ON THE 
NOMENCLATURE 
AND 
CLASSIFICATION 
OF 
DISEASES OF THE SKIN. 
BY 
L. DUNCAN BULKLEY, A.M., M.D., 
Physician to the Skin Department, Demilt Dispensary, New* York ; 
Attending Physician for Skin Diseases at the Out-Patient 
Department of the New York Hospital, etc. 
NEW YORK: 
G. P. PUTNAM’S SONS, 
182 FIFTH AVENUE. 
l877- IE S S .A. IT S 
ON 
DISEASES OF THE SKIN, 
BY 
L. DUNCAN BULKLE7, A.M. M.D., 
Physioian to the Skin Department, Demilt Dispensary, New York. 
I. The Use and Value of Arsenic in the Treatment of 
Disease of tbe Skin. Octavo. Boards, 75 cents. 
II. The Management of Eczema. Octavo. Boards, 50 cents. 
“ The rules for treatment are based on large clinical experience and correct views of the 
nature of the disease are very clearly laid down. We can recommend this essay as an ex- 
cellent guide to the numerous physicians who have occasion to treat eczema.” N. V. Medical 
Journal. 
“ His rules for the management of the disease are clearly expressed, judicious and practical. 
The treatise is short, but contains as much as is to be found in many of the large mono- 
graphs.” London Practitioner. 
III. The Relations of the Nervous System to Diseases of 
the Skin. Octavo. 50 cents. 
“ If the essay of Dr. Bulkley * * * * shall gain the gradual assent of specialists in derma- 
tology, it may mark an era in that department of medicine. ”—Archivces Eleclrology 
and Neurology 
IV. The Relations of the Urine to Diseases of the Skin. 
Octavo. Paper, 35 cents. 
“ The field is a promising one, and Dr. Bulkley has done well to bring this subject prom- 
inently into notice.”—London Pracitioner. 
V. Analysis of One Thousand Cases of Skin Disease, 
with Cases and Remarks on Treatment. Octavo. Paper, 30 cents. 
VI. Analysis of Hundred and Seventeen Cases of Skin 
Disease Treated at Demilt Dispensary during 1875. Octavo. Paper, 
30 cents. 
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series next year.”—Medical Times and Gazette (London.) 
VII. Herpes Gestationis, a Rare Affection of the Skin, 
Peculiar to Pregnancy, Octavo. Papef, 30 cents. 
VIII. Two Cases of Exophthalmic Goitre with Chronic 
Urtiaria, Illustrative of Relations of the Nervous System to 
Diseases of the Skin. Octavo. Paper, 20 cents. 
IX. ' A Clinical Study on Herpes Zoster. Octavo. Paper, 
25 cents. 
The publishers will forward any of the above on receipt ofprice. 
G. P. PUTNAM’S SONS. r82 Fifth Avenue New York. ON THE< ' 
_ 
NOMENCLATURE 
c 
AND 
CLASSIFICATION 
OF 
DISEASES OF THE SKIN. 
BY v / 
L. DUNCAN BULKLEY, A.M., M.D., 
Physician to the Skin Department, Demilt Dispensary, Arew York ; 
Attending Physician for Skin Diseases at the Out-Patient 
Department of the New York Hospital, etc. 
NEW YORK: 
G. P. PUTNAM’S SONS, 
182 FIFTH AVENUE. 
1877. ON THE NOMENCLATURE 
AND 
CLASSIFICATION OF DISEASES OF THE SKIN. 
WHILE it is granted that the discussion of the Nomenclature 
and Classification of Diseases of the Skin is of an import- 
ance far secondary to that in regard to their nature and cure, it 
must be yielded that a correct understanding of the principles of 
nomenclature and classification of any order of diseases is essen- 
tial to a full understanding of the branch of medicine to which those 
diseases naturally belong. It has seemed best, therefore, to pre- 
sent to the readers of the Archives a scheme which, we believe, if 
utilized by those engaged in dermatology, will assist much in a com- 
prehension of the subject and thus secondarily will aid them in 
managing this class of affections. 
The classification which follows is not presented as a new one, 
indeed it possesses very few elements of real novelty, but it is an 
effort to harmonize the classifications now in practical use by many, 
and to present the entire subject in a concise, clear, and practical 
manner. 
