anomalies and curiosities of medicine-第162部分

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assed　from　his　bowels。　Denby　discovered　a　large　egg…cup　in　the　ileum　of　a　man。　Fillion　mentions　an　instance　of　recovery　following　the　perforation　of　the　jejunum　by　a　piece　of　horn　which　had　been　swallowed。　Madden　tells　of　a　person；　dying　of　intestinal　obstruction；　in　whose　intestines　were　found　several　ounces　of　crude　mercury　and　a　plum…stone。　The　mercury　had　evidently　been　taken　for　purgative　effect。　Rodenbaugh　mentions　a　most　interesting　case　of　beans　sprouting　while　in　the　bowel。　Harrison　relates　a　curious　case　in　which　the　swallowed　lower　epiphysis　of　the　femur　of　a　rabbit　made　its　way　from　the　bowel　to　the　bladder；　and　was　discharged　thence　by　the　urethra。

In　cases　of　appendicitis　foreign　bodies　have　been　found　lodged　in　or　about　the　vermiform　appendix　so　often　that　it　is　quite　a　common　lay　idea　that　appendicitis　is　invariably　the　result　of　the　lodgment　of　some　foreign　body　accidentally　swallowed。　In　recent　years　the　literature　of　this　subject　proves　that　a　great　variety　of　foreign　bodies　may　be　present。　A　few　of　the　interesting　cases　will　be　cited　in　the　following　lines：

In　the　New　England　Medical　Journal；　1843；　is　an　account　of　a　vermiform　appendix　which　was　taken　from　the　body　of　a　man　of　eighty…eight　who　had　died　of　pneumothorax。　During　life　there　were　no　symptoms　of　disease　of　the　appendix；　and　after　death　no　adhesions　were　found；　but　this　organ　was　remarkably　long；　and　in　it　were　found　122　robin…shot。　The　old　gentleman　had　been　excessively　fond　of　birds　all　his　life；　and　was　accustomed　to　bolt　the　meat　of　small　birds　without　properly　chewing　it；　to　this　fact　was　attributed　the　presence　of　these　shot　in　the　appendix。　A　somewhat　similar　case　was　that　of　a　man　who　died　in　the　Hotel…Dieu　in　1833。　The　ileum　of　this　man　contained　92　shot　and　120　plum　stones。　Buckler　reports　a　case　of　appendicitis　in　a　child　of　twelve；　in　which　a　common…sized　bird…shot　was　found　in　the　appendix。　Packard　presented　a　case　of　appendicitis　in　which　two　pieces　of　rusty　and　crooked　wire；　one　2　1/2　and　the　other　1　1/2　inches　long；　were　found　in　the　omentum；　having　escaped　from　the　appendix。　Howe

describes　a　case　in　which　a　double　oat；　with　a　hard　envelope；　was　found　in　the　vermiform　appendix　of　a　boy　of　four　years　and　one　month　of　age。　Prescott　reports　a　case　of　what　he　calls　fatal　colic　from　the　lodgment　of　a　chocolate…nut　in　the　appendix；　and　Noyes　relates　an　instance　of　death　in　a　man　of　thirty…one　attributed　to　the　presence　of　a　raisin…seed　in　the　vermiform　appendix。　Needles；　pins；　peanuts；　fruit…stones；　peas；　grape…seeds；　and　many　similar　objects　have　been　found　in　both　normal　and　suppurative　vermiform　appendices。

Intestinal　Injuries。The　degree　of　injury　that　the　intestinal　tract　may　sustain；　and　after　recovery　perform　its　functions　as　usual；　is　most　extraordinary；　and　even　when　the　injury　is　of　such　an　extent　as　to　be　mortal；　the　persistence　of　life　is　remarkable。　It　is　a　well　known　fact　that　in　bull…fights；　after　mortal　injuries　of　the　abdomen　and　bowels；　horses　are　seen　to　struggle　on　almost　until　the　sport　is　finished。　Fontaine　reports　a　case　of　a　Welsh　quarryman　who　was　run　over　by　a　heavy　four…horse　vehicle。　The　stump　of　a　glass　bottle　was　crushed　into　the　intestinal　cavity；　and　the　bowels　protruded　and　were　bruised　by　the　wheels　of　the　wagon。　The　grit　was　so　firmly　ground　into　the　bowel　that　it　was　impossible　to　remove　it；　yet　the　man　made　a　complete　recovery。　Nicolls　has　the　case　of　a　man　of　sixty…nine；　a　workhouse　maniac；　who　on　August　20th　attempted　suicide　by　running　a　red…hot　poker　into　his　abdomen。　His　wound　was　dressed　and　he　was　recovering；　but　on　September　11th　he　tore　the　cast　off　his　abdomen；　and　pulled　out　of　the　wound　the　omentum　and　32　inches　of　colon；　which　he　tore　off　and　threw　between　his　pallet　and　the　wall。　Strange　to　say　he　did　not　die　until　eight　days　after　this　horrible　injury

