anomalies and curiosities of medicine-第194部分

按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！


　and　afterward　atrophy　of　the　testicle　and　loss　of　sexual　desire。

The　names　goiter；　struma；　and　bronchocele　are　applied　indiscriminately　to　all　tumors　of　the　thyroid　gland；　there　are；　however；　several　distinct　varieties　among　them　that　are　true　adenoma；　which；　therefore；　deserves　a　place　here。　According　to　Warren；　Wolfler　gives　the　following　classification　of　thyroid　tumors：　1。　Hypertrophy　of　the　thyroid　gland；　which　is　a　comparatively　rare　disease；　2。　Fetal　adenoma；　which　is　a　formation　of　gland　tissue　from　the　remains　of　fetal　structures　in　the　gland；　3。　Gelatinous　or　interacinous　adenoma；　which　consists　in　an　enlargement　of　the　acini　by　an　accumulation　of　colloid　material；　and　an　increase　in　the　interacinous　tissue　by　a　growth　of　round　cells。　It　is　this　latter　form　in　which　cysts　are　frequently　found。　The　accompanying　illustration　pictures　an　extreme　ease　of　cystic　goiter　shown　by　Warren。　A　strange　feature　of　tumors　of　the　thyroid　is　that　pressure…atrophy　and　flattening　of　the　trachea　do　not　take　place　in　proportion　to　the　size　of　the　tumor。　A　small　tumor　of　the　middle　lobe　of　the　gland；　not　larger　that　a　hen's　egg；　will　do　more　damage　to　the　trachea　than　will　a　large　tumor；　such　as　that　shown　by　Senn；　after　Bruns。　When　a　tumor　has　attained　this　size；　pressure…symptoms　are　often　relieved　by　the　weight　of　the　tumor　making　traction　away　from　the　trachea。　Goiter　is　endemic　in　some　countries；　particularly　in　Switzerland　and　Austria；　and　appears　particularly　at　the　age　of　childhood　or　of　puberty。　Some　communities　in　this　country　using　water　containing　an　excess　of　calcium　salt　show　distinct　evidences　of　endemic　goiter。　Extirpation　of　the　thyroid　gland　has　in　recent　years　been　successfully　practiced。　Warren　has　extirpated　one　lobe　of　the　thyroid　after　preliminary　ligation　of　the　common　carotid　on　the　same　side。　Green　practiced　rapid　removal　of　the　tumor　and　ligated　the　bleeding　vessels　later。　Rose　tied　each　vessel　before　cutting；　proceeding　slowly。　Senn　remarks　that　in　1878　he　witnessed　one　of　Rose's　operations　which　lasted　for　four　hours。　Although　the　operatic　technic　of　removal　of　the　thyroid　gland　for　tumor　has　been　greatly　perfected　by　Billroth；　Lucke；　Julliard；　Reverdin；　Socin；　Kocher；　and　others；　the　current　opinion　at　the　present　day　seems　to　be　that　complete　extirpation　of　the　thyroid　gland；　except　for　malignant　disease；　is　unjustifiable。　Partial　extirpation　of　the　thyroid　gland　is　still　practiced；　and　Wolfler　has　revived　the　operation　of　ligating　the　thyroid　arteries　in　the　treatment　of　tumors　of　the　thyroid　gland。

Fibromata。One　of　the　commonest　seats　of　fibroma　is　the　skin。　Multiple　fibromata　of　the　skin　sometimes　occur　in　enormous　numbers　and　cover　the　whole　surface　of　the　body；　they　are　often　accompanied　by　pendulous　tumors　of　enormous　size。　Virchow　called　such　tumors　fibroma　molluscum。　Figure　237　represents　a　case　of　multiple　fibromata　of　the　skin　shown　by　Octerlony。　Pode　mentions　a　somewhat　similar　case　in　a　man　of　fifty…six；　under　the　care　of　Thom。　The　man　was　pale　and　emaciated；　with　anxious　expression；　complaining　of　a　tumor　which　he　described　as　a　〃wishing…mark。〃　On　examination　he　was　found　to　be　covered　with　a　number　of　small　tumors；　ranging　in　size　from　that　of　a　small　orange　to　that　of　a　pin's　head；　from　the　thoracic　wall　over　the　lower　true　ribs　of　the　right　side　was　situated　a　large　pendulous　tumor；　which　hung　down　as　far　as　the　upper　third　of　the　thigh。　He　said　that　it　had　always　been　as　long　as　this；　but　had　lately　become　thicker；　and　two　months　previously　the　skin　over　the　lower　part　of　the　tumor　had　ulcerated。　This　large　tumor　was　successfully　removed；　it　consisted　of　fibrous　tissue；　with　large　veins　running　in　its　substance。　The　excised　mass　weighed　51　pounds。　The　patient　made　an　early　recovery。

