Case 5.—Dr. D——, aged 53 years. In 1876, while a house-surgeon, he first noticed a patch on one calf; since then the patches have gradually increased in number, and some of them in size. Chrysarobin kills them down for a time, but they re-form in the same place. In his family history a sister died of Addison’s disease, and one daughter is slightly phthisical. His own health is good and he is well nourished.
When seen by me on February 4th, 1904, there was a large irregular lesion occupying nearly the whole of the interscapular region and numerous others on the back, abdomen, and thighs. They were of a dull pale lemon colour; some were distinctly thickened when the skin was pinched up; in others this was not recognisable. On the thighs, they were pinkish and slightly roughened. On the body they were smooth, elongated, oblong, oval, and well defined, symmetrically placed, and on the back in oblique lines sloping down and out from the spine in the lines of cleavage, i.e. corresponding to the rib slope. They seldom itched or gave any trouble.
Case 6.—Mr. H——, aged 37 years, a draper. The disease had been present two years. When seen on April 26th, 1904, he had numerous patches on the calves and front of the legs, some three or four inches across, with distinct thickening. They were round, well-defined, and when pinched up were hard as compared with the adjoining healthy skin. Besides these there were more recent superficial irregular patches symmetrically arranged on both thighs. In the interscapular region and in front under the breasts were slightly yellowish stains, but no other alteration of the skin could be seen or felt, the surface being quite smooth. There was occasionally some itching, but never severe. There was constipation present, but no other symptom of ill health.
He was ordered fifteen grains of salicin three times a day, and to rub in ten per cent. vasogen iodine. He was seen again on June 1st, when there was less thickening in some of the patches, but no other change.
Case 7.—Mr. D——, aged 34 years, was seen first on November 3rd, 1904, in consultation with Dr. Payne. He had had a chancre in 1896. He had a severe sore throat and a rash, which only lasted a short time. He was treated with mercury for eighteen months.
The present eruption began from three to four years ago, and for the last twelve months he had been treated by Dr. Payne with the biniodide of mercury mixture, 1/16 grain three times a day, and also with mercurial inunctions, but without making any material effect upon the present lesions. When I saw him the trunk was only slightly affected. There were a few pale yellow patches below the nipples, elongated and nearly horizontal. On the back, there were one or two commencing yellowish spots in the interscapular region, but in the lumbar and sacral regions they were fairly numerous, and also yellowish and elongated horizontally. On the thighs, the patches were very abundant in vertical elongated streaks about half an inch wide, as if the finger had been wiped down the limb in two- or three-inch pale yellow streaks. On the legs, the patches were larger, irregular in outline from coalescence, and of a yellowish-pink colour. The eruption was very symmetrical, many of them, especially on the thighs, were slightly but distinctly thickened when pinched up. On the anus and forearms there were a good many patches, but not so many as on the thighs, where, arranged in the line of the limb, they were of a paler yellow colour. The patient said that they itched very decidedly almost always at night and very often in the day. Sometimes they were sore. They did not itch when they first came out. The eruption began on the thighs, and although fresh ones were coming out from time to time, none, so far as he knew, had faded or gone away.
He was ordered to rub in vasogen iodine and take salicin 15 grains three times a day. I heard about two months later by letter that there was no material change, but he had not used the iodine local application.