Dermatolysis.
In this affection the skin hangs in loose folds. Its fibro cellular element is greatly increased. The affection really includes all pendulous conditions, from obesity, parturition, the state of skin in lax and enlarged mammae, and the like. In the uncomplicated form of disease, the hypertrophic growth arranges itself in layers like the folds of a tippet; there is little vascularity; the sensibility of the past is diminished.
Elephantiasis.
This affection is characterized by great hypertrophy of the integument of either the leg or scrotum in men, or leg or labia in women, or both locations may be involved at the same time. It occurs frequently in tropical countries, but rarely in northern climes.
In the development of this disease general symptoms precede the local ones, and the first indications are usually a sharp, febrile attack, in no way distinguishable at the beginning from an ordinary severe paludal fever. In a few days, however, pain in the groin, with swellings of the lymphatics, is noticed, and this in turn is followed by more or less oedema of the foot and leg. After the subsidence of the febrile attack the oedema of the limb abates, but does not as a rule wholly subside. After a varying and uncertain interval a second febrile attack occurs, with renewed swelling of the limb, which but partially subsides, leaving the part still a little larger than before. These attacks succeed each other irregularly several years, until finally the leg or other part affected may attain an enormous size.
Elephantiasis is unquestionably due to obstruction of the lymphatic circulation; and this in turn has been most conclusively proved in many cases to be due to the presence of a minute worm, the filaria sanguinis, which lodges and excites inflammation in the lymphatic glands and produces occlusion of the vessels. The febrile attacks, which occur with a certain periodicity, may be due to the development of fresh broods of filaria. This parasite, however, is not met with in the higher latitudes, in which cases of the disease are sometimes encountered; and hence these latter need some other reasonable explanation, which we regret to say is not forthcoming. It is supposed by some what that the mosquito plays an important part in the development and transportation of the undeveloped filariae.
Elephantiasis is always a grave disease, and may last a life time.
Treatment.-A milk diet is the best for the elephantiasis patient, and if it is a possible thing a change of climate should be made.
I can not recommend Esmarch`s bandage, neither amputation, as I have never seen any benefit from either expedient.
Relief, and occasionally beneficial results, come from the use of hamamelis or chaulmoogra oil dressings.
Myristica sebifera is the main internal remedy. Hydrocotyle Asiatica, has been recommended, as have also Anacardium orientale and Elaeis guineensis.
Milium.
This name is given to an affection characterized by the appearance of minute white or pearly papules.
These little papules are usually clustered about the eyes, sometimes on the upper and the lower lids, and often on the cheeks just below the eyes. They correspond to sebaceous glands, of which the orifices have in some manner become occluded, thus allowing an accumulation of sebum. They are much more frequently met with in women than in men.
Treatment.-Milia are readily removed by dividing the skin that retains them with a sharp curved needle ground flat on the curve. A little pressure is exerted, and the tiny white sebous concretion rolls out. The Calcium iod, is the principal remedy, and the next Staphysagria. Tabacum may be thought of.
Mammillitis Maligna.
Under this designation we embrace the peculiar and rare disease of the nipple and areola, commonly known as “Paget`s disease of the nipple”.
Dr. James Paget was the first to describe this disease, and he states that he had seen some fifteen cases, all occurring in women between the ages of forty and sixty. The affection commences as a red, almost raw inflammatory condition, confined to the mammilla and surrounding areola; the surface being somewhat granular and looking not unlike an ordinary eczema rubrum from which the epithelium had exfoliated, and accompanied with a very similar exudation, with some tingling, burning, and itching. In other words, it presented the ordinary appearances of a common eczema, except that, when taken between the fingers, there was a firmness of the tissues, approaching the condition of induration that is never met with in eczema proper.
The chief peculiarities of this disease, however, are the facts that, first it is exceedingly rebellious to treatment, obstinately refusing to heal under the simple measures that would suffice in ordinary eczema; and second that the disease in question proves to be a forerunner of carcinoma.
It is on this fact that the real importance of the disease depends, as in the beginning it gives rise to very little local or other inconvenience.
