PEMPHIOUS NEONATORUM Synonymous.—Sehalblasen,Sehalblattern, pentphigus infantuni (Es cherich, Rine), pemphigu.s neonatorum epidetnicus (Unna), petnphigus conta,giosus (Faber), exanthemata bullosa neonatortan (Barensprung).
This affection was first clescribed in 1610 by Forestus as dyserasia and up to 1870 or longer was looked upon as cachexia; only in the last thirty years its bacteriologieal cause was recognized.
Clinical the third and eighth day- there is a sudden appearance of coarse cysts front the size of a pea to that of a hazel-nut, which are at first tense but finally become flabby and burst (Plate 66). The fluid they contain is at first limpid, then clouded. The skin is apparently normal or at most slightly hyperremic. As the cyst bursts, a red exudating surface remains which is covered by the margin of the epidermis and is promptly renewed. The affected spots remain hyperamie for some time. The cysts appear at all parts of the body (rarely on palms of the hand and. soles of the feet); they may keep recurring for a time and thereby assume a more chronic form which occasionally renders the affection much more malignant and fatal. As a rule the affection which is usually afebrile, is a light one and cured in five vceek.s or less.
to Imithlen the cyst formation occurs by an elevation of the corneal layer; the vessels of the corium are dilated and surrounded by numerous leucocytes. Staphylococci are principally met with in the contents of the cyst.
affection is contagious and quite a series of epi demics and transmissions to children, mothers and nurses (family epidemics) have been reported. If vaccination has taken place, hyper aania occurs five to seven hours later, after twenty-four to seventy-two hours the pcmphigus cysts develop, in which according to the bacterio logical investigations of Almquist, Strelitz, Escherich, Peter and others, the principal bacterium is the micrococcus aureus, but others are also met with. But since Almquist and Strelitz were able to produce
pemphigus cysts by inoculation with the staphylococcus aureus, we have in all probability to regard this coccus as the causative factor. It also appears that there is a connection between impetigo contagiosa and pemphigus neonatorum. According to investigations made by Nobe, Richter and Matzenauer, impetigo contagiosa can be produeed by inocu lating the contents of the cyst upon older children. In the reverse way, impetigo eontagiosa can be transmitted to newborn infants producing pemphigus neonatorum; or at any rate, in both affections the same staphylococcus is met with and dermatitis exfoliativa seems to have the same etiology.
Diagnosis.—There is no difficulty in establishing the cliagnosis of pemphigus neonatorum.
The prognosis is generally favorable, although several epidemics have been reported in which there w;as abnormal mortality (Huart 1878, 60 per cent.; Corrigan 1834, 90 per cent.). In these cases, 'how ever, the victims were invariably badly nourished foundlings. In all eases pemphigus with unfavorable or fatal termination there is always the possibility of pyiernie affections in which the skin shows only part of the disease, or cachexia may lie the cause of the fatal termination.
Treatment.—The treatment demands in the first plaee baths and in the second place medication of the skin. Therefore bran or oak bark baths should be prescribed, while powder and ointment treatment should be resorted to, to effect a healing of the affected surfaces.