anomalies and curiosities of medicine-第211部分

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brupt　or　diffuse。　The　mucous　membranes　are　rosy。　The　functions　of　the　swell…glands　are　unimpaired。

The　theory　of　the　absence　of　pigment　causing　a　loss　of　the　olfactory　sense；　spoken　of　by　Wallace；　is　not　borne　out　by　several　observations　of　Wood　and　others。　Wilson　says：　〃Leukasma　is　a　neurosis；　the　result　of　weakened　innervation　of　the　skin；　the　cause　being　commonly　referable　to　the　organs　of　assimilation　or　reproduction。〃　It　is　not　a　dermatitis；　as　a　dermatitis　usually　causes　deposition　of　pigment。　The　rays　of　the　sun　bronze　the　skin；　mustard；　cantharides；　and　many　like　irritants　cause　a　dermatitis；　which　is　accompanied　by　a　deposition　of　pigment。　Leukoderma　is　as　common　in　housemaids　as　in　field…laborers；　and　is　in　no　way　attributable　to　exposure　of　sun　or　wind。　True　leukodermic　patches　show　no　vascular　changes；　no　infiltration；　but　a　partial　obliteration　of　the　rete　mucosum。　It　has　been　ascribed　to　syphilis；　but　syphilitic　leukoderma　is　generally　the　result　of　cicatrices　following　syphilitic　ulceration。

Many　observers　have　noticed　that　negroes　become　several　degrees　lighter　after　syphilization；　but　no　definite　relation　between　syphilis　and　leukoderma　has　yet　been　demonstrated　in　this　race。　Postmortem　examinations　of　leukodermic　persons　show　no　change　in　the　suprarenal　capsule；　a　supposed　organ　of　pigmentation。

Climate　has　no　influence。　It　is　seen　in　the　Indians　of　the　Isthmus　of　Darien；　the　Hottentots；　and　the　Icelanders。　Why　the　cells　of　the　rete　mucosum　should　have　the　function　in　some　races　of　manufacturing　or　attracting　pigment　in　excess　of　those　of　other　races；　is　in　itself　a　mystery。　By　his　experiments　on　the　pigment…cells　of　a　frog　Lister　has　established　the　relation　existing　between　these　elements　and　innervation；　which　formerly　had　been　supposititious。

Doubtless　a　solution　of　the　central　control　of　pigmentation　would　confirm　the　best　theory　of　the　cause　of　leukodermai。e。；　faulty　innervation　of　the　skin。　At　present；　whether　the　fault　is　in　the　cell　proper；　the　conducting　media；　or　the　central　center；　we　are　unable　to　say。　It　is　certainly　not　due　to　any　vascular　disturbances；　as　the　skin　shows　no　vascular　changes。

White　spots　on　the　nails　are　quite　common；　especially　on　young　people。　The　mechanic　cause　is　the　presence　of　air　between　the　lamellae　of　the　affected　parts；　but　their　origin　is　unknown。　According　to　Crocker　in　some　cases　they　can　be　shown　to　be　a　part　of　trophic　changes。　Bielschowsky　records　the　case　of　a　man　with　peripheral　neuritis；　in　whom　white　spots　appeared　at　the　lower　part　of　the　finger…nails；　grew　rapidly；　and　in　three　weeks　coalesced　into　a　band　across　each　nail　a　millimeter　wide。　The　toes　were　not　affected。　Shoemaker　mentions　a　patient　who　suffered　from　relapsing　fever　and　bore　an　additional　band　for　each　relapse。　Crocker　quotes　a　case　reported　by　Morison　of　Baltimore；　in　which　transverse　bars　of　white；　alternating　with　the　normal　color；　appeared　without　ascertainable　cause　on　the　finger…nails　of　a　young　lady　and　remained　unchanged。

Giovannini　describes　a　case　of　canities　unguium　in　a　patient　of　twenty…nine；　following　an　attack　of　typhoid　fever。　On　examining　the　hands　of　this　patient　the　nails　showed　in　their　entire　extent　a　white；　opaque；　almost　ivory　color。　An　abnormal　quantity　of　air　found　in　the　interior　of　the　nails　explains　in　this　particular　case　their　impaired　appearance。　It　is　certain　that　the　nails；　in　order　to　have　admitted　such　a　large　quantity　of　air　into　their　interior　must　have　altered　in　their　intimate　structure；　and　Giovannini　suggests　that　they　were　subject　to　an　abnormal　process　of　keratinization。　Unna　describes　a　similar　case；　which；　however；　he　calls　leukonychia。

