306 CLINICAL NOTES.

were attended with great heat and itching, and she was compelled to pick them in order to get out ( ( white cores,” of which there were often three or four in each lesion. When these came out she got relief, and, as a rule, healing occurred ; but some became ‘( watery and then mattery,” while others developed again in the same place after healing had taken place. When I saw her on May 30th, 1901, she had what appeared to be an ordinary excoriation ai th a dried scab upon it the size of the thumb-nail, and a smaller one near it on the lower part of the right cheek. She used to have three or four spots at a time, but lately they had not been so numerous. The only lesion besides the above was an excoriation, one-eighth of an inch across, over the left lower jaw, and there was a pale red blotchiness of the rest of the face and slight roughness.

The upper incisor teeth were pegged but not notched, but there were no other signs of specific disease. She had suffered a good deal from cons tipation and indigestion.

A few days later she sent me some of the little pegs, which she had picked out, and they had the same characters as those in the previous cases.

ECZEMA PRODUCED BY FORXALIN.

BY THEODORE FISHER, M.D., M.R.C.P.,

Physician to Out-patients to the Bristol Royal Hospital for fiick Children ; Pathologist to the Bristol Royal Infirmary.

THE brief paper in the British Journal of Dermatology for April, 1901, upon urticaria due to the use of formalin, has prompted me to record my own experience of the irritating effects of this anti- septic upon the skin.

For six years I have used formalin in the preparation of museum specimens. It has been my custom to do more museum work in the winter than in the summer, and during several successive winters I suffered from eczema of the fingers which at first was thought to be probably due to frequent wetting of the hands at that period of the year, but on the third occasion of the recurrence of the skin affection its connection with the use of formalin was noticed to be unmistakable. A student who worked for a short time at mounting morbid anatomy

CLINICAL NOTES. 307

specimens suffered more severely than I, and my colleague in patho- logical work has been similarly affected.

Susceptibility to the irritating influence of formalin seems to be more or less gradually acquired. One may daily dip one's hands into solutions of formalin of strengths varying from 1 per cent. to 5 per cent. during a period of several weeks without noticing any ill effect; then itching and a few vesicles may be noticed to appear along the sides of the fingers, which if the warning be not taken and work immediately stopped, will result in troublesome, and possibly intractable, eczema.

The increased susceptibility of the skin after such an outbreak is shown by the fact that in my own case merely handling specimens preserved in formalin, which have been well washed before I have touched them, has been sufficient on more than one occasion to cause a return of the eczema, and the student mentioned above has told me that merely pointing at a specimen without touching it has pro- duced a mild attack.

The fingers chiefly affected have been the middle and ring-fingers of both hands. My colleague is at the present time suffering from eczema of these fingers. All attempts to cure it have so far proved futile, although it has already lasted over four months, and he has abstained from touching any formalin-preserved specimen.

It may be interesting to mention here that the use of formalin for another purpose has produced in me a different eruption. One morning I put some cotton wool soaked in a weak solution of formalin* into a hollow tooth. About half an hour later there was severe itching between the shoulders, which spread to various parts of the body. Urticaria1 wheals appeared over the itching areas and lasted for about twenty-four hours. I suffered from slight headache and restlessness the following night, but the next day felt in my usual health.

In my own case formalin has proved therefore both to be a local irritant and when taken internally to be a poison of mild degree.

NorE.-It may be added that during the last six years there have been three museum assistants whose work has necessitated the fre-

* I cannot give the actual strength. I believe it to have been about '24 per cent. solution.

308 CLINICAL NOTES.

quent dipping of the hands into solutions of formalin. None have suffered locally. One, however, used to say that he frequently noticed L red itching rash over his chest after contact with formalin. The rash used to pass off in a few hours. Besides the student mentioned, five or six others worked for several weeks at mounting specimens, but none complained of being troubled in any way by the urn of formalin.

HERPES GESTATIONIS.

BY BENJAMIN JONES, L.R.C.P.

As Herpes gestationis is a, somewhat rare complication of preg- nancy, I considered that the following case might be of sufficient interest to be worth recording :-

Mrs. S., aged 29, was confined of her first child on June 19th. Her previous health had been excellent, and she had never suffered from any form of skin eruption till a week before her confinement. Her mother had a healthy skin, but her father was subject to eczema. Her grandmother in each of five pregnancies had suffered from L rash similar in appearance to that of the patient. In this case the dermatitis waa ushered in by troublesome itching and burning sensations about the umbilicus, which developed two days later about the toes.

On June 20th, the day after delivery, she complained of it to me, and on examination I found a multiform rash, consisting of papules, urticaria1 lesions and vesicles around the umbilicus, extending into the groins, and on the feet. In the latter situations the lesions were mostly vesicular. No pustules were present. The next day the eruption had extended over the arma and legs, on both their extensor and flexor aspects, and over the body generally. On the face only a few urticarial spots were noted. The lesions showed a definite grouping on the legs and arms.

On June 23rd large bulls appeared on both the big toes, and a few smaller ones on the soles and sides of the feet. There were no bullse on other parts of the body. She complained of itching, burning, and even pain in the big toes. The itching, she said, was much worse at night. I called in Dr. MacLeod in consultation, and he agreed with my diagnosis.