anomalies and curiosities of medicine-第202部分

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s　paradise　dwell　the　dwarfs；　perhaps　as　degraded　a　race　of　men　and　women　as　may　be　found　in　any　civilized　community。　They　are　almost　without　education；　and　inhabit　wretched　huts　when　they　have　any　shelter。　The　most　intelligent　are　employed　as　shepherds；　and　in　summer　they　live　for　months　at　an　elevation　of　more　than　6000　feet　without　shelter。　Here　they　see　no　human　creature　save　some　of　their　own　kind；　often　idiots；　who　are　sent　up　every　fifteen　or　twenty　days　with　a　supply　of　food。

〃It　is　said　that　formal　marriage　is　almost　unknown　among　them。　The　women　in　some　instances　are　employed　in　the　village　of　Ribas　as　nurses　for　children；　and　as　such　are　found　tender　and　faithful。　Before　communication　throughout　the　region　was　as　easy　as　it　is　now；　it　was　thought　lucky　to　have　one　of　these　dwarfs　in　a　family；　and　the　dwarfs　were　hired　out　and　even　sold　to　be　used　in　beggary　in　neighboring　cities。　There　are　somewhat　similar　dwarfs　in　other　valleys　of　the　Pyrenees；　but　the　number　is　decreasing；　and　those　of　the　Ribas　Valley　are　reduced　to　a　few　individuals。〃

Hiccough　is　a　symptom　due　to　intermittent；　sudden　contraction　of　the　diaphragm。　Obstinate　cases　are　most　peculiar；　and　sometimes　exhaust　the　physician's　skill。　Symes　divides　these　cases　into　four　groups：

（1）　Inflammatory；　seen　particularly　in　inflammatory　diseases　of　the　viscera　or　abdominal　membranes；　and　in　severe　cases　of　typhoid　fever。

（2）　Irritative；　as　in　direct　stimulus　of　the　diaphragm　in　swallowing　some　very　hot　substance；　local　disease　of　the　esophagus　near　the　diaphragm；　and　in　many　conditions　of　gastric　and　intestinal　disorder；　more　particularly　those　associated　with　flatus。

（3）　Specific　or　idiopathic；　in　which　there　are　no　evident　causes　present；　it　is　sometimes　seen　in　cases　of　nephritis　and　diabetes。

（4）　Neurotic；　in　which　the　primary　cause　is　in　the　nervous　system；hysteria；　epilepsy；　shock；　or　cerebral　tumors。

The　obstinacy　of　continued　hiccough　has　long　been　discussed。　Osler　calls　to　mind　that　in　Plato's　〃Symposium〃　the　physician；　Eryximachus；　recommended　to　Aristophanes；　who　had　hiccough　from　eating　too　much；　either　to　hold　his　breath　or　to　gargle　with　a　little　water；　but　if　it　still　continued；　〃tickle　your　nose　with　something　and　sneeze；　and　if　you　sneeze　once　or　twice　even　the　most　violent　hiccough　is　sure　to　go。〃　The　attack　must　have　been　a　severe　one；　as　it　is　stated　subsequently　that　the　hiccough　did　not　disappear　until　Aristophanes　had　excited　the　sneezing。

Among　the　older　medical　writers　Weber　speaks　of　singultus　lasting　for　five　days；　Tulpius；　for　twelve　days；　Eller　and　Schenck；　for　three　months；　Taranget；　for　eight　months；　and　Bartholinus；　for　four　years。

At　the　present　day　it　is　not　uncommon　to　read　in　the　newspapers　accounts　of　prolonged　hiccoughing。　These　cases　are　not　mythical；　and　are　paralleled　by　a　number　of　instances　in　reliable　medical　literature。　The　cause　is　not　always　discernible；　and　cases　sometimes　resist　all　treatment。

