anomalies and curiosities of medicine-第209部分

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　one　time　he　endured　the　attack　in　a　standing　posture；　walking　the　floor；　but　usually　he　seated　himself　very　near　a　hot　stove；　in　a　doubled…up；　cramped　position；　utterly　unmindful　of　all　surroundings；　until　the　worst　pain　had　ceased。　Frequently　he　was　unable　to　control　himself；　calling　out　piteously　and　vehemently　and　beseeching　that　his　life　be　terminated　by　any　means。　In　desperation　he　often　lay　and　writhed　on　the　floor　in　agony。　The　intense　suffering　lasted；　as　a　rule；　for　about　a　half　hour；　but　he　was　never　without　pain　of　the　neuralgic　type。　He　was　freer　of　pain　in　summer　than　in　winter。　Exsection　of　the　brachial　plexus　was　performed；　but　gave　only　temporary　relief。　The　man　died　in　his　eighty…fourth　year　of　senile　debility。

According　to　Osler　the　tubercula　dolorosa　or　true　fascicular　neuroma　is　not　always　made　up　of　nerve…fibers；　but；　as　shown　by　Hoggan；　may　be　an　adenomatous　growth　of　the　sweat…glands。

Yaws　may　be　defined　as　an　endemic；　specific；　and　contagious　disease；　characterized　by　raspberry…like　nodules　with　or　without　constitutional　disturbance。　Its　synonym；　frambesia；　is　from　the　French；　framboise；　a　raspberry。　Yaws　is　derived　from　a　Carib　word；　the　meaning　of　which　is　doubtful。　It　is　a　disease　confined　chiefly　to　tropical　climates；　and　is　found　on　the　west　coast　of　Africa　for　about　ten　degrees　on　each　side　of　the　equator；　and　also　on　the　east　coast　in　the　central　regions；　but　rarely　in　the　north。　It　is　also　found　in　Madagascar；　Mozambique；　Ceylon；　Hindoostan；　and　nearly　all　the　tropical　islands　of　the　world。　Crocker　believes　it　probable　that　the　button…scurvy　of　Ireland；　now　extinct；　but　described　by　various　writers　of　1823　to　1857　as　a　contagious　disease　which　was　prevalent　in　the　south　and　in　the　interior　of　the　island；　was　closely　allied　to　yaws；　if　not　identical　with　it。　The　first　mention　of　the　yaws　disease　is　by　Oviedo；　in　1535；　who　met　with　it　in　San　Domingo。　Although　Sauvages　at　the　end　of　the　last　century　was　the　first　to　give　an　accurate　description　of　this　disease；　many　physicians　had　observed　it　before。

Frambesia　or　yaws　was　observed　in　Brazil　as　early　as　1643；　and　in　America　later　by　Lebat　in　1722。　In　the　last　century　Winterbottom　and　Hume　describe　yaws　in　Africa；　Hume　calling　it　the　African　distemper。　In　1769　in　an　essay　on　the　〃Natural　History　of　Guiana；〃　Bancroft　mentions　yaws；　and　Thomson　speaks　of　it　in　Jamaica。　Hillary　in　1759　describes　yaws　in　Barbadoes；　and　Bajou　in　Domingo　and　Cayenne　in　1777；　Dazille　having　already　observed　it　in　San　Domingo　in　1742。　

