Rupture of the spermatic arteries and veins has caused sudden death.

Schleiser is accredited with describing an instance in which a healthy man was engaged in a fray in the dark, and, suddenly crying out, fell into convulsions and died in five minutes. On examination the only injury found was the rupture of both spermatic arteries at the internal ring, produced by a violent pull on the s.c.r.o.t.u.m and t.e.s.t.i.c.l.es by one of his antagonists. Shock was evidently a strong factor in this case.

Fabricius Hilda.n.u.s gives a case of impotency due to lesions of the spermatic vessels following a burn. There is an old record of an aged man who, on marrying, found that he had erections but no e.j.a.c.u.l.a.t.i.o.ns.

He died of ague, and at the autopsy it was found that the verumontanum was hard and of the size of a walnut and that the ejaculatory ducts contained calculi about the size and shape of peas.

Hydrocele is a condition in which there is an abnormal quant.i.ty of fluid in the tunica v.a.g.i.n.alis. It is generally caused by traumatism, violent muscular efforts, or straining, and is much more frequent in tropic countries than elsewhere. It sometimes attains an enormous size.

Leigh mentions a hydrocele weighing 120 pounds, and there are records of hydroceles weighing 40 and 60 pounds. Larrey speaks of a sarcocele in the coverings of the t.e.s.t.i.c.l.e which weighed 100 pounds. Mursinna describes a hydrocele which measured 27 inches in its longest and 17 in its transverse axis.

Tedford gives a curious case of separation of the ovary in a woman of twenty-eight. After suffering from inv.a.g.i.n.ation of the bowel and inflammation of the ovarian tissue, an ovary was discharged through an opening in the sigmoid flexure, and thence expelled from the a.n.u.s.

In discussing injuries of the v.a.g.i.n.a, the first to be mentioned will be a remarkable case reported by Curran. The subject was an Irish girl of twenty. While carrying a bundle of clothes that prevented her from seeing objects in front of her, she started to pa.s.s over a stile, just opposite to which a goat was lying. The woman wore no underclothing, and in the ascent her body was partially exposed, and, while in this enforced att.i.tude, the goat, frightened by her approach, suddenly started up, and in so doing thrust his horn forcibly into her a.n.u.s and about two or three inches up her r.e.c.t.u.m. The horn then pa.s.sed through the bowel and its coverings, just above the hymen, and was then withdrawn as she flinched and fell back. The resultant wound included the lower part of the v.a.g.i.n.a and r.e.c.t.u.m, the sphincter and, the fourchet, and perineum. Hemorrhage was profuse, and the wound caused excruciating pain. The subject fainted on the spot from hemorrhage and shock. Her modesty forbade her summoning medical aid for three days, during which time the wound was undergoing most primitive treatment.

After suturing, cicatrization followed without delay.

Trompert mentions a case of rupture of the v.a.g.i.n.a by the horn of a bull. There is a case recorded in the Pennsylvania Hospital Reports of a girl of nineteen who jumped out of a second-story window. On reaching the ground, her foot turned under her as she fell. The high heel of a French boot was driven through the perineum one inch from the median line, midway between the a.n.u.s and the posterior commissure of the l.a.b.i.a majora. The wound extended into the v.a.g.i.n.a above the external opening, in which the heel, now separated from the boot, projected, and whence it was removed without difficulty. This wound was the only injury sustained by the fall.

Beckett records a case of impalement in a woman of forty-five who, while attempting to obtain water from a hogshead, fell with one limb inside the cistern, striking a projecting stave three inches wide and 1/2 inch thick. The external l.a.b.i.a were divided, the left crus of the c.l.i.toris separated, the nymphae lacerated, and the v.a.g.i.n.al wall penetrated to the extent of five inches; the patient recovered by the fourth week.

