Anomalies And Curiosities Of Medicine Part 45

Bird reports a compound comminuted fracture of the left temporal region, with loss of bone, together with six drams of brain-substance, which, however, was followed by recovery. Tagert gives an instance of compound depressed fracture of the skull, with loss of brain-substance, in which recovery was effected without operative interference. Ballou, Bartlett, Buckner, Capon, Carmichael, Corban, Maunder and many others, cite instances of cranial fracture and loss of brain-substance, with subsequent recovery. Halsted reports the history of a boy of seventeen, who, while out fowling, had the breech-pin of a shot-gun blown out, the sharp point striking the forehead in the frontal suture, crus.h.i.+ng the os frontis, destroying 1 3/4 inches of the longitudinal sinus, and causing severe hemorrhage from both the longitudinal and frontal sinuses. The pin was pulled out by the boy, who washed his own face, and lay down; he soon became semi-comatose, in which condition he remained for some days; but, after operation, he made complete recovery.

Loss of Brain-substance from Cerebral Tumor.--Koser is accredited with reporting results of a postmortem held on a young man of twenty who suffered from a cerebral tumor of considerable duration. It was stated that, although there was a cavity in the brain at least five inches in length, the patient, almost up to the time of death, was possessed of the senses of touch, taste, hearing, and smell, showed considerable control over his locomotor muscles, and could talk. In fact, he was practically discommoded in no other way than by loss of vision, caused by pressure on the optic centers. It was also stated that the retention of memory was remarkable, and, up to within two weeks of his death, the patient was able to memorize poems. The amount of involvement discovered postmortem in cases similar to the preceding is astonis.h.i.+ng.

At a recent pathologic display in London several remarkable specimens were shown.

Extensive Fractures of the Skull. Jennings mentions an instance of extensive fracture of the skull, 14 pieces of the cranium being found.

The patient lived five weeks and two days after the injury, the immediate cause of death being edema of the lungs. His language was incoherent and full of oaths. Belloste, in his "Hospital Surgeon,"

states that he had under has care a most dreadful case of a girl of eleven or twelve years, who received 18 or 19 cutla.s.s wounds of the head, each so violent as to chip out pieces of bone; but, notwithstanding her severe injuries, she made recovery. At the Emergency Hospital in Was.h.i.+ngton, D.C., there was received a negress with at least six gaping wounds of the head, in some cases denuding the periosteum and cutting the cranium. During a debauch the night before she had been engaged in a quarrel with a negro with whom she lived, and was struck by him several times on the head with an axe. She lay all night unconscious, and was discovered the next morning with her hair and clothes and the floor on which she lay drenched with blood. The ambulance was summoned to take her to the morgue, but on the arrival of the police it was seen that feeble signs of life still existed. On admission to the hospital she was semi-comatose, almost pulseless, cold, and exhibiting all the signs of extreme hemorrhage and shock. Her head was cleaned up, but her condition would not permit of any other treatment than a corrosive-sublimate compress and a bandage of Scultetus. She was taken to the hospital ward, where warmth and stimulants were applied, after which she completely reacted. She progressed so well that it was not deemed advisable to remove the head-bandage until the fourth day, when it was seen that the wounds had almost entirely healed and suppuration was virtually absent. The patient rapidly and completely recovered, and her neighbors, on her return home, could hardly believe that she was the same woman whom, a few days before, they were preparing to take to the morgue.

A serious injury, which is not at all infrequent, is that caused by diving into shallow water, or into a bath from which water has been withdrawn. Curran mentions a British officer in India who, being overheated, stopped at a station bath in which the previous night he had had a plunge, and without examining, took a violent "header" into the tank, confidently expecting to strike from eight to ten feet of water. He dashed his head against the concrete bottom 12 feet below (the water two hours previously having been withdrawn) and crushed his brain and skull into an indistinguishable ma.s.s.

