Part 83

The age of the patient; the sharp limitation; the well-defined, indurated film of infiltration; the peculiar, red, raw, granulating appearance; and, later, the retraction of the nipple; and, finally, the involvement of the deeper parts.

#What is the prognosis?#

If the disease is recognized early, and properly treated, a cure may be anticipated; later the outlook is that of scirrhus of the breast.

#What is the treatment of Paget's disease?#

Thorough cauterization by means of caustic potash or the galvano-cautery; or, its extirpation by means of the curette or excision. After extirpation or cauterization, supplementary treatment by the x-ray is advisable as an additional measure of precaution against relapse.

Until the diagnosis is thoroughly established, soothing applications, such as are employed in acute eczema, are to be advised.

#Sarcoma.# (Synonyms: Sarcoma Cutis; Sarcoma of the Skin.)

#Describe the several varieties of sarcoma.#

Sarcoma of the skin is a more or less malignant new growth, of rapid or slow progress, characterized by the appearance of single or multiple, variously-shaped, discrete, non-pigmented or pigmented tubercles or tumors, of size varying from that of a shot to a hazelnut or larger. As a rule the growths are smooth, firm and elastic, somewhat painful upon pressure, and exhibit a tendency to ulcerate. The overlying skin is at first normal and somewhat movable, but as the growths approach the surface it becomes reddened and adherent; or, if the disease is of the pigmented variety, it acquires a bluish-black color. It is now generally believed that the most of the pigmented cases formerly thought to be of sarcomatous nature are really carcinomatous in character.

The multiple pigmented sarcoma (melano-sarcoma) appears first, usually on the soles and dorsal surfaces of the feet, and later on the hands. There is more or less diffuse thickening of the integument. The lesions themselves manifest a disposition to bleed.

#State the prognosis and treatment of sarcoma.#

The disease is always more or less malignant and, as a rule, sooner or later a fatal termination takes place. It is usually slow in its course.

Excision or extirpation, x-ray exposures, and the administration of arsenic in increasing dosage (preferably by hypodermic injection) now are generally considered the most promising in this usually hopeless malady.

#Granuloma Fungoides.#

#Describe granuloma fungoides.#

A rare form of disease, heretofore looked upon as sarcomatous, but now generally recognized as granuloma, and formerly described under the names mycosis fungoides, inflammatory fungoid neoplasm, and several others. It is characterized usually by symptoms of an eczematous, urticarial, and erysipelatous nature, and by the sudden or gradual appearance of pinkish or reddish, tubercular, nodular, lobulated, or furrowed tumors or flat infiltrations, which may disappear by involution or may be followed by ulceration; several or a larger number of the growths present a mushroom, papillomatous, or fungoid appearance, sometimes roughly resembling the cut part of a tomato. In most cases the tumor stage of the malady is not reached for two or more years; in exceptional instances, however, they appear in the first few months. The lesions, especially in their early stages, are, as a rule, accompanied with more or less burning and itching.

#State the prognosis and treatment of granuloma fungoides.#

The malady may last for several years or much longer, a fatal termination, with rare exceptions, sooner or later taking place. After the tumor stage is well established, the patient usually succumbs in from several months to one or two years.

Treatment consists of tonics, if indicated, and the administration of arsenic, preferably hypodermically, and Röntgen-ray exposures, along with the application of mild antiseptics, and operative interference when necessary or advisable.

#CLASS VII.--NEUROSES.#

#Hyperæsthesia.#

#What is hyperæsthesia?#

By hyperæsthesia is meant increased cutaneous sensibility. It is usually more or less localized, and is met with as a symptom in functional and organic nervous diseases.

#Dermatalgia.# (Synonyms: Neuralgia of the Skin; Rheumatism of the Skin; Dermalgia.)

#What do you understand by dermatalgia?#

By dermatalgia is meant a tender or painful condition of the skin unattended by structural change. It is commonly limited to a small area, and is usually symptomatic of functional or organic nervous disease. As an idiopathic affection it is looked upon as of a rheumatic origin.

Treatment depends upon the cause.

#Anæsthesia.#