Holston　reports　a　case　of　chronic　singultus　of　seven　years'　standing。　It　had　followed　an　attack　of　whooping…cough；　and　was　finally　cured　apparently　by　the　administration　of　strychnin。　Cowan　speaks　of　a　shoemaker　of　twenty…two　who　experienced　an　attack　of　constant　singultus　for　a　week；　and　then　intermittent　attacks　for　six　years。　Cowan　also　mentions　instances　of　prolonged　hiccough　related　by　Heberden；　Good；　Hoffman；　and　Wartmouth。　Barrett　is　accredited　with　reporting　a　case　of　persistent　hiccough　in　a　man　of　thirty…five。　Rowland　speaks　of　a　man　of　thirty…five　who　hiccoughed　for　twelve　years。　The　paroxysms　were　almost　constant；　and　occurred　once　or　twice　a　minute　during　the　hours　when　the　man　was　not　sleeping。　There　was　no　noise　with　the　cough。　There　is　another　case　related　in　the　same　journal　of　a　man　who　died　on　the　fourth　day　of　an　attack　of　singultus；　probably　due　to　abscess　of　the　diaphragm；　which　no　remedy　would　relieve。　Moore　records　a　case　of　a　child；　injured　when　young；　who　hiccoughed　until　about　twenty　years　of　age　（the　age　at　the　time　of　report）。　Foot　mentions　a　lad　of　fifteen　who；　except　when　asleep；　hiccoughed　incessantly　for　twenty…two　weeks；　and　who　suffered　two　similar；　but　less　severe；　attacks　in　the　summer　of　1879；　and　again　in　1880。　The　disease　was　supposed　to　be　due　to　the　habit　of　pressing　the　chest　against　the　desk　when　at　school。　Dexter　reports　a　case　of　long…continued　singultus　in　an　Irish　girl　of　eighteen；　ascribed　to　habitual　masturbation。　There　was　no　intermission　in　the　paroxysm；　which　increased　in　force　until　general　convulsions　ensued。　The　patient　said　that　the　paroxysm　could　be　stopped　by　firm　pressure　on　the　upper　part　of　the　external　genital　organs。　Dexter　applied　firm　pressure　on　her　clitoris；　and　the　convulsions　subsided；　and　the　patient　fell　asleep。　They　could　be　excited　by　firm　pressure　on　the　lower　vertebrae。　Corson　speaks　of　a　man　of　fifty…seven　who；　after　exposure　to　cold；　suffered　exhausting　hiccough　for　nine　days；　and　also　records　the　case　of　an　Irish　servant　who　suffered　hiccough　for　four　months；　the　cause　was　ascribed　to　fright。　Stevenson　cites　a　fatal　instance　of　hiccough　in　a　stone…mason　of　forty…four　who　suffered　continuously　from　May　14th　to　May　28th。　The　only　remedy　that　seemed　to　have　any　effect　in　this　case　was　castor…oil　in　strong　purgative　doses。

Willard　speaks　of　a　man　of　thirty…four　who　began　to　hiccough　after　an　attack　of　pneumonia；　and　continued　for　eighty…six　hours。　The　treatment　consisted　of　the　application　of　belladonna　and　cantharides　plasters；　bismuth；　and　lime…water；　camphor；　and　salts　of　white　hellebore　inhaled　through　the　nose　in　finest　powder。　Two　other　cases　are　mentioned　by　the　same　author。　Gapper　describes　the　case　of　a　young　man　who　was　seized　with　loud　and　distressing　hiccough　that　never　ceased　for　a　minute　during　eighty　hours。　Two　ounces　of　laudanum　were　administered　in　the　three　days　without　any　decided　effect；　producing　only　slight　languor。

Ranney　reports　the　case　of　an　unmarried　woman　of　forty…four　who　suffered　from　paroxysms　of　hiccough　that　persisted　for　four　years。　A　peculiarity　of　this　attack　was　that　it　invariably　followed　movements　of　the　upper　extremities。　Tenderness　and　hyperesthesia　over　the　spinous　processes　of　the　4th；　5th；　and　6th　cervical　vertebrae　led　to　the　application　of　the　thermocautery；　which；　in　conjunction　with　the　administration　of　ergot　and　bromide；　was　attended　with　marked　benefit；　though　not　by　complete　cure。　Barlow　mentions　a　man　with　a　rheumatic　affection　of　the　shoulder　who　hiccoughed　when　he　moved　his　joints。　Barlow　also　recites　a　case　of　hiccough　which　was　caused　by　pressure　on　the　cicatrix　of　a　wound　in　the　left　hand。

