anomalies and curiosities of medicine-第207部分

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　it　is　in　this　last　stage　only　that　the　Fanti　presents　himself。　There　is　in　the　majority　of　cases　a　small　ulcer　in　or　near　the　digito…plantar　fold；　which　causes　most　of　the　pain；　particularly　when　pressed　upon。　This　ulcer　does　not　occur　early；　and　is　not　constant。　The　case　under　Pyle's　observation　showed　no　ulceration；　and　was　absolutely　painless；　the　negress　applying　for　diagnosis　rather　than　treatment。　The　furrow　deepens　until　spontaneous　amputation　takes　place；　which　rarely　occurs；　the　patient　generally　hastening　the　process　by　his　own　operation；　or　by　seeking　surgical　treatment。　A　dry　scab　forms　at　the　furrow；　and　when　picked　and　repicked　constantly　re…forms；　being　composed　of　horny　desquamation　or　necrosis。

The　histology　of　ainhum　shows　it　to　be　a　direct　ingrowth　of　epithelium；　with　a　corresponding　depression　of　surface　due　to　a　rapid　hyperplasia　that　pushes　down　and　strangles　the　papillae；　thus　cutting　off　the　blood　supply　from　the　epithelial　cells；　causing　them　to　undergo　a　horny　change。

The　disease　is　not　usually　symmetric；　as　formerly　stated；　nor　is　it　simultaneous　in　different　toes。　There　are　no　associated　constitutional　symptoms；　no　tendency　to　similar　morbid　changes　in　other　parts；　and　no　infiltration　elsewhere。　There　is　little　or　no　edema　with　ainhum。　In　ainhum　there　is；　first；　simple　hypertrophy；　then　active　hyperplasia　The　papillae　degenerate　when　deprived　of　blood　supply；　and　become　horny。　Meanwhile　the　pressure　thus　exerted　on　the　nervi　vasorum　sets　up　vascular　changes　which　bring　about　epithelial　changes　in　more　distant　areas；　the　process　advancing　anteriorly；　that　is；　in　the　direction　of　the　arteries。　This　makes　the　cause；　according　to　Eyles；　an　inflammatory　and　trophic　phenomenon　due　mainly　to　changes　following　pressure　on　the　vasomotor　nerves。

Etiology。The　theories　of　the　causation　of　ainhum　are　quite　numerous。　The　first　cause　is　the　admirable　location　for　a　furrow　in　the　digito…plantar　fold；　and　the　excellent　situation　of　the　furrow　for　the　entrance　of　sand　or　other　particles　to　make　the　irritation　constant；　thus　causing　chronic　inflammatory　changes；　which　are　followed　subsequently　by　the　changes　peculiar　to　ainhum。　The　cause　has　been　ascribed　to　the　practice　of　wearing　rings　on　the　toes；　but　von　Winckler　says　that　in　his　locality　（British　Guinea）　this　practice　is　confined　to　the　coolie　women；　and　in　not　one　of　his　20　cases　had　a　ring　been　previously　worn　on　the　toe；　in　fact　all　of　the　patients　were　males。　Digby　says；　however；　that　the　Krumens；　among　whom　the　disease　is　common；　have　long　worn　brass　or　copper　rings　on　the　fifth　toe。　Again　the　natives　of　India；　who　are　among　those　most　frequently　afflicted；　have　no　such　custom。

Injury；　such　as　stone…bruise；　has　been　attributed　as　the　initial　cause；　and　well…authenticated　cases　have　been　reported　in　which　traumatism　is　distinctly　remembered；　but　Smyth；　Weber；　and　several　other　observers　deny　that　habits；　accidents；　or　work；　are　a　feature　in　causation。

