LUPUS. 



501 



resemble the cells of the rete Malpighii. The epidermoid elements 

 also suffer " accidentally." The epidermis over the diseased region is 

 very thin, and is usually covered with fine scales. Small white gran- 

 ules, like millet-seeds, are produced from the sebaceous glands ; the 

 hairs become deformed and humped from irregular deposit of the horn- 

 cells, and perish as the disease advances. The neoplasm penetrates 

 deeper and deeper below the surface ; it advances from the skin to 

 the subcutaneous tissues, and thence often attacks the cartilages and 

 bones. As the malady goes on, ulceration generally sets in. Crusts 

 form, under which the tissues break down into " devouring ulcers " 

 {lupus exedens). But it sometimes happens that the lupus-nodules 

 subside, then- cellular elements undergoing fatty degeneration, fol- 

 lowed by absorption. The site of the disease then becomes depressed, 

 and is marked by a deep scar, although it has never been hi a state of 

 ulceration (lupus non exedens). 



The etiology of lupus is quite unknown. It is true that the disease 

 often attacks scrofulous persons ; but there are many well-marked cases 

 of scrofula who remain free from lupus, while quite as many, who never 

 have been scrofulous, and who previously had seemed quite sound in 

 other respects, are attacked by it. Its relations with congenital syphi- 

 lis are very similar. It cannot be denied that lupus is tolerably com- 

 mon among persons whom we suspect, or whom we know, to suffer 

 from hereditary syphilis ; but, on the other hand, it is well estab- 

 lished that the majority of persons so affected never suffer from lupus. 

 Hence we are not warranted in distinguishing lupus into lupus scrof- 

 ulosus, syphiliticus, idiopathicus, etc. Statistics as to the frequence of 

 lupus at different ages, and in the two sexes, and in the various ranks 

 of society, show that the malady is rare before the tenth year of age, 

 and still more rare after the fortieth, and most common between the 

 ages of ten and twenty ; that both sexes are afflicted by it with about 

 equal frequence, although perhaps women suffer a little more often 

 than men ; and, finally, that lupus is less frequently seen among the 

 rich than among the poorer classes. 



SYMPTOMS AND COURSE. The most frequent seat of lupus is 

 upon the face, especially upon the nose. Nevertheless, the disease 

 may attack other regions, such as the neck, shoulders, chest, and ex- 

 tremities, especially over the joints. The first symptoms are often 

 overlooked, or at least too little importance is attached to them. 

 They consist in the formation of small, painless, brownish-red specks or 

 nodules (L maculosus, s. tuber culosus), which, although quite hard, are 

 so remarkably vulnerable and tender, that they bleed readily ; and with 

 very slight force the point of a pencil of nitrate of silver may be made 

 to penetrate them deeply. The disease may remain at this stage, with 



