Loss of Brain-substance from Cerebral Tumor

Anomalies and Curiosities of Medicine
by George M. Gould, M.D., Walter L. Pyle, M.D.

(Page 23 of 41)

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 astonishing. 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 cutlass 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 Washington, 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 mass.

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 nobleman 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 analogous 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.

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 Hildanus 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 Lusitanus 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 washing 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 passed 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.