IMPETIGO CONTAGIOSA (Tilbury Pox) This affection was described in detail by Tilbury Fox in IS64, and consists of small watery vesicles underneath the corneal layer which may gradually attain to the size of a dime to a silver dollar (see Plate 66). They are flabby, filled with seropurulent fluid, anti surrounded by a slightly inflamed areola. The contents of the vesicles soon become purulent, the vesicle bursts and the spot is covered with a yellow scab which looks as of it were glued on (Pax). The vesicles stand separately, often very near each other, anti may coalesce. After removing the crust which was formed through the bursting of the vesicles, a pale red moist surface which may rapidly heal or extend peripherally according to circumstances, will be disclosed underneath a thin purulent coat.
The affection is met with in children of all ages, who are principally affected in the face, on the hands and the hairy part of the head or at any other part open to contact; through :scratching it is transmitted also to the covered parts of the body. By healing in the centre and slowly spreading at the margin, it may assume circinal and annular forms (im petigo eireinata). On the mucous membrane, too, aphthous forms have been observed by Jadassohn.
Impetigo is a con tagious disease. Quite a series of epidemics have occurred in schools, institutions, ete., and it has also been observed as a sequel to vaccina tion (for instance in 1,485 on the island of Rugen).
corneal layer remaining intact, there is formed a vaeuola in which a fluid accumulates con taining more or less pus corpuscles. and which proves to be a serous exudate. Thc retc underneath the vesicle is widened, the cells of the upper stratum are swollen, those of the lower stratum are normal. The
papillary vessels are dilated, also those of the eutis, and there is a slight superficial infiltrate.
Etiology. —The affection, which is exceedingly contagious, is probably caused by streptococci (the most infectious kind) and the less infectious staphylococci. In numerous cases these microiir ganisms have been transmitted into the injured integument. It also appears that there is a con nection between impetigo contagiosa and pemphigus neonatorum.
Diagnosis and Prognosis.—The differential diagnosis is not diffi cult, as in the ca.sc of children only ehicken-pox (without any red inflam matory areola) and inipetiginous eczema (involvement of an entire area) come in question, and the isolated efiloreseences in impetigo are always present to secure the diagnosis. The prognosis is favorable.
treatment consists in opening the vesicles, removing the crusts and cleansing the skin. To this end we avail our selves in the first place of the sulphur preparations which have an excel lent (almost specific) effect on all impetiginous affections. Therefore, as the case may be, the vesicles should be opened first or the crusts softened with oil, after which the affected place should be bandaged with sulphur zinc paste or sulphurated boric, vaselin (10 per cent.). At the same time washing with sulphur soap is indicated, or sulphur baths (30 to 50 Gm. Vlemingkx' solution) if the trunk should be involved. Jarisch favors a 2 per cent. mercurial salve (ung. hydrargyri eineretun P. G.). The body linen should be regularly changed.