In dermatitis herpetiformis most relief gained by lotions of chloroform-water, followed by dusting with powdered talc and inunction with a calomel-and-bella donna ointment. Dubrenilh (Revue de Ther. Medico-Chir., Mar. 1, '39).
Case of a man, aged 51, who suffered from general furunculosis followed by a general bullous eruption. The author considered it a malignant form of der matitis herpetiformis. After failure of other treatment, cacodylate of soda was given up to 20 centigrammes (3 grains) daily. This was afterward changed to hypodermic injections. After several weeks of this treatment the whole dis ease improved, and a, considerable part of the body became healthy. Davezae (Gaz. des I-10p. de Toulouse, July 13,1901).
Dermatitis Gangrenosa.
Definition.—Inflammation of the skin accompanied by sloughing or gangrene.
Etiology. — Gangrene or sloughing may follow any lesion of the skin severe enough to destroy its vitality. Thus it sometimes follows intense or long-con tinued pressure, severe contusions, vio lent inflammation, or some profound nervous disturbance. The ordinary bed sore is an example of gangrenous derma titis from pressure; the acute or neu rotic bed-sore follows a neuritis or other disease of the peripheral nerves. In se vere contusions, the application of caus tics, deep burns, or frost-bite the slough is due to the sudden and violent arrest of nutrition in the part. Diabetes is not rarely accompanied by gangrene. The interesting affection known as Raynaud's disease, whose most marked manifesta tion is symmetrical gangrene of' the ex tremities, cannot properly be described as a gangrenous dermatitis.
A gangrenous dermatitis of infants has been described under various names. It occurs most frequently after varicella in children debilitated by innutrition or constitutional dyscrasim. The lesions consist of ulcerations under a black slough of varying thickness, and occupy ing the site of one of the pustular or bul lous lesions of the disease. The same lesion is not infrequently observed in vaccination, especially with bovine lymph. It is probable that the gangrene is due to an infection by micro-organ isms, but the nature of these has not been determined. This form of local ized gangrene may also follow other skin diseases.
Ten cases of typhoid fever complicated by gangrenous dermatitis. All the pa tients were young men who went out as soldiers in the Spanish war. Bacterio logical examinations from unbroken vesicles and from ulcers showed the staphylococcus albus and aureus; indif ferent bacteria, as cocci and diplococci, were found in cultures from an ulcer. The disease is inoculable. The gangre nous patches appeared on the trunk, face, arms, thighs, and in two instances on the scrotum. The extremities were
attacked in but one case. B. F. Stahl (Amer. Jour. 'Sled. Sci., Mar., 1900).
Treatment. —The treatment of gan grenous dermatitis consists in the appli cation of stimulant and antiseptic lo tions or ointments.
Dermatitis Plaligna, Deflnition.—An inflammation of thEl skin with a tendency to malignant de generation.
Symptoms.—The terms "malignant dermatitis" and "malignant papillary dermatitis" are applied to an inflamma tion, almost exclusively limited to the mammillary portion and areola of the mammary gland, and generally known as "Paget's disease of the nipple." It has much the appearance of an eczema ru brum, and is nearly always followed by epitheliomatous infiltration.
Sir James Paget, who first described the affection in a classical paper in the St. Bartholomew's Hospital Reports for 187'4, gives the following account of its clinical history:— "The patients were all women, ing in age from 40 to GO or more years, having in common nothing but their ease. In all of them the disease began as an eruption on the nipple and areola. In the majority it had the appearance of a florid, intensely-red, raw surface, very finely granular, as if nearly the whole thickness of the epidermis were removed; like the surface of very acute diffuse zema, or like that of an acute balanitis. From such a surface, on the whole or greater part of the nipple or areola, there was always copious, clear, yellowish, viscid exudation. The sensations were commonly tickling, itching, and ing, but the malady was never attended by disturbance of the general health. I have not seen this form of eruption tend beyond the areola, and only once have seen it pass into a deeper ulceration of the skin after the manner of a rodent ulcer. . . . But it has happened that, in every case which I have been able to watch, cancer of the mammary gland has followed within, at most, two years, and usually within one year. The eruption has resisted all treatment, both local and general, that has been used, and 0_ has continued even after the affected part of the skin has been involved in the cancerous disease." The only fact that can be added to this description, after twenty-four years' further observation, is that the disease is not exclusively located upon the nipple of women, but that it may involve the nipple of the male or may occur upon other portions of the body. The in flamed patch of the nipple and areola is usually decidedly indurated, with an ele vated border, and gives the sensation, when pinched up, of a button inserted in the skin.