MISCELLANEOUS SURGICAL ANOMALIES. 9 page

the abdomen was six feet four inches, and the distance from the xiphoid

to the os pubis measured four feet 1/2 inch. In this remarkable case 30

gallons of fluid were drawn off from the abdomen after death.

Bartholinus mentions a dropsy of 120 pounds; and Gockelius one of 180

pounds; there is recorded an instance of a dropsy of 149 pounds. There

is an old record of a woman of fifty who had suffered from ascites for

thirty years. She had been punctured 154 times, and each time about 20

pints were drawn off. During each of two pregnancies she was punctured

three or four times; one of her children was still living. It has been

said that there was a case in Paris of a person who was punctured 300

times for ascites. Scott reports a case of ascites in which 928 pints

of water were drawn off in 24 successive tappings, from February, 1777,

to May, 1778. Quoted by Hufeland, Van Wy mentions 1256 pounds of fluid

being drawn from the abdomen of a woman in five years. Kaltschmid

describes a case of ascites in which, in 12 paracenteses, 500 pounds of

fluid were removed. In 1721 Morand reported two cases of ascites in one

of which, by the means of 57 paracenteses, 970 pounds of fluid were

drawn off in twenty-two months. In the other case 1708 pounds of fluid

issued in ten months. There is a record of 484 pounds of "pus" being

discharged during a dropsy.

The Philosophical Transactions contain the account of a case of

hydronephrosis in which there were 240 pounds of water in the sac.

There are several cases on record in which ovarian dropsies have

weighed over 100 pounds; and Blanchard mentions a uterine dropsy of 80

pounds.

The Ephemerides contains an account of a case of hydrocephalus in which

there were 24 pounds of fluid, and similar cases have been noted.

Elliotson reports what he calls the largest quantity of pus from the

liver on record. His patient was a man of thirty-eight, a victim of

hydatid disease of the liver, from whom he withdrew one gallon of

offensive material.

Lieutaud cites a case, reported by Blanchard, in which, in a case of

hydatid disease, the stomach contained 90 pounds of fluid.

Ankylosis of the articulations, a rare and curious anomaly, has been

seen in the human fetus by Richaud, Joulin, Bird, and Becourt.

Ankylosis of all the joints, with muscular atrophy, gives rise to a

condition that has been popularly termed "ossified man." A case of this

nature is described, the patient being a raftsman, aged seventeen, who

suffered with inflammatory symptoms of the right great toe, which were

followed in the next ten years by progressive involvement of all the

joints of the extremities, and of the vertebrae and temporo-maxillary

articulations, with accompanying signs of acute articular rheumatism.

At the age of thirty-one the pains had subsided, leaving him completely

disabled. All the joints except the fingers and toes had become

ankylosed, and from nonusage the muscles had atrophied. There were no

dislocations, anesthesia, or bedsores, and the viscera were normal;

there were apparently no gouty deposits, as an examination of the urine

was negative.

J. R. Bass, the well-known "ossified man" of the dime museums, has been

examined by many physicians, and was quite intelligent and cheerful in

spite of his complete ankylosis. Figure 269 represents his appearance

in 1887.

Percy speaks of a man named Simoore, born in 1752, who at the age of

fifteen was afflicted with ankylosis of all the joints, and at

different angles He was unable to move even his jaw, and his teeth had

to be extracted in order to supply him with nourishment. Even his ribs

were ankylosed; his chest puffed up, and the breathing was entirely

abdominal. In spite of his infirmities, after his pains had ceased he

lived a comparatively comfortable life. His digestion was good, and his

excretory functions were sufficient. The urine always showed

phosphates, and never the slightest sign of free phosphoric acid. He

still retained his sexual feeling, and occasionally had erections. This

man died in 1802 at the age of fifty, asphyxia being the precursor of

death. His skeleton was deposited in the Museum of the ecole de

Medecine de Paris. In the same Museum there was another similar

skeleton, but in this subject there was motion of the head upon the

first vertebra, the lower jaw was intact, and the clavicle, arms, and

some of the digits of the right hand were movable.

