of the patient. Mr. SOUTH has given a good resemble those of fishes; but psora is more sudigest of surgical opinions on this topic, with perficial and variously figured, and throws out his own advice, and to his translation of CHE- furfuraceous bodies." (Translated by ADAMS, LIUS's system of surgery I refer the reader re- vol. ii., p. 15.) Mr. ADAMS concludes his respecting it. I should, however, add that, wheth-marks respecting the views of the ancients as er the abscess be opened or not, the issues and to these affections as follows: "It will be reconstitutional treatment I have recommended, marked that the Leuce of the Greeks, the leuce with opium and other aids, and alternated, mod- and fourth species of impetigo of CELSUS, and ified, or changed, as circumstances may require, the albarras of most of the Arabians, are the ought to be persisted in throughout the disease. same as the lepra vulgaris of Drs. WILLAN and BIBLIOG. AND REFER.-Ludwig, De Abscessu Latente. BATEMAN; that the alphos of most of the Greek Lips., 1758, v.-Haller, Biblioth. Chirurg., ii., p. 629.-De authorities and of CELSUS, and the morphia alba Haen, Rut. Med., part iv., p. 135.-P. Pott, Chirurgical of most of the Arabians, correspond with the Works, 8vo. Lond., 1783, vol. iii.-Smith, in Med. Facts and Observat., vol. iv. Plenciz, Acta et Observat. Med., lepra alphoides of our English nosologists; that p. 159.-T. Kirkland, An Inquiry into the present State of the melas, alphos niger, and common lepra of Medical Surgery, 2 vols. 8vo. London, 1783, vol. ii.-J. the Greeks, CELSUS's third species of impetigo Pearson, Principles of Surgery, 8vo. Lond., 1788.-Latta, Practical System of Surgery, vol. i. and iii., ch. 3.-Meckel, and his melas, and the morphia nigra and imDe Psoitide. Halae, 1796.-Salzb. Med. und Chirurg. petigo of most of the Arabian translators, apply Zeitung, 1801, b. ii., p. 210.-A. F. Vogel, Chirurgische to the lepra nigricans of our modern arrangeWarnehmungen, b. ii., p. 9.-Tomlinson, in Med. Observ. and Inquiries, vol. v., p. 163.-Wilson, in Lond. Med. and ment; and that the psora of the Greeks, CELPhys. Journ. July, 1802-Ricardo, in ibid. Sept., 1802. SUS's second species of impetigo, and the sca-J. Abernethy, Surgical Works, 2d ed. Lond., 1815, vol. bies of OCTAVIUS HORATIANUS, and of most of ii., p. 137.-A. Cooper, Lectures in Lancet, vol. ii. Lond., the Arabian translators, comprehend both the 1824.-W. Lawrence, in ibid., vol. i., 1830. — - Dupuytren, Leçons Orales, t. i.-S. Cooper, Surgical Dictionary, Lum- psoriasis and scabies of WILLAN and BATEMAN. bar Abscess.-M'Dowell, in Dublin Journ. of Med. Sciences, Since many of the ancient authorities speak of vol. iv., p. 9, et seq. (Abscess communicating with the Ilium, and opening externally near the Spine of the Ilium; scabies as being infectious, they must have apalso, Cases of associated Hip Disease and Psoas Abscess.)-plied the term to the true itch, with which it is W. Coulson, On Dis. of the Hip-joint, 4to. Lond., 1837, p. 71.-W. O. Chalk, in Lond. Med. Gazette, vol. xxvii., p. 103, 146.-J. M. Chelius, A System of Surgery. Translated, with Additions, &c., by J. F. South, 2 vols. 8vo. Lond., 1845, vol. i., p. 185. [AM. BIBLIOG. AND REFER.-See Mott and Townsend's Velpeau, Am. ed. of South's and Chelius's Surgery, Reese's PSORIASIS AND LEPRIASIS.-SYNON. CLASSIF.-4. Class, 8. Order (CULLEN). 1. DEFIN. A chronic inflammation of the skin, either limited to a particular region or extended more or less over the surface, appearing first with slight elevations, which change into scaly patches; the patches of psoriasis being of different sizes, not depressed in the centres, but with irregular and very slightly raised edges; those of Lepriasis being generally rounded, slightly depressed in the centres, and surrounded by slightly raised and reddish circles. 2. Both Psoriasis and Lepriasis or Lepra were considered as modifications of the same disease by most of the ancients, and they are treated of by PAULUS EGINETA by the terms "Leprosy and Psora." He states that "both these affections consist of an asperity of the skin, with pruritus or wasting of the body, having their origin from a melancholic humour. But leprosy spreads over the skin more deeply in a circular form, throwing out scales which not likely, as RAYER maintains, that they were wholly unacquainted. The earlier modern writers, as those of the Schola Salernitana, PLATERIUS, GUY OF CAULIAC, and LANFRANCUS, jumble together the Latin and Arabian names, so as to produce no ordinary degree of confusion." (Op. cit.. vol. ii., p. 21.) 