anomalies and curiosities of medicine-第150部分

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ons；　in　London。　Wallace；　of　Rock　Rapids；　Iowa；　has　successfully　removed　both　forearms；　one　leg；　and　half　of　the　remaining　foot；　for　frost…bite。　Allen　describes　the　case　of　a　boy　of　eight　who　was　run　over　by　a　locomotive；　crushing　his　right　leg；　left　foot；　and　left　forearm　to　such　an　extent　as　to　necessitate　primary　triple　amputation　at　the　left　elbow；　left　foot；　and　right　leg；　the　boy　recovering。　Ashhurst　remarks　that　Luckie；　Alexander；　Koehler；　Lowman；　and　Armstrong　have　successfully　removed　both　legs　and　one　arm　simultaneously　for　frost…bite；　all　the　patients　making　excellent　recoveries　in　spite　of　their　mutilations；　he　adds　that　he　himself　has　successfully　resorted　to　synchronous　amputation　of　the　right　hip…joint　and　left　leg　for　a　railroad　injury　occurring　in　a　lad　of　fifteen；　and　has　twice　synchronously　amputated　three　limbs　from　the　same　patient；　one　case　recovering。

Wharton　reports　a　case　of　triple　major　amputation　on　a　negro　of　twenty…　one；　who　was　run　over　by　a　train。　His　right　leg　was　crushed　at　the　knee；　and　the　left　leg　crushed　and　torn　off　in　the　middle　third；　the　right　forearm　and　hand　were　crushed。　In　order　to　avoid　chill　and　exposure；　he　was　operated　on　in　his　old　clothes；　and　while　one　limb　was　being　amputated　the　other　was　being　prepared。　The　most　injured　member　was　removed　first。　Recovery　was　uninterrupted。

There　are　two　cases　of　spontaneous　amputation　worthy　of　record。　Boerhaave　mentions　a　peasant　near　Leyden；　whose　axillary　artery　was　divided　with　a　knife；　causing　great　effusion　of　blood；　and　the　patient　fainted。　The　mouth　of　the　vessel　was　retracted　so　far　as　to　render　ligature　impossible；　and　the　poor　man　was　abandoned　to　what　was　considered　an　inevitable　fate　by　his　unenlightened　attendants。　Expecting　to　die　every　moment；　he　continued　several　days　in　a　languid　state；　but　the　hemorrhage　ceased　spontaneously；　and　the　arm　decayed；　shrunk；　and　dried　into　a　mummified　stump；　which　he　carried　about　for　quite　a　while。　Rooker　speaks　of　a　fracture　of　the　forearm；　near　the　lower　part　of　the　middle　third；　in　a　patient　aged　fourteen。　Incipient　gangrene　below　the　seat　of　fracture；　with　associate　inflammation；　developed；　but　on　account　of　the　increasing　gangrene　it　was　determined　to　amputate。　On　the　fifth　day　the　line　of　demarcation　extended　to　the　spine　of　the　scapula；　laying　bare　the　bone　and　exposing　the　acromion　process　and　involving　the　pectoral　muscles。　It　was　again　decided　to　let　Nature　continue　her　work。　The　bones　exfoliated；　the　spine　and　the　acromial　end　of　the　scapula　came　away；　and　a　good　stump　was　formed。　Figure　212　represents　the　patient　at　the　age　of　twenty…eight。

By　ingenious　mechanical　contrivances　persons　who　have　lost　an　extremity　are　enabled　to　perform　the　ordinary　functions　of　the　missing　member　with　but　slight　deterioration。　Artificial　arms；　hands；　and　legs　have　been　developed　to　such　a　degree　of　perfection　that　the　modern　mechanisms　of　this　nature　are　very　unlike　the　cumbersome　and　intricate　contrivances　formerly　used。

