anomalies and curiosities of medicine-第200部分

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re　279　represents　a　somewhat　similar　hypertrophic　condition　of　the　scalp　and　face　reported　in　the　Photographic　Review　of　Medicine　and　Surgery；　1870。

Elephantiasis　of　the　face　sometimes　only　attacks　it　on　one　side。　Such　a　case　was　reported　by　Alard；　in　which　the　elephantiasis　seems　to　have　been　complicated　with　eczema　of　the　ear。　Willier；　also　quoted　by　Alard；　describes　a　remarkable　case　of　elephantiasis　of　the　face。　After　a　debauch　this　patient　experienced　violent　pain　in　the　left　cheek　below　the　zygomatic　arch；　this　soon　extended　under　the　chin；　and　the　submaxillary　glands　enlarged　and　became　painful；　the　face　swelled　and　became　erythematous；　and　the　patient　experienced　nausea　and　slight　chills。　At　the　end　of　six　months　there　was　another　attack；　after　which　the　patient　perceived　that　the　face　continued　puffed。　This　attack　was　followed　by　several　others；　the　face　growing　larger　and　larger。　In　similar　cases　tumefaction　assumes　enormous　proportions；　and　Schenck　speaks　of　a　man　whose　head　exceeded　that　of　an　ox　in　size；　the　lower　part　of　the　face　being　entirely　covered　with　the　nose；　which　had　to　be　raised　to　enable　its　unhappy　owner　to　breathe。

Rayer　cites　two　instances　in　which　elephantiasis　of　the　breast　enlarged　these　organs　to　such　a　degree　that　they　hung　to　the　knees。　Salmuth　speaks　of　a　woman　whose　breasts　increased　to　such　a　size　that　they　hung　down　to　her　knees。　At　the　same　time　she　had　in　both　axillae　glandular　tumors　as　large　as　the　head　of　a　fetus。　Borellus　also　quotes　the　case　of　a　woman　whose　breasts　became　so　large　that　it　was　necessary　to　support　them　by　straps；　which　passed　over　the　shoulders　and　neck。

Elephantiasis　is　occasionally　seen　in　the　genital　regions　of　the　female；　but　more　often　in　the　scrotum　of　the　male；　in　which　location　it　produces　enormous　tumors；　which　sometimes　reach　to　the　ground　and　become　so　heavy　as　to　prevent　locomotion。　This　condition　is　curious　in　the　fact　that　these　immense　tumors　have　been　successfully　removed；　the　testicles　and　penis；　which　had　long　since　ceased　to　be　distinguished；　saved；　and　their　function　restored。　Alibert　mentions　a　patient　who　was　operated　upon　by　Clot…Bey；　whose　scrotum　when　removed　weighed　110　pounds；　the　man　had　two　children　after　the　disease　had　continued　for　thirteen　years；　but　before　it　had　obtained　its　monstrous　developmenta　proof　that　the　functions　of　the　testicles　had　not　been　affected　by　the　disease。

There　are　several　old　accounts　of　scrotal　tumors　which　have　evidently　been　elephantoid　in　conformation。　In　the　Ephemerides　in　1692　there　was　mentioned　a　tumor　of　the　scrotum　weighing　200　pounds。　In　the　West　Indies　it　was　reported　that　rats　have　been　known　to　feed　on　these　enormous　tumors；　while　the　deserted　subjects　lay　in　a　most　helpless　condition。　Larrey　mentioned　a　case　of　elephantiasis　of　the　scrotum　in　which　the　tumor　weighed　over　200　pounds。　Sir　Astley　Cooper　removed　a　tumor　of　56　pounds　weight　from　a　Chinese　laborer。　It　extended　from　beneath　the　umbilicus　to　the　anterior　border　of　the　anus；　it　had　begun　in　the　prepuce　ten　years　previously。　Clot…Bey　removed　an　elephantoid　tumor　of　the　scrotum　weighing　80　pounds；　performing　castration　at　the　same　time。　Alleyne　reports　a　case　of　elephantiasis；　in　which　he　successfully　removed　a　tumor　of　the　integuments　of　the　scrotum　and　penis　weighing　134　pounds。

