DISEASES OF THE SKIN.
childhood the skin shares the general susceptibility of the whole sys tem, and is very liable to disease. At this period of life the surface of the body is delicate and readily irritated by the presence of accumulated dirt and dried secretion. Amongst the poor, neglect and want of cleanli ness are common causes of cutaneous affections in the young. Moreover, in the young subject, gastrointestinal derangements are especially liable to be accompanied by the various forms of erythema ; and childhood ap pears in itself to increase the susceptibility to the parasitic diseases of the skin. In a work treating of disease in early life, a consideration of the various eruptions to which childhood is liable must not be entirely neg lected ; but attention will be confined to the more common forms of skin disease met with at this period of life, and the subject must necessarily be discussed somewhat cursorily, and chiefly with a view to diagnosis and treatment.
The popular eruptions do not require very extended notice. Lichen is very rare in the young subject. The form called lichen• urticatus is the most common ; but this eruption appears to be more a modification of net tle rash than a true lichen, and will be afterwards referred to under the head of urticaria.
Prurigo is occasionally met with in dirty, neglected children in, the form of slightly projecting papules, which give rise to considerable irrita tion ; but in early life the rash seems to induce a less intense form of itch ing than that which is a cause of so much suffering to older persons. Mr. Hutchinson has described a prurigo of infants which appears often to be a sequel to or modification of chicken-pox ; and he is disposed to believe that an abortive varicella is often the original cause of the outbreak. The papules are hard and rough, and may be mixed up with wheals of urticaria. In some cases they are large, and resemble half-developed wheals of nettle rash, "with perhaps even some tendency to vesication." The itching aris ing from the eruption is often greatly relieved by the use of warm baths, medicated with the Eq. carbonis cletergens, in the proportion of two tea spoonfuls to the gallon of water. This bath should be used twice a day. The skin may be afterwards anointed with a salve composed of one ounce of storax, two drachms of white wax, and half an ounce of olive-oil. If the child is feeble or delicate, cod-liver oil and iron wine should be prescribed, and the diet should be regulated on the principles elsewhere recommended (see Infantile Atrophy).
Strophulus is a common eruption in infants, and usually arises as a con sequence of laboured digestion. It is met with in two principal forms—a red and a white variety. Red strophulus consists of small red papules of the size of a large pin's head. These papules often occur in groups, and occupy the face, the trunk, and sometimes the limbs. They cause some itching. In white strophulus the colour of the papules is pearly white.
Each papule lasts a few days, and the rash usually comes out in successive crops. It is not accompanied by any general symptoms, and the only treatment required is attention to the digestive organs, and some necessary modification in the diet.
Of the vesicular and bullous group, herpes and are both far from rare. Herpes of the lip is as common a symptom of croupous pneu monia in the child as it is in the adult. Herpes of the pharynx is de scribed elsewhere (see page 580). Herpes zona is comparatively rare in the child, but is sometimes seen, and then differs little from the same eruption in the adult except that it is much less frequently followed by intercostal neuralgia. It requires no treatment.
Pemphigus is occasionally met with in the child. In new-born infants a syphilitic form of the disease is not uncommon, and usually indicates profound contamination of the system. Syphilitic pemphigus is referred to elsewhere.
Pemphigus attacks ill-nourished children, and may be found to occur during convalescence from acute febrile diseases such as scarlatina. It is also apt to be met with as a frequently recurring complaint in children of fairly robust appearance, and in such cases it is difficult to know what is the cause of the repeated returns of the bullous eruption. In the more common variety of the disease the eruption begins in the form of small red spots. On these spots the cuticle rises rapidly into a bleb, which in creases in size until it is as large as a marble or a walnut. The bladders thus formed are tense, and filled with fluid, and their base is surrounded with a red zone of inflammation. The fluid is at first clear, but soon be comes opaque. The blebs may last unbroken for some days, but usually they burst very early, and give place to thin yellowish brown scabs on a purplish ground. The eruption comes out in successive crops. Many blebs do not appear at one time, but the repeated succession of crops covers the body with bladders, crusts, and stains from the various stages of the affection being simultaneously present on the skin. All parts of the body may be affected, even the lips and the ears, but the palms and soles usually escape. The appearance of the eruption is accompanied by some constitutional disturbance, which is often found to vary in severity according to the extent of surface involved in the disease. There may be some fever. In a boy aged eight years, who was admitted into the East London Children's Hospital with extensive pemphigus, the temperature during the first three days was over 101° both morning and evening, and for a fortnight afterwards it rose sometimes in the evening to 99.8° or 100°. Thirst, restlessness, and loss of appetite are also noticed, and there is some times diarrhoea. The eruption at first may be accompanied by some itching, but after the bursting of the blebs the resulting sores cause pain and smarting.