CHAPTER XIV.

MISCELLANEOUS SURGICAL ANOMALIES.

Marvelous Recoveries from Multiple Injuries.--There are injuries so

numerous or so great in extent, and so marvelous in their recovery,

that they are worthy of record in a section by themselves. They are

found particularly in military surgery. In the Medical and

Philosophical Commentaries for 1779 is the report of the case of a

lieutenant who was wounded through the lungs, liver, and stomach, and

in whose armpit lodged a ball. It was said that when the wound in his

back was injected, the fluid would immediately be coughed up from his

lungs. Food would pass through the wound of the stomach. The man was

greatly prostrated, but after eleven months of convalescence he

recovered. In the brutal capture of Fort Griswold, Connecticut, in

1781, in which the brave occupants were massacred by the British,

Lieutenant Avery had an eye shot out, his skull fractured, the

brain-substance scattering on the ground, was stabbed in the side, and

left for dead; yet he recovered and lived to narrate the horrors of the

day forty years after.

A French invalid-artillery soldier, from his injuries and a peculiar

mask he used to hide them, was known as "L'homme a la tete de cire."

The Lancet gives his history briefly as follows: During the

Franco-Prussian War, he was horribly wounded by the bursting of a

Prussian shell. His whole face, including his two eyes, were literally

blown away, some scanty remnants of the osseous and muscular systems,

and the skull covered with hair being left. His wounds healed, giving

him such a hideous and ghastly appearance that he was virtually

ostracized from the sight of his fellows. For his relief a dentist by

the name of Delalain constructed a mask which included a false palate

and a set of false teeth. This apparatus was so perfect that the

functions of respiration and mastication were almost completely

restored to their former condition, and the man was able to speak

distinctly, and even to play the flute. His sense of smell also

returned. He wore two false eyes simply to fill up the cavities of the

orbits, for the parts representing the eyes were closed. The mask was

so well-adapted to what remained of the real face, that it was

considered by all one of the finest specimens of the prothetic art that

could be devised. This soldier, whose name was Moreau, was living and

in perfect health at the time of the report, his bizarre face, without

expression, and his sobriquet, as mentioned, making him an object of

great curiosity. He wore the Cross of Honor, and nothing delighted him

more than to talk about the war. To augment his meager pension he sold

a pamphlet containing in detail an account of his injuries and a

description of the skilfully devised apparatus by which his declining

life was made endurable. A somewhat similar case is mentioned on page

585.

A most remarkable case of a soldier suffering numerous and almost

incredible injuries and recovering and pursuing his vocation with

undampened ardor is that of Jacques Roellinger, Company B, 47th New

York Volunteers. He appeared before a pension board in New York, June

29, 1865, with the following history: In 1862 he suffered a sabre-cut

across the quadriceps extensor of the left thigh, and a sabre-thrust

between the bones of the forearm at the middle third. Soon afterward at

Williamsburg, Va., he was shot in the thigh, the ball passing through

the middle third external to the femur. At Fort Wagner, 1863, he had a

sword-cut, severing the spinal muscles and overlying tissue for a

distance of six inches. Subsequently he was captured by guerillas in

Missouri and tortured by burning splinters of wood, the cicatrices of

which he exhibited; he escaped to Florida, where he was struck by a

fragment of an exploding shell, which passed from without inward,

behind the hamstring on the right leg, and remained embedded and could

be plainly felt. When struck he fell and was fired on by the retiring

enemy. A ball entered between the 6th and 7th ribs just beneath the

apex of the heart, traversed the lungs and issued at the right 9th rib.

He fired his revolver on reception of this shot, and was soon

bayonetted by his own comrades by mistake, this wound also penetrating

the body. He showed a depressed triangular cicatrix on the margin of

the epigastrium. If the scars are at all indicative, the bayonet must

have passed through the left lobe of the liver and border of the

diaphragm. Finally he was struck by a pistol-ball at the lower angle

of the left lower jaw, this bullet issuing on the other side of the

neck. As exemplary of the easy manner in which he bore his many

injuries during a somewhat protracted convalescence, it may be added

that he amused his comrades by blowing jets of water through the

apertures on both sides of his neck. Beside the foregoing injuries he

received many minor ones, which he did not deem worthy of record or

remembrance. The greatest disability he suffered at the time of

applying for a pension resulted from an ankylosed knee. Not satisfied

with his experience in our war, he stated to the pension examiners that

he was on his way to join Garibaldi's army. This case is marvelous when

we consider the proximity of several of the wounds to a vital part; the

slightest deviation of position would surely have resulted in a fatal

issue for this apparently charmed life. The following table shows the

man's injuries in the order of their reception:--

(1) Sabre-cut across the quadriceps femoris of right leg, dividing the

tendinous and muscular structures.

(2) Sabre-thrust between the bones in the middle third of the right

forearm.

(3) Shot in the right thigh, the ball passing through the middle third.

(4) A sword-cut across the spinal muscles covering the lower dorsal

vertebrae.

(5) Tortured by guerillas in Indian fashion by having burning splinters

of wood applied to the surface of his right thorax.

(6) An exploded shell passed through the hamstring muscles of the right

thigh and embedded itself in the ligamentous tissues of the internal

condyle of the femur.

(7) Shot by a ball between the 6th and 7th ribs of the left side.

(8) Bayonetted through the body, the steel passing through the left

lobe of the liver and penetrating the posterior border of the diaphragm.

(9) Pistol-ball shot through the sternocleido muscle of one side of the

neck, emerging through the corresponding muscle of the other side of

the neck.

(10) Sabre-thrust between the bones of the left forearm.

(11) Pistol-shot through the left pectoralis major and left deltoid

muscles.

(12) Deep cut dividing the commissure between the left thumb and

forefinger down to the carpal bones.

Somewhat analogous to the foregoing is a case reported in 1834 by

McCosh from Calcutta. The patient was a native who had been dreadfully

butchered in the Chooar campaign. One of his hands was cut off above

the wrist. The remaining stump was nearly amputated by a second blow. A

third blow penetrated the shoulder-joint. Beside these and several

other slashes, he had a cut across the abdomen extending from the

umbilicus to the spine. This cut divided the parietes and severed one

of the coats of the colon. The intestines escaped and lay by his side.

He was then left on the ground as dead. On arrival at the hospital his

wounds were dressed and he speedily convalesced, but the injured colon

ruptured and an artificial anus was formed and part of the feces were

discharged through the wound. This man was subsequently seen at

Midnapore healthy and lusty although his body was bent to one side in

consequence of a large cicatrix; a small portion of the feces

occasionally passed through the open wound.

There is an account of a private soldier, aged twenty-seven, who

suffered a gunshot wound of the skull, causing compound fracture of the

cranium, and who also received compound fractures of both bones of the

leg. He did not present himself for treatment until ten days later. At

this time the head-injury caused him no inconvenience, but it was

necessary to amputate the leg and remove the necrosed bones from the

cranial wounds; the patient recovered.

Recovery After Injuries by Machinery, with Multiple Fractures,

etc.--Persons accidentally caught in some portions of powerful

machinery usually suffer several major injuries, any one of which might

have been fatal, yet there are marvelous instances of recovery after

wounds of this nature. Phares records the case of a boy of nine who,

while playing in the saw-gate of a cotton-press, was struck by the

lever in revolution, the blow fracturing both bones of the leg about

the middle. At the second revolution his shoulder was crushed; the

third passed over him, and the fourth, with maximum momentum struck his

head, carrying away a large part of the integument, including one

eyebrow, portions of the skull, membranes, and brain-substance. A piece

of cranial bone was found sticking in the lever, and there were stains

of brain on all the 24 posts around the circumference of the hole.

Possibly from 1 1/2 to two ounces of cerebral substance were lost. A

physician was called, but thinking the case hopeless he declined to

offer surgical interference. Undaunted, the father of the injured lad

straightened the leg, adjusted the various fractures, and administered

calomel and salts. The boy progressively recovered, and in a few weeks

his shoulder and legs were well. About this time a loosened fragment of

the skull was removed almost the size and shape of a dessert spoon,

with the handle attached, leaving a circular opening directly over the

eye as large as a Mexican dollar, through which cerebral pulsation was

visible. A peculiar feature of this case was that the boy never lost

consciousness, and while one of his playmates ran for assistance he got

out of the hole himself, and moved to a spot ten feet distant before

any help arrived, and even then he declined proffered aid from a man he

disliked. This boy stated that he remembered each revolution of the

lever and the individual injuries that each inflicted. Three years

after his injury he was in every respect well. Fraser mentions an

instance of a boy of fifteen who was caught in the crank of a

balance-wheel in a shingle-mill, and was taken up insensible. His skull

was fractured at the parietal eminence and the pericranium stripped

off, leaving a bloody tumor near the base of the fracture about two

inches in diameter. The right humerus was fractured at the external

condyle; there was a fracture of the coronoid process of the ulna, and

a backward dislocation at the elbow. The annular ligament was ruptured,

and the radius was separated from the ulna. On the left side there was

a fracture of the anatomic neck of the humerus, and a dislocation

downward. The boy was trephined, and the comminuted fragments removed;

in about six weeks recovery was nearly complete. Gibson reports the

history of a girl of eight who was caught by her clothing in a

perpendicular shaft in motion, and carried around at a rate of 150 or

200 times a minute until the machinery could be stopped. Although she

was found in a state of shock, she was anesthetized, in order that

immediate attention could be given to her injuries, which were found to

be as follows:--

(1) An oblique fracture of the middle third of the right femur.

