most thorough study of the disease in this country is by Duhr ing. It begins with the eruption of small macular or maculo-papular lesions, of a rosy or reddish color, sharply defined against the surrounding skin, being sometimes on a level with it, sometimes slightly raised, and sometimes depressed. The patches are covered with line, branny scales and spread at the margin while healing in the centre. The subjective symptoms are usually slight, only mod erate itching being sometimes com plained of. The disease lasts from one to three months, recovery taking place spontaneously is apparently a vege table parasitic affection, but no charac teristic parasite has been demonstrated in the skin or the scales.
erythematous syphi lide most nearly resembles this affection. The history of the case or observation of the patient for a week or two will clear up the diagnosis.
paste or other mild salicylic-acid or carbolic-acid oint ment may be used. Sulphur is also recommended. As the disease gets well of itself in a short time, not much atten tion need be given to the treatment.
(D) Epidemic Exfoliative Dermatitis.
This has recently been described by Thomas Savill, of London, who ob served a large number of cases in the Paddington Infirmary. The disease be gins as an erythematous or papular eruption, spreading peripherally like ringworm. This is followed by exuda tion and desquamation. The skin is red, thickened, and indurated, the epidermis being shed in flakes or scales. There is moist exudation in most cases, especially in the flexures of the joints or behind the ears. Exfoliation is continuous.
As the disease subsides, the skin be comes brownish, indurated, and thick ened, and may be smooth and shiny or cracked. The hair and nails fall. There is itching and burning, sometimes severe.
Albuminuria is frequent (50 per cent. of cases). There may be fever, although this is usually not high. It is most quent in adults, generally in those of advanced age.
Dermatitis exfoliativa is the only skin malady which, up to the present time, has been connected with epidemic causes. In some respects it resembles eczema. Distinctive points:— Savill (Edinburgh Med. Jour., Apr., '95).
Prognosis.—This is grave. In Savill's experience over 12 per cent. died.
Etiology.—This is not known, though from its epidemic prevalence, apparent contagiousness, and great fatality it seems to be due to some infectious organ ism. This has, however, not yet been demonstrated.
Pathology. — A careful histological study of the changes in the skin has been made by Emilio Echeverria (see illustra tions), who concludes that the essential histological changes in the disease are superficial and to be found mainly in the epidermis. The cutis is rarely affected to any extent. According to Echeverria, the disease is rather an epidermatitis than a dermatitis. He has found a pe culiar diaphanous degeneration of the prickle-cell layer of the epidermis, which he regards as characteristic.
In blastomycetic dermatitis there is a sharply-raised, well-defined, slightly elevated border, composed of minute verruciform projections, comming,led with small purulent points, from which pus can be expressed. On the side of the sound skin there is a bluish-red, sloping border, with pin-point-sized ab scesses, not closely set; while on the morbid side of the inclosing wall is either a moist, granulating surface or a partially-cicatrized reddish and tender disk, with here and there projecting areas made up of the verrucous eleva tions. The regions of preference are, first, the face; next, the lower limbs; then, in order of frequency, the hand, leg, foot, scrotum, and back. One-half of the cases showed multiplicity of lesions in other parts of the body, suggesting, autoinoculability. Evidence favors the view that the medium of in fection lodges on the hand or face, and from thence is transferred to some ac cessible spot. Hyde and Ricketts (Jour. Cutan. and Genito-Urin. Dis., Jan., 1901).
Report of a case. Positive and un questioned diagnosis between blastoniy cetic dermatitis and certain forms of cutaneous tuberculosis can scarcely be made without histological and bac teriological investigations. Stelwagon (Amer. Jour. Med. Sci., Feb., 1901).
Tr eatment.—Savill obtained most benefit from creolin-baths (2 1/, pints of a 1-per-cent. solution in a bath of 15 gallons of water at 95° F.) or creolin ointment (1/,, 1, and 2 per cent.). The baths should be given once or twice a day.