Anomalies And Curiosities Of Medicine Part 50

It is said that in 1691, while playing tricks with a knife 6 1/2 inches long, a country lad of Saxony swallowed it, point first. He came under the care of Weserern, physician to the Elector of Brandenburgh, who successfully extracted it, two years and seven months afterward, from the pit of the lad's stomach. The horn haft of the knife was considerably digested. In 1720 Hubner of Rastembourg operated on a woman who had swallowed an open knife. After the incision it was found that the knife had almost pierced the stomach and had excited a slight suppuration. After the operation recovery was very prompt.

Bell of Davenport, Iowa, performed gastrotomy on a man, who, while attempting a feat of legerdemain, allowed a bar of lead, 10 1/8 inches long, 1 1/2 inches wide, and 9 1/2 ounces in weight, to slip into his stomach. The bar was removed and the patient recovered. Gussenbauer gives an account of a juggler who turned his head to bow an acknowledgment of applause while swallowing a sword; he thus brought his upper incisors against the sword, which broke off and slipped into his stomach. To relieve suffocation the sword was pushed further down.

Gastrotomy was performed, and the piece of sword 11 inches long was extracted; as there was perforation of the stomach before the operation, the patient died of peritonitis.

An hour after ingestion, Bernays of St. Louis successfully removed a knife 9 1/2 inches long. By means of an army-bullet forceps the knife was extracted easily through an incision 5/8 inch long in the walls of the stomach. Gross speaks of a man of thirty who was in the habit of giving exhibitions of sword-swallowing in public houses, and who injured his esophagus to such an extent as to cause abscess and death.

In the Journal of the American Medical a.s.sociation, March 1, 1896, there is an extensive list of gastrotomies performed for the removal of knives and other foreign bodies, from the seventeenth century to the present time.

The physiologic explanation of sword-swallowing is quite interesting.

We know that when we introduce the finger, a spoon, brush, etc., into the throat of a patient, we cause extremely disagreeable symptoms.

There is nausea, gagging, and considerable hindrance with the function of respiration. It therefore seems remarkable that there are people whose physiologic construction is such that, without apparent difficulty, they are enabled to swallow a sword many inches long. Many of the exhibitionists allow the visitors to touch the stomach and outline the point of the sabre through the skin. The sabre used is usually very blunt and of rounded edges, or if sharp, a guiding tube of thin metal is previously swallowed. The explanation of these exhibitions is as follows: The instrument enters the mouth and pharynx, then the esophagus, traverses the cardiac end of the stomach, and enters the latter as far as the antrum of the pylorus, the small culdesac of the stomach. In their normal state in the adult these organs are not in a straight line, but are so placed by the pa.s.sage of the sword. In the first place the head is thrown back, so that the mouth is in the direction of the esophagus, the curves of which disappear or become less as the sword proceeds; the angle that the esophagus makes with the stomach is obliterated, and finally the stomach is distended in the vertical diameter and its internal curve disappears, thus permitting the blade to traverse the greater diameter of the stomach. According to Guyot-Daubes, these organs, in a straight line, extend a distance of from 55 to 62 cm., and consequently the performer is enabled to swallow an instrument of this length. The length is divided as follows:--

Mouth and pharynx, ... ... ... ... 10 to 12 cm.

Esophagus, ... ... ... ... ... . 25 to 28 cm.

Distended stomach, ... ... ... ... 20 to 22 cm.

------------- 55 to 62 cm.

