neck. In impetigo of the head and face the cervical and submaxillary glands are very apt to become enlarged and tender, and in strumous, ill-nourished, and neglected children glandular suppuration may occur. Among this class the affection frequently coexists with paronychia and ulcers of the conjunctiva and buccal mucous membrane. It is said to occur with especial frequence in female children and in the spring, although neither sex nor season is exempt.
The upper illustration in the accompanying plate shows crusted lesions upon the forehead and scalp, and a secondary conjunctivitis which has closed the right eye. Upon the hand a number of incipient pustules are seen, excoriated upon the fingers, but tolerably well developed upon the wrist. Upon the forearm, in the lower illustration, a few typical flattened and umbilicated lesions may be seen, while upon the arm an ecthymatous patch has resulted from the coalescence of several scratched and crusted lesions. In Fig. 10 the eruption presents its characteristic appearance in the form of numerous isolated crusted lesions. In Fig. 11a few lesions have coalesced upon the lips and formed a large, crusted patch resembling impetiginous eczema. In Fig. 12 the lower lip is similarly affected, while upon the forehead the isolated lesions present a typical appearance.
While the individual lesions of contagious impetigo run an acute course of a week or ten days, the development of new lesions and the irritation produced by scratching often keep up the eruption for many weeks. In its treatment cleanliness is of the utmost importance, especially as the affection is most likely to occur among children whose ablutions are neither frequent nor thorough. The finger nails may be advantageously cleansed and cut, and a disinfectant lotion, such as listerine or a saturated solution of sodium hyposulphite in rosewater, should be applied frequently to the affected skin. To remove crusts and heal superficial ulceration an excellent application is a mixture of equal parts of white precipitate ointment and cold cream.
