PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. 1 page

In considering the anomalies of the secretions, it must be remembered

that the ingestion of certain kinds of food and the administration of

peculiar drugs in medicine have a marked influence in coloring

secretions. Probably the most interesting of all these anomalies is the

class in which, by a compensatory process, metastasis of the secretions

is noticed.

Colored Saliva.--Among the older writers the Ephemerides contains an

account of blue saliva; Huxham speaks of green saliva; Marcellus

Donatus of yellow, and Peterman relates the history of a case of yellow

saliva. Dickinson describes a woman of sixty whose saliva was blue;

besides this nothing was definitely the matter with her. It seemed

however, that the color was due to some chemic-pencil poisoning rather

than to a pathologic process. A piece of this aniline pencil was

caught in the false teeth. Paget cites an instance of blue saliva due

to staining the tongue in the same manner. Most cases of anomalous

coloring of this kind can be subsequently traced to artificial

substances unconsciously introduced. Crocker mentions a woman who on

washing her hands constantly found that the water was stained blue, but

this was subsequently traced to the accidental introduction of an

orchid leaf. In another instance there was a woman whose linen was at

every change stained brown; this, however, was found to be due to a

hair-wash that she was in the habit of using.

Among the older writers who have mentioned abnormal modes of exit of

the urine is Baux, who mentions urine from the nipples; Paullini and

the Ephemerides describe instances of urination from the eyes.

Blancard, the Ephemerides, Sorbalt, and Vallisneri speak of urination

by the mouth. Arnold relates the history of a case of dysuria in which

urine was discharged from the nose, breasts, ears, and umbilicus; the

woman was twenty-seven years old, and the dysuria was caused by a

prolapsed uterus. There was an instance of anomalous discharge of urine

from the body reported in Philadelphia many years ago which led to

animated discussion. A case of dysuria in which the patient discharged

urine from the stomach was reported early in this century from Germany.

The patient could feel the accumulation of urine by burning pain in the

epigastrium. Suddenly the pain would move to the soles of the feet, she

would become nauseated, and large quantities of urine would soon be

vomited. There was reported the case of an hysterical female who had

convulsions and mania, alternating with anuria of a peculiar nature and

lasting seven days. There was not a drop of urine passed during this

time, but there were discharges through the mouth of alkaline waters

with a strong ammoniacal odor.

Senter reports in a young woman a singular case of ischuria which

continued for more than three years; during this time if her urine was

not drawn off with the catheter she frequently voided it by vomiting;

for the last twenty months she passed much gravel by the catheter; when

the use of the instrument was omitted or unsuccessfully applied the

vomitus contained gravel. Carlisle mentions a case in which there was

vomiting of a fluid containing urea and having the sensible properties

of urine. Curious to relate, a cure was effected after ligature of the

superior thyroid arteries and sloughing of the thyroid gland. Vomiting

of urine is also mentioned by Coley, Domine, Liron, Malago, Zeviani,

and Yeats. Marsden reports a case in which, following secondary papular

syphilis and profuse spontaneous ptyalism, there was vicarious

secretion of the urinary constituents from the skin.

Instances of the anomalous exit of urine caused by congenital

malformation or fistulous connections are mentioned in another chapter.

Black urine is generally caused by the ingestion of pigmented food or

drugs, such as carbolic acid and the anilines. Amatus Lusitanus,

Bartholinus, and the Ephemerides speak of black urine after eating

grapes or damson plums. The Ephemerides speaks of black urine being a

precursor of death, but Piso, Rhodius, and Schenck say it is anomalous

and seldom a sign of death. White urine, commonly known as chyluria, is

frequently seen, and sometimes results from purulent cystitis. Though

containing sediment, the urine looks as if full of milk. A case of this

kind was seen in 1895 at the Jefferson Medical College Hospital,

Philadelphia, in which the chyluria was due to a communication between

the bladder and the thoracic duct.

Ackerman has spoken of metastasis of the tears, and Dixon gives an

instance in which crying was not attended by the visible shedding of

tears. Salomon reports a case of congenital deficiency of tears.

Blood-stained tears were frequently mentioned by the older writers.

Recently Cross has written an article on this subject, and its analogy

is seen in the next chapter under hemorrhages from the eyes through the

lacrimal duct.

The Semen.--The older writers spoke of metastasis of the seminal flow,

the issue being by the skin (perspiration) and other routes. This was

especially supposed to be the case in satyriasis, in which the

preternatural exit was due to superabundance of semen, which could be

recognized by its odor. There is no doubt that some people have a

distinct seminal odor, a fact that will be considered in the section on

"Human Odors."

