anomalies and curiosities of medicine-第203部分

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sneezing。　The　Ephemerides　records　an　instance　of　prolonged　sneezing　which　was　distinctly　hereditary。

Ellison　makes　an　inquiry　for　treatment　of　a　case　of　sneezing　in　a　white　child　of　ten。　The　sneezing　started　without　apparent　cause　and　would　continue　20　or　30　times；　or　until　the　child　was　exhausted；　and　then　stop　for　a　half　or　one　minute；　only　to　relapse　again。　Beilby　speaks　of　a　boy　of　thirteen　who　suffered　constant　sneezing　（from　one　to　six　times　a　minute）　for　one　month。　Only　during　sleep　was　there　any　relief。　The　patient　recovered　under　treatment　consisting　of　active　leeching；　purgation；　and　blisters　applied　behind　the　ear；　together　with　the　application　of　olive　oil　to　the　nostrils。

Lee　reports　a　remarkable　case　of　yawning　followed　by　sneezing　in　a　girl　of　fifteen　who；　just　before；　had　a　tooth　removed　without　difficulty。　Half　an　hour　afterward　yawning　began　and　continued　for　five　weeks　continuously。　There　was　no　pain；　no　illness；　and　she　seemed　amused　at　her　condition。　There　was　no　derangement　of　the　sexual　or　other　organs　and　no　account　of　an　hysteric　spasm。　Potassium　bromid　and　belladonna　were　administered　for　a　few　days　with　negative　results；　when　the　attacks　of　yawning　suddenly　turned　to　sneezing。　One　paroxysm　followed　another　with　scarcely　an　interval　for　speech。　She　was　chloroformed　once　and　the　sneezing　ceased；　but　was　more　violent　on　recovery　therefrom。　Ammonium　bromid　in　half…drachm　doses；　with　rest　in　bed　for　psychologic　reasons；　checked　the　sneezing。　Woakes　presented　a　paper　on　what　he　designated　〃ear…sneezing；〃　due　to　the　caking　of　cerumen　in　one　ear。　Irritation　of　the　auricular　branch　of　the　vagus　was　produced；　whence　an　impression　was　propagated　to　the　lungs　through　the　pulmonary　branches　of　the　vagus。　Yawning　was　caused　through　implication　of　the　third　division　of　the　5th　nerve；　sneezing　following　from　reflex　implication　of　the　spinal　nerves　of　respiration；　the　lungs　being　full　of　air　at　the　time　of　yawning。　Woakes　also　speaks　of　〃ear…giddiness〃　and　offers　a　new　associate　symptomsuperficial　congestion　of　the　hands　and　forearm。

A　case　of　anomalous　sneezing　immediately　prior　to　sexual　intercourse　is　mentioned　on　page　511。

Hemophilia　is　an　hereditary；　constitutional　fault；　characterized　by　a　tendency　to　uncontrollable　bleeding；　either　spontaneous　or　from　slight　wounds。　It　is　sometimes　associated　with　a　form　of　arthritis　（Ogler）。　This　hemorrhagic　diathesis　has　been　known　for　many　years；　and　the　fact　that　there　were　some　persons　who　showed　a　peculiar　tendency　to　bleed　after　wounds　of　a　trifling　nature　is　recorded　in　some　of　the　earliest　medical　literature。　Only　recently；　however；　through　the　writings　of　Buel；　Otto；　Hay；　Coates；　and　others；　has　the　hereditary　nature　of　the　malady　and　its　curious　mode　of　transmission　through　the　female　line　been　known。　As　a　rule　the　mother　of　a　hemophile　is　not　a　〃bleeder〃　herself；　but　is　the　daughter　of　one。　The　daughters　of　a　hemophile；　though　healthy　and　free　from　any　tendency　themselves；　are　almost　certain　to　transmit　the　disposition　to　the　male　offspring。　The　condition　generally　appears　after　some　slight　injury　in　the　first　two　years　of　life；　but　must　be　distinguished　from　the　hemorrhagic　affections　of　the　new…born；　which　will　be　discussed　later。　The　social　condition　of　the　family　does　not　alter　the　predisposition；　the　old　Duke　of　Albany　was　a　〃bleeder〃；　and　bleeder　families　are　numerous；　healthy　looking；　and　have　fine；　soft　skins。

