anomalies and curiosities of medicine-第210部分

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he　skin　of　the　pubic　region　was　as　black　as　that　of　a　negress。　During　nursing　the　nipples　assume　a　deep　black　color　which　disappears　after　weaning。　Le　Cat　speaks　of　a　woman　of　thirty　years；　whose　forehead　assumed　a　dusky　hue　of　the　color　of　iron　rust　when　she　was　pregnant　about　the　seventh　month。　By　degrees　the　whole　face　became　black　except　the　eyes　and　the　edges　of　the　lips；　which　retained　their　natural　color。　On　some　days　this　hue　was　deeper　than　on　others；　the　woman　being　naturally　of　a　very　fair　complexion　had　the　appearance　of　an　alabaster　figure　with　a　black　marble　head。　Her　hair；　which　was　naturally　exceedingly　dark；　appeared　coarser　and　blacker。　She　did　not　suffer　from　headache；　and　her　appetite　was　good。　After　becoming　black；　the　face　was　very　tender　to　the　touch。　The　black　color　disappeared　two　days　after　her　accouchement；　and　following　a　profuse　perspiration　by　which　the　sheets　were　stained　black。　Her　child　was　of　a　natural　color。　In　the　following　pregnancy；　and　even　in　the　third；　the　same　phenomenon　reappeared　in　the　course　of　the　seventh　month；　in　the　eighth　month　it　disappeared；　but　in　the　ninth　month　this　woman　became　the　subject　of　convulsions；　of　which　she　had　one　each　day。　The　existence　of　accidental　nigrities　rests　on　well…established　facts　which　are　distinctly　different　from　the　pigmentation　of　purpura；　icterus；　or　that　produced　by　metallic　salts。　Chomel　quotes　the　case　of　a　very　apathic　old　soldier；　whose　skin；　without　any　appreciable　cause；　became　as　brown　as　that　of　a　negro　in　some　parts；　and　a　yellowish…brown　in　others。　Rustin　has　published　the　case　of　a　woman　of　seventy　who　became　as　black　as　a　negress　in　a　single　night。　Goodwin　relates　the　case　of　an　old　maiden　lady　whose　complexion　up　to　the　age　of　twenty…one　was　of　ordinary　whiteness；　but　then　became　as　black　as　that　of　an　African。　Wells　and　Rayer　have　also　published　accounts　of　cases　of　accidental　nigrities。　One　of　the　latter　cases　was　a　sailor　of　sixty…three　who　suffered　from　general　nigrities；　and　the　other　was　in　a　woman　of　thirty；　appearing　after　weaning　and　amenorrhea。

Mitchell　Bruce　has　described　an　anomalous　discoloration　of　the　skin　and　mucous　membranes　resembling　that　produced　by　silver　or　cyanosis。　The　patient；　a　harness…maker　of　forty…seven；　was　affected　generally　over　the　body；　but　particularly　in　the　face；　hands；　and　feet。　The　conjunctival；　nasal；　and　aural　mucosa　were　all　involved。　The　skin　felt　warm；　and　pressure　did　not　influence　the　discoloration。　The　pains　complained　of　were　of　an　intermittent；　burning；　shooting　character；　chiefly　in　the　epigastric　and　left　lumbar　regions。　The　general　health　was　good；　and　motion　and　sensation　were　normal。　Nothing　abnormal　was　discovered　in　connection　with　the　abdominal　and　thoracic　examinations。　The　pains　and　discoloration　had　commenced　two　years　before　his　admission；　since　which　time　the　skin　had　been　deepening　in　tint。　He　remained　under　observation　for　three　months　without　obvious　change　in　his　symptoms。　There　was　nothing　in　the　patient's　occupation　to　account　for　the　discoloration。　A　year　and　a　half　previously　he　had　taken　medicine　for　his　pains；　but　its　nature　could　not　be　discovered。　He　had　had　syphilis。