There are many cases on record in which an injury, particularly a gunshot wound of the skull, though showing no external wound, has caused death by producing a fracture of the internal table of the cranium. Pare gives details of the case of a n.o.bleman whose head was guarded by a helmet and who was struck by a ball, leaving no external sign of injury, but it was subsequently found that there was an internal fracture of the cranium. Tulpius and Scultetus are among the older writers reporting somewhat similar instances, and there are several a.n.a.logous cases reported as having occurred during the War of the Rebellion. Boling reports a case in which the internal table was splintered to a much greater extent than the external.

Fracture of the base of the skull is ordinarily spoken of as a fatal injury, reported instances of recovery being extremely rare, but Battle, in a paper on this subject, has collected numerous statistics of nonfatal fracture of the base of the brain, viz.:--

Male. Female.

Anterior fossa, ... ... ... . . 16 5 Middle fossa, ... ... ... ... 50 6 Posterior fossa,... ... ... . . 10 1 Middle and anterior fossae, ... . . 15 5 Middle and posterior fossae,... . . 4 1 Anterior, middle, and posterior fossae, 1 0 ------ ------ 96 18 Total, 114.

In a paper on nonmortal fractures of the base of the skull, Lidell gives an account of 135 cases. MacCormac reports a case of a boy of nine who was run over by a carriage drawn by a pair of horses. He suffered fracture of the base of the skull, of the bones of the face, and of the left ulna, and although suppuration at the points of fracture ensued, followed by an optic neuritis, an ultimate recovery was effected. Ball, an Irish surgeon, has collected several instances in which the base of the skull has been driven in and the condyle of the jaw impacted in the opening by force transmitted through the lower maxilla.

The tolerance of foreign bodies in the brain is most marvelous. In the ancient chronicles of Koenigsberg there is recorded the history of a man who for fourteen years carried in his head a piece of iron as large as his finger. After its long lodgment, during which the subject was little discommoded, it finally came out by the palatine arch. There is also an old record of a ball lodging near the sella turcica for over a year, the patient dying suddenly of an entirely different accident.

Fabricius Hilda.n.u.s relates the history of an injury, in which, without causing any uncomfortable symptoms, a ball rested between the skull and dura for six months.

Amatus Lusita.n.u.s speaks of a drunken courtesan who was wounded in a fray with a long, sharp-pointed knife which was driven into the head.

No apparent injury resulted, and death from fever took place eight years after the reception of the injury. On opening the head a large piece of knife was found between the skull and dura. It is said that Benedictus mentions a Greek who was wounded, at the siege of Colchis, in the right temple by a dart and taken captive by the Turks; he lived for twenty years in slavery, the wound having completely healed.

Obtaining his liberty, he came to Sidon, and five years after, as he was was.h.i.+ng his face, he was seized by a violent fit of sneezing, and discharged from one of his nostrils a piece of the dart having an iron point of considerable length.

In about 1884 there died in the Vienna Hospital a bookbinder of forty-five, who had always pa.s.sed as an intelligent man, but who had at irregular intervals suffered from epileptic convulsions. An iron nail covered with rust was discovered in his brain; from the history of his life and from the appearances of the nail it had evidently been lodged in the cerebrum since childhood.

Slee mentions a case in which, after the death of a man from septic peritonitis following a bullet-wound of the intestines, he found postmortem a knife-blade 5/16 inch in width projecting into the brain to the depth of one inch. The blade was ensheathed in a strong fibrous capsule 1/2 inch thick, and the adjacent brain-structure was apparently normal. The blade was black and corroded, and had evidently pa.s.sed between the sutures during boyhood as there was no depression or displacement of the cranial bones. The weapon had broken off just on a level with the skull, and had remained in situ until the time of death without causing any indicative symptoms. Slee does not state the man's age, but remarks that he was a married man and a father at the time of his death, and had enjoyed the best of health up to the time he was shot in the abdomen. Callaghan, quoted in Erichsen's "Surgery," remarks that he knew of an officer who lived seven years with a portion of a gun-breech weighing three ounces lodged in his brain.