These acrobats with the sword have rendered important service to medicine. It was through the good offices of a sword-swallower that the Scotch physician, Stevens, was enabled to make his experiments on digestion. He caused this a.s.sistant to swallow small metallic tubes pierced with holes. They were filled, according to Reaumur's method, with pieces of meat. After a certain length of time he would have the acrobat disgorge the tubes, and in this way he observed to what degree the process of digestion had taken place. It was also probably the sword-swallower who showed the physicians to what extent the pharynx could be habituated to contact, and from this resulted the invention of the tube of Faucher, the esophageal sound, ravage of the stomach, and illumination of this organ by electric light. Some of these individuals also have the faculty of swallowing several pebbles, as large even as hen's eggs, and of disgorging them one by one by simple contractions of the stomach. From time to time individuals are seen who possess the power of swallowing pebbles, knives, bits of broken gla.s.s, etc., and, in fact, there have been recent tricky exhibitionists who claimed to be able to swallow poisons, in large quant.i.ties, with impunity. Henrion, called "Casaandra," a celebrated example of this cla.s.s, was born at Metz in 1761. Early in life he taught himself to swallow pebbles, sometimes whole and sometimes after breaking them with his teeth. He pa.s.sed himself off as an American savage; he swallowed as many as 30 or 40 large pebbles a day, demonstrating the fact by percussion on the epigastric region. With the aid of salts he would pa.s.s the pebbles and make them do duty the next day. He would also swallow live mice and crabs with their claws cut. It was said that when the mice were introduced into his mouth, they threw themselves into the pharynx where they were immediately suffocated and then swallowed. The next morning they would be pa.s.sed by the r.e.c.t.u.m flayed and covered with a mucous substance. Henrion continued his calling until 1820, when, for a moderate sum, he was induced to swallow some nails and a plated iron spoon 5 1/2 inches long and one inch in breadth. He died seven days later.

According to Bonet, there was a man by the name of Pichard who swallowed a razor and two knives in the presence of King Charles II of England, the King himself placing the articles into the man's mouth. In 1810 Babbington and Curry are accredited with citing the history of an American sailor in Guy's Hospital, London, who frequently swallowed penknives for the amus.e.m.e.nt of his audiences. At first he swallowed four, and three days later pa.s.sed them by the a.n.u.s; on another occasion he swallowed 14 of different sizes with the same result. Finally he attempted to gorge himself with 17 penknives, but this performance was followed by horrible pains and alarming abdominal symptoms. His excrement was black from iron. After death the cadaver was opened and 14 corroded knives were found in the stomach, some of the handles being partly digested; two were found in the pelvis and one in the abdominal cavity. Pare recalls the instance of a shepherd who suffered distressing symptoms after gulping a knife six inches long. Afterward the knife was abstracted from his groin. Fabricius Hilda.n.u.s cites a somewhat similar case.

Early in the century there was a man known as the "Yankee knife-swallower," whose name was John c.u.mmings, an American sailor, who had performed his feats in nearly all the ports of the world. One of his chief performances was swallowing a billiard ball. Poland mentions a man (possibly c.u.mmings) who, in 1807, was admitted to Guy's Hospital with dyspeptic symptoms which he attributed to knife-swallowing. His story was discredited at first; but after his death, in March, 1809, there were 30 or 40 fragments of knives found in his stomach. One of the back-springs on a knife had transfixed the colon and r.e.c.t.u.m. In the Edinburgh Philosophical Journal for 1825 there is an account of a juggler who swallowed a knife which remained in his stomach and caused such intense symptoms that gastrotomy was advised; the patient, however, refused operation.

Drake reports a curious instance of polyphagia. The person described was a man of twenty-seven who pursued the vocation of a "sword-swallower." He had swallowed a gold watch and chain with a seal and key attached; at another time he swallowed 34 bullets and voided them by the a.n.u.s. At Poughkeepsie, N.Y., in August, 1819, in one day and night he swallowed 19 pocket-knives and 41 copper cents. This man had commenced when a lad of fifteen by swallowing marbles, and soon afterward a small penknife. After his death his esophagus was found normal, but his stomach was so distended as to reach almost to the spine of the ilium, and knives were found in the stomach weighing one pound or more. In his exhibitions he allowed his spectators to hear the click of the knives and feel them as low down as the anterior superior spine of the ilium.

The present chief of the dangerous "profession" of sword-swallowing is Chevalier Cliquot, a French Canadian by birth, whose major trick is to swallow a real bayonet sword, weighted with a cross-bar and two 18-pound dumbbells. He can swallow without difficulty a 22-inch cavalry sword; formerly, in New York, he gave exhibitions of swallowing fourteen 19-inch bayonet swords at once. A negro, by the name of Jones, exhibiting not long since in Philadelphia, gave hourly exhibitions of his ability to swallow with impunity pieces of broken gla.s.s and china.

