{"1": {"fulltext": "", "height": "3668", "width": "2236", "jp2-path": "skindiseasesthei00doug_0001.jp2"}, "2": {"fulltext": "Qass.\\nBook\\nCOPYRIGHT DEPOSIT", "height": "3420", "width": "2067", "jp2-path": "skindiseasesthei00doug_0002.jp2"}, "3": {"fulltext": "", "height": "3420", "width": "2067", "jp2-path": "skindiseasesthei00doug_0003.jp2"}, "4": {"fulltext": "", "height": "3420", "width": "2067", "jp2-path": "skindiseasesthei00doug_0004.jp2"}, "5": {"fulltext": "Skin Diseases\\nTHEIR\\nDESCRIPTION, ETIOLOGY, DIAGNOSIS.\\nAND TREATMENT\\nACCORDING TO THE LAW OF THE SIMILARS.\\nBY\\nM; E. DOUGLASS, M. D.,\\nBaltimore, Mb.,\\nLEcxrRER ON Dermatology in the Southern Homceopath\\nMedical College of Baltimore, Md.\\nPHILADBlvPHIA\\nBOERICKE TAFEL.\\n1900.", "height": "3603", "width": "2183", "jp2-path": "skindiseasesthei00doug_0005.jp2"}, "6": {"fulltext": "TWO COPIES RECEIVEO.\\nlibrary of CGiBsr\u00c2\u00a78%\\nOfflee of tli\u00c2\u00ab\\nAPR 7 1900\\nH9Kl9t\u00c2\u00abr of Gopyrlg|fi%\\n60024\\nCOPYRIGHT\\nBY\\nBOERICKE TAFEL,\\n1900.\\nT. B. H. B. COCHRAN, PRINTERS,\\nLANCASTER, PA.\\nSECOND COPY,\\nUo-^fc.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0006.jp2"}, "7": {"fulltext": "PREPACK.\\nMan is a composite being. We have the skeletal man\\nthe muscular man; the arterial man; the nervous man;\\nthe venous man; and enclosing and protecting all these\\nthe skin\u00e2\u0080\u0094 or outer man. This outer man is the one in\\nwhom we all take a greater or lesser pride; the one that\\nreceives the greatest amount of attention; the one that\\nmore pains are taken to beautify and adorn than all the\\nothers; the one in which any imperfection is soonest\\nnoticed, and for which relief is most promptly sought.\\nThe physician who can soonest remove the disfiguring\\nblemishes, heal diseased conditions, smooth and beautify\\nthe skin is the one whose praises are the loudest pro-\\nclaimed by the gratified patient.\\nIn no other department of medical science is a reputa-\\ntion so readily made as in the department of dermatology,\\nfor the reason that patients can speedily judge whether\\nthe physician is likely to do them good or harm.\\nWhat not to do in treating skin diseases is an import-\\nant thing to know. The physician must have a thorough\\nknowledge of the general course and behaviour of skin\\ndiseases, and it is essential that he should be proficient\\nin the principles of general medicine, in order that he\\nmay treat affections of the skin intelligently and success-\\nfully. The reason for this statement will become ap-\\nparent as we study the etiology of the various lesions.\\nWe will then find that it often is necessary only to treat\\nthe cause to remove the lesion; and in this branch of", "height": "3603", "width": "2183", "jp2-path": "skindiseasesthei00doug_0007.jp2"}, "8": {"fulltext": "IV PREFACE.\\nmedical science, more than in any other, perhaps, we will\\nfind Hahnemann s rule to treat the totality of the symp-\\ntoms complained of by the patient, the only method by\\nwhich we may cure our patient.\\nThe highest aim of healing is the speedy, gentle, and\\npermanent restitution of health, or alleviation and oblitera-\\ntion of disease in its entire extent, in the shortest, most\\nreliable, and safest manner, according to clearly intel-\\nligible reasons.\\nWhen the physician knows in each case the obstacles\\nin the way of recovery, and how to remove them, he is\\nprepared to act thoroughly, and to the purpose, as a true\\nmaster of the art of healing.\\nThe author has been prompted to prepare this work by\\na conviction of the existence of an urgent demand for a\\nwork on Dermatology in our School of Medicine, which\\nshould embody the advances recently made and set forth\\nthe distinctive characters of our therapeutics in a rational\\nand practical manner.\\nThe work has been written in the first instance with\\nthe view of meeting the wants of the homoeopathic prac-\\ntitioner in his daily dealings with diseases of the skin;\\nat the same time the needs of the medical student in pre-\\nparing for his examinations has been kept constantly in\\nmind.\\nThe author has endeavored to present his subject in\\nthe most practical manner and with the fewest possible\\nwords consistent with an intelligible presentation of the\\nsame. To this end he has avoided all theoretical and con-\\ntroversial discussions, which are of interest to the special-\\nist rather than to the general practitioner or student.\\n7 W. North Ave.\\nMay, 1899.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0008.jp2"}, "9": {"fulltext": "CONTENTS.\\nCHAPTER I.\\nThh Anatomy of the Skin, 9\\nBlood Vessels, 10. Epidermis, 11. Subcutaneous Cellular\\nTissue, 17. The Sweat Glands, 17. Sebaceous Glands, 20.\\nHair. 22. Muscles of the Skin, 23. Nails, 24. Nature and\\nAmount of Perspiration, 28.\\nCHAPTER II.\\nSome General Observations, 33\\nRules for Studying Skin Diseases, 41.\\nCHAPTER III.\\nClassification of the Elementary Lesions, 48\\nMacule, 49. Vesicle, 50. Bulla, 51. Pustule, 51. Papule,\\n52. Tubercle, 54. Scales, 55. Fissures, 56. Ulcers, 56.\\nDrug Eruptions, 57. Pathology, 59.\\nCHAPTER IV.\\nEtiology, 60\\nCHAPTER V.\\nLocal Dermal Inflammations, 70\\nErythematous Diseases, 72. Erythema, 73. Erythema Mul-\\ntiforme, 73. Erj thema Nodosum, 75. Roseola, 79. Urti-\\ncaria, S2. P^ollicular Hyperaemia, 93. Medicinal Rashes,\\n94.\\nCHAPTER VI.\\nThe Eruptions of Acute Specific Diseases (Zymotic), 96\\nVariola, 96. Varicella, 107 Typhus Rash, 108. Typhoid\\nRash, 108. Measles, 109. Scarlatina, 114. Erysipelas, :i5.\\nRubella, 125. Frambcesia or Jaws, 126.", "height": "3603", "width": "2183", "jp2-path": "skindiseasesthei00doug_0009.jp2"}, "10": {"fulltext": "VI CONTENTS.\\nCHAPTER VII,\\nPapular Infi^ammations, 129\\nLrichen Planus, 129. Ivichen Ruber, 133. L^ichen Simplex,\\n135. lyichen Scrofulosorum, 141. Strophulus, 142. Prurigo,\\n143-\\nCHAPTER VI n.\\nECZRMA, 148\\nCHAPTER IX.\\nBuivi^ous Diseases and Anomalous Forms of Bullous\\nEruption, i S9\\nHerpes Labialis, 191. Herpes Progenitalis, 191. Zoster, 196.\\nPemphigus, 202. Pemphigus Vulgaris, 203. Pemphigus\\nFoliaceus, 204. Hydroa, 208.\\nCHAPTER X.\\nSuppurative Inflammations, 215\\nImpetigo Contagiosa, 216. Erthyma, 223. Furuncle, 228.\\nStye, 232. Carbuncle, 233. Pustula Maligna, 237.\\nCHAPTER XI.\\nSquamous Inflammations, 240\\nPityriasis Rubra, 241. Pityriasis Pilaris, 244. Psoriasis, 245.\\nCHAPTER XII.\\nDiathetic Diseases, 257\\nvScrofuloderma, 257. Syphilis, 267. Condylomata, 288.\\nLeprosy, 290. Morvan s Disease, 299.\\nCHAPTER XIII.\\nHypertrophic and Atrophic Affections, 303\\nCorns, 304. Horns, 305. Warts, 306. Ichthyosis, 317. Mor-\\nphoea, 322. Scleroderma, 325. Scleriasis, 327. vSclerema\\nNeonatorum, 328. Keloid, 328. Fibroma, 331. Derma-\\ntolysis, 332. Elephantiasis, 333. Milium, 334. Mammil-\\nlitis Maligna, 335. Ainhum, 336. Naevus, 336,", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0010.jp2"}, "11": {"fulltext": "CONTENTS. Vll\\nCHAPTER XIV.\\nNeoplasmata 340\\nIvupus, 340. Epithelioma, 34S. Sarcoma, 353. Carcinoma,\\n357. Rodent Ulcer, 371,\\nCHAPTER XV,\\nCutaneous Hemorrhages, 374\\nPurpura. 375.\\nCHAPTER XVI.\\nPruritus, 379\\nCHAPTER XVII.\\nChromatogenous Diseases 387\\nVitiligo, 388. Melanoderma, 389. Ephelis, 391.\\nCHAPTER XVIII.\\nParasitic Diseases 377\\nPhtheiriasis, 393. Psorospermosis, 396. Scabies. 396. Favus,\\n402. Tricophytosis, 407. Chromophytosis, 412. Onychomy-\\ncosis, 413. Paronychia, 416.\\nCHAPTER XIX.\\nDisorders of the Glands, 418\\nDiseases of Sweat Glands, 418. Anidrosis, 421. Dysidrosis,\\n423. Osmidrosis, 425. Chromidrosis, 425. Hsematidrosis,\\n426. Lichen Propicns, 427. Hydro-Adenitis, 427. Sudolor-\\nrhoea, 428. Seborrhoea, 430. Asteatodes, 433, Allosteado-\\ndes, 433. Xanthelasma, 434. Comedo, 435. Molluscum,\\n436. Acne, 437.\\nCHAPTER XX.\\nDiseases of the Hair, 450\\nAlopecia, 450.\\nCHAPTER XXI.\\nPernio, 456. Actinomycosis, 459. Wash-Leather vSkiii, 460.\\nEffects of Rhus Tox. on the Skin, 461.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0011.jp2"}, "12": {"fulltext": "", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0012.jp2"}, "13": {"fulltext": "CHAPTER I.\\nTHE ANATOMY OF THE SKIN.\\nIn order to correctly understand the nature of the mor-\\nbid changes that go on in the skin, and to comprehend\\ncorrectly how and where these changes begin, it is nec-\\nessary to have an accurate knowledge of the healthy skin\\nin its different parts.\\nThe healthy skin is, of course, the standard of com-\\nparison for all changes in the skin, and without the clear-\\nest perception of what that standard is the student can,\\nof course, only fall into error from the inability to distin-\\nguish between what is normal and what is abnormal.\\nThe skin consists of an epithelium resting upon a con-\\nnective tissue basis. The epithelium, which is composed\\nof many layers of cells, is called epidermis^ the connective\\ntissue basis is called cutis vera, dermis, or corium. The\\nsurface of the dermis is thrown up into a number of eleva-\\ntions papillcB which differ in size, form, complexity, and\\narrangement in different regions of the body. Some are\\nsmall, more or less conical elevations, simple papiUcs. In\\nothers, a broader primary elevation is divided at its sum-\\nmit into a number of secondary elevations; these are\\ncompound papillcB. In many regions of the skin, as, for\\nexample, in the palms of the hands, the papillae are\\narranged in ridges separated by shallow furrows. The\\nsurface of the skin, that is, the contour of the epidermis,\\ndoes not follow the papillary contour of the dermis; the\\npapillae accordingly appear to plunge into and be covered", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0013.jp2"}, "14": {"fulltext": "10 SKIN DISEASES.\\nUp by the more even epidermis, the surface of which,\\nhowever, is marked by the ridges and furrows spoken of\\nabove as well as by bolder creases and folds.\\nThe surface of the dermis is not developed into a dis-\\ntinct and separable basement membrane, as is so often the\\ncase in a mucous membrane; but in the most superficial\\nportions of the dermis the connective tissue shows little\\nor no fibrillation and consists of a homogeneous matrix,\\nin which are imbedded connective tissue corpuscles and\\nextremely fine elastic fibres. This superficial portion of\\nthe dermis, which is especially well developed in the pa-\\npillae, serves accordingly the purposes of a basement mem-\\nbrane, and sharply defines the dermis from the overlying\\nepidermis. At a very little distance from the epidermis,\\nfibrillation makes its appearance, the bundles of fibrillse\\ninterlacing in a network which, very closely set in the\\nouter, more superficial layers, becomes more and more\\nopen in the inner, deeper parts. The connective tissue\\nof the dermis thus passes insensibly into the subcutaneous\\nconnective tissue, in which thick interwoven bundles of\\nfibrillse, bearing in transverse section a certain resem-\\nblance to sections of tendon bundles, form a tough open\\nnetwork, the larger spaces of which are frequently occu-\\npied by masses of fat cells of the subcutaneous adipose\\ntissue. Elastic fibres are very abundant in the dermis\\nproper, being very fine immediately beneath the epider-\\nmis and becoming coarser in the deeper parts; they are\\npresent also, though to a less extent, in the subcutaneous\\nconnective tissue. The skin, as a whole, is a very elastic\\nstructure.\\nBlood vessels are very abundant, forming close-set\\ncapillary outworks and looks immediately under the epi-\\ndermis, especially in the papillae, and more open net-\\nworks elsewhere; but no blood vessel passes into the epi-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0014.jp2"}, "15": {"fulltext": "THE ANATOMY OF THE SKIN. 11\\ndermis. Lymphatic vessels and lymphatic capillaries are\\nabundant in the dermis, being connected here as in other\\nregions of the body with smaller lymph spaces.\\nThe consideration of the nerves of the skin will be\\ndeferred until we come to deal with the skin as an organ\\nof sense; for though some of the cutaneous nerve fibres\\nare efferent fibres distributed to the blood vessels, and\\nprobably to the sweat glands and other structures not\\ndirectly connected with the sense of touch, by far the\\ngreater number are afferent fibres beginning in the dis-\\ntinct tactile organs, or otherwise serving as sensory struct-\\nures.\\nThe epidermis consists of two parts, separated by a\\nfairly sharp line of demarcation; an inner soft layer, the\\nMalpighian layer, or stratmn Malpighii, and an outer\\nharder horny layer, or stratum coryieum. The skin, as is\\nwell known, varies in thickness in dffferent regions of the\\nbody, and the differences are due almost exclusively to\\nvariations in the thickness of the horny layer which, as\\nover the lips, may be extremely thin, or as on the heel,\\nexcessively thick; compared with the variations in thick-\\nness of the horny layer, the variations in thickness of the\\nMalpighian layer or of the dermis may be disregarded.\\nThe line of demarcation between the Malpighian and\\nhorny layers follows the contour of the surface of the\\nskin, not that of the dermis, the papillae of which appear\\nin sections as if imbedded in the Malpighian layer. When\\nthe skin after death is macerated, the horny layer is apt\\nto peel off from the Malpighian layer below, which,\\noriginally soft and rendered still softer by the macera-\\ntion, then appears as a layer of slimy tissue spread out\\nbetween the sides of and covering the summits of the\\npapillae of the dermis, somewhat after the fashion of a", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0015.jp2"}, "16": {"fulltext": "12 SKIN DISEASES.\\nnetwork; hence this layer wavS in old times spoken of as\\nthe rete niucosimi.\\nThe lowermost, innermost portion of the Malpighian\\nlayer resting upon the dermis, consists of a single layer\\nof elongated, or almost columnar cells placed vertically,\\nthat is, with their long axis perpendicular to the plane of\\nthe dermis. This layer which preserves the original feat-\\nures of the epiblast of the embryo, and which may be\\nfollowed over the papillae as well as along the intervening\\nvalleys, presents a characteristic appearance in vertical\\nsections of the skin. Bach cell, which is about as large\\nas a leucocyte, consists of a relatively large oval nucleus\\nlying in the midst of a coarsely granular cell substance,\\nwhich stains readily with the ordinary staining reagents.\\nThe base of the cell abutting on the dermis often shows\\nfine processes interlocking with corresponding processes\\nfrom the dermis; the sides of the cells are in close con-\\ntact, but merely in contact, no cement substance existing\\nbetween them.\\nThe rest of the cells of the Malpighian layer, much like\\neach other, are polygonal or irregularly cubical cells, re-\\nsembling the vertical cells just spoken of in so far that\\neach consists of a coarsely granular cell-substance in which\\nis imbeded a relatively large nucleus; this, however, is\\nspherical, not oval. The surface of each cell is thrown\\nup into short ridges, radiating somewhat irregularly from\\nthe centre of the cell and projecting at the surface and\\nedges, so as to give the cell somewhat the appearance of\\nbeing armed with a number of prickles. Hence these\\ncells are often called prickle cells. The prickles of a\\ncell do not interlock with those of its neighbors but touch\\nat their points, so that the contact of two adjacent cells is\\nnot complete but carried out by the points of the prickles\\nonly, minute spaces being left between. Hence the whole", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0016.jp2"}, "17": {"fulltext": "THE ANATOMY OF THE SKIN. 13\\nMalpighian layer is traversed by a labyrinth of minute\\npassages, along which fluid can pass between the touch-\\ning prickles.\\nIn dark skins, as that of the negro, pigment particles\\nabound in the lower Malpighian cells, especially in the\\nvertical layer. In such cases branched pigment cells,\\nconnective tissue corpuscles loaded with pigment gran-\\nules, are to be seen in the dermis also; and occasionally\\nsimilar branched cells may be seen in the epidermis be-\\ntween the Malpighian cells. lycucocytes also not infre-\\nquently pass out at the dermis and wander among the\\ncells of the Malpighian laj^er.\\nThe nuclei, not only of the vertical, but also of the other\\npolygonal cells may, not infrequently, be observed in\\nvarious stages of karyomitosis. Throughout life the\\ncells of this Malpighian layer of the skin appear to be\\nundergoing multiplication by division the increase of\\npopulation thus arising is kept down by the cells passing\\nupward and outward, and becoming transformed into the\\ncells of the horny layer.\\nThe line of demarcation between the Malpighian layer\\nand the horny layer is, as we have said, sharp and dis-\\ntinct. It is furnished by two peculiar strata of cells,\\nmore conspicuous in some regions of the skin than in\\nothers. The lowermost, innermost stratum consists of a\\nsingle layer or of two or three layers of cells which are\\nnot unlike Malpighian cells, but are differentiated by\\ntheir form, being extended horizontally so as frequently\\nto appear fusiform in vertical sections, by the absence of\\nprickles, by their staining very deeply with certain re-\\nagents, such a, i osmic acid, and especially by their cell\\nsubstance being crowded with large discrete granules of\\na peculiar nature. Hence this stratum is called the\\nstratum granulosum.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0017.jp2"}, "18": {"fulltext": "14 SKIN DISEASES.\\nThe stratum above this consists of two or even more\\nlayers of cells, elongated and flattened horizontally, the\\ncell substance of which is homogeneous and transparent,\\nfree from granules and not staining very readily. In the\\nmiddle of a cell may frequently be seen a rod-shaped\\nnucleus placed horizontally. These clear transparent\\ncells form a transparent seam, the stratum lucidum, be-\\ntween the stratum granulosum and Malpighian layer\\nbelow and the horny layer above.\\nThe horny layer, which is, as we have said, of variable\\nbut nearly always of considerable thickness, is formed of\\na number of layers of cells which, differentiated already\\nin the lowest layers, have that differentiation completed\\nas these pass upward. The upper, outer portion of this\\nhorny layer is continually being shed or rubbed off in the\\nform of flakes of variable size. Each flake upon exami-\\nnation, as for instance after dissociation by maceration or\\nwith the help of alkalies, is found to be composed of\\nelements which can no longer be recognized as cells, and\\nwhich may be spoken of as scales. Every scale is a\\nflattened mass or plate in which no nucleus can be seen,\\nand which consists not of the proteids and other constitu-\\nents of ordinary cell substance, but almost exclusively of\\na material called keratiyi. This is a body, the exact\\nnature of which has not yet been clearly made out, but\\nwhich has the general percentage composition of proteids,\\nfrom which it is a derivative, with the exception that it\\ncontains a considerable quantity of sulphur (the keratin\\nof hair contains as much as five per cent); this sulphur\\nappears to be somewhat loosely attached to the other\\nelements of the keratin since it may be removed by boil-\\ning with alkalies.\\nThe lowermost portions of the horny layer are com-\\nposed of elements which may still be recognized as cells,", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0018.jp2"}, "19": {"fulltext": "THE ANATOMY OF THE SKIN. 15\\ninasmuch as each contains a nucleus, though this obvi-\\nously undergoing change and on the way to disappear.\\nEach cell is, however, flattened and plate-like, and its\\nsubstance already consists largely of keratin. In passing\\nupward from the lower to the more superficial pairs of\\nthe horny layer such an imperfect cell loses its nucleus,\\nand becomes the wholly keratinous plate just described.\\nThe whole horny layer consists of strata of elements,\\nhorny to begin with, but becoming more completely so in\\nthe upper parts. Below, in contact with the moist Mal-\\npighian layer, the horny layer is moist but the superficial\\nparts become dry by evaporation; and here the strata\\ndelaminate from each other, the outer ones, as we have\\nsaid, being shed in the form of flakes, which seen in the\\ndry condition under the microscope have often the ap-\\npearance of irregular fibres.\\nThe karyomitosis seen in the cells of the Malpighian\\nlayer, not only in those of the vertical layer, but in the\\nothers as well, show, as we have said, that these multiply\\nby division; we have no evidence of multiplication taking\\nplace elsewhere in the epidermis. The more superficial\\ncells of the Malpighian layer, thrust upward by the new-\\ncomers, are transformed into the cells of the stratum\\ngranulosum; and although we do not as yet fully under-\\nstand the exact nature of the transformation we may con-\\nclude that the peculiar granules of these cells are con-\\ncerned in the manufacture of keratin. Changed by the\\nconsumption of their granules in this manufacture, the\\ncells of the stratum granulosum become first the cells\\nof the stratum lucidum, and then the cells of the dis-\\ntinctl}^ horny layer, pushed upward through which, by\\nthe new formations continually succeeding below them,\\nthey pass to the surface and are eventually shed.\\nThe papillae in the papillary part vary in size and as-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0019.jp2"}, "20": {"fulltext": "16 SKIN DISEASES.\\npect in different parts of the skin. They are pointed or\\nthread-Hke about the fingers, and club-shaped or rounded\\nover the general surface of the body. On the palm of the\\nhand, about the nipple, and the sole of the foot, they are\\nlongest and largest, being often 66 to i m. They are\\nshortest on the face. They are of two kinds nervous,\\ncontaining nerve fibres ending in tactile corpuscles, and\\nvascular, containing blood-vessels in the form of a loop.\\nThere are, in addition, spindle-shaped cells, or cells\\nanastomozing by processes, amongst the connective tissue\\nbundles in the substance of the corium and around the\\nvessels.\\nThe thickness of the corium varies. It is thinnest\\nabout the eyelids and prepuce; on the face, scrotum, and\\nbody, generally, it is thicker. On the sole of the foot and\\npalm of hand it is thickest, being from 2.25-2.28 of a\\nmillimetre.\\nThe corium is well supplied with vessels, lymphatics,\\nand nerves. The vessels come up from the connective\\ntissue below, give off branches to the fat and the glands,\\nthen constitute a network which sends off more or less\\nobliquely twigs to form a longitudinal plexus along the\\nbase of the papillae, from whence finally capillary loops\\nare supplied to most of the papillse. The lymphatics have\\nmuch the same arrangement as the blood-vessels. The\\nplexuses, however, are situated beneath those formed by\\nthe capillaries, but no lymphatics are supplied to the\\npapillae. The spaces normally seen between the connect-\\nive tissue fibres are supposed to be lymphatic spaces; they\\nhave no proper boundaries. The blood-vessels and lym-\\nphatics are thought to communicate, though this has not\\nbeen proved, by means of peri- vascular spaces where the\\nblood-vessels and lymphatics run together, the walls of\\nthese spaces being formed by the connective tissue around.\\nK", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0020.jp2"}, "21": {"fulltext": "THE ANATOMY OF THE SKIN. 17\\nNerves accompany the blood-vessels coming up from\\nbelow, and are of two kinds, medullated and non-meduU-\\nated; the former go with the tactile and Pacinian cor-\\npuscles, and the latter form, it is thought, a fine netw^ork\\nbelow^ the site, in connection with the capillary plexus,\\nand are in communication with those found in the site.\\nNon-meduUated fibres also run with the capillaries, which\\nsupply the vascular papillae.\\nThe subcutaneous cellular tissue is nothing but a lax\\nnetwork of connective tissue. The bundles of fibres,\\nusually cylindrical, exhibit constrictions at various\\npoints like those of the arachnoid membrane, and consist\\nof a number of sinuous fibres of connective tissue, be-\\ntween w^hich lie numerous fusiform and connective-tissue\\ncorpuscles of various forms and dimensions. It is this\\npart in w^hich the fat cells are collected in the meshes of\\nthe fibres, the only seats destitute of fat being the eyelids,\\npenis, scrotum, and ears. The fat I need not describe.\\nThe fusiform cells that lie between the bundles and fibres\\nof the connective tissue are connected with these fibres\\nby means of processes given off one at either end, with\\nother minor ones elsewhere. Other fusiform cells, with-\\nout processes (the migrating cells), and small cells like\\nblood-cells, are observed, the latter being contiguous to\\nthe vessels. There is no line of demarcation between the\\ncorium above and the subcutaneous tissue below.\\nThe Sweat Glands. A sweat-gland, hke other\\nglands, consists of a secreting portion and a conducting\\nportion. The secreting portion is a long tubulur alveolus\\ncoiled up in a knot and placed in the subcutaneous con-\\nnective tissue at some distance from the epidermis. Gen-\\nerally the gland is formed of one such tubule only, but\\nsometimes two tubules unite into a common duct. The\\nduct beginning in the knot, in the convolutions of which", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0021.jp2"}, "22": {"fulltext": "18 SKIN DISEASES.\\nit shares, runs a somewhat wavy but otherwise straight\\ncourse vertically toward the surface of the skin onto\\nwhich its lumen opens.\\nThrough the epidermis the duct is nothing more than\\na tubular passage excavated out of the epidermis with a\\nremarkable corkscrew course, the turns of the screw be-\\ncoming more open and the canal wider in the upper part\\nas it approaches the surface. In the Malpighian layer\\nthe cells bordering on the passage are flattened and in-\\nclined downward so as to afford a more or less definite\\nlining; there is a similar arrangement, but not so well\\nseen, in the corneous layer. Reaching the dermis in a\\nvalley between papillae, the passage becomes a regular\\nduct, with an independent epithelium of its own, a dis-\\ntinct basement membrane continuous with the upper sur-\\nface of the dermis, and an outer coat of connective tissue\\nstrengthened, in the case of some of the larger glands,\\nsuch as those of the axilla, with plain muscular fibres.\\nThe epithelium consists of two or three layers of small\\nrounded cells, each with a relatively large but absolutely\\nsmall nucleus, generally staining deeply. The cells leave\\na narrow tubular thread-like lumen which is lined with a\\nvery characteristic distinct cuticle.\\nThe duct continues to possess these characters after it\\nhas entered the knot and begun to pursue a twisted\\ncourse, but soon changes suddenly into the secreting\\ntubule. This may be distinguished from the duct by\\nbeing wider, and by being lined by a single layer of cubi-\\ncal or columnar cells larger than those of the duct, bear-\\ning larger nuclei, and behaving differently toward various\\nstaining reagents. The lumen though fairly distinct is\\nnot lined by any cuticle as in the duct. Lying between\\nthe basement membrane and the epithelial cells, or rather\\nimbedded in the basement membrane, are seen a number", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0022.jp2"}, "23": {"fulltext": "THE ANATOMY OF THE SKIN. 19\\nof plain muscular fibres disposed longitudinall}^ or in an\\nelongated spiral, and often forming a distinct coat beneath\\nthe epithelium.\\nAs in the case of other glands, we are unable to make\\nany statement as to the work carried on by the epithelium\\nlining the duct, but we may probably assume that the\\nsweat is mainly secreted by the larger cells of the terminal\\ncoiled part of the tubule. These cells, therefore, like\\nother secreting cells, are probably loaded and dis-\\ncharged; but as yet no structural changes in the cells\\ncorresponding to these phases have been satisfactorily as-\\nceHained, though after the administration of pilocarpine,\\nw^hich causes sweating, the cells of glands hardened in\\nalcohol stain more deeply than usual with carmine. It\\nmust be remembered, however, that the sweat contains\\nnormally neither mucus nor proteid substances, and we\\nshould, therefore, not expect to observe granules in the\\ncells.\\nThe peculiarly placed muscular fibres have been sup-\\nposed, by their contraction, to assist in the flow of sweat\\nalong the tubule. In certain cutaneous glands of the\\nfrog, of a relatively simple nature, there is evidence that\\nthe secretion is ejected from the comparatively large\\nlumen by the contraction of plain muscular fibres in the\\nwall of the gland, or by a contraction of the wall itself,\\nwhich is contractile without being distinctly differentiated\\ninto muscular tissue. And this rather supports the\\nabove view; but the matter is at present by no means\\nclear.\\nThe coil of a sweat gland is well supplied with blood-\\nvessels in the form of capillary networks, and nerves have\\nbeen traced to the tubes; but the exact manner in which\\nthese end is not as 3^et known.\\nThough present in all regions of the skin (of man),", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0023.jp2"}, "24": {"fulltext": "20 SKIN DISEASES.\\nthe sweat glands are unequally distributed, being more\\nabundant in some regions, such as the palms of the hand,\\nthan in others. In the axilla are glands of very large size,\\nand in these the ducts possess distinctly muscular coats.\\nThe sebaceous glands are appendages of the hairs, and\\nare seated in the corium; their ducts open into the hair\\nfollicle at the neck in the case of the larger hair follicles;\\nbut in the case of the smaller, or downy hairs, the relative\\nposition of the glands and hair follicle is altered, so that\\nthe minute hair follicle leads into the duct of the seba-\\nceous gland, which opens directly on the surface. These\\nglands are absent from the palm of the hand, the sole of\\nthe foot, and the dorsum of the third phalanges of the\\nfingers and toes, and there are few about the penis. The\\nlargest are found about the nose, scrotum, anus, and\\nlabia.\\nJust where the corneous layer abruptly leaves off in the\\nupper part of the hair follicle, a sebaceous gland opens\\ninto the cavity of the follicle, on each side of the hair.\\nEach gland consists of a short rather wide duct which\\ndivides into a cluster of somewhat flask-shaped alveoli.\\nThe basement membrane, both in the alveoli and in the\\nduct, is lined with a layer of rather small cubical cells\\ncontinuous with the layer of perpendicularly disposed\\ncells which form the innermost layer of the outer root-\\nsheath, as of the Malpighian layer of the skin generally.\\nThis layer of cells leaves a wide lumen both in the alveoli\\nand in the duct; this lumen, however, is occupied not as\\nin other glands with fluid, but with cells. Both alveoli\\nand duct, in fact, are filled with rounded or polygonal\\ncells which may be regarded as modified cells of the Mal-\\npighian layer. The whole gland, indeed, is a solid\\ndiverticulum of the Malpighian layer.\\nIn the alveoli the cells next to the layer of cells imme-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0024.jp2"}, "25": {"fulltext": "THE ANATOMY OF THE SKIN. 21\\ndiately lining the basement membrane, though larger\\nthan these, resemble them in so far that each consists of\\nordinary cell substance surrounding a nucleus of ordinary\\ncharacter. The more central cells are different; their cell\\nsubstance is undergoing change; numerous granules or\\ndroplets, some of them obviously of a fatty nature, make\\ntheir appearance in them, and the nuclei are becoming\\nshrunk and altered. The cells are manufacturing fatty\\nand other bodies and depositing the products in their own\\nsubstance, which, however, is not being removed, but is\\ndying. These changes are still more obvious in the cells\\nlying within the duct; the cells as indicated by the break-\\ning up of the nuclei are dead, and the whole of the cell\\nsubstance has been transformed into the material consti-\\ntuting the secretion of the gland called sebum, which is\\ndischarged on to the surface of the skin through the\\nmouth of the hair follicle.\\nIn these sebaceous glands, secretion, if we may con-\\ntinue to use the word, takes place after a fashion different\\nfrom that which we have hitherto studied. In an ordinary\\ngland the cells lining the walls of the alveoli manufacture\\nmaterial which they discharge from themselves into the\\nlumen to form the secretion, their own substance being at\\nthe same time renewed, so that the same cell may con-\\ntinue to manufacture and discharge the secretion for a\\nvery prolonged period without being itself destroyed. In\\na sebaceous gland the work of the cells immediately lin-\\ning the wall of an alveolus appears limited to the task of\\nincreasing by multiplication. Of the new cells thus\\nformed, while some remain to continue the lining and to\\ncarry on the work of their predecessors, the rest thrust\\ntoward the centre of the alveolus are bodily transformed\\ninto the material of the secretion, and during the trans-\\nformation are pushed out through the duct by the genera-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0025.jp2"}, "26": {"fulltext": "22 SKIN DISEASES.\\ntion of new cells behind them. The secretion of sebum,\\nin fact, is a modification of the particular kind of secre-\\ntion taking place all over the skin, and spoken of as shed-\\nding of the skin. It is chiefly the chemical transforma-\\ntion which is different in the two cases. In the skin\\ngenerally the protoplasmic cell substance of the Malpig-\\nhian cells is transformed into keratin; in the sebaceous\\nglands it is transformed into the fatty and other constitu-\\nents of the sebum.\\nThe so-called ceruminous glands of the external\\nmeatus of the ear are essentially sweat glands. They\\nare wrongly named, since the fatty material spoken of as\\nwax of the ear is secreted not bj^ them but by the\\nsebaceous glands belonging to the hairs of the meatus, or\\nby the general epidermic lining. The ceruminous glands\\nappear at most to supply the pigment which colors the\\nwax.\\nThe Meibomian glands of the eyelids, on the other\\nhand, are essentially the sebaceous glands of the eye-\\nlashes, the glands of Mohl being in turn sweat-glands.\\nA hair is a development, in the form of a c) Under, of a\\ncap of corneous epidermis surmounting a papilla of the\\ndermis sunk to the bottom of a tubular pit, or involution\\nof the skin, called a hair-follicle. In the upper part of\\nthe hair-follicle the walls consist of ordinary skin with\\nall its parts, dermis, Malpighian layer, and corneous\\nlayer, the latter as usual of considerable thickness. At\\nsome little distance from the mouth of the follicle the\\ncorneous layer suddenly ceases, and in the follicle below\\nthis the epidermis is represented by the Malpighian layer,\\nnow called the outer root-sheath, and two layers of pecu-\\nliar cells, forming the inner root-sheath, of which the\\nouter is called Henle s and the inner Huxley s layer;\\nthese may, perhaps, be considered as corresponding to", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0026.jp2"}, "27": {"fulltext": "THE ANATOMY OF THE SKIN. 23\\nthe stratum granulosum lucidum respectively. The\\ndermis of the wall of the follicle is at the same time de-\\nveloped into an outer layer with bundles of connective\\ntissue disposed chiefly longitudinally, and an inner layer\\nof peculiar nature, the arrangement of which is trans-\\nverse, and which at least simulates, if it really be not, a\\nmuscular transverse coat. Betw^een this dermis of the\\nfollicle and the outer root- sheath or Malpighian layer is a\\nvery conspicuous definite hyaline basement membrane, so\\nthick that it presents a very easily recognized double\\ncontour.\\nAt the bottom of the follicle the dermis of the wall of\\nthe follicle is continuous with the substance of the\\n(dermic) papilla, while the outer root-sheath or Mal-\\npighian layer, which here becomes extremely thin and re-\\nduced to one or two layers, is reflected over the papilla,\\nand there expands again into a mass of cells, which like\\nthe cells of the Malpighian la57er in the rest of the skin\\nmultiply, and by their multiplication give rise to the\\ncorneous body of the hair. It is said that in those hairs\\nwhich possess a medulla the vertically disposed lower-\\nmost cells of the Malpighian layer are at the actual sum-\\nmit of the papilla continued upward in the axis of the\\nhair, as the medulla.\\nThe layer of Henle, following the Malpighian layer or\\nouter root-sheath on which it rests, is similarly reflected\\nand forms over the hair a single layer of flat transparent\\nimbricated scales known as the cuticle of the hair; Hux-\\nley s layer, similarly reflected, forms a similar layer of\\nsimilar scales, but this is considered as belonging to the\\nroot-sheath, and is called the cuticle of the root-sheath.\\nMuscles of the skin There appear to be two kinds of\\nmuscles found in the skin the voluntary, or striated,\\nand the involuntary. The former are to be detected in the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0027.jp2"}, "28": {"fulltext": "24 SKIN DISEASES.\\nface, beard, and nose, ascending sometimes obliquely,\\nsometimes vertically, between the hairs and the sebaceous\\nfollicles to terminate in the corium (Biesiadecki).\\nThey come from below. The organic or non-striated\\nmuscles are more abundant. They occur forming a kind\\nof network in the scrotum. Over the general surface of the\\nskin bands of fibres are detected in connection with the\\nhair follicle, and are called arredores pili. These muscles\\nexist as single fasciculi .045 to .22 of a millimetre, some-\\ntimes on one, sometimes on both sides of the hair follicle,\\nin immediate relation to the sebaceous glands, which they\\nenclose more or less. They run from the corium above\\nto the part of the hair follicle just below the glands, and\\nthere end in the inner sheath of the hair follicle. Some\\nauthors affirm that bundles go down to the subcutaneous\\ntissue and send off vertical and horizontal branches.\\nNeuman, who is of this opinion, states that bands run\\nabove and under the sweat glands, more especially in the\\naxilla. He describes also independent bundles of muscle\\nin the corium quite unconnected with the hair follicles.\\nThe nails, and the part upon which they lie, are essen-\\ntially the same in structure as the skin in its different\\nparts, only that the horny layer is more developed, form-\\ning the actual nail. Posteriorly, the nail is fitted into a\\ngroove; the part fitting into the recess is called the root,\\nand the portion underlying the nail is that which repre-\\nsents the corium it is, in fact, the corium; it bears, how-\\never, the name of matrix. Between the nail itself and\\nthe matrix is the rete mucosum in fact, the bed of the\\nnail may be described as consisting of corium with the\\nsub-connective tissue beneath, and the rete above.\\nAs in the case of the skin the rete dips down between\\nthe papillary projections of the corium of the nail.\\nThe corium itself, or matrix, is divided into two parts.\\n{\u00e2\u0096\u00a0\u00e2\u0096\u00a0\u00e2\u0096\u00a0\u00e2\u0096\u00a0\u00e2\u0096\u00a0\u00e2\u0096\u00a0\u00e2\u0096\u00a0\u00e2\u0096\u00a0\u00e2\u0096\u00a0\u00e2\u0096\u00a0\u00e2\u0096\u00a0fii", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0028.jp2"}, "29": {"fulltext": "THE ANATOMY OF THE SKIN. 25\\nwhich are separated by a more or less convex line seen\\nthrough the nail and known as the lunula. The hinder-\\nmost of these two divisions has its papillae directed\\nforward, less distinct, and more closel}^ seated together.\\nThe front portion is thrown into longitudinal folds, and\\nupon these are seated the papillae. These folds are pro-\\nduced by the peculiar disposition of bundles of connective\\ntissue in the structures beneath. The matrix towards\\nthe front part of the nail is covered by cells that are more\\nand more horny, whereas over the posterior surface of\\nthe matrix (the root of the nail) these cells are softer.\\nIn fact, the part of the nail matrix behind the lunula is\\nthe spot where the nail is formed. The soft cells are di-\\nrected forward, guided by the fold of the skin over the\\nnail at its root which fold lacks glands, and papillae on\\nthe surface applied to the nail becoming more horny as\\nthey advance.\\nA correct knowledge of the anatomy of the skin is an\\nimmense aid to the right comprehension of morbid changes\\ngoing on in the skin.\\nThe epithelial stratum of the skin, made up of the\\nhorny and mucous (rete Malpighii) layers, are the special\\nseat of a number of morbid processes. In parenchy-\\nmatous inflammation as in small-pox, the first stage seems\\nto be a great increase in the cells of the rete, and the\\npustule subsequently produced is formed bodily in the\\nrete, its walls being formed by altered rete cells, stretched\\ninto fibres and enclosing pus cells. In the formation of\\nvesicles and bullae, the rete is chiefly concerned. In\\nsome cases of non-inflammatory diseases, the epidermic\\ncells are found to have undergone special changes, or to\\nhave been arrested in their development, as in psoriasis.\\nThe relation of the epidermis to the papillary layer, in", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0029.jp2"}, "30": {"fulltext": "26 SKIN DISEASES.\\nregard to diseased action, is a matter of no little import-\\nance.\\nDr. Auspitz draws the following conclusions in re-\\ngard to the production of diseases from the growth in-\\nwards of and resultant changes in the papillary layer:\\n1. In hyperseraic and inflammatory processes occurring\\nin the skin the papillae are found to be only succulent and\\nslightly swollen but no modifications of form occur, un-\\nless consecutive to secondary change in the Malpighian\\nstratum.\\n2. In simple and lymphatic hypertrophy of the con-\\nnective tissue matrix, as well as in cell-infiltrations of the\\ncorium, the same law holds\\n3. In the keratoses, or horn-producing affections\\nichthyosis there is either no change in the form or size\\nof the papillae, or it is due only to the pressure of the\\nhypertrophied horny layer. The prismatic and columnar\\nforms of the latter are by no means dependent on the\\npapillae of the cutis.\\n4. The papillomata (warts, condylomata, epithelioma)\\noriginate essentially in an active neoplastic process taking\\nplace in the rete, which penetrates to a greater or less ex-\\ntent into the likewise hypertrophied connective tissue\\nmatrix of the corium. The papillae of the cutis, here,\\ntoo, perform only a passive role, their elongation and\\ndentritic form being occasioned by the hypertrophy of\\nthe epidermis; whilst the elevation of the surface of the\\nskin is due to the hypertrophy of both.\\n5. An outgrowth of the connective tissue of the skin\\nsometimes occurs, but is never dependent on the pre-\\nexistent papillae.\\n6. There is no essential anatomical difference between\\nthe several forms of papillomata, warts, pointed condyl-\\nomata, and cauliform excrescences. The syphilitic con-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0030.jp2"}, "31": {"fulltext": "THE ANATOMY OF THE SKIN. 27\\ndyloma differs from these oul}- through the specific cell\\ninfiltration of the coriiim.\\n7. Epithelioma represents exquisitely the types of the\\nhypertrophic growth inwards of the epidermis into the\\nconnective tissue matrix.\\nThe rete is an important pathological ground, from the\\nfact that in most inflammatory processes there is to be\\nfound in it a great increase of the spindle-shaped or\\nmigrating corpuscles. It is now established that cutane-\\nous cancers originate in a morbid change in the cells of\\nthe Malpighian layer, and by the disordered growth of\\nthese same cells in masses from their inter-papillary\\nparts, into the corium. This is an undoubted fact and\\ngives countenance to Dr. Auspitz s views.\\nThe corium is also the seat of very important patho-\\nlogical changes that originate in its substance and various\\nalterations of its component elements It is the essential\\nseat, of course, of hypersemic changes; and according as\\nthe longitudinal plexus, or the papillary vascular loops,\\nor both, are implicated the redness varies in aspect. The\\ncorium is, further, especially its papillary layer, the early\\nseat of many inflammatory changes, the vessels dilating,\\nand permitting moreover the escape of white blood cells\\ninto the corial textures, and likewise serum, which makes\\nits way to the rete, forming vesicles, etc. Then, again,\\nthe fibrous elements of the corium furnish the migrating or\\nfusiform cells that appear in great numbers in chronic in-\\nflammations especially, and migrate to the rete. The\\ncorium is the chief seat, moreover, of neoplasmata other\\nthan cancerous, as in the case of syphilis and leprosy;\\nthese new growths supposedl}^ originating from the con-\\nnective tissue elements. A simple increase of the latter,\\ntoo, is held to constitute certain other diseases, such as\\npachyderma, keloid, etc. The vacuolae and lymphatic", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0031.jp2"}, "32": {"fulltext": "28 SKIN DISEASES.\\nSpaces are also seats of particular changes, as in lepros}\\nA knowledge of the structure and peculiarities of hair\\nfollicles and sebaceous glands is not less important in re-\\nlation to the origin of many common diseases, as acne,\\nfibroma, cancer, lichen planus. Without it the student\\nwill attain little real knowledge of the pathology and\\ntherapeutics of these frequently occurring affections.\\nIn the case of the nail, unless a student knew what was\\nthe part of the matrix at which the nail was actually\\nformed, he would be at a loss to diagnose a syphilitic from\\na non-syphilitic growth, or to comprehend the difference\\nwhich arises when inflammation attacks now the posterior\\npart of the matrix (where the nail is formed), or now the\\nanterior portion; nor would he be able to explain the pre-\\ndilection of parasites for the root of the nail.\\nThe Nature and Amount of Perspiration.\\nThe quantity of matter which leaves the human body\\nby way of the skin is very considerable. Thus it has\\nbeen estimated that while 0.5 gramme passes away\\nthrough the lungs per minute, as much as 0.8 gramme\\npasses through the skin. The amount, however, varies\\nextremely; it has been calculated, from data gained by\\nenclosing the arm in a caoutchouc bag, that the total\\namount of perspiration from the whole body in twenty-\\nfour hours might range from 2 to 20 kilos; but such a\\nmode of calculation is obviously open to many sources of\\nerror.\\nOf the whole amount thus discharged part passes away\\nat once as watery vapor mixed with volatile matters,\\nwhile part may remain for a time as a fluid on the skin;\\nthe former is frequently spoken of as insensible, the latter\\nas sensible, perspiration or sweat. The proportion of the\\ninsensible to the sensible perspiration will depend on the", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0032.jp2"}, "33": {"fulltext": "THE NATURE AND AMOUNT OF PERSPIRATION. 29\\nrapidit}^ of the secretion in reference to the dryness, tem-\\nperature, and amount of movement of the surrounding\\natmosphere. Thus, supposing the rate of secretion to\\nremain constant, the drier and hotter the air, and the\\nmore rapidly the strata of air in contact with the body\\nare renewed, the greater is the amount of sensible per-\\nspiration which is b}^ evaporation converted into the in-\\nsensible condition; and conversely when the air is cool,\\nmoist, and stagnant, a large amount of the total perspira-\\ntion may remain on the skin as sensible sweat. Since, as\\nthe name implies, we are ourselves aware of the sensible\\nperspiration only, it may and frequently does happen that\\nwe seem to ourselves to be perspiring largely, when in\\nreality it is not so much the total perspiration which is\\nbeing increased as the relative proportion of the sensible\\nperspiration. The rate of secretion may, however, be so\\nmuch increased that no amount of dryness or heat, or\\nmovement of the atmosphere, is sufficient to carry out the\\nnecessary evaporation, and thus the sensible perspiration\\nmay become abundant in a hot, dry air. And practically\\nthis is the usual occurrence, since certainly a high tem-\\nperature conduces, as we shall point out presently, to an\\nincrease of the secretion, and it is possible that mere dry-\\nness of the air has a similar effect.\\nThe amount of perspiration given off is affected not\\nonly by the condition of the atmosphere, but also by the\\ncircumstances of the body. Thus it is influenced by the\\nnature and quantity of food eaten, by the amount of\\nfluid drunk, by the character of exercise taken, by the\\nrelative activity of the other excreting organs, more par-\\nticularly of the kidney, by mental conditions and the like.\\nVariations may also be induced by drugs and by diseased\\nconditions. How these various influences produce their\\neffects we shall study shortly.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0033.jp2"}, "34": {"fulltext": "30 SKIN DISEASES.\\nThe fluid perspiration, or sweat, when collected, is\\nfound to be a clear, colorless fluid of a distinctly salt\\ntaste, with a strong and distinctive odor, varying accord-\\ning to the part of the body from which it is taken. Besides\\naccidental epidermic scales, it contains no structural\\nelements.\\nSweat, as a whole, is furnished partly by the sweat\\nglands and partly by the sebaceous glands, for, as we\\nshall see, the small amount which simply transudes\\nthrough the epidermis, apart from the glands, may be\\nneglected. Now, the secretions from these two kinds of\\nglands differ widely in nature, and the characters of the\\nsweat, as a whole, will vary according to the relative\\nproportion of the two kinds of secretion. The secretion\\nof the sebaceous glands appears to be fairly constant, the\\nlarger variations of the total sweat depending chiefly on\\nthe varying activity of the sweat glands. Hence, when\\nsweat is scanty, the constituents of the sebum influence\\nlargely the character of the sweat; when, on the contrary,\\nthe sweat is very abundant, these may be disregarded,\\nand the sweat may be considered as the product of the\\nsweat glands.\\nWe are not able at present to make a complete state-\\nment as to what bodies occur exclusively in the sebum\\nand what in the secretion of the sweat glands. The\\nformer consists very largely of fats and fatty acids, and\\nappear to contain some form or forms of proteids; but we\\nhave reason to think that the sweat glands secrete in small\\nquantity some forms of fat, and especially volatile fatty\\nacids.\\nWhen sweat is scanty, the reaction is generally acid,\\nbut when abundant, is alkaline; and when a portion of\\nthe skin is well washed the sweat which is collected im-\\nmediately afterward is usually alkaline. From this we", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0034.jp2"}, "35": {"fulltext": "THE NATURE AND AMOUNT OF PERSPIRATION. 31\\nmay infer that the secretion of the sweat glands is natur-\\nally alkaline, but that when mixed sweat is acid; the\\nacidity due to fatty (or other) acids of the sebum. In\\nthe horse, which is singular among hair covered animals\\nfor its frequent profuse sweating, the sweat is said to be\\nalways acid and to contain a considerable quantity of\\nsome form of proteid. These features are probably due\\nto the large admixture of sebum from the numerous\\nsebaceous glands connected with the hairs.\\nTaking ordinary sweat, such as may be obtained by\\nenclosing the arm in a bag, we may say that in man the\\naverage amount of solids is from i to 2 per cent., of\\nwhich about two-thirds consist of organic substances.\\nThe chief normal constituents are: (1) Sodium chloride,\\nwith small quantities of other inorganic salts. (2) Vari-\\nous acids of the fatty series, such as formic, acetic, butyric,\\nwith probably propionic, caproic, and caprylic. The pres-\\nence of these latter is inferred from the odor; it is probable\\nthat many various volatile acids are present in small quan-\\ntities. Lactic acid, which has been reckoned as a normal\\nconstituent, is stated not to be present in health. (3)\\nNeutral fats and cholesterin; these have been detected\\neven in places such as the palm of the hand, where\\nsebaceous glands are present. (4) The evidence goes to\\nshow that neither urea nor any ammonia compound exists\\nin the normal secretion to any extent, though some ob-\\nservers have found a considerable quantity of urea (cal-\\nculated at ten grms. in the twenty-four hours for the\\nwhole body). Apparently some small amount of nitro-\\ngen leaves the body or the skin, as a whole, but this is\\nprobably supplied by the sebum or by the epidermis.\\nIn various forms of disease the sweat has been found to\\ncontain, sometimes in considerable quantities, blood, albu-\\nmin, urea (particularly in cholera), uric acid, calcium ox-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0035.jp2"}, "36": {"fulltext": "32 SKIN DISEASES.\\nalate, sugar (in diabetic patients), lactic acid, indigo (or\\nindigo-yielding bodies giving rise to blue sweat), bile,\\nand other pigments. Iodine and potassium iodide, suc-\\ncinic, tartaric, and benzoic (partly as hippuric) acids have\\nbeen found in the sweat when taken internally as medi-\\ncines.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0036.jp2"}, "37": {"fulltext": "CHAPTER IL\\nSOME GENERAL OBSERVATIONS.\\nThe great number of diseases peculiar to the skin\\nwhich present themselves for treatment are well worthy\\nof the most earnest and anxious consideration of the gen-\\neral practitioner as well as of the specialist. It is only\\nof recent years that the varieties of skin diseases have\\nbeen made a special subject of study by numerous phy-\\nsicians in this country and abroad, and we may point\\nwith pride to the rapid strides made as regards the\\npathology, diagnosis, prognosis and treatment of these\\nformerly obscure and obstinate diseases.\\nCorrect diagnosis of cutaneous affections is the founda-\\ntion of successful therapeutics; but diagnosis, properly\\nspeaking, does not alone consist in giving the correct or\\napproved name to the disease immediately under consid-\\neration, nor even in a careful differentiation of the special\\nvariety. It involves a broader knowledge, including a\\nmore or less complete acquaintance with the nature and\\nrelationships of the various affections. The mere naming\\nof a disease is a comparatively easy matter, and of greatl}^\\ninferior value to that more comprehensive knowledge that\\nappreciates that the disease is not a distinct entity by\\nitself, but is rather the result of a particular or peculiar\\npathological process in progress in a person with a given\\nconstitution or habit of body.\\nIn these days patients want to know what disease they\\nare affected with, and, in the great majority of cases,", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0037.jp2"}, "38": {"fulltext": "34 SKIN DISEASES.\\nthey will read up for themselves all that they can find\\nupon the subject. The term eruption will not answer for\\nthe more intelligent. The intelligent physician must not\\nbe content with being able to simply give the systematic\\nname that is applied to the particular lesion or group of\\nlesions present, but should also be able to make a diag-\\nnosis of the patient as well.\\nOf late years dermatology has divided the different\\neruptions into classes and sub-classes, and with this di-\\nvision a more thorough and extended study of the causes\\npathology and treatment of the same has been accom-\\nplished, and the dermatologist can intelligently study the\\nvarious lesions of the skin and form a correct opinion as\\nto the duration, progress and ultimate result in each and\\nevery case.\\nA man says he has an eruption upon the face, and wants\\nto know what it is and when he will get over it. His re-\\nmark that he has an eruption conveys to the mind about as\\nmuch of an idea of the trouble as if he said he had a hole\\nin his coat. We must know, before we can express an\\nopinion, what kind of an eruption it is. Is it vesicular,\\npapular, pustular or tubercular When we find that it is\\nvesicular, we then wish to know the size of the vesicles,\\nwhether they burst or not, whether they itch or not and\\na number of other points which help us to arrive at a\\ncorrect understanding of his case. We are then able to\\ntell what the affection is, and its probable duration and\\nultimate termination. We are enabled, also, to give him\\nthe proper medicines, prescribe a suitable diet, and to take\\nsuch measures as will protect others against the disease,\\nif it is of a contagious nature. Errors in diet predispose\\nto certain affections of the skin, and in very many cases\\naggravate existing disorders. Want of cleanliness is a\\nfrequent cause of cutaneous eruptions, as well as of many", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0038.jp2"}, "39": {"fulltext": "SOME GENERAL OBSERVATIONS. 35\\nof the preventable diseases. So, also, is the abuse, or\\neven use, of alcoholic stimulants, cosmetics, tobacco, etc.\\nA man s occupation is sometimes to blame for his un-\\nhealthy skin; especially is this true of the baker, the\\ngrocer, the mason, the bricklayer, the painter, the pho-\\ntographer, etc. Frequently the medicines taken for some\\ninternal disease cause an eruption, the nature and cause\\nof which is not always seen at a first glance and may be\\nentirely overlooked. Belladonna, Carbolic acid Iodide of\\nPotash, Sulphzi?^, lodofoj^^n, Antipyrine and a great many\\nother remedies produce eruptions. Mental shock and\\nemotions also produce eruptions.\\nThe following cases of Dermatoses following mental\\nshock were reported in our journals in 1889:\\nA lady, after witnessing a violent assault upon her hus-\\nband, was much prostrated by the fright, and three weeks\\nlater a bullous eruption, having the characteristics of\\nfoliaceous pemphigus and accompanied by incessant pru-\\nritus, made its appearance.\\nAnother case was a little girl who was rescued from\\nburning, and remained for some time in a condition of\\nprostration from fright. x\\\\ month afterward a pemphi-\\ngoid eruption made its appearance upon the body, disap-\\npeared under treatment, but reappeared several times.\\nA third case was that of a w^oman who became very\\nmuch excited in a quarrel with her husband. A few days\\nafterward an exudative erythema made its appearance on\\nthe arms, hands and feet; and vesicles on the lips. K.\\nde Smet has recorded cases of purpura hsemorrhagica from\\nthe same cause.\\nThe dermatologist must be very observing and a good\\ncross-examiner in order that he may see all that is upon\\nthe surface of the body, and by his critical examination\\ndraw out all that is below the skin in the shape of ab-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0039.jp2"}, "40": {"fulltext": "36 SKIN DISEASES.\\nnormal sensations and symptoms. The more complete\\nand thorough the description he obtains from the patient,\\nthe more accurate is his diagnosis apt to be, and the more\\nsuccessful his treatment; for the same affection in two\\npatients may require almost opposite treatment. Take\\nshingles, for example. The eruption may be precisely\\nthe same in two children, but the accompanying pains in\\none are burning, jerking and itching, worse in the even-\\ning, and from the slightest touch; in the other, burning,\\nneuralgic pains, worse about midnight, but ameliorated\\nby warmth. The first case will be relieved by Zinc, the\\nsecond by Arsenicum. Or, we may illustrate by two\\ncases of acne occurring in a brother and sister. The one\\npatient addicted to sexual excesses and strong drink,\\nwith a tired feeling all the time; the other, suffering with\\nscanty menses, gastric difficulties and frequent diarrhoea.\\nThe disease is the same in both persons, but the causes\\nare different, and we should be obliged to give Rhus in\\nthe first case, and Ptds. in the other. Again, an eczema\\nin one may be the expression of ill-nutrition from pri-\\nvation or scanty supply of proper food, while in an-\\nother it may be the result of a plethora due to excessive\\nindulgence in the pleasures of the table. We may, it is\\ntrue, apply the name eczema in both instances, on account\\nof the similarity of the lesions; yet the real condition of\\nthe two patients is almost diametrically opposite.\\nA positive diagnosis, it should be remembered, is not\\nalways possible upon a first examination, but it is desir-\\nable at all times that we may distinguish between a con-\\ntagious and a non-contagious affection. For example, how\\nimportant it is to recognize herpes of the prepuce, and\\nnot mistake it for chancre. The one, a disease of but lit-\\ntle importance, the other of the greatest significance; in\\nfact, *a terrible infliction, which, if wrongly diagnosed,", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0040.jp2"}, "41": {"fulltext": "SOME GENERAL OBSERVATIONS. 37\\nmay lead to the infection of perhaps dozens of others,\\nand among the number many perfectly innocent persons.\\nThis statement may seem rather strong, but instances are\\non record where several persons have become infected\\nfrom using the common water-closet. And yet, these two\\ndiseases, herpes of the prepuce and chancre, are fre-\\nquently confounded, but, fortunately for the welfare of\\nthe community, it is usually the innocent one that is\\nmistaken for the more serious.\\nThe prognosis is not as important, perhaps, as the\\ndiagnosis, considering the fact that very few skin diseases\\nare destructive to life, but it is a great comfort to the\\npatient to learn that the disease is one of no danger; that\\nit is not contagious, and that, in a short time, it will be\\ncured. When the patient has good reasons to suspect\\nthat the eruption upon the skin is only a manifestation of\\nsome form of syphilis, no words can convey the feeling\\nof relief experienced when he or she is told that the\\ntrouble is only a skin disease and in no way connected\\nwith that loathsome disorder.\\nThe causation is always to be carefully investigated and\\nstudied, for by removing the special causes in each case a\\nreturn to health may be expected, or at least the patient\\nis put in the best possible condition for recovery. All\\nviolations of the general laws of health may produce dis-\\neases of the skin, hence it is very important to inquire\\ninto the habits, occupation, diet and dwelling-places of\\nthose seeking treatment.\\nThe treatment of skin diseases varies, of course not\\nonly in different affections, but in the same disease as it\\noccurs in persons of different diathetic tendencies. Each\\npatient must be treated according to the special indica-\\ntions in his case. We must consider his age, his sur-\\nroundings, his diet and mode of life, and all co-existing", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0041.jp2"}, "42": {"fulltext": "38 SKIN DISEASES.\\ndiseases which aggravate or are the cause of his trouble.\\nIn short, treat the totahty of symptoms.\\nThe majority of cases of diseases of the skin are not\\npreceded or even accompanied by severe constitutional\\ndisturbances; if there happen to be much fever and\\nmalaise, especially when the patient takes to bed from a\\nsheer feeling of illness, and an eruption rapidly develops\\nitself, something grave, probably one of the acute specific\\ndiseases, is present. This is all the more likely to be the\\ncase if the patient falls, at it were, suddenly ill. The main\\nguide in these cases is the temperature: if the ther-\\nmometer be raised in the axilla to loi or 102 degrees F.,\\nand emphatically so if to a higher point than this, there\\ncan be very little doubt on the point. However, amongst\\nthe occasional exceptions, acute lichen, erythema no-\\ndosum, secondary syphilis, acute eczema, pityriasis rubra,\\nacute pemphigus, urticaria, zoster, may be named, but\\nthese are not accompanied by high temperature. Sec-\\nondary syphilis has been mistaken for the mottling of\\ntyphus and measles, acute lichen for measles, and zoster\\nfor pleurisy, on account of the pain. Occasionally in\\neczema there may be marked pyrexia, but not a markedly\\nhigh temperature. When symmetrical, the disease is\\nusually due to a blood-poison; when unsymmetrical, to\\nlocal causes or perhaps to affections of the nervous\\ntrunks.\\nPerhaps one of the greatest errors committed in diag-\\nnosing cutaneous diseases is the dealing with them in a\\npiecemeal manner. It is the universal expectation of the\\nstudent to be able to diagnose a disease of the skin from\\nmerely looking at it. Many a student, if asked with a\\npatient before him. What is that disease? will look,\\nand, it may be, look closely and then make his diag-\\nnosis and give the thing a name. In no other class of", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0042.jp2"}, "43": {"fulltext": "SOME GENERAL OBSERVATIONS. 39\\ndisease would he do that. He would obtain the objective,\\nand the subjective symptoms; and use every means at his\\ncommand for ph3^sical examination. It is of equal im-\\nportance that he exhibit a like careful comparison in\\nlesions of the skin.\\nOne of the first cares of the dermatologist should be to\\ndistinguish in diagnosis between primary and secondary\\nphenomena. The one set are of course essential points of\\nthe disease, and the secondary results may, if care be not\\ntaken, be elevated to the rank of important items. For\\ninstance: In the case of an erythema, in connection with\\nlong-continued congestion, more or less thickening may\\noccur; if this be not clearl}^ perceived to be an accidental\\noccurrence, the diagnosis becomes difficult. Take the\\ncase of pityriasis rubra, a disease in which the whole\\nskin becomes intensely hyperaemic with free shedding of\\nscales. If this be properl} treated it will disappear, and\\nleave not a trace. It may be unaccompanied throughout\\nits course by anj^ thickening of the papillar} layer; but\\nif it continues a long while this la5^er may be thickened,\\nand then .there are present hyperaemia, papillary h5^per-\\ntrophy, and scaliness, as in psoriasis; and the diagnosis\\nbetween pityriasis rubra and psoriasis could not be made\\nfrom the mere surface appearances and alterations only.\\nBut the two things clinically are wholly different. This\\nshows the importance of attending to the primary ele-\\nmentary lesion and the historj^ and course of diseases.\\nAgain, in searching for the earliest stage of disease\\nwhen that occurs in patches, it is necessary to go to the\\nedge of the disease since it there presents its most recent\\ncharacters.\\nThe typical course and characters of any disease may\\nbe masked by the co-existing development of a second\\ndisease, and here the interminglage of the features of the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0043.jp2"}, "44": {"fulltext": "40 SKIN DISEASES.\\ntwain will be detected, as in urticaria and scabies or pur-\\npura; scabies and syphilis; eczema and scabies; eczema\\nand psoriasis, and the like. The capriciousness as re-\\ngards the appearance and disappearance of an eruption of\\nan erythmatous type, is suspicious of urticaria. Multi-\\nformity means that a disease is complicated, unless it be\\nscabies or syphilis.\\nAs regards the temperament, the dermatologist is gen-\\nerally enabled to say at a glance whether a patient is of\\nfull habit and likely to have a loaded system especially\\nthe case in women; whether there be organic disease, or\\nif there be a dyspeptic habit, or an ill-fed system, that\\nsignifies debility. If lymphatic, the patient is prone to\\neczema, impetigo, intertigo, the pustular aspect of scabies\\nand ringworm; \\\\i gouty, the scaly diseases, chronic eczema\\nand lichen agrius; if rkeu?natic, erythema nodosum; if\\nstrumous, eczema, lupus; if florid, psoriasis especially.\\nThere is also the cancerous cachexia, and in nervous sub-\\njects various hyperesthesia engrafted upon ordinary erup-\\ntions. Red-haired subjects are declared to be very liable\\nto pityriasis of the scalp.\\nSome eruptions are more or less periodic in their oc-\\ncurrence, as in the case of pemphigus, but the derma-\\ntologist should remember that in districts where malarious\\ndisease is common, a disease not usually possessing\\nperiodic features may sometimes be so influenced that its\\neruption occurs in a periodic manner, or the febrile dis-\\nturbance by which it is accompanied may show itself in\\nperiodic outbursts.\\nPsoriasis, eczema, and syphilitic diseases are essentially\\nthose which recur.\\nOccupation exerts considerable influence in some\\nlesions of the skin. Cooks are particularly liable to ec-\\nzema and erythema, and bakers, grocers and bricklayers\\nmmmgM", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0044.jp2"}, "45": {"fulltext": "SOME GENERAL OBSERVATIONS. 41\\nto lichen about the backs of the hands; chimney-sweepers\\nare liable to epithelioma of the scrotum; cotton- workers\\nto urticaria; butchers and graziers to whitlow, boils and\\nmalignant pustule and ecthyma; cavalrymen and shoe-\\nmakers to eczema marginatum in the fork of the thighs;\\nyoung women who come from the country and have the\\nfull diet fare of the city servants and those who change\\ntheir mode of life, so that it entails more exercise and\\nbetter living, get an overloaded system that shows itself\\nin erythema papulatum, erythema nodosum, or impetigo.\\nThe age of the patient is very important. During the\\nfirst six weeks of life congenital syphilis develops itself;\\nintertrigo, eczema of the scalp, and seborrhoea capillitii\\nalso occur about the same time. Syphilitic pemphigus\\noccurs, it is said, before the child is six months old, not\\nafterwards; during the first few months and up to and\\nthrough the period of dentition, strophulus and eczema\\nare met with. Cancer (epithelioma) is a disease of late\\nlife it does not occur before thirty, generally about sixty\\nand bej^ond. Lupus is a disease which commences in\\nearly and j^oung life, and the same may be said of syphilis.\\nThe parasitic diseases occur in the young, rarely after\\ntwenty-one years of age. Herpes circinatus is the form\\nseen in adult life. In old people, phthiriasis, ecthyma\\ncachecticum, pemphigus, and pruritus, with cancer and\\nrodent ulcer, frequently occur.\\nWe should have some rules as to the mode of studying\\nskin diseases. The following are probably the best; they\\nare taken from Fox:\\nI The observer should always strip his patient so that\\nthe disease may be exposed to the fullest extent compati-\\nble with a due regard to the proper feelings and sensitive-\\nness of the individual. To be satisfied with seeing a bit\\nof a patch of disease in this spot, or just a spot or two\\n4", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0045.jp2"}, "46": {"fulltext": "42 SKIN DISEASES.\\nthere where the malady is most marked even, is often to\\nrun great risk of arriving at an erroneous diagnosis, if not\\nto actually make one, certainly to miss the recognition of\\ntransitional stages, which are of the utmost importance\\nin determining the general character and often the exact\\nnature of a disease.\\n2. It is of much importance that mere stages of diseases\\nshould be regarded as stages and nothing else. Diseases\\nmust be dealt with in their entireties. Where the whole\\nof a disease is made up in any particular instance of cer-\\ntain stages, in estimating the nature and characteristics of\\nthat disease one stage must not be regarded in particular\\nbe thrust into undue prominence at the expense of\\nothers. The several stages together constitute the dis-\\nease.\\n3. A clear distinction should be drawn between essen-\\ntials and accidentals. For instance, the essence of scabies\\nis the acarus in its furrow. All else that follow the fol-\\nlicular irritation, improperly called lichen, the ecthyma,\\nthe urticaria, which may occur in many different dis-\\neased states of the skin is accidental, and due to the irri-\\ntation and the scratching practiced.\\n4. It should be a point with the dermatological student\\nto make as little as possible of mere superficial appear-\\nances and changes, because these are brought about as\\nthe result of, and are indeed often secondary to, more im-\\nportant and primary changes in the deeper parts.\\n5. It is important to pay special attention, as far as possi-\\nble, to the primary anatomical seat of the disease. What\\nthe primary seats of individual diseases are, so far as re-\\ngards cutis, cuticle, follicles, and the like, I shall discuss\\nin another place in speaking of elementary lesions and\\nthe individual diseases themselves.\\n6. Special attention should be paid to the fact of the", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0046.jp2"}, "47": {"fulltext": "SOME GENERAL OBSERVATIONS. 43\\ncharacter of an eruption being permanejit, or transient^\\nor interchaiigeable. The case of lichen planus may be\\ntaken to illustrate this point. In it the characteristic\\nlesion is a red flattened papule covered by the minutest\\nscales. This is the sole lesion present. The papule\\nnever changes into a pustule or a vesicle; but not so is it\\nwith the papule of eczema or variola. The tendency of\\na syphilitic papule is to become oftentimes a pustule or\\ntubercle, which gives place to an ulcer, and so on. The\\neruption as a whole may be again capricious, appearing\\nand disappearing suddenly, often in the course of a few\\nminutes. This feature in itself is almost diagnostic of\\nurticaria.\\n7. Those who are studying skin diseases should observe\\nwhether an eruption be uniform or 7nultiform in charac-\\nter. Multiformity implies z) the co-existence of two or\\nmore diseases, in which case there will be present the\\nfeatures of the two or more diseases commingled; or it im-\\nplies {b~) the existence (i) if the lesions be inflamma-\\ntory that is, if pustules or vesicles be present, of scabies,\\nor (2) if the lesions be degenerative, if ulcers and sup-\\npurating tubercles, for example, be present, of syphilitic\\ndisease. The difference between the two main classes of\\ncases, the complicated disease on the one hand and scabies\\nand syphilitic on the other, being that in the former\\nthere are no transitional stages observed, as in purpura\\nurticans, pemphigus pruriginosus, impetigo and scabies;\\nsyphilis and scabies, etc.; whereas, in the latter class,\\nthey are present as between the papules, vesicles, and\\npustules of scabies, or the papules, tubercles, pustules\\nand ulcers of syphiloderma. Multiformity as it exists in\\nscabies and syphilitic eruptions relates in each case to\\nsuch different kinds of eruption, and the multiformity\\nmoreover in complicated or co-existent diseases is seen to", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0047.jp2"}, "48": {"fulltext": "44 SKIN DISEASES.\\nbe due to the commingling of such distinct lesions with-\\nout transitional forms that the character of multiformity\\nbecomes at once a very reliable guide in diagnosis; of\\ncourse, other things help, as rest, development, etc., but\\nmultiformity is a good rough test of syphilis, scabies, or\\ncomplicated diseases.\\n8. It is wise to note certain differences, not only as to\\nthe general nature and character of cutaneous diseases as\\nthey exist in the old and young, but also in reference to\\nthe same disease as it occurs in the old and young. The\\ncutaneous diseases of childhood are essentially distin-\\nguished from those of the adult, in that they are uncom-\\nplicated by organic diseases of the internal organs, and\\nby those more complex and profound perversions of nu-\\ntrition which arise from overworked or badly used\\norgans, such as gout, dyspepsia, free retention of excreta\\nin the blood, rheumatism, and so on. They contrast with\\nthose in the old by the absence of coincident degenera-\\ntive changes in the body, which are to be the lot of the\\nman who passes the meridian of life. The cutaneous dis-\\neases of children are uncomplicated in this respect, and\\nspeaking generally, they are the result of the misuse of\\npabulum supplied to the body, or the direct consequence\\nof improper diet. The case of eczema infantile may be\\ntaken as an example. But there is a difference in consti-\\ntutional conditions the diathetic conditions in the child\\nwho suffers from skin disease are different from those of\\nthe adult or aged. It does not take any long time to see\\nhow frequently the subjects of skin diseases in the young\\nare strumous, and what an influence this diathesis has on\\nthe skin diseases of the young as contrasted with those\\nof the middle-aged and of an age beyond the latter period\\nof life; that syphilitic affections other than those heredi-\\ntarily transmitted are specially the privilege of the adult,", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0048.jp2"}, "49": {"fulltext": "SOME GENERAL OBSERVATIONS. 45\\nand so on; that in the advanced in years there are not\\nonly complicating organic diseases of internal organs,\\nblood alterations due to mal-assimilation, degenerative\\ntissue changes such as cancer, but disease specially con-\\nnected with decay of the nervous system, as in senile pru-\\nritus. But to put what I wish to enforce in a few words,\\nI may say that, as regards kiyid, the diseases of children\\nare the result of malnutrition from deficient or bad feed-\\ning; those of the adult the result of mal-assimilation;\\nthose of the aged the result of degenerative changes. As\\nregards complications, diseases of the young are often\\nclosely connected with the strumous diathesis especially;\\nthose of the adult with functional derangements of in-\\nternal organs and mal-assimilation, such as dyspepsia,\\nhepatic and renal torpor and with the diathetic condi-\\ntions, phthisis, rheumatism, and the commencement of\\ngout; those of the aged are linked with nerve pareses\\nand degenerations of the skin, as evidenced by increased\\npigmentation, atrophy of the glands, and of the nerves\\nin the papillae, and also with organic diseases of important\\ninternal organs. All this is important therapeuticall5^\\n9. It is to be remembered that there is a difference in\\nthe conditions associated with skin diseases, as they occur\\nin hospital and private practice. The constitution of the\\nhospital patient is depraved by mal- hygiene and want\\nof proper food, that of the private patient is depraved, no\\ndoubt by want of hygiene oftentimes, but also by over-\\nloading of the digestive organs, and not from actual want\\nof food. But more than this; the nervous system partici-\\npates in the latter much more actively in helping, con-\\ntrolling, or modifying the existing disease; and this as\\nthe result of the luxury enjoyed by the rich, and the\\ngreater mental toil undergone by the busy man of the\\nmiddle classes, the effects of which, in both cases, are felt", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0049.jp2"}, "50": {"fulltext": "46 SKIN DISEASES.\\nby the offspring. The old amongst the hospital patients\\nshow especially nervous symptoms connected with physi-\\ncal decay, and at the two extremes of life the evil con-\\nsequences of uncleanliness are most marked, because\\nthere is less power to resist its influence in the hospital\\npatient.\\n10. There are differences in the same disease as seen\\nin this and other countries, as well as a distinction to be\\ndrawn between the several kinds of cutaneous affections\\noccurring in this country and abroad. There is, indeed, a\\nnationality of disease as well as of character or physique.\\n11. A very close relation exists in many instances be-\\ntween cutaneous disorders and functional disturbances in\\ninternal organs. Dr. Singer calls attention to this rela-\\ntion, and thinks that it is more frequent than is generally\\nknown, as the symptoms, meteorism, flatulence, eructa-\\ntions, loss of appetite, and constipation, may be lacking.\\nExamination of the urine with detection of the greater or\\nless excretion of indican will give one an index of how\\nmatters stand. Urticaria is nearly always accompanied\\nby digestive disturbances. In the so-called idiopathic\\nurticaria the amount of indican in the urine is nearly con-\\nstantly increased. Collect the twenty-four hours quantity\\nand test from that as it varies during the day. He em-\\nployed Obermayer s reagent. In certain forms of facial\\nacne, and in nearly all cases of senile pruritus, he found\\na constant relation between the skin eruption and in-\\ncreased intestinal fermentations at the lower portion of\\nthe small intestine. In some instances hyperaemic changes\\nin the skin and mucous membrane have a common origin,\\nas in lichen planus and pityriasis rubra, from disturbance\\nof the sympathetic for example, and this is the explana-\\ntion of the coincidence in the two diseases named, of the\\nskin changes, and pyrosis, menorrhagia, and the like. In", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0050.jp2"}, "51": {"fulltext": "SOME GENERAL OBSERVATIONS. 47\\nother instances the changes in skin and internal organs,\\ninstead of having a common origin, react the one upon\\nthe other, and the important point to notice is this: that\\nthe cutaneous troubles ma}^ be excited and intensified by\\ninternal troubles. There are four organs whose derange-\\nment excites or intensifies skin mischiefs. The stomach,\\nthe liver, the kidney, and uterus. In the vast majority\\nof cases it is rather intensification than excitation that\\nthe practitioner has to deal with.\\n12. It is important always to be aware of the fact of\\nthe bias impressed upon skin diseases by various dia-\\ntheses especially the syphilitic, the gouty, the strumous,\\nand the nervous.\\n13. Observers should accustom themselves to examine\\nmicroscopically the morbid products of skin diseases.\\nThe surgeon and the physician obtain most valuable indi-\\ncations from the examination of the minutest portions of\\nmorbid tissue and the juice it may yield; and the derma-\\ntologist is much to blame for an omission in this respect.\\nThe microscope affords very valuable assistance in the\\ndifferential diagnosis of herpes, eczema, psorias is, and\\ntinea especially. For instance, inflammatory products\\nare absent in psoriasis, present in the other three diseases;\\nwhilst in all forms of parasitic disease resembling herpes\\nand eczema, as in so-called eczema marginatum, fungus\\nelements are detected, provided proper care is observed.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0051.jp2"}, "52": {"fulltext": "CHAPTER III.\\nCLASSIFICATION OF THE ELEMENTARY\\nLESIONS.\\nThe first step in diagnosis is to obtain a clear and full\\nunderstanding of the different lesions, so that their true\\ncharacter may be recognized at a glance. Bach author\\nhas a pet classification which he honestly believes to be\\nthe best. One divides them into i. Maculae; 2. Erythe-\\nmatous; 3. Papular; 4. Vesicular; 5. Pustular; 6. Squam-\\nous; 7. Tubercular; 8. Parasitic.\\nAnother gives i. Masculae or stains; 2. Erythema or\\nredness; 3. Wheals; 4. Papules, or pimples; 5. Squam-\\nmse or scales; 6. Vesicles, or little bladders; 7. Blebs, or\\nlarge vesicles; 8. Tubercula, or lumps; 9. Pustules, or\\nmattery heads.\\nI have found the following division to be of the greatest\\nhelp in diagnosing skin affections: Macules, Vesicles,\\nBullae, Pustules, Papules, Tubercles, Scales, Fissures,\\nand Ulcers.\\nThere is one remark I would make with a view of\\nhelping the reader to avoid a common error in regard to\\nthese lesions. It is this, that the different typical forms\\nof lesions embrace or include each of them several varie-\\nties, and the designation of each typical form or lesion is\\nto be regarded as a generic term, applicable to several\\nvarieties of the same lesion. It is not enough, for in-\\nstance, to say a papule is present. Since there are various\\nr", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0052.jp2"}, "53": {"fulltext": "CLASSIFICATION OF THE ELEMENTARY LESIONS. 49\\nkinds of papules, it is necessary to state what particular\\nkind of pustule is meant. When it is said a tubercle is\\npresent, the class to which the lesion belongs has only\\nbeen defined; the tubercle may be that of a cancer, lupus,\\nor syphilis. I am convinced that one of the commonest\\nerrors into which those who are studying skin diseases fall\\nis the neglect to recognize the fact that there aix several\\ndifferent varieties of the same kind of elementary lesions,\\nand their confusion of these several different varieties.\\nThis is especially the case with papules. We will de-\\nscribe the several varieties of elementary lesions.\\nA 7nacule is a small, circumscribed portion of skin, in\\nwhich has occurred some alteration in its color, but with-\\nout any secretion, effusion, infiltration, or change in its\\nthickness or consistence. The macule itself may be w^hite\\nfrom loss of pigment, red from congestion, or dark or\\nblack from increase of pigment.\\nThe principal diseases in which it occurs, and chief\\nfeatures, are:\\n1. Chloasma, in which the macule or discoloration is\\nsomewhat diffuse, occurring on the forehead and cheeks,\\nand is of a browmish color.\\n2. Erythema; The macules are of varying size of a red-\\ndish color.\\n3. Ephelis; Macules of a yellowish to a dark brown\\ncolor. Chiefly found on the exposed parts of the body.\\n4. I^entigo; Small, dark-brown macules scattered over\\nthe surface, on the covered as well as on the uncovered\\nportions.\\n5. lycntigo maligna; Very dark macules, from the size\\nof a large pin-head to that of a pea, later becoming in-\\nfiltrated, and sometimes ulcerating.\\n6. lycprosy; Brownish macules of varying size.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0053.jp2"}, "54": {"fulltext": "50 SKIN DISEASES.\\n7. I^eucoderma; White or light-pinkish macules, sur-\\nrounded by a dark border.\\n8. Lupus; Minute reddish-brown or ham-colored.\\n9. Nsevus; Red or purplish, disappearing on firm\\npressure.\\n10. Purpura; Red or purplish, not disappearing on\\npressure.\\n11. Rosacea; Rosy macules\\n12. Syphilis; (a) Reddish macules, appearing in early\\nsyphilis, chiefly on the chest, abdomen and back; (b)\\nMacules resembling those of leucoderma, and met with\\nabout the neck in young women in the early period of\\nthe disease.\\n13. Xanthelasma; Yellowish macules, chiefly met with\\nabout the eyelids. A vesicle is a small elevation of the\\nhorny layer of the epidermis, by the effusion of a serous\\nfluid.\\nThe principal diseases in which vesicles are found, and\\ntheir chief features, are:\\n1. Eczema; In patches, minute and closely aggregated,\\nand rupturing in a day or two, except where the epi-\\ndermis is very thick.\\n2. Dermatitis multiformis; Lesions of larger size and\\ngreater duration, and frequently accompanied with other\\nlesions of a pustular character.\\n3. Erysipelas; Lesion situated on a diffused inflamed\\nbase, usually on the face.\\n4. Erythema multiforme; Associated with macules and\\npatches of erythema.\\n5. Herpes; One or more groups of three or four vesicles\\nof moderate size, and not packed together so closely as in\\neczema. They usually last a few days, and dry down into\\na small scale or crust, except on the genitals, where they\\nrupture promptly.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0054.jp2"}, "55": {"fulltext": "CLASSIFICATION OF THE ELEMENTARY LESIONS. 51\\n6. Impetigo contagiosa; Medium-sized vesicles, lasting\\na few days and drying down to form crusts, occurring on\\nany part of the body,\\n7. Scabies; Small, pointed vesicles, usually met with\\non the hands and fingers.\\n8. Sudamina; Minute, disseminated vesicles, corre-\\nsponding to the sudoriparous ducts.\\n9. Varicella; Vesicles of medium size, which may or\\nmay not be umbilicated.\\n10. Variola; Umbilicated vesicles succeeding papules.\\n11. Zoster; Vesicles of good size, seated on inflamed\\npatches, and following the course of a nerve-trunk.\\nA bulla is a larger elevation of the epidermis, by a\\nserous or sero-fibrinous effusion, than a vesicle.\\nThe principal diseases in which bullae are found, and\\ntheir chief features are:\\n1. Erysipelas; The bullae of erysipelas are in reality\\nvery large vesicles, seated on the inflamed base.\\n2. Leprosy; Large bullae, usually solitary, and appear-\\ning at intervals.\\n3. Pemphigus; Large bullae, solitary, or in crops at in-\\ntervals.\\nA pustule is an elevation of the epidermis, small or\\nlarge, by a purulent exudation.\\nThe principal diseases in which pustules are found, and\\ntheir chief features are:\\n1. Acne; Small, scattered pustules, resulting from the\\nsuppression of papules, chiefl}^ met with on the face,\\nback, and chest.\\n2. Ecthyma; Scattered pustules, of medium size.\\n3. Eczema; Closely aggregated pustules, of small size.\\n4. Dermatitis multiformis; Pustules associated with\\nother lesions.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0055.jp2"}, "56": {"fulltext": "52 SKIN DISEASES.\\n5. Furuncles; A pustule seated at the apex of an in-\\nflamed, painful, and slightly elevated spot.\\n6. Scabies; Isolated pustules, especially frequent about\\nthe hands and wrists.\\n7. Syphilis; Pustules succeeding papules, or occurring\\nwithout them.\\n8. Variola; Umbilicated pustules which follow vesicles,\\nand which were preceded by papules, discrete or con-\\nfluent.\\nThe common feature of these three lesions vesicle,\\nbulla, pustule is a fluid exudation serous, sero-fibrin-\\nous, or purulent which lifts up a greater or less extent\\nof horny epidermis, producing an elevation on the skin,\\nand the lesion consists of an effused fluid, kept in bounds\\nby a limiting membrane.\\nA vesicle, bulla, or pustule having formed may further\\nprogress in one of several ways. After a few days the\\neffusion may be reabsorbed without rupture of the epi-\\ndermis, and leave nothing but a loosely attached scale,\\nwhich soon exfoliates. On the other hand, the epidermis\\nmay rupture in a day or two, the effusion be poured out,\\nand the whole dry up to a small crust, which in a few\\ndays more is wholly detached; or, still again, a vesicle or\\npustule may rupture promptly, but from the denuded sur-\\nface a serous or purulent fluid may continue to exude for\\nseveral days or even weeks.\\nA papule is a small, solid elevation of the skin. In\\nthis case the exudation into the skin is of a plastic char-\\nacter, mostly cells with but little fluid effusion not suffi-\\ncient, in fact, to produce a vesicle. A papule may disap-\\npear in a few days by absorption of the exudation, or\\nmay be gradually converted into a pustule; or may un-\\ndergo ulceration, or may even persist without alteration\\nalmost indefinitely.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0056.jp2"}, "57": {"fulltext": "CLASSIFICATION OF THE ELEMENTARY LESIONS. 53\\nThe principal diseases in which papules are found, and\\ntheir chief features are:\\n1. Acne; Papules of varying size, chiefly met with on\\nthe face, shoulders, back, and chest, and frequently\\nchanging into pustules.\\n2. Erythema multiforme; Grouped papules, most fre-\\nquent on the extremities.\\n3. Eczema; Scattered, or more or less closely aggre-\\ngated, on the arms, inside of thighs, and elsewhere, fre-\\nquently accompanied with scratch-marks.\\n4. lyichten simplex; Scattered papules, frequentlj^ met\\nwith over the entire surface.\\n5. Eichen planus; Elat, umbilicated papules, greatly re-\\nsembling those of a papular syphilide.\\n6. Lupus; Persistent and gradually increasing in size;\\nbecoming tubercles, usually on the face.\\n7. Milium; Minute white papules on the e3^elids and\\ncontiguous skin.\\n8. Molluscum contagiosum Umbilicated papules, con-\\ntaining a cheesy matter which may be pressed out, fre-\\nquently predunculated in this respect differing from\\nacne papules, which are not pedunculated.\\n9. Prurigo; Hard, and under or in the skin, not much\\nelevated, and with little change in color of the skin; more\\neasily felt than seen, and accompanied with scratch-\\nmarks.\\n10. Rubeola; Red papules, covering the entire surface,\\nand accompanied with febrile symptoms.\\n11. Scabies; Small papules, usually accompanied with\\nother lesions, and generally with their apices scratched off.\\n12. Strophulus; Red papules, in infancy only.\\n13. Syphilis; More or less generalized reddish or copper-\\ncolored; may degenerate into pustules, or become covered\\nwith a fine scale.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0057.jp2"}, "58": {"fulltext": "54 SKIN DISEASES.\\n14. Urticaria; Large papules, lasting a few hours only,\\nbut succeeded at short intervals by others, and accom-\\npanied with sharp pruritus.\\n15. Variola; Discrete or confluent, changing into vesi-\\ncles, and later into umbilicated pustules; usually accom-\\npanied with severe general symptoms.\\n16. Xanthelasma; Yellowish and slightly elevated,\\nmost frequent about the eyes, but may occur elsewhere.\\nA tubercle is a solid elevation of the skin, larger than a\\npapule, but agreeing with it in other respects and capable\\nof undergoing the same changes namely, absorption,\\npulsation, ulceration, or indefinite prolongation.\\nThe principal diseases in which tubercles are found,\\nand their chief features are:\\n1. Acne; Tubercles on face, back, etc., with inflamed\\nbases, and usually terminating with suppuration.\\n2. Fibroma; Single or multiple, and scattered over all\\nparts of the body.\\n3. Framboesia; Fungous tubercles, frequently of large\\nsize very rare.\\n4. Keloid; Flat tubercles, or flattened elevations of the\\nskin, with projecting finger-like processes.\\n5. Lentigo maligna; Commencing as macules, becom-\\ning papules, and afterward tubercles, frequently with\\nulceration.\\n6. Leprosy; Reddish-brown tubercles on the forehead,\\nears, and other parts of face and body.\\n7. Lupus; Solitary or but few reddish- violet tubercles,\\nof very slow increase, and terminating with ulceration.\\n8. Morphoea; Flat, light-colored tubercles, followed by\\natrophy, from one to a dozen rarely more.\\n9. Rosacea hypertrophica; Confined to the nose.\\n10. Syphilis; Copper-colored, terminating with suppu-\\nration or ulceration. In early syphilis, numerous; in late", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0058.jp2"}, "59": {"fulltext": "CLASSIFICATION OF THE ELEMENTARY LESIONS. 55\\nsyphilis, number of lesions limited, and occurring in\\ngroups.\\nScales are collections of cells of the stratum corneum,\\nwhich, instead of pursuing their usual and normal course,\\ncollect in undue number and quantity, and are loosely or\\nfirmly attached to the skin in more or less heaped-up\\nmasses. When these scales are small in size, loosely at-\\ntached, like a fine powder or meal scattered over the sur-\\nface, they are termed farmaceous on the other hand,\\nwhen large, thick, heaped up, and firmly attached, they\\nare called furfuraceous.\\nThe principal diseases in which scales are found, and\\ntheir chief features are:\\n1. Dermatitis exfoliativa; Large scales, consisting of\\nflakes of horny epidermis; sometimes several inches in\\nextent.\\n2. Eczema; Medium size, scales occurring in the last\\nstage of the disease, and frequently preceded by exuda-\\ntion and crusting.\\n3. Ichthyosis; Very adherent thick scales, the disease\\ncommencing in early life and continuing indefinitely.\\n4. Lupus erythematosus; Very fine adhering scales,\\nsituated on a reddened, infiltrated base.\\n5. Pemphigus foliaceus; Large scales, due to imperfect\\nformation of bullae.\\n6. Pityriasis simplex; Fine white scales on a surface\\nbut little affected otherwise, and readily exfoliating.\\n7. Pityriasis rubra; Fine scales on a reddened surface,\\nusually generalized.\\n8. Psoriasis; Thick, adherent, imbricated white scales\\non a reddened infiltrated surface, more or less generalized.\\n9. Syphilis; Small scales at the summit of papules, or\\nthicker and larger on reddened infiltrated surface, more or\\nless generalized.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0059.jp2"}, "60": {"fulltext": "56 SKIN DISEASES.\\nlo. Trichophytosis capitis; Fine scales among hair-\\nstumps on round patches.\\nFissures are solutions of continuity, and are character-\\nized by varying length and depth, but with scarcely\\nappreciable breadth. They rarely extend deeper than\\nthrough the horny or Malpighian layers, though some-\\ntimes they penetrate the cutis vera. They are frequently\\naccompanied with a scanty serous exudation.\\nThe principal diseases in which fissures are found, and\\ntheir chief features are:\\n1. Eczema; Especially at flexor aspect of joints, palms\\nof the hands, and soles of the feet.\\n2. Leprosy; Especially at extensor aspect of small\\njoints or between them, and usually accompanied with\\nanaesthesia.\\nUlcers are solutions of continuity of three dimensions\\nnamely, length, breadth, and depth. Their borders may\\nbe sharp cut and perpendicular to the skin, or may be\\nsloping or overhanging, features which often afford a\\nvaluable clew to the origin of the lesion. jj\\nThe principal diseases in which ulcers are found, and\\ntheir chief features are:\\n1. Carcinoma; Ulceration on the elevated surface of a\\ncarcinomatous tumor; underlying tissues hard.\\n2. Eupus; Ulceration following one or more tubercles,\\nsometimes becoming carcinomatous.\\n3. Scrofula; Irregular and uneven, frequently with\\noverhanging margins.\\n4. Syphilis; Round or ovoid, with straight punched-\\nout margins.\\n5. Simple: Round or oval, with sloping margins.\\nTumors ^IR\\nI. Carcinoma (epithelioma); Usually solitary, hard,\\nand terminating by ulceration.\\n1\\ni.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0060.jp2"}, "61": {"fulltext": "CLASSIFICATION OF THE ELEMENTARY LESIONS. 57\\n2. Elephantiasis; Sometimes immense tumors of the\\ngenitals, which in rare instances have reached the weight\\nof one hundred pounds.\\n3. Fibroma; Solitary or multiple, of varying size,\\nsessile or pedunculated, without tendency to ulceration.\\n4. Papilloma; Warty tumors, of varying size and num-\\nber.\\n5. Sarcoma; Soft fleshy tumors, bleeding readily;\\nusually solitary, unless accompanied with melanotic de-\\nposit.\\n6. Steatoma; Enlarged sebaceous glands, with reten-\\ntion of secretion.\\nIn addition to the above there are certain other lesions,\\nsome of which are secondary, while others are peculiar to\\ncertain special diseases, and will be described in connec-\\ntion with them.\\nWith the foregoing list of diseases and lesions, and\\nwith their chief peculiarities visible at a glance, there\\nshould be but little difl culty in working out an analytical\\ndiagnosis in the great majority of cases of cutaneous dis-\\nease. We would, however, advise the student to pursue\\nthe following course: First, determine the predominant\\nlesion, then turn to the list of diseases which are charac-\\nterized by that lesion, and see how closely the descrip-\\ntions there given agree with the appearances presented;\\nand, when a choice is made, carefully read the descrip-\\ntion of the disease itself as found in later pages of the\\nbook. Should the disease in question present more than\\none lesion, examine the lists of diseases under each lesion,\\nand proceed as before. Several years experience in\\nstudying dermatology has satisfied the writer that the\\npursuit of the method here laid down will enable the\\nstudent to become a prompt and correct diagnostician in a\\nsurprisingly short time. He will, of course, meet with\\n5", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0061.jp2"}, "62": {"fulltext": "58 SKIN DISEASES.\\ncases in which he will not succeed, but he should remem-\\nber that cases not infrequently occur which puzzle even\\nthe most expert.\\nThe subject of diagnosis, however, cannot be dismissed\\nwithout allusion to certain eruptions or rashes that arise,\\nnot spontaneously, but after the ingestion of certain drugs\\nthat have been administered for other diseases. The fol-\\nlowing named drugs have been known to give rise to the\\nlesions which follow their titles, viz.\\nAcid, Carbolic. Erythema.\\nAcid, Salicylic. Erythema, vesicles, papules, and\\nwheals\\nAconite. Erythema and vesicles.\\nAntimony. Vesicles and pustules.\\nA7itipyrin. Papules.\\nArnica. Erythema, bullae, and scales.\\nArsenic. Erythema, papules, vesicles, bullae, pustules,\\nand wheals.\\nBellado7i7ia. Erythema.\\nThe Bromides. Erythema, vesicles, bullae, pustules,\\npapules, tubercles, and wheals.\\nCannabis Indica. Vesicles.\\nChloral. Erythema, papules, vesicles, and wheals.\\nCinchona derivatives. Erythema, papules, vesicles,\\nand wheals.\\nCopaiba, Erythema, papules, vesicles, bullae, and\\nwheals.\\nDigitalis. Erythema and wheals.\\nHyoscyamus.\u00e2\u0080\u0094^XYi\\\\\\\\.^ni2. and w^heals.\\nThe Iodides.\u00e2\u0080\u0094 Erythema, papules, vesicles, bullae,\\npustules,, and wheals.\\nIodoform. Erythema, papules, and vesicles.\\nNapthalhi Papules\\nPhosphorus. Bullae.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0062.jp2"}, "63": {"fulltext": "CLASSIFICATION OF THE ELEMENTARY LESIONS. 59\\nSantonin. Papules, vesicles, and wheals.\\nSulphonal. Macules, papules.\\nSulphur. Erythema and vesicles.\\nViolet-water (locally Papules.\\nPathology.\\nThe pathology of the skin presents no essential differ-\\nences from the pathology of other parts of the bodj^ that\\nis, the same morbid processes that are met with else-\\nwhere also find expression in the dermal tissues. For\\ninstance, congestion, inflammation, hypertrophy, atrophy,\\ncedemas, infiltrations, degenerations, neoplasms, pseudo-\\nplasms, nervous derangements, etc., are the processes\\nwhich result in the production of the various lesions that\\nconstitute the essential visible characteristics of cutaneous\\ndisease. In addition we have certain parasitic invasions,\\nof both animal and vegetable origin. The complex\\nstructure of the skin, and of the special organs contained\\nin it, together with the anatomical peculiarities of the\\nappendages, give rise to an almost infinite variety of\\nchanges.