Case of erytheme indura des scrofulcux of Bazin with microscopical findings showing. its non-relationship to tubercu losis. A few cocci were seen in the sur face, but no tubercle bacilli were found. A guinea-pig inoculated with the frag ments of tissue developed no signs of tuberculosis. C. T. Dade (Jour. of Cut. and Genito-Urin. Dis., July, '99).
Instance of indurated erythema and necrotic granuloma in the same subject. Bazin's erythema and necrotic granuloma are non-microbic. They appear first about the blood-vessels in the deeper layer of the corium, and work outward from that point. The evidence is in favor of the disease being of "toxinic" origin. J. C. Johnston (Jour. of Cut. and Genito-Urin. Dis., July, '99).
Microscopical examinations of tissues obtained from three cases of the in durated erythema. In all the vascular channels were chiefly affected, exhibiting inflammatory and degenerative lesions with the presence of such a number of giant cells that they alone suggested the tubercular nature of the disease. The presence of the tubercle bacillus in more than fifty specimens examined could not be detected, however. The affection is tuberculous owing to the fact that inocu lation from the tissue of one case gave positive results in rabbits. G. Thibierge and P. Ravaut (Ann. de Derm. et de Syph., vol. x, p. 513, '99).
Diagnosis from syphilitic gumma is established by its longer duration before the occurrence of ulceration, and the serpiginous outline of the latter, or the presence of scars.
Erythema Exudativum Multiforme.— Erythema exudativum multiforme is an acute inflammatory and exudative affec tion of the skin, characterized by the appearance of macules, papules, or vesi cles, discrete or confluent, and of varying sizes and configurations.
SYMPTOMS.—The character of lesion observed, with its many configurations, has given rise to the use of certain terms which are indicative of the condition present. Erythema multiforme papulo sum is used when the predominating lesion is of the papular type. Erythema multiformc tuberculosum when the size of lesion is slightly greater than the papule; erythema multiforme vesiculo sum when of the vesicular type; ery thema multiforme bullosum when bul lous; erythema multiforme annulare seu circinatum when it assumes an annular or rounded form; erythema multiforme figuratum seu gyratum when peculiar ir regular lesions are formed from a coales cence of two or more annular or circinate rings; erythema multiforme iris when new lesions appear successively in the clearing centre of the preceding manifes tation; erythema multiforme vesiculo sum circinatum (herpes circinatus) when the borders of a papule are covered with a ring of vesicles; erythema multiforme vesiculosum iris (herpes iris) when sev eral concentric rings of vesicles are formed; erythema multiforme urticatum (lichen urticatus) when from the oedema they closely resemble urticaria.
Erythema exudativum multiforme has points of predilection. For the most part lesions are observed upon the backs of the hands and feet, the forearms, and the legs. Next in frequency they occur upon the region of the head, the cheeks and neck, and lastly upon the trunk, the chest and back, and the abdomen. In aggravated cases, or in those unusual types, the lesions may be observed in other parts of the surface. They are usually first noted upon the hands and fingers, and from these regions spread to other parts, and result in some cases (as recorded by Duhring) to an enormous in volvement of the whole general surface.
Death has been observed by Vidal and Leloir, and Molenes-Mahon speaks of a number in which death also occurred.
DIAGNOSIS.—The fact that death can occur from this affection renders an exact diagnosis of especial importance.
Eczema.—In papular eczema we may notice a symmetrical arrangement, but usually the lesions are regular as to size and outline. They may retain their ap pearance, but are prone to become either vesicles or pustules. Their duration is rather more lengthened, and crusting is likely to result from the excessive exu dation.
Psoriasis.—Psoriasis is not likely to assume a symmetrical arrangement. It is more likely to be covered with decided desquamations and to be of much longer duration.
Tinea Circinata.—Cireinate ringworm is not usually symmetrical, is slower in its extension, and more persistent in its character. The edges in this affection are usually well defined.