anomalies and curiosities of medicine-第154部分

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ld　be　said　that　this　woman　had　died　of　peritonitis　in　the　left　thoracic　cavity。

Extended　tolerance　of　foreign　bodies　loose　in　the　thoracic　cavity　has　been　noticed。　Tulpins　mentions　a　person　who　had　a　sponge　shut　up　in　his　thoracic　cavity　for　six　weeks；　it　was　then　voided　by　the　mouth；　and　the　man　recovered。　Fabricius　Hildanus　relates　a　similar　instance　in　which　a　sponge…tent　was　expelled　by　coughing。　Arnot　reports　a　case　in　which　a　piece　of　iron　was　found　in　a　cyst　in　the　thorax；　where　it　had　remained　for　fourteen　years。　Leach　gives　a　case　in　which　a　bullet　was　impacted　in　the　chest　for　forty…two　years。　Snyder　speaks　of　a　fragment　of　knife…blade　which　was　lodged　in　the　chest　twelve　years　and　finally　coughed　up。

Foreign　Bodies　in　the　Bronchi。Walnut　kernels；　coins；　seeds；　beans；　corks；　and　even　sponges　have　been　removed　from　the　bronchi。　In　the　presence　of　Sir　Morrell　Mackenzie；　Johnston　of　Baltimore　removed　a　toy　locomotive　from　the　subglottic　cavity　by　tracheotomy　and　thyreotomy。　The　child　had　gone　to　sleep　with　the　toy　in　his　mouth　and　had　subsequently　swallowed　it。　Eldredge　presented　a　hopeless　consumptive；　who　as　a　child　of　five　had　swallowed　an　umbrella　ferrule　while　whistling　through　it；　and　who　expelled　it　in　a　fit　of　coughing　twenty…three　years　after。　Eve　of　Nashville　mentions　a　boy　who　placed　a　fourpenny　nail　in　a　spool　to　make　a　whistle；　and；　by　a　violent　inspiration；　drew　the　nail　deep　into　the　left　bronchus。　It　was　removed　by　tracheotomy。　Liston　removed　a　large　piece　of　bone　from　the　right　bronchus　of　a　woman；　and　Houston　tells　of　a　case　in　which　a　molar　tooth　was　lodged　in　a　bronchus　causing　death　on　the　eleventh　day。　Warren　mentions　spontaneous　expulsion　of　a　horse…shoe　nail　from　the　bronchus　of　a　boy　of　two　and　one…half　years。　From　Dublin；　in　1844；　Houston　reports　the　case　of　a　girl　of　sixteen　who　inhaled　the　wooden　peg　of　a　small　fiddle　and　in　a　fit　of　coughing　three　months　afterward　expelled　it　from　the　lungs。　In　1849　Solly　communicated　the　case　of　a　man　who　inhaled　a　pebble　placed　on　his　tongue　to　relieve　thirst。　On　removal　this　pebble　weighed　144　grains。　Watson　of　Murfreesboro　removed　a　portion　of　an　umbrella　rib　from　a　trachea；　but　as　he　failed　to　locate　or　remove　the　ferrule；　the　case　terminated　fatally。　Brigham　mentions　a　child　of　five　who　was　seized　with　a　fit　of　coughing　while　she　had　a　small　brass　nail　in　her　mouth；　pulmonary　phthisis　ensued；　and　in　one　year　she　died。　At　the　postmortem　examination　the　nail　was　found　near　the　bifurcation　of　the　right　bronchus；　and；　although　colored　black；　was　not　corroded。