It is not presented as a classification which we should wish to 
adopt as a final one, but it is offered as a report of progress, repre- 
senting, as I conceive, the present state of opinion of the greatest 
number of those who are, from clinical experience, best able to judge 
of the requirements and proprieties of a Nomenclature and Classifi- 
cation of Diseases of the Skin : this scheme is open to criticism, I 
am well aware, and I am also open to conviction in regard to any 
of its elements, and expect to make such changes in it in the future 
as advancing studies in dermatology will show to be advisable. 
The present classification is based, as will be seen, very largely 
upon that of Hebra, the main principles of which have stood the 
test of nearly a quarter of a century of hard work and active criti- 4 
Z. DUNCAN BULKLEY; 
cism, and which is to-day the accepted guide of many teachers in 
this and other countries. In preparing this nomenclature and 
classification, however, I have taken advantage of suggestions from 
Neumann, Duhring, and others, including French and English 
writers, and, while the elements of the German arrangement of 
Hebra predominate greatly, his arrangement will be found to be 
greatly modified and simplified, so as to form really a new one 
which may be properly called an American classification, for use in 
studying and teaching dermatology in this country.* Such an ar- 
rangement as the following I consider to warrant far better the title of 
a Clinical Classification than the ones, such as that of Wilson, for which 
this name has heretofore been claimed. The main general ele- 
ments of novelty in the present scheme may now be briefly noticed ; 
matters relating to nomenclature and arrangement of separate 
diseases will be referred to later. 
The class of “ Parasitic Affections ” I have placed first, as being 
the first group which has reached the ultima Thule or final limit in 
classification, namely an etiological basis ; this class has long been 
accepted even in classifications claiming a histological basis. 
The second class, that of “ Glandular Affections,” is made to 
embrace all those diseases already recognized as such, but sepa- 
rated by writers under many different names and heads ; this class 
rests on a pathological and clinical, rather than on an etiological or 
histological basis, but we believe it to be sound in theory and use- 
ful in practice. 
As the next best recognized and most clearly defined clinical 
class, with a beginning of histological support as far as relates to 
herpes zoster and trophic disturbances, we place the “ Neuroses ” 
of the skin, a class which is continually being more and more clearly 
defined, and which receives recognition in many classifications. 
The remainder of the classes, as also most of the diseases under 
them, correspond to those of Hebra, with certain exceptions. Thus, 
his class of Amemiae, or anaemic affections, which I have never ob- 
served clinically, if it exists at all, does not find a place here ; also 
his two classes of benign new formations and malignant new for- 
mations are united in our ninth class; and his class of “ Ul- 
cera cutanea,” which includes the primary venereal ulcers and vari- 
cose and other ulcers of the leg, is also omitted ; thus the pres- 
ent arrangement has but nine classes instead of twelve, as proposed 
by Hebra. 
With this much of introduction the classification is presented, 
after which the principles of Nomenclature and their application in 
this scheme may be considered. 
* This classification has been prepared primarily for the use of classes in Der- 
matology at Demilt Dispensary, and is printed on a folded card of four pages,|a 
little larger than a postal card, for convenience of pocket reference. The Editor 
will here state that the Digest Department of the “ Archives ” has been from the 
first divided up on a plan very similar to that indicated by this classification, and 
also that in future, as far as any editorial work in this Journal is concerned, this 
nomenclature and classification will be adhered to; contributors will, of course 
exercise their discretion in regard to terms, etc., employed. NOMENCLATURE AND CLASSIFICATION. 
5 
LESIONS OF THE SKIN. 
A. Primary Lesions. 
B. Secondary Lesions. 
1. Macula; spot, macule. 
2. Papula; papule. 
3. Vesicula; vesicle. 
4. Bulla; bleb. 
5. Pustula; pustule. 
6. Pomphus; wheal. 
7. Tubercula; tubercle. 
8. Phyma; tumor. 
1. Squama; scale. 
2. Crusta; crust. 
3. Fissura; fissure. 
4. Excoriatio; excoriation. 
5. Ulcus; ulcer. 
6. Cicatrix; scar. 
CLASSIFICATION. 
OF 
DISEASES OF THE SKIN. 
