anomalies and curiosities of medicine-第205部分

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hip；　Jacobs；　Jannuzzi　and　others；　report　similar　cases。　These　flesh…flies　are　called　creophilae；　and　the　condition　they　produce　is　called　myiosis。　According　to　Osler；　in　parts　of　Central　America；　the　eggs　of　a　bot…fly；　called　the　dermatobia；　are　not　infrequently　deposited　in　the　skin；　and　produce　a　swelling　very　like　the　ordinary　boil。　Matas　has　described　a　case　in　which　the　estrus　larvae　were　found　in　the　gluteal　region。　Finlayson　of　Glasgow　has　recently　reported　an　interesting　case　in　a　physician　who；　after　protracted　constipation　and　pain　in　the　back　and　sides；　passed　large　numbers　of　the　larvae　of　the　flower…fly；　anthomyia　canicularis；　and　there　are　other　instances　of　myiosis　interna　from　swallowing　the　larvae　of　the　common　house…fly。

There　are　forms　of　nasal　disorder　caused　by　larvae；　which　some　native　surgeons　in　India　regard　as　a　chronic　and　malignant　ulceration　of　the　mucous　membranes　of　the　nose　and　adjacent　sinuses　in　the　debilitated　and　the　scrofulous。　Worms　lodging　in　the　cribriform　plate　of　the　ethmoid　feed　on　the　soft　tissues　of　that　region。　Eventually　their　ravages　destroy　the　olfactory　nerves；　with　subsequent　loss　of　the　sense　of　smell；　and　they　finally　eat　away　the　bridge　of　the　nose。　The　head　of　the　victim　droops；　and　he　complains　of　crawling　of　worms　in　the　interior　of　the　nose。　The　eyelids　swell　so　that　the　patient　cannot　see；　and　a　deformity　arises　which　exceeds　that　produced　by　syphilis。　Lyons　says　that　it　is　one　of　the　most　loathsome　diseases　that　comes　under　the　observation　of　medical　men。　He　describes　the　disease　as　〃essentially　a　scrofulous　inflammation　of　the　Schneiderian　membrane；　。　。　。　which　finally　attacks　the　bones。〃　Flies　deposit　their　ova　in　the　nasal　discharges；　and　from　their　infection　maggots　eventually　arise。　In　Sanskrit　peenash　signifies　disease　of　the　nose；　and　is　the　Indian　term　for　the　disease　caused　by　the　deposition　of　larvae　in　the　nose。　It　is　supposed　to　be　more　common　in　South　America　than　in　India。



CHAPTER　XVI。

ANOMALOUS　SKIN…DISEASES。

Ichthyosis　is　a　disease　of　the　skin　characterized　by　a　morbid　development　of　the　papillae　and　thickening　of　the　epidermic　lamellae；　according　as　the　skin　is　affected　over　a　larger　or　smaller　area；　or　only　the　epithelial　lining　of　the　follicles；　it　is　known　as　ichthyosis　diffusa；　or　ichthyosis　follicularis。　The　hardened　masses　of　epithelium　develop　in　excess；　the　epidermal　layer　loses　in　integrity；　and　the　surface　becomes　scaled　like　that　of　a　fish。　Ichthyosis　may　be　congenital；　and　over　sixty　years　ago　Steinhausen　described　a　fetal　monster　in　the　anatomic　collection　in　Berlin；　the　whole　surface　of　whose　body　was　covered　with　a　thick　layer　of　epidermis；　the　skin　being　so　thick　as　to　form　a　covering　like　a　coat…of…mail。　According　to　Rayer　the　celebrated　〃porcupine…man〃　who　exhibited　himself　in　England　in　1710　was　an　example　of　a　rare　form　of　ichthyosis。　This　man's　body；　except　the　face；　the　palms　of　the　hands；　and　the　soles　of　the　feet；　was　covered　with　small　excrescences　in　the　form　of　prickles。　These　appendages　were　of　a　reddish…brown　color；　and　so　hard　and　elastic　that　they　rustled　and　made　a　noise　when　the　hand　was　passed　over　their　surfaces。　They　appeared　two　months　after　birth　and　fell　off　every　winter；　to　reappear　each　summer。　In　other　respects　the　man　was　in　very　good　health。　He　had　six　children；　all　of　whom　were　covered　with　excrescences　like　himself。　The　hands　of　one　of　these　children　has　been　represented　by　Edwards　in　his　〃Gleanings　of　Natural　History。〃　A　picture　of　the　hand　of　the　father　is　shown　in　the　fifty…ninth　volume　of　the　Philosophical　Transactions。