The Ephemerides, Schurig, and Hoffman report instances of what they

call fetid semen (possibly a complication of urethral disease). Paaw

speaks of black semen in a negro, and the Ephemerides and Schurig

mention instances of dark semen. Blancard records an instance of

preternatural exit of semen by the bowel. Heers mentions a similar

case caused by urethral fistula. Ingham mentions the escape of semen

through the testicle by means of a fistula. Demarquay is the authority

on bloody semen.

Andouard mentions an instance of blue bile in a woman, blue flakes

being found in her vomit. There was no trace of copper to be found in

this case. Andouard says that the older physicians frequently spoke of

this occurrence.

Rhodius speaks of the sweat being sweet after eating honey; the

Ephemerides and Paullini also mention it. Chromidrosis, or colored

sweat, is an interesting anomaly exemplified in numerous reports. Black

sweat has been mentioned by Bartholinus, who remarked that the

secretion resembled ink; in other cases Galeazzi and Zacutus Lusitanus

said the perspiration resembled sooty water. Phosphorescent sweat has

been recorded. Paullini and the Ephemerides mention perspiration which

was of a leek-green color, and Borellus has observed deep green

perspiration. Marcard mentions green perspiration of the feet, possibly

due to stains from colored foot-gear. The Ephemerides and Paullini

speak of violet perspiration, and Bartholinus has described

perspiration which in taste resembled wine.

Sir Benjamin Brodie has communicated the history of a case of a young

girl of fifteen on whose face was a black secretion. On attempting to

remove it by washing, much pain was caused. The quantity removed by

soap and water at one time was sufficient to make four basins of water

as black as if with India ink. It seemed to be physiologically

analogous to melanosis. The cessation of the secretion on the forehead

was followed by the ejection of a similar substance from the bowel,

stomach, and kidney. The secretion was more abundant during the night,

and at one time in its course an erysipelas-eruption made its

appearance. A complete cure ultimately followed.

Purdon describes an Irish married woman of forty, the subject of

rheumatic fever, who occasionally had a blue serous discharge or

perspiration that literally flowed from her legs and body, and

accompanied by a miliary eruption. It was on the posterior portions,

and twelve hours previous was usually preceded by a moldy smell and a

prickly sensation. On the abdomen and the back of the neck there was a

yellowish secretion. In place of catamenia there was a discharge

reddish-green in color. The patient denied having taken any coloring

matter or chemicals to influence the color of her perspiration, and no

remedy relieved her cardiac or rheumatic symptoms.

The first English case of chromidrosis, or colored sweat, was published

by Yonge of Plymouth in 1709. In this affection the colored sweating

appears symmetrically in various parts of the body, the parts commonly

affected being the cheeks, forehead, side of the nose, whole face,

chest, abdomen, backs of the hands, finger-tips, and the flexors,

flexures at the axillae, groins, and popliteal spaces. Although the

color is generally black, nearly every color has been recorded. Colcott

Fox reported a genuine case, and Crocker speaks of a case at Shadwell

in a woman of forty-seven of naturally dark complexion. The bowels were

habitually sluggish, going three or four days at least without action,

and latterly the woman had suffered from articular pains. The

discolored sweat came out gradually, beginning at the sides of the

face, then spreading to the cheeks and forehead. When seen, the upper

half of the forehead, the temporal regions, and the skin between the

ear and malar eminence were of a blackish-brown color, with slight

hyperemia of the adjacent parts; the woman said the color had been

almost black, but she had cleaned her face some. There was evidently

much fat in the secretion; there was also seborrhea of the scalp.

Washing with soap and water had very little effect upon it; but it was

removed with ether, the skin still looking darker and redder than

normal. After a week's treatment with saline purgatives the

discoloration was much less, but the patient still had articular pains,

for which alkalies were prescribed; she did not again attend. Crocker

also quotes the case of a girl of twenty, originally under Mackay of

Brighton. Her affection had lasted a year and was limited to the left

cheek and eyebrow. Six months before the patch appeared she had a

superficial burn which did not leave a distinct scar, but the surface

was slightly granular. The deposit was distinctly fatty, evidently

seborrheic and of a sepia-tint. The girl suffered from obstinate

constipation, the bowels acting only once a week. The left side flushed

more than the right In connection with this case may be mentioned one

by White of Harvard, a case of unilateral yellow chromidrosis in a man.

Demons gives the history of a case of yellow sweat in a patient with

three intestinal calculi.