3. I. CAUSES.-The causes of the several varieties of both Psoriasis and Lepriasis are the same, or the same causes are common to both these species.-A. The predisposing causes are chiefly hereditary conformation, the melancholic temperament, and an habitual languor and weakness of the circulation in the integuments, with dryness of the skin. These affections occur at all ages and in both sexes, but somewhat more frequently in adults and in those advanced in life. The influence of sex is not great, some writers stating that they are more frequent in females, others in males. They are both constitutional maladies, and are often connected with disordered abdominal functions, both at their origin and in their course. They are sometimes connected with the gouty and rheumatic diathesis, and they may appear at any season, but more frequently in spring and autumn: lepriasis oftener in autumn. Prolonged or neglected dyspepsia; inattention to the states of the bowels and of the intestinal secretions and excretions; the habitual retention or accumulation of fæcal matters, improper and insufficient food; mental anxieties, and sexual excesses also predispose to these eruptions. 4. B. The occasional exciting causes are the use of salted, dried, smoked, or otherwise preserved meats and fish; the frequent use of shell-fish; irregularities and improprieties of diet, the use of pork or the flesh of the wild boar, bacon, hams, &c.; drinking cold fluids when the body is perspiring; vicissitudes of temperature and weather; poor, innutritious, or unwholesome food; exposure to cold or moisture, and living in low, damp cellars or localities; prolonged anxiety of mind; the frequent use of heating and stimulating food, sau ces, spices, condiments, pickles, preserves, acids, | or spirituous liquors; debaucheries or excesses of any kind; the want of sufficient personal cleanliness; and the irritation produced by various substances employed in several of the useful arts. 5. The contagious or non-contagious nature of these eruptions has long been a topic of dispute, especially as they appear in countries bordering upon the Mediterranean Sea. My friend and colleague, Mr. DENDY, has considered the subject very fully in his unpublished work on these maladies, which he kindly allowed me to peruse; and concludes that in this country they are not contagious. WILLAN has observed that psoriasis guttata and annulata affect several children about the same time in large families and schools, especially those who sleep together; and the same remark is made by Mr. E. WILSON and others. The simulation of contagion must, however, arise from the constitutional predisposition to these eruptions undoubtedly existing in some families, and from the simultaneous operation of the same exciting causes. The topic, however, deserves farther investigation. in others, but also originate in the same or similar causes, will be farther admitted. Nor are their causes only the same, their constitutional nature, their associations, and their tendencies are also the same or closely similar. Still, it becomes necessary to describe those differences which may be remarked in their external characters, and which enable us to recognise as well as to classify them. The intimate connexion subsisting between these eruptions is shown by the circumstance of their presenting, in some cases, the distinct features of psoriasis in one part, and in another part those of lepriasis; and it occasionally happens that pityriasis of very long duration, or the acute or inflammatory form of that species, when it becomes very chronic, assumes the form either of psoriasis or of lepra, while lepra of long duration often passes into the form of psoriasis inveterata. The three species of eruption, moreover, require the same constitutional and local treatment. For these and other reasons mentioned when treating of tubercular leprosy, or the leprosy of the Arabians and Middle Ages (sce art. LEPROSY), I have viewed lepra as merely a species belonging to the same genus as psoriasis and pityriasis; and have treated of psoriasis and lepra in connexion, their causes, pathology, and treatment being the same.