Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL COMMUNICATIONS. 153
chronic, showing little or no tendency to first written about, this was called lichen
recovery. There is uo rule of constancy in simplex, on account of its slight resemblance
regard to the course of the disease, though to lichen. It consists in an eruption of
at times we encounter cases that occur and rosy-red, pointed, or acuminated, discrete,
recur with remarkable periodicity, at certain grouped, and sometimes confluent papules,
seasons of the year. It may be in the sum- The papules are sometimes surmounted by
mer. spring, autumn, or winter. Any or vesicles which remain discrete, or later con-
ail parts of the cutaneous surface may be fluent: This is perhaps the itchiest of all
invaded, but it seems to have a special pre- varieties. Great excorations consequent
deliclion for the flexures of the joints, the upon scratching occur. This breaks down
face, the scalp, and the sulcus behind the the vesicles of course, and gives exit to the
ear. We may find only a single patch, or serum, and converts it into a moist patch,
there may be many. It is found on both This variety is generally found on the exsides
of the body, but with no decided sym- tensor aspects of the limbs. It is often remetry.
The principal subjective symptoms bellious to treatment.
are itching, which is present to a greater or Eczema J 'esicitlosum, is the most common,
lesser degree in all forms, and which is often and most characteristic form, and consists
so annoying as to cause the subject to ex- in a variously sized eruption, rounded,
coriate the skin bv vigorous attempts at pointed vesicles, that appear on a reddened
scratching. It is extremely prone to excer- surface in immense numbers. Amildtingbations
and remissions. The sensation of ling usually precedes the outbreak. There
burning, and tension are noticable for the is intense itching, and more or less swelling
most part in the initial stage of the attack, attends it. The vesicules are arranged in
or sometimes during an exacerbation of a groups, which sooner or later coalesce, and
subacute, or chronic case. It is generally rupture of themselves, and discharge a clear
conceded that there exists five forms of this mucilaginous fluid, which has the quality
disease. They are called erythematous, of stiffening, and staining the linen, and on
papular, vesicular pustular, and squamous, drying, forms a yellow crust. The physi-
The erythematous form is dry throughout cian rarely sees the vesicles, in fact because
its entire course, and it may be well to stale they rupture so early. Then a crop of new
right here that this form is the only one vesicles form about the old patch, these in
whose characteristics, course, ultimate re- turn rupture early, discharging their consults,
&c., is clear cut, and unchanging, tents, with more crust formation. And so
The other varieties mentioned above are the process continues. When the crust is
subject to many alterations, appearances, removed a raw surface is exposed. Eventvery
erratic, and at times produce a pecu- ually the discharge ceases, the hyperaemia
liar symptom-complex to deal with. lessens, scaling takes place, and after a time
Ecsema Kryl/iiiiiatosiuii.—This is most fre- skin reforms and returns to the normal,
quentlyseen u])on the face of adults though This form seeks parts of the skin, flexures
it often occurs elsewhere, and frequently in of joints, flexures surface of limbs, behind
children. It commonly begins as one, or the ears, &c.
several ill-defined red patches, but by virtue Ecsema Piisiulosim.—This variety occurs
of the coalescence of smaller ones, a contin- in the more or less broken down, cachectic,
uous patch is formed. Sometimes the entire or those of the strumous diathesis. This is
face is invaded, generally only a portion, the most common form of eczema seen in
Often the inflammatory process is attended childhood. In them it occurs by preference
by marked edema of the eyelids, and at times on the face and head. The eruption conassuming
a dangerous phase.- 1 can recall sists of pustules from the beginning, or it
one case, where the corneal surface was in- may develop from vesicles. The pustules
vaded extensively, by continuity of surface have a tendency to break down, and disproducing
corneal ulcers. This isextremely charge, which when dried forms foul greenrare.
The individual experiences great dis- ish crusts, which is very revolting, when
comfort on account of the l)urning and stilT- the scalp is diffusely matted. At this time
ness of theskin. The face feels harsh, dry, the poor sufferer is rendered almost crazy,
and thickened. If it occurs in the folds of though it is not so itchy as some of the other
the skin, slight moisture may be present, forms.
It is exceptional for vesicles to develop. Ecsema Sqamosum is the final stage
After a varying length of time the symp- through which most of the cases pass on
toms may subside, and complete recovery their way to recovery. The skin is very dry
take place, the lesion fading away, com- red, and covered with thin parchment, or
pletely, and not in the centre alone. On the paper like scales. It may continue this way
Other hand, it may assume a chronic form, a long time, with occasional exacerbations.
and continue as a tormentor for years. Then it may pass away entirely, and the
Eczema Papulosum.—When eczema was skin return to normal. In this condition it