PROGNOSIS. — The prognosis is favor able if the proper treatment is promptly applied. When left alone the pigmented masses are prone to epitheliomatous de generation, and may become foci for carcinoma of the face, in which case the dry scales are displaced by a scab, the tis sues become hard, and growth is more rapid.
—In the early stage, in unctions with vaselin or olive-oil and the subsequent use of soap and warm water will remove the trouble. When the masses are firmer, ointments should be applied at night, and soft soap or sapo viridis in the morning, removing the soap by careful washing with clean, warm water; applications of diachylon ointment will heal any excoriations that may have been produced. When marked projection of the mass is present, the thorough use of the curette, or nitric acid on a pointed stick well worked into the parts, will remove the affected tissues. If epitheliomatous change is suspected, prompt excision is indicated.
Clavus (Corn).—Clavus is an hyper plasia of the corneous or horny layer of , the epidermis,. in which there is an in growth as well as an outgrowth of horny substance, forming circumscribed epi dermal thickenings, chiefly about the toes. Corns may be hard or soft, the latter being situated between the toes, where they become softened by macera tion. Both forms are caused by inter mittent pressure and friction. Pressure produces pain by driving the conical mass of hardened epithelium down upon the sensitive corium; constant irritation may produce inflammation and suppuration.
TREATMENT.—The use of well-fitting, comfortable shoes made on properly shaped lasts is the first indication. Temporary relief from hard corns may be obtained by the use of felt rings which are applied over the corns, allow ing the latter to project through the opening, so that pressure is removed from the corn and distributed around it upon the healthy tissue. Prolonged soaking in a warm solution of washing soda will soften the corn, when it may be removed by gentle scraping with a sharp knife; the tender surface left may be protected by covering it with a plaster of salicylic acid or of salicylic acid with cannabis Indica. Another method is that of hardening the surface of the corn by applications of the tincture of iodine or nitrate of silver at night, removing the hardened tissue on the following morn ing. A third method is the use of the salicylic-collodion mixture: Salicylic acid, 30 grains; tincture of iodine, 10 minims; extract of cannabis Indica. 10 grains; collodion, 4 drachms; this to be painted on the corn night and morning for several days and then removed with the corn, by soaking in hot water. Soft corns are best treated by gentle scraping to remove the softened epithelium, the surface being then protected by a pad of natural wool (as it is clipped from the sheep), or of absorbent cotton, having previously dusted the surface with a powder composed of equal parts of oxide of zinc and boric acid. When corns be come inflamed, rest and warm, moist, antiseptic dressings meet the indications. If pus has formed, it must be afforded an exit. Corns should never be cut too closely, as erysipelas and gangrene may follow, especially in the aged.
Verrucae. — Verruca' (condylomata; warts) are circumscribed papillary ex crescences on the skin, variable in color, smooth at the summit, or studded with moniliform elevations or with clusters of minute, pointed, horny filaments. They may be single or multiple, hard or soft, rounded, flattened, or acuminate. They may rapidly attain their full size, may last indefinitely (v. perstans), or spontaneously disappear, at any stage, and are not contagious. If picked or wounded, warts bleed freely, being often very vascular. The etiology of warts is obscure.
PATHOLOGY.—Warts consist of an by perplasia of the papillae, of the blood vessels, and of both the rete mucosum and the corneous layer of the epidermis. The common wart (v. vulgaris) com monly found upon the hands of chil dren, but occurring on other parts and at any age, form flattened or semiglobu lar excrescences varying in size from a pin's head to a half-inch or more in di ameter. At first they are of the same color as the adjacent skin, later they be come darker and harder, and the elon gated papillae, covered at first with corni fied epithelial scales, may become par tially denuded and appear like a number of projecting-points mailed in by a rim of thickened cuticle (seed-wart). Ex
cessive prolongation of the papillae with out the surrounding rim forms the fili form, or thread-like, wart (v. fi/iformis), which is found in narrow lines along the free edges of the nails (v. subunguinalis), on the face, neck, eyelids, ears, and trunk, and may be single or multiple. The flat wart (v. plana) is a flattish wart with a slight elevation and broad and relatively smooth surface, retaining its outer layer of epidermis, and is met with chiefly in old people. V. digitata is a flat wart characterized by digitations springing from its centre or border. acuminala (fig-wart; moist wart; con dyloma; cauliflower excrescence; vene real wart) is a warty growth occurring in parts especially subjected to macera tion with sweat, venereal secretions, and mucous discharges, such as the genitals and anal regions of both sexes. They are flat, acuminate, whitish, reddish, pinkish, or flesh-colored, sessile or pe dunculated masses of vegetations, com monly smeared with a thin, excessively offensive secretion. They are highly vascular, and may be single and small or as large as an orange, or they may he multiple. V. congenita is a wart appear ing at or shortly after birth. V. follicu laris is a wart-like accumulation around the mouth of the sebaceous follicles; it is composed of desiccated epithelium and sebaceous matter. V. glabra is a smooth wart. Ncevus rerrucosus is a form which is congenital, or may appear later, and is apt to be pigmented and become hairy; when these pigmented hairy growths cover a considerable area and lie over important cutaneous nerves, they often cause great disfigurement, and are called papillona neuroticuin. V. necrogenica (post-mortem wart; anatomical tuber cle; warty tubercle; tuberculosis verru cosa cutis) is a warty excrescence found usually on the fingers of those who fre quently handle the tissues of tuberculous subjects; it begins as a vesicular or pustular lesion rising from an engorged (congested) base, and may be purely local or give rise to general infection. V. sebacem is the form met with in persons of seborrhceic tendency and uncleanly habits. V. senilis (keratosis pigmentosa; keratosis senilis) is the flattened, pig mented wart of old people (see KERA TOSIS SENTTJS). V. syphilitica is a syph ilitic condyloma. V. venereoe is a tuber cular syphiloderm arranged in clusters.
—The milder applica tions consist of the juice of the milk weed (Asclepias cornuti seu Syriaca), the tincture of iodine, the solution of the perchloride of iron, moistened powder of chloride of ammonium; stronger ap plications are sublimate collodion (30 grains to the fluidrachm), glacial acetic acid, and fuming nitric (nitroso-nitric) acid. Excision, or curettage if the warts be soft, is the quickest method of re moval; the hypodermic injection of co caine will lessen or prevent the pain, and the application of fuming nitric acid to the stump or base will restrain the hTm orrhage and prevent return.
Instead of cutting or the use of caus tics, an India-rubber finger-stall, if the warts are an the fingers, or an India rubber bandage, if they are on the hands, should be used. The rubber exerts gentle pressure, while the wart is kept moist and macerated from retained perspira tion. This method is always curative. Purdon (Dublin Jour. of Med. Science; Phila. Med. Jour., Mar. 3, 1900).
Warts cured by revaccination in a girl whose hands were covered with warts, there being ninety-four on one hand. No effect on the parts followed the vaccina tion until seven weeks later, when they began to disappear, leaving temporary white spots. Three months later the hands were entirely clean. J. D. Staple (Lancet, Sept. 22, 1900).
Venereal warts may be washed well with bichloride or other antiseptic solu tion, and then dusted with iodoform, calomel, aristol, or europhen.
Cicatricial Tumors.-17nder the name of cicatricial tumors we will mention two important conditions known as "Hyper trophied Scars" and "Keloid."