An ossified man has been recently found and exhibited to the Paris

Academy of Medicine. He is a Roumanian Jew of thirty who began to

ossify twelve years ago, first up the right side of his back, then down

the left side. He has hardened now to the nape of the neck, his head is

turned to the left, and the jaws are ankylosed. He can still move his

arms and legs a little with great difficulty.

Akin to the foregoing condition is what is known as petrifaction or

ossification of portions of the living human body other than the

articulations. Of the older writers Hellwigius, Horstius, and Schurig

speak of petrifaction of the arm. In the Philosophical Transactions

there was a case recorded in which the muscles and ligaments were so

extensively converted into bone that all the joints were fixed, even

including the vertebrae, head, and lower jaw. In a short time this man

was, as it were, one single bone from his head to his knees, the only

joints movable being the right wrist and knee. For over a century there

has been in the Trinity College at Dublin the skeleton of a man who

died about 20 miles from the city of Cork. The muscles about the

scapula, and the dorsum of the ilium (the glutei) were converted into

great masses of bone, equal to the original muscles in thickness and

bulk. Half of the muscles of the hips and thighs were converted into

bone, and for a long time this specimen was the leading curiosity of

the Dublin Museum. In the Isle of Man, some years ago, there was a case

of ossification which continued progressively for many years. Before

death this man was reduced to almost a solid mass of bony substance.

With the exception of one or two toes his entire frame was solidified.

He was buried in Kirk Andreas Churchyard, and his grave was strictly

guarded against medical men by his friends, but the body was finally

secured and taken to Dublin by Dr. McCartney.

Calculi.--In reviewing the statistics of vesical calculi, the strangest

anomalies in their size and weight have been noticed. Among the older

writers the largest weights have been found. Le Cat speaks of a

calculus weighing over three pounds, and Morand is accredited with

having seen a calculus which weighed six pounds. In his statistics in

1883 Cross collected reports on 704 stones, and remarked that only nine

of these weighed above four ounces, and only two above six, and that

with the last two the patient succumbed. Of those removed successfully

Harmer of Norwich reports one of 15 ounces; Kline, one of 13 ounces 30

grains; Mayo of Winchester, 14 ounces two drams; Cheselden, 12 ounces;

and Pare in 1570 removed a calculus weighing nine ounces. Sir Astley

Cooper remarks that the largest stone he ever saw weighed four ounces,

and that the patient died within four hours after its removal. Before

the Royal Society of London in 1684 Birch reported an account of a

calculus weighing five ounces. Fabricius Hildanus mentions calculi

weighing 20 and 21 ounces; Camper, 13 ounces; Foschini, 19 ounces six

drams; Garmannus, 25 ounces; Greenfield, 19 ounces; Heberden, 32

ounces; Wrisberg, 20 ounces; Launai, 51 ounces; Lemery, 27 ounces;

Paget, in Kuhn's Journal, 27 ounces (from a woman); Pauli, 19 ounces;

Rudolphi, 28 ounces; Tozzetti, 39 ounces; Threpland, 35 ounces; and

there is a record of a calculus weighing over six pounds. There is

preserved in Trinity College, Cambridge, a stone weighing 34 ounces

taken from the bladder of the wife of Thomas Raisin, by Gutteridge, a

surgeon of Norwich. This stone was afterward sent to King Charles II

for inspection. In his "Journey to Paris" Dr. Lister said that he saw a

stone which weighed 51 ounces; it had been taken from one of the

religious brothers in June, 1690, and placed in the Hopital de la

Charite. It was said that the monk died after the operation. There is a

record of a calculus taken from the bladder of an individual living in

Aberdeen. This stone weighed two pounds, three ounces, and six drams.

