480 DISEASES OF THE SKIN. 



seated by impetigo. It is very rarely, and then only when the disease 

 is very violent and acute, that impetiginous dermatitis is attended by 

 fever and by general constitutional disturbance. According as the 

 eruption is limited to a small part of the surface, or extends widely 

 over a large area, it is called impetigo figurata, and impetigo sparsa. 

 The former variety is most often seen upon the face, especially upon 

 the cheeks, lips, nose, and scalp ; but its appearance upon the trunk 

 and extremities is also not uncommon. At first red specks, which 

 may be either discrete or confluent, are observed upon rounded, oval, 

 or irregularly-shaped spots of varying size. Extreme redness of the 

 skin, with tension and glistening, accompanied by fever, constitutes a 

 variety of impetigo, to which "Willan has applied the name of impetigo 

 erysipelatodes. Upon the reddened base, minute yellow points imme- 

 diately develop, which soon grow to the size of small lentils, and rise 

 a little above the level of the surrounding parts. After a day or two, 

 perhaps sooner, the pustules burst and discharge their contents, which 

 dry up into yellow crusts. Beneath these, the formation of pus con- 

 tinues, causing a gradual thickening of the crusts, while new pustules 

 continue to spring up at then* edges. At first, upon removing these 

 crusts, which sometimes attain considerable thickness (impetigo sea- 

 bida), we find beneath them the naked corium bathed in puruloid 

 liquid ; but, toward the end of the disease, a new, delicate covering of 

 epidermis appears, through which the redness of the cutis is visible, 

 and in which slight cracks form when the part is moved. The course 

 of impetigo figurata usually is subacute, so that the process termi- 

 nates in two or three weeks by detachment of the crusts. However, it 

 sometimes lasts for several months, and even for several years, al- 

 though this is not very common. In such instances, the substance of 

 the corium takes part in the process, and becomes thickened and indu- 

 rated just as it does in chronic eczema. The favorite seat of impetigo 

 sparsa is upon the extremities ; and it often covers an entire limb, 

 sometimes, indeed, extending over the whole surface of the body. 

 The reddening and itching of the skin, the appearance and bursting 

 of the pustules, the formation and thickening of the crusts, and the 

 continued development of new pustules around them, and, finally, the 

 shedding of the crusts, all occur just as in the form previously described ; 

 only impetigo sparsa more freqently assumes a chronic character, and, 

 since the cell-formation is not confined exclusively to the surface of 

 the corium, but is also going on within it, it is more apt to result in 

 superficial ulceration. 



TREATMENT. Many cases of impetigo require no treatment at all, 

 and heal ot themselves in a few weeks. Hence, in recent cases, we 

 may confine our interference to softening the crusts with fresh butter 



