More Prominent and Larger, One Or Two Measuring More Than Tion

10 the boundary of the elevation, and then separates gradually half an inch in diameter. In this region the cuticle covering from the surface beneath; the central piece separating to- them was dry and corrugated, and in some few instances wards the centre of the convexity of the papule ; the peri- exfoliation had commenced. pheral piece separating towards the sound skin, and forming On the back of the neck, and between the shoulders, were- a kind of frill around its margin. A crop of papules may about fifty of these papules, for the most part isolated; some- sometimes be seen presenting every gradation of this process few, however, were grouped in pairs, and in two instances, a of desquamation at the same moment. There are some in pair had become blended together. They were all exactly which the crack has just taken place; others, in which the circular, and more prominent than those of the neck, but the edge of the central piece has been worn away, and has become most prominent, even here, measured only three-quarters of a. reduced to a small disk, occupying only the central part of line in elevation. In breadth, the extremes of measurement the convexity; others, in which the central piece is- entirely ranged between one line and six (half an inch), the size of gone; some, in which the peripheral position is distinct; others the greater number was five lines; the next common size in which it is partly, and others again in which it is wholly, measured two lines and a half; while below these, were a gone. The papule may now be left quite smooth, or secondary number of smaller papules scattered among the rest, and re exfoliations may commence. The latter, however, are for presenting either the common papules of syphilitic lichen, or the most part irregular and partial, and are not to be con- the early stage of growth of the larger kind. As on the neck, founded with the primary exfoliation now described. When the developed papules presented all the stages of completion ulceration occurs, a crust is formed on the ulcerated surface; and decadence mentioned in my description of this form of and, in proportion to the quantity of pus secreted by the eruption; some were smooth, others wrinkled, others beginning ulcer, or the care with which it is kept, the crust may be- to desquamate, and others again, where desquamation had come very thick, or be a mere scale. advanced some stages. woman the This form of papule occurs most commonly on the back of I prescribed for this young ten grains of iodide the neck and between the shoulders; and it sometimes of potassium, in two ounces of the compound decoction of appears upon the face as well as in the former situation. sarsaparilla, and directed her to keep perfectly quiet. This I now come to the pathology of these papules. This appears medicine, as it frequently does, acted like a charm: her spirits to me to be identical with that of lichen. Their anatomical improved in the course of a few days, the muddiness of her soreness throat the seat, as in lichen, is the vertical capillary plexus of the fol- skin vanished, the of the diminished, licles ; and the only difference between them, that several tumid glands subsided, and the eruption shrunk, faded, and, follicles are involved instead of one. Hence, the large size disappeared, terminating in an exfoliation of yellowish scales which the papules under consideration sometimes attain; but, of epiderma, and leaving behind them dead-leaf-coloured at their first appearance, they are often as small as the stains, which shortly dispersed. smallest pimple of lichen. Occasionally, some few retain this At the end of a fortnight I reduced the dose of the iodide small size, and mark the alliance which subsists between to five grains; and at the completion of a month was enabled them and the lichenous eruption ; while others present every to suspend its use altogether. stage of growth up to the large convex circular tubercle, I was unable to obtain a satisfactory account of the nature measuring three-quarters of an inch in diameter. of the primary disease in this patient; but I have every reason The circular and flat papule of the syphilitic exanthem is, to believe that it originated in a poison, modified by its pas- then, nothing more than a modification of lichen of the most sage through the organism of another individual; in othelt simple kind ; and on this account, as well as for the sake of words, in a modified poison. simplicity, it appears to me desirable that it should be known Henrietta-street, Cavendish-square. by the same generic name ; and for this reason I have termed the eruption, lichen syphiliticus lentiformis. The following is a case in illustration of this form of disease. COMMENTS ON THE LICHEN Sg$HILITICgS ETTIEOR14IIS. INUTILITY OF RESORTING TO THE ITALIAN CLIMATE FOR THE CURE OF PULMONARY to me CASE 12.