m##mm: •iff' "A?: !■>!■: '. )■*■ S".!V '■'■'. ■ :•'•'' ''./'.-I ''\r-; '•'•'£• '.1'*: fe.::»:::c-".iv.'. .■:■'■■: 'V' ,. f:i:fi'°::'::;.V::'. :• ■■ tv.i.-r--..j K1Js.:iyiv"v>:J:v!,;i K'( :):>;#• >;li:ft:r i ;V ■;>"i'-"- r ■ '= , 5::;:,C,V.iUi;!:i;i':'.V: rife-i!,:';i-';v;:'v-. lX:\::',>:,:r. :• ,)■■':■ : £f-:':\'''::>.h:':--.-', W<,-:V".:!- .Vv.'.'.^.'.'.v ■•'..■. . JF THE SKIN y/iifo ^ s "•t'SJS ">■ .".i... IONfl_ _:brarv of medicine NLM DDS7b53D =1 .COZ'VZ'O^OZ Surgeon General's Office Gi U; JsS1^ ;: ■ v' w ft? ^ ■9) '.j^-.1 -j... — it; id) NLM005765309 nL * Macules, Papules, Tubercles Vesicles, Pustules. J8^ Bullae, Scabs. ^^££JL Scales, ^^g%%5^^®?^' ^552SZ2&&ZiSS2500%!?' S0ZZZ&22232S223& Fissures. Ulcers, WnEALS, X 1__s- "N" v Diagrram of the principal elementary cmaueDus lesion ;-in profile—(alter Pif- fard). See page 22. A HAND-BOOK OF SKIN DISEASES, AND THEIR HOMCEOPATHIC TREATMENT. BY JOHN R. KIPPAX. M.D., LL.B., Professor of Institutes and'Practice of Medicixe and Medical Jurispru- dence in the Chicago Homoeopathic College ; Physiciai the Department for Skin Diseases at the Central Homeopathic Free Dis- pensary of Chicago. siciaili© —~-^^ Chicago : DUNCAN BROTHERS. 1880. Vn R IBfif: Copyrighted by Duncan Brothers. 1880. To ALL PRACTITIONERS and STUDENTS OP HOMCEOPATHT, TRUSTING IT WILL MEET THEIR APPROVAL, THIS HAND-BOOK is Respectfully Dedicated. PREFACE. The design of the present Hand-book is to furnish such a digest of the essentials of practical dermatology, as will be serviceable alike to students and practitioners. And in pre- paring the manuscript I have steadily kept one purpose in view, to make it as thorough and practical as possible. To this end condensation has been more or less necessary, and if at times statements appear too absolute, it must be remem- bered that conciseness and the limits of the book, prevented any lengthy discussion. The text consists of short general observations on the anatomy, physiology, and pathology of the skin, and on the s}Tmptomatology, etiology, diagnosis and classification of cutaneous diseases; followed by a detailed description of each individual affection, giving its clinical history and treat- ment. To this is added a chart, with diagnostic, therapeutic and dietetic hints, which it is believed will be found ex- tremely useful. Another feature in the work is the pronounciation of the various medical words used, and the introduction of defini- tions. The terms of measurement employed are arranged according to the metric system, but to make the work more generally useful, a table of English equivalents has been 8 PREFACE. appended. In. regard to nomenclature, I believe matters have been simplified very materially, although originality is by no means claimed for the classification presented. This Hand-book is virtually condensed from notes origi" nally intended for a larger work, and is the result of careful study of the litevature referred to in the bibliography, com- bined with clinical experience. And every effort within the limits assigned in the original plan has baen made to lay before the profession a satisfactory compendium of dermatology in its present stage. A.s regards treatment, my experience leads me to say that the higher attenuations, and the single internal remedy, act most promptly. And general observa- tion has demonstrated that cutaneous diseases disappear more rapidly, when internal and external treatment are combined. \Vith these prefatory remarks I give this work to the pio- fession, trusting it may, to a certain extent at least, supply the present want for a concise and practical exposition of cutaneous affections and their Homoeopathic treatment. To the publishers my thanks are due for the correctness and elegance with which they have executed their work. J. R. Kippax. Chicago, May, 1880. CONTENTS. PART FIRST. Page. General Observations,...... .17 SECTION I. The Anatomy and Pathology of the Skin, . . . 17 SECTION II. Symptomatology,..........22 SECTION III. Etiology,............24 SECTION IV. Diagnosis,............27 10 contexts. SECTIOX V. Classification............29 PART SECOND. The Description and Treatment of Skin Diseases, . 81 Acne,.............31 Alopecia,............36 Alopecia areata,...........37 Anaesthesia.............38 Anidrosis, . . . . . •.......39 Anthrax,........... 39 Atrophy of the Skin, Linear,........41 Atrophy of the Nail,..........42 Baker's Itch,......... ±., Chilblain. See Pernio,....... jq9 Baldness. See Alopecia,........ 42 Barber's Itch. See Tinea Tricophytina, . . . . 43 Boil. See Furuncle......... 40 Bottle Nose. See Eosacea........ 43 Bricklayer's Itch,....... 43 Bromidrosis,...... 4o contents. 11 Comedo,............47 Condylomata, ...........4S Cornu cutaneum,..........49 Dermatalgia,............49 Dermatitis contusiformis,........49 Dermatitis exfoliativa, .........51 Dermatolysis,.......... . 52 Dysidrosis,............52 Ecthyma,............ 53 Eczema,.............54 Elephantiasis,...........69 Ephelis,.............70 Epithelioma,...........70 Erythema, . . '..........72 Erythema nodosum. See Dermatitis contusiformis, ... 75 Favus. See Tinea Favosa,........75 Fibroma,............75 Fish-skin Disease. See Icthyosis,.......76 Frambcesia,............76 Freckles. See Lentigo,.........91 Furuncle,............76 Grocer's Itch,...........79 Guinea-worm Disease,....... . . .79, Herpes,............80 Hydroa,............ . 82 Hydro-adenitis,...........82 Hypersesthesia, . . . . . . . . . . .83 12 CONTENTS. Callositas,............44 Cancer,.............44 Carbuncle. See Anthrax,........45 Chloasma,............45 Chromidrosis,...........46 Clavus, or Corn,...........46 Hyperidrosis,...........83 Icthyosis,.............85 Impetigo contagiosa,.........87 Intertrigo,............. 89 Itch. See Scabies,..........90 Keloid,.......,.....90 Lentigo,............91 Leprosy..............91 Leucoderma,...........94 Lichen planus, . . .....94 Lichen simplex, ..........96 Lupus erythematosus,..........99 Lupus vulgaris,...........100 Miliaria,............102 Milium,............ 103 Mite Disease,...........IO3 Moles. See Verruca,.........159 Molluscum sebaceum, . ........104 Morphoea, ... ... .... 104 Naevus, or Mother's-mark, :.......105 Nails, Diseases of. See Onychia, etc.,......106 contents. 13 Nettle Rash. See Urticaria,........106 Onychauxis,...........106 Onychia.............106 Onychogryphosis,..........106 Onycho-mycosis. See Tinea Tricophytina, .... 107 Paronychia,............107 Pemphigus............107 Pernio,.............109 Phtheiriasis,...........Ill Pityriasis,............113 Pityriasis rubra. See Dermatitis exfoliativa, .... 113 Polypus of the Skin. See Fibroma,......75 Prairie Itch,............113 Prickly Heat. See Miliaria,........102 Prurigo..............114 Pruritus,............ 115 Psoriasis,............115 Purpura,............119 Ringworm. See Tinea Tricophytina,......120 Rhino-scleroma,..........120 Rodent ulcer,...... .... 121 Rosacea,........ ... 121 Roseola,.............123 Rupia,.............123 Salt Rheum. See Eczema,.........124 Sarcoma cutis............124 Scabies.............124 14 contexts. Scleroderma,...........127 Scleriasis,............128 Scrofuloderma,...........129 Sebaceous Cyst............129 Seborrhoea,............130 Shingles. See Zoster,.........132 Stone-pock. See Acne,.........132 Strophulus............132 Sudamina,............133 Sunburn. See Ephelis,........70 Sycosis..............133 Syphilides, ...........135 Telangiectasis,..........■ . 141 The Tinese,...........14_> Tinea Favosa,.......... 143 Tinea Tricophytinia,.........147 Tinea Versicolor, ........ ,151 Trichauxis,......... ]?9 Trichiasis,........^ j,-o Trichoclasis,......... lc-,> Urticaria,......... -.,,.> Verruca or Warts......... -.^ Washerwoman's Itch, . . -,n, . Ibl Wen. See Sebaceous Cyst,...... -.oq Xanthoma..... n_, Ibl Xeroderma. See Icthyosis,..... lfi9 Z0ster'.......* • .... 162 contents. ■ 15 PART THIRD. A Chart of Characteristics, with Diagnostic, Thera- peutic, Dietetic, and Hygienic Hints, , . 166 PART FOURTH. Orthoepic Glossary..........201 PART FIFTH. Metric Table,..........206 PART SIXTH. Bibliography,...........207 DISEASES OF THE SKIN. Part I. GENERAL OBSERVATIONS. Section I. The Anatomy and Pathology of the Skih. To a correct understanding of cutaneous diseases, a knowl- edge of the minute anatomy and physiology of the skin, as well as of the pathological changes that take place in it, is more or less necessary. Like most tissues of the body, the skin is composed of fibres and cells. Its office is to protect the underlying struc- ture from harm, to act as a partial respirator, and to prevent evaporation of the water which enters into the composition of the tissues. The fibres are of two kinds: white fibrous tissue, and yellow elastic fibres. The white fibres give to the skin strength, and the yellow, elasticity. The cells are of three kinds, namely; the cells of the rete, or stratum malpighii; secondly, those of the stratum lucidum; and thirdly, those of the stratum corneum. The cells of the stratum malpighii are polygonal in form, 18 diseases of the skin. and are termed " prickle cells," from their resemblance to a chestnut burr. Those of the stratum lucidum are transversely striated, and are arranged in two rows. And lastly, those of the stratum corneum or horny epi- dermis are flattened, and'are usually larger than the other cells. These five elements, the two kinds of fibres, and the three sorts of cells, constitute the main part of the structure of the skin. Anatomically, the skin may be divided into two layers, termed respectively the derma, and epidermis. And again, these two may be subdivided; the former, into the corium and papillary layer, and the latter into the rete malpighii, the stratum lucidum, and the stratum corneum or horny layer. The derma constitutes the larger part of the skin, and is made up by the interlacement of elastic fibres and connec- tive tissue. It contains as organs peculiar to the skin, prominently sebaceous and sweat glands. The external surface of the corium presents elevations, called papillae These are largest about the female nipple and corona glandis, and smallest over the general cutaneous surface. They present an average of 50,000 to the square inch, and are the seat of the tactile corpuscles of Meissner. An increase of the connective tissue elements is usually found in keloid, fibroma and scleroderma. And a fatty de- generation occasionally takes place in the new growth which destroys the connective tissue as in xanthoma. The papillae may at times become enlarged in psoriasis, and the corium general observations. 19 may become the scat of such parasites as the Guinea worm, the acarus scabiei and the pediculus. Next to the papillary layer of the derma comes the stratum malpighii or rete. The cells of this structure are mainly globular, excepting the two external layers which are fusiform, and fill up the interpapular spaces to a level a short distance beyond the apices of the papilla?. The deeper layers of this stratum are the abiding places of the cutaneous pigment. A hyper-activity of rete cells exists in psoriasis, and epi- thelioma is supposed to take its departure from this mem- brane. Beyond the stratum malpighii is the stratum lucidum, which consists of two layers of transversely striated cells. And after this comes the stratum corneum or horny epi- dermis. The deeper cells of the latter stratum are polygonal in shape while the more superficial are flattened. Its cells arc increased in amount in congested conditions of the skin, as in psoriasis; in inflammatory diseases, as in eczema and dermatitis exfoliativa; and in general hyperplasia as in ele- phantiasis ; they may be congenitally increased as in icthy- osis, or may become hypertrophied as in callositas. The cell layers of both the stratum corneum and stratum lucidum may be elevated along with portions of the rete, by fluid forcing its way up from beneath; and thus they form the walls of vesicles as in eczema or herpes on the one hand, or those of bulla?, as in pemphigus on the other. The organs of the skin are : Bloodvessels, lymphatics and nerves, sweat glands, sebaceous glands, and hair follicles; the appendages are, the hair and nails. 20 diseases of the skin. The bloodvessels after supplying the organs form a deep plexus in the deep layers of the derma. Branches from this plexus, ascend to just beneath the papillary layer of the derma, where they form a superficial plexus. A hyperplasia ot these vessels exists in telangiectasis. The superficial plexus is mainly affected in psoriasis, lichen and prurigo. Both plexuses may be implicated in eczema. The lymphatics also form plexuses, generally one beneath each plexus of bloodvessels, and lymph spaces are usually present in the derma. They are found increased, both as to size and number in elephantiasis. The nerves of the skin are surface branches of the nerve trunks that course beneath. They give to it, the sense of touch, and are intimately connected with the physiolog- ical and pathological changes going on around them. They undergo organic alteration in zoster, leprosy, dermatalgia and telangiectasis. The sweat glands are convoluted tubuli, situated in the deep parts of the derma. They open on the external surface by an efferent duct which presents an oblique valve-like aperture. It is estimated that there are over two million of them in the human body, representing an average of eio-ht miles of perspiratory tubing. By evaporation they tend to regulate the temperature of the body, and usually throw off about two pounds of fluid daily. They also act as auxiliary to the kidneys, in throwing off excrementitious matters. The natural perspiration is generally acid in reaction. It is however, normally alkaline in the axilla and between the fingers and toes, and after prolonged sweating. These sweat producing structures may become functionally GENERAL OBSERVATIONS. 21 disordered, as in hyperidrosis. Or they may be primarily affected as in dysidrosis, or secondarily disordered as in icthyosis. The sebaceous glands are small, sacculated organs, lodged in the substance of the derma. They are furnished with excretory tubes which open usually into the hair follicles, but occasionally upon the cutaneous surface. They secrete an oily substance called sebum, the office of which is to lubri- cate the skin and hair. They may be functionally disordered as in seborrhcea, primarily affected as in acne, or secondarily diseased as in elephantiasis and leprosy. The hairs are peculiar modifications of epidermis and consist of shafts and roots. They are of three kinds: (1). Long hair, as that of the scalp; (2). Short, thick hair, as that of the eyebrows; (3). Fine, soft hair, found upon the face and body, and called lanugo. The outside of the shaft is made up of flat horny cells, next beneath are longi- tudinal fibres forming the bulk of the hair, and internally is a central medulla of nucleated cells. The color of the hair is mostly given to it by the pigment granules that are found in the longitudinal fibres. The root presents a bulbous enlargement which is closely connected with the papilla—a vascular eminence situated at the base of a finger-of-glove depression in the epidermis called the hair follicle. The fol- licles consist of two coats, an outer, dermic, and an inner, cutzcular. The latter forms what is known as the root sheath. Little muscles of the unstriped variety, called arectores pilorum, are connected with the hair follicles. They are supposed to favor the exit of sebum by compressing the 22 DISEASES OF THE SKIN. sebaceous glands, and by erecting the hairs, give rise to the phenomenon, cutis anserina or goose-skin. The hair may be either hypertrophied or atrophied, or it may become text- urally changed. 7 he nails are composed of altered cuticular cells derived from the three strata of the epidermis. They may become structurally changed, as in onychia. Or they may be prima- rily affected, hypertrophied as in onychauxis, or secondarily so, as in psoriasis, syphilis and icthyosis. Or, again, the vegetable parasites may here take up their habitat, giving rise to the condition termed onycho-mycosis. Section II. Symptomatology. Symptoms are signs of disease. They may be either ob- jective or subjective. Objective symptoms are those appear- ances which manifest themselves upon the surface, and are capable of ocular demonstration. Subjective symptoms relate solely to sensations which arise from within, and are cognizant only to the patient. The objective symptoms of diseases of the skin embrace all the elementary cutaneous lesions,* whose physical charac- ters may be roughly outlined as follows: j\fac?des are circumscribed discolorations of skin. They may be primary as in lentigo, or secondary as in Addison's disease. Sometimes they are physiological in character, as in pregnancy. They are met within chloasma, mevus, pur- pura, morphcea and erythema. Pajmles are small acuminated elevations of skin. They *3ee frontispiece. GENERAL OBSERVATIONS. 23 i may be either true or false, and are frequently attended with itching. They are seen in acne, eczema, scabies, lichen, prurigo and milium. \resHes are small elevations of epidermis enclosing a trans- parent or milky fluid. There are three kinds, viz: serous, sweat and lymphatic. The serous are present in eczema, herpes, scabies, impetigo contagiosa and zoster. The sweat are seen in sudamina and dysidrosis. And the lymphatic are observed in elephantiasis. Bulloe are blisters or large vesicles. They may be either primary or secondary. They are primary in pemphigus, lep- rosy, and hydroa. And are secondary or accidental in dysid- rosis, eczema and urticaria. Pustules are small collections of pus covered by cuticle. They are met with in acne, eczema, impetigo contagiosa and ecthyma. Tubercles are small solid fleshy swellings in the skin, covered with epidermis. They are seen in acne, tricophy- tina, sarcoma, and leprosy. Wheals are red or whitish elevations of skin, resembling the sting of the nettle. They are the result of vaso-motor disturbance, and are fugitive and capricious in character. They are pathognomonic of urticaria, but are an occasional result of medicinal poisoning. Scales are collections of altered cells of the stratum cor- neum. They are observed in eczema, pityriasis, psoriasis, icthyosis, seborrhea, tricophytina, etc. Fissures are linear solutions of the continuity of the skin, and take place in eczema, leprosy and psoriasis. Crusts are formed by the drying up of discharges. They 24 DISEASES OF THE SKIN. i are found in eczema, ecthyma, impetigo contagiosa, sycosis, leprosy, etc. Ulcers are circular solutions of continuity of the skin, usu- ally followed by cicatrices. They form in lupus vulgaris, leprosy, scrofuloderma, furuncle, etc. Of subjective symptoms, sensations of heat, burning, and tingling, are the most common. They are met with in varied degrees in all hyperaemic and inflammatory cutaneous affec- tions. Pain is a general accompaniment of acute inflammation, as in herpes, etc. Hyperesthesia or oversensitiveness of the skin is frequently met with in dermatalgia, and in the early stages of leprosy. Anaesthesia or loss of sensibility is present in the later stages of leprosy, and in syphilis. Pruritus or itching is one of the most prominent and annoying of the subjective symptoms. It may be due to local causes, or may be entirely dependent on reflex condi- tions. Section III. Etiology. The etiology or causes cf diseases of the skin may be con- veniently considered under two heads: I. Internal or con- stitutional causes. II. External causes. I. The internal causes which are also the most numer- ous, admit of arrangement and description as follows: 1. Hereditability.—An inheritable state in which clisgases or taints may be handed down from parent to child. As striking examples, syphilis, leprosy, psoriasis, and icthyosis, may be mentioned. general observations. 25 2. Constitutional tendencies.—By which is to be under- stood a disposition either hereditary or acquired, to the de- velopment of certain, usually inflammatory diseases, under favorable conditions. 3. Organic and Functional Diseases of the Internal Or- gans.—-Their name is legion. A few may be cited. De- rangements of the alimentary canal, are frequent causes of cutaneous eruptions, notably of eczema, urticaria and acne. Uterine diseases may complicate or give rise to the same troubles. Disease of the kidney is a common cause, or ag- gravating condition in eczema. Derangement of the nervous system plays a prominent part in a variety of disorders. And affections of the liver have considerable influence in shaping the course of cutaneous affections. 4. Age and Sex are important conditions influencing dis- ease. Certain affections are found to appear at stated periods of life, and are pe3iiliar to one or the other sex. The con- genital syphilide appears during the first months of infant life. Icthyosis manifests itself in the second year. And impet- igo contagiosa is in the majority of cases an affection of child- hood. Of the parasitic affections, tricophytina, excepting when it attacks the beard, is more common in children, while tinea versicolor is oftenest met with in adults. Acne appears about the time of puberty. Epithelioma rarely shows itself before middle life, and is of more frequent occur- rence in males; while lupus originates in childhood and is more common in females. 5. Certain articles of food, may, under peculiar condi- tions become essential factors in the causation of cutaneous eruptions. Of these should be noticed: shell-fish and straw- 26 DISEASES OF THE SKIN. berries as common causes of urticaria; buckwheat as giving rise to irritating conditions, and pruritus; stimulating drinks and highly seasoned food, as aggravating influences in eczema, urticaria and acne. 6. Drug Poisoning.—The overdosing with sueh drugs as Mercury, the Potassium Bromide and Iodide, Copaiba and Valerian, Chloral and Salicylate of Soda, is frequently pro- ductive, in Old School practice, of cutaneous complications. Notably may be mentioned the eczema mercuriale, the urti- caria caused by Valerian and Copaiba, the acne produced by the Potash salts, and the scarlatinal rash induced by Chloral and Salicylate of Soda. II. The external causes, are: 1. Climatic Influences.—Some diseases are ago-ravated in, or peculiar to cold climates, while others flourish in trop- ical regions. And it may be accepted as a general rule, that in any locality, temperature will exert an influence, propor- tionate to the extremes of heat and cold to which the patient is subjected. 2. Irritants.—Want of cleanliness is the exciting cause of many skin affections. The tinea fungus riots in dirt, and filth is a condition favorable to the development oi eczema and other cutaneous inflammations. Local irritants are often met with in particular occupations. Grocers, masons and bakers are often troubled with eczema, induced by handling flour or lime. Washerwomen and workers in dyes are also frequently the subjects of the same disease. 3. Parasites.—Of these there are many varieties, both animal and vegetable, each parasite producing its own char- general observations. 27 acteristic contagious lesion, and only requiring a favorable soil on which to fructify and grow. Section IV. Diagnosis. The diagnosis of cutaneous affections is to the experienced eye an easier task than that of any other class of diseases. The predominance of objective symptoms which serve at all times as "key-notes," enables the physician with a little aid from the patient in the May of subjective symptoms, to ascertain positively the extent and nature of the lesion. The examination must in all cases be thoroughly instituted. The family history of the patient should be learned, and the occupation and habits inquired into. The physical charac- ters of the eruption must be closely scrutinized, and the peculiar features of the extending edges of the patches accurately determined. To this end, it is necessary to examine all the affected portions of skin, special attention being given to the newest developments. The changes, if any, in the character of the eruption from the time of its first appearance should be carefully noted, and the stages through which the disease has already passed, satisfactorily mapped out. It must be borne in mind that the influences of temperament, age, sex or social surroundings may mod- ify the general characters and aspect of a disease: and that complications may so mask a case as to render it difficult of recognition. The examination is best conducted in daylight. A white lio-ht is the better substitute for sunlight. In difficult or complex cases, where the unaided eye is unable to solve the i8 diseases of the skin. problem, the skin microscope may be used with profit. Small slices of the part to be examined, can be easily secured by the use of the skin-grafting scissors, or if still thinner portions are needed, the cutisector may be employed. The temperature of parts, if desired, is readily taken by Seguin's surface thermometer. Very material aid in making a diagnosis is frequently derived from remembering the locality attacked. The fol- lowing table after Fox, gives the main points: The scalp, is the most common seat of seborrhcea, the tinea?, eczema, sebaceous cysts, psoriasis and alopecia areata. The forehead, of acne. The nose, of lupus and rosacea. The cheeks, of lupus, rosacea and eczema. The upper lip, of herpes and eczema. The lower lip, of epithelioma. The chin, of sycosis and tinea tricophytina. The angle of the mouth, of syphilide. The ears, of eczema. The front of chest, of keloid and tinea versicolor. Under the clavicle, of sudamina. Region of the nipples, of scabies. The side of chest, of zoster. The elbows and knees, of psoriasis. The interdigits and front ofivrists, of scabies. Back of the hands, of lichen and eczema. The palms, of syphilide. The buttocks, inner ankle and toes in children, of scabies. The dorsum of penis, of scabies. The scrotum, of eczema, psoriasis and chimney-sweepers' cancer. GENERAL OBSERVATIONS. 29 1he front of the leg, of dermatitis contusiformis. The leg, if running around or lengthwise, of zoster. The whole body, of pemphigus foliaceous and dermatitis exfoliativa. And the flexures of joints, of eczema and scabies. Section V. Classification. Classification is generally resorted to in order to simplify the study of disease, and is as important in the department of dermatology as in any other branch of medical science. The arrangement here presented is a modification of that recently adopted by the American Dermatological Associa- tion. class i. .Disorders of the Glands.— (1). Of the sweat glands: Anidrosis. Bromidrosis. Chromidrosis. Hyperidrosis. Miliaria. Sudamina. (2). Of the sebaceous glands: Comedo. Cysts. Mil- ium. Molluscum sebaceum. Seborrhea. class n. Inflammations.—Erythema. Intertrigo. Dermatitis con- tusiformis. Pityriasis. Urticaria. Acne. Sycosis.—Ec- zema. Dysidrosis. Pernio. Strophulus. Prairie itch.— Herpes. Zoster. Hydroa. Pemphigus.—Impetigo con- tagiosa. Ecthyma.—Lichen planus. Prurigo. Lichen sim- plex.—Psoriasis. Dermatitis exfoliativa.— Anthrax. Fu- runculus. Hydro-adenitis. class hi. Hemorrhages.— (1). Of connective tissue: Purpura. 30 DISEASES OF THE SKIN. CLASS IV. Hypertrophies.— (1). Of pigment: Chloasma. Lentigo. (2). Of epidermal and papillary layers: Callositas. Cornu cutaneum. Clavus. Icthyosis. Verruca. (3). Of connective tissue: Elephantiasis. Frambcesia. Rosacea. Scleriasis. Scleroderma. (4). Of nail: Onychogryphosis. (5). Of cutis: Dermatolysis. CLASS V. Atrophies'.— (1). Of pigment: Leucoderma. (2). Of connective tissue: Morphcea. (3). Of nail: Atrophy of the nail. (4). Of cutis: Linear atrophy. CLASS VI. JVew Growths.—(1). Of connective tissue: Fibroma. Keloid. Xanthoma. (2). Of vessels: Naevus. Telangiectasis. (3). Of granulation tissue: Epithelioma. Leprosy. Lupus erythematosus. Lupus vulgaris. Rhino-scleroma. Sarcoma cutis. Scrofuloderma. Syphilides. CLASb VII. Neuroses.— Anaesthesia. Dermatalgia. Hyperesthesia. CLASS VIII. Parasitic Diseases.