CAPILLARY VARIX, N-EVUS, EREC TILE TUMOR, VASCULAR GROWTH, OR MOTHER'S MARK.—Of these, two varie ties are noted, depending upon the size of the capillary vessels which make up the tumor. When the capillary vessels are large, they usually form a raspberry like tumor, at first small in size and somewhat elevated above the skin. Their tendency, if let alone, is to in crease steadily in size, the capillary walls becoming thinner, until danger from serious haemorrhage threatens. This va riety should be removed early, especially if the tumor show any tendency to grow in size or to extend laterally. If small, the tumors may be removed by excision or ligature, the base in the latter proced ure being transfixed by a harelip-pin and the ligature passed beneath it before tying. If larger, two pins may be in serted at right angles to each other, or a double ligature may be passed around a single pin; the larger tumors are best ligated in sections. In any case care must be taken to insure the removal of the entire tumor.
The PORT-WINE MARK is composed of small, capillary vessels; extends over more or less surface; and exhibits little or no tendency to spread. It is more unsightly than dangerous. It is best removed by excision, if not too large, making the incisions so that a linear scar only shall remain. A small portion of the mark may be frozen, the surface cross-hatched with a fine knife, and the hmmorrhage arrested by firm pressure with blotting-paper. This process, re peated until the whole surface of the tumor has been treated, is said to be practically painless and to leave no ap preciable scar. The cautery and escha rotics have been used with success, but are not to be advised, on account of the unsightly scars which are left.
CephalhTmatoma, or Caput Succeda neum.—During the birth of a child ex travasation of blood and serum not in frequently occurs in that part of the scalp which presents, as a result of the passive congestion. The extravasation varies in degree according to the dura tion of labor and the severity of the pains. This swelling is called caput succedanenm. The seat of this extrava
sation is in the loose connective tissue external to the pericranium. The tumor is usually situated over the occip ital or parietal bones near the posterior fontanelle, and is soft and painless. When the extravasation occurs beneath the pericranium, detaching the latter from the bone, the tumor is called cephalhtematoma.
These conditions seldom require treat ment, as they gradually diminish in size and finally disappear in a few days or weeks.
Fatal case of hemorrhage under the scalp in a newborn infant. After deliv ery with forceps, the supposed caput, in stead of decreasing, became larger, was found to be soft and fluctuating, and due to effusion of blood. On third day tumor extended over whole cranium. In fant pale; rectal temperature only 96.8° F. Tumor still increased, extending over frontal bones and down sides of skull. Death on tenth day. Autopsy showed firm blood-clot under scalp and above periosteum over entire cranium. C. W. Townsend (Boston Med. and Surg. Jour., Mar. 3, '98).
Wounds of the Scalp.—These are of common occurrence, and are more seri ous than similar injuries located else where, especially in persons of vitiated or impaired constitution. These in juries are more likely to be followed by erysipelas, and have a great tendency to the propagation of inflammatory action inward to the brain. which latter gives a serious or even fatal aspect to com paratively slight lesions. It must not be forgotten, however, that the blow or fall which occasions the scalp-wound may produce concussion or even lacera tion of the brain. So far as the tissues of the scalp are concerned, there is little danger, for they are freely supplied with blood and are endowed with ()Teat vi tality, so that repair is favored and sloughing seldom occurs even when the tissues are severely contused and exten sively lacerated, the existence of a slight pedicle of attachment sufficing to insure the vitality of a large flap. It is, there fore, important to save all portions of the lacerated tissue unless entirely de tached.