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anomalies and curiosities of medicine-第205章

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es the history of a case in which the vertebral artery was wounded by the discharge of a pistol loaded with pebbles。 The hemorrhage was checked by compression and packing; and after the discharge of a pebble and a piece of bone from the wound; the man was seen a month afterward in perfect health。 Corson of Norristown; Pa。; has reported the case of a quarryman who was stabbed in the neck with a shoemaker's knife; severing the left carotid one inch below its division。 He was seen thirty minutes later in an apparently lifeless condition; but efforts at resuscitation were successfully made。 The hemorrhage ceased spontaneously; and at the time of report; the man presented the symptoms of one who had had his carotid ligated (facial atrophy on one side; no pulse; etc。)。 Baron Larrey mentions a case of gunshot wound in which the carotid artery was open at its division into internal and external branches; and says that the wound was plugged by an artilleryman until ligation; and in this primitive manner the patient was saved。 Sale reports the case of a girl of nineteen; who fell on a china bowl that she had shattered; and wounded both the right common carotid artery and internal jugular vein。 There was profuse and continuous hemorrhage for a time; and subsequently a false aneurysm developed; which ruptured in about three months; giving rise to enormous momentary hemorrhage; notwithstanding the severity of the injury and the extent of the hemorrhage; complete recovery ensued。 Amos relates the instance of a woman named Mary Green who; after complete division of all the vessels of the neck; walked 23 yards and climbed over an ordinary bar…gate nearly four feet high。

Cholmeley reports the instance of a Captain of the First Madras Fusileers; who was wounded at Pegu by a musket…ball penetrating his neck。 The common carotid was divided and for five minutes there was profuse hemorrhage which; however; strange to say; spontaneously ceased。 The patient died in thirty…eight hours; supposedly from spinal concussion or shock。 

Relative to ligature of the common carotid artery; Ashhurst mentions the fact that the artery has been ligated in 228 instances; with 94 recoveries。 Ellis mentions ligature of both carotids in four and a half days; as a treatment for a gunshot wound; with subsequent recovery。 Lewtas reports a case of ligation of the innominate and carotid arteries for traumatic aneurysm (likely a hematoma due to a gunshot injury of the subclavian artery)。 The patient was in profound collapse; but steadily reacted and was discharged cured on the forty…fifth day; with no perceptible pulse at the wrist and only a feeble beat in the pulmonary artery。

Garengeot; Wirth; Fine; and Evers; all mention perforating wounds of the trachea and esophagus with recoveries。 Van Swieten and Hiester mention cases in which part of the trachea was carried away by a ball; with recovery。 Monro; Tulpius; Bartholinus; and Pare report severance of the trachea with the absence of oral breathing; in which the divided portions were sutured; with successful results。 In his 〃Theatro Naturae;〃 Bodinus says that William; Prince of Orange; lost the sense of taste after receiving a wound of the larynx; according to an old authority; a French soldier became mute after a similar accident。 Davies…Colley mentions a boy of eighteen who fell on a stick about the thickness of the index finger; transfixing his neck from right to left; he walked to a doctor's house; 250 yards away; with the stick in situ。 In about two weeks he was discharged completely well。 During treatment he had no hemorrhage of any importance; and his voice was not affected; but for a while he had slight dysphagia。

Barker gives a full account of a barber who was admitted to a hospital two and a half hours after cutting his throat。 He had a deep wound running transversely across the neck; from one angle of the jaw to the other; cutting open the floor of the mouth and extending from the inner border of the sternocleido…mastoid to the other; leaving the large vessels of the neck untouched。 The razor had passed through the glosso…epiglottidean fold; a tip of the epiglottis; and through the pharynx down to the spinal column。 There was little hemorrhage; but the man could neither swallow nor speak。 The wound was sutured; tracheotomy done; and the head kept fixed on the chest by a copper splint。 He was ingeniously fed by esophageal tubes and rectal enemata; in three weeks speech and deglutition were restored。 Shortly afterward the esophageal tube was removed and recovery was virtually complete。 Little mentions an extraordinary case of a woman of thirty…six who was discharged from Garland's asylum; where she had been an inmate for three months。 This unfortunate woman had attempted suicide by self…decapitation from behind forward。 She was found; knife in hand; with a huge wound in the back of the neck and her head bobbing about in a ghastly manner。 The incision had severed the skin; subcutaneous tissues and muscles; the ligaments and bone; opening the spinal canal; but not cutting the cord。 The instrument used to effect this major injury was a blunt potato…peeling knife。 Despite this terrible wound the patient lived to the sixth day。

Hislop records a case of cut…throat in a man of seventy…four。 He had a huge gaping wound of the neck; extending to within a half inch of the carotids on each side。 The trachea was almost completely severed; the band left was not more than 1/4 inch wide。 Hislop tied four arteries; brought the ends of the trachea together with four strong silk sutures; and; as the operation was in the country; he washed the big cavity of the wound out with cold spring…water。 He brought the superficial surfaces together with ten interrupted sutures; and; notwithstanding the patient's age; the man speedily recovered。 This emphasizes the fact that the old theory of leaving wounds of this nature open was erroneous。 Solly reports the case of a tailor of twenty…two who attempted suicide by cutting through the larynx; entirely severing the epiglottis and three…fourths of the pharynx。 No bleeding point was found; and recovery ensued。

Cowles describes the case of a soldier of thirty…five who; while escaping from the patrols; was shot by the Officer of the Day with a small bullet from a pistol。 The ball entered the right shoulder; immediately over the suprascapular notch; passed superficially upward and forward into the neck; wounding the esophagus posteriorly at a point opposite the thyroid cartilage; and lodged in the left side of the neck。 The patient had little hemorrhage; but had expectorated and swallowed much blood。 He had a constant desire to swallow; which continued several days。 The treatment was expectant; and in less than three weeks the soldier was returned to duty。 From the same authority there is a condensation of five reports of gunshot wounds of the neck; from all of which the patients recovered and returned to duty。

Braman describes the case of a man on whom several injuries were inflicted by a drunken companion。 The first wound was slight; the second a deep flesh…wound over the trapezius muscle; the third extended from the right sterno…cleido…mastoid midway upward to the middle of the jaw
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