anomalies and curiosities of medicine-第183部分

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　supposed　to　swell　and　die。　If　the　dog　was　not　mad　the　cock　would　not　swell；　in　either　case　the　person　so　treated　was　immune。　Mad…stones；　as　well　as　snake…stones；　are　believed　in　by　some　persons　at　the　present　day。　According　to　Curran；　at　one　time　in　Ireland　the　fear　of　hydrophobia　was　so　great　that　any　person　supposed　to　be　suffering　from　it　could　be　legally　smothered。

According　to　French　statistics；　hydrophobia　is　an　extremely　fatal　disease；　although　the　proportion　of　people　bitten　and　escaping　without　infection　is　overwhelmingly　greater　than　those　who　acquire　the　disease。　The　mortality　of　genuine　hydrophobia　is　from　30　to　80　per　cent；　influenced　by　efficient　and　early　cauterization　and　scientific　treatment。　There　is　little　doubt　that　many　of　the　cases　reported　as　hydrophobia　are　merely　examples　of　general　systemic　infection　from　a　local　focus　of　sepsis；　made　possible　by　some　primitive　and　uncleanly　treatment　of　the　original　wound。　There　is　much　superstition　relative　to　hydrophobia；　the　majority　of　wounds　seen　are　filled　with　the　hair　of　the　dog；　soot；　ham…fat；　and　also　with　particles　of　decayed　food　and　saliva　from　the　mouth　of　some　person　who　has　practiced　sucking　the　wound。

Ordinarily；　the　period　of　incubation　of　hydrophobia　in　man　is　before　the　end　of　the　second　month；　although　rarely　cases　are　seen　as　many　as　six　months　from　the　reception　of　the　bite。　The　first　symptoms　of　the　disease　are　melancholia；　insomnia；　loss　of　appetite；　and　occasionally　shooting　pains；　radiating　from　the　wound。　There　may　be　severe　pain　at　the　back　of　the　head　and　in　the　neck。　Difficulty　in　swallowing　soon　becomes　a　marked　symptom。　The　speech　assumes　a　sobbing　tone；　and　occasionally　the　expression　of　the　face　is　wild　and　haggard。　As　regards　the　crucial　diagnostic　test　of　a　glass　of　water；　the　following　account　of　a　patient's　attempt　to　drink　is　given　by　Curtis　and　quoted　by　Warren：　〃A　glass　of　water　was　offered　the　patient；　which　he　refused　to　take；　saying　that　he　could　not　stand　so　much　as　that；　but　would　take　it　from　a　teaspoon。　On　taking　the　water　from　the　spoon　he　evinced　some　discomfort　and　agitation；　but　continued　to　raise　the　spoon。　As　it　came　within　a　foot　of　his　lips；　he　gagged　and　began　to　gasp　violently；　his　features　worked；　and　his　head　shook。　He　finally　almost　tossed　the　water　into　his　mouth；　losing　the　greater　part　of　it；　and　staggered　about　the　room　gasping　and　groaning。　At　this　moment　the　respirations　seemed　wholly　costal；　and　were　performed　with　great　effort；　the　elbows　being　jerked　upward　with　every　inspiration。　The　paroxysm　lasted　about　half　a　minute。　The　act　of　swallowing　did　not　appear　to　cause　distress；　for　he　could　go　through　the　motions　of　deglutition　without　any　trouble。　The　approach　of　liquid　toward　the　mouth　would；　however；　cause　distress。〃　It　is　to　be　remarked　that　the　spasm　affects　the　mechanism　of　the　respiratory　apparatus；　the　muscles　of　mastication　and　deglutition　being　only　secondarily　contracted。

Pasteur　discovered　that　the　virulence　of　the　virus　of　rabies　could　be　attenuated　in　passing　it　through　different　species　of　animals；　and　also　that　inoculation　of　this　attenuated　virus　had　a　decided　prophylactic　effect　on　the　disease；　hence；　by　cutting　the　spinal　cord　of　inoculated　animals　into　fragments　a　few　centimeters　long；　and　drying　them；　an　emulsion　could　be　made　containing　the　virus。　The　patients　are　first　inoculated　with　a　cord　fourteen　days　old；　and　the　inoculation　is　repeated　for　nine　days；　each　time　with　a　cord　one　day　fresher。　The　intensive　method　consists　in　omitting　the　weakest　cords　and　giving　the　inoculations　at　shorter　intervals。　As　a　curious　coincidence；　Pliny　and　Pasteur；　the　ancient　and　modern；　both　discuss　the　particular　virulence　of　saliva　during　fasting。

