Scheme for obtaining a better knowledge of the endemic skin diseases of India / prepared by Tilbury Fox and T. Farquhar.

  • Fox, Tilbury, 1836-1879.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: Scheme for obtaining a better knowledge of the endemic skin diseases of India / prepared by Tilbury Fox and T. Farquhar. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    denseness but not pitting on pressure. The stiffness and induration may come on suddenly over a large area, and subsequently extend in bands or raised lines to a greater or less distance. The skin cannot be pinched up, and it is more or less immoveable over the subjacent parts. The bands or plates of induration may run down the whole back or along the entire length of a thigh or an arm. The diseased surface is yellowish or waxy-looking, and the hue fades away in colour through a dull white into that of the surrounding healthy integuments. There may be a partial boundary line of vessels at the edge of the disease. The deposit contracts somewhat, the skin becoming dryer, denser, more parchment-like, whilst there is much deformity produced, especially about the face and joints, when these are the seats of the disease. Sensation is not at first but only subsequently impaired. Several parts of the body are successively affected. Females are attacked more than males. There are sometimes one or more patches of morphoea present in addition, or the edges of the band or the indurated area may present the aspect of morphoea, being of a whitish hue, though raised. Scleroderma, when in bands or ridges, is distinctly raised. One writer remarks that the appearance is not that of a tumour, but rather as if the arm had been burnt and had left a leather- like hardness, which required surgical operation as after a burn to remove it, or it seems as if a bad erysipelas had become turned into cartilage and bone. (Lancet, 1855.) Dr. Fagge has found the liver tough and thickened, and its fibro- cellular elements increased. The induration in this disease oftentimes after some time disappears. Nature of the disease.—The disease is supposed to be fibroid hypertrophy of the skin; the papillary layer is intact, but bands of closely-packed connective tissue extend into it. The distinction between the corium and subjacent cellular tissues is lost. All the fibro-cellular elements are increased in amount, the fat is absent, the capillaries fewer than natural, the glands unaltered, and the nerves imbedded in the hypertrophied tissue. Now and then are seen collections of connective tissue cells in different parts of the corium. The accompanying illustration is from Neumann's work, for the use of which we are indebted to Dr. Pullar. Relation to Morphcea and Leprosy. —It is thought that morphoea and scleroderma are essentially one and the same disease, the one being the diff'used, the other circumscribed form. They occur together in the same subject, hence this opinion is probably true. But we want more evidence on this point; see questions under the head of Morphoea. It is further a most interesting question whether there is any connection between leprosy and scleroderma. We need information on this point also, we have nothing at present but assertion to deal with. The following queries are specially applicable to the case of sclero- derma :— 1. Is it common or rare in India? Have you observed it ? 2. Age, sex, and occupation of the attacked ? 3. The usual seat of the disease ? 4. Does it usually exist per se f Is it often preceded by morphoea ? or conjoined with it ? 6. Is it ever a stage of leprosy, or is there any reason to believe the two are related ? 6. Does it offer any peculiarities as it occurs in the dark races ? a. epidermis, b. pigmented Malpigliau layer, c. dense fibrous bands, d. isolated vascular strand (pigmented). e. minute clump of pigment. /. transverse section of muscular fibres, ff, muscular fibres.