(2) A transverse fracture of the middle third of the left femur.

(3) A slightly comminuted transverse fracture of the middle third of

the left tibia and fibula.

(4) A transverse fracture of the lower third of the right humerus.

(5) A fracture of the lower third of the right radius.

(6) A partial radiocarpal dislocation.

(7) Considerable injuries of the soft parts at the seats of fracture,

and contusions and abrasions all over the body.

During convalescence the little patient suffered an attack of measles,

but after careful treatment it was found by the seventy-eighth day that

she had recovered without bony deformity, and that there was bony union

in all the fractures. There was slight tilting upward in the left

femur, in which the fracture had been transverse, but there was no

perceptible shortening.

Hulke describes a silver-polisher of thirty-six who, while standing

near a machine, had his sleeve caught by a rapidly-turning wheel, which

drew him in and whirled him round and round, his legs striking against

the ceiling and floor of the room. It was thought the wheel had made 50

revolutions before the machinery was stopped. After his removal it was

found that his left humerus was fractured at its lower third, and

apparently comminuted. There was no pulse in the wrist in either the

radial or ulnar arteries, but there was pulsation in the brachial as

low as the ecchymosed swelling. Those parts of the hand and fingers

supplied by the median and radial nerves were insensible. The right

humerus was broken at the middle, the end of the upper fragment

piercing the triceps, and almost protruding through the skin. One or

more of the middle ribs on the right side were broken near the angle,

and there was a large transverse rent in the quadriceps extensor.

Despite this terrible accident the man made a perfect recovery, with

the single exception of limitation of flexion in the left elbow-joint.

Dewey details a description of a girl of six who was carried around the

upright shaft of a flour mill in which her clothes became entangled.

Some part of the body struck the bags or stones with each revolution.

She sustained a fracture of the left humerus near the insertion of the

deltoid, a fracture of the middle third of the left femur, a compound

fracture of the left femur in the upper third, with protrusion of the

upper fragment and considerable venous hemorrhage, and fracture of the

right tibia and fibula at the upper third. When taken from the shafting

the child was in a moribund state, with scarcely perceptible pulse, and

all the accompanying symptoms of shock. Her injuries were dressed, the

fractures reduced, and starch bandages applied; in about six weeks

there was perfect union, the right leg being slightly shortened. Six

months later she was playing about, with only a slight halt in her gait.

Miscellaneous Multiple Fractures.--Westmoreland speaks of a man who was

pressed between two cars, and sustained a fracture of both collar-bones

and of the sternum; in addition, six or eight ribs were fractured,

driven into and lacerating the lung. The heart was displaced. In spite

of these terrible injuries, the man was rational when picked up, and

lived nearly half a day. In comment on this case Battey mentions an

instance in which a mill-sawyer was run over by 20 or 30 logs, which

produced innumerable fractures of his body, constituting him a surgical

curiosity. He afterward completely recovered, and, as a consequence of

his miraculous escape, became a soothsayer in his region. West reports

a remarkable recovery after a compound fracture of the femur, fracture

of the jaw, and of the radius, and possibly injury to the base of the

skull, and injury to the spine.

There is on record an account of a woman of forty-three who, by

muscular action in lifting a stone, fractured her pubes, external to

the spine, on the left side. Not realizing her injury she continued

hard work all that day, but fell exhausted on the next. She recovered

in about a month, and was able to walk as well as ever.

Vinnedge reports recovery after concussion of the brain and extreme

shock, associated with fracture of the left femur, and comminuted

fractures of the left tibia and fibula.

Tufnell mentions recovery after compound comminuted fracture of the

leg, with simple fracture of both collar-bones, and dislocation of the

thumb. Nankivell speaks of a remarkable recovery in an individual who

suffered compound comminuted fracture of both legs, and fracture of the

skull. It was found necessary to amputate the right thigh and left leg.

Erichsen effected recovery by rest alone, in an individual whose ribs

and both clavicles were fractured by being squeezed.

Gilman records recovery after injuries consisting of fracture of the

frontal bone near the junction with the right parietal; fracture of the

right radius and ulna at the middle third and at the wrist; and

compound fracture of the left radius and ulna, 1 1/4 inches above the

wrist. Boulting reports a case of an individual who suffered compound

fractures of the skull and humerus, together with extensive laceration

of the thigh and chest, and yet recovered.

Barwell mentions recovery after amputation of the shoulder-joint, in an

individual who had suffered fracture of the base of the skull, fracture

of the jaw, and compound fracture of the right humerus. There was high

delirium followed by imbecility in this case. Bonnet reports a case of

fracture of both thighs, two right ribs, luxation of the clavicle, and

accidental club-foot with tenotomy, with good recovery from all the

complications. Beach speaks of an individual who suffered fracture of

both thighs, and compound comminuted fracture of the tibia, fibula, and

tarsal bones into the ankle-joint, necessitating amputation of the leg.

The patient not only survived the operation, but recovered with good

union in both thighs. As illustrative of the numerous fractures a

person may sustain at one time, the London Medical Gazette mentions an

injury to a girl of fourteen, which resulted in 31 fractures.

Remarkable Falls.--In this connection it is of interest to note from

how great a height a person may fall without sustaining serious injury.

A remarkable fall of a miner down 100 meters of shaft (about 333 feet)

without being killed is recorded by M. Reumeaux in the Bulletin de

l'Industrie Minerale. Working with his brother in a gallery which

issued on the shaft, he forgot the direction in which he was pushing a

truck; so it went over, and he after it, falling into some mud with

about three inches of water. As stated in Nature, he seems neither to

have struck any of the wood debris, nor the sides of the shaft, and he

showed no contusions when he was helped out by his brother after about

ten minutes. He could not, however, recall any of his impressions

during the fall. The velocity on reaching the bottom would be about 140

feet, and time of fall 4.12 seconds; but it is thought he must have

taken longer. It appears strange that he should have escaped simple

suffocation and loss of consciousness during a time sufficient for the

water to have drowned him.

While intoxicated Private Gough of the 42d Royal Highlanders attempted

to escape from the castle at Edinburgh. He fell almost perpendicularly

170 feet, fracturing the right frontal sinus, the left clavicle, tibia,

and fibula. In five months he had so far recovered as to be put on duty

again, and he served as an efficient soldier. There is an account of

recovery after a fall of 192 feet, from a cliff in County Antrim,

Ireland. Manzini mentions a man who fell from the dome of the Invalides

in Paris, without sustaining any serious accident, and there is a

record from Madrid of a much higher fall than this without serious

consequence. In 1792 a bricklayer fell from the fourth story of a high

house in Paris, landing with his feet on the dirt and his body on

stone. He bled from the nose, and lost consciousness for about

forty-five minutes; he was carried to the Hotel-Dieu where it was found

that he had considerable difficulty in breathing; the regions about the

external malleoli were contused and swollen, but by the eighth day the

patient had recovered. In the recent reparation of the Hotel Raleigh in

Washington, D.C., a man fell from the top of the building, which is

above the average height, fracturing several ribs and rupturing his

lung. He was taken to the Emergency Hospital where he was put to bed,

and persistent treatment for shock was pursued; little hope of the

man's recovery was entertained. His friends were told of his apparently

hopeless condition. There were no external signs of the injury with the

exception of the emphysema following rupture of the lung. Respiration

was limited and thoracic movement diminished by adhesive straps and a

binder; under careful treatment the man recovered.

Kartulus mentions an English boy of eight who, on June 1, 1879, while

playing on the terrace in the third story of a house in Alexandria, in

attempting to fly a kite in company with an Arab servant, slipped and

fell 71 feet to a granite pavement below. He was picked up conscious,

but both legs were fractured about the middle. He had so far recovered

by the 24th of July that he could hobble about on crutches. On the 15th

of November of the same year he was seen by Kartulus racing across the

playground with some other boys; as he came in third in the race he had

evidently lost little of his agility. Parrott reports the history of a

man of fifty, weighing 196 pounds, who fell 110 feet from the steeple

of a church. In his descent he broke a scaffold pole in two, and fell

through the wooden roof of an engine-house below, breaking several

planks and two strong joists, and landing upon some sacks of cement

inside the house. When picked up he was unconscious, but regained his

senses in a short time, and it was found that his injuries were not

serious. The left metacarpal bones were dislocated from the carpal

bones, the left tibia was fractured, and there were contusions about

the back and hips. Twelve days later he left for home with his leg in

plaster. Farber and McCassy report a case in which a man fell 50 feet

perpendicularly through an elevator shaft, fracturing the skull. Pieces

of bone at the superior angle of the occipital bone were removed,

leaving the aura exposed for a space one by four inches. The man was

unconscious for four days, but entirely recovered in eighteen days,

with only a slightly subnormal hearing as an after-effect of his fall.

