anomalies and curiosities of medicine-第166部分

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ther　structure　besides　the　gall…bladder　had　passed　through　the　ring。　

The　fatality　of　rupture　of　the　spleen　is　quite　high。　Out　of　83　cases　of　injury　to　this　organ　collected　by　Elder；　and　quoted　by　MacCormac；　only　11　recovered；　but　the　mortality　is　less　in　punctured　or　incised　wounds　of　this　organ；　the　same　authorities　mentioning　29　recoveries　out　of　35　cases。　In　his　〃Surgery〃　Gooch　says　that　at　the　battle　of　Dettingen　one　of　Sir　Robert　Rich's　Dragoons　was　left　all　night　on　the　field；　weltering　in　his　blood；　his　spleen　hanging　out　of　his　body　in　a　gangrenous　state。　The　next　morning　he　was　carried　to　the　surgeons　who　ligated　the　large　vessels；　and　extirpated　the　spleen；　the　man　recovered　and　was　soon　able　to　do　duty。　In　the　Philosophical　Transactions　there　is　a　report　of　a　man　who　was　wounded　in　the　spleen　by　a　large　hunting…knife。　Fergusson　found　the　spleen　hanging　from　the　wound　and　ligated　it。　It　separated　in　ten　days　and　the　patient　recovered。

Williams　reports　a　stab…wound　of　the　spleen　in　a　negro　of　twenty…one。　The　spleen　protruded；　and　the　protruding　part　was　ligated　by　a　silver　wire；　one…half　of　the　organ　sloughing　off；　the　patient　recovered。　Sir　Astley　Cooper　mentions　a　curious　case；　in　which；　after　vomiting；　during　which　the　spleen　was　torn　from　its　attachments；　this　organ　produced　a　swelling　in　the　groin　which　was　supposed　to　be　a　hernia。　The　vomiting　continued；　and　at　the　end　of　a　week　the　woman　died；　it　was　then　found　that　the　spleen　had　been　turned　half　round　on　its　axis；　and　detached　from　the　diaphragm；　it　had　become　enlarged；　the　twist　interrupted　the　return　of　the　blood。　Portal　speaks　of　a　rupture　of　the　spleen　simply　from　engorgement。　There　was　no　history　of　a　fall；　contusion；　or　other　injury。　Tait　describes　a　case　of　rupture　of　the　spleen　in　a　woman　who；　in　attempting　to　avoid　her　husband's　kick；　fell　on　the　edge　of　the　table。　There　were　no　signs　of　external　violence；　but　she　died　the　third　day　afterward。　The　abdomen　was　found　full　of　blood；　and　the　spleen　and　peritoneal　covering　was　ruptured　for　three　inches。

Splenectomy；　excision　of　the　spleen；　has　been　performed　a　number　of　times；　with　varying　results；　but　is　more　successful　when　performed　for　injury　than　when　for　disease。　Ashhurst　has　tabulated　a　total　of　109　operations；　27　having　been　for　traumatic　causes；　and　all　but　five　having　terminated　successfully；　of　82　operations　for　disease；　only　32　recovered。　Vulpius　has　collected　117　cases　of　splenectomy；　with　a　death…rate　of　50　per　cent。　If；　however；　from　these　cases　we　deduct　those　suffering　with　leukocythemia　and　lardaceous　spleen；　in　which　the　operation　should　not　be　performed；　the　mortality　in　the　remaining　85　cases　is　reduced　to　33　per　cent。　Terrier　speaks　of　splenectomy　for　torsion　or　twisting　of　the　pedicle；　and　such　is　mentioned　by　Sir　Astley　Cooper；　who　has　found　records　of　only　four　such　cases。　Conklin　reports　a　successful　case　of　splenectomy　for　malarial　spleen；　and　in　reviewing　the　subject　he　says　that　the　records　of　the　past　decade　in　operations　for　simple　hypertrophy；　including　malaria；　show　20　recoveries　and　eight　deaths。　He　also　adds　that　extirpation　in　cases　of　floating　or　displaced　spleen　was　attended　with　brilliant　results。　Zuccarelli　is　accredited　with　reporting　two　cases　of　splenectomy　for　malarial　spleen；　both　of　which　recovered　early。　He　gives　a　table　of　splenectomies　performed　in　Italy；　in　which　there　were　nine　cases　of　movable　spleen；　with　two　deaths；　eight　cases　of　simple　hypertrophy；　with　three　deaths；　12　cases　of　malarial　spleen；　with　three　deaths；　four　cases　of　leukemia　and　pseudoleukemia；　with　two　deaths。　In　his　experiments　on　rabbits　it　was　proved　by　Tizzoni；　and　in　his　experiments　on　dogs；　by　Crede；　that　an　individual　could　live　without　a　spleen；　but　these　observations　were　only　confirmatory　of　what　had　long　been　known；　for；　in　1867；　Pean　successfully　removed　a　spleen　from　a　woman　of　twenty。　Tricomi　reports　eight　cases　in　which　he　had　extirpated　the　spleen　for　various　morbid　conditions；　with　a　fortunate　issue　in　all　but　one。　In　one　case　he　ligated　the　splenic　artery。　In　The　Lancet　there　is　an　account　of　three　recent　excisions　of　the　spleen　for　injury　at　St。　Thomas　Hospital　in　London；　and　it　is　added　that　they　are　among　the　first　of　this　kind　in　Great　Britain。

