Definition And Description

Of this rare affection I have been enabled to watch, for any length of time, a single case only; but the history of this one exhibits so typically a definite and distinct form of disease, that I give it in full: *

Daniel G., a native of Ireland, aged forty-nine years, and a blacksmith by occupation, came under the care of Dr. E. G. Janeway, in the early part of 1869, suffering from emphysema of the lungs and chronic bronchitis. He remained under the care of Dr. J., for more than a year, without presenting any novel or peculiar features; but about the 1st of March, 1870, he noticed a stiffness on moving his neck. This was soon followed by a similar condition affecting the arms, back, chest, and abdominal region. The affection reached its height in about ten days, and then remained stationary for about six weeks after its first appearance. On examination I found the integument of the parts above mentioned to be firmly adherent to the tissues beneath. It was impossible to lift or pinch it op in folds, or to make it glide over the underlying connective tissue. The patient was free from pain, and only complained of the Inconvenience that arose from being encased in an inelastic covering that impeded the use of his arms, and compelled him to abandon his occupation. With the exception of his pulmonary difficulty, his organs and functions were in a normal condition. Careful inquiry failed to throw any hight on the determining cause of the attack, except, perhaps, frequent and sudden changes of temperature; for he stated that when overheated at the forge, he sometimes stood in a draught to cool himself.

* This case was first published by me in the New York Medical Gazette, June 24, 1871.

The patient was placed on small doses of quinine, in addition to the remedies prescribed by Dr. J. for his pulmonary difficulty. The affection gradually subsided, and in three months the scleriasis had entirely disap-peared.

The case here presented is by no means a unique one in cutaneous literature, as many others have been reported; but the reporters of them and dermatological writers generally, have confounded them with and reported them as cases of a totally distinct affection, namely the one to which the name of Scleroderma is now almost universally given. The differences between the two will be pointed out later.

The principal characteristics of Scleriasis are the "hide-bound" condi-tion of the skin, and the rapid invasion of a large portion (in the case given, more than one-half) of the integument, and the spontaneous recovery.*

Diagnosis

The only affection with which this one can be confounded is Scleroderma; the differential diagnosis between them will be given in connection with the latter disease.

Prognosis

Usually good. Etiology. - Unknown.

Treatment

I do not know that any treatment has influenced the course of the disease, but if another case were to come under my care I should probably employ the Turkish bath, with plenty of kneading and shampooing, together with electricity.