anomalies and curiosities of medicine-第52部分

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As　ancient　and　as　obscure　as　are　these　records；　Ballantyne　has　carefully　gone　over　each；　and　gives　the　following　lucid　explanatory　comments：

〃What　'ears　like　a　lion'　（No。　1）　may　have　been　it　is　difficult　to　determine；　but　doubtless　the　direction　and　shape　of　the　auricles　were　so　altered　as　to　give　them　an　animal　appearance；　and　possibly　the　deformity　was　that　called　'orechio　ad　ansa'　by　Lombroso。　The　absence　of　one　or　both　ears　（Nos。　2　and　3）　has　been　noted　in　recent　times　by　Virchow　（Archiv　fur　path。　Anat。　xxx。；　p。　221）；　Gradenigo　（Taruffi's　'Storia　della　Teratologia；'　vi。；　p。　552）；　and　others。　Generally　some　cartilaginous　remnant　is　found；　but　on　this　point　the　Chaldean　record　is　silent。　Variations　in　the　size　of　the　ears　（Nos。　4　and　5）　are　well　known　at　the　present　time；　and　have　been　discussed　at　length　by　Binder　（Archiv　fur　Psychiatrie　und　Nervenkrankheiten；　xx。；　1887）　and　others。　The　exact　malformation　indicated　in　Nos。　6　and　7　is；　of　course；　not　to　be　determined；　although　further　researches　in　Assyriology　may　clear　up　this　point。　The　'round　ear'　（No。　8）　is　one　of　Binder's　types；　and　that　with　a　'wound　below'　（No。　9）　probably　refers　to　a　case　of　fistula　auris　congenita　（Toynbee；　'Diseases　of　the　Ear；'　1860）。　The　instance　of　an　infant　born　with　two　ears　on　the　right　side　（No。　10）　was　doubtless　one　of　cervical　auricle　or　preauricular　appendage；　whilst　closure　of　the　external　auditory　meatus　（No。　11）　is　a　well…known　deformity。

〃The　next　thirteen　cases　（Nos。　12…24）　were　instances　of　anomalies　of　the　mouth　and　nose。　The　'bird's　beak'　（No。　12）　may　have　been　a　markedly　aquiline　nose；　No。　13　was　a　case　of　astoma；　and　Nos。　14　and　15　were　instances　of　stenosis　or　atresia　of　the　anterior　nares。　Fetuses　with　absence　of　the　maxillae　（Nos。　16　and　17）　are　in　modern　terminology　called　agnathous。　Deformities　like　that　existing　in　Nos。　20　and　21　have　been　observed　in　paracephalic　and　cyclopic　fetuses。　The　coincident　absence　of　nose　and　penis　（No。　21）　is　interesting；　especially　when　taken　in　conjunction　with　the　popular　belief　that　the　size　of　the　former　organ　varies　with　that　of　the　latter。　Enlargement　of　the　upper　lip　（No。　22）；　called　epimacrochelia　by　Taruffi；　and　absence　of　the　lips　（No。　23）；　known　now　under　the　name　of　brachychelia；　have　been　not　unfrequently　noticed　in　recent　times。　The　next　six　cases　（Nos。　25…30）　were　instances　of　malformations　of　the　upper　limb：　Nos。　25；　26。　and　27　were　probably　instances　of　the　so…called　spontaneous　or　intrauterine　amputation；　and　Nos。　28；　29；　and　30　were　examples　of　the　comparatively　common　deformity　known　as　polydactyly。　No。　31　was　probably　a　case　of　ectopia　cordis。

〃Then　follow　five　instances　of　genital　abnormalities　（Nos。　32…36）；　consisting　of　absence　of　the　penis　（epispadias？）；　absence　of　penis　and　umbilicus　（epispadias　and　exomphalos？）；　hermaphroditism；　imperforate　anus；　and　nondescent　of　one　testicle。　The　nine　following　cases　（Nos。　37…45）　were　anomalies　of　the　lower　limbs：　Nos。　37；　38；　and　42　may　have　been　spontaneous　amputations；　Nos。　39　and　40　were　doubtless　instances　of　webbed　toes　（syndactyly）；　and　the　deformity　indicated　in　No。　45　was　presumably　talipes　equinus。　The　infant　born　with　three　feet　（No。　43）　was　possibly　a　case　of　parasitic　monstrosity；　several　of　which　have　been　reported　in　recent　teratologic　literature；　but　what　is　meant　by　the　statement　concerning　'male　and　female　legs'　it　is　not　easy　to　determine。