Treatment.-If the diagnosis is firmly established, extirpation, either by the knife or caustic, is the only means of treatment that promises any success, as soothing remedies do not check its progress, while those of a stimulating nature simply aggravate the lesion.
I am unable to recommend any homoeopathic remedy as having had any influence upon the disease. Kali mur. and Silicea might be tried given in alternation.
Ainhum.
This disease consists of spontaneous amputation of the little toes, with hypertrophy of the amputated part. The name means “to saw”. The disease is said to exist amongst the Africans.
A small semi-circular furrow first appears in the digitoplantar fold, which gradually increases, without pain or inflammation, the toe enlarging, and getting loose and in the way. If the toe is cut off, the wound left heals very speedily. The cause is unknown. The general health does not suffer. The disease is symmetrical. The amputated toe shows fatty change of the tissues, enlargement of the areolar spaces of some of the bone of the phalanges, the bones tissue between the middle and proximal phalanges being replaced by fibrous tissue, the separation of the toe taking place at the proximal, inter- phalangeal joint, and not the metatarsal phalangeal joint; the cartilage and articular end of the middle phalanx being removed and replaced by fibrous tissue, which looks like an ordinary cicatrix.
Naevus.
These spots are congenital; and they are not only hardly ever amenable to surgical treatment, but have in many cases been rendered much worse by such injudicious treatment. Some remarkable naevi reproduce upon the skin of the child while yet unborn the vivid impression made upon the mind of the mother. Another and more profound influence of the same kind, or one exerted in an earlier stage of pregnancy, results in actual deformities and monstrosities.
Naevi materni may be arranged in three distinct classes, in the order of their gravity.
1. Moles, the most common of all, whose character and harmlessness are well known, and which are generally attributed to some alteration in the structure of the rete mucosum.
2. Venous Aneurisms-Anastomosis of Venous Capillaries.-These form a dark-red circumscribed stain, which generally appears on one side of the face, and is sometimes of considerable extent. These “marks,” which appear to be simple dilatations of the sub- cuticular capillary vessels, may increase in extent till puberty, and then remains stationary.
3. Aneurisms and Dilatations of the Arterial Capillaries.- These form the most the most important of the naevi; they are apt to enlarge in after-life, especially when stimulated by external irritation, and they may give to dangerous hemorrhage if improperly meddled with. They form slightly elevated spots, with well-defined margin and a granular surface which consists of an erectile vascular tissue. These granulated tumors, raised above the skin, may in fact be constituted of venous or of arterial vessels. In the former case they may be of a dark-blue or livid color; in the later, of a brighter red.
Treatment.-Mr. Thomas reports three cases treated by collodion. The naevi were covered, together with the surrounding skin, with collodion, which was repeatedly applied. Improvement was so marked as to do away with the necessity for operative interference.
Dr. Mayor publishes an interesting case of a naevus of the cutaneo-subcutaneous variety, on the back, in a girl aged ten months, where he successfully tried electrolysis. The number of sittings was two, and the duration of each about two minutes. On examination of the patient, nearly four years later, not a trace of the naevus was detected.
Dr. Marshall, from an experience of many years, recommends the electrolytic treatment of naevi as superior to every other. After criticising the methods in vogue, he claims for electrolysis: That it gives no after-pain; that it is free from danger that there is no bleeding; that the resulting scar is white and shows no tendency to contract-a point not to be forgotten since naevi are so common about the head and face. This method is slow, the disappearance being gradual. One or more needles are used according to the size of the growth, and they are moved about to attack the various portions without withdrawing them. It is well, at first to work well away from the surface to avoid destroying the same. The scars left by the negative needles are apt to be brown and disfiguring and hence the positive pole is to be preferred, being slower in its action, less apt to cause sloughing or to be followed by bleeding after withdrawal of the needle. A rheophore attached to the negative pole completes the circuit, a second puncture being thus avoided. As regards the number of cells, ten are usually sufficient, although in deep naevi as many twenty have been used. A change in color to a dusky hue is the indication to stop the current. To withdraw the needle it should be first rotated and the orifice can be painted with collodion.