— (1). Vegetable or dermatophytic: Tinea favosa. Tinea tricophytina. Tinea versicolor. Alo- pecia Areata. (2). Animal or dermatozoic: Elephantiasis. Guinea- worm disease. Mite disease. Phtheiriasis. Scabies. PART II. THE DESCRIPTION AND TREATMENT OF SKIN DISEASES. ACNE, or Stone-pock is an inflammatory disease of the SEBACEOUS GLANDS CAUSED BY THE RETENTION OF SEBUM, AND CHARACTERIZED BY THE FORMATION OF PAPULES, TU- BERCLES AND PUSTULES. It may show itself on any part of the body, except the palms of the bauds and soles of the feet, but generally selects%s seats, the face or back. It may appear either as a separate and independent affection, or exist as a complica- tion of other follicular diseases. The eruption usually manifests itself in the form of pin- head or pea-sized elevations situated around the glandular orifices, attended by more or le.ss peri-follicular and peri- glandular inflammation. When the inflammation is super- ficial, the disease is apt to run a mild course, presenting only slightly reddened elevations, with or without a central yellow suppurating point (A. vulgaris). On the other hand, when the inflammation extends to the gland struc- tures, considerable disturbance may be occasioned, ending in the formation of little abscesses, and resulting cicatrices (A. indurata). In debilitated states of system, such as attains in anaemia and chlorosis, a form of this affection, 32 DISEASES OF THE SKIN. Acne may be either acute or chronic. The acute variety may run its course in a few days or weeks, while the chronic may last for years. It occurs mostly in light-complexioned young people, about the time of puberty. And is more common at that period because the hair follicles and sebaceous glands are then in a state of physiological hyper- activity, and hence more liable to suffer functional derange- ment, and to take on diseased states. It is often a reflex affection depending on irritation, derangement or disease of other organs, and more especially functional disorders of the sexual system. The severer forms are usually induced by gastric derange- ment. And in young lads, masturbation is a frequent cause. An acne eruption may be produced by the over-use of cer- tain medicinal substances as the Potassium Iodide and Bro- mide. The same result may also come from the injudicious use of tar; and persons who work in tar factories or habitu- ally handle tar, are apt to have this trouble (artificial acne). The differential diagnosis of acne is exceedingly simple, if the chief characteristics and history of the disease are borne in mind. Treatment:—The treatment is both internal and local. The diet should be light and unstimulating; all highly seasoned food, and exhilarating drinks should be avoided. The external treatment will vary according to the extent, obstinacy, and stage in which the disease exists. Whatever comedos are present, should first be pressed out, either with the comedo extractor or a watch-key. In the milder forms stimulating lotions may be used, but in the inflamed variety, soothing applications are called for. DESCRIPTION AND TREATMENT. 33 Large and painful pustules should be lanced, and indolent tubercles, may be treated with the Acid nitrate of Mercury. The best way to apply the acid nitrate, is to touch the tubercles with a glass rod dipped in it, and dry them off with a piece of blotting paper. In ordinary cases the best results will generally be ob- tained from the use of one of the following preparations: Hypochloride of Sulphur, 1 gram., Rose water, 40 grams, mix. Iodide of Sulphur, 1 gram. Rose water, 40 grams, mix. Sulphur 1 gram, Ether and Alcohol each, 15 grams, mix. Mercurius cor., 1-8 to 1-4 gram. Alcohol and Rose water each, 30 grams, mix. Mercurius jod. or bijod., 1-5 to 1 gram, Emulsion of Almonds, 50 grams, mix. Rumex crispus tincture 5 grams, Alcohol and water each, 15 grams, mix. Potassium sulphide, 1 gram, Emulsion of Almonds, 30 grams, mix. The Rumex lotion is adapted to all forms. The Sulphur preparations will be found useful in mild cases, and in the severer forms after the inflammatory symptoms have sub- sided. The Corrosive sublimate wash will also frequently prove of service. The Iodide and Bin-iodide of Mercury, and the Potassium Sulphide lotions are adapted to the indurated forms. The parts should be rubbed with a soft nail brush and warm soap and water, every night, before applying the lotions. The soaps that have frequently been found useful, are notably, Sulphur and Iodide of Sulphur soaps, and the Juniper tar soap. Sea-salt baths about twice a week have occasionally rendered excellent service. 3 34 DISEASES OF THE SKIN. Of internal remedies, one of the following may be selected according to the indications, and administered ter die. Antimonium crudum.—Small red pimples on the right shoulder, stinging when touched. Acne of drunkards. Antimonium tart.— In obstinate cases, and when there is a decided tendency to pustulation. May be used inter- nally and locally. Aurum.—Red pimples on the face. In onanists with dis- position to melancholy. After over-dosing with Potassium iodide. Berberis. vulg.—Red, burning, gnawing pimples, sensi- tive to pressure, surrounded by red areolae, and leavino- brown spots. Adapted to the indurated form. Belladonna.— Large, bright red pimples on back and scapulae. Fine stinging in tips of pimples. Especially in young, full blooded people. Bovista.—Large scattered pimples on the forehead. Hard red pimples, large as peas, on chest, worse from scratching. Bromine.—The indurated form. Aggravated by smoking. Calcium sulphide.—Painless pimples on the nape of the neck, forehead and chin. Crusty pimples on the face of young people. Carbo a eg.—Pimples on the nape of the neck. Red pim- ples on the face in young persons. Aggravated by eating butter or pork. Causticum.—Eruption on the face more felt than seen. Papulous eruption between the eyebrows above the nose. Chelidonium maj.—Pimples and pustules in groups of three or four on the face, except the chin. Chiefly on the left side. Acne dependent upon liver derangement. DESCRIPTION AND TREATMENT. 35 Eugenia jamb.— Pimples on the face which are painful for some distance around. At times useful in the indurated form. Granatum.— Pimples on the forehead and left temple with sore pain. They suppurate, and on drying leave nod- ules. Itching in different parts of the body, as if pimples ivould break out. Iodine.—Indurated acne, in scrofulous subjects. Kali bich.—Face covered with a profuse eruption like acne. When pustules form they resemble small-pox pus- tules. Kali carb.— Small pimples on face, chest and back, with redness and swelling. Aggravated during suppressed menstruation. Ledum.—Red pimply eruption on the face. Small pimples on the root of the nose. In brandy drinkers. Lycopodium.—Red pimples in clusters, between the scap- ula? and on the nape of the neck. Merc. sol.—Papular eruptions having bluish appearance. Mezereum.— Single pimples on the thighs. Red pustules on the outer side of the extremities. Nabulus serpentaria.—Pimples on the face, about the nose, upper lip and chin. Natrum mur.—Acne accompanied by seborrhoea. Nitric acid.—Many small pimples on the forehead, just below the hair. Painful pimples on the chin with hard red areolae. Nux juglans.—Variously sized reddish pimples and pus- tules on face, chiefly around the mouth. Adapted to all stages of acne. 36 DISEASES OF THE SKIN. Nux vom.—Acne with dyspepsia and constipation. Phosphoric acid.—Smooth red pimples with reel areola? on forearm, knees and leg. Large red pimples on the face and scapulae, only sensitive to the touch. Acne in weakly persons, onanists, and victims of spermatorrhoea. Potassium bromide.—Acne on face, neck and shoulders, with peculiar yellow points, which neither coalesce nor burst. Adapted to both the simple and indurated forms. Potassium iodide.—Papulous eruption all over, but es- pecially on face and shoulders. Painful sensitiveness, worse at night. Pulsatilla.—Acne in pale slender individuals. Aggravated by pastry and fat food. Robinia.—Hard pimples which take a great while to sup- purate. Great tendeney of tumors to become indurated. In dyspeptics with sour stomach; worse at night. Rumex crispus.—Dense rash of small red pimples. Erup- tions aggravated by wearing flannel. Sabina.—Papular eruptions during pregnancy. Sarsaparilla.—Acne worse during the menstrual period. Sepia.—Pimples on the mons veneris, legs and flexures of the joints. Ailments following vaccination. Sulphur.—In simple acne, and chronic cases. Sumbul.— Smooth, small, reddish spots on the forehead. Black pores on the face. Veratrum alb.—Pimples on the right labium just before menstruation. ALOPECIA or Simple Baldness, is an absence of hair, either partial or general. It is a symptom rather than a dis- ease, and may exist as an accompaniment of a variety of affections. description and treatment. 37 ALOPECIA AREATA is a parasitic disease, charac- terized BY THE MORE OR LESS SUDDEN APPEARANCE OF VARI- OUSLY SIZED AVHITE BALD PATCHES. It starts usually on the scalp, and generally from the parietal protuberances, but occasionally it commences in the beard. At times the whole body becomes affected. The disease is frequently unilateral, occurs mostly in young people, and is usually announced by the appearance of one or more nickel-sized, roundish or oval areas, devoid of hair. These are apt to extend quite rapidly, and in a few days may have attained the size of an inch or more. Other spots soon appear elsewhere, and in a short time the greater part of the side of the head may be bald. The hairs generally come out by the roots leaving a perfectly smooth polished surface, and do not break off as in tinea tricophytina. At times little fine lanugo or downy hairs appear on the affected part; these, however, are seldom more than tran- sients, and soon fall oft and disappear. After this manner the disease may run indefinitely. It was for some time a mooted question with dermatolo- gists as to whether this was a parasitic affection, or merely a tropho-neurosis. Malassez in the Archives de Physiologic for 1*74, demon- strated its parasitic nature. He found a number of spheri- cal and ovoid double contoured highly refractive bodies, among the epidermal scales. The spores were either annu- lar or formed incomplete rings, and were seldom found on the hairs. treatment.—The treatment is mostly parasiticidal, and consists in epilating with a broad lipped forceps the mar- 38 DISEASES OF THE SKIN. ginal hairs, and applying Acetic acid, tincture of Canthari- des, tincture of Iodine, or equal parts of Glycerine and tincture of Capsicum, to the patch. This treatment is to be followed by a bi-chloride of Mercury ointment, (1-8 gram, to 30 grams,) applied for a fortnight, and changed morning and evening. A weak Phosphorus lotion may at times render excellent service, in promoting the new growth of hair. The principal internal remedy is Phosphorus, and the next Natrum mur. (bis in die.) Others may be indicated for alopecia in general as follows: Aloes.—When the hair conies out in lumps leaving bald patches. Calcarea carb.—When the bald spots are on the temples. Calcium sulphide.—Bald spots on the head, after head- aches. Carbo veg.—Falling off of hair after severe illness, or after parturition. Fluoric acid.—When there is a syphilitic taint. Graphites.—Bald spots on the sides of the head. Helleborus.—Falling of hair from eyebrows and puden- dum. Kali carb.—Dry hair rapidly falling off with much dand- ruff. Mancinella.—Falling off of the hair after severe acute diseases. Phosphoric acid.—Alopecia as a result of debility. Vinca minor.—The hair falls out in single spots, and white hairs grow there. ANAESTHESIA by which is meant partial or complete DESCRIPTION AND TREATMENT. 39 insensibility of the skin, is encountered in such diseases, as leprosy, syphilis, hysteria,and in various affections of the brain and spinal cord. It may result from traumatism, the local use of freezing: mixtures, Carbolic acid and the like, or arise from the toxic effects of Opium, Chloroform or Lead. ANIDROSIS IS A FUNCTIONAL DISORDER OF THE PERSPIR- ATORY APPARATUS, CHARACTERIZED BY INSUFFICIENT SWEAT. It may be congenital, or exist as an accompaniment, in psoriasis, elephantiasis or icthyosis. Treatment.—Turkish baths will be found of service. The internal remedies occasionally indicated, and administered quotidie, are: iErausA.—The skin has a dry white leathery appearance. Natrum carb.—The skin of the whole body becomes dry and cracked. Phosphorus.—The skin is dry and wrinkled. Plumbum.—Dry skin with absolute lack of perspiration. Potassium iodide.—The skin is dried up, and rough like hog skin. ANTHRAX or Carbuncle, is a phlegmonous inflamma- tion OF THE SKIN, CHARACTERIZED BY NECROSIS OF THE CEL- LULAR TISSUE, WITH SUPPURATION, AND THE DISCHARGE OF THE NECROSED MASSES CALLED CORES, WITH PUS, THROUGH CORRESPONDING SIEVE-LIKE OPENINGS. It usually commences with severe burning pains in the part affected, and is accompanied by more or less fever. As the disease progresses, the painful spot becomes hard and swollen and assumes a purplish hue. It is usually circum- scribed, and varies in size from a fifty-cent piece to a saucer. In a few days little openings corresponding to the number 40 DISEASES OF THE SKIN. of cores, form on the surface, and give to the part a cribri- form appearance. The whole mass, now gradually sloughs away, leaving an ulcer with everted edges, which granulates slowly, and leaves when healed, a permanent cicatrix. Anthrax seldom appears before adult life, and attacks mostly the skin of the nape of the neck, shoulders, forehead and buttocks. It is more frequent in winter than in summer, and occasionally displays an epidemic tendency. It may run a mild course with but little constitutional dis- turbance, or it may be so severe as to terminate fatally. Treatment.—The diet should be nourishing, and directed mainly to keeping up the strength of the patient. In debil- itated cases, a jelly made by simmering together equal parts of finely cut mutton, beef and veal, may be used. Brandy and egg, or milk and egg will sometimes prove serviceable. The local treatment consists in the early application of ice and salt bags to the swelling. They invariably lessen the extent of the disease. Later if suppuration threatens, a free crucial incision must be made, and hot flax-seed poultices applied. If the sloughing is extensive, charcoal and yeast poultices, may be used. The sloughs should be picked out, as fast as they form, and the ulcer washed with a weak solu- tion of Carbolic acid. Strapping with soap plaster in the early stages has been recommended. And the practice of using caustics instead of the knife is advocated by some surgeons. Of internal remedies, Arsenicum alb. bears the palm. Others may be used according to the indications, and re- peated pro impetus ratione. DESCRIPTION AND TREATMENT. 41 Aconite.—As an occasional remedy, when there is much inflammation with high fever. Anthracinum.—Burning pain not relieved by Arsenicum. Evidences of blood poisoning. Apis mel.—Continued extension of the erysipelatoid in- flammation with stinging: burning. Arctium lappa has great reputation. Used both inter- nally and locally. Arsenicum alb.—Large painful and malignant carbun- cles. Great prostration. Excessive burning, as from hot coals. Better from warm applications. Belladonna.—Bright redness, with throbbing pain. Carbo veg.— Dark blackish appearance of the sore, with fetid discharge. China.— Debility from excessive suppuration. Lachesis.—Bluish-purplish looking carbuncles, with evi- dences of blood poisoning. Nightly burning, obliging one to rise and wash parts in cold water. Cerebral symptoms. Nitric acid.—When there is a predisposition to anthrax. Phytolacca.—Tendency to carbuncles, especially on the back and behind the ears. Secale cor.—Carbuncle on the arms. Aggravated by warm applications. Gangrenous tendency. Silicea.—To promote healthy granulation. LINEAR ATROPHY of the skin, is characterized by white or claret-colored depressed scar-like streaks or spots. The streaks, which are the commoner form, are usually from two to five millimeters broad, and from two to several centimeters long. The spots may vary in size from a pin's- 42 diseases of the skin. head to a pea or larger. They both present a smooth de- pressed scar-like appearance, and may be either white or claret-colored. They occur mostly on the thighs, but may form on any part of the body. Linear atrophy may occur at all periods of life, runs a chronic course, and seldom affects the general health of the patient. It is supposed to be due to the cessation of the trophic nerve influence in localized areas. Treatment.— Cocculus may be given indies to check the formation of the claret spots. Graphites or Sulphur for the white spots, and Sabadilla for the streaks. Usually, however, medication is unavailing. The diet should be directed to keeping up a proper and healthy state of system. Cod liver oil as a nerve food may be thought of. ATROPHY OF THE NAIL, may be either congenital OR ACQUIRED, AND IS CHARACTERIZED BY A DEFICIENT GROWTH OF NAIL SUBSTANCE. The nails are usually brittle, thinner than normal, and de- void of the natural lustre and smoothness. They frequently present a worm-eaten appearance, and have a deadened leaden hue. Atrophy of the nail may exist as a local affection, or as is more generally the case, occur as a result of other diseases, such as eczema, psoriasis, or syphilis. Ireatment.—The principal internal remedy for simple atrophy of the nail is Silicea, bis in die. BAKER'S ITCH is an inflammation induced by the irri- tant action of flour. See Eczema. BALDNESS, see Alopecia. DESCRIPTION AND TREATMENT. 43 BARBER'S ITCH, see Tinea Tricophytina. BOILS, see Furuncle. BOTTLE-NOSE, see Rosacea. BRICKLAYER'S ITCH is an inflammation excited by the irritant action of lime. See Eczema. BROMIDROSIS or Osmidrosis is a functional dis- order OF THE SWEAT GLANDS, CHARACTERIZED BY OFFENSIVE SWEAT. It may be either general or local, the more common local forms being those of the axilla? and feet. The hands and feet are frequently cold, and present a bluish appearance, due to inactive circulation. Sometimes the disorder is clue to the saturation of long worn socks and boots. The odor varies, being at times almost imperceptible, and in other cases so strong as to be truly disgusting. An osmidrosis may exist, as a symptom in general diseases. Fox mentions the "rank" sweat in rheumatism, "the putrid" sweat in scurvy, the "musky" sweat in chronic peritonitis, the "mouldy" sweat in itch, the "sweet" sweat in syphilis, the "stale beer "sweat in scrofula, and the " fresh-baked brown bread " sweat in intermittent fever. Treatment.— The most rigid cleanliness should be ob- served. The parts may be bathed in Alum or Carbolic acid water and afterwards dressed with diachylon plaster, closely applied. The juniper-tar soap is the best to use in the ordi- nary bath. The internal remedy may be selected from the following, and administered ter die: Cantharis.— Sweat smells like urine. Conium mac— Strong, fetid, acrid, irritating sweat. 44 DISEASES OF THE SKIN. Dulcamara.—Fetid sweat, with copious discharge of limpid urine. Ledum.—Putrid sour sweat at night. Lycopodium.—Sweat smelling like onions. Petroleum.— Fetid sweat in the axilla. Rheum—Sour smelling sweats. Rhus tox.—Acrid smelling sweat. Sepia.—Offensive footsweat. Sweat smells sour or like elder blossoms. Silicea.—-Offensive foot-sweat, with rawness between the toes. Stannum.—Mouldy, musty-smelling sweat. Staphysagria.—Sweat smelling like rotten eggs. Veratrum alb.—Bitter smelling sweat. Zincum.—Profuse sweating of the feet of a bad odor. CALLOSITAS, or Callosity, consists of a yellowish OR WHITISH, NICKEL-SIZED, HORNY ELEVATED PATCH. It may be caused either by continued pressure or friction. It is observed on the hands of mechanics and laboring men. On the foot it is caused by the friction of the boot, and appears mostly on the ball of the great toe, and on the outside of the little toe. It is found more in men than women. Treatment.—Occasionally it disappears spontaneously. If it proves a source of annoyance, it may be removed by the knife, otherwise it is advisable not to interfere with it. Graphites and Silicea are respectively the main remedies for callosities on the hands and feet. They may be taken ter die. CANCER.—The main variety of cancer with which the dermatologist, strictly speaking, has to deal, is the epi- DESCRIPTION AND TREATMENT. 45 thelial. The others belong to the province of the surgeon. See Epithelioma. CARBUNCLE, see anthrax. CHLOASMA is a coloration of the skin, character- ized BY THE FORMATION OF ROUND OR OVAL PATCHES, MCKEL- fclZED OR LARGER, HAVING A YELLOWISH OR BROWNISH COLOR. It occurs more in women than in men, and selects the face as its common seat. In women it is frequently found associated with and dependent upon some physiological or pathological change in the uterus. In men it sometimes occurs in connection with tuberculosis, and after long con- tinued malarial diseases. Treatment.—Local applications are of temporary benefit. That most commonly used is the Merc. cor. lotion, varying in strength from 1-10 to 1 gram in 30 grams of the Emul- sion of Almonds. It may be painted on the parts night and morning. The Calcium chloride solution 1:10, is also of service. The internal remedies most useful in chloasma, and usually given bis in die, are: Argentum nit.—Slight brown spots on the upper part of the chest and on the hands. Peculiar discoloration of the skin from bronze color to black. Antimonium crud.—Brown liver-colored spots on both shoulders. Ferrum met.—In chlorotic individuals. Guarana.—Yellow spots on the temples. Liver spots on the arms. Laurocerasus.—Hepatic spots on the face. Lycopodium.—Hepatic spots on the arms. Several brown spots on inner side of both thighs. 46 diseases of the skin. Petroleum.—Brown spots on the wrists. Yellow spots on the arms. Sepia.—Yellow streak like a saddle on the nose and cheeks. In pregnant or nervous women. Sulphur.—Hepatic spots on the back and chest. Yellow and brown spots. CHROMIDROSIS is a functional disorder of the sweat GLANDS, GIVING RISE TO A COLORED PERSPIRATION. It occurs most commonly in hypochondriacs, and in un- married women associated with uterine disorders. The secretion is usually fitful in its character, and may be excited by emotional conditions. Treatment.—JVux vom. is the most important remedy. It may be given ter die. CLAVUS, or Corn, is a small, usually split-pea-sized, FLAT HORNY FORMATION, MORE OR LESS DEEPLY SEATED, AND PAINFUL ON PRESSURE. It may be either, soft or hard. It resembles a callosity when hard, and a wart when soft. Its most common seat is upon the outer surfaces. Treatment.—First of all the patient must consent to wear easily fitting shoes or boots. And next the corn may be gotten rid of, by poulticing and paring it clown, so that eventually it can be removed without pain. Flexible or arnicated colloid may be used as a dressing for painful soft corns. Corn-plasters often prove valuable aids in protecting the corns. In some cases caustics are of service after the horny growth has been thoroughly softened by poultices. description and treatment. 47 If the corns are inflamed and painful, a Veratrum viride or Arnica lotion 1:10 may be resorted to instead of the poul- tices. Antimonium crudum, ter die, is the principal internal rem- edy for hard corns, and Sulphur for the soft variety. COMEDO, is a disorder of the sebaceous glands, char- acterized by small black-topped sebaceous points. Each black-topped point, or comedo, vulgarly known as a grub, is usually about the size of a pin's head. The disease shows itself generally on the forehead, cheeks and chin. It appears mostly in young people, and is a frequent accompa- niment of acne. It differs from milium in that the sebaceous duct in comedo is patulous, in milium it is closed. The face looks as if sprinkled with gunpowder in comedo, in milium it appears studded with white millet-seed like points. If left to itself, comedo rarely runs longer than four or five years. Matrimony is said to hasten its departure. Ireatment.—The diet should in the majority of cases be regulated so as to exclude oily and fatty foods and pastry. In some cases, however, Cod liver oil may be needed. The individual comedos should be squeezed out by the means of a watch key, or comedo pressor, and a Sulphur lotion, composed of sublimed Sulphur, 10 grams and Alco- hol 2i> to 50 grams applied, and allowed to remain on all night. The principal internal remedies are Baryta carb. and Se- lenium. Others may be indicated as follows, and admin- istered ter die: Belladonna.—Comedos in young full-blooded people. Cicuta.—Black spots on the skin. 48 diseases of the skin. Digitalis.—Black comedos on the skin of the face, which suppurate. Mezereum.—Small comedos on the nose and cheeks. Nitric acid.—Black sweat pores in the skin of the face. Sabina.—Comedos that can be easily pressed out, in the cheeks and about the nose. Sulphur.—Blackish pores in the face. Sumbul.—Numerous black pores on the face. Skin pale. CONDYLOMATA, or Mucous patches, are contagious lesions peculiar to syphilis, and consist of round, oval OR oblong, pale or rosy, usually elevated spots, covered with a whitish pellicle. They vary in size from a pin's head to a fifty-cent piece or larger, and select as seats, notably, the muco-cntaneous sur- faces. They are seen mostly about the anus, throat, mouth and genitals, and usually appear upon the skin in connection with the papular syphilide. Their secretion is contagious. Treatment.—Keep the parts clean and dry. If the excres- cences are troublesome, excise them with the knife and after- wards apply a Merc. cor. lotion, strength 1-10 to 1-5 gram to 50 grams of water. The internal remedy may be given quater in die, and is indicated as follows: Cinnabar.— For fan-shaped fig-warts accompanied by tetter. Euphrasia.—Fig-warts at the anus. Merc. cor.—Dry fig-warts. Merc. nit.—Filiform fig-warts. Merc, precip. ruber.—Fissured condylomata. description and treatment. 49 Merc. sol.—Conical fig-warts. Nitric acid.—Pediculated and moist fig-warts. Fig-warts on the glans. Sarsaparilla.—Flat fig-warts. Staphysagria.—Cock's comb shaped fig-warts. Sulphur.—Soft spongy fig-warts. Thuja.—Cauliflower excrescences. Fig-warts on the scro- tum and prepuce. CORNU CUTANEUM.—The most remarkable case of human horn on record is that of a Mexican named, Paul Rodriguez. It measured fourteen inches in circumference. DERMATALGIA, is an affection of the skin character- ized BY PAIN, AND IS UNATTENDED BY STRUCTURAL CHANGE. It attacks principally parts that are covered with hair, and occurs oftener in women than in men. The affected parts are very sensitive to external impressions, and the pain may be either continuous or intermittent, slight or severe. It is usually [of a burning character, worse at night, and may last a week or longer. 'Treatment.—The galvanic current, at times affords magic relief. The following remedies may be compared and administered pro impetus ratione: Baryta, Bell., Bryonia, China, Ferrum, Maiiganum, Nux mosch., Nux vom., Phos., Sepia, Spigelia, Sulphur, etc. DERMATITIS CONTUSIFORMIS, usually described as Ery- thema nodosum, may be defined as an acute affection, CHARACTERIZED BY OVAL OR ROUND PURPLISH NODULES, VARY- ING FROM THE SIZE OF A HICKORY-NUT TO THAT OF A FIST. The attack is generally ushered in by slight febrile dis- 50 DISEASES OF THE SKIN. turbance, more or less loss of appetite, malaise, and wander- ing rheumatic pains. The nodules are developed suddenly and appear in crops. They are firm and hard, tender to pres- sure and reddish or purplish in color as they are-first formed, but grow darker and softer as they grow older. They develop mostly on the interior surface of the leg, with their long diameters running lengthwise of the limb. Occasion- ally they appear on the arms and face, and are marked by a dark re:l periphery. They never suppurate, but disappear bv absorption, and fade away in color like bruises. The disease is seen mostly in young persons, especially females, and is often associated with rheumatism and chorea. It occurs more frequently in spring and fall, seldom last, longer than two or three weeks, and tends to spontaneous recovery. Relapses are apt to take place. Dermatitis contusiformis is supposed to be due to embolism in the cutaneous vessels, and is somewhat allied to purpura. Treatment.—The local treatment consists in cold or warm Arnica or Hamamelis dressings, and if the part affected is the limb, a horizontal position should be maintained. Rhus venenata, is the principal internal remedy. Others may be used according to the indications, and given pro impetus ratione. Apis mel.—Inflamed erysipelatous appearance of the nodules. Stinging, burning pains. Relieved by cold dress- ings. Arnica.—Yellow, blue, and reddish-blue spots. Pain as if beaten. In lying-in women. Ptelea trif.—Red spots on the lower extremities, alike in position on both. After an hour or so change to purple DESCRIPTION AND TREATMENT. 51 color. The spots become dirty yellow, and leave the appear- ance of a bruise. Rhus venenata.—Red spots from half an inch to two inches in diameter, especially on the legs below the knees, painful and changing color into bluish then greenish yellow. DERMATITIS EXFOLIATIVA, more generally described under the name Pityriasis rubra,—a term, however, that is apt to mislead, as the scales are not branny as in ordinary Pityriasis, but flakey,—may be defined as a disease USUALLY INVOLVING THE WHOLE SURFACE, AND CHARACTER- IZED BY A HIGHLY REDDENED SKIN, AND THE ABUNDANT EXFOLIATION OF EPIDERMIS IN THE FORM OF LARGE THIN WHITISH FLAKES. It commonly begins in the form of small and red flakey patches, which rapidly increase in size, unattended by either thickening of the skin or itching. The flakes vary in size, from a nickel to several centimeters in diameter, and when re- moved, leave the skin red and shining. Handfuls of these armor-like plates may be shed in twenty-four hours. This is a rare disease, occurs mostly in adult life, and may be either acute or chronic. It involves the papillary layer alone and is supposed to be due to a disturbance of the trophic nerves. Treatment.