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§ V ri\'r : PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
BY 
GEORGE HENRY FOX, A.M., M.D. 
ACNE VULGARIS FACIEI 
ECZEMA ERYTHEMATOSUM 
SYPHILODERMA ERYTHEMATOSUM 
ZOSTER PECTORALIS 
DERMATITIS VENENATA 
(TWO ILLUSTRATIONS) 
PART I. PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
A Series of Eighty Plates, comprising One Hundred 
Photographed from Eife and Colored by Hand 
BY 
GEORGE HENRY FOX, A.M., M.D. 
>0 7 7 
CLINICAL PROFESSOR OF DISEASES OF THE SKIN, COLLEGE OF PHYSICIANS AND SURGEONS. NEW YORK; 
CONSULTING DERMATOLOGIST TO THE BOARD OF HEALTH, NEW YORK CITY; 
PPIYSICIAN TO THE NEW YORK SKIN AND CANCER HOSPITAL ; 
ETC. 
NEW YORK 
THE WILLAN PUBLISHING COMPANY 
LONDON 
D. APPLETON & CO 
Copyright, 1897, by George Henry Fox ACNE VULGARIS 
Acne is without doubt the commonest affection of the skin. It 
is pre-eminently a disease of adolescence and tends in time to sponta- 
neous recovery, though often leaving scars upon the face which betoken 
neglect on the part of the patient or lack of skill on the part of the 
physician. 
Although Acne is an inflammatory affection of the sebaceous 
glands, it is usually associated with Comedo and a general inactivity of 
the skin. In the accompanying illustration it is plain to see that the 
functional activity of the sebaceous glands is impaired and that the 
natural oily secretion has become thickened and accumulated in the 
glandular ducts, producing an eruption of conical whitish papules. At 
the summit of many of these a large comedo is apparent. Many appear 
congested (Acne papulosa) and some have undergone suppuration 
(Acne pustulosa). 
In most cases of Acne we find in addition to the local glandular 
disturbance a poor circulation, indicated by cold hands and feet, and an 
impaired digestion, indicated by coated tongue and constipation. These 
general conditions increase facial congestion and aggravate the eruption. 
The best results in the treatment may therefore be expected from 
dietetics, cold bathing and other hygienic measures, and from the 
local use of mechanical agents which tend to empty the distended 
glands and stimulate them to contraction. Vigorous soap frictions and 
the frequent use of a curette will do infinitely more good than the cus- 
tomary prescription of ointments and lotions. COPYRIGHT, 1897, BY G. H. FOX 
ARTOTYPE, E. BIERSTADT, N. Y. 
Acne vulgaris. ECZEMA ERYTHEMATOSUM 
This patient, seventy-one years of age, had suffered more or less 
from eczema for twenty years. It had been chiefly confined to the face 
but occasionally affected other portions of the body. The skin upon the 
forehead and cheeks was of a dull red hue and thickened to such a 
degree that the natural furrows were greatly exaggerated. The itching 
of the affected parts was intense and the eyebrows had been scratched 
or rubbed so persistently that only a short, stubble-like growth of hair 
remained. A chronic conjunctivitis caused constant lachrymation with 
thickening of the lids and prevented the complete opening of one eye. 
The patient was a great eater of meat and suffered from constipa- 
tion. A change of diet with an alkaline diuretic taken in copious 
draughts of water improved his general condition, while an ointment 
containing ten per cent, of oil of cade relieved the intolerable pruritus. 
While erythematous eczema may occur upon various portions of 
the body the illustration shows its favorite seat about the eyes. In this 
location it is often an extremely persistent and annoying affection even 
when the redness and roughness of the skin is scarcely noticeable. COPYRIGHT, 1897. BY G. H. FOX 
ARTOTYPE, E. BIERSTADT, N. Y. 
Eczema erythematosum SYPHILODERMA ERYTHEMATOSUM 
The erythematous syphilide when appearing as the first cuta- 
neous symptom of the constitutional disease presents numerous 
small, rounded, pinkish macules scattered over the surface of the skin, 
and showing no tendency to occur in groups or circles. The relapsing 
erythematous eruption, which is comparatively rare and occurs later 
in the course of the disease, presents, on the other hand, fewer but 
larger erythematous patches, and sometimes an eruption in annular 
form. 
