Scheme for obtaining a better knowledge of the endemic skin diseases of India / prepared by Tilbury Fox and T. Farquhar.

  • Fox, Tilbury, 1836-1879.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: Scheme for obtaining a better knowledge of the endemic skin diseases of India / prepared by Tilbury Fox and T. Farquhar. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    the palm of the hand nearly ; the colour is bright, the rings are itchy, and their surface is to some extent raised, and they leave behind furfuraceous surfaces. The aspect may be altered by scratching, so that the integuments become excoriated and infiltrated. All this means that the fungus is made up of actively-growing mycelial threads that sprout freely and forcibly amid the epithelial layers. Sometimes the disease seems to disappear, and only slight scaly, itchy, scurfy patches remain behind. Again it lights up and reappears in all its intensity. In the other form or degree, the disease is less erythematous, does not take on the ring form, and appears to be limited to the fork of the thigh and the parts about it. There is a red, scaly, itchy surface which festoons a greater or less distance down over the thigh in front, and attacks the perinaeum and the buttocks to some extent. The disease begins as a small itchy scurfy spot—that is to say, the fungus does not luxuriate so freely and so produce red rings—and as this spot spreads the centre pales or rather gets brownish ; the red edge extending. The edge is sometimes distinctly papular, and very well defined. The papules are mostly abortive vesicles, but even vesicles may be visible. If we pass the hand over the patches they feel thickened, dry, and harsh. If the disease is much scratched and irritated it may appear eczematous, or small boils may appear, or there may be a certain amount of lymph infiltration as the result of the irritation, and in such a form as to give the patch an uneven, somewhat knotty aspect and a very rough feel. The disease may after a while break up into islets—one part getting better, another becoming worse, or remaining in statu quo. The disease as a whole, often, if left undisturbed, gets better and worse. It is always itchy, especially with the warmth of the bed, and the skin is, in chronic cases, much discoloured. The fact that the disease occurs where heat and moisture are present accounts for the amount of change induced, and also the variation from ordinary tinea circinata, from which it differs mainly in being accompanied by more infiltration. Nature of the Disease.—Hebra now admits in Eczema marginatum the presence of a fungus, but thinks the disease is tinea engrafted upon an eczema. But it begins as tinea, and not eczema, Kobner, in 1864, described the fungus, and produced tinea circinata on his own arm by inoculation with it. Pick holds that the disease is an intertrigo and a tinea circinata, but as we affirm, it is a tinea circinata modified by the presence of ample heat and moisture, which causes the fungus to luxuriate, and consequently the tissue changes to be greater than in ordinary ringworm of the surface. Now it is easy to see that the occurrence of bright red rings is only a stage of the disease, occurring when and where the fungus happens to find itself in such a condition as to be able to sprout beneath the epithelial tissues far and wdde, and that very rapidly. We sometimes see the same red rings in the onset of tinea vesicolor. But in most cases we have a more gradual growth of fungus, and the production of scurfy patches. We suspect that Burmese ringworm is common in India. When erythematous itchy rings occur about the hairy parts and gradually increase whilst their centres become pale and branny and brownish, or when red itchy patches appear with a well-defined papular edge, and presently become furfuraceous, the scales of such places should always be carefully examined for a vegetable parasite. The fungus may be detected by scraping oflp some of the scales of a patch, placing a very thin layer under the microscope—after adding weak liquor potassae and allowing it to soak for some time—and making careful examination. We must take very thin portions of scale. Sometimes very fine moniliform chains of spores are seen, at other times freely branching my- celial tubes of fungus (trichophyton). The following is a representation of the mycelial threads of the fungus as seen in the scrapings from a case recently under our treatment. The disease under notice is very unhappily called eczema marginatum. It is not an eczema at all. It is not a serous catarrh of the papillary layer, and is not characterised by sero-purulent discharge drying into thin yellow Burmese ringworm, crusts and stiffening linen. ^- ^- Clinique, April 1869. Trichophyton tonsurans, from a case of