anomalies and curiosities of medicine-第199部分

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　thirty　months；　Baillie；　fifteen　weeks；　Blanchard；　six　weeks；　Smetius；　five　mouths；　Trioen；　three　months；　Devilliers；　two　years；　and　Gignony；　seven　years。　Riverius　mentions　death　following　constipation　of　one　month；　and　says　that　the　intestines　were　completely　filled。　Moosman　mentions　death　from　the　same　cause　in　sixty　days。　Frank　speaks　of　constipation　from　intestinal　obstructions　lasting　for　three　weeks；　and　Manget　mentions　a　similar　case　lasting　three　months。

Early　in　the　century　Revolat　reported　in　Marseilles　an　observation　of　an　eminently　nervous　subject　addicted　to　frequent　abuse　as　regards　diet；　who　had　not　had　the　slightest　evacuation　from　the　bowel　for　six　months。　A　cure　was　effected　in　this　case　by　tonics；　temperance；　regulation　of　the　diet；　etc。　In　Tome　xv　of　the　Commentaries　of　Leipzig　there　is　an　account　of　a　man　who　always　had　his　stercoral　evacuations　on　Wednesdays；　and　who　suffered　no　evil　consequences　from　this　abnormality。　This　state　of　affairs　had　existed　from　childhood；　and；　as　the　evacuations　were　abundant　and　connected；　no　morbific　change　or　malformation　seemed　present。　The　other　excretions　were　slightly　in　excess　of　the　ordinary　amount。　There　are　many　cases　of　constipation　on　record　lasting　longer　than　this；　but　none　with　the　same　periodicity　and　without　change　in　the　excrement。　Tommassini　records　the　history　of　a　man　of　thirty；　living　an　ordinary　life；　who　became　each　year　more　constipated。　Between　the　ages　of　twenty　and　twenty…four　the　evacuations　were　gradually　reduced　to　one　in　eight　or　ten　days；　and　at　the　age　of　twenty…six；　to　one　every　twenty…two　days。　His　leanness　increased　in　proportion　to　his　constipation；　and　at　thirty　his　appetite　was　so　good　that　he　ate　as　much　as　two　men。　His　thirst　was　intense；　but　he　secreted　urine　natural　in　quantity　and　quality。　Nothing　seemed　to　benefit　him；　and　purgatives　only　augmented　his　trouble。　His　feces　came　in　small；　hard　balls。　His　tongue　was　always　in　good　condition；　the　abdomen　not　enlarged；　the　pulse　and　temperature　normal。

Emily　Plumley　was　born　on　June　11；1850；　with　an　imperforate　anus；　and　lived　one　hundred　and　two　days　without　an　evacuation。　During　the　whole　period　there　was　little　nausea　and　occasional　regurgitation　of　the　mother's　milk；　due　to　over…feeding。　Cripps　mentions　a　man　of　forty…two　with　stricture　of　the　rectum；　who　suffered　complete　intestinal　obstruction　for　two　months；　during　which　time　he　vomited　only　once　or　twice。　His　appetite　was　good；　but　he　avoided　solid　food。　He　recovered　after　the　performance　of　proctotomy。

Fleck　reports　the　case　of　a　Dutchman　who；　during　the　last　two　years；　by　some　peculiar　innervation　of　the　intestine；　had　only　five　or　six　bowel　movements　a　year。　In　the　intervals　the　patient　passed　small　quantities　of　hard　feces　once　in　eight　or　ten　days；　but　the　amount　was　so　small　that　they　constituted　no　more　than　the　feces　of　one　meal。　Two　or　three　days　before　the　principal　evacuation　began　the　patient　became　ill　and　felt　uncomfortable　in　the　back；　after　sharp　attacks　of　colic　he　would　pass　hard　and　large　quantities　of　offensive　feces。　He　would　then　feel　better　for　two　or　three　hours；　when　there　would　be　a　repetition　of　the　symptoms；　and　so　on　until　he　had　four　or　five　motions　that　day。　The　following　day　he　would　have　a　slight　diarrhea　and　then　the　bowels　would　return　to　the　former　condition。　The　principal　fecal　accumulations　were　in　the　ascending　and　transverse　colon　and　not　only　could　be　felt　but　seen　through　the　abdominal　wall。　The　patient　was　well　nourished　and　had　tried　every　remedy　without　success。　Finally　he　went　to　Marienbad　where　he　drank　freely　of　the　waters　and　took　the　baths　until　the　bowel　movements　occurred　once　in　two　or　three　days。

