IMAGE EVALUATION TEST TARGET (MT-3) 4 1.0 I 1.1 1.25 ut Uii 12.2 »* u WUi. IE Photographic Sciences Corporation 93 WItT MAIN STRUT WltSTIR.N.V, UIM (7U)I73.4S03 CIHM/ICMH Microfiche Series. CIHIVi/iCIVlH Collection de microfiches. Canadian Inatitutt for Historical IMicroraproductions / Inttitut Canadian da microraproductions hiatoriquas ^^^mwp Tachnical and Bibliographic Notaa/Notas tachniquaa at bibliographiquaa Tha Inttituta haa attamptad to obtain tha baat original copy availabia for filming. Faaturaa of thia copy which may ba bibliographicaliy uniqua, which may altar any of tha imagaa in tha raproduction, or which may aignificantly changa tha uaual mathod of filming, ara chackad balow. 0Colourad covara/ Couvartura da coulaur [~~| Covara damagad/ D Couvartura andommagia Covara raatorad and/or laminatad/ Couvartura raataurAa at/ou pallicul4a I — I Covar titia miaaing/ D La titra da couvartura manqua Coiourad mapa/ Cartaa giographiquaa an coulaur □ Coiourad ink (i.a. othar than blua or black)/ Encra da coulaur (i.a. autra qua blaua ou noira) □ Coiourad plataa and/or illuatratlona/ Planohaa at/ou illuatratlona 9n coulaur □ Bound with othar matarlal/ RalM avac d'autraa documatita D n n Tight binding may cauaa shadowa or diatortlon along intarior margin/ La rt liura aarria paut eauaar da I'ombra ou do la diatoraion i« long da la marga intiriaura Blank laavaa addad during raatoration may appaar within tha taxt. Whanavar poaaibia, thaaa hava baan omittad from filming/ II aa paut qua cartainaa pagaa blanehaa aioutiaa lora d'una raatauratlon apparaiaaant dana la taxta. mala, loraqua cala Atalt poaaibia, caa pagaa n'ont paa M film«aa. Additional commanta:/ Commantairaa lupplAmantairaa: L'Inatitut a microfilm* la maillaur axamplaira qu'il lui a ttt poaaibia da sa procurar. Laa dAtaiia da cat axamplaira qui aont paut-Atra uniquas du point da vua bibliographiqua, qui pauvant modifier una imaga raproduita. ou qui pauvant axigar una modification dana la mithoda normala da filmaga aont indlquia ci-dasaoua. r~~| Coiourad pagaa/ D Thia itam it filmad at tha raduetion ratio ehaekad balow/ Ca document ast filmi au taux da reduction indlqu* oi-daaaoua. 10X 14X 1IX 22X Pagaa da coulaur Pagaa damaged/ Pagaa andommagAaa Pagaa raatorad and/oi Pagaa raatauriaa at/ou palliculAaa Pagaa diacolourad. stained or foxei Pages dicolories. tacheties ou piquAas Pagaa detached/ Pagaa dAtachias Showthrough/ Tranaparance Quality of prir Qualiti inAgala da I'impreaaion Includes supplementary matarii Comprend du matirial suppl4mentaire Only edition available/ Saula idition disponible r~n Pagaa damaged/ r~~| Pagaa raatorad and/or laminated/ r~y\ Pagaa diacolourad. stained or foxed/ r~n Pagaa detached/ r~yi Showthrough/ F~| Quality of print variaa/ F~| Includes supplementary materiel/ rn Only edition available/ Pagaa wholly or partially obacurad by errata slips, tissuea, etc.. hava been refilmed to enaura the beat poaaibia image/ Lea pagaa totalement ou partiellement obaourciaa par un fauillet d'errata, una palure, etc., ont Ati f limine A nouveau da fa^on A obtanir la mailleure image poaaibia. 2ex 30X J 12X IfX aox 24X 2fX 32X » tails I du odifier ' una mage Th« copy filmed hw hat b««n raproduead thanks to tha ganarosity of: MMiiMl Library McGill Univaraity Montraal Tha imagaa appaaring hara ara tha baat quality posaibia conaidaring tha condition and lagibility of tha original copy and in icaaping with tha filming contract spacifieationa. L'axamplaira fiimi fut raproduit grica k la gAnirositA da: Ma<:;cal Library MoGili Univaraity Montraal Laa Imagaa auh^antaa ont 4ti raprodultaa avae la plua grand soin, compta tanu da la condition at da la nattatA da l'axamplaira film*, at an conformit* avac laa conditiona du contrat da fiimaga. Original eopiaa in printad papar covara ara filmad baglnning with tha front eovar and anding on tha laat paga with a printad or illustratad impraa- •ion. or tha back eovar whan appropriata. All othar original eopiaa ara filmad baglnning on tha first paga with a printad or iiiuatratad impraa- sion. and anding on tha laat paga with a printad or iiiuatratad impraaaion. Laa axamplalraa originaux dont la couv«rtura an papiar aat Imprimte sont filmAs an commanpant par la pramiar plat at an tarminant solt par la damlAra paga qui comporta una amprainta d'impraaalon ou d'lllustration. solt par la saeond plat, salon la caa. Tous laa autraa axamplalraa originaux sont filmte an commandant par la pramlAra paga qui comporta una amprainta dimprassion ou d'illustratlon .at an tarminant par la damWra paga qui comporta una talla amprainta. Tha last racordad frama on aaeh