500 DISEASES OF THE 6KIN. 



fever. The patient first becomes aware of a pain in the lower extrem- 

 ities, particularly in the legs. Upon examination, the painful part is 

 found slightly swollen, oedematous, and studded with red spots of the 

 size of a millet-seed or lentil. At first the spots are bright red, and 

 disappear under pressure of the finger, which shows that at this period 

 they depend upon hyperaemia. They afterward assume a dirty-brown 

 color, and then no longer are effaced by the finger, proving that blood 

 has escaped from its vessels into the substance of the skin. This erup- 

 tion of spots generally recurs by fits several times in succession, so 

 that the disease usually lasts for several weeks, although, if the pa- 

 tient maintain a recumbent attitude, the first crop of spots usually 

 fades out again in from four to eight days. In some cases the disease 

 drags on for months, with repeated relapses. 



TBEATMENT. In treatment of haemorrhage into the skin, special 

 attention must be paid to whatsoever constitutional disorder may exist. 

 Besides this, it is customary in these cases, as in almost all other 

 haemorrhages, to give the mineral and vegetable acids internally, and 

 to bathe the purpuric spots with dilute acids especially with vinegar 

 and water. The efficacy of these prescriptions is very problematical. 

 In the treatment of peliosis rheumatica it is an important rule that 

 the patient should be kept in bed, and in an uninterruptedly horizontal 

 attitude, until the eruption disappears, and for some little time after- 

 ward. 



VL GROWTHS IN THE SKIN. 



WE shall leave the description of a majority of the cutaneous 

 growths to text-books of surgery, especially the account of^carcinoma, 

 sarcoma, and epithelioma, and shall confine ourselves here to a brief 

 sketch of the disease known as lupus, a neoplastic formation peculiar 

 to the skin, and to the mucous membrane of the nose, mouth, and 

 fauces. 



CHAPTER XVIII. 



LUPUS LUPUS EXEDENS. 



ETIOLOGY. The neoplasm, upon whose development in the skin 

 lupus depends, is classed among the " granulation growths " (Granula- 

 tionsgeschwulste), by Virchow. It arises in the form of nodules, 

 which either remain distinct (lupus tuber osus), or else coalesce, caus- 

 ing a diffuse thickening of the skin (lupus hypertrophicus). The ele- 

 ments which form a nodule of lupus consist of small cells which greatly 