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0063.jp2"}, "64": {"fulltext": "CHAPTER IV.\\nETIOLOGY.\\nThe general question of the treatment of diseases of\\nthe skin involves the consideration of the different and\\nseveral indications, and of the means at our command for\\nthe fulfillment of these indications. Before, however, we\\ncan properly appreciate the special features appertaining\\nto any one given morbid condition, it is better to devote\\na little time to the discussion of the general factors which\\nlead to the development of cutaneous disease; in other\\nwords, to consider the question of etiology.\\nPrimarily it may be stated that cutaneous lesions are\\ndue to influences or forces from without, or from those\\nwhich exist or arise within the body. To the former\\nclass may be assigned such as depend on temperature\\nand climate, such as are due to traumatisms of various\\nkinds, such as result from various parasitic invasions,\\netc. This is in reality but a limited class; on the other\\nhand, the etiological factors which arise within the body\\nitself are very numerous. We will, however, first con-\\nsider the external causes. Excessive heat or direct ex-\\nposure to the sun may excite undue activity of the sudor-\\niferous glands, and result in the production of sudamiiia^\\nor the extremely annoying papular affection known as\\nlichen tropicus; or to an erythematous or even vesicular\\ninflammation, commonly known as sunburn; or to the\\nmore trivial affection called ephelis, or freckles. Excess-\\nive cold may result in absolute congelation of exposed", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0064.jp2"}, "65": {"fulltext": "ETIOLOGY. 61\\nportions of the integument, followed by death and slough-\\ning ofF of the parts; or a less degree of cold may excite\\nthe condition known as pernio, or chilblains, or in some\\npersons produce chapping or fissuring of the skin; or, by\\ndepressing the general vitality, promote an outbreak that\\notherwise would not have occurred. Of the animal para-\\nsites that may infest the body, the different varieties of\\npediculi, or lice; the acarus, or itch insect; the leptiis, etc.,\\nproduce affections more or less annoying, but usually\\nreadily removable. On the other hand, the infinitely\\nminute and to the naked eye invisible parasites of vege-\\ntable origin, as the achorion and the trichophyton, give\\nrise to affections which are exceedingly tenacious, and\\nsometimes well-nigh incurable.\\nThe internal causes of cutaneous diseases, however,\\nare far more frequently in operation, and are far more im-\\nportant than those of external origin. In this class we\\nmay place those affections of the skin which are due to\\npre-existing lesions of some part of the nervous system,\\nas, for instance, zoster, which results from an anterior\\nlesion of the ganglion attached to the posterior root of a\\nspinal nerve; or some of the lesions of leprosy, which\\nsucceed certain degenerations of the spinal cord. The\\nnervous system, however, may be in a perfectly sound\\ncondition, and yet act as the medium for the transmission\\nof. some internal irritation to the surface; thus, the gastric\\nirritation resulting from the ingestion of shell-fish may\\nmanifest itself chiefly on the skin in the form of urticaria,\\nor a chronic irritation of the pelvic viscera may be the\\nactive cause of rosacea. Again, cutaneous lesions maj^ be\\ndue to internal changes which have in turn arisen from\\nexternal causes as, for example, the cutaneous manifes-\\ntations of syphilis, which are due to an internal dyscrasia\\nproduced by the entrance into the body of a certain form", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0065.jp2"}, "66": {"fulltext": "62 SKIN DISEASES.\\nof morbific matter from without. Leprosy may be placed\\nin the same. category.\\nStill another internal cause of cutaneous lesions will be\\nfound in that condition of ill nutrition or imperfect as-\\nsimilation known as scrofula or stru77ia.\\nFinally, we may have external lesions resulting from\\nthe accumulation in the blood of certain materies morbi.\\nMost of the so-called medicinal rashes are due to this.\\nOr, again, we may see the materies morbi generated\\nwithin the body itself through imperfections in the diges-\\ntive, assimilative, or excretory functions As a matter of\\nfact, I believe that fully one-third of the cases of cutane-\\nous disease which come under the physician s eye are due\\nto this last-named cause. If this be true, a somewhat\\nbrief consideration of this topic will not be out of place\\nat this point.\\nIn order that nutrition may be healthily carried on in\\nany part, there must be (i) a proper state of the blood;\\n(2) a proper condition and behavior of the tissues to be\\nnourished; and (3) a right exercise of the controlling in-\\nfluence exerted by the nerves. And these three must\\nwork harmoniously together. Deviations from health may\\noriginate consequently from a flaw in any one of the three\\nconditions above named. The theoretical origin, there-\\nfore, of diseased changes in the skin may be specially in\\nthe blood, as we see in zymotic affections, and here the\\nskin affection is only symptomatic or a part of a more\\ngeneral disease; in the tissues themselves, as seen in the\\ncase of warts, cancer, keloid, psoriasis; or in the nerves,\\nas in pruritus, and, it is thought and now generally taught,\\nherpes, pemphigus, and urticaria. If the exact origin of\\ndisease be not as stated, the parts of the system chiefly\\nconcerned in the production of diseased conditions may\\nbe emphatically in one case the blood, in a second the", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0066.jp2"}, "67": {"fulltext": "I ETIOLOGY. 63\\nj\\nI tissues, and in a third the nerves. But of course, inas-\\nI much as the ordinary action of these three agencies is\\ni bound up and related in the closest manner in health, the\\nmisbehavior in disease of one affects, secondarily, the\\nproper action of others of the three agencies concerned\\nin healthy nutrition. So that all are more or less involved\\nI in disease when fully developed, but primarily one or the\\nI other is mainly concerned in it.\\nNow there is much readiness to ascribe disease to\\nchanges in the blood, but not to sufficiently recognize the\\ninfluence of perversions in the inherent cell-life of the\\ni skin structures, nor the controlling supervision of the\\nnerves in the generation of cutaneous disease. Cancer\\nis an example of disordered tissue-life.\\nIt is more than probable that the origin of some dis-\\neases of the skin may really be in the central nervous\\nsystem, and the cutaneous trouble is the effect of a\\ngeneral disturbance of the nervous system; or in the\\nnerves themselves that run to the affected part; at any\\nrate the nerves are mainl}^ concerned, or they may consti-\\ntute the agency by which the morbid changes in the skin\\nare produced.\\ni| Some of the causes that produce altered states of the\\nblood-current, are:\\nI I Poisons of acute specific diseases\u00e2\u0080\u0094 for example, those\\n1 of small-pox, etc\\n2. The circulation of special poisons, be they animal\u00e2\u0080\u0094\\nj syphilitic; medicinal substances arsenic, etc. or dietetic,\\nj such as shell-fish, giving rise to urticaria, roseola, ery-\\nthema.\\n3. Dietetic errors, as in wine-drinkers, high-livers,\\nnon- vegetarians, etc., leading to the increase of urea and\\nI uric acid in the blood.\\nI 4. The tuberculous, scrofulous, and lymphatic dys-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0067.jp2"}, "68": {"fulltext": "64 SKIN DISEASES.\\ncrasise, giving rise to non-specific eruption impetigo,\\nacne.\\n5. The gouty and rheumatic diatheses, as in lichen\\nagrius.\\n6. Altered and lowered nutrition from such causes as\\nbad living, povert}^, misery.\\n7. The accumulation of excreta in the blood from non-\\nexcretion, suppression of natural discharges, kidney dis-\\nease, etc.\\n8. Convalescence from severe and lowering diseases by\\nwhich the body is rendered much less able to resist\\ndisease.\\n9. Climacteric, or endemic influences, often malarial in\\nnature, which act by deteriorating the system generally.\\n10. Disorders of the liver and spleen leading to pig-\\nmentary deposits in various parts, jaundice, and pruritus,\\netc.\\nlyocal irritants frequently lead to alterations of tissue,\\nand rank here with burns, scalds, parasites, the occupa-\\ntions of bricklayers, masons, and washerwomen, etc., as\\ncauses of local mischief.\\nDyers, and those who handle cheap clothing, frequently\\nsuffer from erythema due to the irritant action of dyes.\\nCertain tissue peculiarities may be inherited. The\\nfather may transmit dispositions in tissues to behave in\\nparticular ways directly to the child, as a local peculiarity,\\nindependent of any blood state, and in this sense psori-\\nasis, cancer, ichthyosis, may be hereditary.\\nThere are two sources of local irritation that deserve\\nspecial notice. I refer to the use of flannel w^orn next\\nthe skin, and scratching. Some skins are so irritable in\\nhealth as to be excited to an unbearable degree by the\\nuse of flannel. In a very large number of cases of skin\\ndisease pruritus is in this way intensified and the disease", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0068.jp2"}, "69": {"fulltext": "ETIOLOGY. 65\\neven protracted, and in proportion to the degree of un-\\ncleanliness. Flannel acts, as a mechanical irritant, by\\naugmenting the loral heat, and intensifying reflex action.\\nScratching plays an important part in the modification\\nof skin diseases, most of which are accompanied by itch-\\ning. To relieve itching scratching is the most natural\\nthing to do. What does it do? i. When there is no\\neruption it may produce one. 2. It augments and modi-\\nfies existing eruptions. 3. When the disease is non-\\ncontagious, secretion, in scratching, may be transfered\\nfrom place to place; and if acrid, set up local inflamma-\\ntion; and when cantagious, scratching is the surest\\nmethod of inoculation, as in the case of contagious im-\\npetigo. Children in this wa}^ transplant the disease from\\nthe head to various parts of the body. Mothers, beyond\\na doubt, get the disease about their hands from contact\\nwith children.\\nUpon the nature of the cause depends the cojitagious\\nor no7i- contagious qualit}^ of any disease. It is generally\\nconceded that parasitic and the acute specific diseases are\\ncontagious.\\nSex has some influence as a cause of disease; males\\nsuffer by preference from sycosis, pemphigus, psoriasis,\\neczema, and epithelioma; and females from acne, kelis,\\nand lupus especiall3\\\\\\nIn our own clime race would seem to exert an influence\\nupon lesions of the skin. Dr. Morrison, of this city, has\\npreserved histories of five hundred cases of skin diseases\\nin negroes, and forms the following conclusions:\\nAcne and lesions due to pediculi and insect-bites are\\nuncommon. Mosquitoes, the cimex lectularius, and in-\\nsects in general, do not produce the same ill effects\\n(My own observation, which has been quite extensive,\\nwould lead me to disagree with the doctor in regard to", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0069.jp2"}, "70": {"fulltext": "66 SKIN DISEASES.\\nthe pediculi. They are very apt to have lesions from this\\ncause). Ainhum is peculiar to the race, two cases hav-\\ning been seen; one man had lost one little toe, and that\\nof the opposite foot was affected.\\nChancre is more indurated, and more frequently com-\\nplicated with phimosis.\\nChloasma appeared to show a lessening of pigment, in-\\nstead of an increase. (Dr. Heitzmann takes issue with\\nDr. Morrison on this subject, and asks how can a diminu-\\ntion of the normal pigment be termed chloasma, an in-\\ncreased pigmentation being usually understood by that\\nname.)\\nChilblain is common.\\nElephantiasis Arabum mostly follows syphilis.\\nErythema multiforme is difficult to diagnose, as are all\\nerythematous conditions.\\nEczema appears to be more amenable to treatment; 129\\ncases are recorded.\\nFavus and pediculi capitis are rare. (The latter is\\ncommon. D.)\\nKeloid appears common, especially false keloid after\\ninjuries. It is seen following variola and zoster, and after\\npiercing the ears.\\nLupus is seldom encountered.\\nLymphadenitis is quite common.\\nPruritus is much complained of, and it is said that\\nsyphilitic lesions itch in this race.\\nScabies was rarely seen. (I have seen several cases.)\\nSyphilis is abundant.\\nScaly and pustular lesions are often seen.\\nUrticaria wheals do not seem to be so elevated, but\\nvery itchy.\\nDr. Atkinson reported a pustular folliculitis very fre-\\nquent in young, closely-shaven negroes. The pustules", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0070.jp2"}, "71": {"fulltext": "ETIOLOGY. 67\\npenetrate into the follicles of the beard without producing\\nthat degree of irritation which is to be called sycosis. He\\nthinks that fifty per cent, of the young negroes who shave\\nvery close have it.\\nHe has noticed that it is common to find deep and per-\\nmanent pigmentation after the application of a mustard\\nplaster. (I have often noticed the same condition.)\\nInvolution occurs after a time in keloidal tumors; they\\nbecome flaccid, and, after some years, soft.\\nPediculosis appeared to him to be as frequent in colored\\nas in white children.\\nAcute exanthemata produce, upon desquamating, a\\npeppered appearance, looking as though the skin were\\ndusty or sprinkled with fine powder. In scarlatina it is\\ndue to the sHght elevation of the papules, which is not\\nevident in Caucasians.\\nWhatever be the causes of the various cutaneous affec-\\ntions, we are chiefly concerned with the means that the\\nphysician has at his command with wdiich to treat them\\nsuccessfull5^ First of these is hygiene. It goes without\\nsaying that recovery is facilitated by the substituting\\nof good hygienic surroundings for bad ones; and under\\nthis head we may include fresh air, wholesome food,\\ncleanliness, exercise, and seasonable clothing. It is\\nhardly necessary to go into details on these points, if the\\nfact is recognized and remembered; and in all chronic\\naffections of the skin, and in some of the acute ones, these\\nmatters should be inquired into, and corrected when pos-\\nsible. Our resources further include mechanical, chemi-\\ncal, and pharmaceutical remedies, and also electricity.\\nAn elastic bandage applied to an old, infiltrated eczema\\nof the leg is an illustration of the first; an active caustic\\napplied to an obstinate ulcer ma}- be considered as an ex-\\nample of the second; but by far the largest proportion of", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0071.jp2"}, "72": {"fulltext": "68 SKIN DISEASES.\\nremedial agents will be found in the pharmaceutical di-\\nvision. This class embraces remedies used both internally\\nand externally. The homoeopathic materia medica is\\nrich in remedies having a direct and specific action upon\\nthe skin. And the fact that we always prescribed for the\\ntotality of symptoms manifested in our patient, laying\\nstress upon the affection as shown in the skin only as a\\nsymptom of the diseased condition, often leads us to pre-\\nscribe, with the happiest results, a remedy not ordinarily\\nclassed among the skin remedies. Great improvements\\nhave been made by both schools, in the last few years, in\\nthe external applications. Formerly lotions and oint-\\nments were almost the only means of making external\\napplications, but within recent years we have learned the\\nvalue of collodion, of solutions of gutta-percha {trau-\\nmaticlri), mixtures of gelatin with glycerin, starch, etc.,\\nplasters and other bland compounds and mixtures, as ex-\\ncipients for the drugs that we desire to bring into direct\\ncontact with the diseased parts.\\nElectricity, also, as a destructive agent (^electrolysis) or\\nas a modifier of local nutrition, or as an excitant of reflex\\naction, plays a by no means humble part in the treatment\\nof these diseases.\\nIf physicians would give as much thought and care to\\nthe study of these affections as they do to others, not only\\nwould our armamentarium be enriched and purified, but\\nour successes would be greater and failures less. They\\nshould not be content with the mere diagnosis and nam-\\ning of the disease, but should study the peculiarities of\\neach case, and the influence exerted by the general health\\nor condition of the patient on the special lesions in ques-\\ntion.\\nWhen treating of the several lesions, therapeutically,\\nit shall be my endeavor to give the best that is recom-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0072.jp2"}, "73": {"fulltext": "ETIOLOGY. 69\\nmended by both schools of medicine. We must bear\\nin mind that The physician s highest and only calling\\nis to restore health to the sick. The highest aim of\\nhealing is the speedy, gentle, and permanent restitution\\nof health, or alleviation and obliteration of disease in\\nits entire extent, in the shortest, most reliable, and safest\\nmanner, according to clearly intelligible reasons.\\nKeeping these aphorisms of our illustrious master ever\\nbefore us, we will proceed in the next chapter to take\\nup the different lesions of the skin, and study them with\\nthe best light we have at our command.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0073.jp2"}, "74": {"fulltext": "CHAPTER V.\\nLOCAL DERMAL INFLAMMATIONS,\\nUnder the head of local dermal inflammations we in-\\nclude those diseases which partake essentially of the\\nnature of local diseases, and are characterized by inflam-\\nmation, as the primary and the essential phenomenon.\\nBy inflammation we understand not merely hypersemia,\\nwith engorgements of the affected parts by blood, so that\\nthe parts are swollen and red and hot, not only hypersemia,\\nwith stasis in the vessels and serous effusion in addition;\\nbut also an increased activity in the tissues themselves\\noutside the vessels, and the formation of new products,\\nor inflammatory exudation, to use a commonly em-\\nployed term. The character and source of these new\\nproducts are important items in this matter of inflamma-\\ntion. As regards the character of the new product, its\\ntypical features, and ultimate destination in marked cases\\nare those of pus. Pus, in fact, is the highest grade of\\ninflammatory products, but pus is not necessarily formed,\\nand it is held that the new products may give rise to the\\nproduction of a tissue-like connective tissue. Pus is de-\\nrived from two sources namely, from white blood cells,\\nand also from connective-tissue corpuscles. There are\\nthree leading changes observed in inflammatory exuda-\\ntion resolution^ organization, and suppuration.\\nThe local inflammations we are about to consider are\\ngenerally characterized by hypersemia and the presence", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0074.jp2"}, "75": {"fulltext": "LOCAL DERMAL INFLAMMATIONS. 71\\nof inflammatory infiltration. They are the erythemata;\\neczema, or catarrhal inflammation; that form which com-\\nmences as a serous catarrh of the papillary layer, and is\\nfollowed by the outpouring of sero-purulent discharge, as\\nin catarrh of the mucous membrane; plastic or papular\\ninflammation, in which the inflammation is characterized\\nas much b}^ the absence of serous as by the deposit of\\nfibrinous exudation; suppurative inflammation; and lastly,\\nhyperaemia, accompanied by excessive formation of epi-\\nthelial and certain cell growths in the papillary layer, con-\\nveniently termed squamous inflammation, as in psoriasis.\\nTwo of these groups or classes might be separated\\nfrom inflammation perhaps, and dealt with as hyper-\\naemias solel^^ and these are the first and the last of the\\nabove named. In the former there is h3 peraemia and\\nserous exudation, as in erythema; but what is the im-\\nportant thing to notice in relation to the point under dis-\\ncussion, there is no cell proliferation or cell infiltration in\\nthe tissues. If the hyperaemia is persistent then there\\nfoUow^s in due course hypertrophy. To avoid, however,\\nmaking another group in classification I have grouped\\nthe erythematous diseases under the head of local infiam-\\nmations. With regard to squamous inflammation,\\nthere is here only h3^persemia and hyperplasia or hj-per-\\ntrophy, and no actual inflammatory infiltration. Psoriasis,\\nthe type of the class, is on the borderland only of inflam-\\nmation; but we will group it under inflammations for the\\npresent at all events.\\nThe reader will very naturally want to be told wherein\\nlies the difference between hypertrophy and h3 perplasia\\nfollowing hyperaemia, on the one hand; and the changes\\nthat occur in the skin in zjanotic diseases, and those that\\nare observed in lupus, syphilis, and leprosy on the other\\nhand; and what are the differences that lead derma-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0075.jp2"}, "76": {"fulltext": "72 SKIN DISEASES.\\ntologists to make the special class of diseases to be dealt\\nwith in this chapter. In the first place, with regard to\\nthe local changes in the zymotic diseases as small-pox\\nand typhoid these are only parts of a general malady,\\nand could not be regarded in a group characterized essen-\\ntially by peculiarities of local change. From an etiologi-\\ncal point of view it would be impossible to do so. Then,\\nin regard to lupus, syphilis, etc., there are certain anatom-\\nical characters and behaviors about the growths, which,\\nno less than peculiar concomitants of associated constitu-\\ntional states and the like, that mark them as belonging to\\na special class of neoplasmata or heterologous new forma-\\ntions. In regard to the distinction to be drawn between\\nhyperplasia consequent on inflammation, and hyper-\\ntrophy, the latter is much slower, even if the etiology be\\nleft out of view; there is in the one the escaped blood\\ncells developing into the new tissue, and in the other the\\nincreased supply of blood and transuded serosity. But\\nthe two have certain analogies, and it is difiicult if not\\nimpossible to draw a line between hypertrophy and in-\\nflammation. But further, it may be said and this ap-\\nplies to tumors and special neoplasms, as lupus and\\nsyphilis whilst the inflammatory infiltration is caused by\\nsome irritant, the tumor or heteroplastic neoplasm arises\\nspontaneously, or from a specific cause acting generally\\nand modifying nutrition. There is with inflammation the\\naccompanying heat, redness, pain, and swelling, and\\nthese signs acutely developed; there is less tendency\\nto spontaneous cure with tumors; and lastly, the inflam-\\nmatory exudations directly tend to the formation of pus.\\nErythematous Diseases.\\nThe diseases which rank under this head as having\\nsimply erythema as their primary and only feature are ex-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0076.jp2"}, "77": {"fulltext": "ERYTHEMA. 73\\nceedingly simple and well defined. They are three: ery-\\nthema, roseola, and urticaria. These erythemata are\\ncharacterized mainly by the occurrence of active hyper-\\naemia of the longitudinal plexus of the skin (erythema),\\nand its immediate consequences for example, serous\\neffusion nothing more. In erythematous diseases the\\nredness may be rosy (roseola), or bright red (erythema\\nurticaria); in urticaria wheals are present. The\\nerythema in these diseases is removable by pressure.\\nUnlike the more common eruptive diseases of the skin,\\nthe erythemata exhibit the closest connection between\\nlocal and constitutional phenomena. Febrile symptoms\\nantecede and are relieved by the development of the\\nerythema in the exanthemata, showing that the local skin\\nchanges are secondary, and onl}^ parts of a general dis-\\nturbance which is primar3^ I shall include under this\\nhead sections on follicular hyperaemia, pellagra, and cer-\\ntain medicinal rashes.\\nErythema.\\nThe term erythema^ used by itself, is the name of a\\nsymptom, not of a disease, and may be applied to any\\nreddened or congested surface not accompanied with ele-\\nvation, and may be produced by a variety of causes.\\nThere are, however, two well-marked affections, erytheyna\\nmultiforme and erythema nodosum, which are distinct\\nmorbid entities, and deserve careful consideration.\\nErythema Multiforme.\\nThe eruption of erythema multiforme is a diffused\\npatch of redness over which circumscribed elevations,\\nalso red, are scattered. These elevations may be few or\\nplentiful, and may be from an eighth to three-quarters of\\nan inch in diameter. The small ones, according to size,\\n6", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0077.jp2"}, "78": {"fulltext": "74 SKIN DISEASES.\\nmay be called papules or tubercles, while the larger ones,\\nwhich are always flattened, may assume the appearance\\nof an elevated ring, around which a second or a third\\nring may develop. On the flattened tubercles, of medium\\nsize, vesicles are sometimes met with, and hemorrhagic\\neffusions may also occur within them.\\nThese lesions rarely persist for more than a few days,\\nor at most a week or so, at the end of which time they\\ngradually subside and disappear, leaving after them slight\\nstains, which last a few days longer. After the disap-\\npearance of the first eruption, or even while it is still in\\nfull bloom, a second crop of lesions may come out, and\\nafter these a third, prolonging the trouble in this way for\\nseveral weeks and even months. Two or more of the\\nlesions mentioned may coexist, and the eruption may ap-\\npear on any part of the surface, but as a rule it prefers\\nthe extremities. Slight febrile action may precede the de-\\nvelopment of the eruption, but it soon disappears, and\\nthere is rarely any accompaniment other than slight itch-\\ning. The causes of erythema multiforme are obscure: oc-\\ncasionall}^ it appears due to errors of diet, and sometimes\\nalso to uterine disorder. The prognosis is favorable, so far\\nas any trouble may result from the eruption; but when it\\nis prolonged for weeks, as is sometimes the case, it proves\\nvery annoying. It attacks by preference the backs of the\\nhands and feet, the arms, the legs, and the forehead. It\\nis mostly an affection of children and young people. It\\nattacks females more than males, and prevails in the\\nspring and fall. Individuals who are troubled with it\\none year are apt to have it again at the same time in suc-\\nceeding years. When occurring on the fingers it closely\\nresembles chilblains. It may be commonly known by its\\nsuperficial and protean character, and its symmetrical\\ndistribution.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0078.jp2"}, "79": {"fulltext": "ERYTHEMA NODOSUM. 75\\nErythema Nodosum.\\nThis is a much more important but also rarer affection\\nthan the preceding one. The disease is characterized by\\nthe eruption of reddish tumors, from the size of a bean to\\nthat of a small egg, and usually situated upon the lower\\nextremities, between the knee and ankle. For a day or\\ntwo the depth of color increases, then becomes somewhat\\npurplish, and with the black-and-blue appearance\\nwhich accompanies hemorrhagic effusions, and finally\\npasses into the stage of green and yellow, like an ordinary\\nbruise. A week or ten da3^s ma}^ be occupied by these\\nprocesses; and, as the color changes, diminution of size\\ntakes place, and in about two weeks complete resolution\\nis effected. Suppuration very rarely occurs. The num-\\nber of the nodes is usually limited to three or four, but\\nmay reach nine or ten, and may appear on the thighs and\\nupper extremities as well as the parts already named.\\nThe swellings are usually a little painful for the first day\\nor two, but not afterward. Relapses may prolong the\\ndisease for several months. Occasionally the eruption is\\nushered in by febrile action, but not in all cases. It usu-\\nally occurs in 3^oung females, and is not unfrequently\\naccompanied by menstrual derangement. In many cases,\\nhowever, the eruption is preceded by or complicated with\\narthritic pains. This has led many writers to believe\\nthe affection to be more or less closely connected with\\nrheumatism.\\nThe disease is self-limited, requiring no special treat-\\nment other than sedative applications to the affected\\nparts.\\nIn erythema multiforme the allopaths claim that Un-\\nless the cause of the affection be discovered, little need", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0079.jp2"}, "80": {"fulltext": "76 SKIN DISEASES.\\nor can be done in the way of treatment, and the affection\\nmay be left to run its course, which it will usually do in\\ntwo or three weeks, and may not return until the follow-\\ning season, for in some persons this disease appears to\\naffect a predilection for the spring and autumn months,\\nreturning annually at one or the other of these seasons.\\nTreatment. When there is much itching and burn-\\ning either a carbolic acid or veratrum viride lotion may be\\nused. When the opposing surfaces are much inflamed\\nthey may be protected by dusting with buckwheat\\npowder, or equal parts of starch and zinc oxide. Espe-\\ncial attention should be paid to cleanliness, and all irri-\\ntants should be removed. Poultices are apt to do more\\nharm than good, and better be avoided. Particular at-\\ntention must be paid to the diet; such food as corn-flour,\\nmaizena, and the like must be forbidden, and proper\\nnutritive substitutes be given to children in conjunction\\nwith a suitable quantity of milk.\\nIn the erythemata dependent upon general causes you\\nmust always remember the effect of ingesta; that a gouty\\nor rheumatic habit, disordered menstrual function, denti-\\ntion, delicacy of skin, or lymphatic temperament, are\\npresent in greater or less degree. It is important to allow\\nthe patient the use of an unstimulating diet only, to for-\\nbid him spirits, wine, and beer, to clear out the bowels,\\nand in the early stage to adopt a soothing regime, with\\ntepid sponging and emollient baths.\\nBed-sores are best treated by attempting to harden\\nthe skin in the early stage by spirit applications, removing\\npressure as much as possible at later stages by pads,\\ncushions, and water-beds, and by using charcoal poultices\\nor soap plaster spread on soft leather to the sores. For\\nchilblains, equal parts of turpentine and tincture of", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0080.jp2"}, "81": {"fulltext": "ERYTHEMA NODOSUM. 77\\nAconite, and soap liniment, together with the indicated\\nremedy, constitute the best treatment.\\nThe internal remedies for erythema are:\\nAconite. Erythema excited by the action of the sun s\\nrays.\\ny^thusa. Appearance and disappearance of reddish-\\nblue spots on the trunk and left leg. General malaise.\\nAila7ithus. Irregular spots of capillary congestion.\\nDark almost livid eruption on the forehead.\\nArsenicum iodide. Erythema, especially of the face.\\nBelladonna. Inflamed red patches, /rr^^zz/ar/y-shaped\\nscarlet spots over the body. More on face and upper part\\nof body.\\nBerberis. Mottled spots as after a bruise on the right\\nshoulder, left humerus, back of the hand and wrist.\\nBryonia. Red round hot spots on the malar bone, as\\nlarge as peas.\\nCadmium sulph. Red spots on the extremities.\\nChelidonium niaj. Round red spots, size of a half\\ndollar, accompanied with burning pain, on anterior surface\\nof the forearms and face, disappearing in a few hours.\\nChloral hydrate. Bright red or bluish erythema over\\nthe whole body, permanent under pressure, mottled with\\nlivid patches and deep red spots. Pruritus of the whole\\nskin.\\nCrocus sat. Circumscribed red spots on the face, which\\nburn.\\nCo7idurango. Erythematous blotches on the face and\\narms.\\nGelsemiuvi. Papulous eruption on the face resembling\\nmeasles.\\nGossypium. Round little spots with pale red circles\\naround the knee caps and over the shin bones, w^hich\\nitch very much.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0081.jp2"}, "82": {"fulltext": "78 SKIN DISEASES.\\nLactic acid. Several bright red blotches on the an-\\nterior surface of the leg, with slight burning and no itch-\\ning. Relieved by cold. Eruption brightest at 8 A. m.\\nLaurocerasus. Erythematous patches, terminating in\\ndark red purple spots.\\nMercurius sol. Eight red patches on the forearm and\\ninner side of the thighs. Itching changed to burning\\nby scratching.\\nMezereum. Erythema on the legs in old people.\\nNux vom. Pimples on the face with itching, burning\\nafter drinking wine or alcoholic liquors.\\nPhytolacca. Painful erythematous blotches of a pale\\nred color.\\nPulsatilla nut. Erythema of the scalp. Dark blue or\\nred eruption on the legs and ankles.\\nRhus tax. Ridges on the lower limbs.\\nSabadilla. Red streaks on the arms. Worse from\\ncold.\\nUstilago. Fine eruption of a deep red color, about the\\nsize of a pin s head, appearing on any part of the body\\nafter scratching. On the neck it takes a circular form.\\nMr. M., a very large and fleshy man of exceedingly\\ngood habits and with no history of specidc trouble,\\npresented himself for a long standing and obstinate ery-\\nthema. The case had been prescribed for under nearly\\nevery conceivable diagnosis, the majority of physicians\\nclaiming it was due to syphilis. During a fishing expe-\\ndition, some years ago, he thought he had been poisoned\\nwhile in bathing, and since that time he has been exceed-\\ningly troubled with this persistent local inflammation.\\nHis unusual flesh had been a constant irritant, and being\\nobliged to work for his living he had almost despaired of\\nrecovery.\\nIn the folds of his right groin and extending back be-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0082.jp2"}, "83": {"fulltext": "ROSEOLA. 79\\ntween the nates an immense phlegmonous surface was\\nvisible. So long had it existed that fissures and ulcera-\\ntions, and excessive secretions of sweat and pus had com-\\nplicated what might have been a short enduring, and\\nsimple sore. A rash, like measles, extended over the\\nsurrounding healthy skin. Extreme local itching and\\ngeneral aching pains made him exceedingly restless.\\nThese symptoms were always worse after midnight and\\nduring wet or cold weather.\\nWith these indications he was given Rhus tox. 30 four\\ntimes daily for a week. He was directed to use a local\\nwash of warm water and lanoline soap, being careful to\\nwipe the parts to perfect dryness. He was then to use a\\ndusting powder of aristol and wear an abdominal sup-\\nporter to relieve any chafing. In four weeks he was\\nentirely well.\\nRoseola.\\nIt is important to know this disease not so much be-\\ncause it gives rise to any anxiety or trouble, as that it is\\nlikely to be confounded with measles and scarlet fever.\\nRoseola is not generally considered to be a contagious\\ndisease, but rather occurs in an epidemic form. The\\neruption is preceded by some febrile symptoms; the rash\\nis not much raised above the level of the surrounding\\npart, and is of a rose color. It is in fact an erythema of\\na rosy hue. The eruption is patchy, and its color\\ndeepens somewhat as the disease advances. It is accom-\\npanied by slight itching and sensation of heat. Before\\nthe eruption makes its appearance, and during the slight\\nfebrile symptoms, a slight redness of the mucous surfaces\\nof the palate and fauces will be noticed on inspection of\\nthese parts. When not epidemic, roseola seems to de-\\npend chiefly upon derangements of the digestive appara-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0083.jp2"}, "84": {"fulltext": "80 SKIN DISEASES.\\ntus as a producing cause, though it may likewise be due to\\nsudden changes of temperature, violent exercise, taking\\ncold drinks while the body is warm and perspiring, etc.\\nThe eruption may appear suddenly during the night,\\nand cover the entire body with its rose-colored patches,\\nsituated closely together, yet distinct.\\nRoseola is divided into two groups. Idiopathic and\\nSymptomatic. In the latter group the roseola occurs as\\nan accidental phenomenon in the course of acute diseases,\\nand hence is called symptomatic; in the other group it\\nexists as the sole and primary disease.\\nIdiopathic Group. Roseola infajitilis is the name given\\nto roseola when it is seen in infants. It roughly re-\\nsembles measles minus the catarrh; it runs an ir-\\nregular course as regards precursory symptoms, which\\nvary in degree, and in the extent, degree, and seat of\\neruption. It may be quite general but patchy, or it may\\nbe limited to the arm, or the neck, or trunk; the rose-\\nblushes often come and go for several days capriciously,\\nand are accompanied by local heat and itching, which are\\noften marked at night. No catarrhal symptoms, as in\\nmeasles, are present. The redness generally lasts a\\ndozen or more hours.\\nWhen the disease assumes the form of rings (and this\\nis generally observed about the buttocks, thighs, and\\nabdomen), developed from little rose spots, and enclosing\\npresently a healthy circle of skin an inch or so in diame-\\nter, the variety R. annulata is present. The concomi-\\ntant symptoms are the same as those of the common form.\\nIt is not necessary to make all the varieties of roseola\\nthat are made by some authors.\\nThe Symptomatic Group contains roseolas which are\\nmerely rosy erythmata developed in the course of acute\\ndiseases, generally appearing about the arms, breast, and", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0084.jp2"}, "85": {"fulltext": "ROSEOLA. 81\\nface, thence spreading over the body. R. vaccijiia co-\\nexists with the formation of the vaccine vesicle, and is\\naccompanied by slight fever. It commences around and\\nabout the seat of the vaccination. In cases of fevers,\\nabout the tenth day or so, and indeed whenever the\\nweather is very warm, the perspiration is apt to distend\\nthe sweat glands, which become more or less hypersemic,\\nso that little vesicles form, for example, miliaria and\\nsudamina. Sometimes red blushes accompany this par-\\nticular kind of vesicular eruption, and to these rosy\\nblushes the name R. miliaris has been given.\\nAfter surgical operations a rash like scarlet fever very\\nfrequently occurs; its color varies somewhat; it is not\\ncontagious, and is without the general symptoms, the\\nthroat complication, hot skin, quick pulse, and tongue of\\nscarlet fever. It is due, doubtless, to some volatile\\npoison free in the blood. It has no gravity.\\nThe Prognosis offers no point of gravity or interest.\\nThe Diagnosis. Roseola is likely to be confounded\\nwith rubeola, scarlatina, urticaria, erythema. It is\\nknown from measles, in that it possesses no catarrhal\\nsymptoms; in that there is no relation between the febrile\\nsymptoms and the amount of eruption; in that there is\\nno epidemic influence at work in its production; in that it\\nis irregular in its distribution, non-crescentric, not uni-\\nform, not dark-colored; but irregular, rosy, and often\\ncommencing in other parts than the face. Rubeola has a\\nregular course, and is not partial in regard to the distri-\\nbution of its accompanying eruption.\\nIt makes very little difference if roseola be confounded\\nwith erythema, for the one is a red, the other is a rosy\\nerythema.\\nIn Scarlatina, the general aspect of the disease is\\ngrave; the fever is marked, the throat is bad, the tongue", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0085.jp2"}, "86": {"fulltext": "82 SKIN DISEASES.\\nis peculiar; the skin harsh, dry; the rash general, puncti-\\nform, boiled-lobster like. The progress is more uniform,\\nand the disease can be traced to contagious or epidemic\\ninfluence.\\nIn Urticaria, the diagnosis is at once settled by the\\ndiscovery or production of a wheal, and the peculiar\\nstinging character of the local irritation, with the capri-\\ncious character of the eruption.\\nTreatment. The benign and self-limiting nature of\\nthe disease leaves but little need for work under this\\nhead. The old-school advise giving salines, aperients,\\nlaxatives, etc and treating any vSpecial symptoms. lyO-\\ncally, in removing all causes of irritation for example,\\nirritated and tender gums, by lancing; acidity of stomach,\\nby magnesia, soda, or lime-water; intestinal irritation,\\nby alteratives, such as rhubarb, and subsequently\\ntonics, keeping up the warmth of the surface, and if pos-\\nsible, bringing on perspiration. The surface should not be\\nchilled. The patient should be kept within doors for a\\nfew days, and have a warm bath at bed-time, followed\\nby cutaneous frictions with oil; the diet should be light\\nand non-stimulating.\\nBelladonna is the principal internal remedy. Ferrum\\nphos. is highly recommended by some physicians. Large\\ndoses of antipyrine produce an erythematous eruption\\nwhich is cinnabar-red in color, slightly elevated, and\\nconsists of rounded spots, disappearing under pressure.\\nAt the knees and elbows are found great red patches,\\nchiefly on the extensor surface. The head, palmar and\\nplantar surfaces are not affected.\\nUrticaria.\\nUrticaria is aa affection of the skin characterized by\\nthe development of white or reddish elevations termed", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0086.jp2"}, "87": {"fulltext": "URTICARIA. 83\\nwheals, which are accompanied with more or less pruritus.\\nThese wheals may be few and localized, or, more fre-\\nquently, they exist in considerable number, and are gen-\\neralized.\\nNot infrequently a little heat and itching first appear;\\nand, if the part be rubbed or scratched, the wheals be-\\ncome manifest. The elevations ma}^ last for a few min-\\nutes only or for a few hours, and disappear, leaving no\\ntrace behind. Later in the day, or perhaps the next day,\\na renewal of the eruption occurs, and these may be re-\\npeated for a few days or persist for months, constituting\\na chronic urticaria.\\nThe degree of pruritus varies; it may be hardly more\\nthan an agreeable sensation, or may be sufficiently severe\\nto constitute a veritable torture. The scratching will,\\nof course, be commensurate with the itching, and lead to\\nmore or less excoriation and even deep wounding of the\\nskin.\\nThe wheals are chiefly met with on the covered por-\\ntions of the body, and their appearance is favored by\\nwarmth frequently disappearing if the parts be exposed\\nto a draught of cold air. Thus it not infrequently hap-\\npens that a patient may have a severe attack at home,\\nbut, by the time he reaches the physician, all signs of\\nthe eruption will have disappeared, or perhaps there will\\nbe nothing visible on the skin except a few insignificant\\nscratch marks. In these cases, if the finger nail or the\\npoint of a pencil be sharply drawn across the skin, it\\nwill be followed by a white line, which in a few moments\\nbecomes elevated and red, and lasts for a brief period,\\nand then disappears.\\nUrticaria presents certain peculiarities according as it\\noccurs in the adult and the child, owing, in the latter, to\\nthe greater sensitiveness of the skin, and the tendency to", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0087.jp2"}, "88": {"fulltext": "84 SKIN DISEASES.\\nthe deposition of lymph in the site of the wheals. Some\\nauthors treat of urticaria in the adult and in the child.\\nI think this is entirely unnecessary and apt to lead to\\nconfusion.\\nThe chronic forms may result from the acute, or de-\\nvelop out of a state of tolerable health, and without ap-\\nparent cause. There is little pyrexia present in chronic\\nurticaria. When the crops of wheals are of pretty long\\ncontinuance, the disease is called U. perstans In other\\ncases the wheals are small and very fugitive; but the\\nskin is irritable, and the itching intense. This is U.\\nevanida. The name oi factitious urticaria has been given\\nto that form of the disease which is easily produced by\\nmechanical irritation, and is not idiopathic.\\nIt occasionally happens that in the formation of wheals,\\ninstead of serum being poured out, a certain amount of\\nhemorrhage occurs. This effusion of blood in con-\\nnection with the escape of serosity from the vessels is\\nnot confined to urticaria, but may take place under cer-\\ntain circumstances in connection with almost every skin\\naffection which is hypersemic and inflammatory. When\\nthe effusion is conjoined with the development of wheals,\\nthe blood generally raises the cuticle somewhat, and pro-\\nduces what is called purpura urtica7is. The cuticle some-\\ntimes bursts, and exposes a reddened surface that does\\nnot heal, and whence a certain amount of bloody fluid\\nmay ooze for a while. The name of Urticaria hemorrhagica\\nhas been given to this latter disease, and it includes the\\nso-called purpura urticans. The hemorrhage, however,\\nis a mere epiphenomenon, though it indicates a purpuric\\ntendency. These little hemorrhagic wheals are some-\\ntimes seen about the neck and face of nervous women\\nand elderly men out of health.\\nEtiology. In a person predisposed to this affection", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0090.jp2"}, "89": {"fulltext": "URTICARIA. 85\\nalmost any external irritation may cause an outbreak; and\\nan exactlj similar eruption may be provoked in some by\\ncontact with certain poisonous plants, as the common\\nnettle. More frequently, however, the eruption is of in-\\nternal origin, and is but the reflection of pre-existing\\nirritation of the gastro-intestinal or sexual organs. Cer-\\ntain articles of diet as crabs, lobsters, various shell-fish,\\nand certain fruits as well as certain medicinal agents,\\nexcite a gastro-intestinal derangement, which is chiefly\\nmade manifest through the cutaneous disturbance.\\nUnder the first head, or local excitants, rank the\\nacarus, fleas, bugs, mosquitoes, lice, flannel, the contact\\nof numerous other irritants, such as jelly-fish.\\nPrognosis. There is no gravity attaching to urticaria.\\nAcute attacks ab ingestis are of short duration. Chronic\\nurticaria is very troublesome; the intermittent form is\\nalso very obstinate.\\nDiagnosis. Urticaria ought not to be confounded\\nwith any other disease. The sudden appearance of erup-\\ntion and its capricious character, the tingling sensation,\\nthe presence of wheals, gastric disturbance, and irrita-\\nbility of skin are absolutely diagnostic.\\nFrankworsky urges flagellation of the skin with nettles\\nas a very efficient remedy in anaesthesia, paralysis, and\\nneuralgia. He has witnessed good effects from the same\\nin locomotor ataxia. In asthma, dyspnoea, amenorrhoea,\\nvirile impotence, and rheumatic pains, it regulates the\\ndisordered functions. In favor of this procedure he cites\\nthe rapidity of its action, its innocuousness even after\\nprolonged use, and the total absence of all irritation of\\nthe kidneys arising from it. It leaves no scars, and gives\\nrise to no suppurating surfaces on the skin. The flagel-\\nlation may be either local or general and should be con-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0091.jp2"}, "90": {"fulltext": "86 SKIN DISEASES.\\ntinned until bullae form. Its action is stimulating and\\nrefreshing.\\nTreatment. The principal consideration in the treat-\\nment is the diet, which should be light, nutritious, and\\neasily digestible. To allay the itching the eruption may\\nbe frequently dusted with toasted rye or wheat flour, or\\nwhen the cuticle is not broken it may be washed with\\nbrandy and water, or salt and water. Warm vinegar and\\nwater lotions may be used to allay the itching and burn-\\ning. Chloroform, one-half drachm to the ounce of\\ncream, will frequently prove serviceable. Benzoic acid,\\ngrs. v-x, water gj. is spoken of favorably. A weak\\ncarbolic acid lotion at times acts well. The Turkish\\nbath may help when other means fail.\\nIn acute cases, especially those in w^hich it is clear that\\nthe trouble has arisen from irritant ingesta, the indica-\\ntions for treatment are clear, and should be promptly\\ncarried out. A good emetic, or a free purge, will clear\\nout the alimentary canal, and, thus removing the cause\\nof the irritation, bring the affection to a speedy close.\\nIn children, especially, the diet must be carefully regu-\\nlated. In chronic cases, especially w^hen caused by eat-\\ning shell-fish, study Arsenicum in cases of gastric origin,\\nconsult Kreosotum, Bovista and Pulsatilla; in children\\nwho are fond of eating salt, Natrum mur,; candy eaters\\nmay be benefited by Argentum 7iitricu7yi.\\nThe indications for the homoeopathic remedies are as\\nfollows:\\nAconite. \u00e2\u0080\u0094Red and broad vesicles with itching, and\\nfeverish symptoms. Urticaria febrillis. Great heat,\\nthirst, frequent pulse, malaise, sleeplessness; fear- or\\nfright.\\nAllium cepa. Nettle-rash on the thighs with stitches\\nand burnings. Acute catarrhal symptoms.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0092.jp2"}, "91": {"fulltext": "URTICARIA. 87\\nAnacardium. Nettle-rash from emotional causes. Dull\\npressure as from a plug in various parts. Weakness of\\nmemory.\\nA7itimon. cnid. White blotches with red areolae, vio-\\nlent burning and stinging. Blotches and vesicles, as from\\nstings of insects, on the face and joints, coming on with\\nitching and disappearing in a few hours. Thirst, nausea,\\nthick white coated tongue, gastric derangement.\\nAntimon. tart. White lumps with red areolae, which\\nitch; eruption comes and goes, makes him irritable, very\\nhot and thirst} worse after meals.\\nApis mel. Red and inflamed raised patches of hives,\\nwith stinging and burning. Aggr. by heat, amel. b}^ cold\\nwater. Itching and appearance of blotches after scratching.\\nStinging burning over the whole body, passing off after\\nsleeping soundly; sudden stinging sensation over the\\nwhole bod}^, with white and red spots in palm of hands,\\nor arms and feet, on head and nape of neck; uterine\\ncatarrh; urine scanty and high colored.\\nAr7iica. Itching wheals, relieved by scratching.\\nArsenicum alb. Itch-like eruption. Wheals of a\\nscarlet color on the face and neck, the size of a half-\\ndollar. Obstinate cases, intense burning. Itching better\\nfrom external heat; worse from cold or from scratching.\\nIrritabilit}^ of the stomach\\nAstacus Jitiv, In chronic cases when other remedies\\nfail. Cla}^ colored stools.\\nArum. Dirty, yellow blotches on calves and legs\\nwith burning. Better in a warm room. Melancholy. In\\nlight-haired, scofulous subjects.\\nA7itipyrin. Dr. Nicot reports in full four cases, all\\noccurring in young women who had since early childhood\\nbeen subject to attacks of urticaria, in which alkaline\\ntreatment had utterly failed to produce any relief. In", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0093.jp2"}, "92": {"fulltext": "88 SKIN DISEASES.\\none of these the eruption appeared periodically each day\\nand Dr. Nicot recommended the use of Ajitipyrin in seven\\nand a half grain doses two or three hours before the ex-\\npected period of eruption. After four days of this treat-\\nment the eruption disappeared entirely and did not\\nreturn. His other cases are somewhat similar to the\\nabove, with the exception that the periodic element was\\nnot so well marked. In very chronic cases the improve-\\nment was less marked than in recent cases, though even\\nthen the cure was progressive and continuous.\\nA lady, 24, suffered for many years with recurring at-\\ntacks of urticaria, from which she could obtain no relief.\\nAs an experiment she took Antipyri?i. One dose of five\\ngrains mitigated the discomfort at once and entirely dissi-\\npated the attack. These cures are in accordance with the\\nlaw of the similars, inasmuch as urticaria has been noted\\nafter the exhibition of this drug. Some observers have\\nnoted a thick crop of urticaria involving the skin that is\\nnot protected by the clothing. Others have discovered\\nswelling of the face and bod} A very common condi-\\ntion produced by the drug is erythema, scarlatina-like\\nredness, with itching and urticaria.\\nBelladonna. Bright scarlet red elevated puffy spots,\\nsurrounded by a white border. Parts sensitive to the\\ntouch. After eating cabbage or sour-krout.\\nBerberis. Blotches like nettle rash on the shoulder and\\nright arm, accompanied with burning and stinging. Mo-\\nmentary cold sensation on the parts. Heartburn with\\nsoap-sud taste in mouth.\\nBryonia. Nettle-rash with rheumatic pains from at-\\nmospheric changes, with sleeplessness. Symptoms worse\\nfrom motion and from exposure to the heat of the fire.\\nCaladmm. Nettle-rash on the chest alternating with", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0094.jp2"}, "93": {"fulltext": "URTICARIA. 89\\nasthma. Itching and sudden, violent corrosive burning,\\noften on small spots. Worse at night.\\nCalcarea carb. Chronic nettle-rash. White elevated\\nhard nettle-rash which disappears in the cold air. Ele-\\nvated red stripes on tibia, with severe itching and burn-\\ning after rubbing. Children inclined to grow fat. Dur-\\ning dentition. Symptoms aggr. by drinking milk.\\nAcidity.\\nCarbo veg. Blotches on the calves of the legs, wrists\\nand feet. Burning in various places on the skin at night\\nin bed. Bloating of the abdomen after a meal Frequent\\neructations. In cachectic individuals, accompanying\\ndyspepsia.\\nCausticum. Chronic nettlerash, coming out more fully\\nin fresh air, with decided aggr. and itching from the\\nheat of the bed. Rash on the thighs just above the\\nknees. Worse during day, better during wet weather.\\nChloral. Eruption on arms and legs, exactly like net-\\ntlerash, in large raised wheals, with intense irritating,\\nitching, oedematous swelling of face, cheeks, eyelids and\\nears, coming on suddenly from a chill, not from heat.\\nAggr. by the smallest quantity of wine, beer or spirits.\\nIn grain doses in obstinate cases.\\nCinchona. Nettle-rash coming out after scratching.\\nFrightful swelling of the face, forearms and hands in the\\nmorning. Debility after loss of animal fluids. Malarial\\ncomplications.\\nCimicifuga. Urticaria from menstrual or rheumatic\\ndisorders. Excessive muscular soreness. Brain feels\\ntoo large for cranium. In nervous hysterical females.\\nCina. White wheals surrounded by er3^thematous red-\\nness, first on the nose, then all over the body. From\\nworms.\\nCocculus \u00e2\u0080\u0094YL^iX^ blotches, surrounded by red areolae,\\n7", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0095.jp2"}, "94": {"fulltext": "90 SKIN DISEASES.\\non the limbs, wrists and back of the fingers. Burning\\nitching as from nettles.\\nConium. Stinging like flea-bites, only one stitch at a\\ntime. Evanescent itching.\\nCopaiva. Urticaria, at first on the face, especially the\\nforehead, then on the back of the hands, and finally in\\nisolated patches all over the body. Large red blotches,\\nwith constipation and fever. Violent chills, headache,\\nand general malaise; red, hot skin, nettle-rash all over\\nthe body, delirium, drowsiness, scanty urine, which is\\ndark, with brick-dust sediment. Great restlessness.\\nCondurango. Chronic urticaria. Gastric pains,\\nmostly at the cul-de-sac of the stomach.\\nCosmolme. Its effects, when applied to the skin in\\ncases of urticaria, eczema, psoriasis, herpes, and in nearly\\nall cutaneous diseases in which the skin is dry and irri-\\ntable, is certainly very soothing and often curative.\\nDulcamara. White blotches, with red areolae, on the\\narms and thighs, stinging and itching with burning after\\nrubbing. After taking cold. Nettle-rash over the whole\\nbody without fever. Eruption preceding the menses.\\nGriping pains in the bowels, with nausea and diarrhoea.\\nFagopyrum. Sore, red blotches inducing scratching,\\nwhich aggravates. Swelling, the size of a hen s ^%z^ on\\nthe neck and shoulder. Dreadful stinging itching.\\nGraphites. Red spots like flea-bites all over, espe-\\ncially on the calves of the legs. Itching worse in the\\nevening and at night. Skin dry, never perspires, and is\\ninclined to crack. In females with disposition to delayed\\nmenstruation.\\nHepar. Chronic nettle-rash on the fingers and hands.\\nBurning and itching of the skin after scratching.\\nHypericum. Eruption like nettle-rash on both hands", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0096.jp2"}, "95": {"fulltext": "URTICARIA. 91\\nat 4 p. M. Crawling in the hands and feet, they felt\\nfuzzy.\\nIg7iatia. During chilly stage of intermittent fever.\\nFrequent discharge of much watery urine. In nervous\\nsubjects.\\nKali carb. Urticaria during menstruation. Worse in\\nwarm weather. In persons with dry skin, or who are\\ninclined to pulmonary troubles.\\nLycopus. Troublesome urticaria, especiall} affecting\\nthe left forearm and right leg, before eating.\\nLycopodium. Itching with nettle-rash eruption on the\\nextremities. Desire to eat, but a small quantity of food\\nfills him up. Inclined to constipation. Urticaria from\\neating oysters, or shell-fish.\\nMagnesia cai^b. Hard blotches as if from nettle-sting,\\nworse during menstruation. Menstrual flow more pro-\\nfuse at night.\\nMercurius. Small flat light red blotches on the\\nsexual parts, abdomen, chest and inner side of the thighs.\\nEasy perspiration without relief.\\nNatrum mur. White blotches on the arms and hands,\\nturning red on scratching. Red blotches over the whole\\nbody. Violent itching.\\nA^iix vom. When accompanied by constipation, vertigo\\nand headache.\\nPodophyllum. Intolerable itching of the skin on the\\nbody and arms; on scratching it raises up in blotches like\\nhives.\\nPsorinum. After suppressed itch, frequent attacks\\nof urticaria, with fine vesicles on the top which dry and\\npeel off in fine scales. Coming on after any exertion.\\nPulsatilla nig. Red, hot spots like nettle-rash. After\\neating fat pork, fruits or buckwheat.\\nPulsatilla nut. Blotches on the right breast, standing", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0097.jp2"}, "96": {"fulltext": "92 SKIN DISEASES.\\nout like measles, with red base, turning white on scratch-\\ning. Violent itching, worse at night before bed time.\\nRhus tox, Vesicular urticaria from getting wet, dur-\\ning the rheumatism, with ch Us and fever, worse in cold\\nair. Rheumatic pains worse at rest. Skin swollen and\\nred; itching all over, worse on hairy parts, burning after\\nscratching.\\nRobinia. Burning itching wherever a part of the face\\nis touched. Itching of skin where anything rests upon\\nit. Sour stomach.\\nSarsaparilla. Blotches as from nettles. Burning\\nitching with chilliness after abuse of mercury.\\nSepia, Chronic form. Red, lentil-sized blotches on\\nthe hands. Eruption breaks out in the open air and dis-\\nappears in a warm room, especially on the face, arms,\\nand thorax. After milk and pork.\\nSolanum oler. Urticaria febrilis.\\nSpigelia, Small elevations like hives on the lower\\nextremities after scratchiyig.\\nStannum. Small, itching hives below the waist\\nthrough the day. Itching aggravated by rubbing. In\\npatients with phthisis.\\nSulphur. Eruption, itching and burning over the\\nwhole body, with febrile symptoms, or when the indi-\\ncated remedy does not act well. Itching aggravated by\\nthe warmth of the bed. Chronic cases.\\nTetradymite. Nettle-rash on face after eating crabs.\\nTrio steum p erf Nettle-rash with gastric derangement.\\nUrtica urens. Nettle-rash attending or preceding\\nrheumatism. Itching swellings all over the fingers. Ag-\\ngravated every year at the same time. Itching and\\nburning of the skin, as if scorched; raised red blotches;\\nfine stinging points; pale rash requiring constant rubbing;\\nconsequences of suppressed nettle-rash; eruption and", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0098.jp2"}, "97": {"fulltext": "FOLLICULAR HYPEREMIA. 93\\nitching disappear as soon as she lays down and re-appear\\nimmediately after rising.\\nUstilago. Terrible itching at night; menstrual irregu-\\nlarities from ovarian irritation. During the climaxis.\\nVeratrum alb. Nettle-rash, about the joints only.\\nZincum met. Stinging itching in the skin with nettle-\\nrash eruption after rubbing. Itching rash in hollows of\\nthe knees and bends of the elbows. After moderate wine\\ndrinking.\\nThe following case, reported by Dr. Hoyne, is very in-\\nstructive: Female, complained of itching all over the\\nbody, but especially bad upon the back. No eruption\\nwas to be seen, but writing a word upon her arm it stood\\nout in blazing red a moment or two afterward, a certain\\ndiagnostic sign of urticaria. Her other symptoms were:\\nUrine quite scanty but clear, and of good color; no appe-\\ntite of consequence; meat does not agree with her; sour\\nthings disagree; drinks a large quantity of water daily;\\nher limbs swell, principally about the ankles; dreams\\nfrequently and they are decidedly unpleasant; alternate\\nconstipation and diarrhoea; nearly every morning she has\\nnausea and dizziness; shortness of breath when lying\\ndown, especially on her back. The urine, on examina-\\ntion, showed no disease of the kidney. She received\\nApis, and in three weeks was entirely relieved of all her\\nsymptoms.\\nFollicular Hypersemia.\\nHyperaemia of the follicles of the skin is often con-\\nfounded with diseases which it complicates, and it is im-\\nportant that this accident common to many dissimilar dis-\\neases and its true significance should be distinctly under-\\nstood in relation especially to the matter of general diag-\\nnosis.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0099.jp2"}, "98": {"fulltext": "94 SKIN DISEASES.\\nWhenever the skin is much irritated, and particularly\\nif scratching is practiced for the relief of itching, the\\nfollicles are apt to become congested. The result is that\\nred hypersemic papules are formed by erection and\\nturgescence of the upper part of the follicular walls. If\\nthe hyperaemia persists long enough a certain amount of\\nhypertrophous growth may take place as a consequence\\nof the hyperaemia, and solid papules may then form at\\nthe hair follicles which may from being scratched be-\\ncome covered at the apex with scales of dried blood that\\nhas been effused from the excoriations; in fact, the\\npapules become pruriginous. But this is only a secondary\\nresult, not a primary condition. This accident of fol-\\nlicular congestion is found in a variety of diseases, and\\nmust be carefully distinguished from primary mischief,\\nthough in itself it indicates an excessive irritation of the\\nskin. It is, in fact, the sign of a scratched skin, and\\nshould be always recognized as such.\\nMedicinal Rashes, or Eruptions, The Direct Result\\nof the Action of Drugs.\\nIt is important that the homoeopathic dermatologist\\nshould be fully acquainted with the eruptions of the skin\\nproduced by the administration of medicinal substances.\\nMany of our remedies are capable of producing some\\nform of an eruption upon the skin and it is this fact, or\\nrather a knowledge of the action of these different\\nmedicinal substances, that enables the homoeopathic\\nphysician to prescribe successfully for many cases that\\nthe old school relegate to hygiene and time for a cure.\\nAs the therapeutic indications in the various lesions of\\nthe skin are but a history of the effects produced upon\\nthe healthy skin, in the prover, of the different medi-\\ncines mentioned, no attempt will be made here to enumer-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0100.jp2"}, "99": {"fulltext": "MEDICINAL RASHES. 95\\nate them. I shall, however, at the close of the volume,\\ngive the skin symptoms of some of the newer rem-\\nedies, as all may not be so familiar with these as with the\\nolder remedies.\\nOccasionally we find a case that will not respond favor-\\nably to any one of our old-tried friends, and some one of\\nthe newer remedies will prove to be the more exact sim-\\nilimum, and prove a grateful blessing to our patient.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0101.jp2"}, "100": {"fulltext": "CHAPTER VI.\\nTHE ERUPTIONS OF ACUTE SPECIFIC\\nDISEASES (ZYMOTIC).\\nWhich Ark of Contagious Nature, of Definite\\nCourse and Duration, Accompanied by Fever,\\nTHE Result of Poisoning of the Blood by\\nSpecial Viruses One of the Effects\\nOF THIS Poisoning Being the De-\\nvelopment OF Certain Char-\\nacteristic Eruptions on\\nTHE Skin.\\nAfter considerable weighing of the question as to\\nwhether it were better to take up these affections or not,\\nI have decided to give, for diagnostic purposes, a short\\ndescription of this class of diseases, more especially of the\\neruptions.\\nVariola.\\nThe eruption on the skin is characterized by the ap-\\npearance of bright, red, hard acuminated points, the size\\nof hemp-seeds, distinct from each other at first, and\\nwhich, passing through the stages of vesicular and pustu-\\nlar inflammation, arrive at their maturity on the eighth\\nday of eruption. The individual pustules then scab,\\ntheir contents drying into brown masses which become\\ndetached in from twelve to fifteen days, and leave behind\\nin their place permanent cicatrices, or pits. Variola", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0102.jp2"}, "101": {"fulltext": "VARIOLA. 97\\nis often preceded, as regards its local state, by more or\\nless erythema, which subsides on the appearance of the\\nvari. This has been termed erythema variolosa. Variola\\nis said to be discrete, when the pustules are scattered over\\nthe surface; coherent, when the eruption is plentiful, and\\nthe vari are closely packed side by side but still dis-\\ntinct confluent, when they run together; modified,\\nwhen the disease succeeds to a prior attack or occurs\\nafter inoculation. Variola is, by universal consent,\\ndivided into five stages: Incubation, which is reckoned\\nby the length of time which elapses between exposure to\\nthe poison of the disease and the development of the\\nfirst effects (from five to twent}^ days); Invasion (two\\ndays); Eruption; Suppuration; Dessication.\\nThe Period of E7mption Eruption makes its ap-\\npearance on the third day after the first occurrence of\\nconstitutional disturbance, and travels over the entire\\nbody within a day, when the febrile condition is greatly\\nrelieved.\\nThere are exceptions to this when the rash appears on\\nthe second, fourth, fifth or sixth day. Should the erup-\\ntion appear on the second day, the attack will be severe\\nand the disease of the confluent variety if on the fourth\\nday or later it will be unusually mild and of the discrete\\nvariety.\\nThe spots appear first on the face, about the forehead,\\nand thence they extend to the trunk and limbs. These\\nspots are, in the very outset, small papules, red, hard,\\nand pointed, and their more or less closely packed or\\nscattered condition affords a good guide as to whether\\nthe disease will be confluent or not if the skin be very\\nred and erythematous, probably the case will assume the\\nconfluent form. On the second day of eruption fourth\\nof disease the papules formed from elevation of the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0103.jp2"}, "102": {"fulltext": "98 SKIN DISEASES.\\nepidermis by an increase of the cells of the Malpighian\\nlayer and distension of the vessels in the true skin, but\\nparticularly the papillary layer, are transformed into\\nvesicles. If these vesicles be punctured, nothing escapes\\nfrom the puncture. On the third day of eruption fifth\\nof disease umbilication commences as a central depres-\\nsion, which becomes more marked every day, pari passu\\nwith suppuration, which now commences the pustules\\nare whitish and surrounded by an inflamed areola the\\nfourth day of eruption. If the contents are now turned\\nout, a little disc of dirty plastic matter, presenting an\\numbilicated shape, and attached to the cutis beneath, will\\nbe noticed. It is not at all unusual to observe the con-\\nfluent in one, the discrete form in another part of the\\nsame subject. The onset of maturation is observed about\\nthe end of the fifth or beginning of the sixth day of erup-\\ntion, or the eighth of disease. The contents of the\\numbiHcated vesicles soften down into pus, the umbilication\\ndiminishing with enlargement of the base of the pustule,\\nand a yellow color replacing the white.\\nThe stage of eruption, lasting about five days, is char-\\nacterized by the cessation or at least by a remission of the\\nfebrile and other symptoms, which is not true of the\\nother eruptive fevers. The temperature which has been\\n104\u00c2\u00b0 to 106\u00c2\u00b0 falls to 100\u00c2\u00b0, the pulse ranging from no to\\n130 falls to 70 or 90 in fact, the patient may feel per-\\nfectly well. These diagnostic symptoms may be wanting\\nif the disease proves to be of the confluent variety.\\nMaturation, as it is called, is complete on the eighth\\nday of eruption; between the eighth and eleventh day,\\nsecondary fever sets in, when the stage of dessication is\\nreached. This is the period of recovery or resolution,\\nwhen the local and general symptoms subside, the scab-\\nbing dries, and the discharge ceases. The crusts fall off", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0104.jp2"}, "103": {"fulltext": "VARIOLA. 99\\ni|i the next three or four daj^s, exposing raw, red sur-\\nfaces, which desquamate, and b3 -and-by leave behind\\nred-looking marks, which gradually fade and assume the\\nwell-known aspect of small-pox marks.\\nItching of the skin to a greater or less extent persists\\nduring the whole course of the eruption. The rash also\\nappears on the mucous membrane of the mouth and\\nthroat at the same time, presenting the appearance of\\nround opaque spots, which are situated mainly on the\\ntongue and soft palate, but are not by any means confined\\nto these parts, for in many instances the rash appears in\\nthe larynx, trachea, bronchi or nostril, upon the mucous\\nmembrane of the vulva, prepuce, etc., with resultant laryn-\\ngitis, bronchitis, etc. Or the eruption may take place in\\nthe e5^e and as a consequence lead to destruction of the\\nsight; in the tunica vaginalis, giving rise to variolous\\norchitis; upon the peritoneum surrounding the ovaries, giv-\\ning rise to variolous ovaritis. Orchitis is more frequently\\nmet with than ovaritis. The eruption upon the mucous\\nsurface gives rise to considerable discomfort, for these\\nulcerated spots are as tender to the touch as ulcers in\\nother situations.\\nWhen variola is produced by inoculation there are\\nsome differences. On the third day the puncture is in-\\nflamed, it is itch}^, and surrounded by a little blush of\\nredness, whilst the spot is slightly indurated; on the\\nfourth or fifth day the central point acuminates, and a\\nlittle coming vesicle is seen; on the sixth day there is an\\nearly state of pustule, and it is umbilicated; on the\\nseventh day a perfect pustule is formed with an inflamed\\nareola; on the ninth or tenth day, maturation takes place,\\nand the umbilication of the pustules goes; from the\\ntwelfth to the fifteenth day desiccation takes place, and", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0105.jp2"}, "104": {"fulltext": "100 SKIN DISEASES.\\nfrom the twentieth to twenty-fifth day the scab falls off.\\nThe disease is rarely confluent.\\nThe fever, which had subsided or entirely disappeared,\\nreturns during the stage of suppuration. The tempera-\\nture rises to io6\u00c2\u00b0 to io8\u00c2\u00b0, the pulse runs up to no to\\n140 or higher, the thirst is urgent and there are no longer\\nperspirations of any sort. This secondary or suppura-\\ntive fever terminates in a few days in the discrete\\nvariety if there are no serious complications, but in the\\nconfluent it is somewhat prolonged.\\nBach pustule has an inflammatory areola of considera-\\nble extent. The face especially becomes greatly swollen\\noedematous. In the confluent variet}^ this cedematous\\nswelling is frequently sufficient to completely close the\\neyes. The hands and feet are likewise swollen and burn\\nlike fire. As a consequence of the eruption in the mouth\\nand throat a free and copious flow of saliva is to be\\nexpected. The glands and subcutaneous tissues of the\\nneck become enlarged in many cases.\\nHemorrhagic variola commences very much like the\\nother varieties, but there is a marked coldness of the ex-\\ntremities followed by a deep purpHsh redness of the sur-\\nface. The eruption at first shows a very deep red color,\\nand when the vesicles appear they are of a bluish-black\\ncolor; in other words, they are filled with blood. At the\\nsame time ecchymosed spots, resembling bruises, are seen\\nmore or less over the entire surface and in the conjunc-\\ntivae of the eye. The patient expectorates blood, vomits\\nblood, passes blood with the stool and urine there is a\\nflow of blood from every outlet of the body. Recovery\\nis very rare, and death may take place at any stage, but\\nusually before the pustules form.\\nI have never had to treat a case of this form, but from\\na comparison of the symptoms as above given would", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0106.jp2"}, "105": {"fulltext": "VARIOLA. 101\\nrecommend the employment of two remedies internally\\nCrotalus hor. and Phosphorus,\\nTo prevent pitting lard and charcoal may be used, or\\nthe face may be painted with sweet cream; the object be-\\ning to exclude light and air. Various expedients have\\nbeen recommended, but they all fail in the majority of\\ncases.\\nThe advice of the dermatologist is not infrequently\\nsought for the removal of certain disfiguring conse-\\nquences of variola about the body.\\nIn the first place redness of the face has to be dealt\\nwith therapeutically. This may be rendered much less\\nvisible by the use of some mild astringent, but the great-\\nest care must be taken to avoid every application which\\ncould in any degree increase by stimulation the hyper-\\nsemia. The following makes a very excellent prepara-\\ntion\\nOxide of Zinc, ^jj.\\nCalamine powder, gss.\\nGlycerine, ^jj.\\nRose water, S^jjj-\\nIt should be used after bathing with hot water, being\\ndabbed in and allowed to dry. Scarring cannot in the\\nnature of things be prevented. If the scars become\\nthe seat of hypertrophous growth of cicatricial tissue the\\nknife must not be used, but the frequent application of\\ncontractile collodion had recourse to. It should be ap-\\nplied twice a day for some time. Acne spots may also\\ndevelop about the nose, for which the ordinary treatment\\nfor acne should be employed.\\nThe indications for remedies are as follows:\\nAco7iite. During the febrile stage at the beginning,\\nheadache, epistaxis, injected eyes and frequent pulse.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0107.jp2"}, "106": {"fulltext": "102 SKIN DISEASES.\\nAnxious restlessness. Pain in the back and aching in\\nthe limbs. Apprehension of a fatal issue. Excessive\\nthirst.\\nA?nmo?i. carb. Hemorrhagic diathesis, from fluidity\\nof blood and dissolution of red blood-corpuscles; ten-\\ndency to gangrenous ulcerations.\\nAmmon. inur. Eruption well developed upon trunk\\nand upper extremities, but scanty on lower ones; sore\\nthroat, with swelling about neck; hemorrhages.\\nAntimon. crud. Gastric state, with vomiting and\\nheavily coated tongue, especially during prodromal\\nstage.\\nApis mel. Erysipelatous redness and swelling, with\\nstinging, burning pains in skin and throat; absence of\\nthirst; scanty micturition; at a later period great\\ndyspnoea; sensation as though he would not be able to\\nbreathe again; great restlessness; suppression of urinary\\nsecretion.\\ny4r^(??2zV. ^Asthenic cases, with great sinking of\\nstrength; burning heat; frequent small pulse; great\\nthirst; great restlessness; irregularly developed variola,\\nwith typhoid tendency; hemorrhagic variola, or when\\nthe pustules sink in and their areolae grow livid; metas-\\ntasis to mouth and throat in last part of eruptive period.\\nBaptisia. Typhoid symptoms; fetid breath; pustules\\nappear thickly upon palatine arch, tonsils, uvula, and in\\nnasal cavities, but scantily upon skin; profuse salivation;\\ngreat prostration, with excessive pains in sacral region.\\nAfter taking the drug appetite improves and the patient\\nis able to take and to retain nourishment.\\nBelladonna. During first stage, high fever with cere-\\nbral congestion intense swelling of skin and of mucous\\nmembranes, with tickling cough, dysuria, and tenesmus\\nof bladder sleeplessness, with desire to sleep delirium", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0108.jp2"}, "107": {"fulltext": "VARIOLA. 103\\nand convulsions photophobia ophthalmia. During\\nlater stages Belladonna modifies the itching of the desic-\\ncating pustules.\\nBryonia. Brings out the eruption when it is dela3^ed,\\nor when it suddenly disappears. In the first stage with\\ngastric symptoms, or after the eruption is out, if ascites\\nsets in, very cross and irritable wants to lie still dry\\nmouth without thirst, or else w^ants large quantities at\\nlong intervals. Constipation of hard, dry stools.\\nCaniphora. Sudden collapse, with coldness of the\\nsurface the swelling of the skin suddenh^ sinks in, and\\nthe pustules seem to dry up, from the complete giving out\\nof the life forces excessive weakness the patient,\\nthough cold, cannot bear to be covered.\\nCalcarea sidph. Pustules discharging matter.\\nCantharis. Hemorrhagic state patient passes bloody\\nurine, with cutting burning pains burning pains through\\nwhole intestinal canal, wdth unquenchable thirst and\\ndisgust for all kinds of drinks.\\nCarbolic acid. Dr. Middleton believes this drug to be\\nas near a specific for variola as it is possible for any\\ndrug to be for any disease, and even in the hemorrhagic\\nvariety, if used early, there wnll be greater prospects of\\nrecovery than with any other drug knowm. He employs\\nthe IX. When given at an early stage of the disease,\\nDr. Montefero has found that the pustules fail to de-\\nvelop they shrink and dr}^ up after a few days without\\nan}^ swelling of the subcutaneous tissue. In the sup-\\npurative stage it moderates the fever, and lessens the suf-\\nfering in the mouth and phar3mx. The urine turns black\\nwhen standing, and in some cases shows some traces of\\nalbumin.\\nCarbo veg. Asthenic variola, with cold breath and", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0109.jp2"}, "108": {"fulltext": "104 SKIN DISEASES.\\nexcessive prostration great desire for fresh air livid\\npurple look of the eruptions hippocratic face.\\nChamomilla. Great fretfulness of children during\\neruptive stage, with the usual impatience and coldness.\\nChina. Variola hemorrhagica, with great exhaustion\\nfrom the copious painful stools excessive debility and\\nprostration after a severe attack.\\nCimicifuga. In the precursory stage, for the muscular\\nrheumatoid pains during eruptive fever great wakeful-\\nness, mental excitement as if the brain would burst out\\ndull heavy aching in small of back, relieved by rest, in-\\ncreased by motion excessive muscular soreness prick-\\nling itching heat of the whole surface eruption of white\\npustules over face and neck it modifies the disease, pre-\\nvents the development of pustules, and thus reduces the\\ndanger of pitting.\\nCoffea. Restlessness and bilious vomiting at the com-\\nmencement of the disease.\\nCupru77i. Convulsions preceding the eruption; vomit-\\ning, delirium, sopor.\\nFerrum. Fiery redness of the face after recovery.\\nGelsemium. Predominance of nervous symptoms, as\\nnervous chills, restlessness intense and painful fever at\\nthe commencement of disease, with tendency to con-\\nvulsions.\\nHamamelis. Hemorrhagic variola blood dark, ve-\\nnous oozing of dark blood from nose bleeding gums,\\nhematemesis, bloody stools uterine hemorrhage, pete-\\nchise tearing pains across the small of back, with ful-\\nness of the joints of the legs; typhoid condition. (If\\nHam. fails, try Crotalus horr.).\\nHepar.\u00e2\u0080\u0094hoosQ, rattling cough, without expectoration\\nsuppurative stage swelling and suppuration of the\\nglands.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0110.jp2"}, "109": {"fulltext": "VARIOLA. 105\\nHydrastis. Itching tingling of eruption, face swollen,\\nthroat sore, pustules dark, great prostration buccal\\ncavity full of pustules pulse slow and labored, with\\npalpitation of heart intense aching pain in small of back,\\nlegs feel very weak and ache is said to prevent- pitting\\nto a great degree.\\nHyoscyamus. Eruption fails to appear at the proper\\ntime, causing great nervous excitement, with rage,\\nanguish, delirium, coming on in paroxysms; patient\\nwants constantly to get out of bed and to be uncovered\\n(hyperaesthesia of skin); vesicles coming out in crops;\\nrestless sleep; slight fever; dry teasing cough, relieved\\nby sitting up.\\nIpecac. Gastricismus during eruptive stage, with con-\\nstant nausea.\\nKali ntur. Controls the formation of pustules.\\nKali phos. Putrid conditions, heavy odor, exhaustion\\nand stupor. iVdynamic symptoms indicating blood de-\\ncomposition.\\nKcili sulph. To promote the formation of healthy\\nskin and the falling off of the crusts,\\nMelandrinum 30X was used during the epidemic of\\n1 880-1 with great success as a preventive as well as a\\ncurative agent. It prevented the suppurative fever, or\\nlessened it at least to a considerable degree, and took\\naway all offensive exhalation.\\nMercurius. Variola in the stage of maturation;\\nptyalism; tendency of blood to head; irritation of mu-\\ncous membranes; moist swollen tongue, with great thirst;\\ndiarrhoea or dysentery, with tenesmus, especially during\\nthe period of desiccation.\\nNatrum mur. Salivary flow, confluence of pustules\\nand drowsiness.\\nOpium. Drowsiness and stertorous breathing. Com-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0111.jp2"}, "110": {"fulltext": "106 SKIN DISEASES.\\nplete loss of consciousness. Impending paralysis of the\\nbrain.\\nPhosphorus. Hemorrhagic diathesis; bloodj^ pustules;\\nhard, dry, exhausting cough, with pain or feeling of raw-\\nness in chest; bronchitis; hemorrhage from lungs; back\\npains as if broken, impeding all motion; frequent faint-\\nings; typhoid variola, even so from the start.\\nPhosphoric acid. Confluent variola, with typhoid con-\\nditions; pustules do not fill with pus, but degenerate into\\nlarge blisters, which, bursting, leave an excoriated sur-\\nface; patient is stupid, does not want anything, not even\\na drink; answers questions, but does not talk otherwise;\\nsubsultus tendinum, great restlessness; fear of death;\\nwatery diarrhoea.\\nRhus tox. Typhoid symptoms, dry tongue; great rest-\\nlessness; patient wants to get out of bed, notwithstanding\\nhis great debility; sordes on lips and teeth; confluent\\nsmallpox, with great swelling at first, but afterwards the\\neruption shrinks and becomes livid; blood in pustules;\\nbloody stools.\\nSarracenia. From reports, the consensus of opinion\\nseems to be in favor of this plant in the treatment of\\nsevere cases of variola; there are no reliable indications\\nas yet.\\nSilicea. Suppurative stage exhausts the strength of\\npatient and desiccation is delayed; caries of bones, fol-\\nlowing severe attacks of variola, with fistulous openings\\nand discharge of thin pus and bony fragments.\\nSolatium nig. Hemorrhagic variola.\\nStramonium. Entire swelling of the face before the\\neruption, with muttering delirium.\\nSulphur. Tendency to metastasis to the brain during\\nsuppuration; stage of desiccation; occasionally indispen-\\nsable as an intercurrent remedy, where others fail.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0112.jp2"}, "111": {"fulltext": "VARICELLA. 107\\nTartarus e7net. Eruption tardy in coming out, with\\ngreat oppression under sternum, nausea, vomiting, sleep-\\niness, or for suppression of eruption; putrid variola,\\nwith typhoid symptoms, especially typhoid pneumonia,\\nwith tendency to paralysis of lungs; vomiting of viscid\\nmucus, clogging the air-passages; pustules in larynx,\\nmouth, throat, and digestive organs; leaving bluish-red\\nmarks on face, genitals, and thighs.\\nVaccininum has been used undoubtedly with great\\nbenefit in variola; its use has shortened and ameliorated\\nall stages quite considerably. Sulphur was given after-\\nwards.\\nVariolinum. Especially where the disease throws\\nitself with full force on throat. Given steadily during\\nthe disease it will run a milder course, changing imper-\\nfect pustules into regular ones, which soon dry up; it\\npromotes suppuration, and desiccation, and prevents pit-\\nting.\\nVeratfum vir. Intense fever, with excessive pain and\\nrestlessness. Used in alternation with Macrothi the pus-\\ntules flattened rapidly, dried, and fell off.\\nVaricella.\\nThis is a disease of childhood. After pyrexia lasting\\na few hours, or not more than a day, the eruption of\\nvaricella appears, often on the back first of all, as distinct\\nred papulae, which become vesicular in a few hours; the\\neruption is successive during three or four days. The\\nsame kind of changes occur in the eruption as in variola,\\nbut the disease is more superficial, and the vesicle is uni-\\nlocular, and it is not generally umbilicated: the con-\\ntents are serous rather than puriform. On the first\\nday the vesicles are transparent; opalescent on the second\\nand third; on the fourth they shrink and desiccate; and", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0113.jp2"}, "112": {"fulltext": "108 SKIN DISEASES.\\non the sixth the scabs fall off. Sometimes, however, the\\ncontents of the vesicles become puriform. The general\\npyrexia is slight.\\nThe prognosis is favorable. If the fever runs high\\nwith much disturbance of the system, the patient may\\nrequire one of the following remedies: Aeon., Bell.,\\nMere., Rhus, Tart, emet., or Verat. v.\\nTyphus Rash.\\nThis consists of two component parts:\\n1. A subcutaneous mottling, of more or less livid\\nhue, and diffused generally over the body.\\n2. Petechise, small, about the size of pin s heads, scat-\\ntered all over the body, and showing out from the mot-\\ntling; at first these are slightly raised, and their color\\nincreases gradually in intensity; they do not fade by\\npressure, except slightly in the very early stages. The\\neruption of typhus is not prolonged by successive crops.\\nIt makes its appearance between the fifth and eighth day\\nof disease, and disappears a few days before convalescence.\\nIt has been mistaken for syphilitic rash.\\nTyphoid Rash.\\nIs characterized by the appearance between the eighth\\nand twelfth day of disease of rose-colored, elevated, cir-\\ncular, softish spots, about a line of so in diameter, on the\\nabdomen, back of hand, arms, chest, and back (if kept\\nwarm). These rose-colored spots disappear by pressure,\\nand they appear in successive crops, each spot lasting\\nthree or four days, and then gradually fading. There\\nmay be from half a dozen to a score of these spots present\\nat one and the same time. Sudamina often co-exist with\\nthem.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0114.jp2"}, "113": {"fulltext": "MEASLES. 109\\nMeasles.\\nWithin fourteen days from the reception of the con-\\ntagion, the eruption of measles appears, the first stage,\\nthe stage of invasion, consisting of a catarrhal attack\\nupon the head and chest. The child is restless and\\nfeverish with headache. The eyes grow red, weak and\\nwatery, unable to bear the light. There is frequent\\nsneezing, with water}^ discharge from the nose and a\\nconstant short, dry and sometimes croupy cough. In ex-\\nceptional cases there may be vomiting and delirium.\\nAbout the fourth day, the stage of eruption comes\\non, the rash appearing first on the face and extending in\\nthe course of 48 hours over the body. About the third\\nday of the disease the rash may be observed on the fauces.\\nThe eruption consists of numerous deep red circular spots\\nresembling flea-bites. Between these spots the skin re-\\ntains its normal color, except upon the face, where it\\nmay be oedematously swollen. On the cheeks the rash\\nsometimes becomes confluent, forming blotches and pre-\\nsenting a crescentic shape. In the same order as it came\\non the rash fades, beginning to grow faint on- the face\\nwhen it is at its height on the body. In this stage the\\nfever increases, the temperature rising to 102\u00c2\u00b0 to 106\u00c2\u00b0.\\nThe third stage, the stage of desquamation, begins about\\nthe eighth or ninth day of the disease, when the rash dis-\\nappears and the epidermis peels off in fine scales. This is\\nthe course of the normal type, but in some cases the onset\\nof the disease is so violent that the child dies in the\\nsecond stage from asthenia with t3^phoid symptoms. In\\nother cases, inflammatory measles, the rash grows darker,\\nassumes a purple color, remaining visible for some days,\\nand all the symptoms are intensified. The cough be-\\ncomes croupy and there may be lobular pneumonia. This", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0115.jp2"}, "114": {"fulltext": "110 SKIN DISEASES.\\nruns to exhaustion, with disappearance of the eruption\\nand collapse The sequelae of measles are chronic\\ncatarrhal cough and chronic pneumonia, which may end\\nin consumption, also scrofulous affections, chronic inflam-\\nmation of the eyes, otorrhoea, swelling of the glands.\\nIn the treatment of measles, the bedroom should be\\nkept at an equal temperature of about 65\u00c2\u00b0 and aired fre-\\nquently with care. The light regulated to the eyes of\\nthe invalid. The diet light, with ripe fruit in season, if\\nthe bowels are not disordered. After the disappearance\\nof the fever and catarrhal symptoms a warm bath may\\nbe given, with another on the following day, with thor-\\nough rubbing and friction of the skin afterward after\\nwhich, if the weather is favorable, the patient may be\\nallowed to go out.\\nTherapeutic Indications.\\nAconite. In the beginning, with dry, hot skin, full,\\nfrequent pulse, thirst, red, watery eyes with photophobia.\\nStitching pain in side and chest. Dry, hacking and\\ncroupy cough. Catarrhal irritation. Anxious restless-\\nness. Vertigo on raising up.\\nAntimon. crud. White- coated tongue. Gastric de-\\nrangements. Pain in the ears.\\nApis. Confluent eruption and oedematous swelling of\\nthe skin. Cough and soreness of the chest, as if bruised.\\nViolent cough similar to whooping cough. Catarrh of\\nthe bowels, diarrhoea in the morning, stools greenish-\\nyellow. Scanty, high-colored urine. Oppression of the\\nchest and inability to remain in a warm room.\\nArsenic. Malignant cases with typhoid symptoms.\\nEruption dark colored or retroceding. Pale, earthy face.\\nGreat dryness, burning and itching of the skin. Rapid\\nprostration. Intense thirst, but drinks ovXy small quanti-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0116.jp2"}, "115": {"fulltext": "THERAPEUTIC INDICATIONS. Ill\\nties. Anxiety and great restlessness. Thrush in the\\nmouth and on the fauces. Worse about midnight.\\nBelladonna. In the commencement with hot, moist\\nskin, and frequent soft pulse. Congestion to the head.\\nConstant drows} sleep or drowsiness with inability to\\nsleep. Bright redness of the throat, with pain on swal-\\nlowing. Diphtheritic symptoms. Back feels as if it\\nwould break. Thick, white-coated tongue. Worse\\nabout three o clock a. m. Complication with scarlet\\nfever.\\nB?yonia. Eruption does not come out well. Con-\\ngestion to the chest with stitching, shooting pains on\\nbreathing or motion. Rheumatic pains in the limbs.\\nGreat dyspnoea and hurried breathing. Dry mouth\\nwithout thirst or thirst for large quantities at long inter-\\nvals. Better from warm drinks. Children grasp the\\ncup with both hands.\\nCamphor a. Vital depression. Face pale, skin cold\\nand blue, inclination to uncover. Eruption does not\\ncome out. Various sequelae, particularh^ difficult and\\npainful micturition.\\nCarbo veg. Persistent hoarseness after measles.\\nChamojnilla. Great restlessness, child w^ants to be\\ncarried. Very cross and fretful. Painful, watery diarrhoea.\\nChina. Violent colic, with unquenchable thirst. Ab-\\ndominal ailments with frequent stool. Debility and no\\nfever.\\nCoffea. Nervous, restless agitation, preventing sleep.\\nDry, hacking cough, with constant tickling in the larynx.\\nCupruin acet. Measles, bronchitis, delirium, wants to\\ngo home. Expectoration onl}- during the night. On\\nfalling asleep, begins to talk, scold, turn, twist and\\nscream on being aroused, was perfectly rational tongue\\nand mouth red.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0117.jp2"}, "116": {"fulltext": "112 SKIN DISEASES.\\nDrosera. Cough, like whooping cough, or hollow,\\nbarking cough.\\nDulcamara. Retrocession of the eruption from ex-\\nposure to cold, damp air.\\nEuphrasia. Profuse, bland discharge from the nose,\\nand of acrid running from the eyes, with photophobia.\\nCough only during the day.\\nFerriim phos. Measles in all stages, especially in the\\ninitiatory and prodromic, also for the symptoms of in-\\nflammatory affections of the chest, eyes, or nose, or ears.\\nGelsejnium. After Aconite, great deal of coryza\\ndrowsy with fever heat, no thirst. When the eruption\\nturns livid, with cerebral symptoms. Rawness of the\\nchest, with cough.\\nHepar sulph. Croupy cough, with rattling in the\\nchest, but without expectoration, worse in the morning.\\nIpecac. Eruption slow to appear, with oppression of\\nthe chest. Constant tickling cough with every breath\\nand rattling of phlegm. Constant nausea and uneasiness\\nin the stomach.\\nKali bichrom. Cough, with rawness of the chest.\\nPustule on the cornea. Stitches in the left ear extend-\\ning into the neck and head. Running of water from the\\neyes, with burning when opening them. Watery dis-\\ncharge from the nose, with great sensitiveness and ulcera-\\ntion of the nose. Loud rattling cough with tough, stringy\\nexpectoration.\\nKalimur. For the hoarse cough, for all the glandular\\nswellings and the furred tongue, with white or gray de-\\nposit, it is a remedy of prime importance. For the after-\\neffects of measles. Diarrhoea, whitish or light-colored,\\nloose stools, white tongue. Deafness from swelling in\\nthe throat, etc.\\nKali sulph. Suppressed rash, rash suddenly recedes", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0118.jp2"}, "117": {"fulltext": "THERAPEUTIC INDICATIONS. 113\\nwith harsh and dry skin. This remedy will assist the\\nreturning of the rash.\\nMercurius. Swelling of the glands of the throat, and\\ndifficult swallowing. Soreness of the throat and ulcera-\\ntion of the tonsils. Profuse secretion of saliva and fetid\\nbreath. Pit of the stomach very sensitive. Profuse\\nsweat without relief.\\nNux vom. Nose stopped. Cough dry in the evening\\nand loose in the morning.\\nPhosphorus. In complication with pneumonia, or ty-\\nphoid symptoms come on. Violent exhaustive cough\\nwith tightness across the chest. Dry cough with vomit-\\ning. Hoarseness, and aphonia. Stitching pains in the\\nchest, worse from coughing or breathing.\\nPulsatilla. Inflammation of the eyes and photophobia;\\nthick, yellow discharge from the nose; dryness of the\\nmouth, without thirst; nightly diarrhoea, after previous\\nrumbling in the bowels; rattHng, loose cough, with ex-\\npectoration of thick, yellow mucus; increase of all the\\nsymptoms towards evening; chronic, loose cough after\\nmeasles.\\nStida pubn. Incessant dry or spasmodic cough, worse\\nin the evening and during the night, with oppression of\\nthe chest and feeling as if a hard mass had collected\\nthere.\\nStramonium. Sometimes before the eruption there is\\ndelirium with frightful visions of rats and mice, from\\nwhich the patient tries to hide. Spasmodic sj^mptoms in\\nthe phar3mx and difficulty of swallowing.\\nSulphur. The eruption does not come out and the ca-\\ntarrh becomes continually worse. Violent otalgia with\\npurulent discharge. Chronic after complaints, otorrhoea,\\ndiarrhoea.\\nVe7 at. alb. Eruption develops slowly and is of a pale,", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0119.jp2"}, "118": {"fulltext": "114 SKIN DISEASES.\\nlivid color. Hemorrhages without relief. Burning heat\\nwith alternate cold extremities. Very frequent weak in-\\ntermittent pulse.\\nVerat. vir. In the early stage with fever and pul-\\nmonary congestion. Cough, dyspnoea and pains in the\\nchest. Convulsions preceding the outbreak of the erup-\\ntion.\\nScarlatina.\\nOn the second day of illness the rash appears on the\\nneck and face, and is made up of small red dots, which\\ncrowd together, forming patches of various sizes and ex-\\ntent; after a while the whole surface becomes of an uni-\\nform hue; on the third day, the eruption is seen on the\\nbody generally, the upper extremities, and the mucous\\nsurfaces visible to the eye; on the fourth day, the lower\\nlimbs are scarlet, whilst the surface is hot, dry, and harsh.\\nThe eruption, which may be called a general efflorescence\\nof boiled lobster color, is most marked about the third or\\nthe fourth day, and it is generally more intense in color\\ntowards evening, especially in the loins and flexures of\\njoints. On the trunk it is often patchy. The erup-\\ntion fades on the fifth day first on the face; desquama-\\ntion follows about the eighth or ninth day.\\nThe diagnosis between scarlatina and rubeola is the\\nonly one that requires notice.\\nIn scarlatina the rash appears on the second, in mea-\\nsles on the fourth day after the first onset of symptoms.\\nIn scarlatina the rash is bright red (boiled lobster color);\\nit is not crescentic, and it is uniform or not patchy, or as-\\nsociated with intervals of normal integument. In measles\\nthe rash is of dull red color, and it takes the form of lit-\\ntle crescentic patches, with intermediate lines of healthy\\nskin. The skin in scarlatina is very dry, harsh, and", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0120.jp2"}, "119": {"fulltext": "ERYSIPELAS. 115\\npungent. In measles this is not so marked, nor is the\\nsubsequent desquamation so distinct or characteristic.\\nIn measles the changes in the mucous membranes are\\naccompanied by secretion; there are coryza, suffusion of\\nconjunctivae in scarlatina, the mucous surfaces are red,\\ndry, ulcerated; there is also sore throat of marked kind,\\nbut this is absent in rubeola. The aspect of the tongue\\nis characteristic in scarlatina, and the pulse is very rapid\\nand irritable.\\nErysipelas.\\nFor generations past, the old school has been enunciat-\\ning learned theories regarding the etiology of this disease.\\nThe status biliosus^ and the ^status saburralis^^ each\\nhad its day. Clogging of the pores of the skin, and con-\\nsequent accumulation of acridities, which nature should\\nhave eliminated; and the theory that some noxious prin-\\nciple from without found entrance in some mysterious\\nmanner, each claimed due regard. Simple inflammation\\non the one hand, and specific inflammation, involving the\\nlymphatics, on the other, have also had their advocates.\\nThus, most opposite theories have been advanced, have\\nbeen held for a season, and then have fallen again into\\ndisrepute. It appears quite probable that some micro-\\ngerm may be the abnormal excitant, it serving as the\\nagent through which the perverting force is enabled to\\nact upon the vital dynamis. However, the observations\\nof different investigators are not in harmony.\\nErysipelas is an acute febrile disease, characterized by\\na peculiar inflammation of the skin and enlargement of\\nthe neighboring lymph-glands, which is accompanied by\\nmore or less severe general symptoms. It is contagious\\nand inoculable, and arises spontaneousl}^ under conditions\\nnot accurately determined; in the latter case it is called", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0121.jp2"}, "120": {"fulltext": "116 SKIN DISEASES.\\nIdiopathic. When spreading by itvS own contagion, which\\ndiffuses itself through the air or is carried by linen or in-\\nstruments previously used for dressing patients with\\nerysipelas, or by flies it is called Traumatic^ and is\\nmostly found in the surgical wards of hospitals. As the\\nslightest scratch may be the recipient of the poison, the\\ndisease is often communicated to nurses and physicians.\\nDaCosta found that the idiopathic form was almost inva-\\nriably attended by albuminuria, which in the traumatic\\nform was either absent or present only in a decidedly less\\nmarked degree.\\nErysipelas affects the skin in its whole thickness and\\nthe subcutaneous cellular tissue. All the layers of the\\ncorium and of the subcutaneous cellular tissue are edema-\\ntous, swollen, and penetrated by large, finely granulated,\\nwhite blood-corpuscles. The most important distinctive\\nfeature of erysipelas is its disposition to spread only by\\ncreeping uninterruptedly onwards without making jumps;\\nit spreads like water in blotting paper. When on the\\nscalp or face it is limited mostly to a more or less exten-\\nsive portion of the skin of the head and face, and seldom\\ndescends over the neck to the trunk; on other parts of\\nthe body it is apt to spread over larger surfaces.\\nThe local symptoms are frequently preceded a day or\\ntwo by a feeling of general malaise, chilliness and fever-\\nishness. Then the part affected begins to feel hot and\\ntense; the skin reddens and swells, and becomes very\\nsensitive to the touch. At the same time the adjacent\\nlymphatic glands commence to swell. This inflamed\\nportion assumes a red, smooth and shiny appearance,\\nwhich is, however, darker and duller on the scalp than\\non other parts, and to the touch it gives the impression of\\na hard, stiff, caked mass. The inflammation gradually", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0122.jp2"}, "121": {"fulltext": "ERYSIPELAS. 117\\ncreeps on until it reaches from side to side of the scalp,\\ndown into the face, and even to the neck and shoulders.\\nOn the second or third da3^ generally, the redness and\\nswelling reach their height, and, at this stage, in some\\ncases, the epidermis becomes raised and filled with a yel-\\nlowish, limpid fluid, sometimes tinged with blood, in the\\nshape of large blisters Erysipelas bullositm which either\\ndry up, or burst and become covered with crusts.