Impetigo Contagiosa

This disease is characterized by the appearance of mild pyrexial symptoms, followed in two or three days by the appearance of one or more small vesicles. They slowly enlarge, but soon dry into thin, light-yellow crusts, or scabs. These lesions may be few or numerous, and successive outbreaks may prolong the affection for several months. The affection is unquestionably contagious, and, when it once appears upon an individual, other members of the family, either children or adults, may contract it. In not a few instances the eruption has appeared within a couple of weeks or so after vaccination. If the crust, which has the appearance of being "stuck on," is removed, a slightly reddened but not eroded surface is revealed, from which but little or no moisture is exuded.

The disease is seen amongst children of the lower orders especially, probably in great measure because the disease spreads by contagion freely amongst them. It occurs also in those who have all the advantages of social position and good hygiene.


The eruption in the disease in the majority of cases appears first of all on the face, sometimes on the top or back of the head, and in the form of "little watery heads" (vesicles) that enlarge into flat bullae if they are not injured by scratching. Sometimes the hands are attacked at the outset, and look as if burnt here and there; phlyctenae may also arise out of and around the remnants of vaccinia, or about cuts or bruises. The disease then extends to other parts, the back of the neck, buttocks, feet, etc. The vesicles are always isolated. In five or six days the bullae may reach the size of a six-pence or shilling unless ruptured, and are then flat and depressed in the centre, their contents becoming turbid. Usually the vesico-pustule is the size of a large split-pea or thereabouts. The secretion consists of lymph-like fluid, granular cells, and subsequently puscells.


Scabs commence to form a few days after the appearance of the disease. They are characteristic of the disease, varying in size from that of a split pea to a shilling; they are flat, straw-colored, dry, and granular-looking, and appear as if "stuck on" on the part; they present, as a rule, no inflammatory areola around their circumferences, though this is the case in severer instances of the disease. If removed, little sores are observed beneath, more or less filled in by gummy-like secretion, or a little pellet of splastic lymph, and when the scabs fall off there is an erythema-tous base left behind, the hue of which gradually fades away. The disease may be spread from spot to spot by direct inoculation with its secretion in the act of scratching. The crop of vesicles is to some extent successive, though the majority of the places "come out" in the first week or so. In some instances the disease resembles vaccinia very slowly. There is always a uniformity about it; it always commences by vesicles; there are no papules pre­sent at the height of the disease. On the face the spots may be confluent, and then the disease resembles eczema impetiginodes; but the patches are made up of the elements described above. On the scalp the disease consists of circular mostly isolated, flat-scabbed spots about the top and back of the head, the hair being matted by the crusts. Usually, no pediculi and no offensive smell are present. Now it is very important to note that an eczema may be readily excited in fair children by scratching or the irritation of the discharge, in connection with impetigo contagiosa - and then the characteristic features of the latter disease are marked. The result of neglecting to attend to this point is that the practitioner regards the disease present as solely and entirely an eczema. The error, too, is a very common one.

The mucous membranes of the eye and the nose are sometimes implicated; then inflammation is produced by the development of little ulcers, that take their origin in the formation apparently of vesicopustules, identical with those seen on the surface of the skin. The eye may look as though affected by slight purulent ophthalmia, but soon recovers itself.

The disease may complicate eczema, scabies, and other affections, and vice versa.