— Soothing local applications, such as bran baths or a decoction of walnut leaves followed by oily inunctions, and later by the tarry preparations, are impor- tant aids. The internal treatment should be directed if need be towards bringing about a healthy condition of the system. Arsenicum alb. is the principal remedy and may be 52 DISEASES OF THE SKIN. administered quater in die. Others may occasionally be called for, notably, Ars. jodat., Kali ars., Piper methysti- cum, Clematis and Phosphorus. DERMATOLYSIS, is a hypertrophy of the skin assum- ing THE FORM OF PENDULOUS PURSE-LIKE FOLDS. It seldom appears before the age of puberty, though occa- sionally congenital. It runs a slow course, and may be con- fined to certain regions, or appear on any part of the body. treatment.—If the folds are large they may be ligatured and excised. The Bromide of Ammonium has some reputation in arrest- ing- the disease. Staphysagria and Carbo animalis may be studied. DYSIDROSIS, may be defined as an inflammation of the SWEAT STRUCTURES OF THE HANDS AND FEET, AND IS CHAR- ACTERIZED BY REDNESS AND SWELLING OF THE PARTS, WITH DIS- TENSION OF THE SWEAT DUCTS, IN THE FORM OF SAGO-LIKE POINTS, AND THE DEVELOPMENT OF BULL.E. It appears more in summer than in winter, and attacks symmetrically the sides and palmar surfaces of the fingers, the palms, and sometimes the soles of the feet. It selects as its victims the nervously debilitated, and tends to run a definite course of two or three weeks duration. Usually after the disease has existed for some time, the epidermis becomes macerated, and peels off, leaving the skin sore and painful. Treatment.—The local treatment consists in using sooth- ing applications, notably alkaline baths to which a little starch has been added, and afterward wrapping the parts up in Carron oil. DESCRIPTION AND TREATMENT. 53 (Jlematis and Natruni sulph. are the most important inter- nal remedies, and may be given pro impetus ratione. ECTHYMA is characterized by the development of LARGE, ISOLATED PAINFUL PUSTULES, SITUATED UPON HARD AND INFLAMED BASES, AND FOLLOWED BY DARK-BROWN CRUSTS. The pustules are roundish or oval, flattened, of a yellow or yellowish-red color, and are surrounded by a bright red areola. Slight febrile disturbance usually precedes their outbreak. After a few days the contents of the pustules dry to form flat dark brown crusts, which when removed leave extensive excoriations, and resultant temporary scars and pigmentation. Ecthyma may occur at any time of life and selects as its victims the badly nourished and cachectic. The neck, shoulders and back are its most frequent seats. It is a superficial lesion, and rarely extends beyond the papillary layer. It may be confounded with eczema and impetigo con- tagiosa, but is more apt to be mistaken for the large, flat, pustular syphilide. Ecthyma, however, develops more rap- idly, has more heat and pain, and has slight ulceration and brownish crusts; while the syphilide has a more or less deep ulcer, with abrupt edges, and a blackish crust. Treatment.—The patient should be well hygiened and given a good generous diet. The affected parts may be anointed once or twice a day with a weak white precipitate ointment (0.1 to 0.3 grains to 50 grams.) After pustules burst, if ulcers show but little tendency to heal, a weak Carbolic acid wash may be used. The appropriate internal remedy may be selected from the following, and administered j^ro impetus ratione: 54 DISEASES OF THE SKIN. Antimonium crud.—Pustules on the face in fat people. Yellowish or brownish scabs. Arsenicum alb.—Red or white pustules with intense burning. Thick crusts, leaving well-marked scars. In cachectic individuals. Cicuta.—Confluent pustules about the face, forming yel- low crusts. Cyclamen.—Pustules on the feet and toes. Kali bich.—Pustules all over the body, having a small brown scab on top. Pustules at the root of the nails, spreading over the hands. Pustules resembling small pox. Mercurius.—Suppurating pustules, which either run into one another, discharging an acrid fluid, or which remain sore, become hollow, and afterwards raised and cicatrized. Piper nigrum.—Large pustules leaving marks on the face. Rhus tox.—Pustules upon a red base. Secale cor.—Pustules on the arms and legs, with tendency to gangrene. In cachectic, scrawny females with rough skin. Tartar emetic.—Large, round, full, burning pustules, with red areola?, forming in two days, and leaving deep scars. Cistus and Nux juglans may at times be indicated. ECZEMA may be defined as a catarrhal inflammation OF THE SKIN, RUNNING THROUGH THE STAGES OF ERYTHEMA, PAPULATION, VESICULATION, PUSTULATION, INCRUSTATION, AND SQUAMATION, AND CHARACTERIZED BY THE PRESENCE OF A DISCHARGE, HAVING THE QUALITY OF STIFFENING LINEN. It may be either acute or chronic, may commence abruptly or gradually, and may run its course in a few weeks, or last for years. DESCRIPTION AND TREATMENT. 55 The disease is frequently though not always ushered in by more or less febrile disturbance, lassitude and loss of appe- tite, which are soon followed by an eruption of one or more reddish patches of variable size, accompanied by heat and burning. In a day or two, or at times even in a few hours, little pin-points are seen on the reddened surface, and vesi- cles make their appearance, attended with more or less in- tense itching. The vesicles are made up mostly of serum containing a few leucocytes and a little fibrin, and rarely last longer than twenty-four or forty-eight hours. The itch- ing is now the most prominent subjective symptom. The period of redness and vesiculation is called the first stage. As the vesicles mature the clear serum becomes cloudy, and pustules are tormed which either rupture spontaneously or from friction. After rupture their contents dry upon the surface in the form of characteristic yellowish-green scabs. (And it may here be noted that in proportion to the amount of leucocytes contained in the effusion, the disease will be either decidedly vesicular or decidedly pustular.) This is the second or exudative stage, and may be of in- definite duration. The advancing border of the disease may be marked, either by the formation of new papules and vesicles, or by the simple exfoliation of the stratum cor- neum. This latter phenomenon, which has led so many to deny that eczema has always a stage of discharge, can be ex- plained by the fact, that succeeding the primary congestion, there is an exudation from the vessels, which may instead of lifting up the layers to form vesicles, ooze through, and float the corneal layer of cells. (E. erythematosum). 56 DISEASES OF THE SKIN. After a time the exudation lessens, the crusts grow thin- ner, the eflusion ceases, the surface becomes dry, white scales take the place of crusts, and the disease is in the third stage. Occasionally the skin becomes much infiltrated and thick- ened, or in more aggravated forms takes on a decided tend- ency to fissure. If, however, the patches tend to recovery, the scales become finer and more adherent, and the skin gradually returns to its natural condition without a scar. According as the disease is mild or severe, or accompanied by an amount of pustulation and crusting, out of proportion to the amount of inflammation present, it has received the names'of E. simplex, E. rubra m and E. iinjw.tiginosum. Acute eczemas are characterized by redness and swelling, with other symptoms of inflammatory action, followed by minute vesicles, which run their normal course, and are always attended by itching. These eczemas may vary some- what in their general characters, according to their location and the temperament of the patient. In nervo-bilious subjects they tend to become irritable, in gouty subjects they are apt to be inflammatory, and in scrofulous individuals they run speedily and freely to the formation of pus. When occurring on the scalp—a common seat in infants — the disease passes rapidly through the erythematous and vesicular to the pustular stage, and is followed by the forma- tion of thick greenish-yellow crusts, covering a raw red and cracked surface. Post-cervical adenitis is its common ac- companiment. On the face, the eruption is often symmetrical, and mav DESCRIPTION and treatment. 57 be present in different stages. It is usually a very stubborn form in adults. In children, eczema in this locality has been given the title of crusta, lactea. On the head, the inflammation elects to extend to the hair follicles, and passes rapidly into the pustular stage. On the cars, there is generally considerable inflammation and swelling. The vesicles may be well developed, but pro- ceed to early pustulation. Small abscesses may at times be formed. In the axillae, enlargement of the axillary glands, with the formation of abscesses are quite frequent. On the nipples, it is usually accompanied by severe pruri- tus, and a copious discharge of yellowish or reddish serum. On the genitals, there is commonly considerable attendant heat and redness. Moisture is always a prominent symp- tom. On the arms, legs, and thighs, it proves one of the most obstinate forms. It is attended by intolerable itching, and is apt to pass rapidly through the erythematous, and be pro- longed in the pustular stage. The flexures of the joints and the clefts of the nates are oftener affected with the severer type, than other parts of the body. On the hands and feet, it is usually symmetrical, and fre- quently assumes the fissured form, with but little exudation and crusting. In voung children "scratch-marks" are scattered with more or less profusion, over the affected surface. Chronic eczemas may either start as primary affections, or with acute or sub-acute symptoms, the disease halting 5 s DISEASES OF THE SKIN. either in the second, or more frequently in the third stage. They are more common than the acute variety, and may be said to exist, whenever eczemas take on definite lines of action, or show a tendency to repeat themselves, and are ac- companied by secondary changes. On the scalp, chronic eczema is frequently accompanied by falling off of the hair. Adults of a lymphatic and scrofulous habit, and especially women at the meno-pause, are apt to be troubled with this lingering form. It tends to spread to the ears and eyebrows, and may be followed by warty thick- ening of the skin. On the cheeks, chin, and upper lip, it is very intractable. The parts are more infiltrated than in the acute form, and may be covered with bran-like scales. On the ears, it is very obstinate when it attacks females at the climacteric. On the nasal mucous membrane, it may form crusts, which adhere for years, and give rise to annual returns of erysip- elas of the face. On the mammae, it may result in the formation of fissures and abscesses. Glycosuria is a common accompaniment. On the perineum and aims, there is always more or less moisture with a decided tendency to fissure. On the genitals, thickening of the scrotum is apt to take place. On the hands and feet, it sometimes commences by the appearance of fissures, which are red and painful, and o?i\e forth a viscid secretion, which dries into scales. On the legs, especially in old people, it is prone to take on an inflammatory state, with a tendency to the formation ot DESCRIPTION AND TREATMENT. 59 ulcers. Infiltration is alwavs a common feature of chronic eczema. Eczema, attacks more frequently light, florid complexioned individuals, and is a commoner affection in this country, than in Europe. In Chicago, according to my experience, it constitutes about forty-five per cent, of the entire number of skin diseases. Like the individual who makes a failure in life, eczema usually travels from, head to foot as age ad- vances. It appears more particularly on the head in infancy and youth, descends to the trunk and genitals as adult life approaches, and appears on the lower limbs as its victim is tottering to the grave. Some individuals are so constituted that their skins are ever ready, on the slightest provocation to take on diseased states. In such persons anything which tends to lower the average degree of health, is apt, other things being equal, to give rise to an attack of eczema. Dyspepsia in its influence through mal-assimilatioii, is after this manner, a very potent cause. Diseased states ot the kidneys or bowels, and an inactive skin, whereby the proper excretory functions are interfered with, frequently produce and keep up the disease. Gouty and rheumatic patients are prone to attacks of eczema. In children, denti- tion plays an important part. Pregnancy at times occa- sions an outbreak. Blacksmiths, grocers, bakers, washer- women, and workers in lime, from the irritating nature of their employment, are liable to the types known as grocer's, baker's, washerwoman's, etc., itch. At times eczema becomes substitutive. And so occasion- ally it may be seen to disappear from the skin in connection 60 DISEASES OF THE SKIN. with the development of a bronchitis, leucorrhcea, or intes- tinal catarrh, or vice versa. Its disappearance is thus looked upon as a consequence, not a cause of the latter. Of local causes or those which give rise to artificial eczema may be mentioned: Excessive use of Mercury, Croton tig., C'antharides, Mustard, Rhus ven. and Rhus tox., strong potash soaps, and the contact of aniline dyes and pediculi. An rttack may sometimes occur from the injudicious use of Turkish baths. Eczema is due to faulty innervation, by which cell prolif- eration and capillary congestion, with their consequences are produced. The papillary layer is its principal seat and the modus operandi oi its development is as follows: An exudation of serum takes place from the congested vessels. which floats the over-supply of new cells, and the two push on to the rete, from the papillary layer, separate the cell elements of the stratum malpighii and stratum lucidum, and uplift the cuticle so as to form first papules, and then vesi- cles. The diagnosis of typical eczema presents but little diffi- culty. It is only in the irregular and imperfectly developed cases that mistakes may arise. In the erythematous stage it may be confounded with ery- thema, but the subsequent course of the disease soon dis- perses any doubt. In the papular stage, it at times resem- bles lichen. Lichen affects particularly the outside of the limbs, and is a decidedly plastic inflammation, while eczema is a serous one. In the vesicular stage, eczema, herpes, zos- ter, and scabies, may bear considerable resemblance. The points of difference are: the vesicles of herpes are larger DESCRIPTION AND TREATMENT. 61 than those of eczema, and appear mostly on the face and genitals. The eczematous vesicles' may be irregularly dis- tributed over the body. Eczema is never attended by the neuralgic pain of zoster, and the eruption does not follow the course of the nerves. It is seldom accompanied by the intense niglitly itching, so characteristic of scabies. The piesence of acari, and the rapid disappearance of the disease under parasiticidal treatment, will at once decide the ques- tion. In the stage of incrustation, it may be mistaken for impetigo contagiosa and tinea favosa. The crusts of impe tigo contagiosa, are superficial and appear as if stuck on. Those of favus are cup-shaped and of a sulphur-yellow color. Eczema crusts are greenish-yellow. In the squamous stage, it may be confounded with psoriasis, seborrhcea, dermatitis exfoliativa, and the foli- aceous variety of pemphigus. Psoriasis never has a history of discharge, and the scales are silvery white. In seborrhcea, the scales are oily and larger than in eczema. Dermatitis exfoliativa presents large, thin, easily detached "flakes," which when removed leave a dry, reddish, glazed surface. Foliaceous pemphigus starts from bulla?, and the scales are thick and parchment-like. Treatment.—The diet should be regulated so as to bring in as many of the oleaginous principles as possible in place of the nitrogenous. Pork, pastry and stimulating drinks should be strictly forbidden. The local treatment consists in first allaying the acute in- flammatory symptoms, if any exist. This is best done by the use of bran washes, poppy fomentations, or emollient poultices of marsh mallow, boiled starch or linseed meal. ■62 DISEASES OF THE SKIN. Iii simple cases where there is but little inflammatory dis- turbance, and the discharge is the principal feature, the parts should be dusted two or three times per day -after the removal of whatever scabs are present—with equal parts of Oxide or Carbonate of Zinc and starch, or Lyco- podium powder. Glyceral tannin is sometimes used with benefit for the same condition. When there is much itching, temporary relief is afforded, by the application of cloths wrung out in hot water. If the itching should prove obstinate, one of the following lotions may be resorted to: Carbolic acid, 0.5 gram, Glycerine, 4 grams, Bran water, 100 grains, mix. Hydrocyanic acid dil., 2 grams, Glycerine, 8 grams, bran water, 60 grams, mix. Grindelia robust tinct., Glycerine, a a, 4 grams, bran water, 40 grams, mix. Pyroligneous oil of Juniper, 20 grams, Olive oil, 40 grams, mix. Borax, 1 to 3 grams, lime water, 30 grams. The first three are adapted to itching attending acute eczemas, but the Pyroligneous oil of Juniper should be used only after the inflammatory symptoms have subsided. Great relief has been occasionally experienced from galvanism. At times oleates or ointments answer better than either lotions, or dusting powders, and this especially, when, as is apt to be the case, there is, outside of the discharge feature, an unnatural dryness of the skin. The Benzoated oxide of Zinc ointment is the one most commonly used. Its action is, however, protective rather than curative. It allavs irri- tation and keeps the air from the surface, and thus aids much in performing a cure. The Oleate of Zinc is at times preferable to the ointment. Diachylon plaster or the Oleate DESCRIPTION AND TREATMENT. 63 of Litharge, spread on strips of linen, and closely applied to the affected part, is useful both in acute cases, and in the severer and more chronic forms occurring on the legs in old people. White precipitate ointment, having the prepared strength of from 0.1 to 0.5 grams of White precipitate to 50 grams of Cosmoline, vies with Graphites cerate in the decidedly pustular eczemas of children. The Red precipitate ointment, varying in strength from 0.5 to 3 grams in 50 grams, will often prove serviceable in localized eczemas, when other means fail. Chrysophanic cerate not too strong may be used in the squamous stage with considerable benefit. The staining it leaves, is, however, one great objection to its use. The special unguents, such as Iris vers., Arctium lappa, Dulcamara, and Croton tiglium cerates, are adapted to those individual cases of eczema, where the medicine that names the cerate, is the renidy for the disease. Ointments should as a rule be applied night and morning, and all scales should be removed, and the parts bathed before every application. The tarry compounds, notably the Oil of Cade and the Pyroligneous oil of Juniper are the most important local aids, Avhere eczema has become chronic, or has arrived at the third stage. They may be applied in strengths, varying from 10 to 30 grams of the tarry preparations to 30 grams of Olive oil. The affected parts should be well rubbed with oil, once or twice a day, for fifteen minutes at a time. When there is much infiltration, and the tarry compounds fail, the Oleate of Tannin, made by triturating and boiling 64 DISEASES OF THE SKIN. 5 grams of Tannin in 30 grams of Oleic acid may be tried. If this fails, it should be remembered that a mixture of alcohol and Sapo viridis, in the proportion of 15 grams of the former to 30 grams of the latter, often acts ser- viceably. And as a dernier resort, the soft soap treat- ment may be employed. The parts should be scrubbed with a soft brush, dipped first in hot water and then in Sapo viridis for five or ten minutes, or at least until an abundant lather is produced, and the skin bleeds slightly. They should then be washed off, and some oily substance, prefer- ably the Oleate of Litharge, closely applied on strips of linen. This process is to be gone through regularly, night and morning. And generally it may be said that the worst cases of infiltrated eczema improve rapidly under this treat- ment. The appropriate internal remedy will usually le one of the following, acccrding to the indications, and may be ad- ministered pro impetus ratione in acute cases, and ter die in chronic cases: Aconite.—In the simpler f'oims of eczema, and when there is much febrile disturbance. Acute cases in plethoric per- sons. Alumina.—Hard crusts on the scalp and arms. Gnawing itching, worse in the evening. Aggravated on alternate days, and from eating new potatoes. Ammonium carb.—Eczema in the bends of the extremities. Excoriations between the legs, and about the anus and gen- itals. Aggravated by hot poultices. In children. Argentum nit.—Eczema on the genitals. In children who eat too much sweets. DESCRIPTION AND TREATMENT. 65 Arsenicum alb.—Eczema on the face, legs and genitals. Intense burning of the surface. Itching worse during the / first hours of sleep. Useful in chronic cases. Baryta carl).— Moist crusts on the scalp. Swelling and induration of the glands. In fat timid children that take cold easily. Belladonna.—Eczema on the face with scarlet redness. In children during dentition. Borax.--Eczema on the seal}) and face. Red papulous eruption around the cheeks and chin. The child starts from sleep while being laid down in the cradle. Iiovista.—Grocers itch. Skin of fingers usually dented by use of scissors or other instruments. Thick crusts. Swell- ing of the upper lip. Bromine.— Eczema covering the head as with a cap, with profuse oozing of dirty, nasty smelling discharge. Glands of the neck swollen. Bryonia.—Eczema all over, especially on the back. Erup- tion slow in making its appearance. Caladium.— Eczema on the genitals. Itching and burn- ing, worse at night. Attacks alternating with asthma. Calcarea carb.—Thick crusts with yellow pus beneath, on the face, legs, and flexures of the extremities. In big- bellied children with light hair and blue eves. Aggravated from drinking milk, and after washing. Calcium sulphide.—Eczema spreading by new pimples beyond the main excoriation. Soreness and moisture in the folds between the scrotum and thighs. Unhealthy skin, even slight injuries maturate. Itching on rising in the morning. Cantharis.— The inflammatory stage. Eruption mostly 5 66 DISEASES OF THE SKIN. on the right side, with burning and itching. When com plicated with urinary troubles. Carbo veg.—Eczema on the legs. Vesicles on the knees. In cachectic individuals, accompanying dyspepsia. Carbolic acid.—Vesicular eruption on the hands. Itching better from rubbing, but leaving a burning pain. Chamomilla.—Excoriations between the thighs in children and infants. Child fretful, must be carried about. Cicuta.—Eczema on the face with yellow scurf on the skin like dried honey. Thick whitish scurf on the chin and upper lip, with oozing. Clematis.—Moist eczema on the neck and occiput, itching terribly. Crotalus.—Vesicular eruption on the septum narium. Croton tig.—-Eczema on the face, genitals and scrotum. Swelling and redness of the face and eyelids, which are covered with small vesicles. Iwo-story pustules. A perfect picture of all the stages of eczema in regular course. Dulcamara.—Thick brown crusts with reddish-brown on the temples, forehead and chin. Kruption precedes th« catamenia. Graphites.—Thick crusts, and a raw surface with deep rhagades. Worse on the chin, behind the ears, on the palms of the hands, and on the left side. Humid eruption with secretion of corrosive serum smelling like herring brine. Itching worse in the evening and at night. Helleborus.—Small vesicles on the fingers of the right hand, humid for a long time and then covered with scurf. Hydrastis.—Eczema along the border of the hairy scalp. Oozing after washing. DESCRIPTION AND TREATMENT. 67 Iris versic.—Eczema of the face. Pustular eruption around the nose and lips, and on the cheeks. Jug]ans cin.—Vesicular eruption on the upper and front part of the chest with burning and itching. Stitch-like pain under the right scapula. Lachesis.—Eczema on the legs. Lappa.—Grayish-white crusts. Moist bad smelling erup- tion on the heads of children. Lycopodium.—Eczema beginning on the back of the head, and extending to the face. Bleeds easily and is covered with thick fetid crusts. Inclined to constipation. Merc, ioclat.—When other remedies fail, and there is a decided syphilitic taint. Merc, precip. ruber.—Eczema of the hairy parts, and of the anus with fissures. Eczema of the umbilicus. Merc. sol.—Yellow crusts with inflamed areola?. Patients perspire easily. Itching worse at night and when warm in bed. Mezereum.—Honey-like scabs around the mouth. Dis- charges profuse, excoriate the surrounding parts. Unbear- able itching as if the head were in an ants nest. Natrum mur.—Eczema raw and inflamed, discharging a corrosive gluey fluid. Worse in the edges of the hair and on the genitals and legs. Nitric acid.—Vesicles on the inner side of the left hand. Moisture and itching in the anus. Nux juglans.—Burning itching vesicles upon a cracked surface, with a greenish discharge which stiffens linen. Large blood boils on the shoulders and hepatic region. Oleander.—Oozing behind the ears, and on the back part 68 DISEASES OF THE SKIN. of the head. Smooth shining surface covered with drop* of serum. Petroleum.—Moist eczema on the genitals. Excoriated running spots on the skiu. Skin of hands cracked and rough. Eruption between the toes. Piper methysticum.— Skin dry, scaly, cracked and ulcer- ated, especially when it is thick, as on the hands and feet. Piper nigrum.—Eczema on the lips. Rhus tox.—In acute eczema. Small yellow vesicles with red areola?. Nightly itching. Aggravated by changes in the weather and by wet weather. Rhus venenata.—Fine vesicular eruption on the upper ex- tremities. Groups of watery vesicles on the fingers. Fis- sures on the ends of the fingers. Lpper lip swollen and covered with vesicles. Sarsaparilla.—Thick scabs on the face. Scabby eruption on the nose and face, like milk crust. Sepia.—Eczema, in rings. During pregnancy and nursing. Silicea.—Eczema on the arms. Scabs behind the ears. Cervical glands swollen. Staphysagria.—Yellow acrid offensive moisture oozes from under the crust. Scalp painfully sensitive. Cross word* injure feelings. Eczema of the feet. Sulphur.—Eczema around the margin of the hairy scalp, from ear to ear, posteriorly. Crusts and pimples and easily bleeding surface. Genitals, legs and bends of the extremi- ties specially affected. Sumbul.—Eczema on the left side of the scalp in infants. Tart. emet.—Vesicular eruption about the nose, eyes, neck and shoulders. Early pustulation. DESCRIPTION AND TREATMENT. 69 Viola tricolor.—Discharge of yellow water or pus. Humid eruption with much vermin and nightly itching. Urine smells like cats urine. ELEPHANTIASIS is a chronic disease characterized by GREAT HYPERTROPHY OF THE SKIN, AND SUBCUTANEOUS CON- NECTIVE TISSUE, USUALLY CONFINED TO THE LOWER LIMBS AND GENITALS. It has been variously known as elephantiasis arabum, ele- phant leg, Barbadoes leg, and tropical big leg. It is more prevalent in low malarial districts, and in tropical climates. It attacks males more than females, is neither hereditary nor contagious, and rarely appears before puberty. The disease is generally ushered in with a chill followed by febrile symptoms. An inflammatory swelling of the leg, soon makes its appearance, accompanied by an inflamed and painfully distended condition of the lymphatics and glands of the groin. In a few days the febrile symptoms subside, but the swelling remains, never entirely disappearing. Re- current inflammatory attacks take place at variable intervals, which leave the leg always larger than it was before. In the course of a year or more, the febrile attacks cease, but the parts continue growing until they reach an enormous size. The etiology of elephantiasis is obscure. Recent investi- gations would, however, lead us to infer that it is due to the action of a parasite, the filaria sanguinis, in obstructing the lymphatics. It is supposed that the mosquito plays an important part in the development and transportation of the undeveloped filaria?. rlreatment.