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

  • James Clarke White
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

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

    9/12 (page 171)
    had before me one of those extraordinary coincidences of the simultaneous occurrence of disease of extreme rarity. Here was again a patient who presented general psoriasis, warty growths upon the hands, and unmistak¬ able epitheliomatous disease. What was their connection in this case ? I found that he had had psoriasis nearly constantly since early manhood, and had tried various methods of cure, including arsenic, mostly in vain as ai even as temporary results. Some ten years ago several of the chronic patches of psoriasis upon his hands began to assume a thickened, horny appealance, and transformed themselves into true warty outgrowths. Some time since one of these upon the palmar surface of the wrist softened and became a sore, which could not be made to heal, and gradu¬ ally developed into its present condition in spite of repeated efforts to cure it by caustics and scraping. Such was the history in brief of the ulcer. In addition, one of the warty formations between the fingers was beginning to soften, and revealed on pressure a boggy consistence. There were also a small, prominent, ulcerating patch upon the inside of the buttock near the anus, and two small excoriations covered with crusts of doubtful character upon the penis and in the groin, none of which were of long duration. The general surface presented a sparsely scattered psoriasis of guttata variety. The patient was somewhat feeble from the suffering caused by the disease in the palm. Ihere was no affection of the brachial glands. He was advised to have the diseased tissue removed by thorough excision, and for this purpose he entered the Massachusetts General Hospital, under the care of Dr. R. M. Hodges, who had seen the patient with me, and recognized the remarkable identity of the case with that first reported. Dr. Hodges has kindly prepared the following account of its subsequent history: “ The operation performed on Mr.-’s wrist, August 18th, was an excision of the diseased tissues, without regard to the extent of surface sacrificed, or the depth or character of the parts involved. This extent represented superficially the area of a circle two and one-eighth inches in diameter, and in depth penetrated to the flexor tendons and the anterior surface of the carpal bones. The ulnar artery and nerve, the palmaris longus tendon, portions of the muscles of the thumb and of the little finger, and the anterior annular ligament were divided or removed. The patch near the anus was also dissected out. September 12, a necrosis of the tendons and fascite along the ulnar side of the forearm, which had slowly taken place, required an incision and the removal of the dead tissues. The healing processes following these two operations having been nearly completed, the patient, without apparent reason, on September 18th, suffered sudden and extreme pain at the inner side of the upper arm. On the 20th the red lines of a lymphatic inflammation were visible, the axilla gradually became swollen and infiltrated without any focal centre, and a deep cellulitis with grave constitutional symptoms developed itself. In spite of free incisions and active supporting treatment, the patient’s strength gave way, and on October 4th death occurred from exhaustion. It is needless to say that from first to last, the most pains¬ taking antiseptic dressings were used.” This unfortunate termination had, of course, only an incidental connection with the operation, which promised to be as successful as that in the first case. An examination of the tissues removed by excision was made by Prof. Fitz, who furnished the following report: “ The specimen was character¬ ized by the presence of large masses of epithelioid cells of irregular shape