it　was　not　until　the　capitulation　of　Marabou；　at　which　place　he　was　wounded；　that　the　patient　was　returned　to　France。　At　this　time　he　presented　a　hideous　aspect。　There　were　no　signs　of　nose；　nor　cartilage　separating　the　entrance　of　the　nostrils；　and　the　vault　of　the　nasal　fossa　could　be　easily　seen。　There　was　a　part　of　the　posterior　region　of　the　right　superior　maxilla；　but　the　left　was　entirely　gonein　fact；　the　man　presented　an　enormous　triangular　opening　in　the　center　of　the　face；　as　shown　by　the　accompanying　illustration。　The　tongue　and　larynx　were　severely　involved；　and　the　sight　in　the　left　eye　was　lost。　This　patient　continually　wore　a　gilded　silver　mask；　which　covered　his　deformity　and　rendered　articulation　a　little　less　difficult。　The　saliva　continually　dribbled　from　the　mouth　and　from　the　inferior　internal　portion　of　his　mask；　compelling　him　to　carry　some　substance　to　receive　the　dribblings。　Whymper　mentions　an　analogous　instance　of　a　gunner　who　had　his　whole　lower　jaw　torn　away　by　a　shell；　but　who　recovered　and　used　an　ingenious　contrivance　in　the　shape　of　a　silver　mask　for　remedying　the　loss　of　the　parts。　Steiner　mentions　a　wound　from　a　cannon…ball；　which　carried　away　the　left　half　of　the　inferior　maxilla；　stripping　the　soft　parts　as　high　as　the　malar；　and　on　the　left　side　of　the　neck　to　within　1　1/2　inches　of　the　clavicle；　laying　bare　the　transverse　processes　of　the　2d　and　3d　vertebrae；　end　exposing　the　external　carotid　and　most　of　its　branches。

It　sometimes　happens　that　a　foreign　body；　such　as　the　breech　of　a　gun；　may　be　imbedded　for　some　time　in　the　face；　with　subsequent　safe　removal。　Keith　mentions　an　instance　of　the　successful　removal　of　the　breech　of　a　fowling…piece　from　the　face；　at　the　root　of　the　nose；　after　a　lodgment　of　four　months；　and　Fraser　cites　an　analogous　instance　in　which　the　breech　was　imbedded　in　the　bones　of　the　face　for　eight　years　Smith　records　an　instance　in　which　a　broken　piece　of　tobacco…pipe　penetrated　the　cheek；　remained　there　for　seven　months；　but　was　successfully　extracted。

Before　leaving　accidents　to　the　head　and　neck；　a　most　curious　case；　cited　by　O'Neill；　will　be　briefly　reviewed。　A　boy　of　twelve　was　entrusted　to　carry　a　new　iron　pot　to　the　destination　of　its　purchaser。　Probably　to　facilitate　transportation；　the　boy　removed　his　hat　and　placed　the　pot　obliquely　on　the　back　part　of　his　head；　but　a　sudden　movement　caused　it　to　slip　forward　and　downward　over　the　head。　Unavailing　efforts　were　made　at　the　time　and　after　he　reached　home；　to　remove　the　pot　from　his　head；　but　in　vain；　and　he　continued　all　the　night　greatly　prostrated　by　fright；　hunger；　and　thirst；　together　with　the　efforts　at　removal。　The　next　morning　he　was　taken　to　a　neighboring　blacksmith；　who；　by　greasing　one　of　his　fingers；　managed　to　insinuate　it　between　the　head　and　pot。　Placing　the　other　side　of　the　pot　against　an　anvil　he　struck　over　the　location　of　his　finger　a　quick；　heavy　tap　with　a　hammer；　and　the　pot　fell　to　pieces。　The　little　patient　was　much　exhausted　by　all　his　treatment　and　want　of　sleep；　and；　in　fact；　could　hardly　have　endured　his　situation　much　longer。