\\nDuring the height of the disea.se, the patient has high\\nfever, with evening aggravations; his sleep is restless and\\nfull of dreams; he sometimes becomes delirious. On the\\nfourth day the redness and swelling gradually subside on\\nthe places first attacked; while those parts which were in-\\nvaded later stand yet in full bloom. By and by, however,\\nthey grow paler, softer, and assume a wrinkled appear-\\nance, as the swelling leaves; the crusts dry off, and on the\\nwhole surface the epidermis peels off in large flakes; the\\nentire process lasting from about eight days to two weeks.\\nBut this is not invariably its course. Just in its very\\nnature to creep on lies its danger. It may, by continuity\\nof tissue^ wander to the mucous membrane of the nasal\\nand phar3mgeal cavities, cause an oedema of the glottis, and\\naffect the larynx, the bronchial tubes, and even produce\\npneumonia and pleuro-pericarditis.\\nThe tongue usually is covered with a white creamy\\ncoat, which dries gradually, becomes dirty yellow and,\\nwhen the fever is protracted, blackish and crust-like;\\nthere is nausea and vomiting; sometimes diarrhoea and,\\nwhat seems very remarkable, in rare cases profuse intes-\\ntinal hemorrhage, in consequence of ulcers in the duo-\\ndenum, which generally have proved fatal, and remind\\none of similar symptoms which are occasionally observed\\nafter severe burns of the skin. In almost all idiopathic\\ncases there is albuminuria. The fever, accompanying", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0123.jp2"}, "122": {"fulltext": "118 SKIN DISEASES.\\nerysipelas, is characterized by a sudden rise of the\\ntemperature to even 104\u00c2\u00b0 F., or higher often within from\\neight to twelve hours, still rising, in some cases, to 107.6\u00c2\u00b0\\nF. When recovery approaches, it usually sinks as rapidly\\nas it rose, and may attain its normal standard within a few\\nhours, or in a single night; then desquamation of the\\nepidermis, in the form of large or branny scales, and\\nwrinkling of the skin terminate the local process. The\\nhair usually falls out, but quickly grows again. The\\nskin, too, recovers its normal vState; only upon the eye-\\nlids, the scrotum, the prepuce and vulva, where it is\\nnaturally tender, it may in severe cases undergo a more\\nor less extensive gangrenous destruction, and its duration\\nbe prolonged to several weeks, even months.\\nUnlike to other infectious fevers, erysipelas leaves a\\nvery great susceptibility for renewed attacks. Not a few\\npersons are subject to a periodically returning form the\\nso-called Habitual erysipelas, which mostly affects the\\nface or lower extremities.\\nPhlegmonous erysipelas is usually the result of an\\ninjury, and deep abscesses form in various parts of the\\nbody, discharging a foul, dirty pus. These cases are\\nvery serious, and often prove fatal.\\nDr. H. I^anderer relates the history of a case of melan-\\ncholia of seven months standing and progressing towards\\nincurable dementia, in which the patient, a young girl,\\nrecovered completely from her mental affection simul-\\ntaneously with the subsidence of an attack of facial\\nerysipelas spreading to the scalp. Two or three years\\nhad elapsed when the report was made, and she still\\nmaintains perfect health.\\nBurns has collected twenty-two cases of tumors which\\nwere the seat of idiopathic erysipelas. Three cases of\\nsarcoma were permanently cured. In four cases of", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0124.jp2"}, "123": {"fulltext": "TREATMENT. 119\\nlymphona of the neck, some of the glands entirely disap-\\npeared, and the others became smaller. In fiv^e cases\\nerysipelas was artificially produced. Three of these cases\\nwere of carcinoma of the breast. In one of them the\\ndisease was not checked; in another the tumor was\\ndiminished to one-half its former size, and the third was\\npractically cured, a small induration in the scar, the size\\nof a pea, remaining. A multiple fibroid sarcoma was\\ndiminished in size, and an orbital sarcoma was unchanged.\\nM}^ own observation has been limited to one case, a\\ncarcinoma of the breast. Erysipelas was artificially^ pro-\\nduced, with the result of death in about three weeks.\\nNo effect was produced upon the carcinoma.\\nTreatment.\\nLocal. The use of oven- dried rj^e meal, or powdered\\nstarch may afford much comfort to the sufferer. The\\nstarch, for such purpose should be carefully prepared by\\nwashing it in cold water in order to remove all foreign\\nmatters; it should then be allowed to settle, the supernat-\\nant water poured off, and the starch then slowly dried.\\nDuring the dr3 ing process it should, from time to time,\\nbe broken up so as to expose fresh surfaces, thereby\\nhastening the process. The starch is thus readily con-\\nverted into an almost impalpable powder, which, when\\napplied to the inflamed surface, promptly relieves the\\nitching and burning. Applications containing fattj^ sub-\\nstances are usually harmful in their effects.\\nThe following makes an excellent application in some\\ncases: The site of the disease is to be painted with this\\nmixture every two hours, and then covered with anti-\\nseptic gauze.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0125.jp2"}, "124": {"fulltext": "120 SKIN DISEASES.\\n1^ Carbolic acid,\\nTincture of iodine,\\nRectified spirit, aa 5j-\\nOil of turpentine, ,^jj.\\nGlycerin, 5jjj.\\nDr. Hilsman recommends the application of strong heat\\nto the parts affected. This procedure is evidently homoeo-\\npathic. Erysipelas is a dermatitis of a specific character,\\nand the application of a high degree of heat produces,\\nitself, a dermatitis. Whether the high heat kills the\\nmicrobe of erysipelas or not does not affect the homoeo-\\npathicity of the treatment. The parts attacked by ery-\\nsipelas are covered with heavy felt and then a red-hot\\nsmoothing iron applied forward and backward over the\\nfelt which heats the affected parts and removes the ery-\\nsipelas. Some cases are intolerant of heat.\\nThe external application of raw cotton to the inflamed\\nparts, to keep off the air, as in burns, is recommended by\\nseveral physicians.\\nI have found the application of Ver. vir, one teaspoon-\\nful of tincture to half a glass of warm water, to be very\\nsoothing.\\nIn domestic practice a poultice of raw cranberries, or\\nscraped potatoes, or raw carrots, is often used with\\ndecided benefit.\\nThe indications for remedies are as follows:\\nAcojiite. Intense synochal fever, with restlessness, fear\\nof death, etc.\\nAmmon. carb. Erysipelas of old people, when cerebral\\nsymptoms are developed, while the eruption is still out;\\ndebility and soreness of the whole body; tendency to\\ngangrenous destruction.\\nAnthracin. Erysipelas gangrenosa with typhoid symp-\\ntoms; great pain in head and dizziness; delirium and un-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0126.jp2"}, "125": {"fulltext": "TREATMENT. 121\\nconsciousness; great prostration and depression; fainting\\nand copious sweating; sleep short, unrefreshing, more\\nlike stupor.\\nApis. Erysipelas, with bruised sore pain and much\\nswelling; stinging, burning, prickling pains in the skin,\\nwhich is very sensitive to the slightest touch; erysipelas\\nof the face a?id scalp, with puffiness of the eyelids; typhoid\\ntendency; sphacelated spots here and there; the whole\\neruption rather pale than deep red; chronic erysipelas,\\nrecurring periodically^; apt to go from right to left.\\nArctium lappa. Chronic erysipelas is said to be re-\\nmoved permanently b}^ its persistent use. {Gymnocladus\\nPtelea.)\\nArnica. Phlegmonous erysipelas, with extreme tender-\\nness and painfulness on pressure, with tendency to the\\nformation of bullae; the swelling hot, hard, shining, even\\ndeep red; the patient feels nervous, cannot stand pain,\\nand feels tired as after hard work, or as if beaten.\\nArsejiic. Irregular progress; disposition to internal\\norgans; terrible restlessness and sinking of strength;\\nfainting pain in the bowels and hemorrhage, as sometimes\\noccurs in large burns.\\nBelladonna. Intense erysipelatous fever, accompanied\\nby inflamed swellings, passing even into gangrene; skin\\nimparts a burning sensation to the examining hand;\\nphlegmonous erysipelas; tendency to attack the brain,\\nwith delirium; severe headache, furious look, violent\\nthirst, dry tongue, parched lips, etc.; smooth and shining\\nerysipelas on the right side of the face; tendency of in-\\nflammation to spread in streaks.\\nBorax. Erysipelas of the left side of the face, painful\\nwhen laughing, with sensation as if covered by cobwebs.\\nBryonia.\u00e2\u0080\u0094 Erysipelas articulorum^ with drawing-tearing\\npains, increased by motion.\\n9", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0127.jp2"}, "126": {"fulltext": "122 SKIN DISEASES.\\nCamphora. Great exhaustion coldness of skin; breath-\\ning scarcely audible or visible.\\nCantharides. Typhoid erysipelas; vesicular erysipelas\\nwith fine stinging-burning pains internally and externally,\\nthe patient being uneasy, restless, distressed, dissatisfied;\\nunquenchable thirst, with disgust for all sorts of drinks;\\nkidneys and bladder involved; erysipelas begins on\\ndorsum of nose and spreads to both cheeks, but more to\\nthe right.\\nComocladia. Burning on face and eyes, worse to-\\nwards evening; excessive swelling of the face, with\\ntormenting itching and swelling; corrosive itching of the\\nhead; dizziness and heaviness of the head, with shooting\\npains, relieved by motion.\\nCroton tigl. CKdematous swelling of eyelids; large\\nand small blisters; intermediate skin cracked and peeling\\noff; violent burning.\\nCuprum. Sudden sinking of the swelling and chang-\\ning into a bluish color; violent brain symptoms.\\nEuphorbium. Erysipelas of head and face, with dig-\\nging, boring, and gnawing pains, followed, when amelior-\\nated, by creeping and itching of the part. Considerable\\nswelling of the parts affected, with small vesicles dis-\\ncharging a rather yellowish fluid.\\nEucalyptus glob. General erysipelas, with putrid\\ndysenteric passages; typhoid symptoms. A desire to be\\nconstantly moving about.\\nFerrum phos. Rose and erysipelatous inflammations\\nof the skin, for the fever and pain and severe symptoms\\nof inflammation.\\nGraphites. Chronic disposition of the disease to return,\\nfrom right to left; phlegmonous erysipelas of head and\\nface, with burning-tingling pains; swelling and induration", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0128.jp2"}, "127": {"fulltext": "TREATMENT. 123\\nof lymphatics and glands; very liable to take cold from\\nthe least cold air.\\nHydrastis. Wandering from left side of nose to right\\nover whole face and scalp; intense pain in the lumbar\\nregion; chills down the back; extremely restless; dis-\\nturbed by noise; delirium; urine suppressed.\\nHydrophyllimi Virg. Burning and watering of e3^es,\\nwith slight itching. Eyelids swollen, sclerotica injected,\\nfiery redness, sensitive to light. In the morning eyelids\\nagglutinated.\\nIpecac. Retrocession of eruption, with vomiting.\\nKalicarb. From right to left side; oedematous swell-\\ning under the eyebrows. When touched ever so slightly\\non his feet, he jerks them up much frightened; he talks\\nof pigeons flj-ing in the room, which he tries to catch with\\nhis hands; he gets regularly worse about 3 o clock A. m.\\nAfter previous attacks.\\nKali mur. Schiissler says this is the chief remedy in\\nvesicular erysipelas.\\nKali sulph. Blistering variety, to facilitate the falling\\noff of scabs.\\nLachesis. Where the cerebral affection does not yield\\nto Belladoiuia bloated red face, attended with heat;\\nheadache and coldness of the extremities; one-sided tense\\nheadache, extending from occiput to eyes, with vomiting,\\nvertigo, tendency to faint, and numbness; left side espe-\\ncially affected. {Bell., right).\\nLedum. Erysipelas of face and eyes from bites of\\ninsects.\\nNati um phos. Er3^sipelas, smooth, red, shiny, ting-\\nling or painful swelling of the skin.\\nNatrum sulph. For the smooth form, with or without\\nvomiting of bile.\\nNatrum benzoicum Dr. Haberkorn uses this drug in", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0129.jp2"}, "128": {"fulltext": "124 SKIN DISEASES.\\nfull physiological doses and given in seltzer water. He\\nhas treated fifty cases without a death, and reports that\\nalmost uniformly within forty-eight hours the tempera-\\nture was reduced to normal, and the patient felt well.\\nThe local symptoms quickly subsided, ending with des-\\nquamation. No local treatment was used.\\nNux vomica. Gastrosis the cause of the erysipelas;\\nburning itching all over the skin, worse in the evening;\\ngreat debility, with oversensitiveness of all the senses, and\\nirritability of temper.\\nPulsatilla. Erysipelas erraticum bluish, spreading\\nrapidly, especially about buttocks and thighs; smooth\\nskin, headache; mucous diarrhoea, nausea, neither appetite\\nnor thirst.\\nRh2is rad. Phlegmonous erysipelas, especially when it\\nbegins in the ankle and moves gradually up the leg in\\nthe deeper tissues; sometimes with very little fever.\\nRhtis tox. Vesicular erysipelas itching all over, espe-\\ncially on hairy parts; after scratching burning; swelling\\nand redness of the face, with partial or entire closure of\\nthe eyelids; bruised feeling in the limbs and back;\\ntendency to attack the brain; dark bluish redness of the\\nparts affected.\\nRhus ven. The symptoms usually begin by itching\\nand tumefaction in the hands and face, the swelling\\ngradually spreading over different parts of the body.\\nRuta. In combination with wounds.\\nSulphur. Erysipelas migrans, appearing in subsequent\\nthroes, and running its course for a longer time than\\nusual. Helps often when all other remedies fail.\\nTerebinthina. Erysipelas buUosum, skin red and in-\\ndurated, swollen; clusters of small, flat, pale, yellow vesi-\\ncles, often confluent, with large red halos, here and there\\nturning bluish-black, showing a tendency to gangrene.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0130.jp2"}, "129": {"fulltext": "RUBELLA. 125\\nTrichlorphe7iol. The daily application of a 5 to 10 per\\ncent, solution of Trichloi^phenol by means of a brush to\\nan erysipelatous surface has been accompanied by ex-\\ncellent results.\\nVerat. vir. Right side of head and face much swollen\\nand covered with large blisters; headache; high fever;\\nno sleep; no appetite; intermitting attacks of nausea;\\noccasional vomiting of the water drank. It was applied\\nlow, externally and internally.\\nRubella.\\nThere is a form of eruption which resembles measles,\\nbut differs in several particulars, and about which some\\ndispute exists. It has received several names, as, for ex-\\nample, rubeola notha, roseola, rotheln, rosalia, German\\nmeasles, etc. Rubella is undoubtedly the proper term for\\nthis rose-red colored eruptive fever. Very little is written\\nof it in our text- books, although it is a disease of frequent\\noccurrence. It is probably contagious, and is more prone\\nto be epidemic than either measles or scarlet fever. One\\nattack usually protects from subsequent invasion, but\\ndoes not protect from either measles or scarlet fever.\\nRubella occurs chiefl}^ between the ages of three and\\ntwelve years. It may be seen in infants, rarely adults,\\nand is characterized by stages of incubation, invasion,\\neruption, and decline, and closely resembles measles in\\nsome cases, and scarlet fever in others.\\nThe history of the patient will aid diagnosis. Has the\\nchild had either scarlet fever or measles Are either of\\nthese diseases existing epidemically? The stage of\\nincubation varies from four to twenty-one days. The in-\\nvasion stage is from twelve to twenty-four hours. Catar-\\nrhal symptoms absent,. though the fauces are reddened.\\nOne of the most characteristic symptoms of rubella is the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0131.jp2"}, "130": {"fulltext": "126 SKIN DISEASES.\\nenlargement and induration of the cervical, post-cervical\\nand post-auricular glands. Occasionally only a fev^ of\\nthese glands may be affected, but more often the entire\\nchain, also the lymphatic glands in other parts of the\\nbody, may be involved.\\nThe eruption may first appear, like the eruption of\\nmeasles, upon the face, but spreads more rapidly over the\\nsurface, or it may appear over the whole surface at once;\\nit is most intense during the first day; it may rapidly\\nfade in one part and appear in another; in color it is of a\\npale rose-red, but not so red as scarlet fever, nor so\\nbluish as measles.\\nOver the more vascular parts it is often slightly\\nelevated, with a tendency to become confluent. In other\\nparts it is more maculate in form and of a much higher\\ncolor in the centre; nor do we have the characteristic\\nodor so peculiar to measles. The tongue is usually\\nslightly coated and cleans in patches, producing the so-\\ncalled mapped tongue but never the strawberry\\ntongue. Desquamation is slightly branny, and follows\\nthe eruption in nearly every case. In some cases it is\\nwell marked; in others, however, it may only be observed\\non some particular parts, as about the nose, and may last\\nfor three weeks or more. The patient very quickly re-\\ncovers; there is no dropsy or renal disease following in\\nits wake.\\nFor internal remedies consult Rubeola.\\nFrambcesia, or Yaws.\\nThis disease is confined almost exclusively to the negro\\nrace; it originated on Guinea coast of Africa. It is a\\nconstitutional disorder, attended often with fever, and by\\na peculiar papular eruption, sometimes having almost a\\ncrimson appearance like that of a wild raspberry, hence", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0132.jp2"}, "131": {"fulltext": "FRAMBCESIA OR YAWS. 127\\nits name. Its probable cause was syphilis, spread among\\nthe negroes of West Africa by the English traders. Proofs\\nof its venereal origin are as follows:\\n1. That it is contagious, and can be inoculated in the\\nsame manner as matter taken from an indurated chancre.\\n2. It is accompanied by ulcerated throat and pains in\\nthe bones.\\n3. The eruption is of a secondary specific type, though\\nnot of the usual lean-ham color but yellowish- white, hav-\\ning an ulcerative tendency.\\n4. It is transmitted by parents to their offspring.\\n5. Such children infect those who suckle them.\\n6. The disease is much improved by mercurial treat-\\nment.\\n7. The pathological histology of the papules resembles\\nthe tissues found in syphilitic gummata.\\nThe disease begins with malaise and fever, pains in the\\nhead and bones which are worse at night, and ulcerated\\nthroat. The body becomes covered with yellowish- white\\npatches of varying size, with the formation of papules\\nwhich break down and ulcerate under a scab with great\\nloss of tissue. The eruption generally breaks out in the\\nface, the neck, the upper and lower extremities, the parts\\nof generation, the perineum, the hips, and about the\\nanus. They are much less frequently observed about the\\ntrunk, and are not so often seen on the hairy scalp. They\\nmay form on the nostrils where the mucous membrane\\njoins the skin, and here the yaws may assume an\\nelongated form, nearly closing the nostril, and hanging\\ndown on the lip. The same form may be observed about\\nthe eyelid. Near to the mouth they may appear in such\\nnumbers and so closely set together as to form almost a\\nring round the mouth. This is especially the case in\\nchildren. Around the anus also they sometimes coalesce", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0133.jp2"}, "132": {"fulltext": "128 SKIN DISEASES.\\nand form one projecting circular band an inch and more\\nin breadth.\\nAn attack of framboesia varies much in severity as re-\\ngards the size and number of actual yaws.\\nAfter the disappearance of the yaws without ulceration,\\na dark spot is left where each yaw has been and of cor-\\nresponding size. These spots are of deeper shade than\\nthe natural black of the skin, and they remain for many\\nyears, but may possibly wear out in time. The skin is\\nquite smooth, and the texture uninjured. In white\\nskins the spots are of lighter hue than natural. When,\\nhowever, the disease ulcerates scars are left.\\nShould yaws not properly develop its several early stages\\nthe general health suffers, the patient becomes cachectic,\\nunhealthy ulcerations appear over the body, especially\\nabout the joints, which swell and become painful, and\\noffensive effluvia are given off from the body, and the at-\\ntacked dies a lingering death, or becomes crippled, more\\nor less, by the deep ulcerations.\\nThe mercurial preparations, and Jatropha curcas, are\\nthe principal internal remedies", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0134.jp2"}, "133": {"fulltext": "CHAPTER VII.\\nPAPULAR INFLAMMATIONS.\\nLichen Planus.\\nLichen planus is a non-contagious affection of the skin,\\ncharacterized by the development of small, flattened\\npapules, which frequently present a distinct central de-\\npression or umbilicus.\\nLichen planus is an eruption of pimples, remarkable\\nfor their color, their figure, their structure, their habits\\nof isolated and aggregated development, their habitat,\\ntheir local and chronic character, and for the melasmic\\nstains which they leave behind them when they disap-\\npear.\\nThe color of the pimples is a dull crimson-red, more or\\nless livid, and suffused with a purplish or lilac tinge.\\nIn figure the papulae are flattened, smooth, and de-\\npressed on the summit, angular in outline, but slightty\\nelevated, and of a size ranging between one and three\\nlines in diameter the flatness is rendered more con-\\nspicuous by the summit of the papule being occupied by\\na thin, horny, semi-transparent lamina of cuticle, de-\\npressed on the surface, and marked by the aperture of a\\nfollicle, which represents a sort of hilum. In structure,\\nthe papule of lichen planus is a hypersemia with exuda-\\ntion, surrounding a follicle and surrounding a thin layer of\\nhorny, transparent cuticle while the aperture of the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0135.jp2"}, "134": {"fulltext": "130 SKIN DISEASES.\\nfollicle and its conical epidermic plug are visible in the\\ncenter of the horny plate. The horny covering is in no-\\nwise a scale it rises and falls with the papule and neither\\nseparates nor exfoliates.\\nLichen planus presents two principal forms of manifes-\\ntation discrete and aggregate.\\nThe habitat of the eruption is also characteristic of the\\nidentity of lichen planus. It is pretty constantly met\\nwith on the front of the forearm, just above the wrist\\nin the hollow of the loins; on the lower half of the abdo-\\nmen; on the hips; around the knees, particularly over the\\nmass of the vastus internus muscle; on the forearms and\\ncalves of the legs, and in women around the waist and in the\\ngrooves occasioned by the garters. We have seen it also,\\nbut less frequently, on the palms of the hands and soles\\nof the feet; and in two instances on the tongue, the\\nbuccal membrane, and the mucous lining of the fauces.\\nlyichen planus is essentially chronic and local in its\\nhabits. In distribution it is generally symmetrical, but\\noccasionally is limited to one side of the body; sometimes\\noccurring on one side in the upper extremity, and on the\\nother in the lower. It has no constitutional symptoms of\\nits own, and frequently prevails with very little disturb-\\nance of any kind.\\nOf course, the totality of the characters above noted\\nare not to be found in every case. The characteristic\\nfeatures, however, are the flattened umbilical papules.\\nThis central depression may not be noted in every papule;\\nand when a number of them have run together and\\ncoalesced, it is commonly absent, and met with only on\\nthose in the neighborhood of, but which do not form a\\npart of, the patch.\\nThe duration of the affection is indefinite. It may\\nundergo resolution, and the papules disappear after three", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0136.jp2"}, "135": {"fulltext": "LICHEN PLANUS. 131\\nor four months; or, especiall}^ when the eruption is ex-\\ntensive, may resist the best-directed treatment for a year\\nor more.\\nEtiology. No one has thus far offered a plausible ex-\\nplanation of the causes of lichen planus. It is undoubt-\\nedly a constitutional affection, but whether due to cer-\\ntain unknown changes in the blood, or to a reflected irri-\\ntation from some special internal organ, is entireh^ un-\\nknown.\\nDiagnosis. In general aspect the affection may be\\nmistaken for a papular syphilide, or a papular eczema,\\nbut hardly for any other than those two diseases, except\\nit be the lichen ruber of Hebra. The positive features,\\nhowever, that have been detailed above do not occur in\\nthe diseases mentioned, and are sufficient of themselves\\nto establish the diagnosis.\\nThe prognosis of lichen planus is favorable, as there\\nis little or no evidence that it tends either directly or\\nindirectly to shorten life. The duration of a given erup-\\ntion, however, is very uncertain, except that, in a general\\nway, the more extensive the lesions the longer they may\\nbe expected to remain.\\nTreatment. Locally, chrysarobin, thirty grains,\\nwith one ounce of traumaticin (liquor gutta percha). This\\nshould be painted on the spots daily until a considerable\\ndegree of local irritation is produced. Sedative applica-\\ntions should then be applied for a few days, and the skin\\nallowed to recover from the effects of the drug. A single\\ncourse of this sort will cause most of the spots to disap-\\npear.\\nWhen there is much itching, temporary relief is af-\\nforded by the application of cloths wrung out in hot\\nwater. Should the itching prove obstinate, a weak car-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0137.jp2"}, "136": {"fulltext": "132 SKIN DISEASES.\\nbolized oil and lime water lotion, or grindelia robusta,\\ndr. j. to water gj may be used.\\nThe following ointment has proven very beneficial in\\nmany cases, to relieve the itching of lichen planus and\\neczema:\\n9^ Chloral hydratis, dr. ss.\\nCamph. pulv., dr. ss.\\nAcidi carbolici, m. x.\\nBalsum peru., dr. j.\\nMenthol, grs. xx.\\nUng, zinci oxidi, q. s. ad. ^j-\\nM. fl. unguent., Sig. Apply morning and night.\\nAs regards internal treatment the old school rely al-\\nmost entirely upon arsenic, giving preference to Fowler s\\nsolution.\\nThe patient should be liberally fed and well hygiened.\\nHomoeopathic Remedies.\\nA?iHmon crud. is the principal internal remedy.\\nOthers are indicated as follows:\\nAgaricus 7nusc. Eruption of small pimples with red\\nareolae and violent itching. Sensation in various parts\\nas if ice cold needles were piercing the skin. In light\\ncomplexioned persons and drunkards.\\nArsen. alb. In chronic cases. Burning itching, pain-\\nful after scratching. Great weakness and- prostration.\\nOppression of breathing.\\nChinin. ars. In the diffused form with threatening\\nmarasmus. Chronic intestinal derangements.\\nIodine. Small dry, red pimples on the arms, chest\\nand back, with jerking sensation while appearing.\\nRough, dry skin. Emaciation. Ravenous hunger.\\nKali bichrom. Papular eruptions on the forearms.\\nRheumatic pains in the limbs. In fat light complexioned\\nindividuals.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0138.jp2"}, "137": {"fulltext": "LICHEN RUBER. 133\\nLedum. Eruption of pimples on the forehead as in\\nbrandy drinkers. Eruption of small pimples like red\\nmillet seeds over the body. Excessive itching on the\\nbacks of both feet, worse after scratching, and by warmth\\nof bed. Relieved after scratching the feet sore.\\nNux jugla7is. Red pimples on face, neck, shoulders\\nand back. Little tubercles with hard scurf on the in-\\nstep.\\nPotassium iodide. Lichen on the face and shoulders.\\nSensitive swelling of the thyroid gland, great general\\ndebility.\\nSarsaparilla. Red dry pimples. Burning itching\\nwith chilliness.\\nStaphisagria. Itching pimplj eruption over the face\\nand behind the ears, with rough skin. Burning of the\\neruption after scratching.\\nSulphur iodide. Red pimples on the nose, chin and\\narms, with itching. In chronic cases.\\nLichen Ruber.\\nTo Hebra is due the description of an eruption to which\\nhe applied the name above given. It, like lichen planus,\\nis a papular affection, but the papules present a different\\naspect, and they are acuminate, not Jlatte?ied. They do\\nnot exhibit the central hilum. The papules rarely\\nif ever undergo spontaneous resolution, but persist\\nthroughout the entire period of the disease, which, as a\\nrule, terminates with the patient s death. The papules\\nat first are discrete, and each is decked with a minute\\nadhering scale. New papules continue to form, and in\\ntime considerable patches, raised, red, and scaly, come\\ninto existence.\\nThe prognosis is essentially grave. A few cases have", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0139.jp2"}, "138": {"fulltext": "134 SKIN DISEASES.\\nbeen reported cured, but in the majority the disease lasted\\nuntil death terminated the patient s existence.\\nExternally we may seek with some measure of success\\nto procure resolution of the lesions by active substitutive\\ntreatment, involving the use of iodine, bichloride of\\nmercury, carbolic acid, strong alkaline applications, etc.;\\nbut whether either or all of them is capable of retarding\\nthe usual termination is problematical.\\nThere are several varieties of lichen given by different\\nauthors, but, as they are but forms of either the two above\\nmentioned or lichen simplex, we will omit them, especially\\nas they will be referred to in the description of the various\\nlesions of the skin, and simply give a description of lichen\\nsimplex.\\nOne case, reported in one of our journals I would like\\nto mention, as showing the efficacy of a well chosen ho-\\nmoeopathic remedy.\\nThe case, as reported, is as follows:\\nCure of Lichen Urticarius by Thuja.\\nA gentleman brought his fourteen year old son for\\ntreatment for a skin affection that had defied two able\\nspecialists. He had been treated both internally and ex-\\nternally and strictly dieted but without effect. The\\nlichen was wont to come periodically in the warm weather;\\nthe patient literally tears himself because of the irritation.\\nThe rash was much worse on the left side, that being the\\nside on which he was vaccinated. Thuja 30, was ordered\\nin very infrequent doses. The spots continued to appear\\nfor a week after taking the powders, then they disap-\\npeared and he has remained quite free from them,\\nalthough eating freely of meat, fish and fruit. It may be\\nremarked that the cure took effect during warm weather,\\nand that the uticarius lumps were described as worse in\\nthe warmth.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0140.jp2"}, "139": {"fulltext": "LICHEN SIMPLEX. 135\\nLichen Simplex.\\nIvichen simplex includes as its sub- varieties, ly. circurn-\\nscriptus, L. agrius, and L. pilaris.\\nLichen shnplex is often seen in the summer, sometimes\\nrecurring in the same person several times; the papules\\nare flesh- colored, red, smallish, sometimes very minute,\\nand more or less pointed, lasting a week or so, and fol-\\nlowed up by the development of others; the papules are\\nusually seen on the back of the hand, the outer aspect of\\nthe forearm, the neck, and the thighs. The}^ are accom-\\npanied by a good deal of itching. The papules disappear\\nby resorption, and never become vesicles or pustules.\\nThis lichen may last for weeks and months. The disap-\\npearance of the papules gives rise to a little desquamation.\\nThe skin generally is dry and thickened. The disease is\\nrare. L. circumscriptus is the name given to the disease\\nwhen the papules are collected together into little round\\nor roundish elevated patches; the border of the diseased\\npatches in such cases is well defined and papular, the\\nsurface elevated, rough and dry to the feel; its area in-\\ncreases by circumferential enlargement, and its centre\\npresently clears somewhat; there are generally several\\ncircles, and their most usual situation is the back of the\\nforearm or the hip; at other times the back of the hand\\nor calf may be affected, or the inside of the thigh. The\\npatches after a while get more or less scaly, or inflamed\\nand cracked, simulating eczema, but never actually dis-\\ncharging; or in consequence of the centre healing, assume\\na circinate form; but the history, absence of moisture,\\nand the dry red roughened base are distinctive.\\nLichen agrius^ or the inflamed form of lichen, diflfers", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0141.jp2"}, "140": {"fulltext": "136 SKIN DISEASl^S.\\nfrom the above in the presence of secretion, and hence\\napproaches eczema; but it is, as its name implies, an\\nacute, inflamed Hchen. The local manisfestation consists\\nof clustered or closely packed red papulae, accompanied\\nby intense itching and burning, causing the patient to\\nscratch violently; this in its turn sets up additional irrita-\\ntion, the torn and excoriated papulae are inflamed, and\\nexude a thin fluid; the whole patch thickens, fissures,\\nand becomes covered over with thin scales, not the yellow\\npuriform scales of eczema. I^ichen agrius may also arise\\nby inflammation of the chronic stage of any of the other\\nforms of lichen, and not primarily as an acute form.\\nThe acute state lasts about ten or fifteen days, the chronic\\nweeks or months; this variety of lichen is observed about\\nthe back, neck, legs, arms, and shoulders; it constitutes\\none aspect of grocers bricklayers and bakers itch.\\nVesicles and pustules may, however, form; and then\\nthere is an inflamed, raised, reddened, excoriated, dis-\\ncharging, fissured patch, the seat of intense and often in-\\ntolerable itching and burning, made worse by stimulation\\nof all kinds, especially the warmth of bed. The disease\\neither subsides or increases by the development of fresh\\ncrops of papulae.\\nLichen pilaris. Occasionally one sees, either alone or\\nin conjunction with ordinary lichen, or other disease\\nwhere the skin is hyperaemic, little elevations like\\npapulae, which are, however, seated at the hair follicles;\\nthe hair in fact piercing the centre of the papule. A dis-\\ntinct lump is felt by the finger. Hyperaemia of the fol-\\nlicular plexus is followed by fibrous deposit outside the\\nfollicle, forming a papule.\\nWhen this is accompanied by inflammatory deposit,\\nthen solid papules are formed at the hair follicles and\\nconstitute lichen pilaris.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0142.jp2"}, "141": {"fulltext": "LICHEN SIMPLEX. 137\\nLichen pilaris is then fibrous inflammation seated at\\nthe upper part of the hair follicles, the effusion of plastic\\nlymph taking place around the follicular walls, and pro-\\nducing, according to its degree, more or less well marked\\nand distinct papulation, each elevation being perforated\\nby a hair. It must not be confounded with pityriasis\\npilaris, which is merely a desquamation of cuticular\\ncells into, and distending, the hair follicles, preventing\\nthe formation of the hair, and producing a blocking up\\nof the follicles, the collected cells forming a knot in\\nthe upper part of each follicle, a state of things that may\\noccur after pityriasis rubra, or as the result of an in-\\nactive state of skin, especially about the thighs, and\\nwhich latter only needs the free use of soap and water\\nfor its removal.\\nPrognosis. As a rule, the simple forms get well,\\nwith proper treatment, in two or three weeks. L. cir-\\ncumscriphis and agrius are often very obstinate.\\nLichen appears to be common in those of nervous tem-\\nperament and in summer time. It attacks all ages, and\\nis evoked by local and reflex irritation, by a deficiency of\\nalkali in the system; irregularities mental, phj^sical,\\nalimentative, etc.; hereditary tendency; certain occupa-\\ntions e. g. cooks, bakers, grocers, bricklayers, etc. hot\\nclimates, all seem to be causative factors of this disease.\\nDiagnosis. We frequently find some difficulty here.\\nThe chief points to remember in regard to lichen are the\\ndry and thickened state of the skin and the presence of\\npapules, which are always to be found, if the disease is\\nin patches, at the extending edge; the hard feel of the\\npapules, and their tingling or itchiness. Lichen simplex\\nand scabies may be confounded, Liche7i is uniform,\\nscabies multiform. In scabies, besides papules there are\\nvesicles, often pustules, and the papules are not so closely\\nID", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0143.jp2"}, "142": {"fulltext": "138 SKIN DISEASES.\\naggregated; the eruption also is in the line of flexion,\\nnot, as in lichen, in that of extension e., lichen is\\nseen chiefly on the outer aspect of the arm; it may occur\\non the back of the hands and fingers, but it is not inter-\\ndigital, lyichen simplex never occurs in the feet; it is\\ncommon on the face; scabies is not. In scabies, too,\\nthere is the characteristic vesicle and sillon, whilst the\\ndisease is contagious and easily removed by sulphur\\ntreatment.\\nPhtheiriasis may simulate lichen, but it is associated\\nwith an unhealthy, relaxed, muddy, dirty state of the\\nskin flabby is the word; the papules (which are pale)\\nare fewer in number, and each is marked at its apex with\\na dark speck (dried blood) effused as the result of scratch-\\ning. The skin is not thickened and dry, as in lichen,\\nnor is there any attempt at scaliness, as in lichen,\\nnor aggregation of papules into patches or groups.\\nPhtheiriasis is essentially a disease of advanced age. It\\noccurs in the uncleanly, and there is often a peculiar\\nurticated state of skin, seen very markedly on the back\\nand chest, produced by an exaggeration of the spaces\\nenclosed by the normal furrows. Phtheiriasis does not\\noccur about the face; the sensation is one of formication,\\nand is altogether out of proportion to the local disease,\\nwhilst pediculi may frequently be detected in the folds of\\nthe linen.\\nLichen agrius resembles eczema, but the latter is moist\\nand discharging, occurs in delicate and thin, not in harsh\\ndry skins; again, the history and edge of the patch in\\nlichen point to the existence of papules; then the patch is\\nmuch thicker and harsher than in eczema, and wants its\\nthick yellow crusts; the latter in lichen are thin, pretty\\nfew, and flimsy.\\nIt is impoi:tant to remember that scabies may be com-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0144.jp2"}, "143": {"fulltext": "LICHEN SIMPLEX. 139\\nplicated with lichen, and the latter may be set up as the\\nresult of irritation in scabies. One sees this state of things\\nvery frequently in the hot season the irritation of a few\\nscabious spots bringing out a pretty general lichen.\\nTreatment. The following ointments are sometimes\\nuseful\\n9? Chloroform, M. vjjj.\\nGlycerine, 3j-\\nWhite wax ointment, 5vj.\\nCyanide of potassium, gr. iv.\\nM. Sig. Apply night and morning.\\nOr,\\n9^ Carbonate of lead, gr. iv.\\nGlyerine, 5j.\\nSimple cerate, gj.\\nM. Sig. Use as above.\\nFor the itching, the prescription mentioned in lichen\\nplanus, or,\\n1^ Dilute hydrocyanic acid, dr. ss.\\nBrandish s solution of potash, dr. j.\\nRose water, gvj.\\nM. Apply as needed.\\nOne of the following internal remedies will generally\\nbe indicated:\\nAlumina. Red pimples on the face. Pimples on the\\nneck and back. Intolerable itching of the whole body,\\nespecially when becoming heated in bed.\\nAmmon. mur. Pimples on the back of the hands\\ndesquamating next day.\\nAnatherimn. Red pimples with itching and burning.\\nScarlet skin with burning.\\nAnthnon. crud. Small red pimples on right shoulder.\\nFrom digestive derangement.\\nArsen. alb, In chronic cases with burning itching.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0145.jp2"}, "144": {"fulltext": "140 SKIN DISEASES.\\nBelladonna. Papular eruption on the hands like lichen\\nagrius.\\nBovista. Red pimples on the foot.\\nBryonia. Pimples on the abdomen and hips.\\nCastanea vesca. -Several small pimples on the right\\nthigh, back of the left ear, and on the left upper lip.\\nCaladium. Pimples on the nions veneris. Soreness of\\npimples to the touch.\\nKreasote. Forehead covered with pimples the size of\\nmillet seeds.\\nLedum. Small pimples like red millet seeds over the\\nwhole body. In brandy drinkers.\\nMercurius. Pimples on the labia. Voluptuous itching.\\nItching changes to burning by scratching.\\nNabulus serp. Pimples on the face about the nose,\\nupper lip and chest with itching.\\nNatrum carb. Pimples on the face and lips. White\\npimples on the nose.\\nNux juglans. Red pimples on the face and neck.\\nPricking itching.\\nPlantago. Hard white flattened isolated papules on the\\ninside of the thigh. Some papules have a red point in the\\ncentre.\\nPhytolacca. Pimples with itching on the left leg.\\nWorse first part of the night.\\nRumex crisp. Red pimples on calves of the legs, with\\nitching worse immediately after undressing.\\nSepia. Pimples close together on the face. Pimples\\non the legs, and in the bends of the joints.\\nSulphur. Pimples on inner parts of the thighs. In\\nsimple cases.\\nSidph. iod. Red pimples on the nose, chin and arms.\\nTilia. Eruption of small red, rather deeply seated\\npimples, with violent itching and burning like fire after\\nscratching.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0146.jp2"}, "145": {"fulltext": "LICHEN SCROFULOSORUM. 141\\nLichen Scrofulosorum.\\nThe disease occurs essentially in strumous subjects. It\\nshows itself in the form of little elevations about the size\\nof millet seeds, either pale, or yellowish, or a brownish-\\nred color. These papules never become vesicles; they\\nare grouped together, sometimes in circles, sometimes in\\nsegments of circles. The papules are seated at the hair\\nfollicles, and are by-and-by covered by thin scales; the\\npatches itch slightly, but not so much as to be scratched,\\nand hence they are not excoriated.\\nThe patches remain in one condition a long time, and\\nundergo no changes but exfoliation and involution. The\\ndisease is limited to the trunk, the bellj^, the breast, and\\nback, being rare on the extremities. Its course is very\\nslow. Generally speaking many groups of papules\\ndevelop at the same time. They soon reach the height\\nof development, and then remain awhile in statu quo. In\\nconsequence of the absence of local symptoms, the disease\\nexists unnoticed for some time. When at its acme, other\\nsymptoms are observed; between the groups, and at the\\nsame time, on parts free from lichen that is, on the ex-\\ntremities and face more or less numerous isolated bluish-\\nred elevations are developed; these are about the size of\\nlentils, and look very much like common acne; some of\\nthe papules are said to contain pus; then by-and-by they\\nwither and disappear, leaving dark pigmented lentil-sized\\nmarks in some places, whilst in others fresh formations\\ntake place. The skin between the diseased patches is the\\nseat of desquamation, the scales being pale and shining,\\nwhilst the whole skin may assume a cachectic appearance.\\nIn 90 per cent., the disease is observed in markedly", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0147.jp2"}, "146": {"fulltext": "142 SKIN DISEAvSES.\\nscrofulous subjects, and particularly children, together\\nwith swelling of the submaxillary, cervical, and axillary\\nglands, with caries and necrosis, or tabes mesenterica.\\nThe treatment is the same as for scrofula. Cod-liver\\noil internally, with inunctions of oil externally is a great\\naid in treatment of these cases.\\nStrophulus.\\nThe disease is popularly known as the red gum, tooth-\\nrash, etc. some authors look upon it as the lichen of\\ninfants. This is wrong, as lichen is an affection of the\\npapillary layer of the derma, about the hair follicles, while\\nstrophulus is at the sweat follicles, and is characterized\\nby the appearance of small red or white papules, varying\\nin size from pins heads to small millet seeds; they are\\nirregularly dispersed or slightly aggregated, and inter-\\nmingled with more or less erythema; are attended with\\nitching, sometimes slight moisture, and desquamation.\\nIt makes its appearance on the most exposed parts, the\\nface especially, but also the neck, arms, and limbs, in\\nsuccessive crops. There are two forms of the affection.\\nOne variety, mostly due to over-clothing, appears in infants\\na few weeks old. The other variety is frequently met\\nwith during the period of dentition, lasts longer than the\\nformer variety, and is often associated with gastro-intes-\\ntinal disturbance.\\nTreatment. Scrupulous cleanliness must be observed;\\nthe diet should be carefully regulated; the child must not\\nbe too much wrapped up; the use of soap must be\\navoided; tepid sponging, spirit or alkaline lotions, may\\nbe used locally. A very useful lotion is:", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0148.jp2"}, "147": {"fulltext": "PRURIGO. 143\\nIjfc Carbonate of soda, gr. xx.\\nGlycerine, dr. jj.\\nRose-water, ^vj.\\nM. x\\\\pply locally.\\nAlmond emulsion and lime- Water may be also used.\\nLancing the gums is proper only when they are swollen\\nor so tender as to distress the child.\\nChamomilla is the principal internal remedy.\\nOther remedies may be indicated as follows:\\nAmnion, carb. Rash appears more on the right side.\\nFrequent starting in sleep as if in affright.\\nAnHnio7i. crud. Child cannot bear to be touched or\\nlooked at. Disturbance of digestion, nausea, vomiting\\nand diarrhoea. Tongue, thickly coated white.\\nCalc. carb. Eruption attended with swelling of glands,\\nheat, thirst and want of appetite. Scrofulous children\\nand during dentition.\\nChamom. Eruption of red pimples, itching worse at\\nnight. Great sensitiveness of the nervous system with\\nirritability, cannot stand pain, the wind, or currents of\\nair. Child very cross and restless, wants to be carried.\\nLycopodium. The skin dry and hot, with yellow color,\\nespecially of the face, and emaciation. Eruptive itching,\\nworse from 4 to 8 p. m. Red sand in urine.\\nNitric acid. Eruption with burning, itching pains,\\nworse at night, from change of weather, or during per-\\nspiration. Strong smelling urine, like that of horses.\\nPrurigo.\\nThe older writers used this term in a variety of ways,\\nand included under it several unrelated affections which\\npossessed the common symptoms of itching. Modern\\nusage, however, confines it to a definite affection, first\\nclearly described by Hebra.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0149.jp2"}, "148": {"fulltext": "144 SKIN DISEASES.\\nThe disease is chiefl}^ characterized by intense itching,\\noften commencing early in life, and extending over a\\nnumber of years. In the beginning little will be found\\nin the way of lesion other than a few scattered papules,\\nwhich are little if at all raised above the surface of the\\nskin, and are perceived more readily by the sense of\\ntouch than by that of sight. They appear to be seated\\nin the skin, and do not, except when directly irritated,\\nproject above it. Accompanying the papules we find the\\nusual indications of all itching affections, namely,\\nscratch-marks, and these will be developed in direct\\nratio with the severity of the pruritus and the vulnera-\\nbility of the skin. In addition to these we will find in-\\ncreased pigmentation, increased distinctness of the\\nnatural lines and furrows, and increased roughness,\\nhardness, and thickness of the skin. The extensor\\nsurfaces of the limbs are the chief seats of the trouble.\\nThese phenomena may be embraced under the title\\nof prurigo mitis, or vulgaris, but in exceptional cases,\\nhowever, all the symptoms may be greatly aggra-\\nvated, constituting the prurigo ferox of Hebra. The\\npapules are larger, the excoriations more severe, and the\\npapules may be torn open, giving exit to a little sero-\\npurulent fluid; and a localized or general eruption may\\ncomplicate, and to a certain extent mask, the primary\\naffection. The whole surface becomes deeply pigmented,\\nand the axillary and inguinal glands become enlarged.\\nPrurigo, whether in a mild or severe form, is a chronic\\ndisease, occurring even in childhood, and lasting for life.\\nThe etiology of prurigo is unknown. The microscope\\nthrows about as much light upon the subject, as on many\\nother cutaneous affections. Different observers obtain\\ndifferent results. The majority suggest the possibility\\nof a connection with the sudatory apparatus.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0150.jp2"}, "149": {"fulltext": "PRURIGO. 145\\nPrurigo is mainly an affection of the poorer classes,\\nand occurs mostly on the extensor surfaces of the lower\\nextremities, but is frequently found on the forearms and\\ntrunk. It is aggravated during the winter months.\\nDiagnosis. The diagnosis of prurigo is not to be\\ndefinitely made at the very beginning of the disease, but\\nmay be suspected in childhood when there is no other\\nobvious cause for the pruritus. When, however, it has\\nlasted for some years, this very fact is presumptive evi-\\ndence; and the discovery of the peculiar papules, in con-\\nnection with the scratch-marks and their location, should\\nin the absence of complications enable the diagnosis to\\nbe made.\\nThe prognosis is bad, except when judicious treatment\\nis instituted early in the course of the affection.\\nTreatment. Relief may be obtained by means of pro-\\nlonged baths and energetic frictions, and alkaline and\\ntarry preparations, such as the tindura sapo7iis viridis, to\\nwhich a liberal amount of tar has been added. Pepper-\\nmint oil acts as a temporary sedative. As the violence of\\nthe disease is most fully displayed at night, the applica-\\ntions should be made at bed-time, except in cases of such\\nseverity that the patient is obliged to abandon business\\nor social life, and give himself up entirely to the treat-\\nment of his disease.\\nPrurigo as a Family Affection. Dr. SokolofF records\\nthe history of a family, in which, of six children (aged\\nfrom I to 12), three (two girls and one boy) were suffer-\\ning from a severe general prurigo. In each instance, the\\nsymptoms had first appeared about six months after the\\nchild s birth to gradually attain their maximum intensity\\nabout the fifth year of the patient s life, after which the\\nitching as gradually decreased. The symptoms were al-\\nways intensified during summer, and under the influence", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0151.jp2"}, "150": {"fulltext": "146 SKIN DISEASES.\\nof heat in general. All the three patients were fair and\\nfat, while those not affected were of dark complexion and\\nlean.\\nThe following makes a very soothing lotion:\\nSodii hyposulphit, dr. j.\\nAcid carbolic, dr. ss.\\nGlycerini, ^j.\\nListerini, ^jjj.\\nM. Sig.: Use as a lotion.\\nlyOtions of bran water, or of Mezereum or Grindelia i\\npart, water lo parts, will be useful in allaying the itch-\\ning, as will also Carbolic acid, gtts. v.; Aqua, ^j. In\\nobstinate cases the use of sulphur vapor baths is com-\\nmended.\\nIndications for internal remedies are as follows:\\nAconite. Furious itching all over the skin, with febrile\\nsymptoms, and especially with inflammation of the skin,\\nthirst and restlessness.\\nArsenic. Chronic form, itching and burning, better\\nfrom warmth. Thirst, drinking little, but often, restless-\\nness.\\nBelladonna. Creeping, crawling itching, with burning\\nand soreness. Aggravated about 3 p. m. Children with\\nblue eyes, blonde hair, delicate skin and red complexion.\\nBorax. Child becomes pale, the flesh relaxed and\\nwithering, with crying, aversion to food, and awakening\\nfrom sleep with screams. Whitish pimples with red\\nareolae.\\nCarbo veg. Itching over the body day and night.\\nDerangement of digestion with bloating of the abdomen\\nand frequent eructations.\\nDolichos. Intolerable itching all over the body, worse\\nat night, preventing sleep, worse after scratching.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0152.jp2"}, "151": {"fulltext": "PRURIGO. 147\\nIgnatia. Fine pricking itching, changing from one\\npart to another.\\nMercurius. Aphthous or eczematous prurigo. Itch-\\ning worse at night, and worse from warmth of the bed.\\nSweating easily, but without rehef.\\nRumex. Itching better from warmth, contagious\\nprurigo.\\nRhus ven. Elevated red blotches, more on face, neck\\nand chest, with violent itching.\\nSulphur. Intense itching, worse in the evening and\\nin bed, recent cases. Dry skin. Averse to washing.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0153.jp2"}, "152": {"fulltext": "CHAPTER VIII.\\nECZEMA.\\nAmong the most common as well as perplexing cases\\nof skin disease met with by the dermatologist and gen-\\neral practitioner, eczema justly occupies a prominent\\nplace, assuming as it does a multitude of forms, general\\nand local, acute and chronic, and appearing so universally\\namong all classes of society, the rich as well as the poor,\\nthe ignorant and the well educated, and arising from the\\nmost varied causes.\\nAn accurate and at the same time concise description of\\neczema is impossible, in view of the fact that the disease\\npresents so many forms and phases, and that of a dozen\\nconsecutive cases no two may look alike, or even bear\\nwhat ordinarily would be termed a family resemblance.\\nThese differences are due to the occurrence of lesions\\nwhich may be quite dissimilar in character and appear-\\nance, and combined in ways and proportions almost with-\\nout number. The aspect, too, of the individual lesions\\nvaries somewhat with the location they occupy, the de-\\ngree of activity they present, and the length of time\\nthey have lasted.\\nThe varieties of eczema dependent on the primitive or\\ncharacteristic lesion are six in number namely, erythe-\\nmatous, vesicular, pustular, nudose, papular, and fissured;\\nand these in their progress may undergo changes and be-\\ncome complicated with or give place to certain secondary\\nlesions.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0154.jp2"}, "153": {"fulltext": "Eczema Rubrum.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0155.jp2"}, "154": {"fulltext": "", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0156.jp2"}, "155": {"fulltext": "ECZEMA. 149\\nThe varieties of eczema dependent on the activity of\\nthe process may be classed as acute and subacute, while\\nthose that run but a short course may also be termed\\nacute, and those of longer duration chronic.\\nLocation greatly influences the appearances presented\\nby eczematous lesions, and the principal modifications\\nmet with in this connection are those seen on the scalp,\\nface hands and feet, genitals, and about the anus.\\nEczema may also invade the follicular apparatus of the\\nskin, and give rise to an eczematous affection of the hair-\\nfollicles and of the sebaceous glands.\\nWe will best understand the appearances presented by\\nthis protein malady if we trace the course of a simple\\nacute eczema of the general surface. It commences with\\na local congestion, or erythema, followed in a few hours,\\nperhaps, by a crop of minute, closely aggregated vesicles\\nfilled with a clear, transparent serum. It often takes a\\nsharp eye, and even a lens, to distinguish their separate\\ncontours. When closely examined, we find them to\\nconsist of a very thin and delicate epidermic covering,\\nwhich for a brief period retains the lymphy exudation\\nthat is seeking an exit. Rubbing, scratching, or other\\nviolence from without, or the pressure of the exudation\\nfrom within, soon ruptures the epidermis, and usually in\\ntwenty-four or thirty-six hours the vesicles have disap-\\npeared, and we find in their place a red and exposed sur-\\nface more or less moist with exudation. If exposed to\\nthe air, the watery portions of the exudation evaporate,\\nand light, straw- colored crusts remain. As the exuda-\\ntion continues, the crusts thicken until they drop off, or\\nare purposely removed. After a varying period (days or\\nweeks, as the case may be) the exudation diminishes, the\\ncrusts lessen or cease to form, and nature makes an\\nattempt to cover the part with a new layer of horny epi-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0157.jp2"}, "156": {"fulltext": "150 SKIN DISEASES.\\nthelial cells. It may be weeks before this effort is en-\\ntirely successful, and the affected surface presents in the\\ninterval a reddened and somewhat glossy surface scantily\\ncovered with loosely attached scales of small size, the\\nscales being composed of embryonic horny cells which\\nhave not yet attained a normal character and consistence.\\nThose first formed are less visable than the normal cell,\\nand are quickly shed, to be replaced by others of more\\nnatural character and aspect, until finally we find a com-\\nplete regeneration of the epidermis, and a return to the\\ncondition which existed before the appearance of the at-\\ntack. In eczema pure and simple we never have ulcera-\\ntion or loss of tissue, and recovery takes place without\\nthe least trace of scarring.\\nFor practical convenience the course described above\\nmay be divided into three stages the first being that of\\ncongestion and vesicle formation, the second that of exu-\\ndation and crusting, and the third that of dryness and\\nscaling.\\nThe pustular variety of eczema pursues the same course\\nand passes through the same stages as the vesicular, and\\ndiffers from it only in the character of the exudation and\\nthe color of the crusts in the second stage. Instead of a\\ntransparent, lymphy exudation we have a purulent one,\\nand the crusts are of a greenish color. In the vesicular\\nform the number of leucocytes in the exudation is limited,\\nwhile in the pustular they are abundant. The third\\nstage of both varieties is identical, and if a case be seen\\nin this stage it is impossible to determine, except by the\\npatient s recital, whether the eruption had been charac-\\nterized by vesicles or pustules.\\nThe nudose, or exfoliative form, differs from the pre-\\nceding forms by the fact that neither vesicles nor pustules\\nare observed, but instead a rapid loosening and exfolia-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0158.jp2"}, "157": {"fulltext": "ECZEMA. 151\\ntion of the horny layer over the whole or greater part of\\nthe affected area. The succeeding exudation may be\\nserous, sero-purulent, or purulent, and crusts form, as\\nalready described. In the second and third stages the\\nappearances are the same as those presented by the two\\nfirst-named varieties.\\nIn the papular variety an area of congestion becomes\\nthe seat of small scattered or aggregated papules, with\\nlittle if any tendency to exudation, unless the papules be\\nwounded by scratching. In this case a small quantity of\\nlymph may exude and dry into a minute scale or lamina.\\nThe papules after a time subside and the surface be-\\ncomes somewhat glossy and scaly, but not to the extent\\nmet with in the varieties already described. The arms\\nand forearms, and the thighs and legs, especially the\\nflexor aspects, are the favorite seats of papular eczema,\\nalthough it is sometimes met with on the face.\\nIn the Assured variety we have a more or less reddened\\nsurface without vesicles, pustules, or epithelial exfoliation,\\nbut instead presenting small cracks or fissures extending\\nthrough- the stratum corneum, and sometimes through\\nthe stratum Malpighii as well. Exudation is slight,\\ncrusting is absent, and the skin after a time returns to\\nthe normal condition by simply closing of the fissures and\\ndisappearance of the congestion. The palms and soles\\nare the favorite seats of this variet}^\\nThe erythematous variety is characterized simply by a\\nred and congested patch of varying extent, and is not ac-\\ncompanied with vesicles, pustules, papules, or the other\\nlesions of the disease.\\nCases of eczema vary in respect to the grade of inflam-\\nmation present. In one it may exhibit great activity and\\nbe accompanied with decided heat, high color, and other\\nevidences of marked inflammatory action, in either the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0159.jp2"}, "158": {"fulltext": "152 SKIN DISEASES.\\nfirst or second stages or in both and this activity may\\ncontinue for an indefinite period, and until the case pre-\\npares to enter the third stage. On the other hand, the\\nnatural color may be but slightly altered, the increase of\\nlocal heat be almost inappreciable, and the general pro-\\ncess partake of a subacute character from the beginning.\\nIn other cases, again, an eruption which is subacute may\\nat any stage of its progress suddenly assume an acute\\nphase, or there may be frequent alternations of activity\\nand comparative quietude. This is a very striking\\nfeature of eczema, and one that should always be borne\\nin mind. A case may be progressing nicely under treat-\\nment, and with the prospect of early recovery, when sud-\\ndenly the trouble may relapse into its previous active\\nstate, and often apparently without sufficient provocation.\\nThe duration of eczema varies. In some cases it may\\nrun its course in a few days or weeks, while in others it\\nmay be prolonged for months or years, constituting the\\nchronic form of the affection or, again, there may be\\nfrequent relapses, even after complete disappearance of\\nthe individual attacks.\\nThe locatio7i of an eczema greatly influences its appear-\\nance, and exhibits also preference for certain varieties of\\nlesion. Thus, in eczema of the scalp, especially in in-\\nfants and children, the process is usually acute, with pro-\\nfuse lymphy or purulent exudation, which mats the hair\\ntogether in a tangled mass, offensive to both sight and\\nsmell. If by chance pediculi find lodgment in such a\\nscalp, they multiply rapidly, and by their irritation in-\\ncrease and aggravate the trouble. If proper care and\\ncleanliness are not practiced, the scalp may become a\\nmere mass of animated filth.\\nWhen eczema attacks the scalp in children, it fre-\\nquently extends to the face, and presents an active form", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0160.jp2"}, "159": {"fulltext": "ECZEMA. 153\\nof inflammation of the vesicular, pustular, or nudose type,\\naccompanied with a good deal of heat and pruritus. If\\nit extends behind the ears, fissures may form.\\nIn adults, eczema of the scalp is usually of the subacute\\nform, without much exudation and on the face it may\\nbe of the erythematous type, without other lesion.\\nWhen the palmar and plantar surfaces are attacked by\\neczema, we may have a purely erythematous lesion,\\ncharacterized by a red, dry, and glossy surface, on which\\nthe natural skin lines are greatly exaggerated as to size\\nand distinctness, and many lines appear which are not\\nnoticeable in the normal condition. In addition fissures\\nmay form, accompanied with slight exudation. This\\ntype of the disease is the most common, and is usually\\nsubacute and chronic. On the other hand, we may have\\nan acute eczema of the hands and feet, accompanied with\\nvesicle formation. In consequence of the thickness of\\nthe horny epidermis on those parts, the vesicles do not\\neasily rupture, but instead retain their integrity, and even\\nbecome larger, and remain as vesicles until absorption of\\nthe contents occurs, when what was the summit of the\\nvesicle separates as a small scale.\\nThe penis and scrotum usually exhibit the erythe-\\nmatous variety, vesicle and scale formation being rarely\\nmet with.\\nThe inner aspect of the thighs and legs is the favorite\\nlocation of the papular form, although it may be met\\nwith on almost any part of the body, and even on the\\nface.\\nOn the lower extremities below the knees eczema is\\nfrequently encountered as a direct result of varicose veins,\\nand, if these latter have given rise to ulcers, a broad and\\ndifi use zone of erythematous eczema will almost always\\nsurround them, with scattered patches on the neighbor-\\ning parts.\\nII", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0161.jp2"}, "160": {"fulltext": "154 SKIN DISEASES.\\nEczema about the anus is frequently marked by radiat-\\ning fissures of greater or less depth.\\nEczema may extend from the skin proper down into\\nthe follicular openings, especially those of the face and\\nother hairy parts, except the scalp. In these cases the\\nsurface eczema may play a very secondary part. On the\\none hand, we may have the hair-follicles especially in-\\nvolved. When this appears, the general surface of the\\npatch will be found red, and either dry or exuding, but\\nthe inflammation having invaded the lining membrane of\\nthe follicles, they will be found swollen and loosened.\\nSlight traction on the hair will extract it, accompanied\\nwith its root-sheaths. Frequently the exudation which\\nforms within the follicle comes to the surface, and lifts the\\nepidermis surrounding the hair, and forms a pustule\\n(rarely a vesicle) pierced through the center by the hair.\\nThis deep-seated inflammation sometimes results in ex-\\ntension of the action beyond the proper outline of the\\nfollicle, and nodules form. This condition must be dis-\\ntinguished from sycosis, with nodules, etc., resulting\\nfrom parasitic invasion.\\nThe sebaceous glands may also become the seat of\\neczematous inflammation, either with or without marked\\nparticipation of the surface. Under the stimulus of the\\neczema the glands exhibit increased functional activity,\\nand the eczematous exudation when present becomes\\nmixed with the increased sebaceous secretion, and, instead\\nof a purely lymphy or purulent exudate, we have some\\nthin sebum mingled with it, which usually dries into\\ngreasy scales or crusts.\\nWhen an eczema persists for any great length of time,\\nand becomes chronic, we find additional features that are\\nimportant both as regards description and treatment.\\nThe chief of these is infiltration. The skin is still red,", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0162.jp2"}, "161": {"fulltext": "ECZEMA. 155\\nbut usually dry, and appears to possess double or treble\\nits natural thickness, and the patch is very appreciably\\nraised above the surrounding surface.\\nDr. Taylor reports three cases of malaria accompanied\\nby an eczematous eruption, both making their appear-\\nance simultaneously under proper treatment both con-\\nditions were relieved, the remedies given relieving both\\nconditions.\\nDr. Stettler reports an interesting case of vulvar eczema\\nas a sequel of the climacteric period.\\nThe extreme prevalence of eczema makes its correct and\\ncertain diagnosis of the first importance and, if the\\nrules laid down in the general chapter be closely followed,\\nthere need not, in the great majority of cases, be any very\\ngreat difficulty. The history of the attack, the frequently\\nmultiple lesions, and their progress as observed or, as re-\\nlated by the patient, should not leave the physician long\\nin doubt.\\nIt is important, however, to distinguish a dry scaly\\neczema of the scalp in children from a condition some-\\ntimes presenting very similar appearances, but due to an\\nentirely different cause namely, the vegetable parasite,\\ntricophyto7i which is the etiological factor of ringworm.\\nIn cases of doubt the microscope will decide by revealing\\nthe presence of the fungus. In like manner eczema of\\nthe hair-follicles of the face must be carefully distin-\\nguished from ringworm of the same parts, to which the\\nname of barber s itch is commonly given.\\nEczema sometimes resembles psoriasis, and psoriasis\\nsometimes resembles eczema or, again, we may have an\\neruption which no one would be justified in pronouncing\\neither one or the other from the appearance only. Usu-\\nally the history will enable us to decide. On the hands\\nand feet we may have appearances which may present", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0163.jp2"}, "162": {"fulltext": "156 SKIN DISEASES.\\ndifficulties in diagnosis between eczema, psoriasis, and\\nsyphilis.\\nLastly, we have known a lichen planus to be mistaken\\nfor a papular eczema even by gentlemen well versed in\\ncutaneous diagnosis.\\nEtiology. It may be regarded as almost axiomatic\\nthat the better we understand a disease the better we will\\nbe able to treat it. This is especially true as regards\\neczema. Occasionally cases of acute eczema will be met\\nwith that recover under the simplest application, and\\neven under the influence of a plain, non-medicated dress-\\ning. Unfortunately, these cases are rare, and in the\\nchronic forms it is often necCvSsary to avail ourselves of\\nevery possible aid to recovery. A thorough appreciation,\\ntherefore, of all the causes of the eruption, both actuating\\nand contributing, can not fail to greatly assist the thera-\\npeutist in the proper selection of the remedial agencies\\napplicable to a given case.\\nEczema attacks more frequently light, florid-complex-\\nioned individuals, and is a commoner affection in this\\ncountry than in Europe. Like the individual who makes\\na failure in life, eczema usually travels from head to foot\\nas age advances. It appears more particularly on the\\nhead in infancy and youth, descends to the trunk and\\ngenitals as adult life approaches, and appears on the\\nlower limbs as its victim is tottering to the grave.\\nAmong the exciting causes we may mention irritation\\nof the skin by scratching, by friction of the clothing, by\\nirritating ointments, by oils, by bandages, by artificial\\nlegs, trusses, etc., by hot baths, by too high a tempera-\\nture, by alternation of heat and cold, by heat and\\nmoisture, by the injudicious use of Turkish and Russian\\nbaths, by strong potash soaps, and by any exciting cause\\ngiving rise to hypersemia of the skin. In quite a number", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0164.jp2"}, "163": {"fulltext": "ECZEMA. 157\\nof cases it seems to be hereditary. It is by no means a\\nrare disease in those who are syphilitic, gouty or strumous.\\nIt is frequently dependent upon renal troubles, men-\\nstrual irregularities, dentition, dyspepsia and mal-assimi-\\nlation, varicose veins and hemorrhoids. Undoubtedly\\nperverted innervation, with general debility and morbid\\nconditions of the blood, is an important cause.\\nOverfeeding, the habit of feeding the child too fre-\\nquently, and of allowing children who have passed the\\nmilk-diet period to eat frequently of inappropriate food\\nbetween meals, will prevent the recovery of chronic cases,\\ndespite the administration of the well-selected remedy.\\nWhen the tongue is coated, the breath foul, and the\\nbowels constipated, the diet requires particular attention.\\nChildren kept in warm rooms where the air is vitiated\\nare liable to suffer from this affection, especially if they\\ncatch cold easily from the least exposure. Allowing the\\nchild to sleep upon a very soft pillow, into which the head\\nbecomes buried at night, or feeding bottle babies\\nwith milk too warm, has seemed to aggravate some cases.\\nFresh air and sunlight, with attention to hygienic\\nmeasures, will exert a favorable influence upon this\\nstubborn disease. The diet must be carefully looked-\\nafter, and all sweets and confections be strictly pro-\\nhibited. The sleeping apartments must be properly ven-\\ntilated. Plenty of exercise in the open air must be\\ntaken. The clothing must be adapted to the season.\\nBathing sufficient to meet the requirements of cleanliness\\nshould be insisted on, but too frequent or too profuse use\\nof water is not advantageous. The acute stage of eczema\\nis very intolerant of water. If the surface is raw and\\ndischarging, water aggravates the condition. Water,\\nhowever, is not to be absolutely excluded from the treat-\\nment of eczema. It not infrequently happens that very", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0165.jp2"}, "164": {"fulltext": "158 SKIN DISEASES.\\nhot water hot as it is possible for the patient to bear it\\nwill cause immediate cessation of itching while in\\nchronic cases, with considerable infiltration, systematic\\nuse two or three times a day of very hot water will often\\nbe followed with the happiest results. A full bath of\\ntepid water, with a pound of sal soda added to it, and\\ntaken at night, will generally exert a soothing influence\\nwhile in sluggish and chronic cases ten or twelve pounds\\nof common salt added to a full bath will exert a stimu-\\nlant action and tend to promote the cure.\\nIn all cases search should be made for all possible\\ncauses of local irritation, and the first care should be to\\nremove them, if practicable.\\nThe diet of eczematous patients is of the first import-\\nance. No hard-and-fast general dietary laws can be\\nadhered to. Bach patient must be treated according\\nto his case, and at first be put upon as simple a diet\\nas possible. When this basis is reached, the patient s\\ntaste is to be consulted and his diet made more varied,\\ncare being taken to avoid anything that is known to\\ndisagree with him. Sometimes, it is advisable to have a\\npatient increase the number of meals in a day, while de-\\ncreasing the quantity of each one. Some patients do best\\non solid food alone, leaving out tea, coffee, and the like.\\nSometimes the best results are obtained by having the\\npatient eat only one sort of food at a meal whatever he\\nfancies. In many cases of chronic eczema a liberal sup-\\nply of fluid is useful, and this not taken at once, but\\noften in small quantities. Up to three quarts of water\\nmay be taken in this way. The addition of salt to the\\ndietary is also useful. As a rule, you will find that adult\\nsufferers from eczema are decidedly carnivorous in their\\ntastes, eating a good deal of meat with a very scant\\nquota of vegetables and cereals. Many of them are par-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0166.jp2"}, "165": {"fulltext": "ECZEMA. 159\\nticularly fond of the pleasures of the table, and indulge\\nmuch more freely than there is any necessity for. As\\nthese matters are under the control of the patient himself,\\nno pains should be spared to impress on him the necessity\\nfor a change in his habits. It is not well to cut off the\\nsupph^ of meat absolutely, but it should be very decidedly\\nrestricted, and a larger proportion of bread, vegetables,\\nand cereals substituted.\\nPatients often fancy that diet of this sort will reduce\\ntheir strength and incapacitate them for the amount of\\nlabor that their daily vocations necessitate. These fears\\nare groundless, and on trial will soon be dissipated.\\nA very interesting and important question has been\\nraised as to the propriety of healing completely a dis-\\ncharging eczema, and the fear of driving in the disease\\nhas often deterred practitioners from affecting a speedy\\ncure.\\nHebra and his school laugh at this idea, and no doubt\\nin the majority of cases with good reason.\\nThe question at issue, whether an habitual discharge\\nma3 be suppressed without danger to a patient, depends\\nupon the patient, and not on the disease.\\nI attended a child who had lost two younger brothers\\nfrom acute tuberculosis. He had a very extensive ec-\\nzema of the scalp and face, but otherwise appeared in\\ngood health. Under appropriate remedies his eczema\\nrapidl}^ got well, but its disappearance was attended with\\nall the signs of acute hydrocephalus, from which he soon\\ndied.\\nWith the family disposition to this disease, it is not\\nunlikely that the child might have succumbed to tuber-\\nculosis had the eczema not been cured but I fear my\\ntreatment was injudicious, as the child s disposition to\\ndisease of a special and serious kind was not taken into\\naccount. (Simon.)", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0167.jp2"}, "166": {"fulltext": "160 SKIN DISEASES.\\nAnalogies of the impropriety of rapidly suppressing\\nhabitual discharges are common enough. Hemorrhages\\nfrom the lungs or stomach occur often enough when\\nhemorrhoids, which have been bleeding for years, are\\nsuddenly cured, and cases have been recorded in which\\ncerebral hemorrhage has seemed to follow rapid cure of\\nan old ulcer.\\nLocal Treatment.\\nThe local treatment consists in first allajdng the acute\\ninflammatory symptoms, if any exist, and involves the\\nemployment of various lotions, glyceroles, ointments^\\noils, plasters, powders and soaps. It is not always an\\neasy matter to say what will soothe in any particular\\ncase. Bran infusion, or decoction of marsh-mallow or\\npoppy heads, to which a little clarified size has been\\nadded, are very good applications to start with as lotions\\nnight and morning. The linimentum aquse calcis is\\nsometimes efiicacious.\\nDuring the first and second stages the solution of the\\nperoxide of hydrogen is of great value. The commercial\\narticle usually contains twelve volumes of the peroxide,\\nand is too strong to apply in many cases of eczema, and\\nmay require dilution with one or two parts of water or\\neven more. The effect of this solution in many cases\\nappears almost magical, reducing the purulent exudation,\\nand hastening the formation of a new epidermis.\\nDilute alkaline preparations, especially a solution of\\ncarbonate of soda, are useful for cleansing purposes, and,\\nto a certain extent, for the relief of pruritus.\\nStrong alkaline preparations, such as liquor potasses\\ngreen soap, and its tincture, have a distinct function to\\nperform in the reduction of thickened epidermis, in\\neczema of the hands and feet and in the removal of infil-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0168.jp2"}, "167": {"fulltext": "LOCAL TREATMENT. 161\\ntration. If a patch of greatl} infiltrated eczema be\\npainted with liquor potassse, in a few moments little\\ndroplets of serum will be seen upon the surface. If that\\nbe wiped off, fresh serum exudes, and this continues for\\nsome minutes. When the tendency- to exudation ceases,\\nthe parts should be wiped dry and a sedative ointment\\napplied. The application is repeated on the second or\\nthird da} according to the degree of irritation produced,\\nand this is continued until several applications have been\\nmade. The result will be a notable reduction of the\\ninfiltration.\\nShould the itching prove obstinate, a weak carbolized\\noil and lime water lotion, or a grindelia robusta lotion,\\none drachm to the ounce of water may be used.\\nThe following lotion I have found very useful to allay\\nthe terrible itching present in some cases, and to soften\\nthe texture of the scalp and reduce the inflammation. At\\nthe same time give internally Lappa major 2x or 3X\\ntablets:\\n9^. Lappa major, ^jj.\\nGlycerine, ^j.\\nAqua destillata, q. s. ad., ^iv.\\nM. Sig. Apply to scalp on retiring.\\nOintments. The ointments most in vogue are the\\nunguentum zinci oxidi, ung. hydrargyri ammoniati, ung.\\npicis liquidi, and ointments containing carbolic acid, sali-\\ncylic acid, and resorcin. Of these the zinc ointment is\\nprobably inert so far as any direct medicinal effect is con-\\ncerned. It is simpl} a protective, and as such serves an\\nadmirable purpose especially in cases of extensive disease,\\nwhere it would be neither safe nor prudent to employ the\\nmercurial preparations. The addition of a little bella-\\ndonna increases its sedative effects.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0169.jp2"}, "168": {"fulltext": "162 SKIN DISEASES.\\nUnguentum hydrargyri atnmoniati, either alone or\\nwith the addition of a little stramonium, is much more\\neffective as a curative agent than zinc ointment, but\\nmust be used with a certain amount of discretion, and\\nshould not be applied to a very extensive surface, lest\\nsalivation should occur. In some cases it irritates and\\nshould be abandoned, and in a few instances I have\\nknown it to excite an intense dermatitis.\\nOintments containing from four to ten grains of car-\\nbolic acid to the ounce are sometimes of service for the\\nrelief of the distressing pruritus.\\nThe following makes an excellent application for the\\nintense itching:\\nChloral hydrastis,\\nCamph. pulv., aa dr. ss.\\nAcidi carbolici, M. x.\\nBalsam Peru, dr. j.\\nMenthol, gr. xx.\\nUng. zinci oxidi, q. s. ad., j.\\nM. ft. unguent. Sig. Apply morning and night.\\nThe second stage of eczema with exudation and crust-\\ning is the period when the above-mentioned ointments\\nare of the most service. After removal of all crusts, and\\ncareful drying of the surface, the ointments may be\\nsmeared on the parts, or applied on muslin and bound on.\\nThe salve- muslins introduced by Dr. Unna, which consist\\nof a loosely woven fabric thickly impregnated with the\\nointment, are exceedingly convenient when a fixed dress-\\ning is desired. The plaster-muslins of Unna have a\\nfirmer consistence, and are more generally useful than\\nthe salve-muslins. Similar dressings have been placed on\\nthe market, and fully meet all requirements.\\nThe frequency of the application or of the dressing\\nwill depend in great measure on the amount of discharge.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0170.jp2"}, "169": {"fulltext": "LOCAL TREATMENT. 163\\nSometimes the applications will require renewal night\\nand morning, and sometimes but once in twenty-four\\nhours. As a rule the parts should be disturbed as little\\nas possible, and the dressings removed only when\\nnecessary.\\nUngue?itum picis liquidi and ointments containing\\noleum cadinum, oleum rusci, and similar empyreumatic\\nsubstances, play quite a different part in the treatment of\\neczema. They vshould never be used in the first or second\\nstage of the disease, or when acute conditions are present.\\nIn the third stage, however, where the skin presents a\\ndry and scaly surface, covered with newly but imperfectly\\nformed epithelium, and especially if the affection is indo-\\nlent, these preparations are of the greatest service.\\nIn inveterate cases, oil of white birch may be used\\nin the form of an ointment, one-half to two drachms to\\nthe ounce of vaseline.\\nCollodiofis. Contractile collodion will sometimes avert\\na threatened eczema, and prevent extension from one al-\\nready existing, if applied around the margin of the lesion.\\nFlexible collodion is a protective only, and may be useful\\nwhen the exudation is slight. Cantharidal collodion is\\nsometimes employed as an application to an old and ob-\\nstinate local patch which it is desired to stir up to some\\ndegree of activity. Occasionally it hastens a cure more\\nfrequently it does more harm than good. Collodion with\\nfive per cent, of iodine will often prove of service in\\nchronic thickened patches, while collodion containing\\nthree or four per cent, of salicylic acid will dissolve and\\nremove thickened epidermis from the hands and feet\\nmore quickly, perhaps, than any other substance. Sali-\\ncylic acid, however, should never be used continuousl}^,\\nor during the second stage, when the epithelium is ab-\\nsent, as it tends to prevent the cornification of the new\\nepithelium.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0171.jp2"}, "170": {"fulltext": "164 SKIN DISEASES.\\nTraumaticin is the name in common use to designate a\\nten per cent, solution of gutta-percha in chloroform,\\nand it possesses many advantages over collodion, and\\nmay be made use of in connection with oxide of zinc, am-\\nmoniated mercury, etc.\\nGelatine, mixed with glycerine, and dissolved by heat,\\nhas been used as a basis for the incorporation of various\\ndrugs applicable to the treatment of eczema. When\\napplied it should be liquefied by heat and painted rather\\nthickly on the parts. It can only be used where patients\\nare confined to the bed, and is not as useful, in my ex-\\nperience, as other applications.\\nPowders. It is sometimes found that in the second\\nstage of the disease ointments and lotions of every kind\\nincrease the irritation and add to the discomfort of the\\npatient. Fortunately, these instances are rare; but when\\nthey are met with simple or medicated powders will\\nsometimes prove of service. Starch, lycopodium, ordi-\\nnary toilet powder, or talc, may be used alone, or the\\noxide of zinc or subnitrate of bismuth may be used with\\neither of them.\\nSoaps. Soft potash soap, equivalent to the sapo\\nviridis of the Pharmacopoeia, contains an excess of alkali,\\nand is used for the reduction of infiltration. It should\\nbe thoroughly rubbed in with the aid of flannel moistened\\nin hot water until a lather has formed. This is left on,\\nand the effect is similar to that of liquor potassse, already\\nnoticed. Hard soda soap, prepared for laundry use, also\\ncontains considerable free alkali, and may be used for\\nthe same purpose. Tar soap is of service in the third\\nand scaly stage of the disease.\\nCertain mechanical means are sometimes employed in\\nthe treatment of eczema. The application of rubber, in\\nthe form of an elastic bandage, often proves of the great-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0172.jp2"}, "171": {"fulltext": "", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0173.jp2"}, "172": {"fulltext": "-ECZEMA.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0174.jp2"}, "173": {"fulltext": "TREATMENT OF ECZEMA. 165\\nest service in thickened eczemas of the lower extremities\\nthen the object sought is steady pressure with a view to\\nproduce absorption of the infiltration. The silk elastic\\nstocking may be used for the same purpose.\\nSometimes localized patches of eczema of long standing\\nfail to yield to any of the ordinary means for their relief,\\nand necessitate more vigorous interference. In this\\nconnection scarification is extremely useful, and patches\\nof thickened eczema will sometimes disappear almost\\nas if by magic after the use of the knife.\\nTreatment of the Special Forms and Varieties of\\nEczema.\\nBearing in mind the general principles that underlie\\nthe treatment of all cases of eczema, we will consider the\\nspecial varieties as influenced by age, degree of inflamma-\\ntory action, locality, etc., commencing with eczema of\\nyoung children.\\nIn eczema intertrigo, so common in the groin and nates\\nof infants, absorbent cotton dusted with finely triturated\\npowder should be constantly applied, so as to come in\\ncontact with the inflamed surfaces and separate them.\\nBoracic and salicylic acids, each one part to two of sub-\\nnitrate of bismuth, and five of oxide of zinc, is a good\\npowder. Camphor mixed with ointments or washes re-\\nlieves itching. A two per cent, solution of acetic acid, or\\na one per cent, solution of aluminium acetate in water,\\nfrequently gives relief. Carbolic acid is very efficient for\\nitching.\\nIn eczema of the scalp in children we frequently, and\\nperhaps generally, find the case acute as regards its char-\\nacter, though it may be chronic as regards the duration\\nof time that it has existed. It is almost always presented\\nto the physician in the second stage characterized by", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0175.jp2"}, "174": {"fulltext": "166 SKIN DISEASES.\\nexudation and crusting, and complicated with enlarged\\nglands at the back of the neck, small abscesses of the\\nscalp, and may also be accompanied with pediculi. The\\nvesicular and pustular forms are the most common, and\\nthe crusts, entangled in and retained by the hair, accu-\\nmulate more thickly than elsewhere. The first thing to\\ndo is to cut the hair off as short as it is possible to do it\\nwith scissors. If pediculi are present, search through\\nhair stumps for their ova, which should be removed. If\\nmany crusts adhere to the scalp after clipping the hair,\\nsaturate the parts with olive oil, and, after a few hours,\\ngive the scalp a good washing with soap and warm\\nwater. After thorough drying, apply zinc or diluted\\nwhite precipitate ointment. The ointment should be\\napplied thickly, and renewed daily and even twice daily,\\nand accumulations of old ointment be removed by gentle\\nuse of the comb as often as necessary. The scalp should\\nnot, however, be washed again for several days in fact,\\nthe less frequently it is washed the better. If abscesses\\nare present, they must be opened, and perhaps poulticed\\nfor a day or two,. Eczema of the scalp, in many cases,\\nseems to be called into existence as a consequence of\\nparasitic irritation; and when the eczema itself is of but\\nlimited extent, but the parasites are numerous, they may\\nbe made the first point of attack and cutting of the hair\\nbe avoided. I know of nothing more effective than\\ndrowning them out with ordinary kerosene. If the hair\\nbe thoroughly saturated with this for two or three days\\nin succession, soap and water, and a fine-tooth comb and\\npatience will do the rest. The parasites destroyed, the\\neczema may recover spontaneously, or more quickly if\\naided with a few applications of ointment.\\nThe enlarged glands at the back of the neck require no\\nspecial attention. When the eczema gets well they will", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0176.jp2"}, "175": {"fulltext": "TREATMENT OF ECZEMA. 167\\nsubside. Eczema of the scalp often extends to the fore-\\nhead, face and ears. If fissures form behind the ears, it\\nis well to add a little finely-powdered graphite to the\\nointment. As the case progresses toward recovery, and\\nthe exudation and crusting cease, and the third stage,\\ncharacterized by dryness and scabs, is ushered in, the\\ntreatment requires a change.\\nA little tar, in some of its forms, should then be added\\nto the ointment, and the proportion of tar gradually in-\\ncreased as improvement occurs. If progress toward re-\\ncovery should halt, a little more active stimulation may\\nbe the thing needed. If, however, the eruption should\\nrevert to the second stage, as not infrequently happens,\\nthe latter treatment will have to be resumed.\\nEczema of the scalp in adults presents itself more\\nfrequently in a subacute than an acute condition, and\\nvery commonly in the dry and scaly stage, the patient\\ncomplaining of a certain amount of irritation and an ex-\\ncessive formation of dandruff. If the same condition\\nshould be present on the non-hairy parts, tar would be\\nthought. of as a remedy. This, however, is practically\\nimpossible on the scalp, except for those who are able to\\nabandon social and business pursuits. As a substitute\\nfor tar Dr. Piffard recommends the following mixture as\\nequally efficacious, and at the same time free from the\\nobjectionable features of the other. I can endorse his\\nclaim.\\n9^. Acidi salicylici, gr. x to xx.\\n01. lavendulse, ^iij.\\nOl. citronellae, ^j.\\nOl, eucalypti, ^ij.\\n01. ricini, |jj.\\nM.\\nIn this preparation the salicylic acid is designed to re-\\nstrict the formation of scale, the eucalyptus to act as a", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0177.jp2"}, "176": {"fulltext": "168 SKIN DISEASES.\\nStimulant, and the castor oil to correct the drying effect\\nof the latter. The best way to apply it is from a small\\noil can. The hairs having been separated, a few drops\\nare applied directly to the scalp and gently rubbed in\\nwith the finger. All the affected portions are gone over\\nin this way. To make the application in the most thor-\\nough manner the patient will, of course, need assistance.\\nIf care be taken, onl}^ so much oil as may be necessary is\\napplied to the scalp, and the hairs, except near the sur-\\nface of the scalp, do not become disagreeably impregnated\\nwith it. This application should at first be made daily but\\nat the expiration of a week the intervals may usually be\\nlengthened. If at any time the condition should revert\\nto the second stage, with exudation and crusting, the oil\\nmust be discontinued, and white precipitate or zinc oint-\\nment substituted. Although I have devoted considerable\\nspace to the local treatment, I do not wish it understood\\nthat this is the most important it is simply one of the\\nmeans to effect a cure. The internal, constitutional\\ntreatment is, by far, the more important they must go\\nhand in hand to procure the best results.\\nEczema barbcB. In eczema of the hairy portions of the\\nface, the disease not infrequently descends into the hair-\\nfollicles, and especially involves the root-sheaths, and may\\nbe accompanied with considerable infiltration of the tis-\\nsues between the follicles. The most frequent form is\\nthe pustular, each pustule being pierced by a hair.\\nWhen the hair is extracted, it is generally accompanied\\nwith the root-sheaths, w^hich are swollen and loosened\\nfrom the follicle. It is of the first importance that this\\naffection be not mistaken for tricophytosis\\nIf the eczema be purely superficial that is, if the in-\\nflammation has not descended into the follicles it may\\nbe treated very much as an eczema situated elsewhere.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0178.jp2"}, "177": {"fulltext": "TREATMENT OF ECZEMA. 169\\nIf, however, it is sycosiform in character, with infiltra-\\ntion and pustules, epilation must be performed. Every\\nhair in the affected region must be plucked out with\\nforceps. As a rule, they come out easily and without\\nmuch pain, in consequence of the loosening of the root-\\nsheaths. The necessity for epilation will be apparent\\nwhen we consider the fact that the loosened bairs, while in\\nthe follicles, are, to all intents, acting as foreign bodies,\\nand thus tend to keep up the inflammation. After epila-\\ntion, white precipitate or zinc ointment should be applied\\ntwo or three times a day\\nEczema of other hairy parts axillae, pubes, etc.\\ndoes not usually take on the sycosiform character, and\\nepilation may be unnecessary.\\nEczema of the genital region frequently presents itself\\nas a chronic affection of the scrotum and most of the\\ncases will have existed for j^ears before consulting the\\nphj^sician. The parts will usually be found red, dry, and\\nthickened, and the seat of more or less pruritus. In\\nlong-standing cases there are usually decided infiltration\\nand thickening of the skin. Of all forms of eczema this\\nis the one which is the most difficult to control. One\\nwriter disposes of the question of treatment in the follow-\\ning words:\\nThe treatment of eczema of the genital organs and\\nanus does not differ from that of eczema in general, ex-\\ncept in so far as we must bear in mind the predisposing\\ncauses, and endeavor to remove them if possible.\\nThis general advice is good as far as it goes, but per-\\nhaps the most important of the predisposing local causes\\nis the dependent position of the parts, and their constant\\nexposure to friction, to say nothing of the natural\\nmoisture of the parts. As these causes can not be con-\\nveniently removed, w^e must confine ourselves to a partial\\n12", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0179.jp2"}, "178": {"fulltext": "170 SKIN DISEASES.\\nmitigation of their effects. This can be accomplished,\\nso far as the scrotum is concerned, by a properly-fitting\\nand snugly-applied suspensory bandage. The bag should\\nbe applied in such a way as to keep the parts as elevated\\nas possible, and with as much pressure as can be con-\\nveniently borne without, however, constricting the\\nupper part so as to impede the venous circulation. If\\nthere is much infiltration, the first efforts should be to-\\nward its reduction. There are three principal methods\\nby which we may seek to accomplish this end; First, by\\na few scarifications of the scrotum, permitting the parts\\nto bleed freely, care being taken not to cut any of the\\nlarger veins. After scarification the patient should sit\\nfor some minutes in a warm antiseptic sitz-bath to en-\\ncourage bleeding and exudation. After the parts are\\ndried, a little tincture of benzoin or other antiseptic\\nlotion may be sprayed over them, and the suspensory ap-\\nplied. In a week or two the scarifications may be re-\\npeated. The relief afforded by this is sometimes sur-\\nprising. Many patients, however, have such a dread of\\ncutting operations about the genitals that some other\\nprocedure must generally be advised. The second means\\nthat we have is galvanization. The constant current,\\napplied daily or on alternate days, will sometimes reduce\\nthe infiltration and relieve the itching. The testicles\\nshould be pushed well up, and the scrotum held between\\ntwo good-sized sponge-covered electrodes, and a current\\nof eight or ten cells passed for five to ten minutes, the\\nstrength and duration of the current being regulated ac-\\ncording to the susceptibility of the patient. The third\\nmethod of reducing the infiltration is the one most com-\\nmonly employed, and consists in the application of liquor\\npotassae. This should be mopped on with a small tuft of\\nabsorbent cotton wrapped around the end of a stick.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0180.jp2"}, "179": {"fulltext": "TREATMENT OF ECZEMA. 171\\nThis application should be made by the surgeon himself,\\nand not intrusted to the patient. After its immediate\\neffects have passed off the parts ma}^ be dressed with zinc\\nointment and the suspensory adjusted. From six to a\\ndozen applications, made at intervals of four or five days,\\nwill frequently produce very marked reduction of the in-\\nfiltration. Eczema of the penis, however, may exist\\nalone, and if met with in persons passed middle life, and\\nespecially if the glans and inner surface of the prepuce is\\ninvolved, the presence or absence of glycosuria should be\\nascertained. If this condition is present, the parts should\\nbe carefully washed after urination if the water comes in\\ncontact with them and an antiseptic lotion or powder ap-\\nplied. The general treatment should be that which is\\nappropriate to the diabetic condition.\\nEczema in the vulva is rarely met with until the cli-\\nmacteric or later. In some cases it is doubtless excited\\nby irritating uterine or vaginal discharges, but in perhaps\\nthe majority it is due to glycosuria. In either case the\\npreliminary treatment is clear, and, probably, the best\\nlocal application is the peroxide of hydrogen.\\nEczema of the /^^/^t?^? and 2;z^ 2r surfaces, frequently\\naccompanied with great thickening of the epidermis and\\nwith fissures, requires special treatment.\\nThe thickened epidermis must be removed mechanic-\\nally with knife, file, or sand-paper. After all that is pos-\\nsible has been removed in this waj^, a five per cent, solu-\\ntion of salicylic acid in flexible collodion should be\\napplied. After several daily applications have been\\nmade, it will be found that still more of the epidermis\\nmay be easily removed. If infiltration be present, liquor\\npotassae should be applied, taking care not to let it get\\ninto the fissures, if any be present. The fissures them-\\nselves should be dressed with graphite, and white pre-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0181.jp2"}, "180": {"fulltext": "172 SKIN DISEASES.\\ncipitate or citric ointment applied to the entire diseased\\nsurface.\\nIf, however, there be Uttle infiltration or epidermic\\nproliferation, tar or its equivalent is indicated if the sur-\\nface is dry and scaling while some of the less stimulat-\\ning ointments should be applied if the surface be moist\\nand exuding. At best, eczema of the hands, if already\\nchronic, is an exceedingly obstinate affection, and one\\ndifficult to remove.\\nEczema of the leg is very frequently dependent on pre-\\nexisting varicose veins, and when such is the case is\\ndifficult to manage, unless the diseased veins can them-\\nselves be brought under control. If the varicose condi-\\ntion be at all severe, the general nutrition of the skin of\\nthe leg seems to suffer greatly, and a slight wound from\\nscratching may degenerate into an ulcer. The cutaneous\\ntissues, which are the site of the lesion, and for a consid-\\nerable space around it, may be greatly thickened, and the\\nsurface present a bluish tint from impeded circulation.\\nWhen this condition exists, the utmost benefit will be\\nsecured from the systematic use of the rubber bandage\\napplied so as to bring firm but even pressure to bear upon\\nthe parts. The bandage should, in the first instance, be\\napplied by the physician, and the mode of its application\\ntaught the patient. The bandage should, when practic-\\nable, be applied morning and night, and, if it becomes\\nsoiled by discharges of any kind, should be replaced by a\\nfresh one, while the first one is permitted to soak in cold\\nwater till again needed. After the leg has been restored\\nto its natural size, the bandage may be discarded, but an\\nordinary eclastic stocking should be worn habitually.\\nThe direct applications to be made will depend on the\\nstage of the eruption and condition of the lesion.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0182.jp2"}, "181": {"fulltext": "TREATMENT OF ECZEMA. 173\\nEczema of the leg, however, is not always of varicose\\norigin, but sometimes presents itself as a chronic subacute\\ncircumscribed lesion, with or without much infiltration.\\nIf scaling be a notable feature that is, with decided epi-\\ndermic thickening and proliferation a few applications\\nof salicylic acid will prove of great service as a prelimi-\\nnary application, and a ten or fifteen grain solution in\\nflexible collodion should be painted over the spot. This\\nmay be repeated a few times until the tendency to scale\\nformation has notably diminished. If there be but little\\ninfiltration, tar, or some of its preparations, is indicated\\nbut if infiltration is marked, potash or scarification should\\nbe employed and afterward zinc or white precipitate\\nointment.\\nAcute eczema of the leg requires different treatment.\\nIf the greater part of the leg or both legs are involved,\\nrest in bed or on a lounge, with the limbs elevated, is a\\nsine qua non. The parts, being inflamed, hot, red,\\nswollen, and exuding, need rest and soothing treatment.