Marcacci　reported　an　observation　of　the　removal　of　a　bean　from　the　bronchus　of　a　child　of　three　and　a　half　years。　The　child　swallowed　the　bean　while　playing；　immediately　cried；　and　became　hoarse。　No　one　having　noticed　the　accident；　a　diagnosis　of　croup　was　made　and　four　leeches　were　applied　to　the　neck。　The　dyspnea　augmented　during　the　night；　and　there　was　a　whistling　sound　with　each　respiratory　movement。　On　the　next　day　the　medical　attendants　suggested　the　possibility　of　a　foreign　body　in　the　larynx。　Tracheotomy　was　performed　but　the　dyspnea　continued；　showing　that　the　foreign　body　was　lodged　below　the　incision。　The　blood　of　one　of　the　cut　vessels　entered　the　trachea　and　caused　an　extra　paroxysm　of　dyspnea；　but　the　clots　of　blood　were　removed　by　curved　forceps。　Marcacci　fils　practised　suction；　and　placed　the　child　on　its　head；　but　in　vain。　A　feather　was　then　introduced　in　the　wound　with　the　hope　that　it　would　clean　the　trachea　and　provoke　respiration；　when　the　feather　was　withdrawn　the　bean　followed。　The　child　was　much　asphyxiated；　however；　and　five　or　six　minutes　elapsed　before　the　first　deep　inspiration。　The　wound　was　closed；　the　child　recovered　its　voice；　and　was　well　four　days　afterward。　Annandale　saw　a　little　patient　who　had　swallowed　a　bead　of　glass；　which　had　lodged　in　the　bronchus。　He　introduced　the　handle　of　a　scalpel　into　the　trachea；　producing　sufficient　irritation　to　provoke　a　brusque　expiration；　and　at　the　second　attempt　the　foreign　body　was　expelled。　Hulke　records　the　case　of　a　woman；　the　victim　of　a　peculiar　accident　happening　during　the　performance　of　tracheotomy；　for　an　affection　of　the　larynx。　The　internal　canule　of　the　tracheotomy…tube　fell　into　the　right　bronchus；　but　was　removed　by　an　ingenious　instrument　extemporaneously　devised　from　silver　wire。　A　few　years　ago　in　this　country　there　was　much　public　excitement　and　newspaper　discussion　over　the　daily　reports　which　came　from　the　bedside　of　a　gentleman　who　had　swallowed　a　cork；　and　which　had　become　lodged　in　a　bronchus。　Tracheotomy　was　performed　and　a　special　corkscrew　devised　to　extract　it；　but　unfortunately　the　patient　died　of　slow　asphyxiation　and　exhaustion。　Herrick　mentions　the　case　of　a　boy　of　fourteen　months　who　swallowed　a　shawl…pin　two　inches　long；　which　remained　in　the　lungs　four　years；　during　which　time　there　was　a　constant　dry　and　spasmodic　cough；　and　corresponding　depression　and　emaciation。　When　it　was　ultimately　coughed　up　it　appeared　in　one　large　piece　and　several　smaller　ones；　and　was　so　corroded　as　to　be　very　brittle。　After　dislodgment　of　the　pin　there　was　subsidence　of　the　cough　and　rapid　recovery。

Lapeyre　mentions　an　elderly　gentleman　who　received　a　sudden　slap　on　the　back　while　smoking　a　cigarette；　causing　him　to　start　and　take　a　very　deep　inspiration。　The　cigarette　was　drawn　into　the　right　bronchus；　where　it　remained　for　two　months　without　causing　symptoms　or　revealing　its　presence。　It　then　set　up　a　circumscribed　pneumonia　and　cardiac　dropsy　which　continued　two　months　longer；　at　which　time；　during　a　violent　fit　of　coughing；　the　cigarette　was　expelled　enveloped　in　a　waxy；　mucus…like　matter。　Louis　relates　the　case　of　a　man　who　carried　a　louis…d'or　in　his　lung　for　six　and　a　half　years。

There　is　a　case　on　record　of　a　man　who　received　a　gunshot　wound；　the　ball　entering　behind　the　left　clavicle　and　passing　downward　and　across　to　the　right　clavicle。　Sometime　afterward　this　patient　expectorated　two　pieces　of　bone　and　a　piece　of　gum　blanket　in　which　he　was　enveloped　at　the　time　of　the　injury。　Carpenter　describes　a　case　of　fatal　pleuritis；　apparently　due　to　the　presence　of　four　artificial　teeth　which　had　been　swallowed　thirteen　years　before。