—A milk diet is the best for the elephantiasis patient, and if it is a possible thing, a change of climate should be made. 70 DISEASES OF THE SKIN. Esmarch's bandage has been employed with good result, as has also prolonged compression of the main artery of the part. Excision of the sciatic nerve is recommended in some cases, and amputation as a dernier resort should not be for- gotten . Relief, and occasionally beneficial results come from the use, of Hamamelis or Chaulmoogra oil dressings. Myristica sebifera, quater in die, is the main internal remedy. Hydrocotile asiatica, has been recommended, as have also Anacardium orientale and Elaeis guineensis. EPHELIS, or Sunburn, is a variety of skin discolora- tion, DUE TO THE DEPOSIT OF PIGMENT, EXCITED BY THE ACTION OF THE SUN'S RAYS. Temporary benefit accrues from the use of local applications strong enough to cause exfoliation of the corneal cells. The Merc. cor. lotion, strength 5 grams to 30 grams, and the Muriate of Lime lotion, strength 5 grams to 40 grams, areth e ones most commonly used. Veratrum alb., Robinia and Kali carb. are useful internal remedies. They may be administered ter die. Bufo is indicated when the face tans quickly. EPITHELIOMA or Epithelial cancer, may start either as a flat infiltration, a wart or other growth. The earliest sign is often a simple crack, or little hard, pale dusky lump, which sooner or later fissures, and is then either moist, or covered with a brownish or yellowish crust. The growth gradually increases in size ami finally breaks down into superficial ulcers. The typical ulcer is roundish, split-pea sized or larger, has hard sharply defined edges, and secretes a scanty, yellow, viscid fluid. This form may con- DESCRIPTION AND TREATMENT. 71 tinue for years, running along as an apparently local affec- tion without in any way undermining the patient's health. It is usually met with in men, especially smokers, and selects as its favorite seat, the lower lip. On the scrotum it constitutes the chimney sweeper s cancer. When occurring on the upper two-thirds of the face it forms the rodent ulcer of English writers. At times epithelioma commences in the form of papules, which are at first movable, but later tend to run together, and form reddish or purplish colored walnut-sized aggrega- tions. These eventually break down and form extensive ulcers. They are attended sooner or later by sharp lancin- ating pains which become almost unendurable as the disease advances. The ulcers are usually roundish, have hard eveited, indurated and undermined edges, secrete an offen- sive pale yellow viscid fluid, and bleed easily. As the destructive process continues, tissue after tissue gives way to the invader, the lymphatic glands become enlarged and suppurate, and the patient ultimately succumbs from exhaus- tion. This form attacks by preference the mucous mem- brane and cheeks, but may appear on any part of the body. Its course may be either slow or rapid, and when left to itself it usually destroys life in from two to five years. Occasionally epithelial cancer develops as wart-like growths or cauliflower excrescences that vary in size from a split pea to a hazel-nut, and ultimately break down, forming irregularly shaped granulating, easily bleeding excavations, which slowly run the course of other epitheliomatous ulcers. Epithelioma is supposed to originate from the endothelium of the lymphatics. It may be confounded with syphilis and 72 DISEASE.*. OF THE >KIN. lupus vulgaris. The history of the cases, however, are differ- ent. Syphilitic formations are alwavs more rapidly devel- oped than epitheliomatous. The ulcers of syphilis are generally multiple, have an abundant secretion, and are devoid of pain, while those of epithelioma are usually single, with scanty secretion, and severe lancinating pain. Lupus vulgaris is commonly a disease of childhood; epi- thelioma is an affection of middle life. The discharge from the epitheliomatous ulcer is generally offensive, while that from lupus is not. Treatment.—The treatment is mostly local. The o-rowth should be removed by the knife, the galvano-caustic, or what is perhaps preferable, Marsden's Arsenical mucilage, (Arsen- ous acid 40 grams, mucilage of gum acacia 20 grains, mix.) The Chromium chloride, used as a paint, has been recom- mended, and Hydrastis dressings may at times be used with benefit. Thuja is the principal internal remedy. Favorable men- tion may be made of Sepia, Arsenicum alb., Condurango, Lapis alba, and red clover blossom tea. ERYTHEMA, though strictly a symptom, meaning simple redness or hypcnemia, and occurring in the course of a variety of diseases, is, by common consent, the name given to AN INFLAMMATION OF THE SKIN, CHARACTERIZED BY THE APPEARANCE OF MACULE*, PAPULES OR TUBERCLES, ATTENDED BY MORE OR LESS ITCHING AND BURNING. The first symptom may be the appearance of one or more erythematous or slightly reddened patches, of variable size and shape. They may be circular in form, the redness grad- ually disappearing in the centre and extending at the°peri- DESCRIPTION AND TREATMENT. 73 phery, (E. annulare.) Several of the circles may run together and by blending in segments, give to the redness a serpen- tine aspect, (E. gyratum.) Occasionally variegated concen- tric rings may be formed (E. iris.) But generally the disease appears in the form of distinct papules, (E. papula- turn,) or tubercles, (E. tuberculatum,) of variable size and shape, having a bluish color and lasting about a week. All these varied forms of manifestation are but stages of one and the same process, and not separate affections. Erythema usually runs an acute course, and appears sym- metrically. It attacks by preference the backs of the hands and feet, the arms, the legs, and the forehead. It is mostly an affection of children, and young people. It attacks females more than males, and prevails in the spring and fall. Individuals who are troubled with it one year, are apt to have it again at the same time in succeeding years. When occurring on the fingers, it closely resembles chilblains. It may be commonly known by its superficial and protean character, and its symmetrical distribution. Treatment.—When there is much itching and burning one of the following lotions may be used. Carbolic acid, 0.1 gram, distilled water, 25 grams, mix. Grindelia robusta tinct., 4 grams, distilled water, 40 grams, mix. Or Veratrum viride tinct., 4 grains, distilled water, 40 grams, mix. When opposing surfaces are much inflamed they may be protected by dusting, with Oxide of Zinc and starch, by Lycopodium, or buckwheat powder. The internal remedies to be administered pro impetus ratione are: Aconite.—Erythema excited by the action of the sun's ray*. 74 DISEASES OF THE SKIN. ^Ethusa.—Appearance and disappearance of reddish-blue spots on the trunk and left leg. General malaise. Ailanthus.—Irregular spots of capillary congestion. Dark almost livid eruption on the forehead. Arsenicum iodatus.—Erythema especially of the face. Belladonna.—Inflamed red patches. Irregularly shaped scarlet spots over the body. More on face and upper part of body. Berber is.—Mottled spots as after a bruise on the right shoulder, left humerus, back of the hand and wrist. Bryonia.—Red round hot spots on the malar bone, as large as peas. Cadmium sulph.—Red spots on the extremities. Chelidonium maj.—Round red spots, size of a half dol- lar, accompanied with burning pain, on anterior surface of the forearms and face, disappearing in a few hours. Chloral hydrate.—Bright red or bluish erythema over the whole body, permanent under pressure, mottled with livid patches and deep red spots. Pruritus of the whole skin. Crocus sat.—Circumscribed red spos on the face, which burn. Condurango.—Erythematous blotches on the face and arms. Gelsemium.—Papulous eruption on the face resembling measles. Gossypium.—Round little spots with pale red circles, around the knee caps, and over the shin bones, which itch very much. Lactic acid.—Several bright red blotches on the anterior DESCRIPTION AND TREATMENT. 75 surface of the leg, with slight burning and no itching. Re- lieved by cold. Eruption brightest at 8 a. m. Laurocerasus.—Erythematous patches, terminating in dark red purple spots. Mercurius sol.—Light red patches on the forearm and inner side of the thighs. Itching changed to burning by scratching. Mezereum.—Erythema on the legs in old people. Nux vom.—Pimples on the face with itching burning. After drinking wine or alcoholic liquors. Phytolacca.—Painful erythematous blotches of a pale red color. Pulsatilla nut.—Erythema of the scalp. Dark blue or red eruption on the legs and ankles. Rhus tox.—Ridges on the lower limbs. Sabadilla.—Red streaks on the arms. Worse from cold. Ustilago.—Fine eruption of a deep red color, about the size of a pin's head, appearing on any part of the body, after scratching. On the neck it takes a circular form. ERYTHEMA NODOSUM, see Dermatitis contusiformis. FAVUS, see Tinea favosa. FIBROMA, or Polypus of the Skin, is characterized by SESSILE OR PEDUNCULATED OUTGROWTHS FROM THE CONNEC- TIVE TISSUE, GENERALLY CLUB-SHAPED, AND YAKYING IN SIZE FROM A PEA TO A LARGE PEAR. The polypi or tumors are as a rule unattended with pain. They may either remain stationary or grow to a consider- able size. In consistence the smaller are usually soft, and 7fi DISEASES OF THE SKIN. the larger more elastic and fibrous. When large they are apt to take on ulceration. Treatment.—The larger tumors m'.y be removed by the knife, the galvano-caustic, or the elastic ligature. The smaller ones gradually disappear under the local use of the Acid nitrate of Mercury. The Arsenite of Calcarea andLycopodiumare the principal internal remedies. They may be given ter die. FISH-SKIN DISEASE. See Icthyosis. FRAMBCESIA, or Yaws, is an endemic, contagious dis- ease, CHARACTERIZED BY VARIOUSLY-SIZED, REDDISH PAPULES, TUBERCLES AND TUMORS, i\ ALL STAGES OF DEVELOPMENT. They start as pin-head sized points and gradually increase in size so as to resemble in their different stages of develop- ment, first a currant, then a raspberry, and lastly a cherry. Later on in their course they are apt to break down and ulcerate, pouring out a thin yellowish offensive discharge. The disease rarely occurs twice in the same individual. It attacks mostly the face and genitals, and occasionally the upper and lower extremities. It is endemic in the West Indies and in some parts of South America and Africa. Treatment.—The local treatment consists in using a Jatropha lotion, having the prepared strength of 5 grams of Jatropha tincture, to from 20 to 30 grams of distilled water, or else a weak citrine ointment. The Iodides of Mercury and Potassium are the most effi- cacious internal remedies. FURUNCLE, or Boil, is a circumscribed inflammation of THE SKIN AND CONNECTIVE TISSUE, VARYING IN SIZE FROM A DESCRIPTION AND TREATMENT. 77 SMALL PEA, TO A HICKORY-NUT, HAVING AN INDURATED AND INFLAMED BASE, AND USUALLY TERMINATING IN SUPPURATION AND THE FORMATION OF A " CORE.'" The boil commences as a small, rcundish, inflamed spot, tender to the touch, and surrounded by a bright red areola, which changes to purple as the disease advances. It gradu- ally increases in size, becomes more and more sensitive to the touch, and the pain which is usually of a throbbing nature increases in intensity. After mulling an increasingly painful course of five or six days, the rounded swelling suppurates and throws out a central slough called a " core." At times the suppurative ^tage is scarcely reached, and no core forms. It is then termed a "blind" boil. After the discharge, the pain, red- ness and inflammatory symptoms quickly subside, the patient feels relieved, and unless there are more to follow, his troubles are over. Generally, however, this is but a fore- taste of things to come, and the end is not yet. Furuncles may make their appearance on any part of the body, but attack by preference, the face, back and gluteal region, and may start either in the hair follicles, sebaceous glands or surrounding cellular tissue. They are usually de- pendent upon disordered blood-states, or depraved condi- tions of system, and are sometimes epidemic. They are more common at the extremes of life, but may occur at any age. Treatment.—Patients should be well hygiened and given a good wholesome diet. In debilitated states the free use of porter may eradicate the tendency to boils. Brewers' yeast, in tablespoonful doses between meals, has the reputa- .* DISEASES OF THE SKIN. tion of being a preventive. And the Muriate of Lime lotion 1:10, well rubbed on the parts when boils thieaten, sometimes occasions their abortion. As soon as a boil has been diagnosed to be fully under way, the best local treat- ment is. to open it with the knife as soon as possible, and apply hot, limited, flaxseed or tomato poultices. The poulticing should be continued until the "core" comes away. Gelsemium or Lappa cerate is a good after-dressing. The appropriate internal remedy will usually be one of the following, and may be used pro impetus ratione: Absinthium.—Eruption of furuncles over the whole body. JEthusa.—Painful boil on small of back. Ammonium carb.—Boils on the cheeks and aroun 1 the ear. Antimonium crud.—Boils on the perineum. Arnica.—Many small boils on "the face. Apis mel.-—Boils on the pubis. Belladonna.—In the early stage, if boil is inflamed and painful. Boils every spring. After measles. Belli> perennis.—Boils beginning as slight pimples, and increasing to large, dark colored swellings, with aching pain. Mostly on the neck and lower jaw. Bromine.—Boils on the arms. Cadmium sulph.—Boils on the nose and buttocks. Calcarea carb.—Boils on the forearms and hands. Calcarea mur.—As a preventive. Calcium sulphide.—When boils mature slowly. ( arbo animalis.—Boils at the anus. Cina.—Boils on the head and face of children. Gelsemiiim.—Large boils. DESCRIPTION AND TREATMENT. 79 Kalmia lat.—Red inflamed tpots like incipient boils. Lappa maj.—Boils on the face, eyelids and all over. Ledum.—Boils on the forehead. Lycopodium.—Boils on the nates. Periodical boils. Manganum.—Small boils. Magnesia mur.—Boils on the nose which suppurate in 24 hours. Boils on the false ribs. Merc. sol.—Boils on the ankles. Natrum carb.—Boils behind the ears. Nitric acid.—Numerous large boils on the scapula?, nape of the neck, nates, thighs and legs. Nitrum.—Boils on the thumb. Nux juglans.—Boils on the right arm. Indurated boils. Blood boils. Nux vom.—Boils on the knees. Phosphoric acid.—Boils in the axilla1, and on the nates. Phytolacca.—Boils on the back. Rhus rad.—Boils on the face which do not mature. Blind boils. Silicea.— Boils on the posterior portion of the thighs, and on the calves. Stramonium.—Boils on the feet. Sulphur.—Boils in the ear. Disposition to boils. Zincuni oxyd.—Boils on the abdomen. GROCER'S ITCH, is an inflammation of the skin due to the irritant action of sugar. See Eczema. GUINEA WORM DISEASE, is a common affection in trop- ical climates, due to the parasite, known as the -filaria medi- nensis. The young worm when quite small bores its way into the skin, generally of one of the lower extremities, and 80 DISEASES of the skin. there takes up its abode. It remains in i quiescent state in the connective tissue for months, until it attains the length of three or six decimeters. More or less local irritation is by this time caused by its presenc?, and generally a pointed tumo" surmounted by a bleb forms, accompanied by swell- ing and pain, which sooner or later breaks, showing the worm in situ. There is as a rule only one worm to each tumor. Treatment. —The treatment consists in removing the worm two or three centimeters at a time, care being taken not to break it, and winding it around a quill until all is removed. The sore may then be dressed as an ordinary ulcer. Ar- senicum alb. or Mercurius may be useful as an internal remedy. HERPES, or lerer blister, is an acute inflammation of the skin, characterized by the appearance of groups of vesicles, having reddened, slightly inflamed BASES, AND SITUATED FOR THE MOST PART ON THE FACE AND GENITALS. The disease is generally preceded by malaise and slight febrile symptoms. A feeling of heat and distress, with red- ness and swelling, is usually present at the outbreak of the eruption, but gradually declines after its appearance. The vesicles appear in clusters, and are commonly bilateral. They are larger than those of eczema, but smaller than those of zoster. On the third day, as a rule, they either rupture or commence drying up, to form thin scales, which drop off' in a day or two, leaving discolorations, which soon dis- appear. Herpes may occur on any part of the face or gen- itals but is commonly encountered about the red of the lips, the prepuce, labia, and mons veneris. It tends to recur DESCRIPTION AND TREATMENT. 81 more on the male genitals than the female, and is apt to be mistaken for chancroid. It is chiefly excited by cold, and may be symptomatic, as in the herpetic patches, called " cold soree,"' that appear on the lip and face in catarrh and pneumonia, and in the crisis of fevers. Treatment.—The local treatment consists in the use of Camphor cerate, Calendula jelly, or Cologne water. The internal remedies to be administered pro impetus ratione, are: Aconite.—In the earlier stages with catarrhal fever. Agnus cast us. Herpes on the cheeks with gnawing itch- ing, worse from getting wet. Alnuis rubra.—Chronic herpes. Arm. alb.-—Red herpetic skin around the mouth, with burning, worse from scratching. Aurum mur.-—Herpes on the prepuce and vulva. Herpes accompanied by intolerable itching. Bufo.—Herpetic eruption after a cold. Causticum.—Burning vesicles under the prepuce which become suppurating ulcers. Burning vesicles on the face, which when touched exude a corrosive water; afterward they dry up to a scurf. Calcium sulphide.—Herpes which tends to recur. After mercurial poisoning. Clematis.—Itching blisters on the lower lip. Worse during increasing, better during decreasing moon. Hamamelis.—Herpes on tin1 nose. Helleborus nig.— White vesicles on the lips. Kali hicii. -Herpes after taking cold. Fluent coryza. e S2 DISEASES of the skin. All the secretions and excretions are of a stringy and lopy character. Merc. sol. -Herpes on the prepuce with a tendency to suppuration. Natrum mur.—Herpes occurring during fevers. Sepia.—Herpetic eruption around the lips. Circular form of eruption. Sarsaparilla.—Herpes on the prepuce. After abuse of Mercury. Upas.—Herpetic eruption on the upper lip, on the left side. HYDROA, is A DISEASE characterized by the eruption OF ISOLATED VESICLES, WHICH TEND TO RECUR. As a skin affection it stands midway between herpes and pemphigus, and is mostly a reflex of excited nerve states. It starts as little papules which ultimately become vesicles, and is usually preceded and accompanied by more or less pruritus. It attacks by preference the face, extensor surfaces of the limbs, and the genitals, is generally symmetrically devel- oped, and runs its course in two or three weeks. Treatment.—The water of the Salzburg springs, Austria, has considerable reputation in curing skin affections, and notably hydroa. Potassium iodide, Kreasote and Magnesia carb., re- peated pro impetus rafione, are the principal remedies. HYDRO-ADENITIS is an inflammation of the perspira- tory follicles and adjacent connective tissue, ordin- arily terminating in suppuration. It may occur on any part of the body except the soles of the feet, but is most common in the axilla?, around the DESCRIPTION and treatment. 83 nipple, and on the perineum. It is usually an acute affec- tion, and commences by the formation of one or more bright red and inflamed pea-sized swellings. In a few days suppuration takes place, and a little abscess is formed which eventually ruptures, and terminates the dis- ease. This affection has generally been described as a variety of furuncle, but it differs from it in being deeper seated, and in being devoid of a "core." Treatment.— Hot fomentations may be used to allay the inflammation. Gelsemium or Lappa lotions, 1:10 are valu- able aids, and tomato poultices at times prove serviceable. Phosphoric acid is the internal remedy for hydro-adenitis in the axilla1. Thosphorus, when around the nipples, and Nitric acid when on the perineum. The indicated remedy may be repeated pro impetus ratione. HYPER/ESTHESIA, by which is meant an increased sensi- bility oi' the skin, is commonly the result of some functional or organic derangement of the nervous system. HYPERIDROSIS, is A FUNCTIONAL DISORDER of the SWEAT glands, characterized BY EXCESSIVE SWEATING. It may be cither general or local, symmetrical or uni- lateral. In the general form it occurs quite frequently in connection with various febrile disorders, and in such dis- eases as pneumonia, rheumatism and tuberculosis. In dis- turbances of the nervous system it is often unilateral. The local form is most common on the head, hands, feet, and genitals. Hyperidrosis occurs in the young and the old alike, and affects females as well as males. Flat-footed 84 DISEASES of the skin. people are especially obnoxious to it. In its causation faulty innervation plays an important part. The prognosis should always be guarded, as many cases prove intractable. Treatment.— Water should be applied to the parts as seldom as possible, and in bathing, the juniper tar soap is the best to use. Dusting powders of Oxide of Zinc and starch, or French chalk and starch are often serviceable. In some cases the best results are obtained from a Tannic acid lotion, prepared by dissolving 1 gram of Tannic acid in 5 grams,of Glycerine, and 40 grams of rose water. The commonly indicated internal remedies in hyperidro- sis are: Baptisia.—In critical sweats. Calcarea carb.—Sweating from the slightest exercise. Cold clammy sweat on the lips at night. Foot sweat makes the foot sore. Chamomilla.—Excessive sweating in women after con- finement. China.—-Exhausting night sweats. Sweats on the left side of the body. Conium.—Sweats as soon as one sleeps. Crocus.—Sweats on lower half of the body. Jaborandi.—Copious sweating and salivation. Profuse secretion from most of the glandular structures of the body. Lactic acid.—Profuse inoffensive sweating of the feet. Nux vom.—Sweat on the upper half of the body. Phosphorus.—Sweat on the right side. Polyporus off.—(In 5 grain doses) for the excessive sweats of consumpti es. DESCRIPTION AND TREATMENT. 85 Pulsatilla. Sweat on the face. Sklbnium.— Profuse sweats in the arm-pits and on the genitals. Sweat stains the linen yellow or white, and stiffens it. Sweat on the anterior surface of the body. Sepia.- Sweat on the posterior surface of the body. Sdicea. -Sweat about the head in large-bellied children. Worse with change of moon. Sulphuric acid.—Excessive sweating. Better from drink- ing wine. Thuja.---Sweat only on uncovered parts. Veratrum alb.—Cold sweats. The indicated remedy may be repeated pro impetus ratione. ICTHYOSIS, or Fish-Skin Disease, is a congenital CHRONIC DISEASE OF THE SKIN, CHARACTERIZED BY DRYNESS AND ROUGHNESS. The mildest form of this affection, occurs in children of two years and upwards, and presents a dry harsh dirty looK- ing skin, covered with a variable amount of furfuraceous scales {Xeroderma.) In severer cases, or when further developed the papillse become enlarged, the discoloration grows more marked, and the epidermal scales are lozenge-shaped, and are separated by numerous lines and fissures. (I. simplex.) In more ex- treme cases still, the scales form dry, hard, brittle plates of a yellowish or greenish hue, separated by white intervening lines, which mark the natural furrows of the skin. ( These plates never overlap one another.) At times the scales Income heaped up into black papillary horny projections. To this extreme condition the term icthyosis hystrix has been applied, from its fancied resemblance to the quills of a porcupine. 8(i DISEASES OF THE SKIN. In icthyosis the whole surface of the body is usually more or less involved, and the front of the knees especially so. The face and flexures of the elbows and knees, however, generally escape. There is always attending the disease a characteristic diminution or absence of perspiration. It is apt to be much worse in the winter time, so that the face and hands become extensively chapped and painful. The diagnosis is generally easy, as pityriasis is the only dis- ease to which it bears any resemblance. In pityriasis it should be remembered, the skin is more or less hypera?mic, while in icthyosis it is not. The scales in pityriasis are "branny" and fall off readily while those of icthyosis resemble " fish-scales" and are more adherent. Treatment.—A generous diet should be allowed the patient and Cod Liver Oil should be a standing order. After every full bath—the Turkish bath being the best— the body should be anointed with either Olive, Chaulmoo- gra, or Cod liver oil, well rubbed in. The sapo virclis treatment as recommended for the squa- mous stage of eczema, is often invaluable in icthyosis. An infusion of Quillaya saponaria bark, sometimes works well as a local application. Arsenicum iodatus is the principal remedy. Others may be indicated as follows, and given ter die: Clematis.—When there are fine scales, with some itching. Iodine.—Skin has a brown dingy color. Potassium iodide.—Skin dried up. Rough like hog skin. Natrum carb.—Skin of the whole body becomes dry, rough and cracked here and there. Phosphorus.—Skin is dry and wrinkled. Skin of hands is rough and dry. DESCRIPTION AND TREATMENT. 87 Plumbum.—-Dry skin. Absolute lack of perspiration. Thuja.—Dirty gray cadaverous looking skin. IMPETIGO CONTAGIOSA, is an acute inflammatory con- tagious AFFECTION, OCCURRING MOSTLY IN CHILDREN AND CHARACTERIZED BY THE PRESENCE OF ONE OR MORE DISCRETE VESICLES OR VESICO-PUSTULES, GENERALLY UMBILICATED, VARY- ING IN SIZE FROM A SPLIT PEA TO A HAZEL NUT, AND FOLLOWED BY FLAT, LARGE STRAW-COLORED, USUALLY FUNGOID CRUSTS. This disease is usually ushered in by a period preceding the eruption, characterized by more or less fever and malaise. After two or three days this stage is followed by crops of small vesicles, which gradually develop into vesico-pustules and pustules. The vesicles which are at first small, grow rapidly and may at maturity have reached the size of even a split pea or a hazel nut. They are generally umbilicated and contain a lymph-like fluid with granular and subsequently pus cells. lied areola- more or less extensive usually surrounds them. In five or six days after their first appearance, their fluid contents begin to dry up, and eventually form flat shaped, straw-colored scabs about the size of split peas or hazel-nuts, looking as if stuck on. In mild cases the eruption may be confined to the skin of the forehead and (hecks, its most usual seat, but quite fre- quently it extends to the arms and head, and may impli- cate the mucous menibrane of the eyes, mouth and nasal cavity. InqH'tigo contagiosa was first described by Tilbury Fox in 18(14. It generally occurs in children of the poorer classes, though the rich are not exempt. It may be epidemic 88 DISEASES OF THE SKIN. but is mostly sporadic, and is both contagious and auto- inoculable. It tends to run a definite course1 and usually lasts from one to two weeks. At the Central Homoeopathic Dispensary of this city, it constitutes about one per cent of all skin affections. Its most frequent cause is vaccination. It can hardly be considered a parasitic affection, for although a fungus, similar to that observed in the vaccine crust has been seen in the scabs of this disease, none have as yet been found in the fluid of the vesicle, or vesico-pustule. By bearing in mind that this affection occurs mostly in children, and frequently in those who are perfectly healthy, that it is preceded by more or less febrile disturbance, con- sists of isolated vesicles usually umbilicated, of split-pea size or larger, seated mostly on the face, following generally in the wake of vaccination, and presenting scabs having the characteristic appearance as if " stuck on," it can hardly be mistaken for any of the other forms of cutaneous trouble. The disease's with which it is most liable to be confounded are eczema and varicella. It may be distinguished from the former by the fact that the children attacked are usually healthy, while those of eczema are not; that the scabs are light yellow, flat and " look as if stuck on," while those of eczema are greenish yellow and adherent; that it is gener- ally confined to the face and upper extremities, while eczema may attack any part of the body. From varicella it may be known by the smaller vesicles and different crusts of the latter, together with the almost constant constitutional disturbance and the appearance of vesicles on all parts of the body. Treatment.—The patient should be w»Jl nourished, and if DESCRIPTION AND TREATMENT. 89 there is much inflammation around the vesicles, the soothing applications spoken of in eczema should be used. White precipitate.cerate (0.5 grams of the white precipitate to 50 grams of Cosmoline,) is the best local dressing. Antimonium crud., internally quater in die is the main remedy. Aconite may be called for in oft repeated doses, if there is much febrile disturbance. liJuj)horbium, is indicated when there is an irritable skin, with swelling of the face, and pea-sized yellow vesicles. Kali bich. stands next to Antimoniun crud. 'lartar emel., is the remedy when the disease is exceed- ingly pustular. Thuja.