For many years there have been persons who have given exhibitions of

high jumps, either landing in a net or in the water. Some of these

hazardous individuals do not hesitate to dive from enormous heights,

being satisfied to strike head first or to turn a somersault in their

descent. Nearly all the noted bridges in this country have had their

"divers." The death of Odlum in his attempt to jump from Brooklyn

bridge is well known. Since then it has been claimed that the feat has

been accomplished without any serious injury. It is reported that on

June 20, 1896, a youth of nineteen made a headlong dive from the top of

the Eads bridge at St. Louis, Mo., a distance of 125 feet. He is said

to have swum 250 feet to a waiting tug, and was taken on board without

having been hurt.

Probably the most interesting exhibition of this kind that was ever

seen was at the Royal Aquarium, London, in the summer of 1895. A part

of the regular nightly performance at this Hall, which is familiar on

account of its immensity, was the jump of an individual from the

rafters of the large arched roof into a tank of water about 15 by 20

feet, and from eight to ten feet deep, sunken in the floor of the hall.

Another performer, dressed in his ordinary street clothes, was tied up

in a bag and jumped about two-thirds of this height into the same tank,

breaking open the bag and undressing himself before coming to the

surface. In the same performance a female acrobat made a backward dive

from the topmost point of the building into a net stretched about ten

feet above the floor. Nearly every large acrobatic entertainment has

one of these individuals who seem to experience no difficulty in

duplicating their feats night after night.

It is a common belief that people falling from great heights die in the

act of descent. An interview with the sailor who fell from the

top-gallant of an East Indiaman, a height of 120 feet, into the water,

elicited the fact that during the descent in the air, sensation

entirely disappeared, but returned in a slight degree when he reached

the water, but he was still unable to strike out when rising to the

surface. By personal observation this man stated that he believed that

if he had struck a hard substance his death would have been painless,

as he was sure that he was entirely insensible during the fall.

A writer in the Pall Mall Gazette, in speaking of the accidents which

had happened in connection with the Forth Bridge, tells of a man who

trusted himself to work at the height of 120 feet above the waters of

the Firth, simply grasping a rope. His hands became numb with cold, his

grasp relaxed, and he fell backward down into the water, but was

brought out alive. In another instance a spanner fell a distance of 300

feet, knocked off a man's cap, and broke its way through a four-inch

plank. Again, another spanner fell from a great height, actually

tearing off a man's clothes, from his waistcoat to his ankle, but

leaving him uninjured. On another occasion a staging with a number of

workmen thereon gave way. Two of the men were killed outright by

striking some portion of the work in their descent; two others fell

clear of the girders, and were rescued from the Firth little worse for

their great fall.

Resistance of Children to Injuries.--It is a remarkable fact that young

children, whose bones, cartilages, and tissues are remarkably elastic,

are sometimes able to sustain the passage over their bodies of vehicles

of great weight without apparent injury. There is a record early in

this century of a child of five who was run over across the epigastrium

by a heavy two-wheeled cart, but recovered without any bad symptoms.

The treatment in this case is quite interesting, and was as follows:

venesection to faintness, castor oil in infusion of senna until there

was a free evacuation of the bowels, 12 leeches to the abdomen and

spine, and a saline mixture every two hours! Such depleting

therapeutics would in themselves seem almost sufficient to provoke a

fatal issue, and were given in good faith as the means of effecting a

recovery in such a case. In a similar instances a wagon weighing 1200

pounds passed over a child of five, with no apparent injury other than

a bruise near the ear made by the wheel.

Infant-vitality is sometimes quite remarkable, a newly-born child

sometimes surviving extreme exposure and major injuries. There was a

remarkable instance of this kind brought to light in the Mullings vs.

Mullings divorce-case, recorded in The Lancet. It appeared that Mrs.

Mullings, a few hours after her confinement at Torquay, packed her

newly-born infant boy in a portmanteau, and started for London. She had

telegraphed Dr. J. S. Tulloch to meet her at Paddington, where he found

his patient apparently in good condition, and not weak, as he expected

in a woman shortly to be confined. On the way to her apartments, which

had been provided by Dr. Tulloch, Mrs. Mullings remarked to the Doctor

that she had already borne her child. Dr. Tulloch was greatly

surprised, and immediately inquired what she had done with the baby.

She replied that it was in a box on top of the cab. When the box was

opened the child was found alive. The Lancet comments on the remarkable

fact that, shortly after confinement, a woman can travel six or seven

hours in a railroad train, and her newly-born babe conveyed the same

distance in a portmanteau, without apparent injury, and without

attracting attention.

Booth reports a remarkable case of vitality of a newly-born child which

came under his observation in October, 1894. An illegitimate child,

abandoned by its mother, was left at the bottom of a cesspool vault;

she claimed that ten hours before Booth's visit it had been

accidentally dropped during an attempt to micturate. The infant lived

despite the following facts: Its delivery from an ignorant,

inexperienced, unattended negress; its cord not tied; its fall of 12

feet down the pit; its ten hours' exposure in the cesspool; its

smothering by foul air, also by a heavy covering of rags, paper, and

straw; its pounding by three bricks which fell in directly from eight

feet above (some loose bricks were accidentally dislodged from the

sides of the vault, in the maneuvers to extricate the infant); its

lowered temperature previous to the application of hot bottles,

blankets, and the administration of cardiac stimulants. Booth adds that

the morning after its discovery the child appeared perfectly well, and

some two months afterward was brought into court as evidence in the

case. A remarkable case of infant vitality is given on page 117.

Operations in the Young and Old.--It might be of interest to mention

that such a major operation as ovariotomy has been successfully

performed in an infant. In a paper on infant ovariotomy, several

instances of this nature are mentioned. Roemer successfully performed

ovariotomy on a child one year and eight months old; Swartz, on a child

of four; Barker, on a child of four; Knowsley Thornton, on a child of

seven, and Spencer Wells Cupples, and Chenoweth, on children of eight.

Rein performed ovariotomy on a girl of six, suffering from a

multilocular cyst of the left ovary. He expresses his belief that

childhood and infancy are favorable to laparotomy.

Kidd removed a dermoid from a child of two years and eleven months;

Hooks performed the same operation on a child of thirty months. Chiene

extirpated an ovary from a child of three; Neville duplicated this

operation in a child one month younger; and Alcock performed ovariotomy

on a child of three.

Successful ovariotomies are infrequent in the extremely aged. Bennett

mentions an instance in a woman of seventy-five, and Davies records a

similar instance. Borsini and Terrier cite instances of successful

ovariotomy in patients of seventy-seven. Carmichael performed the

operation at seventy-four. Owens mentions it at eighty; and Homans at

eighty-two years and four months. Dewees records a successful case of

ovariotomy in a woman over sixty-seven; McNutt reports a successful

instance in a patient of sixty-seven years and six months; the tumor

weighed 60 pounds, and there were extensive adhesions. Maury removed a

monocystic ovarian tumor from a woman of seventy-four, his patient

recovering. Pippingskold mentions an ovariotomy at eighty. Terrier

describes double ovariotomy for fibromata in a woman of seventy-seven.

Aron speaks of an operation for pilous dermoid of the ovary in a woman

of seventy-five. Shepherd reports a case of recurrent proliferous cyst

in a woman of sixty-three, on whom successful ovariotomy was performed

twice within nine months. Wells mentions an ovarian cyst in a woman of

sixty-five, from which 72 pints of fluid were removed.

Hawkins describes the case of a musician, M. Rochard, who at the age of

one hundred and seven was successfully operated on for strangulated

hernia of upward of thirty hours' duration. The wound healed by first

intention, and the man was well in two weeks. Fowler operated

successfully for strangulated umbilical hernia on a patient of

sixty-eight.

Repeated Operations.--Franzolini speaks of a woman of fifty on whom he

performed six celiotomies between June, 1879, and April, 1887. The

first operation was for fibrocystic disease of the uterus. Since the

last operation the woman had had remarkably good health, and there was

every indication that well-merited recovery had been effected. The

Ephemerides contains an account of a case in which cystotomy was

repeated four times, and there is another record of this operation

having been done five times on a man. Instances of repeated Cesarean

section are mentioned on page 130.

Before leaving this subject, we mention a marvelous operation performed

by Billroth on a married woman of twenty-nine, after her sixth

pregnancy. This noted operator performed, synchronously, double

ovariotomy and resections of portions of the bladder and ileum, for a

large medullary carcinomatous growth of the ovary, with surrounding

involvement. Menstruation returned three months after the operation,

and in fifteen months the patient was in good health in every way, with

no apparent danger of recurrence of the disease.