The early erythematous syphilide is rarely observed to be as 
general and as distinct as in the case which forms the subject of the 
accompanying illustration. It is frequently seen only upon the ab- 
domen and flexor aspect of the forearms, and often appears so faint as 
to resemble the mottling of the skin seen upon certain patients with 
a poor circulation when the body is stripped and exposed to a cool 
atmosphere. In most cases the macules do not exist alone but are 
associated with lesions of a more or less papular character. Indeed, the 
centre of a macule sometimes appears darker than its margin and is 
slightly elevated, and at this point a papule may develop. 
In this patient the macular eruption developed suddenly about 
two months after the appearance of the chancre. It was of a bright 
red color at first, disappearing under pressure of the finger, and dis- 
appeared in a few weeks, gradually becoming duller in its hue and 
finally presenting the appearance of a faint, yellowish stain. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E. BIERSTAOT, N, Y 
Syphiloderma erythematosum ZOSTER PECTORALIS 
The gradual and even course which Zoster usually runs enables 
one to judge quite accurately the age of the eruption by the appearance 
of the lesions. As some of the patches, however, may develop a few 
days later than the primary patch, these will naturally be found to be in 
a less advanced stage of development. While some of the vesicles in a 
given case may be tense and filled with clear serum, the vesicles on 
patches a day or two older may appear flattened and of a milky hue. 
In the subject of the illustration the eruption had existed for six 
days at the time when the photograph was taken, but the boy had 
complained of pain for a day or two before the first red patch was 
noted. Upon the side the vesicles are seen to be at their height of 
development, while nearer the spine, where the eruption evidently first 
appeared, they show a tendency to confluence, and are of a purulent 
character. At three points it is evident that they have been irritated 
or broken, doubtless by the friction of the clothing, and small, dark, 
hemorrhagic crusts have formed. 
In the treatment of Zoster many of the applications in com- 
mon use have no curative effect and frequently add to the discomfort 
of the patient. If a simple dusting powder is used, and the inflamed 
skin carefully piotected by a soft linen cloth, the disease will run its 
course and the patient be more comfortable than when the affected 
part is painted with collodion or smeared with an ointment. Galvanism 
applied by means of a metallic roller attached to the negative cord 
furnishes the best means of relieving the intense neuralgic pain which 
is often present in elderly patients. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E, BIERSTADT, N, Y. 
Zoster pectoralis. DERMATITIS VENENATA 
Among the various forms of dermatitis resulting from the action 
upon the skin of toxic agents, whether animal, vegetable or chemical, 
the poison ivy eruption is one of the most common. 
It usually appears as a vesicular dermatitis upon the backs of 
the hands and rapidly extends upon the forearms. In most cases, 
the face and other parts touched by the hands are simultaneously 
affected. 
In the illustration the vesicles are seen to be both isolated and 
aggregated. They spring from a highly inflamed base and vary greatly 
in size. Their coalescence has produced bullae which are both of linear 
and irregular form. Although in this particular case the dermatitis 
followed the handling of leaves of the Rhus toxicodendron it must be 
borne in mind that an eruption identical in appearance may sometimes 
appear upon the hands, forearms and face of those who have handled 
nothing poisonous so far as can be ascertained. In some cases a 
vesicular or bullous dermatitis occurring annually and running an acute 
course may follow a severe attack of rhus poisoning. 
The poison ivy eruption usually runs its course in a few days 
or a week, unless the patient has an eczematous tendency which may 
aggravate and prolong the eruption. Its course is but slightly modified 
by any of the local applications commonly used and to which a mar- 
velous efficacy is often ascribed. A lotion of lime water or a bicar- 
bonate of sodium solution is quite as beneficial as any of the remedies 
which have been most highly recommended. COPYRIGHT. 1897, BY G. M. FOX 
ARTOTYPE. E. BIERSTADT, N. Y. 