\\nAbsolute rest must be insisted on, and when secured\\napply a diluted solution of peroxide of hydrogen. The\\nbest method of applying it is with an atomizer. Purulent\\nexudation is brought under immediate control, and of-\\nfensive odors are destroyed. After two or three days, as\\na rule, the inflammation will be lessened, the area of de-\\nnuded surface diminished, and attempt at healing be\\napparent. Now, some of the medicated plasters contain-\\ning oxide of zinc or ammoniated mercury should be ap-\\nplied. These may be left undisturbed for several days,\\nand if covered with an elastic stocking the patient may\\nbe permitted to take moderate exercise. If no indiscre-\\ntions be committed, steady progress toward cure may\\nusually be expected.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0183.jp2"}, "182": {"fulltext": "174 SKIN DISEASES.\\nEczema of the inner surface of the thigh not unfre-\\nquently appears in the papular form, and may best be\\ntreated with permanently attached dressings containing\\nzinc or white precipitate.\\nEczema of the anus is an insiduous affection, and is\\nfrequently of long standing before it is brought to the\\nnotice of the physician. Thickening and fissures often\\ncoexist, and should first be treated and healed by cau-\\nterization, peroxide of hydrogen, graphite ointment, or\\npowder, etc., before any attempt is made to reduce the\\ninfiltration by strong alkaline applications. One of the\\nmost effective applications to the fissures is the fine point\\nof a Paquelin cautery at a white heat.\\nEczema of the mammae and nipples is a very frequent\\naccompaniment of scabies in the female, and when met\\nwith the latter disease should be suspected and sought\\nfor, and the scabies, if present, receive the first attention.\\nIn obese persons an eczema may arise from the irrita-\\ntion produced by the confinement of the cutaneous secre-\\ntions by overlapping folds of skin, as under pendulous\\nbreasts and in the groin between the thigh and genitals.\\nIn these, simple dusting powders, with separation of the\\nparts by linen, will often accomplish all that is required.\\nWe now come to the consideration of the most import-\\nant of the means of cure of eczema, and one in which\\nHomoeopathy has won some of her brightest laurels, the\\ninternal treatment.\\nIndications for the remedies are as follows:\\nAconite. Acute eczema in plethoric persons.\\nAl2imina. Dry, thin subjects and old people with\\nconstipated bowels the slightest bruise of the skin\\nsmarts brittle nails much itching with no relief from\\nscratching the patient feels as if the white of had\\ndried on the surface itching aggravated in the evening", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0184.jp2"}, "183": {"fulltext": "TREATMENT OF ECZEMA. 175\\nand from the heat of the bed, and every other day and,\\nin the open air.\\nAmmon. carb. Eczema in the bends of the extremities\\nexcoriations between the legs, and about the anus and\\ngenitals violent itching relieved by scratching. Aggra-\\nvated by either cold applications or hot poultices in\\nchildren.\\nAmmon. mur. Eczema on the face and across the\\nloins intense burning, somewhat relieved by cold appli-\\ncations constipation in fat, sluggish individuals.\\nAnacardium. Acute eczema on the face, neck and\\nchest. Tubercles on the scalp, sore when touched vio-\\nlent itching, worse at night, and after scratching redness\\nof the skin with eruption of small vesicles rough, ex-\\nfoliating skin around the mouth, burning around the lips\\nas from pepper sensitiveness to draught.\\nAntimon. crud. Eczema with gastric derangement\\nviolent thirst white coated tongue yellowish, tenacious\\ndischarge violent itching aggravated from wet poul-\\ntices, from bathing and working in water, from alcoholic\\ndrinks and in the sun.\\nAntimo7i. tart. Pustular eczema with bronchitis vio-\\nlent itching, suppurative rash, particularly on the occiput,\\nchest and arms sleepiness with nausea rattling cough\\nirritable wants to be carried complains when touched.\\nApis. Eczema with renal troubles, scanty urine, no\\nthirst; tendenc}^ to dropsical swellings; burning and\\nstinging in the skin aggravated from heat, ameliorated\\nfrom cold water and scratching.\\nArgent, yiitr. Eczema on the genitals urging to\\nurinate in children who eat too much sweets.\\nArse?!, alb. All forms accompanied by intense burn-\\ning of the skin fetid or purulent discharge or dry, scaly\\neruption falling out of the hair in patches here and", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0185.jp2"}, "184": {"fulltext": "176 SKIN DISEASES.\\nthere, leaving the skin dry and dirty looking dry,\\nparchment-like skin thirsty, drinking little and often\\naggravated after midnight, from cold, in open air and\\nfrom scratching with bleeding afterward ameliorated\\nfrom heat.\\nArundo Maui it. Eruption on the chest, upper ex-\\ntremities and behind the ears. Intolerable itching,\\ncrawling sensation, especially over the loins and shoul-\\nders in young children.\\nAstacusfluv. Thick crusts on the scalp enlargement\\nof the lymphatic glands clay colored stools.\\nAurum. Old persons with mercurial symptoms; sui-\\ncidal tendencies constant desire to be in the open air\\neven in bad weather.\\nBaryta carb. Eczema capitis, wdth falling out of the\\nhair and swelling of the adjacent glands fat, dumpy\\nchildren timidity in the presence of strangers chronic\\ndisposition to swelling of the tonsils or glands of the\\nneck takes cold easily aggravation at night and from\\nscratching ameliorated when walking in the open air.\\nBellad. Eczema on the face with scarlet redness,\\nburning, itching eruption, sensitive to the touch in\\nteething children, with tendency to convulsions over-\\nsensitive, excitable persons.\\nBorax. Eczema on the face and scalp red, papulous\\neruption around the cheeks and chin excoriating secre-\\ntions aphthous difficulties slight injuries suppurate\\ndread of slight downward motion.\\nBovista. Eczema about the mouth and nostrils gen-\\neral lassitude, especially in the joints patient wants to\\nurinate immediately after micturition constipation\\nperspiration smells like onions aggravated from warmth\\ngrocers itch; moist vesicular eruption with formation of\\nthick crusts; eruption on the thighs and bends of the", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0186.jp2"}, "185": {"fulltext": "TREATMENT OF ECZEMA. 177\\nknees; on the back of the hand; swelling of the upper\\nlip; burning, itching; no relief from scratching; symptoms\\nworse during hot weather; the skin of the fingers becomes\\ndented by the use of the scissors or other instruments.\\nBro7nine. Profuse oozing of a dirty, nasty-smelling\\ndischarge; eczema covering the head as with a cap; crawl-\\ning sensation beneath the scalp, with sensitiveness to the\\ntouch; glands of the neck hard and swollen; high-colored\\nurine.\\nBryojiia. Eczema capitis when the scalp is ver)^ tender\\nto the touch, and there are pains and aches worse from\\nmotion; eczema all over the body, especially on the back\\neruption slow in making its appearance; symptoms worse\\nfrom exposure to the heat of the fire; stools dry and hard\\nas if burnt.\\nCalcarea carb. Chronic and squamous eczema in\\nscrofulous persons; skin inclined to ulcerate; itching and\\nburning in the skin; thick crusts with oozing; parts\\naffected nape of neck, head, face, on and behind the\\nears, genital organs, region of umbilicus, hands and\\nbends of the extremities; chalky stools; menses too soon\\nand too profuse; takes cold easily; cold feet, as though\\nthere were damp stockings on them; no dread of water,\\nbut the disease is aggravated by water; aggravated in\\nthe open air and from water and from drinking milk;\\nameliorated in a warm room; in big-bellied children with\\nlight hair and blue eyes; profuse sweating of the head.\\nCaladium. Eczema alternating with asthma; great\\ndisinclination to move; vertigo on going to sleep; eczema\\nof vulva, chest and forehead; ameliorated when pertjpiring.\\nCantharis. Eczema with urinary difficulties; much\\nburning and smarting or burning itching; aggravated\\nfrom touch; ameliorated from lying down.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0187.jp2"}, "186": {"fulltext": "178 SKIN DISEASES.\\nCarbo veg. Eczema with hemorrhoids and flatulency;\\nthe most innocent food disagrees; cachectic individuals;\\naggravated from warmth and water.\\nCarbolic acid. Moist vesicular eruption on the hands\\nand all over the body. Itching better from rubbing, but\\nleaving a burning pain.\\nCausticum. Eczema in rheumatic or gouty individuals;\\nmoist eczema on the neck and around the nipple; thick\\ncrusts on the nostrils; great restlessness; child is afraid at\\nnight in a dark room; aggravated in the open air and in\\nthe evening; ameliorated from the warmth of the bed.\\nChamom. Excoriations between the thighs in children\\nand infants; unhealthy skin, every injury suppurates;\\nsevere itching of sweating parts; child fretful, must be\\ncarried about.\\nChelidofi. Eczema rubrum of the scrotum, or ankle;\\nheat, swelling and redness of the parts; bitter taste in the\\nmouth when not eating or drinking; pain in the hepatic\\nregion chronic affections of the abdominal organs.\\nCicuta. Thick, whitish scurfs appear on the chin and\\nupper lip; they secrete a dampness; sometimes affect the\\nnose; no itching; the exudation dries down into a hard,\\nlemon-colored scab.\\nClematis. Red and humid eruptions when the moon\\nis increasing, growing pale and dry with the decrease;\\nscaly spots with yellowish corrosive ichor; pustules\\nover the whole body; eczema, following suppressed gon-\\norrhoea; sticking sensation when touching the skin; ag-\\ngravated from washing and from the heat of the bed.\\nConium. Eczema of old people from being overheated;\\non face, arms and mons veneris; urine flows, and stops\\nand flows, and stops at each emission; vertigo when\\nturning the head, when looking up or when turning", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0188.jp2"}, "187": {"fulltext": "TREATMENT OF ECZEMA. 179\\nover in bed; gluey, sticky discharge; aggravated from\\nscratching.\\nCornus alternifolia. Dr. Lutze reports on the use of\\nthe swamp wahitit, and sums up the following as indica-\\ntions for the remedy: Eczema when the skin was cracked\\neverywhere, but especially where it had a fold or crease,\\nexuding a sticky, watery fluid from these cracks; use\\nlocall}^ and internally.\\nCreosote. Eczema capitis and mammae, with violent\\nburning after scratching; heavy scabs.\\nCrotalus. Vesicular eruption on the septum narium;\\nsour, acrid eructations; painful retention of urine.\\nCroto7i tigl. Any form of eczema uncomplicated with\\ndisease of other organs; watery diarrhoea gushing out\\nforcibly; excessive itching, but the patient cannot bear to\\nscratch very haid as it hurts; a mere rub sufi ces to allay\\nthe itching.\\nCo7idurango. Especially when rhagades are present,\\noozing out a fetid fluid; cachectic or syphilitic dyscrasia.\\nCuprum. With convulsions, or when convulsions fol-\\nlow the suppression of eczema.\\nCyclamen. Eczem.a faciei; when there is stinging itch-\\ning, aggravated in the evening in bed by eating fat food,\\nand ameliorated by scratching or by wiping with the\\nhand.\\nDulcamara. Eczema on the face and extremities\\npreceding the menses, oozing a water}^ fluid and bleeding\\nafter scratching; after its disappearance, faceache and\\nviolent asthma; desire for cold drink, eructations, vomit-\\ning in the morning; persons who get angry easily; ag-\\ngravated in cold weather, after taking cold, from cold,\\nand evening when at rest; ameliorated while moving in\\nwarm air.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0189.jp2"}, "188": {"fulltext": "180 SKIN DISEASES.\\nFluoric acid. Eczema on the face, scalp, neck and\\nchest; dry eruption with itching and burning; painful\\nrhagades after washing; brittle nails.\\nGraphites. Thick crusts and a raw surface with deep\\nrhagades; eczema of fat people, of blonde complexion\\nwho take cold easily; on and behind the ears with con-\\nstant profuse oozing of a sticky fluid; thick crusts some-\\ntimes falling out of the hair; on the face and chin, with\\nconsiderable itching and increased discharge after scratch-\\ning; on genitals and in bends of limbs, especially of\\nwomen with delayed and scanty menses; humid eruption\\nwith secretion of corrosive serum smelling like herring\\nbrine; great soreness of the skin, after scratching, with\\noozing of a sticky moisture; on the hands, with sticky\\nand profuse secretion; itching worse in the evening and\\nat night; skin dry, never perspires, and is inclined to\\ncrack; disease apt to become purulent; aggravated from\\ncold and in the evening; and, when at rest.\\nHelleb. Eczema of the fingers, lips or head, continuing\\nmoist for a long time and then covered with scurf. Ag-\\ngravation of symptoms from 4 to 8 p. m.; in the evening,\\nin cold air, ameliorated in warm weather.\\nHepar. Eczema pustulosum, with glandular enlarge-\\nments, severe itching and scratching, oedematous swell-\\nings; eczema behind the ears and on the scalp, burns and\\nsmarts after scratching, and is very sensitive to the touch;\\nafter the abuse of mercury; sleeplessness after midnight;\\naggravated at night, from cold air and from contact;\\nameliorated from wrapping up warmly.\\nHydrocya7iic acid. Itching, burning vesicles on neck\\nand arms; weakness and anaemia; constant drowsiness.\\nHydrastis. Eczema along the border of the hair in\\nfront; aggravated on coming from the cold into a warm\\nroom; oozing after washing; constipation with hemor-\\nrhoids.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0190.jp2"}, "189": {"fulltext": "TREATMENT OF ECZEMA. 181\\nHypericum. Eczema on the face and hands; yellowish-\\ngreen crusts with violent itching; excessive itching, espe-\\ncially in the sacral region when undressing; the eruption\\nis sometimes dry, and at times fiery red; roughness of\\nthe skin.\\nIris vers. Eczema on the face; pustular eruption\\naround the nose and lips, and on the cheeks; worse in\\nthe evening and at night; gastric and bilious derange-\\nments.\\nJuglans cin. Vesicular eruption on the upper and\\nfront part of the chest with burning and itching; violent\\nitching over the whole body, in spots, worse when being\\nheated from over-exertion; stitch-like pain under the\\nright scapula.\\nKali carb. In persons inclined to pulmonary difficul-\\nties; take cold easil}^- sensitive to cold; sticking pains\\nall over; eruption dry at first, but when scratched\\nexudes a moisture; comes on in warm weather; puffy\\nand baggy swelling of the upper eyelids (Ars., lower\\nlids); great dryness of the skin; deficient perspiration\\n(Graph.; Alum., Led.); yellow, scaly, violent itching\\nspots over the body, especially over abdomen and around\\nthe nipples. Aggravated between 2 and 3 A. m., from\\ncold air {Hep.), from becoming cold. Ameliorated in\\nwarm air and on getting warm.\\nLachesis. Very obstinate cases when seated on the\\nlegs; ulcers on the lower extremities; pricking, pulsating\\ntearing pains; variable appetite; burning in the palms\\nand soles; often useful in women during the climacteric\\nperiod.\\nLappa maj. The lesion is at first vesicular, then a\\nscurf, and afterward a greenish-yellow crust, and is\\nalways accompanied with such intolerable itching that\\nthe child has to be tied or mittened to keep it from maim-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0191.jp2"}, "190": {"fulltext": "182 SKIN DISEASES.\\ning itself; sometimes the crust comes off in large patches,\\nleaving the surface raw and exposed; the eruption smells\\noffensive; swelling and suppuration of the axillary glands;\\ndisposition to boils. I have cured some very bad cases\\nwith this remedy, used as follows: Internally I use the\\nIX three times a day, and apply locally the following\\nlotion:\\nLappa major, ^ij.\\nGlycerine, ^j\\nAqua destillata, q, s. ad ^iv.\\nM. Sig. Apply to scalp on retiring.\\nLedum, Eczema only on covered parts; eczema of\\nrheumatics or drunkards; gnawing, itching of the skin;\\nthe pain commences in the feet and goes up; aggravated\\nfrom heat and motion, and heat of the bed.\\nLycopodiiim. Obstinate cases when the eruption bleeds\\neasily and has a thick, badly smelling discharge;\\nparts affected back of head, face, neck, hands and right\\nfore-finger; bowels constipated; no appetite, a few\\nmouthfuls satisfy him; great debility while at rest; bleed-\\ning after scratching; humid suppurating eruption, with\\nthick crusts and profuse fetid discharge underneath; ag-\\ngravated from 4 to 8 p. m. after getting heated, and from\\nwet poultices; ameliorated from cold, from uncovering\\none s self.\\nMercurius sol. All forms of eczema, especially of the\\nhairy parts in persons who perspire easily, but obtain no\\nrelief from perspiration; tendency to inflammation of the\\nlymphatic glands; increase of saliva; enlargement of the\\ntongue, showing the imprints of the teeth; scorbutic\\ngums; after scratching, bleeding and smarting; sleepless-\\nness before midnight; aggravated at night; after getting\\nwarm in bed; after scratching; ameliorated in the morn-\\ning.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0192.jp2"}, "191": {"fulltext": "TREATMENT OF ECZEMA. 183\\nMercurius iodat. When other remedies fail and there\\nis a decided syphilitic taint; swelHng and induration of\\nthe glands; troublesome itching over the whole body;\\nall symptoms are worse at night.\\nMerc, precip. rube7\\\\ Eczema of the hairy parts, and\\nof the anus with fissures; eczema of the umbilicus; pustular\\neruption with slight itching: oozing of pus from beneath\\nthe crusts; glandular swellings.\\nMezeretim. Eczema crusts with white scabs, itching\\nintolerably, bleeding and burning like fire on being\\nscratched; honey-like scabs around the mouth; dis-\\ncharges profuse, excoriating the surrounding parts; head\\ncovered with a thick, leathery crust, under which pus\\ncollects and mats the hair; constant chilliness; pale urine;\\nthirst, but drinks only a little at a time. Scrofulosis.\\nNatrum mur. Eczema behind the ears, back of head\\nand neck about the edges of the hair, anus, bends of the\\nknees and elbows; humid eruption, with gluey discharge,\\nmatting the hair; raw, inflamed surfaces, with constant\\ncorroding discharge, which eats away the hair; craves\\nsalty food; difficult expulsion of stool Assuring the anus,\\nwith flow of blood; morning headache; cutting in the\\nurethra after micturition; white, coated tongue; lips and\\ncorners of the mouth ulcerated and cracked; eyelids\\nraw and ulcerated; aggravated in the forenoon and from\\nexercise; ameliorated after lying down.\\nNatrum sulph. Very moist eruptions, with much\\noozing of fluids, the secretions more watery than sticky.\\nNitj ic acid. Eczema of gouty origin, about the head,\\nears and genitals; pustular eruption of the face, with large\\nred margin, and heavy scabs; vesicles on the inner side\\nof the left hand; soreness of the feet from profuse, offen-\\nsive perspiration dry, scaly skin; moisture and itching\\nin the anus; syphilitic ulcers after abuse of mercury;", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0193.jp2"}, "192": {"fulltext": "184 SKIN DISEASES.\\nswelling of sub-maxillary glands; strong smelling urine;\\nin dark-complexioned old people; aggravated at mid-\\nnight.\\nNux juglans. Burning itching vesicles upon a cracked\\nsurface, with a greenish discharge which stiffens the\\nlinen; numerous, large, painful boils; itching worse in\\nthe evening and at night.\\nOleander. A humid, scaly eruption of the scalp, with\\ngnawing itching, temporarily relieved by scratching, soon\\nfollowed by burning and increased itching; smooth, shin-\\ning surface, with drops of serum standing out here and\\nthere; humid fetid spots behind the ears, red, rough spots\\nin front; very sensitive skin; it becomes sore, raw and\\npainful merely from friction of the clothes; aggravated\\nwhen undressing. Marked weakness of the lower limbs,\\nand a gloomy irritable mental state.\\nOxalic acid. Exceedingl}^ sensitive skin, with vesicu-\\nlar eruption. Suffers from the use of sugar, and sweets\\nin general. All symptoms worse while thinking of them\\n(reverse, Camph.^.\\nPetroleum. Eczema with red, raw, moist surface;\\nburns like fire; great itching; oozing after scratching;\\nulceration after scratching; small wounds spread and\\nulcerate; obstinate dry eruption on genitals and peri-\\nnseum, inside of thighs; skin of the hands cracked and\\nrough; eruption between the toes; skin heals with diffi-\\nculty; aversion to open air; aggravated in the open air\\nand during a thunder-storm; ameliorated from warmth\\nand warm air.\\nPhosphorus. Dry eruptions, burning and itching; the\\ngums separate from the teeth and bleed easily; ecchy-\\nmosed spots on the body; slight wounds bleed much, ag-\\ngravation at night before midnight; during a thunder\\nstorm; ameliorated after scratching; after sleeping.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0194.jp2"}, "193": {"fulltext": "TREATMENT OF ECZEMA. 185\\nPiper methysticum. Skin dry, scaly, cracked and ulcer-\\nated, especially where it is thick, as on the hands and\\nfeet.\\nPiper nigrum. Eczema on the lips.\\nPsorinum Dry and scaly eruption, with little pointed\\nvesicles around the reddened edges, disappearing during\\nsummer, but reappearing when the cold weather comes\\non; violent itching, worse by heat of bed and scratching;\\ndirty, greasy-looking, foul-smelling skin. This remedy\\nshould be thought of in cases which do not yield to the\\nwell-selected remedy and compared with Sulphur.\\nRanuncuhis bulb. Vesicular eruption on face in clus-\\nters, as from a burn; smarts as if scalded; aggravated in\\nthe evening, from change of temperature, from touch\\nand motion.\\nRhus tox. Eczema inner side of thighs, particularly\\nafter vaccination, with much itching and thirst; the erup-\\ntion is generally moist, the surface raw, and the parts\\nswollen; a red, inflamed, swollen rim from subcutaneous\\ninfiltration surrounds every portion of the eruption\\n{Ars., black rim around the eruption); white, thick,\\nmoist crusts form, which smell offensively, and itch,\\nespecially at night; cheeks, face, and scalp affected;\\nfalling off of the hair; milk crust on face, humid, angry-\\nlooking, with hard, brown crusts; eczema of the scrotum,\\nwith intolerable itching. The child is restless, wants to\\nbe moved continually, especially after midnight, when\\nthe itching is intense, but this is relieved for a time by\\nscratching; the cold fresh air is not tolerated on the\\nhead; it seems to make the scalp painful; hence the child\\nlikes to have its cap on in the open air (compare Silicea\\nRhus venenata. Fine vesicular eruption on the upper\\nextremities; groups of watery vesicles on the fingers;\\nfissures on the ends of the fingers; upper lip swollen and\\ncovered with vesicles.\\n13", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0195.jp2"}, "194": {"fulltext": "186 SKIN DISEASES.\\nSarsaparilla, Eczema on the nose and face; thick\\nscabs on the face; scabby eruption on the nose and face,\\nlike milk crust intolerable itching, worse at night, and\\nafter getting heated; child cries a great deal and is ex-\\ntremely restless.\\nSepia. Eruptions during pregnancy and nursing;\\nitching of skin, changing to burning when scratched;\\nsensation as of ants crawling over the skin; soreness of\\nthe skin and humid places in the bend of the joints and\\nbehind the ears; pruritus, with vesicles on a red base over\\nall parts of the body. Dry ringworm, especially on the\\nface of children; dry offensive eruption on the vertex and\\nback of head, itching and tingling, with cracks behind\\nthe ears; pruritus, with vesicles on acrid base over all\\nparts of the body, face, eyelids, hands, feet, armpits,\\nvulva, anus, ears, hairy parts. Great indifference or\\nsadness; wakes about 3 AM. and lies awake for hours;\\npatient has dark hair, thin, delicate skin, brown discol-\\noration of the forehead, and passes putrid urine (compare\\nCalc. OS., Benz. ac); aggravated in the open air, from\\napplication of cold water; ameliorated from warmth in\\ngeneral.\\nSilicea. Eczema capitis, with humid itching eruption\\nin scrofulous children; pale, cachectic countenance; en-\\nlarged cervical glands; leucorrhoea, backache; menses\\ntoo profuse; eruption on the back part of the head, either\\nmoist, or dry and scaly; offensive; scabby; itching during\\nthe day and evening, never at night; soreness after\\nscratching; burns; pustules form and discharge copiously.\\nChild cries when spoken to; big-bellied children, with\\nweak ankles; emaciated frame, and irritable tempers,\\nwith perspiration about the head towards morning;\\noffensive perspiration on the feet and genitals; aggra-\\nvated during day and evening, and about the new moon;\\nameliorated from warmth in general.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0196.jp2"}, "195": {"fulltext": "TREATMENT OF ECZEMA. 187\\nStaphysagria. Eczema with yellow, moist, offensive\\nscales, with considerable itching, disappearing after\\nscratching, but soon returning; oozing after scratching;\\nhumid scabs with bad smell; j^ellow acrid moisture oozes\\nfrom under the crusts; scratching sometimes changes the\\nlocality of the itching; scalp painfully sensitive; skin\\npeels off with itching, hair falls out; itching of the mar-\\ngins of the lids. Face sunken; nose pointed and blue\\nrings encircle the eyes; the child is irritable, and in-\\ndignantly throws things away from it which were desired\\nbut a moment before. Aggravated from scratching, from\\ntouching the affected parts, from abuse of mercury.\\nAmeliorated from walking in the open air.\\nSulphur. Sequela of a suppressed eruption; voluptu-\\nous itching, with soreness after scratching; eruption on\\nback of head and behind the ears, around the margin of\\nthe hairy scalp from ear to ear posteriorly; dry, offen-\\nsive, scabby, with cracks, easily bleeding, burning\\nand painful; or humid, and offensive, discharging thick\\nor thin acrid pus, which forms into yellow crusts;\\nchronic cases; the child cannot bear to be washed; is\\nmost comfortable when dirty; morning diarrhoea, or\\nbowels moved regularly, but always with great pain.\\nAggravated from getting warm in bed, from washing,\\nfrom wet poultices; ameliorated from heat, in dry\\nweather; after rising.\\nSulphuric acid. Moist eczema after suppressed gonor-\\nrhoea, with pricking of the skin; on scratching the itch-\\ning changes locality; aggravated in the open air.\\nSumbul. Eczema on the left side of the scalp in infants.\\nTerebinthina. Infantile eczema in front of ear, tending\\nto affect the eyelids {Graph., behind ear), often alternat-\\ning with otitis.\\nThuja. Itching vesicles, with shooting pains; skin", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0197.jp2"}, "196": {"fulltext": "188 SKIN DISEASES.\\nextremely sensitive to touch; burns violently after\\nscratching; dry, scaly eruptions on head, extending to\\nthe temples, eyebrows, ears and neck, with itching,\\ntingling and biting; dryness of covered parts; per-\\nspiration of parts uncovered, smelling like honey;\\neruption only on covered parts; after vaccination\\nthe eczema is worse (SiL); eruption is white, scaly,\\nand desquamating; offensive perspiration of the feet;\\nwants head and face wrapped up warm (Stl.). Ag-\\ngravated from cold, wet, heat of bed, about 3 a. m.\\nameliorated from gentle rubbing (itching); from warm\\nwet (reverse, Lj c. and Suipk.); from a development of\\ncoryza.\\nVaccinatio7i. Several cases have been reported cured\\nby vaccination; I have had no personal experience with\\nthis agent in this disease.\\nVinca minor. Eczema on head, face, and septum of\\nthe nose; humid eruptions, itching at night, with burn-\\ning after scratching; offensive moist verminous eruption\\nwith biting itching; eruptions appearing in spots,\\nmoisture oozes therefrom and the hair becomes matted.\\nViola tricolor. Eczema impetiginoides, exudation of\\nyellow viscous pus; the eruption burns and itches, espe-\\ncially at night; thick crusts form; swelling of cervical\\nglands; urine smells like cat s urine; eczema capitis or\\nfacei, in scrofulous children.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0198.jp2"}, "197": {"fulltext": "CHAPTER IX.\\nBULLOUS DISEASES AND ANOMALOUS\\nFORMS OF BULLOUS ERUPTION.\\nUnder this head we include the diseases which are\\nespecially characterized by the occurrence of the bullae as\\nprimary and essential phenomena. A bulla is a large\\nportion of the cuticle detached from the skin by the inter-\\nposition of a transparent watery fluid. In fact, a bulla is\\na large vesicle. In the wide sense of the term several\\ndiseases are really bullous, such as erysipelas, herpes,\\npemphigus, rupia, eczema of the fingers, and impetigo\\ncontagiosa. But of these there are only two that really\\nrank under the term bullous i. e., herpes and pemphi-\\ngus. Erysipelas belongs to the class of zymotic diseases;\\nrupia is always syphilitic, and of course it is grouped un-\\nder that head; the bulla produced by the coalescence of\\nvesicles in eczema is an accidental and secondary phe-\\nnomenon; and in impetigo contagiosa, the primary stage\\nis a vesicle and not a bulla, the secretion subsequently\\nbecoming sero-purulent, whilst the general behavior and\\noutward aspect of the disease are those of an impetigo.\\nBesides, herpes and pemphigus are peculiar and like in\\nregard to the influence of the nervous system in their\\nproduction. Therefore, true bullous diseases, or those\\nwhich are probably of neurotic origin, and in which the\\nbullae are primary, with transparent contents, are herpes\\nand pemphigus.\\nHerpes and pemphigus might have been placed under", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0199.jp2"}, "198": {"fulltext": "190 SKIN DISEASES.\\nthe head of neurotic diseases, but then many others must\\nhave been included, such as urticaria, pityriasis rubra,\\netc., with them, if we carried out the idea of collecting\\ntogether under one head all those diseases which pri-\\nmarily originate in disturbance of the nervous system\\nand arranged them upon a pathological basis As we\\nhave classified diseases, however, clinically, we place\\nherpes and pemphigus under the convenient but most\\nunscientific term, bullous inflammation, because it is\\nto changes implied by that term that the practitioner first\\ndirects his attention in the matter of diagnosis and treat-\\nment.\\nSome anomalous forms of eruption will be noticed at\\nthe latter part of this chapter.\\nHerpes.\\nThe term herpes, used b}^ itself, has little significance,\\nbut the expressions herpes zoster, herpes labialis, herpes\\nprog e7iita lis etc., refer to definite and distinct affections.\\nThe first of these we will describe under the name of\\nZoster, but the other two will be considered here.\\nHerpes Labialis.\\nHerpes is an affection of the skin, characterized by the\\ndevelopment of small clusters of vesicles, usually situated\\non a slightly reddened or inflamed surface, and in the\\nimmediate neighborhood of the mouth.\\nThe vesicles appear unattended with any pain other\\nthan a slight burning or itching sensation, and last for a\\nfew hours or a day or two. They then rupture and give\\nexit to a slight serous discharge, when they dry up and\\nleave a surface which heals in a short time without scars.\\nHerpes labialis usually attacks children or women, but\\nis not commonly met with in men. It frequently comes", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0200.jp2"}, "199": {"fulltext": "HERPES PROGENITALIS. 191\\non as a sequel of a cold, or slight febrile attack, and on\\nthis account has received the names cold sore, fever-\\nsore, etc.\\nThere may be a single group of vesicles, or there may\\nbe several, each group containing four or five vesicles.\\nThe eruption may be confined to one side of the face,\\naffecting either the upper or lower lip, or both, or just as\\nfrequently it may appear on both sides of the mouth. A\\ntrue zoster ma}^ appear on the face and invade the same\\nregions as herpes labialis, except that the eruption is\\nalmost invariably unilateral.\\nThe local treatment of herpes labialis involves nothing\\nmore than a little absorbent powder, or a sedative lotion\\na little camphor- water being a favorite application.\\nThe internal treatment will be taken up in the next\\narticle.\\nHerpes Progenitalis.\\nThe term hei-pes progenitalis includes the herpetic\\naffections of the genital organs of both sexes, and, when\\noccurring in the male, is called herpes preputialis and in\\nthe female heypes vulvaris.\\nHerpes preputialis most frequently occurs in young\\nmen between the ages of 20 and 40, and is not often met\\nwith as a first attack after that age. The vesicles may\\nform on both the cutaneous and mucous surfaces. Owing\\nto the anatomical situation of these parts, and to the\\nfriction to which they are more or less subject, the ves-\\nicles last for but a few hours oxAy, breaking and giving\\nrise to superficial erosions, which from neglect or un-\\ncleanliness may run into slight ulceration.\\nIn herpes vulvaris the lesions may be upon the labia\\nmajora or the labia minora, or upon the prepuce of the\\nclitoris, running the same temporary course as the other\\nvarieties of the affection.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0201.jp2"}, "200": {"fulltext": "192 SKIN DISEASES.\\nHerpes progenitalis is not usually accompanied with\\nmuch pain, unless the parts are subjected to undue fric-\\ntion. As in the male, herpes of the female organs is\\nmost frequently met with between the ages of 20 and 40.\\nA single attack lasts for a few days only, but with many\\npatients herpes proves to be a relapsing affection, and\\ncausing on this account serious inconvenience to those\\nwho are subject to it. In men, relapses may occur after\\nalmost every act of sexual intercourse, but curiously is\\nmuch less frequent in married men than in those who\\nindulge promiscuously and at irregular intervals only.\\nIn women of the town the affection is by no means un-\\ncommon, but is very rarely met with in married women\\nor virgins, except when the attacks coincide with men-\\nstrual periods.\\nIn this connection I will quote from an article in the\\nJournal, Cutaneous and Veneral Diseases, August, 1883,\\nwhere Dr. Unna reports his experience. He has met\\nwith 200 cases in the female. He says: In France,\\nwhere prostitution is under surveillance, and where ex-\\ncellent syphilographers abound, herpes progenitalis early\\nattracted attention and was ascribed to an unnatural irri-\\ntation of the sexual organs to w^hich prostitutes are sub-\\nject. Venereal diseases cannot be the cause, for in mar-\\nried women suffering from syphilis or gonorrhoea herpes\\nis not found. In prostitutes, herpes occurs as often in\\nthose without as those with syphilis. Acute and chronic\\nblenorrhoea often exist as factors in the development of\\nherpes progenitalis, by the congestion of the parts which\\nthey induce. There are prostitutes who have an attack\\nof herpes every time they menstruate. Less frequently\\npregnancy and the puerperal state induce a disposition to\\nherpes progenitalis. Bruneau must be given credit for\\nhaving shown that in women suffering with chronic", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0202.jp2"}, "201": {"fulltext": "HERPES PROGENITALIS. 193\\nmetritis, cervicitis, etc., every herpetic eruption is pre-\\nceded by increased sensibility and signs of heightened\\ncongestion of the pelvic organs. While the vesicles are\\nstill intact, the diagnosis is easy. The vesicles are yel-\\nlowish, translucent and arranged in clusters. When\\nthe epidermis has given way, the surface crusted over,\\nerosion present, the surface must often be first carefully\\ncleansed before we can say whether the disease be a\\nsuperficial wound, a burn, eczema, chancre or herpes.\\nHerpetic erosions are all well defined and of a bright red-\\ndish hue. They are discrete, coalescent or confluent. In\\nany case, the sharply defined contour and crescentic ar-\\nrangement make herpes easy of diagnosis. The parts\\nmost liable to this affection, in order, are the labia\\nminora, prepuce of the clitoris, labia majora, introitus\\nvagina, and caruncula myrtiformis. The disease may be\\nunsymmetrical when such organs as the prepuce of the\\nclitoris, perineum, etc., are attacked. Pain usually pre-\\ncedes the eruption by several days.\\nThe etiology of herpes progenitalis is obscure, and no\\nadequate- explanation has yet been given to account for\\nthe attacks.\\nDiagnosis. The diagnosis of herpes progenitalis\\npresents little difficulty, but care should be taken to dis-\\ntinguish it from mechanical abrasions and from conta-\\ngious venereal lesions.\\nThe treatment of this affection is simple. As a rule,\\nnothing more is required than a little dressing-powder,\\nor a sedative lotion; and if the parts are left at rest the\\nerosions will be covered with new epithelium in a few\\ndays. Should ulcerations have occurred, they may be\\nlightly touched with the solid nitrate of silver, and small\\npieces of linen may be placed between folds of mucous\\nmembrane that are lying in contact. These should be", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0203.jp2"}, "202": {"fulltext": "194 SKIN DISEASES.\\nfrequently changed and the parts kept clean with warm\\nwater and soap.\\nWhen the affection assumes the relapsing form, pa-\\ntients will go from one physician to another, seeking a\\npermanent cure, which we regret to say they will rarely\\nattain until they reach the age at which the trouble tends\\nto disappear spontaneously.\\nThe internal treatment and the indications for the\\nremedies are as follows:\\nAcojiite. In the earlier stages with catarrhal fever.\\nAgnus castus. Herpes on the cheeks with gnawing\\nitching, worse from getting wet.\\nAlnus rubra. Chronic herpes.\\nApis mel. Large confluent vesicles; burning stinging\\npains; vesicular eruption on the lips; cold sores.\\nArsen. alb. Red herpetic skin around the mouth, with\\nburning, worse from scratching and after midnight.\\nHerpes iris.\\nAurum rnur. Herpes on the prepuce and vulva.\\nHerpes accompanied by intolerable itching.\\nBufo. Herpetic eruption after a cold.\\nCausticuni. Burning vesicles under the prepuce, which\\nbecome suppurating ulcers. Burning vesicles on the face\\nwhich, when touched, exude a corrosive water, afterward\\nthey dry up to a scurf.\\nCantharis. Large, burning painful blisters with ery-\\nsipelatous inflammation of the parts. Burning, tearing\\nulcerative pains, worse on the right side. Urinary com-\\nplications.\\nClematis. Itching blisters on the lower lip. Gnawing\\nitching not relieved by scratching. Worse during in-\\ncreasing, better during decreasing moon.\\nGraphites, Herpes in females with scanty menstrua-\\ntion; burning blisters on the lower side and tip of the\\ntongue; dryness of the skin.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0204.jp2"}, "203": {"fulltext": "HERPES PROGENITALIS. 195\\nHama7nelis Herpes on the nose. Profuse epistaxis.\\nHelleb. nig. White vesicles on the lips; aphthae in the\\nmouth; in scrofulous children.\\nHepar. Herpes which tend to recur; herpes on the\\nprepuce, exceedingly sensitive to the touch; small ulcers\\nform around the large one; unhealthy suppurating skin,\\nafter mercurial poisoning.\\nKali bich. Herpes after taking cold; fluent coryza;\\nall the secretions are of a stringy and ropy character.\\nMerciirius sol. Herpes on the prepuce with a tendency\\nto suppuration; ulcers on the glans; itching of the\\ngenitals.\\nMoschus. Herpes, with excessive burning, in hyster-\\nical subjects; menstruation too early and too profuse.\\nNatrum mur. Herpes occurring during fevers; erup-\\ntion on the lips and flexures of the joints; vesicles on the\\ntongue; itching and pricking in the skin.\\nPetroleum. Herpes on the perineum and genitals;\\nitching worse in the open air.\\nRhus tox. Herpes upon the hairy parts with burning\\nand stinging; itching worse after scratching; rheumatic\\npains with great weariness.\\nSepia. Herpetic eruptions around the lips; herpes\\nduring pregnane}^- circular form of epilepsy.\\nSulphur. Herpes about the mouth and nose with\\nitching and burning, aggravated by warmth. Hot palms\\nand soles.\\nSarsaparilla. Herpes on the prepuce; after abuse of\\nmercury.\\nUpas. Herpetic eruption on the upper lip, on the\\nleft side.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0205.jp2"}, "204": {"fulltext": "196 SKIN DISEASES.\\nZoster.\\nZoster is an acute affection characterized by the devel-\\nopment of one or more groups of large-sized vesicles.\\nWhen there are several of these groups, it will be noticed\\nthat they are arranged along the course of one of the\\nlarger nerve-trunks whose filaments are distributed to the\\nskin.\\nThe most frequent and perhaps the most typical seat of\\nthe eruption is on the chest, where it may form a semi-\\ngirdle corresponding to the area supplied by one of the\\nintercostal nerves. Zoster, however, is by no means con-\\nfined to the thoracic region, but may appear on the ab-\\ndomen, the face, in connection with the trigeminal nerve,\\non the shoulders and arms, and on the thighs and legs.\\nThe eruption may or may not be preceded by prodro-\\nmal symptoms, which may partake of a mild febrile\\nattack of one or two days duration, or, instead, of a\\nmore or less, severe neuralgia, without fever; or neither\\nof these phenomena may be present, the eruption itself\\nbeing the first indication of the affection.\\nEach group or patch of vesicles may consist of from four\\nor five to a dozen separate, non-confluent lesions situated\\nupon a reddened, raised, and inflamed base. Occasionally\\nthe vesicles themselves may be absent, and nothing is to\\nbe seen except the circumscribed reddened patch. The\\nseveral groups of vesicles constituting the typical erup-\\ntion do not usually appear at the same time, but the\\npatches may appear in succession, so that several days\\nmay elapse before all the lesions have developed.\\nThe eruption having appeared, is accompanied with\\nmore or less pain of a neuralgic character, together with\\nsome soreness of parts if the vesicles rupture. As a rule,\\nthe lesions remain intact until after a week or so, when", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0206.jp2"}, "205": {"fulltext": "M-^^\\nI\\nZoster.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0207.jp2"}, "206": {"fulltext": "", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0208.jp2"}, "207": {"fulltext": "ZOSTER. 197\\nthe fluid contents become absorbed, and the upUfted\\nepidermis desquamates, leaving a reddened macule, or in\\nsome cases a small cicatrix, to mark the site of the lesion.\\nA striking peculiarity of zoster is the fact that it is\\nstrictly unilateral (with exceedingly rare exceptions).\\nCases of double zoster, in which both sides of the body\\nhave been involved at the same time, have been reported.\\nAnother feature of this affection is the extreme rarity of\\na second attack, resembling in this respect the eruptive\\nfevers.\\nThe neuralgia which precedes or accompanies zoster\\nmay exhibit any degree of severity, and may indeed per-\\nsist for an indefinite period after all symptoms of cuta-\\nneous irritation have disappeared. Instead of neuralgia,\\na more or less intense pruritus ma}^ be present, confined\\nto the affected region, and persist for a long time.\\nAs a rule, zoster is an affection of little gravity that\\nis, in persons who when attacked are in ordinary health.\\nIn those, however, who are aged or feeble, the prog-\\nnosis is not always so favorable, as the vesicles may be\\nfollowed by more or less severe ulceration. When the\\neruption appears on the head, and especially in connec-\\ntion with the branches of the trigeminus that are dis-\\ntributed to the eye, ulceration of the cornea, and even\\ndestruction of the sight, may ensue.\\nEtiology. It has been very clearly demonstrated that\\nthe majority, if not all cases, of zoster appear in connec-\\ntion with irritation or inflammation of the ganglia at-\\ntached to the roots of the sensitive nerves; but what sets\\nup this primary irritation is not always clear. Zoster has\\nbeen known to appear, after exposure to cold, in connec-\\ntion with pleurisy, after traumatisms, and after the\\ninternal administration of arsenic. Quite recently,\\nbacilli are said to have been found in the inflamed", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0209.jp2"}, "208": {"fulltext": "198 SKIN DISEASES.\\nganglia, but how they got there does not appear very\\nclearly.\\nM. Fere reports four cases of herpes zoster, which oc-\\ncurred nearly contemporaneously among his 150 epileptic\\npatients at the Bicetre. The first was a young man of\\nnineteen, who had had a few violent epileptic attacks\\nwithout any unilateral symptoms. The herpes was con-\\nfined to the left side of the thorax and the left side of the\\nface, and along with it he had some spasms of the left\\ncorner of the mouth, illusory impressions of persons ap-\\nproaching him from the left side, and some contractions\\nand sluggishness of the left pupil. The left side of the\\ntongue also was much more thickly furred than the right.\\nThe temperature ran up to 107\u00c2\u00b0 F. at first, but all the\\nmorbid symptoms gradually subsided in a week. In the\\nthree other cases, in middle-aged men, the most promi-\\nnent symptom was severe pain, with tenderness on pres-\\nsure, down the spinal column. M. Fere is led to con-\\nclude from these and similar observations that the most\\nprobable cause of the herpetic eruption is a slight\\nepidemic cerebro-spinal meningitis, which may be\\nwidespread, but perhaps only of sufiicient irritative\\npower to cause the herpes at the root of one or two\\nnerves. Such a pathological condition would not be\\nsurprising in infectious diseases, for in them some forms\\nof meningitis are not rare.\\nZoster may follow influenza; Dr. Finzi reports a case\\nin a girl of fifteen, who, after recovering from a\\nsevere attack of influenza, was seized with neuralgic\\npain, accompanied with a pricking and burning sensation\\nshooting from the back around the right side. On being\\nseen five days later, a chain of herpetic vesicles was\\nfound extending along the seventh intercostal space, the\\nlymphatic glands in the axilla being swollen and tender,", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0210.jp2"}, "209": {"fulltext": "ZOSTER. 199\\nand pressure along the course of the seventh intercostal\\nnerve, making the patient scream with pain. In from\\neight to ten days the vesicles disappeared, the whole\\nduration of the S3 mptoms having been about a fortnight.\\nAnother case is reported of a case of zoster correspond-\\ning to the eighth intercostal nerve of the right side in a\\ngirl of eighteen, in whom the disease appeared at the be-\\nginning of an attack of influenza and lasted a month.\\nThe writer had a case occurring in a girl of twelve cor-\\nresponding to the eighth intercostal nerve of the left side,\\nin which the eruption made its appearance three days\\nafter the beginning of an attack of influenza of a severe\\nform, and the eruption lasted two weeks.\\nTreatment. The chief indications are to preserve the\\nintegrity of the vesicles until their contents are absorbed,\\nand to give relief to the neuralgic pain. We may at-\\ntempt to carry out the first by the application of several\\ncoats of flexible collodion, or trauviaticin, or we may\\nbrush the lesions over with oil, and then cover them\\nfreely with some indifferent dusting-powder. The neu-\\nralgia is to be treated exactly in the same way as if it\\nwere not accompanied with the vesicular lesions.\\nZoster of the mucous membranes is not an infrequent\\naffection. Three cases are reported in which the region\\nsupplied by the trigeminus was affected. In one of\\nthe cases the vesicles were located upon the mucous\\nmembrane of the left cheek; in the second case upon the\\nconjunctiva of the right eye; and in the third case on the\\nleft half of the tongue.\\nThe galvanic current, from four to eight cells of a bat-\\ntery of ordinary strength, has been found very beneficial\\nif the pain is sharp, w^hen applied from fifteen to twenty\\nminutes daily.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0211.jp2"}, "210": {"fulltext": "200 SKIN DISEASES.\\nThe principal internal remedies and their indications\\nare as follows:\\nAconite. In the earlier stages, when the neuralgic\\npain is accompanied by febrile symptoms.\\nApis. Burning and stinging pains with swelling; large\\nvesicles, sometimes confluent; better from cold applica-\\ntions.\\nArsen. alb. Confluent eruption with intense burning\\nof the blisters; worse after midnight, and from cold ap-\\nplications; neuralgia; in debilitated constitutions.\\nCantharis. Large blisters, burning when touched;\\nsmarting and stinging; mostly on the right side; worse in\\nthe open air.\\nCistus. Zoster on the back; neuralgic symptoms; in\\nscrofulous subjects.\\nComodadia. Zoster on the legs; rheumatic pains ag-\\ngravated by rest; relieved by motion.\\nDulcamara. \u00e2\u0080\u0094Zoster after taking cold from damp air;\\nmoist, suppurating eruption; glandular swellings in\\nneighborhood of eruption; eruption precedes the menses.\\nG7 aphites. Zoster on the left side; large blisters from\\nthe spine to the umbilicus, burning when touched; worse\\nindoors; better in the open air; dry skin, tendency to\\nulceration; in blonde individuals inclined to obesity.\\nIris vers. Zoster, especially on the right side; follow-\\ning gastric derangement; pain in the liver; neuralgic\\npains.\\nKali mur. Zoster; vesicles encircling half of the body\\nlike a belt; white tongue.\\nKalmia lat. Facial neuralgia remaining after zoster;\\nworse at night; palpitation of the heart rheumatic pains.\\nLachesis. Zoster during spring and fall; the vesicles\\nturn dark and are very painful; all symptoms are worse\\nafter sleep.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0212.jp2"}, "211": {"fulltext": "ZOSTER. 201\\nMercurius. Zoster on the right side, extending across\\nthe abdomen; worse at night, from the warmth of the\\nbed; tendency to suppuration; easy perspiration without\\nrelief.\\nMezereum. Zoster in old people; constant chilliness;\\nneuralgic pains; worse at 9 p. m.; burning, changing lo-\\ncation after scratching; in scrofulous persons.\\nNatrum mur. Eruptions occurring through the course\\nof any disease.\\nPepperini7it Oil, when applied locally, rapidly allays\\nthe pain of zoster.\\nPru7i2is spinosa has succeeded in removing the very\\ntroublesome neuralgic pain which often remains when\\nthe eruption of shingles has disappeared, by means of\\nPrunus spinosa 30X.\\nRanunculus bulb. Zoster aggravated by change of\\ntemperature; neuralgic sequels; in rheumatic subjects.\\nRhus lox. Burning and stinging pains aggravated by\\nscratching. Small burning vesicles with redness of the\\nskin; confluent vesicles; worse in cold weather; rheu-\\nmatic pains during rest; sleeplessness with restless toss-\\ning about; zoster brought on by getting wet, while over-\\nheated.\\nSeinpervivum ted. In obstinate cases; may be used\\ninternally and locally.\\nThuja. Zoster with eruption only on covered parts;\\nbetter from gentle rubbing; in individuals of lymphatic\\ntemperament.\\nZincum. Neuralgia following zoster; pains relieved by\\ntouching the parts; worse after dinner and towards\\nevening.\\nZincum phos. When other remedies fail; following\\nbrain-fag in literary persons.\\n14", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0213.jp2"}, "212": {"fulltext": "202 SKIN DISEAvSES.\\nPemphigus.\\nUnder this name a number of widely varying diseases\\nhave been described, and one of the earlier writers men-\\ntions upward of a hundred varieties of the affection.\\nWe will confine the name to a single disease, embracing-\\nbut two varieties namely, pe^nphigtcs vulgaris and pem-\\nphigus foliaceus\\nIn childhood two forms are observed; pemphigus acutus\\nneo7iatorum, appearing during the first two weeks. The\\nwhole body is covered with bullae, some of the size of a\\nhazel nut, and its course usually benign. A second form\\nstands in close relationship to acute exanthemata.\\nIn general pe77iphigus is characterized as regards erup-\\ntion by the appearance of little separate blebs, usually\\ngrouped in threes or fours, seated upon slightly inflamed\\nbases, which are quickly covered over by the enlarged\\nbullae. These blebs ma}^ attain a size varying between\\nthat of a pea and a hen s ^z%. They are distended with\\nfluid, which is at first very transparent, but soon becomes\\nmilky. The fluid may be quickly re-absorbed, or the\\nblebs or bullae simply shrivel, the distended globe becom-\\ning flaccid. Very often the blebs burst in a few days,\\nand then the contained fluid dries into crusts of lamellar\\naspect, beneath which is very slight ulceration. The\\ncontents are sometimes sanguinolent. The bullae gener-\\nally occur in successive crops; they develop in the course\\nof a few hours; their outline is generally round or oval;\\nthey may be confluent, but are usually distinct. Now\\nand then a species of false membrane is contained in the\\nbullae. The reaction of the fluid is generally alkaline,\\nbut with the turbidity comes acidity. The local symptoms\\nare, slight itching and smarting at the outset, and more", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0214.jp2"}, "213": {"fulltext": "PEMPHIGUS VULGARIS. 203\\nor less soreness. The healing process in pemphigus is\\nsometimes tard}^, a thin ichor being secreted by the sur-\\nface originally blebbed, and so a quasi-impetiginous crust\\nis often produced. In rare cases, in cachectic subjects,\\nsloughing may occur. The disease attacks all parts of\\nthe body but rarely the head, the palms of the hands,\\nor the soles of the feet. Sometimes the mucous surfaces\\nfor example, the intestines, vagina, etc., are the seat of\\nbullae in pemphigus.\\nPemphigus Vulgaris.\\nThis variety is characterized by an eruption of bullae\\nof varying size, some of which may be as large as a\\npigeon s egg. They may exist singly or in considerable\\nnumber, and successive outbreaks may prolong the affec-\\ntion for an indefinite period.\\nIn pemphigus vulgaris the bullae are well distended\\nwith a thin, not ver}^ plastic fluid, and usuallj- remain in-\\ntact for several days. Sometimes the fluid is resorbed,\\nand the uplifted epidermis applies itself to the skin, with-\\nout, however, becoming permanentl}^ attached, but ex-\\nfoliates as soon as a new stratum corneum has formed\\nbeneath it.\\nMore frequently, however, the bulla ruptures and be-\\ncomes detached, leaving a raw and reddened surface,\\ngiving rise to a slight serous discharge. This gradually\\nlessens, however, until a newly-formed, horny laj^er re-\\nplaces the old.\\nSolitar3^ bullae ma)^ succeed each other at more or less\\nregular intervals, or there may be crops of smaller bullae,\\nappearing weeks or months apart.\\nThe disease may persist unchecked for several years,\\nterminating in spontaneous recovery, or quite frequently\\nending fatally.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0215.jp2"}, "214": {"fulltext": "204 SKIN DISEASES.\\nPemphigus Foliaceus.\\nIn this variety the bullae, instead of being freely dis-\\ntended and tense, are only partly filled with fluid, and are\\nflaccid, and often attain a considerable size. As a rule,\\nthey are accompanied with more or less debility and im-\\npairment of the vital forces. Contiguous bullae may\\ncoalesce, thus forming a large, flat, watery tumor, con-\\ntaining a lymphy exudation. The prognosis of pemphi-\\ngus foliaceus is grave, as the majority of cases go on to a\\nfatal termination.\\nIn some instances pemphigus foliaceus is said to begin\\nas a single blister, which continually enlarges until the\\nwhole surface of the body is skinned and covered with\\na brownish crust; it is always fatal.\\nThe causes of pemphigus are involved in obscurity.\\nPrognosis. The cure is not rapid, but slow; recur-\\nrence of the disease is frequent. In old people, where\\nthe disease is general, and in children, when there is.\\nulceration, the issue of the case is often unfavorable. The\\ngeneral condition of the patient must be the guide, and\\nin these cases a cautious opinion should always be given.\\nDiagnosis. Pemphigus can scarcely be confounded\\nwith anything else, the bullae are so diagnostic a sign.\\nIn eczema of the hands, bullae may be produced second-\\narily by the confluence of vesicles, but their origin is\\nreadily traced, and co-existent eczema is to be found\\nelsewhere. Pemphigus is rare on the hands and fingers,\\nper se. General eczema and P. foliaceus should not be\\nconfounded; in the latter abortive bullae are present, the\\nscales are larger and peculiar, and the skin is not infil-\\ntrated.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0216.jp2"}, "215": {"fulltext": "PEMPHIGUS FOLIACEUS. 205\\nIn ecth3^ma cachecticiim the pustules contain bloody\\nfluid; there are no true bullae in the disease; the crusts\\nare also thick and dirty; whilst the ulceration is deep.\\nIn rupia, the bullae are smaller and flatter, the contents\\nsanious, the crusts thick, dark, prominent cockleshell\\nlike; the ulceration deep and foul. Pemphigus foliaceus\\nresembles pityriasis rubra; but in the latter there is no\\nhistory of bullae; the scales are altogether smaller, and\\nthey are imbricated in a peculiar manner.\\nSometimes in impetigo contagiosa, the bullae become\\nsomewhat large, but they are never distended as in pem-\\nphigus, but flat; the contents soon become purulent, and\\nflat yellow scabs form, which are characteristic. The\\ndisease is clearly pustular.\\nTreatment. The patient should be placed on a full\\nanimal diet, with plenty of fresh air and exercise. Means\\nmust be taken to bring the health up to a normal\\nstandard.\\nLocally, bran, starch or gelatine baths are of decided\\nbenefit. The continuous bath, as recommended by\\nHebra.may be resorted to in some cases.\\nThe old school rely upon quinine, the mineral acids,\\nand arsenic, as internal remedies. They recommend\\ncod-liver oil, combined with either of the above, it is a\\nfavorite prescription with many.\\nDr. Cooper has cured pemphigoid eruptions, particu-\\nlarly those occurring in the ears, with an ointment of\\nscrophulaida nodosa. The same medicine was very useful\\nin bullae surrounded by an inflamed ring.\\nDr. Pope ameliorated a distinctly pemphigoid eruption\\nwith Cantharis 3X. Later in the case one of dissemi-\\nnated sclerosis the eruption reappeared, and passed\\naway without rupture under Phosphorus given on gen-\\neral indications for that drug.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0217.jp2"}, "216": {"fulltext": "206 SKIN DISEASES.\\nThe indications for the principal internal homoeopathic\\nremedies are as follows:\\nAmmo7i. miir. Blisters the size of peas on the right\\nshoulder with itching; burning at small spots on the\\nchest; chilliness, especially when walking; fat body but\\nthin legs.\\nArsen. alb. Black blisters, burning and very painful;\\ngreat restlessness and typhoid symptoms; pemphigus\\nfoliaceus or when gangrene sets in.\\nBelladon. Painful, watery vesicles on the palm of the\\nhand sensitive to the touch; chill in the evening, mostly\\non the arms, with heat in the head.\\nCa7itharis. Pemphigus presents a very exact image of\\nthe lesion produced by the external application of can-\\ntharides; active inflammation, with blisters containing\\nserum, burning more than itching; more on right side.\\nCausticum. I^arge painful blisters on the left side of\\nthe chest and neck, which become flattened; with the\\neruption, there is difficulty of breathing, fever, heat and\\nsweat; very sensitive to cold; corpulent children, with\\ntendency to enlargement of glands; involuntary urination\\nwhen sneezing or blowing the nose.\\nChamo?nilla. Extreme irritability of the nervous sys-\\ntem and great sensitiveness to pain, or to wind or cur-\\nrents of air; darting and lancinating pains.\\nChina. Great nervous irritability; the contents of the\\nvesicles becomes ichorous with a putrid smell; where\\nthere is a tendency to gangrene.\\nClematis. Burning throbbing pains; yellow corrosive\\nichor; great emaciation.\\nDidcajnara. Burning pains, restlessness, thirst and\\nemaciation; the bullse break forming corroding ulcers,\\nGumnii gutti. May be used when other remedies fail.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0218.jp2"}, "217": {"fulltext": "PEMPHIGUS FOLIACEUS. 207\\nKali carb. Burning, itching and stitch pains; blisters\\nwith tendency to spread; pemphigus foliaceus.\\nIodine. Gangrenous tendency, after mercury.\\nLachesis. Gangrenous tendency; bullae and blisters;\\ntossing and moaning during sleep, and aggravation of\\nsymptoms on awaking.\\nMe7ruri2is. The bullae have a tendenc}^ to spread,\\nwith discharge of burning ichor, worse at night, particu-\\nlarly from warmth of the bed; profuse sweat which does\\nnot relieve.\\nNatrumcarb. BHsters with oozing of purulent fluid;\\nthe whole skin becomes dry, rough and chapped.\\nNatrum mur. Fluid from blisters and blebs like water.\\nNatrum siilph. Watery vesicles or blebs all over the\\nbody.\\nPhospho7dc acid. Deep hard bullae on the ball of the\\nthumb; blisters on the balls of the toes; great drowsiness\\nand apathy; in debilitated individuals; after sexual ex-\\ncesses.\\nPhosphorus. The blisters are full to bursting, painful\\nand hard, but not itching; tall fair children with tendency\\nto tuberculosis; languor and nervous itching; chilliness\\n-every evening with shivering; arms and hands become\\nnumb; regurgitation of food; small wounds bleed much.\\nRanmiculus bulb. Blisters on the fingers the size of a\\nhazelnut, followed after healing by small deep transparent\\ndark-blue elevated blisters the size of ordinary pin-heads;\\nthis remedy has cured pemphigus in new-born children.\\nRanunculus seel. Vesicles, which emit a thin acrid,\\n3^ellowish ichor, and form obstinate ulcers; itching, boring,\\ngnawing and biting pains; sleeplessness, with debility\\nand anxiety.\\nRaphanus. Blisters full of water on the breast, with-\\nout inflammation, redness or pain.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0219.jp2"}, "218": {"fulltext": "208 SKIN DISEASES.\\nRhus tox. Acute form, with much itching and burn-\\ning; confluent blisters with milky or watery fluid and\\npeeling of the skin.\\nSepia. Pemphigus on the arms and hands; heaviness\\nof the limbs; sensitive to cold air; arthritic pains in the\\njoints.\\nTartar emet. Vesicles filled with bloody serum, col-\\nlapsing and bursting, turning blackish and changing ta\\nmalignant broad deep ulcers; gastro-intestinal irritation.\\nThuja. Pemphigus foliaceus, with offensive odor, and\\nformation of scales.\\nAnomalous Forms of Bullous Eruption. Hydroa.\\nUnder the head of neurotic diseases, and in connection\\nwith herpes, attention may be directed to certain vesicu-\\nlar or bullous forms of eruption, which have been de-\\nscribed by Bazin under the term of arthritic hydroa. He\\ndistinguishes three varieties of hydroa: i. Hydroa vesi-\\nculeux. 2. Hydroa vseciniforme, confounded with\\naphthae chronique. 3. H5^droa bulleux.\\nHydroa vesiculeux is generally confounded by authors\\nwith erythema papulatum. First, as regards Seat, It\\nis developed on the cutaneous and mucous surfaces. On\\nthe skin it exists ordinarily on the uncovered parts\\nback of the hands and wrists and on the front of the\\nknees, etc In most cases the buccal mucous membrane\\nis affected, and then the eruption occupies by preference\\nthe lower lip and the inside of the cheeks, and appears\\nafter its development on the skin. However, in one of\\nour cases, the base of the uvula was surrounded by a cir-\\ncle of vesicles. The conjunctiva may also be the seat of\\nthis eruption.\\nSymptoms. It is sometimes preceded by malaise^", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0220.jp2"}, "219": {"fulltext": "FORMS OF BULLOUS ERUPTION. 209\\nanorexia, and a slight febrile attack, but these prodromic\\nsymptoms are often wanting, or are so little marked that\\nthe attention of the patient is first attracted by the de-\\nvelopment of the vesicles.\\nWhatever be the seat of the eruption, it presents the\\nfollowing characters:\\nThere is seen at first spots of a deep red color, small,\\nrounded, a little raised, and with their edges clearl}^ de-\\nfined. These spots vary in size from that of a lentil to\\nthat of a twenty-five cent piece; they are sometimes sur-\\nrounded by a rose-colored areola; the}^ show soon in their\\ncentre a small vesicle filled with transparent yellowish\\nliquid. This vesicle appears the day following that of\\nthe red spot. It dries rapidly from the centre, which is\\noccupied by a small blackish scab, whilst the liquid is\\nabsorbed from the circumference. The phenomena takes\\nplace towards the second or third da} of the eruption.\\nThe subsequent phenomena are as follows: The liquid\\nin the circumference of the vesicle is reabsorbed, whilst\\nthat which occupies the centre becomes a blackish scab.\\nAt last it may happen, especially during cold weather,\\nthat the fluid exuded in tbe vesicle is absorbed rapidl3^\\nIt will then have only a small whitish or yellowish\\nmacula, placed in the centre of a red disc, and formed\\nby loosened epiaermis. In this case it is that the affec-\\ntion has been confounded with erythema papulatum. On\\nthe mucous surfaces the vesicles are whitish and sur-\\nrounded by a violet-colored areola the scabs are detached\\nsooner. The red discs and vesicles are more or less\\nnumerous. The} are generally separated by intervals of\\nsound skin; sometimes they are disposed in groups of\\ntwo or three, touching at their circumference. They do\\nnot all appear at once, but b}^ successive crops during\\nmany days. The affected parts have scarcely any itch-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0221.jp2"}, "220": {"fulltext": "210 SKIN DISEASES.\\ning. The febrile symptoms which exist rarely at the\\ncommencement cease when the eruption is developed.\\nThe duration of hydroa vesiculeux is from two to four\\nweeks; each element in the eruption taken by itself runs\\nthrough its course in four or five days. The affection is\\nprolonged for many weeks only by the eruption of fresh\\ncrops of vesicles. A relapse may take place.\\nThe disease is seen in both sexes, but more frequently\\nin the male. It appears among adults from twenty to\\nthirty years of age. It is more frequent in spring and\\nautumn; cold and variation of temperature have a marked\\ninfluence on its appearance and course. Finally it is\\nalways seen amongst people who have had still symp-\\ntoms of gout.\\nHydroa vesiculeux, says Bazin, in continuing his\\ndescription, which we have given above almost at length,\\nis essentially arthritic at least we have always found\\nit among arthritic subjects, and it has steadily presented\\nclear relation to gouty manifestations.\\nPrognosis. This affection is not grave; it disap-\\npears of itself in four or five weeks. It is subject to\\nrecur.\\nHydroa vacciforme is the same, only that the vesicles are\\nvarioliform.\\nHydroa bulleux (pemphigus with little bullae) is an\\narthritic affection which is generally little known.\\nThe eruption shows itself by bullae, which present one\\nimportant character the inequality of their size. Some\\nare as large as a lentil; the largest do not go beyond the\\nsize of a pea. These bullae are rounded, arranged in an\\nirregular manner, in groups of three or four; they are\\nfilled with transparent fluid, which grows thick quickly\\nand takes a yellowish color; finally they are placed on a\\nred surface, which extends from their base in the form", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0222.jp2"}, "221": {"fulltext": "FORMS OF BULLOUS ERUPTION. 211\\nof an areola. Whilst new bullae are developing, the\\nold ones dry up and are replaced by a 3^ellowish scab;\\nand if one of these is rubbed off by scratching there ap-\\npears a violet-colored, slightly excoriated surface In the\\ninterval of the crops of bullae there is no morbid phe-\\nnomenon observed except the ordinary well-marked itch-\\ning. The patient preserves his appetite, and the nutrition\\nis not at all altered. Bazin states that the course is\\nchronic, that the disease appears in successive crops, and\\nlasts generally from five to six months; that it is more\\nfrequent in men than in women, and appears in adults\\nfrom twenty to forty years; that the seasons and varia-\\ntions of temperature have a marked influence on its de-\\nvelopment; that it is most common in the spring, and is\\nexcited by gout.\\nDiagnosis. The characters of hydroa bulleux permit\\nalways of its being recognized. It is important to es-\\ntablish well the differential diagnosis between this disease\\nand pemphigus. In the former the bullae are small, and\\ndo not go beyond the size of a pea; they are further re-\\nmarkable, for the inequality of their size, they occupy re-\\ngions sufficiently well circumscribed. The bullae of pem-\\nphigus are larger they may attain the size of a nut, or\\neven of a hen s ^gg; they exist in various parts, and ex-\\ntend sometimes over the chief part of the skin.\\nThe diseases which it in a measure resembles are, ur-\\nticaria and the various forms of erythema, and perhaps\\nmistakes might be made between it and the vesicular\\nsyphilide, varicella, and variola. As a rule, it has a defi-\\nnite duration, and disappears spontaneously in a few\\ndays, and may be accompanied by slight fever. The first\\nphenotnenon noticed is a faintly-marked, rosy spot, which is\\nsoon replaced by a single vesicle, which 7nay reniai7i intact\\nor may become umbilicated, or may dry up and become a7i", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0223.jp2"}, "222": {"fulltext": "212 SKIN DISEASES.\\numbilicated crust of a yellowish- white color. Around this\\nvesicle i?iflammatory changes very soon take place; a zone of\\na color varying from red to violet^ with a well-defined,\\nslightly elevated periphery, forms, and then around this\\nperhaps a ring of small vesicles, which may coalesce and\\nform a circumferential bullce. These spots vary in size\\nfrom a line to four or five, or even more. There is no\\nhypersemia between the patches, as the inflammatory ac-\\ntion is sharply confined to them. This condition differs\\nfrom that of herpes phlyctenodes, in which the inflamma-\\ntory areola is not thus sharply defined. There is usually\\nno pain or itching, merely a little heat or a feeling of ten-\\nsion. The same appearances, somewhat modified, have\\nbeen observed upon the buccal mucous membrane. The\\neruption disappears by the fall of the crust, which is formed\\nfrom the vesicle, and is generally seen in the centre of\\neach patch, and then there remains a more or less well-\\nmarked hypersemia with slight infiltration. The sites of\\nelection are the back of the hands, the forearms, face, neck,\\nand also the trunk and lower limbs. It is generally\\nsymmetrically developed.\\nThe practitioner may meet with cases in which, with or\\nwithout some slight antecedents, malaise, or pyrexia, a\\nfew scattered spots answering as regards eruptive features\\nto Bazin s hydroa vesiculeux occur that is to say, a few\\nred irritable spots appear, having in the centre a small\\noval or roundish bulla, which may enlarge to the size of a\\nsplit pea, but is generally not so large, and dies away in\\nthe course of a few days. These spots appear on the\\nback of the hands, the arms, the legs, and the shoulders.\\nThe disease may last, by the development of successive\\ncrops of solitary vesicles, for ten days or more.\\nThe more exaggerated form of this disease is that in\\nwhich small bullae are developed rapidly over a large ex-\\ntent of surface, or even the whole body.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0224.jp2"}, "223": {"fulltext": "FORMS OF BULLOUS ERUPTION. 213\\nIn some instances in which this quasi-herpetic or pem-\\nphigoid disease makes its appearance the eruption is pre-\\nceded by an unusual amount of irritation, and it is com-\\nplicated or followed by true pruriginous rash. This is\\nvery probably the disease termed pemphigus pruriginosus.\\nWe may therefore sum up the foregoing remarks by\\nsaying that there is a form of disease which seems to stand\\nmidwa}^ between herpes and pemphigus, the features of\\nwhich allay it, now to herpes, now to pemphigus. It may\\nconsist of solitary small bullae seated on a red base, and\\nscattered here and there over the body, or the bullae may\\nbe surrounded by small vesicles; or these two dispositions\\nof the bullae may be seen in one and the same case, the\\neruption being localized to a certain part of the body, or\\ngenerally distributed and accompanied in severe cases by\\npyrexia and marked constitutional disturbances, which is\\noften the result probably of malarial poisoning. The erup-\\ntion may recur more or less periodically; and lastly it may\\nbe complicated or followed by prurigo, and in that case\\nwill answer to the designation of pemphigus pruriginosus.\\nDiagnosis. The characters I have given are sufficient\\nfor diagnostic purposes. The only disease with which\\nthey might be confounded is urticaria bullosa, and I do\\nnot know that any mischief would accrue to the patient\\nfrom such a mistake.\\nTreatment. The first care of the ph3^sician is to at-\\ntend to the general condition of the patients as regards\\ntheir emunctory organs and their hygiene. Anxiety,\\nworry, and depressing influences must be neutralized.\\nThe patient must be ordered to get good air, to take plain\\nnourishing food, and to avoid luxuries of the table, over-\\nwork, and fatigue of all kinds\\nLocally I know of nothing better than, first of all, va-\\npor baths to encourage the skin to proper action, and the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0225.jp2"}, "224": {"fulltext": "214 SKIN DISEASES.\\nuse of a weak lotion made of liq. carbonis detergens 3jj\\nto ^ss with aquae |vj applied night and morning. Subse-\\nquently sulphuret of potassium baths may be regularly\\ngiven for a long time, and followed up by the drinking of\\nsome sulphurous or iron waters.\\nAccording to old-school authorities, the main remedy\\nis quinine; iron, nux vomica and cod-liver oil are also re-\\ncommended.\\nThe principal internal homoeopathic remedies are: Po-\\ntassium iodide, Kreasote, and Mag?iesia carb.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0226.jp2"}, "225": {"fulltext": "CHAPTER X.\\nSUPPURATIVE INFLAMMATION, OR PUS-\\nTULAR DISEASES\u00e2\u0080\u0094 IMPETIGO\u00e2\u0080\u0094 CONTA-\\nGIOUS IMPETIGO\u00e2\u0080\u0094 ECTHYMA\u00e2\u0080\u0094 FUR-\\nUNCULUS\u00e2\u0080\u0094 ANTHRAX, OR CAR-\\nBUNCLE\u00e2\u0080\u0094MALIGNANT\\nPUSTULE, Etc.\\nGeneral Remarks.\\nIn many very different diseases of the skin pus is pres-\\nent, and if the term pustular were used in its widest\\nsense a large number of diseases would have to be in-\\ncluded under it; for instance, acne; favus; scabies; pem-\\nphigus; variola; farcy; varicella; and so on. But in the\\ndiseases just named the presence of pus is often not a pri-\\nmary or even essential condition, and its importance is\\nthrown into the shade by the prominence of other feat-\\nures. In those affections which may more strictly be\\ncalled pustular, the suppuration is the leading and the\\nprimary condition, the particular morbid condition the\\npractitioner has to recognize and to remedy. Now un-\\nder the term pustular diseases, thus defined, are usually\\ncomprised impetigo, ecthyma, and furuncular affections,\\nthe latter term including furunculus, or boil; anthrax\\nor carbuncle; and pustular maligna, or malignant boil.\\nDelhi boil would come under this division, but, owing to\\nits rarity in this country, will not be treated of.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0227.jp2"}, "226": {"fulltext": "216 SKIN DISEASES.\\nImpetigo Contagiosa.\\nThis disease is characterized by the appearance of\\nmild pyrexial symptoms, followed in two or three days\\nby the appearance of one or more small vesicles. They\\nslowly enlarge, but soon dry into thin, light-yellow\\ncrusts, or scabs. These lesions may be few or numerous,\\nand succeSvSive outbreaks may prolong the affection for\\nseveral months. The affection is unquestionably conta-\\ngious, and, when it once appears upon an individual,\\nother members of the family, either children or adults,\\nmay contract it. In not a few instances the eruption has\\nappeared within a couple of weeks or so after vaccination.\\nIf the crust, which has the appearance of being stuck\\non, is removed, a slightly reddened but not eroded sur-\\nface is revealed, from which but little or no moisture is\\nexuded.\\nThe disease is seen amongst children of the lower\\norders especially, probably in great measure because the\\ndisease spreads by contagion freely amongst them. It\\noccurs also in those who have all the advantages of social\\nposition and good hygiene.\\nThe eruption in the disease in the majority of cases\\nappears first of all on the face, sometimes on the top or\\nback of the head, and in the form of little watery\\nheads (vesicles) that enlarge into flat bullae if they are\\nnot injured by scratching. Sometimes the hands are\\nattacked at the outset, and look as if burnt here and\\nthere; phlyctense may also arise out of and around the\\nremnants of vaccinia, or about cuts or bruises. The dis-\\nease then extends to other parts, the back of the neck, but-\\ntocks, feet, etc. The vesicles are always isolated. In five\\nor six days the bullae may reach the size of a sixpence or", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0228.jp2"}, "227": {"fulltext": "p\\n..J\\nImpetigo Contagiosa.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0229.jp2"}, "228": {"fulltext": "", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0230.jp2"}, "229": {"fulltext": "IMPETIGO CONTAGIOSA. 217\\nshilling unless ruptured, and are then flat and depressed\\nin the centre, their contents becoming turbid. Usually\\nthe vesico-pustule is the size of a large split-pea or there-\\nabouts. The secretion consists of lymph-like fluid, gran-\\niilar cells, and subsequently pus-cells.\\nScabs commence to form a few days after the appear-\\nance of the disease. They are characteristic of the\\n-disease, varying in size from that of a split pea to a\\n-shilling; they are flat, straw-colored, dry, and granular-\\nlooking, and appear as if stuck on to the part; they\\npresent, as a rule, no inflammatory areola around their\\ncircumferences, though this is the case in severer in-\\nstances of the disease. If removed, little sores are\\nobserved beneath, more or less filled in by gummy-like\\nsecretion, or a little pellet of splastic lymph, and when\\nthe scabs fall off there is an erythematous base left\\nbehind, the hue of which gradually fades away. The\\ndisease may be spread from spot to spot by direct inocula-\\ntion with its secretion in the act of scratching. The\\ncrop of vesicles is to some extent successive, though the\\nmajority of the places come out in the first week or\\nso. In some instances the disease resembles vaccinia\\nvery slowly. There is always a uniformity about it; it\\nalways commences by vesicles; there are no papules\\npresent at the height of the disease. On the face the\\nspots may be confluent, and then the disease resembles\\neczema impetiginodes; but the patches are made up of\\nthe elements described above. On the scalp the disease\\nconsists of circular, mostl} isolated, flat-scabbed spots\\nabout the top and back of the head, the hair being matted\\nby the crusts. Usually, no pediculi and no offensive\\nsmell are present. Now it is verj^ important to note that\\nan eczema may be readily excited in fair children by\\nscratching or the irritation of the discharge, in connection\\n^5", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0231.jp2"}, "230": {"fulltext": "218 SKIN DISEASES.\\nwith impetigo contagiosa and then the characteristic\\nfeatures of the latter disease are masked. The result of\\nneglecting to attend to this point is that the practitioner\\nregards the disease present as solely and entirel}^ an\\neczema. The error, too, is a very common one.\\nThe mucous membranes of the eye and the nose are\\nsometimes implicated; then inflammation is produced by\\nthe development of little ulcers, that take their origin in\\nthe formation apparently of vesico-pustules, identical\\nwith those seen on the surface of the skin. The eye\\nmay look as though affected by slight purulent ophthal-\\nmia, but soon recovers itself.\\nThe disease may complicate eczema, scabies, and other\\naffections, and vice versa.\\nDiagnostic features are its apparently epidemic char-\\nacter in many cases; the antecedent febrile condition; its\\nattacking children; the origin from isolated vesicles,\\nwhich tend to enlarge into blebs and to become pustular,\\nthe bleb having a depressed centre, and, it may be, a\\nwell-defined, slightly raised, rounded edge; the isolation\\nof the spots; the u7iiform character of the eruption, and\\nits general and scattered condition; its frequent seat and\\ncommencement about the face or head; the circular, fiat,\\ngranular, yellow crusts looking as if stuck on; its con-\\ntagious nature and inoculability; its frequent follow-\\ning in the wake of vaccination; the absence of pain, and\\nespecially troublesome itching at night.\\nContagious impetigo may be confounded with eczema\\nbut the history is altogether different, and the isolation,\\nthe small scabbed patch, the characters of the crusts, and\\nthe facility of cure at once distinguish it. Impetigo\\nsparsa does not arise from a vesiculation, but is primarily\\npustular, made up of aggregated pustules; it does not\\nphlyctenoid; it is not contagious nor inoculable; it does", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0232.jp2"}, "231": {"fulltext": "IMPETIGO CONTAGIOSA. 219\\nnot run a definite course; it is not confined to the young;\\nit is not so amenable to treatment.\\nPemphigus. In this disease the blebs are larger,\\nmore persistent, oval, and distended; the contents are\\nwatery and acid. Pemphigus is non-contagious; it does\\nnot occur especially on the face or the head; it is less in-\\nflammatory, and wants the characteristic scabs. Ec-\\nthyma. This is primarily a pustular disease; it is seen\\nalso in adults; there are more induration and swelling,\\nand a good deal of pain in connection with the formation\\nof pustules; it is non-contagious; the scabs are heaped-up\\nand dark. Pustular^ scabies. This is the disease with\\nwhich contagious impetigo is at times confounded. It\\nmust be remembered that the two diseases may coexist.\\nIn children both attack the buttocks frequently; both may\\nexist about the hands and feet; but the distinctions are\\nreally very clear. In scabies there is no febrile condition;\\nthe eruption is multiform. If there be ecthymatous pus-\\ntules, like impetigo contagiosa, they are covered by dark\\nthick crusts; there are plenty of characteristic vesicles, with\\ncuniculi and papules. If the impetigo contagiosa begins\\nabout the buttocks, it appears presently on the face or the\\nhead, or both. There is no irritation, nor are the effects\\nof scratching visible about the body as in scabies; the\\nbullous origin of the disease is distinct, and the scabs are\\ncharacteristic. The hands are not specially affected in\\nscabies in the child, but even impetigo contagiosa may\\nattack the hands and feet markedly; still there is no mul-\\ntiform eruption, and there are no cuniculi in the latter.\\nWhen a correct diagnosis is made, the treatment is\\neasy. The natural course of the disease is a short and defi-\\nnite one The secretion is an active agent, by means of\\ninoculation self-practiced by the patient in scratching, in\\ntransmitting the disease from one part to another. There-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0233.jp2"}, "232": {"fulltext": "220 SKIN DISEASES.\\nfore it is of first importance to destroy the activity of the\\npus, and to alter the behavior of the surface that secretes\\nit. A very active agent in procuring this result is an\\nointment containing five grains of the ammonio-chloride\\nof mercury, and apply it to the surface beneath the scabs,\\nwhich must be removed by poulticing or fomentation\\nwith warm water. A sulphur ointment is also beneficial.\\nThe patient must be well-nourished, and strict hygienic\\ntreatment adopted. Cleanliness is all-important.\\nThe old-school rely principall}^ upon the external ap-\\nplications.\\nThe indications for the internal remedies are:\\nAnti7}ion. criid This is the principal internal rem-\\nedy. Eruption forming thick, heavy yellow crusts,\\nwith burning; eruption about face; worse from bathing\\nthe parts; better in open air; chronic cases.\\nArsen. alb. Black pustules, filled with black blood\\nand fetid pus; painful sensation on scalp and face, as from\\ncutaneous ulceration; worse from cold and touch; better\\nfrom warmth.\\nBaryta carb. Especially old people; thick crusts be-\\nhind the ears; fat dumpy children, with swollen lym-\\nphatics; sore throat, with swelling of tonsils after the\\nleast cold; worse at night and when thinking of it; better\\nin open air.\\nCalcarea carb. During dentition; dry crusts; sweat\\nof forehead, particularly in the evening; sensitiveness of\\nthe roots of the hair.\\nCicuta vir. Impetigo sparsa; eruption on chin and\\nlower part of face, forming thick yellow crusts; honey-\\ncomb-like crusts, which fall off and leave a bright-red\\nsmooth surface; painful eruption on scalp.\\nClematis Psoric constitution; pimples on forehead,\\nroot and sides of nose; pustules about lips, tender to", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0234.jp2"}, "233": {"fulltext": "IMPETIGO CONTAGIOSA. 221\\ntouch; large pustules about loins; eruption changes char-\\nacter during the changes of the moon; worse in bed,\\nwashing, and towards morning; feels exhausted on wak-\\ning.\\nConium Sero-purulent eruption in aged people, old\\nhypochondriac maids; vertigo when turning over in bed,\\nlooking up; old, weak, and feeble men; scrofulosis, with\\nengorgement of lymphatics; eruption around mons ve-\\nneris.\\nCroton Hgl, Pustular eruption upon an inflamed base,\\nwith itching and stinging pain upon septum nasi, plug-\\nging the nostril; eruption on abdomen; sore nipples of\\nnursing women.\\nEuphorbium is indicated when there is an irritable\\nskin, with swelling of the face and pea-sized yellow vesi-\\ncles.\\nGraphites. Scabby eruption, with excessive oozing;\\neruption around mouth and nose or the whiskers; hair\\nfalls out; corrosive blisters about extremities, toes, and\\nfingers; dry skin; very sensitive to cold; cold hands and\\nfeet, with scanty menses; rhagades.\\nHepar. Eruption after mercurialism; sensitive to\\ntouch; tendency to ulceration; humid scabs and pustules\\nupon the head, oozing a fetid substance; swollen cervical\\nglands; cracks behind ears; hands cracked and dry.\\nIris vers. Impetigo capitis, with gastric complaints,\\nnausea, and vomiting.\\nKali bichrom. Dry eruption; pustules disappear with-\\nout bursting. Stands next to Antim. cr. as a remedy.\\nKreasotum. Painless pustular eruption all over body,\\nespecially on chin and cheeks; sticking pain, especially\\non points; sad and weeping; worse in open air.\\nLycopodium After abuse of mercury; itching and sup-\\npurating eruption on head and face; full of deep cracks;", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0235.jp2"}, "234": {"fulltext": "222 SKIN DISEASES.\\nabundant and fetid discharge; fetid and moist scabs be-\\nhind ears; humid tinea capitis.\\nMercurius. Swelling and suppuration of glands; gas-\\ntric derangement; moist scabs, with excoriation of the\\nscalp and destruction of the hair; yellowish scabs on\\nface, with fetid discharge; yellowish scabs, especially\\naround mouth.\\nMezereum. Deep inflammatory redness of face; erup-\\ntion fat and moist; ichor from scratched places excoriates\\nother parts.\\nNitric acid Eruption on head, pricking on being\\ntouched; pustular eruption on face, with large red mar-\\ngin and heavy scabs; mercurio-syphilis.\\nRhus tox. Small pustules on black base; greenish pus,\\nwith violent itching at night; humid eruption, with thick\\nscabs on face and head, destroying the hair, wnth fetid\\nsmell; eruption on nose, extending to face.\\nSilicea. Eruption resembling varicella; violent itching\\nof scalp; moist scald head; growing pains; better\\nwarmth, worse from cold.\\nSulphur. Dry, thick, yellow scabs on scalp, with pro-\\nfuse discharge; great itching relieved by scratching; pur-\\nulent eruption on elbows.\\nTartar emet. The remedy when the disease is exceed-\\ningly pustular.\\nThuja. Eruption all over the body; itching and shoot-\\ning, especially at night; pustular eruption about the\\nknee; better from gentle rubbing.\\nViola tricolor. Pustules and scabs upon face, with\\nburning and itching, and discharging fetid pus; sensa-\\ntion as of tension of the integument of face; urine smells\\nlike cat s urine; worse at night. Recent cases.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0236.jp2"}, "235": {"fulltext": "ECTHYMA. 223\\nEcthyma.\\nThis disease is described as consisting of isolated phlyza-\\ncious pustules namely, those which are large, raised\\non a hard base, of a vivid red color, and succeeded by\\nthick, hard, dark-colored scabs, beneath which there is\\nulceration. The pustules are generally distinct, round,\\nand isolated; they are mostly general, but may be par-\\ntial, and leave cicatrices behind. The shoulders, but-\\ntocks, and limbs are the parts usually attacked. There\\nare two chief forms described acute and chronic.\\nAcute general ecthyma is rare. The ordinary scattered\\necthyma is practically always the result of the action of\\nsome irritant upon the skin, in an unhealthy or badly\\nnourished subject; and so ecthymatous pustules frequently\\noccur in connection with scabies and phtheiriasis, and\\nmore rarely in pruri, or eczema, and other diseases.\\nAcute ecthyma commences with slight febrile disturb-\\nances, and occasionally sore throat; locally, there is first a\\nsense of heat and burning, followed by the appearance of\\nreddish raised points, with hard, indurated bases, and\\n\u00e2\u0080\u00a2distinct vivid areolae; these points, which vary in size\\nfrom that of a pea to that of a shilling, quickly pustulate,\\nand are often accompanied by acute, sharp pain. In two\\nor three days the pustules give exit to discharge, which\\ndries into hard, adherent, dirty, discolored scabs, covering\\nover circular ulcerations; the crusts fall off in a week or\\nso, leaving behind dark stains. The ecthymatous spots\\nmay be few or man}^; in the latter case a good deal of ir-\\nritation is set up; the patient may be unable to sleep from\\npain, and the glands and lymphatic vessels may become\\ninflamed, small abscesses forming subsequently. The\\ndisease is generally protracted by successive crops of pus-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0237.jp2"}, "236": {"fulltext": "224 SKIN DISEASES.\\ntules, or it may relapse into a chronic state. The limbs^\\nshoulders, and trunk are chief seats of the disease.\\nChronic ecthyma generally results from the action\\nof some irritation, as in scabies, in connection with pedi--\\nculi, and from scratching and badly nourished subjects.\\nThe ecthymatous pustules in the chronic disease are of\\nsimilar character to those of acute ecthyma. They are\\npainful, with hard, inflammatory bases and a small central\\ncollection of pus. When they occur on the limbs, espe-\\ncially the legs, in old people they are followed some-\\ntimes by troublesome ulcers.\\nIn ecthyma the seat of disease appears to be the upper-\\nmost layer of the derma, not unlikely about the glands of\\nthe skin, the depth of surface involved being less than in\\nfurunculus, and there is no core, otherwise ecthyma\\nwould be well classed with boils. The tendency to ulcer-\\nation and sloughing, the lividity of the inflammatory\\nareola, the disturbance of the general system, all point to\\na cachectic condition.\\nCauses. The predisposing causes are always such as\\nlead to debility and an impoverished state of blood.\\nThey are, in infants, bad nursing, suckling by mothers\\nmuch out of health, scabies, bad clothing, damp dwell-\\nings; in adults and others, over-work, fatigue, convales-\\ncence from acute diseases, bad food, privations, various oc-\\ncupations that induce irritation of the skin, as bricklay-\\ning, excesses of all kinds, debauchery, uncleanliness,\\nnight-watching, overcrowding in public institutions\\nworkhouses, jails, and such like. The immediate excit-\\ning causes are scabies, phtheiriasis, the use of acrid\\nmedicinal applications, and scratchiiig.\\nPrognosis is to be made according to the general con-\\ndition of the patient. The ecthyma, per se, is of little\\ngravity, save when it is accompanied by sloughing, as in\\nold people; then it is grave.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0238.jp2"}, "237": {"fulltext": "ECTHYMA. 225\\nDiagnosis. The distinct, large, isolated pustules,\\nwith an inflamed areola and hard base, distributed over\\nthe body, are very distinctive of the disease. It may be\\nconfounded with impetigo sparsa, but in this disease there\\nare rather sero-pustules than pustules, which are very\\nsuperficial; the discharge is viscid, yellowish; these areas,\\ndark scabs, no indurated, inflamed, and painful bases.\\nFurunculus is deeper, it runs a slower course, and con-\\ntains a central slough or core, as it is called. It\\nis more circumscribed, and there is little scabbing.\\nTreatment. lyocally a good application is an oint-\\nment made by rubbing together an ounce of lard, and\\nhalf a drachm or so of Friar s balsam. The crusts may\\nbe removed after soakings with oil, and the affected parts\\ndressed with an ointment made by adding five to ten.\\ngrains of white precipitate to the ounce of cosmoline.\\nAfter the pustules burst, if the ulcers show but little\\ntendency to heal, a weak carbolized wash may be used.\\nThe patient should be well hygiened and given a good\\ngenerous diet.\\nThe appropriate internal remedy ma^^ be .selected from\\nthe following:\\nAiiacardium Hard, red pustules, itching worse after\\nscratching; crossness and irritability with weakness of\\nmind; sensation of a hoop around the affected part.\\nAntimon. crud. Pustules on the face in fat people;,\\nyellowish or brownish scabs on the face; desire for acids.\\nArsen. alb. Red or white pustules, with intense burn-\\ning; painful black pustules, gnawing, burning, and\\nitching; eruption on the scalp, forehead, around the e5^es,\\ncheeks, arms, shoulders, and upper part of the chest,\\nterminating in thick crusts, and leaving well-marked\\nscars.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0239.jp2"}, "238": {"fulltext": "226 SKIN DISEASES.\\nAurum. Pustules on the face, neck and chest, with\\nirritabiUty and melancholy.\\nBellad. PUvStules surrounded by a whitish areola.\\nBurning and itching with great sensibility to touch.\\nCaladium. White pustules with red areolae, sore to the\\ntouch and itching; better from sleep in the day time.\\nCalcarea carb. Heat, thirst and loss of appetite accom-\\npany the eruption. Scrofulous children and during den-\\ntition.\\nCantharis. Tendency to ulceration and gangrene,\\nafter or with the exanthemata; debility and emaciation.\\nCiciita. Burning suppurating eruption about the face,\\nwith yellowish crusts.\\nCroton tigl. Confluent pustules with oozing and burn-\\ning; greyish-brown crusts on the abdomen; pustules\\nwith scarlet redness of the skin; itching followed by\\npainful burning; pains relieved after sleep; intense itch-\\ning, but cannot bear to scratch on account of the pain it\\ncauses.\\nCyclamen. Pustules on the feet and toes.\\nHepar. Great sensitiveness of the pustules to the\\nslightest touch; redness or little pimples around the ul-\\nceration.\\nKali bichr. Pustules all over the body, in the early\\nstage having a small brown scab on the top; pustules\\nat the root of the nails spreading over the hand; pustules,\\nwith violent itching, which dry without bursting, form-\\ning scabs which sting and burn; pustules resembling\\nsmall-pox, with a hair in the middle, leaving after the\\nscab comes off a small dry ulcer, which heals in about a\\nfortnight, leaving a colorless depressed cicatrix; eruption\\nmore in hot weather. Light-haired children inclined to\\ngrow fat.\\nKali hyd. The eruption is profuse, over the body.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0240.jp2"}, "239": {"fulltext": "ECTHYMA. 227\\nGreat desire for the open air. Catarrhal fever with\\nviolent thirst.\\nKreasotum. Large, fat greasy pustules, with violent\\nitching towards evening; sensation in the skin as from\\nulceration, especially on face and chin.\\nLarhesis. Eruption more on the arms and left side;\\nconstitutional taint; feels worse after sleeping.\\nMercurius. Suppurating pustules, which either run\\ntogether, discharging an acrid humor, or which remain\\nsore, become hollow, and afterwards raised and cicatrized;\\npustules bleed easily and are painful to the touch; itching\\nand burning from the warmth of the bed; sweats easily\\nwithout relief.\\nNitric acid. Feeling as of a splinter sticking into the\\npustules when touching them.\\nPetroleum. Itching and burning pustules, with great\\nweakness on exertion; great lassitude; worse in fresh air.\\nPiper nigrum. Large pustules leaving marks on the\\nface.\\nRhus tox. Pustules seated upon a red base; black\\npustules, forming hard scabs, with burning and itching;\\nworse at night and in cold and stormy weather.\\nSecale corn. Cachectic females, with rough skin; pus-\\ntules on the arms and legs, with tendency to gangrene.\\nSilicea. Pustules all over the body, especially on the\\nback part of the head, sluggish, and do not suppurate or\\ndessicate; sensitive to contact; burning and soreness after\\nscratching; aversion to warm food; worse in cold.\\nScrofulous diathesis.\\nSulphur. Dry, thick, yellowish scabs all over the\\nbody, especially on the scalp; always attended with great\\nitching; painful to touch; aversion to washing.\\nlabacum. Eruption most on neck and upper limbs;\\nweariness, languor and debility; death-like paleness,\\nnausea worse on least motion.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0241.jp2"}, "240": {"fulltext": "228 SKIN DISEASES.\\nTartar emef. Eruption over the wbole body. Pustules\\nare full, large, round, burning and painful with red\\nareolae, soon drying up and leaving deep malignant\\nulcers. Pale,- livid, blackish, depressed pustules filled\\nwith blood or bloody serum collapsing on bursting and\\nchanging to broad, deep ulcers.\\nThuja. Suppurating pustules, especially on lower ex-\\ntremities; worse from touch; relieved by gentle rubbing.\\nFuruncle.\\nA furuncle, or common boil, needs little in the way of de-\\nscription, the features being so familiar to all. Patholog-\\nically considered, it may be described as an acute and\\npainful localized inflammation, differing, however, from\\na simple abscess by the fact that in the furuncle we find a\\ncentral core of necrosed cutaneous and connective tissue,\\naround which the inflammation is developed. Modern\\ninvestigation leads us to the supposition that a micro-\\norganism, having gained an entrance into one of the\\nfollicular openings, sets up changes which result in the\\ndeath of the tissue in the immediate vicinity. This\\nnecrosed tissue acts as a foreign body and excites inflam-\\nmation, as would a thorn, and after a few days the hard,\\npainful, red tubercle exhibits a drop of pus at its summit,\\nwhich gradually increases until the entire lesion softens,\\nand finally breaks, with exit of pus, together with the\\ncore referred to.\\nThe pus which is discharged from a furuncle appears to\\nbe capable of exciting new lesions of a similar nature, and\\ncrops of boils may follow each other in an extremely per-\\nsistent and disagreeable manner.\\nAbortive Treatment. If a furuncle comes under the\\ntreatment at the beginning, there is little doubt but that", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0242.jp2"}, "241": {"fulltext": "FURUNCLE. 229\\nit can be aborted; and one way to do this is to insert the\\nsharp point of a PaqueHn cautery, or a lance-shaped\\ngalvano-cautery. If neither be at hand, a pointed stick\\nof nitrate of silver should be thoroughly bored in. This\\nis painful at the moment, but it saves pain later on, and\\nmay be the means of preventing the formation of new\\nboils. Another method recommended is to scrape the\\nskin over the threatened seat of invasion with a scalpel\\nuntil a drop or two of blood exudes on pressure.\\nAnother:\\nR. Hydrargyr. oxid., o. lo; lanolin, lo.o. S. To be\\nwell rubbed in three or four times daily. This will fre-\\nquently be successful in aborting a boil.\\nSen recommends the following abortive treatment for\\nfuruncles: i. Carbolic acid in hypodermic injections. 2.\\nThe acid must be used early before suppuration appears,\\nin which case the furuncle will be aborted without any\\nconnective tissue necrosis. 3. In advanced cases the\\nadoption of the same treatment will prevent serious scar-\\nring. 4. A three per cent, solution is of more value than\\na weaker one. 5. Patients can follow^ their usual occu-\\npations during the progress of the treatment.\\nFuruncles should never be opened with a knife until\\nthey are ripe that is, until the accumulation of pus\\nhas been sufficient to loosen the central core. When\\nopened, however, the pus should be evacuated as thor-\\noughl}^ as possible, and the central core removed. The\\nparts should then be thoroughl}^ cleansed with mercurial\\nsolution, and an antiseptic dressing applied. The sul-\\nphide of calcium given internally, in doses of one quarter\\nof a grain, hastens the maturation of the lesions.\\nWhen a boil is tense and hard, the best local treatment\\nconsists in applying hot, limited flax seed meal, or pul-\\nverized slippery elm, or tomato poultices. Poultices", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0243.jp2"}, "242": {"fulltext": "230 SKIN DISEASES.\\nshould not be continued after the boil opens, as if too\\nlong used they rather encourage the formation of new\\nboils. Gelsemium or lappa cerate is a good after-dressing.