Homans reports recovery from extensive wounds acquired by a negress who fell from a roof, striking astride an upright barrel. There was a wound of the perineum, and penetration of the posterior wall of the v.a.g.i.n.a, with complete separation of the soft parts from the symphysis pubis, and extrusion of the bladder.

Howe reports a case of impalement with recovery in a girl of fifteen who slid down a hay-stack, striking a hay-hook which penetrated her perineum and pa.s.sed into her body, emerging two inches below the umbilicus and one inch to the right of the median line.

Injuries of the v.a.g.i.n.a may be so extensive as to allow protrusion of the intestines, and some horrible cases of this nature are recorded. In The Lancet for 1873 there is reported a murder or suicide of this description. The woman was found with a wound in the v.a.g.i.n.a, through which the intestines, with clean-cut ends, protruded. Over 7 1/2 feet of the intestines had been cut off in three pieces. The cuts were all clean and carefully separated from the mesentery. The woman survived her injuries a whole week, finally succ.u.mbing to loss of blood and peritonitis. Her husband was tried for murder, but was acquitted by a Glasgow jury. Taylor mentions similar cases of two women murdered in Edinburgh some years since, the wounds having been produced by razor slashes in the v.a.g.i.n.a. Taylor remarks that this crime seems to be quite common in Scotland. Starkey reports an instance in which the body of an old colored woman was found, with evidences of vomiting, and her clothing stained with blood that had evidently come from her v.a.g.i.n.a. A postmortem showed the abdominal cavity to be full of blood; at Douglas'

culdesac there was a tear large enough to admit a man's hand, through which protruded a portion of the omentum; this was at first taken for the membranes of an abortion. There were distinct signs of acute peritonitis. After investigation it was proved that a drunken gla.s.s-blower had been seen leaving her house with his hand and arm stained with blood. In his drunken frenzy this man had thrust his hand into the v.a.g.i.n.a, and through the junction of its posterior wall with the uterus, up into the abdominal cavity, and grasped the uterus, trying to drag it out. Outside of obstetric practice the injury is quite a rare one.

There is a case of death from a ruptured c.l.i.toris reported by Gutteridge. The woman was kicked while in a stooping position and succ.u.mbed to a profuse hemorrhage, estimated to be between three and four pounds, and proceeding from a rupture of the c.l.i.toris.

Discharge of v.a.g.i.n.al Parietes.--Longhi describes the case of a woman of twenty-seven, an epileptic, with metritis and copious catamenia twice a month. She was immoderately addicted to drink and s.e.xual indulgence, and in February, 1835, her menses ceased. On May 8th she was admitted to the hospital with a severe epileptic convulsion, and until the 18th remained in a febrile condition, with abdominal tenderness, etc. On the 21st, while straining as if to discharge the contents of the r.e.c.t.u.m, she felt a voluminous body pa.s.s through the v.a.g.i.n.a, and fancied it was the expected fetus. After washing this ma.s.s it was found to be a portion of the v.a.g.i.n.al parietes and the fleshy body of the neck of the uterus. The woman believed she had miscarried, and still persisted in refusing medicine. Cicatrization was somewhat delayed; immediately on leaving the hospital she returned to her old habits, but the pain and hemorrhage attending copulation was so great that she had finally to desist. The v.a.g.i.n.a, however, gradually yielding, ceased to interfere with the gratification of her desires. Toward the end of June the menses reappeared and flowed with the greatest regularity. The portions discharged are preserved in the Milan Hospital.