Lawson mentions the impaction of a portion of a breech of a gun in the forehead of a man for twelve years, with subsequent removal and recovery. Waldon speaks of a similar case in which a fragment of the breech weighing three ounces penetrated the cranium, and was lodged in the brain for two months previous to the death of the patient.

Huppert tells of the lodgment of a slate-pencil three inches long in the brain during lifetime, death ultimately being caused by a slight head-injury. Larry mentions a person who for some time carried a six ounce ball in the brain and ultimately recovered. Peter removed a musket-ball from the frontal sinus after six years' lodgment, with successful issue. Mastin has given an instance in which the blade of a pen-knife remained in the brain six months, recovery following its removal. Camden reports a case in which a ball received in a gunshot wound of the brain remained in situ for thirteen years; Cronyn mentions a similar case in which a bullet rested in the brain for eight years.

Doyle successfully removed an ounce Minie ball from the brain after a fifteen years' lodgment.

Pipe-stems, wires, shot, and other foreign bodies, are from time to time recorded as remaining in the brain for some time. Wharton has compiled elaborate statistics on this subject, commenting on 316 cases in which foreign bodies were lodged in the brain, and furnis.h.i.+ng all the necessary information to persons interested in this subject.

Injuries of the nose, with marked deformity, are in a measure combated by devices invented for restoring the missing portions of the injured member. Taliacotius, the distinguished Italian surgeon of the sixteenth century, devised an operation which now bears his name, and consists in fas.h.i.+oning a nose from the fleshy tissues of the arm. The arm is approximated to the head and held in this position by an apparatus or system of bandages for about ten days, at which time it is supposed that it can be severed, and further tr.i.m.m.i.n.g and paring of the nose is then practiced. A column is subsequently made from the upper lip. In the olden days there was a timorous legend representing Taliacotius making noses for his patients from the gluteal regions of other persons, which statement, needless to say, is not founded on fact.

Various modifications and improvements on the a Talicotian method have been made; but in recent years the Indian method, introduced by Carpue into England in 1816, is generally preferred. Syme of Edinburgh, Wood, and Ollier have devised methods of restoring the nose, which bear their names.

Ohmann-Dumesnil reports a case of rhinophyma in a man of seventy-two, an alcoholic, who was originally affected with acne rosacea, on whom he performed a most successful operation for restoration. The accompanying ill.u.s.tration shows the original deformity--a growth weighing two pounds--and also pictures the appearance shortly after the operation.

This case is ill.u.s.trative of the possibilities of plastic surgery in the hands of a skilful and ingenious operator.

About 1892 Dr. J. P. Parker then of Kansas City, Mo., restored the missing bridge of a patient's nose by laying the sunken part open in two long flaps, denuding the distal extremity of the little finger of the patient's right hand of nail, flesh, tendons, etc., and binding it into the wound of the nose until firm union had taken place. The finger was then amputated at the second joint and the plastic operation completed, with a result pleasing both to patient and operator.

There is a case quoted of a young man who, when first seen by his medical attendant, had all the soft parts of the nose gone, except one-third of the left ala and a thin flap of the septum which was lying on the upper lip. The missing member was ferreted out and cleansed, and after an hour's separation sutured on. The nostrils were daily syringed with a corrosive sublimate solution, and on the tenth day the dressing was removed; the nose was found active and well, with the single exception of a triangular notch on the right side, which was too greatly bruised by the violence of the blow to recover. When we consider the varicosity of this organ we can readily believe the possibility of the foregoing facts, and there is little doubt that more precaution in suturing severed portions of the nose would render the operation of nose making a very rare one.

Maxwell mentions a curious case of attempted suicide in which the ball, pa.s.sing through the palatine process of the superior maxillary bone, crus.h.i.+ng the vomer to the extent of its own diameter, fell back through the right nostril into the pharynx, was swallowed, and discharged from the a.n.u.s.