—After vaccination. Silicca and Kali nitricum are at times indicated. INTERTRIGO, is a hyper.emic affection caused by the PROLONGED CONTACT OF TWO CUTANEOUS SURFACES, AND CHARACTERIZED BY HEAT, REDNESS AND AN ABRADED SURFACE, WITH MACERATION OF THE EPIDERMIS. It is chiefly met with in fat persons, and in infants. It may occur whenever the skin hangs in fob Is, and is therefore more commonly seen about the nates, groin and axilla?, and in the folds of the neck and beneath the mamma'. Treatment.—The local treatment consists in washing with cold water and Castile soap, and after drying with a soft towed, in dusting the parts with Lycopodium dust, or Oxide of Zinc and rice powder equal parts. Attrition of the sur- faces should be guarded against. The principal internal remedies, to be administered pro impel us ratione, are: 90 DISEASES OF THE SKIN. Borax. -Slight injuries ulcerate. Calcarea carb.—When occurring in fat, scrofulous chil- dren. Ciiamomilla.— In infants. Aggravated by every cold change of weather. Child is cross and fretful. Graphites.—Intertrigo between the thighs with discharge of a glutinous fluid. Hydrastis.—Irritation maddening, with intense burning heat. Mercurius.—Kawness with great soreness, worse at night. Petroleum.—Intertrigo behind the ear*. Psoricuni, Nux juglans, and Lycopodium may be compared in chronic and obstinate cases. ITCH, see Scabies. KELOID, is an affection of the SKIN, characterized by THE DEVELOPMENT OF ONE OR MORE FLATFISH SMOOTH-SUR- FACED TUMORS, USUALLY UPON THE SITE OF CICATRICES. The form of the tumor is very variable, and somewhat peculiar, in that it is usually made up of a central portion or body, having nume'rous prolongations or (laws. It may vary in size from a five-cent piece, to several centimeters in diameter. Its usual seat is the sternum and mamma1, though it may appear on other parts. It is a disease mainly of adult life, and is seen oftenest in colored people. The tumors are slightly painful on pressure, but do not tend toward ulceration. Spontaneous evolution occasion- ally takes place. Treutimnt.—Excision is not attended by good results, as the tumor is prone to return in the scar. Galvanism by DESCRIPTION AND TREATMENT. 91 means of surface applications, does mere than anything else in the way of local treatment. Fluoric acid, ter die is the principal internal remedy, and the next is 0rap kites. Nitric acid and Sabina, are occasionally indicated. LENTIGO, or Freckles, is a skin discoloration due to DEPOSIT OF PIGMENT IN THE RETE MUCOSUM, AND IS CHARAC- TERIZED BY ROUND YELLOWISH SPLIT-PEA SIZED SPOTS. It appears for the most part on the cheeks and back of the hands, and is seen more in light complexioiied, and especially red haired people1. 'Treatment. -The best local application, is the Mercurius cor. lotion, prepared by dissolving 0.1 gram of Corrosive sublimate in from 50 to 100 grams of Almond emulsion. It may be used morning and evening. The internal remedies to be given ter die, are: Ferrum mag.—Spots resembling summer freckles on back of hand and fingers. Kali carb.—Freckles on the. face. Lycopodium.—Freckles on the left side of the face and across the nose. Nitric acid.—Freckles on the chest. Dark freckles. Petroleum.—Freckles on the arms. Phosphorus.—Freckles on the lower limbs. Sepia.—Freckles on the cheeks. Sulphur.—Freckles on the nose. LEPROSY, IS A CONSTITUTIONAL DISEASE, OCCURRING ENDEM- ICALLY IN SOME COUNTRIES, AND CHARACTERIZED BY THE FOR- MATION OF A NEW GROWTH RESEMBLING GRANULATION TISSUE, 92 DISEASES OF THE SKIN. USUALLY RESULTING IN THE DESTRUCTION OF THE PARTS, WITH ANAESTHESIA AND GREAT DEFORMITY. This ia supposed to be the leprosy alluded to in the Bible, and was the leprosy of Europe in the middle ages. It occurs principally in warm climates and is common along the shores of the1 Meeliterranean, and in India, Japan and China, in the Sandwich Islands, Brazil and the West Indies. In the United States it has been seen among the Chinese in California, and in a Norwegian community in Minnesota. Leprosy exhibits several different phases, and according to the predominance of certain lesions or symptoms, may be divided into three sets, viz: The tubercular, the macular, and the anesthetic. A prodromal stage of gradual decline in health, running for weeks, months, or even years, generally precedes the more decided and characteristic features. Faint brownish patches of the size of a nickel or larger, often mistaken for syphilitic maculation, show themselves. Oftentimes an eruption of bulla? followed by slight scars and pigmentation is one of the first symptoms. The macula? as they increase in size peripherally, retain their brownish color at the edges, but gradually fade into dirty gray color in the centre. When first formed the patches are markedly hypera?sthetic, while later they may become completely anaesthetic. They may appear on any part of the body,.but are commonly seen on the trunk, and extensor surfaces of the extremities. In connection with the macula? or independently, dull brownish-red tubercles, roundish in form, and varying in size from a pea to a large plum, may make their appearance'. DESCRIPTION AND TREATMENT. 93 These form in greatest numbers on the face, and by obliter- ating the natural lines, give rise to a peculiar leonine expres- sion. After a time tubercles may appear upon the mucous membrane of rhe buccal cavity, nares and larynx. Ulcer- ation takes place sooner or later, from the breaking down and softening of the tubercles. The hair and nails fall out. The1 fingers anel ten's become bent and crooked, caries sets in, anel one by one the phalanges disinte'grate or finally drop off". The average' duration of leprosy is about fifteen vers. The prognosis is unfavorable. Treatment.—As tending to prevent the spread of leprosy, the' sequestration A' those attacked in infected districts, should be enjoined. A generous diet with plenty of fresh air and out door exercise, is of vital importance. Cod liver oil, or what is belter, Chaulmoogra oil may be taken in such quantities and as often as the stomach will permit. Locally, warm baths with Gurjun oil are highly recom- mended. The principal internal remedy is Hydrocotyle and' the next Piper metliysticuui. Others may be indicated as follows, and repeated pro impetus ratione. Calotropis gig.—In tubercular leprosy. Graphites.—Leprous spots. Coppery annular raised spots on the face, buttocks, legs and feet. Ulcers on the toes. Petroleum.—Tubercles on the face. Ulcers of the fingers and tibia. Numbness of the extremities. Phosphorus.—In the latter stages. 94 DISEASES OF THE SKIN. Sepia.—Swelling of the forehead anel temples. Face thick and covered with tubercles. Gnawing ulcers on the fingers and toes. Leonine face1. Silicea.—Induration of nose with ulceration and discharge. Palsied hands. White spots on the cheeks. Shortening of the ham-strings. Hura Braziliensis, Guano, Helleborus feetidus and Cuprum may be compared. LEUCODERMA, or Acquired Pie-bald Skin is a cutaneous DISEASE, CHARACTERIZED BY LOCALIZED LOSS OF PIGMENT. Congenital absence of pigment is called albinism. Leucodernia is a rare affection, and seldom appears before adult life. The general health is as a rule good, though the nervous system may at times be implicated. The face, hands and genitals are usually the parts first invaded. The patches are' either round or oval, and are of a milk white' color. They may either increase in size or remain stationary, and seldom if ever, regain their normal color. Of the treatment nothing encouraging can be said. Locally the pigmentation around the patch may be lessened by the use of strong Ae'etic acid. Galvanism may prove serviceable. Internally the Sulphide of Arsenicum bis in die will be oftenest used with benefit. Natrum, Nitric acid, Sumbul and the Phosphide of Zinc may be studied. LICHEN PLANUS, is a chronic disease characterized by the appearance of dull-red, flat-topped, angular-based, pin-head sized, glazed papules, running a distinctly pap- ular course, and attended by more or less pruritus. It is a rare elisease in this country, and is usually associ- ated with a debilitated state of the system, depending upon DESCRIPTION AND TREATMENT. 95 a faulty nutrition. The eruption generally makes its appearane-e in the' form of solid, millet-seed sizeel papules, that in the early stages have a shiny aspect, but later on are covered with thin micaceous scales. They start abruptly from the skin, are irregular shaped, flattened on the top and freepiently present in the centre an umbilicateel depression, which is the opening of the hair follicle. They are usually discrete, but may be aggregated in patches, anel as a rule develop slowly anel oetcur symmetrically. Melasmic stains fivquently, anel little pits occasionally, remain after the dis- appearance' cf the papule's. The disease nnuy oce-ur at any time of lite, attacks women more than men, anel select as seats the front of the forearms and wrists, the thighs, abdomen, and the legs below the' knees. It arises primarily as a disturbance of the trophic nervos of the' hair papilla, with resulting hyperemia and formation of new tissue. The. prognosis is usually favorable, except in the diffused form of the elisease, the lichen ruber of Ilebra, which is commonly associated with marasmus, and may terminate fatally. Treatment.—The patient should be liberally fed and wedl hygiencd. Local treatment may be resorted to mainly to allay the annoying itching. The' Carbolic acid, Grindedia, or Hydrocyanic aedd wash, alluded to in eczema may be resorte'el to. The pyroligneous oil of Juniper may prove , useful in old e-ases. Antimonium crudum quater in die, is the principal inter- nal remedy. Others are indicated as follows: 96 DISEASES OF THE SKIN. Agaricus mus.—Eruption of small pimples with red are- ola? and violent itching. Arsenicum alb.—In chronic cases. Chininum ars.—In the diffused form with threatening- marasmus. Iodine.—Small dry red pimples on the arms, chest and back, with jerking sensation while appearing. Iodide of Sulphur.— Red pimples on the nose, chin and arms. Kali bich.—Papular eruptions on the forarms. Ledum.— Eruption of pimples on the forehead as in brandy drinkers. Eruption of small pimples like red millet seed ewer the whole body. Excessive itching on the backs »f both feet, worse after scratching, and by warmth of bed. Relieved after scratching the feet sore. Nux juglans.—Red pimples on face, neck, shoulders and back. Little tubercles with hard scurf on the instep. Potassium iodide.—On the faee and shoulders. Sarsaparilla.—Red dry pimples. Burning itching with chilliness. Staphysagria.—Itching pimply eruption over the face and behind the ears, with rough skin. LICHEN SIMPLEX is a disease characterized by round ■olid millet-seed sized flesh-colored or reddish PAP- ULES, RUNNING A DISTINCTLY PAPULAR COURSE, AND ACCOM- PANIED BY MARKED ITCHING. It is one of the rarer diseases, and appears for the most part in summer time. At" the dispensary it constitutes about three per cent, of all skin affections. The papules are usually seen on the outer aspects of the forearm, the neck and the DESCRIPTION AND TREATMENT. 97 thighs. They last a week or more, and disappear by resorp- tion. Frequently the disease attacks the backs of the hands, which may secondarily become inflamed, and give out a dis- charge. (L. agrius.) When the papules are seated at the hair follicles, it has been termed (L. pilaris.) Treatment.—The lotions recommended in lichen planus to allay the itching may be used in this disease. Bran baths may also be of service, Cyanide of Potassium, Borax and Corrosive sublimate washes of weak strength, occasionally prove useful. A very good unguent in mild cases is that prepared by adding 1 gram of the Iodide of Sulphur to 50 grams of Cosmoline. In the inflamed variety the white pre- cipitate (0.5 gram to 50) ointment or Glyceral tannin is of use. The indicated internal remedy will generally be one of the following, and may be given quater in die: Alumina.—Red pimples on the face. Pimples on the neck and back. Intolerable itching of the Avhole body, especially when becoming heated in bed. Ammonium mm*.—Pimples on the back of the hands des- quamating next day. Anatherium.—Red pimples with itching and burning. Scarlet skin with burning. Antimonium crud.—Small red pimples on right shoulder. From digestive derangement. Arsenicum alb.—In chronic cases with burning itching. Belladonna.—Papular eruption on the hands like lichen agrius. Bovista.—Reel pimples on the foot. 98 DISEASES OF THE SKIN. Bryonia.—Pimples on the abdomen and hips. Castanea vesca.—Several small pimples on the right thigh, back of the left ear, and on the left upper lip. Caladium.—Pimples on the mons veneris. Soreness of pimples to the' touch. Iodide of Sulphur.—Red pimples on the nose, chin and arms. Kreasotuin.—Forehead covered with pimples the size of millet seeds. Ledum.—Small pimples like red millet seeds over the whole body. In brandy drinkers. Mercurius.—Pimples on the labia. Voluptuous itching. Itching changed to burning by scratching. Nabulus serpent.—Pimples on the face about the ne>sei, upper lip and chest with itching. Natrum carb.—Pimples on the face and lips. White pimples on the nose. Nux juglans.—Reel pimples on the' face and neck. Prick- ing itching. Plantago maj.—Hard white fattened isolated papules on the inside' of the thigh. Some papules have a red point in the centre. Phytolacca.— Pimples with itching (>n the left le>g. Worse first part of the night. Rumex crisp.—Red pimples on calves of the legs, with itching worse immediately after undressing. Sepia.—Pimples close together on the face. Pimples on the legs, and in the bends of the joints. Sulphur.— Pimples on inner part of the thighs. In simple cases. DESCRIPTION AND TREATMENT. 99 Tilia.—Eruption of small red, rather deeply seateel pim- ples, with violent itching and burning like fire after scratch- ing. LUPUS ERYTHEMATOSUS, or Erythematous scrofulide, HAS BEEN DEFINED AS CHARACTERIZED BY ONE OR MORE USUALLY ROUNDISH OR OVAL, VARIABLY SIZED, REDDISH PATCHES. COVERED WITH FINE, THIN, WHITISH OR GRAYISH, FATTY, ADHERENT SCALES. The disease appears at the outset as pin-head sized, pale red spots or patches, situated for the most part upon the cheeks and nose. Their centres, occasionally marked by comedo-points of a greenish hue, usually correspond to the orifices of the hair follicles, which are widely distended and patulous. They tend to coalesce and form patches, and are covered with firmly adherent fatty scales. These patches extend gradually by their peripheries, at times healing in the centre, where the skin presents a whitish sunken, as if thinned, appearance. Lupus erythematosus is one of the rarer skin affections, and usually tenets to become chronic. It seldom occurs before the tAventieth year of life, attacks females more than males, and more especially those who are subject to disorders of the sebaceous glands. It is generally confined to the face, and when fully developed presents a peculiar configuration that has been likened to a bat with outspread wings. The body of the bat corre- sponding to the nose and the wings to the cheeks. From lupus vulgaris, it is distinguished by the fact that the tubercles and ulcers of the former are never seen in the latter. The sebaceous glands are disordered in lupus ery- thematosus, not in lupus vulgaris. Lupus vulgaris appears 100 DISEASES OF THE SKIN. during childhood; lupus erythematosus is a disease of adult life. The prognosis should be guarded, as relapses are1 liable to occur. Treatment.—The diet should be of the best quality and generous. Fresh air and frequent bathing are valuable ad- juvants. Saponaria bark or Sulphur baths are often of service; and Oil of Cade at times acts favorably. A mix- ture of equal parts of Oil of Cade, alcohol, and Sapo virielis. applied bis in die, is frequently folloAved by the best results. In severe and obstinate eases resort may be had to the curette or scoop. Iodine, ter die, is the principal internal remedy. Guaraca, Hydrocotyle, Cistus, and Apis may be compared. LUPUS VULGARIS, or Tubercular scrofulide, is a disease OF THE DERMA CHARACTERIZED BY VARIOUSLY SHAPED, PEA- SIZED OR LARGER, YELLOWISH OR REDDISH ELEVATIONS, WHICH USUALLY TERMINATE IN ULCERATION AND CICATRIZATION. It usually begins in the form of yellowish or reddish solid points, at first disseminated but later tending to aggregate in patches. They are firm and painless, and gradually enlarge to form papules and tubercles that vary in size from a pin's head to a split pea, and are covered with a thin layer of ad- herent epidermis. (L. tuberculosus). Later the1 process may terminate either by insensible absorption of the lupus tissue, commencing with its degeneration and followed. without ulceration, by thinning of the textures with marked scaliness (L. exfoliativa), or terminating in a free breaking down of the neoplasm with destruction' of the infiltrated DESCRIPTION AND TREATMENT. 101 ■structure and resulting ulceration followed by atrophic cicatrice's, (L. exed(Mis). Lupus vulgaris, is one; of the most chronic and obstinate of skin affections. It occurs mostly about the age of puberty, selects scrofulous subjects, and attacks fry preference, the face and extremities. The cartilages, fibrous tissues and mucous membrane are its favorite seats. It is a rare elisease in this country, though common in Europe. It may at times be mistaken for syphilis. The hard rapidly developed tnberedes of syphilis, however, differ greatly from the soft slow growing ones of lupus. The ulcers of syphilis have sharply defined borders, and discharge a copious offensive secre'tion; those of lupus are illy defined, and have a slight and iimffensive discharge. The crusts of syphilis are bulky, and of a greenish color; those of lupus are scanty and of a brownish-red color. The cicatrices of syphilis are soft and whitish; those of lupus are shrunken and yellowish. Lupus may also be confounded with epithelioma. But if it is remembered that the hard everted edges of the latter are never seen in the former, and that the former is a elisease of childhood and youth, Avhile the latte'r is confined mostly to adult life, the mistake will rarely be made. Treatment.— An abundant supply of fresh air and outdoor exercise, along Avith a nutritious diet, is of the utmost im- portance in the treatment of this disease. In the earlier stages the Biniodide of Mercury ointment (0.5 gram to 25 or 50 grams) Avill be found serviceable. Later the papules or tubercles may be bored with an irielo-platinum needle dipped two or three times in Squibb's 102 DISEASES OF THE SKIN. fuseel Nitrate and allowed to cool. Smaller and less painful punctures can be made Avith these needles than Avith any other appliances. The Arsenical mucilage alluded to in the treatment of epithelioma is also useful. And a ten per cent, ointment of Pyrogallic acid has of late been highly recommended. In severe cases the curette or scoop may be resorted to. Arsenicum alb. ter die, is the main internal remedy. Others may be indicated as follows: Aurum mur.—When starting from the nasal mucous membrane. Calcium sulphide.—Lupus on the elbows. Cistus.—Lupus on the face. Worse from cold air. Graphites.—Lupus on the nose. Gu araca trich.—Lupus of an ochre-red color. Yellow spots on the temples. Hydrastis.—Ulcers on the legs. Exfoliation of the skin. Hydrocotyle.—Ulcers Avith abundant discharge of pus. Kali bich.—Ulcers painful to the touch. Worse in cold weather. Lycopodium.—In recent cases. Nitric acid. —Lupus on the lobules of the ears. Staphysagria.—Ulcers on the a he of the nose. MILIARIA, or Prickly heat, is a disease of the skin due TO A DISORDERED ACTION OF THE SWEAT GLANDS, AND CHARAC- TERIZED BY THE FORMATION OF NUMEROUS PIN-HEAD SIZED REDDENED PAPULES, OR YESICO-PAPULES, ATTENDED WITH HEAT AND TINGLING. The usual seat of the eruption is the trunk, but it may also appear upon the face, neck and arms. It is extremely DESCRIPTION AND TREATMENT. 103 fitful in its character, frequently appearing anel disappearing many times in twenty-four hours. The disease occurs more during summer time, and Avhen the Aveather changes suddenly to hot. Superfluous clothing is a quite frequent cause. Miliaria is apt to relapse in suc- cessive years. Treatnwnt.—A Aveak Carbolated bran bath, followed by dusting with either the Nitrate of Bismuth and starch, or Lycopoelium powder, is the best local treatment. Internally, Bryonia, repeated pro impetus ratione, is the principal remedy. Arsenicum alb., Centaurea, Hur? Brasil- iensis, and Riphanus may be studied. MILIUM, IS A DISORDER OF THE SEBACEOUS GLANDS, CHAR- ACTERIZED BY THE FORMATION OF WHITE, ROUNDISH, SEBACEOUS POINTS, BENEATH THE EPIDERMIS. These points occur mostly on the forehead and eyelids, are more common in Avemien than in men, and Aary in size from a millet-seed to a spin pea. The " skin-stono-s "' or cutaneous cale-uli occasionally met with are generally milia Avhich have undergone calcareous degeration. Treatment.—The local treatment consists in opening each milium with the knife and removing the more or less hard- ened contents. To prevent the return of the milia the skin may be washed in Saponaria bark water, and afterwards gently rubbed. The Calcium iodide, bis in die, is the most important internal remedy, and the next, Staphysagria. Tabacum may be thought of. MITE DISEASE, is found in the south-western states, lot DISEASES OF THE SKIN. especially along the Mississippi river, and is due to the Lep- tus irritans, or irritating harvest-mite, or "jigger." It occurs mostly in summer and autumn, along the banks of rivers and in swampy places. The mite burroAvs in the skin, generally of the ankles and legs, and causes considerable irritation, resulting in the formation of papules, vesicles and pustules. Treatment.—Mild parisiticides, of Avhich Sulphur ointment is the type, will readily remove the trouble. MOLLUSCUM SEBACEUM, is a disease of the sebaceous GLANDS, CHARACTERIZED BY ROUNDISH, PEA-SIZED TUMORS, UMBILICATED IN THE CENTRE, AND OF A PINKISH-WHITE COLOR. The umbilicated appearance is given to the tumor by the distended gland duct, from which a Avhite, cheesy matter may be squeezed. At times the disease appears to be semi-epidemic, but it has not as yet been clearly demonstrated to be contagious. It is mainly a disease of children, and attacks more espec- ially the face, though it may appear on other parts. Treatment.—In the early stages touching the parts once or tAvice a day Avith the Acid nitrate of Mercury is often of decided benefit. If the tumors are' large, they may lie removed by the knife. Silicea, ter die, as an internal remedy ranks first, and Teucriuin next. Bryonia, Potass, iod., Lycopodium, Na- trum mur., Calc. ars. and Bromine complete the list. MORPHCEA, is a rare disease, characterized by roundish DIRTY ALABASTER LOOKING PATCHES. CIRCUMSCRIBED BY LILAC- TINTED BORDERS, AND VARYING IN DIAMETER FROM ONE TO FIVE CENTIMETERS. DESCRIPTION AND TREATMENT. 105 It usually commences as a elelicate purple-colored spot, in the1 centre of which a pale area shows itself. This central spot becomes more and more decided as it grows, and finally assumes the appearance of a piece of white Avax, depressed anel surrounded bv a lilac-tinted ring. At times the pate dies become the seats of irregular deposits of pigment, and as the disease progresses atrophic edianges are apt to take' place in the affecteel parts. Morpheea occurs more in women than in men, and selects the course of the left supra-orbital nerve as its most frequent scat. It runs an extremely slow course, anel occasionally terminates in spontaneous recovery. It may be mistaken for scleroderma., leprosy, or leucoderma. It never has the scler- odermic hardness of scleroderma. Leprosy never has the waxy [latches of morpheea. Leucoderma is simply a pig- mentary disease', and as such does not present the textural changes of morpheea. Treatment.—The patient should be well fed, and have a daily allowance' of cither the Cod liver or Chaulmoogra oil. Locally, the constant galvanic current, with daily Phos- phorated oil inunctions are beneficial. Phosphorus, ter die. is the internal remedy. N/EVUS, Port-wine stain or mother s mark, is a congen- ital FORMATION, SEATED IN THE SKIN AND SUBCUTANEOUS TISSUE, AND MAY BE EITHER PIGMENTARY OR VASCULAR. Pigmentary ntvui are dark-colored, slightly eleArated, sharply defined spots, a arving in size from a pin's head te> a fifty-cent piece. When covered with hair they are called •; mouse marks." Vascular mcri are the commoner of the tAVO, and may be 10G DISEASES OF THE SKIN. either arterial (fire-marks) or venous. Tlwy are of a reddish or purplish color, and may be large or small. They are met with on all parts of the body, have a variable course, and may elect to increase in size, remain stationary, or dis- appear. Treatment.—The pigmentary mevi may be sloAvly removed by applications of Collodion paint, (Collodion 40 grams, and Merc, cor 0.5 gram) repeated at intervals. The vascular iiievi are best treated either by electrolysis, or the subcuta- neous ligature. Carbo veg., bis in die, is the principal internal lemedy for the pigmentary na?vus, and Thuja for the vascular. Calca- rea and Condurango may be compared. NETTLE-RASH, see Urticaria. ONYCHAUXIS, manifests itself by simple increase in the normal growth of the nail. Treatment.—Graphites, indies, is the remedy. ONYCHIA IS AN INFLAMMATION OF THE MATRIX OF THE NAIL. It may occur in the course of such diseases as eczema, psoriasis and syphilis, or may be due to local injury. Treatment.—For simple onychia, Fluoric acid, quater in die, is the internal remedy. And Avhen occurring from a bruise or other injury, Arnica both internally and extern- ally, proves serviceable. ONYCHOGRYPHOSIS, is characterized by a twisted, bent condition of the nails, Avhich are thickened and of a yellow- ish or broAvnish color. It affects mostly the nails of the toes and fingers, and generally attacks old people. DESCRIPTION AND TREATMENT. 107 Treatment.— Graph.it.es and Silicea, are the main remedies. Lit her may be administered bis in die. ONYCHO-MYCOSIS, is a disease generally confined to one nail, anel is due to the ravages of one of the vegetable para- sites. See Tinea tricophytina. PARONYCHIA, vulgarly called Run-around, is an inflam- mation SITUATED AROUND AND BENEATH THE NAIL, TERMINA- TING IN SUPPl:RATR)N. It attacks mostly the thumb and fingers, and makes its appearance as a dusky-red, extremely painful border, either completedv or partially surrounding the nail. h\ a few days the pain becomes throbbing in character, and pus forms, attended at times by more or less constitutional disturbance'. A form of this affection is sometimes caused by ingroAving of the nail, and more especially the nail of the big toe. Paronychia differs from AvhitloAv or felon, in that the latte'r involves all or nearly all the structures of the fingers, and appears for the most part on the palmar surfaces. Treatment.—Locally, the pith of the common bulrush has been used Avith good results. Xatrum sulph., quater in die, is the principal internal remedy. In slight cases Graphites often proves beneficial, and Avlieui suppuration is tardy, Calcium sulphide renders excellent service. Rana bufo is useful, when there are red streaks up the arm. PEMPHIGUS, IS A CUTANEOUS DISEASE, CHARACTERIZED BY THE APPEARANCE OF BULL.E, USUALLY IN GROUPS OF THREE OR FOUR, AND VARYING IN SIZE FROM A PEA TO A HICKORY NUT. 10S DISEASES OF THE SKIN. It is almost always chronic and may exist in either of two forms, viz: P. foliaceus and P. vulgaris. Pemphigus vulgaris is most common upon the limbs and more especially about the ankles. Occasionally it appears on the mucous membrane and other parts of the body. The blisters or bulky are rounded or oval, and rise abruptly from the skin sometimes to the height of a e'enti- meter or more, and may be attended by slight itching. Their contents are at first colorless, but later they become cloudy or milky. They usually appear in successive crops, each bulla running- its course in from four to five days. Acute pemphigus is rareW met with, excepting in children. It runs its course in from three to six weeks, and relapses are prone to occur. Ptmphigus foliaceus, attacks the body generally, and is often a fatal though rare form of disease. It usually commences by the appearance of a singled/face^ bulla on the sternum, and from there spreads over the Avhole surface. The bulhe differ from those of pemphigus vulgaris, in that they do not become tense, but remain flaccid, and dry up to form yellowish parchment-like flakes, whicli vary in size from one to four centimeters. Treatment.—The patient should be placed on a full animal diet, Avith plenty of fresh air and exercise. Such means should be used as may tend to bring the health up to its accustomed standard. Locally, bran, starch or gelatine baths, arc of decided benefit. The continuous bath, as recommended by Ilebra, may be resorted to in some cases. description and treatment. 109- Rhus ton., repeated pro impetus ratione, is the principal internal remedy for acute pemphigus vulgaris. Arsenicum alb. ter die, for the chronic form. Thuja is oftenest indicated in the foliaceus variety. Others may be indicated as folloAvs: Ammonium mur.—Blisters the size of peas on the right shoulder, Avith itching. Belladonna..