PEMPHIGUS. 



483 



tratccL They resemble the blisters produced by vesicating plasters, 

 or by chafing of the skin. "We have no satisfactory explanation of 

 the cause of this curious disease. In new-born children, pemphigus 

 is nearly always, if not absolutely always, of syphilitic origin. Chil- 

 dren are more frequently attacked than adults. Some persons ex- 

 hibit signs of a general cachexia prior to the outbreak of the pem- 

 phigus ; while others retain their blooming appearance, and feel per- 

 fectly well throughout the disease, unless exhausted by its repeated 

 recurrence and by loss of sleep. Pemphigus sometimes assumes an 

 epidemic form. 



SYMPTOMS AND COURSE. The first change noticed in the skin 

 consists in the appearance, upon the back, belly, and extremities, of 

 red circular spots, which itch and burn. In a few hours, at the middle 

 of the spots, small transparent vesicles arise, which quickly enlarge 

 and soon cover the whole of it, or else merely leave a narrow margin 

 unoccupied. The vesicles are round or oval in shape, and of the size 

 of a pea, a cherry, or perhaps of a walnut. At first their contents 

 are transparent, afterward they become turbid and curdy. In two or 

 three days the blebs burst, leaving an excoriation. For some days 

 this continues to discharge, and then becomes covered by a scab, 

 under which a new epidermis forms. A stain of pigment remains to 

 mark the spot where the bulla was situated. Before the first blebs 

 heal, new ones form ; these are succeeded by others, and thus succes- 

 sive crops continue to spring up ; so that we are often able to study 

 all the stages of pemphigus simultaneously upon one patient. In 

 some cases this only continues for a few weeks, and then ceases. But 

 even then there is usually another attack, the whole process repeating 

 itself after a lapse of weeks or months. These relapses, which are often 

 three, four, or even more in number, resemble the first attack in their 

 course and duration. In other instances, the formation of new blebs 

 does not cease at the end of a few weeks, but continues for months, 

 and even for years. Although at the beginning of the disease the 

 general health of the patient is entirely undisturbed, yet as it pro- 

 gresses he grows pale, thin, and debilitated, either because the dis- 

 charge exhausts him, or because the unknown cause of pemphigus 

 exerts a noxious influence upon the entire economy. The emaciation, 

 and pallid, cachectic look make all the more rapid progress, if rest at 

 night be disturbed by the itching which attends the eruption of the 

 blebs. Nearly all patients with chronic pemphigus finally die of 



marasmus. 



The question has been actively debated, whether pemphigus be 

 always chronic, or whether there be not also an acute pemphigus. 

 This seems to me to be a mere dispute about words. When the enip- 