Pettigrew　mentions　a　man　with　warty　elongations　encasing　his　whole　body。　At　the　parts　where　friction　occurred　the　points　of　the　elongations　were　worn　off。　This　man　was　called　〃the　biped　armadillo。〃　His　great　grandfather　was　found　by　a　whaler　in　a　wild　state　in　Davis's　Straits；　and　for　four　generations　the　male　members　of　the　family　had　been　so　encased。　The　females　had　normal　skins。　All　the　members　of　the　well…known　family　of　Lambert　had　the　body　covered　with　spines。　Two　members；　brothers；　aged　twenty…two　and　fourteen；　were　examined　by　Geoffroy…Saint…Hilaire。　This　thickening　of　the　epidermis　and　hair　was　the　effect　of　some　morbid　predisposition　which　was　transmitted　from　father　to　son；　the　daughters　not　being　affected。　Five　generations　could　be　reckoned　which　had　been　affected　in　the　manner　described。

The　〃porcupine…man〃　seen　by　Baker　contracted　small…pox；　and　his　skin　was　temporarily　freed　from　the　squamae；　but　these　reappeared　shortly　afterward。　There　are　several　older　records　of　prickly　men　or　porcupine…men。　Ascanius　mentions　a　porcupine…man；　as　do　Buffon　and　Schreber。　Autenreith　speaks　of　a　porcupine…man　who　was　covered　with　innumerable　verrucae。　Martin　described　a　remarkable　variety　of　ichthyosis　in　which　the　skin　was　covered　with　strong　hairs　like　the　bristles　of　a　boar。　When　numerous　and　thick　the　scales　sometimes　assumed　a　greenish…black　hue。　An　example　of　this　condition　was　the　individual　who　exhibited　under　the　name　of　the　〃alligator…boy。〃　Figure　286　represents　an　〃alligator…boy〃　exhibited　by　C。　T。　Taylor。　The　skin　affected　in　this　case　resembled　in　color　and　consistency　that　of　a　young　alligator。　It　was　remarked　that　his　olfactory　sense　was　intact。

The　harlequin　fetus；　of　which　there　are　specimens　in　Guy's　Hospital；　London　Hospital；　and　the　Royal　College　of　Surgeons　Museum；　is　the　result　of　ichthyosis　congenita。　According　to　Crocker　either　after　the　removal　of　the　vernix　caseosa；　which　may　be　thick；　or　as　the　skin　dries　it　is　noticeably　red；　smooth；　shiny；　and　in　the　more　severe　cases　covered　with　actual　plates。　In　the　harlequin　fetus　the　whole　surface　of　the　body　is　thickly　covered　with　fatty　epidermic　plates；　about　1/16　inch　in　thickness；　which　are　broken　up　by　horizontal　and　vertical　fissures；　and　arranged　transversely　to　the　surface　of　the　body　like　a　loosely…built　stone　wall。　After　birth　these　fissures　may　extend　down　into　the　corium；　and　on　movement　produce　much　pain。　The　skin　is　so　stiff　and　contracted　that　the　eyes　cannot　be　completely　opened　or　shut；　the　lips　are　too　stiff　to　permit　of　sucking；　and　are　often　inverted；　the　nose　and　ears　are　atrophied；　the　toes　are　contracted　and　cramped；　and；　if　not　born　dead；　the　child　soon　dies　from　starvation　and　loss　of　heat。　When　the　disease　is　less　severe　the　child　may　survive　some　time。　Crocker　had　a　patient；　a　male　child　one　month　old；　who　survived　three　months。　Hallopeau　and　Elliot　also　report　similar　cases。

Contagious　follicular　keratosis　is　an　extremely　rare　affection　in　which　there　are　peculiar；　spine…like　outgrowths；　consisting　in　exudations　of　the　mouths　of　the　sebaceous　glands。　Leloir　and　Vidal　shorten　the　name　to　acne　cornee。