mierofioha shall contain tha symbol — ^ Imaaning "CON- TINUED"), or tha symbol ▼ (moaning "END"), whichavar appliaa. Un daa symbolaa suivants apparaftra sur la damlAra imaga da ehaqua microfieha. salon la caa: la symbola -^ signifia "A 8UIVRE". la symbols ▼ signifia "FIN". rrata :o lalura, 1* 3 32X Mapa. plataa. charts, ate., may ba filmad at diffarant reduction ratioa. Thoae too large to be entirely included in one expoaure are filmed beginning in the upper left hand comer, left to right and top to bottom, aa many framae aa required. The following diagrams illustrate the method: 1 2 3 Lee eartae. planchee, tableaux, etc.. peuvent Atre fllmte A dee taux da rMuetion diff Arants. Loraque la document est trop grand pour Atre reproduit en un seul ciichA. 11 est fllmA A partir da i'angia supArieur gauche, do gauche A drolte. et do haut an bee. en pronant la nombre d'Imegea nAoaasalra. Lea diagrammae suivants lllustrent la mAthoda. 1 2 3 4 5 6 H \^.H ' ALBINISM. BT W. H. DALP^, B.A., Montreal (Reprintfd from Mmtreal Medical Journal, June, 1897.) W.E.MLPE, 1898. ALBINISM I BY W. H. DALPii, B.A., Montreal, Definition. — Albinism is usually defined as a hereditary condition marked by a complete absence of pigment in the iris, skin and hair. However correct this statement is, a long residence with albinos in this Province and in New England, has led me to associate with this condition certain functional and organic alterations in the skin and appendages, and about which I will have to say a few words. Albino means white and was a term used by the Portuguese to desig- nate the white negroes whom they met on the Western Coast of Africa; by extension it is used to designate any pigmentless individual. Occurrence. — Albinism is an affection of a world-wide distribution and not limited to the dark races as was surmised. In the Medical Literature, of Europe and America, several accounts have been giveU; none better or more tersely written than that found in Morrow's Handbook of skin diseases, by one of our best dermatologists. This affection is not peculiar to man but similar conditions are found to exist among the animals, birds and even insects. Characteristics. Eyes. — The irides are usually perfectly pigmentless. In many, these transparent perforated screens take on a pinkish or reddish hue from the capillaries of the fundus. Balmanno Squire reported a case, which he calls atypical and in whom the irides were dark blue Lancet, Feb. 1895. Zeimssen recognising that such blue irides do occur claims this i& due to some phenomenon of interference^ of light. They have appeared to me, on more than one occasion, very much chameleon - like, the most constant colours being tifv white and the pink. Consequent upon this pigmentless condition of the irides, the camera obscura of the eye is changed to a camera lucida, and the image falling on the retina, being more difT\ise, loses proportionately ot its clearness. Again as the sensitive eye-plates of the retina are ill-protected, nystagmus,' photophobia,' colobouia, (Wm. Geo. Syni, Edin.), and oscillatory movements of the eyes may be induced (A. J. Balmanno > Prise BRHay McOIll Medicnl Socl«ty, 18U7. > " NyNtagmuH " and " uMcillatory inovomeiitN " thouKh in Honie rexpcrtN niiulitKoiiN, MTtt not n«o«HAarily Identical. * Usually congenital, and hence it may Ite doubted that nonpignicntt^d Irldf m hold Any cauHfttive relations to it. V;-^^y^V!: TT"" Squire.) But it must not be inferred that all albinos will evince what Prof. Shepherd happily terms " the screwing of the eyelids " under a strong light; neither are they all weak-eyed ; Squire's case could read perfectly in daylight and in the numerous cases which it was my good fortune to see, although their vision was keener at night, yet by day- light they saw perfectly well, neither did I soe any resort to the wear- ing of glasses. {Ab albinisml causa.) Havr. — The hair is possessed of a greater or less degree of white- ness, at times immaculate, at times flaxen, whitish yellow, always exceedingly fine and of a silky lustre, sparse, leaving the brow and nucha well denuded and apt to leave the corona bald in men. This condition especially in women, often, if not always, demands the wearing of false hair. In children their hoary denuded head in the presence of the other conditions makes a picture most sad to behold. Beards were not to be seen among the men in my cases, yet some would see tit to encourage the tonsorial artists, at long intervals, by requesting the removal of what seemed to me more like down than beard. What this would come to, if left unmolested, I am unable