Notes of a case of dermatitis herpetiformis during thirteen years / by Louis A. Duhring.

  • Louis Adolphus Duhring
Date:
[1884]
Catalogue details

Licence: Public Domain Mark

Credit: Notes of a case of dermatitis herpetiformis during thirteen years / by Louis A. Duhring. Source: Wellcome Collection.

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    patient was placed upon a saline laxative mixture, together with full doses of the tincture of chloride of iron. No local treat¬ ment was ordered. The case remained under observation three months, and, according to the notes recorded, the patient was in about the same condition at the expiration of this period as upon admission; the skin, however, underwent several decided changes during the three months, having been on one occasion almost well, but the lesions soon reappeared. The disease did not seem to be in the least degree influenced by treatment, whether internal or local, new pustules, small and large, appear¬ ing from week to week. In November, 1874, he ceased attend¬ ing the dispensary, much discouraged. The diagnosis was as obscure at this time as on admission. In January, 1879, four years after the foregoing note, he presented himself for treatment at the Hospital of the Univer¬ sity of Pennsylvania. I at once recognized my former patient of the Dispensary for Skin Diseases. He stated that he was still afflicted, but that until recently it had existed in a milder form, and that he had experienced intervals of from one to six months of comparative freedom, but he had never been entirely free of eruption. The general health had failed considerably, the nervous system had become more disturbed, and he was habitually constipated. During the four years he had employed various internal and local remedies, but without benefit. The general course of the disease had been about the same as when under observation four years before. He had noted four kinds of lesions, which would manifest themselves together or in different attacks of eruption; these were true pustules, contain¬ ing from the beginning a whitish puriform fluid, and of variable size, from a pin-head to a silver quarter-dollar; vesicles, con¬ taining a clear yellowish fluid, likewise of variable size; blebs, varying in size from a split pea to a half-cherry; and, lastly, papulo-vesicles, acuminate in form, and exuding a small amount of a serous, gluey, gummy product. The “ watery blisters,” as he termed the vesicles and blebs, had, on every occasion of their appearance, been very itchy; the pustules itched but little. The vesicles and blebs grew rapidly, reaching their full size in a few days, and were accompanied by but slight inflammation about
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