524 DISEASES OF THE SKIN. 



appearance of variola ; or it may be accompanied or followed by 

 articular inflammations, giving a resemblance to articular rheuma- 

 tism ; it is even possible that some of those cases of valvular dis- 

 ease of the heart of obscure origin may have been related to a pre- 

 cedent erythema exsudativum. Finally, Lewin believes that in 

 women the erythema may be due to inflammation of the urethra ; 

 that is, it is the manifestation of an irritation starting from the 

 urethral mucous membrane and reflected to the vasomotor nerves 

 of the skin, as gonorrhoeal rheumatism is in males. 



Another form has been observed as an epidemic in Paris, the 

 Crimea, Mexico (acrodynia), as well as that called pellagra in Italy 

 and the South of France. 



2. P. 505. 



The use of even nitrate of silver requires some practice. Each 

 lupus nodule should be bored into with a sharpened point, and 

 loosened up from the sound skin ; which is not difficult, as the for- 

 mer is readily broken up, while the latter is resistant. The pain in- 

 duced ceases after a few hours. The operation may be repeated once 

 or twice a week ; it would be too painful to destroy all the nodules 

 at once, where the nodules are numerous and disseminated. Hebra 

 and Kaposi recommend a sort of weak Cosine's paste (arsenic, alb. 

 gr. x, cinnabar. 3 ss, ung. aquae ros. f ss), which is spread on muslin 

 and applied for three days, being renewed every day. The second 

 day there is mild, the third day tolerably severe pain, and oedema- 

 tous swelling of the face and eyelids ; but the lupus nodules have 

 become dark-brown sloughs, which are detached by suppuration 

 after a few days, leaving cavities which soon granulate. If the 

 nodules have already ulcerated, it may suffice to apply the plaster 

 for one or two days. Arsenical poisoning rarely if ever occurs from 

 the above treatment. Another plan is to scarify the nodules at 

 intervals of some weeks. Volkmann recommends scraping out the 

 nodules with a sharp scoop, and if necessary subsequently scarify- 

 ing or cauterizing the raw surface ; this operation is painful, and 

 requires anaesthesia ; the same is true of treatment by the galvano- 

 cautery. 



But destructive treatment is not always required. Where in- 

 stead of nodules there is merely infiltration of the skin, resolution 

 may take place without ulceration ; so we may try to aid resolution 

 by irritating the part with concentrated solution of nitrate of sil- 

 ver or tincture of iodine with intervals of rest. Mercurial oint- 

 ment may be applied daily. 