Plica　polonica；　or；　as　it　was　known　in　Cracowweicselzopf；　is　a　disease　peculiar　to　Poland；　or　to　those　of　Polish　antecedents；　characterized　by　the　agglutination；　tangling；　and　anomalous　development　of　the　hair；　or　by　an　alteration　of　the　nails；　which　become　spongy　and　blackish。　In　older　days　the　disease　was　well　known　and　occupied　a　prominent　place　in　books　on　skin…diseases。　Hercules　de　Saxonia　and　Thomas　Minadous；　in　1610；　speak　of　plica　as　a　disease　already　long　known。　The　greater　number　of　writers　fix　the　date　of　its　appearance　in　Poland　at　about　the　year　1285；　under　the　reign　of　Lezekle…Noir。　Lafontaine　stated　that　in　the　provinces　of　Cracow　and　Sandomir　plica　formerly　attacked　the　peasantry；　beggars；　and　Jews　in　the　proportion　of　1　1/2　in　20；　and　the　nobility　and　burghers　in　the　proportion　of　two　in　30　or　40。　In　Warsaw　and　surrounding　districts　the　disease　attacked　the　first　classes　in　the　proportion　of　one　to　ten；　and　in　the　second　classes　one　to　30。　In　Lithuania　the　same　proportions　were　observed　as　in　Warsaw；　but　the　disease　has　gradually　grown　rarer　and　rarer　to　the　present　day；　although　occasional　cases　are　seen　even　in　the　United　States。

Plica　has　always　been　more　frequent　on　the　banks　of　the　Vistula　and　Borysthenes；　in　damp　and　marshy　situations；　than　in　other　parts　of　Poland。　The　custom　formerly　prevailing　in　Poland　of　shaving　the　heads　of　children；　neglect　of　cleanliness；　the　heat　of　the　head…dress；　and　the　exposure　of　the　skin　to　cold　seem　to　favor　the　production　of　this　disease。

