CLINICAL ILLUSTRATIONS OF DISEASES OF THE SKIN.[1]
BY L. DUNCAN BULKLEY, A.M., M.D.,
Attending Physician for Skin and Venereal Diseases at the New York Hospital, Out-Patient Department, etc.; Late Physician to the Skin Department, Demilt Dispensary, New York.
II. Tinea trichophytina capitis.—Synonymes: Ringworm of the scalp; Tinea tonsurans; Herpes tonsurans. In the preceding article was illustrated this vegetable parasitic eruption, due to the growth of the trichophyton tonsurans, as it appears on the non-hairy parts of the body and face. We have next to consider it as it affects the hairy scalp, ringworm of the scalp,—the tinea or herpes tonsurans of older writers, trichophytosis of others.
Ringworm of the scalp is not always as easy of recognition as might be supposed, and the writer was especially impressed with this fact during a recent encounter with the disease in a public institution where between thirty and forty children were affected. In many instances it was impossible to make the diagnosis with certainty except after the most minute investigation and very careful microscopic study. Where the eruption takes the form of well-defined circular patches, with broken hairs, the diagnosis may be readily made, but very many cases fail to present typical features, and these very cases may and frequently do go unrecognized and consequently uncured for years. I will first give an illustration of the typical ringworm in which one or more well-defined patches are seen, circular in outline, and shorn of their hair, as in the monk's tonsure, whence the name tinea or herpes tonsurans.
Oscar ——— was brought to me in 1878, with a patch of disease an inch and a half in diameter, circular, situated on the front part of the top of the scalp. The surface was of a dirty gray color, covered with a moderate amount of scales, and could readily be noticed at a distance by the absence of hair upon it; or, rather, it should be said, by the presence of short, stumpy hairs, perhaps a sixth of an inch long, in marked contrast to the hair on the rest of the scalp, looking as if they had been nibbled off. Several smaller spots were discovered on the left side of the head, on closer examination by lifting up the hair, otherwise they could not be seen. These patches did not show the cropped appearance of the hair so markedly, for although there were broken-off hairs there were also many long
- ↑ The very favorable reception which was accorded to the "Notes on the Local Treatment of Certain Diseases of the Skin," until most of the diseases which are at all common were gone over, in previous issues of the Archives, leads the editor to continue this plan of serial writing for general practitioners in the way of "Clinical Illustrations of Diseases of the Skin." It is intended in these to give plain and practical comments on dermatological topics based on illustrative cases taken from private and public practice; some of the matter at times being that delivered in clinical lectures at the New York Hospital. The diseases will, as far as practicable, be treated of in the order in which they occur in the classification at the beginning of the Digest Department. These notes are continued from page 60, Vol. VI.