Dermatitis Venenata. TO MY COLLEAGUES 
OF THE 
NEW YORK DERMATOLOGICAL SOCIETY 
THIS WORK IS AFFECTIONATELY DEDICATED 
BY 
THE AUTHOR PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
BY 
GEORGE HENRY FOX, A.M., M.D. 
PART II. 
ACNE VULGARIS DORSI 
PHTHEIRIAS1S CORPORIS 
PSORIASIS GUTTATA 
PITYRIASIS MACULATA 
( VESICULOSA 
VARIOLA 
PUSTULOSA PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
A Series of Eighty Plates, comprising One Hundred I I lustrations 
Photographed from Life and Colored by Hand 
BY 
GEORGE HENRY FOX, A.M., M.D. 
CLINICAL PROFESSOR OF DISEASES OF THE SKIN, COLLEGE OF PHYSICIANS AND SURGEONS, NEW YORK ; 
CONSULTING DERMATOLOGIST TO THE BOARD OF HEALTH, NEW YORK CITY; 
PHYSICIAN TO THE NEW YORK SKIN AND CANCER HOSPITAL ; 
ETC. 
NEW YORK 
THE WILLAN PUBLISHING COMPANY 
LONDON 
D. APPLETON & CO. 
Copyright, 1897, by George Henry Fox ACNE VULGARIS D0RS1 
Acne of the back and chest is commonly associated with acne 
of the face, although in some cases the eruption may be wholly 
confined to either the face or the trunk. In either location the erup- 
tion will be found to be follicular in its origin and to consist of indolent 
papules and pustules of varying size, with numerous comedos and a 
general plugging of the glandular ducts. In many patients small 
abscesses are liable to develop, and in some cases of long standing 
a number of sharply defined and sunken cicatrices may be found over 
the sternum as well as upon the back. The severe forms of acne 
of the trunk occur usually in male patients. 
The patient who was the subject of the accompanying illus- 
tration manifested a strumous tendency, having a sluggish circulation 
and a thick, greasy, inactive skin. There were many pustules present 
and more traces of former lesions in the shape of stains and pits, 
and at one point a dull red patch of skin was undermined by an 
accumulation of sanious pus. The eruption had persisted for several 
years and grown worse, in spite of the application of various oint- 
ments. A cold bath every morning and the vigorous use of a curette 
twice a week effected a speedy improvement. This treatment is 
usually all that is required, but the progress toward a cure is apt to 
be slow in most cases. COPYRIGHT 1897 BY GEORGE HENRY FOX 
ARTOTYPE. E. BIERSTADT, N. Y 
Acne vulgaris. PHTHEIRIASIS CORPORIS 
The eruption resulting from the presence of lice in the cloth- 
ing is almost wholly due to the action of the finger nails and consists 
of numerous excoriations with scratch marks which are usually long 
and often parallel. Here and there a close scrutiny may detect the 
hemorrhagic points where the pediculus has inserted its haustellum 
in order to enjoy its sanguineous feast, but the diagnosis is commonly 
based upon the character and location of the scratch marks. These 
are generally most numerous across the shoulders, around the waist, 
and upon the outer surface of the thighs. In the case of patients 
who have suffered for many weeks or months from the presence of 
lice in the clothing, the eruption may cover the trunk and extremities 
and be associated with a marked pigmentation of the skin. 
Upon the back of the patient shown in the illustration the 
abundant excoriations indicate that the pediculi were numerous and 
had infested the clothing for a long time. As is usually the case, the 
shoulders and the lumbar region had suffered most. 
A bath, a complete change of clothing (or a thorough baking 
of the infested garments in a hot oven), and a ten per cent lotion of 
carbolic acid will speedily relieve the itching through removal of the 
cause, and effect a cure of the disease. * COPYRIGHT 1897 
ARTOTYPE. E. BIERSTADT, N. Y. 
Phtheiriasis corporis. PSORIASIS GUTTATA 
This illustration shows a mild type of the disease, although 
there was an unusually large number of small, dry, scaly papules 
covering the trunk and limbs. The silvery scales could be readily 
scratched off by the finger-nail, leaving a number of bleeding points 
upon the surface of the denuded corium. The patient was in good 
physical condition, and complained of nothing save the eruption. In 
this respect he was like the majority of psoriatic patients, since 
the disease seems to manifest a predilection for robust and well- 
nourished subjects. 
