The Dublin school: from poverty, a rich legacy.
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Although meningitis has been recognized since antiquity, the clear description of signs of meningeal irritation is relatively recent. Kernig's sign is described in physical diagnosis texts; however, the test for Kernig's sign as currently performed differs from Kernig's original description. Brudzinski described several signs of meningitis; his "nape of the neck" sign is the best known. The contralateral leg signs described by Brudzinski are unfamiliar to most clinicians. Brudzinski believed that knowledge of all the meningeal signs was of use because some may be present while others are absent. Since outcome in meningitis is dependent on early treatment--and therefore early diagnosis--familiarity with all the meningeal signs is desirable.
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Degos' disease, known confusingly as malignant strophic papularis, is an uncommon condition of unknown cause characterized by distinctive infarctive lesions in the skin, gastrointestinal tract, and central nervous system; the lesions at the two latter sites often result in death. We deem Degos' disease to be analogous to lupus erythematosus in the sense that each is fundamentally a systemic pathologic process involving several organs, among them the skin, but, moreover, we regard Degos' disease, in most instances, to be an actual manifestation of lupus erythematosus. Histopathologically, the findings in sections of tissue of skin lesions of Degos' disease are indistinguishable from those of one expression of cutaneous lupus erythematosus; immunopathologically, some patients with morphologic findings stereotypical of Degos' disease display signs characteristic of lupus erythematosus. For these reasons, we consider Degos' disease to be a distinctive pattern of disease, rather than a specific disease per se, just as are erythema multiforme, erythema nodosum, leukocytoclastic vasculitis, Sweet's syndrome, and pyoderma gangrenosum, to name but five of scores of them. The singular pattern that is designated Degos' disease usually is an expression of lupus erythematosus, but, episodically, of conditions like dermatomyositis and rheumatoid arthritis.
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