Crocker　takes　his　account　of　yaws　from　Numa　Rat　of　the　Leeward　Islands；　who　divides　the　case　into　four　stages：　incubation；　primary；　secondary；　and　tertiary。　The　incubation　stage　is　taken　from　the　date　of　infection　to　the　first　appearance　of　the　local　lesion　at　the　sight　of　inoculation。　It　varies　from　three　to　ten　weeks。　The　symptoms　are　vague；　possibly　palpitation；　vertigo；　edema　of　the　limbs　and　eyelids。　The　primary　stage　begins　with　the　initial　lesion；　which　consists　of　a　papule　which　may　be　found　most　anywhere　on　the　body。　This　papule　ulcerates。　The　secondary　stage　commences　about　a　fortnight　after　the　papule　has　healed。　There　is　intermittent　fever；　headache；　backache；　and　shooting　pains　in　the　limbs　and　intercostal　spaces；　like　those　of　dengue；　with　nocturnal　exacerbations。　An　eruption　of　minute　red　spots　appears　first　on　the　face；　and　gradually　extends　so　that　the　whole　body　is　covered　at　the　end　of　three　days。　By　the　seventh　day　the　apex　of　the　papule　is　of　a　pale　yellow　color；　and　the　black　skin　has　the　appearance　of　being　dotted　over　with　yellow　wax。　The　papule　then　develops　into　nodules　of　cylindric　shape；　with　a　dome…shaped；　thick；　yellow　crust。　It　is　only　with　the　crust　off　that　there　is　any　resemblance　to　a　raspberry。　During　the　month　following　the　raspberry　appearance　the　skin　is　covered　with　scabs　which；　falling　off；　leave　a　pale　macula；　in　dark　races　the　macula　becomes　darker　than　normal；　but　in　pale　races　it　becomes　paler　than　the　natural　skin；　and　in　neither　case　is　it　scarcely　ever　obliterated。　Intense　itching　is　almost　always　present；　and　anemia　is　also　a　constant　symptom。　The　disease　is　essentially　contagious　and　occurs　at　all　ages　and　among　all　sexes；　to　a　lesser　degree　in　whites　and　hybrids；　and　is　never　congenital。　It　seems　to　have　a　tendency　to　undergo　spontaneous　recovery。

Furunculus　orientalis；　or　its　synonyms；　Oriental　boil；　Aleppo　boil；　Delhi　boil；　Biskra　button；　etc。；　is　a　local　disease　occurring　chiefly　on　the　face　and　other　uncovered　spots；　endemic　in　limited　districts　in　hot　climates；　characterized　by　the　formation　of　a　papule；　a　nodule；　and　a　scab；　and　beneath　the　last　a　sharply　punched…out　ulcer。　Its　different　names　indicate　the　districts　in　which　it　is　common；　nearly　always　in　tropical　or　subtropical　climates。　It　differs　from　yaws　in　the　absence　of　febrile　symptoms；　in　its　unity；　its　occurrence　often　on　the　feet　and　the　backs　of　the　hands；　its　duration；　and　the　deep　scar　which　it　leaves。　A　fatal　issue　is　rare；　but　disfiguring　and　disabling　cicatrices　may　be　left　unless　great　care　is　employed。

Pigmentary　Processes。Friction；　pressure；　or　scratching；　if　long　continued；　may　produce　extensive　and　permanent　pigmentation。　This　is　seen　in　its　highest　degree　in　itching　diseases　like　prurigo　and　pityriasis。　Greenhow　has　published　instances　of　this　kind　under　the　name　of　〃vagabond's　disease；〃　a　disease　simulating　morbus　addisonii；　and　particularly　found　in　tramps　and　vagrants。　In　aged　people　this　condition　is　the　pityriasis　nigra　of　Willan。　According　to　Crocker　in　two　cases　reported　by　Thibierge；　the　oral　mucous　membrane　was　also　stained。　Carrington　and　Crocker　both　record　cases　of　permanent　pigmentation　following　exposure　to　great　cold。　Gautier　is　accredited　with　recording　in　1890　the　case　of　a　boy　of　six　in　whom　pigmented　patches　from　sepia　to　almost　black　began　to　form　at　the　age　of　two；　and　were　distributed　all　over　the　body。　Precocious　maturity　of　the　genital　organs　preceded　and　accompanied　the　pigmentation；　but　the　hair　was　illy　developed。

Chloasma　uterinum　presents　some　interesting　anomalies。　Swayne　records　a　singular　variety　in　a　woman　in　whom；　during　the　last　three　months　of　three　successive　pregnancies；　the　face；　arms；　hands；　and　legs　were　spotted　like　a　leopard；　and　remained　so　until　after　her　confinement。　Crocker　speaks　of　a　lady　of　thirty　whose　skin　during　each　pregnancy　became　at　first　bronze；　as　if　it　had　been　exposed　to　a　tropical　sun；　and　then　in　spots　almost　black。　Kaposi　knew　a　woman　with　a　pigmented　mole　two　inches　square　on　the　side　of　the　neck；　which　became　quite　black　at　each　pregnancy；　and　which　was　the　first　recognizable　sign　of　her　condition。　It　is　quite　possible　that　the　black　disease　of　the　Garo　Hills　in　Assam　is　due　to　extreme　and　acute　development　of　a　pernicious　form　of　malaria。　In　chronic　malaria　the　skin　may　be　yellowish；　from　a　chestnut…brown　to　a　black　color；　after　long　exposure　to　the　influence　of　the　fever。　Various　fungi；　such　as　tinea　versicolor　and　the　Mexican　〃Caraati；〃　may　produce　discoloration　on　the　skin。

