Page:Archives of dermatology, vol 6.djvu/15

INFLAMMATORY FUNGOID NEOPLASM. 3 and popliteal space lesions there was nothing particular to note, and upon the whole the disease was considered as being unusually quiet.

Feb. I. — The condition had by this date become distressing in the extreme. Sleepless nights, malaise, debility, inability to eat, alternate constipation and diarrhoea, capricious appetite, — oftener absent than present, — itching chiefly in the form of severe par- oxysms, may all be mentioned as having been conspicuous symp- toms; to which must also be added the horrible state of the head and leg, where the disease seemed now to be principally expressing itself, characterized by steady growth, augmented discharge and fetor. Internal treatment, consisting of supporting diet ; stimu- lants, which the patient, however, bore only to a very moderate extent; a preparation of bark and dilute nitric acid, and other similar remedies, were employed from time to time as she felt able to take them, her exceedingly variable condition rendering con- tinuous treatment of any kind out of the question.

Feb. 19. — Within the last month the glands of the parotid and submaxillary regions have begun to enlarge, forming firm subcu- taneous, deep-seated, diffuse swellings. They have of late been slowly but steadily increasing in size. A week ago she was seized suddenly with violent neuralgic pains in her arms, extending from the shoulders to the ends of the fingers. The pain was intense, causing her to cry aloud, and lasted about three hours. The arms were left in a helpless state, and without motion. The next day, at the same hour, the pains recurred, but were relieved in a measure by the application of chloroform. The following day there was no re- currence, but the day after they again attacked the arms, but less severely. The limbs have since been helpless, but show some signs of gradual recovery.

For the last week another new symptom, consisting of distinct attacks of gaping, yawning, and hiccuping, has appeared, coming on every afternoon at about the same time and continuing an hour or more. There has also been daily vomiting of a greenish, watery fluid, otherwise the general condition has changed but little within the past three weeks. The flushing still continues, coming on once or oftener every day. The glandular engorgements of the face and neck are enlarging, and cause much disfigurement, the skin covering them being tense and purplish in color. The integument generally is yellowish, soft, and flabby, and exhibits a cachectic hue, similar to such as is often noted in carcinoma. The pulse is weak, and from 120 to 140 to the minute. The tumor of the forehead has grown immensely within the month, and is so bulky, discharges so much, and is so offensive that the patient desires an operation at any risk. In appearance it resembles closely a huge roasted tomato.*

Feb. 21. — To-day the tumor was removed successfully with the galvano-cautery loop, Dr. F. F. Maury rendering valuable assistance


 * The condition of the tumor at this date is shown in the accompanying portrait.