Case 8.—Charles C——, aged 32 years, tailor, came to University College Hospital on October 4th, 1904. He stated that the skin lesions had commenced four years previously, appearing first on the thighs, then on the legs, and a little later on the forearms. He did not remember when the body was first affected. Fresh patches have appeared from time to time, but none have gone away. The lesions consisted of irregular patches from half to several inches in diameter symmetrically distributed over the trunk and limbs. On the back, they were in elongated or oval patches, symmetrically arranged in oblique lines corresponding to the direction of the ribs. They are well defined from the healthy skin, not raised above the normal skin, and the border was not raised above the central portion either to sight or touch. In front, there were large areas due to coalescence of several patches, but the smaller patches were elongated and horizontally placed. On the thighs near the groin the patches ran obliquely round the limb, but lower down were vertical. The general colour was yellowish pink, but in some the yellow, in others the pink predominated. When pinched up, many of the patches were distinctly thickened, but in the more recent this could not be felt, and some appeared as mere stains. The surface was smooth on the trunk, but on the lower limbs there was some roughness of the surface, more marked below the knee, but not actually scaly. The patches on the trunk were larger than on the limbs, and healthy areas of skin were sometimes completely enclosed by the diseased patches. The upper part of the chest, neck, and face were free, except a small patch on the lower lip. There were also large spaces of unaffected skin on the thighs, but only small ones on the upper limbs. On the back of the hands near the wrists, there were some small patches. The mucous membrane of the mouth was normal. There was no itching nor other subjective sensation. There was a history of phthisis in his mother and brother, but the patient was well nourished and healthy, except that he was liable to bronchitis, and had some enlarged post sterno-mastoid glands on the left side. He was put upon salicin gr. xv ter die, and vasogen iodine rubbed on the forearms, but so far no decisive result has been obtained. Mr. Pernet has obtained a piece of skin from the right forearm, where the lesion was apparently superficial. His report is appended.
Case 9.—A gentleman, aged 29 years, in whom the disease has been present for four and a half years, was seen with Mr. George Pernet, who showed him at the Dermatological Society of London in November, 1904, and the notes of his case were published in the December number of the British Journal of Dermatology, vol. xvi, p. 457.
There remains only the case of the lady, which requires separate consideration.
Case 10.—Mrs. H—— was sent to me by Dr. Vassie on January 18th, 1902. She had suffered from the disease for nine or ten years, had seen other dermatologists, and visited sulphur and other spas. The disease had begun with a single patch on the arm, and after remaining single for a few months, had spread and extended almost all over the body and limbs.
When I saw her, the lesions were practically all over the trunk and limbs with ill-defined pale red patches with powdery roughness and decided thickening of the whole cutis of the patches, most marked in a 3-inch patch, situated high up on the right loin. The thigh patches were also thickened, but on the arms and forearms the thickening was less marked. On the front of the legs, the patches were irregular and more decidedly scaly, but not like either eczema or psoriasis. The eruption, as a whole, was like a seborrhoic eczema but less defined, and in parts the lesions were very pale and shaded off into the healthy skin. The neck, face, and hands were free. It smarted in cold weather, but did not itch.
The catamenia were regular, and her general health when seen was excellent, but a year previously she had had a fibroid removed after it had begun to be troublesome for a month from hæmorrhage. Before that the catamenia were twice a month. There was slight seborrhœa capitis. Salicin, 15 grains three times a day, was given. On July 17th she was seen again, and the eruption on the legs was somewhat paler, and that on the arms was much paler, but over the scapula the lesions were thickened but paler; but she attributed the improvement to the warmer weather during the last month, as there was generally some improvement in the summer, while in the winter it fell back, cracked, and smarted. She was not seen again until May 12th, 1904, having meanwhile had other advice, but without any improvement, and none of the patches had gone away. At Wiesbaden she had subcutaneous injections of cacodylate of soda in the month while she was there, and once a fortnight for twelve weeks after, but without benefit. It was noted that the leg’s were distinctly red and scaly. On the rest of the limbs and body the patches were red and scaly but without thickening, except on the forearms, the patches on the left being distinctly thickened. The patches were large, many being palm-sized and in the aggregate covered three fourths of the body, but the face and hands were quite free, and the neck nearly so. There was no itching. As every previous treatment had failed, the possibility of the disease developing into Mycosis fungoides being entertained, although itching was absent, it was resolved to try the effect of the Röntgen rays on a portion of one leg. Nine exposures of ten minutes each at a distance of eight inches were given, and a month after there was slight improvement where the rays had been used, but it was not very decided; but on the left arm where vasogen iodine had been rubbed in there was decided improvement, the lesions being pale, less scaly, and there was some clearance as compared with the right side, which had not been treated. I did not see her again until February 7th, 1905, and she then told me that the improvement where the X-rays had been applied had continued, and in a few weeks after I last saw her, in August, 1904, the disease had entirely disappeared from the outer side of the leg below the knee, and the skin when I examined it was quite white and smooth on the part exposed and had been so for four months, while the inner side of the leg where the rays had not reached remained unaltered. She had not continued the vasogen iodine to the arm, and it had become scaly again.