In the Hunterian Museum in London there is a stone weighing 44 ounces,

and measuring 16 inches in circumference. By suprapubic operation

Duguise removed a stone weighing 31 ounces from a patient who survived

six days. A Belgian surgeon by the name of Uytterhoeven, by the

suprapubic method extracted a concretion weighing two pounds and

measuring 6 1/2 inches long and four wide. Frere Come performed a high

operation on a patient who died the next day after the removal of a

24-ounce calculus. Verduc mentions a calculus weighing three pounds

three ounces. It was said that a vesical calculus was seen in a dead

boy at St. Edmund's which was as large as the head of a new-born child.

It has been remarked that Thomas Adams, Lord Mayor of London, who died

at the age of eighty-two, had in his bladder at the time of his death a

stone which filled the whole cavity, and which was grooved from the

ureters to the urethral opening, thus allowing the passage of urine.

Recent records of large calculi are offered: by Holmes, 25 ounces;

Hunter, 25 ounces; Cayley, 29 ounces; Humphrys, 33 ounces; Eve, 44

ounces; and Janeway, 51 ounces. Kirby has collected reports ol a number

of large vesical calculi.

Barton speaks of stone in the bladder in very young children. There is

a record of a stone at one month, and another at three years. Todd

describes a stone in the bladder of a child of sixteen months. May

removed an enormous stone from a young girl, which had its nucleus in a

brass penholder over three inches long.

Multiple Vesical Calculi.--Usually the bladder contains a single

calculus, but in a few instances a large number of stones have been

found to coexist. According to Ashhurst, the most remarkable case on

record is that of the aged Chief Justice Marshal, from whose bladder

Dr. Physick of Philadelphia is said to have successfully removed by

lateral lithotomy more than 1000 calculi. Macgregor mentions a case in

which 520 small calculi coexisted with a large one weighing 51 ounces.

There is an old record of 32 stones having been removed from a man of

eighty-one, a native of Dantzic, 16 of which were as large as a

pigeon's egg. Kelly speaks of 228 calculi in the bladder of a man of

seventy-three, 12 being removed before death. The largest weighed 111

grains. Goodrich took 96 small stones from the bladder of a lad. Among

the older records of numerous calculi Burnett mentions 70; Desault,

over 200; the Ephemerides, 120; Weickman, over 100; Fabricius Hildanus,

2000 in two years; and there is a remarkable case of 10,000 in all

issuing from a young girl. Greenhow mentions 60 stones removed from the

bladder. An older issue of The Lancet contains an account of lithotrity

performed on the same patient 48 times.

Occasionally the calculi are discharged spontaneously. Trioen mentions

the issue of a calculus through a perineal aperture, and there are many

similar cases on record. There is an old record of a stone weighing

five ounces being passed by the penis. Schenck mentions a calculus

perforating the bladder and lodging in the groin. Simmons reports a

case in which a calculus passed through a fistulous sore in the loins

without any concomitant passage of urine through the same passage.

Vosberg mentions a calculus in a patent urachus; and calculi have

occasionally been known to pass from the umbilicus. Gourges mentions

the spontaneous excretion of a five-ounce calculus; and Thompson speaks

of the discharge of two calculi of enormous size.

Of the extravesical calculi some are true calculi, while others are

simply the result of calcareous or osseous degeneration. Renal and

biliary calculi are too common to need mention here. There are some

extraordinary calculi taken from a patient at St. Bartholomew's

Hospital and deposited in the museum of that institution. The patient

was a man of thirty-eight. In the right kidney were found a calculus

weighing 36 1/2 ounces, about 1000 small calculi, and a quantity of

calcareous dust. In the left kidney there was a calculus weighing 9 3/4

ounces, besides a quantity of calcareous dust. The calculi in this case

consisted chiefly of phosphate of magnesium and ammonium. Cordier of

Kansas City, Mo., successfully removed a renal calculus weighing over

three ounces from a woman of forty-two. The accompanying illustration

shows the actual size of the calculus.

