Volume 1

Atlas of clinical medicine, surgery, and pathology / edited under the direction of the Council by Jonathan Hutchinson.

  • New Sydenham Society.
Date:
1901-1907
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Atlas of clinical medicine, surgery, and pathology / edited under the direction of the Council by Jonathan Hutchinson. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    Besnier). This case appears to have been similar to the preceding, but that there were no spines and no aggregation into patches. In a third case of Dr. Fox’s the patient was a boy, aged 3L and the diagnosis given was lichen scrofulosorum. The boy had a corneal ulcer and slightly enlarged glands in the neck. Pulmonary tuberculosis was suspected. A follicular eruption occupied all the trunk, the lower part of the neck, and the thighs. Dr. Fox remarks: “The case was somewhat unusual, in that the eruption was so copious that only slight indications of aggregations in patches were observable.” He adds: “Very frequently lichen scrofulosorum is grouped like the lichen spinulosus of Devergie. There were no spines, though little adherent scales simulated spines.” Dr. Fox illustrated this eruption by the drawing of another very similar case, in which large glands in the neck were removed, and proved to be tuberculous. At the same meeting that the cases just quoted were exhibited, Dr. James Galloway showed a boy, aged 3, who had a profuse follicular eruption involving almost the whole surface. The papules were situated round the sweat or hair follicles, the centre of each in the earlier stage of the eruption being marked by the orifice of a duct or a small hair. The lesions had lasted for five months, and had caused little or no incon- venience to the child. There was practically no irritation nor any marks of scratching. The child had at one time been badly fed, but was now apparently in good health. Although such diagnoses as lichen planus and lichen urticatus had been given in this case, it may perhaps be fairly claimed as probably one of the group with which we are dealing. In 1896, Dr. (now Sir) E. C. Perry presented a case with the diagnosis of lichen spinulosus. The patient was a boy, aged 14. The eruption consisted of an innumerable number of small papules, from the centre of which stood out bristles about one eighth of an inch in length. It involved the front and sides of the neck, the shoulders, arms, and axillae, as well as the entire trunk. The patient stated that he had had it for six months, that it had first started on the arms, and that it had itched very little. In the early stage there was some slight congestion around the papule, but as the spine developed and the lesion grew older the colour died away. At p. 297 of vol. xii. is a narrative by Dr. Pringle of “a somewhat aberrant case of lichen spinulosus vel pilaris in a girl, aged 8. The eruption had begun on the legs, and was of nearly three months’ duration. It had produced typical large plaques, with projecting horny spines, giving a nutmeg-grater-like sensation on palpation.” There was a patch also on the back of the neck, and the whole of the back was thickly studded with the spiny lesions arranged either in minute groups or scattered singly. In the early stage of the papules a pink zone surrounded them. Dr. Whitfield has recorded, on p. 293 of vol. xv., the case of a boy, aged 13, who had patches of eruption on his right wrist and on both legs. The patches had been present many years. That on the wrist was circular and an inch in diameter. Those on the legs were diagnosed as lichen planus, the lesions being uniformly follicular in site, and carrying in every instance a small follicular spine. There were also some patches of “ verrucose lichen planus” on the shins. The diagnosis given was of a tubercular affection on the wrist and lichen planus on the legs, but as both conditions had commenced at the same time it seems equally probable that they were of the same nature, and possibly examples of a chronic type of lichen scrofulosorum. This view is strengthened by the circumstance that a subsequent report recorded that the patch on the wrist was surrounded by minute papules in the hair follicles around it. The case is of value as illustrating the transition of a chronic lichen spinulosus into the so-called “verrucous” form of lichen planus. It may be reasonably doubted whether this form has any real affinity with typical lichen planus. A case of lichen scrofulosorum in a little girl who suffered from ulcerating lupus of the nose was brought before the Dermatological Society by Dr. Graham Little. Her eruption had been present only four weeks, and had appeared on the trunk as groups of small pink, rather spiny papules. The papules were obviously follicular in position and gave rise to no objective symptoms. The groups were numerous on the back, but were present in other regions. Microscopic examination did not reveal any evidence of tuberculosis. In some observations recorded by Petersen in 1893, he states, “The essential feature of this disease