Galtier　mentions　congenital　and　bronze　spots　of　the　skin。　A　man　born　in　Switzerland　the　latter　part　of　the　last　century；　calling　himself　Joseph　Galart；　attracted　the　attention　of　the　curious　by　exhibiting　himself　under　the　name　of　the　〃Living　Angel。〃　He　presented　the　following　appearance：　The　skin　of　the　whole　posterior　part　of　the　trunk；　from　the　nape　of　the　neck　to　the　loins；　was　of　a　bronze　color。　This　color　extended　over　the　shoulders　and　the　sides　of　the　neck；　and　this　part　was　covered　with　hairs　of　great　fineness　and　growing　very　thick；　the　skin　of　the　rest　of　the　body　was　of　the　usual　whiteness。　Those　parts　were　the　darkest　which　were　the　most　covered　with　hair；　on　the　back　there　was　a　space　of　an　inch　in　diameter；　which　had　preserved　its　whiteness；　and　where　the　hairs　were　fewer　in　number；　darker　at　their　bases；　and　surrounded　by　a　very　small　black　circle；　the　hair　was　thinner　at　the　sides　of　the　neck；　there　were　a　great　many　individual　hairs　surrounded　by　circles　of　coloring　matter；　but　there　were　also　many　which　presented　nothing　of　this　colored　areola。　In　some　places　the　general　dark　color　of　the　skin　blended　with　the　areola　surrounding　the　roots　of　the　hair；　so　that　one　uniform　black　surface　resulted。　In　many　places　the　dark　color　changed　into　black。　The　irides　were　brown。　The　man　was　of　very　unstable　character；　extremely　undecided　in　all　his　undertakings；　and　had　a　lively　but　silly　expression　of　countenance。　A　distinct　smell；　as　of　mice；　with　a　mixture　of　a　garlicky　odor；　was　emitted　from　those　parts　where　the　excessive　secretion　of　the　coloring　matter　took　place。　In　those　places　the　heat　was　also　greater　than　natural。　Rayer　recites　the　case　of　a　young　man　whom　he　saw；　whose　eyelids　and　adjacent　parts　of　the　cheeks　were　of　a　bluish　tint；　similar　to　that　which　is　produced　on　the　skin　by　the　explosion　of　gunpowder。

Billard　has　published　an　extraordinary　case　of　blue　discoloration　of　the　skin　in　a　young　laundress　of　sixteen。　Her　neck；　face；　and　upper　part　of　the　chest　showed　a　beautiful　blue　tint；　principally　spreading　over　the　forehead；　the　alae；　and　the　mouth。　When　these　parts　were　rubbed　with　a　white　towel　the　blue　parts　of　the　skin　were　detached　on　the　towel；　coloring　it；　and　leaving　the　skin　white。　The　girl's　lips　were　red；　the　pulse　was　regular　and　natural；　and　her　strength　and　appetite　like　that　of　a　person　in　health。　The　only　morbid　symptom　was　a　dry　cough；　but　without　mucous　rattle　or　any　deficiency　of　the　sound　of　the　chest　or　alteration　of　the　natural　beat　of　the　heart。　The　catamenia　had　never　failed。　She　had　been　engaged　as　a　laundress　for　the　past　two　years。　From　the　time　she　began　this　occupation　she　perceived　a　blueness　around　her　eyes；　which　disappeared　however　on　going　into　the　air。　The　phenomenon　reappeared　more　particularly　when　irons　were　heated　by　a　bright　charcoal　fire；　or　when　she　worked　in　a　hot　and　confined　place。　The　blueness　spread；　and　her　breast　and　abdomen　became　shaded　with　an　azure　blue；　which　appeared　deeper　or　paler　as　the　circulation　was　accelerated　or　retarded。　When　the　patient's　face　should　have　blushed；　the　face　became　blue　instead　of　red。　The　changes　exhibited　were　like　the　sudden　transition　of　shades　presented　by　the　chameleon。　The　posterior　part　of　the　trunk；　the　axillae；　the　sclerotic　coats　of　the　eyes；　the　nails；　and　the　skin　of　the　head　remained　in　their　natural　state　and　preserved　their　natural　color。　The　linen　of　the　patient　was　stained　blue。　Chemical　analysis　seemed　to　throw　no　light　on　this　case；　and　the　patient　improved　on　alkaline　treatment。　She　vomited　blood；　which　contained　sufficient　of　the　blue　matter　to　stain　the　sides　of　the　vessel。　She　also　stated　that　in　hemorrhage　from　the　nose　she　had　seen　blue　drops　among　the　drops　of　blood。　One　cannot　but　suspect　indigo　as　a　factor　in　the　causation　of　this　anomalous　coloration。

