anomalies and curiosities of medicine-第152部分

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ch　of　the　substance　of　the　4th　rib　was　lost。　Several　jagged　fragments　were　removed；　a　portion　of　the　pleura；　two　by　four　inches；　had　been　torn　away；　exposing　the　pericardium　and　the　left　lung；　and　showing　the　former　to　have　been　penetrated　and　the　latter　torn。　The　lung　collapsed　completely；　and　for　three　or　four　months　no　air　seemed　to　enter　it；　but　respiration　gradually　returned。　The　lacerated　integument　could　only　be　closed　approximately　by　sutures。　It　is　worthy　of　remark　that；　although　extremely　pale；　the　patient　complained　of　but　little　pain；　and　exhibited　only　slight　symptoms　of　shock。　The　pleural　cavity　subsequently　filled　with　a　dirty　serum；　but　even　this　did　not　interfere　with　the　healing　of　the　wound　and　the　restoration　of　the　lung；　the　patient　recovered　without　lateral　curvature。

Bartholf　reports　a　case　of　rapid　recovery　after　perforating　wound　of　the　lung。　The　pistol…ball　entered　the　back　1　1/2　inches　to　the　right　of　the　spinous　process　of　the　6th　dorsal　vertebra；　and　passed　upward　and　very　slightly　inward　toward　the　median　line。　Its　track　could　be　followed　only　1　1/4　inches。　Emphysema　appeared　fifteen　minutes　after　the　reception　of　the　wound；　and　soon　became　pronounced　throughout　the　front　and　side　of　the　neck；　a　little　over　the　edge　of　the　lower　jaw；　and　on　the　chest　two　inches　below　the　sternum　and　one　inch　below　the　clavicle。　In　four　hours　respiration　became　very　frequent；　short；　and　gasping；　the　thoracic　walls　and　the　abdomen　scarcely　moving。　The　man　continued　to　improve　rapidly；　the　emphysema　disappeared　on　the　seventh　day；　and　eighteen　days　after　the　reception　of　the　wound　he　was　discharged。　There　was　slight　hemorrhage　from　the　wound　at　the　time；　but　the　clot　dried　and　closed　the　wound；　and　remained　there　until　it　was　removed　on　the　morning　of　his　discharge；　leaving　a　small；　dry；　white　cicatrix。

Loss　of　Lung…tissue。The　old　Amsterdam　authority；　Tulpius；　has　recorded　a　case　in　which　a　piece　of　lung　of　about　three　fingers'　breadth　protruded　through　a　large　wound　of　the　lung　under　the　left　nipple。　This　wound　received　no　medical　attention　for　forty…eight　hours；　when　the　protruding　portion　of　lung　was　thought　to　be　dead；　and　was　ligated　and　cut　off；　it　weighed　about　three　ounces。　In　about　two　weeks　the　wound　healed　with　the　lung　adherent　to　it　and　this　condition　was　found　six　years　later　at　the　necropsy　of　this　individual。　Tulpius　quoted　Celaus　and　Hippocrates　as　authorities　for　the　surgical　treatment　of　this　case。　In　1787　Bell　gave　an　account　of　a　case　in　which　a　large　portion　of　the　lung　protruded　and　was　strangulated　by　the　edges　of　the　thoracic　wound；　yet　the　patient　made　a　good　recovery。　Fabricius　Hildanus　and　Ruysch　record　instances　of　recovery　in　which　large　pieces　of　lung　have　been　cut　off；　and　it　is　said　that　with　General　Wolfe　at　Quebec　there　was　another　officer　who　was　shot　through　the　thorax　and　who　recovered　after　the　removal　of　a　portion　of　the　lung。　In　a　letter　to　one　of　his　medical　friends　Roscius　says　that　he　succeeded　in　cutting　off　part　of　a　protruding；　livid；　and　gangrenous　lung；　after　a　penetrating　wound　of　the　chest；　with　a　successful　result。　Hale　reports　a　case　of　a　penetrating　stab…wound　in　which　a　piece　of　lung　was　removed　from　a　man　of　twenty…five。

