Severe form of erythema nodosum oc curring in five children, three of one family, suggesting contagion. In two cases several of the nodules became gangrenous. In spite of the rapid ex haustion attending these cases they all recovered. No bacteria were discovered in the blood, but in the tissue-fluids of the intact nodules and in the bulke, pust ules, and gangrenous patches micro cocci and bacilli were found. Pure cult ures of the bacilli, when inoculated upon the abdominal skin of guinea-pigs, pro duced an eruption of erythematons lumps followed by gangrene. Inocula tion of the micrococei produced no re sult. Demme (Fortschritte der Med., No. 7, 'SS).
Four cases of erythema nodosum seen appeared to have been conveyed by con tagion. Lannois (Annales de Derm. et de Syph., p. 585, '92).
The nodular form of iodic eruption de scribed in a woman where the lesions reached the size of the fist upon a par alyzed limb, but vascular changes pres ent probably accounted for the exag gerated size. Fordyce (Montreal Med. Jour., Nov., '95).
—Erythema nodosum is due to an inflammatory process, at first active and later passive. Atkinson, of Baltimore, argues that it is an over crowding of blood- and lymph- vascular spaces and exudation of blood-cells, both white and red. The process affects the
entire skin, and is believed by Kaposi to be a more fully-developed and stable urticarial wheal.
—The prognosis is usually favorable. Relapses may occur or the process may be extended by successive outbreaks of new lesions. The usual length of each attack is from one to five weeks, although the individual lesions usually run their course in from six to eight days. Death has been recorded, but this is exceptionally rare.
—The disease tends spon taneously toward recovery, and it is very highly probable that constitutional measures exert little influence. General disturbances of the constitution require appropriate attention. A bland diet should be advocated and rest in bed ad vised. Iron, quinine, phosphorus, ace tanilid, and phenacetin are often bene ficial. To reduce inflammation, relieve pain, and prevent complications, a solu tion of sulphite or the hyposulphite of sodium in water, 1 drachm of either to the ounce, will be found useful. Ich thyol has also been of service in many hands (1 drachm to the pint of water). Carbolic acid, sulphurous-acid solutions, lead-water and laudanum, boric acid, and hot fomentations may also be mentioned as useful remedies when the others men tioned fail.