Abnormalities　of　Size　of　the　Spleen。The　spleen　may　be　extremely　small。　Storck　mentions　a　spleen　that　barely　weighed　an　ounce；　Schenck　speaks　of　one　in　the　last　century　that　weighed　as　much　as　20　pounds。　Frank　describes　a　spleen　that　weighed　16　pounds；　there　is　another　record　of　one　weighing　15　pounds。　Elliot　mentions　a　spleen　weighing　11　pounds；　Burrows　one；　11　pounds；　Blasius；　four　pounds；　Osiander；　nine　pounds；　Blanchard；　31　pounds；　Richardson；　3　1/2　pounds；　and　Hare；　93　ounces。

The　thoracic　duct；　although　so　much　protected　by　its　anatomical　position；　under　exceptional　circumstances　has　been　ruptured　or　wounded。　Kirchner　has　collected　17　cases　of　this　nature；　two　of　which　were　due　to　contusions　of　the　chest；　one　each　to　a　puncture；　a　cut；　and　a　shot…wound；　and　three　to　erosion　from　suppuration。　In　the　remaining　cases　the　account　fails　to　assign　a　definite　cause。　Chylothorax；　or　chylous　ascites；　is　generally　a　result　of　this　injury。　Krabbel　mentions　a　patient　who　was　run　over　by　an　empty　coal　car；　and　who　died　on　the　fifth　day　from　suffocation　due　to　an　effusion　into　the　right　pleural　cavity。　On　postmortem　examination　it　was　found　that　the　effusion　was　chyle；　the　thoracic　duct　being　torn　just　opposite　the　9th　dorsal　vertebra；　which　had　been　transversely　fractured。　In　one　of　Kirchner's　cases　a　girl　of　nine　had　been　violently　pushed　against　a　window…sill；　striking　the　front　of　her　chest　in　front　of　the　3d　rib。　She　suffered　from　pleural　effusion；　which；　on　aspiration；　proved　to　be　chyle。　She　ultimately　recovered　her　health。　In　1891　Eyer　reported　a　case　of　rupture　of　the　thoracic　duct；　causing　death　on　the　thirty…eighth　day。　The　young　man　had　been　caught　between　a　railroad　car　and　an　engine；　and　no　bones　were　broken。

Manley　reports　a　case　of　rupture　of　the　thoracic　duct　in　a　man　of　thirty…five；　who　was　struck　by　the　pole　of　a　brewery　wagon；　he　was　knocked　down　on　his　back；　the　wheel　passing　squarely　over　his　abdomen。　There　was　subsequent　bulging　low　down　in　the　right　iliac　fossa；　caused　by　the　presence　of　a　fluid；　which　chemic　and　microscopic　examination　proved　was　chyle。　From　five　to　eight　ounces　a　day　of　this　fluid　were　discharged；　until　the　tenth　day；　when　the　bulging　was　opened　and　drained。　On　the　fifteenth　day　the　wound　was　healed　and　the　man　left　the　hospital　quite　restored　to　health。

Keen　has　reported　four　instances　of　accidental　injury　to　the　thoracic　duct；　near　its　termination　at　the　base　of　the　left　side　of　the　neck；　the　wounding　was　in　the　course　of　removals　for　deep…seated　growths　in　this　region。　Three　of　the　cases　recovered；　having　sustained　no　detriment　from　the　injury　to　the　thoracic　duct。　One　died；　but　the　fatal　influence　was　not　specially　connected　with　the　wound　of　the　duct。