Plica　began　after　an　attack　of　acute　fever；　with　pains　like　those　of　acute　rheumatism　in　the　head　and　extremities；　and　possibly　vertigo；　tinnitus　aurium；　ophthalmia；　or　coryza。　Sometimes　a　kind　of　redness　was　observed　on　the　thighs；　and　there　was　an　alteration　of　the　nails；　which　became　black　and　rough；　and　again；　there　was　clammy　sweat。　When　the　scalp　was　affected　the　head　was　sore　to　the　touch　and　excessively　itchy。　A　clammy　and　agglutinating　sweat　then　occurred　over　the　cranium；　the　hair　became　unctuous；　stuck　together；　and　appeared　distended　with　an　adhesive　matter　of　reddish…brown　color；　believed　by　many　observers　to　be　sanguineous。　The　hair　was　so　acutely　sensitive　that　the　slightest　touch　occasioned　severe　pain　at　the　roots。　A　viscid　matter　of　a　very　offensive　smell；　like　that　of　spoiled　vinegar；　or　according　to　Rayer　like　that　of　mice　or　garlic；　exuded　from　the　whole　surface　of　each　affected　hair。　This　matter　glued　the　hairs　together；　at　first　from　their　exit　at　the　skin；　and　then　along　the　entire　length；　it　appeared　to　be　secreted　from　the　whole　surface　of　the　scalp　and　afterward　dried　into　an　incrustation。　If　there　was　no　exudation　the　disease　was　called　plica　sicca。　The　hair　was　matted　and　stuck　together　in　a　variety　of　ways；　so　as　to　resemble　ropes　（plica　multiformis）。　Sometimes　these　masses　united　together　and　formed　one　single　thick　club　like　the　tail　of　a　horse　（plica　caudiformis）。　Again；　and　particularly　in　females；　the　hair　would　become　matted　and　glued　together　into　one　uniform　intricate　mass　of　various　magnitudes。　The　hair　of　the　whole　body　was　likely　to　be　attacked　with　this　disease。　Kalschmidt　of　Jena　possessed　the　pubes　of　a　woman　dead　of　plica；　the　hair　of　which　was　of　such　length　that　it　must　have　easily　gone　around　the　body。　There　was　formerly　a　superstition　that　it　was　dangerous　to　cut　the　hair　until　the　discharge　diminished。　Lafontaine；　Schlegel；　and　Hartman　all　assure　us　that　the　section　of　the　affected　masses　before　this　time　has　been　known　to　be　followed　by　amaurosis；　convulsions；　apoplexy；　epilepsy；　and　even　death。　Alarmed　or　taught　by　such　occurrences；　the　common　people　often　went　about　all　their　lives　with　the　plica　gradually　dropping　off。　Formerly　there　was　much　theorizing　and　discussion　regarding　the　etiology　and　pathology　of　plica；　but　since　this　mysterious　affection　has　been　proved　to　be　nothing　more　than　the　product　of　neglect；　and　the　matting　due　to　the　inflammatory　exudation；　excited　by　innumerable　pediculi；　agglutinating　the　hair　together；　the　term　is　now　scarcely　mentioned　in　dermatologic　works。　Crocker　speaks　of　a　rare　form　which　he　entitles　neuropathic　plica；　and　cites　two　cases；　one　reported　by　Le　Page　whose　specimen　is　in　the　Royal　College　of　Surgeons　Museum；　and　the　other　was　in　a　Hindoo　described　by　Pestonji。　Both　occurred　in　young　women；　and　in　both　it　came　on　after　washing　the　hair　in　warm　water；　one　in　a　few　minutes；　and　the　other　in　a　few　hours。　The　hair　was　drawn　up　into　a　hard　tangled　lump；　impossible　to　unravel；　limited　to　the　right　side　in　Le　Page's　patient；　who　had　very　long　hair；　and　in　Pestonji's　case　to　the　back　of　the　head；　where　on　each　side　was　an　elongated　mass；　very　hard　and　firm；　like　a　rope　and　about　the　size　of　the　fist。　There　was　no　reason　to　believe　that　it　was　ascribable　to　imposture；　the　Hindoo　woman　cut　the　lumps　off　herself　and　threw　them　away。　Le　Page　found　the　most　contracted　hairs　flattened。　Stellwagon　reports　a　case　of　plica　in　a　woman。　It　occupied　a　dollar…sized　area　above　the　nape　of　the　neck；　and　in　twelve　years　reached　the　length　of　12　feet。　There　was　no　history　of　its　manner　of　onset。

Tinea　nodosa　is　a　name　given　by　Morris　and　Cheadle　to　a　case　of　nodular　growth　on　the　beard　and　whiskers　of　a　young　man。　In　a　case　noticed　by　Crocker　this　disease　affected　the　left　side　of　the　mustache　of　a　medical　man；　who　complained　that　the　hair；　if　twisted　up；　stuck　together。　When　disintegrated　the　secretion　in　this　case　seemed　to　be　composed　of　fungous　spores。　Epithelium　fragments；　probably　portions　of　the　internal　root…sheath；　sometimes　adhere　to　the　shaft　of　the　hair　as　it　grows　up；　and　look　like　concretions。　Crocker　states　that　he　is　informed　by　White　of　Boston　that　this　disease　is　common　in　America　in　association　with　alopecia　furfuracea；　and　is　erroneously　thought　to　be　the　cause　of　the　loss　of　hair；　hence　the　popular　name；　〃hair…eaters。〃

Thomson　describes　a　case　of　mycosis　fungoides　in　a　young　girl　of　the　age　of　fourteen；　whom　he　saw　in　Brussels　toward　the　end　of　October；　1893。　She　was　the　third　of　a　family　of　13　children　of　whom　only　five　survived。　Of　the　children　born　subsequently　to　the　patient；　the　first　were　either　premature　or　died　a　few　days　after　their　births。　The　seventh　was　under　treatment　for　interstitial　keratitis　and　tuberculous　ulceration　of　the　lips　and　throat。　The　disease　in　the　patient　made　its　appearance　about　seven　months　previously；　as　a　small　raised　spot　in　the　middle　of　the　back　just　above　the　buttocks。　Many　of　the　patches　coalesced。　At　the　time　of　report　the　lumbar　region　was　the　seat　of　the　disease；　the　affection