Various

“ The general consensus of opinion was that this was a case of Lichen planus.
Mr. T. J. P. Hartigan showed (1) a case of tertiary syphilis in a man, aged 90 years, with a history of ten years’ duration. It was recorded by Mr. Waren Tay, to whom the exhibitor was indebted for the case, that “there is a very warty patch on the tip of the elbow, the papillæ and epidermis being enormously hypertrophied. Adjacent is a horse-shoe patch, suggesting tertiary syphilis. There are no other patches, and only doubtful evidence of slight scarring, and of its serpiginous character. ”

“ But the changes in the papillæ, the infiltration of the upper layer of the corium, the widening of the blood-vessels, the dilatation of the lymph-channels, taken in conjunction with the clinical symptoms and the results of treatment, leave no doubt that the case was one of true psoriasis vulgaris of the mucous membrane of the mouth. Previously, very few cases of scaly lesions of the mucous membranes had been described, and in psoriasis of the skin the extensive and destructive infiltration seen in these lesions of mucous membranes is unknown. ”

“ The minute bluish nodules in the corium may be regarded as the primary feature of the disease. They either remain for a long time without undergoing much obvious change, or they undergo spontaneous involution and completely atrophy, leaving behind them only a little brownish cutaneous pigmentation; or else (thirdly) they may increase in size, become much elevated, and form definite sessile tumours, which, later on, become pedunculated, and finally drop off. ”

“ A case of Pityriasis rosea in a girl aged about 12 years, with very characteristic pale pink patches, in size about one quarter by half an inch, appearing first upon the upper part of the trunk above the clavicles, and arranged in lines directed obliquely from the summit of the shoulder to the clavicle. Upon the back in the intervertebral groove there were numerous similar patches and also smaller papules, round and faintly scaly. The eruption had made its appearance two days previously, and it was not now present upon the limbs or lower upon the body than the groin. ”

“ Exceptionally this may be wanting in cutaneous psoriasis patches, but its absence is, as a rule, or even always, characteristic, in psoriasis of mucous membranes. In certain sections, however, the uppermost epithelial layers, one found, to a depth of three cell layers, were pressed together to form a dark-coloured narrow band, but having regard to the smooth contour of the surface this could hardly be looked upon as a partly developed scale. The pathological characters of any lesions are to a certain extent altered according to the position in which they occur. ”

“ The legs were much more densely covered with coalesced irregular patches, some enclosing healthy skin, and the surface was rougher than the lesions on the rest of the body. On the neck, there were a few ill-defined spots about one inch square in area. There was slight blotchy redness of a not very obvious kind on the face, scarcely perceptible on the forehead. There was some seborrhœa capitis, but not so much as formerly, as he uses brilliantine. The patches seldom itched unless he got very hot. No illness preceded the eruption; in fact, he has never had any illness ”

“ The absence of itching in nearly all the cases of Urticaria factitia, while the patches are level with the normal skin, and their unchanging character, are all strongly against such a diagnosis, to say nothing of the extreme rarity of adult Urticaria pigmentosa and the improbability of one man meeting with nine cases of it. ”

“ The prevention of late or tertiary phenomena being the most important aim in the treatment of the disease, efforts should be made to this end, and he considers that the immediate use of mercury, which may prevent the secondary stage from developing, has also the effect of reducing the possibilities of the development of the late stage. ”

“ There are at times in some of these cases, aggregations of small flattened papules which may be considered as links connecting it with the second variety.
(6) There is no infiltration of the integument appreciable to the eye or touch.
(7) The face is rarely affected, and there is the same extremely slow evolution, great resistance to local treatment, and few or no subjective symptoms.
Referring to the whole group, he says: “We know nothing very definite about the etiology or pathology of these affections. They may appear at any age, but seem more frequent in youths or adults. ”

“ On exhibition, the patient showed an extensive anæsthetic area over the right side extending up into the axilla, curving down both in front and behind at the level of about the sixth rib, and embracing the whole of the right arm and leg, with the exception of small islands on the palm, sole, and gluteal region, where sensation still persisted. The rash followed a similar distribution, but did not affect the arm, and tailed off on the leg with the appearance of isolated spots. ”

“ Instead of a fine pityriasic desquamation being always present, this is only distinct on the legs, sometimes just recognisable on the thighs and arms, while on the trunk it is absent, the surface being usually quite smooth.
134 (5) The presence of papules I have not observed, except at the commencement of Case 4.
(6) There is distinct infiltration in a large proportion of the patches, perceptible to the touch, though not to the eye.
The resemblances are: the absence of conspicuous pruritus, and there is often none; the occurrence in patches; the slow evolution; a pale redness ”

“ The face is nearly always free, though I have seen faint patches in one case. There is very little to suggest that the disease is inflammatory, and itching is quite absent in most of the cases; a few patients said they had some itching when hot, but only in one case was it really complained of, and that only in the early evoluting stage of the patches. The initial site for the lesions varies; the thighs are the most frequently first affected, the legs next in frequency, and 121then the trunk. The lower limbs, too, are generally more crowded with lesions than other parts. ”

“ As the opsonic index was already high in this case, it was deemed unnecessary to raise it by the injection of tuberculin, and fomentations were applied to the affected areas, to bring 146the opsonins to the diseased parts. The result was very striking. In a few days the lesions were paler, flatter, and clean. When shown at the meeting, after a fortnight’s treatment with fomentations, the infiltration had markedly diminished, the raised margin being flatter and paler, and the ulcerated areas healed up, except upon the stumps of the toes. ”