CHAPTER　XI。

SURGICAL　ANOMALIES　OF　THE　EXTREMITIES。

Reunion　of　Digits。An　interesting　phenomenon　noticed　in　relation　to　severed　digits　is　their　wonderful　capacity　for　reunion。　Restitution　of　a　severed　part；　particularly　if　one　of　considerable　function；　naturally　excited　the　interest　of　the　older　writers。　Locher　has　cited　an　instance　of　avulsion　of　the　finger　with　restitution　of　the　avulsed　portion；　and　Brulet；　Van　Esh；　Farmer；　Ponteau；　Regnault；　and　Rosenberg　cite　instances　of　reunion　of　a　digit　after　amputation　or　severance。　Eve's　〃Remarkable　Cases　in　Surgery〃　contains　many　instances　of　reunion　of　both　fingers　and　thumbs；　and　in　more　recent　years　several　other　similar　cases　have　been　reported。　At　the　Emergency　Hospital　in　Washington；　D。C。；　there　was　a　boy　brought　in　who　had　completely　severed　one　of　his　digits　by　a　sharp　bread…cutter。　The　amputated　finger　was　wrapped　up　in　a　piece　of　brown　paper；　and；　being　apparently　healthy　and　the　wound　absolutely　clean；　it　was　fixed　in　the　normal　position　on　the　stump；　and　covered　by　a　bichlorid　dressing。　In　a　short　time　complete　function　was　restored。　In　this　instance　no　joint　was　involved；　the　amputation　being　in　the　middle　of　the　2d　phalanx。　Staton　has　described　a　case　in　which　the　hand　was　severed　from　the　arm　by　an　accidental　blow　from　an　axe。　The　wound　extended　from　the　styloid　process　directly　across　to　the　trapezium；　dividing　all　the　muscles　and　blood…vessels；　cutting　through　bones。　A　small　portion　of　the　skin　below　the　articulation；　with　the　ulna；　remained　intact。　After　an　unavoidable　delay　of　an　hour；　Staton　proceeded　to　replace　the　hand　with　silver　sutures；　adhesive　plaster；　and　splints。　On　the　third　day　pulsation　was　plainly　felt　in　the　hand；　and　on　the　fourteenth　day　the　sutures　were　removed。　After　some　time　the　patient　was　able　to　extend　the　fingers　of　the　wounded　member；　and　finally　to　grasp　with　all　her　wonted　strength。

The　reproduction　or　accidental　production　of　nails　after　the　original　part　has　been　torn　away　by　violence　or　destroyed　by　disease；　is　quite　interesting。　Sometimes　when　the　whole　last　phalanx　has　been　removed；　the　nail　regrows　at　the　tip　of　the　remaining　stump。　Tulpius　seems　to　have　met　with　this　remarkable　condition。　Marechal　de　Rougeres；　Voigtel；　and　Ormancey　have　related　instances　of　similar　growths　on　the　2d　phalanx　after　the　loss　of　the　1st。　For　several　months　a　woman　had　suffered　from　an　ulcer　of　the　middle　finger　of　the　right　hand；　in　consequence　of　a　whitlow；　there　was　loss　of　the　3d　phalanx；　and　the　whole　of　the　articular　surface　and　part　of　the　compact　bony　structure　of　the　2d。　On　examining　the　sore；　Ormangey　saw　a　bony　sequestrum　which　appeared　to　keep　it　open。　He　extracted　this；　and；　until　cicatrization　was　complete；　he　dressed　the　stump　with　saturnine　cerate。　Some　months　afterward　Ormangey　saw　with　astonishment　that　the　nail　had　been　reproduced；　instead　of　following　the　ordinary　direction；　however；　it　lay　directly　over　the　face　of　the　stump；　growing　from　the　back　toward　the　palmer　aspect　of　the　stump　digit；　as　if　to　cover　and　protect　the　stump。　Blandin　has　observed　a　case　of　the　same　description。　A　third　occurred　at　the　Hopital　de　la　Charite；　in　a　woman；　who；　in　consequence　of　a　whitlow；　had　lost　the　whole　of　the　3d　phalanx　of　one　of　the　forefingers。　The　soft　and　fleshy　cushion　which　here　covered　the　2d　phalanx　was　terminated　by　a　small；　blackish　nail；　like　a　grain　of　spur　rye。　It　is　probable　that　in　these　cases　the　soft　parts　of　the　3d　phalanx；　and　especially　the　ungual　matrix；　had　not　been　wholly　destroyed。　In　his　lectures　Chevalier　speaks　of　analogous　cases。

