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Before the Royal Society, in 1746, Glass of Oxford read the report of a case of preternatural size of the abdomen, and stated that the dropsy was due to the absence of one kidney. The circumference of the abdomen was six feet four inches, and the distance from the xiphoid to the os pubis measured four feet 1/2 inch.
It entered the back near the left clavicle, beneath the scapula, close to the vertebrae between the intercostal spaces of the fifth and sixth ribs; grazing the pericardium it traversed the mediastinum, barely touching the oesophagus, and vena azygos, but completely severing the thoracic duct, and lodging in the xiphoid portion of the sternum.
The measurements made at the time were as follows: circumference at the largest part, just below the umbilicus, 50 inches; circumference just below the mammae, 35 inches; from the xiphoid cartilage to the symphysis pubis, 32 inches, not including the appendum, which is shown in the picture. Percussion suggested a fluid within a sac. The uterus was drawn up to the extent of from 12 to 14 inches.
There is another old record of a gastric fistula through which some aliment passed during the period of eleven years. Archer tells of a man who was stabbed by a negro, the knife entering the cartilages of the 4th rib on the right side, and penetrating the stomach to the extent of two inches at a point about two inches below the xiphoid cartilage.
The tumor had been present three years, but the patient and her family refused an operation until the size of the tumor alarmed them. Its largest circumference was five feet 11 inches. The distance from the xiphoid to the symphysis pubis was three feet. The tumor was covered with veins the size of the little finger.
Both the pericardium and left pleura were distended with fresh blood and large clots. Church reports a case of gunshot wound of the heart in a man of sixty-seven who survived three hours. The postmortem examination showed that the ball had pierced the sternum just above the xiphoid cartilage, and had entered the pericardium to the right and at the lower part.
An incision 14 inches in length was first made in the linea alba, below the umbilicus, and afterward extended up to the xiphoid cartilage. The hemorrhage from the abdominal wall was very free, and the enormously distended vessels required the application of a large number of pressure-forceps.
In the Ephemerides of 1690 Konig gives a description of two Swiss sisters born in 1689 and united belly to belly, who were separated by means of a ligature and the operation afterward completed by an instrument. The constricting band was formed by a coalition of the xiphoid cartilages and the umbilical vessels, surrounded by areolar tissue and covered with skin.
The girl was healthy and well developed, and from the middle line of her body between the xiphoid cartilage and the umbilicus, attached by a soft pedicle, was an accessory individual, irregular, of ovoid shape, the smaller end, representing the head, being upward. The parasite measured a little over 1 foot in length, 9 inches about the head, and 7 3/4 inches around the neck.
Swingler speaks of two girls joined at the xiphoid cartilage and the umbilicus, the band of union being 1 1/2 inches thick, and running below the middle of it was the umbilical cord, common to both. They first ligated the cord, which fell off in nine days, and then separated the twins with the bistoury. They each made early recovery and lived.
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