A meeting of this Society was held on Wednesday, February 22nd, 1905,
Dr. H. WALDO in the chair.
The following cases were exhibited:
* * * * *
Dr. W. CLEMENT DANIEL exhibited a man, a photographer by occupation,
with a _symmetrical eruption upon the legs_ resembling a chronic eczema,
the irritation of which was very severe at times.
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. It is stated to have followed a blow which caused an
abrasion, and that, working with his sleeves up, he often knocked the
elbow.” A histological examination showed a granulomatous infiltration
of the corium very suggestive of syphilis, and there had been marked
improvement under potassium iodide. The case was interesting as showing
(_a_) that extreme old age was no bar to the occurrence of gummata, and
(_b_) the enormous hypertrophy that may accompany the condition.
(2) A case of _atrophy of the nails following measles_ in a girl aged 18
years. Three months after the exanthem all the nails were shed, and
subsequently regenerated, except in the case of the thumbs, both index
and middle fingers and the big toes, where they were either very thin,
striated, and longitudinally fissured, or apparently absent, the
posterior nail-fold having grown forward and become adherent to the
nail-bed, through which more or less of the root of the nail could still
be felt. No member of her family had any affection of the nails. There
was no evidence of syphilis, and she had never had any other illness.
The condition had persisted for thirteen years.
Dr. R. L. BOWLES remarked that anything which lowered the vitality
of the system might produce various abnormalities of the nails, and
he quoted the observations of Sir Samuel Wilks who had seen atrophy
of the nails after scarlet fever.
(3) A case of _ulcer of the cheek_ in a man, aged 52 years, of four
months’ duration. It was roughly circular in shape, at least 1 cm. in
diameter, and scabbed over. The glands were not enlarged, and there was
no evidence of syphilis. If it should turn out to be a rodent ulcer, he
thought it was unusually rapid in its growth. He proposed removing it
entirely, and he would report on it histologically at a subsequent
meeting.
(4) A case of _acute Lupus erythematosus_ in a married woman, with a
history of five months’ duration. It began as two small patches on the
cheek in front of the right ear and extended to the face, the pinna and
concha of the ear, and the neck. Soon after, the fore-arms and and backs
of the hands and fingers became affected. The scalp was very scurfy, and
at one time she was much exposed to the sun. There was scaling, but no
vesication or evidence of atrophy. There was a good deal of pain and
tenderness, and she was quite unfitted for work.
(5) A case of _congenital pigmented nævus_ in a girl aged eleven years.
There were numerous small, dusky, pigmented patches and spots scattered
upon the left side of the neck, shoulder, and breast. There were also a
few spots on the lobule of the corresponding ear. They were said to be
getting darker, and some were becoming papillomatous. They were thickly
grouped around the nipple, the areola of which was deeply pigmented.
There was also a patch of dark hair behind the ear on the same side.
(6) A case of _acquired pigmented nævus_ in a boy aged 11 years. Two
years ago he noticed a freckle beneath the left eye which gradually
became darker, and it was now black. Four more soon followed immediately
below the first, and then another appeared on the lower lip on the right
side. Other spots were to be found on the trunk and neck.
Among the suggestions for treatment put forward by the members of
the Society excision of each nævoid spot was mentioned as being the
most efficient method of radical cure.
(7) A case of _Lichen pigmentosus verrucosus_ in a girl aged 12 years.
The condition started five years ago on the forehead, and extended to
the neck, trunk, groins, and the front and inner aspects of the thighs.
There were innumerable slightly pigmented, warty lesions, irregular in
outline, and varying in size from that of a pin’s head to that of a
split pea. They were composed of a soft, friable substance that could be
easily picked off with the finger-nail. He was not aware of ever having
seen or heard of a similar case. A portion had been removed for
histological examination, and he would endeavour to show a section
before the Society on a future occasion.
This case excited considerable interest, but the majority of the
members preferred to reserve their diagnosis until after the
microscopic examination.
* * * * *
Mr. SPENCER HURLBUTT showed a _case for diagnosis_. The patient was a
delicate-looking woman, aged 22 years, with a symmetrical eruption
affecting both legs. The disease first appeared three months ago as a
brownish-coloured spot on the outer side of the right calf, which was
followed at intervals by similar ones on each leg, and these had
gradually enlarged until the present time. There were now ten to twelve
patches of varying sizes up to that of a florin situated upon the back
and outer surface of the legs. The lesions consisted of fairly
well-defined, non-indurated, circular, dull-red patches, with thin
adherent scales, their general appearance being suggestive of psoriasis
which had undergone treatment. The usual situations affected by that
disease were, however, free from the eruption, and severe itching,
especially toward night-time, was a prominent symptom.
The general opinion was that this was a case of seborrhœic
dermatitis of a psoriasiform type.
* * * * *
Dr. GRAHAM LITTLE showed (1) a case of _Tinea cruris_ in a private
patient, a Japanese gentleman, an exponent of the art of ju-jitsu. The
patient had noticed the eruption for about a month and a half, but could
not be certain that he had not the first trace of it before he left
Japan, six months ago. He was engaged in teaching the national form of
wrestling, and in his exercises had to strip almost entirely, so that he
might well have contracted the disease from a pupil. There were now
large patches of scaly dermatitis occupying the perineum and groins with
extensions on to the scrotum. On the left side of the cheek there was a
circinate patch the size of a florin, having a somewhat intricate
whorled pattern, suggesting tropical ringworm. On the outer side of the
ankle just below the external malleolus there was a small patch the size
of a sixpence, which was fading. No treatment had been applied to any of
the lesions. There was no history of infection among his pupils, with
the exception of one, a friend, who stated that he had some patches on
his skin which he noticed while on the voyage from Japan. The patch on
the groin was scraped, and in the scales thus obtained a very
large-spored mycelium with unusually long branches was demonstrated.
