anomalies and curiosities of medicine-第195部分

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　circumference。　It　is　said　this　tumor　followed　the　reception　of　a　wound。

Among　the　benign　bone　tumors　are　exostoseshomologous　outgrowths　differing　from　hypertrophies；　as　they　only　involve　a　limited　part　of　the　circumference。　When　developmental；　originating　in　childhood；　the　outgrowths　may　be　found　on　any　part　of　the　skeleton；　and　upon　many　and　generally　symmetric　parts　at　the　same　time；　as　is　shown　in　Figure　248。

Barwell　had　a　case　of　a　girl　with　38　exostoses。　Erichsen　mentions　a　young　man　of　twenty…one　with　15　groups　of　symmetric　exostoses　in　various　portions　of　the　body；　they　were　spongy　or　cancellous　in　nature。

Hartmann　shows　two　cases　of　multiple　exostoses；　both　in　males；　and　universally　distributed　over　the　body。

Macland　of　the　French　navy　describes　an　affection　of　the　bones）　of　the　face　known　as　anakhre　or　goundron　（gros…nez）。　It　is　so　common　that　about　one　per　cent　of　the　natives　of　certain　villages　on　the　Ivory　Coast；　West　Africa；　are　subject　to　it。　As　a　rule　the　earliest　symptoms　in　childhood　are：　more　or　less　persistent　headache；　particularly　frontal；　sanguineous　and　purulent　discharge　from　the　nostrils；　and　the　formation　of　symmetric　swellings　the　size　of　an　almond　in　the　region　of　the　nasal　processes　of　the　superior　maxilla。　The　cartilage　does　not　seem　to　be　involved；　and；　although　it　is　not　so　stated；　the　nasal　duct　appears　to　remain　intact。

The　headache　and　discharge　continue　for　a　year；　and　the　swelling　continually　increases　through　life；　although　the　symptoms　gradually　disappear；　the　skin　not　becoming　involved；　and　no　pain　being　present。　It　has　been　noticed　in　young　chimpanzees。　The　illustration　represents　a　man　of　forty　who　suffered　from　the　disease　since　puberty。　Pressure　on　the　eyeball　had　started　and　the　native　said　he　expected　that　in　two　years　he　would　lose　his　sight。　Figure　251　shows　an　analogous　condition；　called　by　Hutchinson　symmetric　osteomata　of　the　nasal　processes　of　the　maxilla。　His　patient　was　a　native　of　Great　Britain。

Among　neuromata；　multiple　neurofibroma　is　of　considerable　interest；　chiefly　for　the　extent　of　general　involvement。　According　to　Senn；　Heusinger　records　the　case　of　a　sailor　of　twenty…three　in　whom　all　the　nerves　were　affected　by　numerous　nodular　enlargements。　Not　a　nerve　in　the　entire　body　was　found　normal。　The　enlargement　was　caused　by　increase　in　the　connective　tissue；　the　axis…cylinders　being　normal。　In　this　case　there　was　neither　pain　nor　tenderness。

Prudden　reports　the　case　of　a　girl　of　twenty…five　who；　during　convalescence　from　variola；　became　paraplegic；　and　during　this　time　multiple　neuromata　appeared。　At　the　postmortem　more　than　a　thousand　tumors　were　found　affecting　not　only　the　peripheral　branches　and　the　sympathetic；　but　also　the　cranial　nerves　and　the　pneumogastric。　Under　the　microscope　these　tumors　showed　an　increase　in　the　interfascicular　as　well　as　perivascular　fibers；　but　the　nerve…fibers　were　not　increased　in　size　or　number。　Virchow　collected　30　cases　of　multiple　neurofibromata。　In　one　case　he　found　500；　in　another　from　800　to　1000　tumors。

Plexiform　neuroma　is　always　congenital；　and　is　found　most　frequently　in　the　temporal　region；　the　neck；　and　the　sides　of　the　face；　but　almost　any　part　of　the　body　may　be　affected。　Christot　reports　two　cases　in　which　the　tumors　were　located　upon　the　cheek　and　the　neck。　Czerny　observed　a　case　in　which　the　tumor　involved　the　lumbar　plexus。　Quoted　by　Senn；　Campbell　de　Morgan　met　with　a　plexiform　neuroma　of　the　musculo…spiral　nerve　and　its　branches。　The　patient　was　a　young　lady；　and　the　tumor；　which　was　not　painful；　had　undergone　myxomatous　degeneration。