\\nThe appropriate internal remedy will usually be one of\\nthe following:\\nAbsinthium. Eruption of furuncles over the whole\\nbody.\\nAethusa. Painful boil on the small of the back; he-\\npatic derangement; intolerance of milk; in children dur-\\ning dentition.\\nAmmon. carb. Boils on the cheeks and around the\\nears; in scrofulous children and in old people.\\nAntimo7i. rr/^^f.\u00e2\u0080\u0094 Boils on the perineum; burning pain\\nfor some distance around; gastric derangement.\\nArctium lappa, When crops of boils persistently oc-\\ncur; hordeolum and ulcerated eyelids.\\nArnica. Many small boils on the face; eructations bit-\\nter and like rotten eggs; general lassitude.\\nApis. Boils on the pubis; burning, stinging pains;\\ngreat sensitiveness to touch and pressure.\\nBellod. In early stages, if boil is inflamed and pain-\\nful; red, hot, shining swelling; boils on the shoulders\\nevery spring; after measles.\\nBellis per. Boils beginning as slight pimples, and in-\\ncreasing to large dark colored swellings, with aching\\npain. Mostly on the neck and lower jaw.\\nBerberis vulg. Hastens suppuration in boils, and pre-\\nvents their recurrence.\\nBromide of potassium causes an eruption of small boilsy\\nin successive crops, chiefly over the face and trunk, with\\ntroublesome itching.\\nBromine. Boils on the arms and face. In light-haired,\\nblue-eyed persons.\\nCadmium sulph. Boils on the nose and buttocks.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0244.jp2"}, "243": {"fulltext": "FURUNCLE. 231\\nCalcarea carb. Boils on the forearms and hands, with\\nlancinating pains; cramps in the arms; glandular swell-\\nings. In scrofulous persons.\\nCalcarea mur. As a preventative.\\nCarbo afi. Boils at the anus; burning, tearing pain.\\nIn scrofulous subjects.\\nCi7ia. Boils on the head and face in children; child is\\nvery fretful; bores in the nose with the fingers; burning\\nheat of the face with a glowing redness of the cheeks.\\nCistus. Boils beginning with a blister.\\nGelsemiujn. Large boils on the face and neck; great\\nmuscular prostration; sleeplessness from nervous irrita-\\ntion; dizziness and blurred vision; heat of face and head.\\nHepa7\\\\ When boils mature slowly; violent throbbing\\ngathering pain; stinging soreness; after injuries. Hepar\\nlow to promote suppuration, and /ilgk to prevent suppura-\\ntion.\\nKaliiod. Papular eruption, or other eruptions with\\nstrumous or syphilitic taint.\\nKalmia 2^. Red inflamed spots like incipient boils.\\nLappa?naj. Boils on the face, eyelids and all over.\\nLedum. Boils on the forehead, itching, pricking tear-\\ning pains worse in the evening before midnight. After\\nmosquito stings. In drunkards.\\nLycopod. Boils on the nates; periodical boils; aggra-\\nvated by warm, wet poultices; after excessive wnne drink-\\ning.\\nManganum. Small boils; every injury tends to sup-\\npurate.\\nMagnesia mur. Boils on the nose which suppurate in\\none day; boils on the false ribs; menstrual derangements;\\ndiarrhoea in children.\\nMerc. sol. Boils on the ankles; coldness of the hands\\nand feet; foetid ulcers on the legs, with gnawing itching;", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0245.jp2"}, "244": {"fulltext": "232 SKIN DISEASES.\\nshooting tensive pains, worse at night; especially when\\ncomplicated with bilious or mucous diarrhoea.\\nNatrum carb. Boils behind the ears; ulcers on the\\nlimbs; burning in the feet when walking; sour eructions.\\nNitric acid. Numerous large boils on the scapulae,\\nnape of the neck, nates, thighs and legs; tensive pains\\nworse in the evening and at night; aggravated by drink-\\ning milk.\\nNitrum. Boils on the thumb.\\nNux juglans Boils on the right arm; indurated boils;\\nblood boils; violent itching and burning.\\nNmx vom. Boils on the knees; gastric derangement;\\nconstipation.\\nPhos. acid. Boils in the axillae, and on the nates;\\nburning, stinging pain; skin feels sore all over. In\\nyoung people who grow rapidly.\\nPhytolacca. Boils on the back.\\nRhus rad. Boils on the face which do not mature;\\nblind boils.\\nSilicea. Boils on the posterior portion of the thighs,\\nand on the calves; disposition to boils; constipation.\\nStramon. Boils on the feet; coldness of the limbs in\\nchildren.\\nSulphur. Boils in the ear; stinging itching with\\nsmarting after scratching; after suppressed menstruation;\\ndisposition to boils.\\nZinciun ox. Boils on the abdomen, aggravated by use\\nof wine; worse before and during menstruation.\\nHordeolum, or Stye,\\nIs a small boil seated at the edge of the eyelids and in-\\nvolving a Meibomian gland. It is not an active kind of\\nboil, but progresses sluggishly, the pustule centre being\\nsmall. It is painful, and some time lapses before all", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0246.jp2"}, "245": {"fulltext": "ANTHRAX, OR CARBUNCLE. 233\\ntraces of its existence go. There may be one, two, or\\nmore on one or both eyelids. Some persons are subject\\nto repeated outbreaks of this furuncular inflammation.\\nWe find it most frequently in youthful individuals of\\nrather delicate health with a tendency to acne, or in per-\\nsons addicted to free living or dissipation. If by frequent\\nrelapses it induces inflammatory changes in the Meibo-\\nmian glands, and is followed by fatty or chalky degener-\\nation of their contents, it is called Chalazion.\\nIndications for the internal remedies are:\\nGraphites. Frequent recurrence of styes, ulcerations\\nof the margins of the lids; biting lachrymation.\\nLycopod. Styes on lids near internal canthus.\\nPulsatilla. More in affections of lower lids, conjunctiva\\ninjected, agglutination of lids in the morning; much\\nswelling of lids; burning, drawing pain, w^orse evenings,\\nin warm room, and in a cold draft, better in fresh air;\\ncatarrhal states tending to suppuration.\\nStaphisagria. Affection of both lids, especially the\\nupper ones; consequences of nervous exhaustion, the affec-\\ntion does not spread to the surrounding tissues; shooting,\\nlancinating pains or tearing, mostly in paroxj^sms, worse\\nduring night; new ones form continually and leave small\\nhard nodules at the tarsal edge.\\nAnthrax, or Carbuncle,\\nIs a multiple furuncle. It arises as a hot, hard swell-\\ning, not so conical as that of the boil more indurated,\\nhowever, the cellular tissue around being much more ex-\\ntensively indurated; its color is dusky, the sensation\\nburning, dull, throbbing; the carbuncle varies in size,\\nthe swelling becomes brawny, from the meshes of the\\ncellular tissue becoming filled with a plastic lymph. The\\nnext step is the formation of a quasi-Qhs,ZQ.ss the central\\ni6", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0247.jp2"}, "246": {"fulltext": "234 SKIN DISEASES.\\npart of the swelling softens, and feels boggj^; the skin be-\\ncomes thin over the surface, and at several points open-\\nings occur, through which slowly issues more or less\\nsanious pus; and the little holes are seen to be plugged\\nup by small white cores, which presently loosen and\\ncome away; the apertures are red and papillated, the\\nedges indurated and everted, particularly when several\\nopenings coalesce, so as to form one or more large open-\\nings. Gangrene may set in. The healing process is\\noften indolent, the parts remaining undermined, brawny,\\ndusky, shreddy, and also sloughy. Carbuncles are gen-\\nerally solitary. The patient, if the attack be severe, gets\\ninto a very depressed state. The posterior aspect of\\nelderly people is the selective seat of carbuncle.\\nIn carbuncles there are similar changes to those in\\nboils, but a much severer degree of disease. Here a\\ngroup of sebaceous glands is involved, and in conse-\\nquence of the more cachectic state of the nutrition the\\nreparative attempt is less perfect, the inflammation is of\\na lower type, and the cellular tissue sloughs and dies to a\\nmuch greater extent. The nutrition is not only unequal\\nto prevent the local disorder, but also incapable of putting\\nrepair in proper operation; and there is one disposition\\nin carbuncular subjects that perhaps has a peculiar in-\\nfluence in disposing to sloughing and gangrene of the\\ncellular tissue; this is the tendency to, or an actual,\\ndiabetic habit. Sugar occurs in the pus of the carbuncle,\\nand it is a curious fact that when anthrax develops the\\nsugar is diminished or disappears from the urine.\\nIn summing up the conditions under which boils occur,\\nit will not be difiicult to classify the main ones as follows:\\nI. during seasonal changes in spring and summer; 2.\\nfrom eating diseased meat (frozen); 3. when any special\\nalteration is made in the ordinary habits and economy of", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0248.jp2"}, "247": {"fulltext": "ANTHRAX, OR CARBUNCLE. 235\\nthe body, as in the training of prize-fighters; 4. from the\\ninfluence of cadaveric poisons; 5. from sudden change\\nof diet; 6. after fatigue of long duration; 7. during\\nconvalescence from debilitating diseases; 8. as a conse-\\nquence of the action of septic poisons, as in fevers, etc.\\n9. in albuminuria; 10. in the diabetic habit; 11. dur-\\ning adolescence, and in the first stage of manhood. In\\nmost of these cases there are debility and an over-\\nloaded state of system for example, the circulation of\\nurea, of sugar, of septic poison, or of effete matter which\\nis plentiful during convalescence; and it only needs the\\naction of some local irritant to determine the develop-\\nment of furunculi in the parts to which that irritant is\\napplied.\\nDiagnosis of Boils and Carbuncles. No error can\\npossibly be made in respect to these two diseases; in the\\nformer the hard, deeply-seated induration, the pain, the\\ncentral suppuration, and the core, are distinctive.\\nThe manifold openings, the boggy feel, the sloughing,\\nthe grumous discharge, and the implication of the cellu-\\nlar tissue in carbuncle are very peculiar. Furunculi are\\nsometimes epidemic.\\nTreatment. I would add one word of caution in re-\\ngard to the use of poultices: The poultices should be\\nconfined as much as possible to the exact seat of local in-\\nflammation. Nothing is more common than the spring-\\ning up of fresh around old boils from the neglect of this\\nprecaution. The same local measures as recommended in\\nfuruncles are useful here. In addition consider the fol-\\nlowing:\\nThe early application of ice and salt bags to the swell-\\ning is said to lessen the extent of the disease. If the\\nsloughing is extensive charcoal and yeast poultices may be\\nused. The sloughs should be picked out as fast as they", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0249.jp2"}, "248": {"fulltext": "236 SKIN DISEASES.\\nloosen, and the ulcer washed out once or twice a day with\\na weak solution of carbolic acid, or peroxide of hydrogen.\\nDr. Owen, of London, treats large carbuncles with ex-\\ntensive sloughs by removing the sloughs, under an\\nanaesthetic, scraping the sores and the diseased under-\\nmined skin with Volkmann s spoon and trimming off the\\nragged edges. The wounds are then washed with a\\ni-iooo sublimate solution, dusted with iodoform, and\\ncovered with moist perchloride gauze and blue wool. Do\\nnot use the knife to open a carbuncle.\\nThe indications for internal remedies are as follows:\\nAconite. As an occasional remedy, when there is much\\ninflammation with high fever.\\nAnthraciyium When the burning pain is violent and\\nnot relieved by Arsenicum; cerebral or typhoid symptoms;\\nevidences of blood poisoning; sloughing, abundant dis-\\ncharge of ichorous, terribly smelling pus.\\nApis. Continued extension of the erysipelatoid inflam-\\nmation with stinging burning.\\nArctium lappa. Has great reputation; used both inter-\\nnally and locally.\\nArse?i. alb. Large, painful and malignant carbuncles;\\ngreat prostration; great restlessness; great thirst, drink-\\ning but little at a time; all the symptoms are worse\\nin the night, and better from external warm applications.\\nBellad. Bright redness, with throbbing pain; when\\ncerebral complications arise; erysipelatous inflammation\\naround the carbuncle; drowsiness with inability to go to\\nsleep.\\nBiifo, at the commencement very efficient.\\nCar bo veg. Dark blackish appearance of the sore;\\nfetid odor of the discharge; hippocratic face; blood poi-\\nsoning.\\nCiitchona. When the asthenic character of the disease\\nis well marked; debility from excessive suppuration.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0250.jp2"}, "249": {"fulltext": "PUSTULA MALIGNA. 237\\nHyoscyamus. When there is great restlessness, caused\\nby excessive nervous excitement; itching around the\\nswelling; in nervous and hysterical individuals.\\nLachesis. Bluish purpHsh looking carbuncles, with\\nevidences of blood poisoning; nightly burning, obliging\\none to rise and wash parts in cold water; inability to bear\\nany bandage around the neck; cerebral symptoms.\\nMuriatic acid. Carbuncles in scorbutic individuals,\\nwith ulcers on the gums; frequent desire to urinate with\\nprofuse emission of clear urine.\\nNitric acid. When there is a predisposition to anthrax.\\nPhytolacca. Tendency to carbuncles, especially on the\\nback and behind the ears.\\nRhus tox. Great restlessness; feels somewhat relieved\\nof the violent pain as long as he is in motion; burning itch-\\ning around the carbuncle, with vertigo; bloody, or serous,\\nfrothy, diarrhoea; typhoid symptoms.\\nSecale corn. Carbuncles on the arms; aggravated by\\nwarm applications; gangrenous tendency.\\nSilicea. During the process of ulceration, to promote\\nhealthy granulation.\\nPastula Maligna, Malignant Pustules,\\nAlso called Carbunculus contagiosus, is characterized by\\nthe appearance of an angry-looking pustule, associated\\nwith gangrenous destruction of the surro.inding pares\\nwhich owes its origin either to a direct inoculation of the\\npoison from an animal affected with the disease called\\nAnthrax, or Charbon, or to a transmission by flies of the\\npoison, or to inoculation of the poison from man to man,\\nor to the eating of the flesh of diseased animals. It is there-\\nfore most frequently found among persons wdio have to\\ndo with diseased animals, or who work in manufacturing\\nestablishments, where the products of such animals", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0251.jp2"}, "250": {"fulltext": "238 SKIN DISEASES.\\n(hides, horsehair, wool) are prepared for different uses.\\nThe infection takes place principally on the uncovered\\nparts of the body which are exposed to the entrance of\\nthe poison. The eating of diseased flesh first causes gen-\\neral malaise and intestinal troubles, after which, in about\\neight or ten days, anthrax carbuncles appear, by prefer-\\nence on the arm, forearm and head.\\nAfter an incubation of from a few hours to several\\ndays, there is at first felt on the spot where the poison took\\nhold a slight burning and itching, as if from the bite\\nof an insect, and one can see a little red speck with a\\nblack point in its centre. This soon becomes changed\\ninto an itching papule, capped with a small, generally\\nreddish or bluish vesicle, which gradually enlarges. Af-\\nter bursting it discloses a dark red base, which becomes\\ncovered with a crust, while often, though not always, sec-\\nondary vesicles spring up around it, which contain a yel-\\nlowish, reddish or blackish fluid. At the same time the\\nsurrounding parts swell oedematously over a considerable\\narea, the cellular tissue underneath also becomes infil-\\ntrated, and in many cases discolored lines mark the\\ncourse of the veins, or red stripes the course of the lym-\\nphatic vessels in the oedematous region; the corresponding\\nlymphatic glands also swell. The general symptoms cor-\\nrespond with the severity of the local affection; there is\\nfever, great weakness, delirium, excitement, confusion;\\nsweating, diarrhoea and pain in the extremities; in fatal\\ncases collapse; in favorable cases after the dead masses\\nhave been removed by sloughing off, the wound gradu-\\nally heals by healthy granulation.\\nThe indications for internal remedies are few:\\nLachesis. Bluish color of the pustule and red streaks\\nalong the lymphatic vessels.\\nAnthi^acinum. Blood poisoning.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0252.jp2"}, "251": {"fulltext": "PUSTULA MALIGNA. 239\\nMala7idrinum Blackish diarrhoea; pain in back and\\nlimbs; pustule similar to a badly-looking vaccine pustule.\\nCompare the remedies given under Carbuncle.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0253.jp2"}, "252": {"fulltext": "CHAPTER XI.\\nSQUAMOUS INFLAMMATION.\\nGeneral Remarks.\\nThere are two important diseases of the skin with\\nwhich we shall deal in this chapter namely, pityriasis\\nand psoriasis. In the former malady, in its typical form,\\nthe surface of the body is deeply reddened (hypersemic),\\nand covered by large and freely imbricated scales or\\nflakes; hence the term applied to it pityriasis rubra.\\nIn the disease there is no real inflammation in the form\\nof new products. Hebra allies it to eczema, and upon the\\nground that we occasionally find moist excoriated\\npatches on other portions of the skin, especially in the\\nflexures of the joints. But this is infinitely rare; from\\nbeginning to end, there need be nothing but hypersemia\\nand scaliness present in the disease.\\nThere is not necessarily any change in the corium\\ntissue or the connective tissue, though the hypersemia,\\nif persistent, maybe followed by hyperplasia and thick-\\nening of these parts, but only as accidental epiphe-\\nnomena.\\nIn psoriasis a somewhat different state of things\\nobtains; there is hypersemia of the papillary layer of the\\nskin, with hyperplasia of the epithelial elements, but I\\nbelieve the latter to be the more important of the two;\\nand in this respect psoriasis contrasts with pityriasis\\nrubra the former being essentially a disease of cell\\ntissue, the latter rather an hyperaemia, primarily.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0254.jp2"}, "253": {"fulltext": "PITYRIASIS RUBRA. 241\\nPityriasis Rubra.\\nUnder this title two distinct types of disease have been\\ndescribed the one by Devergie and the other by Hebra.\\nThey both possess certain marked features which would\\nentitle them to the designations they have received; but,\\nas there are also marked differences in their course, and\\nprognosis, they must and should receive separate consid-\\neration.\\nPityriasis Rubra (Devergie).\\nThis affection is chiefly met with in persons between\\nthe ages of forty and fifty, and commences by the ap-\\npearance of well-marked redness, wath a sharply limited\\nmargin on the anterior aspect of the trunk and limbs.\\nAs it advances new surfaces are invaded, the skin\\nslightly thickens, and the increase may be so rapid that\\nthe entire skin may become involved in from two to four\\nweeks. Accompanying this diffuse redness we find free\\ndesquamation or exfoliation of medium-sized epidermic\\nscales, with more or less watery exudation, resembling\\nsweat rather than the l3miphy and plastic exudation of\\neczema. There is also an intense burning heat of the\\nsurface, so that the patient suffers from the warmth of\\nhis clothing and of the bed coverings at night.\\nThe acute symptoms mentioned are tenacious, and the\\naffection m^ay persist in this condition for months, but in\\nperhaps the majority of cases they gradually subside, and\\nrecovery takes place.\\nOn the other hand, the acute phase of the disease may\\nbe followed by one that is subacute, but more persistent,\\nand continue to harass the patient for years, gradually\\nbreaking down his health and terminating fatally,", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0255.jp2"}, "254": {"fulltext": "242 SKIN DISEASES.\\nthrough the supervention of chronic diarrhoea or the de-\\nvelopment of pemphigus.\\nThe prognosis is in the main favorable, except when it\\noccurs in aged or debilitated subjects, or assumes the dis-\\ntinctly chronic form.\\nPityriasis Rubra (Hebra).\\nUnder this name Hebra has described a disease that is\\nwholly different from the foregoing, and the principal\\ncharacters of which are as follows:\\nThe skin presents a persistent deep-red coloration, dis-\\ntributed over the entire surface, but without papules,\\nvesicles, or any exudation. Scales are found in small\\nnumbers, but do not become a prominent feature of the\\naffection.\\nThe local subjective symptoms are insignificant.\\nThe progress of the disease is remarkably slow, and\\nin its early periods the general health is not notably\\naffected; but little by little there is a gradual weakening\\nof the vital forces, and fatal marasmus marks the termi-\\nnation of the patient s sufferings.\\nIt will be seen from the foregoing that the affections\\ndescribed under the same name by the eminent French\\nand German authors differ from each other in every im-\\nportant respect, and are, in fact, quite distinct diseases.\\nDr. Piffard has met with a number of cases of Dever-\\ngie s disease, but only a single undoubted example of the\\nmalady described by Hebra.\\nIf, as asserted by Hebra, pityriasis rubra is always and\\nunnecessarily fatal, treatment other than palliative is out\\nof the question.\\nIn Devergie s affection, however, every effort should be\\nmade to cut short its progress, and benefit may be ex-\\npected from baths, emollients, and therapeutics.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0256.jp2"}, "255": {"fulltext": "PITYRIASIS RUBRA. 243\\nSoothing local applications, such as bran baths or a de-\\ncoction of walnut leaves followed by oil}^ inunctions, and\\nlater by oil of white birch, are important aids. Lotions\\nwith corrosive sublimate i-iooo, or with hydrate of chlo-\\nral 1-50 or i-ioo, constitute an excellent application in\\npityriasis capitis. Sulphurated pomades have been ad-\\nvised; flowers of sulphur 1-30 or 1-60. For pityriasis of\\nthe face a pomade of calomel i-ioo is often eflQcient.\\nArsenicum album is the principal internal remedy used\\nby both schools. It produces pityriasis by its physiolog-\\nical action; its well known characteristics indicate its use;\\nfeverishness, with restlessness and thirst, for small quan-\\ntities, etc.\\nNatru7n ajsenicum. This drug corresponds very\\nclosely to the leading peculiarities of this disease, and I\\nhave prescribed it successfully in several cases. Its skin\\nsymptoms read: Squamous eruption, scales thin,\\nwhite, and when removed leave the skin slightly reddened.\\nIf scales remain they cause itching, worse when warm\\nfrom exercise.\\nArsen. tod. and Kali ars. are preparations that may be\\noccasionally useful. I have had no trustworthy expe-\\nrience with either.\\nOther remedies may be indicated as follows:\\nAntim. crud. Brownish-red spots, like small hepatic\\nspots, here anci there.\\nCajitharis. Itching, followed by burning, when\\nscratching; tendency to formation of blisters; most suit-\\nable when the disease appears in children.\\nCocculus. Red, irregularly shaped spots on the skin,\\nover the whole chest, and on the sides of the neck, be-\\nhind the ears, without heat or itching^ intolerance of both\\ncold and warm air.\\nConium. Frequently recurring red, somewhat itching,\\nspots on the body.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0257.jp2"}, "256": {"fulltext": "244 SKIN DISEASES.\\nGraphites. Pityriasis capitis, dryness of the skin, with\\ncracking; localization of the eruption; tendency to cold\\nfrom draughts of air; pains from changes of the weather;\\nabundant desquamation from the hairy scalp.\\nKreasotum. Uneasiness during rest, with irritation\\nthroughout the body; child cannot sleep unless carried or\\nfondled; scaly ulceration on face, elbows, wrists and\\nfingers.\\nLachesis. Small reddish spots on face, neck and chest,\\nwhich increase in numbers, become scurfy, and then dis-\\nappear.\\nLedum. Aching, bruised feeling in the whole body;\\nwarm sweat of the hands and feet; bluish spots on the\\nbody like petechiae; eruption itching, with anxiety; cold-\\nness in affected parts.\\nMezereum. Chronic pityriasis capitis, loss of hair and\\ngreat itching, brownish miliary rash on the chest, arms\\nand thighs; phlegmatic temperament, with light hair.\\nPhosphorus, Brown, bluish-red, or yellow blotches on\\nabdomen and chest.\\nSepia. Brown-red hepatic spots on the skin.\\nSulphur advised by the two schools. Its pathoge-\\nnesis contains the formation of furfur.\\nTartar e7net. Eruption dependent upon gastric de-\\nrangement, nausea and vomiting, with thick white coat-\\ning on tongue.\\nPityriasis Pilaris.\\nDevergie, who was the first to describe this rare der-\\nmatosis, states that in its most benign form it consists of\\na more or less localized eruption on the external aspects\\nof the members, and especially the forearms and legs.\\nThe essential seat of the eruption is at the pilous orifices\\nof the general surface, but not on the scalp. The only\\nlesion is a minute papule, with a small adhering scale.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0258.jp2"}, "257": {"fulltext": "", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0259.jp2"}, "258": {"fulltext": "Psoriasis.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0260.jp2"}, "259": {"fulltext": "PSORIASIS. 245\\nIn more severe cases it may become generalized, with\\nslight thickening of the skin about the follicle, forming a\\nsmall, red pyramidal papule decked with a white scale.\\nThe skin between the papules is apparently unchanged.\\nThere is little or no pruritus, and it apparently causes\\nbut trifling inconvenience to the patient, except as it pro-\\ngresses from bad to worse.\\nIt is exceedingly obstinate, and palliative and emoUient\\ntreatment is our only resource.\\nWhen associated, as it may be, with pityriasis rubra, it\\npresents a striking likeness to lichen, rubra and may pos-\\nsibly be in reality the same affection.\\nThere is considerable discussion as to whether pityri-\\nasis is not a parasitic affection. Some observers claim to\\nhave discovered a special parasite in this affection, con-\\nsisting of very minute spores, averaging a thousandth of\\na millimetre in diameter. The extreme smallness of the\\nspores and their irregularity in size have induced M. Vi-\\ndal to name the parasite Microsporon anomoeon or dispar.\\nThis is a point that has not been fully settled as yet,\\nand I prefer to class the disease among the squamous in-\\nflammations until further light has been thrown upon the\\nsubject.\\nSepia and Natr. ars. are the principal internal remedies\\nfor pityriasis pilaris.\\nPsoriasis.\\nPsoriasis is a constitutional disease, characterized by\\ncutaneous lesions of the squamous type.\\nThis affection may appear in the early years of child-\\nhood, or at almost any later period up to and including\\nso-called middle life. It rarely appears at either of the\\nextremes that is, during infancy or old age.\\nIts first manifestations usually take the form of small", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0261.jp2"}, "260": {"fulltext": "246 SKIN DISEASES.\\nred papules, soon decked with a white scale. These may-\\nbe few and scattered, or many and closely aggregated.\\nThe scaly papules increase at their periphery, becoming\\nflattened patches from the size of a pea to that of a coin\\nor even larger. When the progress of the disease con-\\ntinues, neighboring patches encroach on each other, and\\nin time coalesce, giving rise to irregular gyrate forms.\\nCoincident with the peripheral extension there is an in-\\ncrease in the infiltration or thickening of the skin, and\\nthe scales become large, imbricated, and more or less ad-\\nherent. On forcible removal of the scales, a red infil-\\ntrated patch is brought to light, on the surface of which\\nminute droplets of blood may be seen. After the disease\\nhas attained its maximum development, which may in-\\nclude the greater portion of the surface, it may remain\\nstationary for an indefinite period, or may undergo a\\ngradual involution and disappear. This is the course fol-\\nlowed in not a few cases of mild type. A single attack\\nof this sort, howeVer, is exceedingly rare. In almost\\nevery instance the eruption reappears after a shorter or\\nlonger interval. In not a few cases of mild type there\\nwill be an appearance of the lesions at the beginning of\\nthe cold and a disappearance of them at the beginning of\\nthe warm seasons.\\nIn cases even where the eruption is caused to disappear\\nby treatment there is the same tendency to return, and\\nthis relapsing feature of the disease is one of its most im-\\nportant and most annoying characteristics. To such an\\nextent is this true, that even with the most judicious treat-\\nment there is no certainty of a radical cure. As a rule, if a\\nperson once has psoriasis, he may expect to have it al-\\nways that is, with certain intervals of freedom. The\\nreverse of this is rare, as it is extremely exceptional for a\\npatient to recover permanently, or to enjoy immunity for\\na term of years.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0262.jp2"}, "261": {"fulltext": "PSORIASIS. 247\\nThe subjective sj^mptoms are usually unimportant,\\namounting at most to a moderate degree of pruritus^\\nthough in man}^ cases this is not sufficient to be com-\\nplained of by the patient.\\nThe eruption frequently exhibits a more or less sym-\\nmetrical disposition, and prefers the extensor surface, with\\na special predilection for the elbows and knees. The\\nupper half of the body usually presents more lesions than\\nthe lower. It very rarely affects the palms or soles.\\nWhen situated on the genitals it may excite an analogous\\ncondition of the mucous membrane.\\nThe features of the disease are the more characteristic\\nif account be taken of its negative signs; for in it there is\\nan entire absence of any discharge, vesiculation, or pus-\\ntulation throughout the whole course of the disease.\\nThe characteristics above described constitute a primary\\ncondition\\nThe eruption affects (by preference) certain parts of\\nthe skin whose epithelium is thick, especially the elbows\\nand knees. It may be partial or general. At the outset\\nthe disease may be attended by more or less pruritus.\\nThe increase of the patches is by centrifugal growth,\\nand there is oftentimes a slightly red margin; the scales\\nare shed, to be again replaced by others; in chronic cases\\nthe derma itself becomes very distinctly infiltrated and\\nthickened. The general health is often apparently good.\\nThe disease is non-contagious, runs a chronic course, and\\nis very prone to recurrence.\\nIt is customary to make certain local varieties; they\\nare:\\nPsoriasis capitis. The head is one of the commonest\\nseats of the disease, next to the elbows and the knees;\\nthe whole scalp may be affected, or there may be only\\none or two small points of eruption; when extensive, the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0263.jp2"}, "262": {"fulltext": "248 SKIN DISEASES.\\ndisease travels on to the forehead, forming a kind of\\nfringe along it at the upper part. There is co-existent\\ndisease elsewhere. The hair on the scalp thins out fre-\\nquently when psoriasis attacks it.\\nPsoriasis faciei. In this local variety of psoriasis, the\\npatches are often circular; they are less hypersemic, less\\nthick, and less scaly than when the disease attacks other\\nparts of the body, and they present consequently much\\nsimilarity to tinea circinata, except that typical patches\\nof the disease are seen in other parts of the body.\\nPsoriasis palmaris ?indi psojiasis plantaris are important\\nlocal varieties. These local varieties are infinitely rare.\\nOf course, instances of so-called psoriasis palmaris and\\nplantaris are common enough, but they are practically al-\\nways syphilitic. Non-syphilitic psoriasis may occur,\\nthough rarely, in connection with general psoriasis. But\\nwhen such a condition exists as the sole disease, it is syph-\\nilitic and nothing else, and the concomitance of sore\\ntongue and other evidences of constitutional syphilis at\\nonce make the diagnosis certain. The skin in the affected\\nparts is generally thick, and dry, harsh, discolored; the\\nscaliness is not very marked, but the superficial layers\\npeel off from time to time. Presently the surface cracks\\nand fissures, and healing is very tardy; occasionally the\\nsurface bleeds. The muscular movements of the hand\\nmay be painful.\\nPsoriasis unguinum is mostly a complication of the in-\\nveterate form of psoriasis, but it may exist alone. The\\nnails (and several are usually affected) lose their polish,\\nand soon become opaque, thickened, irregular, and brit-\\ntle; they are then fissured and discolored in lines (from\\ndirt), their matrix becoming scaly.\\nPsoriasis also affects the scrotum and prepuce occasion-\\nally; the parts are swollen, red, hard, tender, scaly, fis-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0264.jp2"}, "263": {"fulltext": "PSORIASIS. 249\\nsured more or less, and give exit to a thin secretion,\\nwhich adds to the scaUness; there are pain and pruritus;\\nand the local mischief may be the sole, or part only, of\\ngeneral disease.\\nPsoriatic syphilides. Nozo asserts that psoriatic syphi-\\nlides always indicate the presence of a grave variety of\\nsyphilis and that they occur most commonly in cachectic\\nsubjects. In some cases they may appear as late mani-\\nfestations of the disease; and their development is fa-\\nvored by old age, alcoholism, congenital or acquired dry-\\nness of the skin, and perhaps, also, by gout. Cases\\noccur concerning which even the most expert diagnosti-\\ncian may be in doubt as to whether the eruption is the\\nordinary psoriasis or a specific eruption.\\nWhen psoriasis is in progress of cure, the scales lessen\\nand the reddened elevated surface beneath comes more\\nprominently into view; but this diminishes gradually till\\nthe eruption disappears, leaving oftentimes no trace of its\\nformer presence behind. It may leave, however, pig-\\nmentary stains, the result of the congestion. It is in the\\ndisappearance of patches of psoriasis that the centre\\nrapidly clears, and the ringed form or psoriasis circinata^\\nor the lepra of old authors is produced.\\nEtiology. We possess no certain knowledge as to\\neither the proximate or remote causes of the disease. It\\nis not uncommon to find an extensive eruption in those\\nwho otherwise appear to enjoy the most robust health;\\nwhile, on the other hand, it may appear only during\\nperiods of temporary debility, as in women during preg-\\nnancy and lactation. That the affection is constitutional\\nand connected with similar conditions to those underly-\\ning eczema we have no doubt, and each year s experience\\nmore strongly confirms this opinion. Some have claimed\\nthat the eruption is purely local or due to the presence of\\n17", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0265.jp2"}, "264": {"fulltext": "250 SKIN DISEASES.\\na parasite. Positive evidence of this is wanting. Others\\npretend that it is but a relic of syphilis handed down\\nfrom a remote ancestor. This view also has little to sup-\\nport it.\\nPsoriasis is often hereditary. It attacks males more\\nthan females, and is most common between the ages of\\nfifteen and thirty. Persons of sanguineous temperament\\nare most liable to the disease perhaps, and it is seen in\\npersons of all classes of society, and mostly in summer\\nand winter.\\nPrognosis. The disease is mostly difficult of cure\\nand has a tendency to recur. The most obstinate cases\\nare those of psoriasis mummularis of the back and but-\\ntocks, in which there is much elevation and thickening\\nand deep redness; and psoriasis about the hands and\\nfeet.\\nDiagnosis. In well-marked and typical cases there\\ncan not be the least difficulty in diagnosis, especially to\\nany one who has already seen an example of the disease.\\nUnfortunately, however, cases are not always typical;\\nand we must learn to distinguish psoriasis from syphilis,\\neczema, and dermatitis exfoliativa. As we have already\\nstated, eczema may closely resemble psoriasis. In like\\nmanner the latter disease may closely counterfeit the\\nformer in its outward appearance; and in this particular\\ncase the diagnosis will be by no means easy, nor arrived\\nat at a glance, but only by careful consideration of the\\ncase in all its bearings. A squamous syphilide may\\nclosely resemble psoriasis; but here the history will aid\\nus greatly if we bear in mind a few fundamental facts.\\nIn psoriatic cases of long standing we will have the his-\\ntory of repeated outbreaks of eruption, but they will all\\nhave presented the same general type that is to say, a\\nrepetition of the same kind of eruption a squamous", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0266.jp2"}, "265": {"fulltext": "PSORIASIS. 251\\nS3^philide will probably have been preceded by other\\neruptive attacks; but these have been in all probability a\\ndifferent sort of eruption papular, pustular, or what\\nnot. Syphilis rarely repeats itself in its manifestations.\\nIf in addition we learn from the patient the prior exist-\\nence of the primary lesion, or if we find other co-exist-\\ning lesions, as alopecia, mucous patches, throat trouble,\\netc. we should not long remain in doubt as to the nature\\nof the eruption about which we have been consulted.\\nThe existence of squamous lesions on the palms and soles\\nin connection with squamous patches on the general sur-\\nface is evidence positive of syphilis. In psoriasis the\\nepidermic proliferation or desquamation is much greater\\nthan in syphilis. We have known a case of exfoliative\\ndermatitis to be mistaken for psoriasis; but if we recollect\\nthat the characteristic feature of the former disease is the\\nexfoliation of quite extensive laminae, of not very greatly\\nthickened epidermis, sometimes several square inches in\\nextent, there is no excuse for mistaking the one disease\\nfor the other.\\nPsoriasis and syphilis may of course coexist. There\\nwill be but little difficulty in differentiating the respective\\nlesions.\\nPsoriasis may coexist with eczema, both presenting\\ntypical lesions, or we may have lesions of mixed char-\\nacter, in which it would be hard to say which disease\\npredominated. Certain diseases of other organs appear\\nto bear a close relationship to psoriasis. This is notably\\ntrue of arthritic affections and also of asthma. As a rule,\\nthese do not coexist with the psoriasis, but manifest\\nthemselves during the time that the skin is free from\\neruption, alternating as it were with the cutaneous\\nlesion.\\nTreatment. It is but a few years since the chief re-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0267.jp2"}, "266": {"fulltext": "252 SKIN DISEASES.\\nliance of the old school in the treatment of psoriasis was\\nthe internal use of arsenic and the external use of tar.\\nSlow and tedious was the cure. Now, however, they\\npossess an agent which they claim exhibits a remarkable\\nenergy in the control of the eruption. We allude to\\nchrysarobin. This is employed in various ways, but the\\none seemingly most satisfactory is a mixture of thirty\\ngrains of the drug with one ounce of traumaticin {liquor\\ngutta-percha). This should be painted on the spots\\ndaily until a considerable degree of local irritation is\\nproduced. Sedative applications should then be applied\\nfor a few days, and the skin allowed to recover from the\\neffects of the drug. A single course of this sort will\\ncause most of the spots to disappear that is, as regards\\nscale formation and infiltration and these spots will\\nusually appear distinctly white and ansemic in comparison\\nwith the surrounding skin, which has been darkened by\\ncongestion produced by the chrysarobin. Unless the\\neruption was limited both as to size and extent of the\\nlesions, we will find many patches in which complete\\nrecovery has not taken place. These will require addi-\\ntional applications. Chrysarobin possesses the incon-\\nvenience of staining the surrounding skin (temporarily)\\nand permanently staining the clothing; and a number of\\nsubstitutes naphthol, resorcin, antarobin, hydroxylamin,\\netc. have been proposed. Some of these are dangerous,\\nwhile others are inefficient, and none of them are equal in\\nefficacy to chrysarobin. This drug, however, should not\\nbe applied to the face or scalp, and we must instead use\\nmilder applications, such as tar or some of the essential\\noils, as the oleum pini sylvestris, oleum eucalypti, etc.\\nThe following is an excellent aid\\n9^, Chrysarobin,\\nAcid Salicylici, aa gr. x.\\nUnquent Resiuol, ^j.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0268.jp2"}, "267": {"fulltext": "PSORIASIS. 253\\nSig. Apply thoroughly at night and bathe thoroughly\\nnext morning, or,\\n9^. Tar,\\nAlcohol,\\nSoft soap, aa Jj. M.\\nSig. Apply locally, with flannel or a coarse piece of\\ncloth, and is firmly rubbed into the part night and morn-\\ning according to the effect.\\nThe following is a very good application for an\\nordinary case of psoriasis which is passing on to the\\nchronic stage.\\nNitrate of mercury ointment, 3J to gjj.\\nPowdered oxide of zinc, 5jj-\\nSolution of lead (liquor plumbi), ^ss.\\nCarbolic acid, fl. drops, jj.\\nOlive oil, ^j or ^j ss.\\nM. Sig. Apply nightly.\\nAnother excellent application is made as follows\\nRed precipitate, finely powdered,\\nWhite precipitate, aa gr. vj.\\nLard, ^j.\\nMix. Sig. Apply night and morning.\\nDr. Stern recommends for psoriasis capitis Precipit.\\nalb., lo.o Sapon. nigr., 40.0; Lanoline anhydr., 50.0.\\nM. Ft. ung., S. Rub in every evening a portion the\\nsize of a filbert.\\nAfter four days all the scales are gone, and the\\naffected parts become smooth and take on a natural\\nappearance. It is usually advisable to continue the\\napplication of the lanoline alone for a time longer.\\nDr. Patterson reports a case of psoriasis of fifteen years\\nstanding cured in one month by an ointment of vaseline,\\noxide of zinc and Sanitas oil. He fails to give the pro-\\nportions.\\nThe pomade of tar is classical in the treatment of", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0269.jp2"}, "268": {"fulltext": "254 SKIN DISEASES.\\npsoriasis. Axunge or oil, with one-tenth part of tar.\\nThe pomade of oil of cedar has been employed in the\\nsame proportion. The immediate action of these pomades\\nis a notable amelioration of this affection. But they\\nnever effect a cure.\\nIn obstinate cases, unless the skin is very irritable, the\\noil of white birch may be used in the form of an\\nointment, one drachm to the ounce of vaseline.\\nThe diet in psoriasis should be a generous one, and in\\nit meat ought always to play an important part. Cod\\nliver oil is generally needed.\\nThe indications for the internal remedies are as follows:\\nIt is better to commence the internal treatment with\\nSulphur. Afterwards one of the following remedies may\\nbe given\\nAmmon. carb. White pea-sized spots upon the cheek,\\nwhich continually exfoliate; skin very sensitive to cold;\\naversion to being washed; nose-bleed when washing the\\nface in the morning; in weak, nervous individuals.\\nArsen. alb. Eruption red or white and scaling; skin\\ndry and scaly; great restlessness with weakness and pros-\\ntration, worse about midnight; burning itching; oppres-\\nsion of breathing; aggravated by eating fruit, ice cream,\\netc.\\nArsen. iod. Dry scaly burning itching eruption on\\nvarious parts; persistent itching on the back; in obsti-\\nnate cases.\\nBerber, vulg. The eruption appears with itching,\\nlymphatic swellings on the articulations; must scratch\\nvery hard.\\nCalcarea carb. Scurfy spots on the leg; burning and\\nitching; skin cracks; profuse sweat from the slightest\\nexertion; large abdomen; blue eyes, blonde hair, fair\\nskin.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0270.jp2"}, "269": {"fulltext": "PSORIASIS. 255\\nClematis. The eruption is chronic and long lasting,\\nand becomes redder and more humid with the increasing,\\npaler and dryer with the decreasing moon.\\nFluoric acid. Roughness on the forehead like a rough\\nline with its convexity upwards. Reddish spots above\\nthe eyebrows; desquamation on the eyebrows; nails\\nbrittle, edges bent in.\\nHydrocotyle Circular spots with slightly raised scaly\\nedges.\\nIodine. Rough, dry and dirty 3 ellow color of the\\nskin. Nervous irritation, and emaciation, with good ap-\\npetite; psoriasis circinata.\\nIris vers. Irregular psoriatic patches on the knees and\\nelbows, covered w^ith shining scales; eruption becomes\\nhard and dry; skin fissured and irritable; digestive de-\\nrangement, with nausea, and debilit}^; starting during\\nsleep; psoriasis diffusa.\\nMajiganum. In inveterate cases.\\nMercurius. Psoriasis of the hands; psoriasis in spots\\nall over the body; scaling off and exfoliation of the finger\\nnails; the scalp is painful to the touch; easy perspiration\\nwithout relief; recent cases.\\nMezej eum. Scurf- like scales on the back, chest, scalp\\nand thighs; roughness and scaling here and there;\\npruritus increased by scratching or when undressing.\\nMicriatic acid. Psoriasis of the hands; great sensitive-\\nness to damp weather.\\nNatruvi ars. Thin whitish scales, which when re-\\nmoved leave the skin slightly reddened.\\nNitric acid. Burning, itching or stabbing pains, worse\\nat night, from change of weather, or during perspiration;\\nstrong smelling urine, like that of horses.\\nPetroleum. Skin of the hands cracked and rough;", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0271.jp2"}, "270": {"fulltext": "256 SKIN DISEASES.\\nunhealthy skin; aversion to the open air; extreme sen-\\nsitiveness to sHght touch; falhng off of the hair.\\nPhosphorus. Psoriasis of the arms and hands, and on\\nthe knees and elbov^^s; arms and hands become numb;\\nbrownish or bluish-red blotches, with furfuraceous dry\\nscaling; coldness of the knees at night in bed; falling\\nout of the hair in large bunches; dry cough, with sore-\\nness in the chest; tall, fair children, with tuberculous\\ntendency.\\nPhytolacca. Surface of the skin shrunken and of a\\nleaden color; squamous eruption; rheumatic pains in the\\nextremities.\\nPsorinum. Eruption dry and scaling, with itching,\\nweakness, and debility; after acute diseases; profuse\\ncolliquative sweats.\\nSelenium. Dry, scaly eruption on the palms of the\\nhands, with slight itching.\\nSepia. Psoriasis on the face; red roughness of the\\nskin; falling off of the hair; during pregnancy and\\nnursing; dark complexioned individuals.\\nSilicea. Elevated scurfy spots near the coccyx; small\\nwhite scales on the face and neck; white spots on the\\ncheeks; sensation of numbness in the extremities; brit-\\ntleness of the nails; in scrofulous, large-bellied children.\\nTellurium. Psoriasis annulata, eruption over the\\nwhole body.\\nleiicrium. Psoriasis on the index finger of the right\\nhand.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0272.jp2"}, "271": {"fulltext": "CHAPTER XII.\\nDIATHETIC DISEASES.\\nI shall adopt the plan as outlined by Dr. Fox, and\\ninclude under the head of diathetic diseases the strumous,\\nthe syphilitic, and the leprous diseases of the skin.\\nThere are some objections to this classification, but they\\ndo not outweigh the advantages of the arrangement.\\nIn struma, sj^philis, and leprosy the changes in the skin\\nare but a small part of the whole disease, and only\\nevidence of a disposition on the part of the tissues of\\nthe bod}^ as a w^hole, to become changed and disor-\\ndered.\\nScrofuloderma.\\nThis disease does not require to be dealt with very\\nelaborately. It is scrofula of the skin, and only a\\npart of the general diathetic condition, w^hich is evi-\\ndenced by the ordinary signs of struma in greater or\\nless degree of expression. As regards the skin, scrofula\\nis generally characterized by the appearance at the\\noutset of indolent, dull red, soft, tubercular formations,\\nthat rapidl}^ suppurate, and are soon covered over with\\ndarkish scabs, from beneath which oozes an unhealthy\\npus. Ulceration to a greater or less degree takes place,\\nwith the formation of exuberant granulations at times,\\nand the healing is accompanied by distinct scarring.\\nThe whole disease is of the most chronic character.\\nOne can scarcely mistake the strumous ulceration for\\nany other disease; it may spread and cover a large", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0273.jp2"}, "272": {"fulltext": "258 SKIN DISEASES.\\nextent of surface, and in this case the ulcerated surface\\nis half covered by darkish irregular crusts, whilst the\\nulcers discharge a thin disagreeable dark pus, and\\ngranulations are flabby and pallid, bleeding freely on\\nbeing touched; the edges of the ulcers are livid, and\\nvarious attempts at repair are made. The mucous\\nsurfaces of the nose or eye may be inflamed and slightly\\nulcerated and onychia may be present. There are old\\nscars of former strumous disease, and the whole aspect\\nof the patient is a sufficient tell-tale of the disease.\\nThe old school advises the use of cod-liver oil, iodide\\nof iron, the phosphates of lime and iron, and locally an\\nastringent ointment of tannin; or acetate of lead; or\\nmercurial plaster; or iodide of lead ointment to the indo-\\nlent ulcerated surfaces. Residence at the seaside is also\\nadvisable.\\nThese patients should be allowed an abundance of\\nfresh air, plenty of outdoor exercise, and a generous\\ndiet. When the ulcers have formed, dress them with\\nthe iodide of starch paste.\\nThe indications for the homoeopathic remedies are:\\nAlnus rubra. Enlargement of submaxillary glands,\\nstrumous enlargement of tonsils; obstinate impetigo and\\nporrigo, chronic diarrhoea; scrofulous disease of hip-\\njoint; disease of mucous membranes, which arise from\\nor alternate with eruptions of the skin.\\nArsen. zW.-\u00e2\u0080\u0094 Diseases of mucous membranes, charac-\\nterized by a peculiar and persistently irritating corrosive\\ncharacter of the discharges; constant susceptibility to\\ntake cold; excoriated nostrils and lips; swollen and cov-\\nered with scabs\\nArsen. 7net. Great emaciation, clay-colored face, blue\\nmargin around the eyes; great weakness of all the limbs;\\nwant of disposition to do anything, and constant inclina-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0274.jp2"}, "273": {"fulltext": "DIATHETIC DISEASES. 259\\ntion to rest; lax muscles; swelling of the cervical glands;\\ndistended abdomen; diarrhoea; scurf} eruptions and\\nulcers; ophthalmia; carcinoma.\\nAsafcetida. Glands hard, swollen, hot, and throbbing,\\nwith shooting jerking pains; soft enlargement of bones,\\nwith curvature; ulcers with high hard edges, sensitive to\\ntouch, easih bleeding, pus profuse, greenish, thin,\\noffensive, even ichorous; psoitis when suppuration\\nthreatens; osteitis and caries; scrofulous ozaena; hard-\\nness of hearing, with thin purulent discharge of offensive\\nodor; scrofulous, bloated, clumsj^ children, with phleg-\\nmatic temperament.\\nAsclepias tub. Strong tendenc}^ to tubercular develop-\\nment; sharp pains in different parts of the body, with\\nmuscular soreness, changing from one part to another;\\nimpaired strength, rather feeble digestion and assimila-\\ntion; glandular enlargement about neck; vesicles; pim-\\nples and pustules all over the bod}\\nAuriwi met. Scrofula, rudd} complexion, light\\nhaired, sanguine temperament; glands painfully swollen;\\nozaena, with caries of nasal bones; fetid otorrhoea from\\ncaries of mastoid process; caries of cheek bones; tearing,\\nboring, burning stitches in zygoma; red and swollen ton-\\nsils; profound ulceration in throat.\\nBadiaga. Dandruff or dry, tetter-like appearance of\\nscalp, with slight itching; scrofulous ophthalmia, with\\nhardening of the Miebomian glands; tonsils red and in-\\nflamed; indurated inguinal glands; glandular swellings\\non left side of face, throat, and neck, some hard, some\\nsuppurating; small hard lumps along tibia; flesh feels\\nsore as if it had been beaten, and ver}^ sensitive to touch\\nor friction of clothes.\\nBaryta carb. Physical and mental debility; atroph}^,\\ngreat weakness; face red and abdomen bloated, glands", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0275.jp2"}, "274": {"fulltext": "260 SKIN DISEASES.\\nswollen, indurated; fatty or encysted tumors; coryza,\\nnose, and upper lip swollen, scurfs under the nose;\\nchronic induration of tonsils; sensation as of a plug in\\nthroat, worse swallowing solids; crawling in rectum, ex-\\npulsion of ascarides; cannot retain the urine; chronic\\ncough, with swollen glands and enlarged tonsils; worse\\nafter slightest cold, with soreness in chest when cough-\\ning; chronic torticollis; pimples, ringworms, humid\\nsores.\\nBellad. Hard, swollen, and ulcerated glands; muscu-\\nlar debility, with difficulty of learning to walk; photo-\\nphobia, inflammation of eyes and eyelids; cough, with\\nmucous rales; otorrhoea; emaciation and atrophy; ulcers;\\ninflammatory swelling of nose and lips; frequent epistaxis;\\nfrequent sore throat, with swelling; distended and hard\\nabdomen; enuresis day and night; premature develop-\\nment of mind; blue eyes and blonde hair.\\nBerberis aquifol. This remedy is highly recommended\\nby several physicians. Dr. Mallery uses the following\\nprescription\\n9^, Fluid ext. berberis,\\nSyrup simplex, aa ,^iv.\\nM. S. Teaspoonful every four hours.\\nBromium. Swelling and induration of the glands; en-\\nlargement of thyroid, in children with Hght hair, blue\\neyes, and fair skin; pimples and pustules; boils on the\\narms and face; hard swelling of left parotid, edges\\nof opening smooth, discharge watery and excoriating,\\nswelling remaining hard and unyielding; tonsiUitis; swal-\\nlowing of fluids more difficult than of solids; hard uneven\\ntumor in right mammae, firmly adherent to its surround-\\nings, with lancinating pains, worse at night; stiffness of\\nneck.\\nCalcarea carb. Malassimilatioii; tardy developmejit of", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0276.jp2"}, "275": {"fulltext": "DIATHETIC DISEASES. 261\\nbony tissue; large head with open fontanels; curvature of\\nthe back and vertebrae or other rickitic affections; herpes,\\ntinea, crusta lactea; hard or suppurating glandular swell-\\nings; ulcers, exostosis, or caries; hard and enlarged\\nabdomen, with swelling of mesenteric glands; emaciation\\nand voracious appetite; thirst constant, even after drink-\\ning; profuse perspiration of head; thin and wrinkled\\nface, with dim eyes; dry and flaccid skin; difiQculty of\\nlearning to walk; difficult dentition; red swelling of\\nnose; bronchocele; swelling of upper lip; frequent bleed-\\ning of nose; feet cold and damp; craves eggs.\\nCalcarea iod. Tendency to alternate diarrhoea and\\nconstipation; no thirst; pustular eruption, sore and pain-\\nful, with desire to rub and scratch it, though it makes it\\nworse; abdomen enlarged, breath offensive; cold sticky\\nperspiration, feet cold and damp; restless, fretful, and\\nirritable; pus from abscesses thin and ichorous; granular\\ninflammation of membrana tympani; scrofulous oph-\\nthalmia.\\nCalcarea phos. Emaciation, dirty- white or brownish\\ncomplexion; skull soft, thin, crepitating when pressed,\\nespecially in occiput; craves bacon, salt meat, and potatoes;\\nswelling of the epiphyses, difficult teething, slow closing\\nof the fontanels; curvature of spine to the left, lumbar\\nvertebrae bent forward; abscesses near lumbar vertebrae;\\nincipient mesenteric tabes, with much fetid diarrhoea.\\nTendency to tuberculosis.\\nChimaphila. Glandular enlargement, especially of\\nlymphatics; enlargement of mesenteric glands; ulcers of\\nan indolent and flabby character tumors in mammae.\\nCina. Child feels uneasy and distressed, does not\\nwant to be touched, is not pleased or satisfied with\\nanything, leaves his head side-ways all the time, rubs\\nnose constantl}^ pale sickly-looking face hunger and", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0277.jp2"}, "276": {"fulltext": "262 SKIN DISEASES.\\nthirst soon after eating, with gnawing sensation in\\nstomach abdomen hard and distended itching at anus;\\nulcers with scanty discharge inability to retain urine.\\nCistus Can. Glands swollen, inflamed, indurated, or\\nulcerated; drawing tearing pains in all joints; itching\\nall over the body, without eruption; herpetic erruption of\\nvarious parts; chronic scrofulous ophthalmia, feeling as if\\nsomething was passing around in the eye, with stitches;\\nwatery, bad-smelling pus discharged from ears; tetters on\\nand around ears; swelling of parotids; eczema of nose;\\ncaries of lower jaw, with suppurating glands in neck;\\ncool feeling in stomach and abdomen; cool eructations;\\nchronic diarrhoea; swelling and suppuration of glands of\\nthroat; scrofulous ulcers on back; desire for acids and\\nacid fruit, but they cause pain and diarrhoea.\\nConium. Swelling of glands, with tingling and\\nstitches; marasmus with frequent sour belching, worse\\nduring night; erratic itching of all parts of body; humid,\\nburning, corroding, crusty herpes; blackish ulcers, with\\nbloody, fetid, ichorous discharges, especially after con-\\ntusions; ophthalmia with photophobia; blenorrhoea\\nbronchialis; asthma; carcinoma.\\nCory dalis form. Scrofulous cutaneous diseases, accom-\\npanied by feeble digestion and poverty of blood; scrofu-\\nlous syphilitic diseases.\\nCornus circin. Scrofulous ophthalmia, herpes of eye-\\nlids; ulcerations of tongue, gums, and mouth.\\nGraphites. Swelling and induration of glands; eczema\\ncapitis of entire scalp, forming massive dirty crusts,\\nwhich mat the hair together; eczema beginning as a\\nmoisture behind left ear, and spreading over cheeks and\\nneck; thick, yellowish, fetid discharge from nose; dry\\nscabs in nose, with sore, cracked, and ulcerated nostrils;\\npainful nodules on lower jaw; chronic catarrhs of", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0278.jp2"}, "277": {"fulltext": "DIATHETIC DLSEASES. 263\\nstomach and bowels; glandular swelling in groins;\\nfissures and rhagades; turbid urine; unpainful swollen\\nglands on nape of neck.\\nHecla lava. Scrofulous ostitis or periostitis, resting on\\na syphilitic basis, and especially affecting the bones of\\nface and of antrum highmori; difficult dentition; rachit-\\nis; hip disease; white swelling; induration and infiltra-\\ntion of cervical glands, studding the neck like a row of\\npearls; toothache from swelling about the jaws; abscesses\\nof gums from decayed teeth.\\nHepar. Glands inflame, swell, and suppurate; hard\\nburning nodosities; unhealthy skin: slight injuries sup-\\npurate; stinging burning of edges of ulcers, discharging\\nbloody pus; humid eruption of fetid odor, feeling sore,\\nitching violently; nodosities on head, relieved by cover-\\ning the head warmly and from sweat; discharge of fetid\\npus from ears; boils on face, lips, and chin; cancerous\\nulcers; disposition to phlegmonous sore throat, catarrh,\\nor bronchitis; atrophy.\\nHydrastis. Chronic catarrhs of mucous membranes\\nwherever situated; cancerous cachexia; cancers hard,\\nadherent; skin mottled; puckered, with lancinating\\ncutting pains; atony of muscles.\\nHypophosphite of Lime One of the best remedies we\\nhave for so-called scrofulous manifestations. It fully\\nanswers Hahnemann s indications for the use of Calc.\\ncarb. in scrofulous affections, especially when occurring\\nin children, namely, the overgrowth, the large head and\\nopen fontanels, the distended abdomen, the tendency to\\nswelling of lymphatic glands, the tendency to brain\\naffections, to catarrhal discharges, abscesses, etc.\\nlodum. Emaciation, in spite of the necessity of eating\\nevery few hours; swelling and induration of glands, the\\nwhole of the lymphatic system being involved; swelling", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0279.jp2"}, "278": {"fulltext": "264 SKIN DISEASES.\\nof mesenteric glands; bronchocele; scrofulous women,\\nwith dwindling and falling away of the mammae.\\nKali bichr. Scrofulous ulcers and skin diseases; dis-\\ncharges from mucous membranes tough, stringy, sticking\\nto the parts; caries of the bones of the nose; strumous\\nophthalmia; pustular diseases of skin, secreting a watery\\nfluid when broken or drying up into a yellow tough mass;\\nfat, chubby children; fat, light- haired persons.\\nKali hydroiod. It distends all tissues by interstitial\\ninfiltration; enlarged glands; tophi; exostosis; swelling\\nof bones; necrosis; all worse at night; bronchial and\\nsubmaxillary glands swollen, ulcerating, atrophied;\\ngoitre; papules on face, back; small boils on face, head,\\nneck, back, and chest, leaving scars; pustules on cornea,\\nwithout photophobia, redness, or pain.\\nLithium carb. Skin rough as a grater, harsh, dry;\\ndry itching eruption like ringworms; milk crust; whole\\nbody, bones, joints, muscles, sore as if beaten.\\nLycopodium. Swelling and suppuration of glands;\\nherpes and ulcers; humid suppurating eruptions, full of\\ndeep rhagades, breeding lice, itching violently; inter-\\ntrigo; raw places, readily bleeding; boils which do not\\nmature, but remain blue; scalp covered with scabs;\\nchronic enlargement of tonsils.\\nLapis albus. Scrofulous affections, abscesses, and\\nsores; enlargement and induration of glands, especially\\ncervical; glandular tumors, where physiologically no\\nglands are usually found; goitre; cretinism.\\nMercurius. Glandular swellings, with or without sup-\\npuration; cachectic affections; exostosis, curvature,\\ncaries, and other affections of bones; eruptions and\\ncorrosive herpes with crusts; tinea capitis; crusts in the\\nface; suppuration, especially if too profuse; ulceration of\\ntonsils.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0280.jp2"}, "279": {"fulltext": "DIATHETIC DISEASES. 265\\nMercurius biniod. This is one of our best remedies.\\nIt is especially in the relief of those tardy engorgements\\nand ulcerations which follow the discharge of the soft-\\nened scrofulous matter. It may be given during the\\ngrowth or swelling of the gland with the hope of disper-\\nsion, as we cannot always surely know whether the en-\\nlargement is attributable to the presence of scrofulous\\nmatter or to simple congestion and engorgement.\\nNatrum carb. Swelling and induration of glands;\\nemaciation, with pale face, dilated pupils, dark urine;\\nskin dry, rough, and chapped; suppurating herpes, with\\nyellow rings; goitre; swollen cervical glands; humid\\nherpetic eruptions and ulcers on nose, lips, and around\\nmouth; burning fissures on lower lips.\\nOleum jec. ars. Only indicated inpatients of a slender\\nand lean figure, thin, transparent skin, with a frequent\\npulse, great excitability of the nervous system, and high\\nspecific gravity of the urine all signs of an accelerated\\nmetamorphosis.\\nPetroleum. Swelling and induration of glands; un-\\nhealthy skin; small wounds ulcerate and spread; polypi;\\nsalt rheum on arms and hands, red, raw, burning, moist,\\nor covered with thick crusts; herpes on knees and\\nankles.\\nPhytolacca. Swollen tonsils; indurated glands; glands\\nand bones inflamed and swollen.\\nPsorinum. Pale, sickly, delicate children, whose body\\nalways has a filthy smell, even after a bath; deeply pene-\\ntrating, ichorous ulcers; skin dirty, greasy-looking, with\\nyellow blotches here and there, at times itching; scratch-\\ning gives temporary relief; hair dry, lustreless, tangles\\neasily; pustules and boils on head; scalp looks dirty and\\nemits an offensive odor; wants to have the head covered\\ni8", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0281.jp2"}, "280": {"fulltext": "266 SKIN DISEASES.\\neven in hot weather; purulent offensive otorrhcea; sub-\\nmaxillary and lingual glands swollen, sore to touch.\\nRhus tox. Swelling of glands; herpes in the face and\\nother eruptions discharging pus or forming crusts; emaci-\\nation; hard and distended abdomen.\\nSarsaparilla. Great emaciation, skin shrivelled or lies\\nin folds; herpetic circular ulcers, forming no crusts, red\\ngranulated bases, white borders; deep burning rhagades;\\nmilk-crust; ophthalmia after checked tetters; marasmus\\nof childreji; neck emaciated,\\nSilicea. Swelling and suppuration of glands; exos-\\ntosis; curvature, and caries of bones; pale and bloated;\\ndisposition of skin to ulcerate; eczema, impetigo, herpes;\\ntendency to boils, which leave indurations; carbuncles;\\nmalignant pustule; blepharitis; otorrhoea; canine hunger,\\nwith nervous irritable persons; desires only cold things;\\nswelling and induration of cervical glands and parotitis;\\nimperfect ?i2itrUion, not from want of food, but from imper-\\nfect assimilatio7i.\\nSpongia. Swelling and induration of glands; skin\\nand muscles lax; light hair; fevers; yellow scabby erup-\\ntion; suppuration of external ear; insatiable appetite\\nand thirst.\\nSulphur. Scrofulous and rickety complaints; emacia-\\ntion of children, face has a very old look; dry flabby\\nskin; glandular swellings, indurating and suppurating;\\nulcers, with raised swollen edges, bleeding easily, dis-\\ncharging fetid pus, surrounded with pimples; humid of-\\nfensive eruptions, with thick pus, yellow crusts, itching,\\nbleeding, and burning; ophthalmia and blepharitis; puru-\\nlent offensive otorrhcea; painful eruptions around chin;\\nlips dry, rough, and cracked; curvature of spine from\\nsoftening of vertebrae; hangnails; burning of soles, wants", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0282.jp2"}, "281": {"fulltext": "", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0283.jp2"}, "282": {"fulltext": "im\\nSyphiloderma Pustulosum.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0284.jp2"}, "283": {"fulltext": "DIATHETIC DISEASES. 267\\nthem uncovered; children dislike being bathed; especially-\\nsuitable for lean stoop-shouldered persons.\\nTheridi07i. Scrofula, rachitis, caries, necrosis, when\\nother remedies fail to reach the root of the evil, and\\ndestroy cause; itching on scalp; itching behind ears,\\nshe would like to scratch them off; chronic catarrh of\\nnose, discharge offensive, thick yellow or yellowish-\\ngreen; phthisis florida, in beginning.\\nSyphilis.\\nSyphilis is a disease that involves, not only the skin,\\nbut every other organ and tissue of the body. Its\\ncutaneous relations, however, are those which chiefly\\nconcern us.\\nThe first visible lesion of syphilis usually appears in\\nfrom ten to twenty days after an infective intercourse, as\\na small papule or erosion, going on to ulceration, and\\nmost frequently situated on the genital organs. Extra-\\ngenital chancre, however, may be met with in a variety\\nof locations, more frequently, perhaps, about the mouth\\nthan elsewhere. This lesion is termed a chancre. In\\na short time a limited induration of the subjacent tissue\\noccurs, so that the chancre when taken between the\\nfingers appears to have a hardened base. This indura-\\ntion may be, and frequently is, absent in genital chan-\\ncres in women, and the lesion may be altogether over-\\nlooked. In the course of two or three weeks after the\\nappearance of the chancre certain of the lymphatic glands\\nbecome involved, and take on enlargement and hardness.\\nThe glands chiefly noticeable in this respect are the\\ninguinal, cubital, post-cervical, and post-auricular.\\nAbout this time, or a little later, we may expect a\\ngeneralized outbreak upon the skin.\\nThe various manifestations of syphilis on the skin, or", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0285.jp2"}, "284": {"fulltext": "268 SKIN DISEASES.\\nsyphilides, as they are commonly called, present different\\ntypes and degrees of severity, and involve the skin either\\nsuperjScially or deeply. We may, however, classify them\\nto a certain extent, and in doing so will find that they\\npartake of one or the other of the following characters,\\nnamely macular, papular, tubercular, pustular, squa-\\nmous, bullous, and gummatous, together with ulcera-\\ntion, occurring with, or following, any of the five types\\nlast mentioned.\\nThe appearance of the first cutaneous eruption ushers\\nin what is termed the secondary period of the disease.\\nAs a rule, the first eruption is macular, and consists\\nof small, rosy points or spots usually called syphilitic\\nroseola. These present little or no elevation, and disap-\\npear under pressure, showing that they are little more\\nthan points of congestion. They usually pass away\\nwithin a few weeks, with or without treatment. They\\nare chiefly met with on the trunk and extremities.\\nAnother and much rarer macular lesion is the pigmen-\\ntary syphilide, which appears as dark-colored spots on the\\nneck, and almost w^holly confined to j^oung females. After\\na time a portion of the pigmentary deposit fades away,\\nproducing a somewhat characteristic appearance some-\\nwhat resembling vitiligo.\\nAfter the macules of syphilis have disappeared, or\\neven before they are quite gone, a generalized eruption\\nof papules may appear. These are solid elevations, and\\nnot unfrequently present minute scales at their apices.\\nShould the patient be broken in health, a tendency to\\npustulation and ulceration may be developed; and we\\nmay have the papules becoming purulent at their sum-\\nmits, or we may have a frankly pustular eruption from\\nthe outset. As the disease progresses there is a tendency\\nto deeper involvement of the integument and larger size", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0286.jp2"}, "285": {"fulltext": "DIATHETIC DISEASES. 269\\nof the lesions, so the papules are not uncommonly fol-\\nlowed by tubercles, not perhaps as numerous as the\\npapules, but still freely distributed over the entire sur-\\nface. These not infrequently undergo ulceration and\\nbecome covered with greenish-black crust.\\nIn addition to the foregoing, we may have the appear-\\nance of reddish and not greatly elevated patches, covered\\nwith white scabs, constituting the so-called squamous\\nsyphilide. These various manifestations may occupy\\na year or more in their evolution, and embrace the\\nsecondary period of the disease. After the disappearance\\nof these various eruptions, there is not infrequently a de-\\ncided halt in the progress of the disease, and the patient\\nmay go on for a considerable period, for years even,\\nwithout a fresh outbreak. When it does come, however,\\nit ushers in what is known as the tertiary stage of the\\ndisease.\\nIn the tertiary period of syphilis the eruptions are\\nusually of a tubercular or ulcerative character, and, in-\\nstead of being generally and somewhat evenly distributed\\nover the surface, they are usually collected into groups;\\nfor instance, half a dozen or more tubercles may form a\\ngroup or patch, and there may be one or several such\\npatches. As a rule, the number of patches is limited.\\nThe individual lesions sometimes disappear b}^ absorption,\\nbut very frequently undergo ulceration, and in either\\ncase leave indelible scars. In this stage of syphilis we\\nmeet with the lesion known as the gumma. It consists\\nof a small tumor, which usually undergoes softening\\nthroughout its entire substance, and terminates by ulcera-\\ntion. This lesion is not confined to the skin, but niay in-\\nvolve almost any organ of the body.\\nConcomitants of Syphilis. The disease we are describ-\\ning does not vent its entire energy upon the skin, but", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0287.jp2"}, "286": {"fulltext": "270 SKIN DISEASES.\\nearly in its history it exhibits its presence on the mucous\\nmembranes by the development of rather large, flattish\\ntubercles in the mouth and about the genital organs and\\naround the anus. It is in females especially that the\\nmucous patch or condyloma reaches its highest develop-\\nment.\\nEarly in the disease, too, the hair may fall out, so that\\nan almost complete alopecia of the scalp may occur be-\\nfore it is checked by treatment. This early alopecia,\\nhowever, is not permanent, as the hair begins to grow\\nagain as soon as the patient is brought under the in-\\nfluence of proper constitutional treatment. During this\\nperiod, also, inflammation of the iris is a not infrequent\\ncomplication.\\nUlcerations, more or less extensive, of the soft palate\\nand tonsils, may supervene among the early or late\\nsymptoms of the disease.\\nIn the tertiary period painful swellings are met with\\nalong the course of the long bones, especially the tibia\\nand in the flat bones of the skull. These nodes, as they\\nare called, are due to an inflammatory deposit beneath\\nthe periosteum, which is usually accompanied with con-\\nsiderable pain, worse at night. The gummy deposit,\\nseparates the periosteum from the bone, and, by depriv-\\ning the bone-tissue of its proper nourishment, produces\\nnecrosis.\\nAn interesting case is reported of ulcerating gummata\\nof the scalp forty-four years after infection, as occurring\\nin a man aged 63, who contracted syphilis when between\\neighteen and twenty years of age. Typical syphilides\\nfollowed, relapsed a number of times and finally disap-\\npeared without treatment. When he was twenty-four\\nyears old (about five years after infection) he married.\\nHis wife miscarried once, but remained healthy, dying", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0288.jp2"}, "287": {"fulltext": "DIATHETIC DISEASES. 271\\nat sixty. His eldest son developed psoriasis palmaris\\nwhen seven yearsold and again when eighteen, which was\\ncaused by anti-syphilitic treatment; in other respects, as\\nwell as his younger sister, remained well. The patient\\nhimself was affected by herpes zoster in 1878. In 1886 a\\ngumma appeared on the left parietal bone, which\\nulcerated and exposed the bone and caused necrosis.\\nGradually the bone was cast off, and necrosis of the\\n\u00e2\u0080\u00a2diploe appeared. As, however, demarcation proceeded\\nslowly and symptoms of pressure on the brain set in,\\ntrephining was decided upon, which exposed a collection\\n\u00e2\u0080\u00a2of pus under the necrosed bone. Improvement set in on\\nanti-syphilitic remedies. Soon, however, an attack oc-\\ncurred during which he lost consciousness; then the\\nfunctions of the brain becam^e disturbed, intelligence\\ngradually waned, oedema of the extremities set in, new\\ngummata appeared on the scalp, and the patient died.\\nPost-mortem there were found thrombosis of the iliacs,\\ncaries and necrosis of the left parietal bone, thickening\\nof the meninges, beneath it, but no pathological changes\\nin the brain.\\nThe ulcerations of syphilis are somewhat peculiar, and,\\nonce seen, can hardly be mistaken afterward. The}^ are\\nusually round, and with clean-cut margins, as if punched\\nout, differing in this respect from the overhanging walls\\nof scrofulous ulcers, or the sloping margins of the simple\\nvariety.\\nLate in the disease, and among the tertiary group of\\nsymptoms, w^e meet with a peculiar deformity of the\\nphalanges, commonly known as dactylitis syphilitica^ the\\nappearance of which is so peculiar and characteristic that\\nit should not be mistaken for anything else. This lesion\\nis rare, however, and perhaps unknown to man}^ physi-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0289.jp2"}, "288": {"fulltext": "272 SKIN DISEASES.\\ncians, and the illustration best shows its characteristic\\nfeatures.\\nNecrosis of the nasal and palatal bones may occur late\\nin the disease.\\nSyphilis is an all-pervading disease, and may involve\\nthe viscera as well as the more superficial organs The\\nliver, kidneys, lungs, brain, spinal cord, etc., may be-\\ncome the seat of gummy tumors, which, according ta\\ntheir location and size, may do more or less damage^\\neven to the extinction of life.\\nDr. Marchiafava thus describes the lesions found by\\nhim in the kidney in two cases of hereditary syphilis r\\nThe organs were of normal size, but the cortical sub-\\nstance was of a grayish color, and dotted with minute\\nwhitish nodules, corresponding to the glomeruli. Under\\nthe microscope, the lesions w^ere seen to proceed from a\\ndiffuse arteritis of the glomerular and afferent vessels.\\nThe arteries were contracted, and finally obliterated, and\\nbecame converted into a hyaline mass The vascular\\nloops of the glomeruli were thus destroyed, as was also,,\\nat a later period, the epithelium of the convoluted\\ntubules which derives its nourishment from the afferent\\nvessels.\\nDr. Ingram has observed, in twelve cases of congenital\\nsyphilis, concentric enlargement of the wrists. This en-\\nlargement has more the appearance as if two fine silk\\nligatures had been tied around the wrist immediately\\nabove the joint, the strands being placed about half an\\ninch apart and tied tight enough to hide themselves in\\nthe flesh. To the touch they have all the dense hard\\nfeeling that callus does when thrown about a fracture.\\nEtiology. The original first cause of syphilis is un-\\nknown. We know, however, that at the present time it\\nis propagated from one to the other by contact. The", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0290.jp2"}, "289": {"fulltext": "DIATHETIC DISEASES. 273\\nblood and the secretions from early syphilitic lesions are\\nthe medium of contagion, and the contact of these with\\nan abrasion of the skin or with an even unabraded\\nmucous surface is sufficient to transfer the disease.\\nWhether a bacillus is an accidental or an essential feature\\nof the process may as yet be considered unsettled.\\nIn the vast majority of instances syphilis is contracted\\nduring sexual intercourse; occasionally, however, the\\nbuccal cavity is made to serve the ordinary purposes of\\nthe vagina, and the disease is transferred from or to the\\nmouth. There are, however, many innocent wslys of\\ncontracting the disease; for instance, using drinking-\\nglasses, cups, spoons, pipes, etc., which have been\\npreviously used by a syphlitic, etc.\\nSternback reports a severe attack of syphilis in an\\narmy surgeon, acquired in a peculiar manner. While\\nattending a case of blenorrhoea of the eye he was at-\\ntacked by the same disease and had leeches applied ta\\nthe temple to combat the acute inflammatory sj^mptoms.\\nOne of the leech-bites became the site of the initial\\nsclerosis of syphilis, to be followed later by the usual\\nsecondary manisfestations. After bix months iritis de-\\nveloped, and shortly afterwards svmptoms of severe\\ncerebral syphilis. How the leech-bite was infected by\\nthe syphilitic virus is unexplainable.\\nIt is altogether probable, however, that in tertiary\\nS3^philis, especially if a considerable number of years\\nhave elapsed since the first contraction of the disease^\\nneither the blood nor secretions are contagious.\\nSyphilis may also result from hereditary transmission.\\nShould the father alone be syphilitic, the offspring\\nusually escapes; but if the mother be affected, the child\\nwill almost certainly suffer. In the majority of cases,\\nwhen infection of the mother occurred but a short time", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0291.jp2"}, "290": {"fulltext": "274 SKIN DISEASES.\\nbefore conception, the foetus will die in utero, and be ex-\\npelled before time. A second or third abortion may suc-\\nceed, but ultimately the mother may give birth to a liv-\\ning child, which, however, may soon succumb to the\\ndisease. As the period of time from the date of infection\\nbecomes greater, the less does the poison affect the off-\\nspring, until a time arrives when the offspring of parents\\nwho have both been previously syphilitic may be born\\nwithout apparent taint and grow up healthy children,\\nreaching adult life without mishap. The symptoms of\\nhereditary syphilis may be manifested shortly after birth\\nby erythematous blotches, bullae, coryza, and marasmus,\\nor may be deferred until about the period of puberty. In\\nthis event, interstitial keratitis, or various ulcerations,\\nmay be the chief features presented by the disease.\\nAn interesting case was reported in 1889 of a child\\nfour months of age, whose parents had acquired syphilis\\nfourteen years before. Though anti-syphilitic treatment\\nhad been insufficient, their syphilis ran a very mild\\ncourse, and they experienced very few syphilitic\\nmanifestations. Their first child, born three years after\\ntheir marriage, died from meningitis at the age of seven\\nyears; the second had a syphilitic eruption at the end of\\nthe second month; the third succumbed to cholera\\ninfantum; the fourth died in its first month, of broncho-\\npneumonia; the fifth had an interstitial keratitis three\\ndays after its birth. This, the sixth child, showed an\\nextensively distributed papular syphilide. At the time\\nof conception, the parents did not show any syphilitic\\nsymptoms. Other cases have been met with of syphilitic\\ninfection from parents to children even twenty years after\\nthe primary infection in the parent.\\nDr. Mackenzie gives the history of a case of congenital\\nsyphilis in which ulceration of the throat was a marked", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0292.jp2"}, "291": {"fulltext": "DIATHETIC DISEASES. 275\\nphenomenon. This progressed in spite of the remedies\\nemployed to check it, until the child was taken with a\\nmild form of scarlatina, when the ulceration at once\\nbegan to heal. When the stage of desquamation was\\nreached, cicatrization was complete. In his remarks on\\nthe case, which is but typical of a class, he says that\\nfrequently specific ulcerations in children stubbornly\\nrefuse to cicatrize. Under such circumstances when\\nremedial measures are apparently of little or no avail,\\nthej^ sometimes cicatrize, as if by magic, on the accession\\nof an acute disease. While congenital syphilis affords no\\nabsolute protection against certain acute infectious\\ndiseases, its existence in the individual seems often,\\nother things being equal, to mitigate their severity and\\nexert a favorable influence on their course. Certain\\nacute diseases, accompanied by an exanthem, favor the\\ndissipation, at least temporarily, of the throat and other\\nmanifestations of syphilis. While at no period of the\\ndisease is the child exempt from these affections, they are\\nmore liable to be contracted during the period of latency,\\nthat curious interval of apparent health in congenital\\nsyphilis, which Cazenave has poetically called the sleep\\nof the virus. These remarks are limited to scarlet fever,\\nmeasles and chicken-pox, but they could doubtless be ex-\\ntended to embrace others of the exanthemata; or, in\\nother words, to those diseases which present a certain\\nanalogical resemblance to syphilis. They do not apply,\\nfor obvious reasons, in the case of excessive virulence of\\nthe syphitilic cachexia or malignant epidemic influence of\\nthe inter-current disease. Of special interest is the effect\\nproduced by acute febrile disease upon the throat lesions\\nof congenital syphilis. Chronic inflammatory conditions\\nand ulceration of the larynx, pharynx, and nasal passages\\nare often influenced in a remarkable manner through the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0293.jp2"}, "292": {"fulltext": "276 SKIN DISEAvSES.\\npresence in the individual of an inter-current febrile\\naffection. This is, moreover, eminently true of those\\nacute blood diseases with special tendency to local mani-\\nfestations in the throat, such as scarlet fever, measles,\\ndiphtheria, etc. According to personal experience,\\nscarlatina and measles exert, as a rule, a favorable\\ninfluence on the course of the throat affection, their sup-\\nervention being of itself sufficient to cause its complete\\ndisappearance. The poisons of the two diseases, in their\\ncirculation in these regions, appear to be mutally destruc-\\ntive and the throat escapes by virtue of such reciprocal\\nantagonism. The cure here may be permanent, or\\nrelapses of the inflammatory or ulcerative process may\\nfollow the removal of the antagonistic influence of the\\ninter-current disease. These remarks do not apply to\\ndiphtheria. When this affection supervenes during the\\nexistence of lesions in the throat, the patients rapidly\\nsuccumb to the disease. The existence of syphilis in the\\nchild apparently increases the tendency to membranous\\nformation; indeed in some instances, apart from the\\npresence of the diphtheritic process, there seems to be a\\nspecial tendency to fibrinous formation in the nose and\\nretronasal space.\\nDiagnosis. To commence at the beginning, the\\ninitial lesion or chancre is to be distinguished from the\\nsoft venereal ulcer (chancroid) by its long (two or three\\nweeks) incubation, its plastic character, its indurated\\nbase and its slight tendency to secretion, and the single\\nor very limited number of lesions.\\nThe soft chancre, on the other hand, appears a few\\ndays after intercourse, presents a necrobiotic or ulcerative\\ncharacter, is not accompanied with the hard, infiltrated\\nbase, and may exist to the number of a dozen or more on\\nthe same patient.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0294.jp2"}, "293": {"fulltext": "DIATHETIC DISEASES. 277\\nIn syphilis the initial lesion is usually accompanied\\nwith a number of moderately enlarged hard inguinal\\nglands, while the chancroid may be accompanied with\\none or more very much enlarged and greatly inflamed\\nand painful glands, which not infrequently go on to sup-\\npuration. In addition, we have in syphilis the other\\nglandular indurations already noticed.\\nThere are very few cases in which the earlier syphilitic\\neruptions cause any great trouble in diagnosis. Taking\\nthe history into consideration, neither the macular nor\\ntubercular eruptions are liable to be mistaken for anything\\nelse. The papular eruption of lichen planus, however,\\nmay sometimes closel}^ resemble a syphilide. The\\nsquamous syphilide may in like manner be mistaken for\\nordinary psoriasis. In most cases, however, we will\\nlearn (if the case is psoriasis) that the patient has had\\nprevious attacks of the same form of eruptions, while in\\nsyphilis the previous eruptions will have been of a\\ndifferent type.\\nIn late syphilis a patch of tubercular lesions may be\\nmistaken for lupus. The history, however, again helps\\nus, for a lupus patch will have been many months, per-\\nhaps years, in forming, while the syphilitic lesions\\nmight have reached the same development in a few weeks.\\nThe real difficulties that surround the diagnosis of\\nsyphilitic eruption, however, do not so often occur in\\nsimple, uncomplicated cases as in those where a syphilide\\ncoexists with some other eruptive affection. Thus we\\nhave seen at the same time a syphilide and an eczema, a\\nsyphilide and a psoriasis, a syphilide and leprosy, a\\nsyphilide and scabies, etc., and each of these separate\\neruptions pursued its own course apparently unmodified\\nby the presence of the other.\\nTreatment. In former times it was a question", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0295.jp2"}, "294": {"fulltext": "278 SKIN DISEASES.\\nwhether the disease or its treatment caused the greater\\ninconvenience or suffering to the patient.\\nThe treatment of a given case of syphilis will, of course,\\ndepend on the stage of the disease and the condition of\\nthe patient; but if the case comes at the beginning that\\nis, during the period of the chancre the early or sub-\\nsequent treatment ma}^ be pretty clearly mapped out in\\nadvance.\\nWhen a patient presents a venereal sore, the question\\nof diagnosis must be settled at the outset, and settled in\\nthe most definite manner prior to the institution of a\\ndirect anti-syphilitic treatment. If the diagnosis cannot\\nbe made with absolute certainty, defer the specific treat-\\nment until the secondary eruption appears. Granting,\\nhowever, that the diagnosis of syphilitic chancre has\\nbeen made, let us first consider what shall not be\\ndone. Some have fancied that they could produce an\\nabortion of the syphilis by early destruction of the\\ninitial lesions; and, to this end, the chancre was ex-\\ncised or cauterized. Experience shows that this hope\\ncan not be reahzed. Neither excision nor cauterization,\\nno matter bow early they are practiced, will prevent the\\nfurther development of the disease, while they do add\\nvery materially to the discomfort of the patient. What,\\nthen, shall be done? There is but one drug, so far as\\nknown, that is positively and directly curative in this dis-\\nease namely, mercury; and the sooner the patient is\\nbrought under its influence the better. The two schools\\nemploy it in different ways. We will first look at the\\nmethod employed by the old school, and afterwards the\\nmethod as employed by the new school. An eminent\\nwriter of the old school, in speaking of the treatment of\\nsyphilis, uses the following language:\\nMy own practice is to use this agent (mercury) both", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0296.jp2"}, "295": {"fulltext": "DIATHETIC DISEASES. 279\\ninternally and externally, believing as I do that the drug\\nacts by virtue of its particles being brought into direct\\ncontact with the lesions, externally by means of lotions,\\nsalves, or other applications, internally through the\\nmedium of the blood and circulation. To the chancre,\\nthen, we may make a mercurial application, and the old\\nblack wash answers admirably, except that it should con-\\ntain about four times as much calomel as the officinal\\npreparation allows. This should be applied two or three\\ntimes daily. At the same time mercury should be given\\ninternally. Before commencing treatment, however, it\\nis m}^ custom to have a distinct understanding with\\nthe patient on two points \u00e2\u0080\u0094namely, the use of tobacco\\nand alcohol. If the patient is in a fair state of general\\nhealth, and will consent to the absolute abandonment of\\nthese two substances, it will not be going too far to promise\\nhim a very easy time in connection with his disease, pro-\\nvided, of course, that he pursues the direct medical treat-\\nment with persistence and regularity.\\nThe choice of the mercurial preparation to be given\\nis not a matter of indifference. During the early period\\nof the disease say, for the first six months or a year\\nmetallic mercury or the protosalts are to be preferred to\\npersalts. Later the persalts seem to be more useful.\\nMetallic mercury, either in the form of blue-pill or in\\ntrituration, may be given, so that the patient receives a\\nhalf-grain of the metal three or four times a day. The\\ndose, however, should be pushed until the patient is on\\nthe verge of salivation, but never in the slightest degree\\nbeyond this. When this point is reached, we have a\\nguide to the patient s tolerance of the drug, and omission\\nof treatment for a day or two is recommended. It should\\nthen be resumed in somewhat smaller doses, and, with\\nthe gums and salivary glands for a guide and warning,", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0297.jp2"}, "296": {"fulltext": "280 SKIN DISEASES.\\nthe drug should be administered with scrupulous regu-\\nlarity for weeks and months. In former times salivation\\nwas considered the sheet-anchor of safety. Now, we\\nknow that it is a danger to be avoided. Under this\\ntreatment many a patient will go on for a j^ear or more\\nwith only the slightest inconveniences from his disease.\\nInstead of metallic mercury, the protoiodide may be em-\\nployed; and this, indeed, is the favorite with most vene-\\nreal surgeons. After this period, if all has gone well,\\nI prefer to give either the bichloride or the biniodide.\\nSome cases, however, will not go well, and, instead of\\nsuperficial and not very serious eruptions, we find a\\ntendency to ulceration developing quite early. This\\nopens the gate for another drug namely, the iodide of\\npotassium. There are physicians who appear to be afraid\\nof mercury, and who, believing the iodide to be compara-\\ntively a benign and innocent drug, give it in even the\\nearliest stages of the disease. Personally I regard the\\nearl}^ administration of this drug as harmful. The iodide\\nof potassium, in the writer s judgment, does not exert the\\nslightest curative influence on the disease itself, or tend\\nin the slightest degree to eradicate it from the system.\\nIt does, however, possess a wonderful power over certain\\nmanifestations of the disease. In syphilitic ulcerations,\\nin gummatous lesions, and in periostitis, the effects of\\nthe iodide are not only positive but marvelous. Pe?\\ncontra^ in early superficial lesions and in late necrotic af-\\nfections of the bones, it is not only useless but harmful.\\nIn syphilis we have two types of ulceration. In one the\\nprocess is sluggish, and in the other active and rapid in\\nits destructive effects. In both of these the iodide should\\nbe employed. In the former it should be given in small\\ndoses \u00e2\u0080\u0094say, five to ten grains three times a day\u00e2\u0080\u0094 and com-\\nbined with small doses of either the bichloride or binio-\\nii", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0298.jp2"}, "297": {"fulltext": "DIATHETIC DISEASES. 281\\ndide; while in the rapidly destructive forms of ulceration\\nthe mercury should be omitted, and the iodide given in\\nfull and increasing doses.\\nAs soon, however, as the particular lesions for which\\nthe iodide is given are brought under subjection, the\\ndrug should be given in diminished doses and soon dis-\\ncontinued, and mercury in small doses substituted for it.\\nIn the sluggish ulcerations of cutaneous syphilis\\nthere is no question as to the benefit to be derived from\\nlocal mercurial applications, and a favorite with the\\nwriter is fifteen grains of the protoiodide to an ounce of\\nsimple ointment.\\nInstead of administering mercury by the mouth, it\\nmay be used in the form of blue ointment rubbed into the\\ngroin or axilla. Or it may be given in hypodermic injec-\\ntion, employing either a soluble or an insoluble prepara-\\ntion. There are, doubtless, occasional cases in which\\nthese methods may be preferred; but as habitual or\\nroutine methods of treatment they are mentioned only to\\nbe condemned.\\nThere remains one drug, however, that is useful in\\ncertain syphilitic conditions, but of which very little\\nmention is made in modern text-books. I allude to gold.\\nIn necrosis of the bones, especially the nasal and pala-\\ntine, gold unquestionably hastens the separation of the\\nsequestrum by promptly determining the line of demark-\\nation between the healthy and the diseased tissues. A\\ngrain of the chloride of gold and sodium may be dis-\\nsolved in an ounce of water, and five to ten drops be\\ngiven once or twice a day. No advantage, we believe,\\nwill be derived from increasing this dose. It should be\\ncontinued for a short time after the separation and re-\\nI moval of the bone, as it seems to decidedly promote the\\nI healing process.\\n19", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0299.jp2"}, "298": {"fulltext": "282 SKIN DISEASES.\\nIn contrast with this heroic treatment comes the recom-\\nmendation of Hahnemann to use Mercurius vivus in the\\n30X potency, one dose of which will usually be suflScient\\nto establish a cure.\\nLater, we will give the indications for the homoeo-\\npathic remedies indicated in the different forms of\\nsyphilis.\\nJust here I wish to call attention to the mechanical\\ntreatment of the syphilitic affection of the tongue and\\nmouth known as keratosis or ichthyosis linguae, or as\\nleukoplakia specifica, which is due to unequal develop-\\nment of epithelium over different papillae, and which is\\nby no means a very easy affection to treat successfully,\\ncaustic, astringent, and disinfecting applications hav-\\ning but little effect upon it; according to Dr. Horwitz, it\\nis best managed by mechanical scraping. He uses a\\nsharp spoon, with which he removes the thickened\\nepithelium; in order to accomplish this, several sittings\\nmay be required. He scrapes away the indurated tissue\\nuntil the surface presents the appearance of a multitude\\nof minute-bleeding points, showing that the vascular\\nloops in the papillae of the dermis have been reached,\\nlodo- glycerine, glycerine of borax or a ten per cent,\\nsolution of sulphate of copper is applied to the raw sur-\\nface. The pain is usually not severe, but in the case of\\nsensitive persons cocaine can be used.\\nIndications for the homoeopathic remedies useful in\\nsyphilitic affections:\\nArsenicum. Inflammation and swelling of genitals;\\nphagedenic and gangrenous chancres; copper- colored\\neruptions on genitals; burning pimples or pustular erup-\\ntions on skin.\\nAsafoetida. Tertiary syphilis, especially after abuse of\\nmercury; ulcers, particularly when affecting the bones,", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0300.jp2"}, "299": {"fulltext": "DIATHETIC DISEASES. 2S3\\ndischarging ichorous, fetid, thin pus; syphilitic caries\\nand necrosis, with fetid and bloody suppuration: ulcers\\nvery st sitive to touch: rs:re~e nocturnal pains.\\nSecondary syr 5 low-spirited; bones of\\n5^_-. _:_:nful when lyinr in zztm: exostosis on head;\\nA.r: sodii S; ^^^i.is a::er azuse :f mer-\\nc;:: :r ^htn, during st: -iir; :r .tr: ary stages :he\\nbcnes :iie nose are ize::ei ;r :J:e :hroat is ulcer-\\nated.\\nBadiaga. ^Syphilitic bubo, as hard as a stone, uneven,\\nragged at night violent lancinations as if with red hot\\n\u00c2\u00a3!i T r^i.^- -11 _i osis erysir-c-ir _ .i:r z s..mins; pamiu. eru-^-\\nBc juifolium. ^Inve:tra:e cases 0: :er:: ry\\nsyphilis.\\nCalcarea fluar. Chancres nari ml incnra .ef.\\nCalcarea sulpk. In en:; c:n:r;l sn^rnra.in.\\nChronic suppurating s t 1 s\\nCar bo an. ^Indurarei. ciit; -:n lancinating or cut-\\nting pains; chancre n s l syrhilis\\nCarbo veg, Syrli: trs :n lii^n :ri- :e-\\ncome irritable from :a ::-i::nrn: niir^n^ sires\\nsharp, raggei nnierminei i ~:iir^e chin ache chen-\\nsive; ulcer ranee ene he he tre freely ~hen", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0301.jp2"}, "300": {"fulltext": "284 SKIN DISEASES.\\ntouched; vesicles or blisters on prepuce; burning of labia;\\nburning eruptions on skin.\\nCinnaharis. Swelling of penis; redness and swelling\\nof prepuce, with painful itching; violent itching of\\ncorona glandis, with profuse secretion of pus; small\\nshining red points on the glans; blenorrhoea of glans;\\nsycotic excrescences; violent erections in the evening;\\nsmall ulcer on roof of mouth, on the right side of tip\\nof tongue, and on tip.\\nCoral, rubr. Chancre and gonorrhoea of glans.\\nCorydalis. Syphilitic nodes on skull; ulceration of\\nfauces; profuse morbid secretion of mucus; tongue\\ncoated, with fetid breath.\\nFerriim phos. Bubo with heat, throbbing or tender-\\nness.\\nHecla lava. Destructive ulceration of the nasal bones.\\nHepar. Mercurius-sj philitic diseases of gums; pains\\nin bones; chancres not painful, but disposed to bleed\\nreadily; margins of ulcers elevated and spongy looking,\\nwithout granulations in their centre; buboes after mer-\\ncurial treatment; phimosis, with discharge of pus, accom-\\npanied by throbbing; itching of penis, glans, and\\nfraenum; ulcers like chancres on prepuce; humid sore-\\nness on genitals, scrotum, and folds between thigh and\\nscrotum; humid, suppurating herpes praeputialis.\\nHydrastis. Ozsena, with ulceration, bloody or mixed\\npurulent discharge; mercurial salivation.\\nKali bichr. Syphilitic affections of mouth and fauces;\\nbone pains, with stitches as if from sharp needles; period-\\nical wandering pains all over the body; pustular syphilo-\\nderma; indurated chancre.\\nKali hydroiodicum. Secondary and tertiary syphilis;\\nabuse of mercury.\\nKali mur. Soft chancre, 3x tr. internally, and also", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0302.jp2"}, "301": {"fulltext": "DIATHETIC DISEASES. 285\\nexternally as a lotion; chronic stage of syphilis. In\\nbubo for the soft swelling.\\nKali phos. Phagedenic chancre and bubo.\\nKali sulph. Syphilis, with yellow, slimy coating;\\ntongue coated yellow; aggravation in the evening.\\nChronic syphilis.\\nLachesis. Phagedejiic chancre; gangrene of glans and\\nmons veneris; ulcers in throat and inflamed tonsils;\\ncaries of tibia; flat ulcers on lower extremities, with blue\\nand purple areola.\\nLycopodiu7n. Chancres with raised edges; indolent\\nchancres, with thick, rounded, prominent margins, granu-\\nlations flabby or absent; eruptions on glans; condy-\\nlomata; syphilitic ulcers in mouth.\\nMercurius corros. Excessive pain, swelling, and inflam-\\nmation; regular indurated Hunterian chancre with lar-\\ndaceous bottom; swelling and redness of nose, ozaena;\\nmargins of soft chancre dark-red, painful, and easily\\nbleeding; neighboring parts oedematous, hot, and painful;\\nchancres on inner surface of prseputium or corona glandis;\\nchancres with ichor adhering to the bottom of ulcer so\\nfirmly that it cannot be removed by washing; ulcers with\\nthin pus, leaving stains upon the linen, as from melted\\ntallow; phagedenic ulcers in mouth, gums, and throat,\\nwith fetid breath; tonsils swollen and covered wnth ulcers;\\nbubo and swelling of glands generally.\\nMercur. iodat. rubr. Hujiterian hard chancre; threat-\\nened gangrene of glans in paraphimosis; soreness of bones\\nof face; sharp shooting stitches in the end of penis\\nthrough the glans; old buboes, discharging for years.\\nMercur. vivus. Red chancre on prepuce; spreading\\nand deeply penetrating ulcer on glans and prepuce; pale-\\nred vesicles, forming small ulcers after breaking, on\\nglans and prepuce; painful bleeding chancres, with yel-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0303.jp2"}, "302": {"fulltext": "286 SKIN DISEASES.\\nlowish, fetid discharge; small chancres, with a cheesy\\nbottom and inverted red edges; ulcers of glans and pre-\\npuce, with cheesy, lardaceous bottom and hard edges.\\nMezereum. Syphilitic periostitis; constant headache\\nfrom tophi of skull; pains through whole body, with\\nnightly pains in the bones, brought on by syphilis,\\nmercury, or both combined; bones inflamed, swollen,\\nespecially shafts of cylindrical bones; fainting sort of\\nvertigo; weary of life.\\nNatrum mur. Chronic syphilis, serous exudations, etc.\\nNatrum sulph. Condylomata of anus, syphilitic in\\norigin, externally and internally.\\nNux vom. Chancroid; shallow and fiat-bottomed ulcer-\\nation, showing a disposition to spread irregularly and\\nindefinitely, exuding a thin, serous discharge.