THE IMPETIGOS

In olden times the term impetigo, as well as impetigo simplex,
impetigo sparsa (Willan, Bateman, Wilson, Hillairet), was applied to
various pustular inflammations of the skin. From this ill-denned
classification many authors gradually accepted two divisions of this
group: one under the name of impetigo or impetigo simplex, and the
other under the name of impetigo contagiosa (Tilbury Fox²); under
the former were included most accidental pustular lesions seen in
connection with parasitic diseases, especially pediculosis, and those

¹ Hallopeau and Gastou, Annales, 1904, p. 1021.

² Tilbury Fox, Brit. Med. Jour., 1864, pp. 467, 495, 553, and 607; and Jour. Cutan.
Med., Oct., 1869, p. 231; Treatise on Diseases of the Skin, third edit., p. 227.

396

INFLAMMATIONS

occasionally occurring in connection with eczema and other inflammatory
dermatoses, and this variety was for a long while thought to be non-
contagious. While most authors considered this type more of an acci­
dental lesion than a distinct morbid entity, others, and in our own country
notably, Duhring¹ and Robinson² contended that there was a special
disease of which the rounded, semiglobular pustule, practically non-
contagious, and occurring in children, and presenting a variable number
of lesions, did exist. Under the other heading—impetigo contagiosa—
authors have been accustomed to place those cases of vesicular and sero-
purulent and purulent lesions seen chiefly upon the face of children,
usually running a definite limited course, and which clinical observation
had pointed out had very decided contagious properties. Later, chiefly
since the experiments of Bockhart,³ all these various pustular lesions
have been thought to represent the same morbid process resulting from
inoculation by pyogenic cocci. This acceptation would attribute
the somewhat varied clinical pictures to the fact of different environ­
ment, different “soil,” and different virulence of the infecting germ.
For clinical purposes and for treatment this view, while in the light
of more recent research not wholly scientifically exact as to the patho­
genic organisms, appeared to be the most satisfactory. Since this
view became the prevailing one, however, clinical and experimental
studies by Unna,⁴ Sabouraud,⁵ and others⁶ seem to show various
types of impetigo due to different micro-organisms. Unna would
have us believe that there are, in reality, several distinct diseases:
impetigo vulgaris (impetigo contagiosa of Tilbury Fox and others),
impetigo staphylogenes (impetigo of Bockhart and Duhring), and
impetigo circinata and impetigo streptogenes. Sabouraud‘s clean-
cut investigations led him to conclude that there are two separate
maladies, one due to the streptococcus and the other to the staphyl-
ococcus, the former causing the impetigo contagiosa of Tilbury Fox
and others, and the latter the impetigo of Bockhart. It will be seen
that while the question of impetigo is still in an unsettled condition,
much has been done, and is being done, to add to its elucidation.

The facts as now known seem to indicate that there are several
types of impetigo, sometimes doubtless mixed in character, the slightly
varied clinical differences of which, for practical purposes, may be

¹ Duhring, Diseases of the Skin, third edit., p. 293; part ii, Cutaneous Medicine,
p. 422.

² Robinson, Manual of Dermatology, p. 280.

³ Bockhart, Monatshefte, 1887, p. 450.

⁴ Unna and Schwenter-Trachsler, “Impetigo Vulgaris,” Monatshefte, vol. xxviii,
pp. 229, 281, 333, and 385 (an elaborate and experimental paper reviewing the whole
subject and literature of impetigo).

⁵ Sabouraud, “Etude clinique et bacteriologique de l‘impetigo,” Annales, 1900,
pp. 62 and 320 (a complete and elaborate investigation of the subject, with important
literature references and a number of cuts).

⁶ Other important recent literature: Wickham, Union mêdicale, Feb., 1892, Nos.
16 to 23, and Brit. Jour. Derm., 1892, p. 202; Balzer and Griffon (bacteriologic; strep­
tococci found in every instance), La Presse méd., 1897, No. 89; Dubreuilh, “De la
nature de 1‘impetigo et de 1‘eczèma impetigineux,” Annales, 1890, p. 289. Also valu­
able papers bearing upon the role of pus-producing organisms in skin diseases in Trans.
Amer. Derm. Assoc. for 1899, by Elliot (p. 75) and Gilchrist (p. 87) and (of staphylo-
coccus) C. J. White, Med. Com. Mass. Med. Soc, 1899, p. 157.

IMPETIGO CONTAGIOSA

397

ignored, inasmuch as for all the treatment is always the same. All
forms are contagious, the impetigo of Bockhart being the least so. As
Tilbury Fox's impetigo contagiosa is that most commonly observed,
they will be here considered under that heading.

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