There　is　much　discussion　over　the　extent　of　injury　a　shark…bite　can　produce。　In　fact　some　persons　deny　the　reliability　of　any　of　the　so…called　cases　of　shark…bites。　Ensor　reports　an　interesting　case　occurring　at　Port　Elizabeth；　South　Africa。　While　bathing；　an　expert　swimmer　felt　a　sharp　pain　in　the　thigh；　and　before　he　could　cry　out；　felt　a　horrid　crunch　and　was　dragged　below　the　surface　of　the　water。　He　struggled　for　a　minute；　was　twisted　about；　shaken；　and　then　set　free；　and　by　a　supreme　effort；　reached　the　landing　stairs　of　the　jetty；　where；　to　his　surprise；　he　found　that　a　monstrous　shark　had　bitten　his　leg　off。　The　leg　had　been　seized　obliquely；　and　the　teeth　had　gone　across　the　joints；　wounding　the　condyles　of　the　femur。　There　were　three　marks　on　the　left　side　showing　where　the　fish　had　first　caught　him。　The　amputation　was　completed　at　once；　and　the　man　recovered。　Macgrigor　reports　the　case　of　a　man　at　a　fishery；　near　Manaar；　who　was　bitten　by　a　shark。　The　upper　jaw　of　the　animal　was　fixed　in　the　left　side　of　the　belly；　forming　a　semicircular　wound　of　which　a　point　one　inch　to　the　left　of　the　umbilicus　was　the　upper　boundary；　and　the　lower　part　of　the　upper　third　of　the　thigh；　the　lower　boundary。　The　abdominal　and　lumbar　muscles　were　divided　and　turned　up；　exposing　the　colon　in　its　passage　across　the　belly。　Several　convolutions　of　the　small　intestines　were　also　laid　bare；　as　were　also　the　three　lowest　ribs。　The　gluteal　muscles　were　lacerated　and　torn；　the　tendons　about　the　trochanter　divided；　laying　the　bone　bare；　and　the　vastus　externus　and　part　of　the　rectus　of　the　thigh　were　cut　across。　The　wound　was　19　inches　in　length　and　four　or　five　inches　in　breadth。　When　Dr。　Kennedy　first　saw　the　patient　he　had　been　carried　in　a　boat　and　then　in　a　palanquin　for　over　five　miles；　and　at　this　time；　three　hours　after　the　reception　of　the　wound；　Kennedy　freed　the　abdominal　cavity　of　salt　water　and　blood；　thoroughly　cleansed　the　wound　of　the　hair　and　the　clots；　and　closed　it　with　adhesive　strips。　By　the　sixteenth　day　the　abdominal　wound　had　perfectly　closed；　the　lacerations　granulated　healthily；　and　the　man　did　well。　Boyle　reports　recovery　from　extensive　lacerated　wounds　from　the　bite　of　a　shark。　Both　arms　were　amputated　as　a　consequence　of　the　injuries。　Fayrer　mentions　shark…bites　in　the　Hooghley。

Leprosy　from　a　Fish…bite。Ashmead　records　the　curious　case　of　a　man　that　had　lived　many　years　in　a　leprous　country；　and　while　dressing　a　fish　had　received　a　wound　of　the　thumb　from　the　fin　of　the　fish。　Swelling　of　the　arm　followed；　and　soon　after　bullae　upon　the　chest；　head；　and　face。　In　a　few　months　the　blotches　left　from　this　eruption　became　leprous　tubercles；　and　other　well…marked　signs　of　the　malady　followed。　The　author　asked　if　in　this　case　we　have　to　do　with　a　latent　leprosy　which　was　evoked　by　the　wound；　or　if　it　were　a　case　of　inoculation　from　the　fish？