Self-performed Surgical Operations.--There have been instances in which

surgeons and even laymen have performed considerable operations upon

themselves. On the battlefield men have amputated one of their own

limbs that had been shattered. In such cases there would be little

pain, and premeditation would not be brought into play in the same

degree as in the case of M. Clever de Maldigny, a surgeon in the Royal

Guards of France, who successfully performed a lithotomy on himself

before a mirror. He says that after the operation was completed the

urine flowed in abundance; he dressed the wound with lint dipped in an

emollient solution, and, being perfectly relieved from pain, fell into

a sound sleep. On the following day, M. Maldigny says, he was as

tranquil and cheerful as if he had never been a sufferer. A Dutch

blacksmith and a German cooper each performed lithotomy on themselves

for the intense pain caused by a stone in the bladder. Tulpius,

Walther, and the Ephemerides each report an instance of self-performed

cystotomy.

The following case is probably the only instance in which the patient,

suffering from vesical calculus, tried to crush and break the stone

himself. J. B., a retired draper, born in 1828, while a youth of

seventeen, sustained a fracture of the leg, rupture of the urethra, and

laceration of the perineum, by a fall down a well, landing astride an

iron bar. A permanent perineal fistula was established, but the patient

was averse to any operative remedial measure. In the year 1852 he

became aware of the presence of a calculus, but not until 1872 did he

ask for medical assistance. He explained that he had introduced a

chisel through his perineal fistula to the stone, and attempted to

comminute it himself and thus remove it, and by so doing had removed

about an ounce of the calculus. The physician started home for his

forceps, but during the interval, while walking about in great pain,

the man was relieved by the stone bursting through the perineum,

falling to the floor, and breaking in two. Including the ounce already

chiselled off, the stone weighed 14 1/2 ounces, and was 10 5/8 inches

in its long circumference. B. recovered and lived to December, 1883,

still believing that he had another piece of stone in his bladder.

In Holden's "Landmarks" we are told that the operation of dividing the

Achilles tendon was first performed by an unfortunate upon himself, by

means of a razor. According to Patterson, the late Mr. Symes told of a

patient in North Scotland who, for incipient hip-disease, had the

cautery applied at the Edinburgh Infirmary with resultant great relief.

After returning home to the country he experienced considerable pain,

and despite his vigorous efforts he was unable to induce any of the men

to use the cautery upon him; they termed it "barbarous treatment." In

desperation and fully believing in the efficacy of this treatment as

the best means of permanently alleviating his pain, the crippled

Scotchman heated a poker and applied the cautery himself.

We have already mentioned the marvelous instances of Cesarean sections

self-performed, and in the literature of obstetric operations many of

the minor type have been done by the patient herself. In the foregoing

cases it is to be understood that the operations have been performed

solely from the inability to secure surgical assistance or from the

incapacity to endure the pain any longer. These operations were not the

self-mutilations of maniacs, but were performed by rational persons,

driven to desperation by pain.

Possibly the most remarkable instances of extensive loss of blood, with

recoveries, are to be found in the older records of venesection. The

chronicles of excessive bleeding in the olden days are well known to

everybody. Perhaps no similar practice was so universally indulged in.

Both in sickness and in health, depletion was indicated, and it is no

exaggeration to say that about the hospital rooms at times the floors

were covered with blood. The reckless way in which venesection was

resorted to, led to its disuse, until to-day it has so vanished from

medical practice that even its benefits are overlooked, and depletion

is brought about in some other manner. Turning to the older writers, we

find Burton describing a patient from whom he took 122 ounces of blood

in four days. Dover speaks of the removal of 111 and 190 ounces; Galen,

of six pounds; and Haen, of 114 ounces. Taylor relates the history of a

case of asphyxia in which he produced a successful issue by extracting

one gallon of blood from his patient during twelve hours. Lucas speaks

of 50 venesections being practiced during one pregnancy. Van der Wiel

performed venesection 49 times during a single pregnancy. Balmes

mentions a case in which 500 venesections were performed in twenty-five

years. Laugier mentions 300 venesections in twenty-six months.

Osiander speaks of 8000 ounces of blood being taken away in thirty-five

years. Pechlin reports 155 venesections in one person in sixteen years,

and there is a record of 1020 repeated venesections.

The loss of blood through spontaneous hemorrhage is sometimes

remarkable. Fabricius Hildanus reports the loss of 27 pounds of blood

in a few days; and there is an older record of 40 pounds being lost in

four days. Horstius, Fabricius Hildanus, and Schenck, all record

instances of death from hemorrhage of the gums. Tulpius speaks of

hemoptysis lasting chronically for thirty years, and there is a similar

record of forty years' duration in the Ephemerides. Chapman gives

several instances of extreme hemorrhage from epistaxis. He remarks that

Bartholinus has recorded the loss of 48 pounds of blood from the nose;

and Rhodius, 18 pounds in thirty-six hours. The Ephemerides contains an

account of epistaxis without cessation for six weeks. Another writer in

an old journal speaks of 75 pounds of blood from epistaxis in ten days.

Chapman also mentions a case in which, by intestinal hemorrhage, eight

gallons of blood were lost in a fortnight, the patient recovering. In

another case a pint of blood was lost daily for fourteen days, with

recovery. The loss of eight quarts in three days caused death in

another case; and Chapman, again, refers to the loss of three gallons

of blood from the bowel in twenty-four hours. In the case of

Michelotti, recorded in the Transactions of the Royal Society, a young

man suffering from enlargement of the spleen vomited 12 pounds of blood

in two hours, and recovered.

In hemorrhoidal hemorrhages, Lieutaud speaks of six quarts being lost

in two days; Hoffman, of 20 pounds in less than twenty-four hours, and

Panaroli, of the loss of one pint daily for two years.

Arrow-Wounds.--According to Otis the illustrious Baron Percy was wont

to declare that military surgery had its origin in the treatment of

wounds inflicted by darts and arrows; he used to quote Book XI of the

Iliad in behalf of his belief, and to cite the cases of the patients of

Chiron and Machaon, Menelaus and Philoctetes, and Eurypiles, treated by

Patroclus; he was even tempted to believe with Sextus that the name

iatros, medicus, was derived from ios, which in the older times

signified "sagitta," and that the earliest function of our professional

ancestors was the extraction of arrows and darts. An instrument called

beluleum was invented during the long Peloponnesian War, over four

hundred years before the Christian era. It was a rude

extracting-forceps, and was used by Hippocrates in the many campaigns

in which he served. His immediate successor, Diocles, invented a

complicated instrument for extracting foreign bodies, called

graphiscos, which consisted of a canula with hooks. Otis states that it

was not until the wars of Augustus that Heras of Cappadocia designed

the famous duck-bill forceps which, with every conceivable

modification, has continued in use until our time. Celsus instructs

that in extracting arrow-heads the entrance-wound should be dilated,

the barb of the arrow-head crushed by strong pliers, or protected

between the edges of a split reed, and thus withdrawn without

laceration of the soft parts. According to the same authority, Paulus

Aegineta also treated fully of wounds by arrow-heads, and described a

method used in his time to remove firmly-impacted arrows. Albucasius

and others of the Arabian school did little or nothing toward aiding

our knowledge of the means of extracting foreign bodies. After the

fourteenth century the attention of surgeons was directed to wounds

from projectiles impelled by gunpowder. In the sixteenth century arrows

were still considerably used in warfare, and we find Pare a delineating

the treatment of this class of injuries with the sovereign good sense

that characterized his writings. As the use of firearms became

prevalent the literature of wounds from arrows became meager, and the

report of an instance in the present day is very rare.

Bill has collected statistics and thoroughly discussed this subject,

remarking upon the rapidity with which American Indians discharge their

arrows, and states that it is exceptional to meet with only a single

wound. It is commonly believed that the Indian tribes make use of

poisoned arrows, but from the reports of Bill and others, this must be

a very rare custom. Ashhurst states that he was informed by Dr. Schell,

who was stationed for some time at Fort Laramie, that it is the

universal custom to dip the arrows in blood, which is allowed to dry on

them; it is not, therefore, improbable that septic material may thus be

inoculated through a wound.

Many savage tribes still make use of the poisonous arrow. The Dyak uses

a sumpitan, or blow-tube, which is about seven feet long, and having a

bore of about half an inch. Through this he blows his long, thin dart,

anointed on the head with some vegetable poison. Braidwood speaks of

the physiologic action of Dajaksch, an arrow-poison used in Borneo.

Arnott has made observations relative to a substance produced near

Aden, which is said to be used by the Somalies to poison their arrows.

Messer of the British Navy has made inquiries into the reputed

poisonous nature of the arrows of the South Sea Islanders.

Otis has collected reports of arrow-wounds from surgical cases

occurring in the U. S. Army. Of the multiple arrow-wounds, six out of

the seven cases were fatal. In five in which the cranial cavity was

wounded, four patients perished. There were two remarkable instances of

recovery after penetration of the pleural cavity by arrows. The great

fatality of arrow-wounds of the abdomen is well known, and, according

to Bill, the Indians always aim at the umbilicus; when fighting

Indians, the Mexicans are accustomed to envelop the abdomen, as the

most vulnerable part, in many folds of a blanket.

