anomalies and curiosities of medicine-第170部分

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　it　took；　and　judging　from　the　situation　of　the　cicatrix　and　all　the　circumstances　it　was　apparent　that　the　arrow…head　had　passed　through　the　glutei　muscles　and　the　obturator　foremen　and　entered　the　cavity　of　the　bladder；　where　it　remained　and　formed　the　nucleus　of　a　stone。　Stone　in　the　bladder　is　extremely　rare　among　the　wild　Indians；　owing；　no　doubt；　to　their　almost　exclusive　meat　diet　and　the　very　healthy　condition　of　their　digestive　organs；　and　this　fact；　in　connection　with　the　age　of　the　patient　and　the　unobstructed　condition　of　his　urethra；　went　very　far　to　sustain　this　conclusion。　On　August　23d　I　removed　the　stone　without　difficulty　by　the　lateral　operation　through　the　perineum。　The　lobe　of　the　prostate　was　enlarged；　which　seemed　to　favor　the　extent　of　the　incision　beyond　what　would　otherwise　have　been　safe。　The　perineum　was　deep　and　the　tuberosities　of　the　ischii　unnaturally　approximated。　The　calculus　of　the　mixed　ammoniaco…magnesian　variety　was　egg…shaped；　and　weighed　19　drams。　The　arrow…point　was　completely　covered　and　imbedded　near　the　center　of　the　stone。　It　was　of　iron；　and　had　been　originally　about　2　1/2　inches　long；　by　7/8　inch　at　its　widest　part；　somewhat　reduced　at　the　point　and　edges　by　oxidation。　The　removal　of　the　stone　was　facilitated　by　the　use　of　two　pairs　of　forceps；one　with　broad　blades；　by　which　I　succeeded　in　bringing　the　small　end　of　the　stone　to　the　opening　in　the　prostate；　while　the　other；　long　and　narrow；　seized　and　held　it　until　the　former　was　withdrawn。　In　this　way　the　forceps　did　not　occupy　a　part　of　the　opening　while　the　large　end　of　the　stone　was　passing　through　it。　The　capacity　of　the　bladder　was　reduced；　and　its　inner　walls　were　in　a　state　of　chronic　inflammation。　The　patient　quickly　recovered　from　the　effects　of　the　chloroform　and　felt　great　relief；　both　in　body　and　mind；　after　the　operation；　and　up　to　the　eighth　day　did　not　present　a　single　unfavorable　symptom。　The　urine　began　to　pass　by　the　natural　channel　by　the　third　day；　and　continued　more　or　less　until；　on　the　seventh　day；　it　had　nearly　ceased　to　flow　at　the　wound。　But　the　restless　spirit　of　the　patient's　friends　could　no　longer　be　restrained。　Open　hostility　with　the　whites　was　expected　to　begin　at　every　moment；　and　they　insisted　on　his　removal。　He　needed　purgative　medicine　on　the　eighth　day；　which　they　refused　to　allow　him　to　take。　They　assumed　entire　charge　of　the　case；　and　the　following　day　started　with　him　to　their　camps　60　miles　away。　Nineteen　days　after　he　is　reported　to　have　died；　but　his　immediate　relatives　have　since　assured　me　that　his　wound　was　well　and　that　no　trouble　arose　from　it。　They　described　his　symptoms　as　those　of　bilious　remittent　fever；　a　severe　epidemic　of　which　was　prevailing　at　the　time；　and　from　which　several　white　men　and　many　Indians　died　in　that　vicinity。〃　The　calculus　was　deposited　in　the　Army　Medical　Museum　at　Washington；　and　is　represented　in　the　accompanying　photograph；　showing　a　cross…section　of　the　calculus　with　the　arrow…head　in　situ。

