Biomedical Ephemera, or: A Frog for Your Boils

Ganglion cyst, aka "Bible bump", aka "Let's hit you with a large book!"

Given the name "Bible cyst" or "Bible bump" from the original "treatment" of hitting the deformity with a Bible or other large book, ganglion cysts are actually considered tumors. Over 60% of the non-cancerous tumors of the hand are ganglionic, but their etiology is still not completely understood.

The first description of these tumors was given by Hippocrates as "knots of tissue containing mucoid flesh", but the first theories of their origins weren't put forth until 1746, when one Dr. Eller wrote a descriptive paper on them. He believed that they came from synovial herniation,  or rupture through the tendon sheath, and that they were true cysts.

Later theories recognized that the tumors were growths arising from ganglionic sheaths and not encysted fluids or mucoid tissues, but the old theory of "just smack it with a heavy object to burst it and make the body reabsorb it" still stuck around for a long time. Though bursting the tumor can cause temporary disappearance, this often causes more serious recurrence and additional growth. As these tissues are not cancerous, it's generally recommended to leave them alone when they're not interfering with normal function. Sometimes they can press against other tendons or nerves and necessitate aspiration or surgical removal, but the incidence of recurrence is over 40%. In about 75% of cases, the "cyst" will disappear or significantly decrease on its own.

So, yeah, don't let anyone convince you to let them smack you with a heavy object, just because you have one of these growths! It's a bad idea to let people smack you with heavy objects, just as a general rule...

[Source: Medscape Reference: Ganglions]

[Image: Iconograms. Prof. Bockenheimer, 1913.]

Combustio (X-Rays)

This patient had been exposed to a single long exposure of x-ray radiation in the thought that it would help a chronic swelling of his thigh. Over the course of the hours and days following the exposure, the skin became brown, then red, then white, and eventually ulcerated. There was also noticeable hardening of the skin and hypodermis in the most burned sections.

The brown areas shown are the least affected. The ulcers cleared in short order, with the application of dusting powder. The hardened skin and sub-dermal tissues regained its normal pliability within several weeks.

Iconograms: A Collection of Colored Plates Illustrating Interesting Surgical Conditions. Prof. Bockenheimer, 1913.

Hemorrhage and petechiae 

Petechiae are the smallest class of purpura (under 3 mm), caused by hemorrhage of capillary blood vessels at the surface of the skin. They look like tiny red or purple spots that don't blanche (turn white) when you press down on them, like, say, a sunburn does.

In forensics, petechiae can indicate death due to compression of the thorax or throat, including death due to manual strangulation or hanging. In this case, death was caused by the complete compression of the thorax by a rolling mill, which caused massive hemorrhaging in the face, due to the blood being pushed upwards. There are also petechial hemorrhages throughout the chest and collarbone area.

Iconograms: A Collection of Colored Plates Illustrating Interesting Surgical Conditions. Prof. Bockenheimer, 1913.

Gangraena humida pedis - wet gangrene of the foot

Though it can form from any occlusion of blood supply, this gangrenous foot has a particularly interesting origin. 

Following the forcible correction of a flexion contracture due to tuberculosis of the hip-joint, the toes became flexed, cold, and blue. Shortly thereafter, the toes blackened, and fistulae formed on the first and fifth toes, where necrotic bone began to protrude.

As the gangrenous tissue only formed on the end of the foot, it is obvious that there was no full occlusion or rupture of the femoral artery. The physician surmised that the pinched intima of the artery caused thrombosis of a vessel in the foot, and the tissue beyond that point died. 

This case only required the amputation of the anterior portion of the foot and recovered easily.

Iconograms: A Collection of Colored Plates Illustrating Interesting Surgical Conditions. Prof. Bockenheimer, 1913.

Necrosis Fasciae [Necrotizing fasciitis]

I've seen an oddly large number of cases of necrotizing fasciitis on the abdomen involving infection after spider bites. I'm not sure if this is actually something that's common, or if I've just seen those cases and not the others.

Iconograms: A Collection of Colored Plates Illustrating Interesting Surgical Conditions. Prof. Bockenheimer, 1913.

Incurable cancer "en cuirasse". Both mammae affected with carcinoma. Right side showing a recurrence of the growth in the scar seen soon after operation where a soft, fungating, ulcerating, easily bleeding ulcer is seen. In the surrounding skin there are several isolated nodules. The left mammae is involved in a hard, immovable, carcinomatous infiltration. The transmigration of carcinoma from one side to the other is possibly explained by the persistence of congenital lymphaties.

From Bockenheimer's Iconograms of Interesting Surgical Conditions

Two gummatous syphilitic lesions, from advanced stages of infection.

From Bockenheimer’s Iconograms Illustrating Interesting Surgical Conditions. 1913.

From Bockenheimer's Iconograms Illustrating Interesting Surgical Conditions. 

An elephantiasic thickening of the toes, developed in connection with a varicose ulcer of the leg. The whole foot is enormously enlarged and the arch of the foot is obliterated. The thickening increased and extended to the ankle. 

Varicose ulcers generally occurred in old people of the poorer classes, who cannot take care of their varices [distended veins, known as varicose veins in legs now] and have to do much standing; uncleanliness makes matters worse.