Erythema exudativum multiforme in childhood.

Hebra (1860) entered into a friendly rivalry with the English dermatologist Robert Willan in his classical dissertations on the 'polymorphous ery-themata.' Even in these early years dermato-logical nomenclature had reached a complex state. Hebra comments that ' these various names by no means answer to as many distinct disese, and our object must be to determine which of them apply merely to appearances developed in succession during the course of one and the same disease, and, in reference to this, expeience has taught me that are merely forms of the same disea according to the period of its course; to this malady I shall apply the name E. multiforme.' The phases and trnsitions are clearly described by Hebra and some emphasis is placed upon the regional distribution of the rash, it appearig initially on the dorsm of the hands and feet, being in severe cases more generalized even to include, in exceptional cases, the trunk and face. In Hebra's description E. papulatum represents the lowest and E. gyratum the highest grade in the eruption, and he deprecates the notion that these are different species. Also, E. exudativum multiforme may give rise to tifling subjective disorder, fever being observed only in exceptional cases and in those in which the affection spreads over large tracts of the surface and having a duration of up to four weeks. Hebra agrees with Willan that vesicular forms of the eruption may appear, but he refuses to agree that there is any relation uith Herpes; and he concludes his masterly clinical description in confessing his complete ignorance of the cause of these erythemata, although his experience indicated a preponderance of these affections in young persons. It is of some historical interest in this connexion that Hebra (1860) disusses E. epidemicum, aero-dynia (which Alibert says prevailed in Paris in 1828), and classifies it as an exudative erythema. Two years later, Bazin (1862) described vesiculo-bullous stomatitis in association with multiform cutaneous lesions. It is evident that in the following years there was much dispute in regard to the clasiftion and etiology of the erythematous dermatoses. We now understand that individual susceptibility and reaction is indicated by a wide variation in clinical response, and this is specially so in the cutaneous and mucosal surfaces, which in their display of colour, form, shape, and distribution rarely fail to demand careful clinical scrutiny. Whilst, therefore, for certain practical reasons, many of …