This form differs from the other mainly In the fact that the bullae are not filled with fluid, that is, the epidermic covering is not tense or stretched but somewhat flaccid. The bullae are often of large size, funning flattish fluid tumors as large as the hand. Bullae, arising in close proximity to each other by mutual extension, become confluent, and the epidermis at the same time appears to thicken. The eruption may be limited in distribution, or may invade several regions. If the thickened epidermis is stripped off, the reddened surface will be found covered with a whitish exudation resembling a diphtheritic membrane.

Course And Prognosis

In ordinary Pemphigus Vulgaris the general health may not suffer in any marked degree, or, at all events, until after a considerable period of time. In some cases, however, after the lapse of a year or two, if the disease is not checked, debility and progressive asthenia may bring the affection to a close. In foliaceous pemphigus these symptoms set in earlier and are more marked, and the disease usually proceeds to a fatal termination.

Diagnosis

Pemphigus is closely imitated by a number of anomalous and as vet unclassified eruptions, which are characterized by the development of large vesicles or bullae. These, however, all have an acute course, and by this means are to be distinguished from the disease under consideration.

Etiology

The causes of Pemphigus are unknown.

Treatment

Until within a very few years most authorities believed that very little could be done for this affection by internal treatment, and some German writers appear to be of this opinion still.

Hutchinson, however, states that he has been uniformly successful in controlling and curing the affection by means of Arsenic. The author, and others in this country, have had a like favorable experience with this drug in the disease under notice. The drug should be given in full doses, and continued for some time after the eruption has ceased to appear.

The local treatment is not without importance. That which I have found most serviceable is to rupture the bulla as soon as it appears, sop up the fluid with a soft rag, and then apply the nitrate of zinc to the raw surface. The pain, at first sharp, soon passes off; the patient suffers little subsequent inconvenience from the lesion. It will, moreover, usually heal in about one-third the time it would take if left alone.

The following drugs have been recommended: Acidum Nitricum, 9; Acid. Sulphuric, 11; Argent. Nitric, 21; Liq. Calais, 37; Calx Chlo-rinata, 38; Quinine, 45; Collodium, 46; Zinum, 74; Potassii Chloras, 92; and Rhus Tox., 99.