THE
MEDICAL EXAMINER,
AND
RECORD OF MEDICAL SCIENCE.
NEW SERIES.—NO. LXVII.—.JULY, 1 8 50.
ORIGINAL COMMUNICATIONS.
Pathological Cases. By Carter P. Johnson, M. D., Professor of
Anatomy and Physiology, in the Medical Department of Hamp-
den Sidney College, Richmond, Virginia.
Case 1.—Extensive necrosis and reproduction of the bones of
the Fore-arm and Hand.—The specimen which is the subject of
the following description, was presented by Dr. James A. Forbes,
of Nelson, Virginia, from whom I obtained these facts. The patient
was a negro man, about forty years of age, subject, for a number of
years, to epileptiform convulsions. While under the effects of a
convulsion, he fell into the fire and burned his right hand and arm
and the right side of his face very severely. A high degree of in-
flammation in the arm and hand followed the accident, and was
suffered to run on for the space of twelve months, during which
time extensive sloughing of the parts took place, accompanied
from time to time by discharge of bone. About a year after the
accident, he was seen by Dr. Forbes, and found very much emacia-
ted, and laboring under hectic fever. The arm was immediately
amputated a short distance below the elbow, and in fifteen days
the patient was walking about. His general health improved very
much after the operation, and, singular to say, four years subse-
quently (the date of the Dr.’s letter to me) he had had no return
of the convulsive disease.
A ligamentous preparation of the fore arm and hand presents
the following appearances. The ulna, throughout its entire extent,
is healthy, and does not seem to have participated in the disease.
The radius is healthy to within two inches of its inferior extremity,
where it becomes enlarged by the deposition of new bone. This
new bone, characterized by a peculiar soft and spongy texture, is
deposited at its superior limit upon the dorsal portion of the radius,
upon and intimately united with the old bone; the amount of new
bone increases as you pass down the radius, in the inferior half inch
of which it entirely supplants the old bone, and forms the whole
of the articulating portion of the carpal extremity of the radius.
In the carpus no trace of the old bone is discoverable, each of
its eight bones being replaced by a corresponding perfectly formed
new bone. In the metacarpus, on the palmar aspect, five newly
formed metacarpal bones are seen, all perfect except the anterior
portion of that of the thumb ; on the dorsal aspect the remaining
shells of the old bones of the thumb, index, and middle fingers are
seen, being pushed away by the growth of new bone underneath
them ; the ring finger presents a small sequestrum just making its
way through an ulceration in the otherwise perfect involucrum
which surrounds it, and in the little finger every particle of the old
bone has been replaced by new.
The phalanges of the thumb and index finger, and the second
and third phalanges of the middle finger are wanting, (I presume
they sloughed away during the progress of the disease. The first
phalanges of the middle, the ring, and the little finger are entirely
reformed, thin scales of the old bone lying upon their dorsal sur-
faces, and apparently in the act of being thrown off. The second
and third phalanges of the ring finger and the second phalanx of
the little finger have been entirely reproduced ; the third phalanx
of the little finger, which still retains its nail, does not seem to
have been materially affected.
In this case we see another illustration of the wonderful repara-
tive power of nature, and of the great results which she is capable
of working out, even in a system debilitated by previous disease,
when left entirely to her own resources.
Another interesting point connected with the case is the entire
cessation of the epileptic attacks subsequent to the accession of
the external injury. Did the irritation caused by this extensive
disease, which must have been reflected to the nervous centres,
excite in the latter a new train of actions preponderating over or
breaking up those which had previously given rise to periodical
convulsions ? And if there is any truth in this vague conjecture,
might not the use of counter irritation more extensive, and longer
continued than usual, merit a trial in these generally unmanage-
able affections ?
Case 2.—Congenital malformation of the bladder.—This speci-
men was presented to me by Dr. R. W. Haxall, of this city, and
was obtained from a white male child who died at the age of about
eight months, having suffered violent paroxysms of pain in the
hypogastric and umbilical regions for several weeks previously.
The bladder is of the natural size and form, and viewed on its
anterior aspect presents no unusual appearance. Viewed from be-
hind, the following condition of things, accurately represented in
the accompanying diagram, is observed.
The prostate occupies
its usual position at the
neck of the bladder.
Above this, on the left,
are seen the ureter and
vas deferens for the left
side. The vesicula semi-
nalis for this side exists
normally. On the light
side is seen the right
ureter entering the blad-
der in its usual manner,
just below and a little
to the left of which, oc-
cupying the usual posi-
tion of the right vesicula
seminalis, there emerges
an appendage which
passes along the poste-
rior wall of the bladder
from below upwards, and
extends about two inches
above its upper border.
The general shape of
this appendage is irregularly cylindrical ; attaching itself by a
small pedicle of about four lines in diameter to the bladder, it
very soon enlarges to a diameter of about ten lines, which it
maintains throughout its course.
On examiningthe interior of the bladder, this appendage, which
is hollow throughout, is found to open by a contracted orifice just
within and below the orifice of the right ureter. Its structure is
the same as that of the bladder, of which it forms a simple diver-
ticulum. When the body was opened it was found distended with
urine.
Have the congenital absence of the right vesicula seminalis and
the existence of this singular diverticulum any relation to each
other, or are they to be regarded as simple coincidences ? Know-
ing, as we now do, that all glands whose ducts open upon either
of the great mucous surfaces, are originally developed as diverti-
cula from these surfaces, it does not seem unreasonable to regard
this appendage as a malformation of the right seminal vesicle,
which, opening abnormally into the interior of the bladder, became
filled with urine during the contractions of that organ, whereby its
ordinary spiral folds were destroyed, or, more probably, were pre-
vented from ever being formed. In confirmation of this view, it is
well known that if the seminal vesicle is carefully dissected out and
inflated so as to obliterate the folds, it presents an appearance by
no means unlike that of the appendage here described. (See
Quains’ Plates, Viscera, Pl. 27, fig. 6.)