Deformities of the nose causing enormous development, or the condition called "double-nose" by Bartholinus, Borellus, Bidault, and others, are ordinarily results of a pathologic development of the sebaceous glands.

In some cases tumors develop from the root of the nose, forming what appears to be a second nose. In other cases monstrous vegetations divide the nose into many tumors. In the early portion of this century much was heard about a man who was a daily habitue of the Palais-Royal Gardens. His nose was divided into unequally sized tumors, covering nearly his entire face. Similar instances have been observed in recent years. Hey mentions a case in which the tumor extended to the lower part of the under lip, which compressed the patient's mouth and nostrils to such an extent that while sleeping, in order to insure sufficient respiration, he had to insert a tin-tube into one of his nostrils. Imbert de Lannes is quoted as operating on a former Mayor of Angouleme. This gentleman's nose was divided into five lobes by sarcomatous tumors weighing two pounds, occupying the external surface of the face, adherent to the buccinator muscles to which they extended, and covering the chin. In the upright position the tumors sealed the nostrils and mouth, and the man had to bend his head before and after respiration. In eating, this unfortunate: person had to lift his tumors away from his mouth, and during sleep the monstrous growths were supported in a sling attached to his night cap. He presented such a hideous aspect that he was virtually ostracized from society The growth had been in progress for twelve years, but during twenty-two months'

confinement in Revolutionary prisons the enlargement had been very rapid. Fournier says that the most beautiful result followed the operation which was considered quite hazardous.

Foreign bodies in the nose present phenomena as interesting as wounds of this organ. Among the living objects which have been found in the nose may be mentioned flies, maggots, worms, leeches, centipedes, and even lizards. Zacutus Lusita.n.u.s tells of a person who died in two days from the effects of a leech which was inadvertently introduced into the nasal fossa, and there is a somewhat similar case of a military pharmacist, a member of the French army in Spain, who drank some water from a pitcher and exhibited, about a half hour afterward, a persistent hemorrhage from the nose. Emaciation progressively continued, although his appet.i.te was normal. Three doctors, called in consultation, prescribed bleeding, which, however, proved of no avail. Three weeks afterward he carried in his nostril a tampon of lint, wet with an astringent solution, and, on the next day, on blowing his nose, there fell from the right nostril a body which he recognized as a leech.

Healey gives the history of four cases in which medicinal leeches were removed from the mouth and posterior nares of persons who had, for some days previously, been drinking turbid water. Sinclair mentions the removal of a leech from the posterior nares.

In some regions, more particularly tropical ones, there are certain flies that crawl into the nostrils of the inhabitants and deposit eggs, in the cavities. The larvae develop and multiply with great rapidity, and sometimes gain admission into the frontal sinus, causing intense cephalalgia, and even death.

Dempster reports an instance of the lodgment of numerous live maggots within the cavity of the nose, causing sloughing of the palate and other complications. Nicholson mentions a case of ulceration and abscess of the nostrils and face from which maggots were discharged.

Jarvis gives the history of a strange and repeated hemorrhage from the nose and adjacent parts that was found to be due to maggots from the ova of a fly, which had been deposited in the nose while the patient was asleep. Tomlinson gives a case in which maggots traversed the Eustachian tube, some being picked out of the nostrils, while others were coughed up. Packard records the accidental entrance of a centipede into the nostril. There is an account of a native who was admitted to the Madras General Hospital, saying that a small lizard had crawled up his nose. The urine of these animals is very irritating, blistering any surface it touches. Despite vigorous treatment the patient died in consequence of the entrance of this little creature.

There have been instances among the older writers in which a pea has remained in the nose for such a length of time as to present evidences of sprouting. The Ephemerides renders an instance of this kind, and Breschet cites the history of a young boy, who, in 1718, introduced a pea into his nostril; in three days it had swollen to such an extent as to fill the whole pa.s.sage. It could not be extracted by an instrument, so tobacco snuff was used, which excited sneezing, and the pea was ejected.