It will be noted that the eruption is symmetrical, as is usual 
in psoriasis, but the guttate lesions are not as rounded as they often 
appear in this disease, and consequently bear a resemblance to pityriasis 
maculata. Indeed, it is difficult in some cases of mild psoriasis to 
distinguish the eruption at first glance from pityriasis (seborrhoeic 
eczema), but the characteristic tendency of the psoriatic eruption to 
recur at certain seasons, year after year, will usually settle the question 
of diagnosis. It will be further noted that in this case there are no 
erythematous spots. While congestion exists beneath the patches of 
thickened epidermis, all that can be seen of the eruption are white 
silvery scales with a line of redness at the border. 
Under a restricted diet and an alkaline diuretic taken before 
meals, with cold baths and the inunction of salicylated vaseline, the 
eruption speedily disappeared. COPYRIGHT. 1897, BY G. H. FOX 
ARTOTYPE, E. BIERSTADT. N. Y 
Psoriasis guttata PITYRIASIS MACULATA 
Pityriasis is a superficial inflammatory affection of the skin, 
occurring either in small rounded discs, in rings, or in diffused patches, 
and is characterized by a light roseate hue and a branny desquamation. 
It is often classed with eczema, but differs from this affection in several 
important features. It usually runs a self-limited course, and never 
presents any notable thickening of the skin nor manifests any tendency 
to moisture. It differs from psoriasis in beginning as an erythema, 
in presenting only a slight degree of scaling, in usually running an 
acute course, and in showing no tendency to recurrence at certain 
seasons. 
In the case of the patient who was the subject of the accom- 
panying illustration, the eruption appeared suddenly over the trunk 
and in less degree upon the extremities, and for a few days bore a 
slight resemblance to an erythematous syphilide. Many of the discs 
or roseate macules soon began to desquamate, and in a few weeks 
the eruption disappeared without any vigorous treatment. 
The general resemblance of the eruption to a guttate psoriasis, 
as well as the characteristic points of difference, may be readily seen 
by a comparative examination of the plates illustrating these two 
affections. While all of the guttate lesions of the psoriatic patient 
were covered with thick silvery scales, most of the lesions in the 
case of pityriasis were simply erythematous at the outset and the 
desquamation was slight and secondary.  
Pityriasis maculata VARIOLA 
The two cases of Variola which are reproduced in the accom- 
panying illustration were photographed by the author at the Riverside 
Hospital, on North Brothers' Island, an institution under the control of 
the New York Board of Health. 
The photograph of the vesicular stage was taken on the seventh 
day of the disease, just before the isolated lesions were beginning to 
assume the umbilicated character which is noted usually on the eighth 
or ninth day. At this period the contents of the vesicles become puru- 
lent and an inflammatory halo develops around each separate lesion. 
This was an exceptionally severe case, as may be seen by the intense 
congestion of the face and the confluence of the vesicles. 
The photograph of the pustular stage was taken on the eleventh 
day of the disease when most of the umbilicated pustules had become 
tense and hemispherical. A few umbilications may still be seen upon 
the forehead. This notable change in the appearance of the lesions 
results from a loosening of the trabecular bands, which produce the 
umbilication, a characteristic feature which is most marked at a time 
when the lesions are passing from the vesicular into the pustular stage. 
In determining the previous duration of the disease from the 
stage of development of the lesions, it should be borne in mind that 
the pocks upon the face, where the eruption begins in Variola, are apt 
to be two or three days more advanced than upon the extremities, and 
that in some cases of Varioloid the lesions may appear first upon the 
trunk, occur in successive crops, and perhaps desiccate within a week. COPYRIGHT, 1897, BY G. H, FOX 
Variola vesiculosa 
Variola pustulosa. 
ARTOTYPE, E. BIERSTADT, N. Y TO MY COLLEAGUES 
OF THE 
NEW YORK DERMATOLOGICAL SOCIETY 
THIS WORK IS AFFECTIONATELY DEDICATED 
BY 
THE AUTHOR PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
BY 
GEORGE HENRY FOX, A.M., M.D. 