—Watery vesicles on the palm of the hand, and so painful that he could scream. Causticum.—Large painful blisters, on the left side of the idlest and neck, which heroine flattened, Avith anguish in the chest and fever. Gunnni gutti.- May be used when other remedies fail. Phosphoric acid.—Deep hard bulla1 on the ball of the thumb. Blisters on the balls of the toes. In debilitated individuals. Phosphorus.-—Painful hard blisters, full to bursting. Ranunculus bulb.—Blisters on the fingers, the size of a hazel nut, followed after healed by small, deep, transparent, dark-blue, elevated blisters, the size of ordinary pin's heads. Raphanus.—Blisters full of water on the breast, without inflammation, redness or pain. Sepia.—Pemphigus on the arms and hands. PERNIO, or Chilblain, is an inflammation of the skin, OCCURRING AS A SECONDARY EFFECT OF COLD, AND APPEARING FOR THE MOST PART UPON THE HANDS AND FEET. Occasionally it attacks the nose and ears, and may appear on any part of the body. It commences after exposure to cold, by slight vesication, attended with tingling, itching, burning sensations. In mild eases it may terminate in a 110 DISEASES OF THE SKIN. few days with desquamation. In sewerer cases, remissions and exacerbations are prone to occur and thus prolong the disease for months. The parts are usually left in an irrita- ble state, and are liable to reneAvecl attacks from the slight- est causes. Any sudden change of temperature, and espe- cially a combination of cold and moisture, may renew the trouble. In chronic cases the parts become1 livid or pur- plish in color, and are more or less swollen and itchy. Ulcers not unfrequently form. Pernio when it becomes chronic may last for years, dis- appearing usually in the summer time, but returning again as winter approaches. Treatment—When there is much inflammation a decoction of marsh-mallows, locally, acts well. Tamus communis tincture, is recommended as a topical remedy for unbroken chilblains. Broken chilblains may lie dressed Avith either Diachylon plaster or Oxide of Zinc ointment, or the Glycerole of Calen- dula. Resin ointment is adapted to the ulcers that sometimes fol- io AV. The Tincture of llenzoin, painted on the parts once or twice a day, acts as a preventive. The medicines likely to prove beneficial, and to be admin- isteredpro impetus ratione, are: Agaricus.—Violent itching. Worse at night. Arsenicum alb.—Ulcerated chilblains. Badaiga.—Flesh and integuments sore to the touch. Sensitive to cold air. DESCRIPTION AND TREATMENT. Ill Bwlladonna.—Bright reel shining sAvelling, with pulsa- tive pains. Cantiiaris.—Itching SAvellings on the fingers. Blisters burning on touch. Citrus vulg.—Itching of the sAvollen hands and arms. General itching which prevents sleep. Nitric acid.—Itching on the feet. Spreading blisters on tlie toes. Petroleum.—Broken chilblains with tendency to fester. Primus spinosa.—Itching on tips of fingers as if frozen. Pulsatilla.—Blue-red chilblains Avith pricking, burning pain, worse toAvards evening. Rhus tox.—Inflamed chilblains with excessive itching. Sulphur.—Thick red chilblains on the fingers Avhich itch severely Avhen Avarm. Predisposition to chilblains. Urtica dioica.—Both internally and externally. Yeratrum vir.—Intense painful itching. Chilblains on the nose. Internally and externally. PHTHEIRIASIS, or Lice disease, is a contagious affec- tion DUE TO THE PRESENCE OF PEDICULI. There are three varieties of this disease, each being the outward demonstration of the ravages of distinct species of pediculi. The pediculus capitis or head louse, gives rise to the vari- ety kiiovvm as phtheiriasis capitis. It may be found on all parts of the head, but its favorite seat is the occipital region. Numerous ova or " nits'' may be seen deposited along the shafts of the hair. They exist mostly among the children of the poorer classes, but are quite frequently found on women. They cause considerable irritation not by biting, 112 DISEASES OF THi: SKIN. as imagined, but by inserting their suckers or haustella into the pores of the skin, and so distending them as to fre- quently cause drops of blood to follow on their withdrawal. This irritation together with the scratching it induces, gives rise to the development of papules, Avhose apices Avhen scratched off, present the blood tipped appearance so char- acteristic of phtheiriasis. Thepediculus vestimenti. or body louse, has its habitat in the e lothing, and attacks the body, giving rise to phtheiriasis corporis. Its ova are deposited and hatched in the clothing. P. corpjoris is mainly a disease of adult years, and is seen mostly in the loAver Avalks of life. The lesions are multi- form, due principally to scratching, and have their chief seats on the trunk, hips and thighs. The pediculus pubis or crab louse, usually infests the hair of the pubis, but may wander to other parts. It attacks adults mostly. Treatment.—The treatment is mainly local, and consists in the destruction of the parasites and their ova. Phthei- riasis capitis responds readily to repeated dusting with poAvdered Staphysagria. Cocculus indicus tincture, often proves serviceable. Anel white precipitate ointment (1 gram to 50 grams) is useful Avhen " scratch-marks " prove troublesome. The "nits" may be removed by repeated washing with carbolizecl water. Phtheiriasis corporis is best treated by Staphysagria oint- ment (10 grams of poAvdered Staphysagria to 50 grams of Cosmoline) Avell rubbed in. The patient's clothing should be thoroughly boiled or baked, so as to ensure the destruc- tion of whatever pediculi may have made it their habitation. description and treatment. 113 For phtheiriasis pubis, either Cocculus indicus tincture, a Mercurius e-en-r. lotion (0.2 gram to 50 grams), or a Chloro- form application proves an effectual remedy. Internally, Oleander may be given, ter die, in phtheiriasis capitis, and Mercurius in the other varieties, if desired. PITYRIASIS, or Branny tetter, is a cutaneous affection , characterized by fine, dry, bran-like scales, seated on a slightly reddened non-infiltrated surface. It affects mostly the scalp, face and upper part of the body, and seldom or never becomes general. If left to itself it is apt to become chronic, and last for years. When occurring on the scalp it tends to cause falling of the hair. It is accompanied by slight itching, and may be caused either by heat, cold winds, or local irritants. The disease is seated in the deep layers of the epidermis, and consists in exces- sive e-ell proliferation. Treatment.—Locally an infusion of Saponaria bark is the best remedy. If the affection is located on the hairy scalp, it may be necessary to cut the hair. Glycerole of Borax (10 grams of Borax to 40 grams of Glycerine) is frequently of service. Arsenicum alb., ter die, is the principal internal remedy. Fluoric acid, Colchicum, and Kali arsenicatum are occasion- ally indicated. PITYRIASIS RUBRA, see Dermatitis exfoliativa. PRAIRIE ITCH, is an acute inflammation of the skin, ap- pearing in neAv districts—where it may be for a time en- demic It may be preceded by the premonitory symptoms of malaise, headache, and slight febrile disturbance; or its onset may be first marked by the appearance of erythema 8 114 DiSEASES OF THE SKIN. tous spots, covered with small transparent vesicles, varying in size from a pin's head to a mustard seed, and situated for the most part on the neck, shoulders, back and outer surface of the limbs. An intolerable nightly itching accom- panies the eruptiou, creating an almost irresistible desire te> scratch the parts. The scratching obliterates the vesicles, and gives rise to scratch marks, and to the secretion of an ex- ceedingly acrid irritating fluid, which oftentimes indefinitely prolongs the disease. Large blackish crusts covering sup- purating ulcers are an occasional result. Furuncles quite ■frequently complicate the trouble. Treatment.—Locally, the diluted lye of wood ashes is the best remedy. Internally, Rumex crispus repeated pro impetus ratione, will be oftenest called for. Rhus tox. and Ledum may be studied. PRURIGO, is a disease characterized by the deaelop- MENT OF SMALL PAPULES, OF THE SAME COLOR AS THE SKIN, ACCOMPANIED BY INTENSE ITCHING. It commences by the gradual formation of small, sub- epidermic elevations, which have a peculiar shot-like feel, and are frequently perforated by small hairs. These papules are clue to chronic inflammatory changes in the papillary layer. Intense itching or pruritus, with formication is one of the earliest symptoms, and generally continues with more or less intensity throughout the entire course of the disease. Hence '• scratch marks" are often found complicating the eruption. And as the disease progresses the skin becomes thickened and presents a dry, rough, harsh appearance. DESCRIPTION AND TREATMENT. 115 Prurigo is mainly an affection of the poorer classes, and occurs mostly on the extensor surfaces of the lower extrem- ties, but is frequently found on the forearms and trunk. It starts as a rule before puberty, becomes aggravated during the winter months, and is apt to continue through life. It is a rare disease in this country. It differs from phtheiriasis Avith which it has been frequently confounded, in that, pediculi which are the cause of the latter are never present in the former. Treatment.— A thoroughly nutritious diet should be ordered for the patient. Locally, either Tar or Sulphur baths are the most serviceable. To allay the itching, a Car- bolic acid, Dioscorea, or Mezereum lotion may be used. Sulphur, bis in die, is the principal internal remedy for recent attacks. And Arsenicum alb., ter die, for the more chronic forms. Carbolic acid, Ambra, Dioscorea, Dolichos pruriens, Mercurius, Oleander, and Nitric acicl may be studied. PRURITUS, or Simple itching, Avithout any eruption can hardly be called a disease. It is merely a perverted sensa- tion, and is a common accompaniment of a variety of cuta- neous affections. "When occurring to all appearances inde- pendently— as far as any eruption is concerned — it is even then simply symptomatic of some nerve disturbance, indica- tive of the circulation of bile or some other foreign material in the blood, or else dependent on local excitants. PSORIASIS, is a constitutional, non-contagious disease OF THE SKIN, CHARACTERIZED BY REDDISH THICKENED PATCHES, COVERED AMTH WHITISH OR YELLOWISH-WHITE, MOTHER-OF PEARL-COLORED SCALES. lit) DISEASES OF THE SKIN. The patches vary both in size and form. They usually commence as small reddish spots, hardly raised above the skin, and covered with whitish scales. As a rule they de- velop rapidly, so that in a few days they may be as large as a nickel, and present the appearance of drops of mortar. Generally the patehes tend to run together as they increase in size, and lose the circular outline that at first character- ized them. Occasionally the centres of the patches clear up, giving to the disease the appearance of rings. Some writers err in speaking of these different stages, as distinct varieties of disease, and so allude to psoriasis punctata, psoriasis nummularis, psoriasis gyrate, etc. Such, however, can not be held to be distinct varieties of cutaneous trouble, but are simply stages of one and the same affection. The scales of psoriasis are peculiar and characteristic. They are imbricated, of a silvery Avhite color, and situated on a red anel inflamed base. The presence of air in the scales is the supposed cause of their white appearance. The favorite seats of this disease are the elboAvs and knees. It may, however, appear on any part of the body, and is apt to be symmetrical. It forms principally in the upper layers of the corium and in the apices of the papilla?, and is due to a perversion of the cell life of the rete. It is more common in gouty families, and prevails more in Avinter than in sum- mer. Its etiology is still obscure. By some it is claimed to be of malarial and by others of traumatic origin. Next to eczema it is one of the commonest diseases of this country. My experience at the dispensary, ranks it the fourth in order of frequency. The diagnosis is generally easy. The silvery-white, heaped up scales,seated on an in- DESCRIPTION AND TREATMENT. 117 flamed cutis, which inclines to bleed in pin-point drops on their removal, and the selection of the elbows and knees as sites, are very characteristic. Treatment.—The diet in psoriasis should be a generous one, and in it meat ought always to play an important part. Cod liver oil is generally needed. The local treatment con- sists in first removing the scales by means of Saponaria or bran baths. Inunctions Avith Cod liver oil or Chaulmoogra oil, may then be resorted to, and especially so, if, as occa- sionally happens, there is considerable attendant inflamma- tion. If the oily inunctions prove insufficient, either the Iodide of Sulphur ointment, or Chrysophanic cerate not too strong, may be used. One great objection to the use of the cerate, especially upon uncovered parts, is the staining that attends it. It may be prepared in strengths Aarying from 1 to 4 grains of Chrysophanic acid to 30 grams of simple cerate. In non-inflammatory cases the Oil of Cade, either full strength or diluted with Olive oil, may be used with benefit, if it agrees with the skin. A mixture of tar and alcohol (10 grams of the former to 50 of the latter), at times proves efficacious. The Biniodide of Mercury oint- ment (0.5 to 1.5 grams to 50 grams) has been highly recom- mended; and the white precipitate ointment (1 gram to 20 grams) will often be followed by good results. A weak Calcium sulphide lotion, may be of service in obstinate cases. And the green soap treatment recommended in the squamous stage of eczema, is needed in indolent cases when the patches are much infiltrated and thickened. It is best to commence the internal treatment with Sul- 118 DISEASES OF THE SKIN. phur, bis in die. Afterwards, one of the following reme- dies may be given ter die: Ammonium carb.—White pea-sized spots upon the cheek, which continually exfoliate. Skin very sensitive to cold. Arsenicum alb.—Skin dry and scaly. Arsenicum iodide.—In obstinate cases. Persistent itch- ing on the back. Calc. carb.—Scurfy spots on the leg. Scurfy pimples. Fluoric acid.—Roughness on the forehead like a rough line with its convexity upwards. Reddish spots above the eyebrows. Desquamation on the eyebrows. Hydrocotyle.— Circular spots with slightly raised scaly edges. Iris versicolor.—Irregular psoriatic patches on the knees and elbows, covered with shining scales. Skin fissured and irritable. Manganum.—In inveterate cases. Mercurius sol.—Psoriasis of the hands. Psoriasis in spots all over the body. Recent cases. Muriatic acid.—Psoriasis of the hands. Natrum ars.—Thin whitish scales, which, when removed, leave the skin slightly reddened. Petroleum.—Skin of the hands cracked and rough. Un- healthy skin. Phosphorus.—Psoriasis of the arms and hands; and on the knees and elbows. Phytolacca.—Surface of the skin shrunken and of a leaden color. Selenium.—Dry scaly eruption on the palms of the hands, with slight itching. DESCRIPTION and treatment. 119 Sepia.—Psoriasis on the face. Red roughness of the skin. Silicea.—Elevated scurfy spots near the coccyx. Small white scales on face and neck. White spots on the cheeks. Teucrium.—Psoriasis on the index finger of the right hand. PURPURA, MAY BE described AS A DISEASE of THE SKIN CHARACTERIZED BY AN EFFUSION OF RED BLOOD GLOBULES INTO THE CUTIS, USUALLY UNATTENDED BY CONSTITUTIONAL DISTURB- ANCE. The spots at the time of their appearance are bright red, but gradually become purplish, and subsequently undergo the usual changes of color that are the accompaniments of a bruise. They appear mostly on the legs, and are usually symmetrically arranged; they may also show themselves on any part of the body excepting the head. The disease occurs more in the old than in the young, and generally comes in successive crops, each crop running a course of eight or ten days. Hemorrhage from the mucous membranes may at times complicate the trouble {land scurvy). It is then apt to be attended by more or less con- stitutional elisturbances. Treatment.—The diet should consist of the most nutruj tious articles. Malt preparations are useful foods. Outdoor exercise is very beneficial. Locally, Hamamelis is one of the best remedies, and Avhen there is much hemorrhage, ice treatment may be resorted to. Simple purpura responds best to Arsenicum alb., and the ha?morrhagic form- to Sulphuric acid, quater in die. Other remedies may be indicated as folloAVS : Aconite.—In simple cases Avhen attended by fever. 120 DISEASES Or THE 8KU*. Arnica.—Yellow, blue and reddish blue spots. In lying- in women. Baptisia.—Livid spots all over the body and limbs, of the ize of a three-cent piece. Berberis.—Petechia? on the right shoulder or left humerus, back of the hand and wrist. Bryonia.- — Hemorrhagic purpura. Chloral.—Deep red spots on reddened bases, permanent underpressure. Hemorrhagic purpura. Lips covered with sordes and dried blood. Great prostration. Cocoa.—Dark spots like ecchymosis under the skin, about the size of a pin's head, on the fingers. May be used to pro- tect from skin diseases. Hamamelis.—Hemorrhagic purpura. In old people. Lachesis.—Simple purpura. Mercurius.—Bluish-red spots, darker on the margin, and ighter in the centre. Phosphorus.—Petechial spots on the skin. Bluish-red spots on the legs. Purple like exanthem over the Avhole body. Small wounds bleed much. Rhus tox.—Simple purpura. Dark brown spots on inside of ankles. Rheumatism of joints worse during rest. Terebinthina.—Hemorrhagic purpura. Veratrum vir.-—Simple purpura. RINGWORM, see Tricophytina. RHINOSCLEROMA, is characterized by~ irregularly- shaped, SHARP-BORDERED, FLAT SAVELLINGS, OF A NORMAL OR DARK REDDISH-BROWN COLOR, OCCURRING FOR THE MOST PART ON THE NOSE AND UPPER LIP. DESCRIPTION AND TREATMENT. 121 It is a disease of adult life, runs a slow course, and may remain stationary for years. The tubercles are seldom attended by pain, but are usually extremely sensitive to pressure. And Avhen treatment is necessary, they are best removed by the use of the irido-platinum points, and Squibb's fused nitrate, as recommended in Lupus vulgaris. Calcarea phos., bis in die, will probably be the most useful internal remedy. Guaraca, and Rhus racl., may be studied. RODENT ULCER, see Epithelioma. ROSACEA, IS A CHRONIC DISEASE, AFFECTING MORE PARTICU- LARLY THE NOSE, CHEEKS AND FOREHEAD, RESULTING FROM A DILATATION OF THE BLOOD-A'ESSELS AVITH INCREASED GROWTH OF CONNECTIVE TISSUE, AND CHARACTERIZED BY REDNESS, AND A TENDENCY TO THE DEVELOPMENT OF TUBERCLES AND PUS- TULES. It has three stages. In the first there is more or less passive hyperemia of the parts affected. The whole diseased surface may be reddened, or it may be reddened only in spot*. If the nose is attacked, it is apt to feel cold and greasy to the touch. After months or perhaps years, the second stage sets n. The redness is now more marked, and minute blood-vessels appear upon the surface. As the disease progresses these vessels increase in size, and take a tortuous course. Sooner or later, the integument becomes thickened, acne papules and pustules sIioav themselves, the nose becomes warm, and the disease passes into the third stage. It may remain in this condition for years, or if the morbid action continues, great thickening and hypertrophy of the parts, with deformity may result. 122 DISEASES OF THE SKIN. Rosacea is mostly a disease of middle life. It attacks both sexes, but males more than females. Anything which tends to increase the circulation in the face may produce rosacea. Excessive spirituous indulgence is a prominent eause, as is also functional or organic disease of the uterus or ovaries. The prognosis is generally favorable if the disease has not passed beyond the first stage. Treatment.—In the first stage a Sulphur or Hypochloride of Sulphur lotion, (5 grams of S. to 45 grams of lavender water) may be used with benefit. And occasionally a Mer- curius cor. lotion (0.05 to 0.2 gram co 50 grams) acts well. In the second stage the distended blood-vessels should be incised bi-weekly. Gossypium may be used to check the hemorrhage. All indolent pimples may be touched Avith a glass rod dipped in Acid nitrate of Mercury. Good results are reported from the use of the Faraclic current. As a last resort portions of the redundant integument may be excised. The internal remedy will usually be one of the folloAving, and may be repeated pro impetus ratione. Agaric us.—-Redness with burning heat in the face. Burn- ing itching on the cheeks. Antimonium crud.—Red points with white dots in the centre. Arsenicum alb.—In long-lasting cases Avith debility. Arsenicum bromide.—Violet papules on the nose. Arsenicum iodide.—Redness with itching. Belladonna.—Nose red, swollen and shining, Avith small red pimples. Bromine.—Pimples on the nose. Calcium sulphide.—When there is a pustular tendency. DESCRHTION AND TREATMENT. 123 Calcarea phos.—Nose shining like oil. Cannabis sat.—Large pimples surrounded by red SAvelling* Carbo animalis.—Pimples on the face. Eruption like red spots on the cheeks. Causticum.—Pimples on the nose. Curare.—Pimples like tubercles on the tip of the nose. Rosacea with varices and bleeding of the cheeks. Guarea trich.—Rosacea, Avith pain as from excoriation when touched. Hydrocotyle.—Papular eruption on the face. Tickling in the nose. Nux juglans.—In strumous subjects. Nux vom.—Rosacea associated Avith dyspepsia and consti- pation. In drunkards. Opium.—Dusky red bloated appearance. Phosphorus.—Pimples on the face and wing of the nose. Petroleum.—In the second stage. Rhus rad.—Tip of the nose red and painful, as if it would suppurate. Ruta.—Rosacea. Deep fine stitches in the parts. Aggra- vated by eating uncooked food. Sulphur.—In chronic cases. ROSEOLA, see Erythema. RUPIA, may be the result of either the pustular or the bullous syphilide. It consists of thick, greenish cr blackish " cockle-shaped" crusts, covering unhealthy punched-out looking ulcers. It is a late and malignant manifestation of syphilis, and is seldom met with in private practice. Mercurius bijodat., quater in die, and Potassium iodide, are the principal internal remedies. Arsenicum, Berberis 124 DISEASES OF THE SKIN. aqu., and Nit. acid may be studied. Locally, Iodide of starch dressings are serviceable. SALT-RHEUM, see Eczema. SARCOMA CUTIS, consists of brownish-red or bluish-red, variously sized tubercles or nodules, attended by a diffused thickening of the skin. It is a rare and malignant disease, occurs mostly in adult life, and usually terminates fatally. SCABIES Or Itch, IS A CONTAGIOUS DISEASE CAUSED BY THE BURROWING OF AN ANIMAL PARASITE CALLED THE ACARUS SCABIEI, IN THE SKIN, AND IS CHARACTERIZED BY THE FORMA- TION OF CUN1CULI, ATTENDED AVITH INTENSE NIGHTLY ITCHING, AND HAVING AS ACCIDENTAL ACCOMPANIMENTS, VESICLES, PUS- TULES AND CRUSTS. The first symptom after exposure to the contagion, is usually a more or less extensive local irritation of the skin5 attended by the formation of minute inflammatory points or vesicles, and an itching characteristically worse at night. On examining the parts carefully at this stage, a burrow or cuniculus, just beneath the horny layer, may be discovered as a slightly raised, straight or tortuous line, with a vesicle at one end, and the itch insect marked by a whitish-yellow speck, headed off by a dark curved line, at the other. The disease spreads from this point, usually Avith great rapidity, so that in four or six Aveeks it may cover the greater part of the body. The parts most obnoxious to this affection are, in adults the interdigits, the front of the arm and wrists, the flexures of the joints and the dorsal surface of the penis. In children the buttocks and ankles are as a rule primarily affected oftener than the other parts. The disease seldom appears above the nipple line, and in chronic cases is found DESCRIPTION AND TREATMENT. 125 more on the abdomen and inner surface of the upper part of the thigh. The vesicles are generally isolated, irregular in size and shape, stand out prominently, and are frequently topped Avith short burrows. On account of the intense itching, " scratch-marks '■' miay so mask the disease as to at times, almost obliterate the cuniculi and vesicles. These " scratch- marks " are, however, in their turn, more or less characteris- tic of scabies. The cause of scabies is the acarus scabiei. The disease arises only from contagion. It may be conveyed from one person to another by hand shaking or by sleeping Avith one avIio is affected. All are subject to the contagion, Avhether high or Ioav, rich or poor. Men are as a rule oftener affected than women. It is one of the more common skin diseases in Europe, but in this country it is quite rare. The acarus exists male and female, and is barely visible to the naked eye, being about half a millimeter in length. To the zoologist it is a beautiful and elegant little creature. It resembles a turtle in shape, and has an oval body, convex on the back, and flat on the belly. The back is armed Avith short spines, which are directed backwards, and are so arranged as to effectually tlrwart any attempt at retrogres- sion oii the part of the insect. The head is small and closely set to the body, and is devoid of eyes. There are four front legs armed Avith suckers, and four hind legs armed Avith hairs. The tAVO inner hind legs in the male are armed Avith suckers. The organs of generation are conspicuously marked on the under surface of the body. The female acarus is thrice the size of the male. Males are short lived. The 12G DISEASES OF THE SKIN. female lives from three to four months, and lays from 24 to 50 eggs at the rate of from one to two a day. As the male insect is seldom found on the skin, it is presumed that he plays but an inferior part in the development of scabies. The female acarus within thirty minutes after its arrival on the skin, commences boring perpendicularly through the horny layer and tunnels a place in which to lay its eggs. This burrow or tunnel is called a cuniculus, and may vary from tAvo to several centimeters in length. Here is the little miner's habitat, in Avhich the deposited eggs are usually hatched in about two Aveeks. The young acari or " brigands " as they are sometimes called, are liberated in the order of their birth, by the gradual wearing off of the horny layer of the cuticle, and most invariably adopt the mining habits of their progenitors. The acarus has considerable tenacity of life. It has been knoAvn to live from 8 to 10 days in Avater, and from 2 to 4 days in vinegar. The following are the main diagnostic points of scabies: 1. The presence of funiculi with their contained acari. 2. The seat of the eruption, which is mostly in the inter- digits and Avrists, and in the flexures of the body, the buttocks, and on the dorsal surface of the penis. Scabies seldom appears above the nipple line. 3. The multiformity of the eruption. 4. The itching, Avhich though continuing through the day is characteristically worse at night. 5. The evidences of contagion in the household, other members of the family being affected. DESCRIPTION AND TREATMENT. 127 6. The rapid disappearance of all the symptoms under parasiticidal treatment. The prognosis may usually be considered favorable, pro- vided a correct diagnosis is made, otherwise the disease may last for years. Treatment.—Once recognized the disease is speedily cured. A high potency of Sulphur given internally has the reputa- tion of curing scabies. But perhaps the best and most prompt results will be had from well directed local treat- ment, as the disappearance of the trouble depends on the removal of the cause, or in other words upon the death of the insect. Sulphur ointment (3 to 6 grams to 45 grams) is to be recommended as the best parasiticide. Storax ointment is preferred by some, as being cheaper, and less liable to irri- tate the skin. (Care must always be taken in using parasi- ticides not to have them too strong, as the secondary rash is invariably aggravated thereby.) ' The Oil of lavender may at times be used, as may also the Balsam of Peru. Before using the parasiticide, the patient should be ordered to take a hot soap and Avater bath. The cerate or oil may then be rubbed firmly into the skin of the whole body, for twenty minutes, and allowed to remain on all night. In the morning another hot soap and Avater bath should be taken- The same programme may be folloAved on the next and suc- ceeding evenings, or until every trace of itching is gone. In this Avay the majority of cases of itch can be cured in from 1 to 3 clays. All the clothing of the patient should be care- fully boiled or baked before being used. SCLERODERMA, or Hide-bound disease, is a chronic 128 DISEASES OF THE SKIN. AFFECTION CHARACTERIZED BY HARDNESS AND LNELASTICITY OF THE INTEGUMENT. It is a rare disease, and commonly commences as a circum- scribed infiltration of the skin and subcutaneous tissues. As the disease advances, the parts are found to become hard and immovable, as if frozen or petrified. The skin has generally a yelloAvish-broAvn or at times Avaxy appearance. Sclero- derma may occur on any part of the body, and at any period of life, and is apt to be symmetrical. It is supposed to be due to a stagnation of lymph in the lymph spaces. It runs a chronic course, but tends to get Avell in years. The disease bears some resemblance to morpheea, Avith whicli it is apt to be confounded. Scleroderma, however is pathologically a hypertrophy, while morpheea is an atrophy. Treatment.