Cardiac　Injuries。For　ages　it　has　been　the　common　opinion　relative　to　injuries　of　the　heart　that　they　are　necessarily　fatal　and　that；　as　a　rule；　death　immediately　follows　their　reception。　Notwithstanding　this　current　belief　a　careful　examination　of　the　literature　of　medicine　presents　an　astounding　number　of　cases　in　which　the　heart　has　been　positively　wounded；　and　the　patients　have　lived　days；　months；　and　even　recovered；　postmortem　examination；　by　revealing　the　presence　of　cicatrices　in　the　heart；　confirming　the　original　diagnosis。　This　question　is　one　of　great　interest　as；　in　recent　years；　there　has　been　constant　agitation　of　the　possibility　of　surgical　procedures　in　cardiac　as　well　as　cerebral　injuries。　Del　Vecchio　has　reported　a　series　of　experiments　on　dogs　with　the　conclusion　that　in　case　of　wounds　in　human　beings　suture　of　the　heart　is　a　possible　operation。　In　this　connection　he　proposes　the　following　operative　procedure：　Two　longitudinal　incisions　to　be　made　from　the　lower　border　of　the　3d　rib　to　the　upper　border　of　the　7th　rib；　one　running　along　the　inner　margin　of　the　sternum；　the　other　about　ten　mm。　inside　the　nipple…line。　These　incisions　are　joined　by　a　horizontal　cut　made　in　the　fourth　intercostal　space。　The　4th；　5th；　and　6th　ribs　and　cartilages　are　divided　and　the　outer　cutaneous　flaps　turned　up；　pushing　aside　the　pleura　with　the　finger；　expose　the　pericardium　and　incise　it　longitudinally；　suture　the　heart…wound　by　interrupted　sutures。　Del　Vecchio　adds　that　Fischer　has　collected　records　of　376　cases　of　wounds　of　the　heart　with　a　mortality　two　to　three　minutes　after　the　injury　of　20　per　cent。　Death　may　occur　from　a　few　seconds　to　nine　months　after　the　accident。　Keen　and　Da　Costa　quote　Del　Vecchio；　and；　in　comment　on　his　observations；　remark　that　death　in　cases　of　wound　of　the　heart　is　due　to　pressure　of　effused　blood　in　the　pericardial　sac；　and；　because　this　pressure　is　itself　a　cheek　to　further　hemorrhage；　there　seems；　as　far　as　hemorrhage　is　concerned；　to　be　rather　a　question　whether　operative　interference　may　not　be　itself　more　harmful　than　beneficial。　It　might　be　added　that　the　shock　to　the　cardiac　action　might　be　sufficient　to　check　it；　and　at　present　we　would　have　no　sure　means　of　starting　pulsation　if　once　stopped。　In　heart…injuries；　paracentesis；　followed；　if　necessary；　by　incision　of　the　pericardium；　is　advised　by　some　surgeons。

Realizing　the　fatality　of　injuries　of　the　heart；　in　consequence　of　which　almost　any　chance　by　operation　should　be　quickly　seized　by　surgeons　rather　than　trust　the　lives　of　patients　to　the　infinitesimal　chance　of　recovery；　it　would　seem　that　the　profession　should　carefully　consider　and　discuss　the　feasibility　of　any　procedure　in　this　direction；　no　matter　how　hypothetic。

Hall　states　that　his　experience　in　the　study　of　cardiac　wounds；　chiefly　on　game…animals；　would　lead　him　to　the　conclusion　that　transverse　wounds　the　lower　portions　of　the　heart；　giving　rise　to　punctures　rather　than　extensive　lacerations；　do　not　commonly　cause　cessation　of　life　for　a　time　varying　from　some　considerable　fraction　of　a　minute　to　many　minutes　or　even　hours；　and　especially　if　the　puncture　be　valvular　in　character；　so　as　to　prevent　the　loss　of　much　blood。　However；　if　the　wound　involve　the　base　of　the　organ；　with　extensive　laceration　of　the　surrounding　parts；　death　is　practically　instantaneous。　It　would　seem　that　injury　to　the　muscular　walls　of　the　heart　is　much　less　efficient　in　the　production　of　immediate　death　than　destruction　of　the　cardiac　nervous　mechanism；　serious　irritation　of　the　latter　producing　almost　instantaneous　death　from　shock。　In　addition；　Hall　cites　several　of　the　instances　on　which　he　based　his　conclusions。　He　mentions　two　wild　geese　which　flew　respectively　1/4　and　3/4　of　a　mile　after　having　been　shot　through　the　heart；　each　with　a　pellet　of　BB　shot；　the　base　in　each　instance　being　uninjured；　in　several　instances　antelope　and　deer　ran　several　rods　after　being　shot　with　a　rifle　ball　in　a　similar　manner；　on　the　other　hand；　death　was　practical