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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    are, after all, very probably a modification. It may depend upon the peculiarities of the patient's skin and the degree of activity of the sebaceous glands themselves whether a comedo or a spine be the result. Devergie’s lichen is a term often used, but seldom or never defined, and is perhaps usually applied to local conditions in which the backs of the hands are chiefly affected. It is not known that Devergie ever described a spinulosus form of lichen, and it is difficult to distinguish cases to which his name is now given from local manifestations of lichen scrofulosorum. Very similar remarks apply to what is sometimes termed lichen pilaris, if we put aside certain peculiar conditions in which an imprisoned hair is coiled up in an obstructed follicle. We must leave aside, also, certain forms of lichen obviously due to external irritation—tar, for instance. Restricting our purview to cases of a chronic lichenoid condition occurring chiefly in young people, affecting chiefly the parts which are in contact with clothes, free for the most part from itching, we have to ask whether they can be divided with any definiteness into more than one group, and whether any group can be constructed which does not connect itself in more or less close identity with what we ought to name lichen scrofulosorum. The following citations from authors may perhaps help us to answer this question. It will be well to remember, with reference to what has been suggested as regards the influence of clothing, that the kind of irritation caused differs very much in different individuals and in relation to the clothing worn. Probably in almost all persons woollen clothing, especially if worn at night, tends to stimulate the action of the sebaceous glands, and, in those who are inattentive as regards frequent changes, chronic forms of lichen are apt to occur. If the patient inherit tuberculous tendencies and the bacillus be present it may be plausibly suggested that the lichen will assume the scrofulosus type. The entire absence of Darier’s Dermatosis amongst the richer classes of the community has probably an important lesson in this direction. Hebra’s original description of the eruption which he named “ Lichen scrofulosorum ” will be found in the second volume of the New Sydenham Society’s translation. The translation was by Dr. Hilton Fagge, who, in a footnote stating that the disease had not been recognized in England, suggests that some of the cases which Hebra himself had shown him in Vienna might have been named in England lichen circumscriptus. Hebra described groups of indolent papules which did not itch much, and which occurred chiefly on the trunk. They never suppurated, and were but little scratched, but in late stages they resembled acne spots, which might occur on the face and limbs, and went through the same stages as acne. When the little papules dis- appeared, discoid darkly pigmented maculae, the size of lentils, were left, and the skin generally assumed a peculiar cachectic appearance. The disease might go on in successive crops for many years. Very usually other indications of scrofula in glands, bones, &c., were present, but not tuberculosis of the lungs. The papules were seated at the openings of hair sacs, and usually formed elevations which consisted of a mass of epidermis. After removal of these semiglobular masses of epidermis, the orifice of the hair sac might be easily seen. The surrounding skin was slightly reddened. It was a disease met with in males only, and Hebra especially admitted that some of his patients had appeared to be in excellent health. He thought the disease readily curable by efficient treatment, but showing no tendency to spontaneous disappearance. His remedy was cod liver oil internally and externally. By far the most important measure was rubbing in the oil four times a day and clothing the patient in flannel saturated with it. Of this he speaks as an infallible cure. Hebra, in his large atlas, gave one portrait of the eruption. It was that of a man, and exhibits conditions which might very well pass for those of Darier’s malady. The eruption is shown on the arm quite as abundantly as on the trunk. In the ‘ Hand-Atlas’ subsequently published by Kaposi (Hebra’s son-in-law) the original portrait is repro- duced and several new ones added. Unfortunately, no letterpress descriptions accompany this work. One of the portraits is named “ Lichen scrofulosorum et acne cachecticorum, and shows the eruption on both trunk and upper extremity. In another, Tafel, 178, the eruption is very abundant and severe. The conditions represented are precisely those of Darier’s disease, and the localities affected are also similar. Groups of papules are shown in the fossa between nose and cheek, just as noted repeatedly by those who have described this latter malady. The arms are affected quite as severely as the trunk. No one who has seen examples of Darier's malady, and who carefully inspects this portrait, can doubt the identity of the two. A further portrait, Tafel, 179, is named 11 lichen scrophulosorum et chloasma cachecticorum,” and shows the eruption on the trunk and limbs, and even on the backs of the hands. It occurs on the forehead and cheeks, and is again not distinguishable from Darier s malady. Tafel, 180, is named “ lichen scrofulosorum serpiginosus, and exhibits large circumscribed dusky patches, with spreading lichenoid borders, on the trunk of a young man.