A Descriptive Catalogue of the Warren Anatomical Museum. By...

Jackson, J. B. S. (John Barnard Swett), 1806-1879.

952.    Cast of the head of a man who was transfixed through the head by an iron gas-pipe, and who, to a very considerable extent, recovered from the accident.

The accident happened in the State of Ohio, May 14th, 1867, and the following is an abstract of the case, which was reported to Dr. Bigelow by the attending physicians, Drs. M. Jewett and F. W. Inman. The patient, a healthy and intelligent man, about twenty-seven years of age, was blasting coal, when the charge exploded unexpectedly, and the pipe was driven through his head, entering at the junction of the middle and outer thirds of the right supraorbitary ridge, and emerging near the junction of the left parietal, occipital, and temporal bones. One of his fellow-miners saw him upon his hands and knees, and struggling as if to rise; and, going to his assistance, he placed his knee upon his chest, supported his head with one hand, and with the other withdrew the pipe. This last projected about equally from the front and back of the head; and much force was required for its withdrawal. On being raised from the bottom of the shaft, which was about 100 ft. deep, he shivered as if he was very cold, groaned heavily, put both hands to his forehead, shook his head deprecatingly when spoken to, but moved his lips.

Three hours after the accident Dr. I was called, and found him comatose, and in a state of collapse; pulse 35, an weak; respirations nine per minute, and every breath seemed as if it would be the last. The right eye protruded half an inch, and blood, mixed with portions of brain, was oozing from the anterior wound, which was smooth, and about large enough to admit the index finger; the hemorrhage, however, being inconsiderable, though free at first. Posteriorly the opening was much larger, and the bones protruded; the extent of the fracture being about 3 in. The gas pipe (No. 3107.) was shown, and about one-half of it was smeared with blood and brain; 4 ft. 2 in. in length, and 5/8 in. in diameter. Some spiculae of bone were removed from the back of the head; the free use of stimuli was ordered, with cold to the head, and warmth to the extremities. On the 16th his breathing was stertorous, with a pulse of 40; and calomel with podophyllin was given, with beef-tea. On the 17th there was some reaction; and as the medicine had had no effect, it was repeated, and after an enema, free catharsis followed, with a taenea, 17 ft. long. On the 19th he was more restless, and, as it was difficult to keep him in bed, tart. antimony, with opium, was given.

In a very few days he began to swallow what was put into his mouth; about the twelfth day he began to take food freely, and in about three weeks from the time of the accident he ate voraciously. A pint of whiskey was given daily for the first five days, and on the 19th reaction commenced, with a pulse of 80. If he did not want food or whiskey, he would roll over and turn away. For six weeks the discharges from the bowels and bladder were involuntary. In seven weeks he sat up, and in one more he walked about a little. The right hand he used somewhat, but less well than the left. For about ten months after the accident his memory for some things was nearly lost, but during the next two months there was a considerable improvement.

When he was first seen, a probe, 4 in. in length, was passed into each of the wounds as far as it would reach, and without obstruction; and the chief point in the treatment consisted in the frequent passage of the probe, with a view to keeping the openings perfectly free. During the first ten days the probe was passed its whole length, and daily. If the orifices, and especially the posterior one, were at any time obstructed by a plug of brain, the coma would very much increase; and by shaving it off repeatedly, and passing the probe, the relief would often be very considerable; and, as it became quite offensive, injections of chlorate of potash were frequently used. On the sixth day there was a slight ptyalism, and this Drs. J. and I. thought may have tended to prevent secondary inflammation.

Dr. Jewett visited Boston with the patient, at the invitation of Dr. Bigelow, and kindly presented to him the gas-pipe, and transferred to him the case, with liberty to make such use of it as he should see fit. Dr. B. exhibited the patient, with the gas-pipe, to the Mass. Medical Society, at their annual meeting in June, 1868, and then added the pipe to his collection in this museum; the cast being taken subsequently. The man appeared to be in a good state of general health; and, though his mental powers were considerably impaired, there was nothing unusual in his expression, nor would there be noticed, in a few minutes' conversation with him, any marked deficiency of intellect. He had done no work, however, since the time of the accident, and he had not full recovered the use of his eye, nor of his right hand. Above the eye there was a small cicatrix, and a slight irregularity to the feel of the surface of the bone. Posteriorly there was a depression, quite defined, and nearly large enough to admit the top of the index finger, but without any elevation, or irregularity of the surrounding bone.

Drs. Jewett and Inman delivered to Dr. Bigelow, with their report, the statements of different physicians who saw the man with them, and no one of whom had the slightest doubt of the main fact in the case. Statements also were given by different non-professional persons. After Dr. J. returned to Ohio he sent to Dr. B. the had that his patient wore at the time of the accident, and in it are holes corresponding to the openings in the skull. 1868. See No. 3107.      Dr. H. J. Bigelow.

3107.    An iron gas-pipe, by which a man was transfixed through the head in May, 1867. (see No. 952.)

Dr. Bigelow mentions (April 1st, 1870) some important facts in regard to this case, and that were not referred to in the papers from which the history (p. 149) was drawn up. He says: "When addressed, his expression was intelligent and singularly pleasant. He evidently apprehended what was said to him, but rarely replied in words. His habitual reply on such occasions was 'mais, oui;' and this, with the word 'tabac,' of which article he was very fond, seemed to consititute his vocabulary. There could be no question that this was a case of what has been called aphasia. As far as could be judged, his intellectual functions were not disturbed. Being brought to a new city, he showed within a few days a singular faculty of finding his way home, through the streets, and from long distances, unaided." Dr. B. has also handed to me a letter from Dr. Jewett, that I had not before seen (dated April 29th, 1868), and in which he says: "To my request that he would go home with me, and work in my garden, replied, 'No, sir-ee,' — the largest number of words I have heard him connect since the injury." — Dr. B. has heard nothing (1870) of the man since the middle of last summer, but he was then in fine health, and in regard to speech he had decidedly improved. There has never been, he says, any paralysis. 1868.      Dr. H. J. Bigelow.

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