Class I. Morbi cutis parasitici. Parasitic Affections. 
“ II. Morbi glandularum cutis. Glandular Affections. 
“ III. Neuroses. Neurotic Affections. 
“ IV. Hyperaemiae. Hyperaemic Affections. 
“ V. Exudationes. Exudative Affections. 
“ VI. • Haemorrhagiae. Haemorrhagic Affections. 
“ VII. Hypertrophiae. Hypertrophic Affections. 
“ VIII. Atrophiae. Atrophic Affections. 
“ IX. Neoplasmata. New Formations. 
Class I. Morbi cutis parasitici. Parasitic affections. 
1. Tinea trichophy- 
tina (parasite— 
Trichophyton 
tonsurans) 
corporis (or circinata.) 
capitis (or tonsurans.) 
barbae (or sycosis parasitica.) 
cruris (or eczema marginatum.) 
A. Vegetable. 
2" favus)Sa {Paras**e'—Achorion Schcenlcinii.) 
3. Tinea versicolor (parasite—Microsporon furfur.) 
corporis 
capitis 
pubis 
B. Animal. 
I. Phthiriasis 
2, Scabies {parasite—Acarus scabiei.) 
(parasite—Pediculus.) 
Class II. Morbi glandularum cutis. Glandular affections. 
I. Due to 
faulty 
secretion 
or excre- 
tion of 
Sebaceous 
matter. 
1. Acne sebacea 
2. Acne punctata 
3. Acne molluscum. 
oleosa 
cerea 
cornea 
(or seborrhcea.) 
A. Diseases 
of the 
Sebaceous 
Glands. 
exsiccata (or xeroderma.) 
nigra (or comedo.) 
albida (or milium.) 
II. Due to inflammation of 
sebaceous glands with 
surrounding tissue. 
4. Acne simplex. 
5. Acne indurata. 
6. Acne rosacea. 6 
Z. DUNCAN BULK LEY; 
I. As to quantity of 
secretion 
1. Hyperidrosis. 
2. Anidrosis. 
B. Diseases of 
the Sweat 
Glands. 
II. As to quality of 
secretion. 
3. Bromidrosis. 
4. Chromidrosis. 
III. With retention ( 
of secretion, j 
5. Dysidrosis. 
6. Sudamina. 
Class III. Neuroses. Neurotic affections. 
1. Herpes zoster (or zona.) 
2. Pruritus. 
3. Dermatalgia. 
4. Hyperaesthesia cutis. 
5. Anaesthesia cutis. 
6. Trophic disturbances. 
Class IV. Hyperaemiae. Hyperaemic affections. 
A. Active. 
1. Erythema simplex 
2. Roseola. 
idiopathicum. 
traumaticum. 
1. Livedo mechanica. 
2. Livedo calorica. 
R p.ccivb 
B. Passive. 
Class V. Exudationes. Exudative affections. 
1. Morbilli. 
2. Scarlatina. 
3. Variola. 
4. Varicella. 
5. Vaccinia. 
6. Pustula maligna. 
7. Equinia (or glanders.) 
8. Diphtheritis cutis. 
9. Erysipelas. 
A. Induced by Infection or Con- 
tagion. 
multiforme. 
nodosum. 
I. Erythematous, 
1. Erythema 
2. Urticaria. 
II. Papular. 
3. Lichen 
simplex. 
planus. 
scrofulosus. 
4. Prurigo. 
' febrilis. 
iris. 
progenitalis. 
L gestationis. 
III. Vesicular. 
5. Herpes. 
B. Of Internal 
or of Local 
Origin. 
IV. Bullous. 
6. Hydroa. 
7. Pemphigus 
vulgaris. 
foliaceus. 
8. Sycosis. 
9. Impetigo. 
10. Impetigo contagiosa. 
11. Ecthyma. 
V. Pustular. 
VI. Erythematous, 
papular, ves- 
icular, pustu- 
lar, etc. 
(12. Eczema. 
j 13. Dermatitis 
' calorica. 
venenata, 
traumatica. 
