2024 



PYOGENIC DERMAL INFECTIONS 



from all the cases of the Khartoum epidemic, and a similar organism 

 was found by Corlett, but not fully defined; (3) a vaccine prepared 

 from it cured the patients quickly. It is, of course, possible that the 

 same clinical correlation may be caused by various, as yet unknown, 

 allied organisms. 



The Khartoum epidemic was traceable to a case of ' Nile boils,' 

 caused by the same organism. 



Symptomatology. — The incubation period is unknown, but in 

 some cases the initial lesion is a small papule on the head or chest, 

 which is so quickly followed by an outbreak of bullae that the 

 eruption is well developed in two days. 



The essential feature of the eruption is a bulla arising on 

 apparently healthy skin, and measuring about 2 cm. in diameter, 

 but associated with some much larger blebs measuring about twice 

 this size, and also smaller bullae which rapidly increase in diameter. 



A bulla appears to start as a small vesicle situate in the epidermis, 

 containing a clear, watery fluid. This vesicle rapidly increases in 

 size until it forms a bulla, the walls of which are first tense and the 

 contents watery, but later they become flaccid and the contents 

 purulent. 



The bulla bursts, the contents escape, and the lesions dry up 

 and disappear, usually without forming a scab, but in the case of 

 the larger lesions it leaves behind it a certain amount of dark dis- 

 coloration of the skin, indicating the affected area. 



If a bulla is pricked it is found to have a glazed, parchment-like 

 base. The edges of the bulla are also observed to be undermined, 

 and it is apparent that the increase in size from a vesicle or small 

 bulla to a larger one is by the spreading outwards of the edges. If 

 scratched, excoriations and crusts are formed, but crusty lesions 

 are rare and, when present, only slightly developed. 



The bullae are situate most abundantly on the thighs, back, and 

 chest, and less abundantly on the neck, arms, and legs, and more 

 rarely on the face and head. The axillary and scroto-crural regions 

 are singularly free from the disease, only one case showing a slight 

 amount of the eruption at the margins of the axillae. 



There are no constitutional symptoms, and only rarely do cases 

 complain of a slight amount of itching, which is probably due not 

 so much to the eruption itself as to the rubbing of the clothing 

 producing slightly raw areas where bullae have burst. When this 

 takes place, small scabs are apt to form, especially if the patient 

 scratches the area, but they are entirely secondary in nature and 

 not part of the true eruption. 



The differential leucocyte count based on 1,000 cells is: — 



Polymorphonuclear leucocytes . . . . . . 86*7 



Mononuclear leucocytes . . . . . . . . 3*8 



Large lymphocytes , . . . . . . . 4*4 



Small lymphocytes . . . . . , . . 3'2 



Eosinophile leucocytes .. .. .. 1*9 



Total . . , . , , loo'O 