* * 6. I have observed these eruptions more frequently in unmarried than in married females. They are often dependent upon impaired digestion and assimilation, and upon equally imMy colleague, Mr. DENDY, whose experience in the paired function of the skin, kidneys, and intestreatment of these eruptions is very great, has endeavoured tinal canal, the blood thereby abounding in im- to clear up the confusion, existing even down to the present perfectly assimilated chyle and in effete mate- day, respecting squamous diseases. He has arranged psorials. I have seldom observed them in females riasis, lepra, and the inflammatory form of pityriasis as species constituting one genus," Lepriasis," and has assign whose catamenial discharges were quite reg-ed to each species what he considers its synonyme in anular and sufficient, these discharges, when cient and modern authorities. His views, as well as his healthy, being manifestly depurative as respects descriptions, are most deserving attention. I give his arrangement, but I take the liberty of placing his species, the circulation, and no mean preventive of "Lepriasis furfurans," or acute pityriasis, before the other chronic cutaneous eruptions. Many modern more chronic and severe species, consisting of psoriasis and pathologists have viewed both psoriasis and le- lepra. priasis as symptomatic of gastro-intestinal irritation. That there is more or less disorder of the digestive canal in most cases of both these eruptions must be admitted; but it does not strictly follow that this disorder consists of inflammatory irritation. It is generally functional merely a defect of function as much as disorder of function, the digestive and assimilative derangement and the cutaneous affection proceeding from the same source, viz., impaired organic nervous power, the cutaneous disorder only being the last of the series of functional and morbid changes. 7. Every arrangement of the scaly eruptions must necessarily be, to a certain extent, conventional, and be based on the more prominent phenomena and differences which they present. The chief points of difference have thus become the most familiar, as being the most commonly noted and represented, while the gradations by which the one variety and species pass into the other are so far kept out of view as to be either overlooked or unacknowledged. That this is the case more especially with the three species of scaly eruptions to which the terms of pityriasis, psoriasis, and lepra have been applied is not to be doubted by any one whose knowledge of them has been acquired from observation, and not from writers who have been more anxious to create distinctions than to trace resemblances. That these three species of eruption do not merely present points of resemblance in most cases, and even of identity LEPRIASIS.1-SYNON. Zaraab, H.-Kouba, Kuba, Al kauba, Ar.-Aenpai, Gr.-Lepra, W.-Lepidosis lepriasis, VAR. Centrifugal; Crescentic; Gyrated. VAR.-Confluent, &c. SPEC. v. LEPRIASIS INVETERATA.-SYNON. Bahereth lebena, H. (Translated plague of leprosy.)-Beras begas, Ar.-Acukη, Gr.-Agria.-Bright white leprosy.-Lichen agrius. Pellagra. — Acrodynia. - Psoriasis inveterata, W.-Dartre squammeuse invétéré: Lichenoide, Al.-Lepriasis Candida, G.-Inveterate dry scall. VAR.-Scabida; Indurata; Prominens. 1 The capital letters following the synonymes represent the authorities. Al. Alibert.-Ar. Arabians.-C. Celsus.G. Good.Gr. Greeks.-H. Hebrews. - R. Rayer.-W. Willan. 11. Diffuse psoriasis may occur in a single patch, of various sizes, or in several and upon any part of the body; but most frequently on the fore-arms, or about the elbow and wrist, and, unlike lepra, chiefly the fleshy parts of the limbs. Its duration is always chronic; even its mildest states may continue for weeks or months, and the severest forms may remain for months or years. 12. Diffuse psoriasis, when extensive, is often preceded by symptoms of constitutional disorder; especially indigestion, costiveness, languor, and debility, which frequently subside as the eruption is developed, but which often recur. The eruption is generally attended by slight pruritus, and by pain and tenderness after the removal of the scales, or when the patches are fissured or chapped. It occurs chiefly in adults and the middle-aged. 13. b. This variety has, in rare instances, assumed a gyrated form-Psoriasis gyrata, or that of narrow bands, or curved or tortuous lines. BIETT describes it as long, narrow, tortuous stripes, resembling worms; and sometimes bending into rings, occurring generally on the back, or trunk of the body. These stripes are covered by very delicate epidermic scales, which exfoliate, and are reproduced as in the other forms of this variety. They are attended by a slight pruritus, and but little inconvenience. In very rare cases the eruption assumes an annular form, especially about the neck and face of delicate persons, and is very slight. 