14. Psoriasis. 
15. Pityriasis rubra. 
VII. Squamous. 
VIII. Phlegmonous 
16. Furunculus. 
17. Anthrax. NOMENCLATURE AND CLASSIFICATION 
7 
Class VI. Haemorrhagiae. Haemorrhagic affections. 
simplex. 
papulosa. 
rheumatica (or peliosis rheumatica.) 
haemorrhagica. 
i. Purpura. 
2. Haematidrosis (or bloody sweat.) 
3. Scorbutus. 
Class VII. Hypertrophiae. Hypertrophic affections. 
A. Of Pigment. 
1. Lentigo. 
2. Chloasma. 
3. Naevus pigmentosus. 
4. Morbus Addisonii. 
B Of Epidermis 
a. UF epidermis 
„ AND 
Papilla. 
1. Lichen pilaris. 
2. Ichthyosis. 
3. Cornu cutaneum 
4. Clavus. 
5. Callositas (or tylosis.) 
6. Verruca. 
vulgaris. 
senilis. 
acuminata. 
C. Of Connective 
Tissue. 
1. Scleroderma. 
2. Scleremia neonatorum. 
3. Morphcea. 
4. Elephantiasis (Arabum.) 
D. Of Hair. i. Hirsuties. 2- Naevus pilosus. 
E. Of Nail. i. Onychia. 2. Onychauxis, 
5. Dermatolysis. 
Class VIII. Atrophiae. Atrophic affections 
A Of Pigment 
1. Albinismus. 2. Leucoderma (or vitiligo.) 
3. Canities. 
B. Of Corium. i. Atrophia cutis. 2. Atrophia senilis. 
1. Alopecia. 2. Alopecia areata. 
3. Atrophia pilorum (or fragilitas crinium.) 
C Op Haiti 
l. uf ib. 
D. Of Nail. Onychatrophia. 
Class IX. Neoplasmata. New formations. 
I. Benign New Formations. 
A. Of Connective 
Tissue. 
1. Keloid. 2. Molluscum fibrosum (or fibroma.) 
3. Xanthoma (xanthelasma or vitiligoidea.) 
i. Lupus 
vulgaris. 
erythematosus. 
B. Cellular. 
2. Scrofuloderma. 
3. Rhinoscleroma. 
4. Syphiloderma. 
C. Of Blood 
Vessels. 
1. Naevus vasculosus. 
2. Telangiectasis. 
D. Of Lymphatics. 
11 Lympbangioma oife. 
2 Lymphadenoma cutis. 
E. Of Nerves. Neuroma cutis. 
II. Malignant New Formations. 
I. Lepra. 
tuberculosa 
maculosa 
anaesthetica 
(or elephantiasis Graecorum.) 
r, . 
2. Carcinoma, 
epitheliomatosum (or epithelioma.) 
papillomatosum (or papilloma.) 
o 
3 Sarcoma, 
idiopathicum. 
pigmentosum. 8 
Z. DUNCAN BULKLEY; 
In adopting a Nomenclature I have (with one exception to be 
mentioned later) followed a plan which has been more or less rec- 
ognized by several writers, of selecting, as far as possible, words 
derived from the Greek for the primary name of the disease, while 
secondary terms and expletives are given always in Latin, a plan 
which has been heretofore followed in making the report of my Dis- 
pensary work during the past three years. Where it was thought 
that the term given was not sufficiently clear, synonyms have been 
introduced. 
Under parasitic diseases, the affection tinea trichophytina or 
ringworm in its various forms, has been designated by names sig- 
nifying the various portions of the body affected ; thus, tinea cir- 
cinata, the old herpes circinatus, or ringworm of the body, here has 
the designation “ tinea corporis,” indicating its location ; tinea capi- 
tis (trichophytina), replaces the old herpes tonsurans, or tinea tondens, 
etc. ; tinea barbce is the more proper designation for the parasitic 
sycosis, thus leaving the name sycosis for the ordinary non-para- 
sitic peri-follicular disease ; while eczema marginatum, the parasitic 
affection about the thighs and genitals, so long misnamed, here 
takes the proper name tinea cruris (trichophytina), tinea genito-cru- 
ralis would perhaps be more accurate, but the shorter term is pre- 
ferred. The other names in this group do not differ from those or- 
dinarily accepted; alopecia areata is excluded from among parasiic 
diseases. 