Artificial　discolorations　of　the　skin　are　generally　produced　by　tattooing；　by　silver　nitrate；　mercury；　bismuth；　or　some　other　metallic　salt。

Melasma　has　been　designated　as　an　accidental　and　temporary　blackish　discoloration　of　the　skin。　There　are　several　varieties：　that　called　Addison's　disease；　that　due　to　uterine　disease；　etc。　In　this　affection　the　skin　assumes　a　dark　and　even　black　hue。

Leukoderma　is　a　pathologic　process；　the　result　of　which　is　a　deficiency　in　the　normal　pigmentation　of　the　skin；　and　possibly　its　appendages。　Its　synonyms　are　leukopathia；　vitiligo；　achroma；　leukasmus；　and　chloasma　album。　In　India　the　disease　is　called　sufaid…korh；　meaning　white　leprosy。　It　has　numerous　colloquial　appellations；　such　as　chumba　or　phoolyree　（Hindoo）；　buras　（Urdu）；　cabbore　（Singalese）；　kuttam　（Taneil）；　dhabul　（Bengal）。　It　differs　from　albinism　in　being　an　acquired　deficiency　of　pigment；　not　universal　and　not　affecting　the　eye。　Albinism　is　congenital；　and　the　hair　and　eyes　are　affected　as　well　as　the　skin。

The　disease　is　of　universal　distribution；　but　is　naturally　more　noticeable　in　the　dark…skinned　races。　It　is　much　more　common　in　this　country　among　the　negroes　than　is　generally　supposed。

The　〃leopard…boy　of　Africa；〃　so　extensively　advertised　by　dime　museums　over　the　country；　was　a　well…defined　case　of　leukoderma　in　a　young　mulatto；　a　fitting　parallel　for　the　case　of　ichthyosis　styled　the　〃alligator…boy。〃

Figure　293　represents　a　family　of　three　children；　all　the　subjects　of　leukoderma。　Leukoderma　is　more　common　among　females。　It　is　rarely　seen　in　children；　being　particularly　a　disease　of　middle　age。　Bissell　reports　a　case　in　an　Indian　ninety　years　of　age；　subsequent　to　an　attack　of　rheumatism　thirty　years　previous。　It　is　of　varying　duration；　nearly　every　case　giving　a　different　length　of　time。　It　may　be　associated　with　most　any　disease；　and　is　directly　attributable　to　none。　In　a　number　of　cases　collected　rheumatism　has　been　a　marked　feature。　It　has　been　noticed　following　typhoid　fever　and　pregnancy。

In　white　persons　there　are　spots　or　blotches　of　pale；　lustreless　appearance　either　irregular　or　symmetric；　scattered　over　the　body。　In　the　negro　and　other　dark…skinned　races　a　mottled　appearance　is　seen。　If　the　process　goes　to　completion；　the　whole　surface　changes　to　white。　The　hair；　though　rarely　affected；　may　present　a　mottled　appearance。　There　seems　to　be　no　constitutional　disturbances；　no　radical　change　in　the　skin；　no　painin　fact；　no　disturbance　worthy　of　note。　The　eye　is　not　affected；　but　in　a　negro　the　sclerotic　generally　appears　muddy。

It　appears　first　in　small　spots；　either　on　the　lips；　nose；　eyelids；　soles；　palms；　or　forehead；　and　increases　peripherallythe　several　spots　fusing　together。　The　skin　is　peculiarly　thin　and　easily　irritated。　Exposure　to　the　sun　readily　blisters　it；　and　after　the　slightest　abrasion　it　bleeds　freely。　Several　cases　have　been　reported　in　which　the　specific　gravity　of　the　urine　was　extremely　high；　due　to　an　excess　of　urea。　Wood　calls　attention　to　the　wave…like　course　of　leukoderma；　receding　on　one　side；　increasing　on　the　other。　The　fading　is　gradual；　and　the　margins　may　be　abrupt　or　diffuse。　The　mucous　membranes　are　rosy。　The　functions　of　the　swell…glands　are　unimpaired。