8. II. DESCRIPTION.-i. PSORIASIS GUTTATA. | slightly elevated above the surrounding skin, -SYNON. Lepra alphoides; Lepriasis albida, intersected by furrows which correspond with Good. Psoriasis discreta, Rayer. Dartre squam- those of the epidermis, and often fissured by meuse orbiculaire, Alibert. Lepriasis guttata, several deep chaps. The patches are covered Dendy. Guttated dry scall.-Psoriasis, even in by numerous thin epidermic scales, the remothis the mildest of its forms, is often preceded val of which is rarely followed by any fluid exor attended by symptoms of indigestion, lassi- udation. The eruption often assumes the chartude, and inaptitude for physical or mental ex- acters of the guttated or discrete variety over ertion; but these are often so slight as to be different parts of the body, and the diffused overlooked. In this variety numbers of small, form around the joints and extremities. distinct elevations or papulæ occur, sometimes appearing at first of the size of a pin's head, their summits soon becoming covered with a minute scale of a dull white colour. These elevations are generally, at first, from two to three or four lines in diameter, irregularly circumscribed, and generally rounded. They increase somewhat in size, but always remain distinct, with the skin sound between them. When freed from the squamæ on their surfaces, they appear red and irritable, forming rounded spots or patches, from two to four or five lines across; and are slightly prominent, and of a brownish red hue. These patches occasionally heal, like those of lepra, from the centre to the circumference; and in this case they present slight depressions in the centres, and acquire a yellowish dusky tint. The scales formed on their surface are reproduced as soon as they are removed. As they decline, the patches often are transformed into segments or arcs of circles; and when quite removed the skin presents small stains of a grayish brown | or yellowish hue in the spots occupied by them. 9. This variety is seldom accompanied with much pruritus, unless when the body is heated by exercise, or by stimulating or heating food and drink. It may be confined to the hairy scalp, face, trunk, or extremities; or be disseminated over these regions, appearing either at once upon all of them, or upon each in succession. The patches or spots are generally irregularly disseminated, being crowded in one situation, and thinly scattered in others; but they are more numerous in the line of exten- 14. c. In children, diffuse psoriasis is occasion in the extremities than in that of flexion. sionally seen in a sub-acute form-Psoriasis inGuttated psoriasis appears most frequently infantilis, WILLAN. It appears from two or three spring and autumn, and often disappears in summer or in winter. It may thus recur for many successive years. It is not infrequent in children, and is more quickly evolved in them, often with slight fever. It is more prevalent in adults than in children and old persons. It often presents characters intermediate between psoriasis and lepra. It sometimes coexists with one of the other forms of psoriasis, and I have seen it associated with pityriasis. When it affects the fingers, it often implicates the nails. 10. i. PSORIASIS DIFFUSA. SYNON. Psoriasis confluens, Rayer. Lepidosis psoriasis, Good. Lepriasis diffusa, Dendy. Spreading dry scall; scally tetter.-a. In this variety the patches are of large size, of variable extent, and irregular form. They are developed either by a number of small elevations, like the preceding variety, which run together and form one continuous patch, or by a papular roughness of a patch of the epidermis and congestion of the subjacent dermis, or by several patches, which speedily increase in size and coalesce. In each of these modes the patches may require two or three weeks to be fully formed. The surface of each is usually then of a dull red colour, rough, and | months to two or three years of age. It is more acute, is attended by more pruritus and smarting, and is much more rapid in its progress than in adults. The surface of the patches, which are often large, is intersected by numerous fissures or chaps, and often excoriated by friction; the excoriations exuding an ichorous fluid, which dries into hard scabs of con. siderable size. In infants and children this eruption may be attended by phlyzacious pustules, by a morbid secretion from the nostrils, by loss of the hair of the eyebrows and the eyelashes when the forehead is affected, and by hardened elevations of a reddish hue. 15. iii. PSORIASIS INVETERATA.