Page:Archives of dermatology, vol 6.djvu/22

10 LOUIS A. DUHRING; on the contrary, with but few exceptions, they all aggravated the condition, and some of them in a very positive degree. Thus, small doses of iodide of potassium, mercury, and arsenic produced almost immediate and decided exacerbations, which in the case of iodide of potassium was alarming. Concerning local remedies, it was found that beyond modifying certain symptoms, such as itching and the amount of discharge, they were entirely powerless.

It will be remembered that five operations for the removal of the tumors were performed on four different occasions. The vitality and vascularity of the disease was at these times plainly established by the disposition to hemorrhage, which, in the case of the operations upon the face, was only arrested after the liberal use of ligatures. The disposition for the wounds to heal kindly and readily (when the tumor and its base had been completely extirpated) was re- markable ; and the more so as in no instance was there subsequently any tendency to repuUulation. The apparently healthy character of the granulations of the several wounds, the rapid process of healing, and the final result — scarcely a trace of thp incision being afterwards discernible on the face — are, moreover, all worthy of remark. At no period in the course of the disease was it noted that the lesions followed local irritation ; they rather appeared to be entirely arl)itrary as to their points of election, and consequently were generally dis- tributed, with, however, preference for the head and trunk.

Of the nature of the disease unfortunately but little positive knowl- edge can be offered, for the process seems to be sui generis, regard- ing the matter as a whole and including all points, clinical as well as pathological. The inflammatory symptoms in the early stages of the disease are perhaps capable of being variously interpreted, but I cannot regard them other than as secondary to the disease proper. The profound impression on the system produced by the process, so plainly manifest latterly, without doubt insidiously began its work of disturbance very soon. Symptoms, some of which were regarded as insignificant at the time, occurred earlier even than the history shows, and differed only in degree from those that followed. The disease, as exemplified in the tumors, is unquestionably a nevv growth, allied in its pathology to sarcoma, but different from what we have heretofore recognized as sarcoma ; very different from the forms of this disease as described (either clinically or pathologically) by authorities. Therefore, if we place this case among the sarco- mata, as Dr. Heitzmann suggests,* the subject of sarcoma must be allowed a broader definition than obtains to-day; for there are many points which are difficult or impossible to reconcile with our present views of sarcoma. Indeed, it seems to me that rather than relegate the disease to that already confused group, it is wiser to allow it to remain for the present as unclassified. One case is insuf- ficient to determine the question. In time the disease will doubtless find its place, and I venture to predict it will be no uncertain one.


 * See Archives of Dermatology, January, 1879, page 19.