Wilson says that cases of green, yellow, and blue perspiration have

been seen, and Hebra, Rayer, and Fuchs mention instances. Conradi

records a case of blue perspiration on one-half the scrotum. Chojnowski

records a case in which the perspiration resembled milk.

Hyperidrosis occurs as a symptom in many nervous diseases, organic and

functional, and its presence is often difficult of explanation. The

following are recent examples: Kustermann reports a case of acute

myelitis in which there was profuse perspiration above the level of the

girdle-sensation and none at all below. Sharkey reports a case of tumor

of the pons varolii and left crus cerebri, in which for months there

was excessive generalized perspiration; it finally disappeared without

treatment. Hutchinson describes the case of a woman of sixty-four who

for four years had been troubled by excessive sweating on the right

side of the face and scalp. At times she was also troubled by an

excessive flow of saliva, but she could not say if it was unilateral.

There was great irritation of the right side of the tongue, and for two

years taste was totally abolished. It was normal at the time of

examination. The author offered no explanation of this case, but the

patient gave a decidedly neurotic history, and the symptoms seem to

point with some degree of probability to hysteria. Pope reports a

peculiar case in which there were daily attacks of neuralgia preceded

by sweating confined to a bald spot on the head. Rockwell reports a

case of unilateral hyperidrosis in a feeble old man which he thought

due to organic affection of the cervical sympathetic.

Dupont has published an account of a curious case of chronic general

hyperidrosis or profuse sweating which lasted upward of six years. The

woman thus affected became pregnant during this time and was happily

delivered of an infant, which she nursed herself. According to Dupont,

this hyperidrosis was independent of any other affection, and after

having been combated fruitlessly by various remedies, yielded at last

to fluid extract of aconitin.

Myrtle relates the case of a man of seventy-seven, who, after some

flying pains and fever, began to sweat profusely and continued to do so

until he died from exhaustion at the end of three months from the onset

of the sweating. Richardson records another case of the same kind.

Crocker quotes the case of a tailor of sixty-five in whom hyperidrosis

had existed for thirty-five years. It was usually confined to the hands

and feet, but when worst affected the whole body. It was absent as long

as he preserved the horizontal posture, but came on directly when he

rose; it was always increased in the summer months. At the height of

the attack the man lost appetite and spirit, had a pricking sensation,

and sometimes minute red papules appeared all over the hand. He had

tried almost every variety of treatment, but sulphur did the most good,

as it had kept the disease under for twelve months. Latterly, even that

failed.

Bachman reports the history of a case of hyperidrosis cured by

hypnotism.

Unilateral and localized sweating accompanies some forms of nervous

disturbance. Mickle has discussed unilateral sweating in the general

paralysis of the insane. Ramskill reports a case of sweating on one

side of the face in a patient who was subject to epileptic convulsions.

Takacs describes a case of unilateral sweating with proportionate

nervous prostration. Bartholow and Bryan report unilateral sweating of

the head. Cason speaks of unilateral sweating of the head, face, and

neck. Elliotson mentions sweat from the left half of the body and the

left extremities only. Lewis reports a case of unilateral perspiration

with an excess of temperature of 3.5 degrees F. in the axilla of the

perspiring side. Mills, White, Dow, and Duncan also cite instances of

unilateral perspiration. Boquis describes a case of unilateral

perspiration of the skin of the head and face, and instances of

complete unilateral perspiration have been frequently recorded by the

older writers,--Tebure, Marcellus Donatus, Paullini, and Hartmann

discussing it. Hyperidrosis confined to the hands and feet is quite

common.

Instances of bloody sweat and "stigmata" have been known through the

ages and are most interesting anomalies. In the olden times there were

people who represented that in their own persons they realized at

certain periods the agonies of Gethsemane, as portrayed in medieval

art, e.g., by pictures of Christ wearing the crown of thorns in

Pilate's judgment hall. Some of these instances were, perhaps, of the

nature of compensatory hemorrhage, substituting the menses or periodic

hemorrhoids, hemoptysis, epistaxis, etc., or possibly purpura. Extreme

religious frenzy or deep emotions might have been the indirect cause of

a number of these bleeding zealots. There are instances on record in

which fear and other similar emotions have caused a sweating of blood,

the expression "sweating blood" being not uncommon.

Among the older writers, Ballonius, Marcolini, and Riedlin mention

bloody sweat. The Ephemerides speaks of it in front of the

hypochondrium. Paullini observed a sailor of thirty, who, falling

speechless and faint during a storm on the deck of his ship, sweated a

red perspiration from his entire body and which stained his clothes. He

also mentions bloody sweat following coitus. Aristotle speaks of bloody

sweat, and Pellison describes a scar which periodically opened and

sweated blood. There were many cases like this, the scars being usually

in the location of Christ's wounds.

