Psoriasis--verruca--epithelioma : a sequence / by James C. White.

  • White, James C. (James Clarke), 1833-1916.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Psoriasis--verruca--epithelioma : a sequence / by James C. White. Source: Wellcome Collection.

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    palmar fold of skin between the fore and middle fingers of the left hand, was also thoroughly curetted. lliese more radical operations were, however, as unsuccessful as the measures previously employed. The wound closed up, and some sort of epidermal covering was established, but the areas primarily affected be¬ came the seat of a much more rapidly progressive induration and thicken¬ ing, so that the integument of the right palm became involved in the process to the extent of more than an inch in circumference, and pre¬ sented subsequently, at the beginning of this year, at a consultation held by Prof. Henry J. Bigelow, and Dr. R. M. Hodges, under whose skilful and constant surgical care the case had been for a long time, with the writer, a reddened prominence, largely occupying the lower third of the palm, of somewhat uneven surface, in the centre of which a new ulcer had estab¬ lished itself with an everted edge of exuberant fungoid granulations. To the touch the rest of the mass was deeply resisting, except in one or two parts, where boggy-feeling globular elevations the size of a large pea, and somewhat translucent, existed. These had also formed in the neighbor¬ hood of the ulcer before the last operation. Upon the other hand, too, the tissues surrounding the seat of the curetted ulcer were becoming '— Q rapidly indurated to a much greater extent than previously. The bra¬ chial and axillary glands remained unaffected. The parts had been ex¬ cessively painful for a long time, and the patient’s strength was giving way under his suffering and anxiety. His medical attendants had long pre¬ viously formed an opinion that the disease had become epitheliomatous in character, and were then of the unanimous conclusion that it could be overcome only by thorough removal of the affected tissues. The growth had penetrated so deeply that a radical local excision of the diseased parts alone was no longer possible, so that amputation of the right hand and of as much of the left as was involved in the diseased process was advised. JL Before resorting to such extreme measures, however, it was thought ad¬ visable by them, considering the rare, or even unparalleled, history of the case, that the patient should have the benefit of the opinion also of cer¬ tain distinguished dermatologists and surgeons in Europe, and accordingly he proceeded thither in January of this year and consulted Mr. Hutchin¬ son and Sir James Paget, of London, and Professors Kaposi and Billroth, in Vienna. On his return, after an absence of six or seven weeks, during which he had the personal attention of Dr. G. W. West, the disease was found to have made great advance. The skin of the whole palm of the right hand had apparently become implicated in the process, and the lower half was fully occupied by a deep ulcer with dense, enormously everted edges in a state of flamboyant granulation, encroaching at its inferior part upon the wrist. The ulcer upon the left hand had also extended rapidly, and was assuming the same fungous, exuberant appearance as the other. The patient’s general condition had naturally become decidedly worse, for the prognosis had not been lightened by the opinions he had obtained from the eminent professional gentlemen above named, and the affected parts were excessively painful, so that sleep was obtained only by the aid of narcotics. As it was decided by his medical attendants after repeated consultations that nothing was to be gained by further delay he consented to submit to the measures previously advised, and in April last the right hand was amputated above the wrist, and the fore and middle fingers of the left hand were excised through the middle of the metacarpal bones by