Foreign Bodies in the Alimentary Ca.n.a.l.--In the discussion of the foreign bodies that have been taken into the stomach and intestinal tract possibly the most interesting cases, although the least authentic, are those relating to living animals, such as fish, insects, or reptiles. It is particularly among the older writers that we find accounts of this nature. In the Ephemerides we read of a man who vomited a serpent that had crept into his mouth, and of another person who ejected a beetle that had gained entrance in a similar manner. From the same authority we find instances of the vomiting of live fish, mice, toads, and also of the pa.s.sage by the a.n.u.s of live snails and snakes. Frogs vomited are mentioned by Bartholinus, Dolaeus, h.e.l.lwigius, Lentilus, Salmuth, and others. Vege mentions a man who swallowed a young chicken whole. Paullini speaks of a person who, after great pain, vomited a mouse which he had swallowed. Borellus, Bartholinus, Thoner, and Viridet, are among the older authorities mentioning persons who swallowed toads. Hippocrates speaks of asphyxia from a serpent which had crawled into the mouth.

Borellus states that he knew a case of a person who vomited a salamander. Plater reports the swallowing of eels and snails. Rhodius mentions persons who have eaten scorpions and spiders with impunity.

Planchon writes of an instance in which a live spider was ejected from the bowel; and Colini reports the pa.s.sage of a live lizard which had been swallowed two days before, and there is another similar case on record. Marcellus Donatus records an instance in which a viper, which had previously crawled into the mouth, had been pa.s.sed by the a.n.u.s.

There are also recorded instances in French literature in which persons affected with pediculosis, have, during sleep, unconsciously swallowed lice which were afterward found in the stools.

There is an abundance of cases in which leeches have been accidentally swallowed. Pliny, Aetius, Dioscorides, Scribonius-Largus, Celsus, Oribasius, Paulus Aegineta, and others, describe such cases.

Bartholinus speaks of a Neapolitan prince who, while hunting, quenched his thirst in a brook, putting his mouth in the running water. In this way he swallowed a leech, which subsequently caused annoying hemorrhage from the mouth. Timaeus mentions a child of five who swallowed several leeches, and who died of abdominal pains, hemorrhage, and convulsions.

Rhodius, Riverius, and Zwinger make similar observations. According to Baron Larrey the French soldiers in Napoleon's Egyptian campaign occasionally swallowed leeches. Grandchamp and Duval have commented on curious observations of leeches in the digestive tract. Dumas and Marques also speak of the swallowing of leeches. Colter reports a case in which beetles were vomited. Wright remarks on Banon's case of fresh-water shrimps pa.s.sed from the human intestine. Dalton, d.i.c.kman, and others, have discussed the possibility of a slug living in the stomach of man. Pich.e.l.ls speaks of a case in which beetles were expelled from the stomach; and Pigault gives an account of a living lizard expelled by vomiting. Fontaine, Gaspard, Vetillart, Ribert, MacAlister, and Waters record cases in which living caterpillars have been swallowed.

Sundry Cases.--The variety of foreign bodies that have been swallowed either accidentally or for exhibitional or suicidal purposes is enormous. Nearly every imaginable article from the minutest to the most incredible size has been reported. To begin to epitomize the literature on this subject would in itself consume a volume, and only a few instances can be given here, chosen in such a way as to show the variety, the effects, and the possibilities of their pa.s.sage through the intestinal ca.n.a.l.

Chopart says that in 1774 the belly of a ravenous galley-slave was opened, and in the stomach were found 52 foreign bodies, including a barrel-hoop 19 inches long, nails, pieces of pipe, spoons, buckles, seeds, gla.s.s, and a knife. In the intestines of a person Agnew found a pair of suspenders, a ma.s.s of straw, and three roller-bandages, an inch in width and diameter. Velpeau mentions a fork which was pa.s.sed from the a.n.u.s twenty months after it was swallowed. Wilson mentions an instance of gastrotomy which was performed for the extraction of a fork swallowed sixteen years before. There is an interesting case in which, in a delirium of typhoid fever, a girl of twenty-two swallowed two iron forks, which were subsequently expelled through an abdominal abscess. A French woman of thirty-five, with suicidal intent, swallowed a four-p.r.o.nged fork, which was removed four years afterward from the thigh. For two years she had suffered intense pain in both thighs. In the Royal College of Surgeons in London there is a steel b.u.t.ton-hook 3 1/2 inches in length which was accidentally swallowed, and was pa.s.sed three weeks later by the a.n.u.s, without having given rise to any symptom.