Bicet　mentions　a　curious　instance　of　elephantiasis　of　the　penis　and　scrotum　which　had　existed　for　five　years。　The　subject　was　in　great　mental　misery　and　alarm　at　his　unsightly　condition。　The　parts　of　generation　were　completely　buried　in　the　huge　mass。　An　operation　was　performed　in　which　all　of　the　diseased　structures　that　had　totally　unmanned　him　were　removed；　the　true　organs　of　generation　escaping　inviolate。　Thebaud　mentions　a　tumor　of　the　scrotum；　the　result　of　elephantiasis；　which　weighed　63　1/2　pounds。　The　weight　was　ascertained　by　placing　the　tumor　on　the　scales；　and　directing　the　patient　to　squat　over　them　without　resting　any　weight　of　the　body　on　the　scales。　This　man　could　readily　feel　his　penis；　although　his　surgeons　could　not　do　so。　The　bladder　was　under　perfect　control；　the　urine　flowing　over　a　channel　on　the　exterior　of　the　scrotum；　extending　18　inches　from　the　meatus。　Despite　his　infirmity　this　patient　had　perfect　sexual　desire；　and　occasional　erections　and　emissions。　A　very　interesting　operation　was　performed　with　a　good　recovery。

Partridge　reports　an　enormous　scrotal　tumor　which　was　removed　from　a　Hindoo　of　fifty…five；　with　subsequent　recovery　of　the　subject。　The　tumor　weighed　111　1/2　pounds。　The　ingenious　technic　of　this　operation　is　well　worth　perusal　by　those　interested。　Goodman　successfully　removed　an　elephantiasis　of　the　scrotum　from　a　native　Fiji　of　forty…five。　The　tumor　weighed　42　pounds；　without　taking　into　consideration　the　weight　of　the　fluid　which　escaped　in　abundance　during　the　operation　and　also　after　the　operation；　but　before　it　was　weighed。　Van　Buren　and　Keyes　mention　a　tumor　of　the　scrotum　of　this　nature　weighing　165　pounds。　Quoted　by　Russell；　Hendy　describes　the　case　of　a　negro　who　had　successive　attacks　of　glandular　swelling　of　the　scrotum；　until　finally　the　scrotum　was　two　feet　long　and　six　feet　in　circumference。　It　is　mentioned　that　mortification　of　the　part　caused　this　patient's　ultimate　death。

Figure　281　is　taken　from　a　photograph　loaned　to　the　authors　by　Dr。　James　Thorington。　The　patient　was　a　native　of　Fiji；　and　was　successfully　operated　on；　with　preservation　of　the　testes。　The　tumor；　on　removal；　weighed　120　pounds。

W。　R。　Browne；　Surgeon…General；　reports　from　the　Madras　General　Hospital　an　operation　on　a　patient　of　thirty…five　with　elephantoid　scrotum　of　six　years'　duration。　The　proportions　of　the　scrotum　were　as　follows：　Horizontally　the　circumference　was　six　feet　6　1/2　inches；　and　vertically　the　circumference　was　six　feet　ten　inches。　The　penis　was　wholly　hidden；　and　the　urine　passed　from　an　opening　two　feet　5　1/2　inches　from　the　pubis。　The　man　had　complete　control　of　his　bladder；　but　was　unable　to　walk。　The　operation　for　removal　occupied　one　hour　and　twenty　minutes；　and　the　tumor　removed　weighed　124　3/4　pounds。　Little　blood　was　lost　on　account　of　an　elastic　cord　tied　about　the　neck　of　the　tumor。　and　secured　by　successful　removal　of　a　scrotal　tumor　weighing　56　pounds。

Fenger　describes　a　case　of　the　foregoing　nature　in　a　German　of　twenty…three；　a　resident　of　Chicago。　The　growth　had　commenced　eight　years　previously；　and　had　progressively　increased。　There　was　no　pain　or　active　inflammation；　and　although　the　patient　had　to　have　especially　constructed　trousers　he　never　ceased　his　occupation　as　a　driver。　The　scrotum　was　represented　by　a　hairless　tumor　weighing　22　pounds；　and　hanging　one　inch　below　the　knees。　No　testicles　or　penis　could　be　made　out。　Fenger　removed　the　tumor；　and　the　man　was　greatly　improved　in　health。　There　was　still　swelling　of　the　inguinal　glands　on　both　sides；　but　otherwise　the　operation　was　very　successful。　The　man's　mental　condition　also　greatly　improved。　Fenger　also　calls　especial　attention　to　the　importance　of　preserving　the　penis　and　testes　in　the　operation；　as　although　these　parts　may　apparently　be　obliterated　their　functions　are　undisturbed。

