A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 8).
- Copland, James, 1791-1870.
- Date:
- 1834-59
Licence: Public Domain Mark
Credit: A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 8). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
![sponding to that observed in mucous, serous, and parenchymatous structures. Tubercles, however, appear in ulcers affecting the cutaneous expan- sions of scrofulous persons, but most frequently in a softened form, or in that of puriform tuber- cular matter. An ulcerative softening of the skin, in connexion with tubercular deposits in the sub-cutaneous cellular tissue or in lymphatic glands, is a common occurrence. 30. k. Cysts do not occur in the cutis vera; but the sebaceous glands often degenerate into cysts of considerable size. Cysts also form in the sub- jacent cellular tissue, and become closely con- nected with the skin. These, as well as morbid- ly-enlarged sebaceous follicles, commonly contain cholosterine. This substance has also been met with as a stratum on the surface of open ulcers of the skin. 31. I. Cancer and cancerous ulceration are often met with on the skin. When cancer commences in the sub-cutaneous or glandular tissues, particu- larly the mamma? and lymphatic glands, it gener- ally soon implicates the skin, and becomes, from an early period, very closely connected with the cutis. But cancer often also originates in the skin, in the form either of fibrous or scirrhous cancer, or of medullary cancer. 32. (a) Fibrous cancer of the skin generally assumes the form of a tuberculated or rounded nodule, sometimes flattened, or even 'depressed, below the surface of the skin, and forming an umbilicated fossa. It is generally single, about the size of a hempseed, pea, or small nut, firmly fixed, and as hard as cartilage. Sometimes it is smooth and shining externally, occasionally cov- ered by a hard, laminated crust of cuticle, and often darker than the surface around. It occurs chiefly on the face, lips, and nose, but occasion- ally on other parts of the body. It is commonly the primary cancerous growth, and often the first of a scries of cancerous formations in different organs. In some instances it reaches a consid- erable size, growing into a tuberous mass, pro- jecting beyond the skin. (Rokitansky.) [This form of cancer is called superficial epi- thelial by Paget. The condylomatous appear- ance which it assumes is owing to enlargement of the papillse of the skin or mucous membrane. It is this character which often leads to mistak- ing them for common warty growths. For a very lucid account of the different forms of epithelial cancer, see American edition of Lectures on Surgical Pathology, by James Paget, Phila- delphia, 1854.] 33. (b) The medullary kind is usually a sec- ondary formation, and consequent upon large cancerous growths, which first appear just be- neath the skin, or which involve the sub-cutaneous structure first, and then the skin itself. In either case it grows in the skin in isolated or confluent nodules, near the primary mass. It sometimes also appears in the skin after it has been local- ized in one or more organs. The nodules^lhich it forms in the cutis are mostly numerous, and about the size of peas or hazel-nuts; they are scattered over the body, especially over the trunk, and generally near similar growths in the sub-cu- taneous cellular tissue. In the case of a boy, about 14 years of age, for whom I was consult- ed, I counted upward of twenty thus dissemin- ated. It is characterized as a whitish or whitish red growth, which is sometimes tolerably firm and lardaceous, or medullary, and occasionally looser, softer, and resembling cerebral substance, or even much softer and diffluent, and it often grows to a considerable size. It may also con- tain black pigment, and thus constitute cancer mclanodes of the skin. The layer of skin above the nodule becomes stretched, and shining or transparent, or rough from the loss of its epider- mis. Sometimes the elementary particles of the disease are deposited in vascular ncevi, or, as the deposition takes place, the vessels of the part are excessively developed, and a cancerous structure, of uncommon vascularity, is the result, or fungus hcematodes of the skin. Rokitansky considers chimney-sweepers'' cancer and Alibert's ebur- natcd cancer of the skin as special varieties of this disease. 34. a. Chimney-sweepers'' cancer appears to be medullary. It begins in the scrotum as a tolerably firm, small nodule, or warty excrescence, which after some time becomes red, excoriated, moist, and covered by a cortex of thickened cuticle. The papillffi beneath enlarge, and the whole becomes an ulcer, with irregular, hard, and raised edges. Fresh nodules form around the original one, un- dergo the same changes, and enlarge the disease superficially. The nodules are developed into fungous cauliflower excrescences, and the dis- ease extends deeply, until the dartos, the tunica vaginalis, and testicle are successively implicated, and the gland itself ulcerates, while the adjoining lymphatic glands and vas deferens degenerate up to the abdominal cavity.* 35. (3. Eburnated cutaneous cancer is a second- ary degeneration of the cutis over a sub-cutaneous scirrhous mass. The skin is white, glistening, indurated, partially transparent, and immovable, over the firm or hard mass. This change of the skin evidently belongs to the fibrous form of cancer, as it is always connected with the subja- cent scirrhus. Cancerous ulceration supervenes, at a sooner or later period, upon all the forms of cutaneous cancer, and generally proceeds as I have described when treating of Cancer. (See that art., § 11, et seq.) 36. m. Parasites.—Several kinds ofpediculi are found on the skin, especially on parts covered by hair ; and the acarus scabici, and probably other species of the genus acarus, occur on, and in eruptions of, the skin. Various fungi also exist in certain chronic eruptions on the cutis, as in cases of tinea favosa and sycosis. The sub-cu- taneous cellular tissue not infrequently lodges the filiaria medinensis, especially in certain climates, as the western coast of Africa, &c. 37. III. The Sebaceous Glands or follicles and their ducts are often the seats of various dis- orders ; and in many of the affections of the skin, and in some of the exanthemata, especially small- pox and measles, they are especially implicated. But they are more manifestly the seat of disor- der when an accumulation of thin secretion takes place in them, owing to an impaired power of dis- charging it, or of throwing it off, or to obstruction of their ducts. In the former state, or impaired power of excretion, the duct is enlarged, and fill- * [Small, scaly, or incrusted warts are very common in chimney-sweeps, and the whole skin is apt to be dry, harsh, and dusky. They are not confined to the scrotum, but may exist on every part of the trunk and limbs. Why soot should produce such a condition of skin as to lead to epithelial cancer in persons of a cancerous diathesis (for it is inoperative in others), it were in vain to seek. Charcoal dust and other powdery substances produce no such effect, so far as we have observed.]](https://iiif.wellcomecollection.org/image/b21111066_0015.jp2/full/800%2C/0/default.jpg)