Keloids　are　fibromata　of　the　true　skin；　which　may　develop　spontaneously　or　in　a　scar。　Although　the　distinction　of　true　and　false　keloid　has　been　made；　it　is　generally　discarded。　According　to　Hebra　a　true　typical　keloid　is　found　once　in　every　2000　cases　of　skin…disease。　It　is；　however；　particularly　the　false　keloid；　or　keloid　arising　from　cicatrices；　with　which　we　have　mostly　to　deal。　This　tumor　may　arise　from　a　scar　in　any　portion　of　the　body；　and　at　any　age。　There　seems　to　be　a　disposition　in　certain　families　and　individuals　to　keloid…formations；　and　among　negroes　keloids　are　quite　common；　and　often　of　remarkable　size　and　conformation。　The　form　of　injury　causing　the　cicatrix　is　no　factor　in　the　production　of　keloid；　the　sting　of　an　insect；　the　prick　of　a　needle；　and　even　the　wearing　of　ear…rings　having　been　frequent　causes　of　keloid…formations　among　the　negro　race。　Collins　describes　a　negress　of　ninety；　born　of　African　parents；　who　exhibited　multiple　keloids　produced　by　diverse　injuries。　At　fourteen　she　was　burned　over　her　breasts　by　running　against　a　shovelful　of　hot　coals；　and　several　months　later　small　tumors　appeared；　which　never　suppurated。　When　a　young　girl　a　tumor　was　removed　from　the　front　of　her　neck　by　operation；　and　cicatricial　tumors　then　spread　like　a　band　encircling　one…half　her　neck。　There　were　keloids　over　her　scapulae；　which　followed　the　application　of　blisters。　On　her　back；　over；　and　following　the　direction　of　the　ribs；　were　growths　attributed　to　the　wounds　caused　by　a　flogging。　This　case　was　quite　remarkable　for　the　predisposition　shown　to　keloid　at　an　early　age；　and　the　variety　of　factors　in　causation。

About　1867　Duhring　had　under　his　observation　at　the　Philadelphia　Hospital　a　negro　whose　neck　was　encircled　by　enormous　keloids；　which；　although　black；　otherwise　resembled　tomatoes。　A　photograph　of　this　remarkable　case　was　published　in　Philadelphia　in　1870。　

A　lipoma　is　a　tumor　consisting　of　adipose　tissue。　When　there　is　much　fibrous　tissue　in　the　tumor　it　is　much　firmer；　and　is　known　as　a　fibro…lipoma。　Brander　describes　a　young　native　of　Manchuria；　North　China；　from　whom　he　removed　a　fibro…lipoma　weighing　50　pounds。　The　growth　had　progressively　enlarged　for　eleven　years；　and　at　the　time　of　extirpation　hung　as　an　enormous　mass　from　beneath　the　left　scapula。　In　operating　the　tumor　had　to　be　swung　on　a　beam。　The　hemorrhage　was　slight　and　the　patient　was　discharged　in　five　days。

The　true　lipoma　must　be　distinguished　from　diffuse　accumulations　of　fat　in　different　parts　of　the　body　in　the　same　way　that　fibroma　is　distinguished　from　elephantiasis。　Circumscribed　lipoma　appears　as　a　lobulated　soft　tumor；　more　or　less　movable；　lying　beneath　the　skin。　It　sometimes　reaches　enormous　size　and　assumes　the　shape　of　a　pendulous　tumor。

