diers around. Now this desperate character marched, in a quarter of an hour afterwards, to the hospital, three-quarters of a mile distant; and at the end of a fortnight was discharged from the same, to be placed upon trial for his life. The day after his admission his urine was a little bloody; and subsequently there was a general anesthesia of the walls of the thorax and abdomen, which lasted but for a while. With these exceptions, the injury was not followed by a symptom, nor did the subject of it require a dose of medicine for his recovery. To the circumstances of this affray having been enacted before dinner, I am disposed to attribute much of the immunity from evil which this ruffian enjoyed. Had the stomach been full it is not easy to conceive how a bayonet could have traveled through such a track of vital organs without endangering one or more. The reader may be interested to know that the life of this soldier was spared, transportation for the rest of his days being the sentence of the court martial."10 287. Pelvis.-Injuries to the pelvis bones, when they are of a serious nature, are usually associated with great violence, which is necessary to fracture the solid bony parts. Of the internal organs the most significant is the bladder, which is liable to rupture after kicks, blows, crushing accidents, etc. It is always a serious injury. When the rupture is such that it allows the escape of the contents of the bladder into the peritoneal cavity, and the wound is not promptly treated by surgical means, the result is almost invariably fatal. If the urine escape into the other tissues around the bladder the outcome may be more fortunate. The cause of the rupture of the bladder may be disputed, as, in some instances, the bladder has ruptured without injury. These nontraumatic ruptures, however, are almost invariably due to previous disease of the bladder or obstruction to the outflow of the urine, as in the cases of stricture of the urethra. One instance is recorded of over-distention of the bladder at an operation. In cases where a nontraumatic origin for the rupture of the bladder is argued and no diseased condition is found, the plea cannot be allowed. In the words of Dr. Taylor: "If a man were in good health prior to being struck,-if he suddenly felt intense pain, could not pass his urine afterwards, and died from an attack of peritonitis in five or six days,-if, after death, the bladder was found lacerated, but this organ and the urethra were otherwise in a healthy condition, Several other instances of trans- Anomalies and Curiosities of Medicine, fixion of the abdomen, with recovery, p. 648. are recorded in Gould and Pyle's -there can be no doubt that the blow was the sole cause of rupture and death. In such a case, to attribute the rupture to spontaneous causes would be equal to denying all kinds of causation." 288. Genitals; female.— Injuries to the female organs of generation have been considered in connection with the signs of artificial abortion by local mechanical means. The occasional immunity from the serious effects of similar wounds is illustrated by the following cases: Dr. Sargent, of Worcester, Mass., reported to the Boston Society for Medical Improvement11 a case which occurred in his practice. A woman, about thirty-seven years of age, in sliding down from a hayloft, impaled herself upon the handle of a pitchfork, which passed in at her vagina to the length of 22 inches, when her feet struck the ground. The handle was immediately withdrawn. Dr. S. saw the handle of the fork, which was rounded a little larger at the end than elsewhere, perfectly smooth, two inches in diameter, and showed distinctly the stain of blood up to an abrupt line, 22 inches from the end. It was supposed that the instrument perforated the upper end of the vagina on the left side, passed between the uterus and rectum, in front of the kidney, behind the spleen, and between the diaphragm and false ribs, peeling up the costal pleura till it reached the scaleni muscles. The subsequent history of the case, which showed a fracture of the first rib, proved this diagnosis corThe woman entirely recovered in a few weeks. Another case is reported by Dr. Bryant, of Mississippi,12 of a negro woman who leaped from the height of ten feet and alighted upon a tobacco stick, which had been driven firmly in the ground, and was concealed by some loose fodder. The stick was 412 feet long and 1 inch square. It entered the vagina, penetrated its upper part, and traversed the abdomen at the eleventh or twelfth rib. The stick was smeared with bloody mucus to the extent of 1211⁄2 inches, and its termination was abrupt and distinct. "It was quite clear that the stick was not stained by the fluid running down upon it." This woman also recovered, after losing a considerable quantity of blood. rect. Wounds of the genitals in the female are generally due to the violence of others. A number of criminal trials have taken place in Scotland in conse "Am. Journ. Med. Sci., Oct. 1853, p. 355. "Am. Journ. Med. Sci., Oct. 1853, p. 399. The sequel of Dr. Sargent's case is given in the Boston Med. and Surg. Journ., Dec. 1856, p. 387, and several analogous ones are there referred to by Dr. Coale. Dr. Maynard has reported a fatal case in a woman who, in sliding down a hay-mow, fell upon a hay-hook. (Ibid., Aug. 1857, p. 29.) quence of women, for the most part pregnant, having died of hemorrhage from the pudendum. In most or all of these cases, it has been averred that the wound was inflicted with criminal intent by the husband or others. A case occurred at Dundee, in which there were no grounds for suspicion that the woman had received a wound. She lived on good terms with her husband and neighbors. She had been straining at the night-stool when the hemorrhage came on. A large quantity of blood was found about her person; it had flowed from the genital organs, but not from the uterus, which was fully expanded in pregnancy. On examining the vagina, Dr. Kyle found a recent aperture in one labium, which he traced into a large vein; one of a plexus which extends some distance into the vagina. A case is related by Dr. Thomson, in which the woman, however, recovered after losing a large quantity of blood. In this instance, the woman's husband, a cattle drover, had been long absent from home, and, on his return, remained alone with his wife about half an hour. The bleeding commenced immediately after this visit. A wound was discovered