to say, other than it must of necessity be a caricature of the genuine article. In the axilla) and over the pubes, the growth of hair was seen to be more vigorous, and the hair yellowish-white, curly, more brittle — a condition which was no doubt due to the hyperidrosis of the part. The Skin is also devoid of pigment, but it may acquire a rosy colour from the underlying vessels, in places where the integument is thin as over the cheeks and the dorsum of the hands. This gives the albinos a pale, sallow, sickly appearance ; extreme anasmia may appear to exist. The skin is soft to the touch, dry, in some places very thin. Yet in the portions of the body subjected to pressure as the surface of the hands or the soles of the feet" the skin was granular, rough, full of rugae not only in working people but in individuals not inured to hard labour and in whom, presumably, this condition could not be due to this cause. In the normal, the pigment occurs between the cuticle and the cutis vera ; here seemingly an epiblastic derivative has one of its functions absent, whilst in the eye some me8oe congenital as was that condition which I observed in my albinos. The teeth were also found to be hypoplastic or stunted in a variable but always in a marke(^ degree ; they were squarish, and stood apart; this gave my albinos the appearance of old people, the mouth receding with its stunted teeth, standing in marked cqntrast to the prominent chin and nose. 1 Here there was no gouging of the middle incisors as is apt to occur in congenital lues, nor was there any other evidence of this virus in the system ; however, in one family I was given to understand that a leutic taint existed. Their teeth did not seem to tend to early decay. Brow.idroais. A fetid perspiration has long been recognised in some pathological conditions ; thus scrofula, rheumatism, lues, the parturie."*'. state have all been associated with a particular emanation- Howevei n some it cannot be connected with any morbid conditions. In such albinos and sons of albinos with whom I played, walked, slept, a peculiar, penetrating, not absolutely unpleasant odour was at once perceptible, which forced ablutions could only dispel for a limited time. Moreover, it was asserted to me that this was increased in females at the menstrual period, but whether it w^as complementary or vicarious my informers were unable to state. Excepi cum grano aalia. Zeimssen says the functions of the skin are normal. The albinos barring these physical differences do not seem to be an inferior class of people. The authors usually say they are of a weakly constitution, but Zeimssen says this is a rule with manifold exceptions. I have always been of opinion that this was more apparent than real. The general cachectic appearance might easily be attributed to the general pigmentless condition of the skin and hnir, the weak eyes and receding mouth. Many, I have found, to be surprisingly agile and strong. Several severe shakings which I got at school, by an albino, the seventeenth child of an albino mother, have forcibly con- vinced me that albinos are not physical degenerates. This particular boy, conscious of his own strength and endurance, was wont to afford us evidences of them by lifting steel rails and by running to a pump, a distance of 150 yards, in cold stormy mid- winter nights, bareheaded, barefooted, and with only thin underwear on, and there to fill his pitcher and to bring it back full. Nor was he ever sick as a conse- I 1 f quence. Neither was he intellectually deficient, but he now wears a clerical dress, with at least, much decorum and success. In a family of which four generations have come under my obser- vation, the representative of the first was a man of unusually ready wit ; his son, though only five feet three inches in height, was a wiry little personality ; in the third generation were observed four profes- sional men and a fifth an albino, a sculptor. Of course the albinos ordinarily are not all physically and intellect- ually the par of those just referred to. My albinos were for the most part long-lived, not phthisical ; I have not yet come across a case of idiocy amongst them. They are generally discriminated against when it is a question of giving or taking in marriage, and they, as a class, feel that a stigma attaches to them, whereby they are often rendered abashed, morose, melancholic. This hM been noted by most authors. Menfolks usually marry others than albinos, but the women usually do not marry at all, probably for want of suitors, unless there be a large dowry in sight. Thus the increase amongst