LUPUS ERYTHEMATOSUS 
LUPUS VULGARIS 
SYPHILODERMA PAPULOSUM 
VITILIGO MANUUM 
LICHEN PLANUS 
(TWO ILLUSTRATIONS) 
PART III. PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
A Series of Eighty Plates, comprising One Hundred Illustrations 
Photographed from Life and Colored by Hand 
BY 
GEORGE HENRY FOX, A.M., M.D. 
CLINICAL PROFESSOR OF DISEASES OF THE SKIN, COLLEGE OF PHYSICIANS AND SURGEONS, NEW YORK; 
CONSULTING DERMATOLOGIST TO THE BOARD OF HEALTH, NEW YORK CITY ; 
PHYSICIAN TO THE NEW YORK SKIN AND CANCER HOSPITAL ; 
ETC. 
NEW YORK 
THE WILLAN PUBLISHING COMPANY 
LONDON 
D. APPLETON & CO. 
Copyright, 1897, by Georgf. Henry Fox LUPUS ERYTHEMATOSUS 
Erythematous lupus has often been called the “butterfly” form 
of lupus on account of its occasional outline when involving the ridge 
of the nose and malar regions. In most cases, however, there is no 
suggestion of this resemblance, and very often this characteristic site 
of the eruption remains entirely free. 
The portrait shows a typical, rounded spot upon the cheek, 
slightly elevated, and with a dry, harsh, scaly surface. These scales 
are quite adherent, and when one is forcibly raised the under surface 
often shows a number of prolongations corresponding to the follicular 
orifices. The disease is also shown in two very common localities, viz., 
near the ear and upon the scalp. The crusting seen in the patch upon 
the auricle is unusual, but the bald spot upon the crown, with its dull 
red hue and slight roughness of surface, is very typical. Such a patch 
often serves as a basis of diagnosis in cases where the facial lesions 
might appear to be of doubtful character. 
The cause of erythematous lupus is unknown. The bacillus 
tuberculosis is not found in sections of the affected skin, and there is no 
kinship between this disease and lupus vulgaris save in the name and 
an occasional clinical resemblance. > 
The treatment is, in most cases, notably unsatisfactory. Some 
recent and superficial patches, unaccompanied by much congestion, 
will yield to applications of pure carbolic acid, but in cases of long 
standing, and especially in those of an irritable type, stimulating treat- 
ment often does more harm than good. I have seen excellent results 
follow the internal use of salicylate of sodium. COPYRIGHT 1897 BY GEORGE HENRY FOX 
ARTOTYPE, E. BIERSTAOT, N. Y. 
LUPUS ERYTHEMATOSUS. LUPUS VULGARIS 
In the case of the young man who is the subject of this illustra- 
tion, the disease began at six years of age and has slowly but steadily 
spread over the neck and a portion of the cheek. The lesions are 
rather superficial and have shown little tendency to soften and ulcerate. 
They are most prominent at the advancing border of the patch and 
some isolated ones enclose areas of normal skin. Where the disease 
appears to have first developed, patches of wrinkled cicatricial tissue 
are to be seen dotted with many dull red, flattened tubercles, which are 
evidently tending towards a spontaneous disappearance. 
The patient has always been in fair health, although the indica- 
tions of a scrofulous taint are manifested in the thickened lips and 
peculiar doughy skin, and may be discerned in the partial view of the 
physiognomy revealed in the portrait. 
In the treatment of this case a steel burr dipped in carbolic acid 
was used for a time with good effect, but as the patient did not care 
to suffer the slight pain involved in this rapid and efficient method, 
a twenty per cent, salicylic plaster was applied at the Vanderbilt Clinic 
and during the past few months a notable improvement has taken 
place. The lesions have ulcerated beneath the plaster, applied succes- 
sively to small portions of the diseased skin, and a complete cure is 
expected. COPYRIGHT, 1897, BY G. H. FOX. 
ARTOTYPE, E. BIERSTADT, N. Y. 
