Dr. J. J. Pringle Showed a case of Lupus erythematosus associated with Raynaud’s disease in a highly neurotic woman, aged 44 years. The symptoms of Raynaud’s disease apparently first manifested themselves in 1895, but were first recognised as such in 1896. Associated with the typical phenomena of recurrent local syncope and asphyxia of the extremities, more especially of the hands, there were attacks of severe griping abdominal pain. The exact nature of these attacks had never been accurately determined, but there were evidences of some chronic intestinal obstruction, which could not, however, be located. The exhibitor had witnessed several occurrences of typical Raynaud symptoms in the hands, and the nutrition of all the fingers was impaired, their tips being stumpy and atrophied, but no gangrene had ensued. The first manifestations of Lupus erythematosus showed themselves in 1900, in the temporal regions and scalp. They were regarded as “gouty psoriasis,” and were treated by a physician professing the cult of homœopathy by repeated painting with pure oil of cade (!), under which they progressed rapidly, but in the wrong direction. She was also advised to winter in a high, cold, and dry locality, but she suffered terribly from this experience, which was carried out last winter in Switzerland.
The Lupus erythematosus was of severe inflammatory type and occupied a great portion of the scalp, denuding it of hair, and giving rise to a large atrophic scar which was the seat of peculiarly obstinate recurrent attacks of suppuration, probably referable to a dirty toupet, worn for cosmetic purposes. Symmetrical patches were also present behind the ears, inside the pinnæ, and in the zygomatic regions, while there were present over the whole face a large number of telangiectatic spots averaging nearly the size of a pea. The nasal and buccal mucous membranes were healthy. The urine contained neither albumen nor blood-pigment, nor was there any history pointing towards hæmoglobinuria. The exhibitor asked the experience of members as to the value of treatment of such a condition by Finsen’s method, X-rays, and especially by high-frequency currents, which he was inclined to try as of possible value in both the associated conditions present.
Dr. Pringle’s suggestion, that treatment by high-frequency currents afforded the best prospect of benefiting the patient, especially with regard to the Raynaud phenomena, was generally accepted.
Dr. Dore was of opinion that the disease would thereby be considerably ameliorated and possibly even arrested, but the attitude of the majority of members present was somewhat sceptical.
Dr. H. Radcliffe-Crocker showed a case of tuberculous gummata (or gummatous tuberculides). The patient was a well-grown and well-nourished, healthy-looking girl, aged 18 years, who first came under observation on February 17th, when the following notes were made: The disease began at the age of 7 years, when a crop of lesions made their appearance. One of these occurred on the abdomen, near the right ilium, where a large scar, about 3 inches (over 7 centimetres) in diameter, was present. This condition lasted for a few months. Then very few lesions appeared up to the age of 15, when they became more numerous and had gone on ever since without any interval of freedom. For three years the patient had been subject to flat circumscribed infiltrations of the skin varying from a shilling to a crown in size. These lesions all broke down more or less into superficial ulcers, which healed in from two to three weeks. On the legs and thighs up to the crest of the ilium there were a large number of more or less circular scars varying in size, but most of them about as large as half a crown (3 centimetres). On the thighs, however, some were over 2 inches in diameter (about 5 centimetres). On the right thigh near the knee there was a recent lesion (two weeks old), which was about 2-1/2 inches by 1 inch (6 centimetres by 2 centimetres), dull red, with great thickening; it presented on its surface a pea-sized ulceration, which had formed within twenty-four hours of the time when the patient was first seen. A similar lesion, with a more advanced ulceration, on the right calf, had been present three weeks. Below the left knee there was a flat infiltration, slightly raised and well defined, about the size of a shilling (about 2 centimetres). On the right temple there was a small circular scar of 1/4 inch, which had resulted from a similar lesion to those already described. The patient’s lungs were unaffected, but the history was strongly tuberculous on the father’s side, a large number of his relations having died of consumption, whilst some others were dying of the same disease at the present moment. The patient had lost one sister, aged 21 years, of phthisis, and a brother and another sister of “consumption of the bowels.”
Dr. Sequeira showed a case of Lupus vulgaris to illustrate the value of Dr. A. E. Wright’s recent work upon opsonins. The patient, a Jewess, aged 20 years, was first seen at the London Hospital in the summer of 1900. The whole of the face and part of the neck were then much infiltrated and in parts ulcerated. The feet also were affected, parts of several toes having been destroyed. Owing probably to the fact that she was unable to walk, the patient was not seen again until February, 1905. Fortunately, photographs of the condition in 1900 were preserved, and these showed that the disease had extended very little in the four years and a half, although the patient had had no treatment whatever in the interval. The general health had improved, but the lupoid infiltration of the face and neck were well marked and there was still considerable ulceration, the ulcers being covered with dirty scab. The destructive ulceration of the toes had slightly increased. There were no physical signs pointing to tuberculosis of the internal organs. The glands were slightly enlarged, but this was not a marked feature.
Dr. Sequeira took the patient into the hospital, intending to use tuberculin. Before doing this, the blood was examined by Dr. Wm. Bulloch, who found that the opsonic index was 1·3, normal blood being 1. A high opsonic index, it may be mentioned, has been found by Dr. Bulloch in a certain proportion of the cases of Lupus attending the London Hospital, and particularly in the chronic cases doing well under the light treatment. As the opsonic index was already high in this case, it was deemed unnecessary to raise it by the injection of tuberculin, and fomentations were applied to the affected areas, to bring the opsonins to the diseased parts. The result was very striking. In a few days the lesions were paler, flatter, and clean. When shown at the meeting, after a fortnight’s treatment with fomentations, the infiltration had markedly diminished, the raised margin being flatter and paler, and the ulcerated areas healed up, except upon the stumps of the toes.