anomalies and curiosities of medicine-第186部分

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d　seven　days　old；　taken　from　the　abdominal　wall　and　even　from　the　tail；　was　used　with　most　satisfactory　results　in　grafting　an　extensive　ulcer　following　a　burn　on　the　left　leg　of　a　boy　of　ten。　Masterman　has　grafted　with　the　inner　membrane　of　a　hen's　egg；　and　a　Mexican　surgeon；　Altramirano；　used　the　gills　of　a　cock。

Fowler　of　Brooklyn　has　grafted　with　the　skin　from　the　back　and　abdomen　of　a　large　frog。　The　patient　was　a　colored　boy　of　sixteen；　who　was　extensively　burned　by　a　kerosene　lamp。　The　burns　were　on　the　legs；　thighs；　buttocks；　and　right　ankle；　and　the　estimated　area　of　burnt　surface　was　247。95　square　inches。　The　frog　skin　was　transferred　to　the　left　buttocks；　and　on　the　right　buttocks　eight　long　strips　of　white　skin　were　transferred　after　the　manner　of　Thiersch。　A　strip　of　human　skin　was　placed　in　one　section　over　the　frog　skin；　but　became　necrotic　in　four　days；　not　being　attached　to　the　granulating　surface。　The　man　was　discharged　cured　in　six　months。　The　frog　skin　was　soft；　pliable；　and　of　a　reddish　hue；　while　the　human　white　skin　was　firm　and　rapidly　becoming　pigmented。　Leale　cites　the　successful　use　of　common　warts　in　a　case　of　grafting　on　a　man　of　twenty　who　was　burned　on　the　foot　by　a　stream　of　molten　metal。　Leale　remarks　that　as　common　warts　of　the　skin　are　collections　of　vascular　papillae；　admitting　of　separation　without　injury　to　their　exceptionally　thick　layer　of　epidermis；　they　are　probably　better　for　the　purposes　of　skin…grafting　than　ordinary　skin　of　less　vitality　or　vascularity。　Ricketts　has　succeeded　in　grafting　the　skin　of　a　frog　to　that　of　a　tortoise；　and　also　grafting　frog　skin　to　human　skin。　Ricketts　remarks　that　the　prepuce　of　a　boy　is　remarkably　good　material　for　grafting。　Sponge…grafts　are　often　used　to　hasten　cicatrization　of　integumental　wounds。　There　is　recorded　an　instance　in　which　the　breast　of　a　crow　and　the　back　of　a　rat　were　grafted　together　and　grew　fast。　The　crow　dragged　the　rat　along；　and　the　two　did　not　seem　to　care　to　part　company。

Relative　to　skin…grafting　proper；　Bartens　succeeded　in　grafting　the　skin　of　a　dead　man　of　seventy　on　a　boy　of　fourteen。　Symonds　reports　cases　of　skin…grafting　of　large　flaps　from　amputated　limbs；　and　says　this　method　is　particularly　available　in　large　hospitals　where　they　have　amputations　and　grafts　on　the　same　day。　Martin　has　shown　that；　after　many　hours　of　exposure　in　the　open　air　at　a　temperature　of　nearly　32　degrees　F。；　grafts　could　be　successfully　applied；　but　in　such　temperatures　as　82　degrees　F。；　exposure　of　from　six　to　seven　hours　destroyed　their　vitality；　so　that　if　kept　cool；　the　limb　of　a　healthy　individual　amputated　for　some　accident；　may　be　utilized　for　grafting　purposes。

Reverdin　originated　the　procedure　of　epidermic　grafting。　Small　grafts　the　size　of　a　pin…head　doing　quite　as　well　as　large　ones。　Unfortunately　but　little　diminution　of　the　cicatricial　contraction　is　effected　by　Reverdin's　method。　Thiersch　contends　that　healing　of　a　granulated　surface　results　first　from　a　conversion　of　the　soft；　vascular　granulation…papillae；　by　contraction　of　some　of　their　elements　into　young　connective…tissue　cells；　into　〃dry；　cicatricial　papillae；〃　actually　approximating　the　surrounding　tissues。　thus　diminishing　the　area　to　be　covered　by　epidermis；　and；　secondly；　by　the　covering　of　these　papillae　by　epidermic　cells。　Thiersch　therefore　recommends　that　for　the　prevention　of　cicatricial　contraction；　the　grafting　be　performed　with　large　strips　of　skin。

