482 DISEASES OF THE SKIN. 



SYMPTOMS AND COURSE. The inflammation and infiltration of the 

 skin, which precedes and accompanies the development of ecthyma 

 pustules, are usually attended by lancinating pain, and in irritable per- 

 sons by fever. The pustules are scarcely ever very numerous. They 

 are isolated, surrounded by a broad, red areola, and are most fre- 

 quently situated upon the extremities, the seat, the bosom, the throat, 

 and, far more rarely, upon the face. These pustules are hemispherical, 

 project distinctly above the level of the surrounding skin, and are 

 usually somewhat larger than a pea (phlyzacium). Their contents 

 consist of a yellow, purulent liquid, often mingled with blood. After 

 a few days, the contents of the pustules dry up, forming round, brown- 

 ish scabs, which either remain flat, and soon fall off, or else, where the 

 suppuration continues beneath them, they gradually grow thicker, and 

 adhere for a longer time. In the first instance the scabs, after falling, 

 leave behind them red spots, covered with new epidermis, and in the 

 latter they leave ulcers, which, although usually shallow ones, some- 

 times eat deep into the skin. The course of ecthyma is sometimes 

 acute, sometimes chronic. In the acute form, induced by external 

 causes, or in that which arises symptomatically in febrile disease, there 

 is generally but a single eruption of pustules. Each pustule lasts but 

 for a short time, and the scab soon falls, leaving no excoriation, or at 

 most a very slight one. In the chronic form, which is peculiar to 

 cachectic ecthyma, successive eruptions of pustules take place at vary- 

 ing intervals ; the redness of the surrounding areola of inflammation 

 is often livid, and the contents of the pustules are bloody, or discolored 

 (ecthyma luridum). Moreover, beneath the thick scab, which is long 

 in forming, and late in falling, very obstinate ulcers develop, which 

 often penetrate deeply into the cutis. 



TREATMENT. The only species of ecthyma which requires active 

 treatment is the chronic variety, with tendency to ulceration of the 

 skin. First of all, the cachectic condition must be corrected, if pos- 

 sible, by means of proper ventilation, generous food, the use of wine, 

 good beer, and the preparations of iron and quinine. Externally, 

 while the inflammation continues, warm poultices must be applied ; 

 afterward, when the ulcers are indolent, they require stimulation, 

 especially by touching then* surface with nitrate of silver. 



CHAPTER X. 



PEMPHIGUS POMPHOLIX SUPERFICIAL DERMATITIS, WITH THE 



FORMATION OF LARGE ISOLATED BLEBS. 



ETIOLOGY. In pemphigus, large blebs (bullas), filled tensely with 

 clear liquid, form upon a base which is slightly reddened but not infil- 