Beilby　reports　a　peculiar　case　in　a　girl　of　seventeen　who　suffered　an　anomalous　affection　of　the　respiratory　muscle；　producing　a　sound　like　a　cough；　but　shriller；　almost　resembling　a　howl。　It　was　repeated　every　five　or　six　seconds　during　the　whole　of　the　waking　moments；　and　subsided　during　sleep。　Under　rest　and　free　purgation　the　patient　recovered；　but　the　paroxysms　continued　during　prolonged　intervals；　and　in　the　last　six　years　they　only　lasted　from　twenty…four　to　forty…eight　hours。

Parker　reports　four　rebellious　cases　of　singultus　successfully　treated　by　dry　cups　applied　to　the　abdomen。　In　each　case　it　was　necessary　to　repeat　the　operation　after　two　hours；　but　recovery　was　then　rapid。　Tatevosoff　reports　a　brilliant　cure　in　a　patient　with　chronic　chest　trouble；　by　the　use　of　common　snuff；　enough　being　given　several　times　to　induce　lively　sneezing。　Griswold　records　a　successful　treatment　of　one　case　in　a　man　of　fifty；　occurring　after　a　debauch；　by　the　administration　of　glonoin；　1/150　of　a　grain　every　three　hours。　Heidenhain　records　a　very　severe　and　prolonged　case　caused；　as　shown　later　at　the　operation　and　postmortem　examination；　by　carcinoma　of　the　pancreas。　The　spasms　were　greatly　relieved　by　cocain　administered　by　the　mouth；　as　much　as　15　grains　being　given　in　twelve　hours。　Laborde　and　Lepine　report　the　case　of　a　young　girl　who　was　relieved　of　an　obstinate　case　of　hiccough　lasting　four　days　by　traction　on　her　tongue。　After　the　tongue　had　been　held　out　of　the　mouth　for　a　few　minutes　the　hiccoughs　ceased。　Laborde　referred　to　two　cases　of　a　similar　character　reported　by　Viand。

Anomalous　Sneezing。In　the　olden　times　sneezing　was　considered　a　good　omen；　and　was　regarded　as　a　sacred　sign　by　nearly　all　of　the　ancient　peoples。　This　feeling　of　reverence　was　already　ancient　in　the　days　of　Homer。　Aristotle　inquired　into　the　nature　and　origin　of　the　superstition；　somewhat　profanely　wondering　why　sneezing　had　been　deified　rather　than　coughing。　The　Greeks　traced　the　origin　of　the　sacred　regard　for　sneezing　to　the　days　of　Prometheus；　who　blessed　his　man　of　clay　when　he　sneezed。　According　to　Seguin　the　rabbinical　account　says　that　only　through　Jacob's　struggle　with　the　angel　did　sneezing　cease　to　be　an　act　fatal　to　man。　Not　only　in　Greece　and　Rome　was　sneezing　revered；　but　also　by　races　in　Asia　and　Africa；　and　even　by　the　Mexicans　of　remote　times。　Xenophon　speaks　of　the　reverence　as　to　sneezing；　in　the　court　of　the　King　of　Persia。　In　Mesopotamia　and　some　of　the　African　towns　the　populace　rejoiced　when　the　monarch　sneezed。　In　the　present　day　we　frequently　hear　〃God　bless　you〃　addressed　to　persons　who　have　just　sneezed；　a　perpetuation　of　a　custom　quite　universal　in　the　time　of　Gregory　the　Great；　in　whose　time；　at　a　certain　season；　the　air　was　filled　with　an　unwholesome　vapor　or　malaria　which　so　affected　the　people　that　those　who　sneezed　were　at　once　stricken　with　death…agonies。　In　this　strait　the　pontiff　is　said　to　have　devised　a　form　of　prayer　to　be　uttered　when　the　paroxysm　was　seen　to　be　coming　on；　and　which；　it　was　hoped；　would　avert　the　stroke　of　the　death…angel。

There　are　some　curious　cases　of　anomalous　sneezing　on　record；　some　of　which　are　possibly　due　to　affections　akin　to　our　present　〃hay　fever；〃　while　others　are　due　to　causes　beyond　our　comprehension。　The　Ephemerides　records　a　paroxysm　of　continual　sneezing　lasting　thirty　days。　Bonet；　Lancisi；　Fabricius　Hildanus；　and　other　older　observers　speak　of　sneezing　to　death。　Morgagni　mentions　death　from　congestion　of　the　vasa　cerebri　caused　by　sneezing。　The　Ephemerides　records　an　instance　of　prolonged　sneezing　which　was　distinctly　hereditary。