—Galvanism is recommended as having proved beneficial in some cases. As internal remedies, Antimonium crudum, Alumina, Berberis, Eleis and Rhus tox., may be studied. SCLERIASIS, IS AN INDURATION OF THE CELLULAR TISSUE IN NEW BORN CHILDREN. It may be congenital or appear during the first months of infant life. The skin Avhich is at first of a yellowish, broAvn- ish or reddish hue, gradually fades and becomes hard and rigid. The surface is generally cold, and more or less cedema is usually present. The causes of this disease are supposed to be congenital debility, vascular disturbances, and affections of the navel. The inflexibility is caused by a stearine-like deposit in the subcutaneous tissue. The prognosis is unfavorable, as most children die. DESCRIPTION AND TREATMENT. 129 Treatment.—E/ais guineensis may prove useful as an internal remedy, llydrocotyle, Phosphorus and Stillingia may be thought of. SCROFULODERMA, is a strumous disease of the skin COMMENCING AS INDOLENT, PAINLESS, LIVID TUBERCLES, THAT SLOAVLY SOFTEN AND GIVE PLACE TO UNHEALTHY ULCERS AVITH FREE INCRUSTATION. It is often est encountered on the neck, and beneath the loAver jaw, but is frequently met with on the thorax, and in the axille and groins. The cause of this disease is to be found in that peculiar condition of system, Avhich has been termed scrofulosis. Treatment.—Such patients should be alloAved an abund- ance of fivsh air, plenty of outdoor exercise, and a generous diet. Cod liver oil should be one of their standard foods. Locally, the ulcers when formed may be dressed Avith the Iodide of Starch paste. The Calcium sulphide, ter die, is the prima pal internal remedy. The Calcium iodide, Thericlion, and Scrofularia may be compared. SEBACEOUS CYST, or Wen, is a whitish, round or oval TUMOR OF VARIABLE SIZE, COMPOSED OF SEBACEOUS MATTER ENCLOSED IN A SAC. The tumors occur either singly or in numbers, and appear mostly on the scalp, face and back. Their contents are either hard and friable, soft and chee'sy, or fluid in character. They are1 usually painless, run a chronic course, and may end spou- taneously by degeneration of the contents and destruction of the cyst. o 130 DISEASES OF THE SKIN. Treatment.—Excision is the best local remedy. Potassium iodide lx, ter die, Baryta carb., and Bromine, have more or less repute in removing cysts, and may be used to prevent their return. SEBORRHCEA, or Sebaceous flux, is a functional disorder of the sebaceous glands,.characterized by an excessive secretion of sebum. It may appear on any portion of the body, but attacks chiefly the scalp and face. It occurs at all periods of life, is seen more in women than in men, and is either local or o-en- eral. In the neAvly-born it is a physiological rather than a athological process, and constitutes the vernix caseosa. As a disease it appears either in the form of an oily coatino- on the skin, or as dirty-Avhite or yellow^ flat scales, which are more or less greasy, and slightly adherent {dandruff). Light complexioiied people are more subject to the former, and dark complexioiied to the latter. When occurring on the scalp, seborrhcea is one of the most frequent causes of baldness; and as a sequel of variola an oily nose is not uncommon. This affection may at times be very easily confounded with eczema. But if it is remembered that seborrhcea is always a dry or oily disease, and that eczema has always a history of discharge; and also that the scales of seborrhcea, are usually seated on a pale bluish-colored skin, and abundant, while those of eczema are scanty and seated on a reddened more or less infiltrated surface, the diagnosis will not be difficult. Treatment.—The hygienic influences should be so arrano-ed as to keep the system in the healthiest possible state. All oily scales and crusts should be saturated Avith some oily DESCRIPTION AND TREATMENT. 131 substance, such as Olive oil or Glycerine, before their re- moval is attempted. Ten or twelve hours generally suffices to macerate them, so that they can be readil}- removed with warm soap and wate/. The common hard soap is scarcely strong enough for this purpose, and so Sapo viridis should be used. An elegant preparation is made by mixing 30 grams of Sapo viridis Avith 20 grams of Cologne Avater. After this treatment one of the simple oils should be applied, otherwise the skin "will become dry and harsh. In mild cases all the local treatment that is necessary is an infusion of Saponaria bark applied morning and evening. Glyceral tannin at times acts favorably. A Mercurius cor. lotion (0.1 gram to 50 grams) may be frequently used Avith advantage. And occasionally the red precipitate ointment (0.3 to 0.5 gram to "2') grams) is followed by good results. For seborrhcea occurring on the face, a Tannin dusting pow- der, prepared by mixing, from 2 to 6 grains of Tannic acid Avith 40 grams of rice powder, has been highly recom- mended. The most serviceable internal remedies, used ter die, are the following: Arsenicum alb.—Smutty brown, mottled skin. Yellow color of the face. Ammonium mur.—Large accumulation of bran-like scales, with falling off of the hair. Bufo.—Skin greenish, and always looking dirty and oily. Bryonia.—In long lasting cases. Calcarea carb.—Nose shines as from oil. Seborrhcea with hyperemia of the scalp and headache. Graphites.—Seborrhcea behind the ears. 132 DISEASES OF THE SKIN. Iodine.—Firmly adhering scales, Avhich leave the skin red and painful, on removal. Kali carb.—Dry hair rapidly falling off, Avith much dan- druff. Lycopodium.—Seborrhcea on the chin. Mercurius sol.—Seborrhcea of the genitals, accompanied Avith hyperemia. Mezereum.—Excessive formation of smegma. Natrum mur.--Severe itching of the scalp. The hair falls out in masses. Seborrheica of the face. Plumbuai.—The skin of the face shines as if oily, and feels oily. Phosphorus.—Copius dandruff; falls off in clouds. Potassium bromide.—Seborrhcea on hairy portions of the face, forehead, and neck. Raphanus.—Skin is greasy and makes the hands greasy to touch it. Sepia.—Seborrhcea of the genitals in Avomen. Sulphur.—Dandruff. Thuja.—White scaly dandruff. Hair dry anel falling off. Vinca minor.—Seborrhcea on upper lip and base of the nose. STONE-POCK, see Acne. SHINGLES, see Zoster. STROPHULUS, commonly knoAvn as Red-gum or tooth rash is a disease of early life, due to congestion about the mouths of the sweat follicles, and is characterized by the appear- ance of small red or Avhite papules, varying in size from a pin's head to a millet seed. The face, neck and arms are the DESCRIPTION AND TREATMENT. 133 usual seats of the eruption, but it may be general in its dis- tribution. There are tAvo forms of the affection. One variety mostly due to over-clothing, appears in infants a few Aveeks old. In this the eruption reaches its height in tAvo or three days, and then gradually disappears. The other variety is frequently met Avith during the period of denti- tion, lasts longer than the former variety, and is often asso- ciated with gastro-intestiiial disturbance. . Treatment.-—The diet should be carefully regulated, and all superfluous clothing abandoned. Lancing the gums is proper only when they are sAvollen or so tender as to distress the child. Chamomilla quater in die, is the principal internal remedy. Calcarea carl, may be called for Avhen there is a chronic acidity. Spiranthes is often indicated. Borax, Ledum, Apis, Cicuta, and Sunibul, may be studied. SUDAMINA, IS A DISORDER OF THE SWEAT GLANDS, CHARAC- TERIZED BY PIN-HEAD SIZED A ESICLES, FORMED BY THE COL- LECTION OF SWEAT BETAVEEN THE LAYERS OF THE EPIDERMIS. It is more particularly met Avith during the summer months, and in acute febrile, and constitutional, diseases. It occurs both in children and adults, and may be esteemed a sign of general debility. The mal-administration of Tuik- ish baths occasionally gives rise to a general attack. Treatment.—Bryonia, Ammonium mur. and Urtica urens, are the most important remedies. They may be repeated pro impetus ratione. SYCOSIS, IS A CATARRHAL INFLAMMATION OF THE HAIR FOL- LICLES OF THE BEARD, AND IS CHARACTERIZED BY THE FORMA- 134 DISEASES OF THE SKIN. TION OF PAPULES, TUBERCLES, AND PUSTULES, ATTENDED WITH PAIN, HEAT AND SAVELLING. The affection demonstrates itself by the development of acuminated, more or less indurated, pin-head or split-pea sized pustules immediately around the hairs, containing a thick yellow fluid. More or less peri-follicular inflamma- tion usually accompanies the disease, and according as this is slight or severe, the patient suffers pain. If the inflamma- tion is severe the pustules are croAvded together, otherwise they are generally discrete. The hairs of the affected part are as a rule healthy, and cause pain on extraction, (a char- acteristic). The disease is not contagious. Treatment.—Shaving is the first thing to be done, and it must if necessary, be kept up for months. Hot fomentations should be applied if there is much inflammation. Good results may be expected from the use of a Tartar emetic lotion (Tartar emetic 0.1 gram, Glycerine 2h grams, Cologne Avater 25 grams), as recommended by Ruddock. Lotions containing Sulphur are often of great service. They may bo prepared by dissolving from 5 to 15 grains of Sulphur in 50 grains of water. Mercurius cor. may also be em- ployed with favorable result in the strength of from 0.05 to 0.2 gram to 50 grams of alcohol and water. A Aveak red precipitate ointment, 0.5 to 1 gram to 50 grams, frequently proves one of the most efficacious remedies. As regards the internal treatment, Tartar emet. quater in die, is alloAved by common consent to rank first. Othei remedies occasionally of service, are: Calcium sulphide.—Many little pimples on the chin, sore ay hen touched. DESCRIPTION AND TREATMENT. 135 Cereus serpentinus.—Pustules on the right upper lip and angle of the mouth, on parts covered by beard. Itching of the pafts covered by the beard. Cicuta.— Elevated eruption, which causes burning pain Avhen touched. Itching papular eruption on chin. Graphites.—Chin covered Avith eruption. Hard white pimples on red base. Kali bich.—Pustules on the right side of the chin, seated on reddened bases. Mercurius precip. ruber, is, next to Tartar emet., one of the most prompt remedies for sycosis. Petroleum.—Papular eruption at the corner ot the mouth with sticking pain. Painful pustules on the chin. Sulphur.—Painful pea-sizecl pimples, with red areole. SYPHILIDES, are the manifestations of general syphi- lis UPON THE SKIN. They may be divided into two arbitrary groups, viz., the secondary and the tertiary; and possess the following general features: They have a history of syphilitic inoculation. They are of a reddish, yelloAv-brown color, often described as copper- colored. They are polymorphous, and elective. They are devoid of both pain and itching-. The crusts are thick, green- ish-black. The ulcers are of an ash-gray color, are often serpiginous or horse-shoe shaped, and are bounded by sharply cut edges. The diffused eruptions are generally symmet- rical. Later the distribution is irregular. The scales occur in small circular spots, and are thinner and fewer in number than in non-syphilitic cases. They are of a non-inflammatory character, and are prone to recur. 13t) DISEASES OF THE SKIN. The secondary syphilides are: 1. Erythematous Syphilide.—This consists in the forma- tion of'flat or slightly raised patches, varying in size from a split pea to a two-cent piece. It is the earliest and most frequent cutaneous manifestation of constitutional syphilis, and appears generally at about the sixth Aveek. It often comes on slowly, but may appear suddenly, and is confined in the majority of cases, to the covered parts of the body. When it occurs early in the disease it may last for months. The rash is unaccompanied by itching, but is usually at- tended by such significant signs of syphilis, as the chancre or its scar, the redness of the fauces, and the mucous patches. Treatment.—The Avhite precipitate ointment (0.3 to 1 gram to 30 grams) may be used externally, and Merc. iodat. or Merc, cor., given quater in die, at the same time internally. 2. Papular Syphilide.—This eruption is usually super- ficial and may either folloAv the former, or occur as the first outbreak after chancre. It may appear as early as the third Aveek after the chancre, or not until the fourth month, and usually lasts from three to eight Aveeks. The papules may be either acuminated or broad and flattened, and may vary in size from a millet seed to a split pea or larger. They are at first rose-colored, and are surrounded by a Avhite border of fine scales. Later they assume a taAvny hue, and may be moist, or covered Avith thin scales. They are usually most marked on the nape of the neck, the flexor surfaces of the extremities, and on the perineum and genitals. Treatment.—The five per cent. Oleate of Mercury is the DESCRIPTION AND TREATMENT. 137 best local application. Internally, Potassium iodide and J/erc. cor. are the principal remedies. 3. Vesicular Syphilide.—This is a rare type of syphi- litic eruption, and in the majority of cases, takes the form of herpes. Occasionally it is varicella form. The vesicles of the herpetic manifestation vary in size from a millet seed to a pea, and are seated upon a copper colored base. They are arranged either in circles or in segments of circles, usually last about a Aveek, and disappear Avithout scarring. Their first appearance1 is generally about three weeks after the disappearance of the primary lesion. The vesicles of the varvellaform eruption are about the size of small peas, are surrounded by a coppery-red areola, and are iioav and then umbilicated. They may be either isolated or confluent, and are succeeded by greenish-brown scabs Avhich fall off in about two Aveeks, leaA'ing sIoavIv dis- appearing purplish discolorations. The lesion appears about the sixth month after chancre, and shows itself mostly about the face. Treatment.—Merc, cor., Cinnabar, and Merc, jodatus are three main internal remedies. A Merc. cor. lotion, or the Oleate of Mercury, may be used externally. 4. Pigmentary' Syphilide.—This consists of" coftee-Avith- milk" colored macules, varying in size from a cent piece to a half dollar. It occurs oftenest in women, and appears mostly on the neck, but occasionally extends to the body anel extremities. It conies between the fourth and tyvelfth month, and lasts one or tAvo months, or longer. Treatment.—Nitric acid is the generally indicated remedy. The Calcium snlpleide is sometimes called for. 138 DISEASES OF THE SKIN. 5. Pustular syphilide.—This may exist in either of three forms: (a.) As small millet-seed sized ephemeral dead-gray colored pustules which dry up and form brownish, rough, scabs, or else linger as slightly ulcerating, vegetating surfaces. They are apt to appear on the forehead, angles of the mouth and base of the nose, and usually leave a brownish centrally depressed spot on their disappearance. {b.) As pin-head or split-pea sized acuminated pustules Avhich form brownish colored scabs, and leave small, Avhite, depressed cicatrices. They develop about six months after chancre, and last about two months. They appear mostly on the scalp, face, and trunk, and more rarely on the loAver extremities. (c.) As ecthymatous umbilicated pustules, which vary in size from a pea to a hickory nut, and are surrounded by a dark red areola. These form rough, dark, greenish-brown scabs, and leave slight copper-colored cicatrices, Avhich grad- ually disappear. Ire/dment.—-Locally, white precipitate ointment (0.3 to 0.5 gram to 30 grams) may be used. Kali bich. and Aleve, nit. are the more common internal remedies. 6. Bullous Syphilide.—The eruption is characterized by blebs, Avhich vary in size from a pea to a walnut, and after lasting a variable time, dry up and form dark greenish- broAvn scabs. It is a rare and late manifestation of syphilis, but may occur in the neAvly-born as a result of inherited dis- DESCRIPTION AND TREATMENT. 13<> Treatment.—Potassium iodide and Syphilinum, are the generally used remedies. 7. SenJAMous saphilide.—This may develop on the syphil- ized, in the course of other eruptions, or start as a primary condition with febrile symptoms, by the formation of small, red, circular blotches, Avhich in a few days become covered Avith scales. After a feAv weeks the scales fall off, leaving dark colored spots, that gradually disappear Avithout cicatri- zation. Lentil-sized, copper colored spots, sometimes form on the palms of the hands and soles of the feet. The patches may be either fissured, or covered by adherent grayish scales, and are usually limiteel by the characteristic livid areolae. The eruption is commonly symmetrical, and may last for months, or even years. The scaly syphilides rarely appear before the sixth month from the chancre, and when entirely removed by treatment are not apt to return. Treatment.—The local treatment consists in the- use of the red precipitate ointment. The internal remedies are Merc, precip. ruber, Arsenicum sulphide and Cinnabar. Sarsaparilla, Merc. cor. and Phyto- lacca . 8. Tubercular Syphilide.—This is a common form of secondary syphilis verging on the tertiary. It rarely appears before a year or longer after chancre, and consists of circumscribed, dome-shaped, brownish-red elevations, which vary in size from a split-pea to a nut. They are situated for the most part on the face and back, but occasionally appear on the extremities. They develop slowly, may last for weeks or months, and disappear either by absorption or ulceration. 140 diseases of the SKIN. When absorption takes place, small depressed pigmented spots remain, Avhich either finally disappear or leave but very superficial cicatrices. If ulceration ensues, the tubercles become covered with a brownish or blackish crust, and the ulcers have a punched- out appearance. Occasionally the eruption is grouped into circles or figures-of-eight, a peculiarity observed mostly about the forehead and nose. Treatment.—The tubercles may be treated locally with the Acid nitrate of Mercury, and Avhen ulcers form thoy may be dressed a\ ith Iodide of Starch paste. Merc, biniod., and Potassium iodide are the generally indicated remedies. Thuja is adapted to mucous tubercles. The tertiary syphilides are principally Rupia and the Gumm atous syp h Hide. 9. Gummatous syphilide.—This is a late syphilide, and appears first as little hard lumps, seldom larger than a hazel-nut situated on the head, buttocks, and flexor surfaces of the extremities. They are loosely imbedded in the tissues, may be either single or multiple, and groAV sloAvly. They either undergo absorption or eventually break down, and form grayish deeply excavated ulcers, that vary in size from a finger nail to the palm of the hand. Treatment.—In addition to the treatment suggested for the eighth syphilide, Carbo animalis, Condurango, Berberis aqui, and Bi-cyanide of Mercury, may be thought of. In Mercurio-syphilitic ulcers, Cistus canadensis acts well. Syphilides in children.—The cutaneous manifestations of hereditary syphilis, as observed in childrer., differ from those of the acquired form, as seen in the syphilized adult. Usu- description and treatment. 141 ally Avithin tAvo or three weeks, after the birth of the tainted child, distinctive signs of syphilization shoAv themselves. The little one, hitherto, it may be, of robust appearance, gradually declines in health. Fissures and chaps appear about the mouth, anus anel genitals. The skin becomes harsh and dry, and assumes a dingy yellowish hue. The face grows wrinkled, and the babe patient appears like a little dried up old man. Sooner or later snuffles sets in, the dis- ease extends to the larynx, and the child has a peculiar hoarse cry. About the same time coppery-red mucous patches vary- ing in size from a finger-nail to the palm of the hand, ap- pear on the' buttocks, thighs or genitals. Occasionally the hands exfoliate in thin dry seniles. After a variable season, dry or moist papules — the moist predominating — make their appearance on the reeldened patches. Tubercles may form. The matrix of the nail may suppurate, and the nail be shed several times. Excoriations and mucous patches are the most common, and at the same' time, the most character- istic manifestations of syphilis in the young. Occasionally syphilis is acquired by a healthy baby, from nursing a avoiii- un Avith chancre, or through vaccination, this is called Tnfantile syphilis. If the child is born Avith a general erup- tion, death is almost inevitable. The bullous syphilide in infants usually manifests itself at birth, and generally results fatally. Treatment.^— The Calcium iodide, ter die, is the principal remedy, and next, Mere. viv. Corallium rub. is adapted to the syphilitic erosions. A five per cent. Oleate of Mer- cury inunction is highly recommended. TELANGIECTASIS, is characterized by circumscribed 142 DISEASES OF THE SKIN. VASCULAR CUTANEOUS GROAVTHS, APPEARING FOR THE MOST PART DURING ADULT LIFE. The growths are usually of a bright red color, and vary in size from a pin's head to a split pea. They differ from nevi in that they are not congenital, but acquired. Telangiectasis selects as its favorite seats the face and neck. It runs a chronic course, and may either terminate spontaneously or remain through life. The treatment is the same as that of nevus. Condurango is reported as having cured some cases. THE TINE/E, is a generic term given to a class of cuta- neous AFFECTIONS, THAT OWE THEIR ORIGIN TO VEGETABLE PARASITES. At the Central Dispensary they constitute about four per cent, of all the cases, in the department for skin diseases. They are all contagious, occur more in populous districts, and are curable by parasiticides. The parasites are the Achorion Schonleinii, the Tricophy- ton, and the Microsporon furfur. They exist in three forms: 1. Conidia or spores, which are made up of an outer and inner enveloping menibrane composed of cellulose, enclosing a liquid containing floating granules. They present an aver- age diameter of .006 mm. 2. Mycelia, or thread-like structures, Avhich vary in size and shape, from simple, fine, transparent filaments, to large, double-contoured tubes. 3. Granules, the nuclear form of the fully developed fungus. They require a high power for their detection. The conidia are the most developed parts of the fungus. They may be either round or oval. The mycelia are the growing or producing structures. They may be either long DESCRIPTION AND TREATMENT. 143 or short, branched or straight, filled Avith or almost devoid of granules. And the granules being the more elementary forms, may be either numerous or only sparcely distributed. From this it may be noted, that whenever in the field of the microscope, a large number of conidia or spores are seen it can be safely said that the fungus has age, and that conse- quently the disease has been running for some time, or has become chronic. If on the other hand sprouting mycelia filled Avith granules, marked off as it Avere by partitions, and called sporqphores, are present in large numbers, it may be taken for granted that the fungus groAvth is active, and that consequently the disease is spreading rapidly, or is in the acute stage. There are three varieties of "the tinea'," due respectively to the ravages committed by the afore-mentioned parasites upon the skin. They are Tinea favosa, Tinea tricophytina and Tinea ver- sicolor. TINEA FAVOSA or Favus is a contagious diseases, char- acterized BY THE PRESENCE OF ONE OR MORE, CLUSTERED OR SCATTERED, VARIOUSLY-SIZED, CUP-SHAPED SCABS, OF A SUL- PHUR-YELLOW COLOR, AND PIERCED BY^ A HAIR. It appears mostly among the poorer classes and flourishes in dirt. It is oftenest found on the head, frequently on the trunk, and occasionally on the lower extremities. It shows itself first at the point where the vegetable parasite touches the skin, as aslight redness, accompanied by a varying amount of itching. Scales soon make their appearance on the reddened surface and assume the form of pin-head sized crusts. These con- tinue to increase, and the disease spreads, so that at the end 144 DISEASES OF THE SKIN. of two Aveeks, the collected mass presents the umbilicated form of the fully developed favus cup. They may now re- main separated, or coalesce and form yelloAvish-e-olored, aggregations, having a characteristic honeycomb aspect. The scabs are peculiarly cup-shaped in appearance, Avith the concavity eliiected upAvards, and vary in size from a split- pea to a ten cent piece or even larger. They have a straAv or sulphur-yellow color, and are as a rule pierced by a hair. A special odor generally attaches to the favus crust; it is that of stale straAv, mice or cat's urine. On removing the scab, the skin is seen to present a more or less reddened, hollowed out appearance, corresponding to the convexity on its under surface. Most generally the hair is loosened in the follicle, by the fungus affecting its formative apparatus, and comes away Avith the scab. If the elisease is severe, and the ravages of the parasite are in any Avay extensive, the hair follicles may be destroyed and the scalp left red, smooth and shining. Favus may, at least in this country, be classed among the rarer diseases. It is eminently contagious, never originates spontaneously, but may be communicated from animals to man. It may have its seat in either the hair follicles or the hair, or upon the surface of the skin, and is due to the action of the vegetable parasite known as the achorion schonleinii. This fungus Avas named after Schonlein, its discoverer, by Remy. Its history dates back to 1at the acute char- acter of the disorder, and by the absence of enlarged folli- cles and a greasy surface. From the squamous stage of an eczema, it may be distinguished by the abrupt marginal 150 DISEASES OF THE SKIN. form of the eruption, the loosening of the hair, the history of contagion, and the more rapid course. From psoriasis, it may be told, by the history of the case, and the decision of the microscope. From favus, by the absence of the char- acteristic crusts of the latter, and the different fungus. From sycosis, by the loosened hairs, the characteristic tuber- cles, and the ever present fungus. And from acne, by its seldom or never appearing on the non-hairy parts of the face, as the cheeks anel forehead, Avhich are the favorite seats of acne. A very easy wray to detect the nature of the trouble is, to apply a little Chloroform to the suspected part. If fun- gus is present, it turns Avhitish-yellow as if sprinkled with Sulphur powder, otherAvise the appearance is unaltered. Treatment.—As in tinea favosa so in tinea tricophytina the cardinal point to be remembered is — kill the parasite. This is best done by epilation and the use of parasiticieles. Mercurius corrosivus lotion (0.1 to 0.2 gram to 50 grams) is one of the best. Shaving every other day, and epilation on the days between, accompanied by a diligent use of the Cor- rosive sublimate lotion, proves a sovereign remedy for the form, '' barbers' itch." Sulphurous acid either as a lotion of fifty per cent, strength, or as a spray, will sometimes do more service on an irritable skin than Avill the Merc. cor. lotion. Acetic acid or Coster's paint (10 grams of tincture of Iodine to 40 grams of colorless oil of Tar) may occasion- ally be called tor in the more obstinate forms. While using one of the stronger parasiticides, once or tAvice a day, a milder one should if possible be kept constantly applied under oiled silk, between times. Chrysophanic cerate, not DESCRIPTION AND TREATMENT. 