DIAGNOSIS.—Owing to the great re semblance of this affection to the rash of scarlatina, it is important that a close differentiation be obtained. The symp toms of the latter affection may present characters — such as the strawberry tongue, sore throat, great depression, and the presence of large or small quantities of albumin in the urine—which will usually be sufficient for all practical pur poses. The early desquamation or the desquamation during the height of the fever will generally serve to establish the nature of the affection present.
ETIOLOGY.—It may be the expression of forms of stomachic disturbances, such as produced by the ingestion of toxic agents, as alcohol, antipyrine, bella donna, copaiba, arsenic, opium, the iodides, salicylates, or carbolic acid.
Interesting case in a middle-aged woman in which the ingestion of grains of quinine was followed by the appearance of a scarlatinoid rash over the whole surface of the skin, accom panied by painful swelled throat. The symptoms, however, disappeared in a few hours. Glax (Lancet, Jan. 17, '91).
Typhoid fever, surgical operations, rheumatism, parturition, certain infec tious affections, and sewer-gas poisoning (Crocker) are among the numerous con ditions which may give rise to the disease.
Woman observed in whom an ery thema having no relation to scarlatina followed each of three labors. Gaertig (Centralb. f. Gynak., No. 30, '94).
PATHOLOGY.—Why so many different avenues should lead to the same result is difficult to determine. Idiosyncrasy may play a very important part in assisting its appearance. Brocq has advanced the idea that the desquamative or subacute variety, as previously noted, is only a be nign form of pityriasis rubra, but this theory has not obtained many followers.
PROGNOSIS.—Serious consequences are unlikely to follow if produced by some form of irritative ingesta. Elliot states that the affection "is grave and indica tive of death when it appears in the course of a pymmia, a septicaemia, or a puerperal peritonitis." The relapses may be more or less numerous and a dif ferent cause may be ascertained in some cases for each recurrence.
TREATMENT.—The first indication is the removal of the inducing cause where possible. Should this be some form of irritative ingesta the use of catharsis may suffice. The local symptoms should be relieved by means of antipruritic or stimulating washes. Boric and carbolic acids are probably the best remedies of this class. It may be deemed advisable in many cases to use more active local measures. For this purpose some active
drugs, such as menthol or thymol, may be used.
Erythema Induratum Scrofulosorum. —This condition was first described by Bazin under the title "erytheme indure des scrofuleux." It is an affection that may be mistaken for erythema nodosum. It is found in those persons of strumous diathesis and especially women and young girls (Crocker) who are easily fatigued and who are obliged to remain for long periods in a standing position.
Erythema peculiar to lymphatic or scrofulous young girls who are obliged to remain much of the time in an up right position. It is to be considered as a scrofulo-tubercular gamma developed in the subcutaneous tissue of the lower limbs, and associated with congestion of the skin in the neighborhood as a result of the venous stasis to which the local ization of the affection in these limbs is due. G. Thibierge (Med. Week, Paris, Jan. 17, 'K.
It generally presents itself upon the anterior surface of the legs and occasion ally upon the calf (Crocker); the lesions may be deep-seated nodes or nodules, which are either absorbed or break down into suppurating ulcers. In color they are first of a bright red, but they soon be come darker or of a livid tint. After breaking they are observed to be punched out, round or irregularly oval ulcerations which resemble to a marked extent gum matous lesions.
Erythema induratum (Bazin's disease) is a manifestation of scrofula occurring mostly in young women, in which mul tiple ulcers, the consequence of a sub cutaneous and self-infective inflamma tion, occur on the legs, such ulcers being difficult of cure, prone to relapse, and presenting appearances very likely to be mistaken for syphilis. Hutchinson (Ar chives of Surg., Oct., '93).
In differentiating the early characters from erythema nodosum the acute and shorter course observed in the latter affection is to be noted.
Histological and bacteriological survey of the lesions of erythema induratum of Bazin, showing that there is nothing to authorize us to attach it directly to tuberculosis. The histological a ppear ances seem to be due to fatty degenera tion, which develops ulteriorly on regions affected with a considerable and spon taneous (edema. The inflammatory signs are there reduced to a minimum. The erythema induratum of Bazin is but a chronic, and occasionally ulcerative, variety of erythema nodosum. Audry (Ann. de Derm. et de Syph., Mar., '98).