Tait　claims　that　surgical　treatment；　as　exemplified　by　Biondi's　experiment　in　removing　portions　of　lung　from　animals；　such　as　dogs；　sheep；　cats；　etc。；　is　not　practical；　he　adds　that　his　deductions　are　misleading；　as　the　operation　was　done　on　healthy　tissue　and　in　deep　and　narrow…chested　animals。　Excision　of　diseased　portions　of　the　lung　has　been　practised　by　Kronlein　（three　cases）；　Ruggi　of　Bologna　（two　cases）；　Block；　Milton；　Weinlechner；　one　of　Kronlein's　patients　recovered　and　Milton's　survived　four　months；　but　the　others　promptly　succumbed　after　the　operation。　Tuffier　is　quoted　as　showing　a　patient；　aged　twenty…nine；　upon　whom；　for　beginning　tuberculosis；　he　had　performed　pneumonectomy　four　years　before。　At　the　operation　he　had　removed　the　diseased　area　at　the　apex　of　the　right　lung；　together　with　sound　tissue　for　two　cm。　in　every　direction。　Tuffier　stated　that　the　result　of　his　operation　had　been　perfectly　successful　and　the　patient　had　shown　no　suspicious　symptoms　since。

Rupture　of　the　Lung　Without　Fracture。It　is　quite　possible　for　the　lung　to　be　ruptured　by　external　violence　without　fracture　of　the　ribs；　there　are　several　such　cases　on　record。　The　mechanism　of　this　rare　and　fatal　form　of　injury　has　been　very　aptly　described　by　Gosselin　as　due　to　a　sudden　pressure　exerted　on　the　thoracic　wall　at　the　moment　of　full　inspiration；　there　being　a　spasm　of　the　glottis　or　obstruction　of　the　larynx；　in　consequence　of　which　the　lung　bursts。　An　extravasation　of　air　occurs；　resulting　in　the　development　of　emphysema；　pneumothorax；　etc。　Subsequently　pleurisy；　pneumonia；　or　even　pus　in　the　pleural　cavity　often　result。　Hemoptysis　is　a　possible；　but　not　a　marked　symptom。　The　mechanism　is　identical　with　that　of　the　bursting　of　an　inflated　paper　bag　when　struck　by　the　hand。　Other　observers　discard　this　theory　of　M。　Gosselin　and　claim　that　the　rupture　is　due　to　direct　pressure；　as　in　the　cases　in　which　the　heart　is　ruptured　without　fracture　of　the　ribs。　The　theory　of　Gosselin　would　not　explain　these　cardiac　ruptures　from　external　violence　on　the　thoracic　walls；　and；　therefore；　was　rejected　by　some。　Pare；　Morgagni；　Portal；　Hewson　Smith；　Dupuytren；　Laennec；　and　others　mention　this　injury。　Gosselin　reports　two　cases　terminating　in　recovery。　Ashurst　reports　having　seen　three　cases；　all　of　which　terminated　fatally　before　the　fifth　day；　he　has　collected　the　histories　of　39　cases；　of　which　12　recovered。　Otis　has　collected　reports　of　25　cases　of　this　form　of　injury　from　military　practice　exclusively。　These　were　generally　caused　by　a　blow　on　the　chest；　by　a　piece　of　shell；　or　other　like　missile。　Among　the　25　cases　there　were　11　recoveries。　As　Ashhurst　very　justly　remarks；　this　injury　appears　more　fatal　in　civil　than　in　military　life。