The injuries received during coitus have been cla.s.sified by Spaeth as follows: Deep tears of the hymen with profuse hemorrhage; tears of the c.l.i.toris and of the urethra (in cases of atresia hymenis); vesicov.a.g.i.n.al fistula; laceration of the v.a.g.i.n.al fornices, posteriorly or laterally; laceration of the septum of a duplex v.a.g.i.n.a; injuries following coitus after perineorrhaphy. In the last century Plazzoni reports a case of v.a.g.i.n.al rupture occurring during coitus. Green of Boston; Mann of Buffalo; Sinclair and Munro of Boston, all mention lacerations occurring during coitus. There is an instance recorded of extensive laceration of the v.a.g.i.n.a in a woman, the result of coitus with a large dog. Haddon and Ross both mention cases of rupture of the v.a.g.i.n.a in coitus; and Martin reports a similar case resulting in a young girl's death. Spaeth speaks of a woman of thirty-one who, a few days after marriage, felt violent pain in coitus, and four days later she noticed that fecal matter escaped from the v.a.g.i.n.a during stool.

Examination showed that the columns of the posterior wall were torn from their attachment, and that there was a rectov.a.g.i.n.al fistula admitting the little finger. Hofmokl cites an instance in which a powerful young man, in coitus with a widow of fifty-eight, caused a tear of her fornix, followed by violent hemorrhage. In another case by the same author, coitus in a sitting posture produced a rupture of the posterior fornix, involving the peritoneum; although the patient lost much blood, she finally recovered. In a third instance, a young girl, whose lover had violent connection with her while she was in an exaggerated lithotomy position, suffered a large tear of the right v.a.g.i.n.al wall. Hofmokl also describes the case of a young girl with an undeveloped v.a.g.i.n.a, absence of the uterus and adnexa, who during a forcible and unsuccessful attempt at coitus, had her left labium majus torn from the v.a.g.i.n.al wall. The tear extended into the mons veneris and down to the r.e.c.t.u.m, and the finger could be introduced into the v.a.g.i.n.al wound to the depth of two inches. The patient recovered in four weeks, but was still anemic from the loss of blood.

Crandall cites instances in which hemorrhage, immediately after coitus of the marriage-night, was so active as to almost cause death. One of his patients was married three weeks previously, and was rapidly becoming exhausted from a constant flowing which started immediately after her first coitus. Examination showed this to be a case of active intrauterine hemorrhage excited by coitus soon after the menstrual flow had ceased and while the uterus and ovaries were highly congested. In another case the patient commenced flooding while at the dinner table in the Metropolitan Hotel in New York, and from the same cause an almost fatal hemorrhage ensued. Hirst of Philadelphia has remarked that brides have been found on their marital beds completely covered with blood, and that the hemorrhage may have been so profuse as to soak through the bed and fall on the floor. Lacerations of the urethra from urethral coitus in instances of v.a.g.i.n.al atresia or imperforate hymen may also excite serious hemorrhage.

Foreign Bodies in the v.a.g.i.n.a.--The elasticity of the v.a.g.i.n.a allows the presence in this pa.s.sage of the most voluminous foreign bodies. When we consider the pa.s.sage of a fetal head through the v.a.g.i.n.a the ordinary foreign bodies, none of which ever approximate this size, seem quite reasonable. Goblets, hair-pins, needles, bottles, beer gla.s.ses, compa.s.ses, bobbins, pessaries, and many other articles have been found in the v.a.g.i.n.a. It is quite possible for a phosphatic incrustation to be found about a foreign body tolerated in this location for some time.

Hubbauer speaks of a young girl of nineteen in whose v.a.g.i.n.a there was a gla.s.s fixed by incrustations which held it solidly in place. It had been there for six months and was only removed with great difficulty.

Holmes cites a peculiar case in which the neck of a bottle was found in the v.a.g.i.n.a of a woman. One point of the gla.s.s had penetrated the bladder and a calculus had formed on this as well as on the v.a.g.i.n.al end.

When a foreign body remains in the v.a.g.i.n.a for a long time and if it is composed of material other than gla.s.s, it becomes influenced by the corrosive action of the v.a.g.i.n.al secretion. For instance, Cloquet removed a foreign body which was incrusted in the v.a.g.i.n.a, and found the cork pessary which had formed its nucleus completely rotted. A similar instrument found by Gosselin had remained in the v.a.g.i.n.a thirty-six years, and was incrustated with calcareous salts. Metal is always attacked by the v.a.g.i.n.al secretions in the most marked manner. Cloquet mentions that at an autopsy of a woman who had a pewter goblet in her v.a.g.i.n.a, lead oxid was found in the gangrenous debris.