Lupus vu lgaris. SYPH1L0DERMA PAPULOSUM 
The papular syphilide may occur in several forms, presenting a 
variety of clinical features. The miliary eruption consists of pinhead 
sized papules usually occurring in small clusters and is comparatively 
rare. The lenticular eruption, which is the most common form, is 
characterized by disseminated papules of split pea size. These may 
be few or numerous and are symmetrically distributed over head, 
trunk, and extremities. The large papular syphilide usually consists 
of fewer lesions which may be scaly, simulating psoriasis, circinate and 
resembling ringworm or moist and appearing' like mucous patches 
upon the skin. 
The unusually copious eruption upon the back shown in the 
i 
illustration was of the ordinary lenticular variety. It had existed for 
about six weeks at the time the photograph was taken, and without 
treatment the lesions, especially upon the shoulders, were tending to 
flatten and disappear. Upon the lower portion of the back many 
of the papules were covered with scales, and some had softened and 
crusted so that the plate might have been designated as a papulo- 
pustular syphilide, although the papular element still predominated. 
It is rare indeed for an early syphilide to present throughout its course 
but one variety of primary lesion, and in many cases macules, 
papules and pustules will be found to coexist. COPYRIGHT 1897, BY GEORGE HENRY FOX 
ARTOTYPE, E BIERSTADT, N. Y. 
Syphiloderma papulosum. VITILIGO 
The backs of the hands are the most frequent site of vitiligo, 
and in many cases the affection is confined to this locality. In other 
cases the white spots appear upon the face and neck as well, and 
not infrequently are found upon the trunk and extremities. In the 
negro race the affection sometimes increases until the greater portion 
of the skin becomes white. 
In this patient, a man of nearly seventy years, the patches had 
existed for a long time and shown little tendency to increase in size 
or to appear elsewhere. As is usual, the skin around the white patches 
had assumed a slightly darker hue and, as the patient was naturally 
of a dark complexion and the photograph was taken in the summer 
time, when the hands were tanned through exposure to the sun, the 
contrast was exceptionally well marked. 
The patient suffered no discomfort whatever from the spots 
and no treatment was employed, In fact, there is little that can be 
done in such a case beyond lessening the intense contrast of color by 
keeping the hands from exposure to the sun and by bleaching the 
darker skin by the frequent application of peroxide of hydrogen. 
Aside from its disfigurement, the only disadvantage arising from 
vitiligo upon the hands is the marked tendency of the unpigmented 
skin to redden and blister when exposed to the rays of a summer sun. COPYRIGHT. 1897,, BY G. H. POX 
ARTOTYPE, E. BIERSTADT, N. Y. 
Vitiligo LICHEN PLANUS 
Although lichen planus may appear upon various portions of 
the body, and sometimes present a general eruption, the anterior 
aspect of the forearm is its most frequent and characteristic site. In 
some cases the eruption is limited to the forearms, and only in rare 
cases is this part found to be free. 
Upon the woman's arm, shown in the upper illustration, many 
isolated lesions may be noted, some of which show the characteristic 
angular outline, flattened glistening summit, and central depression. 
Near the bend of the elbow the tendency of the lesions to aggregate 
in small clusters is well shown. The coalescence of such clusters has 
produced the large patch with the scaly surface which extends along 
the forearm. The desquamating rings seen upon the wrist are an 
exceptional feature of lichen planus which is rarely met with and only 
in cases in which the eruption is abundant and acute. 
Upon the man’s arm, shown in the lower illustration, the 
individual lesions are somewhat larger, but show the same tendency 
to coalescence, and upon the radial aspect where the eruption was of 
longer duration the characteristic glistening surface of the patch is 
clearly seen. 
The peculiar purplish hue of the eruption in cases of lichen 
planus is always a striking feature, and as it is rarely met with in other 
affections, it serves as a very important point in differential diagnosis. COPYRIGHT 1897 BY GEORGE HENRY FOX 
ARTOTYPE, E. BIERSTAOT. N. Y. 
Lichen planus. TO MY COLLEAGUES 
OF THE 
NEW YORK DERMATOLOGICAL SOCIETY 
THIS WORK IS AFFECTIONATELY DEDICATED 
BY 
THE AUTHOR PHOTOGRAPHIC ATLAS 
( 
OF THE 
DISEASES OF THE SKIN 
BY 
GEORGE HENRY FOX, A.M., M.D. 