Pyle　reports　a　case　successfully　treated；　as　follows：

〃Lewis　W。；　ten　years　old；　white；　born　in　Maryland；　and　living　now　in　the　District　of　Columbia；　was　brought　in　by　the　Emergency　Hospital　ambulance；　on　the　afternoon　of　November　10th；　with　a　history　of　having　been　run　over　by　a　hose…cart　of　the　District　Fire　Department。　The　boy　was　in　a　state　of　extreme　shock；　having　a　weak；　almost　imperceptible　pulse；　his　respirations　were　shallow　and　rapid；　and　his　temperature　subnormal。　There　were　no　signs　of　external　injury　about　his　thoracic　cavity　and　no　fracture　of　the　ribs　could　be　detected；　although　carefully　searched　for；　there　was　marked　emphysema；　the　neck　and　side　of　the　face　were　enormously　swollen　with　the　extravasated　air；　the　tissues　of　the　left　arm　were　greatly　infiltrated　with　air；　which　enabled　us　to　elicit　the　familiar　crepitus　of　such　infiltration　when　an　attempt　at　the　determination　of　the　radial　pulse　was　made。　Consciousness　was　never　lost。　There　were　several　injuries　to　the　face　and　scalp；　and　there　was　hemorrhage　from　the　nose　and　mouth；　which　was　attributed　to　the　fact　that　the　patient　had　fallen　on　his　face；　striking　both　nose　and　lip。　This　was　confirmed　subsequently　by　the　absence　of　any　evidences　of　hemoptysis　during　the　whole　period　of　convalescence。　The　saliva　was　not　even　blood…streaked；　therefore；　it　can　be　said　with　verity　that　there　was　no　hemoptysis。　Shortly　after　admission　the　patient　reacted　to　the　stimulating　treatment；　his　pulse　became　stronger；　and　all　evidences　of　threatened　collapse　disappeared。　He　rested　well　the　first　night　and　complained　of　no　pain；　then　or　subsequently。　The　improvement　was　continuous。　The　temperature　remained　normal　until　the　evening　of　the　fifth　day；　when　it　rose　to　102。2　degrees；　end　again；　on　the　evening　of　the　sixth；　to　102。3　degrees。　This　rise　was　apparently　without　significance　as　the　patient　at　no　time　seemed　disturbed　by　it。　On　the　eighth　day　the　temperature　again　reached　the　normal　and　has　since　remained　there。　The　boy　is　apparently　well　now；　suffers　no　inconvenience；　and　has　left　the　hospital；　safe　from　danger　and　apparently　free　from　any　pulmonary　embarrassment。　He　uses　well…developed　diaphragmatic　breathing　which　is　fully　sufficient。〃


Pollock　reports　the　case　of　a　boy　of　seven；　whose　lung　was　ruptured　by　a　four…wheeled　cab　which　ran　over　him。　He　was　discharged　well　in　thirty…two　days。　Bouilly　speaks　of　recovery　in　a　boy　of　seventeen；　after　a　rupture　of　the　lung　without　fracture。　There　are　several　other　interesting　cases　of　recovery　on　record。

There　are　instances　of　spontaneous　rupture　of　the　lung；　from　severe　cough。　Hicks　speaks　of　a　child　of　ten　months　suffering　with　a　severe　cough　resembling　pertussis；　whose　lung　ruptured　about　two　weeks　after　the　beginning　of　the　cough；　causing　death　on　the　second　day。　Ferrari　relates　a　curious　case　of　rupture　of　the　lung　from　deep　inspiration。

Complete　penetration　or　transfixion　of　the　thoracic　cavity　is　not　necessarily　fatal；　and　some　marvelous　instances　of　recovery　after　injuries　of　this　nature；　are　recorded。　Eve　remarks　that　General　Shields　was　shot　through　the　body　by　a　discharge　of　a　cannon　at　Cerro　Gordo；　and　was　given　up　as　certain　to　die。　The　General　himself　thought　it　was　grape…shot　that　traversed　his　chest。　He　showed　no　signs　of　hemoptysis；　and　although　in　great　pain；　was　able　to　give　commands　after　reception　of　the　wound。　In　this　case；　the　ball　had　evidently　entered　within　the　right　nipple；　had　passed　between　the　lungs；　through　the　mediastinum；　emerging　slightly　to　the　right　of　the　spine。　Guthrie　has　mentioned　a　parallel　instance　of　a　ball　traversing　the　thoracic　cavity；　the　patient　completely　recovering　after　treatment。　Girard；　Weeds；　Meacham；　Bacon；　Fryer　and　others　report　cases　of　perforating　gunshot　wounds　of　the　chest　with　recovery。

Sewell　describes　a　case　of　transfixion　of　the　chest　in　a　youth　of　eighteen。　After　mowing　and　while　carrying　his　scythe　home；　the　patient　accidentally　fell　on　the　blade；　the　point　passed　under　the　right　axilla；　between　the　3d　and　4th　right　ribs；　horizontally　through　the　chest；　and　came　out　through　corresponding　ribs　of　the　opposite　side；　making　a　small　opening。　He　fell　to　the　ground　and　lay　still　until　his　brother　came　to　his　assistance；　the　latter　with　great　forethought　and　caution