Page:Archives of dermatology, vol 6.djvu/154

 142 A. R. ROBINSON;

II. Case of Morphoea. By A, R. Robinson, M.D., etc., of New York.

The following case was exhibited at a meeting of the New York Dermatological Society, and as all the members present agreed that the disease was without doubt true morphoea, I here give a short account of the clinical history of the case.

Jennie Stirrat, set. 8 years, born in New York City, third child ; two still living; one died of entero-colitis at 8 months of age; pa- rents healthy; no history of any disease of the nervous system in parents or their relatives.

This child had scarlatina when 4 years of age, and measles a few weeks previously to the scarlatina. No symptoms of renal disease showed themselves after the scarlatina. With the exception of the scarlatina and measles, she has always enjoyed apparently excellent health. She is well nourished, and has firm muscles. She goes to school, and learns as rapidly as other children of her age.

The morphoea was first observed two years ago. At that time it was nearly as large as at present. The disease appeared without pain or any symptom whatever, and was only observed by the mother when washing the patient. Since then her health has also always been good, the pathological process producing no abnormal sensations.

The disease is seated on the inner surface of the left thigh and foreleg. It commences above at the lower part of the upper third of the thigh, near the anterior line, and extends obliquely down- wards on the inner side of the thigh, and almost disappears about one inch above the inner tuberosity of the femur. This patch is from one to one and one-half inches in diameter, the broadest por- tion being the lowest part. Its margin is well defined throughout the greater part of its extent. The whole patch except at the mar- gin is somewhat sunken beneath the general surface. This arises from atrophy, as the healthy leg is from one-quarter to half an inch larger in circumference than the diseased leg. The patch pre- sents a yellowish-white appearance, and is crossed by a few veins. The yellowish-white color contrasts pretty strongly with the slightly hypersemic surrounding tissue. The whole patch feels dense and firm, the central portion being harder and firmer than the periph- eral part. The skin cannot be pinched up to the same extent as on the sound leg.

A second patch is seated on the inner surface of the knee-joint, and is united to the former by a narrow strip of morphoea tissue. It is one and one-half inches in diameter, and one inch in length. Here there is also atrophy, but the disease being necessarily more superficial, the circumference of the joint is not much diminished. It is one-eighth of an inch smaller than the opposite knee. This patch is of a pearly-white color, and has a close resemblance to some scars resulting from burns.

A third patch, of irregular outline and faint white color, is seated