QUEER CASES.

Wairarapa Daily Times, Volume 4, Issue 1256, 16 December 1882, Page 1 (Supplement)

QUEER CASES.

BY A SURGEON. lif TWO I'ABTS.—PART I. The old adage, that truth is stranger than fiction, is seldom verified in a more marked mannor than by tho annals of modern surgery, In these days of extirpation of spleens and kidneys, of skin-grafting—when not only new noses, lips, and eyelids owe their origin to plastic operations, but even artificial windpipes are attempted by chirurgical art—tho prophecy of the American humorist, that we shall shortly go into a shop and get measured for a new set of "works'' with as much nonchalance as we now order a suit of clothes —to say nothing of false teeth and glass eyes —is not so very wild after all, looked at by analogy, In the following papers, I propose to relate some curious incidents and accidents of surgical practice, which, although on rej cord iu the literature of the profession, are not generally known to the public. Those instances in which no authority is quoted, have either occurred under my own observation, or have been related to me by various surgeons of eminence under whom I studied, as having happened within their personal experience, _ When I was a student at St, George's Hospital, a man was brought in one night with a compound fracture of the thigh-bone—that is to say, the bone was not only broken but exposed to view through awound in the skin—a very serious state of affairs, He had been detected by the police in the act of stealing lead oft the roof of an empty house in Pirnlico; and being surprised and chased, had dropped into an area, and sustained the injury which occasioned his removal to the hospital instead of a police station, An unsuc-

cessful attempt was made to save the limb; amputation was then performed; and after lingering some weeks, the patient died. So f»r there was nothiDg in the case to call for remark; but after death a curious fact cropped up. This was the discovery, at the post morttm examination, of a rough jagged piece of lead weighing several ounces, in the stomach, which could not possibly have been swallowed after his reception into the ward. It must have been bolted by him in the fright and oonfusion of the chase, or possibly, may have been bitten off a larger fragment in his agony while he lay in the area j but however that might be, its presence had never been suspected; the man had never mentioned it; and itlmd set upnosymptoms while he was under treatment. It is now preserved in the Museum of the Hospital, side by side with the famous half-sovereign which got into Brunei's windpipe, and which was extracted by Sir Benjamin Broclie by means of an operation, combined with the action of a swivelled table designed by the sufferer himself, Some years ago, a poor woman was discovered lying dead on the floor of her room in a low part of Westminster, with such marks of violence upon her body—notably a deop longitudinal cut on the head, which had incised the bone of the skull itself—as to point to the conclusion that she had been the victim of foul-play, Her husband was taken into custody, and put upon trial for murder, In making his defence, ho accounted for the bruises, blood-stains, and ptljpr collateral evidence in various plausible ways; and for the scalp-wound by showing that the room was an attic with a broken skylight in the roof, and insinuating that a sharp-edged piece of glass must have fallen on his wife's head as sbe stopd underneath, The surgeon who had beeu calleoj in to view fclie bqdy, jij giving his evidence expressed his opinion that a piece of glass in falling would not have sufficient force to cut into a bone. Notwithstanding this and other facts tending to prove that there was no moral doubt as to the guilt of the accused, the balance, of jegal testimony against him was not strong cnougll to convict, and he escaped. The surgeonlong since risen to the top of the professional tree, and now a man of European reputation —was at that time curator of an Anatomical Museum, where, in the department devoted i to Zoology and Comparative Anatomy, stood the skeleton of a cow. A few weeks after ■ ine trial above quoted, it violent thunderi storm, accompanied'by'hail, burst oyerLon--1 don ono night, and much damage was dime'; s amongst other things, the Museum skylights ; were extensively shattered. When the enraI pr arrived next morning, he found a spicu-

lum.of broken glass actually sticking upright i in the very edge of one'of the sharp .'prominences of bone—technically, the spinous jiwm«-projeoting from the vertobra of. the cow! I liavo often heard him narrate i tho incidentn't lecture, as a warning to young men against conclusions jumped at on the strength of preconceived ideas, instead of i patient investigation and experiment. The 1 wound in the woman's skull might, after all, 1 have been produced by falling glass. , A lad was once admitted into St, Barthoi lomew's Hospital upon whose head a brick had just fallen from a considerable height, i He was wounded, bleeding, and insensible; i and au examination with the probe rovealed i " exposed bone "—that is, yielded the rough ; grating sensation characteristic of tho headr bones from which tho covering membrane has been rudely stripped, But there was no apparent fracture or depression of tho skull, and the medical men were at a loss to account for the marked symptoms of compression of the brain, which became more and more apparent every minute, These grew so sovero at length that it was determined to enlarge 1 tho wound in the scalp, and inspect the parts beneath, This having been done, the my. stery was explained at once. A corner of the friahlo brick, pyramidal-shaped, had broken off, and was driven into the bono, • tho apex of tho pyramid piercing it, and splintering it inwards; while tho base 1 actually filled up the aperture, and was just oua level with tho surrounding bone; and this it was which had come in contact with the probe. The brick boiug removed and the 1 bone elevated, the boy recovered, 1 Being dresser to Mr, Pollock in May, 1870, I was fortunate enough to have under my 1 charge one of the first cases of skin-grafting | performed in England. The idea had already i been mooted in Paris and Vienna, but had never been carried out successfully. It must be borne in mind that this so-called skin-grafting-n. process nearly analogous to tho sowing of seed in the earth for the reproduction of a plant-is not to be confounded with transplantation of skin, which has been practised from a vory early date to the history of surgery, To cover a large raw sore, a flap of healthy skin has often been dissected from the adjacent part, leaving a pedicle of attachment to the surrounding surface; this, slid over or twisted round on to the wound, will stick and grow there, under favorable circumstances, receiving its life through tho pedicle uutil it has formed a perfect attachment to the parts beneath, Noses are built up in the same way with three triangular flaps cut from the forehead and cheeks; and occasionally whole pieces of skin are taken" bodily away from one part and transplanted to an un-

