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

  • Lucius Duncan Bulkley
Date:
1886
Catalogue details

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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    Alfred S., aged 24, a blacksmith, of muscular build and very intelli- gent, presented himself at my clinic at the New York Hospital, Novem- ber 25, 1885, suffering from a chronic, universal, multiform, and intensely itching eruption, and gave the following history. His parents, who were Irish, came to this country in 1850 ; a number of his mother’s family and his cousins died of phthisis, and his father died of the same complaint; his mother is living and liealthy. One brother, who died at twenty-four, was exceedingly nervous and irritable, having strange attacks, almost of temporary insanity. The patient has chewed tobacco excessively since he was nine years old, and also drank very heavily from eighteen to twenty years of age. Wlicn thirteen years old he began to masturbate, and practised this excessively-until sixteen years of age, and probably later. He worked in a blacksmith shop from fifteen to seventeen, and then took up rag-carpet weaving for three years, after which he returned to blacksmithing. The eruption (irst appeared in the summer, five years ago, when he was nineteen years of age, and has continued, almost without interrup- tion—that is, with periods of improvement and relapse—up to the pres- ent time. It began during the period when he was working very hard, for nearly twelve hours a day, at carpet-weaving, and while he was chewing a paper of tobacco daily and drinking heavily, both in the day- time and during the evening. It may be mentioned that his work was done in a sitting posture, with both legs and arms actively engaged. The first symptoms of his disease consisted of intense itching, with the sudden development of successive crops of what he described as white pimples,” apparently vesico-papules, present over much of the surface, except the head, which has been involved only within the past year. During the hot weather, when the eruption first appeared, the patient perspired profusely across the chest, and affirms that his under- shirt was always stained a peculiar greenish color by the perspiration ; this phenomenon he had never observed before or since. 'L’he eruption has generally been somewhat worse in the summer time. While it has affected at times most of the surface of the body and limbs, it has appeared most profusely upon the buttocks and the lower abdomen and groins, extending even upon the penis. The patient has himself re- marked tlie multiform character of the eruption, it often changing its form to boils and abscesses, as he says, and at other times ])resenting ulcerations, the result of scratched lesions. The itching has always been most intense during the day, and to relieve this he at one time took con- siderable liquor, which seemed to have a temporary benumbing effect; beer was always found to have a worse after-effect than spirits. He had tried the greatest variety of treatment, but all with only temporary, if any, benefit. When first seen (November 25, 1885), both forearms and elbows were covered with small, shining papules, a few of them showing vesiculation, from which a drop of clear serum could be squeezed. The thighs were thickly sprinkled with reddish blotches of various sizes, some over half an inch in diameter, many of them not elevated above theskin, and rep- resenting only pigmented stains, while others were more or less elevated and represented the remains of the inflammatory bases and areolte of for- mer pustules. The loins and buttocks were also the seat of eruption, presenting hat, adherent crusts on slightly inflammatory bases. There