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A New Case of Granuloma Annulare SOCIETY INTELLIGENCE. 307 the first week of life, but that these had cleared off, and that the child had been free until five months ago. The health of the child was and had always been quite good, but recently it had suffered from broken sleep caused by the irritation of the present eruption. The whole of the body and limbs were covered with a very poly- morphous eruption, and on the face there were a few impetiginous scabs. The buttocks showed the typical thumb-nail-sized red papules of Lichen urticatus, and on the thighs and forearms, especially on the extensor surfaces, were the small hard lichenoid papules which are generally seen as the involution-form of this disease. In addition to these lesions, however, were numerous scratch marks whizh, when first seen, showed a tendency to rise into bulls. There were also large blood-stained hulls on the knees and elbows, and the mark of a recent one on the dorsnm of the right foot. There was no factitious urticaria, and the exhibitors had not found any factitious bullous production, though the case had not been watched rmfficiently long for them to be certain on this point. Dr. WHITFIELDsaid that he thought that everyone present would agree with the diagnosis of Lichen urticatus, but the question arose whether there was something else behind it. Epidermolysis bullosa had occurred to him, but although unable to exclude it he thought the history of seven months’ complete freedom from skin-trouble was against it. Dr. COLCOTTFox said that in his opinion the Lichen urticatus was undoubted, and that he would not like to state without watching the case whether this was accompanied by Epidermolysis bullosa or not. He would point out, however, that in his experience the bullae were almost limited to the hands and feet in pure Lichen urticatus. CLINICAL NOTES. A NEW CASE OF GRANULOMA ANNULARE, BY H. RADCLIFFE-CROCKER. ANOTHERcam of this rare disease has recently come under my observation, the seventh on record. Mr. T. P., aged 34, surveyor, 308 CLINICAL NOTES. was first seen on April Sth, 1902, with two ringed lesions on the hands : one over the first knuckle of the right hand, the other on the side and palmar surface of the left index-finger. He stated positively that the lesions began four years ago from cuts which he picked. The one on the right knuckle was the first to appear and spread, so that in the course of a year it took a circular form, clearing in the centre as it spread peripherally. The ring on the left index-finger began about the same time, and also spread from a cut or scratch. When seen, the ring on the right hand was about 14 inches in diameter, situated over the first and part of the second knuckle. The border, abrupt on the outer side, sloped gradually inwards. It was about + to )inch wide, with crenated outline, and in parts showed that it was made up of semi-coalesced nodules. As a whole, it was of a violaceous red colour, with a brighter red outer border, and he said the tint varied much according to the tem- perature, being scarcely visible when it was cold, and in warm weather projecting nearly + of an inch. The continuity of the circle was broken for 4 an inch at the web of the first two fingers, which was never affected ; but the line was continued on the first phalanx of the index-finger, and the gap was only of an inch when the fingers were together. On the side of the left index-finger, over the second and third phalanges, there was a similar lesion, but while it was nearly 14 inches long, it was only 9 of an inch wide. The proximal border was fairly well-developed, and of nearly similar character to the right knuckle, but there was a little rough skin on the border. On the palmar side, the ring was much broken up, and there were isolated firm nodules, but none of them were more than 4 of an inch in diameter. There were also three small nodules on the back of the second phalanx ; these had a whitish top and a red areola around them. There were no lesions on the nape, elbows, or knees. About 2 inches above the occipital protuberance there was an area, of about of an inch, partially denuded of hair, which was reducsd to stumps of an inch long. The skin there mas thickened and roughened. The condition was ascribed by t.he patient to a habit of scratching his head, and had probably no relation to the other lesions. The patient’s general health was good, except that he had ;I poor circulation, and there were no subjective symptoms. CLINICAL NOTES. 