Le　Progres　Medical　contains　an　interesting　account　of　a　curious　contest　held　between　dismembered　athletes　at　Nogent…Sur…Marne；　a　small　town　in　the　Department　of　the　Seine；　in　France。　Responding　to　a　general　invitation；　no　less　than　seven　individuals　who　had　lost　either　leg　or　thigh；　competed　in　running　races　for　prizes。　The　enterprising　cripples　were　divided　into　two　classes：　the　cuissards；　or　those　who　had　lost　a　thigh；　and　jambards；　or　those　who　had　lost　a　leg；　and；　contrary　to　what　might　have　been　expected；　the　grand　champion　came　from　the　former　class。　The　distance　in　each　race　was　200　meters。　M。　Roullin；　whose　thigh；　in　consequence　of　an　accident；　was　amputated　in　1887；　succeeded　in　traversing　the　course　in　the　remarkable　time　of　thirty　seconds　（about　219　yards）；　whereas　M。　Florrant；　the　speediest　jambard；　required　thirty…six　seconds　to　run　the　same　distance；　and　was；　moreover；　defeated　by　two　other　cuissards　besides　the　champion。　The　junior　race　was　won　in　thirty…five　seconds；　and　this　curious　day's　sport　was　ended　by　a　course　de　consolation；　which　was　carried　off　in　thirty…three　seconds　by　M。　Mausire；　but　whether　he　was　a　cuissard　or　a　jambard　was　not　stated。

On　several　occasions　in　England；　cricket　matches　have　been　organized　between　armless　and　legless　men。　In　Charles　Dickens'　paper；　〃All　the　Year　Round；〃　October　5；　1861；　there　is　a　reference　to　a　cricket　match　between　a　one…armed　eleven　and　a　one…legged　eleven。　There　is　a　recent　report　from　De　Kalb；　Illinois；　of　a　boy　of　thirteen　who　had　lost　both　legs　and　one　arm；　but　who　was　nevertheless　enabled　to　ride　a　bicycle　specially　constructed　for　him　by　a　neighboring　manufacturer。　With　one　hand　he　guided　the　handle　bar；　and　bars　of　steel　attached　to　his　stumps　served　as　legs。　He　experienced　no　trouble　in　balancing　the　wheel；　it　is　said　that　he　has　learned　to　dismount；　and　soon　expects　to　be　able　to　mount　alone；　although　riding　only　three　weeks；　he　has　been　able　to　traverse　one…half　a　mile　in　two　minutes　and　ten　seconds。　While　the　foregoing　instance　is　an　exception；　it　is　not　extraordinary　in　the　present　day　to　see　persons　with　artificial　limbs　riding　bicycles；　and　even　in　Philadelphia；　May　30；　1896；　there　was　a　special　bicycle　race　for　one…legged　contestants。

The　instances　of　interesting　cases　of　foreign　bodies　in　the　extremities　are　not　numerous。　In　some　cases　the　foreign　body　is　tolerated　many　years　in　this　location。　There　are　to…day　many　veterans　who　have　bullets　in　their　extremities。　Girdwood　speaks　of　the　removal　of　a　foreign　body　after　twenty…five　years'　presence　in　the　forearm。　Pike　mentions　a　man　in　India；　who；　at　the　age　of　twenty…two；　after　killing　a　wounded　hare　in　the　usual　manner　by　striking　it　on　the　back　of　the　neck　with　the　side　of　the　hand；　noticed　a　slight　cut　on　the　hand　which　soon　healed　but　left　a　lump　under　the　skin。　It　gave　him　no　trouble　until　two　months　before　the　time　of　report；　when　he　asked　to　have　the　lump　removed；　thinking　it　was　a　stone。　It　was　cut　down　upon　and　removed；　and　proved　to　be　the　spinous　process　of　the　vertebra　of　a　hare。　The　bone　was　living　and　healthy　and　had　formed　a　sort　of　arthrodial　joint　on　the　base　of　the　phalanx　of　the　little　finger　and　had　remained　in　this　position　for　nearly　twenty…two　years。