De Thou mentions an Italian officer who in 1552, during the war between

Henry II of France and Emperor Charles V, was threatened with public

execution; he became so agitated that he sweated blood from every

portion of the body. A young Florentine about to be put to death by an

order of Pope Sixtus V was so overcome with grief that he shed bloody

tears and sweated blood. The Ephemerides contains many instances of

bloody tears and sweat occasioned by extreme fear, more especially fear

of death. Mezeray mentions that the detestable Charles IX of France,

being under constant agitation and emotion, sank under a disorder which

was accompanied by an exudation of blood from every pore of his body.

This was taken as an attempt of nature to cure by bleeding according to

the theory of the venesectionists. Fabricius Hildanus mentions a child

who, as a rule, never drank anything but water, but once, contrary to

her habit, drank freely of white wine, and this was soon followed by

hemorrhage from the gums, nose, and skin.

There is a case also related of a woman of forty-five who had lost her

only son. One day she fancied she beheld him beseeching her to release

his soul from purgatory by prayers and fasting every Friday. The

following Friday, which was in the month of August, and for five

succeeding Fridays she had a profuse bloody perspiration, the disorder

disappearing on Friday, March 8th, of the following year. Pooley says

that Maldonato, in his "Commentaries of Four Gospels," mentions a

healthy and robust man who on hearing of his sentence of death sweated

blood, and Zacchias noted a similar phenomenon in a young man condemned

to the flames. Allusion may also be made to St. Luke, who said of

Christ that in agony He prayed more earnestly, "and His sweat was, as

it were, great drops of blood falling down to the ground."

Pooley quotes the case of a young woman of indolent habit who in a

religious fanatical trance sweated blood. The stigmatists were often

imposters who artificially opened their scars, and set the example for

the really peculiar cases of bloody sweat, which among ignorant people

was considered evidence of sympathy with the agony of the Cross.

Probably the best studied case on record is that of Louise Lateau of

Bois d'Haine, which, according to Gray, occurred in 1869 in a village

of Belgium when the girl was at the age of twenty-three; her previous

life had offered nothing remarkable. The account is as follows: "One

Friday Louise Lateau noticed that blood was flowing from one side of

her chest, and this recurred every Friday. On each Thursday morning an

oval surface about one inch in length on the back of each hand became

pink in color and smooth, whilst a similar oval surface on the palm of

each hand became of the same hue, and on the upper surface of each foot

a pinkish-white square appeared. Examined under a magnifying glass, the

epidermis appeared at first without solution of continuity and

delicate. About noon on Thursday a vesicle formed on the pink surfaces

containing clear serum. In the night between Thursday and Friday,

usually between midnight and one o'clock, the flow of blood began, the

vesicle first rupturing. The amount of blood lost during the so called

stigmata varied, and some observers estimated it at about one and

three-quarter pints. The blood itself was of a reddish color, inclining

to violet, about the hue therefore, of capillary blood, coagulating in

the usual way, and the white and red corpuscles being normal in

character and relative proportion. The flow ceased on Saturdays. During

the flow of the blood the patient was in a rapt, ecstatic condition.

The facial expression was one of absorption and far-off contemplation,

changing often to melancholy, terror, to an attitude of prayer or

contrition. The patient herself stated that at the beginning of the

ecstasy she imagined herself surrounded by a brilliant light; figures

then passed before her, and the successive scenes of the crucifixion

were panoramically progressive. She saw Christ in person--His clothing,

His wounds, His crown of thorns, His cross--as well as the Apostles,

the holy women, and the assembled Jews. During the ecstasy the

circulation of the skin and heart was regular, although at times a

sudden flash or pallor overspread the face, according with the play of

the expression. From midday of Thursdays, when she took a frugal meal,

until eight o'clock on Saturday mornings the girl took no nourishment,

not even water, because it was said that she did not feel the want of

it and could not retain anything upon her stomach. During this time the

ordinary secretions were suspended."

Fournier mentions a statesman of forty-five who, following great

Cabinet labors during several years and after some worriment, found

that the day after indulging in sexual indiscretions he would be in a

febrile condition, with pains in the thighs, groins, legs, and penis.