At the University College Hospital, London, there are exhibited 485

gall-stones that were found postmortem in a gall-bladder. Vanzetti

reports the removal of a preputial calculus weighing 224 grams.

Phillipe mentions the removal of a calculus weighing 50 grams from the

prepuce of an Arab boy of seven. Croft gives an account of some

preputial calculi removed from two natives of the Solomon Islands by an

emigrant medical officer in Fiji. In one case 22 small stones were

removed, and in the other a single calculus weighing one ounce 110

grains. Congenital phimosis is said to be very common among the natives

of Solomon Islands.

In September, 1695, Bernard removed two stones from the meatus

urinarius of a man, after a lodgment of twenty years. Block mentions a

similar case, in which the lodgment had lasted twenty-eight years.

Walton speaks of a urethral calculus gradually increasing in size for

fifty years. Ashburn shows what he considers the largest calculus ever

removed from the urethra. It was 2 1/8 inches long, and 1 1/4 inches

in diameter; it was white on the outside, very hard, and was shaped and

looked much like a potato. Its dry weight was 660 grains. At one end

was a polished surface that corresponded with a similar surface on a

smaller stone that lay against it; the latter calculus was shaped like

a lima bean, and weighed 60 grains. Hunt speaks of eight calculi

removed from the urethra of a boy of five. Herman and the Ephemerides

mention cases of calculi in the seminal vesicles.

Calcareous degeneration is seen in the ovary, and Peterman speaks of a

stone in the ovary. Uterine calculi are described by Cuevas and Harlow;

the latter mentions that the calculus he saw was egg-shaped. There is

an old chronicle of a stone taken from the womb of a woman near Trent,

Somersetshire, at Easter, 1666, that weighed four ounces. The

Ephemerides speaks of a calculus coming away with the menstrual fluid.

Stones in the heart are mentioned by medical writers, and it is said

that two stones as large as almonds were found in the heart of the Earl

of Balcarres.

Morand speaks of a calculus ejected from the mouth by a woman.

An old record says that stones in the brain sometimes are the cause of

convulsions. D'Hericourt reports the case of a girl who died after six

months' suffering, whose pineal gland was found petrified, and the

incredible size of a chicken's egg. Blasius, Diemerbroeck, and the

Ephemerides, speak of stones in the location of the pineal gland.

Salivary calculi are well known; they may lodge in any of the buccal

ducts. There is a record of the case of a man of thirty-seven who

suffered great pain and profuse salivation. It was found that he had a

stone as large as a pigeon's egg under his tongue.

Umbilical calculi are sometimes seen, and Deani reports such a case.

There is a French record of a case of exstrophy of the umbilicus,

attended with abnormal concretions.

Aetius, Marcellus Donatus, Scaliger, and Schenck mention calculi of the

eyelids.

There are some extraordinary cases of retention and suppression of

urine on record. Actual retention of urine, that is, urinary secretion

passed into the bladder, but retention in the latter viscus by

inanition, stricture, or other obstruction, naturally cannot continue

any great length of time without mechanically rupturing the vesical

walls; but suppression of urine or absolute anuria may last an

astonishingly extended period. Of the cases of retention of urine,

Fereol mentions that of a man of forty-nine who suffered absolute

retention of urine for eight days, caused by the obstruction of a uric

acid calculus. Cunyghame reports a ease of mechanic obstruction of the

flow of urine for eleven days. Trapenard speaks of retention of urine

for seven days. Among the older writers Bartholinus mentions ischuria

lasting fourteen days; Cornarius, fourteen days; Rhoclius, fifteen

days; the Ephemerides, ten, eleven, and twelve days. Croom notes a case

of retention of urine from laceration of the vagina during first

coitus. Foucard reports a case of retention of urine in a young girl of

nineteen, due to accumulation of the menstrual fluid behind an

imperforate hymen.