(2) 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. It itched slightly. There was no similar eruption in any
member of the family. This was the second case the exhibitor had seen of
the disease this week, and it was probably true that the malady was an
exanthem occurring in epidemic form during certain periods of the year.
Dr. WILFRID WARDE agreed as to the epidemic character of the
disease, and he remarked upon the general good health of the
patients. He thought that the so-called “herald-patch” was
frequently missed, both by the patient and the physician.
(3) A case of _Lupus vulgaris_ of the nose and cheek in a little weakly
East-end child who had had a remarkably complete series of tubercular
affections, commencing with a tubercular ulcer upon the right
conjunctiva and cornea for which the eye had been enucleated eight years
ago. Six years afterwards she developed lupus of the nose, which had run
a very acute course and had speedily ulcerated, producing considerable
loss of tissue in the cartilaginous portion of the nose. She was treated
at first with cod-liver oil and thyroid extract for some months, and
later with X-rays, which had been continued for many months with
apparently no good effect. After several months of this treatment sudden
improvement took place up to a certain stage, but there it stopped, the
nose being still the seat of active disease. The application of Finsen
light by the Finsen-Reyn lamp was then tried, and, in all, sixty
exposures had been given of an hour and a quarter at a sitting, at daily
intervals. The result had been satisfactory beyond belief to those who
had seen the case at its worst. It was also an interesting fact that
this patient had been the subject of an acute attack of typical Lichen
scrofulosorum of the trunk, and she had been shown with this eruption at
the Dermatological Society of London, in the _Transactions_ of which it
was fully recorded.[7]
All the members agreed upon the excellent results which had been
obtained in the treatment of this case.
(4) A case of _Linear lichen planus_ in a middle-aged woman, who had
been under observation since August of last year. At that time she
presented herself with no symptoms of the disease except a broad, linear
patch running vertically across the popliteal space on the left side.
This patch was of a violaceous tint, and the skin was thickened along
its course and was intensely irritable. But there were no papules
distinctive of _Lichen planus_ on any part of the body, until about a
month ago, when she began to develop an acute attack of the disease. It
was interesting to observe that new papules continued the line of the
original streak from the popliteal space up the back of the right thigh
as far as the buttock in an almost unbroken line, other papules being
distributed extensively upon the body, but without any linear
arrangement. She had well-marked lesions of Lichen planus upon the
buccal mucous membrane, which had also developed within the last few
weeks. The itching was a very severe symptom, and it kept the patient
awake at night.
(5) A case of _syphilis_ in a man, aged 25 years, with an affection of
the upper lip which it was a little difficult to classify, the question
being whether it was a primary or a tertiary ulcer. The whole of the lip
was greatly swollen, and at each angle of the mouth there was a
deeply-excavated ulceration scabbed over, the intervening portion of the
lip being occupied by a papillomatous infiltration resembling the
appearance of frambœsiform syphilis. The man absolutely denied previous
lesions of any kind; there was no scar upon the penis or upon any
portion of the body, and no history of a secondary rash at any time. But
the uvula bad been apparently destroyed by ulceration and was now merely
rudimentary, and there was a deep ulcer upon the back of the pharynx
very suggestive of tertiary disease. The absence of primary and
secondary symptoms was peculiar. It should be mentioned that there was
no pronounced enlargement of the glands in connection with the deep
ulcers of the lip, which, it might be considered, precluded the
diagnosis of primary sores here.
Mr. ARTHUR SHILLITOE suggested the possibility of the case being an
instance of tertiary symptoms in a patient the subject of congenital
syphilis, but the teeth and physiognomy generally did not confirm
this possibility. The general opinion supported the diagnosis of
tertiary syphilis.
* * * * *
Mr. GEORGE PERNET showed a case of _superficial scarring and
telangiectases of the left side of the face and neck following an X-ray
burn_. The patient, aged 28 years, was treated three years ago in the
provinces for what was said to be a tuberculous lesion upon the left
side of the chin. As far as she recollected, the affected part was
exposed on eight occasions to the X-rays for about ten minutes at a
time, the eyes only being protected, but not the adjacent parts of the
face and neck. The patient stated that as a result the face was dressed
and bandaged for three months. The parts now exhibited the well-known
characteristic features following such burns. The original lesion for
which she had been treated appeared to be healed.
* * * * *
Dr. V. H. RUTHERFORD showed microscopic sections from the case of
_multiple sarcoma cutis_ which he had exhibited at the previous meeting
of the Society:
(1) An early nodule—the size of a pea—over which the skin still retained
its natural colour, displayed chiefly fibrillary bundles with a small
number of cells in various stages of development, some being round,
others elongated with fine protoplasmic processes, and others again with
irregular outlines.
(2) In a later nodule—the size of a bean—over which the skin had become
red, the bundles of fibres were replaced by typical small round cells
(lympho-sarcoma). The sections were stained with hæmatoxylin.
A post-mortem examination was made on Monday, February 20th, when a
considerable growth was found in the mediastinum (probably primary),
pressing upon the right bronchus, and smaller growths sparsely
distributed in the pleura, lungs, retroperitoneal glands, etc.
Footnote 7:
_British Journal of Dermatology_, 1903, p. 210.