healthy wound; the'now sores caused by their removal being presumed to heal more rapidly than the ulcer. But these measures were not only severe in themselves, but resulted in many failures, and were attended with the disastrous condition, that a want of success left the patient in a doubly worse plight thai) before the operation, Grafting, however, is a wholly different thing j and perhaps a short account of the case to which I have alluded will convey a better idea of : the process audits effects, than a dissertation on the mere physiology of the subject. The patignt, a pretty little girl of eight, was admitted into tho Wellington ward of St, George's Hospital with the history that, two years previously, her dress had caught lire, burning both legs from the hips to the knees severally. After a year's treatment the left thigh had healed up; but the right had never got better, and presented a terrible ulcer, extending all down tho outer side, She was a bright, intelligent little thing, and her sad condition excited much sympathetic interest. For lout'months she i lay there without any signs of improvement, '■ Though nourishing food, with wine and ; strengthening medicines, were freely ad- i ministered, and all manner of local remedies applied, and particularly that most excellent dressing, carded oakum, all was in vain j and when, on the sth of May, the child was brought into the. operating theatre, and placed under the inlluence of chloroform, it certainly appeared to us to be as unlikely a case to afford a fair criterion of a new treat- ' rapnt as could m)\ be imagined. Two pall ; pieces of skjn were then "snipped from the back with a pair of sharp-pfiiuted scissors, aud imbedded—planted, in fact—in the granulations or "prondflesh" of the wound—two tiny atoms, scarcely bigger than a pin's head, and consisting of little mope'than' the cnticje or outer skin, which \y.e rn'ise'in blisters by rowing or exposure to a hot sun. Five days later, no change was visible; aud by-and-by the operation was considered to have failed, since the pieces of skin had disappeared, instead of growing, as had been expected! But twelve days after the operation, two little white oioatrioes appeared where the seeds had been sown; and in my notes I find that a week later these were big enough to be dignified as "islands of new tissue." The most wonderful part of it was that, not only did these islands grow and increase rapidly in circumference, but the fact of their presence seemed to stimulate tho uloor; itself, whjoli fo#h\yith took dn a healing action' around'its' margin'. Several mb're- grafts 'were- implanted subsequently, including morsels from Mr, Pol. lock's arm, from my own,, and from the

shoulder of a negro; the last producing a white .'scar-tissue. like-the rest,'' In ; two months the wound was healed, and the little patient was discharged cured. : - l ■, ' Skin-grafting is. uow performed • daily in' surgical practice, and a special instrument—a combination of knife and scissors-has been ihveuted for the purpose,' It is impossible to estimate the immense benefit of this discovery to mankind in many different aspects. Poor p eopl e, hi thertb incapacitated from labor by" incurable" ulcers, and for' years a burden on their parish, or inmates of workhouses and asylums, will' now again resume their place in the great toiling hive, from whose daily work is distilled the' prosperity of a nation, Von Grnffe's operation of iridectomy, whereby hundreds of people, who were formerly considered irremediably blind, are now restored to sight by a simple proceeding, is said to have exercised a very appreciable effect on the poor-rates of the country, As an instance of true tramplantation, John Hunter's celebrated; kperiment of causing ahuman tooth to tskcrool and growin the comb of acock, isawell-krjown instance. Dentists nowadays often remove teeth, and having excised diseased portions, replant them iu their sockets with frequent, though uot invariable success; and cruel plastic operations havo been performed on rats, by which they havo been joined like Siamese twins, or their tails caused to grow from their shoulders, or between their eyes. The late Mr. Frank Buckland, in his Curiosities of Halural History, gives an amusing account of an action-at-law brought by M, Triguel, a French naturalist, against a Zouave who had sold him what was terinoda " trumpet-rat" for one hundred francs; the said trumpet-rat proving to be au ordinary " varmint," with the tip of another rat's tail planted in its nose, aud growing there, A watchmaker in Piccadilly was afflicted with suicidal mania of rathor an extraordinary description, So far from seeking death as a refuge from trouble, it was only at such times as the world was running along smoothly with him that he was not to be trusted wjjh lethal weapons, Did sickness or domestic affliction cast their shadow over him ? did pecuniary embarrassment, or even the ordinary worries and vexations incidental to business, harass him? tkenthero was not a saner man breathing, nor one better qualified to cope with his difficulties, and withstand manfully the slings and arrows of outrajeous fortune. But directly the "bad time" was over, and his horizon was uncheekered with a single cloud, an irresistible propensity to destroy himself seemeii to seize hold upon him. He had taken poison twice, had thrown himself iuto a canal, and

had made an attempt to shoot himself, but all ineffectually Soveral times he hal been imprisoned, and once spent some months in a uuatic asylum; but the very trouble which his act entailed'upon himself appeared on each Mcasion to away with all desire to repeat it A.t length he ci\fc his throat so badly that for many months his life was despaired of; he recovered eventually, and expressed the greatest abhorrence of his oonduet; hut a small fistulous opening in the windpipe re, mained obstinately unclosed in spite of treatment, and becamo a source of great annoyanoe to him, renderins it necessary for him always to close it with the finger when he wanted to speak, and giving rise at times to dangerous attacks of inflammation, This went on for three years, during which time he steadily attended to his business, and was in conduct, conversation, and every other respect as rational a wakbkeepey as might be encountered befween John O'Groat's and Land's End. But a successful operation was performed at the end of that time; the aperture healed up; and the man was relieved of a distressing infirmity. Within two weeks, he left his shop one afternoon, and committed, aviioido. this tim« in deter, mined earnest,- Chambers' Jounml,