Acanthosis　Nigricans　may　be　defined　as　a　general　pigmentation　with　papillary　mole…like　growths。　In　the　〃International　Atlas　of　Rare　Skin　Diseases〃　there　are　two　cases　pictured；　one　by　Politzer　in　a　woman　of　sixty…two；　and　the　other　by　Janovsky　in　a　man　of　forty…two。　The　regions　affected　were　mostly　of　a　dirty…brown　color；　but　in　patches　of　a　bluish…gray。　The　disease　began　suddenly　in　the　woman；　but　gradually　in　the　man。　Crocker　has　reported　a　case　somewhat　similar　to　these　two；　under　the　head　of　general　bronzing　without　constitutional　symptoms；　in　a　Swedish　sailor　of　twenty…two；　with　rapid　onset　of　pigmentation。　

Xeroderma　pigmentosum；　first　described　by　Kaposi　in　1870；　is　a　very　rare　disease；　but　owing　to　its　striking　peculiarities　is　easily　recognized。　Crocker　saw　the　first　three　cases　in　England；　and　describes　one　as　a　type。　The　patient　was　a　girl　of　twelve；　whose　general　health　and　nutrition　were　good。　The　disease　began　when　she　was　between　twelve　and　eighteen　months　old；　without　any　premonitory　symptom。　The　disease　occupied　the　parts　habitually　uncovered　in　childhood。　The　whole　of　these　areas　was　more　or　less　densely　speckled　with　pigmented；　freckle…like　spots；　varying　in　tint　from　a　light；　raw　umber　to　a　deep　sepia；　and　in　size　from　a　pin's　head　to　a　bean；　and　of　a　roundish　and　irregular　shape。　Interspersed　among　the　pigment…spots；　but　not　so　numerous；　were　white　atrophic　spots；　which　in　some　parts　coalesced；　forming　white；　shining；　cicatrix…like　areas。　The　skin　upon　this　was　finely　wrinkled；　and　either　smooth　or　shiny；　or　covered　with　thin；　white　scales。　On　these　white　areas　bright　red　spots　were　conspicuous；　due　to　telangiectasis；　and　there　were　also　some　stellate　vascular　spots　and　strife　interspersed　among　the　pigment。　Small　warts　were　seen　springing　up　from　some　of　the　pigment　spots。　These　warts　ulcerated　and　gave　rise　to　numerous　superficial　ulcerations；　covered　with　yellow　crusts；　irregularly　scattered　over　the　face；　mostly　on　the　right　side。　The　pus　coming　from　these　ulcers　was　apparently　innocuous。　The　patient　complained　neither　of　itching　nor　of　pain。　Archambault　has　collected　60　cases；　and　gives　a　good　resume　to　date。　Amiscis　reports　two　cases　of　brothers；　in　one　of　whom　the　disease　began　at　eight　months；　and　in　the　other　at　a　year；　and　concludes　that　it　is　not　a　lesion　due　to　external　stimuli　or　known　parasitic　elements；　but　must　be　regarded　as　a　specific；　congenital　dystrophy　of　the　skin；　of　unknown　pathogenesis。　However；　observations　have　shown　that　it　may　occur　at　forty…three　years　（Riehl）；　and　sixty…four　years　（Kaposi）。　Crocker　believes　that　the　disease　is　an　atrophic　degeneration　of　the　skin；　dependent　on　a　primary　neurosis；　to　which　there　is　a　congenital　predisposition。

Nigrities　is　a　name　given　by　the　older　writers　to　certain　black　blotches　occurring　on　the　skin　of　a　white　personin　other　words；　it　is　a　synonym　of　melasma。　According　to　Rayer　it　is　not　uncommon　to　see　the　scrotum　and　the　skin　of　the　penis　of　adults　almost　black；　so　as　to　form　a　marked　contrast　with　the　pubes　and　the　upper　part　of　the　thighs。　Haller　met　with　a　woman　in　whom　the　skin　of　the　pubic　region　was　as　black　as　that　of　a　negress。　During　nursing　the　nipples　assume　a　d