PEMPIIIGUS NEONATORUM is seldom, if ever, present at birth, and does not de velop before the third day, rarely later than the fourteenth. The eruption, un less complications occur, is not accom panied by fever, and consists of round or oval blisters upon apparently normal skin. These blisters are at first trans parent, slightly yellowish, and are sur rounded by a reddish areola, which in rare cases invades the surrounding tissue. The blisters usually rupture, and in se vere cases give rise to an appearance resembling that of pemphigus foliaceus of adults. After the blisters have broken a raw surface is left, covered by mem brane; but, unlike pemphigus foliaceus, the skin beneath rapidly recovers. This disease is infectious, and infants are, as a rule, either infected by the physician or the midwife, who may be suffering from the disease (Luithlen). It occa sionally proves fatal, the appearance of thrush and intestinal disorders being unfavorable signs in this connection.
Etiology and Pathology.—Pemphigus is believed by many modern observers to be the active manifestation of a neu rosis. It is often met with in neurotic or hysterical subjects, chronic drunkards, and syphilitics. In a case of pemphi gus foliaceus Schlesinger found syringo myelia to have been present. On the
other hand, there is considerable evi dence in favor of the view that it is due to a special micro-organism.
Demme, Claessen, Bullock, and, more recently, Whipham found in the con tents of the bullae a diplococcus which grew as a pure culture outside the body, and caused death when injected into guinea-pigs. Whipham obtained pure culture from the blood of animals thus infected and inoculated others, which after death showed typical manifestations in the lungs.
Treatment.—Arsenic in gradually-in creasing doses is usually preferred in pemphigus vulgaris, given until the physiological effects are noted. Small doses of strychnine given hypodermically are also valuable. Tonics are important aids and the patient should receive food rich in proteids, while the emunctories, the intestinal and urinary systems, should be kept active if a tendency to torpidity is apparent. Warm baths, especially bran-baths, are soothing and tend to re lieve the pruritus and burning sensation experienced. Externally, oxide of zinc and boric-acid ointment are useful; when the burning is severe, an effective remedy sometimes is a solution of acetate of lead in linseed-oil.