-SYNON. Lepriasis candida, Good. Dartre Squammeuse lichenoide, Alibert. Lepriasis inveterata, Dendy. Inveterate dry scall.-When either discrete or confluent psoriasis has continued months, or years, or sometimes after the more inflammatory form of pityriasis has persisted long, especially when the eruption is hereditary, or occurs at an advanced age, or attacks a debilitated or shattered constitution, or is consequent upon protracted functional disorder of the digestive organs, then the eruption assumes the erate form, or with psoriasis palmaris. As respects the characters of the eruption, there are no differences produced by these localities. But swellings of the inguinal glands are often caused by the appearance of the eruption in these situations; and care should be taken not to confound it with venereal affections. form thus named. It may be regarded as an aggravated form of psoriasis diffusa. Inveterate psoriasis usually extends over a large surface, occupying the most of the limbs, and of the trunk; the face, the palms of the hands, and the soles of the feet being free. The skin is thickened, congested, hot, dry, and harsh. It is stiff, fissured by deep cracks, and covered 19. (d) Palmar psoriasis-Psoriasis palmaris-by epidermic scales and scabs, which are thrown may be either distinct or confluent; but in eioff in great abundance. Pruritus is very trou- ther form the elevations are generally broad, blesome in this variety, and is increased by the of a pale reddish hue, and the seat of much heat heat of bed and by a heating regimen. The and itching. If the elevations are numerous thickening of the integuments restrains the they become painful, and interfere with the pamotions of the limbs and flexions of the joints. tient's occupations. In the confluent form the When the surface is abraded or excoriated by palm of the hand swells, and presents a unifriction or otherwise, a fluid exudes which con- form brownish red colour. As the eruption cretes into scabs. When this eruption affects becomes more chronic, the heat and itching are the scalp, the scales collect in numbers; and less troublesome, the cuticle covering the elewhen they are removed, an ichorous fetid ex-vations grows thicker, acquires a yellowish hue, udation takes place from the reddened surface. dries up and becomes friable, and at last of a When it extends to the hands, the nails are re-dead white on the surface of the patches. The markably affected; but in some cases I have observed the affection of the nails without the fingers being otherwise implicated, and have imputed the disease of the nails to the infection of the fluid exuded from the surface scratched by them. The constitutional disturbance may be but slight even in the severest cases, particularly in respect of febrile symptoms. But the functions of the stomach, liver, and bowels are often languid and torpid, and the several depurating actions impaired. The duration of this variety is always prolonged and indeterminate. In old persons it continues for the rest of life. epidermis then cracks, and is detached either spontaneously or by the nails of the patient, and leaves a new epidermis, through which the corion appears red and vascular. The epidermis surrounding the diseased patch also undergoes a change, being thicker than usual, of a dirty yellow tint, and subsequently becoming dry or mealy on the surface. It finally exfoliates irregularly, at first adjoining the older patches, and then in the flexuses of the joints and natural folds of the palm. The desquamation is always irregular, and very different in appearance from that of the next variety, the psoriasis palmaris centrifuga; but, like it, and even more constantly, is attended by linear fissures, which penetrate to the quick in the lines of the palms, and by smaller cracks or fissures which extend less deeply. 16. LOCAL STATES OF PSORIASIS.