〃Certain　of　the　ten　following　prodigies　（Nos。　46…55）　cannot　in　the　present　state　of　our　knowledge　be　identified。　The　presence　of　congenital　patches　of　white　or　gray　hair　on　the　scalp；　as　recorded　in　No。　46；　is　not　an　unknown　occurrence　at　the　present　time；　but　what　the　Chaldeans　meant　by　ipga；　pinde；　hali　riksi；　and　kali　on　the　head　of　the　new…born　infant　it　is　impossible　to　tell。　The　guess　may　be　hazarded　that　cephalhematoma；　hydrocephalus；　meningocele；　nevi；　or　an　excessive　amount　of　vernix　caseosa　were　the　conditions　indicated；　but　a　wider　acquaintance　with　the　meaning　of　the　cuneiform　characters　is　necessary　before　any　certain　identification　is　possible。　The　'pieces　of　skin　hanging　from　the　head'　（No。　51）　may　have　been　fragments　of　the　membranes；　but　there　is　nothing　in　the　accompanying　prediction　to　help　us　to　trace　the　origin　of　the　popular　belief　in　the　good　luck　following　the　baby　born　with　a　caul。　If　No。　53　was　a　case　of　congenital　horns　on　the　head；　it　must　be　regarded　as　a　unique　example；　unless；　indeed；　a　form　of　fetal　ichthyosis　be　indicated。

〃The　remaining　observations　（No。　56…62）　refer　to　cases　of　congenital　teeth　（No。　56）　to　deformity　of　the　ears　（Nos。　60　and　61）；　and　a　horn　（No。　62）。〃


From　these　early　times　almost　to　the　present　day　similar　significance　has　been　attached　to　minor　structural　anomalies。　In　the　following　pages　the　individual　anomalies　will　be　discussed　separately　and　the　most　interesting　examples　of　each　will　be　cited。　It　is　manifestly　evident　that　the　object　of　this　chapter　is　to　mention　the　most　striking　instances　of　abnormism　and　to　give　accompanying　descriptions　of　associate　points　of　interest；　rather　than　to　offer　a　scientific　exposition　of　teratology；　for　which　the　reader　is　referred　elsewhere。

Congenital　defect　of　the　epidermis　and　true　skin　is　a　rarity　in　pathology。　Pastorello　speaks　of　a　child　which　lived　for　two　and　a　half　hours　whose　hands　and　feet　were　entirely　destitute　of　epidermis；　the　true　skin　of　those　parts　looked　like　that　of　a　dead　and　already　putrefying　child。　Hanks　cites　the　history　of　a　case　of　antepartum　desquamation　of　the　skin　in　a　living　fetus。　Hochstetter　describes　a　full…term；　living　male　fetus　with　cutaneous　defect　on　both　sides　of　the　abdomen　a　little　above　the　umbilicus。　The　placenta　and　membranes　were　normal；　a　fact　indicating　that　the　defect　was　not　due　to　amniotic　adhesions；　the　child　had　a　club…foot　on　the　left　side。　The　mother　had　a　fall　three　weeks　before　labor。

Abnormal　Elasticity　of　the　Skin。In　some　instances　the　skin　is　affixed　so　loosely　to　the　underlying　tissues　and　is　possessed　of　so　great　elasticity　that　it　can　be　stretched　almost　to　the　same　extent　as　India　rubber。　There　have　been　individuals　who　could　take　the　skin　of　the　forehead　and　pull　it　down　over　the　nose；　or　raise　the　skin　of　the　neck　over　the　mouth。　They　also　occasionally　have　an　associate　muscular　development　in　the　subcutaneous　tissues　similar　to　the　panniculus　adiposus　of　quadrupeds；　giving　them　preternatural　motile　power　over　the　skin。　The　man　recently　exhibited　under　the　title　of　the　〃Elastic…Skin　Man〃　was　an　example　of　this　anomaly。　The　first　of　this　class　of　exhibitionists　was　seen　in　Buda…Pesth　some　years　since　and　possessed　great　elasticity　in　the　skin　of　his　whole　body；　even　his　nose　could　be　stretched。　Figure　70　represents　a　photograph　of　an　exhibitionist　named　Felix　Wehrle；　who　besides　having　the　power　to　stretch　his　skin　could　readily　bend　his　fingers　backward　and　forward。　The　photograph　was　taken　in　January；　1888。