Vidal and the Ephemerides report several instances of tolerance of foreign bodies in the nasal cavities for from twenty to twenty-five years. Wiesman, in 1893, reported a rhinolith, which was composed of a cherry-stone enveloped in chalk, that had been removed after a sojourn of sixty years, with intense ozena as a consequence of its lodgment.

Waring mentions the case of a housemaid who carried a rhinolith, with a cherry-stone for a nucleus, which had been introduced twenty-seven years before, and which for twenty-five years had caused no symptoms.

Grove describes a necrosed inferior turbinated bone, to which was attached a coffee-grain which had been retained in the nostril for twenty years., Hickman gives an instance of a steel ring which for thirteen and a half years had been impacted in the nasopharyngeal fossa of a child. It was detected by the rhinoscope and was removed. Parker speaks of a gunbreech bolt which was removed from the nose after five years' lodgment. Major mentions the removal of a foreign body from the nose seven years after its introduction.

Howard removed a large thimble from the posterior nares, although it had remained in its position for some time undetected. Eve reports a case in which a thimble was impacted in the right posterior nares.

Gazdar speaks, of a case of persistent neuralgia of one-half of the face, caused by a foreign body in the nose. The obstruction was removed after seven years' lodgment and the neuralgia disappeared.

Molinier has an observation on the extraction of a fragment of a knife-blade which had rested four years in the nasal fossae, where the blade had broken off during a quarrel.

A peculiar habit, sometimes seen in nervous individuals, is that of "swallowing the tongue." Cohen claims that in some cases of supposed laryngeal spasm the tongue is swallowed, occluding the larynx, and sometimes with fatal consequences. There are possibly a half score of cases recorded, but this anomaly is very rare, and Major is possibly the only one who has to a certainty demonstrated the fact by a laryngoscopic examination. By the laryngoscope he was enabled to observe a paroxysm in a woman, in which the tongue retracted and impinged on the epiglottis, but quickly recovered its position. Pett.i.t mentions suffocation from "tongue swallowing," both with and without section of the frenum. Schobinger cites a similar instance, due to loosening of the frenum.

a.n.a.logous to the foregoing phenomenon is the habit of "tongue sucking."

Morris mentions a young lady of fifteen who spontaneously dislocated her jaw, owing indirectly to this habit. Morris says that from infancy the patient was addicted to this habit, which was so audible as to be heard in all parts of the room. The continued action of the pterygoid muscles had so preternaturally loosened the ligaments and muscular structures supporting the joint as to render them unable to resist the violent action of "tongue sucking" even during sleep.

Injuries to the Tongue.--Hobbs describes a man of twenty-three who, while working, had a habit of protruding his tongue. One day he was. .h.i.t under the chin by the chain of a crane on a pier, his upper teeth inflicting a wound two inches deep, three inches from the tip, and dividing the entire structure of the tongue except the arteries. The edges of the wound were brought into apposition by sutures, and after the removal of the latter perfect union and complete restoration of the sensation of taste ensued. Franck mentions regeneration of a severed tongue; and Van Wy has seen union of almost entirely severed parts of the tongue. De Fuisseaux reports reunion of the tongue by suture after almost complete transverse division.

There is an account of a German soldier who, May 2, 1813, was wounded at the battle of Gross-Gorschen by a musket ball which penetrated the left cheek, carrying away the last four molars of the upper jaw and pa.s.sing through the tongue, making exit on the left side, and forcing out several teeth of the left lower jaw. To his surprise, thirty years afterward, one of the teeth was removed from an abscess of the tongue.

Baker speaks of a boy of thirteen who was shot at three yards distance.