-(a) Psoriasis may occur primarily on the hairy scalp; but it is more frequently consequent upon the eruption in some other part, or upon neglected pityriasis. It is oftener seen in the distinct 20. (e) Centrifugal palmar psoriasis is less form; much more rarely in the confluent. In common than the preceding. It begins in the rare instances it has extended over nearly all palm by a single elevated spot, solid, and of the scalp, extending to the forehead in a line small size, upon which a small white scale is parallel with that of the hair. The inflamma- formed. Around this elevation a series of red tion sometimes attacks the bulbs of the hair, eccentric circles are produced, each in succeswhich become detached in the patches affected.sion, and are covered by epidermic scales, 17. (b) The face is rarely affected alone, the eruption generally appearing also in some other part. The patches on the face are usually red and furfuraceous, the scales being light and thin. On the eyebrows and eyelids it appears, as everywhere else, by the formation of papulæ. The eyelids become stiff, and slightly fissured or chapped, and these changes are followed in children by the loss of the ciliæ and the hair of the eyebrows. It rarely affects the lips, as true psoriasis, but generally in a form that more strictly belongs to pityriasis. which exfoliate. As these circles appear, each successive one is more eccentric, until the whole palm is implicated, and each undergoes desquamation. Squamous patches also appear on the palmar aspects of the fingers. The palmar integument is reddish where the exfolia, tion of the scales has taken place, is thickened, and fissured by numerous chaps, some of which, upon opening the hand, which is painful and stiff, sometimes exude a little blood. 21. Both these forms of palmar psoriasis are of long duration, they seldom continuing for a 18. (c) Psoriasis genitalium is not infrequent, shorter time than several months, and often and either the prepuce, or the scrotum, or the persisting for years. They often decline in labia majora vulva may be the seat of the erup- summer and autumn, and are exacerbated in tion. In either of these situations it presents winter and spring, for a number of years. Palthe characters already described. It seldom mar psoriasis is sometimes complicated with appears in any of these primarily, but generally psoriasis genitalium in either sex. A modificain connexion with its occurrence in other sit-tion of it sometimes affects, although much less uations. It may, however, be consequent upon frequently, the soles of the feet-psoriasis planprurigo or pruritus of these parts. In the pre- taris; but the severity of the symptoms is less puce this eruption is often obstinate and severe, in this situation, owing probably to the strucand is sometimes attended by thickening, pain- ture of the plantar integument, and to the proful exudations of blood and fissures, and phy-tective coverings of the part. Fissures in this mosis. Psoriasis in this situation may be as- situation are much less apt to occur, and are sociated with psoriasis of the scrotum, which is smaller when they occur. often most obstinate, and assumes the invet 22. (f) A variety of psoriasis diffusa occa sionally affects the backs of the hands, and is called grocers' itch, because it is often seen in persons engaged in this trade; but it also often attacks bakers, laundresses, and others. It begins with two or three squamous elevations, which often spread until the whole back of the hand is covered. The integument at length presents numerous dry and painful fissures over or near the wrist and the articulations of the metacarpal bones and first phalanges of the fingers. This variety is distinguished from confluent and chronic lichen of this part by the circumstance of the latter always commencing in an eruption of small papulæ. 26. A. Lepra vulgaris commences with small, smooth, solid elevations of a dull red hue, around which numbers of other reddish, prominent spots, about a line in diameter, are evolved. The surface of the elevations become cov. ered in two or three days with thin whitish 23. (g) Psoriasis of the Nails-Psoriasis Un- scales. In four or five days the elevations guium.--When the disease affects either the spread, having thrown off the small spangleupper or the lower extremities, the nails are like scale from their summits, and are attended often attacked, even although neither the fin- by a sense of heat, tingling, or pruritus. They gers nor the toes may be affected. But the af- then enlarge rapidly by the extension of their fection of the nails never occurs without some circumference, which is raised and red; while other part being attacked. It is most frequently the centres become depressed and paler than associated with psoriasis guttata of the hands the margins. As the scales exfoliate others or arms. The nails, when diseased, become are