In　some　instances　avulsion　of　a　finger　is　effected　in　a　peculiar　manner。　In　1886　Anche　reported　to　his　confreres　in　Bordeaux　a　rare　accident　of　this　nature　that　occurred　to　a　carpenter。　The　man's　finger　was　caught　between　a　rope　and　the　block　of　a　pulley。　By　a　sudden　and　violent　movement　on　his　part　he　disengaged　the　hand　but　left　the　3d　finger　attached　to　the　pulley。　At　first　examination　the　wound　looked　like　that　of　an　ordinary　amputation　by　the　usual　oval　incision；　from　the　center　of　the　wound　the　proximal　fragment　of　the　1st　phalanx　projected。　Polaillon　has　collected　42　similar　instances；　in　none　of　which；　however；　was　the　severance　complete。

It　occasionally　happens　that　in　avulsion　of　the　finger　an　entire　tendon　is　stripped　up　and　torn　off　with　the　detached　member。　Vogel　describes　an　instance　of　this　nature；　in　which　the　long　flexor　of　the　thumb　was　torn　off　with　that　digit。　In　the　Surgical　Museum　at　Edinburgh　there　is　preserved　a　thumb　and　part　of　the　flexor　longus　pollicis　attached；　which　were　avulsed　simultaneously。　Nunnely　has　seen　the　little　finger　together　with　the　tendon　and　body　of　the　longer　flexor　muscle　avulsed　by　machinery。　Stone　details　the　description　of　the　case　of　a　boy　named　Lowry；　whose　left　thumb　was　caught　between　rapidly　twisting　strands　of　a　rope；　and　the　last　phalanx；　the　neighboring　soft　parts；　and　also　the　entire　tendon　of　the　flexor　longus　pollicis　were　instantly　torn　away。　There　was　included　even　the　tendinous　portion　of　that　small　slip　of　muscle　taking　its　origin　from　the　anterior　aspect　of　the　head　and　upper　portion　of　the　ulna；　and　which　is　so　delicate　and　insignificant　as　to　be　generally　overlooked　by　anatomists。　There　was　great　pain　along　the　course　of　the　tract　of　abstraction　of　the　tendon。

Pinkerton　describes　a　carter　of　thirty…one　who　was　bitten　on　the　thumb　by　a　donkey。　The　man　pulled　violently　in　one　direction；　and　the　donkey；　who　had　seized　the　thumb　firmly　with　his　teeth；　pulled　forcibly　in　the　other　direction　until　the　tissues　gave　way　and　the　man　ran　off；　leaving　his　thumb　in　the　donkey's　mouth。　The　animal　at　once　dropped　the　thumb；　and　it　was　picked　up　by　a　companion　who　accompanied　the　man　to　the　hospital。　On　examination　the　detached　portion　was　found　to　include　the　terminal　phalanx　of　the　thumb；　together　with　the　tendon　of　the　flexor　longus　pollicis　measuring　ten　inches；　about　half　of　which　length　had　a　fringe　of　muscular　tissue　hanging　from　the　free　borders；　indicating　the　extent　and　the　penniform　arrangement　of　the　fibers　attached　to　it。　Meyer　cites　a　case　in　which　the　index　finger　was　torn　off　and　the　flexor　muscle　twisted　from　its　origin。　The　authors　know　of　an　unreported　case　in　which　a　man　running　in　the　street　touched　his　hand　to　a　hitch