The　duration　of　this　tendency；　and　its　perpetuation　in　a　family；　is　remarkable。　The　Appleton…Swain　family　of　Reading；　Mass。；　has　shown　examples　for　two　centuries。　Osler　has　been　advised　of　instances　already　occurring　in　the　seventh　generation。　Kolster　has　investigated　hemophilia　in　women；　and　reports　a　case　of　bleeding　in　the　daughter　of　a　hemophilic　woman。　He　also　analyzes　50　genealogic　trees　of　hemophilic　families；　and　remarks　that　Nasse's　law　of　transmission　does　not　hold　true。　In　14　cases　the　transmission　was　direct　from　the　father　to　the　child；　and　in　11　cases　it　was　direct　from　the　mother　to　the　infant。

The　hemorrhagic　symptoms　of　bleeders　may　be　divided　into　external　bleedings；　either　spontaneous　or　traumatic；　interstitial　bleedings；　petechiae；　and　ecchymoses；　and　the　joint…affections。　The　external　bleedings　are　seldom　spontaneous；　and　generally　follow　cuts；　bruises；　scratches；　and　often　result　seriously。　A　minor　operation　on　a　hemophile　may　end　in　death；　so　slight　an　operation　as　drawing　a　tooth　has　been　followed　by　the　most　disastrous　consequences。

Armstrong；　Blagden；　and　Roberts；　have　seen　fatal　hemorrhage　after　the　extraction　of　teeth。　MacCormac　observed　five　bleeders　at　St。　Thomas　Hospital；　London；　and　remarks　that　one　of　these　persons　bled　twelve　days　after　a　tooth…extraction。　Buchanan　and　Clay　cite　similar　instances。　Cousins　mentions　an　individual　of　hemorrhagic　diathesis　who　succumbed　to　extensive　extravasation　of　blood　at　the　base　of　the　brain；　following　a　slight　fall　during　an　epileptic　convulsion。　Dunlape　reports　a　case　of　hemorrhagic　diathesis；　following　suppression　of　the　catamenia；　attended　by　vicarious　hemorrhage　from　the　gums；　which　terminated　fatally。　Erichsenf　cites　an　instance　of　extravasation　of　blood　into　the　calf　of　the　leg　of　an　individual　of　hemophilic　tendencies。　A　cavity　was　opened；　which　extended　from　above　the　knee　to　the　heel；　the　clots　were　removed；　and　cautery　applied　to　check　the　bleeding。　There　was　extension　of　the　blood…cavity　to　the　thigh；　with　edema　and　incipient　gangrene；　necessitating　amputation　of　the　thigh；　with　a　fatal　termination。

Mackenzie　reports　an　instance　of　hemophilic　purpura　of　the　retina；　followed　by　death。　Harkin　gives　an　account　of　vicarious　bleeding　from　the　under　lip　in　a　woman　of　thirty…eight。　The　hemorrhage　occurred　at　every　meal　and　lasted　ten　minutes。　There　is　no　evidence　that　the　woman　was　of　hemophilic　descent。

Of　334　cases　of　bleeding　in　hemophilia　collected　by　Grandidier；　169　were　from　the　nose；　43　from　the　mouth；　15　from　the　stomach；　36　from　the　bowels；　16　from　the　urethra；　17　from　the　lungs；　and　a　few　from　the　skin　of　the　head；　eyelids；　scrotum；　navel；　tongue；　finger…tips；　vulva；　and　external　ear。　Osler　remarks　that　Professor　Agnew　knew　of　a　case　of　a　bleeder　who　had　always　bled　from　cuts　and　bruises　above　the　neck；　never　from　those　below。　The　joint…affections　closely　resemble　acute　rheumatism。　Bleeders　do　not　necessarily　die　of　their　early　bleedings；　some　living　to　old　age。　Oliver　Appleton；　the　first　reported　American　bleeder；　died　at　an　advanced　age；　owing　to　hemorrhage　from　a　bed…sore　and　from　the　urethra。　Fortunately　the　functions　of　menstruation　and　parturition　are　not　seriously　interfered　with　in　hemophilia。　Menstruation　is　never　so　excessive　as　to　be　fatal。　Grandidier　states　that　of　152　boy　subjects　81　died　before　the　termination　of　the　seventh　year。　Hemophilia　is　rarely　fatal　in　the　first　year。