“ The Lupus erythematosus was of severe inflammatory type and occupied a great portion of the scalp, denuding it of hair, and giving rise to a large atrophic scar which was the seat of peculiarly obstinate recurrent attacks of suppuration, probably referable to a dirty toupet, worn for cosmetic purposes. Symmetrical patches were also present behind the ears, inside the pinnæ, and in the zygomatic 144regions, while there were present over the whole face a large number of telangiectatic spots averaging nearly the size of a pea. The nasal and buccal mucous membranes were healthy. ”

“ The rash developed, according to the patient’s history, in the form of red spots, on which a blister full of clear fluid formed. The fluid then became mattery, and an ulcer resulted. The development of an ulcer was heralded by a pricking sensation. On exhibition, the striking characteristics were the presence of patches of excoriated skin and white scars, surrounded by pigmentation. The patches were oval in shape, with the long axis running down the limb or transversely on 143the trunk. The more recent lesions consisted of red, raised papules with an excoriation on the summit. ”

“ They increased in numbers very slowly for a long time, and were confined to the limbs until three years ago, when they attacked the trunk, and during the last year have greatly increased in number; in fact, most of them have appeared in the last twelve months. His father was drowned and his mother died of fatty heart at the age of 51 years. When first seen by me the disease was in yellowish patches which commenced four inches above the nipples, but were not abundant till the line of the nipples, and they were less numerous below the umbilicus than above it. ”

“ The colliquation of the epithelium is produced by the action of an exudation rich in fibrin on the epithelial cells, which have suffered in their nutrition but which have maintained their connection with the cutis. The disturbance of nutrition is a combined result of the vascular lesion, the pressure of the exudation, and the resultant anæmia. ”

“ A histological examination of all classes of tumour showed them to be either pure fibromata or angio-fibromata, though Buschke admits that in the case of the face tumours the excision was so superficial that it is possible that deep sebaceous glands might be present below the point at which the excision took place. ”

“ Generally, the patches come out very gradually and in small numbers and, in the main, symmetrically, but as the older patches never go away spontaneously, while fresh ones are continually evoluting at short or long 120intervals, large areas are involved, and in the course of years (in one case, months) the whole trunk and limbs are crowded with lesions, though there are always spaces of normal skin intervening, or sometimes completely enclosed by the diseased process, where the original patches have coalesced. ”

“ The greater frequency of cancer of the mouth in men than in women coincides with the greater frequency of syphilis in men; according to Fournier, syphilis is eight times more common in males. Etcheverry hazards the suggestion that the cachexia produced by syphilis may be a directly provocative cause of ensuing cancer. ”

“ They slowly increase in size, and after about 136three months constitute little pendulous tumours, which ultimately fall off spontaneously or else are knocked off or pulled off by chance; in this way local healing occurs, but fresh nodules form elsewhere. Though, as stated, some of the nodules become pedunculated growths, others appear to atrophy and merely leave brownish pigment in the skin, whilst others seem to undergo very little change, and, at all events, persist for a long time in their primitive form, namely, as hard bluish lumps under the epidermis. ”

“ The anæsthesia was shown to be of psychical nature, and the exhibitor therefore considered most, if not all, of her disabilities to be of an hysterical nature. He asked the opinion of the Society as to the nature of the eruption.
Most members, including the exhibitor, considered that the eruption was artificially produced by the patient.
Dr. J. J. Pringle Showed a case of Lupus erythematosus associated with Raynaud’s disease in a highly neurotic woman, aged 44 years. The symptoms of Raynaud’s disease apparently first manifested themselves in 1895, but were first recognised as such in 1896. ”

“ All forms of dermatitis, except that of transient erythema, produce permanent baldness. Permanent alopecia may also result without dermatitis in cases where the amount of X-rays given has been insufficient to cause epilation, and a second séance has been necessary. In this case certain hairs will have received a dose beyond the maximum for safety, and these will be permanently destroyed. For safe working, it is necessary to have a measure of the rays coming from the tube at any given time ”

“ In our patient there is no evidence of gout as in certain cases described by Mr. Hutchinson. [6]
The prognosis in the present case is not altogether unfavourable, considering that the patient’s general health is good, that the disease is probably seldom of itself fatal, and that in some cases improvement or spontaneous care has, apparently, occurred after the disease has lasted twenty years or more.
SOCIETY INTELLIGENCE.
THE DERMATOLOGICAL SOCIETY OF LONDON. An Ordinary Meeting of the above Society was held on March 8th, 1905, at 5.15 p.m., Dr. J. H. STOWERS in the chair. ”

“ Within these areas there were islets of paler and shiny skin, which showed superficial atrophy. A small area in each patch was covered with a crust which was difficult to remove, and when detached showed little tags and prominences on the under surface. The appearance of the eruption had not materially altered since the patient was first seen fourteen months ago.
All the members present agreed with the diagnosis of the exhibitor.
(2) A woman, aged 38 years, suffering from a curious eruption associated with obscure nerve symptoms. ”

“ On the sole of the right foot, especially on the inner part, there are nodules in various stages of development. The minute ones, those in an early stage of development, are slightly elevated and of a bluish colour, similar to those on the hands. ”

“ The only female case, a lady aged 47 years, resembled the other cases in its gradual evolution, long duration, absence of itching, in the persistence of the old patches with continual evolution of new ones, in its limitation to the covered parts, and in the general good health of the patient. ”