large enough to admit the finger to the depth of about half an inch, in the anterior wall of the vagina, at the union of its upper with its middle third. It was probably an accidental laceration, but if death had actually resulted, the existence of the wound might have given rise to suspicions of criminal violence.13 Dr. Menzies relates that a woman three weeks after delivery, on rising from bed, accidentally fell on the top rail of a common stuff-bottomed chair. Profuse hemorrhage ensued, which, on examination, was found to proceed from a wound in the vagina nearly half an inch in length, and which looked exactly as if it had been inflicted with a sharp instrument. In another case reported by Dr. Ellis, and also of a pregnant woman, death by hemorrhage resulted from a lacerated wound of the vagina, supposed to have been inflicted by her falling on the post of a crib. In a third case, related by Dr. Morland, a woman five months advanced in pregnancy, fell upon the roof of a woodshed, by slipping upon one of the steps by which the roof was ascended. The hemorrhage was very profuse and, but for timely assistance, would probably have been fatal. The wound was an inch and a half long by an inch deep, upon the internal surface of the left nympha. In these cases there was nothing in the character of the wound to distinguish it from those in which the absence of contusion "Ger. Leichenöff, 2 Hundert. Fall., p. 249, from Glasgow Med. Journ., 43. April, 1862, and Gazette des Hôpitaux. "Am. Journ. Med. Sci., Vol. XLIV., VOL. IIL MEd. Jur.-16. has been supposed to indicate a homicidal origin. They also appear to show the peculiar danger to which wounds of the genitals expose pregnant women. 289. Genitals; male.— Wounds of the genitals in the male are usually self-inflicted, and instances of this kind most usually occur in the insane. The danger to life is principally from the hemorrhage, and may be very profuse and not easily controlled. Impotence may be the result of even imperfect mutilation. M. Toulmouchel has contributed some interesting cases of wounds of the genitals. One of them, a case of castration of the right testicle, is especially interesting, inasmuch as M. Toulmouche was enabled to state, from the appearance of the wound and in spite of the obstinate silence of the patient, that the castration must necessarily have been performed by a second person. The recipient of the injury must have been forcibly held. The tunica vaginalis was neatly opened from above downwards, the testicle drawn out, and the cord divided above in an artistic manner. In Although "fracture" of the penis is a rare accident, a sufficient number of cases have been reported to make it worthy of notice. the Cincinnati Journal of Medicine for July, 1866, Dr. J. P. Bing relates a case which was tried in the court of common pleas, in Meigs county, Ohio, February, 1866. The indictment was substantially as follows: "That one Mary Broderick, of the county aforesaid, did, on the 29th day of July, 1865, purposely and maliciously, but without deliberation and premeditation, with her right hand, grasp and wrench the penis of Patrick Broderick, with intent to inflict a mortal wound; thus the urethra with the corpus spongiosum and corpus cavernosum were broken and severed; and that Patrick Broderick (her husband) died from the effects of the wound, on the eleventh day after the injury was inflicted." The physicians who attended the case stated that there had been retention of urine with apparent extravasation; and it was not until after three days that they had succeeded in introducing a catheter and drawing off the urine. At the post-mortem examination the "corpus cavernosum, left side, was found to be ruptured; corpus spongiosum mutilated, and urethra entirely severed; infiltration of urine into cellular tissue of penis, perineum, and into scrotum, with incipient gangrene." The defense set up was that the injury was received by falling down stairs, the deceased having been in a state of intoxication at the time. The verdict rendered was, "Guilty of manslaughter," and "not guilty of murder in the second degree." Dr. Blackman refers, in the same journal, to several other cases of a similar injury. One of them is reported by M. Huguier.16 There was a "complete rupture of the canal of the urethra and partial rupture of the corpora cavernosa, followed by death." "The patient, a vigorous man, æt. thirty-seven, had some affection of the ear, for which he applied a blister. Some days afterwards, while in bed with his wife, and having des erections continuelles, from the effect of the blister, had connection, the wife having the superincumbent position. The whole weight of her body was brought to bear upon the organ then in violente érection, and the latter was thrust against the thigh and perineum. On account of retention of urine and failure to introduce a catheter, the bladder was tapped above the pubis. "Erysipelatous inflammation, with emphysema, showed itself at various points, and the patient died on the twelfth day after the accident. The postmortem showed that the rupture of the canal was complete, and the corpora cavernosa were partially divided." 290. Extremities.-Wounds of the arms and legs are most often of significance from the interference with the function of the part, rather than from the danger to life. In considering traumatic dislocations it is necessary to exclude previous dislocations of the same joint, for a joint that has had its capsule ruptured once is very apt to be dislocated a second time on very slight traumatism. Fractures of the long bones of the extremities will cause disability for a length of time varying with the bone broken. Fingers take two weeks to heal; metacarpal bones, three weeks; forearm bones, five weeks; humerus and fibula, six weeks; tibia, seven weeks; both bones of the leg, eight weeks; femur, in cases where the shaft of the bone is fractured, ten weeks; and if the neck of the femur is broken, twelve weeks. If the patient is not well nourished and healthy, any fracture may require longer to heal, and poorer results may follow. There was an account17 not long ago of a man who used a novel method of procuring a livelihood, being a professional bone breaker. He would seek out a street in some city where he could find a bit of caved-in sidewalk or some other convenient spot, and then, at an ap 16 Bull. de la Soc. de Chir. de Paris, III., 514. "Weekly Med. Rev., St. Louis, Apr.. 1890. |