Of the arrow-wounds reported, nine were fatal, with one exception, in

which the lesion implicated the soft parts only. The regions injured

were the scalp, face, and neck, in three instances; the parietes of the

chest in six; the long muscles of the back in two; the abdominal

muscles in two; the hip or buttocks in three; the testis in one; the

shoulder or arm in 13; forearm or hand in six; the thigh or leg in

seven.

The force with which arrows are projected by Indians is so great that

it has been estimated that the initial velocity nearly equals that of a

musket-ball. At a short distance an arrow will perforate the larger

bones without comminuting them, causing a slight fissure only, and

resembling the effect of a pistol-ball fired through a window-glass a

few yards off.

Among extraordinary cases of recovery from arrow-wounds, several of the

most striking will be recorded. Tremaine mentions a sergeant of

thirty-four who, in a fray with some hostile Indians, received seven

arrow-wounds: two on the anterior surface of the right arm; one in the

right axilla; one on the right side of the chest near the axillary

border; two on the posterior surface of the left arm near the

elbow-joint, and one on the left temple. On June 1st he was admitted to

the Post Hospital at Fort Dodge, Kan. The wound on the right arm near

the deltoid discharged, and there was slight exfoliation of the

humerus. The patient was treated with simple dressings, and was

returned to duty in July, 1870.

Goddard mentions an arrow-wound by which the body was transfixed. The

patient was a cutler's helper at Fort Rice, Dakota Territory. He was

accidentally wounded in February, 1868, by an arrow which entered the

back three inches to the right of the 5th lumbar vertebra, and emerged

about two inches to the right of the ensiform cartilage. During the

following evening the patient lost about eight ounces of blood

externally, with a small amount internally. He was confined to his bed

some two weeks, suffering from circumscribed peritonitis with

irritative fever. In four weeks he was walking about, and by July 1st

was actively employed. The arrow was deposited in the Army Medical

Museum.

Muller gives a report of an arrow-wound of the lung which was

productive of pleurisy but which was followed by recovery. Kugler

recites the description of the case of an arrow-wound of the thorax,

complicated by frightful dyspnea and blood in the pleural cavity and in

the bronchi, with recovery.

Smart extracted a hoop-iron arrow-head, 1 3/4 inches long and 1/2 inch

in breadth, from the brain of a private, about a month after its

entrance. About a dram of pus followed the exit of the arrow-head.

After the operation the right side was observed to be paralyzed, and

the man could not remember his name. He continued in a varying

condition for a month, but died on May 13, 1866, fifty-two days after

the injury. At the postmortem it was found that the brain-tissue, to

the extent of 3/4 inch around the track of the arrow as a center, was

softened and disorganized. The track itself was filled with thick pus

which extended into the ventricles.

Peabody reports a most remarkable case of recovery from multiple

arrow-wounds. In a skirmish with some Indians on June 3, 1863, the

patient had been wounded by eight distinct arrows which entered

different parts of the body. They were all extracted with the exception

of one, which had entered at the outer and lower margin of the right

scapula, and had passed inward and upward through the upper lobe of the

right lung or trachea. The hemorrhage at this time was so great that

all hope was abandoned. The patient, however, rallied, but continued

to experience great pain on swallowing, and occasionally spat blood. In

July, 1866, more than three years after the injury, he called on Dr.

Peabody to undergo an examination with a view of applying for a

pension, stating that his health was affected from the presence of an

arrow-head. He was much emaciated, and expressed himself as tired of

life. Upon probing through a small fistulous opening just above the

superior end of the sternum, the point of the arrow was found resting

against the bone, about 1 1/2 inches below, the head lying against the

trachea and esophagus, with the carotid artery, jugular vein, and

nerves overlying. After some little difficulty the point of the arrow

was raised above the sternum, and it was extracted without the loss of

an ounce of blood. The edge grazed against the sheath of the innominate

artery during the operation. The missile measured an inch at the base,

and was four inches long. The health of the patient underwent

remarkable improvement immediately after the operation.

Serious Insect-stings.--Although in this country the stings of insects

are seldom productive of serious consequences, in the tropic climates

death not unfrequently results from them. Wounds inflicted by large

spiders, centipedes, tarantulae, and scorpions have proved fatal. Even

in our country deaths, preceded by gangrene, have sometimes followed

the bite of a mosquito or a bee, the location of the bite and the

idiosyncrasy of the individual probably influencing the fatal issue. In

some cases, possibly, some vegetable poison is introduced with the

sting. Hulse, U.S.N., reports the case of a man who was bitten on the

penis by a spider, and who subsequently exhibited violent symptoms

simulating spinal meningitis, but ultimately recovered. Kunst mentions

a man of thirty-six who received several bee-stings while taking some

honey from a tree, fell from the tree unconscious, and for some time

afterward exhibited signs of cerebral congestion. Chaumeton mentions a

young man who did not perceive a wasp in a glass of sweet wine, and

swallowed the insect. He was stung in the throat, followed by such

intense inflammation that the man died asphyxiated in the presence of

his friends, who could do nothing to relieve him. In connection with

this case there is mentioned an English agriculturist who saved the

life of one of his friends who had inadvertently swallowed a wasp with

a glass of beer. Alarming symptoms manifested themselves at the moment

of the sting. The farmer made a kind of paste from a solution of common

salt in as little water as possible, which he gave to the young man,

and, after several swallows of the potion, the symptoms disappeared as

if by enchantment. There is a recent account from Bridgeport, Conn., of

a woman who, while eating a pear, swallowed a hornet that had alighted

on the fruit. In going down the throat the insect stung her on the

tonsil. Great pain and inflammation followed, and in a short time there

was complete deprivation of the power of speech.

Mease relates the case of a corpulent farmer who, in July, 1835, was

stung upon the temple by a common bee. He walked to a fence a short

distance away, thence to his house, 20 yards distant, lay down, and

expired in ten minutes. A second case, which occurred in June, 1811, is

also mentioned by Mease. A vigorous man was stung in the septum of the

nose by a bee. Supported by a friend he walked to his house, a few

steps distant, and lay down. He rose immediately to go to the well,

stepped a few paces, fell, and expired. It was thirty minutes from the

time of the accident to the man's death. A third case is reported by

the same author from Kentucky. A man of thirty-five was stung on the

right superior palpebrum, and died in twenty minutes. Mease reports a

fourth ease from Connecticut, in which a man of twenty-six was stung by

a bee on the tip of the nose. He recovered after treatment with

ten-grain doses of Dover's Powder, and persistent application of

plantain leaves. A fifth case was that of a farmer in Pennsylvania who

was stung in the left side of the throat by a wasp which he had

swallowed in drinking cider. Notwithstanding medical treatment, death

ensued twenty-seven hours afterward. A sixth case, which occurred in

October, 1834, is given by the same author. A middle-aged man was stung

by a yellow wasp on the middle finger of the right hand, and died in

less than twenty minutes after having received his wound. A seventh

case was that of a New York farmer who, while hoeing, was bitten on the

foot by a spider. Notwithstanding medical treatment, principally

bleeding, the man soon expired.

Desbrest mentions the sting of a bee above the eyebrow followed by

death. Zacutus saw a bee-sting which was followed by gangrene.

Delaistre mentions death from a hornet-sting in the palate. Nivison

relates the case of a farmer of fifty who was stung in the neck by a

bee. The usual swelling and discoloration did not follow, but

notwithstanding vigorous medical treatment the man died in six days.

Thompson relates three cases of bee-sting, in all of which death

supervened within fifteen minutes,--one in a farmer of fifty-eight who

was stung in the neck below the right ear; a second in an inn-keeper of

fifty who was stung in the neck, and a third of a woman of sixty-four

who was stung on the left brow. "Chirurgus" recalls the details of a

case of a wasp-sting in the middle finger of the right hand of a man of

forty, depriving him of all sense and of muscular power. Ten minutes

after receiving it he was unconscious, his heart-beats were feeble, and

his pulse only perceptible.

Syphilis from a Flea-bite.--Jonathan Hutchinson, in the October, 1895,

number of his unique and valuable Archives of Surgery, reports a

primary lesion of most unusual origin. An elderly member of the

profession presented himself entirely covered with an evident

syphilitic eruption, which rapidly disappeared under the use of

mercury. The only interest about the case was the question as to how

the disease had been acquired. The doctor was evidently anxious to give

all the information in his power, but was positive that he had never

been exposed to any sexual risk, and as he had retired from practice,

no possibility of infection in that manner existed. He willingly

stripped, and a careful examination of his entire body surface revealed

no trace of lesion whatever on the genitals, or at any point, except a

dusky spot on one leg, which looked like the remains of a boil. This,

the doctor stated, had been due to a small sore, the dates of the

appearance and duration of which were found to fit exactly with those

of a primary lesion. There had also been some enlargement of the

femoral glands. He had never thought of the sore in this connection,

but remembered most distinctly that it followed a flea-bite in an

omnibus, and had been caused, as he supposed, by his scratching the

place, though he could not understand why it lasted so long. Mr.