Harte　gives　illustrations　of　a　case　of　extensive　skin…grafting　on　the　thigh　from　six　inches　above　the　great　trochanter　well　over　the　median　line　anteriorly　and　over　the　buttock。　This　extent　is　shown　in　Figure　228；　taken　five　months　after　the　accident；　when　the　granulations　had　grown　over　the　edge　about　an　inch。　Figure　229　shows　the　surface　of　the　wound；　six　and　one…half　months　after　the　accident　and　three　months　after　the　applications　of　numerous　skin…grafts。

Cases　of　self…mutilation　may　be　divided　into　three　classes：those　in　which　the　injuries　are　inflicted　in　a　moment　of　temporary　insanity　from　hallucinations　or　melancholia；　with　suicidal　intent；　and　in　religious　frenzy　or　emotion。　Self…mutilation　is　seen　in　the　lower　animals；　and　Kennedy；　in　mentioning　the　case　of　a　hydrocephalic　child　who　ate　off　its　entire　under　lip；　speaks　also　of　a　dog；　of　cats；　and　of　a　lioness　who　ate　off　their　tails。　Kennedy　mentions　the　habit　in　young　children　of　biting　the　finger…nails　as　an　evidence　of　infantile　trend　toward　self…mutilation。　In　the　same　discussion　Collins　states　that　he　knew　of　an　instance　in　India　in　which　a　horse　lay　down；　deliberately　exposing　his　anus；　and　allowing　the　crows　to　pick　and　eat　his　whole　rectum。　In　temporary　insanity；　in　fury；　or　in　grief；　the　lower　animals　have　been　noticed　by　naturalists　to　mutilate　themselves。

Self…mutilation　in　man　is　almost　invariably　the　result　of　meditation　over　the　generative　function；　and　the　great　majority　of　cases　of　this　nature　are　avulsions　or　amputations　of　some　parts　of　the　genitalia。　The　older　records　are　full　of　such　instances。　Benivenius；　Blanchard；　Knackstedt；　and　Schenck　cite　cases。　Smetius　mentions　castration　which　was　effected　by　using　the　finger…nails；　and　there　is　an　old　record　in　which　a　man　avulsed　his　own　genitals。　Scott　mentions　an　instance　in　which　a　man　amputated　his　genitals　and　recovered　without　subsequent　symptoms。　Gockelius　speaks　of　self…castration　in　a　ruptured　man；　and　Golding；　Guyon；　Louis；　Laugier；　the　Ephemerides；　Alix；　Marstral；　and　others；　record　instances　of　self…　castration。　In　his　Essays　Montaigne　mentions　an　instance　of　complete　castration　performed　by　the　individual　himself。

Thiersch　mentions　a　case　of　a　man　who　circumcised　himself　when　eighteen。　He　married　in　1870；　and　upon　being　told　that　he　was　a　father　he　slit　up　the　hypogastrium　from　the　symphysis　pubis　to　the　umbilicus；　so　that　the　omentum　protruded；　he　said　his　object　was　to　obtain　a　view　of　the　interior。　Although　the　knife　was　dirty　and　blunt；　the　wound　healed　after　the　removal　of　the　extruding　omentum。　A　year　later　he　laid　open　one　side　of　the　scrotum。　The　prolapsed　testicle　was　replaced；　and　the　wound　healed　without　serious　effect。　He　again　laid　open　his　abdomen　in　1880；　the　wound　again　healing　notwithstanding　the　prolapse　of　the　omentum。　In　May　of　the　same　year　he　removed　the　right　testicle；　and　sewed　the　wound　up　himself。　Four　days　later　the　left　was　treated　the　same　way。　The　spermatic　cord　however　escaped；　and　a　hematoma；　the　size　of　a　child's　head；　formed　on　account　of　which　he　had　to　go　to　the　hospital。　This　man　acted　under　an　uncontrollable　impulse　to　mutilate　himself；　and　claimed　that　until　he　castrated　himself　he　had　no　peace　of　mind。