Among the insane a favorite trait seems to be swallowing nails. In the Philosophical Transactions is an account of the contents of the stomach of an idiot who died at thirty-three. In this organ were found nine cart-wheel nails, six screws, two pairs of compa.s.ses, a key, an iron pin, a ring, a bra.s.s pommel weighing nine ounces, and many other articles. The celebrated Dr. Lettsom, in 1802, spoke of an idiot who swallowed four pounds of old nails and a pair of compa.s.ses. A lunatic in England e swallowed ten ounces of screws and bits of crockery, all of which were pa.s.sed by the a.n.u.s. Boardman gives an account of a child affected with hernia who swallowed a nail 2 1/2 inches long. In a few days the nail was felt in the hernia, but in due time it was pa.s.sed by the r.e.c.t.u.m. Blower reports an account of a nail pa.s.sing safely through the alimentary ca.n.a.l of a baby. Armstrong mentions an insane hair-dresser of twenty-three, in whose stomach after death were found 30 or more spoon handles, 30 nails, and other minor articles.

Closmadenc reported a remarkable case which was extensively quoted. The patient was an hysteric young girl, an inmate of a convent, to whom he was called to relieve a supposed fit of epilepsy. He found her half-asphyxiated, and believed that she had swallowed a foreign body.

He was told that under the influence of exaggerated religious scruples this girl inflicted penance upon herself by swallowing earth and holy medals. At the first dose of the emetic, the patient made a strong effort to vomit, whereupon a cross seven cm. long appeared between her teeth. This was taken out of her mouth, and with it an enormous rosary 220 cm. long, and having seven medals attached to it. Hunt recites a case occurring in a pointer dog, which swallowed its collar and chain, only imperfectly masticating the collar. The chain and collar were immediately missed and search made for them. For several days the dog was ill and refused food. Finally the gamekeeper saw the end of the chain hanging from the dog's a.n.u.s, and taking hold of it, he drew out a yard of chain with links one inch long, with a cross bar at the end two inches in length; the dog soon recovered. The collar was never found, and had apparently been digested or previously pa.s.sed.

Fear of robbery has often led to the swallowing of money or jewelry.

Vaillant, the celebrated doctor and antiquarian, after a captivity of four months in Algiers, was pursued by Tunis pirates, and swallowed 15 medals of gold; shortly after arriving at Lyons he pa.s.sed them all at stool. Fournier and Duret published the history of a galley slave at Brest in whose stomach were found 52 pieces of money, their combined weight being one pound, 10 1/4 ounces. On receiving a sentence of three years' imprisonment, an Englishman, to prevent them being taken from him, swallowed seven half-crowns. He suffered no bad effects, and the coins not appearing the affair was forgotten. While at stool some twenty months afterward, having taken a purgative for intense abdominal pain, the seven coins fell clattering into the chamber. Hevin mentions the case of a man who, on being captured by Barbary pirates, swallowed all the money he had on his person. It is said that a certain Italian swallowed 100 louis d'ors at a time.

It occasionally happens that false teeth are accidentally swallowed, and even pa.s.sed through the intestinal tract. Easton mentions a young man who accidentally swallowed some artificial teeth the previous night, and, to further their pa.s.sage through the bowel, he took a dose of castor oil. When seen he was suffering with pain in the stomach, and was advised to eat much heavy food and avoid aperients. The following day after several free movements he felt a sharp pain in the lower part of his back. A large enema was given and the teeth and plate came away.

