3978

Vol. XVI. No. 1. January, 1895.

Original Articles.

I

ODERM.

BY J. ABBOTT CANTRELL, M. D.,

Professor of Diseases of the Skin in the Philadelphia Polyclinic and College for Graduates in Medicine; Dermatologist to the Philadelphia Hospital, etc.

As the records of many interesting cases are not seen other than by the assistants in the several departments, I take great pleasure in giving the account of one that was more than usually interesting.

The case in question resembled both the eruptions due to syphilis and tuberculosis, and so much that it took some time before a correct diagnosis was made.

The patient, a male, 47 years of age, shoemaker, presented himself at my service at the Philadelphia Polyclinic on August 8th, last, complaining of an eruption upon the middle finger of the right hand, stating that it was of ten weeks' duration.

The family history was recorded as follows: Father living, in good health at the age of 88 years; mother died of so-called galloping phthisis at the age of 28 or 29 years. Besides himself there were three members of his immediate family living and in good health, one only having died, a sister, one year ago, of inflammation of the intestines at the age of 52 years.

The maternal grandparents lived to be quite aged, two of his maternal aunts being alive and over 80 years of age, while two maternal uncles were also living, although at an age younger than the patient. The notes fail to give the paternal history, probably on account of want of knowledge of the patient.

According to the personal and family history of the patient, he had smallpox at the age of 17, which marks he shows at the date of this examination. He contracted an initial lesion of syphilis at the age of 32, and again six months before his visit to my clinic.

He stated that he never had a generalized eruption follow. Otherwise he has never had any sickness.

living in Yorkshire, England, and from whom he had separated.

The lesion to which our attention was called was situated upon the upper and outer border of the middle finger of the right hand. On close inspection it was noted to be irregular in outline, being about three-quarters of an inch in diameter, and showing a pinkish-red color when the hand was held above the head, but on allowing the hand to hang at the side for a few moments the color gradually changed to a bluish tint, with the exception of a small area on the summit of the lesion, which became shiny and looked as if it were moist, but upon passing the finger over the part this condition was not noticeable.

The lesion was raised about three-sixteenths of an inch above the surrounding healthy skin. As above stated, it gave us a very irregular outline, showing indentations here and there, and strongly resembled the appearance of a circular saw.

The part to the touch appeared to be very much thickened, although not infiltrated, and apparently affected the subcutaneous as well as the superficial layers. There was no ulceration, and the condition did not give the patient discomfort, with the exception that the eruption interfered with his work, being in the position where the thread would irritate it occasionally.

Without reference to the points of differential diagnosis in this report, I feel that the record of the treatment employed and the result obtained from its use will be sufficient to give you the correct diagnosis.

On the date of his visit he was ordered to take 15 grains of potassium iodide three time a day, and to report some days later. He appeared at the clinic on the following dates: September 1st, and occasionally until the 26th of that month, when he was discharged, the eruption having disappeared entirely.