PART IV. 
ROSACEA ERYTHEMATOSA 
ALOPECIA AREATA 
PSORIASIS NUMMULATA 
PITYRIASIS CIRCINATA 
(TWO ILLUSTRATIONS) 
PEMPHIGUS 
(TWO ILLUSTRATIONS) PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
A Series of Eighty Plates, comprising One Hundred Illustrations 
Photographed from Life and Colored by Hand 
BY 
GEORGE HENRY FOX, A.M., M.D. 
CLINICAL PROFESSOR OF DISEASES OF THE SKIN, COLLEGE OF PHYSICIANS AND SURGEONS, NEW YORK; 
CONSULTING DERMATOLOGIST TO THE BOARD OF HEALTH, NEW YORK CITY; 
PPIYSICIAN TO THE NEW YORK SKIN AND CANCER HOSPITAL ; 
ETC. 
NEW YORK 
THE WILLAN PUBLISHING COMPANY 
LONDON 
D. APPLETON & CO, 
Copyright, 1897, by George Henry Fox ROSACEA ERYTHEMATOSA 
The three forms in which rosacea may appear are commonly 
described as the erythematous, the pustular, and the hypertrophic. 
The accompanying portrait represents a combination of the first two 
types, although the erythematous element is the most marked. The 
nose and malar regions are the favorite seat of the affection, but in 
this case, one of long standing, the whole lower portion of the face 
is involved. The cheeks and chin present numerous indolent nodules 
some of which show a tendency to suppuration. Between and over 
these a persistent passive congestion gives to the skin its character- 
istic rubicund color. 
This affection is frequently described as a form of acne (acne 
rosacea), but it differs in several essential respects. It is not primarily 
of follicular origin. There are never any comedos or other evidence 
of follicular disturbance such as is invariably present in cases of acne, 
and the disease is usually noted at a more advanced age. Indeed, it 
commonly begins at about the age when the ordinary acne of youth 
begins to disappear spontaneously, and most patients over thirty who 
suffer from rosacea will be found to have shown little or no dis- 
position to acne during their teens. COPYRIGHT 1897, BY GEORGE HENRY FOX 
ARTOTYPE, E. B1ERSTADT, N. Y. 
Rosacea erythematosa. ALOPECIA AREATA 
This patient, a teacher by occupation, had suffered from alopecia 
areata for over twelve years, the hair falling out in spots and growing 
in again. During the past year the increasing baldness had necessitated 
the wearing of a wig, and the disease had begun to affect the eye- 
brows. Pure carbolic acid was applied in this case, one half of the 
scalp being dotted or striped with the acid every ten days. This 
treatment caused epidermic exfoliation followed by pinkish spots, but 
had no apparent effect in restoring the hair. As the patient grew 
stronger under a general tonic treatment, and her frequent headaches 
disappeared, the hair returned and grew quite as readily on the 
untouched portions of scalp as where the acid had been applied. 
Six months later, after the strain of nursing a sick relative, the hair 
began to fall again, thereby showing the dependence of the disease 
upon the state of the patient’s general health. 
The illustration shows an advanced stage of the disease in 
which the individual areas of baldness have enlarged and coalesced 
until the greater portion of the scalp is denuded. The numerous 
patches of dark hair indicate that there were originally many bald 
areas of small size, the circular outlines of which are still suggested 
by the concave margin of the hairy patch upon the occiput. The 
growth of white hair at various points indicates a tendency to 
recovery, and constitutes a favorable element of prognosis. This 
non-pigmented hair, which often appears first upon the bald areas, 
gradually assumes a normal color. COPYRIGHT 1897, BY GEORGE HENRY FOX 
ARTOTYPE, E, BIERSTADT, N. Y. 
Alopecia areata. PSORIASIS NUMMULATA 
The psoriatic eruption presents a great diversity of appearance 
in different patients, although rounded and circumscribed patches 
covered with silvery or yellowish white scales are characteristic of 
all cases. The eruption is nearly always symmetrical, whether the 
scaly lesions be punctate, guttate or nummular in size or occur in 
large diffused patches. Although the extensor surface of the ex- 
tremities, and particularly the region of the elbows and knees, is 
most frequently affected, the trunk in some cases may be the principal 
seat of the disease. 