Long Retention of Pessaries, etc.--The length of time during which pessaries may remain in the v.a.g.i.n.a is sometimes astonishing. The accompanying ill.u.s.tration shows the phosphatic deposits and incrustations around a pessary after a long sojourn in the v.a.g.i.n.a. The specimen is in the Musee Dupoytren. Pinet mentions a pessary that remained in situ for twenty-five years. Gerould of Ma.s.silon, Ohio, reports a case in which a pessary had been worn by a German woman of eighty-four for more than fifty years. She had forgotten its existence until reminded of it by irritation some years before death. It was remarkable that when the pessary was removed it was found to have largely retained its original wax covering. Hurxthal mentions the removal of a pessary which had been in the pelvis for forty-one years.

Jackson speaks of a glove-pessary remaining in the v.a.g.i.n.a thirty-five years. Mackey reports the removal of a gla.s.s pessary after fifty-five years' incarceration.

There is an account of a young girl addicted to onanism who died from the presence of a pewter cup in her v.a.g.i.n.a; it had been there fourteen months. Shame had led her to conceal her condition for all the period during which she suffered pain in the hypogastrium, and diarrhea. She had steadily refused examination. Bazzanella of Innsbruck removed a drinking gla.s.s from the v.a.g.i.n.a by means of a pair of small obstetric forceps. The gla.s.s had been placed there ten years previously by the woman's husband. Szigethy reports the case of a woman of seventy-five who, some thirty years before, introduced into her v.a.g.i.n.a a ball of string previously dipped in wax. The ball was effectual in relieving a prolapsed uterus, and was worn with so little discomfort that she entirely forgot it until it was forced out of place by a violent effort. The ball was seven inches in circ.u.mference, and covered with mucus, but otherwise unchanged. Breisky is accredited with the report of a case of a woman suffering with dysmenorrhea, in whose v.a.g.i.n.a was found a cotton reel which had been introduced seven years before. The woman made a good recovery. Pea.r.s.e mentions a woman of thirty-six who had suffered menorrhagia for ten days, and was in a state of great prostration and suffering from strong colicky pains. On examination he found a silk-bobbin about an inch from the entrance, which the patient had introduced fourteen years before. She had already had attacks of peritonitis and hemorrhage, and a urethrov.a.g.i.n.al fistula was found. The bobbin itself was black. This patient had been married twice, and had been cared for by physicians, but the existence of a body 3/4 inch long had never been noticed. Poulet quotes two curious cases: in one a pregnant woman was examined by a doctor who diagnosticated carcinomatous degeneration of the neck of the uterus. Capuron, who was consulted relative to the case, did not believe that the state of the woman's health warranted the diagnosis, and on further examination the growth was found to have been a sponge which had previously been introduced by the woman into the v.a.g.i.n.a. The other case, reported by Guyon, exemplified another error in diagnosis. The patient was a woman who suffered from continuous v.a.g.i.n.al hemorrhage, and had been given extensive treatment without success. Finally, when the woman was in extreme exhaustion, an injection of vinegar-water was ordered, the use of which was followed by the expulsion from the v.a.g.i.n.a of a live leech of a species very abundant in the country. The hemorrhage immediately ceased and health returned.

There is a record of a woman of twenty-eight who was suddenly surprised by some one entering her chamber at the moment she was introducing a cedar pencil into her v.a.g.i.n.a. With the purpose of covering up her act and dissembling the woman sat down, and the shank of the wood was pushed through the posterior wall of the v.a.g.i.n.a into the peritoneal cavity. The intestine was, without doubt, pierced in two of its curves, which was demonstrated later by an autopsy. A plastic exudation had evidently agglutinated the intestine at the points of penetration, and prevented an immediate fatal issue. Erichsen practiced extraction eight months after the accident, and a pencil 5 1/2 inches long, having a strong fecal odor, was brought out. The patient died the fourth day after the operation, from peritonitis, and an autopsy showed the perforation and agglutination of the two intestinal curvatures.

