LUPUS. 503 



Beatrix; the disease is then called lupus serpiginosus. The more 

 deeply destructive form of lupus exedens begins almost exclusively 

 upon the alae nasi and the tip of the nose. It is accompanied by de- 

 cided swelling and hyperaemia of the anterior part of the nose. The 

 scab which forms upon these deeply-seated nodules is of great thickness, 

 proportionate to the depth to which the destructive process has pene- 

 trated. Beneath this scab, which is continually renewed, the skin, 

 subcutaneous tissue, cartilage, and even the bones of the nose, are 

 destroyed, sometimes in the space of a few weeks' time, but mom 

 frequently in course of several months or years. Sometimes the dis-* 

 ease, instead of commencing in the integument of the nose, first at- 

 tacks the mucous membrane, causing great devastation of the interior 

 of the nasal cavity, and even destroying the septum narium before the 

 ulceration involves the skin. 



It now remains for us to describe lupus hypertrophicus. The most 

 frequent seat of this form of lupus is also upon the face, although it 

 not unfrequently appears upon other parts of the body. I have known 

 it to attack the face and extremities simultaneously. Here, too, numer- 

 ous nodules of variable size are first observed ; they are covered with 

 desquamating epithelium, and do not usually ulcerate except upon 

 the nose. In consequence of the generation and confluence of new 

 nodules, the skin becomes diffusely, and often quite uniformly, thick- 

 ened. The surface is red, shining, and tense ; here and there upon it 

 there are a few spots of a darker red, covered with denser scales of 

 epidermis. 



Lupus hypertrophicus also shows a tendency to subside at its 

 point of origin, and to extend into the surrounding skin. In con- 

 sequence of the retraction of the new connective tissue which forms 

 during cicatrization, the swollen and reddened integument becomes 

 traversed by interlacing, hard, white cords. In the case of lupus hy- 

 pertrophicus mentioned above, the whole face had become a rigid, cal- 

 lous cicatrix, traversed by varicose vessels, and presented a frightful 

 deformity. The eyelids were everted, the nostrils dilated ; while upon 

 the ears the process was only just commencing. It must not be sup- 

 posed that, in a given case of lupus, one only of these varieties appears, 

 to the exclusion of the others. On the contrary, they usually exist to- 

 gether, one form generally predominating, although traces of the others 

 are nearly always to be found. 



TREATMENT. In the treatment of lupus our task is a double one. 

 In the first place, we have to remove the neoplasm which is embedded 

 between the fibres of the cutis, or else, by its gradual growth and sub- 

 sequent retrocession, it will cause great destruction of the skin ; and, 

 in the second place, we must endeavor to prevent the formation of 

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