William R.,age 22, American, driver:  SARCOMA PIGMENTOSUM

[THIS IS FOX'S longest case study (nearly 1500 words) and his strangest entry for it involves no discussion of treatment or conclusions as to the cause.] Six years before the photographs were taken he received a blow on the outer side of the right eye-ball. Shortly after a minute black speck appeared on the site of the bruise, which steadily, though slowly, increased in size. Small tumors appeared later on various portions of the body. In June, 1874, there were about forty or fifty tumors, varying from a slight nodosity to a large horse-chestnut in size. One of hazel-nut size on the right temple was excised to relieve the deformity. The tumor was friable in structure, and almost black in color. Microscopically a great excess of pigment matter was found, and many large cells, with two or even three nuclei. The urine was of a smoky color. The prognosis which had been made in his case rendered him despondent. From this time forward the development of the tumors was pretty rapid, new ones being discovered almost daily. The general surface of the skin grew darker. All of the tumors are decidedly hard and firm to the feel. Some of them are colored, of various shades, from a greenish brown to a deep blue-black. After having attained a certain size, or rather height, they become first of a purplish color, which deepens until of a deep black. The subsequent history of the case can be told in a few words. The patient rapidly lost in strength and flesh, and the tumors continued to develop anew and reappeared in the site of those excised. In six weeks he was in a greatly depressed state. He remained in the hospital about three weeks, and died there on May 16. He failed rapidly, becoming more and more bronzed, until, at the time of death, the general melasmic state of the skin was very striking. Autopsy, May 17, 1875. The entire skin is of a dark color. The substance of the brain is not pigmented and appears normal, but black nodules are found in the liver. On the right eye close to the outer edge of the cornea, is a small black nodule, the size of half a grape seed.

What happened here? What had William,
despondent American driver, seen
at the age of sixteen that so rebuked his eye,
struck it and set so Stygian a sty
that his whole body rocked and began to knot,
to harden, to clot and burl like wood,
grow brown as bark, then begin to bronze
in a frenzy of small and briaring fists?

Where had you driven then, William?
And what did you see? Tell us; be shriven.
What turned you like some male Daphne to a tree,
broke your body in galls
and made your liver as black as ill augury?

Some Olympian spied in Brooklyn?
A ritual intruded? A passion curtailed?
Were you the man who was changed
because he saw what he should not see?

But surely there's no myth here, no Attic bit,
to make this tragic consequence of accident
more than mere anomaly. What deity
in a scientific century could so consume a man,
knot and bark his body, light fires within to smoke
his urine and set his skin to a martyr's bubble
as in days when gods ate with untroubled appetite?
He myths no order undone, serves no blind
or twisted eye, for if he did, such a presence
would unjoint the sky, snap the world's rivets
to break our purposeless spin
about the sun, and give meaning
to a whirling monotony where there is none.

Or so we like to think—unless Nature
be imped—or be Badland where the only law
is that there is no law; some random rolling
Loki-cell or particle that might
bit by bit, and habit by habit—
with perfect resonance—negate it all.

For example, if the first man sprang, as some have said,
from an ash tree in the earth's first spring,
and if William R's "R" might be for rowan,
the mountain ash, cousin to Yggdrasil,
that holder of all in harmony, joint of hell,
earth and sky, horse of Yggr—or Uggr, fear,
the word ugly's briared and knotty root,
would not William R's body
be the picture of negated harmony?

But, of course, it was all caprice,
ill fortune and bad luck, pure chance
that struck the eye of William R.
and set into motion
a scientific sarcomatosis
that turned him tree
and felled him down.

All pointless and plotless,
absurd and meaningless . . .
as a grape seed—
or shard of sharpened mistletoe—
speeding toward a bright and opened eye.

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