-A single woman, aged twenty-two, applied CONSUMPTION. at the beginning of last year for an eruption of flat papules, which covered her face and neck, the upper part of the back (FROM PERSONAL OBSERVATION IN ITALY.) and the arms. The eruption was confined to these regions, BY THOMAS BURGESS, M.D., was abundant on the the and the and most face, head, back; TRANSLATOR OF "CAZENAVE’S MANUAL OF CUTANEOUS DISEASES," AND on the arms there were only a few isolated spots. AUTHOR OF "THE REGIONAL PATHOLOGY OF THE SKIN." She informed me that the eruption appeared first on her forehead, next on the face and head, and that by degrees it No. II. to observed at the time of seemed spread downwards. She ROUTE TO ITALY THROUGH THE SOUTH OF FRANCE. the outbreak of the disorder that her skin became remarkably discoloured, and that all her efforts failed in removing what Provence. she considered to be a yellowish brown dirt from its surface. i THE favorite route to Italy of the consumptive invalid has She perspired a good deal at night, was restless and depressed hitherto been via Languedoc and Provence, the climate of in spirits, and felt ill, without being able to explain the cause which, for a long period of time, enjoyed a celebrity scarcely of her illness. After the eruption had been out for the space inferior to that of Italy itself. of a month, she began to complain of soreness of the throat, Although the towns of Aix and Montpellier afforded con- and it was at this time that I first saw her. venient resting-places for the exhausted pilgrims to refresh The throat was of a dark-red colour, the mucous membrane themselves when half way on their long and fatiguing journey, and tonsils were swollen and congested, butthere was no ulcera- -if indeed the boasted sanative influence of the climate did tion. There was also some enlargement of the sub-maxillary and not induce the invalids to remain altogether,-I am yet utterly sub-lingual glands, and the sub-occipital and cervical glands at a loss to conceive how either of those places ever obtained were swollen and tender. Her face presented a very remark- a name for salubrity; as I really know of no place more unable appearance; it was suffused with a yellowish brown pig- favorable for patients suffering from organic disease of the ment, swollen, particularly in the region of the eyes, nose, and lungs, than the far-famed and much-frequented depots of con- mouth, and studded over with the perfectly circular, isolated, sumption-Aix and Montpellier. and lentil-shaped elevations of secondary syphilis. There In this part of France, there is generally a clear blue sky, were several of these papules on the upper eyelid near its but then, the air is sharp and biting, especially in the spring, margin, several at the angle of the eye, a considerable number and the frequent recurrence of the noxious winds-the bise by the side of and at the aperture of the nose, five or six at and the marin-one cold and cutting, the other damp, irri- each angle of the mouth, and some upon the ears. On the tates weak lungs, and excites coughing. No atmosphere, forehead they formed a complete corona veneris; they were of however pure, if occasionally keen and piercing, can prove a dull red, almost livid colour, for the most part smooth, and beneficial for pulmonary consumption, and this is the true of pretty uniform size-namely, a quarter of an inch in dia- character of the air of Montpellier. Provence is, moreover, meter. At the angles of the mouth were one or two fissures the land of dust, from the nature of the soil. Indeed, there produced by the escape of the saliva, and these were covered are parts of this " Province of the Sun," popularly so called, with slight incrustations. which might vie, in whirlwinds of dust, even with the banks On the neck the papules were less numerous, but a little of the Nile, the most recent foreign fashion for consump- more prominent and larger, one or two measuring more than tion. 11 The Mistral. Italy. The territory where Nice now stands, near where the Var falls into the Gulf of Genoa, was part of the ancient The south of France has been, ever since the earliest period Liguria, and lies close to the Roman road called the via Au- famous for violent which from of history, and impetuous winds, amongst relia, passed Rome to Arles, through0 Tuscany and which the north-west wind, or mistral, enjoys an unenviable over the maritime Alps.

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