As　quoted　by　Chelius；　both　Hennen　and　Cline　relate　cases　in　which　men　have　been　shot　through　the　skirts　of　the　jacket；　the　ball　penetrating　the　abdomen　above　the　tuberosity　of　the　ischium；　and　entering　the　bladder；　and　the　men　have　afterward　urinated　pieces　of　clothing；　threads；　etc。；　taken　in　by　the　ball。　In　similar　cases　the　bullet　itself　may　remain　in　the　bladder　and　cause　the　formation　of　a　calculus　about　itself　as　a　nucleus；　as　in　three　cases　mentioned　by　McGuire　of　Richmond；　or　the　remnants　of　cloth　or　spicules　of　bone　may　give　rise　to　similar　formation。　McGuire　mentions　the　case　of　a　man　of　twenty…three　who　was　wounded　at　the　Battle　of　McDowell；　May　8；　1862。　The　ball　struck　him　on　the　horizontal　ramus　of　the　left　pubic　bone；　about　an　inch　from　the　symphysis；　passed　through　the　bladder　and　rectum；　and　came　out　just　below　the　right　sacrosciatic　notch；　near　the　sacrum。　The　day　after　the　battle　the　man　was　sent　to　the　general　hospital　at　Staunton；　Va。；　where　he　remained　under　treatment　for　four　months。　During　the　first　month　urine　passed　freely　through　the　wounds　made　by　the　entrance　and　exit　of　the　ball；　and　was　generally　mixed　with　pus　and　blood。　Fecal　matter　was　frequently　discharged　through　the　posterior　wound。　Some　time　during　the　third　week　he　passed　several　small　pieces　of　bone　by　the　rectum。　At　the　end　of　the　fifth　week　the　wound　of　exit　healed；　and　for　the　first　time　after　his　injury　urine　was　discharged　through　the　urethra。　The　wound　of　entrance　gradually　closed　after　five　months；　but　opened　again　in　a　few　weeks　and　continued；　at　varying　intervals；　alternately　closed　and　open　until　September；　1865。　At　this　time；　on　sounding　the　man；　it　was　found　that　he　had　stone；　this　was　removed　by　lateral　operation；　and　was　found　to　weigh　2　1/4　ounces；　having　for　its　nucleus　a　piece　of　bone　about　1/2　inch　long。　Dougherty　reports　the　operation　of　lithotomy；　in　which　the　calculus　removed　was　formed　by　incrustations　about　an　iron　bullet。

In　cases　in　which　there　is　a　fistula　of　the　bladder　the　subject　may　live　for　some　time；　in　some　cases　passing　excrement　through　the　urethra；　in　others；　urine　by　the　anus。　These　cases　seem　to　have　been　of　particular　interest　to　the　older　writers；　and　we　find　the　literature　of　the　last　century　full　of　examples。　Benivenius；　Borellus；　the　Ephemerides；　Tulpius；　Zacutus　Lusitanus；　and　others　speak　of　excrement　passing　through　the　penis；　and　there　are　many　cases　of　vaginal　anus　recorded。　Langlet　cites　an　instance　in　which　the　intestine　terminated　in　the　bladder。　Arand　mentions　recovery　after　atresia　of　the　anus　with　passage　of　excrement　from　the　vulva。　Bartholinus；　the　Ephemerides；　Fothergill；　de　la　Croix；　Riedlin；　Weber；　and　Zacutus　Lusitanus　mention　instances　in　which　gas　was　passed　by　the　penis　and　urethra。　Camper　records　such　a　case　from　ulcer　of　the　neighboring　or　connecting　intestine；　Frank；　from　cohesion　and　suppuration　of　the　rectum；　Marcellus　Donatus；　from　penetrating　ulcer　of　the　rectum；　and　Petit；　from　communication　of　the　rectum　and　bladder　in　which　a　cure　was　effected　by　the　continued　use　of　the　catheter　for　the　evacuation　of　urine。

Flatus　through　the　vagina；　vulva；　and　from　the　uterus　is　mentioned　by　Bartholinus；　the　Ephemerides；　Meckel；　Mauriceau；　Paullini；　Riedlin；　Trnka；　and　many　others　in　the　older　literature。　Dickinson　mentions　a　Burmese　male　child；　four　years　old；　who　had　an　imperforate　anus　and　urethra；　but　who　passed　feces　and　urine　successfully　through　an　opening　at　the　base　of　the　glans　penis。　Dickinson　eventually　performed　a　successful　operation　on　this　case。　Modern　literature　has　many　similar　instances。