Possibly　the　boldest　operation　in　the　history　of　surgery　is　that　for　ligation　of　the　abdominal　aorta　for　inguinal　aneurysm。　It　was　first　practiced　by　Sir　Astley　Cooper　in　1817；　and　has　since　been　performed　several　times　with　a　uniformly　fatal　result；　although　Monteiro's　patient　survived　until　the　tenth　day；　and　there　is　a　record　in　which　ligature　of　the　abdominal　aorta　did　not　cause　death　until　the　eleventh　day。　Loreta　of　Bologna　is　accredited　with　operating　on　December　18；　1885；　for　the　relief　of　a　sailor　who　was　suffering　from　an　abdominal　aneurysm　caused　by　a　blow。　An　incision　was　made　from　the　ensiform　cartilage　to　the　umbilicus；　the　aneurysm　exposed；　and　its　cavity　filled　up　with　two　meters　of　silver…plated　wire。　Twenty　days　after　no　evidence　of　pulsation　remained　in　the　sac；　and　three　months　later　the　sailor　was　well　and　able　to　resume　his　duties。

Ligation　of　the　common　iliac　artery；　which；　in　a　case　of　gunshot　injury；　was　first　practiced　by　Gibson　of　Philadelphia　in　1812；　is；　happily；　not　always　fatal。　Of　82　cases　collected　by　Ashhurst；　23　terminated　successfully。

Foreign　bodies　loose　in　the　abdominal　cavity　are　sometimes　voided　at　stool；　or　may　suppurate　externally。　Fabricius　Hildanus　gives　us　a　history　of　a　person　wounded　with　a　sword…thrust　into　the　abdomen；　the　point　breaking　off。　The　sword　remained　one　year　in　the　belly　and　was　voided　at　stool。　Erichsen　mentions　an　instance　in　which　a　cedar　lead…pencil　stayed　for　eight　months　in　the　abdominal　cavity。　Desgranges　gives　a　case　of　a　fish…spine　in　the　abdominal　cavity；　and　ten　years　afterward　it　ulcerated　through　an　abscess　in　the　abdominal　wall。　Keetley　speaks　of　a　man　who　was　shot　when　a　boy；　at　the　time　of　the　accident　the　boy　had　a　small　spelling…book　in　his　pocket。　It　was　not　until　adult　life　that　from　an　abscess　of　the　groin　was　expelled　what　remained　of　the　spelling…book　that　had　been　driven　into　the　abdomen　during　boyhood。　Kyle　speaks　of　the　removal　of　a　corn…straw　33　inches　in　length　by　an　incision　ten　inches　long；　at　a　point　about　equidistant　from　the　umbilicus　to　the　anterior　spinous　process　of　the　right　ilium。

There　are　several　instances　on　record　of　tolerance　of　foreign　bodies　in　the　skin　and　muscles　of　the　back　for　an　extended　period。　Gay　speaks　of　a　curious　case　in　which　the　point　of　a　sheath…knife　remained　in　the　back　of　an　individual　for　nine　years。　Bush　reported　to　Sir　Astley　Cooper　the　history　of　a　man　who；　as　he　supposed；　received　a　wound　in　the　back　by　canister　shot　while　serving　on　a　Tartar　privateer　in　1779。　There　was　no　ship…surgeon　on　board；　and　in　about　a　month　the　wound　healed　without　surgical　assistance。　The　man　suffered　little　inconvenience　and　performed　his　duties　as　a　seaman；　and　was　impressed　into　the　Royal　Navy。　In　August；　1810；　he　complained　of　pain　in　the　lumbar　region。　He　was　submitted　to　an　examination；　and　a　cicatrix　of　this　region　was　noticed；　and　an　extraneous　body　about　1/2　inch　under　the　integument　was　felt。　An　incision　was　made　down　it；　and　a　rusty　blade　of　a　seaman's　clasp…knife　extracted　from　near　the　3d　lumbar　vertebra。　The　man　had　carried　this　knife　for　thirty　years。　The　wound　healed　in　a　few　days　and　there　was　no　more　inconvenience。

Fracture　of　the　lower　part　of　the　spine　is　not　always　fatal；　and　notwithstanding　the