Neuroma　of　the　vulva　is　a　pathologic　curiosity。　Simpson　reports　a　case　in　which　the　tumor　was　a　painful　nodule　situated　near　the　urinary　meatus。　Kennedy　mentions　an　instance　in　which　the　tumor　appeared　as　extremely　tender　tubercles。

Tietze　describes　a　woman　of　twenty…seven　who　exhibited　a　marked　type　of　plexiform　neurofibroma。　The　growth　was　simply　excised　and　recovery　was　promptly　effected。

Carcinomatous　growths；　if　left　to　themselves；　make　formidable　devastations　of　the　parts　which　they　affect。　Warren　pictures　a　case　of　noli…me…tangere；　a　destructive　type　of　epithelial　carcinoma。　The　patient　suffered　no　enlargement　of　the　lymphatic　glands。　The　same　absence　of　glandular　involvement　was　observed　in　another　individual；　in　whom　there　was　extensive　ulceration。　The　disease　had　in　this　case　originated　in　the　scar　of　a　gunshot　wound　received　during　the　Civil　War；　and　had　destroyed　the　side　of　the　nose；　the　eye；　the　ear；　the　cheek；　including　the　corresponding　half　of　the　upper　and　lower　lips。

Harlan　reports　a　most　extraordinary　epithelioma　of　the　orbit　in　a　boy　of　about　five　years。　It　followed　enucleation；　and　attained　the　size　depicted　in　a　few　months。

Sarcomata；　if　allowed　full　progress；　may　attain　great　size。　Plate　10　shows　an　enormous　sarcoma　of　the　buttocks　in　an　adult　negro。　Fascial　sarcomata　are　often　seen　of　immense　size。　Senn　shows　a　tumor　of　this　variety　which　was　situated　between　the　scapulae。

Schwimmer　records　a　curious　case　of　universal　small　sarcomata　over　the　whole　body　of　a　teacher　of　the　age　of　twenty…one；　in　the　Hungarian　lowlands。　The　author　called　the　disease　sarcomata　pigmentosum　diffusum　multiplex。

The　bones　are　a　common　seat　of　sarcomatous　growths；　the　tumor　in　this　instance　being　called　osteosarcoma。　It　may　affect　any　bone；　but　rarely　involves　an　articulation；　at　times　it　skips　the　joint　and　goes　to　the　neighboring　bone。

A　case　of　nasal　sarcoma　is　shown　by　Moore。　The　tumor　was　located　in　the　nasal　septum；　and　caused　a　frightful　deformity。　In　this　case　pain　was　absent；　the　sense　of　smell　was　lost；　and　the　sight　of　the　right　eye　impaired。　Moore　attempted　to　remove　the　tumor；　but　in　consequence　of　some　interference　of　respiration　the　patient　died　on　the　table。

Tiffany　reports　several　interesting　instances　of　sarcoma；　one　in　a　white　female　of　nineteen　following　a　contusion　of　tibia。　The　growth　had　all　the　clinical　history　of　an　osteosarcoma　of　the　tibia；　and　was　amputated　and　photographed　after　removal。　In　another　case；　in　a　white　male　of　thirty；　the　same　author　successfully　performed　a　hip…amputation　for　a　large　sarcoma　of　the　left　femur。　The　removed　member　was　sent　entire　to　the　Army　Medical　Museum　at　Washington。

The　fatality　and　incurability　of　malignant　growths　has　done　much　to　stimulate　daring　and　marvelous　operations　in　surgery。　The　utter　hopelessness　of　the　case　justifies　almost　any　means　of　relief；　and　many　of　the　visceral　operations；　resections　of　functional　organs；　and　extraordinary　amputations　that　were　never　dreamed　of　in　the　early　history　of　medicine　are　to…day　not　only　feasible　and　justifiable；　but　even　peremptorily　demanded。