\\nNitric acid. Phagede^iic chancres; ulcers in urethra,\\nwith purulent or bloody mucous discharge; ulcers bleed\\nwhen touched, with exuberant, but pale and flabby\\ngranulations, irregular edges; moist condylomata, like\\ncauliflower, or on thin pedicles; ulcers in vagina, looking\\nas if covered with yellow pus, with burning pain or itch-\\ning; copper-colored spots on anus; syphilitic ulcers in\\nmouth; syphilitic epilepsy and melancholia.\\nPhosphoric acid. Chancres with raised edges; chancres\\nlike an indolent ulcer, edges thick, rounded, and promi-\\nnent; granulations pale and flabby, or absent; corroding,\\nitching herpes praeputialis; blisters and condylomata on\\nglans; sycotic excrescences, chronic, with heat, burning\\nand soreness, when sitting or walking; figwarts, compli-\\ncated with chancre; painless swelling of glans; interstitial\\nostitis of mercurio-syphilitic origin, with nocturnal pains,\\nas if bones were scraped with a knife.\\nPhytolacca. Secondary syphilis; ulcers in throat and\\ngenitals; syphilitic rheumatism and syphilitic eruptions;", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0304.jp2"}, "303": {"fulltext": "DIATHETIC DISEASES. 287\\npains shift; joints swollen, red; periostitis; pains in\\nmiddle of long bones, or attachment of muscles, worse at\\nnight, and in damp weather; glans inflamed, swollen;\\nulcers with appearance as if punched out, lardaceous\\nbottom; weakness and prostration, but no paralytic symp-\\ntoms.\\nSepia. hidolent chancre; burning itching, humid, or\\nscurfy herpes praeputialis; chappy herpes, with a circular\\ndesquamation of skin; eruptions on glans and labia; itch-\\ning and dr}^ eruptions on genitals; chancres on glans and\\nprepuce.\\nSilicea. Chancres with raised edges; inflamed, painful,\\nirritable chancres, with discolored, thin, and bloody dis-\\ncharge, granulations indistinct or absent; painful erup-\\ntions on mons veneris; itching, moist or dry eruptions of\\nred pimples or spots on genitals; chronic syphilis with\\nsuppurations or indurations; ulcerated cutaneous affec-\\ntions where mercury has been given to excess, nodes in\\ntertiary syphilis; caries and necrosis with discharge of\\noffensive pus.\\nStaphisagria. Soft, humid excrescences on and behind\\ncorona glandis; dry, pediculated fig- warts; excrescences\\nand nodosities of gums; female sexual organs painfully\\nsensitive, especially when sitting; mercurialism.\\nStillingia. Secondary syphilis extreme torture from\\nbone-pains; nodes on head and legs.\\nSulphur. Inflammation and swelling of sexual organs,\\nwith deep rhagades; burning and redness of prepuce;\\ndeep suppurating ulcer on glans and prepuce, with puffed\\nedges; phimosis, with discharge of fetid pus; glandular\\nswellings, indurated or suppurating.\\nThuja. Chancres, with pain as from a splinter stick-\\ning; sycotic moist excrescences on prepuce and glans;\\nmoist mucous tubercles; itching ulcers with unclean\\nbottoms, or whitish chancres with hard edges.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0305.jp2"}, "304": {"fulltext": "288 SKIN DISEASES.\\nCondylomata, Sycosis, Fig- warts.\\nThese excrescences are a morbid growth of the skin and\\nmucous membrane, or, better defined, of the subcutaneous\\nand submucous cellular tissue. They are of different ex-\\nternal appearance, according to their coating. When\\nthey are covered by the epidermis they appear dry, hard,\\nhorny, like common warts; when covered with thin\\nepithelium, or when they are entirely bare and excoriated,\\nthey appear soft, moist and secrete more or less of a\\nslimy, acrid, badly-smelling fluid. These latter are the\\ngeyiuine syphilitic condylomata or tubercula mucosa.\\nTheir forms are likewise various; some are flat, upon a\\nbroad basis; others are conical, growing on a pedicle; others\\nappear like a cock s comb. The flat fig- warts are chiefl}\\nfound around the anus, between the glutens muscles; on\\nthe perineum, scrotum, external skin of the penis, glans\\npenis, and on the external surface of the labia in women;\\nwhilst the conical and pediculated are usually found in the\\nentrance of the vagina, on the clitoris and even far back\\nin the vagina, and on the neck of the womb; in males on\\nthe interior surface of the prepuce; also between the\\nnates. They sometimes grow so luxuriantly that the\\nwhole vagina and interior surface of the prepuce is\\ncovered by them. A third kind is quite small, in the\\nshape of pin-heads, which are generally found around the\\ncorona in men, and on the interior surfaces of the labia in\\nwomen. In secondary syphilis they appear also in other\\nlocalities, especially on the tongue, corners of the mouth,\\nchin, face, forehead, eyelids, iris, scalp, meatus auditorius,\\naxillae, nipples, and between the toes. Soon after the\\noutbreak of this pest in the middle ages we read of condy-\\nlomatous excrescences in the face, which were of a finger s", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0306.jp2"}, "305": {"fulltext": "CONDYLOMATA. 289\\nlength, and which caused, for their bearers, more ridicule\\nthan compassion.\\nTreatment. Keep the parts clean and dry. If the\\nexcrescences are troublesome, excise them with the knife\\nand afterwards appl}^ a mercuric bichloride lotion, strength\\none to two grains to the ounce of water. The principal\\ninternal remedy is Thuja.\\nTherapeutic Hints. For the mucous tubercles the\\nmain remedies are: Cinnba., AHtr. ac, Thuja.\\nFig-warts, when complicated with gonorrhoea^ require\\nThuja, Cinnba., Nitr. ac, Sulph., Lycopodium.\\nWhen complicated with chancre, Cinnab., Nitr. ac.^\\nPhos. ac, Staph., Thuja.\\nWhen jlat, Magnes Nitr. ac.\\nWhen exuberant, like cauliflower or mulberries, Thuja,\\nStaph.\\nWhen fan-shaped, Cinnab.\\nWhen growing on pedicles, Lycopod. Nitr. ac.\\nWhen conical, Merc, solub.\\nWhen dry, Thuja, Staph., Merc, solub., Nitr. ac,\\nLycopod:\\nWhen moist, S2ipp2irating Nitr. ac, Thuja, Sulph.,\\nhuphras^\\nWhen soft, spongy, Sulphur.\\nWhen intolerably bunmig and itclmig, Sabina.\\nCinnabar. Fan-shaped fig- warts accompanied by tetter.\\nIn scrofulous infants and children.\\nEuphrasia. Fig-warts at the anus.\\nMercur. cor. Dry fig- warts, or else fig- warts accom-\\npanied by acrid discharges. Soft, flat condylomata.\\nMercurius nit. Filiform fig- warts.\\nMercurius prcBcip. ruber. Fissured condylomata.\\nMercur. sol. Conical fig-warts; small, itching pimples\\nwhich ulcerate and become incrusted; mild types.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0307.jp2"}, "306": {"fulltext": "290 SKIN DISEASES.\\nNitr. ac. Pediculated and pen-shaped, moist condy-\\nlomata; fig- warts on the glans.\\nSabina. Condylomata attended with itching and burn-\\ning.\\nSarsaparilla. Flat fig -warts.\\nStaphisagria. Cock s-comb-shaped fig-warts.\\nSulphur. Soft, spongy fig- warts.\\nThuja. Cauliflower excrescences. Condylomata on\\nthe penis, vulva and about the anus; broad, flat condy-\\nlomata; after iritis, tubercles or warty excrescences on\\nthe iris.\\nLeprosy.\\nlyCprosy is a disease that has been known from the\\nearliest ages, and has prevailed among all races and in\\nall climes.\\nAt present it is most wide-spread in countries lying\\nboth to the north and to the south of the temperate zone\\nand among the less enlightened people of the earth.\\nTo a limited extent, however, it is met with in Europe\\nand the United States.\\nThe disease manifests itself in three chief forms or\\nphases of development, known as the macular, tuber-\\ncular, anaesthetic. The first is characterized by the de-\\nvelopment of brownish discolorations of varying size and\\nnumber. These, after an existence of months or years,\\nmay lose their heightened color and become pigmentless,\\nand the cutaneous nerves in the affected parts lose their\\nsensibility.\\nThe tubercular form is characterized by the develop-\\nment of tubercles upon various parts of the body.\\nThese exhibit a slightly heightened color, becoming\\nlater somewhat copper-colored, and affect a preference for\\nthe face, especially just above the eyebrows and upon", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0308.jp2"}, "307": {"fulltext": "LEPROSY. 291\\nthe nose and ears, but may, and usually do, appear upon\\nthe extremities.\\nIn the anaesthetic form, bullae, usually solitary, de-\\nvelop upon various parts of the integument. They per-\\nsist for a short time only and leave behind them discolora-\\ntions, which in time may become whitened and\\nanaesthetic. In this form of the disease there is grave\\nimplication of the principal nerve-trunks of the ex-\\ntremities. This is notably the case with the ulnar nerve,\\nwhich in cases moderately advanced may be readily per-\\nceived as a thickened cord just above the head of the bone\\nwhose name it bears. In this form, especially, pain in\\nthe extremities is a more or less prominent feature.\\nConnected with the development of the disease, anaes-\\nthesia of the integument, chiefly of the extremities, be-\\ncomes a prominent feature. The gradual destruction of\\nthe ulnar nerve leads to impairment of its functions and\\natrophy of the more distant parts to which it is distributed.\\nThis atrophic action is most distinctly manifested in the\\nfingers and toes. Fissures occur in the integument, and\\nabsorption of the phalanges takes place and leads to loss\\nof these parts. The separation usually occurs at some\\npoint between the joints rather than at the joints them-\\nselves. A continuance of the morbid action may result\\nin loss of all the phalanges, and even of some of the\\nmetacarpal and metatarsal bones.\\nLeprosy is essentially a chronic disease. Before the\\nappearance of cutaneous or nervous lesions there usually\\nexists a prodromal period of several years duration, with-\\nout definite symptoms other than impairment of the gen-\\neral vigor. During this period it is hardly possible to\\nmake a diagnosis of the impending trouble. After the\\ndisease, however, is fully developed, ten, fifteen, or\\ntwenty years may pass before the fatal termination.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0309.jp2"}, "308": {"fulltext": "292 SKIN DISEASES.\\nAfter careful investigation Drs. Fox and Graham arrive\\nat the following conclusions concerning leprosy:\\n1. Leprosy is a constitutional disease, and, in certain\\ncases, appears to be hereditary.\\n2. It is undoubtedly contagious by inoculation.\\n3. There is no reason for believing that it is transmitted\\nin any other way.\\n4. Under certain conditions a person may have leprosy\\nand run no risk of transmitting the disease.\\n5. It is not so liable to be transmitted to others as is\\nsyphilis in its early stages. There is no relation between\\nthe two diseases.\\n6. Leprosy is usually a fatal disease its average dura-\\ntion being from ten to fifteen years.\\n7. In rare instances there is a tendency to recover after\\nthe disease has existed many years.\\n8. There is no valid reason for pronouncing the disease\\nincurable.\\n9. Judicious treatment improves the condition of the\\npatient and often causes a temporary disappearance of the\\nsymptoms.\\n10. There is a ground for the hope that an improved\\nmethod of treatment will in time effect the cure of leprosy,\\nor at least that it will arrest and control the disease.\\nDr. Perry has arrived at the following conclusions,\\nafter years of study and residence in India:\\n1. Leprosy is an endemic disease, malignant, constitu-\\ntional, progressive; evidenced by tubercular degeneration\\nof the tissues, and accompanied by anaesthesia, ulcera-\\ntion, and gangrene; terminates in death from exhaustion,\\npyaemia, or rupture of the arteries.\\n2. That it is due to a specific bacillus he considers an\\nunsettled point.\\n3. That leprosy is contagious only by inoculation, the", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0310.jp2"}, "309": {"fulltext": "LEPROSY. 293\\ndirect transmission of the virus into the blood of healthy\\npersons. This assertion does not exclude the transmis-\\nsion of the disease by clothing, tools, etc., which have\\nbeen used by lepers.\\n4. The disease is practically limited to people living\\nupon a fish diet along the sea coast.\\n5. It is incurable. The best treatment is only pallia-\\ntive. His experience with iodide of potash, iodoform,\\nmercury, and other so-called antisyphilitics having been\\nas satisfactory as with chaulmoogra oil and other\\nrarer and costlier drugs.\\n6. The average life of the leper, after the full develop-\\nment of the disease, is from ten to fifteen years. This\\ndoes not include the prodromal stage. Some cases die\\nsooner, and some live much longer.\\n7. The period of incubation is less than one year; the\\nprodromal stage may last for five or more years. Leon-\\ntiasis may develop in twelve months, and may be the\\nonly hint of the latent disease for years, until some\\nexciting cause brings it out.\\n8. Hereditary leprosy does not usually develop until\\nthe age of puberty, unless there be some exciting cause.\\nThis exciting cause may be inflammatory skin disease,\\nsuppurating wound, or prolonged illness.\\nEtiology. If we may judge from Holy Writ, the an-\\ncient Jewish lawgivers regarded the disease as contagious.\\nModern science declares that it is not. The discovery\\nin recent times of a peculiar bacillus by Hansen gives a\\nclue to the medium of contagion, and corroborates the\\nresults of careful clinical observation. While we cannot\\ndoubt the possibility of contagion, we must admit that\\nwithin the temperate zones the direct transfer of the\\ndisease from one person to another has been very rarely\\nobserved. It is by no means unusual for a Caucasian to", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0311.jp2"}, "310": {"fulltext": "294 SKIN DISEASES.\\ncontract the disease when dwelling among the natives\\nwhere it is endemic; but it is extremely rare for him,\\non returning to his native country, to convey the malady\\nto those with whom he associates. During the past\\nseveral years there have been a large number of lepers\\nwho have passed months and sometimes years in the hos-\\npitals of New York, and yet not a single case of leprosy\\nhas developed in this city.\\nFox says: The causes of propagation are mainly\\nthese:\\n1. Intermarriage of the leprous or with the leprous.\\n2. Hereditary transmission,\\n3. Inoculation and cohabitation.\\n4. Vaccination\\nAs to intermarriage, little need be said. It sufficiently\\naccounts for the occurrence of a large number of cases of\\nleprosy in the offspring of lepers, and the continuous\\nintermarriage of people of the same caste in India, en-\\nforced rigidly by custom and superstition, tends greatly\\nto the spread of leprosy hereditarily.\\nSecondly. As regards hereditary influence, this is\\nmost marked in children who are begotten by lepers far\\nadvanced in the disease.\\nThirdly. As to cohabitation and inoculation. Of\\ncourse, these are not such potent causes as intermarriage\\nand hereditary tendency in spreading leprosy, but still it\\nis probable that they may account for a certain number of\\ncases.\\nIt has been said that leprosy may be communicated by\\nvaccination, but if so it must be infinitely rare and\\nscarcely worthy of being taken into account.\\nPrognosis. The prognosis is uniformly unfavorable\\nthat is, when the disease is left to its natural course.\\nSpontaneous recovery, if it ever occurs, is extremely", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0312.jp2"}, "311": {"fulltext": "LEPROSY. 295\\nrare. A few cases of cure have been reported, but a\\nshade of doubt hangs over them. Mitigation of the\\naffection, and even abeyance of the symptoms for a time,\\nare by no means uncommon.\\nTreatment. Good food and good hygienic surround-\\nings are of the first importance in the treatment of\\nleprosy. Strychnine and chaulmoogra-oil are highly\\nrecommended by the old school. They claim that with\\nthese four means at command the majority of cases of\\nleprosy can be greatly benefited. They give the drugs\\nin full doses, the oil being applied externally as well as\\ninternally.\\nSurgeon-major Peters gives as the result of two years*\\nexperience at a leper asylum in India, with twenty-nine\\ncases, improvement in all the cases by the following plan:\\nThe patients had to rub the body for two hours early in\\nthe morning with Carbolic oil, i to 40; then bathe in\\nwarm soap and water. Afterwards an emulsion composed\\nof Gurgium oil and lime water was rubbed into the\\naffected parts only, any ulcerations being filled with\\ncotton smeared with the same. Under this treatment the\\nulcers healed rapidly, while the anaesthetic parts and\\nnodules remained unimproved They, however, were\\nbenefited by Cashew-nut oil rubbed on to blistering.\\nInternally, the remedy administered was as follows:\\nChaulmoogra Oil, m. v.\\nSodas Bicarb., gr. v.\\nAquae Menthae Pip. j\\nM. Size of dose not stated.\\nLocally, warm baths with Gurgium oil are highly\\nrecommended.\\nThe principal homoeopathic internal remedies are\\nHydrocotyle^ Hoang nan and Piper methysHcum.\\nOthers may be indicated as follows:", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0313.jp2"}, "312": {"fulltext": "296 SKIN DISEASES.\\nAnacardium. Numbness and feeling of pins and\\nneedles in affected parts, which are cold; patches of\\nraised and hardened skin on face and arms; perfect\\nanaesthesia of affected parts; weakness and prostration.\\nAlumina. Copper-colored tubercles in face; leprous\\nspots on legs; lips swollen; nose heavy; husky voice;\\nhypersesthesia; ulcers on planta pedis.\\nArsenicum. Yellow or white spots; tubercular swell-\\ning in nose; burning ulcers at the ends of the fingers, at\\nthe toes, soles of feet, navel, cheek; raised up tubercles;\\nloss of hair and eyebrows; livid tubercles on any part of\\nthe body; hyperaesthesia and anaesthesia alternating;\\ngeneral prostration.\\nArsen. iod. Pricking sensation in the skin; loss of\\nthe voice; enlargement of the glands; hoarse cough; fall-\\ning off of the fingers and toes; ozaena; tubercles dirty\\nlooking.\\nAurum. Melancholy disposition; discharge from the\\nnares very offensive; absorption of the bones of the nose;\\nhas no desire to talk about sickness.\\nCalotropis gig. Tubercular leprosy; lassitude, indis-\\nposition to move; loss of energy; apathy and obstruction\\nof the capillaries; intolerable itching over the whole\\nbody.\\nCarica papaya. Tubercular leprosy.\\nColocynth. Desquamation of the whole epidermis; ab-\\nscess of axilla.\\nCrotalus. Swelling of the limbs or body spots\\nappearing like gangrene.\\nCupmm. Leprous eruptions cramps suffocating\\nspells.\\nGraphites. Leprous spots, coppery, annular, raised on\\nthe face, ears, buttocks, legs, and feet ulcers on toes.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0314.jp2"}, "313": {"fulltext": "LEPROSY. 297\\ncrusts in nostrils skin cracks and discharges a sticky\\nfluid.\\nHydrocotyle, Well-marked cases of tubercular leprosy;\\nleonine face nose flattened and swollen lobes of the\\nears pendulous and swollen ulcers in the alse nasi and\\ncorners of the mouth ears discharge hands and feet\\nswollen so that fingers and toes spread apart itching of\\nany part of body feeling of lassitude yellowish or\\nreddish spots on the trunk and extremeties.\\nlodujn. Emaciation marked swelling of the glands\\nwhen mercury has been taken in large quantities loss of\\nvoice and hoarseness voracious appetite.\\nKali bichrom. Brownish colored spots ulcers with an\\nunhealthy look blisters on the extremities little boil or\\npustules on any part of body thick, tough discharge\\nfrom nose hard plugs in nose thick, ^^ellow, putrid\\ndischarge from the ears ulcers on tongue and on\\ncornea.\\nKreosote. Soreness on the nose swollen gums\\npainful ulcers wheals like urticaria numbness in\\ndifferent parts of the body.\\nLachesis. Spots yellow, red, green, lead and copper\\ncolored, pale livid hard and pale swelling large boils\\nulcers surrounded by nodes and vesicles the muscles\\nfall off in shreds from the bones bloody serum discharge\\nfrom the nose, ears and mouth obstinate ulcers wdth\\nblack spots in the granulations.\\nMadaru albuin. The whole surface of the skin\\nbecomes leprous livid and gangrenous tubercles\\nthickening of the whole skin.\\nMercurius. Falling out of the teeth absorption of the\\nsmall bones swollen gums sore tongue flat indolent\\nulcers.\\nNatrum carb. Spots and tubercles all over the face,\\n20", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0315.jp2"}, "314": {"fulltext": "298 SKIN DISEASES.\\narms, thighs, legs, which ulcerate ulcers in the nostrils\\nand on the heels.\\nPetroleum. Tubercles on the face; herpetic and tuber-\\nculous spots on the body; ulcers of fingers, tibia;\\nunhealthy skin with brown spots; skin dries and forms\\ndeep cracks; falling out of hair; hypersesthesia of scalp\\nand ears followed b}^ anaesthesia; hoarseness, suffocating\\ncough, numbness of extremities.\\nPhosphorus. Later stages of the disease; brown spots\\non an even base; boils; spots like blood blisters on the\\nbody; tubercles on the trunk, buttocks; thick patches on\\nface and arms; discolored borders around the white\\nspots; hair falls out; tension in the fingers, and dullness\\ntowards the end; great debility with increa.se of sexual\\ndesire.\\nRhus tox. Scalp sensitive, cannot bear to have the\\nhair touched; pulsation in the ears; loss of smell;\\nswollen face so that patient is not recognized;\\ntubercles with sharply defined margins; bright red skin,\\nviolent itching; hardness and thickening of skin on any\\npart of body.\\nSecale. Can hardly talk, the tongue will not respond\\nto the will; fingers and toes drop off; falling out of the\\nhair; eyes look sunken; cold, dried-up-looking skin.\\nSepia. Swelling of forehead, around temples; face\\nthick, covered with tubercles; leonine face, pendant ears;\\neyes red, dull, weeping; purulent discharge from nose;\\ntubercles and spots all over the body; gnawing ulcers on\\nfingers and toes; excoriation at the tip of tongue;\\ndischarge from the swollen ears; nose and lower lip\\nswollen; red herpetic spots at the elbow and hip; herpetic\\nsores; white spots and ulcers on the articulations of the\\nfingers; coppery tubercular spots all over the body,\\nespecially on the buttocks, arm-pits; tubercles on the\\nface, trunk, buttocks, prepuce; brownish spots on face;", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0316.jp2"}, "315": {"fulltext": "morvan s disease. 299\\nskin peels off from hands and feet; nails look dried up\\nand deformed; falling out of the hair and eyebrows; loss\\nof smell; breath offensive.\\nSilicea. Induration of nose, with ulceration and\\ndischarge; palsied hands; white spots on cheeks; coppery\\nspots and hard tubercles on testicles and buttocks; ulcers\\nat tips of fingers; shortening of the hamstrings.\\nSulphur. The usual antipsoric indications.\\nWoorali Obstinate boils^ that will not heal; slowly\\nforming and suppurating pimples; dirty looking skin;\\nblood oozes through the skin; tubercles on nose; stoppage\\nof nose, with swelling of parts; falling of the hair;\\nswelling of the lobes of ears; falling out of the teeth;\\ndischarge of matter from the ears; tonsils inflame and\\nsuppurate.\\nHura Bras.y Guano, Helleboi^ous foetidus and Veronica\\nmay be compared.\\nMorvan s Disease.\\nMorvan s disease must be differentiated from Sclero-\\ndactily, from Lepramutilans, and from symmetric gan-\\ngrene of the extremities.\\nThe analgesic paresis with panaris of the superior ex-\\ntremities was first described by Morvan. The patient\\ncomplains at first of neuralgiform pains in the fingers,\\nwhich are soon followed by a paretic state with muscular\\natrophy, more or less pronounced, in the hands and\\nforearms, sometimes spreading through the whole arm\\nand other parts of the body. There is at the same time\\nanalgesia and anaesthesia, especially for the touch, for\\npain and temperature (here it is necessary not to mistake\\nit for syringomyelia, where there is no anaesthesia, but\\nonly a relative analgesia and especially thermo-anaes-\\nthesia). This state is followed by panaritiae, which start.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0317.jp2"}, "316": {"fulltext": "300 SKIN DISEASES.\\nlike any other plain panaritium, with redness, heat and\\nswelling, but it soon shows its malignant character, as\\nnecrosis of the bone follows, destroying not only the\\nupper phalanx, but sometimes also the others, resulting\\nin mutilations. We meet here also multiple panaritiae,\\nattacking nearly all the fingers, which may follow one\\nanother at shorter or longer intervals, so that years may\\nintervene between them. Though the first panaritium\\nmay be painful, the subsequent ones are usually painless.\\nTrophic troubles are more or less observed, as more or\\nless deep rhagades, ulcerations in the folds of the skin,\\nextending to the tendinous sheaths, which are bathed in\\nsuppuration, but all is of an indolent character. The\\nnails fall off or become deformed as in no other affection.\\nFinally the whole hand becomes livid and its temperature\\nbelow the normal.\\nPrognosis in relation to the use of the upper extremi-\\nties is bad, as the disease leads to incurable deformities\\nand mutilations. It attacks more often males than\\nfemales, of all ages, and whether traumatism is to blame\\nfor it remains more than doubtful.\\nIt is easy to differentiate it from Ball s sclerodermitis,\\nfor here one never meets necrosis of the bone, nor are\\nbone pieces discharged; the mutilations take place grad-\\nually by a kind of absorption of the tissues of the fingers;\\nnor is there any paresis or anaesthesia. Finally the\\nsclerodermic mark is specific, and can never be mistaken\\nfor anything else.\\nIn relation to anaesthesia with its atrophy the patient s\\nhands become very similar to those of the monkey, and\\nthe lesions are mostly symmetric. The same trophic\\ntroubles may be found anywhere on the body and ulcera-\\ntions are frequent, and the leprous spots on the skin of\\nsuch patients are characteristic and known as morphea", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0318.jp2"}, "317": {"fulltext": "301\\nalba or rubra. Lepra is an exotic plant and so far con-\\nfined to few countries.\\nNor can Morvan s disease be mistaken for syringo-\\nmyelia, characterized, as it is, by more extensive mus-\\ncular atrophy, and though the sensation of contact is pre-\\nserved, the sensibility to heat and cold is abolished over\\nlarge surfaces of the body, a characteristic which is only\\npartially met with in hysteria. The rhagades, the\\narthropachies and the scoliosis belong to both, but a\\npanaris is an exception, while in Morvan s disease it re-\\nmains the predominant phenomenon.\\nAbnormal sensitiveness of the fingers, painful at first,\\nwith redness and swelling, then bullae which break and\\ndry up, followed by atrophy of the upper phalanx, which\\nbecomes deformed and absorbed.\\nNobody as yet has discovered the origin of the malady,\\nand none has yet given a treatment for it. We may\\nclaim that constitutional treatment may eradicate the\\npoison and Homoeopathy is rich in resources.\\nThuja, Fluoric acid, Silicea, Sulphur and others are of\\ngreat assistance.\\nThuja. Erysipelatous swelling of the tips of the\\nfingers and of the fingers; nails are crippled, discolored,\\ncrumbling off; twitchings of the muscles of the arms;\\ncoldness and sensation of deadness of the fingers and tips\\nof the fingers; stinging pains in the arms and in the\\njoints; emaciation and deadness of the affected parts\\ndirty and brownish color of the skin.\\nSilicea and scoliosis go hand in hand, and according to\\nsome authors it is found in nearly half the cases of\\nMorvan s Disease. It is also complementary to Thuja,\\nand in most cases where Silicea suits there is a tendency\\n^to chronicity of the disease; emaciation and atrophy of\\naffected parts; paretic states; nails rough and yellow;", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0319.jp2"}, "318": {"fulltext": "302 SKIN DISEASES.\\npain as if panaritium would form on left index; dryness\\nof tips of fingers; ulcers about nails; felons with violent\\nshooting pains deep in the fingers, with great restlessness\\nand irritability.\\nSodium sulphate is also correlated to Thuja. Perhaps\\nit may come in at a later stage when the paronychia sets\\nin painless or with hardly any pain. Among its symp-\\ntoms we read twitchings of the hands, trembling of the\\nhands on waking, and also when writing; loss of strength\\nof the hand, is unable to hold anything heavy; tingling,\\nulcerative ])ain under the nail; internal coldness; with\\nyawning and stretching.\\nGraphites has emaciation of the hands, distortion of\\nthe fingers, gouty nodosities on the finger-joints; thick\\nand crippled nails; soreness between the fingers; sensa-\\ntion of debility without pain and liability to take cold.\\nCracks and fissures anywhere are often the key-note to\\nthe use of this drug, and as it has a long action, it ought\\ncertainly be of benefit in such a chronic affection as\\nMorvan s Disease.\\nSepia also has diseased and crippled nails with painless\\nulcers on the joints and tips of the fingers and paralytic\\ndrawing and tearing in arms and fingers. Venosity and\\nstagnation is the red thread which goes all through the\\npathogenesis of the drug; it is also a long lasting remedy,\\nhence the neuraesthenia and the paretic condition, and\\nthe more we consider all these diseases, except lepra, of\\nconstitutional origin, the more will we be able to prevent\\nthe deformities which, when once present, are out of the\\npale of therapeutic measures.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0320.jp2"}, "319": {"fulltext": "CHAPTER XIII.\\nHYPERTROPHIC AND ATROPHIC AFFEC-\\nTIONS.\\nUnder the terms h^^pertrophy and atrophy ma} be in-\\ncluded all cases of development in excess of the normal\\ntissues of the skin on the one hand and wasting on the\\nother; the atrophy and hypertrophy being in each case\\nprimary conditions.\\nThe maladies ranking under these two classes may be\\narranged as follows:\\nA. Hypertrophic diseases, com^rismg: i. Diseases of\\nthe epithelial layer of the skin, including callosities,\\ncorns, and horns, in which the epithelial tissue is specially\\naffected. 2. Diseases involving the dermic portion, in\\nwhich the true skin is affected with or without the\\nepithelium. In some cases the papillary layer is chiefl}^\\naffected, but in connection with augmented production of\\nthe epithelium also, as in ichthyosis and xeroderma. In\\nother cases the fibro-cellular tissue of the corium proper\\nis the special seat of change, as in the diseases termed\\nscleroderma, keloid, fibroma, Elephantiasis iVrabum, and\\nderma tolysis. 3. Diseases seated in the vascular\\nstructures, including such growths as vascular naevi.\\nB. Atrophic diseases, including general wasting and\\nsenile atrophy, and local or linear atrophy, which will be\\nincidentally noticed together with morphoea.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0321.jp2"}, "320": {"fulltext": "304 SKIN DISEASES.\\nHypertrophic Affections.\\nWe will first deal in detail with hypertrophic affec-\\ntions. It will be understood that no reference is made\\nin this chapter to secondary or accidental hypertrophy\\nthe consequence of congestion or inflammatory conditions,\\nbut to those diseases in which hypertrophy is the promi-\\nnent or only condition.\\nCorns.\\nThese are composed of an accumulation of the cells of\\nthe horny layer, which, generally, are pressed together\\ninto a conical mass that dips deeply downwards. The\\npapillae beneath may be enlarged, but are usually\\natrophied. The corn mass presses even upon the rete\\ncells, and it also obliterates more or less the sweat glands.\\nCorns are caused by pressure and friction; they are of two\\nkinds the hard ordinary corns, and soft corns. The\\nsoft corns occur between the toes, and being saturated\\nwith the secretion of the part, are moist and soft; gen-\\nerally there is some serosity effused under the upper\\nlayers or the bursse normally found at the parts over the\\njoints of the toes where the corns form, enlarge and pour\\nout fluid, which is discharged from a little central\\naperture.\\nTreatment. The shoes or boots worn must fit the\\nfoot neither too small nor too large. The corn may be\\ngotten rid of by soaking it in warm water, after which\\nthe outer layers may be removed by a sharp knife, and a\\nslice of lemon bound upon it, and worn during the night.\\nThis treatment continued for three or four nights, the\\ncorn can be removed with but little pain.\\nFlexible or arnicated colloid may be used as a dressing\\nfor painful soft corns.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0322.jp2"}, "321": {"fulltext": "HYPERTROPHY OF THE PAPILL.E:. 305\\nRinged corn plasters will protect the corns from press-\\nure.\\nIf the corns are inflamed and painful, a veratrum\\nviride or arnica lotion, one part to two, may be used.\\nA lotion, composed as follows, applied once or twice a\\nday with a camel s hair brush, has been used with great\\nsuccess in removing corns:\\n9^. Salicylic acid, drachm j.\\nExt. Cannabis Ind., grs. x.\\nCollodion, ^j.\\nM. S. Apply as directed above.\\nAnother excellent application is as follows:\\n9. Acid Salicylic, drachm j,\\nEmplast. Saponat, Jjjj.\\nM. f, empl. Sig. Apply on lint.\\nAntimon. crud. is the principal internal remed}^ for\\nhard corns, and Sulphur for the soft variety.\\nDr. Berridge reports a case of soft corn between fourth\\nand fifth toes of right foot; the corn shoots and burns;\\nalso, dull aching in outer side of right ankle extend-\\ning up to hip, as cured by the internal use of Wiesbaden\\n200, a dose every other day for fourteen days.\\nCallosities are merely hardened conditions of the skin\\nproduced by pressure, differing from corns rather in the\\nfact that they are on a larger scale than by any other\\nfeature.\\nHypertrophy of the Papillae and Epithelium\\nConjoined.\\nHorns. These may be sebaceous in origin; usually,\\nhowever, they are made up of hypertrophied papillae,\\neach containing one or more vessels and being covered by\\nepidermis; on section they have a granular texture\\npierced with small orifices, and when dry, numerous con-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0323.jp2"}, "322": {"fulltext": "306 SKIN DISEASES.\\ncentric cracks. These orifices are the sections of little\\nblood-vessels; a clear amber-colored circular area sur-\\nrounding each of the vessels, which are separated by the\\ngeneral granular structure of the mass, incapable in the\\ncompact part of the horn of being reduced to its ultimate\\noriginal elements. The central parts of the horn are\\nmore compact and less vascular than the outside.\\nVerrucae, or Warts.\\nThese are little raised tumors, sessile or pedunculated,\\nhard, generally round, rugose, and mammillated. They\\nare made up of coherent and enlarged papillae, each con-\\ntaining a loop of blood vessels, and more or less nerve-\\ntissue, especially at their base. The sessile warts, or the\\ntrue hypertrophous papillae, are seen mostly on the hands\\nin children; they may be multiple, solitary, or aggre-\\ngated in clusters. They may form a fiat mass or present\\na digitate appearance. Warts are often the result of\\nsyphilis about the anus, vulva, penis, but they may also\\narise from simple irritation.\\nVenereal warts are pinkish or reddish vascular vegeta-\\ntions, and occur for the most part on the genitals, pref-\\nerably on the penis and labia. They may also form\\nabout the mouth and anus, in the axilla and between the\\ntoes. They are apt to grow very rapidly, and may attain\\nconsiderable size. They are caused by the contact of\\nirritating fluids, and may be either dry or moist, accord-\\ning to their location. They may occur in connection with\\ngonorrhoea, but are never like the condylomata, a sign of\\nconstitutional syphilis.\\nThe causes of warts are unknown; they appear some-\\ntimes to be contagious. The local treatment consists in\\ndestroying the abnormal growth by caustics the acid", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0324.jp2"}, "323": {"fulltext": "VERRUCA, OR WARTS. 307\\nnitrate of mercury, caustic potash, arsenical paste,\\nperchloride of iron, or chromic acid. The smaller warts\\nmay be removed by the curved scissors, and the larger\\nand more vascular ones by the curette, ligature or gal-\\nvano-caustic wire.\\nVenereal warts need the strictest cleanliness. The dry\\nones may be treated locally by thuja or mercuric bichlor-\\nide lotion. The moist ones respond best to dusting\\nwith the mercuric chloride.\\nThuja externally and internally has great reputation\\nin removing all kinds of warts.\\nMoles may be removed by the topical use of the acid\\nnitrate of mercury.\\nThe following repertory of warts and condylomata,\\nprepared by Dr. Olin M. Drake, is so complete and ex-\\ncellent, that I transcribe it here:\\nWarts, confinement, following, small: Calc. c.\\ngirls, upon young: Sep., Sulph., Thuja.\\nhorses, upon: Lach., Thuja.\\nupon, about the head and ears; bell-shaped, small\\nat the attachment and one to one-and-a-half\\ninches long: Thuja.\\nimagines w. upon the body: Mez.\\ninternal: Caust.\\nisolated: Calc. c, Caust., Lyco., Natr. c.\\nonanists, upon: Nitr. ac, Sep., Sulph., Thuja.\\nsalt, from abuse of: Natr. mur.. Nit. d. s.\\nLocality.\\nAnus, about: Aur., Thuja.\\nArms, upon: Ant. cr., Ars., Calc. c, Caust., Dulc,\\nFerr. ma.. Lye, Natr. c, Nat. sulph., Nitr. ac,\\nRhus tox., Sep., Sil., Sulph., Thuja,\\nleft forearm: Sulph.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0325.jp2"}, "324": {"fulltext": "308 SKIN DISEASES.\\nbend of elbow: Calc. c.\\nwrist (left) Ferr. ma.\\nBack: Nat. c.\\nBody: Caust., Medor., Thuja.\\nButtocks, small, scattered, flat, grayish-brown: Con.\\nCheek (left): Calc. c, Sep., Thuja.\\nChest: Aur., Calc. c, Nit. ac.\\nConjunctiva: Thuja.\\nCornea, warty in appearance: Sil.\\nEars, behind: Calc. c, Thuja.\\nwart-like growths: Calc. c. j\\nEyeballs, sensation as though was studded with:\\nEuphr.\\nEyebrows, upon: Anac, Caust., Thuja.\\nEyelids: Calc. c, Caust., Mag. s., Nit. ac, Sulph.,\\nThuja.\\nupper: Calc. c. Mag. s. Nitr. ac.\\nEyes, under: Sulph.\\nFace, upon: Alco., Am. m., Calc. c, Caust., Dulc,\\nKa. bi., Ka. c, Mag. s., Natr. m., Nitr. ac, Sep.,\\nThuja.\\nFeet: Calc. c, Sulph.\\nsoles: Sep.\\nFingers: Ambra, Ars., Bar. c, Berb., Calc. c, Carb.\\nan., Caust., Dulc, Ferr., Lac c, Lach., Lyco,,\\nNat. m., Nat. sulph., Nit. ac, Ox. ac, Pal., Petrol.,\\nPsor., Ran. b., Rhus t., Sars., Sel., Sep., Sulph.,\\nThuja, Verrucinum.\\nindex finger: Caust. (right), Lyco. (left), Thuja.\\nlittle finger: Caust., Lace\\nmiddle finger: Berb., Lach.\\nfinger, back of: Lach.\\nring finger: Nat. sulph.\\nback of: Dulc, Lach.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0326.jp2"}, "325": {"fulltext": "YERRUC^, OR WARTS. 309\\nside of: Calc. c, Sep., Thuja.\\ntips of Caust., Thuja.\\njoints, around: Sars.\\nknuckles, on: Ox. ac, Pal., Sal.\\nclose to the nails: Caust.\\nrudimentary: Berb.\\nthumb: Lach., Ran. b., Thuja.\\nleft hand: Psor.\\nForehead, upon: Nitr. ac.\\nGenitals, upon: Calc. c, Cinnab., Eucalyp., Nit.\\nac, Pho. ac. Sec c. Thuja.\\nupon glans penis: Nit. ac. Pho. ac, Thuja.\\nOS uteri: Calc. c, Nit. ac. Sec. c, Thuja,\\nstinging and burning, when urinating: Thuja.\\npapilloma urethrae: Eucalyp., Thuja.\\nprepuce, frsenum and inner surface, bleeding when\\ntouched: Cinnab., Eucalyp.\\nHands, upon back of: Ars., Dulc, Ferr., Nat. c,\\nNit. ac, Thuja.\\nleft: Ferr. ma.\\nright: Ars.\\nball of the: Berb.\\ninside of: Ruta.\\nknuckles: Ox. ac, Pal., Sel.\\nleft: Ferr. ma., Psor., Thuja.\\nonanists of: Nitr. ac, Sep., Sulph., Thuja.\\npalm of: Anac, Nat. m., Ruta.\\nwart-like induration in the palm, after a long con-\\ntinued pressure on the part: Borax.\\nright: Ars., Caust., Nat. sulph.. Thuja.\\nHead, upon: Caust., Sep.\\nIris: Thuja.\\nlyips: Caust., Con., Nat. m.. Nit. ac, Thuja.\\nupper, smart and bleed on washing: Nit. ac", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0327.jp2"}, "326": {"fulltext": "310 SKIN DISEASES.\\ndrawing pain in an old w.: Con.\\nMouth and chin, about the: Calc. c, Calc. ph., Cun.,\\nKa. ca.. Ivy CO., Medor., Psor. Sep., Thuja.\\nthickly studding the mouths of sheep: Calc. c.\\nNeck, upon: Ant. cr., Calc. c, Lyco., Nit. ac, Sep.,\\nSyph., Thuja.\\nright side, filled with blood: Thuja.\\nNose: Alco., Caust., Laur., Nit. ac, Thuja.\\nSternum: Nit. ac.\\nThighs, upon: Medor.\\nThumb, upon: lyach., Ran. b. Thuja.\\nToes, upon: Spig.\\nTongue, upon: Aur. m., Aur. m. n., Mang., Thuja.\\nObjectively considered.\\nBleeding: Calc. c, Caust., Cinnab., Ferr. ma., Lyco.,\\nNatr. c, Nitr. ac, Pho. ac, Rhus t., Staph., Thuja.\\nBreaking open: Calc. c\\nBrittle: Ant. cr.\\nCauliflower, like: Nitr. ac. Ran. b., Thuja.\\non outer side of terminal phalanx of right thumb:\\nRan. b.\\nCleft. See jagged.\\nColor, almost the color of the skin: Calc. c\\ndark: Sep., Thuja,\\nred: Ars., Bell Calc c, Caust.\\nsize of a bean: Calc c\\nand angry looking: Ars.\\ncircles around with: Caust.\\nstreaks with: Bell.\\nFlat: Ant. cr., Berb., Dulc, I^ach., Ruta, Sep., Verru-\\ncinum.\\nGroups or crops, in: Dulc, I^ach., Nat. m., Psor.,\\nSep., Thuja.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0328.jp2"}, "327": {"fulltext": "VERRUCA, OR WARTS. 311\\nHollow, become: Calc. c.\\nHorny or hard: Ant. cr., Borax, Calc. c, Caust.,\\nDulc, Fl. ac, Graph., Lach., Nit. ac, Ran. b.,\\nSep., Sil., Sulph., Thuja.\\nupper surface: Calc. c.\\nIncipient or recent: Nat. c.\\nInflamed: Amm. carb. x\\\\rs.. Bell., Bovis. Calc. c,\\nCaust., Dulc, Hep., Lyco., Nat. c, Nitr. ac, Rhus\\nt., Ruta, Sep., Staph., Sulph., Thuja.\\nas if ulceration would set in: Hep.\\nInveterate or old: Calc. c, Caust., Cun., Ka. ca.,\\nNat. m.,Nit. ac, Rhust., Sars., Sulph., Thuja.\\ngrow larger; Cun.\\nIsolated: Calc. c, Caust., lyyco., Nat. c\\nJagged (cleft, divided or indented): Calc c, Caust.,\\nEuphr., L^ co. Nit. ac, Pho. ac, Rhust., Sabi.,\\nStaph., Thuja.\\nsurrounded b}^ a hepatic areola, with bran-like\\ndesquamation: Lyco.\\nLarge or fleshy: Caust., Dulc, Ka. c, Lyco,, Nat. c,\\nNat.m., Nit. ac Pho. ac, Rhust., Sabi., Sep., Sil.,\\nThuja, Verrucinum.\\nMalignant: Ars.\\nMoisture, exuding: Calc c, Caust., Lj-co., Nitr. ac,\\nPho. ac, Rhus t., Sabi., Thuja.\\na fetid humor: Nitr. ac.\\nPedunculated: Caust., Dulc, Lyco., Medor.j Nit. ac,\\nPho. ac, Rhus t., Sep., Staph., Thuja.\\nSmall, all over the body: Caust.\\nwith pin-heads, like button mushrooms, on various\\nparts of body and thighs: Medor.\\nRecent or incipient: Nat. c\\nRough, upper surface whitish and horny: Calc. c\\nRound: Calc. c", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0329.jp2"}, "328": {"fulltext": "312 SKIN DISEASES.\\nRudimentary, on fingers: Berb.\\nScrofulous: Aur.\\nSeedy: Calc. c, Caust., Medor., Nat. m., Sep., Thuja.\\nsmall: Bar. c, Berb., Calc. c, Caust., Cun., Dulc,\\nFerr., Ferr. ma,, Fl. ac, Hep., Lach., Medor.,\\nNit. ac, Psor., Rhust., Sars., Sep., Sulph., Thuja.\\nSmooth: Ant. cr., Dulc, Psor., Ruta.\\nSoft: Alum., Ant. cr., Calc. c, Nit. ac, Thuja.\\nat the base, almost the color of the skin; upper\\nsurface hard, rough, whitish and horny: Calc c\\nwith thin epidermis, and moist: Nit. ac.\\nto touch, like lipoma and pointed, on neck: Thuja.\\nSolid body, with horny top: Caust., Rhus t., Sep.\\nSpongy: Alum. See soft.\\nSuppurating (see Ulcerating): Ars., Bovista, Calc. c,\\nCaust., Hep., Nat. c, Pho., Sil., Thuja.\\nthen healing: Calc. c\\na previously existing wart, developed a red point,\\nsuppurated and disappeared: Bovista.\\nsensation as if they would suppurate; in the evening\\nin bed: Petrol.\\nSycotic: Alum., Aur., Cinnab., Medor., Mil., Nat.\\nsulph., Pho. ac, Sars.\\nOld, dry; after mercurial treatment for gouty pains:\\nSars.\\nSyphilitic: Aur., Cinnab., Ka. iod.. Thuja.\\nUlcerating (See Suppurating): Ars., Calc. c, Caust.,\\nHep., Nat. c, Pho., Sil., Thuja.\\nUlcers breaking out around warts: Ant. cr., Ars., Nat.\\nsulph., Pho.\\nhaving the shape of warts: Ars.\\norignating in warts: Thuja.\\nturning into warts: Calc. c.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0330.jp2"}, "329": {"fulltext": "VERRUCA, OR WARTvS. 313\\nSubjective Symptoms.\\nBurning: Amm. carb., Ars., Ivyco., Nit. ac, Petrol.,\\nPho., Rhus t., Sep., Sulph., Thuja.\\nItching: Calc. c, Carb. a.. Kuphr. Hep., Ka. carb.,\\nNit. ac, Pho., Psor., Sep., Sulph., Thuja.\\nPainful: Ars Amm. carb.. Ant. cr.,Bar. c, Bovis.,\\nCalc. c, Caust., Con., Euphr., Hep., Ka. carb.,\\nLyco., Nat. carb., Nat. mur., Nit. ac, Petrol., Pho.,\\nRhus t., Sabi., Sep., Sil, Staph., Sulph., Thuja,\\nameliorated on the appearance of menses: Thuja,\\npreventing rest at night: Ars.\\nlike a boil: Calc. c\\ncutting: Nat. mur.\\ndrawing, in an old w. on upper lip: Con.\\npricking: Ant. cr. Calc c, Lyco., Nit. ac, Pe-\\ntrol., Rhus tox., Sep., Sil., Sulph.\\nin the evening in bed: Petrol,\\npulsating (beating or throbbing): Ars., Calc. c,\\nCaust., Hep., Ka. carb., Lyco., Nit. ac. Petrol.,\\nSep., Sil., Sulph.\\nshooting: Ars., Bovis.\\nwith pains, sticking: Hep., Nit. ac.\\nstinging: Amm. carb., Ant. cr.. Bar. c, Calc. c,\\nCaust., Euphr., Hep., Lyco., Nitr. ac, Rhus t.,\\nSep., Sil., Staph., Sulph., Thuja,\\nas if ulceration would set in: Hep.\\ntearing: Amm. carb.\\nthrobbing: See pulsating.\\nextending up the arm to the axilla, from a malig-\\nnant wart on the hand, rendering the arm use-\\nless: Ars.\\nSoreness of: Ambra, Ars., Hep., Lach., Nat. carb.,\\nNat. mur., Nit. ac, Petrol., Ruta, Sabi., Thuja.\\nTickling (see itching): Sulph., Thuja.\\n21", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0331.jp2"}, "330": {"fulltext": "314 SKIN DISEASES.\\nCondylomata, mercury; after the abuse of: Aur. Lyco.,\\nNit. ac, Staph,\\nwomen, particularly in: Merc, d., Sabi.\\nI.OCALITY.\\nAnus, upon or about: Aur., Aur. m., Benz. ac.\\nEuphr., Lyco., Merc, c, Merc, d.. Mil., Nit. ac,\\nSabi., Sep., Staph., Sil., Thuja,\\na growth, like a w. a quarter of an inch in height,\\nand as thick as a pea, painless, itching, opening\\nat the top and suppurating, in the ridge, close\\nto the anus, lasting four weeks and gradually\\nhealed: Thuja.\\nClitoris, upon or about: Thuja.\\nEyebrows, upon or about: Thuja.\\nEyelids, upon or about; either on the internal or exter-\\nnal surface: Cinnab,, Nit. ac. Thuja,\\nupon or about, lower: Nit. ac.\\nFrsenum, upon or about: Cinnab.\\nupon or about, oozing, especially during new moon:\\nThuja.\\nGenitals, upon or about: Alum., Benz. ac, Lyco.,\\nMedor., Thuja.\\nupon or about, female: Merc d.. Thuja.\\nIris, upon or about: Cinnab., Merc sol,. Thuja.\\nLabium, upon or about: Sulph., Thuja.\\nLarynx, upon or about: Merc c, Nit. ac, Thuja.\\nMouth, upon or about (inner): Phos. ac\\nNeck, upon or about: Nit. ac.\\nPenis, upon or about: Ant. t., Aur., Aur. m., Cinnab.,\\nKa. iod., Ka. mur.. Lye, Merc c, Nit. ac, Nux\\nv., Pho. ac, Psor., Sabi., Sanic, Sep., Staph.,\\nSulph., Thuja.\\nglans: Ant. t., Cinnab., Ka. iod., Ka. mur., Lyco.,\\nNit. ac, Nux v., Pho. ac, Sanic, Staph., Sulph.,\\nThuja.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0332.jp2"}, "331": {"fulltext": "VERRUCA, OR WARTS. 315\\nCorona glandes, upon; after chancre: Ka. mur.\\naround: Aur.\\nupon and behind: Staph.\\nsurrounding: Sep.\\nPrepuce, upon: Aur., Aur. m., Cinnab., lyyco., Nux\\nvom., Merc, c, Nit. ac, Sabi., Thuja.\\nedge of, itching and burning: Psor.\\nPerineum, upon: Merc, d., Thuja.\\nScrotum, upon: Aur. m., Thuja.\\nTongue, upon: Aur. mur.\\nUterus, upon: Lach.\\ncervix: Kreos. Merc, sol.. Nit. ac, Tarent., Thuja.\\nos: Calc. c. Kreos., Merc. sol.\\nvagina, in: Medor., Nit. ac. Pho. Tarent., Thuja.\\nvulva, upon: Merc. d.\\nObjectively Considered.\\nBleeding: Arg. n., Medor., Nit. ac, Sulph., Thuja.\\nBroad: Ac. ac, Kuphr., Merc, d., Nit. ac, Thuja.\\nBulbous: Alum.\\nCauliflower or mulberry like: Staph., Thuja.\\nChancre, complicated with: Arg. n., Cinnab., Ka.\\nbichr., Merc, sol., Nat. sulph., Nit. ac, Pho. ac,\\nStaph., Thuja.\\nafter: Kali iod.\\nCock s comb shape: Euphr., Staph., Sulph.\\nConical: Ka. mur., Merc, v., Thuja.\\nDry: Ac. ac, Cinnab., I^yco., Merc c, Merc, v..\\nNit. ac, Sars., Staph., Thuja.\\nFan-shaped: Cinnab., Thuja.\\nFiliform: Staph.\\nFlat: Ac. ac, Euphr., Nit. ac, Sars., Sulph., Thuja.\\nGonorrhoea, complicated with: Cinnab., Con., Ka.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0333.jp2"}, "332": {"fulltext": "316 SKIN DISEASES.\\nmur., Lyco. Merc, c, Nit. ac, Pic. ac, Puis.,\\nSars., Sulph., Thuja.\\nMoist discharging Ac. ac. Benz ac, Calc. c,\\nEuphr., Graph., Hep., Ka. iod., lyyco., Medor.,\\nMerc, d., Nat. sulph.. Nit. ac, Psor., Sanic, Staph.,\\nSulph., Thuja.\\ndischarging profuse: Benz. ac, Medor.\\ngreenish: Nat. sulph.\\noffensive: Medor., Merc, d.. Nit. ac.\\nsmelling like fish-brine: Sanic\\nherring-brine: Calc c, Graph., Hep., Thuja,\\nold cheese: Calc c. Hep., Thuja,\\nyellow fluid: Medorrh.\\nMoon, worse with the increase of the: Thuja.\\nMulberry or cauliflower like: Staph., Thuja.\\nOld, long standing, in cachectic subjects: Ka. iod.\\nPedicles, growing on. See pedunculated.\\nPedunculated: Lyco., Nit. ac, Sabi., Staph.\\nSoft and spongy: Alum., Nat. sulph., Sulph.\\nSpHt: Lyco., Nit. ac, Thuja.\\nStrawberry-like: Medor.\\nSuppurating (see Moist): Ka. iod.. Nit. ac. Thuja.\\nTubular: Thuja.\\nUlcers elevated, which have the appearance as if w.\\nwould grow out of them: Cinnab.\\nWart-shaped: Benz. ac. Nit. ac, Nux vom., Sars.,\\nSulph., Thuja.\\nWhite: Lyco.\\nSubjectively.\\nBurning: Kuphr., Pho. ac, Psor., Merc, d., Sabi.\\nwhen touched: Euphr., Sabi.\\nItching: Cinnab., Euphr., Phyt., Psor., Sabi., Thuja.\\nespecially when walking: Euphr.\\nabout the joints: Cinnab.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0334.jp2"}, "333": {"fulltext": "", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0335.jp2"}, "334": {"fulltext": "Ichthyosis.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0336.jp2"}, "335": {"fulltext": "ICHTHYOSIS. 317\\nPainful: Euphr., Sabi., Thuja.\\neven when free from contact: Sabi.\\nPainless: Lyco.\\nPain in bones or bone pains, with: Pho. ac.\\nSore; Euphr., Sabi., Thuja.\\nwhen touched: Euphr., Thuja.\\nStinging: Thuja.\\nStitches in: Euphr.\\nespecially when walking: Euphr.\\nIchthyosis.\\nIchthyosis is a chronic disease of the skin, in which the\\nepidermis is developed in excessive accumulations, usually\\naccompanied by more or less hypertrophy of the papillae,\\npresenting a dry, harsh, and scaly surface, whence\\nits name, and arising from a congenital or hereditary pre-\\ndisposition in the patient.\\nThis disease is usually divided into two forms, ac-\\ncording to the degree of development.\\nThe mild form, called simplex, is more frequently\\nfound, and varies from a very mild xerodermatous to a\\ndecidedly scaly condition of the skin.\\nThe severe form, called hystrix, shows its most ad-\\nvanced stage, with the papillae enlarged and the cones\\nbetweefi extended and capped with horny excrescences of\\nvarious sizes and shapes.\\nWhile the characteristics of this disease are marked,\\nparticularly the objective symptoms, the subjective\\nsymptoms are almost entirely lacking.\\nIchthyosis Simplex.\\nIn this, the mild form, the skin of a new born infant is\\nfree from any apparent symptoms. It is usually not\\nuntil after the lapse of a few weeks or months, and some-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0337.jp2"}, "336": {"fulltext": "318 SKIN DISEASES.\\ntimes years, that the disease is sujSiciently advanced to\\nattract attention, when there is first noticed a dry, rough\\ncondition of the skin; its color, however, remains un-\\naffected. The skin may be generally involved, or the\\naffection may be confined to certain localities, such as\\nthe extensor surfaces of the limbs, and afterward extend\\nover the whole surface of the body. By gradual devel-\\nopment, the epidermis becomes slightlj^ thickened, and\\nthe natural lines of the skin begin to deepen, and those\\nbecome apparent which ordinarily can not be seen. In\\nits further development the epidemic scales become larger\\nand more abundant. The scales enlarge in area and\\nthickness, their outline being limited and conforming to\\nthe natural lines and furrows of the skin, and form plates\\nof various shapes; those on the extensor surfaces of the\\nextremities are the largest and resemble the scales of a\\nfish. The well-developed scales are detached about their\\nedges, but are quite firmly attached in their centres, and\\ncan be removed with little difficulty without abrading the\\nsurface of the papillae beneath, and blood following, as is\\nthe case in psoriasis. When the scales are thin and the\\nskin kept clean, they present a white or pearly appear-\\nance. When more developed and thickened, this color is\\ndeepened, shading from yellowish to darkish-green or\\neven brown or blackish. This is due partly to pigmen-\\ntary deposits in the plates, but mainly to accumulations\\nand incorporations of extraneous matter not removable\\nby washing. Fissures or cracks are formed on the sur-\\nface where it is thickest and most unyielding; but they\\nextend only through the upper layer of the skin, and re-\\nmain dry, thus differing from those found in eczema,\\nwhich extend deeper, giving exit to a serous discharge\\nwhich dries into crusts. The anidrotic or dryish state\\nof the skin, so markedly shown here, is probably due to", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0338.jp2"}, "337": {"fulltext": "ICHTHYOSIS HYSTRIX. 319\\na sparse and defective development of the sweat glands\\nand follicles and to their functional inactivity in the\\nparts affected; the unaffected parts remaining in the\\nnormal state.\\nIchthyosis Hystrix.\\nThis form is the more severe and rare manifestation of\\nthe disease, and presents a variety of developments. It\\nis characterized by the excessive growth and accumula-\\ntion of epidermis in the form of thick, irregularl}^ shaped,\\nvariously colored, horny masses, which admit of being\\ndetached, exposing a dr}^ and rough surface; or by more\\nmarked hypertrophied papillary growths which are sur-\\nmounted by variously sized and shaped horny projections.\\nIn some instances they take the semblance of the\\nquills of the porcupine; hence the name, hystrix. Its\\ndistribution may extend irregularly over various parts of\\nthe body, or may be localized in one or more well-defined\\npatches, as, for instance, about the axillary folds, the\\nknees, elbows, neck, or other regions. This form is also\\nof gradual growth, is the most advanced, and its degree\\nof development increases with age.\\nThe eruption is particularly severe and annojdng in\\nwinter, and sometimes diminishes in summer, recurring\\nagain the succeeding winter.\\nCourse. The disease is progressive as age increases,\\nuntil the climax is reached, usually at adult age, where-\\nafter there is little change. A spontaneous cure has\\nrarely, if ever, occurred. The two varieties of the\\ndisease may occur together.\\nDiagnosis. Ichthyosis is so distinctly characterized as\\nto render its diagnosis eas}^ and certain. In its mild form\\nit is to be differentiated from xeroderma, meaning dry\\nskin, which properly refers to a condition not ichthyotic", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0339.jp2"}, "338": {"fulltext": "320 SKIN DISEASES.\\nin origin; from eczema, by the absence of pruritus; and\\nfrom all other inflammatory disorders which tend to\\ndesquamation, by the absence of previous inflammation.\\nPrognosis. The simplex form may often be amelior-\\nated; but the hystrix form is rarely, if ever, more than\\ntemporarily improved. The general health is apparently\\nunimpaired in either case; and there are instances where\\nthe mild form has decreased in development with\\nincreasing years; but it is a question if the disease once\\ndeveloped ever disappears or is cured radically.\\nEtiology. Ichthyosis is an hereditary affection, and\\nusually transmitted in the line of sex; but there are\\nman}^ exceptions to this rule, and numerous instances of\\nthe crossing of the sex. It is common to find several\\ninstances in the same family.\\nTreatment. This disease is seldom, if ever, radically\\ncured, but the condition of the patient can be consider-\\nably bettered. The general health is apparently\\nunaffected. The treatment should be directed to the\\nrelief of the symptoms present. The anidrotic condition\\nof the skin may be improved by the employment of such\\nagents as will increase the sweat-secretion. For this\\npurpose the old school recommend jaborandi, in the form\\nof fluid extract, taken daily, in drachm-dOvSes, and they\\nclaim that in some instances it has prompt effect, and at\\nthe same time loosening of the epidermic scales occur.\\nThe wet-pack has also been advantageously employed, or\\nfrequent washing and alkaline or other baths may be\\nsubstituted with success for this purpose. After the\\nremoval of the epidermic accumulations, the newly\\nexposed epidermis should be kept as soft and pliable as\\npossible, by inunctions of some bland oil, to prevent a\\nreturn to its former condition. Such treatment will\\nafford relief, more or less permanent.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0340.jp2"}, "339": {"fulltext": "ICHTHYOSIS HYSTRIX. 321\\nA generous diet should be allowed the patient.\\nAn infusion of quillaya saponaris bark sometimes works\\nwell as a local fomentation.\\nInternal homoeopathic remedies are:\\nArsen. iod. Dry scaly skin itching and burning\\nin scrofulous subjects with swelling of the lymphatic\\nglands.\\nClematis. When there are fine scales wnth some itch-\\ning, worse when getting warm in bed; painful swelling\\nand induration of the glands. Eruption changes charac-\\nter with the changes of the moon.\\nGraphites. Skin dry and inclined to crack; unhealthy\\nskin; every injury tends to ulceration; thick and crippled\\ntoe nails; extremities go to sleep; itching of the genitals.\\nIodine. The skin has a brown dingy color; ravenous\\nhunger; swelling and distension of the abdomen; emacia-\\ntion in dark-complexioned, scrofulous children.\\nMercurius. Dirty, yellow color of the skin; itching,\\nworse at night when warm in bed; dry, scaly spots; in\\nsyphilitic and scrofulous subjects.\\nNatrum carb. Skin of the whole body becomes dry,\\nrough and cracked here and there; frequent empty or\\nsour eructations; great prostration.\\nPhosphorus. Skin is dry and wrinkled; skin of hands\\nis rough and dry; pains in the chest; desire for acids and\\nspicy foods; falling of the hair; great indisposition; in\\ntall, slender people.\\nPotassium iodide. Skin dried up; rough, like hog skin;\\nsensitive swelling of the thyroid gland; oedematous in-\\nfiltration of the tissues; after mercury or syphilis.\\nPlumbum. Dry skin; absolute lack of perspiration;\\nobstinate constipation; paralytic weakness of the limbs.\\nThuja. Dirty, gray, cadaverous looking skin. Wart-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0341.jp2"}, "340": {"fulltext": "322 SKIN DISEASES.\\nshaped excrescences; brittle or soft nails; lymphatic\\ntemperament.\\nHypertrophic Diseases of the Corium.\\nUnder this head are included all those diseases in which\\nthe fibrous tissue of the skin is in excess, and in which\\nthe disease extends to or involves the subjacent cellular\\ntissue. These may be termed Jibro- cellular hyperplasicE\\nThey are: Morphoea; scleroderma; keloid; fibroma; bue-\\nnemia tropica; and dermatolysis.\\nMorphoea.\\nMorphoea, formerly called Addison s keloid, is a chronic\\ncutaneous affection, characterized by the appearance of\\none or more discrete spots or patches, usually isolated and\\nroundish in form, pinkish in color, and slightly elevated\\nwhen hypersemic and hypertrophic, surrounded by a\\ntinted or violaceous border, later becoming whitish,\\nanaemic, atrophic, and slightly depressed; and upon\\ntheir surface, in the early stage, may be seen small\\nstreaks of dilated blood-vessels.\\nForms. This rather infrequent affection assumes\\nvarious definite forms, according as the character of its\\ndevelopment is mainly hypertrophic or atrophic.\\nPatches of the first form, which are mainly hyper-\\ntrophic, enlarge until they are of the size of small or\\nlarge coins, and are roundish in outline; after a prelimi-\\nnary hypersemic stage, they gradually assume a lardaceous\\nappearance, and later on show a distinct atrophic aspect.\\nLesions of the second form, which is mainly atrophic,\\nmanifest little or no tendency to hyperplasia, and occur\\nin small, pit-like, or slightly depressed, cicatriform or\\ntelangiectasia, isolated or grouped spots or steaks, form-\\ning 7no,culcB et striiE atrophicce.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0342.jp2"}, "341": {"fulltext": "MORPHCEA. 323\\nSymptoms. A typical case of morphoea usually\\nmakes its appearance by the formation of one or more\\nroundish, circumscribed, hyperaemic, slightly elevated\\nmacules or patches, varying in diameter from one-quarter\\nto a couple of inches; the centre gradually whitens, and\\nis bordered by a tinted circle of violaceous or pinkish hue,\\ncomposed of dilated capillaries, and often there is to be seen\\na plexus of small blood-vessels extending upon the surface\\nof the lesion. The hyperaemia of the patch is soon suc-\\nceeded by an anaemic state, which may be sometimes so\\ndecided as to cause a slight depression of the surface.\\nThe patch, from this time, undergoes a gradual change\\nuntil it presents the characteristic smooth, lardaceous ap-\\npearance, resembling inlaid wax, or old ivory. The con-\\nnective tissue of the skin is increased and becomes con-\\ndensed. The activity of its process of development\\nbecomes lessened during this stage of the disease and\\nenters on a chronic course. The skin of the patch may\\nbe soft, or quite firm and inelastic.\\nIn its further progress the affection may manifest\\natrophic changes in the tissues as well as of the glands\\nand vessels of the affected skin, resulting in contraction\\nand also depression of its surface, together with a lessen-\\ning or cessation of the secretions of the sweat and\\nsebaceous glands; and the skin feels stretched and\\nthinned. These later changes may extend over a\\nperiod of years and become permanent, or the affection,\\nbefore it has become decidedly atrophic, sometimes dis-\\nplays its tendency to recovery by the disappearance of\\nthe lesion.\\nThe distribution of the lesions is asymmetrical, and\\nhas been found upon various regions of the body, as upon\\nthe face, chest, back, buttocks, arms, and thighs. The\\nshape of the patches, even in individual cases, is", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0343.jp2"}, "342": {"fulltext": "324 SKIN DISEASES.\\nirregular, and varies, being round or elongated, but\\nusually roundish.\\nIn its early stage, morphoea develops usually without\\nany or with but slight attending subjective symptoms;\\nlater there may be more or less anaesthesia.\\nDiagnosis. In its advanced stage, morphoea is so\\ncharacterized that its diagnosis is readily made. Some-\\ntimes, however, it is so very like scleroderma that it is\\ndifficult to differentiate between them.\\nIn scleroderma the patches are usually symmetrically\\ndistributed, and the affected skin is hide-bound, or can\\nnot be lifted up into a fold by the fingers, and feels hard.\\nIn morphoea the patches are asymmetrically distributed,\\nand the affected skin feels soft or firm.\\nIn scleroderma the patches are not circumscribed, but\\nshow a tendency to spread over a large surface, and at\\ntheir border merge indistinctly and gradually into the\\nsurrounding skin. In morphoea the patches are often\\ndistinctly circumscribed, and confined to a limited area;\\nand in their earlj^ stage are surrounded with a tinted\\nborder of pinkish or lilac hue, or the surrounding healthy\\nskin is more or less pigmented.\\nWhen the pigmentless spots in vitiligo resemble the\\nwhitish spots of morphoea, it is only to be remembered that\\nthe former is due simply to the absence of pigment, while\\nthe latter is caused by an abnormal state of structure, and\\nof vascular supply.\\nPatches of morphoea sometimes present appearances\\nvery similar to those of anaesthetic leprosy. The ob-\\njective and subjective symptoms in the progress of these\\ndiseases are so different as to render the diagnosis be-\\ntween them certain.\\nPrognosis. The prognosis of the disease is, to a cer-\\ntain extent, favorable, but depends largely on the degree", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0344.jp2"}, "343": {"fulltext": "SCLERODERMA. 325\\nof development, particularly if it has not yet become\\natrophic. In this latter condition the lesions are lasting;\\nbut in its earlier stage, and especially when there is only\\nmoderate hypertrophic change in the connective tissue,\\nthere is a tendency to spontaneous disappearance.\\nIts course of development, when mainly hypertrophic,\\nis quite short, as compared with the period elapsed dur-\\ning the atrophic stage, which is usually slow and chronic,\\nextending over several years.\\nEtiology. The cause of this disease is yet to be de-\\ntermined. From what is known concerning the func-\\ntional disturbances and trophic changes that occur in the\\ndevelopment of its lesions, and their appearances in the\\nhypertrophic and atrophic stages, the disease is thought\\nto be due to some disorder of the nervous system, and\\nprobably of tropho-neurotic nature. Its occurrence has\\nbeen noted mostly in females, and is at times attended\\nwith symptoms of more or less nervous debility. Sclero-\\nderma, in some essential respects, resembles morphoea,\\nand inferentially is very likely of a similar origin.\\nIndeed, some view morphcea as merely a localized form of\\nscleroderma.\\nTreatment. In the treatment of this disease, locally,\\nsome mild stimulant may be applied, as a mercurial\\npreparation, and electricity to promote resolution.\\nPhosphorated oil inunctions are beneficial. The patient\\nshould be well-fed, and have a daily allowance of either\\ncod-liver or chaulmoogra oil.\\nPhosphorus is the principal internal remedy.\\nScleroderma.\\nScleroderma is a chronic circumscribed affection of the\\nskin, appearing on almost any part of the body, having\\nI been observed on the face, neck, upper and lower", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0345.jp2"}, "344": {"fulltext": "326 SKIN DISEASES.\\nextremities and elsewhere. It commences with slowly-\\nforming infiltration, apparently permeating the entire\\nthickness of the skin, with slight elevation of the affected\\narea. The color is slightly heightened, with a brownish\\nred tint. At the same time the integument becomes\\nmatted to the underlying connective tissue and fasciae,\\nand so tightly bound down to them that no motion of the\\nskin over them is possible, resembling scleriasis in this\\nrespect. This condition remains for a varying period,\\nwith constant tendency to spread, usually in the form of\\na band. Thus, when it commences on one of the lower\\nextremities, for instance, it slowly progresses upward,\\ninvolving a breadth of integument equally perhaps one-\\nfourth or one- third of the circumference of the limb.\\nAfter a time the other limb, or one of the arms, may\\nbecome involved. As the disease progresses, however,\\nthe parts first involved undergo a change. The infiltra-\\ntion subsides, and gradually reveals the fact that the\\nnormal connective tissue of the skin has in part dis-\\nappeared. In other words, marked atrophy is manifest.\\nThe skin, however, has not loosened its hold on the\\nunderlying tissues, and still remains as firmly bound\\ndown to them as ever.\\nThe affection is accompanied with very little pain or\\nother local inconvenience, except so far as it interferes\\nwith the free action of the joints and muscles.\\nThe diagnosis of scleroderma is not difificult, as the\\nhide-bound condition above described is met with in but\\none other affection, namely, scleriasis. The history of\\nthe invasion and the course of the affection should be\\nsufficient to enable it to be distinguished from Morphoea.\\nThe prognosis of scleroderma varies. In some cases it\\nmay continue for many years without apparently com-\\npromising the general health, while in others its progress", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0346.jp2"}, "345": {"fulltext": "SCLERIASIS. 327\\nmay be more rapid, and possibly be the exciting cause of\\nvisceral troubles that ultimately prove fatal.\\nTreatment. There are no drugs known to the old\\nschool which, given internally or applied externally,\\ninfluence the progress of the disease in the slightest\\ndegree.\\nFrictions, massage, and the constant galvanic current,\\nhowever, will sometimes result in very marked improve-\\nment in the condition of the affected parts.\\nAntini. crud.^ Alumina, Berberis, Causticuin, Mer-\\ncurius, Pulsatilla, Rhus tox., and Sulphu? may often be\\nof service.\\nScleriasis.\\nScleriasisis an acute affection of the skin, characterized\\nby the sudden development of a curious scleroid condition\\nover an extensive surface. In a few days the greater\\npart of the integument of the chest, abdomen, or back\\nma3^ without change of color or any inflammatory symp-\\ntoms, become rigid and firmly bound down to the tissues\\nbeneath. It appears to have absolutely lOvSt its elasticity,\\nand to be so firmly attached that it is as impossible to\\nraise or pinch it up in folds as it would be to pinch up\\npaint or varnish from a board.\\nThis condition ma}^ exist in varying extent and of\\nvarying degrees of severity for several weeks, when a\\ngradual return to the normal may ensue.\\nThe prognosis is good, as the cases usually recover.\\nThe etiology is obscure, but the affection is probably\\nof rheumatic origin.\\nTreatment. Little need be done in the way of special\\ntreatment, but proper attention should be given to the\\ncorrection of any marked impairment of the general\\nhealth. Turkish baths and massage, with or without", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0347.jp2"}, "346": {"fulltext": "328 SKIN DISEASES.\\nelectricity, appear to shorten the course of the affection.\\nAs internal remedies Hydrocotyle, Phos. and Stillingia\\nmay be thought of.\\nSclerema Neonatorum.\\nThis is an affection of the skin met with in new-born\\ninfants, in which the greater part of the integument may\\nbecome rapidly involved in a process which results in a\\ngenerahzed hide-bound condition, which interferes with\\nmotion of the limbs, and even restricts the action of the\\nthoracic muscles. A fatal termination is usually to be\\nlooked for in a few days.\\nThe nature of the disease is obscure in fact, its exact\\netiolog}^ is unknown; but its general features point to a\\nclose relationship to the affection described as scleriasis,\\nas met with in adults the better prognosis in this latter\\ndisease being due to the greater resisting powers of the\\nadult.\\nTreatment, other than sustaining, appears to be of lit-\\ntle avail.\\nKeloid.\\nKeloid is characterized by the growth upon the skin of\\none or more rounded or oval, flat, smooth-surfaced\\ntumors of varying size, from the margins of which irreg-\\nular projections are frequently met with.\\nThe development and progress of the affection is\\nchronic, and is attended with but little pain or other in-\\nconvenience. The color of the skin is in some cases little\\nchanged, while in others it becomes paler and even com-\\npletely blanched, like that of ordinary scar tissue.\\n,The affection is said to arise spontaneously, and at\\nother times at the site of some traumatism or wound of\\nthe skin; and the terms true and false keloid have", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0348.jp2"}, "347": {"fulltext": "KELOID. 329\\nbeen applied to these two forms, which are to be distin-\\nguished only by their etiolog3^\\nVidal reports the case of a 53 year old man in whom\\na keloid, nine centimetres long, three centimetres wide\\nand one centimetre high, developed spontaneously in the\\nsternal region. He did not have syphilis and no discov-\\nerable cause could be found. At first it increased in\\nsize, but slowly; since 1878, however, it grew more\\nrapidly and became painful. A second keloid has lately\\ndeveloped in the flexure of the right elbow, also without\\nvisible cause.\\nWe know, however, that keloid may arise from even\\nthe minutest wounding of the skin, as from the prick of\\na pin or lancet point.\\nAmicus reports the case of a young nervous woman\\nwho, from childhood, suffered from nervous symptoms.\\nOne year before coming under his observation she was\\nattacked with a symmetrical eruption on the trunk and\\nlower extremities, showing 318 keloids, the size of millet\\nseeds. The lymphatics were normal; the urine showed\\nnothing wrong. During her sojourn in the hospital she\\nhad several convulsions, retention of urine, etc. These\\nso-called keloids were small pinkish elevations on the\\nskin, which might be mistaken for sarcomata. No\\ntrauma preceded the trouble.\\nMr. Hutchinson mentions some rare forms of keloid,\\nin which he details several interesting cases, with the fol-\\nlowing conclusions:\\n1. That with keloid, as with other skin diseases, we\\nmust not expect too close a conformity to the type form.\\n2. That for clinical convenience, we may recognize\\nseveral varieties of keloid, the prognosis as to sponta-\\n,neous disappearance and proneness to return after ex-\\n1 cision differing much in each.\\n22", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0349.jp2"}, "348": {"fulltext": "330 SKIN DISEASES.\\n3. That the first and most typical is that in which\\nkeloid begins in very small, perhaps forgotten, scars, and\\nslowly spreads far beyond their limits into sound skin.\\nIn most cases, the extension and duration are indefinite;\\nand the hardness, glossiness, abruptness of outline, etc.\\nare always well marked. The proneness to recur very\\nquick! 3^ after excision is very great in these.\\n4. That in the second group, in which keloid growth\\nbegins in the middle of large scars, such as those of\\nburns, it is seldom so well characterized. It often does\\nnot extend beyond the scar, and often, especially in\\nyoung persons, soon begins to soften again, and to grad-\\nually disappear.\\n5. That in a third form the keloid growth is deeper,\\nnever produces the glossy, superficial, elevated, and\\nspurred patches which occur in the others. These cases\\nare very slow, and show but little tendency to spontan-\\nneous disappearance. They do not develop in connection\\nwith large scars, but rather with inflammatory damage\\nto the skin. They are less prone than the others to\\nrecur after excision.\\n6. That although definite scars almost invariably pre-\\ncede the formation of keloid, yet that there are allied\\nconditions which result rather from inflammation after\\ninjury, than from anything which is demonstrable as\\ncicatrix.\\n7. That the cases of multiple keloid prove either that\\nthere is in some persons a remarkable tendency to the\\ndisease, or that primary patches have the power of in-\\nfecting the blood and producing others.\\n8. That there is little or no clinical proof of tendency\\non the part of keloid to pass into cancer.\\nThe etiology of keloid is unknown, and we can only say\\nthat some individuals possess a certain peculiarity or", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0350.jp2"}, "349": {"fulltext": "FIBROMA. 331\\nidiosyncracy that leads to the development of this curious\\naffection.\\nTreatment. Excision, cauterization, potential caus-\\ntics, whether alkaline or acid, when of suflSicient power\\nto rapidly destroy the tumor, are almost invariably fol-\\nlowed by relapse and often in an aggravated form. Re-\\nlief sometimes follows scarifications followed by the\\napplication of acetic acid. The operation should be per-\\nformed a number of times, according to the size, etc., of\\nthe tumor. In cases of excessive keloidal growth, ex-\\ncision may be employed as a means of temporary relief.\\nSeveral cases are recorded where electricity has been\\nemployed with excellent results.\\nFluoric acid is the principal internal remedy, and the\\nnext is Graphites. Nitric acid and Sabina are occasionally\\nindicated.\\nDr. Neatly reports a number of cases as cured by the\\npersistent use of Silicea for a few months.\\nFibroma.\\nThis name is applied to tumors of varied size and form,\\nwhich take their origin from the dermal or sub-dermal\\ntissues, which are single or multiple, and vary in size\\nfrom a small nodule to a tumor of many pounds weight.\\nThese tumors may be sessile or pedunculated.\\nThe affection is chronic, taking years for its complete\\ndevelopment, but the growths are usually painless, and\\ngive little or no inconvenience, except such as may arise\\nfrom their size or particular location.\\nThe causes of fibroma are unknown, but they are of\\nperhaps more frequent occurrence in mulattoes than in\\neither the pure white or black races.\\nDiagnosis. Fibromata are to be distinguished from\\nsarcomata and neuromata, and this may be readily done", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0351.jp2"}, "350": {"fulltext": "332 SKIN DISEASES.\\nwhen we remember that the former are of more rapid\\ngrowth, and exhibit changes in the color and texture of\\nthe skin, which in fibroma are unaffected. Neuromata\\nare usually painful. The diagnosis must be made in the\\nearly stage from sebaceous cysts; in the case of cysts,\\nthe origin from a flat gland, the central aperture or en-\\ntrance to it, and the fatty contents which can be squeezed\\nout, determine the nature of the disease. The hard con-\\ntractile sessile outgrowths of keloid could not well be\\nmistaken for the lax, flabby, pedunculated tumors of\\nfibroma, which have the aspect of normal integument.\\nTreatment. Piffard says: Excision is the only\\npracticable method of treatment, and this is to be recom-\\nmended only when the tumors are few in number, or\\nwhen their situation demands it.\\nFox says the treatment is simple: When small,\\nfibromata may be removed. In elderly men they are\\nsometimes small, flat, and numerous especially about\\nthe back, over the shoulders, and on the chest. I have\\nnever had the least trouble in getting rid of them all by\\nthe use of acid nitrate of mercury caustic to the smaller,\\nand the joint use of that remedy and the ligature to the\\nlarger ones. I generally, after applying the acid, give\\nan oxide of zinc paste to be used, to prevent too much\\nirritation.\\nThe Arsenzte of calcarea and Lycopodium are the princi-\\npal internal remedies.\\nThere is yet another form of fibrous hypertrophy, in\\nwhich greater laxity of tissue is observed. It is called\\nDermatolysis.\\nIn this affection the skin hangs in loose folds. Its\\nfibro-cellular element is greatly increased. The affection\\nreally includes all pendulous conditions, from obesity,", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0352.jp2"}, "351": {"fulltext": "ELEPHANTIASIS. 333\\nparturition, the state of skin in lax and enlarged mammse,\\nand the like. In the uncomplicated form of disease, the\\nhypertrophic growth arranges itself in layers like the\\nfolds of a tippet; there is little vascularity; the sensibility\\nof the past is diminished.\\nElephantiasis.\\nThis affection is characterized by great hypertrophy\\nof the integument of either the leg or scrotum in men, or\\nleg or labia in women, or both locations may be involved\\nat the same time. It occurs frequently in tropical coun-\\ntries, but rarely in northern climes.\\nIn the development of this disease general symptoms\\nprecede the local ones, and the first indications are\\nusually a sharp, febrile attack, in no way distinguishable\\nat the beginning from an ordinary severe paludal fever.\\nIn a few days, however, pain in the groin, with swelling of\\nthe lymphatics, is noticed, and this in turn is followed by\\nmore or less oedema of the foot and leg. After the subsi-\\ndence of the febrile attack the oedema of the limb abates, but\\ndoes not as a rule wholly subside. After a varying and\\nuncertain interval a second febrile attack occurs, with re-\\nnewed sw^elling of the limb, which but partially subsides,\\nleaving the part still a little larger than before. These at-\\ntacks succeed each other irregularly several years, until\\nfinally the leg or other part affected may attain an enor-\\nmous size.\\nElephantiasis is unquestionably due to obstruction of\\nthe lymphatic circulation; and this in turn has been\\nmost conclusively proved in many cases to be due to the\\npresence of a minute worm, the filaria sanguinis, which\\nlodges and excites inflammation in the lymphatic glands\\nand produces occlusion of the vessels. The febrile\\nattacks, which occur with a certain periodicity, may be", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0353.jp2"}, "352": {"fulltext": "334 SKIN DISEASES.\\ndue to the development of fresh broods oi filaria. This\\nparasite, however, is not met with in the higher latitudes,\\nin which cases of the disease are sometimes encountered;\\nand hence these latter need some other reasonable ex-\\nplanation, which we regret to say is not forthcoming.\\nIt is supposed by some that the mosquito plays an im-\\nportant part in the development and transportation of\\nthe undeveloped filarise.\\nElephantiasis is always a grave disease, and may last a\\nlife time.\\nTreatment. A milk diet is the best for the elephan-\\ntiasis patient, and if it is a possible thing a change of\\nclimate should be made.\\nI can not recommend Esmarch s bandage, neither\\namputation, as I have never seen any benefit from either\\nexpedient.\\nRelief, and occasionally beneficial results, come from\\nthe use of hamamelis or chaulmoogra oil dressings.\\nMyristica sebifera is the main internal remedy. Hy-\\ndrocotyle Asiatica^ has been recommended, as have also\\nAnacardium orientale and Elceis guineensis.\\nMilium.\\nThis name is given to an affection characterized by the\\nappearance of minute white or pearly papules.\\nThese little papules are usually clustered about the\\neyes, sometimes on the upper and the lower lids, and\\noften on tbe cheeks just below the eyes. They cor-\\nrespond to sebaceous glands, of which the orifices have in\\nsome manner become occluded, thus allowing an accu-\\nmulation of sebum. They are much more frequently\\nmet with in women than in men.\\nTreatment. Milia are readily removed by dividing\\nthe thin skin that retains them with a sharp curved", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0354.jp2"}, "353": {"fulltext": "MAMMILLITIS MALIGNA. 335\\nneedle ground flat on the curve. A little pressure is\\nexerted, and the tiny white sebous concretion rolls out.\\nThe Calcium iod. is the principal remed}^ and the next\\nStaphysagria. Tabaciim may be thought of.\\nMammillitis Maligna.\\nUnder this designation we embrace the peculiar and\\nrare disease of the nipple and areola, commonly known as\\nPaget s disease of the nipple.\\nDr. James Paget was the first to describe this disease,\\nand he states that he had seen some fifteen cases, all oc-\\ncurring in women between the ages of forty and sixty.\\nThe affection commences as a red, almost raw inflamma-\\ntory condition, confined to the mammilla and surround-\\ning areola; the surface being somewhat granular, and\\nlooking not unlike an ordinary eczema rubrum from\\nwhich the epithelium had exfoliated, and accompanied\\nwith a very similar exudation, with some tingling, burn-\\ning, and itching. In other words, it presented the ordi-\\nnary appearances of a common eczema, except that,\\nwhen taken between the fingers, there was a firmness of\\nthe tissues, approaching the condition of induration, that\\nis never met with in eczema proper.\\nThe chief peculiarities of this disease, however, are the\\nfacts that, first, it is exceedingly rebellious to treatment,\\nobstinately refusing to heal under the simple measures\\nthat would suffice in ordinary eczema; and, second, that\\nthe disease in question proves to be a forerunner of car-\\ncinoma.\\nIt is on this fact that the real importance of the disease\\ndepends, as in the beginning it gives rise to very little\\nlocal or other inconvenience.\\nTreatment. If the diagnosis is firmly established,\\nextirpation, either by the knife or caustic, is the only", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0355.jp2"}, "354": {"fulltext": "336 SKIN DISEASES.\\nmeans of treatment that promises any success, as sooth-\\ning remedies do not check its progress, while those of a\\nstimulating nature simply aggravate the lesion.\\nI am unable to recommend any homoeopathic remedy\\nas having had any influence upon the disease. Kali\\nmur. and Silicea might be tried, given in alternation.\\nAinhum.\\nThis disease consists of spontaneous amputation of\\nthe little toes, with hypertrophy of the amputated part.\\nThe name means to saw. The disease is said to exist\\namongst the Africans.\\nA small semi-circular furrow first appears in the digito-\\nplantar fold, which gradually increases, without pain or\\ninflammation, the toe enlarging, and getting loose and in\\nthe way. If the toe is cut off, the wound left heals very\\nspeedily. The cause is unknown. The general health\\ndoes not suffer. The disease is symmetrical. The am-\\nputated toe shows fatty change of the tissues, enlarge-\\nment of the areolar spaces of some of the bones of the\\nphalanges, the bone tissue between the middle and\\nproximal phalanges being replaced by fibrous tissue, the\\nseparation of the toe taking place at the proximal,\\ninter-phalangeal joint, and not the metatarsal phalangeal\\njoint; the cartilage and articular end of the middle\\nphalanx being removed and replaced by fibrous tissue^\\nwhich looks like an ordinary cicatrix.\\nNsevus.\\nThese spots are congenital; and they are not only\\nhardly ever amenable to surgical treatment, but have\\nin many cases been rendered much worse by such inju-\\ndicious treatment. Some remarkable nsevi reproduce\\nupon the skin of the child while yet unborn the vivid", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0356.jp2"}, "355": {"fulltext": "N^vus. 337\\nimpression made upon the mind of the mother. An-\\nother and more profound influence of the same kind, or\\none exerted in an earlier stage of pregnane}^, results in\\nactual deformities and monstrosities.\\nNcBvi materni may be arranged in three distinct classes,\\nin the order of their gravity.\\n1. Moles, the most common of all, whose character\\nand harmlessness are well known, and which are gener-\\nally attributed to some alteration in the structure of the\\nrete raucosum.\\n2. Venous Aneurisms Anastomosis of Venous CapiU\\nlaries. These form a dark-red circumscribed stain,\\nwhich generally appears on one side of the face, and is\\nsometimes of considerable extent. These marks,\\nwhich appear to be simple dilatations of the sub-cuticular\\ncapillary vessels, may increase in extent till puberty, and\\nthen remain stationary.\\n3. A?ieurisms and Dilatations of the Arterial Capil-\\nlaries These form the most important of the naevi; they\\nare apt to enlarge in after-life, especially when stimulated\\nby external irritation, and they may give rise to danger-\\nous hemorrhage if improperl}^ meddled with. They form\\nslightly elevated spots, with well-defined margin and a\\ngranular surface, which consists of an erectile vascular\\ntissue. These granulated tumors, raised above the skin,\\nmay in fact be constituted of venous or of arterial vessels.\\nIn the former case they may be of a dark-blue or livid\\ncolor; in the latter, of a brighter red.\\nTreatment. Mr. Thomas reports three cases treated\\nb}^ collodion. The nsevi were covered, together with the\\nsurrounding skin, with collodion, which was repeatedly\\napplied. Improvement was so marked as to do away with\\nthe necessity for operative interference.\\nDr. Mayor publishes an interesting case of a nsevus of", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0357.jp2"}, "356": {"fulltext": "338 SKIN DISEASES.\\nthe cutaneo-subcutaneous variety, on the back, in a girl\\naged ten months, where he successfully tried electrolysis.\\nThe number of sittings was two, and the duration of each\\nabout two minutes. On examination of the patient,\\nnearly four years later, not a trace of the naevus was\\ndetected.\\nDr. Marshall, from an experience of many years,\\nrecommends the electrolytic treatment of naevi as superior\\nto every other. After criticising the methods in vogue,\\nhe claims for electrolysis: That it gives no after-pain;\\nthat it is free from danger; that there is no bleeding;\\nthat the resulting scar is white and shows no tendency to\\ncontract a point not to be forgotten since nsevi are so\\ncommon about the head and face. This method is slow,\\nthe disappearance being gradual. One or more needles\\nare used according to the size of the growth, and they\\nare moved about to attack the various portions without\\nwithdrawing them. It is well, at first, to work well\\naway from the surface to avoid destroying the same. The\\nscars left by the negative needles are apt to be brown and\\ndisfiguring and hence the positive pole is to be preferred,\\nbeing slower in its action, less apt to cause sloughing or\\nto be followed by bleeding after withdrawal of the needle,\\nA rheophore attached to the negative pole completes the\\ncircuit, a second puncture being thus avoided. As re-\\ngards the number of cells, ten are usually sufiicient,\\nalthough in deep nsevi as many as twenty have been\\nused. A change in color to a dusky hue is the indica-\\ntion to stop the current. To withdraw the needle it\\nshould be first rotated and the orifice can be painted with\\ncollodion.\\nThe following remedies should be carefully studied, in\\norder to find the simile in each case: This being found, it\\nshould be given sufficiently high and at long intervals, in", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0358.jp2"}, "357": {"fulltext": "N^vus. 339\\norder to remove as rapidly as possible from the system\\nthe morbid condition which sustains these irregularities\\nof the circulation, and to enable nature to remedy the\\ndeficiency in structural organization from which perhaps\\nthey originally sprung.\\nIf the arterial capillaries are involved:\\nBellad. will be indicated by red radii extending from\\nthe centre.\\nCalc. carb. In leucophlegmatic temperaments.\\nLycopod. In hypertrophied capillary tumors, both\\nvenous and arterial.\\nIf the venous capillaries are hivolved\\nCarbo veg. Particularly when the slightest irritation\\ncauses free hemorrhage.\\nPhos. Small wounds bleed much; this may be either\\nvenous or arterial.\\nDr. Wilkinson reports a case of naevus on left labium\\nmajus, little girl aged six weeks, cured by application of\\nthuja 6 thrice daily for six weeks.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0359.jp2"}, "358": {"fulltext": "CHAPTER XIV.\\nNEW FORMATIONS, OR NEOPLASMATA.\\nNeoplasmata are essentially characterized by the for-\\nmation of new kinds of tissue in the skin. Neoplasms\\nare observed in many different diseases of the skin, and\\nunder a variety of circumstances, but those diseases only\\nare included in this chapter in which a neoplasm forms\\nthe entire disease. The new tissue in neoplasms has\\nbeen regarded as originating in, and therefore an hyper-\\ntrophy of, already existing elements; but it is certainly\\nnot a pure hypertrophy, and it is new in regard to its\\ncharacters and behavior. On this account it is impossi-\\nble to include the neoplasmata in any but a special\\ngroup.\\nLupus.\\nThere are three principal forms of this disease the\\nsuperficial variety, commonly spoken of as lupus erythe-\\nmatosus the deeper, or lupus vulgaris and the deeply\\ndestructive form, or lupus exedens.\\nThese three varieties present certain features in com-\\nmon, and their color is peculiar. It is neither the frank\\nred of an active congestion nor the brownish ham-color\\nof syphilis, but rather the vinous color that derives its\\nhue from chronic venous congestion; mingled with a\\ncertain amount of red. The lesions are few in number;\\noften but a single lesion may be present, but quite fre-\\nquently we may find two or three rarely more. Their\\ncourse is chronic, years being devoted to their develop-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0360.jp2"}, "359": {"fulltext": "LUPUS ERYTHEMATOSUS. 341\\nment. They almost always leave scars, even in the\\nabsence of ulceration. The local symptoms are insignifi-\\ncant, as there is rarely either pain or itching, at most a\\nslight burning sensation, to which the patient becomes\\nhabituated and ceases to notice. In the patient s family\\nhistory, pulmonary phthisis is an almost constant feature.\\nSeveral years ago Bazin and Hardy gave the name of\\nscrofidides to these affections, recognizing at that time\\ntheir dependence on the general constitutional condition\\nthat predisposes to tuberculosis. Quite recently, the\\nbacillus tuberculosis has been found to be a constant ac-\\ncompaniment of the lesions, thus demonstrating the\\nsoundness of the opinions advanced by the eminent der-\\nmatologists above mentioned.\\nLupus Erythematosus.\\nIn this variety the lesion commences as a reddish\\nmacule, barely elevated above the level of the surround-\\ning skin. As it slowly but gradually increases in size,\\nthe elevation slightly increases, and small, closely ad-\\nherent scales form upon the surface. The extension is\\nperipheral, and after many months, or perhaps years, may\\nattain the size of a coin. When it has reached a\\ndiameter of, say, one-half to three-quarters of an inch, the\\ncentral and older portions begin to lose their infiltrated\\ncharacter, sink to the level of and even beneath the level\\nof the skin, at the same time losing their color. This\\ncontinues until we find a white depressed scar, sur-\\nrounded by a still infiltrated raised reddened ring. Dur-\\ning the progress of the lesion as described, other similar\\nones may have appeared on neighboring or on distant\\nparts; but, as a rule, their number is limited. When\\ntwo patches have appeared in close proximity, the}^ may\\njoin by mutual peripheral extension. In this way the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0361.jp2"}, "360": {"fulltext": "342 SKIN DISEASES.\\ngreater portion of one side, or even both sides, of the\\nface may become involved by the disease. Such ex-\\ntensive invasion, however, is the result of years, as cases\\nare met with in which the lesions have been gradually\\nextending in this manner for twenty years or more, the\\nolder portions of the lesion undergoing the retrogressive\\nchanges we have noticed.\\nThe favorite seat of all varieties of lupus is the face,\\nalthough other parts may be attacked as well, and even\\nto the exclusion of the face.\\nEpithelioma may develop upon the site of a long-\\nexisting erythematous lupus, or in the neighborhood of\\nlupous lesions.\\nLupus Vulgaris.\\nL. vulgaris is characterized by the development of\\ntubercles within or projecting to a greater or less degree\\nabove the surface of the skin. It rarely appears as an\\nisolated tubercle, but more frequently in groups of six or\\na dozen tubercles, quite close to, but not touching one\\nanother, little bands of apparently healthy skin inter-\\nvening, thus forming a patch. As the disease progresses,\\nhowever, the tubercles may unite by mutual extension\\nand the entire patch present a lupous character. There\\nmay be one or more of these patches. The tubercles\\nthemselves are soft, sometimes almost jelly-like, in\\nappearance and consistence. The extension of the lesions\\nis slow, years intervening before the patches attain any\\nnotable size.\\nJust as in the erythematous variety, the lesions of\\nlupus vulgaris may undergo resolution, leaving a\\ndepressed cicatrix, or else they may ulcerate superficially.\\nThe ulcerative action is exceedingly slow, and appears to\\ninvolve only the upper portion of the derm more rarely", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0362.jp2"}, "361": {"fulltext": "LUPUS EXEDENS. 343\\nits entire thickness. The exudation from the surface of\\nthe ulcer is exceedingly scanty, and forms a crust\\nadhering somewhat closely to the sore. The scars that\\nresult are of a reticulate character, not unlike those\\nproduced by a severe burn, and naturally cause more or\\nless disfigurement. Lupus vulgaris, after ulceration\\ntakes place, may be succeeded by epithelioma at the\\nmargins of the ulcer.\\nLupus Exedens.\\nThis form of lupus was recognized by all the older\\nwriters; but those of recent times seem disposed to deny\\nit a place in nosology, or declare that the cases described\\nunder this name were not lupus at all, but were epithe-\\nliomata. This is not in accord with Dr. Piffard s\\nobservations, and he describes in this place a variety of\\nlupus characterized by the development of usually a\\nsingle good-sized soft tubercle. This slowly increases in\\nsize, until after a lapse of years, perhaps, ulceration sets\\nin, which extends both in width and depth, involving the\\ntissues beneath the skin. The margins of the ulcer are\\nuneven, ragged, and burrowed under. The edges,\\nhowever, are soft, not presenting any hardness or indura-\\ntion. After an indefinite period, however, at one or more\\npoints on the periphery of the ulcer hard nodules may\\nand usually do develop, and which can easily recognize\\nas unmistakable epithelioma. This epitheliomatous pro-\\ncess may extend until the greater part of the ulcer is\\ninvolved. The only contention concerning the nature of\\nthis disease is whether it is a true epithelioma from the\\nbeginning, or whether it is an epithelioma ingrafted on a\\nlupous basis. Whatever may be the true pathology of\\nthe disease, the practical outcome is the same, and this is", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0363.jp2"}, "362": {"fulltext": "344 SKIN DISEASES.\\nusually a fatal termination, unless the lesions be early\\nvigorously dealt with.\\nLupus may occur in the throat, and may make its\\nappearance at any time of life. It occurs in men oftener\\nthan in women. It may occur in any constitution but\\nseems to prefer the lymphatic temperament. Inheritance\\nhas nothing to do with it. Sometimes the mucous\\nmembrane assumes a purplish color, swells up and\\nbecomes granular and one or two of the granulations\\ndevelop so much as to reach the size of a pea, or even\\nthat of a hazel-nut. Occasionally, the tubercles become\\nprominent in the throat previous to alteration in the\\nmucous membrane, and without differing from its normal\\ncolor. They may be either superficial or deep. Their\\nsurface is smooth and brilliant, but if several of them\\nbecome intimately united they appear as a single mass,\\nrounded, cloven, and anfractuous. When the tubercles\\ndevelop exuberantly in the larynx, breathing becomes\\nembarrassed, and even stridulous. There is no alteration\\nin the sensitiveness of the affected parts. Finally, the\\ntubercles soften and become ulcerated. This melting\\ndown does not take place in a complete manner. In\\nsome cases, only the surface of the tumor becomes\\nfissured or excavated as a margin to simple excoriations.\\nIn others, the destructive process attacks a greater or\\nsmaller portion of the tubercle in its entire depth,\\nproducing ulcers which dip out of sight in the midst of\\nthe tissues. The cure of these cases is difficult and is\\nfollowed by indelible scars. In some cases, the ulcers are\\ndeveloped in a slow but fatal manner; in others, they\\nspread with astonishing rapidity; while in some others,\\nthey stop in the beginning, but how far their ravages may\\nextend it is impossible to predict.\\nInstead of appearing in its usual idiopathic form,", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0364.jp2"}, "363": {"fulltext": "LUPUS EXEDENS. 345\\nlupus, at times, develops subsequent to other skin lesions,\\nfor instance, a traumatism. In such cases it affects one\\nor more localities, but always where formerly an injury,\\nulceration or scar has been.\\nIf the disease attacks the fingers it can completely de-\\nstroy thern, but never the nails or the matrix. As the\\nfinger is shortened by the disease the nail maintains its\\nposition at the end of the stump, and may finally reach a\\nposition over the head of the metacarpal bone, where it\\nremains in apparently as healthy a condition as in its nor-\\nmal condition.\\nThe family history of the great majority of patients\\nsuffering from lupus reveals the important fact that\\nphthisis pulmonaris is met among the near relations to a\\nsurprising extent, and we are forced to the conclusion\\nthat the same constitutional condition that predisposes\\none subject to the invasion of tuberculosis of the lungs\\npredisposes another to tuberculosis of the skin; but the\\nexact role played by the tubercle bacillus is no more\\nknown to us in the one case than in the other.\\nThe diagnosis of lupus is in general easy. When we\\nconsider the location of the disease, the color of the\\nlesions, their slow development, the absence of sub-\\njective symptoms, the presence of citatrices in cases of\\nlong standing, and the repeated relapses after even vigor-\\nous attempts at treatment, we ought not to be often led\\nastray. A question may sometimes arise as to whether\\ncertain tubercles or ulcerations are lupous or syphilitic.\\nThe length of time they have existed will usuall}^ settle\\nthis, when we remember that syphilitic lesions may reach\\na degree of development in a few weeks that might\\nhardl}^ be accomplished b}^ lupus in years. The single\\ntubercle of lupus exedens is to be distinguished from\\nsarcoma and epithelioma. In sarcoma the development\\n23", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0365.jp2"}, "364": {"fulltext": "346 SKIN DISEASES.\\nof the lesion is much more rapid, while in epithelioma,\\nthe tubercle is hard, but in lupus exedens it is soft.\\nIn no disease of the skin is the prognosis more de-\\npendent on the character of the treatment. In early\\ncases it is absolutely good if sufficiently vigorous treat-\\nment be instituted, while lack of appreciation or lack of\\nvigor on the part of the physician is responsible for most\\nof the extensive and long-standing cases that we meet\\nwith.