[Reprinted from the Journal op Cutanf.ous and Genito-Urinary Diseases 
for March, 1896.] 
A CASE OF RHINOSCLEROM A ORIGINATING IN THE 
UNITED STATES. 
By GROVER WILLIAM WENDE, M. D., 
Clinical Instructor in the Diseases of the Skin, University of Buffalo. 
CIIAS. B., whose case is here reported, is of American parentage 
and a resident of Buffalo, where he was born, which place lie 
never left except on one occasion, when I presented him be- 
fore the New York Dermatological Society, December 18, 1895. He 
is eleven years of age, and is apparently strong and robust. His family 
history is exceptionally good, exclusive of the mother, who died at the 
age of thirty-three, during pregnancy. His grandparents were noted 
for their remarkable longevity, his paternal grandfather having attained 
the age of ninety, and his paternal grandmother having exceeded the 
age of one hundred and one years; while on the maternal side their 
respective ages were eighty and seventy-eight. 
The father, a locomotive engineer, is forty-four years old, and is 
seemingly a typical specimen of health and strength. The patient has 
two brothers, aged respectively seventeen and eighteen, who have al- 
ways enjoyed the best of health. It was ascertained upon inquiry that 
the disease from which the patient was suffering had existed in a 
less marked degree for about a year and a half, and was progressive in 
its nature. 
The patient disclaimed all knowledge of any injury or of exposure 
to irritating influences of any description. His father was the first to 
observe the change in the normal skin, consisting of a pink spot slightly 
raised, below the right naris. There was no pain. At the expiration 
of three months a perceptible elevation appeared, the beginning of 
what soon developed into a pronounced ridge. These manifestations— 
the spot and the ridge—were joined at their margins near their respect- 
ive centers. 
As time went on, the ridge assumed greater proportions, and finally 
extended to the left side of the nose. My first examination revealed a 
nodule, irregular in outline, just below the right naris, as seen por- 
Copyright, 1896, by D Appleton and Company. 2 
Original Communications. 
trayed in the accompanying illustration (Fig. 1), which was removed 
some time in August for a microscopical examination. 
The character of the nodule was quite superficial, while the tissue 
beneath was infiltrated and very hard. Upon the right side of the 
nose two sharply defined ridges were seen, each measuring about an 
Fig. 1. 
inch and three quarters in length, having between them a small area 
of unaffected skin. 
The upper one was the least pronounced and was of uneven width. 
The left side of the nose showed but one ridge, which had a uniform 
width of nearly half an inch. These ridges, which were exceedingly 
pronounced and indurated, united upon the bridge of the nose (Fig. 2). A Case of Rh/inoscleroma Originating in the United States. 
3 
The right ala was uniformly thickened, causing a narrowing of the 
corresponding lumen of the nostril. The left ala, at this time, was not 
involved. The lines of demarcation between these lesions and the 
healthy skin were abrupt. 
I71 considering the diagnosis, we may readily eliminate rhinophyma, 
tubercular lepra, tubercular lupus, keloid, epithelioma, and sarcoma by 
the process of exclusion. That this is not a case of syphilis has been 
Fig. 2. 
demonstrated by the fact that one year’s thorough antisyphilitic treat- 
ment proved unavailing. The disfiguring growth, its glossy appear- 
ance and localization, its origin from the nasal mucous membrane— 
later, its encroachment upon the lower part of the naris, its extension 
backward in the nasal cavity to the posterior nares, its gradual devel- 
opment without disintegration, its peculiar hardness and elasticity, its 
extension to the upper lip with a sharp border, and its regeneration of 4 
Original Communications. 
the excised portions—all this has led me to conclude that my patient 
is afflicted with rhinoscleroma. 
The case is one of unusual interest, not alone for its rarity, but 
from the fact that, so far as records show, this is its first appearance 
in a person born in the United States. The result of this bacteriologi- 
cal investigation of this case is still in doubt, and when completed it 
will be made known in a future number of this Journal