The accumulation of urine in cases of ischuria is sometimes quite

excessive. De Vilde speaks of 16 pints being drawn off. Mazoni cites a

case in which 15 pounds of urine were retained; and Wilson mentions 16

pounds of urine being drawn off. Frank reports instances in which both

12 and 30 pounds of urine were evacuated. There is a record at the

beginning of this century in which it is stated that 31 pounds of urine

were evacuated in a case of ischuria.

Following some toxic or thermic disturbance, or in diseased kidneys,

suppression of urine is quite frequently noticed. The older writers

report some remarkable instances: Haller mentions a case lasting

twenty-two weeks; Domonceau, six months; and Marcellus Donatus, six

months.

Whitelaw describes a boy of eight who, after an attack of scarlet

fever, did not pass a single drop of urine from December 7th to

December 20th when two ounces issued, after vesication over the

kidneys. On January 2d two ounces more were evacuated, and no more was

passed until the bowel acted regularly. On January 5th a whole pint of

urine passed; after that the kidneys acted normally and the boy

recovered. It would be no exaggeration to state that this case lasted

from December 5th to January 5th, for the evacuations during this

period were so slight as to be hardly worthy of mention.

Lemery reports observation of a monk who during eight years vomited

periodically instead of urinating in a natural way. Five hours before

vomiting he experienced a strong pain in the kidneys. The vomitus was

of dark-red color, and had the odor of urine. He ate little, but drank

wine copiously, and stated that the vomiting was salutary to him, as he

suffered more when he missed it.

Bryce records a case of anuria of seventeen days' standing. Butler

speaks of an individual with a single kidney who suffered suppression

of urine for thirteen days, caused by occlusion of the ureter by an

inspissated thrombus. Dubuc observed a case of anuria which continued

for seventeen days before the fatal issue. Fontaine reports a case of

suppression of urine for twenty-five days. Nunneley showed the kidneys

of a woman who did not secrete any urine for a period of twelve days,

and during this time she had not exhibited any of the usual symptoms of

uremia. Peebles mentions a case of suspension of the functions of the

kidneys more than once for five weeks, the patient exhibiting neither

coma, stupor, nor vomiting. Oke speaks of total suppression of urine

during seven days, with complete recovery; and Paxon mentions a case in

a child that recovered after five days' suppression. Russell reports a

case of complete obstructive suppression for twenty days followed by

complete recovery. Scott and Shroff mention recovery after nine days'

suppression.

The most persistent constipation may exist for weeks, or even months,

with fair health. The fact seemed to be a subject of much interest to

the older writers. De Cabalis mentions constipation lasting

thirty-seven days; Caldani, sixty-five days; Lecheverel, thirty-four

days; and Pomma, eight months; Sylvaticus, thirty months; Baillie,

fifteen weeks; Blanchard, six weeks; Smetius, five mouths; Trioen,

three months; Devilliers, two years; and Gignony, seven years. Riverius

mentions death following constipation of one month, and says that the

intestines were completely filled. Moosman mentions death from the same

cause in sixty days. Frank speaks of constipation from intestinal

obstructions lasting for three weeks, and Manget mentions a similar

case lasting three months.

Early in the century Revolat reported in Marseilles an observation of

an eminently nervous subject addicted to frequent abuse as regards

diet, who had not had the slightest evacuation from the bowel for six

months. A cure was effected in this case by tonics, temperance,

regulation of the diet, etc. In Tome xv of the Commentaries of Leipzig

there is an account of a man who always had his stercoral evacuations

on Wednesdays, and who suffered no evil consequences from this

abnormality. This state of affairs had existed from childhood, and, as

the evacuations were abundant and connected, no morbific change or

malformation seemed present. The other excretions were slightly in

excess of the ordinary amount. There are many cases of constipation on

record lasting longer than this, but none with the same periodicity and

without change in the excrement. Tommassini records the history of a

man of thirty, living an ordinary life, who became each year more

constipated. Between the ages of twenty and twenty-four the evacuations

were gradually reduced to one in eight or ten days, and at the age of

twenty-six, to one every twenty-two days. His leanness increased in

proportion to his constipation, and at thirty his appetite was so good

that he ate as much as two men. His thirst was intense, but he secreted

urine natural in quantity and quality. Nothing seemed to benefit him,

and purgatives only augmented his trouble. His feces came in small,

hard balls. His tongue was always in good condition, the abdomen not

enlarged, the pulse and temperature normal.