Tardieu　relates　the　case　of　a　chemist　who　removed　a　large　part　of　the　mesentery　with　a　knife；　and　yet　recovered。　Delmas　of　Montpellier　reports　the　history　of　a　wagoner　with　complete　rupture　of　the　intestines　and　rupture　of　the　diaphragm；　and　who　yet　finished　his　journey；　not　dying　until　eighteen　hours　after。

Successful　Intestinal　Resection。In　1755　Nedham　of　Norfolk　reported　the　case　of　a　boy　of　thirteen　who　was　run　over　and　eviscerated。　It　was　found　necessary　to　remove　57　inches　of　the　protruding　bowel；　but　the　boy　made　a　subsequent　recovery。　Koebererle　of　Strasburg　performed　an　operation　on　a　woman　of　twenty…two　for　the　relief　of　intestinal　obstruction。　On　account　of　numerous　strictures　it　was　found　necessary　to　remove　over　two　yards　of　the　small　intestine；　the　patient　recovered　without　pain　or　trouble　of　any　kind。　In　his　dissertation　on　〃Ruptures〃　Arnaud　remarks　that　he　cut　away　more　than　seven　feet　of　gangrenous　bowel；　his　patient　surviving。　Beehe　reports　recovery　after　the　removal　of　48　inches　of　intestine。　The　case　was　one　of　strangulation　of　an　umbilical　hernia。

Sloughing　of　the　Intestine　Following　Intussusception。Lobstein　mentions　a　peasant　woman　of　about　thirty　who　was　suddenly　seized　with　an　attack　of　intussusception　of　the　bowel；　and　was　apparently　in　a　moribund　condition　when　she　had　a　copious　stool；　in　which　she　evacuated　three　feet　of　bowel　with　the　mesentery　attached。　The　woman　recovered；　but　died　five　months　later　from　a　second　attack　of　intussusception；　the　ileum　rupturing　and　peritonitis　ensuing。　There　is　a　record　in　this　country　of　a　woman　of　forty…five　who　discharged　44　inches　of　intestine；　and　who　survived　for　forty…two　days。　The　autopsy　showed　the　sigmoid　flexure　gone；　and　from　the　caput　ceci　to　the　termination　the　colon　only　measured　14　inches。　Vater　gives　a　history　of　a　penetrating　abdominal　wound　in　which　a　portion　of　the　colon　hung　from　the　wound　during　fourteen　years；　forming　an　artificial　anus。

Among　others　mentioning　considerable　sloughing　of　intestine　following　intussusception；　and　usually　with　complete　subsequent　recovery；　are　Bare；　13　inches　of　the　ileum；　Blackton；　nine　inches；　Bower；　14　inches；　Dawson；　29　inches；　Sheldon；　4　1/2　feet；　Stanley；　three　feet；　Tremaine；　17　inches；　and　Grossoli；　40　cm。

Rupture　of　the　Intestines。It　is　quite　possible　for　the　intestine　to　be　ruptured　by　external　violence；　and　cases　of　rupture　of　all　parts　of　the　bowel　have　been　recorded。　Titorier　gives　the　history　of　a　case　in　which　the　colon　was　completely　separated　from　the　rectum　by　external　violence。　Hinder　reports　the　rupture　of　the　duodenum　by　a　violent　kick。　Eccles；　Ely；　and　Pollock　also　mention　cases　of　rupture　of　the　duodenum。　Zimmerman；　Atwell；　and　Allan　report　cases　of　rupture　of　the　colon。

Operations　upon　the　gastrointestinal　tract　have　been　so　improved　in　the　modern　era　of　antisepsis　that　at　the　present　day　they　are　quite　common。　There　are　so　many　successful　cases　on　record　that　the　whole　subject　deserves　mention　here。

