按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！
y of 29。4 per cent）； 26 recoveries with benefit； and five recoveries in which the ultimate result has not been observed。 It must be mentioned that several of the fatal cases reported were those of cervical fracture； which is by far the most fatal variety。
Injury to the spinal cord does not necessarily cause immediate death。 Mills and O'Hara； both of Philadelphia； have recorded instances of recovery after penetrating wound of the spinal marrow。 Eve reports three cases of gunshot wound in which the balls lodged in the vertebral canal； two of the patients recovering。 He adds some remarks on the division of the spinal cord without immediate death。
Ford mentions a gunshot wound of the spinal cord； the patient living ten days； after death the ball was found in the ascending aorta。 Henley speaks of a mulatto of twenty…four who was stabbed in the back with a knife。 The blade entered the body of the 6th dorsal vertebra； and was so firmly embedded that the patient could be raised entirely clear of the bed by the knife alone。 An ultimate recovery ensued。
Although the word hernia can be construed to mean the protrusion of any viscus from its natural cavity through normal or artificial openings in the surrounding structures； the usual meaning of the word is protrusion of the abdominal contents through the parieteswhat is commonly spoken of as rupture。 Hernia may be congenital or acquired； or may be single or multipleas many as five having been seen in one individual。 More than two…thirds of cases of rupture suffer from inguinal hernia In the oblique form of inguinal hernia the abdominal contents descend along the inguinal canal to the outer side of the epigastric artery； and enter the scrotum in the male； and the labium majus in the female。 In this form of hernia the size of the sac is sometimes enormous； the accompanying illustration showing extreme cases of both scrotal and labial hernia。 Umbilical hernia may be classed under three heads： congenital； infantile； and adult。 Congenital umbilical hernia occurs most frequently in children； and is brought about by the failure of the abdominal walls to close。 When of large size it may contain not only the intestines； but various other organs； such as the spleen； liver； etc。 In some monsters all the abdominal contents are contained in the hernia。 Infantile umbilical hernia is common； and appears after the separation of the umbilical cord； it is caused by the yielding of the cicatrix in this situation。 It never reaches a large size； and shows a tendency to spontaneous cure。 Adult umbilical hernia rarely commences in infancy。 It is most commonly seen in persons with pendulous bellies； and is sometimes of enormous size； in addition to the ordinary abdominal contents； containing even the stomach and uterus。 A few years since there was a man in Philadelphia past middle age； the victim of adult umbilical hernia so pendulous that while walking he had to support it with his arms and hands。 It was said that this hernia did not enlarge until after his service as a soldier in the late war。
Abbott recites the case of an Irish woman of thirty…five who applied to know if she was pregnant。 No history of a hernia could be elicited。 No pregnancy existed； but there was found a ventral hernia of the abdominal viscera through an opening which extended the entire length of the linea alba； and which was four inches wide in the middle of the abdomen。
Pim saw a colored woman of twenty…four who； on December 29； 1858； was delivered normally of her first child； and who died in bed at 3 A。M。 on February 12； 1859。 The postmortem showed a tumor from the ensiform cartilage to the symphysis pubis； which contained the omentum； liver （left lobe）； small intestines； and colon。 It rested upon the abdominal muscles of the right side。 The pelvic viscera were normally placed and there was no inguinal nor femoral hernia。
Hulke reports a case remarkable for the immense size of the rupture which protruded from a spot weakened by a former abscess。 There was a partial absence of the peritoneal sac； and the obstruction readily yielded to a clyster and laxative。 The rupture had a transverse diameter of 14 1/2 inches； with a vertical diameter of 11 1/2 inches。 The opening was in the abdominal walls outside of the internal inguinal ring。 The writhings of the intestines were very conspicuous through the walls of the pouch。
Dade reports a case of prodigious umbilical hernia。 The patient was a widow of fifty…eight； a native of Ireland。 Her family history was good； and she had never borne any children。 The present dimensions of the tumor； which for fifteen years had been accompanied with pain； and had progressively increased in size； are as follows： Circumference at the base； 19 1/2 inches； circumference at the extremity； 11 1/4 inches； distance of extremity from abdominal wall； 12 3/4 inches。 Inspection showed a large lobulated tumor protruding from the abdominal wall at the umbilicus。 The veins covering it were prominent and distended。 The circulation of the skin was defective； giving it a blue appearance。 Vermicular contractions of the small intestines could be seen at the distance of ten feet。 The tumor was soft and velvety to the touch； and could only partially be reduced。 Borborygmus could be easily heard。 On percussion the note over the bulk was tympanitic； and dull at the base。 The distal extremity contained a portion of the small intestine instead of the colon； which Wood considered the most frequent occupant。 The umbilicus was completely obliterated。 Dade believed that this hernia was caused by the weakening of the abdominal walls from a blow； and considered that the protrusion came from an aperture near the umbilicus and not through it； in this manner differing from congenital umbilical hernia。
A peculiar form of hernia is spontaneous rupture of the abdominal walls； which； however； is very rare。 There is an account of such a case in a woman of seventy…two living in Pittsburg； who； after a spasmodic cough； had a spontaneous rupture of the parietes。 The rent was four inches in length and extended along the linea alba； and through it protruded a mass of omentum about the size of a child's head。 It was successfully treated and the woman recovered。 Wallace reports a case of spontaneous rupture of the abdominal wall； following a fit of coughing。 The skin was torn and a large coil of ileum protruded； uncovered by peritoneum。 After protracted exposure of the bowel it was replaced； the rent was closed； and the patient recovered。
CHAPTER XIII。
SURGICAL ANOMALIES OF THE GENITO…URINARY SYSTEM。
Wounds of the kidney may be very severe without causing death； and even one entire kidney may be lost without interfering with the functions of life。 Marvand； the Surgeon…Major of an Algerian regiment； reports the case of a young Arab woman who had been severely injured in the right lumbar region by a weapon called a 〃yataghan；〃 an instrument which has only one cutting edge。 On withdrawing this instrument the right kidney was extruded； became strangulated between the lips of the wound； and caused considerable hemorrhage。 A ligature was put around the base of the organ； and after some weeks the mass separated。 The patient conti