Emily Plumley was born on June 11,1850, with an imperforate anus, and

lived one hundred and two days without an evacuation. During the whole

period there was little nausea and occasional regurgitation of the

mother's milk, due to over-feeding. Cripps mentions a man of forty-two

with stricture of the rectum, who suffered complete intestinal

obstruction for two months, during which time he vomited only once or

twice. His appetite was good, but he avoided solid food. He recovered

after the performance of proctotomy.

Fleck reports the case of a Dutchman who, during the last two years, by

some peculiar innervation of the intestine, had only five or six bowel

movements a year. In the intervals the patient passed small quantities

of hard feces once in eight or ten days, but the amount was so small

that they constituted no more than the feces of one meal. Two or three

days before the principal evacuation began the patient became ill and

felt uncomfortable in the back; after sharp attacks of colic he would

pass hard and large quantities of offensive feces. He would then feel

better for two or three hours, when there would be a repetition of the

symptoms, and so on until he had four or five motions that day. The

following day he would have a slight diarrhea and then the bowels would

return to the former condition. The principal fecal accumulations were

in the ascending and transverse colon and not only could be felt but

seen through the abdominal wall. The patient was well nourished and had

tried every remedy without success. Finally he went to Marienbad where

he drank freely of the waters and took the baths until the bowel

movements occurred once in two or three days.

There is a record of a man who stated that for two years he had not

passed his stool by the anus, but that at six o'clock each evening he

voided feces by the mouth. His statement was corroborated by

observation. At times the evacuation took place without effort, but was

occasionally attended with slight pain in the esophagus and slight

convulsions. Several hours before the evacuation the abdomen was hard

and distended, which appearance vanished in the evening. In this case

there was a history of an injury in the upper iliac region.

The first accurate ideas in reference to elephantiasis arabum are given

by Rhazes, Haly-Abas, and Avicenna, and it is possibly on this account

that the disease received the name elephantiasis arabum. The disease

was afterward noticed by Forestus, Mercurialis, Kaempfer, Ludoff, and

others. In 1719 Prosper Alpinus wrote of it in Egypt, and the medical

officers of the French army that invaded Egypt became familiar with it;

since then the disease has been well known.

Alard relates as a case of elephantiasis that of a lady of Berlin,

mentioned in the Ephemerides of 1694, who had an abdominal tumor the

lower part of which reached to the knees. In this case the tumor was

situated in the skin and no vestige of disease was found in the

abdominal cavity and no sensible alteration had taken place in the

veins. Delpech quotes a similar case of elephantiasis in the walls of

the abdomen in a young woman of twenty-four, born at Toulouse.

Lymphedema, or elephantiasis arabum, is a condition in which, in the

substance of a limb or a part, there is diffused dilatation of the

lymphatics, with lymphostasis. Such a condition results when there is

obstruction of so large a number of the ducts converging to the root of

the extremity or part that but little relief through collateral trunks

is possible. The affected part becomes swollen and hardened, and

sometimes attains an enormous size. It is neither reducible by position

nor pressure. There is a corresponding dilatation and multiplication of

the blood-vessels with the connective-tissue hypertrophy. The muscles

waste, the skin becomes coarse and hypertrophied. The swollen limb

presents immense lobulated masses, heaped up at different parts,

separated from one another by deep sulci, which are especially marked

at the flexures of the joints. Although elephantiasis is met with in

all climates, it is more common in the tropics, and its occurrence has

been repeatedly demonstrated in these localities to be dependent on the

presence in the lymphatics of the filaria sanguinis hominis. The

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