Getch.e.l.l relates the description of a calculus in the v.a.g.i.n.a, formed about a hair-pin as a nucleus. It is reported that a country girl came to the Hotel-Dieu to consult Dupoytren, and stated that several years before she had been violated by some soldiers, who had introduced an unknown foreign body into her v.a.g.i.n.a, which she never could extract.

Dupuytren found this to be a small metallic pot, two inches in diameter, with its concavity toward the uterus. It contained a solid black substance of a most fetid odor.

Foreign bodies are generally introduced in the uterus either accidentally in v.a.g.i.n.al applications, or for the purpose of producing abortion. Zuhmeister describes a case of a woman who shortly after the first manifestations of pregnancy used a twig of a tree to penetrate the matrix. She thrust it so strongly into the uterus that the wall was perforated, and the twig became planted in the region of the kidneys.

Although six inches long and of the volume of a goose feather, this branch remained five months in the pelvis without causing any particular inconvenience, and was finally discharged by the r.e.c.t.u.m.

Brignatelli mentions the case of a woman who, in culpable practices, introduced the stalk of a reed into her uterus. She suffered no inconvenience until the next menstrual epoch which was accompanied by violent pains. She presented the appearance of one in the pains of labor. The matrix had augmented in volume, and the orifice of the uterine cervix was closed, but there was hypertrophy as if in the second or third month of pregnancy. After examination a piece of reed three cm. long was extracted from the uterus, its external face being incrusted with hard calcareous material. Meschede of Schwetz, Germany, mentions death from a hair-pin in the uterine cavity.

Crouzit was called to see a young girl who had attempted criminal abortion by a darning-needle. When he arrived a fetus of about three months had already been expelled, and had been wounded by the instrument. It was impossible to remove the needle, and the placenta was not expelled for two days. Eleven days afterward the girl commenced to have pains in the inguinal region, and by the thirty-fifth day an elevation was formed, and the pains increased in violence. On the seventy-ninth day a needle six inches long was expelled from the swelling in the groin, and the patient recovered. Lisfranc extracted from the uterus of a woman who supposed herself to be pregnant at the third month, a fragment of a large gum-elastic sound which during illicit maneuvers had broken off within five cm. of its extremity, and penetrated the organ. Lisfranc found there was not the slightest sign of pregnancy, despite the woman's belief that she was with child.

CHAPTER XIV.

MISCELLANEOUS SURGICAL ANOMALIES.

Marvelous Recoveries from Multiple Injuries.--There are injuries so numerous or so great in extent, and so marvelous in their recovery, that they are worthy of record in a section by themselves. They are found particularly in military surgery. In the Medical and Philosophical Commentaries for 1779 is the report of the case of a lieutenant who was wounded through the lungs, liver, and stomach, and in whose armpit lodged a ball. It was said that when the wound in his back was injected, the fluid would immediately be coughed up from his lungs. Food would pa.s.s 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 ma.s.sacred 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 sh.e.l.l. 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 pa.s.sing 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 sh.e.l.l, which pa.s.sed 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 pa.s.sed 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 pa.s.sing 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 sh.e.l.l pa.s.sed 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 pa.s.sing 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 a.n.a.logous 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 a.n.u.s was formed and part of the feces were discharged through the wound. This man was subsequently seen at Midnapore healthy and l.u.s.ty although his body was bent to one side in consequence of a large cicatrix; a small portion of the feces occasionally pa.s.sed 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 pa.s.sed 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 circ.u.mference 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 a.s.sistance 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 b.l.o.o.d.y 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:--