In　the　older　literature　it　was　not　uncommon　to　find　accounts　of　persons　passing　worms　from　the　bladder；　no　explanations　being　given　to　account　for　their　presence　in　this　organ。　Some　of　these　cases　were　doubtless　instances　of　echinococcus；　trichinae；　or　the　result　of　rectovesical　fistula；　but　Riverius　mentions　an　instance　in　which；　after　drinking　water　containing　worms；　a　person　passed　worms　in　the　urine。　In　the　old　Journal　de　physique　de　Rozier　is　an　account　of　a　man　of　forty…five　who　enjoyed　good　health；　but　who　periodically　urinated　small　worms　from　the　bladder。　They　were　described　as　being　about　1　1/2　lines　long；　and　caused　no　inconvenience。　There　is　also　mentioned　the　case　of　a　woman　who　voided　worms　from　the　bladder。　Tupper　describes　a　curious　case　of　a　woman　of　sixty…nine　who　complained　of　a　severe；　stinging　pain　that　completely　overcame　her　after　micturition。　An　ulceration　of　the　neck　of　the　bladder　was　suspected；　and　the　usual　remedies　were　applied；　but　without　effect。　An　examination　of　the　urine　was　negative。　On　recommendation　of　her　friends　the　patient；　before　going　to　bed；　steeped　and　drank　a　decoction　of　knot…grass。　During　the　night　she　urinated　freely；　and　claimed　that　she　had　passed　a　worm　about　ten　inches　long　and　of　the　size　of　a　knitting…needle。　It　exhibited　motions　like　those　of　a　snake；　and　was　quite　lively；　living　five　or　six　days　in　water。　The　case　seems　quite　unaccountable；　but　there　is；　of　course；　a　possibility　that　the　animal　had　already　been　in　the　chamber；　or　that　it　was　passed　by　the　bowel。　A　rectovaginal　or　vesical　fistula　could　account　for　the　presence　of　this　worm　had　it　been　voided　from　the　bowel；　nevertheless　the　woman　adhered　to　her　statement　that　she　had　urinated　the　worm；　and；　as　confirmatory　evidence；　never　complained　of　pain　after　passing　the　animal。

Foreign　bodies　in　the　bladder；　other　than　calculi　（which　will　be　spoken　of　in　Chapter　XV）；　generally　gain　entrance　through　one　of　the　natural　passages；　as　a　rule　being　introduced；　either　in　curiosity　or　for　perverted　satisfaction；　through　the　urethra。　Morand　mentions　an　instance　in　which　a　long　wax　taper　was　introduced　into　the　bladder　through　the　urethra　by　a　man。　At　the　University　Hospital；　Philadelphia；　White　has　extracted；　by　median　cystotomy；　a　long　wax　taper　which　had　been　used　in　masturbation。　The　cystoscopic　examination　in　this　case　was　negative；　and　the　man's　statements　were　disbelieved；　but　the　operation　was　performed；　and　the　taper　was　found　curled　up　and　covered　by　mucus　and　folds　of　the　bladder。　It　is　not　uncommon　for　needles；　hair…pins；　and　the　like　to　form　nuclei　for　incrustations。　Gross　found　three　caudal　vertebrae　of　a　squirrel　in　the　center　of　a　vesical　calculus　taken　from　the　bladder　of　a　man　of　thirty…five。　It　was　afterward　elicited　that　the　patient　had　practiced　urethral　masturbation　with　the　tail　of　this　animal。　Morand　relates　the　history　of　a　man　of　sixty…two　who　introduced　a　sprig　of　wheat　into　his　urethra　for　a　supposed　therapeutic　purpose。　It　slipped　into　the　bladder　and　there　formed　the　nucleus　of　a　cluster　calculus。　Dayot　reports　a　similar　formation　from　the　introduction　of　the　stem　of　a　plant。　Terrilon　describes　the　case　of　a　man　of　fifty…four　who　introduced　a　pencil　into　his　urethra。　The　body　rested　fifteen　days　in　this　canal；　and　then　passed　into　the　bladder。　On　the　twenty…eighth　day　he　had　a　chill；　and　during　two　days　made　successive　attempts　to　break　the　pencil。　Following　each　attempt　he　had　a　violent　chill　and　intense　evening　fever。　On　the　thirty…third　day　Terrilon　removed　the　pencil　by　operation。　Symptoms　of　perivesical　abscess　were　present；　and　seventeen　days　after　the　operation；　and　fifty　days　after　th