Page:Archives of dermatology, vol 6.djvu/17

INFLAMMATORY FUNGOID NEOPLASM. 5 Her mind, which has heretofore been in a perfect state of preserva- tion, has lately begun to fail, especially her memory. The swellings of the face and neck have steadily increased in size, but they vary from day to day, and moreover show a decided tendency to change from hiorning to night, being swollen half as large again in the morning, and decreasing in size by afternoon. They have lately been painful. The swelling is now so enormous that the mouth can scarcely be opened. The tumor on the back of the scalp is now the size of a small orange, but flat and lobulated, soft and boggy, and for some time has been discharging an ounce or more daily of a bloody, puriform, fetid fluid. It is, moreover, excoriated and fun- goid, being in a similar state to that of the forehead at the date of operation. No new lesions of any size are noted over the general surface. The growth on the arm near the axilla has likewise now at- tained a greater size, being as large as a goose-egg; and the axillary glands still remain free, slight engorgement only being present.

April 6. — The tumors on the side of the face, those over the parotid and submaxillary region, have been growing perceptibly from week to week. The face is now so disfigured as to be barely recognizable, the swellings protruding so as to render the shape of the head some- what square. One tumor on the side of the neck has recently opened, exhibiting a vegetating, fungoid appearance, and is still discharging freely. The vomiting continues constantly, as a rule every ten or twenty minutes, the fluid being offensive and varying from a bloody to a greenish color.

May I. — Patient has been failing rapidly within the last month. The retching and vomiting are constant, day and night, often but a few drops of fluid being ejected ; other times larger quantities, the matter, as before, varying in character. Nothing worthy of mention has remained on the stomach now for some weeks, while during the last fortnight scarcely anything has passed her lips. There has been constant diarrhoea of late, the discharges being bloody and blackish. She is much emaciated, and, as before, entirely helpless. The eyes have lately become closed by the densely infiltrated eyelids, which are the seat of flat tumors. A itw new small growths, mostly flat, have come here and there, and many of the older ones have gone, the trunk exhibiting chiefly the remains, in the shape of diffuse infiltra- tions and pigmentations, of the former lesions.

May 5. — Patient to-day expired from exhaustion, being conscious to the last.

AUTOPSY.

Autopsy made twenty-four hours after death, by Dr. Morris Long- streth. Pathologist to the Pennsylvania Hospital. Body markedly emaciated, slight rigidity. No posterior discoloration. Skin of general surface, apart from the lesions and a few petechias on back of hands, is soft and pliable and natural in color. Scattered over the surface are variously sized and shaped, for the most part sharply defined, flat or raised, reddish, more or less crusted cutaneous lesions;