Rhinoscleroma.
—The bacillus of rhinoscleroma was described in the chapter on Inflammation, under the heading Pyogenic Organisms. It is a specific infection, primarily of the skin, which appears invariably upon the nose. It begins either in the skin or mucous membrane, or both, and having once thoroughly invaded the tissues grows in all directions. It shows no tendency to heal, but gives to the tissues a distinctive brawny induration. From the nose it extends to the palate, pharynx, and antrum, making steady encroachment upon the parts which it affects, distorting the features, obstructing respiration, and often causing pain by pressure on the sensory nerves. Its first appearance is characterized by nodules, frequently covered with dilated bloodvessels. Unless it can be seen and recognized early it is a wellnigh hopeless condition with which to contend. Extirpation of the affected tissue is the only satisfactory method of dealing with it. It is a different disease from rhinophyma described elsewhere. (See [Figs. 7] and [8], [p. 55].)
Mycosis Fungoides.
—This form of skin infection, of somewhat uncertain origin, is met in shape of fungoid nodules, and likely to involve the upper part of the body; they tend to increase in number and size, to infiltrate, often to ulcerate, sometimes to disappear by spontaneous absorption, but in severe cases cause death, either by malnutrition or sepsis. Tumors are thus formed which attain the size of a child’s head. As soon as surface infection or ulceration begins the breaking-down process is rapid; there is early involvement of the lymph nodes, and the general health begins to suffer. The tendency in almost every case is to fatal termination. Cases may run from a few months to fifteen years, however, before this stage is reached. By some authors the disease is considered as a peculiar form of sarcoma. It is, however, generally regarded as a granuloma, whose specific organism has not been ascertained.
Fig. 104
Ulcerating gumma of skin, cicatrizing in certain areas. (Lexer.)
Actinomycosis, Syphilis, Leprosy, and Glanders
should be included among the chronic infections of the skin, and have been described.