ADDITIONS TO THE REVISED EDITION OF 1880. 523 



the skin and the trophical changes have long directed attention to 

 the nerVous system, and large nerve-trunks have been found nodu- 

 lated. But in the central nervous system also changes have been 

 found, and perhaps more perfect methods of examination will there 

 find the causal changes. In one case Langhans found great soften- 

 ing of the gray commissures and posterior horns, showing the spinal 

 cord to be the seat of disease in that case at least. The neurotic 

 nature of leprosy is rendered more probable by the frequent coin- 

 cidence of pemphigus (which is regarded as a neurosis), and by its 

 tendency to occur symmetrically on the two sides. 



The prognosis is bad. Though perhaps not for years, it usually 

 causes death, preceded by loss of the limbs, face, etc. Sometimes 

 the course is milder, and after many years ends in recovery. 



TREATMENT is of little avail. None of the vaunted specifics 

 have held their own. So far as at present known, the best treat- 

 ment is change of residence, good hygienic surroundings, cleanli- 

 ness, nourishment, fresh air, iron and cod-liver oil, and attention to 

 special symptoms. At a leper asylum in British Guiana gurjun oil 

 is said to have proved beneficial, as has also chaulmoogra oil, in 

 doses of five to twenty drops three times daily, while it was applied 

 externally combined with psoralea corylifolia.] 



ADDITIONS TO THE REVISED EDITION OF 1880. 



DISEASES OF THE SKIN. 



l._p. 455. 



Besides ordinary erythema nodosum, which occurs in children 

 and youth otherwise healthy, Uffelmann describes a modified form 

 with certain constitutional peculiarities, where the patients have 

 an hereditary tendency to tuberculosis, feeble health, and delicate 

 frames. 



Bohn regards erythema nodosum (as well as peliosis rheumatica) 

 as an inflammatory infarction from embolism of the cutaneous 

 arteries, while other observers make a decided distinction between 

 cutaneous embolism as seen in endocarditis and exudative erythema 

 proper. 



Lewin defines exudative erythema as a vasomotor neurosis, and 

 calls attention to its symmetrical occurrence on the two sides of the 

 body. It is not unfrequently so modified as to resemble other dis- 

 eases. Pustules forming on the erythematous spots may induce the 



