Case of thickening and deep fissures of the skin in an infant at birth / by Alexander Keiller. Notes of cases of intra-uterine cutaneous disease analogous to that described in the preceding article, with remarks on the pathological nature of the affection / by J.Y. Simpson.

  • Keiller, Alexander, 1811-1892.
Date:
[1843]
Catalogue details

Licence: Public Domain Mark

Credit: Case of thickening and deep fissures of the skin in an infant at birth / by Alexander Keiller. Notes of cases of intra-uterine cutaneous disease analogous to that described in the preceding article, with remarks on the pathological nature of the affection / by J.Y. Simpson. Source: Wellcome Collection.

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    jections like small hairs. Beneath both the two layers the skin is stated to have shown no abnormal appearance. In Hinze’s case, on some parts, the segments of the skin had a smooth surface; in other situations the surface was rough, and here and there had a tuberculated appearance. In Richter’s case, as in Dr Keiller’s, the eyes are said to have been awant- ing, and in their place fleshy masses, very tender to the touch, were seen projecting from the orbits. In Steinhausen’s the eyelids presented the same appearance as the rest of the skin; the eyes themselves were, probably, sound, as the contrary is not stated. In Hinze’s case there was ectropion of the upper eyelids, so that the eyes, which were healthy, appeared as if covered with a bloody skin. This would probably present precisely the same appear¬ ance as is described in Richter’s case, and naturally leads to the question whether the true state of the organ may not have been overlooked by him, especially as in all other situations the disease seems to have been confined almost entirely to the cutaneous texture. In all, the ears were almost or altogether wanting; in Richter’s case, there were small foramina in their place, and in Steinhausen’s merely small tuber¬ cles without any opening. The nose in Richter’s case was also absent; the opening of the nostrils was present. In Steinhausen’s the nose was very small, and the lips were much disfigured, though internally they had their natural appearance. Richter mentions that the tongue in his case was un¬ usually large and cleft, and that the anus was wanting. In Steinhausen’s this last mentioned opening was very small. The extremities in Hinze’s case were much deformed and swollen, and the fingers and toes, with the fore part of the foot, are described to have been so disfigured as to resemble bird’s claws. Otherwise, the child appears to have been well formed. In the case described by Steinhausen the hands were much swollen, and had each five fingers; the same was the case with the feet. In Richter’s case both hands and feet were malformed; the extremities termi¬ nating in rounded knobs. Those of the upper extremities had warty projec¬ tions instead of fingers. The head was also malformed, and, like all the others, was very scantily provided with hairs. In Richter’s case the infant lived for three days, though it could take no nourishment without being threatened with suffocation. The child described by Hinze lived four days. During the first twenty-four hours it was re¬ markably lively, and took eagerly the milk and water on which it was fed, the mother not being allowed to see it. The meconium was of the natural colour. The urine is said to have been clear and inodorous. In Steinhausen’s case the child lived three days and a half. In one case (Richter’s) it was born about the eighth month; in the others not till the full period. In one of these cases (Hinze’s) the mother, who was 34 years of age, had enjoyed excellent health during her pregnancy, and had previously given birth to three healthy children. In another (Steinhausen’s) both parents are said to have been healthy, as in Dr Keiller’s case. Nature of the Disease.—The pathological nature of the disease before us is, under our present deficiencies of accurate anatomical details, a difficult and unsatisfactory problem. One thing, however, seems ma¬ nifest, viz. that the cutaneous fissures are in all probability merely a secondary and mechanical result. The integumentary parts having by previous disease lost their expansibility, and no longer increasing with the increasing dimensions of the growing body of the foetus, at last split and fissure under the stretching from within to which they are sub¬ jected. It is a much more difficult matter to determine the character of the morbid action which has produced the physical inexpansibility of the integu¬ mentary coverings of the body. Hinze considered the disease to be of the nature of the lepra of the Greeks, or elephantiasis leprodes, and supposed that it depended on a syphilitic taint on the part of the parents, though of