The teeth were cleansed and put back in his mouth, and the patient walked out. Nine years later the same accident again happened to the man but in spite of treatment nothing was seen of the teeth for a month afterward, when a body appeared in the r.e.c.t.u.m which proved to be a gold plate with the teeth in it. In The Lancet of December 10, 1881, there is an account of a vulcanite tooth-plate which was swallowed and pa.s.sed forty-two hours later. Billroth mentions an instance of gastrotomy for the removal of swallowed artificial teeth, with recovery; and another case in which a successful esophagotomy was performed. Gardiner mentions a woman of thirty-three who swallowed two false teeth while supping soup. A sharp angle of the broken plate had caught in a fold of the cardiac end of the stomach and had caused violent hematemesis.

Death occurred seventeen hours after the first urgent symptoms.

In the Museum of the Royal College of Surgeons in London there is an intestinal concretion weighing 470 grains, which was pa.s.sed by a woman of seventy who had suffered from constipation for many years. Sixteen years before the concretion was pa.s.sed she was known to have swallowed a tooth. At one side of the concretion a piece had been broken off exposing an incisor tooth which represented the nucleus of the formation. Mana.s.se recently reported the case of a man of forty-four whose stomach contained a stone weighing 75 grams. He was a joiner and, it was supposed, habitually drank some alcoholic solution of sh.e.l.lac used in his trade. Quite likely the sh.e.l.lac had been precipitated in the stomach and gave rise to the calculus.

Berwick mentions a child of eight months who was playing with a detached organ-handle, and put it in its mouth. Seeing this the mother attempted to secure the handle, but it was pushed into the esophagus. A physician was called, but nothing was done, and the patient seemed to suffer little inconvenience. Three days later the handle was expelled from the a.n.u.s. Teakle reports the successful pa.s.sage through the alimentary ca.n.a.l of the handle of a music-box. Hashimoto, Surgeon-General of the Imperial j.a.panese Army, tells of a woman of forty-nine who was in the habit of inducing vomiting by irritating her fauces and pharynx with a j.a.panese toothbrush--a wooden instrument six or seven inches long with bristles at one end. In May, 1872, she accidentally swallowed this brush. Many minor symptoms developed, and in eleven months there appeared in the epigastric region a fluctuating swelling, which finally burst, and from it extended the end of the brush. After vainly attempting to extract the brush the attending physician contented himself with cutting off the projecting portion.

The opening subsequently healed; and not until thirteen years later did the pain and swelling return. On admission to the hospital in October, 1888, two fistulous openings were seen in the epigastric region, and the foreign body was located by probing. Finally, on November 19, 1888, the patient was anesthetized, one of the openings enlarged, and the brush extracted. Five weeks later the openings had all healed and the patient was restored to health.

Garcia reports an interesting instance of foreign body in a man between forty-five and fifty. This man was afflicted with a syphilitic affection of the mouth, and he constructed a swab ten inches long with which to cleanse his fauces. While making the application alone one day, a spasmodic movement caused him to relinquish his grasp on the handle, and the swab disappeared. He was almost suffocated, and a physician was summoned; but before his arrival the swab had descended into the esophagus. Two weeks later, gastro-peritoneal symptoms presented, and as the stick was located, gastrotomy was proposed; the patient, however, would not consent to an operation. On the twenty-sixth day an abscess formed on the left side below the nipple, and from it was discharged a large quant.i.ty of pus and blood. Four days after this, believing himself to be better, the man began to redress the wound, and from it he saw the end of a stick protruding. A physician was called, and by traction the stick was withdrawn from between the 3d and 4th ribs; forty-nine days after the accident the wound had healed completely. Two years afterward the patient had an attack of cholera, but in the fifteen subsequent years he lived an active life of labor.

Occasionally an enormous ma.s.s of hair has been removed from the stomach. A girl of twenty a with a large abdominal swelling was admitted to a hospital. Her illness began five years previously, with frequent attacks of vomiting, and on three occasions it was noticed that she became quite bald. Abdominal section was performed, the stomach opened, and from it was removed a ma.s.s of hair which weighed five pounds and three ounces. A good recovery ensued. In the Museum of St. George's Hospital, London, are ma.s.ses of hair and string taken from the stomach and duodenum of a girl of ten. It is said that from the age of three the patient had been in the habit of eating these articles.

