Volume 1
A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper.
- Date:
- 1893-1894
Licence: Public Domain Mark
Credit: A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper. Source: Wellcome Collection.
888/962 (page 866)
![picked up or pinched. The wrinkles are effaced and the skin looks stretched, dry, and glossy. Dinklei*, who has recently made a careful study of the con- dition from Erb's clinic, states that of 44 cases, in 24 the first appearances were on the arms; in 7 on the legs, in 1 on both ; in 10 on the face and neck; and in 2 on the trunk. Gradnally extending, the disease may involve the greater portion of the skin of the trunk or that of an entire limb. Occasionally it becomes universal. The joints are fixed in semiflexion, and movements are impossible on account of the hidebound condition. The face is expressionless, immobile, and it may be almost impossible for the patient to chew his food. The sensory changes are not marked, but during the development of the affec- tion there may be great itching. The mucosa of the mouth and pharynx has been occasionally involved. The disease persists for months or years, and there are instances on record of its persistence for more than twenty years. The disease is sometimes arrested, and in a few instances recovery has fol- lowed. Death usually results from intercurrent pulmonary afiFection or from nephritis. Tiie nature of the disease is unknown. Some cases have been pre- ceded by rheumatism; others have been met with in connection with endo- carditis and rheumatic nodules. It is generally regarded as a tropho-neurosis, possibly depending upon changes in the arteries of the skin, and so leading to connective-tissue overgrowth. As the patients are particularly sensitive to changes in the weather and to cold, they should be warmly clad, and when possible live in a mild climate. Frictions with oil and electricity have been recommended, and in the local forms galvanism seems to have been beneficial. Allied to scleroderma is the remarkable afFection known as sclerema neona- torum, in which, either at birth or shortly after, there are large areas of indu- ration of the skin, which is tense and glossy and does not pit on pressure. It is sometimes associated with oedema of the subcutaneous tissues. The disease may spread rapidly, and the congenital cases are usually fatal. Recovery, however, is not impossible. In a remarkable case recently seen with Dr. Ellis of Elkton a healthy, well-grown child of two and a half months had an acute pleuro-pneumonia, during which, on the sixth day, it developed gen- eral scleroderma, the entire skin becoming hard and leathery, the legs stiff, and the whole body looking rather like a model of a child in wax. Facial Hemiatrophy. This is a rare affection, and less than one hundred cases have been reported in the literature. The wasting: is on one side of the face—hence the name— is progressive in character, and involves bones and soft tissues. It begins, as a rule, in childhood, and the onset may be accompanied by pains and parses- thesia. It may start at one or two spots on the skin and gradually spread, or begin diffusely and gradually involve soft parts and bones. The atrophy is strictly confined to one side, and when fully developed gives a i-emarkable ap])earance to the patient, whose face looks made up of two unsymmetrical halves. The atrophy is strictly limited to the middle line. Sensibility is not](https://iiif.wellcomecollection.org/image/b20413920_001_0888.jp2/full/800%2C/0/default.jpg)
