Duhring, Louis Adolphus, 1845-1913.

Journal : Photographic review of medicine & surgery ; vol. 1., no. 5.

Philadelphia : J. B. Lippincott & Co., 1870-71.

Description : pp. 64-67, [1] pl. ; ill.: 1 photo. ; 24 cm.

Photograph : mounted albumen.

Subject : Misdiagnosis — Necrotizing fasciitis.

Notes :

The ulcerations which existed four years ago, already described and as seen in the photograph, have cicatrized to a great extent, but the ulcers about the eyelids and around the nose are still open, with but little tendency to heal. His skin over the whole body is soft, flabby, and lax, particularly so about the face. He has no control over the saliva, which flows continuously from him. He suffers no pain. Both eyes are covered with a thick, opaque deposit, and his sight in consequence is nearly gone. — page 65.

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What can be called the Proteus of diseases, syphilis manifests in a remarkable variety of symptoms and loci. In this paper, Duhring writes at length on why the face of his twelve year old patient was obliterated by syphilis and not by lupus exulcerans or an epithelioma. However, his argument is controverted by the circumstances which strongly indicate a streptococcal gangrene of the face. Neither parent was marked by syphilis and the first symptoms originated when the boy was kicked violently in the face at the age of ten. This, then, may be the earliest published photograph of a necrotizing fasciitis involving the face.

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