Hutchinson concludes that all the evidence tends to show that the

disease had probably been communicated from the blood of an infected

person through the bite of the insect. It thus appears that even the

proverbially trivial fleabite may at times prove a serious injury.

Snake-bites.--A writer in an Indian paper asserts that the traditional

immunity of Indian snake-charmers is due to the fact that having been

accidentally bitten by poisonous serpents or insects more than once,

and having survived the first attack, they are subsequently immune. His

assertion is based on personal acquaintance with Madari Yogis and

Fakirs, and an actual experiment made with a Mohammedan Fakir who was

immune to the bites of scorpions provided by the writer. The animals

were from five to seven inches long and had lobster-like claws. Each

bite drew blood, but the Fakir was none the worse.

The venom of poisonous snakes may be considered the most typical of

animal poisons, being unrivaled in the fatality and rapidity of its

action. Fortunately in our country there are few snake-bites, but in

the tropic countries, particularly India, the mortality from this cause

is frightful. Not only are there numerous serpents in that country, but

the natives are lightly dressed and unshod, thus being exposed to the

bites of the reptiles. It is estimated by capable authorities that the

deaths in India each year from snake-bites exceed 20,000. It is stated

that there were 2893 human beings killed by tigers, leopards, hyenas,

and panthers in India during the year 1894, and in the same year the

same species of beasts, aided by snakes, killed 97,371 head of cattle.

The number of human lives destroyed by snakes in India in 1894 was

21,538. The number of wild beasts killed in the same year was 13,447,

and the number of snakes killed was 102,210.

Yarrow of Washington, who has been a close student of this subject, has

found in this country no less than 27 species of poisonous snakes,

belonging to four genera. The first genus is the Crotalus, or

rattlesnake proper; the second is the Caudisona, or ground-rattlesnake;

the third is the Ancistrodon, or moccasin, one of the species of which

is a water-snake; and the fourth is the Elaps, or harlequin snake.

There is some dispute over the exact degree of the toxic qualities of

the venom of the Heloderma suspectum, or Gila monster. In India the

cobra is the most deadly snake. It grows to the length of 5 1/2 feet,

and is most active at night. The Ophiophagus, or hooded cobra, is one

of the largest of venomous snakes, sometimes attaining a length of 15

feet; it is both powerful, active, and aggressive. The common snakes of

the deadly variety in the United States are the rattlesnake, the

"copperhead," and the moccasin; and it is from the bites of one of

these varieties that the great majority of reported deaths are caused.

But in looking over medical literature one is struck with the scarcity

of reports of fatal snake-bites. This is most likely attributable to

the fact that, except a few army-surgeons, physicians rarely see the

cases. The natural abode of the serpents is in the wild and uninhabited

regions.

The venom is delivered to the victim through the medium of a long fang

which is connected with a gland in which the poison is stored. The

supply may be readily exhausted; for a time the bite would then be

harmless. Contrary to the general impression, snake-venom when

swallowed is a deadly poison, as proved by the experiments of Fayrer,

Mitchell, and Reichert. Death is most likely caused by paralysis of the

vital centers through the circulation. In this country the wounds

invariably are on the extremities, while in India the cobra sometimes

strikes on the shoulder or neck.

If called on to describe accurately the symptoms of snake-venom

poisoning, few medical men could respond correctly. In most cases the

wound is painful, sometimes exaggerated by the mental condition, which

is wrought up to a pitch rarely seen in other equally fatal injuries.

It is often difficult to discern the exact point of puncture, so minute

is it. There is swelling due to effusion of blood, active inflammation,

and increasing pain. If the poison has gained full entrance into the

system, in a short time the swelling extends, vesicles soon form, and

the disorganization of the tissues is so rapid that gangrene is liable

to intervene before the fatal issue. The patient becomes prostrated

immediately after the infliction of the wound, and his condition

strongly indicates the use of stimulants, even if the medical attendant

were unfamiliar with the history of the snake-bite. There may be a

slight delirium; the expression becomes anxious, the pulse rapid and

feeble, the respiration labored, and the patient complains of a sense

of suffocation. Coma follows, and the respirations become slower and

slower until death results. If the patient lives long enough, the

discoloration of the extremity and the swelling may spread to the neck,

chest and back. Loss of speech after snake-bite is discussed in Chapter

XVII, under the head of Aphasia.

A peculiar complication is a distressing inflammation of the mouth of

individuals that have sucked the wounds containing venom. This custom

is still quite common, and is preferred by the laity to the surer and

much wiser method of immediate cauterization by fire. There is a

curious case reported of a young man who was bitten on the ankle by a

viper; he had not sucked the wound, but he presented such an enormous

swelling of the tongue as to be almost provocative of a fatal issue. In

this case the lingual swelling was a local effect of the general

constitutional disturbance.

Cases of Snake-bite.--The following case illustrative of the tenacity

of virulence of snake-venom was reported by Mr. Temple, Chief Justice

of Honduras, and quoted by a London authority. While working at some

wood-cutting a man was struck on a heavy boot by a snake, which he

killed with an axe. He imagined that he had been efficiently protected

by the boot, and he thought little of the incident. Shortly afterward

he began to feel ill, sank into a stupor, and succumbed. His boots were

sold after his death, as they were quite well made and a luxury in that

country. In a few hours the purchaser of the boots was a corpse, and

every one attributed his death to apoplexy or some similar cause. The

boots were again sold, and the next unfortunate owner died in an

equally short time. It was then thought wise to examine the boots, and

in one of them was found, firmly embedded, the fang of the serpent. It

was supposed that in pulling on the boots each of the subsequent owners

had scratched himself and became fatally inoculated with the venom,

which was unsuspected and not combated. The case is so strange as to

appear hypothetic, but the authority seems reliable.

The following are three cases of snake-bite reported by surgeons of the

United States Army, two followed by recovery, and the other by death:

Middleton mentions a private in the Fourth Cavalry, aged twenty-nine,

who was bitten by a rattlesnake at Fort Concho, Texas, June 27, 1866.

The bite opened the phalangeal joint of the left thumb, causing violent

inflammation, and resulted in the destruction of the joint. Three years

afterward the joint swelled and became extremely painful, and it was

necessary to amputate the thumb. Campbell reports the case of a private

of the Thirteenth Infantry who was bitten in the throat by a large

rattlesnake. The wound was immediately sucked by a comrade, and the man

reported at the Post Hospital, at Camp Cooke, Montana, three hours

after the accident. The only noticeable appearance was a slightly wild

look about the eyes, although the man did not seem to be the least

alarmed. The region of the wound was hard and somewhat painful,

probably from having been bruised by the teeth of the man who sucked

the wound; it remained so for about three hours. The throat was bound

up in rancid olive oil (the only kind at hand) and no internal remedy

was administered. There were no other bad consequences, and the patient

soon returned to duty.

Le Carpentier sends the report of a fatal case of rattlesnake-bite: A

private, aged thirty-seven, remarkable for the singularity of his

conduct, was known in his Company as a snake-charmer, as he had many

times, without injury, handled poisonous snakes. On the morning of July

13, 1869, he was detailed as guard with the herd at Fort Cummings, New

Mexico, when, in the presence of the herders, he succeeded in catching

a rattlesnake and proving his power as a sorcerer. The performance

being over and the snake killed, he caught sight of another of the same

class, and tried to duplicate his previous feat; but his dexterity

failed, and he was bitten in the middle finger of the right hand. He

was immediately admitted to the Post Hospital, complaining only of a

little pain, such as might follow the sting of a bee or wasp. A

ligature was applied above the wound; the two injuries made by the

fangs were enlarged by a bistoury; ammonia and the actual cautery were

applied; large doses of whiskey were repeated frequently, the

constitution of the patient being broken and poor. Vomiting soon came

on but was stopped without trouble, and there were doubts from the

beginning as to his recovery. The swelling of the hand and arm

gradually increased, showing the particular livid and yellowish tint

following the bites of poisonous snakes. A blister was applied to the

bitten finger, tincture of iodin used, and two ounces of whiskey given

every two hours until inebriety was induced. The pulse, which was very

much reduced at first, gained gradually under the influence of

stimulants; two grains of opium were given at night, the patient slept

well, and on the next day complained only of numbness in the arm. The

swelling had extended as far as the shoulder-joint, and the blood,

which was very fluid, was incessantly running from the wound. Carbolic

acid and cerate were applied to the arm, with stimulants internally. On

the 15th his condition was good, the swelling had somewhat augmented,

there was not so much lividity, but the yellowish hue had increased. On

the 16th the man complained of pain in the neck, on the side of the

affected limb, but his general condition was good. Examining his

genitals, an iron ring 3/4 inch in diameter was discovered, imbedded in

the soft tissues of the penis, constricting it to such a degree as to

have produced enormous enlargement of the parts. Upon inquiry it seemed

that the ring had been kept on the parts very long, as a means of

preservation of chastity; but under the influence of the snake's venom

the swelling had increased, and the patient having much trouble in

passing water was obliged to complain. The ring was filed off with some

difficulty. Gangrene destroyed the extremity of the bitten finger. From

this date until the 30th the man's condition improved somewhat. The

progress of the gangrene was stopped, and the injured finger was

disarticulated at the metacarpal articulation. Anesthesia was readily

obtained, but the appearance of the second stage was hardly

perceptible. Le Carpentier was called early on the next morning, the

patient having been observed to be sinking; there was stertorous

respiration, the pulse was weak and slow, and the man was only partly

conscious. Electricity was applied to the spine, and brandy and

potassium bromid were given, but death occurred about noon. A necropsy

was made one hour after death. There was general softening of the

tissues, particularly on the affected side. The blood was black and

very fluid,--not coagulable. The ventricles of the brain were filled

with a large amount of serum; the brain was somewhat congested. The

lungs were healthy, with the exception of a few crude tubercles of

recent formation on the left side. The right ventricle of the heart was

empty, and the left filled with dark blood, which had coagulated. The

liver and kidneys were healthy, and the gall-bladder very much

distended with bile. The intestines presented a few livid patches on

the outside.