There is a record in the last century of a boy of sixteen who ate all the hair he could find; after death his stomach and intestines were almost completely lined with hairy ma.s.ses. In the Journal of the American Medical a.s.sociation, March 1, 1896, there is a report of a case of hair-swallowing.

Foreign Bodies in the Intestines.--White relates the history of a case in which a silver spoon was swallowed and successfully excised from the intestinal ca.n.a.l. Houston mentions a maniac who swallowed a rusty iron spoon 11 inches long. Fatal peritonitis ensued and the spoon was found impacted in the last acute turn of the duodenum. In 1895, in London, there was exhibited a specimen, including the end of the ileum with the adjacent end of the colon, showing a dessert spoon which was impacted in the latter. The spoon was seven inches long, and its bowl measured 1 1/2 inches across. There was much ulceration of the mucous membrane.

This spoon had been swallowed by a lunatic of twenty-two, who had made two previous ineffectual attempts at suicide. Mason describes the case of a man of sixty-five who, after death by strangulated hernia, was opened, and two inches from the ileocecal valve was found an earthen egg-cup which he had swallowed. Mason also relates the instance of a man who swallowed metal b.a.l.l.s 2 1/2 inches in diameter; and the case of a Frenchman who, to prevent the enemy from finding them, swallowed a box containing despatches from Napoleon. He was kept prisoner until the despatches were pa.s.sed from his bowels. Denby discovered a large egg-cup in the ileum of a man. Fillion mentions an instance of recovery following the perforation of the jejunum by a piece of horn which had been swallowed. Madden tells of a person, dying of intestinal obstruction, in whose intestines were found several ounces of crude mercury and a plum-stone. The mercury had evidently been taken for purgative effect. Rodenbaugh mentions a most interesting case of beans sprouting while in the bowel. Harrison relates a curious case in which the swallowed lower epiphysis of the femur of a rabbit made its way from the bowel to the bladder, and was discharged thence by the urethra.

In cases of appendicitis foreign bodies have been found lodged in or about the vermiform appendix so often that it is quite a common lay idea that appendicitis is invariably the result of the lodgment of some foreign body accidentally swallowed. In recent years the literature of this subject proves that a great variety of foreign bodies may be present. A few of the interesting cases will be cited in the following lines:--

In the New England Medical Journal, 1843, is an account of a vermiform appendix which was taken from the body of a man of eighty-eight who had died of pneumothorax. During life there were no symptoms of disease of the appendix, and after death no adhesions were found, but this organ was remarkably long, and in it were found 122 robin-shot. The old gentleman had been excessively fond of birds all his life, and was accustomed to bolt the meat of small birds without properly chewing it; to this fact was attributed the presence of these shot in the appendix.

A somewhat similar case was that of a man who died in the Hotel-Dieu in 1833. The ileum of this man contained 92 shot and 120 plum stones.

Buckler reports a case of appendicitis in a child of twelve, in which a common-sized bird-shot was found in the appendix. Packard presented a case of appendicitis in which two pieces of rusty and crooked wire, one 2 1/2 and the other 1 1/2 inches long, were found in the omentum, having escaped from the appendix. Howe describes a case in which a double oat, with a hard envelope, was found in the vermiform appendix of a boy of four years and one month of age. Prescott reports a case of what he calls fatal colic from the lodgment of a chocolate-nut in the appendix; and Noyes relates an instance of death in a man of thirty-one attributed to the presence of a raisin-seed in the vermiform appendix.

Needles, pins, peanuts, fruit-stones, peas, grape-seeds, and many similar objects have been found in both normal and suppurative vermiform appendices.

Intestinal Injuries.--The degree of injury that the intestinal tract may sustain, and after recovery perform its functions as usual, is most extraordinary; and even when the injury is of such an extent as to be mortal, the persistence of life is remarkable. It is a well known fact that in bull-fights, after mortal injuries of the abdomen and bowels, horses are seen to struggle on almost until the sport is finished.

Fontaine reports a case of a Welsh quarryman who was run over by a heavy four-horse vehicle. The stump of a gla.s.s bottle was crushed into the intestinal cavity, and the bowels protruded and were bruised by the wheels of the wagon. The grit was so firmly ground into the bowel that it was impossible to remove it; yet the man made a complete recovery.