Diffuse　lipoma；　occurring　in　the　neck；　often　gives　the　patient　a　grotesque　and　peculiar　appearance。　It　is　generally　found　in　men　addicted　to　the　use　of　alcohol；　and　occurs　between　thirty…five　and　forty…five　years　of　age；　in　no　case　has　general　obesity　been　described。　In　one　of　Madelung's　cases　a　large　lobe　extended　downward　over　the　clavicle。　The　growth　has　been　found　between　the　larynx　and　the　pharynx。　Black　reports　a　remarkable　case　of　fatty　tumor　in　a　child　one　year　and　five　months　old　which　filled　the　whole　abdominal　cavity；　weighing　nine　pounds　and　two　ounces。　Chipault　mentions　a　case　of　lipoma　of　the　parietal　region；　observed　by　Rotter。　This　monstrous　growth　was　three　feet　three　inches　long；　descending　to　the　knees。　It　had　its　origin　in　the　left　parietal　region；　and　was　covered　by　the　skin　of　the　whole　left　side　of　the　face　and　forehead。　The　left　ear　was　plainly　visible　in　the　upper　third　of　the　growth。

Chondroma；　or　enchondroma；　is　a　cartilaginous　tumor　occurring　principally　where　cartilage　is　normally　found；　but　sometimes　in　regions　containing　no　cartilage。　Enchondroma　may　be　composed　of　osteoid　tissue；　such　as　is　found　in　the　ossifying　callous　between　the　bone　and　the　periosteum；　and；　according　to　Virchow；　then　takes　the　name　of　osteochondroma。　Virchow　has　divided　chondromata　into　two　formsthose　which　he　calls　ecchondromata；　which　grow　from　cartilage；　and　those　that　grow　independently　from　cartilage；　or　the　enchondromata；　which　latter　are　in　the　great　majority。　Enchondroma　is　often　found　on　the　long　bones；　and　very　frequently　upon　the　bones　of　the　hands　or　on　the　metatarsal　bones。

Figure　244　represents　an　enchondroma　of　the　thumb。　Multiple　enchondromata　are　most　peculiar；　and　may　attain　enormous　sizes。　Whittaker　describes　a　farmer　of　forty　who　exhibited　peculiar　tumors　of　the　fingers；　which　he　calls　multiple　osteoecchondromata。　His　family　history　was　negative。　He　stated　that　at　an　early　age　he　received　a　stroke　of　lightning；　which　rendered　him　unconscious　for　some　time。　He　knows　of　nothing　else　that　could　be　in　possible　relation　with　his　present　condition。　Nine　months　after　this　accident　there　was　noticed　an　enlargement　of　the　middle　joint　of　the　little　finger；　and　about　the　same　time　an　enlargement　on　the　middle　finger。　Gradually　all　the　joints　of　the　right　hand　became　involved。　The　enlargement　increased　so　that　at　the　age　of　twelve　they　were　of　the　size　of　walnuts；　and　at　this　time　the　patient　began　to　notice　the　same　process　developing　in　the　left　hand。　The　growths　continued　to　develop；　new　nodules　appearing；　until　the　fingers　presented　the　appearance　of　nodulated　potatoes。

One　of　the　most　frequent　of　the　fibro…cartilaginous　tumors　is　the　〃mixed　cartilaginous〃　tumor　of　Paget；　which　grows　in　the　interstitial　tissues　of　the　parotid　gland；　and　sometimes　attains　enormous　size。　Matas　presented　the　photograph　of　a　negress　having　an　enormous　fibroma　growing　from　the　left　parotid　region；　and　there　is　a　photograph　of　a　similar　case　in　the　Mutter　Museum　of　the　College　of　Physicians；　Philadelphia。

The　hyaline　enchondroma　is　of　slow　growth；　but　may　at　times　assume　immense　proportions；　as　is　shown　in　the　accompanying　illustration；　given　by　Warren；　of　a　patient　in　whom　the　growth　was　in　the　scapula。

In　1824　there　is　quoted　the　description　of　a　peculiar　growth　which；　though　not　definitely　described；　may　be　spoken　of　here。　It　was　an　enormous　encysted　tumor；　springing　from　the　clavicle　of　a　Veronese　nobleman。　Contrary　to　general　expectations　it　was　successfully　removed　by　Portalupi；　a　surgeon　of　Venice。　It　weighed　57　pounds；　being　20　1/2　inches　long　and　30　inches　in　circumference。　It　is　said　this　tumor　followed　the　reception　of　a　wound。

Among　the　benign　bone　tu