Hydrophobia.--The bite of an enraged animal is always of great danger

to man, and death has followed a wound inflicted by domestic animals or

even fowls; a human bite has also caused a fatal issue. Rabies is

frequently observed in herbivorous animals, such as the ox, cow, or

sheep, but is most commonly found in the carnivore, such as the dog,

wolf, fox, jackal, hyena, and cat and other members of the feline

tribe. Fox reports several cases of death from symptoms resembling

those of hydrophobia in persons who were bitten by skunks. Swine,

birds, and even domestic poultry have caused hydrophobia by their

bites. Le Cat speaks of the bite of an enraged duck causing death, and

Thiermeyer mentions death shortly following the bite of a goose, as

well as death in three days from a chicken-bite. Camerarius describes a

case of epilepsy which he attributed to a horse-bite. Among the older

writers speaking of death following the bite of an enraged man, are van

Meek'ren, Wolff, Zacutus Lusitanus, and Glandorp. The Ephemerides

contains an account of hydrophobia caused by a human bite. Jones

reports a case of syphilitic inoculation from a human bite on the hand.

Hydrophobia may not necessarily be from a bite; a previously-existing

wound may be inoculated by the saliva alone, conveyed by licking.

Pliny, and some subsequent writers, attributed rabies to a worm under

the animal's tongue which they called "lytta." There is said to be a

superstition in India that, shortly after being bitten by a mad dog,

the victim conceives pups in his belly; at about three months these

move rapidly up and down the patient's intestines, and being mad like

their progenitor, they bite and bark incessantly, until they finally

kill the unfortunate victim. The natives of Nepaul firmly believe this

theory. All sorts of curious remedies have been suggested for the cure

of hydrophobia. Crabs-claws, Spanish fly, and dragon roots, given three

mornings before the new or full moon, was suggested as a specific by

Sir Robert Gordon. Theodore De Vaux remarks that the person bitten

should immediately pluck the feathers from the breech of an old cock

and apply them bare to the bites. If the dog was mad the cock was

supposed to swell and die. If the dog was not mad the cock would not

swell; in either case the person so treated was immune. Mad-stones, as

well as snake-stones, are believed in by some persons at the present

day. According to Curran, at one time in Ireland the fear of

hydrophobia was so great that any person supposed to be suffering from

it could be legally smothered.

According to French statistics, hydrophobia is an extremely fatal

disease, although the proportion of people bitten and escaping without

infection is overwhelmingly greater than those who acquire the disease.

The mortality of genuine hydrophobia is from 30 to 80 per cent,

influenced by efficient and early cauterization and scientific

treatment. There is little doubt that many of the cases reported as

hydrophobia are merely examples of general systemic infection from a

local focus of sepsis, made possible by some primitive and uncleanly

treatment of the original wound. There is much superstition relative to

hydrophobia; the majority of wounds seen are filled with the hair of

the dog, soot, ham-fat, and also with particles of decayed food and

saliva from the mouth of some person who has practiced sucking the

wound.

Ordinarily, the period of incubation of hydrophobia in man is before

the end of the second month, although rarely cases are seen as many as

six months from the reception of the bite. The first symptoms of the

disease are melancholia, insomnia, loss of appetite, and occasionally

shooting pains, radiating from the wound. There may be severe pain at

the back of the head and in the neck. Difficulty in swallowing soon

becomes a marked symptom. The speech assumes a sobbing tone, and

occasionally the expression of the face is wild and haggard. As regards

the crucial diagnostic test of a glass of water, the following account

of a patient's attempt to drink is given by Curtis and quoted by

Warren: "A glass of water was offered the patient, which he refused to

take, saying that he could not stand so much as that, but would take it

from a teaspoon. On taking the water from the spoon he evinced some

discomfort and agitation, but continued to raise the spoon. As it came

within a foot of his lips, he gagged and began to gasp violently, his

features worked, and his head shook. He finally almost tossed the water

into his mouth, losing the greater part of it, and staggered about the

room gasping and groaning. At this moment the respirations seemed

wholly costal, and were performed with great effort, the elbows being

jerked upward with every inspiration. The paroxysm lasted about half a

minute. The act of swallowing did not appear to cause distress, for he

could go through the motions of deglutition without any trouble. The

approach of liquid toward the mouth would, however, cause distress." It

is to be remarked that the spasm affects the mechanism of the

respiratory apparatus, the muscles of mastication and deglutition being

only secondarily contracted.

Pasteur discovered that the virulence of the virus of rabies could be

attenuated in passing it through different species of animals, and also

that inoculation of this attenuated virus had a decided prophylactic

effect on the disease; hence, by cutting the spinal cord of inoculated

animals into fragments a few centimeters long, and drying them, an

emulsion could be made containing the virus. The patients are first

inoculated with a cord fourteen days old, and the inoculation is

repeated for nine days, each time with a cord one day fresher. The

intensive method consists in omitting the weakest cords and giving the

inoculations at shorter intervals. As a curious coincidence, Pliny and

Pasteur, the ancient and modern, both discuss the particular virulence

of saliva during fasting.

There is much discussion over the extent of injury a shark-bite can

produce. In fact some persons deny the reliability of any of the

so-called cases of shark-bites. Ensor reports an interesting case

occurring at Port Elizabeth, South Africa. While bathing, an expert

swimmer felt a sharp pain in the thigh, and before he could cry out,

felt a horrid crunch and was dragged below the surface of the water. He

struggled for a minute, was twisted about, shaken, and then set free,

and by a supreme effort, reached the landing stairs of the jetty,

where, to his surprise, he found that a monstrous shark had bitten his

leg off. The leg had been seized obliquely, and the teeth had gone

across the joints, wounding the condyles of the femur. There were three

marks on the left side showing where the fish had first caught him. The

amputation was completed at once, and the man recovered. Macgrigor

reports the case of a man at a fishery, near Manaar, who was bitten by

a shark. The upper jaw of the animal was fixed in the left side of the

belly, forming a semicircular wound of which a point one inch to the

left of the umbilicus was the upper boundary, and the lower part of the

upper third of the thigh, the lower boundary. The abdominal and lumbar

muscles were divided and turned up, exposing the colon in its passage

across the belly. Several convolutions of the small intestines were

also laid bare, as were also the three lowest ribs. The gluteal muscles

were lacerated and torn, the tendons about the trochanter divided,

laying the bone bare, and the vastus externus and part of the rectus of

the thigh were cut across. The wound was 19 inches in length and four

or five inches in breadth. When Dr. Kennedy first saw the patient he

had been carried in a boat and then in a palanquin for over five miles,

and at this time, three hours after the reception of the wound, Kennedy

freed the abdominal cavity of salt water and blood, thoroughly cleansed

the wound of the hair and the clots, and closed it with adhesive

strips. By the sixteenth day the abdominal wound had perfectly closed,

the lacerations granulated healthily, and the man did well. Boyle

reports recovery from extensive lacerated wounds from the bite of a

shark. Both arms were amputated as a consequence of the injuries.

Fayrer mentions shark-bites in the Hooghley.

Leprosy from a Fish-bite.--Ashmead records the curious case of a man

that had lived many years in a leprous country, and while dressing a

fish had received a wound of the thumb from the fin of the fish.

Swelling of the arm followed, and soon after bullae upon the chest,

head, and face. In a few months the blotches left from this eruption

became leprous tubercles, and other well-marked signs of the malady

followed. The author asked if in this case we have to do with a latent

leprosy which was evoked by the wound, or if it were a case of

inoculation from the fish?

Cutliffe records recovery after amputation at the elbow-joint, as a

consequence of an alligator-bite nine days before admission to the

hospital. The patient exhibited a compound comminuted fracture of the

right radius and ulna in their lower thirds, compound comminuted

fractures of the bones of the carpus and metacarpus, with great

laceration of the soft parts, laying bare the wrist-joint, besides

several penetrating wounds of the arm and fore-arm. Mourray gives some

notes on a case of crocodile-bite with removal of a large portion of

omentum. Sircar speaks of recovery from a crocodile-bite. Dudgeon

reports two cases of animal-bites, both fatal, one by a bear, and the

other by a camel. There is mention of a compound dislocation of the

wrist-joint from a horse-bite. Fayrer speaks of a wolf-bite of the

forearm, followed by necrosis and hemorrhage, necessitating ligature of

the brachial artery and subsequent excision of the elbow-joint.