\\nTreatment. Lupus erythematosus may sometimes be\\ncured by the induction of an artificial eruption produced\\nby the action of irritants. This method, however, is not\\nto be commended. It is much better to destroy it with\\nan active caustic, provided the extent of the eruption\\ndoes not contra-indicate this method. When the lesion\\nis quite small, excision may be practiced; or thorough\\nscraping with the dermal curette, followed by nitric acid,\\nor the actual cautery. lyUpus vulgaris demands the same\\ntreatment as the other form. In lupus exedens\\nthorough removal with the knife of the diseased portions,\\nincluding a portion of the surrounding apparently\\nhealthy tissue, is the better plan.\\nDr. Mackay reports two cases of lupus healed after a\\nfew weeks of treatment by a twenty per cent, ointment\\nof resorcin, applied after scarification. The application\\nof resorcin was attended with but comparatively little\\npain.\\nSulphurous acid, in the form of a lotion, or an oil, or\\nin the gaseous state, has been employed as a remedial\\nagent in lupus. The gaseous form may readily be ob-\\ntained by burning in a jar, and allowing the fumes free\\ncontact with the surface to be treated. This can only be\\nused upon parts removed from the respiratory organs.\\nAs a rule, two applications daily, each for about twenty", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0366.jp2"}, "365": {"fulltext": "LUPUS EXEDENS. 347\\nminutes, will be found best. The lotion is best obtained\\nby the use of the pharmacopoeical preparation of the\\nacid, diluted in strengths of one in two, or one in three.\\nThis can be applied to any part of the face without pro-\\nducing disagreeable effects. The oil is preferred by some,\\nand is prepared b} dissolving the anhydrous acid in cas-\\ntor or olive oil. Satisfactory results frequently follow\\nthis method of treatment.\\nAlveloz has latel} been recommended as a local appli-\\ncation for lupus and cancer. Cases have been reported\\nwhere brilliant cures were effected by the use of the\\ndrug. I have had no opportunity of testing its virtues.\\nThe application of ice will frequently relieve the severe\\npain that is sometimes the accompaniment of lupus;\\nsome authors claim curative effects from the use of ice.\\nArsenicum alb. and Hydrocotyle, are the main internal\\nremedies.\\nOthers ma}^ be indicated as follows:\\nAurum miir. When starting from the nasal mucous\\nmembrane; a discharge from the nares very offensive;\\nabsorptiori of the bones of the nose; melancholia.\\nCishis. Lupus on the face; worse from cold air.\\nGraphites. Lupus on the nose; obstruction of the\\nnares; dry, cracked skin; every injury tends to ulcera-\\ntion.\\nGuarana. Lupus of an ochre-red color, yellow spots\\non the temples.\\nHepar. Lupus on the elbows; ulcers with burning or\\nstinging edges; nodosities on the head sore to the touch;\\nswelling of the upper lip.\\nHydrastis. Ulcers on the legs; exfoliation of the\\nskin; purulent discharge from the nostrils; faint, sinking\\nfeeling at the stomach.\\nKali bichrom. Ulcers painful to the touch; worse in", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0367.jp2"}, "366": {"fulltext": "348 SKIN DISEASES.\\ncold weather; ulceration of the nasal septum; loss of\\nappetite; all the secretions are tenacious and stringy.\\nLycopod. In recent cases; hunger with constant feeling\\nof satiety; arms and fingers go to sleep easily; purulent\\ndischarge from the ears; weakness of memory; melan-\\ncholia.\\nNitric ac. Lupus on the nodules of the ears; offensive\\npurulent discharge from the ears; dry, scaly skin; affec-\\ntions of the bones and glands; in dark complexions.\\nOleum jec. ass. A valuable remedy.\\nStaphysagria. Ulcers on the alse of the nose; weary\\npains in the limbs as if bruised; teeth turn black and\\ndecay; in scrofulous subjects.\\nEpithelioma.\\nEpithelioma, or epithelial cancer of the skin, is character-\\nized by the appearance of a hard tubercle or nodule,\\nslowly increasing in size until ulceration sets in, which\\nulceration may extend both laterally and deeply and\\ndestroy all tissues with which it comes in contact. As\\nits name implies, it is an outgrowth from the epithelial\\ntissues, in which a more or less extensive and exuberant\\nproliferation of epithelial cells occurs. The typical\\nepithelioma may be said to take its origin in the\\nMalpighian layer, the cells of which increase in number\\nand seek accommodation in the deeper layers of the skin.\\nAs they increase, however, some of them, from the\\npressure of the neighboring connective tissue, are forced\\nto occupy a smaller space than they would if permitted\\nto multiply freely in all directions. As a result of this\\ncompression, small rounded bodies are formed, in which\\nthe cells assume a stratified arrangement, constituting\\nthe epithelial cell-nests well-known to every microscopical\\nobserver. Coincident with this extension of the disease\\nii", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0368.jp2"}, "367": {"fulltext": "EPITHELIOMA. 349\\ninward there is a greater or less projection outward,\\nforming a distinct sessile tubercle, or a more flattened\\ngrowth.\\nPrimary cancer of the skin is a rare condition, while\\n\u00e2\u0096\u00a0epithelioma, involving both cutaneous and mucous sur-\\nfaces as ordinary cancer of the lip is sufiiciently com-\\nmon. Cancer of the skin, however, w^hich has developed\\nsecondarily to some pre-existing morbid growth, is the\\nvariety most frequently found in practice.\\nEpithelioma is distinctly the product of irritation not\\nan acute and transient irritation, even if frequently re-\\npeated, but rather one that is hardly, if at all, appreciable\\nto the senses, and which is persistent and active through\\na lengthened period. Thus we may find that a purely\\ninnocent and benign growth, like a simple wart, may\\nafter a lapse of years become the seat of an epithelioma,\\nwhich would not otherwise have appeared. A localized\\nseborrhoeic condition, which of itself implies an irritation\\nof the epithelial lining of the glands, may, and not infre-\\nquently does, become the starting point of cancer.\\nLupus offers an inviting field for the development of the\\ndisease; and in general it may be said that an ulcerating\\nlupus, if left to itself, will almost invariably in time be-\\ncome supplanted by epithelioma. Sarcoma more rarely\\nis followed by epithelioma, and this rarity may be ex-\\nplained by the fact that sarcoma usually runs its course\\nand has destroyed the patient before the cancerous af-\\nfection has had time to develop the irritation produced\\nby the sarcoma being more active than that w^hich ordi-\\nnarily leads to the occurrence of the other disease.\\nEpithelioma is met wdth clinically in two distinct forms,\\nin one of which the cutaneous involvement is more\\nsuperficial than in the other. In the superficial variety,\\n\u00e2\u0096\u00a0which is less frequently met with than the other, the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0369.jp2"}, "368": {"fulltext": "350 SKIN DISEASES.\\npatient s attention is first attracted to a little crust\\nusually on some part of the face. This he picks off, and\\ngives little further attention to the matter. A new crust\\nforms, and this is in turn picked off, and reveals, per-\\nhaps, a slightly excoriated surface. He consults a phy-\\nsician, who, failing to recognize the gravity of the condi-\\ntion, prescribes some salve or other, or lightly touches\\nthe part with caustic. The lesion extends, and perhaps\\nrarely reaches the hands of a surgeon until it has ad-\\nvanced to the stage of frank ulceration. We now find a\\nsharp-cut ulcer, extending through the entire thickness\\nof the skin, but not involving the subcutaneous tissues.\\nThis ulceration advances at its borders, or sometimes in\\none direction only, while reparative changes may some-\\ntimes occur in the other, much after the manner of some\\ncases of lupus. The progress of the ulceration is exceed-\\ningly tardy, and years may elapse before the ulcer has\\nattained any considerable size, and, when it does, we will\\nsometimes find that cicatricial tissue now occupies a por-\\ntion of the territory that had been the early seat of the\\ncancerous lesion.\\nThe other, or tuberous form of epithelioma, will be\\nrecognized at the beginning as a hard tubercle, occupy-\\ning the seat of what may have been previously the situa-\\ntion of a wart, mole, etc. This tubercle increases in size^\\nand the tissues beneath it are palpably involved in the\\nmorbid process. The skin surrounding the tubercle is\\nalso involved to a certain, or, rather, uncertain extent,\\nas is evident to sight and touch. Later, ulceration ap-\\npears, and the margins of the ulcer are everted and hard.\\nAs the ulcer spreads laterally, so also does it become\\ndeeper, and the process continuing unchecked leads in\\ntime to a fatal termination.\\nThe diagnosis of epithelioma, when actually existing.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0370.jp2"}, "369": {"fulltext": "EPITHELIOMA. 351\\nis surrounded with very few difi culties as the induration of\\nthe tissues is hardly to be met with in any other chronic\\ncutaneous lesion; but the physician should be prepared\\nas well to recognize conditions which will probably\\nbecome epitheliomatous in time. It is this failure to\\ndiagnosticate an impending epithelioma that leads more\\nfrequently than it should to inefficient treatment and the\\nsacrifice of lives that might otherwise have been saved.\\nThe face is the most frequent seat of purely cutaneous\\nepitheliomata; and, if a physician can not make up his\\nmind as to whether a certain hard tubercle or a chronic\\nulceration is cancerous or not, his plain duty is to take\\nhis patient to some one who can.\\nThe prognosis of cutaneous epithelioma is good,\\nprovided the lesion is seen in its early stages, and its\\nlocality permits of suitable and efficient local treatment.\\nOn the other hand, it is distinctly dad if the disease has\\ngained much headway or involves an extensive surface.\\nThe treatment of epithelioma will depend, firstly, on\\nW hether the particular lesion in question is, or is not, in a\\ncurable condition. This is in realitj^ the most serious\\nquestion that the surgeon has to determine, and to its\\nsolution he should bring his best judgment, based on his\\nknowledge and experience. If he decides that it is\\nincurable, any operation would be a barbarity, and\\nsuggestive of charlantry; but if there is a good prospect\\nfor the thorough removal of the neoplasm, no time should\\nbe lost in carrying it into effect.\\nThe removal of epitheliomata may be effected in two\\nways. One of these is with the knife, and, when this is\\npracticable, it is the best way; and there is but one rule\\nto follow cut widely and cut deeply. If for any reason\\nthe knife is impracticable, the diseased tissues may be\\ndestroyed by a sufficiently active chemical agent; and", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0371.jp2"}, "370": {"fulltext": "352 SKIN DISEASES.\\nexperience has shown that arsenic properly used is\\nprobably the most efficient means at our command. Now,\\nthere are two ways of using arsenic; one is to use it\\nstrong enough to destroy the cancer; and the other is to\\nuse a weaker preparation and destroy your patient by\\narsenical poisoning. The stronger the arsenial preparation\\nthe greater its local action; while the weaker it is, the\\nless is its topical action, and the greater the probability\\nof systemic absorption. Take anhydrous chloride of zinc\\nand mix it with an equal weight of water to this add\\nsufficient arsenic to make a moderately stiff paste. This\\nshould be applied to the diseased parts in a reasonably\\nthick layer with a little absorbent cotton as a top dressing.\\nTo this treatment there is one objection, namely, the\\nsevere pain that the arsenic will cause, which can only be\\nmitigated by the free use of morphine. If the lesion be\\nof moderate size, and the application thorough, the\\nfalling slough will, in a week or two, reveal a healthy\\nulcer, which only requires a little time for complete\\nhealing.\\nIf the case has progressed beyond the period when a\\ncure may reasonably be expected, the prudent surgeon\\nwill seek only to mitigate the patient s sufferings until\\ndeath brings its release.\\nResorin grammes 30.\\nVaseline, 100, applied daily, has cured some\\ncases that were diagnosed as epithelioma. The parts\\nwere first cleansed with borax water.\\nAristol has been successfully used as a topical applica-\\ntion.\\nIts advantages over arsenic are its painlessness, and\\nrapidity of action.\\nThuja is the principal internal remedy. Other\\nremedies are: Sepia Ars. alb. (malignant form), Con-\\nil", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0372.jp2"}, "371": {"fulltext": "SARCOMA. 353\\ndurango. Lapis alba. Nitric acid.: A roundish ulcer,\\nbluish-red and nodulated; bleeds upon slightest touch;\\nburning pain which becomes almost unbearable, when\\neating or drinking, when touched by cold or warm food.\\nHoang nan. Attacking especially the mucous surfaces.\\nPetroleu7?i. Nodules on hands, wrists, arms, feet and\\nlegs; worse about wrists or wherever the dress is tight\\n(palms and soles being free), less on face, neck and parts\\nto which oily matters find access. Pimples itching on\\nangle between scrotum and thigh, scabs in fold of left\\nwing of nose.\\nSarcoma.\\nThe word literally means a fleshy tumor, and embraces\\nin its scope a varity of new growths, which present\\ncertain common features, but which differ, however,\\namong themselves in many essential particulars, both as\\nto form and constitution.\\nIn general, it may be stated that a sarcoma is a tumor\\ncomposed in the main, of cellular tissues, the cells them-\\nselves being either round or fusiform, and partaking of the\\ncharacters of embryonic rather than fully organized adult\\ntissue. The new growth is usually exceedingly\\nvascular, being permeated with large vessels, some of\\nwhich are doubtless extensions from pre-existing vessels of\\nthe neighboring parts, while others are doubtless first\\nand independently formed in the new growth itself, and\\nconnect themselves later with the older vessels. In some\\ninstances there is a considerable deposit of pigmentary\\nparticles, probably derived from the blood coloring\\nmatter throughout the growth. These histological\\nchanges give rise to three types of tumor namely, the\\nround-cell sarcoma, in which the round cells greatly\\npredominate over the fusiform; the spindle-cell sarcoma.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0373.jp2"}, "372": {"fulltext": "354 SKIN DISEASES.\\nin which these cells make up the greater part of the\\ngrowth; and, thirdly, the melano or pigment-sarcoma,\\nwhich may resemble either of the addition of the\\nforegoing with the addition of the pigmentary deposit.\\nAs a rule, neither of these types is met with in its purity,\\nthe majority of sarcomata being of a mixed type, with\\none or the other greatly predominating.\\nThe earliest noticeable lesion of sarcoma may be a\\nmacule or a tubercle. The macule may develop into a\\ntubercle, or, on the other hand, may vSpread laterally in\\nthe skin, forming a patch or blotch one, two, or more\\ninches in diameter. These patches are heightened in\\ncolor, the hue being a bluish-brown, are hardly at all\\nelevated, and differ in consistence but little from the\\nsurrounding integument. In fact, they appear to be\\npatches of chronic congestion rather than infiltration.\\nThe evolution of the macules is tardy, and a year or more\\nma}^ be occupied before they attain any considerable size.\\nIt is possible that these macules may exist singly, but they\\nare usually multiple. These macules may undergo com-\\nplete resolution, and leave little trace of their previous ex-\\nistence. Under these circumstances the propriety of\\nclassing them as a variety or lesion of sarcoma might be\\nseriously questioned were it not for the fact that they\\nnot infrequently become the starting-point of typical sar-\\ncomatous growths. After the macule has attained a cer-\\ntain size, an elevation at one point occurs, developing\\ninto a tubercle and ultimately into a tumor.\\nThe primary tubercle of sarcoma may develop at the\\nsite of some long-standing innocent growth, as a mole,\\netc., or may take its origin in apparently normal skin.\\nThe former is the more usual course in persons advanced\\nin years, while the latter is commonly the case in children\\nand young persons.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0374.jp2"}, "373": {"fulltext": "SARCOMA. 355\\nThe progress of sarcoma is usually rapid, and a tubercle\\nin a few weeks may deserve the title of tumor, and after\\nthe lapse of some months may attain the size of a child s\\nhead or even larger.\\nThe sarcomatous tubercles and tumors present one\\ncharacter which is in striking contrast with carcinomatous\\ngrowth. I allude to their consistency. Sarcomata are\\nsoft, sometimes of almost jelly-like consistence, w^hile car-\\ncinomata are hard.\\nAfter sarcomata have attained a certain size, they\\nusually soften in the more central and older portions, and\\nbreak down, forming a fungoid ulcer, from the base and\\nedges of w^hich secondary sarcomata may spring. Occa-\\nsionally the margin of the ulcer becomes epitheliomatous.\\nNo age is exempt from the development of sarcoma,\\nbut it is decidedl}^ more frequent before the age of fifteen\\nand after forty-five than during the intermediate period.\\nWhen w^e compare the three most important tumor\\ntypes namely, carcinoma, fibroma, and sarcoma we\\nare struck with their peculiarities and contrasts. Carcin-\\noma is especialh^ prone to occur late in life; it is a\\nmalignant growth, composed of tissue elements w^hich are\\nlittle viable, and do not form permanent tissue, but ulti-\\nmateh^ break down with ulceration. Fibroma, on the\\nother hand, prefers the middle period of life, is benign,\\nand is composed of viable and permanent tissue; while\\nsarcoma, as we have seen, prefers the extremes of life,\\nand is malignant, its elements not going to the formation\\nof permanent tissue.\\nSarcoma may be characterized by the development of\\neither single or multiple tumors. When single and not\\ninterfered with they may attain a considerable size.\\nWhen multiple the tumors vary in size from that of a pea\\nto that of a hen s egg.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0375.jp2"}, "374": {"fulltext": "356 SKIN DISEASES.\\nHemorrhages accompany advanced cancerous disease,\\nbut they are insignificant compared with those which\\nmay occur in sarcoma. The extreme vascularity of the\\nnew growth and^ the unsubstantial character of the ves-\\nsel s walls are sufficient to account for this pronounced\\nhemorrhagic feature, which is met with not only in old\\nand advanced tumors, but even in those that are small\\nand have had but a few weeks growth.\\nSarcomata may appear on any portion of the integu-\\nment, and exhibit little preference for any particular\\nlocation, and after they have existed for some time are\\nliable to develop on the mucous membranes, and also in-\\nvade the viscera.\\nThe general health and vigor may be apparently un-\\nimpaired during the early periods of the existence of\\nsarcoma; but as the disease advances, these gradually\\nfail, but without, however, the development oi a cachexia^\\nas marked as in the latter stages of cancer.\\nThe prognosis of sarcoma varies. In single small\\ntumors of recent appearance it is good, as they can be\\neasily removed; and when the operation is properly per-\\nformed they do not as a rule return. When sarcoma be-\\ncomes generalized the prognosis is unfavorable, and this\\nis specially the case when complicated with melanosis.\\nLarge sarcomatous tumors are usually fatal.\\nTreatment. Beyond attention to the general health,\\nthere need be little expected from internal treatment,\\nalthough there are undoubted cases of sarcoma on record\\nin which the homoeopathic remedy exerted a favorable in-\\nfluence and apparently effected a cure.\\nIn small and young single sarcomata mechanical re-\\nmoval should be effected just as soon as a diagnosis is\\nestablished, care being taken to remove a considerable\\nportion of the apparently healthy skin, and the location", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0376.jp2"}, "375": {"fulltext": "CARCINOMA. 357\\nof the tumor will permit. Special provision should be\\nmade against hemorrhage, which, from the large number\\nand size of vessels entering the tumor, may be excessive.\\nIn very large sarcomata, in which an ultimate fatal\\ntermination is to be anticipated, removal is hardly to be\\nrecommended, except as a palliative measure, looking\\nonly to temporary relief. In these cases removal by\\nmeans of a loop of platinum ware heated by electricity\\nis to be preferred to the knife, on the score of safety from\\nhemorrhage.\\nCarcinoma.\\nThe carcinomatous family of malignant tumors con-\\ntain the tumors which the term cancer, as understood at\\nthe present day, is properly applied. A carcinoma is a\\ntumor made up of a typical epithelial new formation-cells,\\nof epithelial origin, but imperfect embryonic cells.\\nStructurally it consists of cavernous, fibrous stroma, in\\nthe interspaces or alveoli of which are found the epithe-\\nlial cells suspended in a serous fluid. The cells are not\\nseparated by any visible intercellular substance. Even\\nthe blood vessels run in the fibrous stroma and not be-\\ntween the cells.\\nThe development of cancer from epithelium has been\\nclearly shown in certain localities where morbid processes\\nare taking place. Some years ago, Paget called atten-\\ntion to the point that a certain eczema of the nipple is\\noften the precursor of cancer. In cases of this kind, it has\\nbeen showm that the proliferation of cells which is active\\nover the denuded portions is continued down into the\\nmilk ducts until these ducts have become filled and ex-\\npanded by the over-accumulation of imperfectly formed\\ncells. At the same time, the connective tissue surround-\\ning the duct takes on an increased vascularity from the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0377.jp2"}, "376": {"fulltext": "358 SKIN DISEASES.\\nirritation, and is infiltrated with small cells resembling\\nleucocytes. There is no direct connection between the\\ncells of the duct and those found in the connective tissues\\noutside. The latter are not migrating epithelial cells,\\nbut appear as the product of inflammation. As the ducts\\nbecome filled and their walls distended, they give way,\\nand the epithelial cells infiltrate into the surrounding\\ntissues where they proliferate and become centres of\\ndisease.\\nIt is believed by some pathologists that the entire\\ngrowth is not due to the proliferation of epithelium, al-\\nthough originating in this way. Endothelial cells, con-\\nnective tissue cells, and indifferent corpuscles in the pres-\\nence of, or by contact with, a growing carcinoma, it is\\nclaimed, become infected and transformed into cells simi-\\nlar to those of the tumor itself. While this may be true,\\nthe progress of carcinoma in its extension to the lymphatic\\nglands does not support this theory, for instead of in-\\nfecting and transforming the gland as a whole, the mode\\nof invasion is between and around the lymph corpuscles,\\nthey being affected only by the pressure of the rapidly\\ngrowing masses. As the cells increase and distend the con-\\nnective-tissue spaces the fibrous tissues are pressed back\\nand welded together, and the stroma of the cancer makes\\nits appearance. The stroma is not real cancerous tissue,\\nbut the natural tissue of the part is sometimes increased\\nby unnatural activity of the surrounding tissue. The\\nblood-vessels of the stroma, like the fibrous tissue, in-\\ncrease in size, so that the stroma becomes much more\\nvascular than the original fibrous tissue.\\nScheurlen claims to have obtained by cultivation from\\nthe juice of cancer of the breast in sterilized plural fluid,\\ncolonies of bacilli and spores, the bacilli being from, i 3m.\\nto 2.5m. in length. By inoculating six dogs, in the", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0378.jp2"}, "377": {"fulltext": "CARCINOMA. 359\\nposterior mammary glands, with an emulsion of these\\ncultures he has demonstrated the appearance of cancerous\\ntumors. Finally, he has found the spores, if not the bacilli\\nin question, in all the preparations of cancer stained by\\nGram s method. His conclusions are as follows: i.\\nThere exist constantlj^ in cancerous tumors bacilli which\\nmay be isolated. 2. The spores of these bacilli are\\nfound in all microscopic preparations of cancerous tissue.\\n3. Inoculation of animals with pure cultures of these\\nbacilli determines the development of cancerous tumors.\\n4. There is a relation of cause and effect between these\\nbacilli and cancer.\\nThe female sex, on the whole, is much more exposed\\nto cancer than the male, on account of the greater\\nliability of the female organs of generation. The breast\\nalone probably furnishes as many cases of carcinoma as\\nall other portions of the body.\\nCarcinoma is essentially a disease of old age. It is so\\nrare before thirty years that the age is often the most\\nimportant consideration in the early diagnosis between\\nbenign and malignant growths. After thirty years of\\nage it becomes more frequent, but it is not until the acme\\nof life is reached and the organs begin their natural retro-\\ngression, that cancer becomes common. At, and after\\nthe climacteric in women, and at a somewhat later period\\nin men, the cancer is most active. So well recognized is\\nthis fact that a tumor appearing at this time of life is\\nalways regarded with suspicion. Certain localities are\\nattacked much earlier than others. In early adult life\\nit is found most frequently in the testicle and labia; from\\nthirty-five to fifty, in the breast, uterus, the tongue, and\\nthe penis; from fifty to sixty-five years, on the lip and\\noesophagus. It is a noticeable fact that the organs in", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0379.jp2"}, "378": {"fulltext": "360 SKIN DISEASES.\\nwhich natural degeneracy of function takes place are the\\norgans most frequently attacked.\\nThe carcinoma is a tumor of rapid growth. It never\\nremains idle, and, with the exception to be noted, never\\ndecreases in size. In the manner of its extension, locally,\\nit resembles sarcoma.\\nThe carcinoma is liable to many changes, but one of\\nthe most common features is the tendency to ulceration\\nshown by the growth.\\nThe reproduction of cancer in an associated lymphatic\\ngland is of such frequent occurrence that it is looked upon\\nas one of the most certain signs of carcinoma. The\\nglands affected are usually those having a direct ana-\\ntomical connection with the affected part. Thus the\\naxillary glands follow infection of the breast; the lym-\\nphatics in the groin, carcinoma of the testicle; and the\\nsubmaxillary or sublingual glands, infection of the\\ntongue or lip. There seems to be no limit to the number\\nof glands involved. From one to fifty have been found\\nenlarged, varying all the way from the size of a pea to\\nthat of a walnut.\\nThe lungs, liver, etc., may become infected through\\nmetastatic deposits, carried thence by the blood.\\nThe chief forms of carcinoma are the schirrus, en-\\ncephaloma, colloma,and melanoma.\\nThe schirrus is characterized by its firm, hard, dense\\nfeel, having a similarity, in this respect, to normal\\ncartilage. It is most frequent of all the forms, and has\\nbeen observed and recognized from the earliest times.\\nThe e?icephaloma is a soft tumor, and is the most\\nmalignant of all tumors. It occurs at an earlier age than\\nthe other forms of cancer, being almost the only one\\nwhich is found before the age of puberty. To the touch,\\nthe tumor presents a peculiar soft feel, giving way under", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0380.jp2"}, "379": {"fulltext": "CARCINOMA. 361\\npressure, and returning to its shape again, as if filled\\nwith fluid. It varies in volume from the smallest kernel\\nto a tumor of the size of an adult s head.\\nThe collorna is so called because it consists, in large\\npart, of a clear, viscid, gelatine-like substance.\\nThe melayiotic cancer, is apparently an encephaloid\\ncancer which has been changed in appearance by the\\ndeposition of a black pigment in the elements composing\\nthe growth. A noted peculiarity of melanosis of the\\nintegument is its pronounced tendency to form in or\\ntinder a pigmentary mole.\\nThe diagnosis of the different forms of carcinoma,\\nwhen located in some external part, is usually a matter of\\nno great difficulty.\\nThe schirrus is generally found in the breast. It is a\\nsolitary tumor, and rarely appears before the forty-fifth\\nyear of age. In feel it is firm, hard, dense, resembling\\ncartilage. It grows slowly, and never attains large size.\\nFrom its start it is accompanied by sharp, shooting,\\nlancinating pains, which are distinctly localized. It early\\ncontracts adhesions to the integument and deeper tissues.\\nIf in the breast, the nipple is retracted. The superficial\\nveins are but slightly enlarged. Ulceration occurs early,\\nand the ulcer has an abrupt, steep edge, and a firm hard\\nbase. The lymphatics are invaded at, or soon after, the\\nbeginning of ulceration. The diagnostic symptoms of\\nschirrus are clear-cut and cannot be mistaken.\\nThe encephaloma may occur at any age and in almost\\nany portion of the body. It is soft, lobulated, usually\\nsolitary. It grows rapidly, and often acquires a very\\nlarge size. Pain is absent or slight until the advent of\\nulceration, when it becomes severe, but does not assume\\nthe lancinating character of the schirrus. The sub-\\ncutaneous veins are always enlarged. Ulceration is early\\n24", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0381.jp2"}, "380": {"fulltext": "362 SKIN DISEASES.\\nand the ulcer is foul, with thin edges, and is often\\ncovered with a fungous, friable mass. The lymphatics\\nare early involved.\\nThe colloid cancer is rare, and its characteristics are not\\npronounced. It is tardy in its growth, of uniform con-\\nsistency, free from pain, and often attains an immense\\nbulk. It is usually found in the peritoneal cavity; when\\nsuperficial, it may be confounded with a fibrous or carti-\\nlaginous tumor or sarcoma. It is distinguished from\\nfibroma by its more rapid growth, its large size, and its\\nconstitutional tendency; from chondroma by its elasticity\\nand less firm feel, as well as by its more rapid progress;\\nfrom sarcoma by its more uniform growth and compara-\\ntively slow progress.\\nThe 7nelanotic cancer can only be distinguished by the\\npeculiarity of its color and its frequent origin from pig-\\nmentary moles. From the facts given in the diagnosis\\nthis may be deduced; a tumor appearing late in life,\\nwhich grows rapidly, is attended with pain, infiltration of\\nthe surrounding tissues, and adhesions to the integument\\nand tissues beneath, shows a marked tendency to ulcera-\\ntion and to infection of the lymphatic glands, and decay\\nof the vital forces, is a cancer or malignant tumor.\\nThe prognosis in carcinoma is exceedingly unfavorable/\\nthe natural progress in every case being toward the de-\\nstruction of life. The prognosis, as to course and dura-\\ntion of the disease, varies much in the different forms and\\nin the different parts of the system affected. Scirrhous\\ncancer is one of the most regular in its course, its average\\nduration, when uninterrupted by operation, being about\\nthree years.\\nThe encephaloma is more rapid in its course, the aver-\\nage duration of life being less than two years, even in\\nparts whose formations are not essential to life. Carci-\\nI", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0382.jp2"}, "381": {"fulltext": "CARCINOMA. 363\\nnoma of the tongue, the interior of the month, the\\noesophagus, and the penis are very rapid in progress,\\nbeing usuall} fatal in from twelve to eighteen months.\\nCarcinoma of the lip, the face, and the rectum are slower\\nand more amenable to treatment.\\nTreatment. The treatment of cancer has always\\nbeen extremely unsatisfactory. Various remedies have\\nfrom time to time been heralded as cures, but after\\nthorough trial have in every instance been discarded.\\nAmong these are: Chian turpentine; Resorcin; Inter-\\nparenchymatous injections of ozone- water; Chromic acid;\\nCundurango bark, etc. Galvanism has been highly\\nrecommended, as has also the inoculation of the cancer\\nwith erysipelas.\\nOccasionally, cures of cancer by the administration of\\nhomoeopathic remedies have been recorded, but the cases\\nare so few, and the possibilities of error in diagnosis so\\nmany, that the value of these remedies in the treatment\\nof this disease cannot but be called into question. There\\nare many tumors, the result of acute or chronic inflam-\\nmatory action, which resemble very closely some of the\\nforms of cancer. Many of these are amenable to the\\nproperly selected remedy, and it is cases of this character\\nthat have been cured by the remedy recorded. That no\\nremedy has been discovered which is absolutely specific\\nto the disease there can be no reason to doubt, but that\\nremedies are of no value in the treatment of the disease\\ncannot be so positively asserted. Whatever doubts may\\narise as to the value of remedies in overcoming the dis-\\nease when once aroused, there can be none as to service\\nrendered by remedies in retarding the development of the\\ndisease and in relieving many of the accompanying symp-\\ntoms. At the close of this article will be found the\\nremedies employed in the treatment of cancer.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0383.jp2"}, "382": {"fulltext": "364 SKIN DISEASES.\\nWhile remedies are of value in relieving many of the\\nattendant symptoms of cancer, and are often curative\\nin ulcerations and indurations resembling cancer, at the\\npresent day surgery offers the only possibility of a radical\\ncure. In certain forms of cancer in which involvement\\nof the lymphatics does not occur until late in the prog-\\nress of the disease, the possibility of cure following an\\noperation is always greater than in those in which lym-\\nphatic involvement is early noticed.\\nEpitheliomas of the lower lip are quite amenable to\\ntreatment, the thorough removal of the tumor before the\\nsubmaxillary gland becomes involved being, in many in-\\nstances, followed by cure. Even in the more rapid and\\nmalignant scirrhous and encephaloid tumor, thorough\\nremoval gives a percentage of cures sufficiently large to\\nencourage the belief that early and radical measures will\\nsucceed in materially reducing the mortality of the dis-\\nease.\\nThe removal of the disease, if it does not succeed in\\neffecting a cure, is still a great benefit to the patient. A\\ncareful study of the statistics shows that the average\\nduration of life is increased twelve months in cases oper-\\nated upon over those in which the disease proceeds un-\\nmolested by surgical measures. The increase in life in\\nsome cases is several years. Even if this hope cannot\\nbe entertained, an operation is often justifiable on the\\nground that it will avert the suffering attendant upon the\\nregular progress of the disease. The relief which fol-\\nlows an operation is sometimes remarkable. Freed of the\\nlocal pain and offensive discharge, the patient will become\\ncheerful, sleep, eat, and even gain in flesh.\\nIn those cases in which an operation is not advisable,\\nmuch relief from pain and offensive odor may be ob-\\ntained by the use of certain applications. The best of\\nij", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0384.jp2"}, "383": {"fulltext": "CARCINOMA. 365\\nthese is hydrochlorate of Cocaine. Painting the ulcerated\\nsurface with a two-to- four per cent, solution affords instant\\nrelief. When the discharge is profuse and offensive, the\\nulcer should be washed frequently with a strong solution\\nof carbolic acid. Hyposulphite of soda may be used\\nwhen other disinfectants fail. The surface of the ulcer\\nis washed with a saturated solution added to an equal\\nquantity of water, and lint steeped in the solution is laid\\nupon it. The distressing night-sweats of the later stages\\nof the disease may be controlled or improved by the use\\nof aromatic sulphuric acid or aromatic vinegar. At this\\ntime also the use of morphine to allay pain and to secure\\nsleep is permissible. It is best given by hypodermic in-\\njection.\\nTherapeutical indications:\\nAcetic acid. Cancer of stomach, ulcerative gnawing\\npain at one spot in stomach with agony and depression,\\npreventing sleep; severe burning pain in stomach and abdo-\\nmen, vomiting of yellow, j^eastlike matter, of blood; eyes\\nsunken and surrounded by a dark circle; face pale and\\nw^axen; tongue pale and flabby.\\nApis met. Is indicated in cancer of the breast, in\\nwhich the induration has followed an old case of mastitis^\\nand in which the pain is of a burning, stinging character.\\nThe characteristic urinary symptoms of the drug are the\\nbest indications for its use.\\nArsen. alb. Foul, destructive, easily bleeding, and\\ncancerous ulcers, with burning and corrosive pains in the\\ninterior of the affected parts; terrible darting and lanci-\\nnating pains through them; burning discharges, which\\nmay be thick or thin, brown or black, extremely offen-\\nsive; worse after midnight.\\nAurum. The womb is prolapsed and indurated; pain\\nlike that of a bruise, with shooting and drawing, and the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0385.jp2"}, "384": {"fulltext": "366 SKIN DISEASES.\\nmind constantly dwells on suicide. Cancer of the palate\\nand nasal bones, or of the nose; pus greenish, ichorous,\\nand putrid; cancer of stomach in last stage, when there\\nare only few subjective symptoms.\\nBellad. Scirrhous indurations; cancerous ulcers, burn-\\ning when touched; black crust of blood in the bottom of\\nthe ulcer; pus scanty. Pains come and go suddenly.\\nCarbo mi. Cachexia fully developed. Scirrhous can-\\ncer on the forehead; sudden and short aching from col-\\nloid cancer in the pit of the stomach, on taking a deep\\ninspiration, clawing and griping in stomach, violent\\npressing in loins, small of back and thighs during\\nmenses, with chilliness and yawning; weak empty feel-\\ning in the pit of the stomach; it checks the putrid taste,\\nthe waterbrash, and contracting, spasmodic burning;\\nscirrhous mammae with dirty bluish loose, skin or red\\nspots on skin, burning and drawing towards axilla; ax-\\nillary glands indurated.\\nCausticum. Patient cannot bear the pressure of the\\nclothes on the stomach; the lightest food or even the\\nsmallest quantity causes a violent lancinating pain in the\\nstomach; scirrhus of the lips, with itching and soreness,\\nwhich when ulcerated has a violent burning pain; pus\\nbloody, or greenish, or corroding, or thin, watery, and\\nyellow.\\nChelidoiimm. Old, spreading, putrid, carcinomatous\\nulcers; the pain in the stomach is of a gnawing or digging\\ncharacter; nausea, with sensation of heat in the stomach;\\nburning in stomach.\\nCalcarea phos. Cancer in scrofulous constitutions.\\nCalcarea fluor Knots, kernels, hardened glands in the\\nfemale breast. Swelling on the jaw bone which is hard.\\nChimaphila. Tumors of the mammae, enlargements of\\nlymphatic glands.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0386.jp2"}, "385": {"fulltext": "CARCINOMA. 367\\nClematis. For softened scirrhous uteri, with corrosive\\nleucorrhcea and lancinating pains.\\nConium. Bleeding of the ulcers, with a secretion of\\nfetid ichor; a portion becomes gangrenous; concealed\\n\u00e2\u0080\u00a2cancer of bone; cancerous swelling and induration of\\nglands; cancer of the lips; spreading cancerous ulcers in\\nthe face; contractive spasmodic pains in the stomach;\\ncancer and cancerous ulcers after contusion; burning\\nstitches; stinging in the affected parts.\\nCundurango Is onl}^ eflScacious in open cancer and\\ncancerous ulcers, where it effectually moderates the\\n-severit}^ of the pains. It does not act on scirrhous and in-\\ndurated parts.\\nFemim phos. An excellent alternate remedy for ex-\\ncessive pain in cancer.\\nEucalyptus. One of the best remedies for destroying\\nthe fetid odor of cancerous discharges, used internally\\nand locally.\\nGalium. Epithelioma, when the disease is slow in its\\nprogress, and where there are nodular deposits near the\\nsurface.\\nGraphites. Hot and painful vagina; swelling of the\\nlymphatic vessels and mucous follicles; the neck of the\\nuterus is hard and swollen, with tuberculous 7iodes and\\ncauliflower excrescences; great weight in the abdomen on\\nrising, with fainting sort of weakness and aggravations\\nof the pains, delaying menses, with aggravation of the\\npains shortly before and at the appearance of the menses;\\ndischarge of black, lumpy, fetid blood; stitches shooting\\nthrough the abdomen as far as the thighs; buryiing and\\nstitching pains; constipation; livid complexion; sad and\\nanxious mood. Frequently useful in connection with\\novarian diseases.\\nHepar. Corrosive pain in a cancerous ulcer, bleeding", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0387.jp2"}, "386": {"fulltext": "368 SKIN DISEASES.\\nat the slightest touch; yellow skin and complexion; erup-\\ntions around the mouth, lips and chin, which are con-\\nverted into cancerous ulcers, rapidly spreading; pressure\\nand dull aching pain in the stomach after moderate eating;\\ncancerous ulcer of the mammae, with stinging burning in\\nthe edges; pus, copious or scanty, smells like old cheese..\\nHydrastis. Recommended for all sorts of cancer, but\\nit will only act as a regulator for the faulty nutrition^\\nand thus exerts a favorable influence in soft or encepha\\nloid cancer.\\nIodide of Arsenic. Swollen gland in the left axilla, size\\nof a hen s hard, and exuding a fluid which forms a\\nhard, brown crust. The tumor is painful and sensitive\\nto the touch; breast of the same side enlarged, indurated\\nand very sore. Yellow, bloody, and irritating leucorrhoea,\\nwith swelling of the labia.\\nlodium. Uterine hemorrhage after every stool, with\\ncutting in the abdomen, and pains in the loins and small of\\nthe back; great weakness during the menses, particu-\\nlarly in going upstairs; long-lasting uterine hemorrhage;:\\ndwindling and falling away of the mammse; aggravated\\nfrom externa] warmth; complete prostration of strength\\nand general emaciation; violent vomiting, renewed by\\neating; pulsations in the pit of the stomach.\\nKali phos. Cancer, pain, offensive discharge and dis-\\ncoloration.\\nKali sulph. Epithelioma. Cancer on the skin near a\\nmucous lining, with discharge of thin, yellow, serous^\\nmattery secretions.\\nKreosotum. Shooting stitches in the vagina, burning\\nand swelling of the external and internal labia; profuse\\ndischarge of dark coagulated blood, or of a pungent\\nbloody ichor, preceded by pain in the back; aggravation\\nof the pains at night; fainting on rising from the bed;", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0388.jp2"}, "387": {"fulltext": "CARCINOMA. 369\\nshe alwa3^s feels chill}^ at the menstrual period; complex-\\nion livid; disposition sad, irritable; cauliflower excres-\\ncences; wretched complexion, great debility, sleepless-\\nness. Tightness of the pit of the stomach, cannot bear\\nthe weight of her clothing; painful hard place on the left\\nside of her stomach.\\nLachesis. Melanosis, colloid, and encephaloid cancer;\\nviolent burning, gangrenous spots; cancer of the breast,\\nwith lancinating pains; the pit of the stomach very sensi-\\ntive to touch; uterine cancer developing itself at the\\nclimacteric, or as a consequence of the change of life; the\\npains increase rapidly, until relieved by a profuse dis-\\ncharge of blood; violent pains, as if a knife were thrust\\nthrough the abdomen, which has to be relieved from all\\npressure.\\nLapis albus. Cancer as long as it has not opened,\\nbased on scrofulosis.\\nLycopod. Swelling of the upper lip, with a large ulcer\\non the Vermillion border of the lower one; vomiting of\\nfood, bile, coagulated blood, and pus; tension in the hy-\\npochondria as from a loop; great emaciation and internal\\ndebility.\\nMercurius. Cancerous ulcers, with a severe shooting\\nand lancinating pain, not relieved by either hot or cold\\napplications; spreading ulcers, spongy, readily bleeding,\\nand extremely painful; unequal elevations and depres-\\nsions in the floor of the ulcer; swelling of the w^bole or\\nonly the tip of the nose, accompanied by pain and inflam-\\nmation, followed by cancer; pus thin, ichorous, and\\nacrid.\\nMezereum. Scirrhus ventriculi with burning, corrod-\\ning pains; internal surface of the gastric mucous mem-\\nbrane feels raw, with sensation as if food remained for a", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0389.jp2"}, "388": {"fulltext": "370 SKIN DISEASES.\\nlong time undigested in the stomach, causing pressure\\nand blood vomiting; hypochondriasis.\\nMurex. Carcinoma uteri, with great depression of\\nmind; pain in uterus as if wounded by a cutting instru-\\nment; lancinating, throbbing pains in uterus; acrid dis-\\ncharge, causing pudenda and thighs to swell and become\\nraw, burning and itching; faintness and an all-gone\\nfeeling in epigastrium deep hypochondriasis.\\nNatru7n carb. Induration of neck of womb, os uteri\\nout of shape; pressing in hypogastrium towards genital\\norgans, as if everything would come out; headache in\\nsun and from mental labor; great nervousness and\\nanxiety.\\nNitric acid. Pain and swelling of the submaxillary\\ngland, with induration, ultimately becoming scirrhous;\\nburning sensation in the stomach; mercurio-syphilitic\\ntaint; urine very offensive; aggravated after midnight;\\nin uterine cancer sympathetic affection of the inguinal\\nglands; violent cramp-like pains, as if the abdomen\\nwould burst, with constant eructations; violent pressing,\\nas if everything would come out of the vulva, with pain\\nfrom the back down the thighs.\\nNux vom. Ulcers with pale red, elevated edges; a\\npainful, small, scirrhous tumor on the forehead; vomit-\\ning of sonr-smelling mucus and dark clotted blood.\\nNupha? Several cases of cancer have been reported\\nas cured by the use of this drug. Its use is empirical,\\nand comes to us from the Indians.\\nPhosphorus. Cutting pains through the abdomen,\\nsometimes with vomiting, painful to the touch, and when\\nwalking; belching up of large quantities of wind after\\ndinner; frequent and profuse hemorrhages, pouring out\\nfreely, and then ceasing for some hours or days.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0390.jp2"}, "389": {"fulltext": "RODENT ULCER. 371\\nPhytolacca. Scirrhus, especially mammae; cancer of\\nlips and cancerous, ill conditioned ulcers of the face.\\nSepia. Suspicious tubercle on lip of a cartilaginous\\nappearance, sometimes bleeding and having a scirrhous\\nappearance, with a broad base; epithelial cancer of lip,\\nwith burning pain and a pricking as from a splinter of\\nwood; complexion yellow and earthy; cancer of rectum;\\nindurations, ulcerations, and congestion of the os and\\ncervix uteri; cutting pains in abdomen and a pressure on\\nuterus downward, as if everything would fall out; sinking\\nsensation at pit of stomach.\\nSilicea. Painful dryness of the nose; scirrhous indura-\\ntion of the upper lip and face; continuous nausea and\\nvomiting, especially when drinking; sensitiveness of the\\npit of the stomach; melancholy; in uterine cancer dis-\\ncharge of blood between the regular periods, with\\nrepeated paroxysms of ic}^ coldness over the whole body;\\nfetid, brownish, purulent, ichorous leucorrhoea.\\nStaph. Scurfy and burning painful lips with pain in\\nthe submaxillary glands, with or without swelling.\\nSyphilis and mercurialization.\\nThuja. Sycosis; cauliflower excrescences; medullary\\nand fungoid cancers.\\nZincum Pewter-like hue of the face; scirrhous tumors\\nin different parts of the body.\\nRodent Ulcer.\\nRodent ulcer has been called cancerous ulcer of the\\nface, cancroid ulcer, ulcus exedens, noli 7ne tangere. A.\\npatient has a small tubercle upon the face, covered by a\\nsmooth skin; he may call it a wart, and it may remain on\\nthe face unaltered for years, and then, when the patient\\ngets old, it may begin to ulcerate. The ulcer spreads", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0391.jp2"}, "390": {"fulltext": "372 SKIN DISEASES.\\nslowly, but constantly, and if it be left alone it may\\ndestroy the whole of the cheek, the bones of the face, and\\nultimately the patient s life; but it may take some years\\nto run this course.\\nThe disease is entirely local. It does not affect the\\nlymphatic glands, nor do similar tumors appear on other\\nparts of the body. The disease usually attacks some\\npart near the eyelids; it is of slow progress; there is\\nlittle pain. The disease has been described as commenc-\\ning as a pimple, a blind boil, a small hard pale\\ntubercle, etc.; which tends to scab after a small central\\ncrack makes its appearance. There is, in fact, a small\\npimple followed by a minute ulcer. The disease extends\\ngradually in all directions, but very slowly. When an\\nulcer forms, the edge is indurated and raised, but not un-\\ndermined and everted; and there is no infiltration of the\\nsurrounding healthy structures. The surface of the\\nulcer is dry, clean, glossy, and does not give exit to any\\nfoul secretion; it is irregular in form, more or less oval,\\nhowever.\\nThe disease differs clinically from the ordinary progress\\nof cancer by its greater slowness, the little pain and\\nhemorrhage, the absence both of any attempt at the for-\\nmation of a fungoid growth, and of fetor. The glands,\\nmoreover, are never affected. The advances of the de-\\nposit and ulceration are unequal, hence the eaten-out or\\nrodent appearance. The ulceration advances in extent,\\nand in depth. The growth is always in one mass, not in\\ndistinct centers.\\nRodent ulcer then occurs on the face, has an indurated\\nedge, a tendency to spread without respect to kind of\\ntissue, is of slow progress, painless, is not related to\\nany cachexia, never causes enlargement of glands, and\\nmicroscopically presents characters that betoken it as the", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0392.jp2"}, "391": {"fulltext": "RODENT ULCER. 3 73\\nleast expressed form of the cancerous cachexia. It is\\nmost common between fifty and sixty, and it does not\\noccur before thirty; generally it has its seat about the\\neyelids, and occurs in either sex equally, and it never at-\\ntacks the lower lip.\\nThe treatment is simple and satisfactory. Experience\\nteaches that extirpation by the knife is the most success-\\nful mode of treatment.\\nOne case is reported where the application of lactic\\nacid resulted in the speedy cure of a rodent ulcer.\\nThe following homoeopathic remedies may be com-\\npared: Arsenicum, Belladon7ia, Cicuta, Hepar, Hydro-\\ncotyle, Hydrastis, Mercurius, Nitric acid, Silicea, Sta-\\nphisagria, Sulphur, Uranium.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0393.jp2"}, "392": {"fulltext": "CHAPTER XV.\\nCUTANEOUS HEMORRHAGES.\\nGeneral Remarks.\\nBlood may be effused into the skin under a variety of\\ncircumstances. The occurrence may take place as an\\nidiopathic condition spontaneously or secondarily in con-\\nnection with other diseases of the skin. The blood-ves-\\nsels may be ruptured, and so permit the escape of blood,\\nor the blood globules may escape bodily through the\\nactual vessel walls. The usual cause of rupture is trau-\\nmatic injury. The hemorrhagic spots receive different\\nnames according to their size and shape. When they are\\nsmall, in the form of red points, they are Q^Vi^d. petechics\\nwhen larger, and more or less linear, vibices; when large\\nin the form of bruises, ecchymosis; and when the blood\\ncollects in the form of a distinct tumor, hcBmatomata.\\nThe seco7idary forms of cutaneous hemorrhage occur in\\nconnection with typhus, measles, scarlatina, and variola,\\nthe early eruptions of which may severally be more or\\nless hemorrhagic, the hypersemia being accompanied by\\nactual hemorrhage into the skin. The eruption of sev-\\neral of the ordinary inflammatory diseases of the skin\\nalso are sometimes complicated by a certain amount of\\neffusion of blood. Other conditions under which cuta-\\nneous hemorrhages arise are altered states of the blood\\ncurrent, such as impurifications by bile products, stasis of\\nthe capillaries produced in connection with kidney and\\nheart disease, etc.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0394.jp2"}, "393": {"fulltext": "PURPURA. 375\\nIt is only to hemorrhage occurring as a primary and\\nindependent disease that the term purpura is applied, and\\nthis we will now describe.\\nPurpura.\\nPurpura is an affection of the skin characterized by the\\nsudden appearance of reddish macules of varying size\\nand on various parts of the body. In a short time they be-\\ncome purplish, the color not being removable by pressure.\\nAfter they have existed a few days they undergo changes\\nin color similar to those which follow a bruise.\\nThe eruption ma}^ appear in either sex, at any age,\\nand in almost any condition of general health; in those\\nwho are greatly enfeebled as w^ell as in those in an ap-\\nparentl}^ robust condition.\\nThe eruption may cover the greater part of the surface,\\nbut more frequently is confined to the lower extremities.\\nA single purpuric outbreak may be the beginning\\nand end of the trouble, or, as frequently happens, fresh\\ncrops may appear at regular or irregular intervals for a\\nconsiderable period. The affection has been noticed in\\nconnection wnth suppressed menstruation, apparently\\ntaking the place of the natural flow. The foregoing\\nfeatures characterize purpura simplex, which, as a rule,\\nis not a serious affection.\\nSometimes, however, the hemorrhages are not confined\\nto the cutaneous tissues, but may take place internally as\\nwell, and serious loss of blood may result from the\\nrupture of superficial capillaries in the various mucous\\nmembranes, and especially those of the gastro-intestinal\\ntract. This form is termed purpura hemorrhagica.\\nThe etiology of purpura is absolutely unknown. It\\nhas no connection, however, with the congenital anomaly", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0395.jp2"}, "394": {"fulltext": "376 SKIN DISEASES.\\nknown as hemophilia, nor with the acquired condition\\nknown as scorbutus, or scurvy.\\nDiagnosis. The name should be confined to the sim-\\nple affection we have described, and should not be used\\nin connection with any other distinct disease that hap-\\npens to be complicated with minute hemorrhagic effu-\\nsions.\\nScurvy should never be mistaken for purpura, or vice\\nversa. In the former disease the limbs are swollen and\\ntense, and the hemorrhages form diffuse patches rather\\nthan macules. The gums also are swollen, and ready to\\nbleed at the slightest provocation. Purpuric blotches are\\nlikewise met with in speliosis rheumatica; but the pro-\\nnounced arthritic symptoms serve as a mark of distinction.\\nPetrone found single, small, ovoid micrococci in the\\nblood of a young man who was suffering from purpura\\nhemorrhagica rheumatica febriHs. Some of his blood\\nwas subcutaneously injected into a rabbit. After two\\ndays numerous hemorrhagic spots appeared in the skin of\\none ear. By this experiment Petrone thinks he has\\ndemonstrated the infectious nature of the disease.\\nTreatment. Piffard says that one drug stands pre-\\neminent and alone as an efficient agent in the treatment\\nof purpura, and this is ergot. He advises the use hypo-\\ndermically of ergotine, or drachm doses of the fluid ex-\\ntract given internally two or three times a day. He also\\nadvises against the use of iron, quinine, and similar drugs\\nof the tonic class.\\nThe diet should consist of the most nutritious articles.\\nMalt preparations are useful foods. Outdoor exercise is\\nvery beneficial. Locally, hamamelis is one of the best\\nremedies, and when there is much hemorrhage, ice treat-\\nment may be resorted to.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0396.jp2"}, "395": {"fulltext": "PURPURA. 377\\nSimple purpura responds best to Ars. aid., and the\\nhemorrhagic form to Sulph. acid. Other remedies may-\\nbe indicated as follows:\\nArnica. Yellow, blue and reddish-blue spots; in ly-\\ning-in women.\\nBaptisia. Livid spots all over the body and limbs, of\\nthe size of a three-cent piece; great languor; desire to lie\\ndown; tired, bruised, sick feeling all over the body.\\nBerberis. Petechise on the right shoulder or left\\nhumerus, back of the head and wrist. Bruised pain\\nwith stiffness and lameness in small of back; renal or\\nvesical complications.\\nChloral. Its continued use internally has caused pur-\\npura hemorrhagica, preceded by a bright red blush, ery-\\nthematous in aspect, but permanent under pressure, fol-\\nlowed in two days by deep red spots, mixed with mottled\\nlivid patches. The buccal mucous membrane becomes\\nred, raw, ulcerated, and blistered, breath fetid, pulse 120\\nand feeble. A desquamation ensued, but with bed-sores\\nin some places. In other cases it caused petechise, vibices,\\nand ecchymoses.\\nCocoa. Dark spots like ecchymoses under the skin,\\nabout the size of a pin s head, on the fingers.\\nErigeron. When apparently well-indicated remedies\\nfail.\\nHa7namelis. Hemorrhagic purpura; profuse epistaxis;\\npassive, venous hemorrhages; great lassitude and weari-\\nness; in old people.\\nLachesis. Simple purpura; blackish-blue spots; great\\nphysical and mental exhaustion; climacteric troubles.\\nMercurius. Bluish-red spots, darker on the margin\\nand lighter in the centre. Other symptoms of Merc.\\npresent.\\n25", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0397.jp2"}, "396": {"fulltext": "378 SKIN DISEASES.\\nPhosphorus. Petechial spots on the skin; bluish-red\\nspots on the legs; purple-like exanthem over the whole\\nbody.\\nRhus tox. Simple purpura; dark brown spots on in-\\nside of ankles; rheumatism of joints worse during rest;\\nswollen ankles after sitting too long.\\nTerebinth. Hemorrhagic purpura; intestinal hemor-\\nrhages; hematuria.\\nVerat. vir. Simple purpura; galvanic- like shocks in\\nthe limbs; rapid pulse; slow respiration; in plethoric in-\\ndividuals.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0398.jp2"}, "397": {"fulltext": "CHAPTER XVI.\\nPruritus.\\nPruritus is characterized by the occurrence of itching;\\nin fact, pruritus is itching. It may co-exist with, or be\\nentirely unaccornpanied by, organic change in the skin;\\nand a knowledge of the conditions under which it occurs\\nis essential.\\nPruritus occurs in the course of most inflammations of\\nthe skin; in connection with rheumatic manifestations;\\nthe circulation of morbid elements, as bile, urinary ex-\\ncreta; elevations of temperature, senile decay of the skin,\\ngastro-intestinal disturbance, nervous diseases, Bright s\\ndisease, genito-urinary and uterine derangements, seden-\\ntary habits, and stimulating diet; it is also occasioned by\\nlocal causes; about the rectum by ascarides and piles, and\\nover the body in various parts by parasites (animal or\\nvegetable). When pruritus is spoken of in the abstract,\\nitching, as constituting the primar}^ and sole disease pres-\\nent, is signified, and the nervous character of the itching\\nis frequently shown by its sudden appearance, its almost\\nas sudden disappearance, and often its marked tendency\\nto periodicity.\\nPruritus may be general or local, and it is very gener-\\nally followed by secondary changes in the skin. When\\ngeneral it is due to the causes of more general operation,\\nmentioned above.\\nWhen pruritus occurs, of course in most cases the\\n-patient scratches more or less violently for the relief of", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0399.jp2"}, "398": {"fulltext": "380 SKIN DISEASES.\\nthe itching, and this induces certain special diseased con-\\nditions. In fact, the phenomena of a scratched skin are\\nproduced, or what is termed a pruriginous eruption.\\nIn certain cases pruritus exists in the first place as ap-\\nparently the sole disease, and in which scratching is\\npracticed, and eruptions follow. These conditions we\\nwill now discuss.\\nPruritus Senilis. In old people whose skin begins\\nto exhibit atrophous changes the sensibility of the skin\\nis much disordered and more or less associated pruritus\\noccurs. The practitioner is consulted for this pruritus,\\nand at first there is nothing else to be observed in the\\nskin but laxity and thinness of the integuments, with\\nperhaps plugging up of a certain number of the follicles\\nby the exuviae shed from the sebaceous glands. The\\npruritus is the evil from which the patient desires to be\\nrid. It is increased by heat, cold, the warmth of the bed,\\nby digestion, and other things. These cases may be re-\\nlieved by the use of alkaline baths, free oiling of the sur-\\nface, or some local anodyne application. Besnier advises\\nin these cases that the patient bathe in a solution contain-\\ning to each litre a solution of carbolic acid lo.oo to 500\\ngrammes of acet. aromat. This should be followed by\\ndusting the affected parts with amylum, 90; bismuth\\nsalicyl., 20.0.\\nAfter awhile the scratching practiced to relieve the ir-\\nritation induces the development of distinct eruptive\\nphenomena. A certain amount of hypersemia occurs, and\\nthis is followed by the formation of lymph papules, which,\\nbeing scratched, become pruriginous that is to say, the\\napices are torn, a little blood oozes out and dries on these\\napices as a dark speck. These changes are followed by\\nmore or less infiltration of certain parts, by the inter-\\nmingling of excoriations made by the nails with the pru-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0400.jp2"}, "399": {"fulltext": "PRURITUS. 381\\nriginous rash, and in some instances by ecthymatous pus-\\ntules or urticaria. The pruritus is often intense, and\\ntakes the form of a stinging, creeping, or burning sensa-\\ntion. The pruritus is the primar}^ as it is occasionally\\nthe sole condition. The disease may be, of course, more\\nor less general, or more marked in one place than an-\\nother.\\nThe cure of pruritus senilis is, too, effected by emollient\\nand vapour baths, and anodjmes, locall}^ applied. The\\nfollowing formulae are often of benefit:\\n1^. Sodii Hyposulphit, dr. j.\\nAcid Carbol., dr. ss.\\nGlycerini, oz. j.\\nLislerine, oz. iij.\\nM. Sig. Use as a lotion.\\nOr,\\nOr,\\nOr,\\nOr,\\n1^. Ammon. sulpho-ichthyolat, 5jj-\\nAquae rosge,\\nGlycerini, aa 3ss.\\nM. Sig.: Use as a lotion.\\nfl. Opium, gr. viij.\\nCreasote, gtt. x.\\nI^ard, 5Jj.\\nM. Sig.: Use locally.\\n9^. Tincture of myrrh, gtt. xxx.\\nOxide of zinc, gr. xx.\\nCold cream, 5J.\\nM. Sig.: Use locally.\\n9^. Carbonate of soda, 3ss.\\nConium juice, ^j.\\nElder flower water, \u00c2\u00a7j.\\nM. Sig. Use locally.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0401.jp2"}, "400": {"fulltext": "382 SKIN DISEASES.\\nThe above formulae, and many others, may be used in\\nany of the forms of pruritus. Under the varieties men-\\ntioned below, some other means of affording relief will be\\nnoticed.\\nPruritus Ani. Itching about the anus arises from a\\nvariety of causes. It is a common consequence of piles,\\nas carides, tinea circinata, the friction of the parts in\\nstout people (intertrigo), gout, and uterine disorder. It\\noccurs from the latter by reflex action. It is often very\\ntroublesome. The result of scratching is to give rise to\\nthe development of papulae, and, it maj^ be, considerable\\ninflammatory thickening.\\nThe practitioner must of course discover any local\\ncause for the disease, and take care to negative its opera-\\ntion. The same local applications recommended for the\\npreceding will be useful. In addition I would advise the\\nfollowing:\\n9^. Oil of bitter almonds, ^ij.\\nCyanide of potassium, gr. x.\\nGalen s cerate, ^ij.\\nM. Sig. Apply locally. This must be used with great\\ncaution.\\nPruritus PrcEputii. Is merely itching about the glans,\\nconnected with an abnormal secretion from the follicles of\\nthat part. The remedy is free washing with soap and\\nwater and the application of an oxide of zinc powder or\\nlotion, as follows:\\nOxide of zinc, 5ij-\\nGlycerine, 5ij-\\nLead-water, 3iss.\\nlyime-water, \u00c2\u00a7vj to viij.\\nM. Sig.: Apply locally.\\nPruritus Piideyidi, or itching about the genital parts,\\nis common in women, and arises from a variety of causes", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0402.jp2"}, "401": {"fulltext": "PRURITUS. 383\\neczema, intertrigo, the presence of vegetable fungi,\\novarian and uterine irritation, hemorrhoids, and varicosity\\nof veins of the genital parts. In those cases in which\\nthere appears no structural change relief is to be obtained\\nby the locally applied anodynes, care being taken to treat\\nany uterine or ovarian disease appropriately.\\nFor the relief of the itching the following means may\\nbe .used: The cure of the complaint in any of its above\\nforms can only be accomplished by the administration of\\nthe properly indicated homoeopathic remedy, hints of\\nwhich will be found at the close of this article. In many\\ncases, relief will be demanded for the excessive itching,\\nand in such cases it is admissible to make use of one or\\nmore of the following:\\n1^. Hyposulphite of soda, 5j.\\nGlycerine, ^j.\\nWater, giij.\\nM. Sig. Use locally.\\nPeppermint water is one of our best local applications\\nin the above-mentioned forms of pruritus. Patients can\\neasily make their own lotion, as required for use, by\\nputting a teaspoonful of borax into a pint bottle of hot\\nwater, and adding to it five drops of oleum menthae\\npeperitse, and shaking well; the parts affected to be freely\\nbathed with a soft sponge.\\nIf cracks, or sores, or eczema, or rawness be present\\nthis lotion will be too severe. Olive oil, with five grains\\nof iodoform to the ounce, is better.\\nA sitz bath of cold water is often beneficial.\\nGalvanism, as a remed}^ in pruritus vulvae et ani, is a\\nvaluable adjuvant. A current from six elements with\\nthe anode applied to the vulva and the cathode to the af-\\nfected portions of the integument. The sittings should\\nlast about ten minutes.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0403.jp2"}, "402": {"fulltext": "384 SKIN DISEASES.\\nTherapeutic Hints:\\nItching as if from ants: I^ach., Phos., Puis., Secale.\\nBitings: Berb., Bry., Chin., Colch., I^ach., Led.,\\nMagn. acet., Merc, Nux vom., Oleand., Puis.\\nBurning: Agar., Arg. n., Ars., Bry., Calad., Caps.\u00c2\u00bb\\nCic, Kupliorb., Hep,, Ign., Merc, Nux vom., Ran.,\\nRhus, Sabad., Spig., Staph., Sulph., Verat., VioL\\nod.\\nAs if from congelation: Agar.\\nCorrosive itching: Rhus ven.\\nCrawling: Arg. n., Ars., Dulc, Magn. c, Sil., Spig.,\\nStaph.\\nCreeping: Sil.\\nDull: Hepar.\\nAs if electric sparks: Phell.\\nAs if from fleas: Arg. n., Lyco. Magn. acet., Merc,\\nMezer., Oleand., Puis., Sil., Spong., Staph.,\\nTabac, Teucr., Thuja, Zinc\\nGnawing: Agn., Ars., Cocc, Dig., Euphorb., Magn.\\naust., Oleand., Plat., Puis., Rhod., Ruta.\\nIntolerable: Merc, Sil.\\nItch-like: Amb., Merc, Verat.\\nJerking: Staph.\\nItching as of lice: Arg. n., Canth., Magn. m., Plat.,\\nZinc\\nAs from mosquito-bites: Rhus ven.\\nAs of nettles: Colch., Lupul.\\nPainful: Alum., Ammon., Baryt., Cham., Cocc,\\nLupul., Nitr.\\nPinching: Mosch.\\nPleasant: Merc.\\nPrickling: Cin., Plat., Zinc.\\nStinging: Agn., Arg., Arn., Asaf., Bry., Con., Cycl.,\\nDros., Graph., Ign., Led., Magn. acet., Merc,", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0404.jp2"}, "403": {"fulltext": "PRURITUS. 385\\nOleand., Puis.. Ran. sc, Rhus, Ruta, Sabina,\\nSpig., Spoiig., Squill., Stan., Staph., Thuja, Ver.,\\nViol. tr.\\nTearing: Bell., Bry.\\nTickling: Agar., Calc. c, Euphorb., Merc, Plat.,\\nPuis., Ruta.\\nTitillating: Bell., Chel., Chin., Plat., Puis., Rhod.,\\nSabad., Squilla.\\nViolent: Agar., Dros., Ipec, Lach.\\nVoluptuous: Anac, Merc, Sulph.\\nWandering: Cham., Graph., Kali c, Magn. m.,\\nMez., Rhus v.. Staph., Zinc\\nOf wounds: Chin., Tart. emet.\\nLocation.\\nAnus: Alum., Ambra, Amm. c, Anac, Calc. c\\nCarbo veg., Caust., Kali c, Lyco., Nux vom.,\\nPhos., Sabad., Sep., Sil., Spig., Sulph.\\nnates, between the: Alum,, Con., Seneg.\\nperinaeum: Agn., Alum., Ars., Carbo veg., Ign.,\\nMur. ac, Nux vom., Plumb., Tarax.\\nSexual parts: Ambra, Amm. c, Berb., Calc c,\\nCann., Canth., Carbo veg., Caust., Cocc, Coff.,\\nRaph., Con., Hep., Ign., Kali c, Kreas., lyyco.,\\nMagn. acet., Magn. m., Merc, Natr. m., Nitr.\\nac, Nux vom., Petr. Puis., Rhus, Sep., Sil.,\\nSulph., Thuja.\\nfraenulum: Cann., Caust., Hep., Merc.\\nglans: Merc, Natr. c, Natr. m., Nitr. ac, Nux\\nvom., Sep., Thuja.\\ntesticles: Merc.\\nscrotum: Berb., Carbo veg., Caust., Cocc, Graph.,\\nLyco., Nitr. ac, Nux vom., Petr.\\nclitoris: Sulph.\\npenis: Nitr. ac.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0405.jp2"}, "404": {"fulltext": "386 SKIN DISEASES.\\nmons veneris: Kali c.\\nlabia: Amm. c, Calc. c, Carbo veg., Con., Graph.,\\nKalic, Merc, Natr. m., Nitr. ac, Sil., Staph.,\\nSulph.\\nvagina: Canth., Con., Kreas., Sulph.\\nprepuce: Cann., Carbo veg., Lyco., Magn. acet.,\\nNitr. ac, Nux vom., Puis.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0406.jp2"}, "405": {"fulltext": "CHAPTER XVII.\\nChromatogenous Diseases, or Alteration In the\\nPigmentation of the Skin.\\nPigmentary discolorations may be divided into three\\nmain groups (i) primary and idiopathic, (2) secondary\\nor symptomatic, and (3) congenital.\\nThe primary or idiopathic pigmentations result from the\\napplication of irritants, which set up hyperaemia in some\\ncases and in others not as after the action of heat or\\nfriction, or irritants, such as mustard plasters, or the\\npressure on a part, as by dresses, mechanical restraints,\\nthe friction of straps, and the following of certain handi-\\ncrafts by which certain parts of the body are exposed to\\nthe sun or specially rubbed, as in masons. Scratching\\nalso will be followed in some cases by discoloration this\\nis seen in phtheiriasis particularly.\\nSecondary or symptomatic staiiiings are those which\\nfollow in the wake of other diseases, or are due to dis-\\nturbance of organs at a distance from the seat of discolor-\\nation that do not, in other words, constitute the essential\\ndisease, but are secondary to, or form only a part of, the\\nessential diseases present in any given case. There are\\nthree groups of secondary pigmentations: i. Those which\\nfollow in the wake of and occur in the same seat as cer-\\ntain skin eruptions; 2. Pigmentations occurring in con-\\nnection with certain cachexias, the latter being associated\\nwith definite organic diseases of important internal or-\\ngans; 3. Physiological pigmentations connected with\\nuterine functional changes.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0407.jp2"}, "406": {"fulltext": "388 SKIN DISEASES.\\nAs regards congenital pigmentations^ I need only say\\nthese are seen in moles and pigmentary nsevi.\\nThose cases in which the pigmentation of the skin is at\\nfault as the sole existing disease may be divided into two\\nclasses those in which the pigment is deficient in\\nquantity (Leucoderma, or Vitiligo), and those in which\\nit is in excess (Melanoderma). These may be congenital\\nor acquired, general or local. The seat of change is the\\nrete mucosum.\\nVitiligo.\\nVitiligo, or leucoderma, is an affection characterized by\\ncircumscribed patches of skin, from which the pigment\\nhas disappeared to a greater or less extent. At the be-\\nginning the patches will be quite limited in extent, and\\naffect by preference the face, neck, hands, and genitals.\\nAs a rule, however, triey increase for a certain length of\\ntime, and neighboring patches coalesce. The borders\\nof the spots are usually somewhat hyperpigmented, as if\\nthe pigment which had been removed from the centre had\\nbeen simply deposited at the edges. This feature, how-\\never, is not always met with.\\nThe course of vitiligo varies. With some individuals\\nit reaches a certain degree of development, and then re-\\nmains stationary for years; in others, it progresses in-\\ndefinitely, and this so particularly when it affects the\\nnegro.\\nIn perhaps the majority of cases there is a return of\\nthe natural pigment after the lapse of a few years, while\\nin others the affection appears, lasts a few months and\\ndisappears, only to be followed by one or several re-\\ncurrences. It may be absent during the hot months, and\\nreturn during the cold ones.\\nThe causes of vitiligo are unknown. It occurs in both", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0408.jp2"}, "407": {"fulltext": "Vitiligo,", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0409.jp2"}, "408": {"fulltext": "", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0410.jp2"}, "409": {"fulltext": "MELANODERMA. 389\\nsexes with apparently the same frequenc}^ and usually\\nwithout being preceded by any acute disease, or general\\nfailure of health. In fact, the majority of patients will\\ncomplain of nothing except the uusightliness of the af-\\nfection, which may pursue its course uncomplicated by\\ntrouble that can be attributed to it. There is no reason\\nfor believing that it ever shortens life. When we con-\\nsider the permanency and progressive nature of some\\ncases, we are utterly at a loss to account for this curious\\naffection.\\nTreatment. The old school acknowledge their in-\\ncapacity to do anything in this affection. Our school is\\nbut little better off.\\nLocally, the pigmentation around the patch may be\\nlessened by the use of strong acetic acid. Galvanism\\nma}^ prove serviceable. Internall}* the Sulphide of Arseni-\\ncum will be oftenest used with benefit. Natrum c., Nitr.\\nac., Su7?tbul din6. the Phosphide of Zi?ic may be studied.\\nMelanoderma.\\nThis term of course means excess of pigment resulting\\nin dark discoloration s, but the altered tint of skin may be\\nblue, yellowish, or black; hence the terms cyanoderma,\\nxanthoderma, and melasma.\\nMelasma^ or that condition in which the discoloration\\nof skin is black in color, is general or partial. The\\nlatter is generally called melasma. It may be a physi-\\nological condition, as seen in the staining around the\\nnipple andthelinea alba in pregnancy; this condition may\\nbe excessive. The varieties of melasma are lentigo and\\nephelis.\\nLentigo is known as freckles. The seat of the pig-\\nment deposit is the rete mucosum; it is often congenital,\\nand of varying extent and distribution; generally, how-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0411.jp2"}, "410": {"fulltext": "390 SKIN DISEASES.\\never, it consists of round yellowish spots, the size of\\nsplit peas and less, not only on the parts exposed to the\\nlight, but also those covered by the dress. Lentigo oc-\\ncurs in those with fair skins, and particularly red-haired\\nfolk. There is no desquamation, no itching, and no\\nheat of any kind in connection with freckles, which\\noften disappear after puberty. Freckles do not depend\\nupon seasonal change.\\nLentigo may sometimes be made to disappear by an\\napplication of citric acid night and morning. One\\nwriter reports the application of emulsion of almonds,\\nnight and morning, to be the most satisfactory treatment,\\nand advises its continuance until a slight amount of des-\\nquamation takes place. Another writer recommends the\\napplication of oleate of copper for the removal of\\nfreckles. Care should be exercised that a pure sample\\nof the drug is obtained.\\nCupric. Oleat., ^j.\\nPetrolei, ^xvj.\\nM. Sig. Appl twice a day.\\nThe internal remedies are:\\nFerrum mag. Spots resembling summer freckles on\\nback of hands and fingers.\\nKali carb. Freckles on the face.\\nLycopod. Freckles on the left side of the face and\\nacross the nose.\\nNitric acid. Freckles on the chest; dark freckles.\\nPetroleum. Freckles on the arms.\\nPhosphorus. Freckles on the lower limbs.\\nSepia. Freckles on the cheeks.\\nSulphur. Freckles on the nose.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0412.jp2"}, "411": {"fulltext": "EPHELIS, OR SUNBURN. 391\\nEphelis, or Sunburn.\\nIn this particular variet}^ of discoloration the pigment\\ndeposit is excited b}^ the sun s raj^s. Sunburn consists\\nof little dots the size of pins heads, which appear upon\\nthe parts of the body exposed to the influence of the sun,\\nand are seen mostly in lymphatic subjects with delicate\\nskins. Temporary benefit accrues from the use of local\\napplications strong enough to cause exfoliation of the\\ncorneal cells. A one per cent, solution of mercuric\\nbichloride and a ten per cent, solution of calcium chlo-\\nride are the lotions most commonly used.\\nVer. alb. Robinia and Kali carb. are useful internal\\nremedies. Bufo is indicated when the face tans quickly.\\nMelasmic discoloration likewise occurs as the result of\\nthe action of local irritants excessive scratching, strong\\nlights, blisters\\nPigmentary Ncsvi. These consist of collections of pig-\\nment in the rete and corium, and a certain amount of\\nhypertrophy of the papilla at times. They may be fur-\\nnished with hairs. Moles are of this nature.\\nXanthoderma. In this disease the pigmentary dis-\\ncoloration is yellowish. It is characteristic of certain\\nraces, and is due to some special condition of the color-\\ning matter of the skin, molecular or chemical.\\nCyanoderma, or blue discoloration, is different from\\ncolored sweat. It is a curiosity, if not, at least in the\\ngreater number of instances, a hoax.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0413.jp2"}, "412": {"fulltext": "CHAPTER XVIII.\\nPARASITIC DISEASES.\\nThe parasites are of two kinds, animal and vegetable.\\nThe principal animal parasites are the Acarus scabiei,\\nor itch mite; the Pedicuhis, or louse; the Cimex lectu-\\nlariuSy or bedbug; the Ptilex irritans, or flea; and the\\nPulex penetrans, or chigoe.\\nThe bite of the Cimex lectularius causes a hypersemic\\npapule with a small red spot in the centre. That of the\\nflea produces a little circular erythematous spot, which\\nexhibits a dark speck in the centre, that marks the\\nwound made by the insect. The chigoe attacks the feet\\nand hands, entering the skin beneath the nails or betwixt\\nthe toes, or upon some portion of the extremities, either\\nby a channel made for itself, or by the ducts of the skin;\\nits tracks can sometimes be traced as an elongated brown\\nspot.\\nThe application of a lotion of glycerine and water, of\\neach 5jj, and tincture of calendula 5j will be found very\\nuseful in allaying the irritation in the case of the first two.\\nThe treatment of chigoe disease consists in dilating the\\noriginal channel of entrance, and carefully removing the\\nchigoe bodily; after which apply an ointment composed of\\nlard and salt.\\nCertain caterpillars, if they get upon the skin, may ex-\\ncite urticaria also.\\nChildren of lymphatic temperament who are not kept\\nclean, are poorly nourished, or insufficiently clothed, and", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0414.jp2"}, "413": {"fulltext": "PHTHEIRIASIS. 393\\nlive in rooms badly ventilated, are particularly liable to\\nvegetable parasitic diseases; and unless measures are\\nadopted to remove the exciting causes and predisposing\\nconditions treatment is unsatisfactory and relapses are\\nfrequent. The patients should be isolated whenever\\npracticable.\\nThe varieties are: Tinea favosa, or favus; tinea ton-\\nsurans; tinea circinata; tinea versicolor; and onychia\\nparasitica,\\nPhtheiriasis.\\nPhtheiriasis is the name applied to the affections pro-\\nduced by the invasion of the there well known varieties\\nof pediculus namely, the head-louse, body-louse, and\\npubic or crab louse.\\nThe nature and appearance of these insects are so well\\nknown that we need not describe them. The first of\\nthese infest the scalp; the second confines itself to the\\nnon-hairy portions of the surface; and the third prefer\\nthe pubic region, but may be met with wherever the hairs\\nare short, but avoiding the scalp.\\nPhtheiriasis Capitis.\\nThis affection occurs most frequently in children, more\\nrarely in women, and almost never in men. The insect\\n{pediculus capitis) finds its most congenial abiding-place\\nin the hair of children, where it lays its eggs, and at-\\ntaches them by a kind of cement to the shafts of the\\nhair. The eggs take but a few days to hatch, and in a\\nshort time the parts may become pretty thickly settled.\\nThey derive their nourishment from the skin, and by\\ntheir presence produce considerable itching and lead to a\\ncorresponding amount of scratching. In children predis-\\n26", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0415.jp2"}, "414": {"fulltext": "394 SKIN DISEASES.\\nposed to eczema they not infrequently lead to the devel-\\nopment of this affection.\\nThe diagnosis is, of course, readily made, as inspec-\\ntion of the scalp will quickly reveal the presence of the\\ninsects and their ova, if at all abundant. In doubtful\\ncases the fine- tooth comb will soon settle the question.\\nThe treatment, of course, involves the removal of the\\ninsects and their ova, usually called nits. In children,\\nclipping the hair as close as possible, or perhaps shaving\\nit, is, of course, the quickest way of relieving the patient\\nof these pests. When this is not practicable, the scalp\\nshould be thoroughly washed with tincture of staphisa-\\ngria, or with ordinary kerosene oil. A few applications\\nwill kill the living insects, but do not appear to destroy\\nthe vitality of the ova. These should be removed as far\\nas possible with the fine-tooth comb. Many, however,\\nwill still remain, and the best way to get rid of them will\\nbe to go over the scalp carefully and clip the shafts of all\\nthe hairs to which they are attached. The head should\\nbe washed for a week or ten days, for fear some of the\\neggs may have escaped detection. It is almost needless\\nto say that soap and water, freely used, are essential ad-\\njuvants to the means just mentioned.\\nThe following is a very excellent application:\\n9? 01. Staphisagrise, ^j.\\n01. Ivimonis, dr. j.\\n01. Amygdalse, ^iv.\\nM. Sig. Apply to the aflfected parts daily.\\nPhtheiriasis Corporis.\\nThis affection is very rarely met with in young persons,\\nand is found most frequently in middle and advanced\\nlife, and especially in the feeble and ill-fed, and among", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0416.jp2"}, "415": {"fulltext": "PHTHEIRIASIS PUBIS. 395\\nthe frequenters of prisons and cheap lodgings. Though\\nsometimes met with in women, nine- tenths of the cases\\nare among men.\\nTh.Q pediadus coj pojHs diOQS not lodge upon the body,\\nbut infests and breeds among the folds of the under-gar-\\nments, from which hiding places it sallies forth to seek its\\nnourishment from the skin. This it pierces with the\\nsucker, and continues to feed until gorged with blood.\\nThese insects excite at times a liveh^ and most annojnng\\nitching, and lead to vigorous scratching. In cases that\\nhave lasted for any length of time, the skin gradually\\n3arkens, even to the color of a mulatto.\\nDiagnosis. After a little experience a case of phthei-\\nriasis will, in most cases, be recognized at a glance, and\\nshould alwaj^s be proved by a careful search for the in-\\nsects. Strip the patient, if possible, and then examine\\nnot his skin, but his shirt, and, as a rule, you will find\\nthe pediculi, if present, without dijB culty.\\nTreatment. Soap, water, and clean clothes are all\\nthat are necessary. The old clothes should be destroyed,\\nor thoroughly disinfected by boiling or baking.\\nPhtheiriasis Pubis.\\nThQ pediculus pubis affects a preference for the pubic\\nregion of both sexes, but is not confined to this locality;\\nbut in women may also be met with in the axillary\\nregion and in the eyebrows, and in men among the chest\\nhairs and in the baard and whiskers. It rarely gives rise\\nto as much irritation as the other varieties of pediculus,\\nand its presence is often discovered accidentally. The\\ninsect attaches its eggs to the hairs like the pediculus\\ncapitis, and adheres to them itself or to the skin in the\\nmost tenacious manner by the aid of its crab-like claws.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0417.jp2"}, "416": {"fulltext": "396 SKIN DISEASES.\\nThe diagnosis is to be made by the discovery of the\\ninsect, but, having been found in its favorite seat, thor-\\nough examination of all other parts of the body liable to\\nbe infested should not be omitted.\\nThe treatment of this affection involves the employ-\\nment of some anti-parasitic application, and the one most\\nin vogue is the common blue ointment. When, hov^^-^\\never, the patient will consent to it, shaving of the affected\\nparts is to be preferred. The affection is most frequently\\ncontracted during sexual intercourse, but may be de-\\nrived from wearing infected clothing, or sleeping in an\\ninfected bed. The patient s under-clothes and bed-clothes\\nshould be boiled or baked, in order to destroy the insects\\nand their eggs.\\nPsorospermosis.\\nPsorospermosis may be defined as a condition of the\\nskin of varied lesion, but characterized by the presence\\nof psorosperms. The psorosperm is a living animal\\nparasite, which infests the human skin as well as the\\nbodies of some of the lower animals, and consists of a\\nroundish or oval cell, containing one or more neuclei;\\nthe nucleus occupying but a small portion of the cell, the\\nplasmic portion of which is extremely transparent and\\nstructureless.\\nMuch doubt exists among dermatologists as to the\\nnature of this affection; and but little is known positively\\nconcerning it.\\nScabies.\\nScabies is a contagious affection of the skin character-\\nized by the development of vesicles, pustules, and other t\\nlesions on the skin, and caused by the presence of an\\nanimal parasite, known as the Acarus scabiei.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0418.jp2"}, "417": {"fulltext": "Scabies.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0419.jp2"}, "418": {"fulltext": "", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0420.jp2"}, "419": {"fulltext": "SCABIES. 397\\nThe affection usually commences by the appearance of\\nsmall, non-umbilicated vesicles on the hands and between\\nthe fingers, accompanied with severe itching. The itch-\\ning leads to scratching, and as a consequence transfer of\\nthe affection to other parts of the body with which the\\nTiands are brought in contact. Very earl 3^ in the disease,\\nthen, we will find it appearing on the penis, on the breasts\\nin women, and on the feet in children. From these parts\\nit may spread over the greater part of the surface, more\\nprofoundly on the anterior than posterior parts and avoid-\\ning the face and scalp.\\nThe vesicles above mentioned may be termed the\\nprimary lesions of the disease, but are usually followed\\nin a few days by others secondary to the irritation pro-\\nduced by the insect, and to the effects of the finger\\nnails. These new lesions may be papular or pus.tular in\\ncharacter, and may even assume distinctly eczematous\\ncharacters, or develop into a true eczema in those predis-\\nposed to this affection. On the penis the lesions are\\nusually papular. None of these features are absolutely\\npathognomonic. There is, however, a lesion which is met\\nwith in no other disease, and which when found renders\\nthe diagnosis absolute. This is a fine, grayish line fre-\\nquently terminating in a vesicle, and found between the\\nfingers more frequently than elsewhere. It is called the\\n4icarian burrow. When an impregnated female acarus\\nfinds lodgment on the skin, she immediately seeks a\\nplace in which to deposit her eggs. This she accom-\\nplishes by boring beneath the epidermis and laying an\\n\u00e2\u0082\u00acgg\u00c2\u00bb and then advancing in a straight or slightly curved\\nline for several days until ovulation is complete. She\\nthen dies, and her decomposing remains give rise to a\\nvesicle or pustule. When the eggs hatch, the young find\\ntheir way to the surface, and as soon as they assume the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0421.jp2"}, "420": {"fulltext": "398 SKIN DISEASES.\\nadult form copulate, and the impregnated females com-\\nmence to burrow as did their mother before them, A\\nsharp needle-point, if guided by a sharper eye, will\\nsometimes extract the acarus from her nest. The male\\nacarus never burrows, and is very rarely detected.\\nEtiology. Scabies is one of the few diseases of which\\nwe can say that we absolutely know the cause; and yet\\nthere is no chapter in medical history more interesting\\nthan that which concerns the etiology of this affection.\\nThe acarus is exceedingly minute, and when first\\nhatched has but six legs. It soon assumes its adult form,,\\nhowever, with eight legs; and the sexes are easil}^ distin-\\nguished by the fact that in the female the four posterior\\nlegs are furnished with projecting hairs, while in the\\nmale two of these legs terminate in suckers instead of\\nhairs.\\nDiagnosis. The diagnosis of scabies should not in\\nmost cases be difiicult. The early vesicles on the hands\\nare either to be found, or the patient may tell you that\\nthe affection commenced with small watery pimples.\\nNext, examine the penis, and you will rarely miss find-\\ning papules on the glans or papules or vesicles on the\\ncutaneous surface. Rather good-sized isolated pustules\\nabout the wrists are commonly present, and in women\\nyou usually find an eczematous eruption around the\\nnipple. If on inquiry you find that one or the other of\\nthe patient s associates is suffering from a similar trouble,\\nand that he has slept with him or worn his clothes, you\\nmay be fully confident of the diagnosis.\\nThe mere presence or the intensity of the itching can\\nnot be relied on to establish the nature of the disease, as\\nin several other affections intense pruritus is a marked\\nfeature; and this is notably the case in phtheiriasis, pro-\\nduced by the pediculus corporis, or body louse. The\\nJ.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0422.jp2"}, "421": {"fulltext": "SCABIES. 399\\npapules or other lesions on the penis should not be mis-\\ntaken for lesions of venereal origin.\\nTo briefly sum up, then, the diagnostic points are:\\n1. A history of contagion.\\n2. The development of minute papulo- vesicles or ves-\\nicles, spreading on contiguous portions of the skin or on\\nparts habitually handled by the patient (never in patches\\nbut in rather a scattered manner).\\n3. Itching, worse at night and becoming progressively\\nworse as larger areas become invaded by the itch-mite.\\n4. Sites of predilection shown by the disease. They\\nare the webs of the fingers, the front of the wrists, the\\nanterior edges of the axillae, the mamma, the penis, the\\nabdomen and groins, the toes and feet. Flexor surfaces\\nare more involved than extensor.\\n5. That the face remains free from the disease, except\\nin the case of infants at the breast.\\n6. That it has taken about three weeks for the disease\\nto involve the whole surface.\\n7. That old cases show all the lesions that can possibly\\nbe produced by disease of the skin, expressed by the\\nterm multiformity of lesions.\\n8. Incidentally numerous scratch-marks.\\n9. The itch-mite and its canaliculi.\\nTreatment However distressing the present symp-\\ntoms, the patient may be confidently assured of speedy\\nrelief. This may be most promptly brought about by\\nadopting the following somewhat vigorous treatment:\\nPut the patient into a warm bath and let him soak for\\nfifteen or twenty minutes. Then let him be rubbed thor-\\noughly all over with soft soap, assisted with a flesh-\\nbrush. Every part of the body from the neck down\\nshould receive a thorough application of the soft-soap\\nand water and brush, in order to break over the burrows", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0423.jp2"}, "422": {"fulltext": "400 SKIN DISEASES.\\nof the insects. The soap is then washed off and the sur-\\nface rubbed dry. Then rub the entire surface with alka-\\nline sulphur ointment to each ounce of which a\\ndrachm of iodide of potassium has been added. After\\na thorough inunction the patient should go to bed and\\nstay there until the following morning. When morning\\ncomes a warm bath should be given to remove the oint-\\nment, and the patient should put on new under-clothes.\\nThe under-clothes and bedding that have been in use\\nshould be thoroughly disinfected by boiling or baking, in\\norder to destroy any wandering acari. This treatment is\\neffective but harsh, and for a day or two the patient s\\nskin will be far from comfortable, and the eczematous and\\nother secondary lesions will be greatly aggravated.\\nEmollient treatment, therefore, will in almost every in-\\nstance be needed for a few days longer, and the use of\\nthe oxide of zinc ointment is as good as any.\\nOne of the following B s is, I think, far preferable, and\\nless annoying to the patient:\\nBeta naphtholi,\\nBalsam Peru, da gm. x\\nSapon. kalini viridis,\\nCretse albae pulveris, da gm. xx\\nVasogen. Sulph (3 per cent.) spiss. gm. x L.\\nM. f. unguentum.\\nTwenty-four hours covering of the affected parts is\\nsufficient in most cases\\nOr,\\nP^ Sapon. med., 100.\\n01. petrae.,\\nAlcotiol, dd 50.\\nCerae alb., 40.\\nM, Sig. Soap the whole body with this three or four times\\ndaily and the itch-mite will be destroyed.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0424.jp2"}, "423": {"fulltext": "SCABIES. 401\\nAnother, which has proved very efficacious in destroy-\\ning the acarus scabiei, is:\\nNaphthol, 15.\\nLard, 100.\\nGreen soap, 50.\\nPrepared chalk, 10.\\nM. ft. Unguent.\\nFor obstinate cases the following is excellent:\\nPelroleum, 50 parts.\\nWhite wax, 40 parts.\\nAlcohol, 50 parts.\\nSoap, 100 parts.\\nM. Sig. Apply locally.\\nRemedies indicated:\\nArsen. alb. Inveterate cases; eruption in the bends of\\nthe knees; pustular eruption, burning and itching; better\\nfrom external warmth.\\nCarbo veg. Eruption dry and fine, almost over the\\nwhole body, worst on extremities; itching worse after un-\\ndressing; dyspeptic symptoms, belching of wind and\\npassing flatus; after abuse of mercurial salves.\\nCaiisticum. After abuse of sulphur or mercury; yel-\\nlowish color of face; warts on the face; involuntary urina-\\ntion when coughing, sneezing, or walking; sensitive to\\ncold air.\\nCroton tig. Itching and painful burning, with redness\\nof skin; formation of vesicles and pustules; desiccation,\\ndesquamation, and falling off of the pustules.\\nHepar. Fat, pustular, and crusty itch; also after pre-\\nvious use of mercury.\\nLobelia. Pricking itching of the skin all over the\\nbody.\\nLycopodium. Humid suppurating eruption, full of\\ndeep fissures; itching violently, when becoming warm\\nthrough the day.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0425.jp2"}, "424": {"fulltext": "402 SKIN DISEASES.\\nMercurius. Fat itch, especially in the bends of the\\nelbows, if some of the vesicles become pustular; itching\\nall over, worse at night when warm in bed; sleepless at\\nnight from the itching; diarrhoea.\\nPsorinum. Inveterate cases, with symptoms of tuber-\\nculosis; also, in recent cases, with eruptions in the bend\\nof the elbows and around the wrists; repeated outbreak\\nof single pustules after the main eruption seems all gone.\\nSepia. After previous abuse of sulphur; itching worse\\nevenings, especially in females.\\nSulphur, Mai7i remedy; voluptuous tingling, itching\\nwith burning and soreness after scratching; worse in\\nwarm bed; disposition to excoriation; glandi lar swellings.\\nSulph. ac. When itchiness of skin and single pustules\\nappear every spring; after imperfectly cured itch.\\nVEGETABLE PARASITIC DISEASES.\\nFavus.\\nFavus is a parasitic disease of the skin caused by a\\nminute vegetable fungus.\\nThis disease may affect any portion of the body where\\nthere are hairs; but it pre^fers the scalp, especially the\\nscalps of children. The fungus on which the disease de-\\npends is called Ackorioji Schonlemii, and falling on a con-\\ngenial soil, gains access to the hair follicles, where it\\nspreads and multiplies. In a short time it is perceived\\non the surface as a whitish speck, and later forms a very\\nlight-yellow umbilicated crust, the centre of which is per-\\nforated by a hair. A number of contiguous cups may\\ncoalesce, forming a crusty patch. The fungus, by its\\ndevelopment and increase, presses on the follicular con-\\ntents, and interferes with the nutrition of the hairs, and", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0426.jp2"}, "425": {"fulltext": "FAYUS. 403\\nin time insures their destruction and permanent disap-\\npearance. Favus of the scalp usually makes its first ap-\\npearance in childhood. Spontaneous cure rarel} if ever,\\noccurs; and the affection lasts indefinitely that is, as\\nlong as there is a hair follicle left for the achorion to lodge\\nin. In this way the affection may be prolonged for\\ntwenty years or more. The most striking features of a\\nlong-standing case are the sparseness of the hairs over the\\naffected area, the appearance presented being entirely\\ndifferent from that of any of the commoner forms of\\nalopecia. The peculiar crusts may be present to aid the\\ndiagnosis, but not infrequently they are entirely absent\\nfrom the surface, -as various ointments, or even plenty\\nof soap and water, are sufficient to prevent their develop-\\nment on the surface to an extent to prevent them to be\\nvisible to the naked eye.\\nThe progress of the affection is extremely slow, and,\\nwhen not checked by efficient treatment, may last for\\ntwent}^ years or more.\\nFavus on the body that is, on the trunk or extemities\\nfirst exhibits its presence by a small erythematous,\\npatch like a commencing ringworm; this spreads until it\\nhas a diameter of an inch or more, when the character-\\nistic crusts appear.\\nEtiology. The disease is due to a vegetable parasite,\\nand is communicable from one to another. This disease\\nis not infrequent in the common domestic mouse, from\\nwhich animal it is sometimes conve3^ed to the household\\ncat, who in turn transmits it to the children of the\\nfamily.\\nDiagnosis. In most cases the diagnosis is easy. If\\nthe affection is in full efflorescence, it can hardly be mis-\\ntaken for anything else, as there is no other disease that\\npresents the characteristic umbilicated, light yellow, and", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0427.jp2"}, "426": {"fulltext": "404 SKIN DISEASES.\\ndry crusts. lu an advanced case the peculiar alopecia,\\nmarked by the presence of a few, scattered, lusterless\\nhairs, distinguishes it from every other form of baldness.\\nIn doubtful cases the microscope will reveal the parasite,\\nwhich consists of minute spores and mycelium.\\nTreatment. The treatment of favus of the general\\nsurface is exceedingly simple. All that is necessary is to\\npick off the crusts and make a few applications of tincture\\nof iodine, or other efficient parasiticide, to the affected\\npatches.\\nWhen, however, the affection is located on the scalp,\\nit is very difficult to cure. The primary indication is to\\ndestroy the parasite. As this fungus flourishes in the\\nlowest depths of the hair follicles, ordinary applications\\nmade to the surface are not sufficient. It is necessary to\\nattack the parasite in its stronghold, and this can only be\\ndone by first extracting the hairs. These should be re-\\nmoved by properly constructed epilation forceps. After\\nepilation a solution of corrosive sublimate, two grains to\\nthe ounce, should be rubbed in. This should be repeated\\ndaily until a considerable degree of irritation is produced.\\nThe artificial irritation should be sufficient to produce ex-\\nfoliation of the epithelial lining of the follicle. If the\\naffected surface is at all extensive, it is hardly practicable\\nto epilate and mercurialize the whole of it at a single\\nsitting; it should be done in sections. This treatment\\nshould be continued with as much regularity and thor-\\noughness as circumstances will permit. In a few weeks\\nthe disease will appear to be cured; but in general this\\nappearance is delusive, and treatment should not be re-\\nlaxed simply because the disease is no longer visible on\\nthe surface. In all cases the patients should be kept\\nunder observation for several months after active treat-\\nment has been suspended.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0428.jp2"}, "427": {"fulltext": "FAVTTS. 405\\nOf internal remedies the following may be mentioned:\\nAgaricus. Favus with biting itching in the scalp;\\ncrusts sometimes spread to other parts of the body sen-\\nsation as if ice-cold needles were piercing the skin.\\nArsenicum alb. The scalp is found perfectly dry and\\nrough, covered with dry scales and scabs, extending\\nsometimes even over the forehead, face, and ears.\\nArsenicum iod. Scalp dry and rough, and covered\\nwith dry scales and scabs; extend to forehead, face and\\nears; intense itching and burning.\\nBromine, Malignant scald head, oozing profusely;\\ndischarge dirty looking, offensive smelling; when the\\nskin is dry, extreme tenderness of the scalp; crawling\\nbeneath the skin of the occiput.\\nCalcarea carb. Scabs are thick, and cover a quantity\\nof thick pus; the scabs are large, even one-half of the\\nentire scalp being covered with a single scab; eruption\\nspreading to the face; burning and itching; glandular\\nswellings on the neck.\\nClematis. Eruption on occiput, extending down the\\nneck, moist, sore, with crawling and stinging itching;\\noften drying up in scales; itching worse when getting\\nwarm in bed, and but temporary relief by scratching.\\nCornus circinata. Dry or moist eruption; scrofulosis,\\nwith dry spasmodic cough, or tedious chronic cough,\\nwith mucous expectoration.