Erythema Nodosum

This is a much more important but also rarer affection than the preceding one. The disease is characterized by the eruption of reddish tumors, from the size of a bean to that of a small egg, and usually situated upon the lower extremities, between the knee and ankle. For a day or two the depth of color increases, then becomes somewhat purplish, and with the "black-and-blue" appearance which ac­companies hemorrhagic effusions, and finally passes into the stage of green and yellow, like an ordinary bruise. A week or ten days may be occupied by these processes; and, as the color changes, diminution of size takes place, and in about two weeks complete resolution is effected. Suppuration very rarely occurs. The number of the nodes is usually limited to three or four, but may reach nine or ten, and may appear on the thighs and upper extremities as well as the parts already named. The swellings are usually a little painful for the first day or two, but not afterward. Relapies may prolong the disease for several months. Occasionally the eruption is ushered in by febrile action, but not In all cases. It usually occurs in young females, and is not unfrequently accompanied by menstrual derangement. In many cases, however, the eruption is preceded by or complicated with arthritic pains. This has led many writers to believe the affection to be more or less closely connect­ed with rheumatism.

Tht: disease is self-limited, requiring no special treatment Other than sedative applications to the affected parts.

In erythema multiforme the allopaths claim that "Unless the cause of the affection be discovered, little need or can be dene in the way of treatment, and the affection may be left to run its course, which it will usually do in two or three weeks, and may not return until the following season, for in some persons this disease appears to affect a predilection for the spring and autumn months, returning annually at one or the other of these seasons."

Treatment
When there is much itching and burning either a carbolic acid or veratrum viride lotion may he used. When the opposing surfaces are much inflamed they may be protected by dusting with buckwheat powder, or equal parts of starch and zinc oxide. Especial attention should be paid to cleanliness, and all irritants should be removed. Poultices are apt to do more harm than good, and better be avoided. Particular attention must be paid to the diet; such food as cornflour, maizena, and the like must be forbidden, and proper nutritive substitutes be given to children in conjunction with a suitable quantity of milk.

In the erythemata dependent upon general causes you must always remember the effect of ingesta; that a gouty or rheumatic habit, disordered menstrual function, dentition, delicacy of skin, or lymphatic temperament, are present in greater or less degree. It is important to allow the patient the use of an unstimulating diet only, to forbid him spirits, wine, and beer, to clear out the bowels, and in the early stage to adopt a soothing regime, with tepid sponging and emollient baths.


Bed-sores are best treated by attempting io "harden" the skin in the early stage by spirit applications, removing pressure as much as possible at later stages by pads, cushions, and water-beds, and by using charcoal poultices or soap plaster spread on soft leather to the sores. For chilblains, equal parts of turpentine and tincture of Aconite, and soap liniment, together with the indicated re­medy, constitute the best treatment.

The internal remedies for erythema are:
Aconite.- Erythema excited by the action of the sun's rays.
Aethusa.- Appearance and disappearance of reddish-blue spots on the trunk and left leg. General malaise.
Ailanthns.- Irregular spots of capillary congestion. Dark almost livid eruption on the forehead.
Arseniawi iodide.- Erythema, especially of the face.
Belladonna.- Inflamed red patches. Irregularly-shaped scarlet spots over the body. More on face and upper part of body.
Berberis.- Mottled spots as after a bruise on the right shoulder, left humerus, back of the hand and wrist.
Bryonici.- Red round hot spots on the malar bone, as large as peas.
Cadmium sulph.- Red spots on the extremities.
Chelidonium niaj.- Round red spots, size of a half dollar, accompanied with burning pain, oh anterior surface of the forearms and face, disappearing in a few hours.
Chloral hydrate.- Bright red or bluish erythema over the whole body, permanent under pressure, mottled with livid patches and deep red spots. Pruritus of the whole skin.
Crocus sat.- Circumscribed red spots on the face, which burn.
Condurango.- Erythematous blotches on the face and arms.
Gehemium.- Papulous eruption on the face resembling measles.
Gossypium.- Round little spots with pale red circles around the knee caps and over the skin bones, which itch very much.
Lactic acid.- Several bright red blotches on the ante­rior surface of the leg, with slight burning and no itching. Relieved by cold. Eruption brightest at 8 a.m.
Laurocerasus.- Erythematous patches, terminating in dark red purple spots.
Mercurius sol.- Light red patches on the forearm and inner side of the thighs. Itching changed to burning by scratching.
Mezereum.- Erythema on the legs in old people.
Nux vorn.- Pimples on the face with itching, burning after drinking wine or alcoholic liquors.
Phytolacca.- Painful erythematous blotches of a pale red color.
Fulsatilla nut.- Erythema of the scalp. Dark blue or red eruption on the legs and ankles.
Rhus tox.- Ridges on the lower limbs.
Sabadilla.- Red streaks on the arms. Worse from cold.
U.stilago.- Fine eruption of a deep red color, about the size of a pin's head, appearing on any part of the body after scratching. On the neck it takes a circular form.

Mr. M., a very large and fleshy man of exceedingly good habits and with no history of specific trouble, presented himself for a long standing and obstinate erythema. The case had been prescribed for under nearly every conceivable diagnosis, the majority of physicians claiming it was due to syphilis. During a fishing expedition, some years ago, he thought he had been poisoned while in bathing, and since that time he has been exceedingly troubled with this persistent local inflammation. His unusual flesh had been a constant irritant, and being obliged to work for his living he had almost despaired of recovery.


In the folds of his right groin and extending back between the nates an immense phlegmonous surface was visible. So long had it existed that fissures and ulcerations, and excessive secretions of sweat and pus had complicated what might have been a short enduring, and simple sore. A. rash, like measles, extended over the surrounding healthy skin. Extreme local itching and general aching pains made him exceedingly restless. These symptoms were always worse after midnight and during wet or cold weather.

With these indications he was given Rhus tox. 30 four times daily for a week. He was directed to use a local wash of warm water and lanoline soap, being careful to wipe the parts to perfect dryness. He was then to use a dusting powder of aristol and wear an abdominal sup­porter to relieve any chafing. In four weeks he was entirely well.