the albinos is not a very rapid one. The sexual propensities are very highly developed in some if not in most and have been noted in the non-albino progeny of mixed unions. Sed hoc non semper albinum eat. Etiology. — Heredity is recognised as the most important factor in the causation of the disease. Thus some parents, immediate or remote are looked upon as the channel of transmission ; the atavism may be so great that the cases may appear sporadic. Case of Balmanno Squire, the Lancet, Feb., 1S95. The cases of Geo. Wm. Sym, Edin. The children of an union between an albino and a normal individual iare for the most part normal; rarely do we see the majority of them pigmentless. A child having a full development of hair may yet have a stunted growth of teeth or may even have a partial onychogry- phosis, or again these may disappear from one generation and re- appear in some members of the next to tell its tale of a lurking albinism. As a second possible etiological factor some include some telluric conditions Thus it is claimed that it occurs endemically in Loango or Lower Guinea. However, such telluric causation is usually not admitted. Beyond this we enter the realm of hypothesis. Are we to look for a cause within the part affected or to some anomaly in the ductless glands ? No answer is at present forthcoming. Giaaaijica' ion. — Barensprung classified pigment atrophies into acquired albinism or vitiligo, and congenital albinism which he further sub-divided into universalis and partialis. The first and the last he 6 misused, using the one for morphea and acUrodermie en plaqv^a, the other for vitiligo. (Zeimssen.) Vitiligo or leucopatia acquisita is a progressive pigment atrophy, which is regardless of sex,, appears usually between the tenth and thirtieth year, may remain stationary or extend over the whole body or may even disappear spontaneously. It may run a symmetrical course on both sides of the body. The skin around these white spots usually becomes more pigmented. Nacke Levy. It is often seen in cases of acquired syphilis. When it involves the scalp, canities result. Berliner Klinische, Feb., 1894. In the course of the diseases of the thyroid leucopatia acquisita may occur and by the total in- volvement of the skin may even simulate albinismus universalis. In Graves' disease, however, there would be tachycardia, an enlarged thyroid, venous pulsation, muscular tremors, and characteristic eye- changes. In scleroderma either in the localised or the diffuse form, following hyperaeraia and preceding induration, leucoderma often appears and often with it dystrophy and sclerodactylism. Here, given a very chronic case, symmetrically distributed gryphotic albinism might be very closely simulated. But in scleroderma, sensibility and secretion are lessenea, there is bradycardia, and intellection is lowered. In some cases of albinismus acquisitus partialis, the area of pigment atrophy may correspond to the area of supply of some nerve. From clinical notes I obtained two remarkable cases, one with a pigmentless spot corresponding to the hypogastric branch of the ilio- hypogastric, another with a white spot corresponding to the distribution of the subcutaneous colli viedius et inferiori 1 might also say that a somewhat similar auto-observation was made by myself several years ago. Of congenital partial albinism, I need not say much. The colour merges gradually from the pigmentless spot into that of the healthy surrounding skin \^hich is not more pigmented than elsewhere. In some canities may occur without a lack of pigment in the scalp. Strieker refers to a white lock of hair transmitted for six genera- tions. A pseudo-albinismus universalis congenitalis, I think, may be rightly said to occur. I am very much inclined to look upon Sym's four cases as such. The hair was extremely fair but not (juite white ; the irides of an exceedingly pale blue colour, not pink. It is not an uncommon thing to find individuals with very pale yellow or flaxen hair, eyebrows and cilie, and with almost pigmentless skin and irides, so that one almost feels as if they should be classed in a sub- variety ;\. of albinism. These pseudo- albinos would be characterised by the fact that the lack of pigmentation is not so marked nor so persistent, by the gradual deepening in colour noticed in the hair as age advances by the appearing of freckles ; here again beards will often grow, though not always ; nor will there be usually gry|ihotic changes in the nails, nor hypoplasia of the teeth. Yet here, as in many other things, > fast and hard rules are only good enough to be broken. V