Erasmus　Wilson　speaks　of　it　as　ichthyosis　sebacea　cornea。　H。　G。　Brooke　describes　a　case　in　a　girl　of　six。　The　first　sign　had　been　an　eruption　of　little　black　spots　on　the　nape　of　the　neck。　These　spots　gradually　developed　into　papules；　and　the　whole　skin　took　on　a　dirty　yellow　color。　Soon　afterward　the　same　appearances　occurred　on　both　shoulders；　and；　in　the　same　order；　spread　gradually　down　the　outer　sides　of　the　armsfirst　black　specks；　then　papules；　and　lastly　pigmentation。　The　black　specks　soon　began　to　project；　and　comedo…like　plugs　and　small；　spine…like　growths　were　produced。　Both　the　spines　and　plugs　were　very　hard　and　firmly…rooted。　They　resisted　firm　pressure　with　the　forceps；　and　when　placed　on　sheets　of　paper　rattled　like　scraps　of　metal。　A　direct　history　of　contagion　was　traced　from　this　case　to　others。

Mibelli　describes　an　uncommon　form　of　keratodermia　（porokeratosis）。　The　patient　was　a　man　of　twenty…one；　and　exhibited　the　following　changes　in　his　skin：　On　the　left　side　of　the　neck；　beyond　a　few　centimeters　below　the　lobe　of　the　ear；　there　were　about　ten　small　warty　patches；　irregularly　scattered；　yellowish…brown　in　color；　irregular　in　outline；　and　varying　in　size　from　a　lentil　to　a　half…franc　piece；　or　rather　more。　Similar　patches　were　seen　on　other　portions　of　the　face。　Patches　of　varying　size　and　form；　sharply　limited　by　a　kind　of　small；　peripheral　〃dike；〃　sinuous　but　uninterrupted；　of　a　color　varying　from　red　to　whitish…red；　dirty　white；　and　to　a　hue　but　little　different　from　that　of　the　healthy　skin。　Similar　patches　were　seen　on　the　right　hand；　and　again　on　the　back　of　the　right　hand　was　a　wide　space；　prolonged　upward　in　the　form　of　a　broad　band　on　the　posterior　surface　of　the　forearm　to　just　below　the　olecranon；　where　the　skin　was　a　little　smoother　and　thinner　than　the　surrounding　skin；　and　altogether　bare　of　hairs。　The　disease　was　noticed　at　the　age　of　two；　and　gradually　progressed。　The　patient　always　enjoyed　the　most　perfect　health；　but　had　contracted　syphilis　three　years　before。　A　brother　of　the　patient；　aged　twenty…four；　for　sixteen　years　has　had　the　same　skin…affection　as　this　patient；　on　the　back　of　the　hand；　and　the　sister　and　father　had　noticed　similar　lesions。

Diffuse　symmetric　scleroderma；　or　hide…bound　disease；　is　quite　rare；　and　presents　itself　in　two　phases：　that　of　infiltration　（more　properly　called　hypertrophy）　and　atrophy；　caused　by　shrinkage。　The　whole　body　may　be　involved；　and　each　joint　may　be　fixed　as　the　skin　over　it　becomes　rigid。　The　muscles　may　be　implicated　independently　of　the　skin；　or　simultaneously；　and　they　give　the　resemblance　of　rigor　mortis。　The　whole　skin　is　so　hard　as　to　suggest　the　idea　of　a　frozen　corpse；　without　the　coldness；　the　temperature　being　only　slightly　subnormal。　The　skin　can　neither　be　pitted　nor　pinched。　As　Crocker　has　well　put　it；　when　the　face　is　affected　it　is　gorgonized；　so　to　speak；　both　to　the　eye　and　to　the　touch。　The　mouth　cannot　be　opened；　the　lids　usually　escape；　but　if　involved　they　are　half　closed；　and　in　either　case　immovable。　The　effect　of　the　disease　on　the　chest…walls　is　to　seriously　interfere　with　the　respiration　and　to　flatten　and　almost　obliterate　the　breasts；　as　to　the　limbs；　from　the　shortening　of　the　distended　skin　the　joints　are　fixed　in　a　more　or　less　rigid　position。　The　mucous　membranes　may　be　affected；　and　the　secretion　of　both　sweat　and　sebum　is　diminished　in　proportion　to　the　degree　of　the　affection；　and　may　be　quite　absent。　The　atrophic　type　of　scleroderma　is　preceded　by　an　edema；　and　f