2022 



PYOGENIC DERMAL INFECTIONS 



smooth surface. Besides these large lesions, small papulo-vesicles 

 and minute pustules are often present. The larger lesions are 

 frequently surrounded by a halo of hyperpigmentation. There is 

 severe pruritus. On healing, also, the ulcers and nodules leave a 

 zone of hyperpigmentation or, more rarely, depigmentation. In 

 chronic cases plaques of hyperkeratosis may develop, especially 

 on the exterior regions of the arms and the elbows. 



Diagnosis. — On superficial examination, the disease might be 

 easily mistaken for framboesia. In contrast to framboesia, the 

 ulcers are superficial, and the nodules, when present, are generally 

 smaller, have no morif orm surface, and in scrapings from the lesions 

 the Treponema pertenue Castellani is absent. From scabies it is 

 distinguished by the absence of burrows and absence of the Acarus. 

 From ecthyma, to which it is closely related, the condition differs by 

 the fact that, on removing the crusts, besides the ulcerative lesions, 

 rather large, smooth hemispheric nodules may be seen. 



Prognosis. — ^The disease' is very persistent, but the general 

 health is not affected. 



Treatment. — If the disease is not properly treated, it has a 

 tendency to become chronic. In some cases the opsonic treatment 

 gives satisfactory results. The vaccine should be prepared with 

 staphylococci grown from the lesions. It has been used by 

 Castellani with good results in Ceylon in 1910, by Chalmers and 

 O'Farrell in 1913, and by Pijper in 1918. Chalmers and O'Farrell 

 gave with success 250 millions of an autogenous vaccine to an 

 adult, and repeated it in three days; Pijper treated children with 

 4 to '5 millions of an autogenous streptococcus obtained from a 

 case, or by a mixture of streptococci and staphylococci. The local 

 treatment consists in removing the crusts by soaking them with a 

 salicylic oil made according to the following formula:' — 



Acidi salicylici . . . . . . . . . . gr. xxx. 



Olei ricini . . . . . . . . . . n.s. 



Olei olivce . . . . . . . . . . ad §iv. 



or by compresses soaked in hot boric lotion. 



All the lesions are then disinfected with a solution of perchloride 

 of mercury (i in 1,000), carbolic acid (2 per cent.), cylhn (i in 300), 

 or permanganate of potash (i in 4,000). A shghtly antiseptic 

 ointment is then applied, such as europhen (2 per cent.), iodoform 

 (2 per cent.), protargol (5 per cent.), calomel (5 to 10 per cent.). 

 An ointment which in our experience is often efficacious is /?-naph- 

 thol gr. ii.-v., acidi carbolici gr. v.-x., vasehni ad §i. 



Pyosis Palmaris. 



Definition. — Pyosis palmaris is characterized by the presence of 

 numerous,' discrete, conical, white pustules, which do not form 

 crusts and which appear on the palms of the hands of native children. 



Historical. — The disease Was described some ten years ago by 

 Castellani in native children in Ceylon, where it is rare. 



