The question as to the origin of these effiorescenees, whether they are due to a toxic effect from the intestines or whether they are produced by the migration of bacteria, is still undecided. Nor is it demonstrated whether the constipation or intestinal catarrhs which have occasionally been observed in this affection, have any influence nu the course.
Differential Diagnosis.—The affection may be mistaken for medicinal exanthema; for the condition of general ill-being described under the name of purpura; for polymorphous erythema; and for chilblains. Mistaking it for chilblains can only occur in the very begin ning of the illness. when only a few places on the back of the hands or at the fingers are involved. It is more difficult to exclude toxic erythetna, but here also the site, course and concomitaut manifestations determine the diagnosis. A large number of the complications attributed to ery thema exudativuna multiforme (endocarditis, septic manifestations) are probably explained by their haying been mistaken for real toxic erythema. Confusion with medicinal exantherna is also possible, but here again the polymorphous character of the latter determines the diagnosis.
prognosis of erythema exudativum multiforme is generally favorable. As mentioned above, severe cases arc but rarely observed in children. The majority of the malignant cases which have been observed can, I believe, be referred to their having been mistaken for toxic erythema.
object of the treatment is, in the first place, the removal of the cause, and in the second place the mitigation of the subjective complaints. Thus, rest in bed and lukewarm baths should be prescribed with a view to effecting an improvement in the general condition, thereby relieving the complaints., while internal medication is required to remove any possible intestinal autointoxication. In ease of constipation calomel should be prescribed to purge the intestine, or salicylic preparations are indicated to disinfect it. In my hands potas sium salicylate, as recommended by Neisser, has given the greatest satisfaetion. The dose for children from Ito 2 years is 1 to 2 Gm. (15-30 gr.), from 2 to 6 years 1.5 to 3..5 Gm. 22-45 gr.), from 6 to 10 years 2 to 4 Gm. (.1-1 dr.) a day. Also aspirin and salipyrin (substitutes for salicyl) have met with success. Haushalter and Villemin have seen good results from the administration of potassium iodide.
The external treatment of erythema is confined to leashing with .spirits .1 per cent. thymol, 1 per cent. of carbolic acid and menthol, with an addition of 10 per cent. glyeerin), and to the application of cool ing ointments in order to alleviate the complaints. Cold packs (with acetic alumina) and powdering can also be recommended.