Nicolls has the case of a man of sixty-nine, a workhouse maniac, who on August 20th attempted suicide by running a red-hot poker into his abdomen. His wound was dressed and he was recovering, but on September 11th he tore the cast off his abdomen, and pulled out of the wound the omentum and 32 inches of colon, which he tore off and threw between his pallet and the wall. Strange to say he did not die until eight days after this horrible injury.

Tardieu relates the case of a chemist who removed a large part of the mesentery with a knife, and yet recovered. Delmas of Montpellier reports the history of a wagoner with complete rupture of the intestines and rupture of the diaphragm, and who yet finished his journey, not dying until eighteen hours after.

Successful Intestinal Resection.--In 1755 Nedham of Norfolk reported the case of a boy of thirteen who was run over and eviscerated. It was found necessary to remove 57 inches of the protruding bowel, but the boy made a subsequent recovery. Koebererle of Strasburg performed an operation on a woman of twenty-two for the relief of intestinal obstruction. On account of numerous strictures it was found necessary to remove over two yards of the small intestine; the patient recovered without pain or trouble of any kind. In his dissertation on "Ruptures"

Arnaud remarks that he cut away more than seven feet of gangrenous bowel, his patient surviving. Beehe reports recovery after the removal of 48 inches of intestine. The case was one of strangulation of an umbilical hernia.

Sloughing of the Intestine Following Intussusception.--Lobstein mentions a peasant woman of about thirty who was suddenly seized with an attack of intussusception of the bowel, and was apparently in a moribund condition when she had a copious stool, in which she evacuated three feet of bowel with the mesentery attached. The woman recovered, but died five months later from a second attack of intussusception, the ileum rupturing and peritonitis ensuing. There is a record in this country of a woman of forty-five who discharged 44 inches of intestine, and who survived for forty-two days. The autopsy showed the sigmoid flexure gone, and from the caput ceci to the termination the colon only measured 14 inches. Vater gives a history of a penetrating abdominal wound in which a portion of the colon hung from the wound during fourteen years, forming an artificial a.n.u.s.

Among others mentioning considerable sloughing of intestine following intussusception, and usually with complete subsequent recovery, are Bare, 13 inches of the ileum; Blackton, nine inches; Bower, 14 inches; Dawson, 29 inches; Sheldon, 4 1/2 feet; Stanley, three feet; Tremaine, 17 inches; and Grossoli, 40 cm.

Rupture of the Intestines.--It is quite possible for the intestine to be ruptured by external violence, and cases of rupture of all parts of the bowel have been recorded. t.i.torier gives the history of a case in which the colon was completely separated from the r.e.c.t.u.m by external violence. Hinder reports the rupture of the duodenum by a violent kick.

Eccles, Ely, and Pollock also mention cases of rupture of the duodenum.

Zimmerman, Atwell, and Allan report cases of rupture of the colon.

Operations upon the gastrointestinal tract have been so improved in the modern era of antisepsis that at the present day they are quite common.

There are so many successful cases on record that the whole subject deserves mention here.

Gastrostomy is an operation for establishing a fistulous opening in the stomach through the anterior wall. Many operations have been devised, but the results of this maneuver in malignant disease have not thus far been very satisfactory. It is quite possible that, being an operation of a serious nature, it is never performed early enough, the patient being fatally weakened by inanition. Gross and Zesas have collected, respectively, 207 and 162 cases with surprisingly different rates of mortality: that of Gross being only 29.47 per cent, while that of Zesas was for cicatricial stenoses 60 per cent, and for malignant cases 84 per cent. It is possible that in Zesas's statistics the subjects were so far advanced that death would have resulted in a short time without operation. Gastrotomy we have already spoken of.

Pyloroplasty is an operation devised by Heineke and Mikulicz, and is designed to remove the mechanic obstruction in cicatricial stenoses of the pylorus, at the same time creating a new pylorus.

Gastroenterostomy and pylorectomy are operations devised for the relief of malignant disease of the pylorus, the diseased portions being removed and the parts resected.