produced, and are of a glistening or opayellowish or tawny; thickened and irregular lescent, or of a pearl-gray or pale yellow tint. in their structure; rough, ragged, and brittle, The squamæ are not evenly spread over the and often bent over the ends of the fingers. A surface of the patches, and they are detached cheesy-like matter is sometimes formed at the partially and irregularly. After their fall, the roots of the nails, or between the roots and the skin which they covered looks red, shining, and matrix, as at the extremity of the papillary sur- somewhat raised. They are superposed, esface, these parts sometimes becoming unusual-pecially in the circumference of the patches, ly vascular, and giving rise to thickening, &c. and thus become thicker and thicker, so as to 24. (h) Psoriasis is often complicated with vis- form prominent layers. Even when small, the ceral disorder, as already noticed, and some-patches are never covered by a single scale. times with lepra or pityriasis. It has also been seen associated, especially in children, with eczema impetiginodes, vesicles and purulent points appearing amid the thin squamæ covering the patches of psoriasis. At a later period these patches become excoriated, and form thin, lamellar, yellowish scabs like those of eczema. This association is not infrequent in children during the period of teething, and occasionally at a more advanced period. When they are recent, the corion does not present lines corresponding to those of the cuticle, but when they are older such lines are observed, and are often increased to wrinkles, which correspond with small indentations or ridges in the inner surfaces of the scales. However detached from the inflamed surface, a fresh formation of scales takes place. the circle at last is broken in one or more places, and the spot ultimately disappears entirely. (RAYER.) 27. The cure of the orbicular patches of lepra begins in the centres, and extends to the cir25. iv. PSORIASIS LEPREFORMIS. -SYNON. cumference. After the detachment of the squaLepra; Lepriasis. Lepra Græcorum, Auct. mæ the skin acquires, when they are not reLepra vulgaris, Willan. Psoriasis circinnatus; newed, a grayish tint, with a shade of yellow. Lepidosis lepriasis, Good. Lepriasis annulata, At a later period, the ring bounding the patches Dendy. Psoriasis orbicularis; Dartre Squamis narrowed progressively from within outward; meuse arrondie, Alibert. Scaly leprosy; Greck leprosy. This chronic squamous eruption is characterized chiefly by its consisting of circular and slightly-raised patches, which are speedily covered by thin, semi-transparent, epidermic scales, the patches being prominent at their edges, and somewhat depressed in their centres, and the scales being thrown off and replaced by successive formations. Lepra is occasionally confined to the knees and elbows, and it generally appears first in these situations, or, rather, immediately below them. In most cases it affects both legs or both arms at the same time. It is apt to extend by the successive formation of new scaly patches along the arms and thighs, to the breast and shoulders, and to the lumbar and lateral regions of the abdomen. The patches are sometimes more numerous, large, and prominent on the lower part of the trunk. The disease rarely extends to the hands or hairy scalp. The patches which appear on the head are usually of a small size. They are seen near the outer angles of the orbits, whence they spread along the eyebrows to the forehead and temples. When lepra extends 28. Lepra is seldom attended by any febrile disturbance, or other disorder than impaired digestion, assimilation, and excretion. The appetite is usually good, and generally greater than the powers of digestion. It occasions no farther inconvenience than slight itching upon getting into bed, or upon changes of temperature. But when the patches are extensive or numerous, or when the inflammation of them is increased by a heating regimen, the patient feels so much burning or stinging pruritus as often to disturb repose. When the patches surround the joints they cause stiffness, and occasionally are attended by small painful fissures. The disease is always of considerable duration; it often continues for years, sometimes for life. I am now attending a lady who has been afflicted with it extensively for upward of forty years, although she has always had the advantage of the best medical advice. 29. B. The variety denominated Lepra alphoides by WILLAN is merely a milder form |