The boy who was the subject of the illustration presented 
an eruption of the nummular or coin-like form. Both trunk and 
extremities were the seat of numerous rounded and scaly patches, 
varying somewhat in size, but bearing a sufficiently strong resem- 
blance to silver coins stuck upon the skin to warrant the use of the 
descriptive adjective. All of the larger lesions show an elevation of 
the border and a corresponding depression of the central portion 
of the patch. Upon the thigh a portion of the thick whitish scale 
has evidently been scratched off from some of the patches, leaving 
exposed a red and slightly elevated surface. The boy was admitted 
as a patient at the Skin and Cancer Hospital, and in a few weeks was 
quite free from the eruption—the regularity of sleep, diet, etc., doing 
as much for him perhaps as the special treatment employed. COPYRIGHT 1897, BY GEORGE HENRY FOX 
ARTOTYPE, E. B1ERSTADT. N. Y. 
Psoriasis nummulata. PITYRIASIS CIRCINATA 
To the circinate form of pityriasis a variety of names have 
been applied. When it occurs upon the anterior portion of the chest, 
which is a favorite location, it is often designated as pityriasis rosea, 
lichen circinatus, or seborrhoea corporis. Upon the extremities or 
other portions of the trunk it is frequently called eczema seborrhoicum, 
despite the fact that it is not an eczema and has no relation whatever 
to the sebaceous glands. In patients with a marked eczematous 
tendency, however, a part of the eruption may become irritated and 
a secondary eczema develop, as it often does upon a patch of tricho- 
phytosis. Although the eruption is undoubtedly of internal origin, 
many believe in its parasitic nature, and some have regarded it as 
disseminated ringworm (herpes tonsurans maculosus). 
In the case of the female shown in the upper illustration the 
eruption, as is frequently the case, occurred in both the macular and 
circinate form. Many of the patches, as they increased in size, assumed 
a circular or oval outline and presented a central area of a dull, 
yellowish hue surrounded by a scaly margin. The disease ran an 
acute course. 
In the lower illustration the eruption upon a male chest is seen 
to be more confluent and to present a slightly papular character. 
When such an eruption occurs over the sternum it may run an acute 
course of one or two months, but in many instances it shows a 
tendency to relapse and to become chronic. COPYRIGHT 1897 BY GEORGE HENRY FOX 
ARTO^PE^^IERSTAof^^V 
Pityriasis circinata. PEMPHIGUS 
The patient represented in the upper illustration was a boy of 
fourteen, delicate and undersized. From five to seven years of age 
he had suffered from a general bullous eruption. The present attack 
had lasted three months. The eruption was symmetrical and appeared 
on the forearms, backs of hands, legs and feet, and to a slight degree 
upon the face and neck. In the two months during which he was 
under my observation there was a constant recurrence of bullae and 
severe itching of the skin where the lesions had dried and crusted. 
The eruption seemed to be checked but was not cured by the use 
of arsenic, a remedy which is often of great value, though by no means 
a specific, in this disease. 
Upon the arm the tense rounded bullae springing from an 
apparently sound skin are plainly seen, as well as the various stages 
of drying and crusting through which the lesions pass and the ser- 
piginous form which often characterizes the eruption especially in 
children. 
The subject of the lower illustration was a little boy in the Clinic 
of the Skin and Cancer Hospital who had suffered from several acute 
attacks. Here again are seen the tense bullae with dried and crusted 
lesions, and also the dull red stains of recent lesions and leucoder- 
matous spots upon the abdomen where the eruption had previously 
existed. In this case the use of arsenic combined with general tonic 
treatment was speedily followed by a complete disappearance of the 
eruption. COPYRIGHT, 1897, BY G. H. FOX 
ARTOTYPE, E. BIERSTADT, N. Y. 
Pemphigus. TO MY COLLEAGUES 
OF THE 
NEW YORK DERMATOLOGICAL SOCIETY 
THIS WORK IS AFFECTIONATELY DEDICATED 
BY 
THE AUTHOR