The bullet knocked out two teeth and pa.s.sed through the tongue, although it produced no wound of the pharynx, and was pa.s.sed from the a.n.u.s on the sixth day. Stevenson mentions a case of an organist who fell forward when stooping with a pipe in his mouth, driving its stem into the roof of the pharynx. He complained of a sore throat for several days, and, after explanation, Stevenson removed from the soft palate a piece of clay pipe nearly 1 1/4 inches long. Herbert tells of a case resembling carcinoma of the tongue, which was really due to the lodgment of a piece of tooth in that organ.

Articulation Without the Tongue.--Total or partial destruction of the tongue does not necessarily make articulation impossible. Banon mentions a man who had nothing in his mouth representing a tongue. When he was young, he was attacked by an ulceration destroying every vestige of this member. The epiglottis, larynx, and pharynx, in fact the surrounding structures were normal, and articulation, which was at first lost, became fairly distinct, and deglut.i.tion was never interfered with. Pare gives a description of a man whose tongue was completely severed, in consequence of which he lost speech for three years, but was afterward able to make himself understood by an ingenious bit of mechanism. He inserted under the stump of the tongue a small piece of wood, in a most marvelous way replacing the missing member. Articulation with the absence of some const.i.tuent of the vocal apparatus has been spoken of on page 254.

Hypertrophy of the Tongue.--It sometimes happens that the tongue is so large that it is rendered not only useless but a decided hindrance to the performance of the ordinary functions into which it always enters.

Ehrlich, Ficker, Klein, Rodforffer, and the Ephemerides, all record instances in which a large tongue was removed either by ligation or amputation. Von Siebold records an instance in which death was caused by the ligature of an abnormally sized tongue. There is a modern record of three cases of enormous tongues, the result of simple hypertrophy.

In one case the tongue measured 6 1/4 inches from the angle of the mouth about the sides and tip to the opposite angle, necessitating amputation of the protruding portion.

Carnochan reports a case in which hypertrophy of the tongue was reduced to nearly the normal size by first tying the external carotid, and six weeks later the common carotid artery. Chalk mentions partial dislocation of the lower jaw from an enlarged tongue. Lyford speaks of enlargement of the tongue causing death.

The above conditions are known as macroglossia, which is a congenital hypertrophy of the tongue a.n.a.logous to elephantiasis. It is of slow growth, and as the organ enlarges it interferes with deglut.i.tion and speech. It may protrude over the chin and reach even as far down as the sternum.

The great enlargement may cause deformities of the teeth and lower jaw, and even present itself as an enormous tumor in the neck. The protruding tongue itself may ulcerate, possibly bleed, and there is constant dribbling of saliva. The disease is probably due to congenital defect aggravated by frequent attacks of glossitis, and the treatment consists in the removal of the protruding portions by the knife, ligation, the cautery, or ecraseur.

