Dr. J. M. H. MacLeod showed a case of grouped comedones associated with acneiform lesions on the chest of a boy aged 2 years. The comedones were present chiefly on the sternal region, but several isolated groups occurred around the nipple and umbilicus. Only a few of the comedones had become inflamed or transformed into acne pustules. The mother had noticed the comedones about a month before exhibition. There was a definite history of local irritation in the case, for since the child was a few months old he had worn a piece of flannel over the chest in the affected region, and as the mother believed that he had a delicate chest the flannel had been frequently saturated with camphorated oil. The exhibitor intended to make a bacterial examination of the lesions with the object of trying to find the acne bacillus, and hoped to report the result at a subsequent meeting of the Society. Another point of interest in connection with the case was the fact that it occurred in a boy, as the large majority of reported cases have been in boys. Dr. MacLeod referred also to another case in an infant boy of about a year old, which he had seen on the afternoon of the meeting, but unfortunately had been unable to bring up, in which the comedones were grouped on the forehead and cheeks and in which there was no history of local irritation to account for the lesions.
Mr. Malcolm Morris showed a case of early Parakeratosis variegata, a full report of which will be published in a future issue of the journal.
Dr. Ormerod showed: (1) A case of Lupus erythematosus telangiectodes. The patient was a woman, aged 44 years, who stated that she had suffered from an eruption on the cheeks for the last eighteen months. On exhibition, there was a large red area situated symmetrically on either check, the redness being due to dilatation of the small vessels. Within these areas there were islets of paler and shiny skin, which showed superficial atrophy. A small area in each patch was covered with a crust which was difficult to remove, and when detached showed little tags and prominences on the under surface. The appearance of the eruption had not materially altered since the patient was first seen fourteen months ago.
All the members present agreed with the diagnosis of the exhibitor.
(2) A woman, aged 38 years, suffering from a curious eruption associated with obscure nerve symptoms. The history showed that four years ago she had suffered from some chest affection, accompanied by the expectoration of blood and offensive matter. She was ill three months, and during her convalescence she scratched her right thumb, and a lymphangitis of the arm, with axillary abscess, resulted. She next developed a painful swelling of the right elbow, which was opened and drained, and she thought a piece of bone came away; the arm was put up in splints. The right elbow had been stiff since that time, and during its healing she had developed pricking sensations in the fingers, which became contracted. There was then an interval of nine months’ good health, after which, two years ago, she developed an abscess in front of the right thigh, which eventually broke, and laid her up for four months. Subsequently, about eighteen months ago, the rash appeared, at first round the site of the abscess, then spreading towards the buttock and loin, and finally extending down the leg.
On exhibition, the patient showed an extensive anæsthetic area over the right side extending up into the axilla, curving down both in front and behind at the level of about the sixth rib, and embracing the whole of the right arm and leg, with the exception of small islands on the palm, sole, and gluteal region, where sensation still persisted. The rash followed a similar distribution, but did not affect the arm, and tailed off on the leg with the appearance of isolated spots. The rash developed, according to the patient’s history, in the form of red spots, on which a blister full of clear fluid formed. The fluid then became mattery, and an ulcer resulted. The development of an ulcer was heralded by a pricking sensation. On exhibition, the striking characteristics were the presence of patches of excoriated skin and white scars, surrounded by pigmentation. The patches were oval in shape, with the long axis running down the limb or transversely on the trunk. The more recent lesions consisted of red, raised papules with an excoriation on the summit. In spite of bandaging with boric acid ointment in the hospital a few lesions formed beneath the dressings, though more appeared outside. Examination of the supposed affected joints showed nothing abnormal; the reactions of the atrophied muscles to electricity were also normal. The anæsthesia was shown to be of psychical nature, and the exhibitor therefore considered most, if not all, of her disabilities to be of an hysterical nature. He asked the opinion of the Society as to the nature of the eruption.
Most members, including the exhibitor, considered that the eruption was artificially produced by the patient.