There　is　a　record　of　a　man　who　stated　that　for　two　years　he　had　not　passed　his　stool　by　the　anus；　but　that　at　six　o'clock　each　evening　he　voided　feces　by　the　mouth。　His　statement　was　corroborated　by　observation。　At　times　the　evacuation　took　place　without　effort；　but　was　occasionally　attended　with　slight　pain　in　the　esophagus　and　slight　convulsions。　Several　hours　before　the　evacuation　the　abdomen　was　hard　and　distended；　which　appearance　vanished　in　the　evening。　In　this　case　there　was　a　history　of　an　injury　in　the　upper　iliac　region。

The　first　accurate　ideas　in　reference　to　elephantiasis　arabum　are　given　by　Rhazes；　Haly…Abas；　and　Avicenna；　and　it　is　possibly　on　this　account　that　the　disease　received　the　name　elephantiasis　arabum。　The　disease　was　afterward　noticed　by　Forestus；　Mercurialis；　Kaempfer；　Ludoff；　and　others。　In　1719　Prosper　Alpinus　wrote　of　it　in　Egypt；　and　the　medical　officers　of　the　French　army　that　invaded　Egypt　became　familiar　with　it；　since　then　the　disease　has　been　well　known。

Alard　relates　as　a　case　of　elephantiasis　that　of　a　lady　of　Berlin；　mentioned　in　the　Ephemerides　of　1694；　who　had　an　abdominal　tumor　the　lower　part　of　which　reached　to　the　knees。　In　this　case　the　tumor　was　situated　in　the　skin　and　no　vestige　of　disease　was　found　in　the　abdominal　cavity　and　no　sensible　alteration　had　taken　place　in　the　veins。　Delpech　quotes　a　similar　case　of　elephantiasis　in　the　walls　of　the　abdomen　in　a　young　woman　of　twenty…four；　born　at　Toulouse。

Lymphedema；　or　elephantiasis　arabum；　is　a　condition　in　which；　in　the　substance　of　a　limb　or　a　part；　there　is　diffused　dilatation　of　the　lymphatics；　with　lymphostasis。　Such　a　condition　results　when　there　is　obstruction　of　so　large　a　number　of　the　ducts　converging　to　the　root　of　the　extremity　or　part　that　but　little　relief　through　collateral　trunks　is　possible。　The　affected　part　becomes　swollen　and　hardened；　and　sometimes　attains　an　enormous　size。　It　is　neither　reducible　by　position　nor　pressure。　There　is　a　corresponding　dilatation　and　multiplication　of　the　blood…vessels　with　the　connective…tissue　hypertrophy。　The　muscles　waste；　the　skin　becomes　coarse　and　hypertrophied。　The　swollen　limb　presents　immense　lobulated　masses；　heaped　up　at　different　parts；　separated　from　one　another　by　deep　sulci；　which　are　especially　marked　at　the　flexures　of　the　joints。　Although　elephantiasis　is　met　with　in　all　climates；　it　is　more　common　in　the　tropics；　and　its　occurrence　has　been　repeatedly　demonstrated　in　these　localities　to　be　dependent　on　the　presence　in　the　lymphatics　of　the　filaria　sanguinis　hominis。　The　accompanying　illustration　shows　the　condition　of　the　limb　of　a　girl　of　twenty…one；　the　subject　of　lymphedema；　five　years　after　the　inception　of　the　disease。　The　changes　in　the　limb　were　as　yet　moderate。　The　photograph　from　which　the　cut　was　made　was　taken　in　1875　At　the　present　time　（seventeen　years　later）　the　case　presents　the　typical　condition　of　the　worst　form　of　elephantiasis。　Repeated　attacks　of　lymphangitis　have　occurred　during　this　period；　each　producing　an　aggravation　of　the　previous　condition。　The　leg　below　the　knee　has　become　enormously　deformed　by　the　production　of　the　elephantoid　masses；　the　outer　side　of　the　thigh　remains　healthy；　but　the　skin　of　the　inner　side　has　developed　so　as　to　form　a　very　large　and　pendant　lobulated　mass。　A　similar　condition　has　begun　to　develop　in　the　other　leg；　which　is　row　about　in　the　condition　of　the　first；　as　shown　in　the　figure。　Figure　273　represents　this　disease　in　its　most　aggravated　form；　a　condition　rarely　observed　in　this　country。　As　an　example　of　the　change　in　the　weight　of　a　person　after　the　inception　of　this　disease；　we　cite　a　case　reported　by　Griffiths。　The　patient　was　a　woman　of　fifty…two　who；　five　years　previous；　weighed　148　pounds。　The　elephantoid　change　was　below　the　waist；　yet　at　the　time　of　report　the　woman　weighed　387　pounds。　There　was　little　thickening　of　the　skin。　The　circumference　of　the　calf　was　28　inches；　of　the　thigh；　38　inches；　and　of　the　abdomen；　80　inches；　while　that　of　the　arm　was　only　15　inches。