Cutliffe　records　recovery　after　amputation　at　the　elbow…joint；　as　a　consequence　of　an　alligator…bite　nine　days　before　admission　to　the　hospital。　The　patient　exhibited　a　compound　comminuted　fracture　of　the　right　radius　and　ulna　in　their　lower　thirds；　compound　comminuted　fractures　of　the　bones　of　the　carpus　and　metacarpus；　with　great　laceration　of　the　soft　parts；　laying　bare　the　wrist…joint；　besides　several　penetrating　wounds　of　the　arm　and　fore…arm。　Mourray　gives　some　notes　on　a　case　of　crocodile…bite　with　removal　of　a　large　portion　of　omentum。　Sircar　speaks　of　recovery　from　a　crocodile…bite。　Dudgeon　reports　two　cases　of　animal…bites；　both　fatal；　one　by　a　bear；　and　the　other　by　a　camel。　There　is　mention　of　a　compound　dislocation　of　the　wrist…joint　from　a　horse…bite。　Fayrer　speaks　of　a　wolf…bite　of　the　forearm；　followed　by　necrosis　and　hemorrhage；　necessitating　ligature　of　the　brachial　artery　and　subsequent　excision　of　the　elbow…joint。

Injuries　from　Lightning。The　subject　of　lightning…stroke；　with　its　diverse　range　of　injuries；　is　of　considerable　interest；　and；　though　not　uncommon；　the　matter　is　surrounded　by　a　veil　of　superstition　and　mystery。　It　is　well　known　that　instantaneous　or　temporary　unconsciousness　may　result　from　lightning…stroke。　Sometimes　superficial　or　deep　burns　may　be　the　sole　result；　and　again　paralysis　of　the　general　nerves；　such　as　those　of　sensation　and　motion；　may　be　occasioned。　For　many　years　the　therapeutic　effect　of　a　lightning…stroke　has　been　believed　to　be　a　possibility；　and　numerous　instances　are　on　record。　The　object　of　this　article　will　be　to　record　a　sufficient　number　of　cases　of　lightning…stroke　to　enable　the　reader　to　judge　of　its　various　effects；　and　form　his　own　opinion　of　the　good　or　evil　of　the　injury。　It　must　be　mentioned　here　that　half　a　century　ago　Le　Conte　wrote　a　most　extensive　article　on　this　subject；　which；　to　the　present　time；　has　hardly　been　improved　upon。

The　first　cases　to　be　recorded　are　those　in　which　there　has　been　complete　and　rapid　recovery　from　lightning…stroke。　Crawford　mentions　a　woman　who；　while　sitting　in　front　of　her　fireplace　on　the　first　floor　of　a　two…story　frame　building；　heard　a　crash　about　her；　and　realized　that　the　house　had　been　struck　by　lightning。　The　lightning　had　torn　all　the　weather…boarding　off　the　house；　and　had　also　followed　a　spouting　which　terminated　in　a　wooden　trough　in　a　pig…sty；　ten　feet　back　of　the　house；　and　killed　a　pig。　Another　branch　of　the　fluid　passed　through　the　inside　of　the　building　and；　running　along　the　upper　floor　to　directly　over　where　Mrs。　F。　was　sitting；　passed　through　the　floor　and　descended　upon　the　top　of　her　left　shoulder。　Her　left　arm　was　lying　across　her　abdomen　at　the　time；　the　points　of　the　fingers　resting　on　the　crests　of　the　ilium。　There　was　a　rent　in　the　dress　at　the　top　of　the　shoulder；　and　a　red　line　half　an　inch　wide　running　from　thence　along　the　inside　of　the　arm　and　fore…arm。　In　some　places　there　was　complete　vesication；　and　on　its　palmer　surface　the　hand　lying　on　the　abdomen　was　completely　denuded。　The　abdomen；　for　a　space　of　four　inches　in　length　and　eight　inches　in　breadth；　was　also　blistered。　The　fluid　then　passed　from　the　fingers　to　the　crest　of　the　ilium；　and　down　the　outside　of　the　leg；　bursting　open　the　shoes；　and　passing　then　through　the　floor。　Again　a　red　line　half　an　inch　wide　could　be　traced　from　the　ilium　to　the　toes。　The　clothing　was　not　scorched；　but　only　slightly　rent　at　the　point　of　the　shoulder　and　where　the　fingers　rested。　This　woman　was　neither　knocked　off　her　chair　nor　stunned；　and　she　felt　no　shock　at　the　time。　After　ordinary　treatment　for　her　burns　she　made　rapid　and