The arrangement of the diseases of the sebaceous glands, and 
the names employed, correspond more to the French teachings, and 
are the same as those which I suggested four years ago, after a careful 
clinical study of acne and its accompaniments,* and continued obser- 
vation and study has still further demonstrated to me the propriety 
of classing all of these affections together under the generic term 
acne. 
Some objections might be made to placing herpes zoster among 
the “ Neuroses,” Class III. ; it has never thus been located in the 
classifications of others, but its true nervous origin is now so incon- 
testably demonstrated that if we wish to really base our classifica- 
tion on pathological facts this disease should form the centre 
around which we may group others whose clinical features are 
wholly neurotic, but whose nerve origin is at present less clearly 
demonstrated. In regard to the “ trophic disturbances ” placed in 
this class, as far as I am aware, these have never entered any pre- 
vious classification of diseases of the skin, and it would be difficult 
to place them anywhere but in the present location, for they may 
present many if not all the phenomena exhibited in other cutaneous 
maladies, erythema, vesiculation, atrophy, etc. It would, perhaps, 
be better to give a Latin equivalent for the name, but the subject 
of “ trophic disturbances,” or the changes in tissues resulting from 
nerve injuries, is so recent that it does not appear best to burden it 
with any new elements. The other diseases in this class are those 
commonly placed there by those who have written on the subject. 
*The American Practitioner, December, 1872. NOMENCLATURE AND CLASSIFICATION 
9 
In Class IV., “ Hyperaemiag,” the names and their arrangement 
are those of Hebra and Neumann, and are familiar to all. 
The fifth class, “ Exudative Affections,” includes a large share 
of the more commonly met with diseases of the skin, and is at the 
same time the most interesting and yet the least satisfactory class ; 
its basis is pathological rather than histological, while its two main 
subdivisions are purely clinical. Most of the subdivisions and the 
diseases under them will be readily accepted, but some differences 
of opinion may arise in regard to individual elements. Many recent 
writers have excluded the lichen simplex of older authorities, class- 
ing this papular eruption as eczema ; this I do not accede to and 
still retain lichen simplex, acute and chronic, as a papular disease 
distinct from papular eczema, and also quite distinct from the other 
varieties here given, lichen planus and scrofulosus, as also different 
from the lichen pilaris, found among the epidermal hypertrophies. 
It will be seen that both prurigo and pruritus enter this classifi- 
cation ; the difference between the diseases represented by these 
names has not been recognized by the profession at large in this 
country, and I would call attention to the fact that by prurigo is 
understood the disease to which Hebra, and others following him, 
have firmly attached this name, which is a papular disease, not as- 
sociated with lice nor related to pruritus, which appears under the 
head of neurotic affections. 
Herpes, in the present scheme is made to include several forms 
which have been recognized by writers under this name, except 
herpes zoster, which, as before mentioned, is reckoned among the 
neuroses ; also many cases of irregular bullous disease, formerly 
classed as herpes phlyctenodes or as pemphigus, are here assigned 
a separate place with the provisionary designation of hydroa. Ec- 
zema and dermatitis are here brought together, because their le- 
sions ofttimes closely resemble each other, and because this very 
proximity of relation will suggest the necessity of recognizing the 
purely local affair dermatitis and separating it clinically from the 
constitutional disease eczema. 
The rheumatic form of purpura (Class VI.) has been called by 
some peliosis rheumatica ; it is desirable that the name o( a disease 
shall as far as possible indicate its true nature, and it is here given 
its proper title, purpura rheumatica, inasmuch as it is undoubtedly 
a form of purpura occurring in rheumatic subjects. Haematidrosis, 
or bloody sweat, and scorbutus have not generally been classed 
among the cutaneous haemorrhages, the former, however, is plainly 
but an effusion of blood from the capillaries of the sweat glands, 
and the latter, scorbutus, should be recognized and described 
among haemorrhages in the skin, because its cutaneous manifesta- 
tions are frequent, and are very liable to be mistaken for purpura. 
