Lectures on clinical surgery. Vol. I. Pt. I. On certain rare diseases of the skin / by Jonathan Hutchinson.

  • Hutchinson, Jonathan, Sir, 1828-1913.
Date:
1878
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Licence: Public Domain Mark

Credit: Lectures on clinical surgery. Vol. I. Pt. I. On certain rare diseases of the skin / by Jonathan Hutchinson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of tlie trunk, back and front, and on the upper parts of the thighs. On the arms they are equally abundant on both surfaces. On the back the patches looked very much like the remains of a papular syphilide. They were everywhere aiTanged with accurate sym- metry. He complained that they itched much from cold, and there was general evidence of scratching (‘ S. H. A.,’ 94). I feel sure that this is essentially, as suggested above, a pruriginous example of relapsing lichen-psoriasis (lichen ruber of Hebra). In some of the best-marked examples of the latter there is a history that the patient had for years before the more severe outbreak been liable to occasional and slight attacks. (See cases in the lecture on Lichen-psoriasis.) It is doubtful whether the following ease properly belongs to this group, although the patient was worse in winter. From the nature of his occupation he was exposed to more heat in winter than in summer, and it seemed probable that heat was the exciting cause. A man named Offord was under care in April, 1870, for a pruriginous eruption, which he said always left him in May and always troubled him through the avinter. He explained this by the fact that during the whole winter he worked in a malting-house, and that during the summer he was engaged in out-of-door occupations. The eruption was most severe on his thighs and legs, but it occurred also on his forearms, arms, and neck, and a little on his back. It consisted of scratched papules with small blood-crusts. He denied having ever suffered from lice, and we could find no ova. Neither his wife nor his children had suffered. The irritation had often kept him awake at night. He considered that the eruption began as little bumps, from which the heads got scratched off. He wore flannel next his skin, but the parts covered by it were those least affected. Winter prurigo in its milder forms is, I suspect, a very common affection; and not a few who read this lecture will probably, from personal experience, be able to confirm my description of it. It is not, however, very often that it rises