Von　During　reports　a　curious　case　which　he　calls　sclerodactylia　annularis　ainhumoides。　The　patient　was　a　boy　about　twelve　years　old；　born　in　Erzeroum；　brought　for　treatment　for　scabies；　and　not　for　the　affection　about　to　be　described。　A　very　defective　history　led　to　the　belief　that　a　similar　affection　had　not　been　observed　in　the　family。　When　he　was　six　years　old　it　began　on　the　terminal　phalanges　of　the　middle　fingers。　A　myxomatous　swelling　attacked　the　phalanges　and　effected　a　complete　absorption　of　the　terminal　phalanx。　It　did　not　advance　as　far　as　gangrene　or　exfoliation　of　bone。　At　the　time　of　report　the　whole　ten　fingers　were　involved；　the　bones　seemed　to　be　thickened；　the　soft　parts　being　indurated　or　sclerosed。　In　the　right　index　finger　a　completely　sclerosed　ring　passed　around　the　middle　phalanx。　The　nails　on　the　absorbed　phalanges　had　become　small　and　considerably　thickened　plates。　No　analogous　changes　were　found　elsewhere；　and　sensation　was　perfectly　normal　in　the　affected　parts。　There　were　no　signs　whatever　of　a　multiple　neuritis　nor　of　a　leprous　condition。

There　is　a　rare　and　curious　condition　known　as　〃deciduous　skin〃　or　keratolysis；　in　which　the　owners　possess　a　skin；　which；　like　that　of　a　serpent；　is　periodically　cast　off；　that　of　the　limbs　coming　off　like　the　finger　of　a　glove。　Preston　of　Canterbury；　New　Zealand；　mentions　the　case　of　a　woman　who　had　thus　shed　her　skin　every　few　weeks　from　the　age　of　seven　or　even　earlier。　The　woman　was　sixty…seven　years　of　age；　the　skin　in　every　part　of　the　body　came　away　in　casts　and　cuticles　which　separated　entire　and　sometimes　in　one　unbroken　piece　like　a　glove　or　stocking。　Before　each　paroxysm　she　had　an　associate　symptom　of　malaise。　Even　the　skin　of　the　nose　and　ears　came　off　complete。　None　of　the　patient's　large　family　showed　this　idiosyncrasy；　and　she　said　that　she　had　been　told　by　a　medical　man　that　it　had　been　due　to　catching　cold　after　an　attack　of　small…pox。　Frank　mentions　a　case　in　which　there　was　periodic　and　complete　shedding　of　the　cuticle　and　nails　of　the　hands　and　feet；　which　was　repeated　for　thirty…three　consecutive　years　on　July　24th　of　each　year；　and　between　the　hours　of　3　P。M。　and　9　P。M。　The　patient　remembered　shedding　for　the　first　time　while　a　child　at　play。　The　paroxysms　always　commenced　abruptly；　constitutional　febrile　symptoms　were　first　experienced；　and　the　skin　became　dry　and　hot。　The　acute　symptoms　subsided　in　three　or　four　hours　and　were　entirely　gone　in　twelve　hours；　with　the　exception　of　the　redness　of　the　skin；　which　did　not　disappear　for　thirty…six　hours　more。　The　patient　had　been　delirious　during　this　period。　The　cuticle　began　to　shed　some　time　between　the　third　and　twelfth　day；　in　large　sheets；　as　pictured　in　the　accompanying　illustrations。　The　nails　were　shed　in　about　four　weeks　after　the　acute　stage。　Crocker　had　an　instance　of　this　nature　in　a　man　with　tylosis　palmae；　in　which　the　skin　was　cast　off　every　autumn；　but　the　process　lasted　two　months。　Lang　observed　a　case　in　which　the　fingers　alone　were　affected。

There　is　a　case　of　general　and　habitual　desquamation　of　the　skin　in　the　Ephemerides　of　1686；　and　Newell　records　a　case　which　recovered　under　the　use　of　Cheltenham　water　for　several　seasons。　Latham　describes　a　man　of　fifty　who　was　first　seized　about　ten　years　previously　with　a　singular　kind　of　fever；　and　this　returned　many　times　afterward；　even　twice　in　the　course　of　the　same　year；　attended　with　the　same　symptoms　and　circumstances；　and　appearing　to　be　brought　on　by　obstructed　perspiration；　in　consequence　of　catching　cold。　Besides　the　common　febrile　symptoms；　upon　the　invasion　of　the　disease　his　skin　universally　itched；　more　especially　at　the　joints；　and　the　itching　was　followed　by　many　little　red　spots；　with　a　small　degree　of　swelling。　Soon　after　this　his　fingers　became　stiff；　hard；　and　painful　at　the　ends；　and　at　the　roots　of　the　nails。　In　about　twenty…four　hours　the　cuticle　began　to　separate　from　the　cutis；　and　in　ten　or　twelve　days　this　separation　was　general　from　head　to　foot；　during　which　time　he　completely　turned　the　cuticle　off　from　the　wrists　to　the　fingers'　ends　like　a　glove；　and　in　like　manner　on　the　legs　to　the　toes；　after　which　his　nails　shot　gradually　from　their　roots；　at　first　with　exquisite　pain；　which　abated　as　the　separation　of　the　cuticle　advanced；　and　the　old　nails　were　generally　thrown　off　by　new　ones　in　about　six　months。　The　cuticle　rose　in　the　palms　and　soles　like　blisters；　having；　however；　no　fluid　beneath；　and　when　it　came　off　it　left　the　underlying　cutis　exposed　for　a　few　days。　Sometimes；　upon　catching　cold；　before　quite　free　from　feverish　symptoms；　a　second　separation　of　the　cuticle　from　the　cutis　occurred；　but　it　appeared　so　thin　as　to　be　like　scurf；　demonstrating　the　quick　renewal　of　the　parts。

