Original Communications. MOLLUSCUM CONTAGIOSUM—A PRELIMINARY REPORT.* By HENRY W. Of Philadelphia. V 0 PINION as to the histological formation and the clinical behavior of molluscum contagiosum is at the present day tolerably well defined, but the same unanimity can not be said to hold in regard to the subject of its contagiousness. English writers as a body, as is well known, take the side of the affirmative on this question; the Germans and French, on the contrary, take an opposite view. American opinion, as a whole, has followed the Germans. The latest American contribution to the literature of this disease, by Allen, based upon an observation of fifty cases occurring in an institution, presents, as the writer claims, facts which appear to prove that the disease has contagious properties. My own experience, which I shall here briefly relate, seems, contrary to pre- conceived prejudices, to have much in common with that of the last- named writer. The cases comprised in this report number thirty-two, and were observed, so to speak, in four groups. The first series, numbering four cases, came to my notice at the Children’s Hospital, of Philadelphia, in 1881 or 1882, through the kindness of Dr. Henry R. Wharton. My notes of these cases, unfortunately, have been mislaid, and the exact data can not therefore be given. I remember, however, that the disease was first seen in one of the crippled inmates, and that soon afterward three other cases among his fellows in the same ward were observed. The ward con- tained twelve patients, all of whom were confined to bed. The disease was of the moderately developed type, each case showing from three to a dozen lesions, and these chiefly upon the face. This was the extent of the spread of the disease, although, it must be stated, the hospital con- tained a tolerably large number of children. The second group I saw in the latter part of March, of last year, at St. Vincent’s Home for Children, with the attending physician, Dr. Joseph Lopez. In this series were thirteen cases, all of which had made their appearance within a few months. In these thirteen, with one exception, the mollusca were seated upon the face only; in the one excepted, in addition to those on the face there were two upon the hands. This dis- tribution I mention especially for the reason that at the same time scabies was prevalent at the Home, and if irritation strongly favors the produc- tion of molluscum, as suggested by some writers, then the three or four * Read before the American Dermatological Association, at the Congress of Phy- sicians and Surgeons, Washington, September 19, 1888. Z S' f-kW™ J- 2 Molluscum Contagiosum: A Preliminary Report. cases of this series who had the itch also, should have shown mollusca upon the parts affected by this disease; but, on the contrary, while all parts of the body except the face gave evidence of a well-marked scabies, the face alone was the seat of the molluscum tumors. Moreover, the single case showing molluscum upon the hand was entirely free from the itch. The affection—molluscum contagiosum—had been introduced into the institution by one of the inmates, and subsequently showed itself in the other children. The Home contained in all one hundred and fifty chil- dren. The number of lesions in the individual cases varied from one to twenty, and in size from a pin-liead to a large pea. In fact, the eruption was of the ordinary character, and under hygienic and therapeutic meas- ures soon disappeared. The cases of the third group were observed last autumn at the service of the Philadelphia Dispensary for Skin Diseases. This group consisted of three cases, all in the same family. The affection first appeared in the daughter, a young girl of twelve years, and consisted of six characteristic lesions—three on the face, one on the trunk, one on the thigh, and one on the arm. When first seen the disease had lasted several weeks. Shortly afterward the father of the girl developed a lesion on the neck, and at the same time the sister presented a lesion on the thigh. In these three cases there was a marked disposition for the mollusca to become pedunculated, and to gradually disappear by ulceration. The fourth series I saw in the past month, at the same institution at which the cases of the second group were observed. It consisted of twelve cases, and in this instance was apparently traceable to two imported cases, all cases of the former group having been cured or discharged. In this series, also, the disease was of a moderately developed type, and displayed no unusual manifestation. These four groups constitute all the cases of this disease, with possibly one or two exceptions, which have come under my observation in a period of thirteen years, and it must be admitted that, with this experience before me, my former belief in its non-contagiousness has been somewhat shaken. Various attempts at inoculation were made, but never with any further result than the appearance of insignificant and evanescent inflammatory papules, in no way characteristic. In studying these cases and the cases reported by others, especially with reference to the subject of contagion, three or four facts stand out prominently: First, that the disease, while occasionally occurring upon covered regions, is practically seen either upon exposed parts or parts with which the hands must of necessity come more or less in contact, as the genitalia. Second, that the disease is observed chiefly in children, and as a rule in children of the poorer classes. Third, that while it is com- paratively rare to meet with single cases, it is exceedingly common for the Original Communications. 3 affection to be seen in groups or series, as in a family or an institution. Fourth, that, in admitting its contagious nature, it must at the same time be acknowledged that apparently it possesses this property only in an extremely slight degree.