There　is　a　similar　report　in　an　Italian　journal　which　was　quoted　in　London。　It　described　a　student　at　law；　of　delicate　complexion；　who　at　the　age　of　fourteen　gave　himself　up　to　masturbation。　He　continually　studied　until　the　age　of　nineteen；　when　he　fell　into　a　state　of　dulness；　and　complained　that　his　head　felt　as　if　compressed　by　a　circle　of　fire。　He　said　that　a　voice　kept　muttering　to　him　that　his　generative　organs　were　abnormally　deformed　or　the　seat　of　disease。　After　that；　he　imagined　that　he　heard　a　cry　of　〃amputation！　amputation！〃　Driven　by　this　hallucination；　he　made　his　first　attempt　at　self…mutilation　ten　days　later。　He　was　placed　in　an　Asylum　at　Astino　where；　though　closely　watched；　he　took　advantage　of　the　first　opportunity　and　cut　off　two…thirds　of　his　penis；　when　the　delirium　subsided。　Camp　describes　a　stout　German　of　thirty…five　who；　while　suffering　from　delirium　tremens；　fancied　that　his　enemies　were　trying　to　steal　his　genitals；　and　seizing　a　sharp　knife　he　amputated　his　penis　close　to　the　pubes。　He　threw　the　severed　organ　violently　at　his　imaginary　pursuers。　The　hemorrhage　was　profuse；　but　ceased　spontaneously　by　the　formation　of　coagulum　over　the　mouth　of　the　divided　vessels。　The　wound　was　quite　healed　in　six　weeks；　and　he　was　discharged　from　the　hospital；　rational　and　apparently　content　with　his　surgical　feat。

Richards　reports　the　case　of　a　Brahman　boy　of　sixteen　who　had　contracted　syphilis；　and　convinced；　no　doubt；　that　〃nocit　empta　dolore　voluptus；〃　he　had　taken　effective　means　of　avoiding　injury　in　the　future　by　completely　amputating　his　penis　at　the　root。　Some　days　after　his　admission　to　the　hospital　he　asked　to　be　castrated；　stating　that　he　intended　to　become　an　ascetic；　and　the　loss　of　his　testes　as　well　as　of　his　penis　appeared　to　him　to　be　an　imperative　condition　to　the　attainment　of　that　happy　consummation。　Chevers　mentions　a　somewhat　similar　case　occurring　in　India。

Sands　speaks　of　a　single　man　of　thirty　who　amputated　his　penis。　He　gave　an　incomplete　history　of　syphilis。　After　connection　with　a　woman　he　became　a　confirmed　syphilophobe　and　greatly　depressed。　While　laboring　under　the　hallucination　that　he　was　possessed　of　two　bodies　he　tied　a　string　around　the　penis　and　amputated　the　organ　one　inch　below　the　glans。　On　loosening　the　string；　three　hours　afterward；　to　enable　him　to　urinate；　he　lost　three　pints　of　blood；　but　he　eventually　recovered。　In　the　Pennsylvania　Hospital　Reports　there　is　an　account　of　a　married　man　who；　after　drinking　several　weeks；　developed　mania　a　potu；　and　was　found　in　his　room　covered　with　blood。　His　penis　was　completely　cut　off　near　the　pubes；　and　the　skin　of　the　scrotum　was　so　freely　incised　that　the　testicles　were　entirely　denuded；　but　not　injured。　A　small　silver　cap　was　made　to　cover　the　sensitive　urethra　on　a　line　with　the　abdominal　wall。

There　is　a　record　of　a　tall；　powerfully…built　Russian　peasant　of　twenty…nine；　of　morose　disposition；　who　on　April　3d；　while　reading　his　favorite　book；　without　uttering　a　cry；　suddenly　and　with　a　single　pull　tore　away　his　scrotum　together　with　his　testes。　He　then　arose　from　the　bank　where　he　had　been　sitting；　and　quietly　handed　the　avulsed　parts　to　his　mother　who　was　sitting　near　by；　saying　to　her：　〃Take　that；　I　do　not　want　it　any　more。〃　To　all　questions　from　his　relatives　he　asked　pardon　and　exemption　from　blame；　but　gave　no　reason　for　his　act。　This　patient　made　a　good　recovery　at　the　hospital。　Alexeef；　another　Russian；　speaks　of　a　similar　injury　occurring　during　an　attack　of　delirium　tremens。

Black　details　the　history　of　a　young　man