There　is　a　similar　case　in　the　Philosophical　Transactions　in　a　miller　of　thirty…five　who　was　exposed　to　great　heat　and　clouds　of　dust。　On　the　first　cold　a　fever　attacked　him；　and　once　or　twice　a　year；　chiefly　in　the　autumn；　this　again　occurred；　attended　with　a　loosening　and　detachment　of　the　cuticle。　The　disorder　began　with　violent　fever；　attended　with　pains　in　the　head；　back；　limbs；　retching；　vomiting；　dry　skin；　furred　tongue；　urgent　thirst；　constipation；　and　high…colored　urine。　Usually　the　whole　surface　of　the　body　then　became　yellow。　It　afterward　became　florid　like　a　rash；　and　then　great　uneasiness　was　felt　for　several　days；　with　general　numbness　and　tingling；　the　urine　then　began　to　deposit　a　thick　sediment。　About　the　third　week　from　the　first　attack　the　cuticle　appeared　elevated　in　many　places；　and　in　eight　or　ten　days　afterward　became　so　loose　as　to　admit　of　its　easy　removal　in　large　flakes。　The　cuticle　of　the　hands；　from　the　wrists　to　the　fingers'　ends；　came　off　like　a　glove。　The　patient　was　never　disposed　to　sweat；　and　when　it　was　attempted　to　force　perspiration　he　grew　worse；　nor　was　he　much　at　ease　until　his　urine　deposited　a　sediment；　after　which　he　felt　little　inconvenience　but　from　the　rigidity　of　the　skin。　The　nails　were　not　detached　as　in　the　previous　case。

It　is　quite　natural　that　such　cases　as　this　should　attract　the　attention　of　the　laity；　and　often　find　report　in　newspapers。　The　following　is　a　lay…report　of　a　〃snake…boy〃　in　Shepardstown；　Va。：

〃Jim　Twyman；　a　colored　boy　living　with　his　foster…parents　ten　miles　from　this　place；　is　a　wonder。　He　is　popularly　known　as　the　〃snake…boy。〃　Mentally　he　is　as　bright　as　any　child　of　his　age；　and　he　is　popular　with　his　playmates；　but　his　physical　peculiarities　are　probably　unparalleled。　His　entire　skin；　except　the　face　and　hands；　is　covered　with　the　scales　and　markings　of　a　snake。　These　exceptions　are　kept　so　by　the　constant　use　of　Castile　soap；　but　on　the　balance　of　his　body　the　scales　grow　abundantly。　The　child　sheds　his　skin　every　year。　It　causes　him　no　pain　or　illness。　From　the　limbs　it　can　be　pulled　in　perfect　shape；　but　off　the　body　it　comes　in　pieces。　His　feet　and　hands　are　always　cold　and　clammy。　He　is　an　inordinate　eater；　sometimes　spending　an　hour　at　a　meal；　eating　voraciously　all　the　time；　if　permitted　to　do　so。　After　these　gorgings　he　sometimes　sleeps　two　days。　There　is　a　strange　suggestion　of　a　snake　in　his　face；　and　he　can　manipulate　his　tongue；　accompanied　by　hideous　hisses；　as　viciously　as　a　serpent。〃

Under　the　name