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Lorsque Ie document est trop grand pour Atre reproduit en un seul cllchA, ii est filmA A partir de I'angle supArieur gauche, de gauche A droite, et de haut en bas, en prenant Ie nombre d'images nAcessaire. Les diagrammes sulvants lllustrant la mAthode. 1 2 3 1 2 9 4 S 6 li •wf i\ Re-printed from the "Canada Medical & Surgical Journal," Montreal, December, 1880. CA.SE OF LICHEN SCROFULOSDM IN A FEMALK. By FRANCIS J. SHEPHERD, M.D., CM., M.R.C.S., Em. Surgeon to the Out- Door Department of the Montreal General HoRpital ; Demonstrator of Anatomy, McGill University. The following case, both on account of its rarity and interest, I think worthy of being placed on record : — Sophie B., aged 22, unmarried, well nourished and healthy looking, came under my care on the 20th April, 1880, suffering from a skin eruption of the hands, which had lasted for three years. She had been treated by various physicians without any improvement, for as fast as the old spots disappeared new ones came out. On examination I saw that the eruption was con- fined to the hairy parts of the dorsal surfaces of the first phalanges and the hairy parts of the back of the hands, and consisted of a number of groups of minute papules of a brownish red colour. Each papule surrounded a hair follicle ; the papules were quite dry and the patient said, never ran water. Rubbing the hand over the eruption it felt exactly like a nutmeg grater. She told me that occasionally it was very itchy, but as there were no excoriations or black cruste of dried blood I judged that this could not be a prominent symptom. The lymphatic glands of the neck and submaxillary region were much enlarged. i \ *, ^ Lungs, on examination, were perfectly healthy. Recognizing the case as one of Lichen Scrofulosum I prescribed cod-liver oil in doses of a tablespoonful three times a day, and also directed her to keep the oil continually in contact with the skin by rub- bing it in several times a day, and covering the hands with woollen gloves. * In two weeks she returned, the eruption was much in the same condition, but in addition to the papules, several bluish red tubercles, characteristic of the disease, were seen, about the size of split peas, and some large pustules which she told mo had commenced as these bluish tubercles. There were also num- bers of pigmented spots, the remains of old papules. I advised her to continue the same treatment, and explained to her that the cure, though tedious, was tolerably certain. I forgot to mention that in addition to the eruption on the hands a few papules had come out on the extensor surfaces of the legs, to which I directed her to apply cod-liver oil. I saw her again on June 1st, at which time her condition was much improved. The eruption had entirely disappear3d from the right hand, leaving spots of slight discoloration ; on the left hand the eruption was fiiding, and no new papules were coming out, the only parts affected were the back of the first phalanx of the thumb and the back of the hand near the wrist. The en- larged lymphatic glands in t';o neck were much reduced in size. On June 22nd the eruption had entirely disappeared both , from the hands and legs, and there was no return when last seen early in November. The patient, by thus persevering in ilebra's cod-liver oil treatment for three months, had got rid of an erup- tion which had tormented her for over three years. Remarks. — Hebra was the first to describe this form of Lichen which he always found associated with a scrofulous diathesis. In his work on Diseases of the Skin*, Ilebra states that he had seen over fifty cases, all in males, between 15 and 25, and that this eruption occurs chiefly on the trunk, being rarely seen on the limbs. Now this case is remarkable from •New Sydenham Society's TmnHlation, vol. II., p. 64. a the eruption being confined to the limbs, and also from its occur- ring in a female. The only other case I ever saw of Lichen Scrofulosum in a female was under the care of Mr. Waren Tay at the Stamford Street Skin Hospital in London, and, strange to say, in this case also the eruption was principally on the backs of first phalanges and hands ; it was associated, if I remember correctly, with general psoriasis. Having seen the above men- tioned case, greatly facilitated my diagnosis in this one.