On the existence of 'dermatitis herpetiformis' (of Duhring) as a distinct disease / by L. Duncan Bulkley.

  • Lucius Duncan Bulkley
Date:
1886
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Licence: Public Domain Mark

Credit: On the existence of 'dermatitis herpetiformis' (of Duhring) as a distinct disease / by L. Duncan Bulkley. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    3. Does this name, dermatitis lierpetiformis, best express the nature and character of the disease? In answer to the first-question, I would saytliatthe more I see of these cases of multiform, inflammatory eruption, with itching, the more im- pressed I am that we are as yet unacquainted with their nature and cause, and. the more certain I feel that there must be some grave nervous disor- der as a ])rime factor in tlieir etiology; probably some changes will be found in tlie nervous centres or trunks, as in herjies zoster and pemphi- gus. Whether the cases all own the same, or even a similar cause, can- not by any means be determined, much moi'e study, both in the direc- tion of clinical record and pathological research, is necessary before their entire history can be written. I believe, however, that such cases as that I have detailed, and some (>f those reported by Dr. Duhring and others, belong to a class of disease which has not hitherto been recognized in our text-books, and I quite agree in grouping them together under one designation, and in recogniz- ing them hereafter as representing a particular disease; although I think that later we shall find it desirable to isolate individual instances exhibit- ing peculiar elements of causation. Whether we are, however, con'oet in creating a single disease out of the varied pathological changes tlius far mentioned, iri'espective of their varied causation, appears to be as yet somewhat problematical. Closely connected with this is our second question, whether we ad- vance any nearer a right understanding of the nature, cause, and cure of these cases by thus grouping thein together under a single name. As we have seen. Dr. Duhring claims that quite a number of affections, hither- to regarded as distinct, and described under different names, such as herpes gestationis, pemphigus pruriginosus, hydroa, and the like, are all to be regarded as but phases of this complaint, dermatitis herpetiformis, asserting most positively that tlie impetigo herptiformis of llebra, which was always observed in connection with the parturient state, and was almost invariably fatal, is certainly only the pustular variety of this one great disease, which he never observed to be fatal. Until much more light is thrown on the etiology and pathology of all these affections, it would seem that we lose rather than gain by considering them togethei-, for the conditions under which they have been observed are so entirely dissimilar. It is difficult from Dr. Duhring^s statements to discover just how far he would go in claiming cases which others would recognize as erythema multiforme, urticaria bullosa, herpes iris, liydroa, pemphigus, or even eczema, to be illustrations of the different aspects of dermatitis herpetiformis. It would, of course, be very convenient to have one grand disease into which anomalous and polymorphous eruptions could be thrown, but the very serious question arises whether, by thus contenting