—Radesyge is a granulomatous involvement of the skin, peculiar to certain parts of Europe, particularly Norway, which has been by some considered to be an expression of leprosy, by others to be a disease by itself. It is generally held that the lesions which have passed under this name are really expressions of cutaneous syphilis.
Framboesia; Yaws.
—This is an endemic tropical disease, of which we see our nearest specimens in the West Indies, and involves especially the negro and Oriental races. It begins with an eruption, papules maturing in fungoid form, being met with most often at mucocutaneous borders, but appearing anywhere upon the surface. It is specific and inoculable, having a period of incubation of about two weeks, and becoming generalized in from fifteen to twenty weeks. The papules increase in size, become covered with yellow crusts, which fall off and expose a rough surface which discharges an offensive puruloid material. After remaining in this condition for an indefinite time the lesions spontaneously improve and may disappear, leaving only pigmented spots to mark their previous sites. Beyond local cleanliness and antiseptic applications the lesions require but little treatment. If anything more is attempted it should be thorough and effected with the cautery or the sharp spoon.
Mycetoma.
—Mycetoma is more commonly known as Madura foot, or sometimes the fungus foot of India. It prevails especially in Southern India and about Madras, and is apparently confined to that part of the globe. Nevertheless it has been reported from Algiers and from South America. It is a specific infection of the foot, beginning in the skin; it rarely occurs on the hands, the scrotum, etc. It leads to the formation of an infectious granuloma, which gradually destroys the texture and identity of the tissues, and finally demands amputation or ablation of the part.
Russian bacteriologists have discovered parasites resembling the protozoa which they have found in the granulations and ulcerations of the Delhi boil. They were also occasionally seen in the leukocytes. By these observers these parasites have been regarded as active agents and have been given the name ovoplasma orientale.
Oriental Boil.-This also is a slow infection of the skin, met with especially in Southern India, where it is known as the Biskra button and the Aleppo or Delhi boil.[19] It appears mainly on the unprotected parts of the body at first as a papule and then a nodule, which enlarges, ulcerates, usually tends to heal spontaneously, and leaves an ineffaceable scar. It is practically a granuloma of the skin, is auto-inoculable, and is best treated by complete excision.
[19] Delhi boil is now known to be another of the local infections of exposed surfaces, occurring especially about the lower extremities and the genitals, due to the invasion of one of the trypanosomas, its actual pathology having been only recently demonstrated.
Guinea Worm, or Filaria Medinensis.
—This worm is about one line in diameter and two or three feet long, and is found generally throughout the tropics. The embryo is taken into the intestines with drinking water and migrates to the skin, beneath which it develops. The male worm has never been discovered. What is known of the evidence of its presence pertains only to the female. When fully developed it can be felt in a coil beneath the skin. It produces local inflammation, a vesicle forms, and the head of the worm then protrudes. When it is exposed it can be frequently extracted by gentle traction, removing as much each day as protrudes. Christie has suggested to destroy the worm by electrolysis, and others inject into the vesicle some antiseptic, by which the worm is killed, it being afterward absorbed without difficulty ([Fig. 105]).