In Class VII., under connective-tissue hypertrophies, I have in- 
cluded both scleroderma and scleremia neonatorum as separate dis- 
eases, as they are generally recognized and described as such, 
although some confusion exists yet in reference to their true points 
of similarity and difference. Morphcea is classed by Duhring among 10 
NOMENCLATURE AND CLASSIFICATION 
the atrophies of the skin, he stating that “ the more important 
changes which take place are manifestly of an atrophic nature ; ” 
Fox places it among the hypertrophies. By morphcea I understand 
the same disease which Duhring has so well described, but I take 
issue with him in regard to the process of disease, which I regard 
to be an hypertrophy rather than an atrophy, the hardening resem- 
bles that of scleroderma in some of its features, but distinct, dif- 
ferences exist, and the final result in morphcea is less of an atrophic 
process than is that of scleroderma, as I have elsewhere shown,* 
and yet scleroderma is recognized by all as an hypertrophic dis- 
ease ; morphcea appears to be rather a lardaceous infiltration of the 
connective tissue ; researches are needed in order to determine its 
exact place in classification, for the present it must remain here. 
The term leucoderma (Class VIII.) I have preferred to other 
terms applied to this affection, inasmuch as it corresponds to cer- 
tain other names which have taken a firm hold on dermatological 
nomenclature, as syphiloderma, scrofuloderma, xeroderma ; vitiligo 
signifies but little etymologically, while albinismus partialis, quite 
as much as leucoderma, fails to recognize the darkened borders of 
the white patches. 
In the ninth class, “ New Formations,” I have followed the Ger- 
mans as closely as possible, combining, as mentioned before, the 
two classes of Hebra, benign and malignant new formations in one 
class. Epithelioma is made here to include rodent ulcer ; and pig- 
ment sarcoma represents many cases of so-called melanosis. 
As before mentioned this nomenclature and classification is not 
all that we could desire, it is based on several modes of grouping 
diseases, etiological, clinical, pathological, and histological (the 
latter especially in the ninth class), but I shall not attempt here 
to defend it, because its different elements have received the sanc- 
tion of those well versed in dermatology, and, were a complete rev- 
olution attempted, much confusion would necessarily result and the 
student and those little acquainted with the subject would be 
thereby perplexed instead of assisted. It is sincerely hoped that 
those writing and reporting cases in this country will endeavor to 
use a uniform system of nomenclature and classification, and, after 
much candid study of the matter, and a due consideration of der- 
matological literature, the present scheme is presented as most 
likely, in my opinion, to harmonize and reduce to a clear and prac- 
tical basis the, to many, obscure and difficult matter of the Nomen- 
clature and Classification of Diseases of the Skin. 
* Archives of Dermatology, Vol. III., No. 2, January, 1877, page 100. ARCHIVES OF DERMATOLOGY: 
A QUARTERLY JOURNAL 07 
SKIN AND VENEREAL DISEASES. 
L. Duncan Bulkley, A. M., M. D., Editor. 
The Archives, designed largely for the general practitioner, is now the only 
Scientific Journal published in the English language devoted exclusively to Skin and 
Venereal Diseases. It is supported hy an able staff of collaborators and will aim 
to contain, besides original matter, an epitome of all that is valuable in the litera- 
ture of the day bearing on topics represented. 
NOTICES OF THE PRESS. 
The editor has enlisted as co-workers many of the specialists of these two 
branches of medicine in New York, Philadelphia, and Boston, and there is* no 
reason why it may not be successful.—Boston Medical and Surgical Journal. 
Interesting cases, fresh translations and reviews, with a variety of carefully- 
selected miscellany, make the present number a very attractive one.—New York 
Medical Journal. 
If the conductors can secure a succession of numbers in the future as good in 
character and material as this first specimen one, they will not fail, we think, to 
meet with success.—London Lancet. 
It at once assumes rank among the leading authoritative journals of the coun- 
try, and should be handsomely sustained.— Virginia Medical Journal. 
Bids fair to be the standard journal of the country in the specialty of 6kin and 
venereal diseases.—Atlanta Medical and Surgical Journal. 
That future numbers will be still better we are confident from our personal 
knowledge of the ability and qualifications of the editor and his co-workers.— 
Detroit Heview. 
Subscription $3 a year, in advance. Single number Si. 
G. P. PUTNAM'S SONS, Publishers, 
182 Fifth Avenue, NEW YORK. 
V VOLUMS II. BEGINS OCTOBKB, 1875.,