\\nDulcamara. In scrofulous children when the crusts\\nare thick and the hair falls out; bleeding after scratching;\\nglandular swellings in the neighborhood of the eruption.\\nGraphites. Exudation of clear, glutinous fluid form-\\ning moist scabs; secretion from scratching; falling out of\\nhair; skin dry and inclined to crack; tendency to ulcera-\\ntion.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0429.jp2"}, "428": {"fulltext": "406 SKIN DISEASES.\\nJacea. Thick incrustations, pouring out a large quan-\\ntity of thick yellow fluid, which agglutinates the hair.\\nKali carb. Exudation of moisture after scratching;\\nsensitiveness to cold; frequent urination, especially at\\nnight; dryness and falling out of the hair, in old over-\\ntreated cases.\\nLappa major. Scalp covered with a grayish- white\\ncrust, and most of the hair disappeared; eruption spread-\\ning overhead, face, and neck; moist foul-smelling eruption\\non the head of children; swelling and suppuration of the\\naxillary glands; boils all over the body.\\nLycopodium. Eruption beginning on the back of the\\nhead; when there are several spots, and when the crusts\\nare fetid, thick and bleed easily. Hunger, but a small\\nquantity of food fills him up.\\nMezereiim. Head covered with a thick leathery crust,\\nunder which pus collects and mats the hair; dry eruption\\non the head, with intolerable itching, as if the head were\\nin an ant s nest. White, scaly, peeling off eruption on\\nthe scalp, extending over forehead and temples.\\nOleander. Biting itching on the scalp, as if from ver-\\nmin; worse back part of head and behind ears; better when\\nfirst scratching it, followed by burning and soreness;\\nworse evenings when undressing; humid, scaly, biting,\\nitching eruption, especially on the back part of head.\\nPhosphoriis. May be used when the follicles appear to\\nhave been destroyed, and the scalp left smooth and\\nshining.\\nPsorinum. Moist, suppurating, fetid eruption, or dry\\neruption; hair dry, lusterless, tangles easily; averse to\\nhaving head uncovered; wears a fur cap even in hottest\\nweather.\\nStaphisagria. Yellow, moist, offensive scales; falling\\nout of the hair; humid, itching, fetid eruption on occiput,", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0430.jp2"}, "429": {"fulltext": "TRICOPHYTOSIS. 407\\nsides of the head, and behmd ears; scratching changes\\nthe place of itching, but increases the oozing.\\nSulphur. May be necessary to help along the action\\nof the indicated drug.\\nUstilago. When there is great moisture, with matting\\nand falling of the hair.\\nVinca minor. Offensive, moist eruption, with brownish\\ncrust; abundance of lice on the head; hair matted to-\\ngether; the hair falls out in single spots and white hairs\\ngrow there.\\nViola tricolor. Thick crusts; hair becomes matted;\\nurine smells like cat s urine. Swelling of the cervical\\nglands; intolerable itching at night.\\nTricophytosis.\\nTricophytosis is an affection of the skin, due to the de-\\nvelopment of a minute fungus known by the name of the\\nTricophyton tonsurans. The disease itself bears the com-\\nmon name of ringworm. There are four principal\\nvarieties of the affection, which present appearances dif-\\nfering somewhat from each other, due to differences of\\nlocation. These are tricophytosis capitis, barbce, corporis^\\nand genisto-fevioralis.\\nTricophytosis Capitis.\\nThis variety is almost wholly confined to childhood\\nand youth very rarely, if ever, appearing in adult life.\\nThe symptom that usually first attracts attention is a\\nsmall, scaly, patch on the scalp, perhaps half an inch in\\ndiameter, from which the hair appears to have fallen.\\nOn closer examination, however, it is found that, instead\\nof the hairs having fallen, they are broken off a line or\\ntwo from the surface. If an attempt be made to extract\\na few of these short stumps with forceps, it will be found", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0431.jp2"}, "430": {"fulltext": "408 SKIN DISEASES.\\nthat many of them do not come out by the roots, but\\nbreak off in the follicle, leaving the lower extremity of\\nthe root in situ. This fragility of the hairs is a marked\\nfeature of the disease, and brings it into contrast with\\nfavus, in which affection the hair-shafts are not notably\\nweakened.\\nIf one of the extracted hair-stumps be examined under\\nthe microscope, it will be found infiltrated throughout its\\nentire extent with the minute spores of the tricophyton.\\nThis fungus, when it takes lodgment on the scalp, gains\\naccess to the hair-follicles, into which it descends until it\\nreaches the bottom. Here it increases and invades the\\nroot, and travels up the shaft toward the surface. It\\nproduces dissociation of the fibres, and thereby weakens\\nthe hair. After the surface is reached, there is no out-\\nside pressure to counteract the pressure from within the\\nshaft, and the latter gives way and breaks off. The\\noriginal patch extends centrifugally, and new ones form,\\nso that after a few weeks or months there may be a pretty\\ncomplete involvement of a considerable portion of the\\nscalp.\\nIn scrofulous subjects, or those prone to suppurative\\naction, the irritation of the fungus may cause the forma-\\ntion of little collections of pus on the substance of the\\nscalp, which, opening on the surface, give a honey-\\ncombed appearance to the lesion, to which the older\\nwriters assigned the name of kerion.\\nWhen left to nature, the affection persists indefinitely,\\napparently as long as the hairs and hair-follicles afford\\nsufficient pabulum for the fungus. The ultimate ter-\\nmination is baldness. The circular patches on the scalp\\nmay spread beyond the line of the hair and down upon\\nthe adjacent uncovered skin; and in the form of tricho-\\nphytosis corporis may appear on other parts of the body.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0432.jp2"}, "431": {"fulltext": "TRICOPHYTOSIS BARB^. 409\\nTricophytosis Barbae.\\nThis variety is confined to adult males, and appears on\\nthe bearded portions of the face and neck. At its first\\nappearance we usually find a small, red, and very slightly\\nraised spot. In a few days this develops into a distinct\\nring, with elevated margin, gradually increasing in size,\\nand new spots and rings appearing. Accompanying\\nI these lesions we may have pustules, tubercles, and some-\\nI times considerable infiltration of the integument in fact,\\nI something not unlike the kerion of children. If shaving\\nI be practiced, the irritation is increased. The hairs some-\\ni times break and sometimes fall out, and, if examined\\ni microscopically, will be found infiltrated with the fungus.\\nTricophytosis Corporis.\\nThis is the ordinary ringworm of the body, and is too\\nI familiar to need any special description. Appearing at\\nI first as a small red spot, it soon assumes the annular form,\\nii bounded by a slightly reddened and raised periphery.\\nThe center of the patch is apparently healthy, or, at\\nj most, slightly reddened. When two neighboring rings\\nextend until they meet, the elevated margins which are\\ni in contact melt away, and we may have a figure eight,\\nIj or some similar form.\\nII This form of tricophytosis rarely gives rise to much in-\\ni convenience by itself, except in tropical countries, when\\nthis fungus is found to flourish with a vigor not met with\\nin cooler regions.\\nTricophytosis Genito-Femoralis.\\ni| This is not a very uncommon variety of ringworm, and\\nis almost wholly confined to adult males. The usual loca-\\n27", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0433.jp2"}, "432": {"fulltext": "410 SKIN DISEASES.\\ntion is at the tipper and inner aspect of the thigh and\\ncontiguous parts. It generally involves a portion of the\\nscrotum as well as the thigh.\\nThe diagnosis of t. capitis is usually easy, as the\\nbroken-off hair-stumps are characteristic. T. barbcs, when\\nseen early, and before marked inflammatory action has\\nchanged the aspect of the part, ought to be recognized\\nwithout difficulty, but later in the course of the disease it\\nmight be mistaken for eczema barbae, or so-called non-\\nparasitic sycosis. Ringworm of the body is recognizable\\nunder almost any condition that can be imagined, and\\ntricophytosis genito-femoralis equally so, unless obscured\\nby a co-existing eczema. Under all circumstances, how-\\never, the microscope may be relied on to settle the\\ndiagnosis.\\nEtiology. Trichophytosis is due to a vegetable para-\\nsite, and is propagated from one to another by contact.\\nRingworm of the head is usually contracted by the care-\\nless habit among children of wearing each other s head-\\ngear, and in public institutions by the common use of\\nbrushes and combs, towels, etc. In nursing infants the\\ntrouble is sometimes conveyed to the breasts of their\\nmothers.\\nRingworm of the beard is perhaps more frequently con-\\ntracted at barber shops than elsewhere, from the use of\\ncontaminated utensils, and may be passed in turn to the\\nlips or cheeks of young women.\\nTricophytosis is met with in the rat, cat, dog, cow,\\nhorse, and perhaps in other animals, and may be con-\\nveyed by them to man. Cavalrymen, who are accus-\\ntomed to practice their exercises on bare-back horses,\\nsometimes contract the genito- femoral variety.\\nTreatment. The cure of t. capitis is by no means\\neasy. Methods of treatment innumerable have been and", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0434.jp2"}, "433": {"fulltext": "TRICOPHYTOSIS GENITO-FEMORALIS. 411\\nare being proposed; but none are simpler or more effect-\\nive than the treatment originally proposed by Bazin fort}^\\nyears ago. This consists in thorough epilation, combined\\nwith applications of a solution of bichloride. If the parasite\\nis destroyed, the affection ceases; hence the first object is to\\nsecure destruction of the tricophytoji. The spores, how-\\never, are deeply buried in the hair-follicle, and are not\\neasily reached by lethal applications while the hairs are\\nstill i7i situ. The first thing to be done, then, is to re-\\nmove them as thoroughly as possible with the aid of a\\nproperly constructed epilation forceps.\\nAttack the affected spot or spots with forceps, extract-\\ning every hair-stump possible. Many will break off; but\\ndo not leave a single one visible above the surface. Then\\nthoroughly wash with a bichloride lotion, of the strength\\nof one to three grains to the ounce. Apply this daily,\\nunless it produces too much reaction, in which case dilute\\nit, or omit for a few days. At the end of a week, again,\\nwith forceps in hand, repeat the epilation, as many of the\\nbroken hairs will have appeared above the surface. Ex-\\ntract as many of them as possible, and continue this treat-\\nment as long as necessary, which may perhaps be six\\nweeks or six months, according to the extent of the dis-\\nease, or the intelligence and care with which the treat-\\nment is carried out, remembering that patience and bi-\\nchloride will succeed in the end.\\nThe following makes a good application:\\n9^. CarboHc acid.\\nChloral,\\nTincture Iodine, aa ^jjj.\\nM. Sig. Apply once a day with a brush. Three or\\nfour times for ringworm.\\nRingworm of the beard demands and will respond to\\nthe same treatment.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0435.jp2"}, "434": {"fulltext": "412 SKIN DISEASES.\\nRingworm of the non-hairy parts is a very readily\\ncurable affection. Sulphur ointment, any form of mer-\\ncurial ointment, tincture of iodine, or chrysarobin dis-\\nsolved in traumaticin. A few applications of either of\\nthese will prompty remove the trouble.\\nRingworm of the crotch may be treated in a similar\\nmanner, without epilation an excellent application be-\\ning a solution of six or seven grains of chrysarobin in an\\nounce of traumaticin.\\nInternal remedies:\\nSepia and Tellurium are adapted to the ringworm\\nvariety, as occurring on either body or scalp.\\nSee remedies under Favus.\\nChromophytosis.\\nChromophytosis is a parasitic affection characterized by\\nthe appearance of yellowish-brown spots on the skin.\\nThe discolored spots are in the beginning small and ir-\\nregularly scattered over the invaded surface. They are very\\nslightly, if at all, elevated, and are covered with minute,\\nbarely perceptible scales. The affection is usually con-\\nfined to the trunk and upper extremities, almost never\\nappearing on the lower limbs. Its favorite seat is the\\nchest and back; but it may spread to the neck and down\\nupon the abdomen, and upon the arm between the\\nshoulder and elbow. The macules may be very numer-\\nous, and many of them not larger than a pea; or they\\nmay coalesce by mutual extension, and form patches of\\nconsiderable size.\\nThe progress of the affection is slow; and it is not un-\\ncommon to meet with cases in which the lesions have ex-\\nisted for several years. It is sometimes met with in the\\nstrong and hearty, but most commonly in those who are\\nenfeebled by chronic disease, and is especially frequent in", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0436.jp2"}, "435": {"fulltext": "ONYCHOMYCOSIS. 413\\nthose who are suffering from phth;sis or syphilis. It was,\\nin fact, at one time classed as a symptom of phthisis.\\nThis was, of course, before the true nature of the disease\\nhad been ascertained. It is usually more noticeable in\\nwinter than in summer, a fact explainable by the lighter\\nclothing and more frequent ablutions in warm than in\\ncold weather. Itching is sometimes present, but is rarely\\nsevere enough to seriously incommode the patient.\\nEtiology. Chromophytosis is caused by the develop-\\nment of a minute fungus, called the microsporon andonini\\namong the superficial epidermic cells. Being of a para-\\nsitic nature, it is presumably contagious.\\nTreatment. This affection is easily cured, provided\\nproper treatment is instituted and persisted in. The\\none prominent indication is to destroy the superficial\\nepithelial cells, and bring about their exfohation, bringing\\nwith them the parasite. The list of agents that will ac-\\ncomplish this is a long one; but those found most gen-\\nerally useful are lotions of bichloride, tincture of iodine,\\nsulphur ointment, and chrysarobin. If seven or eight\\ngrains of the latter be added to an ounce of traumaticin,\\nand painted upon the spots for several days in succession,\\nthe epidermis will soon desquamate. For the treatment\\nto be effectual, it is necessary that every spot, no matter\\nhow minute, should receive the selected application.\\nThis is rarely done the first time, and the case should be\\ninspected weekly by the physician, and the applications\\nmade by him so far as practicable. It must not be forgotten\\nthat the under clothes need disinfection or destruction;\\notherwise the affection is very liable to recur.\\nOnychomycosis.\\nThis term is used to designate disease of the nails due\\nto the attack upon them of vegetable parasites. The\\nname of the fungus is the achorion.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0437.jp2"}, "436": {"fulltext": "414 SKIN DISEASES.\\nSpeaking generally, the effect of the attack of the fun-\\ngus upon the nail is to thicken it, to render it brittle, to\\nbreak it up into layers, and to make it opaque, or it may\\nbe yellowish. The seat of the fungus growth is shown in\\nsome cases in the early stage by yellowish specks im-\\nbedded in the nail, and the fungus oftentimes attacks in\\nthe first place the side or the part near the root of the\\nnail, giving rise to a certain amount, it may be, of inflam-\\nmation and discomfort.\\nThis condition of nail has been produced in those who\\nhave attended to children s heads affected with ringworm,\\nin one or more nails, and as an independent state of dis-\\nease or preceded by tinea circinata of the fingers or back\\nof the hand, which has spread to the nail, and in that\\nway infected it.\\nThe diagnosis is made by paying attention to the co-\\nexistence of parasitic disease, and by the microscopical\\nexamination. It must not be forgotten that the nails are\\nrendered opaque, thick, and brittle in connection with\\npsoriasis, pityriasis rubra, lichen ruber, and the like; but\\nin parasitic cases the evidence of the connection between\\nthe nail and the general disease and the origination of the\\nformer from the latter is usually clear.\\nThe treatment is, in the majority of cases, very satis-\\nfactory, but in order that a successful result may be at-\\ntained speedily it is necessary that the parasiticide should\\nbe made to reach the deeper parts of the nail, and that\\nthe nail structure should be kept soaked in the parasiti-\\ncide lotion. Scrape off some of the loose laminae of the\\nnails, then apply every second or third day some strong\\nacetic acid to the seat of the change, the whole nail area\\nif necessary, taking care not to make the matrix too\\ntender; and then keep the nail or nails soaked in a solu-\\ntion of hyposulphite of soda (gss to gvj of water).", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0438.jp2"}, "437": {"fulltext": "INGROWING TOE-NAILS. 415\\nPerseverance with the lotion will certainly cure the dis-\\nease.\\nThere are a few diseases of the nails that can hardly be\\nclassified, yet are of sufi cient importance to demand a\\npassing notice; and we know of no more suitable place\\nthan the present one to take them up. The first of which\\nwe will make mention is that very uncomfortable condi-\\ntion known as:\\nIngrcwing Toe-Nails.\\nThis affection is too well known to need any descrip-\\ntion, and we will simply giv^e two methods of treatment\\nthat have been very successfully used in our practice.\\nThe first is known as the liquor ferri sesquichlor. treat-\\nment, and the method of using, as follows:\\nAfter disinfecting the wound with corrosive mercury\\napply a few drops of the liquor ferri sesquichlor. after\\nlifting the nail somewhat. Allow this to dry. On the\\nsecond and third days, the same process is repeated.\\nThen with delicate forceps try to remove the hard crust\\nthat has formed. The slight bleeding that ensues is im-\\nmediately stopped by a fresh application of the liquor.\\nIn a few days more the same process of ablation is again\\npracticed. After a few applications, thus carried out, the\\nnail rots so that it can be removed with the aid of the\\n\u00e2\u0096\u00a0scissors or a dull knife without causing any pain To\\nprevent relapses, it is well to insert fine layers of cork\\nunder the edges of the new nail as it grows forward.\\nThe second plan of treatment is preferable in some\\n\u00e2\u0080\u00a2cases. After cleaning the diseased nail in a soap-bath\\nand having dried it thoroughly, the whole nail is smooth-\\nly enveloped with tin-foil. A thin strip of tin-foil is\\npressed in on the side where the nail has grown in, or\\ntries to grow in. These strips are kept in their place by", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0439.jp2"}, "438": {"fulltext": "416 SKIN DISEASES.\\na thin layer of 5^ellow wax, so that in all places where\\nthe nail touches the flesh some tin-foil lies between them.\\nTin-foil acts not only mechanically, but the constant con-\\ntact of these moist and granulating spots with the me-\\ntallic foil dries up the affected places in a few weeks and\\ncauses a more healthy state in the morbid nail. It is a\\ngreat gain for laboring people that they are thus able to\\nfollow their usual avocations, and it is only necessary to\\nrenew the dressing three times during the first two weeks.\\nThe feet must not be bathed during that time, but may\\nbe cleansed with dry wheat bran.\\nParonychia.\\nParonychia is an inflammation, situated around and be-\\nneath the nail, terminating in suppuration.\\nIt attacks mostly the thumb and fingers, and makes its\\nappearance as a dusky-red, extremely painful border,\\neither completely or partially surrounding the nail. In a\\nfew days the pain becomes throbbing in character and\\npus forms, attended at times by more or less constitutional\\ndisturbance.\\nTreatment. Locally, thepithof the common bullrusk\\nhas been used with good results. Natrum sulph. is the\\nprincipal internal remedy.\\nParonychia may sometimes be aborted by the following\\nsimple treatment: Take a handful of fresh wood-ashes;\\npour upon it a quarter of a litre of boiling water, so as to\\nget a strong lye. As soon as the patient feels the char-\\nacteristic pains of the paronychia, with hammering and\\nthrobbing, the hand should be put in the hot lye, after\\nwhich it is covered with compresses soaked in the solu-\\ntion. It maj^ be necessary to repeat the procedure once\\nor twice.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0440.jp2"}, "439": {"fulltext": "PARONYCHIA. 417\\nA very annoying condition, especially when occurring\\nin young women, is red hands. An excellent oint-\\nment for this condition is the following:\\nJ^. Lanolin, loo grms.\\nParaffin, liquid, 25 grms.\\nVanilHn, o.oi grms.\\n01. rosse, gtt. j.\\nM. Sig. Apply a thin coating of this ointment to\\nthe hands at bed time.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0441.jp2"}, "440": {"fulltext": "CHAPTER XIX.\\nDISORDERS OF THE GLANDS.\\nThere are two sets of organs to deal with here the\\nsweat glands and the sebaceous glands.\\nI. Diseases of the Sweat Glands.\\nThe deviations from health may be functional or struct-\\nural; the former include all those cases in which the\\nsweat varies in amount and kind, but in which there is\\nno change in the actual tissue of the glands or follicles\\nthemselves; the latter, those in which the sweat follicles\\nare likewivSe congested, obliterated, inflamed, enlarged, or\\notherwise structurally altered.\\nThe disorders may be arranged thus:\\nA. Disorders of Function and B. Structural Disorders.\\nA. Functional Diseases of the Sweat Glands.\\nHypkridrosis is the term applied to excessive sweating.\\nIt is, however, not very often an independent form of dis-\\nease. It occurs in connection with general febrile dis-\\nturbances, as in pneumonia, phthisis, rheumatism ap-\\npearing to be critical in some cases. It may, how-\\never, occur as a purely local disease, and then the\\nexcessive secretion of sweat takes place from the face, the\\nhands, the feet, or the armpits, and it is very annoying.\\nA similar state of things is natural to some persons. The\\nsweat may be very offensive. Hyperidrosis may give rise\\nto eczema and intertrigo, as about the feet frequently.\\nIn some cases hyperidrosis, that is, a freer secretion of", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0442.jp2"}, "441": {"fulltext": "FUNCTIONAL DISEASES. 419\\nsweat than usual, may be conjoined with or followed by\\nmore or less congestion of the follicles, and then the\\nmorbid states known as miliaria and lichen tropicus re-\\nsult. If the sweat fails to escape it may collect under the\\ncuticle, forming sweat vesicles. This is sudamina.\\nProbably the most annoying form of this affection is\\nthat where the feet are the parts attacked. Various\\nmeans have been used with varying success. Dr. Ar-\\nmingaud recommends a hypodermic injection of Pilocar-\\npine in cases of fetid foot-sweat.\\nChromic acid has been used with excellent results.\\nFrequently, one application of a five per cent, solution of\\nchromic acid suffices. The solution should be applied\\nwith cotton-wool to the soles of the feet and between the\\ntoes. If there are wounds on the feet, they had better\\nbe healed before applying the chromic acid.\\nTherapeutical indications:\\nBar. carb. Fetid foot-sweat, with callosities on the\\nsoles which are painful on w^alking; soles feel bruised at\\nnight, keeping one awake, after rising and walking.\\nCalc. carb. Foot-sweat which makes the feet sore; feet\\nfeel cold and damp, as if she had wet stockings; burning\\nin the soles.\\nCanthar. Temporary cold sweat on feet; smells like\\nurine.\\nCarbo veg. Foot-sweat excoriating toes; toes red,\\nswollen; stinging, as if frosted; tip of toes ulcerated.\\nGraphites. Profuse foot-sweat, not fetid as in Sepia or\\nSilic. but the most moderate walking causes soreness be-\\ntween the toes, so that the parts become raw; spreading\\nblisters on the toes, thick and crippled toe-nails.\\nHelleborus. Humid, painless vesicles between the toes.\\nlodum. Acrid, corrosive foot-sweat; edematous swell-\\ning of the feet.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0443.jp2"}, "442": {"fulltext": "420 SKIN DISEASES.\\nKali carb. Profuse fetid foot- sweat; swelling and red-\\nness of the soles; chilblains; stitches in the painful and\\nsensitive corns.\\nLac. ac. Profuse foot- sweat, but not fetid.\\nLycopod. Profuse and fetid foot- sweat, with burning in\\nthe soles; one foot hot, the other cold, or both cold and\\nsweaty; swelling of the soles; they pain when walking;\\nfissures on the heel.\\nMur. ac. Cold sweat on the feet, evening in bed;\\nswelling, redness and burning of tips of toes; chilblains.\\nNitr. ac. Foul-smelling ?/-^ze/^a// chilblains on the\\ntoes.\\nPetrol. Feet tender and bathed in a foul moisture; feet\\nswollen and cold; hot swelling of the soles, with burning;\\nheel painfully swollen and red; chilblain; tendency of skin\\nto fester and ulcerate.\\nPlumbtim. Fetid foot-sweat; swelling of the feet.\\nPodoph. Foot-sweat evenings.\\nSepia. Profuse foot-sweat or very fetid, causing sore-\\nness of toes; burning, or heat of the feet at night;\\ncrippled nails.\\nSilicea. Offensive foot- sweat with rawness between the\\ntoes; itching of soles, driving to despair.\\nSquilla. Cold foot-sweat; sweat only on toes; soles red;\\nand sore when walking.\\nSulphur. Sweating and coldness of the soles; burning\\nsoles, wants them uncovered.\\nThuja. Fetid sweat on toes, with redness and swell-\\ning of the tips; nets of veins, as if marbled, on the soles\\nof the feet; suppressed foot-sweats, nails crippled, brittle\\nor soft.\\nZincum. The feet are sweaty and sore about toes;\\nalso fetid; chilblains from scratching and friction; the\\nsuppression of sweat causes paralysis of the feet.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0444.jp2"}, "443": {"fulltext": "ANIDROSIS. 421\\nAnidrosis.\\nA disorder of the function of the sweat-glands, char-\\nacterized by deficiency or absence of perspiration.\\nIt is either idiopathic or symptomatic, general or con-\\nfined to a location, and derived from ancestors or acquired\\nin life from such predisposition, and may or may not be\\npermanent.\\nThis functional disorder of the skin is found apparently\\nalone, unaccompanied by any other disturbance of health,\\nin which case it is known as idiopathic. A typical case\\nis the instance of a person who perspires but little, or ap-\\nparently not at all, under conditions which would natur-\\nally provoke or accelerate the secretion of sweat, were\\nthe glands in their normal condition, as when no effect\\nresults from moist or dry heat, or diaphoretics. The\\nskin is dry and harsh to the touch, such as seen in cases\\nof ichthyosis or xeroderma.\\nThe symptomatic is the more common form, and is\\noften found associated with other cutaneous or general\\ndiseases or nervous disorders, and accompanied by gen-\\neral debility and impaired nutrition. There is the same\\ndry, rough skin as in the idiopathic form, and the patient\\nfeels a tightness of the skin, with an itching sensation.\\nThis condition is general, as in diabetes; or local, as in\\nnervous disorders like certain forms of neuralgia and\\nparalysis; and it may be temporary, as in fevers, eczema,\\nand psoriasis; or permanent, as in diabetes and tubercu-\\nlosis.\\nEtiology. Idiopathic anidrosis may be ascribed to a\\nfaulty development of, or defect in, the sweat-glands from\\nliereditary, congenital, or other causes, as shown in the\\nichthyotic, xerodermic, and paralytic conditions, the\\notherwise general good health remaining unaffected.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0445.jp2"}, "444": {"fulltext": "422 SKIN DISEASES.\\nSymptomatic anidrosis, on the other hand, may be\\nascribed to functional torpor resuhing in deficient .secre-\\ntion without structural defects in the sweat-glands, as\\nfound in cases of eczema, psoriasis, diabetes, and phthisis.\\nPrognosis. In the idiopathic form, this is uncertain\\nand unfavorable; but in the symptomatic form it is to be\\ndetermined by the nature and duration of the primary\\ndisorder.\\nTreatment. In the old school, the concensus of\\nopinion seems to be that when treatment is admissible in\\nthe idiopathic form, benefit is only to be derived by\\nstimulating the functions of the sudoriparous glands, and\\nby the application of suitable emollients to relieve the\\nexisting dryness of the skin. In the symptomatic form\\nthe exciting cause should be removed, and the treatment\\ndirected to the relief of the subjective symptoms present.\\nThey claim that the activity of the sweat-glands may be\\nrestored mainly by diaphoretics. Resort should also be\\nmade to friction and to the use of alkaline, Turkish, or\\nother hot baths.\\nInternal remedies may assist in some cases, and those\\nheretofore found of benefit are:\\ny^thusa. The skin has a dry, white, leathery ap-\\npearance.\\nNatrum carb. The skin of the whole body becomes\\ndry and cracked.\\nPhosphorus. The skin is dry and wrinkled.\\nPlumbum. Dry skin, with absolute lack of perspira-\\ntion.\\nPotass, iod. The skin is dried up, and rough, like hog\\nskin.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0446.jp2"}, "445": {"fulltext": "DYSIDROSIS. 423\\nDysidrosis.\\nThis name is applied to an acute affection of the sweat-\\nglands and ducts, characterized by vesicular eruptions,\\nusually located and confined upon the palms of the hands,\\nbut sometimes upon the soles of the feet; and in either\\ncase the sides of the fingers and toes may be involved.\\nThe vesicles at first are small, discrete, and deep; after-\\nward they become confluent and superficial; and, finally,\\ndisappear 1?y absorption.\\nThe earliest symptoms of this affection, previous to the\\nappearance of the eruption, are a tingling sensation, ac-\\ncompanied by heat and tension of the parts involved.\\nWhen the eruption first appears, the vesicles are minute,\\ntransparent, and discrete, imbedded deeply in the skin,\\nand there they slowly increase and become opaque or\\nwhitish in color. The end may come here, and the erup-\\ntion disappear by absorption, accompanied by slight\\nscaling of the parts affected; but, when the affection con-\\ntinues, the vesicles grow larger and coalesce, forming\\nbullae; and when its course is run, usually in a few days\\nor weeks, absorption, or rupture and evaporation of the\\nfluid contents take place, and the bullae disappear, leav-\\ning a dry, reddened skin. The reaction of the fluid con-\\ntained is acid. More or less pruritus is always present.\\nThe eruption is usually S3^mmetrically distributed, and,\\nwhen both the hands and feet are involved, it first appears\\non the hands. The duration and severity of the attack\\nare increased in persons of impaired health. Such per-\\nsons, particularly young women, are predisposed to this\\naffection, being in a relaxed and depressed nervous state,\\nmanifested in part by a mild, continuous hyperidrosis of\\nthe palmar surfaces of the hands.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0447.jp2"}, "446": {"fulltext": "424 SKIN DISEASES.\\nDiagnosis. This affection, when mild, somewhat re-\\nsembles sudamina, but, if severe, might be mistaken for\\neczema vesiculosum, or scabies.\\nItching and burning sensations will distinguish it from\\nsudamina.\\nIn eczema vesiculosum there is increased and severe\\npruritus, attended with a hot and reddened surface sur-\\nrounding the vesicles, which are of a pin-head or less in\\nsize; these vesicles rupture early and expose a moist sur-\\nface, and the drying exudation forms crusts. In dysi-\\ndrosis this exposed surface is dry, and in th^ vesicular\\nstage unsurrounded with inflamed skin.\\nIn scabies there is the characteristic burrow, or cunic-\\nulus, leading up to the vesicle, and, in a later stage,\\nmultiform lesions appear, such as papules, pustules,\\nscratch marks, etc., which, together with its favorite\\nregions and the reddened surface surrounding the vesicles,\\nmake this affection distinct.\\nPrognosis. There is always a favorable termination\\nto this affection. Its tendency is self-limiting, but re-\\nlapses are likely.\\nEtiology. This affection is caused by a disturbance\\nof the functions of the sudoral apparatus, both of secre-\\ntion and excretion, usually ascribed to disordered inner-\\nvation; and occurs in persons suffering from nervous\\ndepression, weakness, innutrition, and other symptoms of\\nneurasthenia.\\nTreatment. This will consist in carefully considering\\nevery abnormal condition of the patient, and prescribing\\nthat remedy whose symptoms cover most closely those\\ncomplained of by the patient. As almost any remedy in\\nthe materia medica may be needed, it would not be\\npossible to give the indications here.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0448.jp2"}, "447": {"fulltext": "OSMIDROSIS. 425\\nOsmidrosis.\\nThis is that disease in which the odor of the perspira-\\ntion becomes so offensive as to constitute the thing to\\nbe remedied.\\nOsmidrosis may co-exist with other functional de-\\nrangements of the sweat apparatus. In general diseases\\nthe sweat exhibits very peculiar odors in rheumatism it\\nis rank, in scurvy, putrid, in chronic peritonitis,\\nmusky, in scrofula like stale beer, in intermittent\\nfevers like fresh-baked brown bread, in fevers, am-\\nmoniacal, and so on. When the feet are affected, the\\nsweat is sometimes most offensive, especiall}^ in the sum-\\nmer time.\\nChromidrosis.\\nThis term signifies colored perspiration, a condition by\\nno means common. The perspiration may be changed to\\na black, a blue, a red, or a green color in certain cases.\\nThe black {melanidrosis) and the blue {cyanidrosis) va-\\nrieties of perspiration are probably the same in nature,\\nthe substance giving the color being identical, but vary-\\ning in hue in the two cases.\\nIt generall}^ occurs in hj^pochondriacs, or in women\\nwith uterine disorders of different kinds. It is seen as a\\nsymmetrical affection attacking mostly the eyelids, and\\nthe lower one chiefly, but in other instances and more\\nrarely the upper eyelid, the cheeks, the forehead, the\\nsides of the nose, the breast, the stomach, and the hands.\\nIt consists of an oozing of black matter which can be\\nwiped away, but only as a rule to quickly reappear. The\\ndiscolored secretion is excited by grief, by emotions, by\\nfright, and the like, it is said.\\nThe disease may be, and often is, simulated. But\\nthere appears to be no doubt that there is a real chromi-\\n28", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0449.jp2"}, "448": {"fulltext": "426 SKIN DISEASES.\\ndrosis. The coloring matter is probably indican^ which\\nis, as it normally exists, colorless, and occurs patholog-\\nically in human urine. The indican is believed to be\\nsecreted by the sweat glands in a colorless state, and to\\nbe acted upon by the air so as to be oxidized blue, or\\nbrown, or blackish, as the case may be.\\nHsematidrosis.\\nHsematidrosis, or Bloody Sweating, occurs under similar\\ncircumstances, and is supposed to be due to the escape\\ninto the sweat glands of blood from the capillaries, in its\\nturn the result of great excitement.\\nB. Structural Diseases of the Sweat Glands.\\nMiliaria and Sudamina.\\nThese two affections really have no right to be con-\\nsidered as separate diseases. Sudamina is the lesser\\ndegree of miliaria, the contents of the vesicles being acid;\\nmiliaria is the more developed condition, in which in-\\nflammation has occurred and the contents are alkaline\\nin fact, inflamed sudamina. Sudamina have been de-\\nscribed as little round vesicles, produced by distension of\\nthe cutis by sweat, and therefore seated at the orifices of\\nthe sweat follicles. These vesicles may be attended with\\nmore or less inflammation. Then the disease is termed\\nmiliaria. Sometimes the vesicles are reddish (miliaria\\nrubra), sometimes white (miliaria alba). These vesicles\\nare developed about the neck, axillae, clavicles, and\\ntrunk, in diseases in which profuse sweating occurs, their\\ncontents quickly dry; each crop is usually succeeded in\\nfrom three to six days by furfuraceous desquamation.\\nThe disease is seen in phthisis during summer-time, in\\nacute febrile diseases, the parturient state, fevers, and", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0450.jp2"}, "449": {"fulltext": "LICHEN PROPICUS, OR PRICKLY HEAT. 427\\nrheumatism. Since the adoption of a cooler regimen\\nin sick-rooms, the disease has been altogether less fre-\\nquent than formerl}^\\nBryo7iia, Amnion, ^nur., Arsen. alb., Ledutn^ and\\nUrtica ure7is are the most important internal remedies.\\nSulphur and Apis may be studied.\\nA weak carbolated bran bath, followed by dusting with\\neither the nitrate of bismuth and starch, or lycopodium\\npowder, is the best local treatment.\\nLichen Propicus, or Prickly Heat.\\nThis has nothing to do with lichen. It is a congestive\\nor inflammatory disorder of the sweat follicles of the skin.\\nIt occurs as the result of the stimulant action of heat\\nupon the surface. It is therefore common in hot coun-\\ntries, but not rare in this climate. Prickly heat is\\ngeneral!}^ described as an eruption of numerous papillae\\nof vivid red color, about the size of a pin s head, without\\nredness of the skin generally, often interspersed with\\nvCvSicles .and accompanied by a peculiar tingling and\\npricking sensation, which may be almost intolerable, and\\nis excited and intensified by heat, warm drinks, flannel,\\netc. The disease attacks chiefly the parts covered by the\\nclothes, the arms, legs, breast, thighs, flanks, and the\\nupper part of the forehead.\\nThe treatment is the same as that for miliaria.\\nHydro-Adenitis.\\nThis is an inflammatory state of the perspiratory folli-\\ncles, ending in suppuration. The disease may occur in\\nevery region of the body where there are glands, except\\nin the sole of the foot; but it is most frequent in the\\naxilla, at the margin of the anus, and near the nipple.\\nIt also is seen on the face. The disease commences by", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0451.jp2"}, "450": {"fulltext": "428 SKIN DISEASES.\\na crop of, or perhaps only one or two small inflammatory,\\ntumors, always distinct, about the size of peas, of bright\\nred hue. and at first somewhat like boils; but they are\\nunlike boils in the fact that the little inflamed indurations\\nbegin not on the surface of the skin, in a sebaceous or\\nhair follicle, but beneath the skin, which is reached and\\ninvolved secondarily. The suppurating follicles offer no\\nprominent point or head, and there is no dis-\\ncharge till the swelling bursts, when the disease is\\nbrought to a sudden termination. The causes are said\\nto be uncleanliness, friction, the contact of irritants, pus,\\nparasites, profuse perspiration, and, according to Bazin,\\nthe arthritic dyscrasia, syphilis, and scrofula, but nothing\\nis known about this. The disease is often mistaken for\\nscrofuloderma.\\nCystic Formations (Obstructed Sweat Glands).\\nIn some cases one sees developed in the skin a cyst,\\nwhich takes its origin in a dilated follicle or sac of the\\nperspiratory gland. The follicle of the sweat gland be-\\ncomes obstructed, and instead of the gland inflaming and\\nsuppurating the fluid collects and distends the follicle.\\nThe line of demarcation between hydro-adenitis and\\ncyst formation in the early stage is not well defined.\\nThe continuous application of collodion is the best\\ntreatment; the cysts, however, may be punctured, and\\nthe contents allowed to escape; the incisions must, how-\\never, be deep enough.\\nSudolorrhoea.\\nThis is characterized by the appearance of one or more\\nslightly reddened, barely elevated, and sharply limited\\npatches, more or less thickly covered with a few greasy\\nscales. These appear occasionally on the scalp; more", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0452.jp2"}, "451": {"fulltext": "SUDOLORRHCEA. 429\\nfrequentl}^, however, on the contiguous skin along the\\nhairy border; and still more frequently on the chest in\\nmen rarely in this region in women.\\nThe affection is essentially sub-acute in its behavior,\\nand chronic in its duration. Vigorous friction will re-\\nmove the scales and leave a surface not wholly unlike\\nthat of a dry eczema which has been submitted to the\\nsame treatment, and occasionally will excite a slight ooz-\\ning of oleaginous matter, quite different, however, from\\nthe clear but plastic exudation of eczema. If a little\\nliquor potasses be rubbed on the spot, we will have under\\nthe finger a thin, non-adhesive emulsion, and not the\\nsticky layer which follows a like application to a patch of\\neczema.\\nBesides the regions mentioned, the affection may ap-\\npear on the back, and, according to Unna, on the lower\\nextremities. The patches may vary in number and in\\nshape, being round, oval, semilunar, or irregular, as if\\nmade up of several circular patches which had united; in\\nfact, it may assume the varieties of form that are familiar\\nto us in connection with psoriasis, for which disease it\\nis not infrequently taken.\\nSudorrhoea, when left unchecked by treatment, often\\npersists, with varied activity, for an indefinite period, even\\nfor years.\\nNothing definite is known as to the cause of the affec-\\ntion. It is possibly due to a micro-organism, but this\\nhas not as yet been positively shown to be the case.\\nTreatment. There is little difficulty in causing a\\ntemporary amelioration, and even disappearance, of the\\nlesions. Frictions, with precipitated sulphur, sulphur-\\nointment, white precipitate, and applications of chrj^sa-\\nrobin, will usually be sufficient to restore the skin to a\\ncomparatively healthy condition, but within a few weeks", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0453.jp2"}, "452": {"fulltext": "430 SKIN DISEASES.\\nafter treatment is discontinued we not infrequently see\\nevidences of relapse. These must be immediately taken\\nin hand, and we can usually count on a complete cure if\\ntreatment be followed up with needful persistence.\\nI know of no homoeopathic remedy that is especially\\nuseful in this complaint, as I have never had an oppor-\\ntunity of treating a case of sudolorrhoea.\\nII. Diseases of the Sebaceous Glands.\\nThe diseases of the sebaceous glands are divided into\\ntwo groups namely:\\nFuNCTiONAiv. Including seborrhoea (increased secre-\\ntion), asteatodes (deficient secretion) and allosteotodes, or\\nalteration in the character of the secretion. Retention of\\nsecretion is usually accompanied by alteration of structure.\\nStructurai, Including diseases of the lining mem-\\nbrane of the sebaceous glands; retention of the secretion\\nand its consequence, and, lastly, congestive diseases and\\ninflammatory diseases.\\nSeborrhoea.\\nSeborrhoea is a functional affection of the sebaceous\\nglands, and its chief varieties are Seborrhoea oleasa,\\nsicca, and kerativa.\\nSeborrhoea Oleasa.\\nThis variety is characterized by the excessive formation\\nof a thin, oily, sebaceous secretion, which flows in ab-\\nnormal quantity from the orifices of the glands and\\ncovers the affected parts with a shiny and greasy coating,\\nplainly visible to the eye, and on this account annoying\\nto the patient. The usual seat of the trouble is the fore-\\nhead, cheeks, and nose, and especially the latter. If this\\norgan be taken between the fingers and squeezed, the", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0454.jp2"}, "453": {"fulltext": "SEBORRHCEA SICCA. 431\\nfluid may sometimes be seen to exude like little droplets\\nof sweat. The affection is perhaps more frequent in\\nyouth, and often lasts for several years, and appears to\\nbe connected with puboric changes. If the secretion be\\nnot wiped off, it may lose its watery parts by evaporation\\nand leave thin scales, consisting of epidermic cells\\nmingled with oil-globules, and more or less dirt and dust\\nfrom the atmosphere.\\nSeborrhoea Sicca.\\nIn this variety there is excessive formation of sebum,\\npossessing more nearly the character of the normal secre-\\ntion that is, less fluid than in the last named affection.\\nThere is also a larger proportion of epidermic cells, and\\nthese, mingled with the oil, dry upon the skin as thin,\\nslightly adhering, and usually circumscribed crusts. The\\naffection is usually of an extremely mild inflammatory\\ntype, with slight redness of the skin underlying the\\nscales. It may be found on the situations favored by the\\nlast mentioned variety, or upon the chest in man and\\n-other parts w^here the sebaceous glands are well devel-\\noped, but the hairs not so abundant or long as upon the\\nhead, except in infancy, during the early periods of\\nwhich it is quite common.\\nSeborrhcea Kerativa.\\nThis affection is rare and peculiar, and the few cases\\nthat have been observed during recent years have been\\ndescribed under a variety of names. It appears to con-\\nsist in a hyperplasia of the lining cells of the sebaceous\\nglands, associated with keratization in place of the usual\\nfatty degeneration of these cells. The result of this\\npathological process when generalized is a condition of\\nthe skin that may be likened to the surface of a magni-", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0455.jp2"}, "454": {"fulltext": "432 SKIN DISEASES.\\nfied nutmeg grater. The orifices of the sebaceous folli-\\ncles are widened, and from them project horny plugs in\\nalmost infinite number. The affection is chronic in its\\ndevelopment, spreading gradually until almost the entire\\nsurface is involved. We have little definite knowledge\\nof the subsequent course of the affection.\\nDiagnosis. The diagnosis of seborrhoea oleosa is self-\\nevident. S. sicca is to be distinguished, on the one hand,\\nfrom eczema oleosa, and, on the other, from pityriasis,\\ncapitis. This latter is distinctively an affection of the\\nadult scalp, characterized by excessive hyperplasia and\\nexfoliation of the horny cells of the epidermis, and\\nmingled with but a scant amount of sebaceous secretion.\\nTreatment. lyOtions containing hydrochloric and\\nchromic acids either of which may be employed in the\\nstrength of from two to four per cent., are highly recom-\\nmended by the old school.\\nThe indications for the homoeopathic remedies are:\\nArsen. alb, Smutty brown, mottled skin; yellow\\ncolor of face.\\nAmmon. mur. L arge accumulation of bran-like\\nscales, with falling off of the hair.\\nBufo. Skin greenish, and always looking dirty and\\noily.\\nBryonia. In long lasting cases.\\nCalcarea carb. Nose shines as from oil. Seborrhoea\\nwith hypersemia of the scalp and headache.\\nGraphites. Seborrhoea behind the ears.\\nIodine. Firmly adhering scales, which leave the skin\\nred and painful, on removal.\\nKali carb. Dry hair rapidly falling off, with much\\ndandruff.\\nLycopodium. Seborrhoea on the chin.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0456.jp2"}, "455": {"fulltext": "ASTEATODES. 433\\nMerc. sol. Seborrhcea of the genitals, accompanied\\nwith hyperaemia.\\nMezereum. Excessive formation of smegma,\\nNatrum viur. Severe itching of the scalp; the hair\\nfalls out in masses; seborrhcea of the face.\\nPlumbum. The skin of the face shines as if oily, and\\nfeels oily.\\nPhosphorus. Copious dandruff; falls off in clouds.\\nPotass, brom. Seborrhcea on hairy parts of the face,\\nforehead and neck.\\nRaphanus. Skin is greasy and makes the hands greasy\\nto touch it.\\nSepia. Seborrhcea of the genitals in women.\\nSulphu r, Dandruff.\\nThuja. White scaly dandruff. Hair dry and falling\\noff.\\nVinca minor. Seborrhcea on upper lip and base of the\\nnose.\\nAsteatodes.\\nThis is deficiency of the sebaceous secretion. The skin\\nappears to be dry and harsh, and this arises from deficient\\naction of the sebaceous glands. Asteatodes is seen in\\nhereditary syphilis, and in badly-nourished or uncleanly\\nfolk. The treatment consists especiall}^ in the use of the\\nbath, oil}^ infrictions, generous diet, and cod-liver oil.\\nAllosteadodes.\\nAlteration in the quality of secretion is the characteristic\\nof this form of disease. The secretion may be of various\\ncolors yellow (seborrhcea flavescens), or black (so-\\ncalled seborrhcea nigricans).", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0457.jp2"}, "456": {"fulltext": "434 SKIN DISEASES.\\nStructural Diseases.\\nXanthelasma.\\nH3^pertrophy of the epithelial lining and adjacent\\nstructures of the follicle, with fatty degeneration, is\\ncalled Xanthelasma, because of the yellow laminae which\\ncharacterize it. The disease may occur in two forms\\neither as tubercles, varying from the size of a pin s\\nhead to that of a large pea, isolated or confluent; or\\nsecondly, as yellowish patches of irregular outline,\\nslightly elevated, and with but little hardness. These\\nare mere modifications of one disease, but may occur to-\\ngether in the same person. The disease is seen about\\nthe face, the ear, and the limbs and palms of the hands.\\nThe most common form and seat is a yellowish patching\\nabout the inner part of the eye; the disease is symmetri-\\ncal; the cuticle over the diseased part is unaffected. It\\nnever occurs in children; but it is fairly common in\\nmiddle and senile periods of life. In a small proportion\\nof cases, that are very severe, jaundice with enlargement\\nof the liver is met with. When jaundice occurs, it almost\\nalways precedes the xanthelasmic patches. The form of\\njaundice is peculiar, the skin becoming of an olive brown,\\nor almost black tint, rather than yellow, and the color\\nbeing remarkable for its long persistence.\\nXanthelasma occurs more frequently in females than in\\nmales, the proportion being two to one. The patches\\noccur to those who have been liable to have dark areola\\nround the eyes, whether from sick-headaches, ovarian\\ndisturbance, nervous fatigue, pregnancy, or from any\\nother causes. Hence their frequency in bilious subjects,\\nand in the female sex.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0458.jp2"}, "457": {"fulltext": "RETENTION OF SECRETION. 435\\nRetention of Secretion.\\nComedones, or Comedo.\\nThis name is applied to an affection of the skin charac-\\nterized by little black points corresponding to the open-\\nings of the sebaceous follicles. If the skin in the neigh-\\nborhood of these specks be squeezed between the finger-\\nnails, the sebaceous plug which fills the follicles will be\\npressed out.\\nThis affection is more frequent in youth and adoles-\\ncence than at any other ages. The glands of the face are\\nthe ones that are chiefly affected.\\nThe causes of comedo are probably similar to thOvSe\\nwhich lead to the development of ordinary acne simplex,\\nin company with which affection they are usually found,\\nthough they sometimes exist without any inflammatory\\ncomplication\\nOne author holds that comedones in children differ\\nfrom those of adults in being mainly dependent on local\\ncauses, on their greater tendency to group and to be more\\nclosely set, in their involving the hairy scalp, and finally\\nto their being generally readily amenable to treatment,\\nall that is usually required being friction with a weak\\nsoft soap and spirit liniment, or a weak sulphur applica-\\ntion may be employed in mild cases, preceded by fomen-\\ntation with very hot water.\\nA peculiar variety is described by Dr. Dumesnil, as\\noccurring in two patients. In both cases, the unusual\\neruption occurred on the back, which was also well cov-\\nered with acne. The comedones, in both cases, were well\\nmarked, the skin not being elevated at the sites where\\nthey existed. The distribution of these comedones was\\nall over the back, though inclined to be discrete. One", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0459.jp2"}, "458": {"fulltext": "436 SKIN DISEASES.\\npeculiarity of the distribution was, that many of them\\nwere in pairs, the distance between each varying from\\none-eighth or less to about three-sixteenths of an inch,\\nwith a channel connecting them. By bringing firm\\nlateral pressure upon one of the condones in the direction\\nof the other; both follicles were emptied from one point,\\nand a fine probe introduced at one opening would appear\\nat the other. There was but one plug, and that was\\nblack at both extremities.\\nTreatment. The comedones may in most instances\\nbe readil}^ removed by pressure with the fingers or aided\\nby some one of the many comedone extractors. Sexual\\nhygiene is to be enforced if the trouble is to be radically\\ncured.\\nThe principal internal remedies are Baryta carb. and\\nSelenium.\\nOthers may be indicated as follows:\\n^(?//a\u00c2\u00ab^.\u00e2\u0080\u0094 Comedos in young full-blooded people.\\nCicuta. Black spots on the skin.\\nDigitalis. Black comedos on the skin of the face,\\nwhich suppurate.\\nMezereum. Small comedos on the nose and cheeks.\\nNitr. ac. Black sweat pores in the skin of the face.\\nSabiiia. Comedos that can be easily pressed out, in\\nthe cheeks and about the nose.\\nSulphur. Blackish pores in the face.\\nSumbul. Numerous black pores on the face; skin\\npale.\\nMolluscum.\\nThis affection is characterized by the development of\\nsmall, umbilicated papules, or tubercles, from the size of\\na small bird-shot to that of a pea, and sometimes even\\nlarger.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0460.jp2"}, "459": {"fulltext": "INFLAMMATORY AFFECTIONS. 437\\nThe natural color of the skin is usually preserved, and\\nthe tubercles are not accompanied with inflammatory\\naction. If they are squeezed between the fingers, a\\ncheesy or sebaceous-looking matter issues from the\\nhilum.\\nThese molluscous growths are met with on the face,\\nneck, chest, limbs, and genitals, and may be few or numer-\\nous, coming out one after the other for several weeks or\\nmonths.\\nAfter they have attained a certain size they may per-\\nsist for an indefinite period, often at the end shriveling\\nup and leaving a little tab of loose skin.\\nThis affection is most frequently developed in young\\nfemales, but is occasionally met with in males and in per-\\nsons more advanced in years.\\nThe etiology of molluscum is obscure, but the weight\\nof evidence appears to be in favor of contagion. In what\\nthe contagious element, however, consists is unknown.\\nThe diagnosis of molluscum is easy, as we have sim-\\nply to recognize a non-inflammatory, umbilicated tuber-\\ncle, with cheesy contents.\\nTreatment. The quickest way to get rid of them is\\nto snip them off with scissors; and, after pressing out the\\nremaining contents, to introduce the point of a pencil of\\nnitrate of silver.\\nSilicea as an internal remedy ranks first, and Teucrium\\nnext. Bryonia^ Bromine, Calc. ars., Lycopodium, Natr.\\nmur. and Potass, iod. complete the list.\\nINFLAMMATORY AFFECTIONS.\\nAcne.\\nAcne is an inflammatory affection of the sebaceous\\nglands.\\nAcne, in its mildest form of development, consists of a", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0461.jp2"}, "460": {"fulltext": "438 SKIN DISEASES.\\nsmall papule, usually seated on the face, chest, or back.\\nThe papule is red, pointed, and may be slightly sore to\\nthe touch, presenting the usual features of a localized in-\\nflammation. The papules may vary in number from one\\nor two to several hundred, scattered over the nose, cheeks,\\nforehead, temples, chest, and back. The little pimple\\nmay, on pressure with the finger, present slight firmness,\\nindicative of the inflammatory effusion. After a few days\\nit may undergo spontaneous resolution and disappear,\\nothers appearing from time to time to take the places of\\nthose which have disappeared. This constant succession\\nmay be kept up for an indefinite period. Instead of\\nundergoing resolution, pus may make its appearance,\\neither at the summit of the papule or more deeply in its\\nstructure, thus converting the papule into a pustule. If\\nthe pustule be squeezed between the fingers, the pus is\\ndischarged, and with it the somewhat altered contents of\\nthe sebaceous glands. This form of acne, in which there\\nis little or no implication of the tissues surrounding the\\nfollicle, is usually termed acne simplex, or on account of\\nthe age at which it is most prevalent, ^lQ^q juvenilis.\\nThe variety of acne just considered is the special ap-\\npenage of youth, and occurs in both sexes between the\\nages of fifteen and twenty-five. Associated with it we\\nfrequently and perhaps usually find comedones in greater\\nor less number scattered over the surface affected by the\\nacne.\\nIn more advanced life from twenty-five or thirty up\\nto fifty years we may encounter a form of acne charac-\\nterized by much larger lesions than those of acne sim-\\nplex. In fact, they are large enough to be classed as\\ntubercles, and the affection has received the name of acne\\ntuberculata, and, when seated on a hardened base, acne\\nindurata. In this form there is more or less involvement", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0462.jp2"}, "461": {"fulltext": "ACNE. 439\\nof the tissues surrounding the follicles. These larger\\nlesions are usually more sluggish in their develop-\\nment and coarser than those of acne simplex, but go\\nthrough essentially the same phases as the smaller ones.\\nThat is, there is the same tendency to pus formation, and\\nthe larger ones may form veritable abscesses, followed by\\npermanent cicatrices.\\nThe causes of the affection are well-known to be local\\nirritants, cosmetics, want of cleanliness, exposure to heat,\\ncold winds, some varieties of soap, all debilitating causes,\\ntoo rich or insufficient food, onanism or sexual excesses,\\nliver, stomach or uterine derangements, and any cause\\nthat may lead to congestion of the face. Scrofulous sub-\\njects are very prone to this form of skin disease.\\nAcne tuberculata is not a very common affection in\\nwomen; but when not associated with intemperance will\\nusually be found accompanied by disease or derangement\\nof the uterine or ovarian functions.\\nGastric and hepatic disturbances, associated with con-\\nstipation, are unquestionably important factors in the\\ncausation of acne, and too free indulgence in alcoholic\\nstimulation is well recognized as the promoter of acne\\ntuberculata in men who are advancing from youth to\\nmiddle age.\\nTreatment. Time alone, without special medical treat-\\nment, is sufficient in many cases of acne simplex in young\\npersons to bring about a cure. Acne simplex is in a certain\\nsense a self-limited affection, but this limitation is not a\\nmatter of weeks or months but of years, and the patient\\nwho leaves the affection entirely alone may usually count\\non six or eight years of annoyance. The majority prefer\\na quicker cure, and to that end consult the physician.\\nNow, the cure of an acne involves two quite different\\nquestions. The first relates to the speed}^ removal of the", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0463.jp2"}, "462": {"fulltext": "440 SKIN DISEASES.\\nexisting eruption, and the second to the prevention of the\\never-recurring tendency to relapse.\\nBaehr says that acne patients are very hard to treat, as\\nthey generally feel so well that a restriction in their diet\\nis hardly ever taken with good grace, or strictly followed\\nout.\\nHebra says: I must confess that, in spite of many ef-\\nforts, I have not yet succeeded in finding a remedy by\\nwhich acne can be prevented from developing itself, or\\nquickly got rid of when established.\\nIn acne simplex the measures best calculated to pro-\\nmote disappearance of the eruption are: Puncture of the\\npapules and pustules; hot fomentations, in cases charac-\\nterized by marked inflammatory action; stimulant and\\ndiscutient applications in those of a more sluggish nature.\\nIt is good practice in every case to puncture the papules\\nwith a lancet- point, and at the earliest possible moment.\\nIf pus has already formed, this should be vSqueezed out.\\nHot fomentations for several minutes should then follow,\\nand the fomentations with water, as hot as it can be\\nborne, repeated night and morning.\\nIn subacute cases an artificial irritation should be set\\nup by nightly rubbing with green soap. Usually in a\\nv^eek, or in less time, the skin will be inflamed to as great\\nan extent as the patient s endurance will permit. Sooth-\\ning applications should now be employed, and in a few\\ndays the irritation will subside, accompanied with des-\\nquamation of the outer layers of the cuticle. This will\\nbe followed by a greater or less disappearance of the\\neruption. If necessary, the applications may be repeated.\\nIn like manner, sulphur, either pure or diluted with some\\nviolet powder, may be applied with a ladies puff. Chrys-\\narobin, in the strength of four or ten grains to the ounce\\nof traumaticin, effects similar results. In the use of", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0464.jp2"}, "463": {"fulltext": "ACNE. 441\\nchrysarobin, however, it will be wise to commence with\\nrather mild applications confined to the papules them-\\nselves, and not permitted to spread to the adjacent\\nhealthy skin, as this drug when too freely applied to the\\nface may set up a considerable degree of inflammation,\\nalmost simulating erysipelas.\\nDr. Hutchinson advises the passage of the cold\\nurethral sound every third day in cases that are attended\\nwith or caused by hypersemia or irritability of the genital\\norgans. In females, he orders hot water vaginal injec-\\ntions every other night, and claims in both instances suc-\\ncessful results.\\nThe following ointment is highly recommended:\\n9= Resorcin, 2 to 5 parts.\\nZinci oxid.\\nPulv. amyH., aa 5 parts.\\nVaseline, 10 parts.\\nFiat vinguentum. Sig. Apply to parts as often as occupation of\\npatient will permit.\\nDr. Piffard says: The effect of internal medication\\nin acne simplex sometimes appears to be very striking,\\nand at other times absolutely ?2z7. The drugs which we\\nhave found most useful are, in ordinary cases, calc. sul-\\nphurate, arsenic, and ergot. The first of these is decid-\\nedly the most useful, and may be given in doses of one-\\ntenth to one-half a grain two, three, or four times daily,\\nbearing in mind that the more acute the process the\\nvsmaller the dose should be, while in sluggish and indo-\\nlent lesions it should be pushed to the maximum.\\nThe dosage of arsenic should be governed by the same\\nprinciples. Ergot was introduced into the treatment of\\nacne by Dr. Denslow. It has appeared to me to be spe-\\ncially useful in the treatment of pustular acne in females.\\n29", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0465.jp2"}, "464": {"fulltext": "442 SKIN DISEASES.\\nWhether it directly affects the local circulation, as believed\\nby Dr. D., or whether its primary effect on those cases is\\non the pelvic organs, I do not know. It has also been\\nfollowed by good results in males.\\nIn patients who are suffering from anaemia, struma,\\netc. iron and cod-liver oil should form an important pari\\nof the treatment.\\nIn acne tuberculata and indurata the same generat\\nprinciples of treatment are to be followed; except that in\\nthese forms arsenic has appeared to me to be of very little\\nuse. On the other hand, iodide of potassium, in doses of\\nfive to ten grains, has in some instances been followed by\\nfavorable results.\\nThe foregoing applies to the removal of the existing\\neruption. The prevention of relapses, or frequent out-\\nbreaks of eruption, is quite another matter; and success\\nin this regard will be due to the accuracy with which the\\npractitioner unravels the etiological factors, and is suc-\\ncessful in bringing about their removal or amelioration.\\nOur first object should be to get at the cause of the\\ndisease, if possible, and remove that. The dyspeptic\\nshould avoid pastry, highly-seasoned food, beer and spirits\\nof all kinds. The poorly nourished patient should be\\nfed on good food, and should have plenty of it. Buck-\\nwheat cakes, hot bread, nuts, cheese, fried substances,\\nexhilarating drinks, and all sweet and rich articles of\\nfood should be avoided. In dyspeptic patients, a cup of\\nhot water taken a half hour before meals, will often prove\\nbeneficial.\\nThe soaps that have been found most useful are,\\nnotably, sulphur and iodide of sulphur soaps, and the\\nJuniper tar soap. I have seen excellent results from the\\nuse of a soap made from^ the waters of the Shookum\\nChuck I^ake, and prepared by Boericke and Tafel.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0466.jp2"}, "465": {"fulltext": "ACNE. 443\\nAs for remedies, we should choose that one that meets\\nall the symptoms of the case, and not some one that has\\nbeen suggested for acne, for cases differ widely in their\\ncauses and symptoms.\\nOne of the following will likely be indicated\\nAntim. crud. Small, red pimples about the face, and\\non the right shoulder, stinging when touched acne in\\ndrunkards, with gastric derangements, severe thirst, and\\nwhite- coated tongue.\\nAntimon. tart. In obstinate cases, with longing for\\nacids, and when there is a decided tendency to pustula-\\ntion the pustules are thickest on the neck and shoulders,\\nand after discharging leave bluish-red cicatrices. May\\nbe used internally and locally.\\nAjxtium lappa. Aggravated cases, wnth numerous\\nsmall boils all over the body.\\nArse7iicum. In chronic cases where the skin is dry,\\nrough, and dirty-looking, and when the eruption is most\\nmarked on the face and extremities cachectic acne.\\nAsimina. Itchirg red pimples, appearing first on the\\nleft, then on the right side pustular acne, with itching\\nin the evening when undressing.\\nAurum. Red pimples on the face disposition to\\nmelancholy disgust for life, with suicidal tendency in\\nonanists and syphilitics after over-dosing with the\\niodide of potash.\\nBaryta carb. In obstinate cases, especially when the\\npapules or pustules are interspersed with comedones; per-\\nsons who take cold easily wine drinkers hysterical or\\nscrofulous persons.\\nBerberis vulg. Red, burning, gnawing pimples, sensi-\\ntive to pressure, surrounded by red areolae, and leaving\\nbrown stains adapted to indurated acne, associated with\\nurinary or hemorrhoidal troubles in women with scanty", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0467.jp2"}, "466": {"fulltext": "444 SKIN DISEASES.\\nor suppressed menstruation the patient complains of a\\ngood deal of chilliness.\\nBelladonna. Large, bright, red pimples on the face,\\nback, and scapulae, especially in young, full-blooded\\npeople; fine stinging in the tips of the pimples; frequent\\ncongestion of the face and epistaxis; aggravation during\\nprofuse menses, pregnancy and confinement.\\nBovista. lyarge, scattered pimples on the forehead;\\nhard, red pimples, large as peas, on the chest, worse from\\nscratching; in delicate women, with thick acrid or cor-\\nrosive, greenish-yellow leucorrhoea, after the menses; ill-\\nhumor.\\nBromine. Indurated acne in scrofulous individuals;\\naggravated by smoking; swelling and induration of the\\nglands of the neck; prone to erysipelatous inflammation.\\nBryonia. In dyspeptic cases, aggravated by eating\\ncabbage, or warm food; or occasioned by suppressed\\nperspiration; constipation as a rule.\\nCalcarea carb. Acne on the face and neck; when due\\nto sexual excesses; redness of the nose in consequence of\\ndysmenorrhoea or amenorrhoea; people who work much\\nin water; scrofulous persons; always worse before the\\nmenses.\\nCalcarea phos. Has been used successfully for similar\\nindications after the failure of the carbonate; chronic\\nenlargement of the tonsils; red pimples full of yellow pus.\\nIn young people during puberty.\\nCannabis. Meets acne rosacea better than simplex\\nwhen there is morning aggravation with burning like\\nfire; sj^philitic patients with much headache on top of the\\nhead.\\nCarbo veg. Pimples on the nape of the neck; red pim-\\nples on the face and chin; young people, with aggrava-\\ntion from eating butter or pork; lymphatic swellings with", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0468.jp2"}, "467": {"fulltext": "ACNE. 445\\nsuppuration and burning pains; dyspeptics, when the\\nmost innocent food disagrees.\\nCausticum. Eruption on the face, more fek than seen;\\nyellow color of the face; papulous eruption between the\\neyebrows above the nose; dark-haired persons; in cases\\nwhich have not been improved by Ars., Hepar, or Sul-\\nphur aggravation from cold, with sensitiveness to cold\\nair.\\nChelidonium. Pimples and pustules in groups of three\\nor four on the face, except the chin; chiefly on the left\\nside; acne dependent upon liver derangement.\\nAdea rac. Acne in women, dependent upon gastric,\\novarian, or uterine derangement; melancholy persons.\\nConium. In obstinate, indurated acne occurring on\\nthe face; aggravation from suppressed menses; swelling\\nof the parotid or submaxillary glands; fetid, smarting\\nperspiration; adapted to scrofulous persons and old maids.\\nEugenia. Pimples on the face which are painful for\\nsome distance around; at times useful in the indurated\\nform.\\nGranatum. Pimples on the forehead and left temple\\nwith sore pain; they suppurate, and on drying leave\\nnodules; itching in different parts of the body as if pim-\\nples would break out.\\nGraphites. Pimples in persons inclined to obesity;\\nparticularly females with disposition to delaj^ed menstru-\\nation; aggravation during, after, and from suppressed\\nmenstruation; the skin is very dry, inclined to crack, and\\neasily tends to ulceration.\\nHepar. Painless pimples on the nape of the neck,\\nforehead, and chin; crusty pimples on the face in young\\npeople; swelling and suppuration of glands; skin yellow\\nand unhealthy, every small injury suppurates; cough\\nwith rattling in the chest but no expectoration.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0469.jp2"}, "468": {"fulltext": "446 SKIN DISEASES.\\nIodine. Indurated acne in scrofulous subjects with\\nulcers in the throat; adapted to young persons with dark\\nhair and eyes; and rough, dry skin; skin insensible and\\nof a dirty yellow color.\\nKali bich. Face covered with a profuse eruption re-\\nsembling acue; when pustules form they resemble small-\\npox pustules; in persons with loud rattling cough and\\nstringy expectoration; especially suitable for fat, light-\\nhaired persons.\\nKali carb. Small pimples on the face, chest, and back,\\nwith redness and swelling; deficient perspiration; cases\\naggravated by suppressed menses; rough, chapped skin\\nof the hands; dry, parched skin of the face; persons in-\\nclined to pulmonary difficulties.\\nKali mur. Pimples on the face with thick white con-\\ntents, caused by a disturbed action of the follicular\\nglands.\\nKreasote. Acne worse after menstruation, or from\\ngetting heated; dry pimples on the forehead; greasy\\npimples on the right cheek and chin; sad and irritable in-\\ndividuals, always worse after the menses, or from getting\\nheated.\\nLedum. Red pimply eruption on the face; small pim-\\nples on the root of the nose; in rheumatic persons or\\ndrunkards, also when greatly aggravated by heat.\\nLycopodium. Red pimples in clusters, between the\\nscapulae and on the nape of the neck; after the failure of\\nSulph., Rhus, or Hepar dyspeptic ailments; red sand in\\nthe urine; cold feet; constipation.\\nMe7xu7 ius sol. Indolent bluish-red papules, especially\\non the lower extremities; dirty yellow color of the skin,\\nwith glandular swellings; in syphilitic and scrofulous\\npersons.\\nMezereum. Single pimples on the thighs; red pustules", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0470.jp2"}, "469": {"fulltext": "ACNE. 447\\nwith inflamed areolae on the outer side of the extremi-\\nties; in scrofulous individuals, and in persons who have\\nalread}^ taken mercury; in those who have attacks of\\nintercostal neuralgia.\\nNabalus. Pimples on the face, about the nose, upper\\nlip and chin.\\nNatrum mur. When the skin between the acne points\\nlooks as if besmeared with oil; aggravated after violent\\nexercise, and periodically.\\nNitric ac. Many small pimples on the forehead, just\\nbelow the hair; painful pimples on the chin with hard,\\nred areolae; skin dry, scaly; brown-red spots on the skin;\\nafter the abuse of mercury; dr3mess of the tongue and\\nthroat; itching mostly at night.\\nNux juglans, Variousl}^ sized reddish pimples and\\npustules on the face, chiefl}^ around the mouth; large,\\npainful blood-boils on the shoulders, and in the hepatic\\nregion; adapted to all stages of acne.\\nNux vom. Dyspepsia with constipation; small fetid\\nulcers in the mouth and fauces; persons who use coffee,\\nwine or liquors, tobacco, or who have been allopathically\\ndrugged; sedentary habits.\\nPhos. ac. Smooth, red pimples with red areolae on the\\nforearm, knees and leg; large, red pimples on the face\\nand scapulae, only sensitive to the touch; acne in weakly\\npersons, onanists, and victims of spermatorrhoea; also\\nwhen due to suppressed perspiration, or loss of animal\\nfluids.\\nPhosphorus. Acne in persons predisposed to bronchial\\nand lung trouble; of hemorrhagic diathesis; lean and\\nslender individuals with painless diarrhoea; aggravated\\nfrom salt and camphor.\\nPicric acid Severe and chronic cases; eruption on\\nface, especially on chin and along edges of the sides of", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0471.jp2"}, "470": {"fulltext": "448 SKIN DISEASES.\\nthe nose on either side, of indurated and elevated papules^\\ndark red, painless, but sore to touch, upon the surface of\\nwhich small pustules develop.\\nPotass, bromide. Acne ou the face, neck and shoulders,\\nwith peculiar yellow points which neither coalesce nor\\nburst; frontal headache at night; adapted to both the\\nsimple and indurated forms.\\nPotass, iodide. Papulous eruption all over, but espe-\\ncially on the face and the shoulders; painful sensitiveness^\\nworse at night; in mercurial and syphilitic affections.\\nPulsat. Acne in mild, gentle persons, or pale, slender\\nindividuals; delayed or scanty menses; predisposition to\\ncatarrh or diarrhoea; gastric difficulties; aggravated by\\nrich or fat food, pork, pastry, etc.\\nRhus tox. Acne in hard drinkers or persons addicted\\nto sexual excesses; rheumatic individuals, always worse\\nduring rest; aggravated after getting wet and cold; de-\\nbility and tired feeling nearly all the time.\\nRohinia. -Hard pimples, which take a great while to\\nsuppurate; great tendency of tumors to become in^\\ndurated; in dyspeptics with sour stomach, worse at\\nnight; nocturnal emissions; increased sexual desire.\\nRumex. Dense rash of small red pimples; eruptions\\naggravated by wearing flannel; itching on various parts,,\\nworse while undressing.\\nRuta. Itching over the whole body relieved by\\nscratching; all parts of the body upon which he lies feel\\nsore.\\nSabi?ia. Acne during pregnancy; desponding and hy-\\npochondriac; desire for acid things.\\nSarsaparilla. Acne on the nose and face, worse dur-\\ning the menstrual period; acne after the abuse of mer-\\ncury, after gonorrhoea suppressed by mercury; burning\\nitching of the eruption.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0472.jp2"}, "471": {"fulltext": "ACNE. 449\\nSepia Acne on the chin, aggravated during menstru-\\nation and pregnancy; pimples on the mons veneris, legs\\nand flexures of the joints; skin dirty-yellow and scurfy;\\nailments following vaccination and self-abuse.\\nSilicea. Obstinate cases in scrofulous persons; fetid\\nsweat of the feet; constipation; aggravated from drinking\\nwine, from getting cold or wet.\\nSulphur. In acne vulgaris with black pores in the\\nface; red, itching pimples on the nose, lip, around the\\nchin, and on the forearm; furunculosis; chronic cases.\\nSu7nbul. Smooth, small, reddish spots on the fore-\\nhead; black pores on the face; the least draught of air is\\nfelt down the spine; debility.\\nThuja. Acne, especially on the wings of the nose;\\ndirty, brownish color of the skin; sweet, honey-like per-\\nspiration; aggravated during menses; after over-heating;\\nafter eating fat meat, onions, acids and sweets; after\\ndrinking beer or wine; after using tobacco, sulphur and\\nmercury.\\nVerat. alb. Pimples on the right labium just before\\nmenstruation.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0473.jp2"}, "472": {"fulltext": "CHAPTER XX.\\nDISEASES OF THE HAIR AND HAIR FOL-\\nLICLE.\\nDiseases of the Hair.\\nDiseases of the hair may be divided into those of Aug-\\nmented and Diminished Formation, Abnormal Direc-\\ntion, and Alteration in Physical Aspect.\\nAugmented growth may be congenital, of varying ex-\\ntent, from small localized growths, such as little hairy\\nmoles, to the extensive tracts covering more or less of\\nthe body, as in the hairy man described by Mr.\\nCrawford. Stimulation has a tendency to augment the\\ngrowth of hair, if the formative power is normal. Dur-\\ning convalescence a freakish, reactionary growth, in odd\\nand unusual places, sometimes takes place.\\nDiminished formation of hair is partial or general, com-\\nparative (thinning) or absolute (alopecia). It may be\\ncongenital, accidental, or normal (senile).\\nAlopecia.\\nWhen the hair is lost entirely from a part, this is called\\nalopecia, or baldness. Parasitic disease and atrophy of\\nthe bulbs are the most usual causes of localized bald-\\nness; syphilis, violent emotion, atrophy of the scalp,\\nand senility are most efiicient in producing an absolute\\nor a great amount of baldness. The total loss of hair is\\nsometimes seen in early life.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0474.jp2"}, "473": {"fulltext": "Alopecia Areata.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0475.jp2"}, "474": {"fulltext": "n", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0476.jp2"}, "475": {"fulltext": "ALOPECIA AREATA. 451\\nAlopecia Areata.\\nAlopecia areata is an affection characterized by circum-\\nscribed patches of baldness on the scalp or other hairy\\nparts of the body.\\nIt usually commences with a single spot, rarely noticed\\nuntil it has attained a diameter of perhaps the third of an\\ninch. This spot gradually increases in size, and others\\nmake their appearance to the number, in some instances,\\nof a dozen or more. As the several spots increase in size,\\nthey encroach on each other until they finally coalesce\\nand form patches of considerable size, and if unchecked\\nmay denude the entire scalp.\\nThe spots themselves are absolutely deprived of hair,\\nthe short stubble met v^ith in tricophytosis being absent.\\nAs a rule, the normal hue of the skin is preserved, but\\noccasionally we meet with cases in which a slight conges-\\ntion is apparent. Sometimes the reverse is the case, and\\nthe affected portions appear to have a lessened blood-\\nsupply..\\nAlthough most frequently met with on the scalp, and\\nusually confined to this region, the disease may invade\\nthe beard and eyebrows, axillary and pubic hairs, and,\\nin fact, cases have been observed in which apparently\\nevery hair of the body has fallen.\\nThe cause and progress of the affection vary. In some\\ncases they proceed by gradual steps to entire denudation\\nof the scalp, while in others spontaneous recovery and re-\\ngrowth of the hair may be observed. The new hair that\\ncomes in, either spontaneously or as the result of treat-\\nment, is usually fine and silky, and very much lighter in\\ncolor than the surrounding healthy hair, and may even\\nbe entirely colorless. This early growth is not very\\nviable, and the hairs are gradually supplanted by others", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0477.jp2"}, "476": {"fulltext": "452 SKIN DISEASES.\\nStronger and more normal in appearance, until finally the\\nformerly bald patch is to be in no way distinguishable\\nfrom the surrounding hair.\\nDiagnosis. There is, or should be, no difficulty in\\ndiagnosis, as there is no other affection that presents the\\nfeatures of circumscribed and progressive patches of bald-\\nness.\\nPrognosis. When cases are met with in the earlier\\nstages, and are subjected to judicious treatment, the prog-\\nnosis is almost invariably good. In cases in which it has\\nprogressed further, the prognosis is less favorable, al-\\nthough the increase of the area of baldness can generally\\nbe stopped, even if the hair can not be brought back to\\nthe already affected portions. Cases, however, in which\\ntotal baldness has already occurred may usually be re-\\ngarded as hopeless.\\nEtiology. The nature and causes of alopecia areata\\nare unknown. On the one side, there are those who\\nmaintain that it is a purely trophoneural affection; and on\\nthe other, those who are equally satisfied that it is of\\nmicrobian origin. The specific microbe, however, has\\nnot been determined with any certainty, and the chief\\nsupport of the parasitic theory lies in the fact that the dis-\\nease frequently appears in certain series of cases as if it\\nwere spread by contagion. Perhaps both theories are\\nright, and that two entirely different diseases exist, in-\\ncluded under the same name one of them nervous in\\norigin, and the other parasitic.\\nFragility of the hair, seen oftentimes about the beard,\\nis explained by the attack of fungi, or by such causes as\\nlead to insufficient nourishment of the hair, whereby its\\nfibres are ill-formed, and tend to undergo degeneration.\\nSenile baldness is due to an atrophy of the structures\\ngenerally; it commences on the crown of the head, the", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0478.jp2"}, "477": {"fulltext": "ALOPECIA AREATA. 453\\nhair first turning gray; the scalp is dry, thinned, loses its\\nsubcutaneous fat, and the follicles become indistinct. In\\nsome people this change takes place at an early age; it is\\neither an hereditary or physiological peculiarity.\\nGeneral thinning of the hair is most likely to occur\\nunder conditions which lower the vital energy of the\\npatient. The scalp generally is scurfy and dry. This is\\nin all probabilit}^ due to the sluggish action which goes\\non. The usual sebaceous matter is not secreted; the fol-\\nlicles become choked by retained fatty and epithelial mat-\\nter, and the formation of the hair is interfered with. This\\nis also the case in eruptive disease and in syphilis.\\nThe loss of hair in all these cases is an evidence of the\\nworking of some debilitating cause; it is not remediable\\nto the most perfect extent without the use of constitu-\\ntional remedies.\\nThe hair in cases of thinning and baldness is often dry,\\nbrittle, and twisted or split up. This results from the\\npeculiar absence of moisture; in its turn from the dimin-\\nished activity of the circulation of the scalp; in its turn\\nagain, from the general debility of the system.\\nThe various other alterations in physical aspect come\\nunder the head of Parasitic Disease.\\nTreatment. The removal of superfluous hair ma}^ be\\naccomplished by shaving, epilation, depilation, bleaching\\nand electrolysis; of these agents electrolysis is far the\\npreferable. This is easily done by introducing a fine,\\nneedle-shaped electrode into the papilla and connecting it\\nwith a galvanic battery. Any acid battery of from four\\nto eighteen cells will be sufl cient. The positive elec-\\ntrode is taken in the hand. From 25 to 50 hairs may be\\nremoved at one sitting, being careful not to remove hairs\\nnear together.\\nIn the case of total loss, much good may oftentimes", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0479.jp2"}, "478": {"fulltext": "454 SKIN DISEASES.\\nbe done. In the first place, all syphilitic taints require\\ntreatment. Then debility of all kinds must be removed.\\nIn the cases which occur from a failure of the repro-\\nductive function of hair- forming apparatus, local stimu-\\nlation is necessary whenever any downy hairs are visible;\\nif these be absent, the scalp atrophied from disease, and\\nwhite and shining, little good will be done. If there be\\ncedema, or any tension, though the follicles are distinct,\\ntincture of iodine applied over diseased parts every\\ntwo or three days is of service. Shaving the downy-\\nhaired scalp is also beneficial.\\nI have used the following application with excellent\\nresults:\\nOuinise Sulph., dr. jj.\\nBay Rum, ^v.\\nOl. Rosemary, dr. iv.\\nTinct. Canth., gj.\\nGlycerine, ^jss.\\nM. Sig. Rub into the scalp every morning with a\\nsmall sponge.\\nSome may prefer the following:\\nj^l. Carbolic acid,\\nChloral,\\nTinct. Iodine, aa ^iij.\\nM. Sig. Apply once a week with a brush.\\nThe principal internal remedy is Phosphorus, and the\\nnext Natrum mur. Others may be indicated for alopecia\\nin general, as follows:\\nAloes. When the hair comes out in lumps, leaving\\nbald patches.\\nArsen. When it falls out in circular patches.\\nCalc. carb. When the bald spots are on the temples.\\nCarbo veg. Falling off of hair after severe illness, or\\nafter parturition.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0480.jp2"}, "479": {"fulltext": "ALOPECIA AREATA. 455\\nFluor, ac. When there is a syphilitic taint.\\nGraph, Bald spots on sides of the head.\\nHelleb. Falling off of hair from eyebrows and puden-\\ndum.\\nHepar. Bald spots on the head, after headaches.\\nKali carb. Dry hair rapidly falling off with much\\ndandruff.\\nMayicinilla. Falling off of the hair after severe acute\\ndiseases.\\nPhos. Falling out in tufts.\\nPhos. ac, Alopecia as a result of debility.\\nVinca minor. The hair falls out in single spots, and\\nwhite hair grows there.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0481.jp2"}, "480": {"fulltext": "CHAPTER XXI.\\nVARIOUS LESIONS NOT CLASSIFIED.\\nPernio.\\nPernio, or chilblains, is an inflammation of the skin,\\noccurring as a secondary effect of cold, and appearing for\\nthe most part upon the hands and feet. Occasionally\\npernio attacks the nose and ears, and may appear on any\\npart of the body. It commences after exposure to cold\\nby slight vesication attended with tingling, itching, burn-\\ning sensations. In mild cases it may terminate in a few\\ndays with desquamation. In severer cases, remissions\\nand exacerbations are prone to occur, and thus prolong\\nthe disease for months. The parts are usually left in an\\nirritable state, and are liable to renewed attacks from the\\nslightest causes. Any sudden change of temperature,\\nand especially a combination of cold and moisture, may\\nrenew the trouble. In chronic cases the parts become\\nlivid or purplish in color, and are more or less swollen\\nand itchy. Ulcers frequently form. One author claims\\nthat the ulcerations of erythema pernio were very fre-\\nquent in scrofulous patients. Chilblains present special\\ngravity in certain cases, as they might become the start-\\ning point of cutaneous tuberculosis, and are specially\\ntenacious when they occur on the fingers of patients\\naffected with spina ventosa.\\nPrognosis. Pernio when it becomes chronic may last\\nfor years, disappearing usually in the summer time, but\\nreturning again as winter approaches.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0482.jp2"}, "481": {"fulltext": "PERNIO. 457\\nTreatment. When there is much inflammation a de-\\ncoction of marshmallows, locally, acts well.\\nTamus communis tincture is recommended as a topical\\nremedy for unbroken chilblains.\\nBroken chilblains may be dressed with either Oxide of\\nzinc ointment or the Glycerole of calendula.\\nResin ointment is adapted to the ulcers that sometimes\\nfollow.\\nThe Galvanic current acts favorably in most cases.\\nPaint the affected parts every evening with a mixture\\nof\\nIJ;. Resorcin, i part.\\nIchthyol, I part.\\nTannin, i part.\\nWater, 5 parts.\\nThis will soon turn to a dry varnish on the skin, caus-\\ning the latter to shrivel and the chilblains to disappear.\\nA very successful application consists of compresses of\\ncotton moistened with a solution of permanganate of\\npotassium. The strength of the solution to be from one\\nto three grains to the ounce of water.\\nAnother excellent application is:\\n9;, lodinipur., i part.\\nCollodion, 40 parts.\\nDissolve the iodine in the collodion, and apply to con-\\ngested areas once daily.\\nChilblains may be relieved by local baths of sulphuric\\nacid and water, a liquor-glass of the former to a quart of\\nthe latter. Ulceration does not contra-indicate. The\\nbaths, lasting about ten minutes, are employed twice\\ndaily.\\nThe tincture of benzoin acts as a preventive. It is ap-\\nplied by simply painting it on the skin. The stockings\\n30", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0483.jp2"}, "482": {"fulltext": "458 SKIN DISEASES.\\nmay be prevented from sticking to the feet by rubbing\\nsome oil over the benzoin.\\nThe remedies likely to prove useful are:\\nAgaricus. Violent itching, worse at night; burning in\\nthe fingers, lower limbs and toes; itching, burning and\\nredness of the toes.\\nArsen. alb. Ulcerated chilblains; red spots on the\\nfeet; violent tearing pains in edges of ulcers when ex-\\nposed to cold; relieved by warm applications.\\nBadiaga. Flesh and integuments sore to the touch;\\nsensitive to cold air.\\nBellad. Bright red shining swelling, with pulsative\\npains; burning in skin when touched; tingling itching,\\nworse at night.\\nCalc. ^2^^.^.\u00e2\u0080\u0094 Discharging pus.\\nCantharis. Itching and swelling of the fingers; blis-\\nters burning on touch burning in the soles of the feet at\\nnight in hysteric patients; tearing and ulcerative pains.\\nCitrus vulg. Itching of the swollen hands and arms;\\ngeneral itching, which prevents sleep.\\nKali phos. Chilblains on toes, hands and ears, tingling\\nand itching pain.\\nNitric acid. Itching of the feet spreading blisters on\\nthe toes; ulcers with stinging and pricking pains as of\\nsplinters; offensive profuse perspiration on the feet, caus-\\ning soreness.\\nPetroleum. Broken chilblains, with tendency to fester;\\nheel painfully swollen and red with stitches; tips of fingers\\nrough, cracked and fissured, with sticking cutting pain;\\nunhealthy skin.\\nPrimus. Itching on tips of fingers as if frozen.\\nPulsat. Blue red chilblains with pricking burning\\npain, worse toward evening; redness and swelling of joints", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0484.jp2"}, "483": {"fulltext": "ACTINOMYCOSIS. 459\\nwith stinging pains; feet feel hot and swollen with tensive\\nburning pains; wandering pains.\\nRhus tox. Inflamed chilblains with excessive itching;\\naching pains in the legs; worse before storms and from\\ngetting wet.\\nSulphur. Thick red chilblains on the fingers which\\nitch severely when warm; predisposition to chilblains.\\nUrtica dioica. Has been used both internally and ex-\\nternally with good results.\\nVerat. vir. Intense painful itching; chilblains on the\\nnose; prickling in the fingers and toes; used internally\\nand loyally.\\nActinomycosis.\\nThis is a very rare disease, and may best be described\\nby the following case as reported by Drs. J. Darier and G.\\nGautier:\\nThe patient was aged 24. The disease, the etiology\\nof which could not be definitely traced, had appeared\\nnine months previously. The lesion occupied almost the\\nentire right cheek, extending from the inferior border of\\nthe orbit above, limited on the inner side by the nasal\\nfurrow, and arrested below at a line corresponding to the\\nupper border of the inferior maxilla, and extending over\\nthe entire cheek-bone. The surface was of a reddish-\\nviolet, of the color of certain forms of lupus, and covered\\nin part by scales. The lesion was somewhat elevated\\nand studded with half a dozen hemispherical elevations or\\nnipples of about one centimetre in diameter, some of\\nthem ulcerated at the summit and covered with crusts.\\nThe diagnosis was established by the abundant pres-\\nence in the pus of minute grains of actinomycosis, each\\ndrop of pus containing from ten to fifteen of these minute\\nbodies.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0485.jp2"}, "484": {"fulltext": "460 SKIN DISEASES.\\nThe case was cured by the electro- chemical treatment.\\nThis treatment is based upon the decomposition of a\\nsolution of iodide of potassium (one to ten), in living\\ntissues, into iodide and potassium by the galvanic cur-\\nrent. To obtain this result. Dr. Gautier introduced two\\nplatinum needles into the nodules of the tissue, and by\\nmeans of a syringe injected, every minute during the\\noperation, a few drops of the solution. The two needles\\nwere connected with the two poles of a battery. The\\ntreatment, which was under chloroform, consisted of\\nthree seances, twenty minutes each, at intervals of eight\\ndays, with an intensity of fifty milliamperes.\\nThe patient being enciente, the treatment was inter-\\nrupted for fear of compromising the natural evolution of\\nthe pregnancy. Six weeks after her accouchment a final\\ntreatment was given, with the result of accomplishing\\nwhat is apparently a complete cure.\\nWash-leather Skin.\\nDr. Ferrier, in 1879, first recorded a peculiar condition\\nof the skin in which certain metals marked it with black\\nlines; this condition he terms Wash-leather Skin.\\nFrom an analysis of fifty cases, Mr. Emerson concludes\\nthat:\\n1. As a rule, wash-leather skin does not occur in the\\nhealthy.\\n2. It does not occur in many diseases.\\n3. It occurs in patients suffering, as a rule, from dis-\\neases which directly or indirectly affect either the trophic\\nor the secretory nerves of the skin, such as renal disease,\\nphthisis, erysipelas, and hemiplegia.\\n4. Silver is the best metal to use for bringing out\\nthe marks.", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0486.jp2"}, "485": {"fulltext": "EFFECTS OF RHUS TOX. ON THE SKIN. 461\\n5. It may precede, and in the cases cited did precede,\\nbed-sores.\\n6. It is of diagnostic value in testing vitality of the\\nskin, and the site for the experiment is the lumbo-sacro-\\ngluteal region.\\n7. So far as one may judge at present, it may be of\\nvalue in foretelling bed-sores; and should this be estab-\\nlished it would be of great use, for the proper precau-\\ntions might be taken as soon as the black line is diagnosed;\\nthis, at present, seems to be its only. probable use. The\\npathology of this phenomenon is as yet only conjectural.\\nEffects of Rhus tox. on the Skin.\\nThe toxic action of this species is one difiGcult to ex-\\nplain. The first noticeable peculiarity is its choice of\\nvictims, many persons being entirely devoid of response\\nto its influences, many others peculiarly susceptible.\\nAnother peculiarity is that in many cases it is not\\nnecessary to even touch the plant to be severely poisoned.\\nA third peculiarity is that the plant is more poisonous\\nduring the night, or at any time in June and July when\\nthe sun is not shining upon it. Absence of sunlight,\\ntogether with dampness, seems to favor the exhalation of\\nthe volatile principle Toxicodendric acid) contained in\\nthe leaves. An acrimonious vapor, combined with car-\\nburetted hydrogen, exhales from a growing plant of the\\npoison ivy during the night. It can be collected in ajar, and\\nis capable of inflaming and blistering the skin of persons\\nof excitable constitution who plunge their arms into it.\\nThe symptoms caused by this plant are: First, redness\\nand swelling of the affected part, with intolerable itching\\nand burning, followed by vertigo, weariness, and a sort of\\nntoxication. Infiltration of the face and eyes, and agglu-\\ntination of the lids after sleep; great restlessness, pain,", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0487.jp2"}, "486": {"fulltext": "462 SKIN DISEASES.\\nthirst, and fever. The surface of the skin, after a time,\\nbecomes studded with confluent bullae where the cellular\\ntissue is loose, then a dermatitis follows resembling ery-\\nsipelas; this may spread rapidly and finally communicate\\nto the mucous membranes. This is followed by swelling\\nof the mouth and throat, cough, nausea, and vomiting.\\nRheumatoid pains develop about the joints, and a painful\\nstiffness asserts itself in the lumbar region, while the legs\\nand arms become numb. Confusion of mind and delirium\\nmay then set in, during which the patient may become ill-\\nhumored, restless, and anxious, that he will jump out of\\nbed.\\nThe concomitant symptoms are inflammation of the\\neyes, dilation of the pupil, weakness of vision, and some-\\ntimes diplopia; frequent epistaxis; brown coated tongue,\\nwith a triangular red tip; swelling of the parotid glands,\\nwith difficult deglutition; griping in the abdomen; diar-\\nrhoea; profuse urination; oppression; rapid pulse; great\\nweakness, weariness, and prostration; soreness of the\\nmuscles, worse while at rest, and passing off when exer-\\ncising; sleepiness; and chilliness, followed by fever and\\ncopious sweat.\\nThere are almost as many antidotes recommended for\\nRhus tox. poisoning as for the bite of the rattlesnake.\\nProminent, however, among the applications are: Alka-\\nline lotions, especially carbolate of soda, alum-curd, and\\nhyposulphite of soda, keeping the skin constantly moist\\nwith the agent in solution. A strong infusion of red\\nSassafras root is strongly recommended. It is applied\\nfreely to the parts, and gives almost immediate relief,\\nand this, too, when other remedies fail.\\nThe fluid extract of serpentaria has been used in quite\\na large number of cases of rhus poisoning with great sue-", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0488.jp2"}, "487": {"fulltext": "EFFECTS OF RHUS TOX. ON THE SKIN. 463\\ncess. It is best applied by placing cloths moistened with\\nthe extract upon the affected parts without an}^ friction.\\nThe internal remedies most likely to pro re beneficial\\nare: Agaricus, Apis, Ar^iica^ Belladonna, Biyonia, Croton\\ntiglium, Graphites, Gri?idelia robusta. Ledum, Nymphoea,\\nSanguinaria, Sepia, or Verbena urtic^folia.", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0489.jp2"}, "488": {"fulltext": "", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0490.jp2"}, "489": {"fulltext": "INDEX,\\nAcne, 437\\nActinomycosis, 459\\nAinhum, 336\\nAlopecia, 450\\nAlopecia Areata, 451\\nAllosteadodes, 433\\nAnatomy, 9\\nAnidrosis, 421\\nAnthrax, 233\\nAsteatodes, 433\\nBulla, 51\\nBullous Diseases, 188\\nCarbuncle, 233\\nCarcinoma, 357\\nChromidrosis, 425\\nChromophytosis, 412\\nChromotogenous Diseases, 307\\nComedo, 435\\nCondylomata, 288\\nCorns, 304\\nCutaneous Hemorrhages, 374\\nDiathetic Diseases, 257\\nDermatol) sis, 332\\nDrug Eruptions, 58\\nDysidrosis, 423\\nEcthyma, 225\\nEczema, 225\\nEczema Barbae, 168\\nElementary L/Csions, Classi-\\nfication, 48\\nElephantiasis, 333\\nEphelis, 391\\nEpithelioma, 34^\\nEruptions of Acute Specific\\nDiseases, 9^\\nErysipelas, 115\\nErythematous Diseases, 72\\nErythema, 73\\nErythema Multiforme, 73\\nErythema Nodosum, 74\\nEtiology, 60\\nFavus, 402\\nFibroma, 33^\\nFig Warts, 288\\nFissures, 56\\nFollicular Hyperaemia, 93\\nFramboesia, 126\\nFuruncle, 228\\nGeneral Observations, 33\\nHsematidrosis, 426\\nHerpes Labialis, 190\\nHerpes Progenitalis, 191\\nHordeolum, 232\\nHorns, 305\\nHydroa, 208\\nHydro-Adenitis, 427\\nHypertrophic Affections, 303\\nIchthyosis, 317\\nIchthyosis Simplex, 318\\nIchthyosis Hystrix, 319\\nImpetigo Contagiosa, 216", "height": "3677", "width": "2150", "jp2-path": "skindiseasesthei00doug_0491.jp2"}, "490": {"fulltext": "466\\nINDEX.\\nIngrowing Toe-Nails, 415\\nKeloid, 328\\nLeprosy, 290\\nLichen Pilaris, 136\\nLichen Planus, 129\\nLichen Propious, 427\\nLichen Ruber, 133\\nLichen Scrofulosum, 141\\nLichen Simplex, 135\\nLocal Dermal Inflamma-\\ntions, 70\\nLupus 340\\nMacule, 49\\nMalignant Pustules, 237\\nMammillitis Maligna, 335\\nMeasles, 109\\nMedicinal Rashes, 94\\nMelanoderma, 389\\nMiliaria 426\\nMilium, 334\\nMoUuscum, 436\\nMorphoea, 322\\nMorvan s Disease, 299\\nMuscles of Skin, 23\\nNaevus, 336\\nNails, 24\\nNeoplasmata, 340\\nOnychomycosis, 413\\nOsmidrosis, 425\\nPapule, 52\\nParasitic Diseases, 392\\nParonychia, 416\\nPathology, 59\\nPemphigus, 201, 219\\nPemphigus Vulgaris, 203\\nPemphigus Foliaceus,\\nPernio,\\nPerspiration, Nature and\\nAmount of,\\nPithiriasis,\\nPithiriasis Capitis,\\nPithiriasis Corporis,\\nPithiriasis Pubis,\\nPityriasis Rubra,\\nPityriasis Pilaris,\\nPrickly Heat,\\nPrurigo,\\nPruritus,\\nPsoriasis,\\nPsoriatic Syphilides,\\nPsorospermosis,\\nPurpura,\\nPustule,\\nPustular Diseases,\\nEffects\\n204\\n456\\n28\\n393\\n393\\n394\\n395\\n241\\n244\\n427\\n143\\n379\\n245\\n249\\n396\\n375\\n51\\n215\\nRhus Tox.\\nSkin, 461\\nRodent Ulcer, 371\\nRoseola, 79\\nRubella, 125\\nRules for Studying Skin\\nDiseases, 41\\nSarcoma,\\nScabies,\\nScales,\\nScarlatina,\\nSclerma Neonatorum,\\nScleriasis,\\nScleroderma,\\nScrofuloderma,\\nSeborrhoea,\\nSeborrhcea Kerativa,\\nSeborrhoea Oleosa,\\nSeborrhoea Sicca,\\nSquamous Inflammation,\\n358\\n396\\n55\\n114\\n328\\n327\\n325\\n257\\n430\\n431\\n430\\n431\\n240", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0492.jp2"}, "491": {"fulltext": "INDEX.\\n467\\nstrophulus,\\nStye,\\nSudamina,\\nSudolorrhoea,\\nSunburn,\\nSweat Glands,\\nSweat Glands, Disorders of,\\nSycosis,\\nSyphilis,\\nTubercle\\nTumors,\\nTricophytosis,\\nTricophytosis Barbge,\\nTricophytosis Capitis,\\nTricophytosis Corporis,\\nTricophytosis Genito-Fem-\\noralis\\n142\\n232\\n426\\n428\\n391\\n17\\n418\\n288\\n267\\n54\\n56\\n407\\n409\\n407\\n409\\nTyphoid Rash, 108\\nTyphus Rash, 108\\nUlcers 56\\nUrticaria, 82\\nVaricella, 107\\nVariola 96\\nVerrucse, 306\\nVesicle, 50\\nVitiligo, 388\\nWarts, 306\\nWash-Leather Skin, 460\\nXanthelasma, 434\\n409 I Zoster, 196", "height": "3693", "width": "2241", "jp2-path": "skindiseasesthei00doug_0493.jp2"}, "492": {"fulltext": "5 J.-?\\ni. C", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0494.jp2"}, "493": {"fulltext": "", "height": "3693", "width": "2241", "jp2-path": "skindiseasesthei00doug_0495.jp2"}, "494": {"fulltext": "", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0496.jp2"}, "495": {"fulltext": "", "height": "3693", "width": "2241", "jp2-path": "skindiseasesthei00doug_0497.jp2"}, "496": {"fulltext": "", "height": "3755", "width": "2195", "jp2-path": "skindiseasesthei00doug_0498.jp2"}}