Living Fish in the Pharynx.--Probably the most interesting cases of foreign bodies are those in which living fish enter the pharynx and esophagus. Chevers has collected five cases in which death was caused by living fish entering the mouth and occluding the air-pa.s.sages. He has mentioned a case in which a large catfish jumped into the mouth of a Madras bheestie. An operation on the esophagus was immediately commenced, but abandoned, and an attempt made to push the fish down with a probang, which was, in a measure, successful. However, the patient gave a convulsive struggle, and, to all appearances, died. The trachea was immediately opened, and respiration was restored. During the course of the night the man vomited up pieces of fish bone softened by decomposition. In 1863 White mentions that the foregoing accident is not uncommon among the natives of India, who are in the habit of swimming with their mouths open in tanks abounding with fish. There is a case in which a fisherman, having both hands engaged in drawing a net, and seeing a sole-fish about eight inches long trying to escape through the meshes of the net, seized it with his teeth. A sudden convulsive effort of the fish enabled it to enter the fisherman's throat, and he was asphyxiated before his boat reached the sh.o.r.e. After death the fish was found in the cardiac end of the stomach. There is another case of a man named Durand, who held a mullet between his teeth while rebaiting his hook. The fish, in the convulsive struggles of death, slipped down the throat, and because of the arrangement of its scales it could be pushed down but not up; asphyxiation, however, ensued. Stewart has extensively described the case of a native "Puckally" of Ceylon who was the victim of the most distressing symptoms from the impaction of a living fish in his throat. The native had caught the fish, and in order to extract it placed its head between his teeth, holding the body with the left hand and the hook with the right. He had hardly extracted the hook, when the fish p.r.i.c.ked his palm with his long and sharp dorsal fin, causing him suddenly to release his grasp on the fish and voluntarily open his mouth at the same time. The fish quickly bolted into his mouth, and, although he grasped the tail with his right hand, and squeezed his pharynx with his left, besides coughing violently, the fish found its way into the esophagus. Further attempts at extraction were dangerous and quite likely to fail; his symptoms were distressing, he could not hold his head erect without the most agonizing pain and he was almost prostrated from fright and asphyxia; it was thought advisable to push the fish into the stomach, and after an impaction of sixteen hours the symptoms were relieved. The fish in this instance was the Anabas scandens or "walking perch" of Ceylon, which derives its name from its power of locomotion on land and its ability to live out of water for some time. It is from four to five inches long and has a dorsal fin as sharp as a knife and directed toward the tail, and pectoral fins following the same direction; these would admit of entrance, but would interfere with extraction. MacLauren reports the history of a young man who, after catching a fish, placed it between his teeth. The fish, three inches long, by a sudden movement, entered the pharynx. Immediately ensued suffocation, nausea, vomiting, together with the expectoration of blood and mucus. There was emphysema of the face, neck, and chest. The fish could be easily felt impacted in the tissues, but, after swallowing much water and vinegar, together with other efforts at extraction, the fins were loosened--about twenty-four hours after the accident. By this time the emphysema had extended to the s.c.r.o.t.u.m. There was much expectoration of muco-purulent fluid, and on the third day complete aphonia, but the symptoms gradually disappeared, and recovery was complete in eight days. Dantra is accredited with describing asphyxiation, accompanied by great agony, in a man who, while swimming, had partially swallowed a live fish. The fish was about three inches in length and one in breadth, and was found lying on the dorsum of his tongue and, together with numerous clots of blood, filled his mouth. Futile attempts to extract the fish by forceps were made. Examination showed that the fish had firmly grasped the patient's uvula, which it was induced to relinquish when its head was seized by the forceps and pressed from side to side. After this it was easily extracted and lived for some time. There was little hemorrhage after the removal of the offending object, and the blood had evidently come from the injuries to the sides of the mouth, caused by the fins. The uvula was bitten, not torn.

There is an interesting account of a native of India, who, while fis.h.i.+ng in a stream, caught a flat eel-like fish from fifteen to sixteen inches long. After the fas.h.i.+on of his fellows he attempted to kill the eel by biting off its head; in the attempt the fish slipped into his gullet, and owing to its sharp fins could not be withdrawn.

The man died one hour later in the greatest agony; so firmly was the eel impacted that even after death it could not be extracted, and the man was buried with it protruding from his mouth.

A Leech in the Pharynx.--Granger, a surgeon in Her Majesty's Indian Service, writes:--"Several days ago I received a note from the political sirdar, asking me if I would see a man who said he had a leech in his throat which he was unable to get rid of. I was somewhat sceptical, and thought that possibly the man might be laboring under a delusion. On going outside the fort to see the case, I found an old Pathan graybeard waiting for me. On seeing me, he at once spat out a large quant.i.ty of dark, half-clotted blood to a.s.sure me of the serious nature of his complaint. His history--mostly made out with the aid of interpreters--was that eleven days ago he was drinking from a rain-water tank and felt something stick in his throat, which he could not reject. He felt this thing moving, and it caused difficulty in swallowing, and occasionally vomiting. On the following day he began to spit up blood, and this continued until he saw me. He stated that he once vomited blood, and that he frequently felt that he was going to choke.