Varicose　veins　sometimes　become　so　enlarged　and　distorted　as　to　simulate　the　appearance　of　one　varicose　tumor。　Adams　describes　a　curious　case　of　congenital　dilatation　of　the　arteries　and　veins　in　the　right　lower　limb；　accompanied　by　an　anastomosis　with　the　interior　of　the　os　calcis。　The　affected　thigh　exceeded　the　other　in　size　by　one…third；　all　the　veins　being　immensely　swelled　and　distorted。　The　arteries　were　also　distorted　and　could　be　felt　pulsating　all　over　the　limb。　The　patient　died　at　thirty　from　rupture　of　the　aneurysm。

Abbe　shows　a　peculiar　aneurysmal　varix　of　the　finger　in　a　boy　of　nine。　When　a　babe　the　patient　had；　on　the　dorsum　of　the　little　finger；　a　small　nevus；　which　was　quiescent　for　many　years。　He　received　a　deep　cut　at　the　base　of　the　thumb；　and　immediately　after　this　accident　the　nevus　began　to　enlarge　rapidly。　But　for　the　local　aneurysmal　thrill　at　the　point　of　the　scar　the　condition　would　have　been　diagnosed　as　angioma；　but　as　a　bruit　could　be　heard　over　the　entire　mass　it　was　called　an　aneurysmal　varix；　because　it　was　believed　there　was　a　connection　between　a　rather　large　artery　and　a　vein　close　to　the　mass。　There　is　a　curious　case　reported　of　cirsoid　tumor　of　the　ear　of　a　boy　of　thirteen。　Figure　259　shows　the　appearance　before　and　after　operation。

Jessop　records　a　remarkable　case　of　multiple　aneurysm。　This　case　was　particularly　interesting　as　it　was　accompanied　by　a　postmortem　examination。　Pye…Smith　reports　an　extremely　interesting　case　in　which　death　occurred　from　traumatic　aneurysm　of　an　aberrant　subclavian　artery。　The　patient　fell　from　a　height　of　28　feet；　lost　consciousness　for　a　few　minutes；　but　soon　recovered　it。　There　was　no　evidence　of　any　fracture；　but　the　man　suffered　greatly　from　dyspnea；　pain　between　the　shoulders；　and　collapse。　The　breath…sounds　on　auscultation　and　the　difficulty　in　swallowing　led　to　the　belief　that　one　of　the　bronchi　was　blocked　by　the　pressure　of　a　hematoma。　Dyspnea　continued　to　increase；　and　eighteen　days　after　admission　the　man　was　in　great　distress；　very　little　air　entering　the　chest。　He　had　no　pulse　at　the　right　wrist；　and　Pye…Smith　was　unable　to　feel　either　the　temporal　or　carotid　beats　on　the　right　side；　although　these　vessels　were　felt　pulsating　on　the　left　side。　Laryngotomy　was　done　with　the　hope　of　removing　a　foreign　body；　but　the　man　died　on　the　tenth　day。　A　postmortem　examination　disclosed　the　existence　of　an　aberrant　right　subclavian　artery　in　the　posterior　mediastinum；　and　this　was　the　seat　of　a　traumatic　aneurysm　that　had　ruptured　into　the　esophagus。

Relative　to　the　size　of　an　aneurysm；　Warren　reported　a　case　of　the　abdominal　aorta　which　commenced　at　the　origin　of　the　celiac　axis　and　passed　on　to　the　surfaces　of　the　psoas　and　iliac　muscles；　descending　to　the　middle　of　the　thigh　The　total　length　of　the　aneurysm　was　19　inches；　and　it　measured　18　inches　in　circumference。

A　peculiar　sequence　of　an　aortic　aneurysm　is　perforation　of　the　sternum　or　rib。　Webb　mentions　an　Irish　woman　who　died　of　aneurysm　of　the　aorta；　which　had　perforated　the　sternum；　the　orifice　being　plugged　by　a　large　clot。　He　quotes　17　similar　cases　which　he　has　collected　as　occurring　from　1749　to　1874；　and　notes　that　one　of　the　patients　lived　seven　weeks　after　the　rupture　of　the　aneurysmal　sac。

Large　Uterine　Tumors。Before　the　meeting　of　the　American　Medical　Association　held　in　Washington；　D。C。；　1891；　McIntyre　a　reported　a　case　of　great　interest。　The　patient；　a　woman　of　thirty…eight；　five　feet　5　1/2　inches　in　height；　coarse；　with　masculine　features；　h