MISCELLANEOUS SURGICAL ANOMALIES. 1 page

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.

Date: 2014-12-29; view: 707