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113
In addition to the usual common types of dermatitis there have been several
cases of sufficient interest to be worthy of notice.
Ichthyosis bullosa.—At present in the hospital there are two cases of this rare
condition, a boy, admitted at the age of 10 months and now aged 10 years, and a
girl, admitted at the age of 5, now 14 years old. Both these cases are gradually
healing. This unusual congenital condition forms a connecting link between ordinary
ichthyosis and epidermolysis bullosa, and is characterised by a coarse thickening
of the horny layer of the skin, especially in the extremities and lower parts of the
back. This horny thickening becomes raised up from time to time by the formation
of flaccid bullae beneath it. These lead to the separation of the epidermis in sheets
leaving raw, moist surfaces. The eruption of the bullae is aperiodic and no special
reason for their occurrence has yet been ascertained, except that in some instances
they may have been caused by friction or injury. Occasionally the formation of
bullae is associated with a general toxic condition and a rise in temperature, possibly
caused by their becoming septic. As usually occurs in ordinary ichthyosis,
a definite improvement takes place with the growth of the child, the bullae become
less frequent, and the skin less vulnerable and less liable to secondary septic infection.
In the case of the girl the improvement during the last year has been so marked
that it is hoped that by the time she reaches the age limit and leaves the hospital,
her skin condition and general health may be so improved as to enable her to earn
a living. For this happening considerable credit is due to the unremitting care
and skilled attention of the nursing staff.
Perleche.—There was one instance of this somewhat unusual affection in a boy.
The condition is characterised by circumscribed patches of scaly erythema surrounding
the mouth and extending for a short distance on the cheeks. It is of
septic origin and usually associated with cracks at the commissures of the mouth
which are kept open and infected by organisms in the saliva. These cases are
extremely intractable, and so long as the cracks persist the surrounding inflammation
remains. Such remedies as Friar's balsam and nitrate of silver are of uncertain
value in healing them, and the most satisfactory treatment is one or more exposures
to X-rays, giving an initial dose of a half pastille unscreened, repeated if necessary
a fortnight later.
Pityriasis rosea.—There have been two cases of this elusive affection and both
from one residential school. This disease is of very rare occurrence in the hospital,
and it is an odd coincidence that the two cases should have been admitted simultaneously,
and from the same school, as there is no evidence that the condition is
infectious.
During 1934 there was an excessive number of cases of scabies, and a larger
number of cases of molluscum contagiosum than usual. In a certain number of the
molluscum cases the lesions were present on admission, but there have been several
in which they appeared in hospital in cases admitted for other conditions. Molluscum
is one of the most difficult skin affections in which to prevent spreading.
When cases are admitted they are isolated in bed until cured ; they are not allowed
to use the bathrooms and every precaution is taken to avoid indirect contacts.
In spite of these precautions sporadic cases keep cropping up among the
patients. These may be possibly due in some instances to infection being present
on admission, the lesions, however, being so small as to be unrecognised.
Non-tuberculous chest conditions in children.
During the year a block for non-tuberculous chest conditions such as fibrosis
and bronchiectasis was opened at High Wood hospital for children. This has made
it possible to retain in the hospital debilitated children who, although not suffering
from pulmonary tuberculosis, nevertheless need fresh air and the sanatorium type
of treatment for three or four months. In doubtful cases of fibrosis and bronchiectasis,
lipiodol examinations have been made. A special curved cannula, which
will not easily slip out of the trachea, is being used for this purpose.