Gastrostomy　is　an　operation　for　establishing　a　fistulous　opening　in　the　stomach　through　the　anterior　wall。　Many　operations　have　been　devised；　but　the　results　of　this　maneuver　in　malignant　disease　have　not　thus　far　been　very　satisfactory。　It　is　quite　possible　that；　being　an　operation　of　a　serious　nature；　it　is　never　performed　early　enough；　the　patient　being　fatally　weakened　by　inanition。　Gross　and　Zesas　have　collected；　respectively；　207　and　162　cases　with　surprisingly　different　rates　of　mortality：　that　of　Gross　being　only　29。47　per　cent；　while　that　of　Zesas　was　for　cicatricial　stenoses　60　per　cent；　and　for　malignant　cases　84　per　cent。　It　is　possible　that　in　Zesas's　statistics　the　subjects　were　so　far　advanced　that　death　would　have　resulted　in　a　short　time　without　operation。　Gastrotomy　we　have　already　spoken　of。

Pyloroplasty　is　an　operation　devised　by　Heineke　and　Mikulicz；　and　is　designed　to　remove　the　mechanic　obstruction　in　cicatricial　stenoses　of　the　pylorus；　at　the　same　time　creating　a　new　pylorus。

Gastroenterostomy　and　pylorectomy　are　operations　devised　for　the　relief　of　malignant　disease　of　the　pylorus；　the　diseased　portions　being　removed　and　the　parts　resected。

Gastrectomy　or　extirpation　of　the　stomach　is　considered　by　most　surgeons　entirely　unjustifiable；　as　there　is　seldom　hope　of　cure　or　prospect　of　amelioration。　La　Tribune　Medicale　for　January　16；　1895；　gives　an　abstract　of　Langenbuch's　contribution　upon　total　extirpation　of　the　stomach。　Three　patients　were　treated；　of　whom　two　died。　In　the　first　case；　on　opening　the　abdominal　cavity　the　stomach　was　found　very　much　contracted；　presenting　extensive　carcinomatous　infiltration　on　its　posterior　surface。　After　division　of　the　epiploon　section　was　made　at　the　pylorus　and　at　the　cardiac　extremities；　the　portions　removed　represented　seven…eighths　of　the　stomach。　The　pylorus　was　stitched　to　the　remains　of　the　cardiac　orifice；　making　a　cavity　about　the　size　of　a　hen's　egg。　In　this　case　a　cure　was　accomplished　in　three　weeks。　The　second　case　was　that　of　a　man　in　whom　almost　the　entire　stomach　was　removed；　and　the　pyloric　and　cardiac　ends　were　stitched　together　in　the　wound　of　the　parietes。　The　third　case　was　that　of　a　man　of　sixty…two　with　carcinoma　of　the　pylorus。　After　pylorectomy；　the　line　of　suture　was　confined　with　iodoform…gauze　packing。　Unfortunately　the　patient　suffered　with　bronchitis；　and　coughing　caused　the　sutures　to　give　way；　the　patient　died　of　inanition　on　the　twenty…third　day。

Enterostomy；　or　the　formation　of　a　fecal　fistula　above　the　ileocecal　valve；　was　performed　for　the　first　time　by　Nelaton　in　1840；　but　the　mortality　since　1840　has　been　so　great　that　in　most　cases　it　is　deemed　inadmissible。

Colostomy；　an　operation　designed　to　make　a　fistulous　opening　in　any　portion　of　the　rectum；　was　first　practiced　by　Littre。　In　early　times　the　mortality　of　inguinal　colostomy　was　about　five　per　cent；　but　has　been　gradually　reduced　until　Konig　reports　20　cases　with　only　one　death　from　peritonitis；　and　Cripps　26　cases　with　only　one　death。　This　will　always　retain　its　place　in　operative　surgery　as　a　palliative　and　life…saving　operation　for　carcinomatous　stenosis　of　the　lower　part　of　the　colon；　and　in　cases　of　carcinoma　of　the　rectum　in　which　operation　is　not　feasible。

Intestinal　anastomosis；　whereby　two　portions　of　a　severed　or　resected　bowel　can　be　intimately　joined；　excluding　from　fecal　circulation　the　portion　of　bowel　whic