Of　the　hemorrhagic　diseases　of　the　new…born　three　are　worthy　of　note。　In　syphilis　haemorrhagica　neonatorum　the　child　may　be　born　healthy；　or　just　after　birth　there　may　appear　extensive　cutaneous　extravasations　with　bleeding　from　the　mucous　surfaces　and　from　the　navel；　the　child　may　become　deeply　jaundiced。　Postmortem　examination　shows　extensive　extravasations　into　the　internal　viscera；　and　also　organic　syphilitic　lesions。

Winckel's　disease；　or　epidemic　hemoglobinuria；　is　a　very　fatal　affection；　sometimes　epidemic　in　lying…in　institutions；　it　develops　about　the　fourth　day　after　birth。　The　principal　symptom　is　hematogenous　icterus　with　cyanosis；the　urine　contains　blood　and　blood…coloring　matter。　Some　cases　have　shown　in　a　marked　degree　acute　fatty　degeneration　of　the　internal　organsBuhl's　disease。

Apart　from　the　common　visceral　hemorrhages；　the　results　of　injuries　at　birth；　bleeding　from　one　or　more　of　the　surfaces　is　a　not　uncommon　event　in　the　new…born；　particularly　in　hospital…practice。　According　to　Osler　Townsend　reports　45　cases　in　6700　deliveries；　the　hemorrhage　being　both　general　and　from　the　navel　alone。　Bleeding　also　occurs　from　the　bowels；　stomach；　and　mouth；　generally　beginning　in　the　first　week；　but　in　rare　instances　it　is　delayed　to　the　second　or　third。　Out　of　50　cases　collected　by　Townsend　31　died　and　19　recovered。　The　nature　of　the　disease　is　unknown；　and　postmortem　examination　reveals　no　pathologic　changes；　although　the　general　and　not　local　nature　of　the　affection；　its　self…limited　character；　the　presence　of　fever；　and　the　greater　prevalence　of　the　disease　in　hospitals；　suggest　an　infectious　origin　（Townsend）。　Kent　a　speaks　of　a　new…born　infant　dying　of　spontaneous　hemorrhage　from　about　the　hips。

Infantile　scurvy；　or　Barlow's　disease；　has　lately　attracted　marked　attention；　and　is　interesting　for　the　numerous　extravasations　and　spontaneous　hemorrhages　which　are　associated　with　it。　A　most　interesting　collection　of　specimens　taken　from　the　victims　of　Barlow's　disease　were　shown　in　London　in　1895。

In　an　article　on　the　successful　preventive　treatment　of　tetanus　neonatorum；　or　the　〃scourge　of　St。　Kilda；〃　of　the　new…born；　Turner　says　the　first　mention　of　trismus　nascentium　or　tetanus　neonatorum　was　made　by　Rev。　Kenneth　Macaulay　in　1764；　after　a　visit　to　the　island　of　St。　Kilda　in　1758。　This　gentleman　states　that　the　infants　of　this　island　give　up　nursing　on　the　fourth　or　fifth　day　after　birth；　on　the　seventh　day　their　gums　are　so　clinched　together　that　it　is　impossible　to　get　anything　down　their　throats；　soon　after　this　they　are　seized　with　convulsive　fits　and　die　on　the　eighth　day。　So　general　was　this　trouble　on　the　island　of　St。　Kilda　that　the　mothers　never　thought　of　making　any　preparation　for　the　coming　baby；　and　it　was　wrapped　in　a　dirty　piece　of　blanket　till　the　ninth　or　tenth　day；　when；　if　the　child　survived；　the　affection　of　the　mother　asserted　itself。　This　lax　method　of　caring　for　the　infant；　the　neglect　to　dress　the　cord；　and　the　unsanitary　condition　of　the　dwellings；　make　it　extremely　probable　that　the　infection　was　through　the　umbilical　cord。　All　cases　in　which　treatment　was　properly　carried　out　by　competent　nurses　have　survived。　This　treatment　consisted　in　dressing　the　cord　with　iodoform　powder　and　antiseptic　wool；　the　breast…feeding　of　the　baby　from　the　first；　and　the　administration　of　one…grain　doses　of　potassium　bromid　at　short　interv