Definition And Description

This affection occurs almost always on the face. I do not recollect having seen it elsewhere. It commences with a little tumor taking its rise in the corium. The tumor usually has an oval form, and gradually increases in size, reaching at length that of an almond, or a little larger. The skin covering the tumor presents a violet, reddish, or livid hue. Little by little the tumor softens, and the skin becomes thinner and thinner, until at last it breaks, giving exit to an ill-conditioned scrofulous pus. A crust forms over the opening, damming Dp the fluid, which, after a time, breaks out anew at the same or at some other point. This process continues until several opeuings are made, which uniting, form an ulceration of greater or less extent, and possessing the usual scrofulous characters. These abscesses may be single or multiple, and their number is variable. This condition of affairs may progress for months or years before final cicatrization occurs. The scar, at first violaceous, ultimately becomes white, irregular, and reticulate. In some cases the abscess does not open, but the pus is absorbed without the occurrence of ulceration; but even in these a violet spot remains for a long time, to be ultimately followed by a depressed and puckered scar. Successive crops may prolong the affection for years.

* It in proper to state that, unknown to me at the time, Fieber had reported a case (177, Nov. 20, '70), antedating my own some months, that was likewise improved by electricity.

+ Sur un cas de sclerodermic, etc. Paris, 1878.

Diagnosis

This form of disease possesses such well-marked characteristics, that it ought never to be mistaken for abscesses occurring in the subcutaneous connective tissue or in the glands. As a rule, other plain indications of the scrofulous diathesis are manifest.

Prognosis

The prognosis will depend on the promptness with which judicious treatment is undertaken. If left entirely alone the ulcerations will ultimately heal, but not until after the lapse of many months, and considerable scarring is the inevitable result. If, however, the lesion be treated promptly and properly, a much better result may be obtained.

Etiology

We can say nothing on this point other than that the affection is clearly one of the manifestations of the scrofulous diathesis. The special causes of its production are unknown.

Treatment

First and foremost, hygienic and constitutional treatment should be considered. Cod-liver oil, Iodine, Iodide of Iron, in fact, the entire Armamentarium, anti-striumtrium may be brought into play. In addition to the remedies of this class in common use, I have employed, to advantage, the Helianthemum Canadense (tincture from the fresh plant), and would suggest for trial, on Negrier's recommendation, the Juglans regia * (p. 72), and on Shoemaker's recommendation the Chlorate of Potassium (143, June 5, '80, 629).

Local treatment, however, is not to be neglected. If the nodules have not yet softened, they may sometimes be made to disappear by the use of Ungt. lodinii, or Ungt. Potassii Iodidi. If they have already softened, and contain pus, remove this by aspiration with a hypodermic syringe; inject a few drops of tincture of iodine, and apply pressure. If this fails, lay open the abscess freely, scrape its cheesy walls with the dermal curette, and apply tincture of Iodine, Carbolic acid, Liq. Hydrarg. Nitratis, or Ungt. Hydrarg. Biniod. of one-half or one-quarter the present officinal strength. An application of one of these may be sufficient to induce the formation of laudable pus, after which simple applications should be employed, so long as matters proceed favorably. If stimulation is again needed it should be employed. Instead of the drugs mentioned, tin-actual cautery, after scraping, may be employed. This has, on the whole, given mo the best results. The affection requires energetio local treatment, and the sooner it is undertaken the less will be the amount of subsequent scarring.

* I have failed to derive benefit from the use of Juglans cinerea - perhaps the preparation was not a good one.