The veins of these parts became engorged, and subsequently blood oozed

from them, the flow lasting several days. The penis was the part most

affected. He was under observation for twenty months and presented the

same phenomena periodically, except that during the last few months

they were diminished in every respect. Fournier also mentions a curious

case of diapedesis in a woman injured by a cow. The animal struck her

in the epigastric region, she fell unconscious, and soon after vomited

great quantities of blood, and continued with convulsive efforts of

expulsion to eject blood periodically from every eight to fifteen days,

losing possibly a pound at each paroxysm. There was no alteration of

her menses. A physician gave her astringents, which partly suppressed

the vomiting, but the hemorrhage changed to the skin, and every day she

sweated blood from the chest, back of the thighs, feet, and the

extremities of the fingers. When the blood ceased to flow from her skin

she lost her appetite, became oppressed, and was confined to her bed

for some days. Itching always preceded the appearance of a new flow.

There was no dermal change that could be noticed.

Fullerton mentions a girl of thirteen who had occasional oozing of

blood from her brow, face, and the skin under the eyes. Sometimes a

pound of clots was found about her face and pillow. The blood first

appeared in a single clot, and, strange to say, lumps of fleshy

substance and minute pieces of bone were discharged all day. This

latter discharge became more infrequent, the bone being replaced by

cartilaginous substance. There was no pain, discoloration, swelling, or

soreness, and after this strange anomaly disappeared menstruation

regularly commenced. Van Swieten mentions a young lady who from her

twelfth year at her menstrual periods had hemorrhages from pustules in

the skin, the pustules disappearing in the interval.

Schmidt's Jahrbucher for 1836 gives an account of a woman who had

diseased ovaries and a rectovesicovaginal fistula, and though sometimes

catamenia appeared at the proper place it was generally arrested and

hemorrhage appeared on the face. Chambers mentions a woman of

twenty-seven who suffered from bloody sweat after the manner of the

stigmatists, and Petrone mentions a young man of healthy antecedents,

the sweat from whose axillae and pubes was red and very pungent.

Petrone believes it was due to a chromogenic micrococcus, and relieved

the patient by the use of a five per cent solution of caustic potash.

Chloroform, ether, and phenol had been tried without success. Hebra

mentions a young man in whom the blood spurted from the hand in a

spiral jet corresponding to the direction of the duct of the

sweat-gland. Wilson refers to five cases of bloody sweat.

There is a record of a patient who once or twice a day was attacked

with swelling of the scrotum, which at length acquired a deep red color

and a stony hardness, at which time the blood would spring from a

hundred points and flow in the finest streams until the scrotum was

again empty.

Hill describes a boy of four who during the sweating stage of malaria

sweated blood from the head and neck. Two months later the

skin-hemorrhages ceased and the boy died, vomiting blood and with

bloody stools.

Postmortem sweating is described in the Ephemerides and reported by

Hasenest and Schneider. Bartholinus speaks of bloody sweat in a cadaver.

In considering the anomalies of lactation we shall first discuss those

of color and then the extraordinary places of secretion. Black milk is

spoken of by the Ephemerides and Paullini. Red milk has been observed

by Cramer and Viger. Green milk has been observed by Lanzonius,

Riverius, and Paullini. The Ephemerides also contains an account of

green milk. Yellow milk has been mentioned in the Ephemerides and its

cause ascribed to eating rhubarb.

It is a well-known fact that some cathartics administered to nursing

mothers are taken from the breast by their infants, who,

notwithstanding its indirect mode of administration, exhibit the

effects of the original drug. The same is the case with some poisons,

and instances of lead-poisoning and arsenic-poisoning have been seen in

children who have obtained the toxic substance in the mother's milk.

There is one singular case on record in which a child has been poisoned

from the milk of its mother after she had been bitten by a serpent.

Paullini and the Ephemerides give instances of milk appearing in the

perspiration, and there are numerous varieties of milk-metastasis

recorded Dolaeus and Nuck mention the appearance of milk in the saliva.

Autenreith mentions metastasis of milk through an abdominal abscess to

the thigh, and Balthazaar also mentions excretion of milk from the

thigh. Bourdon mentions milk from the thigh, labia, and vulva. Klein

speaks of the metastasis of the milk to the lochia. Gardane speaks of

metastasis to the lungs, and there is another case on record in which

this phenomenon caused asphyxia. Schenck describes excretion of milk

from the bladder and uterus. Jaeger in 1770 at Tubingen describes the

metastasis of milk to the umbilicus, Haen to the back, and Schurig to a

wound in the foot. Knackstedt has seen an abscess of the thigh which

contained eight pounds of milk. Hauser gives the history of a case in

which the kidneys secreted milk vicariously.

Date: 2014-12-29; view: 636