309 AN ERUPTION OCCURRING IN THE COURSE OF DIPHTHERIA. BY E. GRAHAM LITTLE, M.D., M.R.C.P. LONDON, Aaaiatant Physician to the East London Hospital for Children, #hadwell. HENOCH(“Lectures on Children’s Diseases,” New Sydenham Society’s Translation, p. 284, Vol. 11.) has noted the mxasional appearance of skin-eruptions during the evolution of diphtheria ; these have usually been “ either forms of diffuse erythema or more or less extensive roseola.” I have not seen any reference to this observation in any dermatological text-book, and the Allowing case may therefore be of sufficient interest to dermatologists to report in this journal. I regret that, owing to the case having occurred during the Easter holidays, I did not personally see the child, and I am indebted to Dr. Dawson Williams, under whose care the case was admitted, for permission to publish it. Arthur W., aged 4 months, was admitted on the 28th March with a temperature of 105”, respiration 52, and pulse 144. There was some nasal discharge, but this was examined for diphtheria and gave a negative result. He was, according to the notes, a fat, well-nourished child. There was complete right-sided facial paralysis. The mouth was very foul, but no membrane was visible in the throat. When the child had been in the hospital a few hours a rash was noted on the front of the chest, consisting of small round red spots, and soine of these were also found on the neck behind the ears. On the following day the rash was very much more marked. The spots were raised and hard, about the size of a split pea, and covered the front of the chest and abdomen ; they were also seen on the back, but less thickly here. There were a few of the same lesions on the legs and the feet ; some of the spots were larger and flatter, and were not raised. Most of them were beginning to become vesicular or pustular. The temperature was still 105”, and the child was very ill. The eruption was also on the neck and scalp, but here it was not raised or pustular. There was no rash on the face, and very little on the arms, and none on the feet. A diagnosis of small-pox was suggested, and the child was seen by a medical officer of health, who pronounced against this opinion. It was then thought to be a septic rash. The discharge from the nose now gave a growth of diphtheria bacilli. 310 CLINICAL NOTES. He was much worse on the 30th. The spots were niiich larger, but not more raised, and only slizhtly pustular. There were numerous fresh lesions, and the rash was now distributed over the greater part of the body. The face reniained free. The palms and soles were a bright red. The pulse was feeble, and the patient died in the afternoon of this day. The post-mortem established the diagnosis of diphtheria. The bacilli were of the small diplo-bacillary form showing nietachromatism, and staining well with Neisser’s stain. Antitoxin was injected on the 29th (4,000 units), local washes of pot. chlor. were used for the nose and mouth, and quinine and brandy given every four hours. The temperature remained above 104” throughout. The right tympanic cavity contained pus. REVIEWS. MALADIESDU CUIRCHEVELU.* THIS volume of 347 pages is the first in order of n series of fire projected by Dr. Sabollrand dealing with five synthetic groups or natural families of diseases particularly affccting the scalp, and, not to artificially limit the subjects, the niani- festations of these diseases on other regions also come in for consideration. The present volume deals with the Seborrhoic nznZac7ies, and the otliers In order will treat of Elefoliating maladies, which include Pityriasis simplex and all that Unn3 has ranged under Eczema seborrhoicuni up to Psoriasis itself, of Gourmes, which reunite all tho suppuratile and exudative affections of the epidermis, of Blopccim and Pelades, and of Tincns. In this first volume, which is bcautifully printed and well-illustrated, the aui,hor discusses the subject of XeborrlLEa, and traces the process in the scalp to its terrui- iintion in a spceial progressive total alopecia, almost peculiar to the innsculine scx, and known as Calvzlies. He then goes on to -describe diverse secondary infections which may be engrafted on this seborrhea and give rise to the various forms of Acne, including Cheloid-Acne and Varioliforna Necrotic Acne. Thereafter ho proceeds to deal with certain coinplications of Seborrhea, such as (1) Regional Congestive States producing Congestive Acne, and Hypertrop7~icAcne, which are Maladies du Cuir Chcvelu. I.-Lcs Maladies Sdborrlv%pcs : Sdborrhde, Am&, Caluitie. Par Le Docteur R. Sabouraud, chef du laboratoirc de la Ville de Paxis it l’hdpitrtl Saint-Louis.
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