White　has　described　a　case　in　which　a　nail　broken　off　in　the　foot；　separated　into　26　splinters；　which；　after　intense　suffering；　were　successfully　removed。　There　was　a　case　recently　reported　of　a　man　admitted　to　the　Bellevue　Hospital；　New　York；　whose　arm　was　supposed　to　have　been　fractured　by　an　explosion；　but　instead　of　which　11　feet　of　lead　wire　were　found　in　it　by　the　surgeons。　The　man　was　a　machinist　in　the　employ　of　the　East　River　Lead　Co。；　and　had　charge　of　a　machine　which　converted　molten　lead　into　wire。　This　machine　consists　of　a　steel　box　into　which　the　lead　is　forced；　being　pressed　through　an　aperture　1/8　inch　in　diameter　by　hydraulic　pressure　of　600　tons。　Reaching　the　air；　the　lead　becomes　hard　and　is　wound　on　a　large　wheel　in　the　form　of　wire。　Just　before　the　accident　this　small　aperture　had　become　clogged；　and　the　patient　seized　the　projecting　wire　in　his　hand；　intending　to　free　the　action　of　the　machine；　as　he　had　previously　done　on　many　occasions；　by　a　sharp；　strong　pull；　but　in　so　doing　an　explosion　occurred；　and　he　was　hurled　to　the　floor　unconscious。　While　on　the　way　to　the　hospital　in　the　ambulance；　he　became　conscious　and　complained　of　but　little　pain　except　soreness　of　the　left　arm　about　the　elbow。　The　swelling；　which　had　developed　very　rapidly；　made　it　impossible　for　the　surgeons　to　make　an　examination；　but　on　the　following　day；　when　the　inflammation　had　subsided　sufficiently；　a　diagnosis　of　fracture　of　the　bones　of　the　arm　was　made。　There　was　no　external　injury　of　the　skin　of　any　magnitude；　and　the　surgeons　decided　to　cut　down　on　the　trifling　contusion；　and　remove　what　appeared　to　be　a　fragment　of　bone；　lodged　slightly　above　the　wrist。　An　anesthetic　was　administered；　and　an　incision　made；　but　to　the　amazement　of　the　operators；　instead　of　bone；　a　piece　of　wire　one　inch　in　length　and　1/8　inch　in　diameter　was　removed。　On　further　exploration　piece　after　piece　of　the　wire　was　taken　out　until　finally　the　total　length　thus　removed　aggregated　11　feet；　the　longest　piece　measuring　two　feet　and　the　shortest　1/4　inch。　The　wire　was　found　imbedded　under　the　muscles　of　the　arm；　and　some　of　it　had　become　wedged　between　the　bones　of　the　forearm。　Probably　the　most　remarkable　feature　of　this　curious　accident　was　the　fact　that　there　was　no　fracture　or　injury　to　the　bone；　and　it　was　thought　possible　that　the　function　of　the　arm　would　be　but　little　impaired。

Tousey　reports　a　case　of　foreign　body　in　the　axilla　that　was　taken　for　a　necrotic　fragment　of　the　clavicle。　The　patient　was　a　boy　of　sixteen；　who　climbed　up　a　lamp…post　to　get　a　light　for　his　bicycle　lamp；　his　feet　slipped　off　the　ornamental　ledge　which　passed　horizontally　around　the　post　about　four　feet　from　the　ground；　and　he　fell。　In　the　fall　a　lead　pencil　in　his　waistcoat　pocket　caught　on　the　ledge　and　was　driven　into　the　axilla；　breaking　off　out　of　sight。　This　was　supposed　to　be　a　piece　of　the　clavicle；　and　was　only　discovered　to　be　a　pencil　when　it　was　removed　six　weeks　after。

There　are　several　diseases　of　the　bone　having　direct　bearing　on　the　anomalies　of　the　extremities　which　should　have　mention　here。　Osteomalacia　is　a　disease　of　the　bones　in　adult　life；　occurring　most　frequently　in　puerperal　women；　but　also　seen　in　women　not　in　the　puerperal　state；　and　in　men。　It　is　characterized　by　a　progressive　softening　of　the　bone…substance；　from　a　gradual　absorption　of　the　lime　salts；　and　gives　rise　to　considerable　deformity；　and　occasionally　to　spontaneous　fracture。

Rachitis　or　rickets　is　not　a　disease　of　adult　life；　but　of　infancy　and　childhood；　and　never　occurs　after　the　age　of　puberty。　It　seldom　begins　before　six　months　or　after　three　years。　There　are　several　theories　as　to　its　causation；　one　being　that　it　is　due　to　an　abnormal　development　of　acids。　There　is　little　doubt　that　defective　nutrition　and　bad　hygienic　surroundings　are　prominent　factors　in　its　production。　The　principal　pathologic　change　is　seen　in　the　epiphyseal　lines　of　long　bones　and　beneath　the　periosteum。　Figure　213　shows　the　appearance　during　life　of　a