In　these　congenital　cases　there　is　loose　attachment　of　the　skin　without　hypertrophy；　to　which　the　term　dermatolysis　is　restricted　by　Crocker。　Job　van　Meekren；　the　celebrated　Dutch　physician　of　the　seventeenth　century；　states　that　in　1657　a　Spaniard；　Georgius　Albes；　is　reported　to　have　been　able　to　draw　the　skin　of　the　left　pectoral　region　to　the　left　ear；　or　the　skin　under　the　face　over　the　chin　to　the　vertex。　The　skin　over　the　knee　could　be　extended　half　a　yard；　and　when　it　retracted　to　its　normal　position　it　was　not　in　folds。　Seiffert　examined　a　case　of　this　nature　in　a　young　man　of　nineteen；　and；　contrary　to　Kopp's　supposition；　found　that　in　some　skin　from　over　the　left　second　rib　the　elastic　fibers　were　quite　normal；　but　there　was　transformation　of　the　connective　tissue　of　the　dermis　into　an　unformed　tissue　like　a　myxoma；　with　total　disappearance　of　the　connective…tissue　bundles。　Laxity　of　the　skin　after　distention　is　often　seen　in　multipara；　both　in　the　breasts　and　in　the　abdominal　walls；　and　also　from　obesity；　but　in　all　such　cases　the　skin　falls　in　folds；　and　does　not　have　a　normal　appearance　like　that　of　the　true　〃elastic…skin　man。〃

Occasionally　abnormal　development　of　the　scalp　is　noticed。　McDowall　of　twenty…two。　On　each　side　of　the　median　line　of　the　head　there　were　five　deep　furrows；　more　curved　and　shorter　as　the　distance　from　the　median　line　increased。　In　the　illustration　the　hair　in　the　furrows　is　left　longer　than　that　on　the　rest　of　the　head。　The　patient　was　distinctly　microcephalic　and　the　right　side　of　the　body　was　markedly　wasted。　The　folds　were　due　to　hypertrophy　of　the　muscles　and　scalp；　and　the　same　sort　of　furrowing　is　noticed　when　a　dog　〃pricks　his　ears。〃　This　case　may　possibly　be　considered　as　an　example　of　reversion　to　inferior　types。　Cowan　records　two　cases　of　the　foregoing　nature　in　idiots。　The　first　case　was　a　paralytic　idiot　of　thirty…nine；　whose　cranial　development　was　small　in　proportion　to　the　size　of　the　face　and　body；　the　cranium　was　oxycephalic；　the　scalp　was　lax　and　redundant　and　the　hair　thin；　there　were　13　furrows；　five　on　each　side　running　anteroposteriorly；　and　three　in　the　occipital　region　running　transversely。　The　occipitofrontalis　muscle　had　no　action　on　them。　The　second　case　was　that　of　an　idiot　of　forty…four　of　a　more　degraded　type　than　the　previous　one。　The　cranium　was　round　and　bullet…shaped　and　the　hair　generally　thick。　The　scalp　was　not　so　lax　as　in　the　other　case；　but　the　furrows　were　more　crooked。　By　tickling　the　scalp　over　the　back　of　the　neck　the　two　median　furrows　involuntarily　deepened。

Impervious　Skin。There　have　been　individuals　who　claimed　that　their　skin　was　impervious　to　ordinary　puncture；　and　from　time　to　time　these　individuals　have　appeared　in　some　of　the　larger　medical　clinics　of　the　world　for　inspection。　According　to　a　recent　number　of　the　London　Graphic；　there　is　in　Berlin　a　Singhalese　who　baffles　all　investigations　by　physicians　by　the　impenetrability　of　his　skin。　The　bronzed　Easterner；　a　Hercules　in　shape；　claims　to　have　found　an　elixir　which　will　render　the　human　skin　impervious　to　any　metal　point　or　sharpened　edge　of　a　knife　or　dagger；　and　calls　himself　the　〃Man　with　Iron　Skin。〃　He　is　now　exhibiting　himself；　and　his　greatest　feat　is　to　pass　with　his　entire　body　through　a　hoop　the　inside　of　which　is　hardly　big　enough　to　admit　his　bod