The　condition　commonly　known　as　〃Barbadoes　leg〃　is　a　form　of　elephantiasis　deriving　its　name　from　its　relative　frequency　in　Barbadoes。

Figure　275　represents　a　well…known　exhibitionist　who；　from　all　appearances；　is　suffering　from　an　elephantoid　hypertrophy　of　the　lower　extremities；　due　to　a　lymphedema。　Quite　a　number　of　similar　exhibitionists　have　been　shown　in　recent　years；　the　most　celebrated　of　whom　was　Falmy　Mills；　one　of　whose　feet　alone　was　extensively　involved；　and　was　perhaps　the　largest　foot　ever　seen。

Elephantiasis　seldom　attacks　the　upper　extremities。　Of　the　older　cases　Rayer　reports　four　collected　by　Alard。　In　one　case　the　hard　and　permanent　swelling　of　the　arm　occurred　after　the　application　of　a　blister；　in　another　the　arm　increased　so　that　it　weighed　more　than　200　Genoese　pounds；　40　of　which　consisted　of　serum。　The　swellings　of　the　arm　and　forearm　resembled　a　distended　bladder。　The　arteries；　veins；　and　nerves　had　not　undergone　any　alteration；　but　the　lymphatics　were　very　much　dilated　and　loaded　with　lymph。

The　third　case　was　from　Fabricius　Hildanus；　and　the　fourth　from　Hendy。　Figure　276　represents　a　remarkable　elephantoid　change　in　the　hand　of　an　elderly　German　woman。　Unfortunately　there　is　no　medical　description　of　the　case　on　record；　but　the　photograph　is　deemed　worthy　of　reproduction。

Terry　describes　a　French　mulatto　girl　of　eleven　whose　left　hand　was　enormously　increased　in　weight　and　consistency；　the　chief　enlargement　being　in　the　middle　finger；　which　was　6　1/2　inches　long；　and　5　1/2　inches　about　the　nail；　and　8　1/2　around　the　base　of　the　finger。　The　index　finger　was　two　inches　thick　and　four　inches　long；　twisted　and　drawn；　while　the　other　fingers　were　dwarfed。　The　elephantiasis　in　this　case　slowly　and　gradually　increased　in　size　until　the　hand　weighed　3　1/2　pounds。　The　skin　of　the　affected　finger；　contrary　to　the　general　appearance　of　a　part　affected　with　elephantiasis；　was　of　normal　color；　smooth；　shiny；　showed　no　sensibility；　and　the　muscles　had　undergone　fatty　degeneration。　It　was　successfully　amputated　in　August；　1894。　The　accompanying　illustration　shows　a　dorsal　view　of　the　affected　hand。

Magalhaes　of　Rio　Janeiro　reports　a　very　interesting　case　of　elephantiasis　of　the　scalp；　representing　dermatolysis；　in　which　the　fold　of　hypertrophied　skin　fell　over　the　face　like　the　hide　of　an　elephant；　somewhat　similar　in　appearance　to　the　〃elephant…man。〃　Figure　279　represents　a　somewhat　similar　hypertrophic　condition　of　the　scalp　and　face　reported　in　the　Ph