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In accordance with the situation in which herpes tonsurans appears, herpes tonsurans of the scalp may in the first place be distinguished. The trichophyton-fungus, like the favus-fungus, invades the hair-follicles, penetrating at first between the hairsheaths, then, after destroying the superficial covering of the hair, into the substance of the hair itself, and causes changes in the latter. The hairs appear dry, and, in contradistinction from favus, acquire a chalky-white color on addition of chloroform, to the extent that fungi have invaded the hair. They are prone readily to yield to traction and to break, and there then result circular areas of skin covered with stumps of hair, which resemble a badly cared for tonsure, and from which the name of the disorder has been derived. In contradistinction from favus, the trichophytonfungus does not penetrate so deeply into the hair-follicles, and it almost always leaves the hair-papillæ intact, and as a result the hairs grow again after removal of the fungus. Herpes tonsurans of the scalp generally occurs as the squamous variety, and it frequently extends beyond the actual boundaries of the hair, invading for a short distance also the adjacent nucha and the forehead. Herpes tonsurans of the beard gives rise to the clinical picture of parasitic sycosis, which has been described on p. 182.

Herpes tonsurans of the skin can be readily recognized from its circular distribution. Naturally, the diagnosis is unequivocally certain only when the distinctive trichophyton-fungi can be demonstrated in the epidermic scales after previous clearing with potassium hydroxid. To this end the most peripheral portions must be examined, as the fungi frequently have already disappeared from the central portions. It also happens not rarely that fungi can nowhere be found, although in consequence of the characteristic appearance of the lesions in the skin there can be no doubt as to the nature of the disorder. In examining diseased hairs a large number must frequently be studied before the fungus is found.

Trichophyton-fungi, like favus-fungi, form roundish and cylindric conidia, and branched filamentous mycelia, filled with granules and vacuoles (Fig. 48), and it would not be possible to distinguish the fungi of favus and trichophytosis from the appearance of individual conidia and mycelial filaments. In the differentiation from favus the mycelial filaments predominate in the presence of herpes tonsurans, and they exhibit a lesser tendency to ramification. The fungi are situated in the skin between the horny and the mucous layer of the epidermis, and never penetrate the structures of the cutis. Marginate eczema represents a special variety of cutaneous herpes tonsurans. It is encountered upon the scrotum and the adjacent surfaces of the thighs, although it may extend also to the perineum and the sacral region. The skin appears greatly reddened and is often covered with vesicles, pustules,

crusts, and scales. The sharp limitation from the healthy skin is especially distinctive. The demonstration of the trichophytonfungus is again decisive in diagnosis. This peculiar variety of herpes tonsurans results from the application of adjacent portions of skin to each other and the consequent chafing and maceration. Marginate eczema therefore occurs also at other suitable portions of the body, thus at the umbilicus, beneath the fold of the breast, and the axillary cavity.

Trichophyton onychomycosis is attended with turbidity, thickening, fragility, and friability of the nail-tissue. The condition

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FIG. 48.-Epidermic scales from a case of squamous herpes tonsurans; potassiumhydroxid preparation; magnified 275 times (personal observation, Zurich clinic).

obviously results from auto-inoculation in scratching a diseased part of the skin. Occasionally recovery from the disease of the skin has already taken place, while the nail remains diseased. Herpes of the nails occurs, as experience has shown, more commonly than favus of the nails. The fungi can be readily demonstrated in the scales from the nails cleared up with potassium hydroxid.

The duration of herpes tonsurans is occasionally protracted over many years, although spontaneous recovery may take place.

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Prognosis. The prognosis is favorable from every point of view. The disorder is never dangerous to life, and apart from itching it gives rise to no other symptom, and, besides, it is readily amenable to treatment.

Treatment. The prophylactic measures consist in care in associating with individuals and animals suffering from herpes, and in thorough cleansing of all tonsorial instruments. The treatment of herpes tonsurans is the same as that of favus (p. 225).

ERYTHRASMA.

Erythrasma occurs upon the same portions of the skin as marginate eczema, with which it is often confounded. It, likewise, is attended with the presence of reddish and brownish-red areas of skin, covered with crusts and scales, and characterized by their sharp margins. The fungus of erythrasma forms conidia and mycelial filaments, although the former are exceedingly small, almost like micrococci, and the mycelial filaments also are conspicuous for their narrowness. The treatment is the same as that for pityriasis versicolor (p. 222).

crusts, and scales. The sharp limitation from the healthy skin is especially distinctive. The demonstration of the trichophytonfungus is again decisive in diagnosis. This peculiar variety of herpes tonsurans results from the application of adjacent portions of skin to each other and the consequent chafing and maceration. Marginate eczema therefore occurs also at other suitable portions of the body, thus at the umbilicus, beneath the fold of the breast, and. the axillary cavity. THE Trichophyton onychomycosis is attended with turbidity, thicken ing, fragility, and friability of the nail-tissue. The condition

[graphic]

FIG. 48.-Epidermic scales from a case of squamous herpes tonsur hydroxid preparation; magnified 275 times (personal observation, Z.

obviously results from auto-inoculation in scratching part of the skin. Occasionally recovery from the diskin has already taken place, while the nail remai Herpes of the nails occurs, as experience has shown. monly than favus of the nails. The fungi can be read strated in the scales from the nails cleared up with hydroxid.

The duration of herpes tonsurans is occasionally pro many years, although spontaneous recovery may take p

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