The　statistics　of　this　major　operation　show　a　surprisingly　small　mortality。　Fayrer　operated　on　28　patients　with　22　recoveries　and　six　deaths；　one　from　shock　and　five　from　pyemia　The　same　surgeon　collected　193　cases；　and　found　the　general　mortality　to　be　18　per　cent。　According　to　Ashhurst；　Turner；　who　practiced　as　a　medical　missionary　in　the　Samoan　Islands；　claims　to　have　operated　136　times　with　only　two　deaths。　McLeod；　Fayrer's　successor　in　India；　reported　129　cases　with　23　deaths。

Early　in　this　century　Rayer　described　a　case　of　elephantiasis　in　a　boy　of　seventeen　who；　after　several　attacks　of　erysipelas；　showed　marked　diminution　of　the　elephantoid　change；　the　fact　shows　the　antagonism　of　the　streptococcus　erysipelatis　to　hypertrophic　and　malignant　processes。

Acromegaly　is　a　term　introduced　by　Marie；　and　signifies　large　extremities。　It　is　characterized　by　an　abnormally　large　development　of　the　extremities　and　of　the　features　of　the　face；the　bony　as　well　as　the　soft　parts。　In　a　well…marked　case　the　hands　and　feet　are　greatly　enlarged；　but　not　otherwise　deformed；　and　the　normal　functions　are　not　disturbed。　The　hypertrophy　involves　all　the　tissues；　giving　a　curious　spade…like　appearance　to　the　hands。　The　feet　are　similarly　enlarged；　although　the　big　toe　may　be　relatively　much　larger。　The　nails　also　become　broad　and　large。　The　face　increases　in　volume　and　becomes　elongated；　in　consequence　of　the　hypertrophy　of　the　superior　and　inferior　maxillary　bones。　The　latter　often　projects　beyond　the　upper　teeth。　The　teeth　become　separated；　and　the　soft　parts　increase　in　size。　The　nose　is　large　and　broad；　and　the　skin　of　the　eyelids　and　ears　is　enormously　hypertrophied。　The　tongue　is　greatly　hypertrophied。　The　disease　is　of　long　duration；　and　late　in　the　history　the　bones　of　the　spine　and　thorax　may　acquire　great　deformity。　As　we　know　little　of　the　influences　and　sources　governing　nutrition；　the　pathology　and　etiology　of　acromegaly　are　obscure。　Marie　regards　the　disease　as　a　systemic　dystrophy　analogous　to　myxedema；　due　to　a　morbid　condition　of　the　pituitary　body；　just　as　myxedema　is　due　to　disease　of　the　thyroid。　In　several　of　the　cases　reported　the　squint　and　optic　atrophy　and　the　amblyopia　have　pointed　to　the　pituitary　body　as　the　seat　of　a　new　growth　of　hypertrophy。　Pershing　shows　a　case　of　this　nature。　The　enlargement　of　the　face　and　extremities　was　characteristic；　and　the　cerebral　and　ocular　symptoms　pointed　to　the　pituitary　body　as　the　seat　of　the　lesion。　Unverricht；　Thomas；　and　Ransom　report　cases　in　which　the　ocular　lesions；　indicative　of　pituitary　trouble；　were　quite　prominent。　Of　22　cases　collected　by　Tamburini　19　showed　some　change　in　the　pituitary　body；　and　in　the　remaining　three　cases　either　the　diagnosis　was　uncertain　or　the　disease　was　of　very　short　duration。　Linsmayer　reported　a　case　in　which　there　was　a　softened　adenoma　in　the　pituitary　body；　and　the　thymus　was　absent。

Hersman　reports　an　interesting　case　of　progressive　enlargement　of　the　hands　in　a　clergyman　of　fifty。　Since　youth　he　had　suffered　with　pains　in　the　joints。　About　three　years　bef