constitutional symptoms, and the weakness resulting from a continued loss of blood sometimes leads to a fatal termination.
Another form of the disease is associated with severe arthritic pains and the appearance of elevated purpuric lesions, especially in the vicinity of the affected joints. This is termed purpura or peliosis rheumatica. This affection usually runs a brief course, although a repeated onset of fever and rheumatic pains, followed by cutaneous hemorrhages, may protract it for months. It commonly attacks those who have a rheumatic tendency but are otherwise apparently well.
There is little difficulty in the diagnosis of purpura, as the color of the lesions is characteristic and their hemorrhagic nature can be readily demonstrated by the pressure of the finger. It is well to remember, however, that cutaneous hemorrhage is not infrequently an accompaniment of the eruption in severe cases of the common exanthemata.
In the treatment of mild cases of purpura, rest in bed, with a nutritious diet and administration of the tinctura ferri chloridi, is generally followed by a prompt recovery. In severe cases, especially of the Hemorrhagic type, iron, turpentine, and ergot are commonly employed with good effect. Ergot may be given by the moath or by hypodermatic injection. For the latter purpose a grain of ergotin may be dissolved in warm water and glycerin, and injected with such frequency as the exigencies of the case may demand.
Molluscum is a term which has been applied to two distinct affections having no pathological relation to one another. One is the molluscum fibrosum of older writers, which is now commonly designated as fibroma. The other is the molluscum contagiosum, which was first described by the English dermatologist Bateman early in this century. The latter is a somewhat rare affection of the skin, but of much more frequent occurrence in childhood than in adult life. It consists of one or more small, flattened whitish tumors, varying in size from a pin's head at the outset to a split pea when fully developed. These little growths are sometimes pedunculated and usually present a central depression, from which a whitish substance can be readily pressed out. This looks like ordinary sebaceous matter, but under the microscope is found to contain certain oval corpuscles which are a characteristic of the disease.
The tumors are commonly seen upon the face and neck, but may occur on various portions of the body. They are usually multiple, sometimes numerous, and, though unsightly, are never the source of any particular discomfort. They develop slowly and last indefinitely. Each begins as a minute elevation of a whitish color, and gradually the flattened summit and umbilication develops. When of full size the walls are sometimes traversed by fine blood vessels which give the tumor a pinkish appearance.
The disease is often called molluscum contagiosum, and, though its contagious character is not always apparent, it has
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Fig. 56.—Molluscum.
been known to affect several in a family or in a ward of a children's hospital, and attempts at artificial inoculation have sometimes been successful. It is doubtless of microbic origin, but the conditions favoring its development are as yet obscure. It is especially liable to affect children of a poorer class, and hence is much more common in dispensary than in private practice. Damp and crowded dwellings seem to favor its development, and in dispensary practice I have known a number of cases to originate in the same locality. Children suffering from molluscum are especially prone to have warts upon the hands.
The diagnosis of molluscum is usually made with ease by any one at all familiar with the appearance of the tumors. Large milia upon the face might be mistaken for them; but these tumors are rounded, of much firmer consistence, not likely to occur in groups, and always lack the characteristic flattened surface and central umbilication.
The treatment of molluscum is simple and effective. Many of the tumors, after a duration of a few weeks or months, undergo a process of destructive inflammation, and a spontaneous cure results. This is especially apt to be the case when two are close together and coalesce as they increase in size. If a tumor is vigorously compressed and the contents evacuated it will usually disappear. Incision and cauterization, or abscission by means of a sharp knife, have been recommended, but the simplest method of removing the tumors is to scrape them quickly with a curette and to lightly touch the bleeding surface with nitrate of silver. The main object in treating these tumors is to destroy them completely and to excite as little inflammation as possible in so doing. When even a large molluscum is removed by means of the curette no scar or trace of the growth is usually left, since the tumor is an outgrowth of the epidermis and does not involve the true skin. But when an inflamed molluscum is scratched or irritated to the extent of inducing a purulent secretion, a slight pit may be expected to result.
Keratosis follicularis is an affection not infrequently seen in childhood, especially among children who are poorly cared for. It is the result of an abnormally dry condition of the skin and the accumulation of epidermic scales in the hair follicles. This produces an eruption of small, conical papules, which are commonly found upon the outer aspect of the extremities. These are usually of the color of the skin. Sometimes they are discolored by dirt, and in some cases they become inflamed and present a dull-red hue. The fine hairs growing upon the affected skin are often broken off or coiled up in the follicles. When the disease is severe and of several years' duration the .skin has an ichthyotic appearance and to the touch feels like a nutmeg grater. The disease is described in some text books under the name of lichen pilaris or keratosis pilaris, but the follicle is primarily involved and not the hair. Recently the term keratosis follicularis has been applied by some writers to