Injuries from Lightning.--The subject of lightning-stroke, with its

diverse range of injuries, is of considerable interest, and, though not

uncommon, the matter is surrounded by a veil of superstition and

mystery. It is well known that instantaneous or temporary

unconsciousness may result from lightning-stroke. Sometimes

superficial or deep burns may be the sole result, and again paralysis

of the general nerves, such as those of sensation and motion, may be

occasioned. For many years the therapeutic effect of a lightning-stroke

has been believed to be a possibility, and numerous instances are on

record. The object of this article will be to record a sufficient

number of cases of lightning-stroke to enable the reader to judge of

its various effects, and form his own opinion of the good or evil of

the injury. It must be mentioned here that half a century ago Le Conte

wrote a most extensive article on this subject, which, to the present

time, has hardly been improved upon.

The first cases to be recorded are those in which there has been

complete and rapid recovery from lightning-stroke. Crawford mentions a

woman who, while sitting in front of her fireplace on the first floor

of a two-story frame building, heard a crash about her, and realized

that the house had been struck by lightning. The lightning had torn all

the weather-boarding off the house, and had also followed a spouting

which terminated in a wooden trough in a pig-sty, ten feet back of the

house, and killed a pig. Another branch of the fluid passed through the

inside of the building and, running along the upper floor to directly

over where Mrs. F. was sitting, passed through the floor and descended

upon the top of her left shoulder. Her left arm was lying across her

abdomen at the time, the points of the fingers resting on the crests of

the ilium. There was a rent in the dress at the top of the shoulder,

and a red line half an inch wide running from thence along the inside

of the arm and fore-arm. In some places there was complete vesication,

and on its palmer surface the hand lying on the abdomen was completely

denuded. The abdomen, for a space of four inches in length and eight

inches in breadth, was also blistered. The fluid then passed from the

fingers to the crest of the ilium, and down the outside of the leg,

bursting open the shoes, and passing then through the floor. Again a

red line half an inch wide could be traced from the ilium to the toes.

The clothing was not scorched, but only slightly rent at the point of

the shoulder and where the fingers rested. This woman was neither

knocked off her chair nor stunned, and she felt no shock at the time.

After ordinary treatment for her burns she made rapid and complete

recovery.

Halton reports the history of a case of a woman of sixty-five who,

about thirty-five minutes before he saw her, had been struck by

lightning. While she was sitting in an outbuilding a stroke of

lightning struck and shattered a tree about a foot distant. Then,

leaving the tree about seven feet from the ground, it penetrated the

wall of the building, which was of unplastered frame, and struck Mrs.

P. on the back of the head, at a point where her hair was done up in a

knot and fastened by two ordinary hair-pins. The hair was much

scorched, and under the knot the skin of the scalp was severely burned.

The fluid crossed, burning her right ear, in which was a gold ear-ring,

and then passed over her throat and down the left sternum, leaving a

burn three inches wide, covered by a blister. There was another burn,

12 inches long and three inches wide, passing from just above the crest

of the ilium forward and downward to the symphysis pubis. The next burn

began at the patella of the right knee, extending to the bottom of the

heel, upon reaching which it wound around the inner side of the leg.

About four inches below the knee a sound strip of cuticle, about 1 1/2

inches, was left intact. The lightning passed off the heel of the foot,

bursting open the heel of a strongly sewed gaiter-boot. The woman was

rendered unconscious but subsequently recovered.

A remarkable feature of a lightning-stroke is the fact that it very

often strips the affected part of its raiment, as in the previous case

in which the shoe was burst open. In a discussion before the Clinical

Society of London, October 24 1879, there were several instances

mentioned in which clothes had been stripped off by lightning. In one

case mentioned by Sir James Paget, the clothes were wet and the man's

skin was reeking with perspiration. In its course the lightning

traveled down the clothes, tearing them posteriorly, and completely

stripping the patient. The boots were split up behind and the laces

torn out. This patient, however, made a good recovery. Beatson

mentions an instance in which an explosion of a shell completely tore

off the left leg of a sergeant instructor, midway between the knee and

ankle. It was found that the foot and lower third of the leg had been

completely denuded of a boot and woolen stocking, without any apparent

abrasion or injury to the skin. The stocking was found in the battery

and the boot struck a person some distance off. The stocking was much

torn, and the boot had the heel missing, and in one part the sole was

separated from the upper. The laces in the upper holes were broken but

were still present in the lower holes. The explanation offered in this

case is similar to that in analogous cases of lightning-stroke, that

is, that the gas generated by the explosion found its way between the

limb and the stocking and boot and stripped them off.

There is a curious collection of relics, consisting of the clothes of a

man struck by lightning, artistically hung in a glass case in the

Museum of the Royal College of Surgeons, London, and the history of the

injury, of which these remnants are the result, is given by Professor

Stewart, the curator, as follows: At half past four on June 8, 1878,

James Orman and others were at work near Snave, in Romney Marsh, about

eight miles from Ashford. The men were engaged in lopping willows, when

the violence of the rain compelled them to take refuge under a hedge.

Three of the men entered a shed near by, but Orman remained by the

willow, close to the window of the shed. Scarcely were the three inside

when a lightning-stroke entered the door, crossed the shed, and passed

out the window, which it blew before it into the field. The men noticed

that the tree under which Orman stood was stripped of its bark. Their

companion's boots stood close to the foot of the tree, while the man

himself lay almost perfectly naked a few yards further on, calling for

help. When they left him a few moments previously, he was completely

clad in a cotton shirt, cotton jacket, flannel vest, and cotton

trousers, secured at the waist with leather straps and buckles. Orman

also wore a pair of stout hobnail boots, and had a watch and chain.

After the lightning-stroke, however, all he had on him was the left arm

of his flannel vest. The field was strewn for some distance with

fragments of the unfortunate man's clothing. Orman was thrown down,

his eyebrows burned off, and his whiskers and beard much scorched. His

chest was covered with superficial burns, and he had sustained a

fracture of the leg. His strong boots were torn from his feet, and his

watch had a hole burned right through it, as if a soldering iron had

been used. The watch-chain was almost completely destroyed, only a few

links remaining. Together with some fused coins, these were found close

by, and are deposited in a closed box in the Museum. According to

Orman's account of the affair, he first felt a violent blow on the

chest and shoulders, and then he was involved in a blinding light and

hurled into the air. He said he never lost consciousness; but when at

the hospital he seemed very deaf and stupid. He was discharged

perfectly cured twenty weeks after the occurrence. The scientific

explanation of this amazing escape from this most eccentric vagary of

the electric fluid is given,--the fact that the wet condition of the

man's clothing increased its power of conduction, and in this way saved

his life. It is said that the electric current passed down the side of

Orman's body, causing everywhere a sudden production of steam, which by

its expansion tore the clothing off and hurled it away. It is a

curious fact that where the flannel covered the man's skin the burns

were merely superficial, whereas in those parts touched by the cotton

trousers they were very much deeper. This case is also quoted and

described by Dr. Wilks.

There was a curious case of lightning-stroke reported at Cole Harbor,

Halifax. A diver, while at work far under the surface of the water, was

seriously injured by the transmission of a lightning-stroke, which

first struck the communicating air pump to which the diver was

attached. The man was brought to the surface insensible, but he

afterward recovered.

Permanent Effect of Lightning on the Nervous System.--MacDonald

mentions a woman of seventy-eight who, some forty-two years previous,

while ironing a cap with an Italian iron, was stunned by an extremely

vivid flash of lightning and fell back unconscious into a chair. On

regaining consciousness she found that the cap which she had left on

the table, remote from the iron, was reduced to cinders. Her clothes

were not burned nor were there any marks on the skin. After the stroke

she felt a creeping sensation and numbness, particularly in the arm

which was next to the table. She stated positively that in consequence

of this feeling she could predict with the greatest certainty when the

atmosphere was highly charged with electricity, as the numbness

increased on these occasions. The woman averred that shortly before or

during a thunder storm she always became nauseated. MacDonald offers as

a physiologic explanation of this case that probably the impression

produced forty-two years before implicated the right brachial plexus

and the afferent branches of the pneumogastric, and to some degree the

vomiting center in the medulla; hence, when the atmosphere was highly

charged with electricity the structures affected became more readily

impressed. Camby relates the case of a neuropathic woman of

thirty-eight, two of whose children were killed by lightning in her

presence. She herself was unconscious for four days, and when she

recovered consciousness, she was found to be hemiplegic and

hemianesthetic on the left side. She fully recovered in three weeks.

Two years later, during a thunder storm, when there was no evidence of

a lightning-stroke, she had a second attack, and three years later a

third attack under similar circumstances.