151 too strong, Avill prove useful in many cases. The white pre- cipitate ointment may be resorted to, if other means fail, as may also a Tartar emetic lotion. Of internal remedies the following may be mentioned: Sepia and Tellurium are adapted to the ringworm variety, as occurring on either body or scalp. For the form, "barber's itch," wrongly termed tinea sycosis, Merc precip. ruber, Kali bich., Plantago, Tartar emet., and Cicuta are the main remedies. Cocculus indicus and the remedies mentioned in the treat- ment of favus may also be compared. TINEA VERSICOLOR, is characterized by the appear- ance OF FAWN-COLORED PATCHES, SLIGHTLY' RAISED ABOVE THE LEVEL OF THE SKIN, ACCOMPANIED BY CONSIDERABLE ITCHING AND DESQUAMATION. It is a disease of the superficial cells of the cuticle, caused by the presence of a parasite — the microsporon furfur — and has been confusedly termed, by some, pityriasis versi- color. It is the mildest of all the tinee, and occurs mostly in phthisical patients, between the ages of twenty and forty, and attacks women oftener than men. The chest and abdomen are most obnoxious to the disease, Avhich Avhen at all extensive gives to the skin a peculiarly mapped appearance. The microsporon furfur Avas discovered by Eichstedt in 1846. Under the microscope its conidia appear of variable size oval or irregularly rounded, and bilinear. They are of a yellowish-gray color, have an average diameter of .005 mm. and are generally devoid of granules. They manifest a 152 DISEASES OF THE SKIN. peculiarity in that, they tend to cluster, which none of the other conidia do. The mycelia differ but little from those of the tricophyton, onty they are shorter, more branched, and are occasionally tipped with single spores. They have an average diameter of .0025 mm. The parasite attacks neither hair nor nail. It is the most superficially seated of all the vegetable para- sites, having its habitat in the horny layer of the epidermis, and is less tenacious of life than any of the other fungi. The main disease Avith which tinea versicolor is most liable to be confounded is the erythematous syphilide. The micro- scope Avill easily settle this question, even if the syphilitic history of the one does not. Next to tinea tricophytina it is the most common of the parasitic diseases. It may be found in all classes of society, and tends to run a chronic course. Relapses are frequent, but are more easily managed than in the other varieties of tinea. Its contagious properties are feeble. Treatment.—The affected parts should be thoroughly bathed with soap and Avater, or an infusion of Saponaria bark, every day, and the milder parasiticides used. A Sul- phurous acid lotion will generally be all that is needed. At times Acetic acid baths may be resorted to. Sepia and Xatrum ars., ter die, are the principal internal remedies. TRICHAUXIS, IS AN ABNORMAL DEVELOPMENT OF HAIR. It may be either general or local, and often gives rise to much disfigurement, especially in females. Treatment.—Epilation, and the breaking up of the folli- cle by a bayonet-pointed needle, should be resorted to. The DESCRIPTION AND TREATMENT. 153 Sulphide of Barium depilatory powder may also be used. It is prepared by mixing 10 grams of Sulphide of Barium, Avith 15 grams of Oxide of Zinc, and 15 grams of Amy- lum. Lycopodium has been recommended as an internal remedy. TRICHIASIS, IS CHARACTERIZED BY AN ABNORMAL DIRECTION OF THE HAIR, AFTER IT LEAVES THE FOLLICLE. It affects more commonly the eyelashes, but is occasionally seen on the scalp and eyebroAVs. Treatment.—The treatment which is mainly local consists either in pulling out the hairs, which is palliative, or in excising a portion of the palpebral skin if it affects the eye- lids, and bringing the edges of the wound together with three or four sutures. Borax has been recommended as a useful remedy, both internally and locally. TRICHOCLASIS, is characterized by brittleness of the HAIR, AND THE DEVELOPMENT OF LITTLE KNOTS ALONG THE SHAFT, WHICH LOOK LIKE " NITS." It is usually confined to the hair of the beard, and is not contagious. Treatment.—Shaving off the hair is occasionally neces- sary. JVatrum mur. may be given internally, and salt water washes used externally. URTICARIA, IS AN INFLAMMATION OF THE SKIN, CHARACTER- IZED BY CAPRICIOUSNESS OF ERUPTION, AND THE DEVELOPMENT OF REDDISH OR AVHITISH " AVHEALS," ATTENDED BY TINGLING AND STINGING. The Avheals of this affection vary greatly in size, but are ordinarily of the dimensions of a finger nail, and are com- 154 DISEASES OF THE SKIN. monly surrounded by an areola. They may be multiform, but are usually roundish or oval. To the touch they may be either soft or hard. When simple or uncomplicated they disappear Avithout leaving any mark or scar. A very annoy- ing, burning, stinging, tingling sensation, likened to the sting of the nettle, is a more or less constant accompani- ment, and gives rise to an almost irresistible desire to scratch. And so ephemeral is the disease that " scratch marks" are often all that is left for inspection. The wheals come and go suddenly, are oftentimes excited by simply rubbing the skin, and are prone to change base. Urticaria occurs at all periods of life, and may appear on any part of the body or mucous membrane. It usually pre- sents itself as an acute disorder, the result of some dietetic error, lasting only a Aveek or two. Occasionally, however, it appears as a chronic affection. Sometimes an cedematous condition precedes and accompanies the eruption, and at times an effusion of blood into the wheals, may take place. (U. purpurea.) An acute attack is generally ushered in Avith febrile symp- toms, headache, and more or less gastric derangement. The eruption appears suddenly, accompanied by intolerable itch- ing, and the entire surface may be covered in a very short time. After a while, it may be on the removal of the exciting cause, the symptoms begin to subside, and soon all vestiges of the disease have vanished. Urticaria constitutes about ten per cent, of all skin affec- tions. Its causes are many. Organic uterine disease in wo- men, and intestinal irritation in children are not infrequent sources. Acute urticaria may be precipitated by overloading DESCRIPTION AND TREATMENT. 155 the stemiach, or by the excessive use of wine or highly sea- soned food. A peculiar idiosyncrasy may cause its appearance after eating crabs, oysters, lobsters, sausage, mushrooms, strawberries, eggs, etc. Overdosing Avith Copaiva, Cubebs, Turpentine, or Valerian, will give rise to the rash. Urticaria, can hardly be mistaken for any other disease, although it bears some resemblance to dermatitis contusi- formis. It, however, wants the lividity, the regular course) the oval shape of the tumors, and the absence of itching of the latter. Treatment.—All dietetic errors^should be corrected, and ii an overloaded stomach is the cause, an emetic should be ad- ministeTed. The exciting cause must in all cases be removed as early as possible. Locally, warm vinegar and water lotions may be used to allay the itching and burning. A Chloroform and e-ream mixture, 2 grams of the former to 30 grams of the latter, "will oftentimes prove serviceable. FaAorable mention may also be made of the Benzoic acid wash (Benzoic acid 0.5 gram; Rose water 40 grams.) A Grincielia or Carbolic acid lotion at times acts well. The Turkish bath may help when other means fail. One of the following internal remedies Avill generally be indicated, and may be repeated ^pro impetus ratione. Allium ce'pa.—Nettle-rash on the thighs. Aiiacarclium.—Nettle-rash from emotional caus?s. Aiitimonium cruel.-—Chronic nettle-rash on the face and joints, accompanied by thirst, nausea and thick white coated tongue. Apis mel.—Red and inflamed raised patches of hives, with stinging and burning. Aggravated by heat, ameliorated by 156 DISEASES OF THE SKIN. cold Avater. Itching and appearance of blotches after scratching. Uterine catarrh. Arsenicum alb.—Wheals of a scarlet color on the face and neck, the size of a half dollar. With burning. Astacus fluvialis.—Iii chronic cases, when other reme- dies fail. Aurum.—Dirty yellow blotches on calves and legs, Avith burning. Better in a Avarm room. Belladonna.—Bright scarlet red, elevated puffy spots, surrounded by a white border. After eating cabbage or sour-krout. Berberis.—Blotches like nettle-rash on the shoulder and right arm, accompanied with burning and stinging. Mo- mentary cold sensation on the parts. Heart-burn Avith soap- sud taste in mouth. Bryonia.—Nettle-rash Avith rheumatic pains. From atmos- pheric changes. Caladium.—Nettle-rash on the chest, alternating with asthma. Calcarea carb.—Chronic nettle-rash. White elevated hard nettle-rash which disappears in the cold air. Acridity. Calcium sulphide.—Chronic nettle-rash on the fingers and hands. Carbo veg.—Blotches on the calves of legs, Avrists and feet. Burning in various places of the skin. Causticum.—Rash on the thighs just above the knees. Worse during dry, better during Avet Aveather. Cdironic net- tle rash. China.—Nettle-rash coming out after scratching. Fright- ful swelling of the face, forearms and hands, in the morning. DESCRIPTION AND TREATMENT. 157 Cimicifuga.—Urticaria from menstrual disorders. Cina.—White wheals surrounded by erythematous red- ness, first on the nose, then all over the body. From Avorms. Chloral.— Large raised wheals on the arms and legs, coming on suddenly, from a chill. Aggravated by the small- est quantity of Avine, beer, or spirits. In grain doses in obstinate cases. Cocculus.—Hard blotches, surrounded by red areolse, on the limbs, Avrists and back of the fingers. Burning itching as from nettles. Coniuni.—Stinging like flea-bites, only one stitch at a time. Evanescent itching. Copaiva.—Urticaria at first on the face, especially the forehead, then on the back of the hands, anel finally in iso- lated patches all oxer the body. Large red blotches, Avith constipation and fever. Urine scanty and full of sediment. Great restlessness. Condurango.—Chrcnic urticaria. Gastric pains, mostly at the cul-ele-sac of the stomach. Dulcamara.—White blotches Avith red areole, on the arms and thighs. Nettle-rash over the a\ hole body without fever. With intestinal catarrh. From exposure to damp, cold air. Fagopyrum.—Sore, red blotches inducing scratching, which aggravates. Swelling the size of a hen's egg on neck and shoulder. Dreadful stinging itching. Graphites.—Red spots like flea-bites all over, especially on the calves of the legs. Hypericum.—Eruption like nettle-rash on both hands at 4 p. m. Crawding in the hands and feet, they felt fuzzy. Io-natia.—During chilly stage of intermittent fever. 158 DISEASES OF THE SKIN. Kali carb.—Urticaria during menstruation. Lycopus.—Troublesome urticaria, especially affecting the left forearm and right leg, before eating. Magnesia carb.—Hard blotches as if from nettle' sting, worse during menstruation. Lycopodium.—Itching Avith nettle rash eruption on the- extremities. Merc. viv.—Small flat, light red blotches on the sexual parts, abdomen, chest and inner side of the thighs. Natrum mur.— White blotches on the arms and hands, turning red on scratching. Reel blotches over the whole body. Violent itching. Nux vom.—When accompanied by constipation, vertigo and headache. Podophyllum.—Intolerable itching of the skin on the' body ind arms; on scratching it raises up in blotches, like hives. Pulsatilla nig.—Red, hot spots like nettle-rash. After eating fat pork, fruits or buckAvheat. Pulsatilla nut.—Blotches on the right breast, standing out like measles, Avith red base, turning white on scratching. Violent itching, worse at night, before bed time. Robiuia.—Burning itching wherever a part of the face is touched. Itching of skin Avheie rests upon it. Sour stomach. Sarsaparilla.—Blotches as from nettle s. Ruining itchino- with chilliness. After abuse of Mermry. Sepia.—Red lentel-sized blotches on the hands. Chronic nettle rash, especially on the face, arms and thorax. Aggra- vated by cold. Ameliorated by warmth. After milk anel pork. DESCRIPTION AND TREATMENT. 159 Solanum oler.—Urticaria febrilis. Spigelia.—Small eleATitions like hives on the lower ex- tremities after scratching. Stannum.—Small itching hives below the wrist, through the day. Itching aggravated by rubbing. Sulphur.—Itching hives over the Avhole body. Chronic cases. Tartar emetic.—White lumps with red areola?. Eruption comes and goes. Worse after meat. IVtradyniite.- Nettle rash on face, after eating crabs. Triosteum pert.—Nettle-rash Avith gastric derangement. Urtica urens.—Nettle-rash attending or preceding rheuma- tism. Itching swellings all over the fingers. Aggra- vated every year at the same time. Ustilago.—Terrible nightly itching. Menstruation irreg- ular from ovarian irritation. During the climaxis. Veratrum alb.—Nettle-rash about the joints only. Zincuni met.—Stinging itching in the skin Avith nettle- rash eruption, after rubbing, Itching rash in hollows of the knees and bends of elbows. After moderate Avine drinking. VERRUCA, or Wart, may be defined as a hypertrophied PAPILLA OF THE SKIN, COA ERED AVITH A HYPERTROPHIC LAYER OF EPIDERMIS. Warts may develop as small circumscribed split-pea sized elevations, broad at the base, and of the same color or a little darker than the surrounding skin, e>r as flat and broad slightly elevated finger nail sized brownish colored growths. The former develop mostly on the hands in young people, and the latter on the back in elderly persons. 160 DISEASES of the skin. At times they appear as slender, conical, thread-like growths, and are about three millimeters long. These may occur either singly or in groups, and are seen mostly on the neck, face and eyelids. Digitated broad Avarts sometimes form on the scalp. They somewhat resemble a crab iu appearance, and hence have obtained the vernacular " crab Avarts." Venereal warts are pinkish or reddish vascular vegeta- tions, and occur for the most part on the genitals, prefer- ably on the penis and labia. They may also form about the mouth and anus, in the axille and between the toes. They are apt to grow very rapidly, and may attain considerable size. They are caused by the contact of irritating fluids, and may be either dry or moist, according to their location. They may occur in connection with gonorrhoea, but are never like the condylomata, a sign of constitutional syphilis. Treatment.—The smaller Avarts should be removed by the scissors, and the larger and more vascular ones by the liga- ture or galvano-caustic wire. Venereal warts need the strictest cleanliness. The dry ones may be treated locally by Thuja or Merc. cor. lotion. The moist ones respond best to dusting with the Proto-chloride of Mercury. Thuja locally has great reputation in removing all kinds of Avarts. Moles may be removed by the Acid nitrate of Mercury. The following are the uaually indicated internal remedies, and may be given ter die. Antimonium crud.—Soft smooth warts on the neck, arms, and hands. Berberis.—Warts the size of millet seeds. Bufo.—Warts on the back of the hands. DESCRIPTION AND TREATMENT. 161 Calcarea carb.—Small, soft Avarts. Cinnabar.—"Warts on the prepuce which bleed when touched. Causticu.ai.—Warts on the nose and eyebrows. Painful warts. Dulcamara.—Flat Avarts. Lachesis.—Warts on the thumb. Lyc< >podium .—Pediculated Avarts. Magnesia carb.—May be given two or three grains a day, when other remedies fail. Natruai carb.—Ulcerated Avarts. Nitric acid.—Soft warts. Warts on the eyelids. Sepia.—Large, hard warts. Sulphur.—Hard Avarts. W^arts under the eyes. Thuja.—Warts on the fingers. Horny, hard Avarts. It follows Avell after Calcarea. WASHERWOMAN'S ITCH, is an inflammation of the skin occurring on the hands in Avasherwomen, see Eczema. XANTHOMA, is a connective tissue new groavth, char- acterized BY THE PRESSENCE OF SLIGHTLY-RAISED, CIRCUM- SCRIBED " CHAMOIS-LEATHER" PATCHES, OR GOLDEN-YELLOW TUBERCLES. Its most common seat is the eyelid, near the inner canthus, but it may occur on any part of the body. It never occurs in children, is more common in Avomen than in men, and is frequently associated Avith jaundice. The macular form appears as yelloAV rounded, oval, or semi-circular, "chamois-leather" looking patches, unaccom- panied by pain. The tubercular form consists of rounded, golden-yellow tubercles, varying in size from a pin's-head 11 162 DISEASES OF THE SKIN. to a large pea. This variety is found less frequently upon the eyelids than on other parts. In both forms the new growth consists of fibrous tissue containing fat granules, and it is to the latter that the disease oAves its color. Treatment.—Xanthoma can only be cured by removing the patch. XERODERMA, see Icthyosis. ZOSTER, or Shangles, is an acute disease, characterized BY THE APPEARANCE OF GROUPS OF VESICLES, UPON INFLAMED BASES, ALONG THE COURSE OF THE CUTANEOUS NERVES, AT- TENDED BY' NEURALGIC PAIN. Like the eruptive fevers, zoster is attended by symptoms preceding the outbreak of the eruption, such as fever and neuralgic pain; the eruption, too, presents definite charac- ters, runs a clearly defined course, and with it the febrile malady disappears. Moreover it rarely attacks the same person twice, and is usually attended by sequela — notably neuralgic pain. It appears mostly on the chest, along the course of the intercostal nerves, and is generally unilateral. When occur- ring in the orbital region, it may seriously affect the eye, and is apt to leave behind a severe neuralgia. The eruption is usually preceded by a feeling of prickling, stinging itch- ing of the parts, which lasts from tAventy-fourto forty-eight hours, and abates on the appearance of the vesicles. The vesicles are at first filled with a clear serum, which soon becomes turbid. They last from eight to ten days, and if not broken, either undergo absorption or dry up and disap- pear in little brown scales. Zoster occurs most frequently between the ages of tAvelve DESCRIPTION AND TREATMENT. 163 and twenty-four, and attacks males more than females. It runs its course in from two to three Aveeks, and is due to an inflammation of the sympathetic fibres of the ganglia through which the nerves course to the part affected. The eruption involves generally the stratum corneum, the stratum lucidum and the rete, and acts, if the expression is allowed, as the explosion of the nerve disease on the surface. Atmospheric changes and mechanical violence play important parts in its causation. The characters of zoster are usually so well marked, that it can hardly be mistaken for any other affec- tion. From herpes Avith which it maybe confounded, it can be distinguished as follows: Zoster appears but once in a life time, and is generally unilateral. Herpes is prone to recur and is usually bi-lateral. Zoster is associated with a lesion of some nerve or ganglion, and appears along the course of a nerve or nerves. Herpes folloAVS in the train of catarrhal affections and pneumonia, and is generally confined to the face and genitals. Neural- gic pains precede the eruption of zoster; herpes has only a burning itching. Zoster often leaves cicatrices and a trou- blesome neuralgia. Herpes never does. Treatment.—The galvanic current has been found very beneficial, when applied from fifteen to twenty minutes daily, d'he local treatment consists in protecting the vesicles and relieving the neuralgic pain. To this end the parts may be painted with Collodion, or dusted Avith the Sub-nitrate of Bismuth and starch, equal parts, and a protective bandage applied. Chaulmoogra oil will oftentimes prove a very ben- eficial application. Canthaiis lotion has been highly recom- mended, and Avill at times be of service. 164 DISEASES OF THE SKIN. Rhus tox., repeated pro impetus ratione, is the principal internal remedy. Others may be indicated as folloAvs: Aconite.—In the earlier stages, when the neuralgic pain is accompanied by febrile symptoms. Arsenicum alb.—Confluent eruption, Avith intense burn- ing of the blisters. In debilitated constitutions. Neural- gia. Cantharis.—Large blisters, burning on touching. More on the right side. Worse in the open air. Cistus.—Zoster on the back. Neuralgic symptoms. Comocladia.—Zoster on the legs. Dulcamara.—Zoster after taking cold from damp air. Better from gentle exercise. Graphites.—Zoster on the left side. Large blisters from the spine to the umbilicus, burning Avhen touched. Worse indoors. Better in the open air. Iris versic.—Zoster especially on the right side. Follow- ing gastric derangement. Pain in the liver. Kalmia lat.—Facial neuralgia remaining after zoster. Worse at night. Lachesis.—Zoster during spring and fall. Mercurius.—Zoster on the right side, extending across the abdomen. Worse at night, from the Avarmth of the bed. Tendency to suppuration. Mezereum.—Zoster in old people. Neuralgic pains. Worse at 9 p. m. Ranunculus bulb.—Zoster aggravated by change of tem- perature. Neuralgic sequele. Sempervivium tect.—In obstinate cases. May be used internally and locally. description and treatment. 165 Thuja.—Zoster, with eruption only on covered parts. Better from gentle rubbing. Zinc met.—Neuralgia following zoster. Zinc phos.—When other remedies fail. Following brain- fag in literary men. PART III.—A Chart of Characteristics With Diagnostic, erapeutic, Dietetic, and Hygienic Hints. CL.ASS. DISEASES. DEFINITIONS AND DIAGNOSTIC FEATURES. THERAPEUTIC, DIETETIC AND HYGIENIC HINTS. « < O H n O CO W 0 Pi o OQ M ft M Anidrosis. Functional disease of the perspiratory apparatus. Char-acterized by insufficient sweat. May be either congenital or ac-quired. iEthusa. Flum bum, etc. Turkish baths. Free use of water internally an d e x t e r-nally. Bromidrosis. (Osmidrosis.) Functional disorder of sweat glands. Characterized by offen-bive sweat. Most in axille and feet. General or local. Conium mac, (acrid.) Petro-leum, [axillae). Silicea, [feet). Staphysagria, ( rotten ). Zin-cum, (profuse), etc. Alum or Carbolic acid lotion and Dia-cnylon plaster dressings. Strictest cleanliness. Chromidrosis. Functional disorder of sweat glands. Characterized b y colored perspiration. Fitful secretion. In hypochondri-acs and unmarrie d women with uterine disorders. Nux Vomica. Comedo. (Grub.) Disorder of sebaceous glands Characterized by small black-topped, sebaceous points. Chin, forehead and cheeks. Young people. Face looks as if sprinkled with gunpowder. Baryta carb. Selenium, Sumb'ul, etc. Remove •'grubs'' with comedo extractor. Sul-phur lotion. Matrimony. Ex-clude fatty food. i Sebaceous Cyst, (Wen.) Hyperidrosis. Miliaria. ( Prickly heat.) Milium. (Skin-stones.) A white, round or oval tumor, of variable size, composed of se- baceous matter enclosed in a sac. Single or multiple. Painless. Scalp, face and neck. Disordered action of the sweat glands. Characterized by numer- ous pin-head sized reddened papules or vesico-papules attend- ed with heat and tingling. Trunk usual seat. May appear on neck, face and arms. More in summer. Apt to relapse. Disorder of sebaceous glands. Characterized by white, round- ish sebaceous points beneath the epidermis, size from millet-seed to a split-pea. Eyelids and fore- head. More common in women than in men. Potassium iodide. Baryta or Bromine. Excision. Bryonia. Arsenicum a 1 b. Raphanus, etc. Carbolated bran baths, followed by dusting with sub-nitrate of bismuth and starch, or lycopodium powder. Cast off superfluous clothing. Calcium iodide and Staphysa- gria, and Tabacum. Remove by knife. Use Saponaria bark wash. Functional disorder of sweat glands. Characterized by exces- sive sweat. General or local. Sym- metrical or unilateral. Local. Most on head, hands, feet and genitals. Flat-footed people. Baptisia, Boletus. Calc. carb. Jaborandi. Lactic acid. Sele- nium, etc. Use as little water as possible. GO 0 < « W O GO H Q O 00 S molltjscum Sebaceum. Seborrhcea. (Sebaceous flux.) Sudamina. Disease of sebaceous glands. Characterized by roundish, pea- sized tumors, umbihcated in the center and of a pinkish white color. Face mostly. In chil- dren. May be semi-epidemic. Tumors contain cheesy matter. Functional diseireler of seba- ceous glands. Characterized by excessive secretion of sebum. On face and scalp. More in women than in men. Appears in the light complexioiied, as an oily coating; and in the dark complexioned, as dirty white or yellow flat scales, (dandruff). Disorder of sweat glands, Characterized by pin-head "sized vesicles, formed by the collec- tion of sweat between the layers of epidermis. In summer and in acute diseases. Sign of general debility. Silicea and Teucrium. Calc. ars. Bromine, etc. In early stage, Acid nitrate of Mercury, locally. If tumors are large use the knife. Bufo. Bryonia. Calc. carb. Kali carb. Nairnm. Plumbum. Raphanus, etc. Locally, in mild cases. Saponaria bark wash. Glyceral tannin, or tannin and rice powder, (face). In chronic cases. Sapo viridis. Merc. cor. lotion, or Red precipitate oint. Keep system in healthy state. Bryonia, Ammonicum raur., and Urtica urens. Look after the general health. Acne. (Stone-pock.) Anthrax. (Carbuncle.) Dermatitis Contusiformis. (Erythema nodosum.) Disease of the sebaceous glands. Caused by retention of sebum. Characterized by papules, tuber- cles and pustules. Pin-head or pea- sized elevations around glandular orilices. On face and back. At puberty. From gastric derange- ment, functional derangement of sexual system. Tar, etc. Phlegmonous inflammation, characterized by necrosis of the cellular tissue, with suppuration and the discharge of the necrosed masses, called cores, with pus, through corresponding sieve-like openings. Circumscribed. Com- mences with burning pains. Size from a fifty-cent piece to a saucer. On'nape of neck, shoulders, fore- head and buttocks. More in win- ter. May be epidemic. Characterized by oval or round purplish noelules, varying in size from a hickory nut to a fist. Fe- brile disturbance. Nodules form suddenly. Never suppurate. Fade away like bruises. Anterior surface of leg. Young persons, especially females. Relapses. Ant. crud. Bell. Chel.maj. Granatum. Kali. bich. Kali. bromat. Peitass. iod. Nit. acid. Nux. jug. Ledum. Phos. acid. Sulphur. Siimbul.etc. Extract comedos. Stimulating lotions in mild forms. Soothing appli- cations in severe cases. Rumex lotion. Merc.corr. Merc, jodat. and Bi-jodat (indurated). Light diet. Sea-salt baths. Anthracinum. Ars. alb. Arc- tium lappa. Nit. acid. La- chesis. Phytolacca. Silicea. etc. Locally : Ice-bags in early stages. Later: crucial incision, hot poultices, or strapping early. Later: caustics. Nourishing diet. Brandy and egg, etc. Rhusvenenat. Arnica. Pte- lea trif., etc. Locally : Arnica or Hamamelis. Horizontal pos- ture. en Dermatitis Exfoliativa. ( Pityriasis rubra.) Dysidrosis. Ecthyma. Characterized by highly red- dened skin, and abundant ex- foliation of epidermis in large white flakes. Whole surface. Handfuls of flakes shed. Adult life. Involves papillary layer. Due to disturbance of trophic nerves. Disease of sweat structures of hands and feet. Characterized by redness and swelling of the parts, with distension of the sweat ducts in the shape of sago- like points, and the develop- ment of bullae. In summ e r. The nervously debilitated. At- tacks symmetrically the fingers, palms and soles. Characterized by large, isolat- ed, painful pustules, situated upon hard and iDflamed bases, and followed by dark brown crusts. Slight fever. Superfi- cial lesion. Develops rapidly. On neck, shoulders and back. Ars. alb. Ars. jodat. Kali ars. Piper methyst., etc. Bran baths or decoction of walnut leaves, followed by oily inunc- tions. Tarry preparations. Clematis and Natrum sulph. Alkaline starch baths. Carron oil. Ars. alb. Merc. Tart. emet.. etc. Weak, White Precipitate oint. Carbolic acid wash. Gen- erous diet. Eczema. (Salt-rheum.) (Grocer's itch.) (Baker's itch.) (Washerwoman's it.h,) Erythema. A catarrhal inflammation. Characterized by presence of a discharge having the quality of stiffening linen. Stages; Ery- thema, papulation, vesiculation, pustulation, incrustation, and squamation. Acute or chronic. Light florid complexioiied indi- viduals. Head in infancy. Trunk and genitals in adult life. Lower limbs in old ag e. Itching. Greenish yellow crusts. Due to faulty innervation. Characterized b y macules, papules or tubercles, attended by more or less itching and burn- ing. Redness disappears under pressure leaves a yellow spot, which becomes red again. In children and young people. On back of hands and feet, arms. legs and forehead. Spring and fall. Known by its superficial protean character, and general distribution. Ars. alb. Bovista. Calc. carb. Croton tig. Graph. Nux. jug. Oleander. Rhus. Sarsap. Sul- phur, etc. Locally—Early: Bran washes, emollient poultices, etc. Later: Zinc and starch, Lycopo- dium or Glyceral tannin. For itching: Dioscorea, Carbolicacid or Hydrocyanic acid, lotions or Grimlel. cerate (acute cases). Py- roligneous oil of Juniper (in non- inflammatory cases). Benz. oxide of Zinc oipt. or Oleate of Lith- arge. White or red precipitate oint. Chrysophanic cerate (squa- mous stage). Sapo viridis (chron- ic). Tarry compounds. Iris, ver- sic. Dulc. Lappa, etc. Cerates. Aconite. Ars. jodat. Hell. Chei. maj. Chloral hydrate. Lactic acid. Mezereum. -Nux. vom. Ustilago, etc. Carbolic acid, Grindelia or Verat. vir., lotion. Oxide of Zinc or Lyco- podium powder. CO O M H ■< i—i Furuncle. (Boil.) Circumscribed inflammation of the skin and connective tis-sue, varying in size from a small pea to a hickory nut, having an indurated and inflamed base, and terminating in suppuration and the formation of a " core." On face, back and gluteal region. Dependent on disordered blood states or depraved conditions of system. Ant. crud. Bell. Bellisperen-nis. Calc. carb. Calc. mur. Calc. sulph. Gels. Nitric acid. Nux. jug. Phos. acid. Rhus rad., etc. Muriate of Lime lo-tion. Flax-seed or tomato poul-tices. Gelsemium or Lappa cerate. Well hygiened. Good wholesome diet. Herpes. (Fever blister.) Acute. Characterized b y groups of vesicles, having redden-ed slightly inflamed bases, and situated on lace and genitals. Febrile symptoms. Heat, red-ness and swelling. Vesicles larger than in eczema, but smaller than in zoster. Excited by cold. May be symptomatic. Aconite. Ars. alb. Bufo. Calcium sulph. Kali bich. Merc. sol. Natrum mur. Sar-saparilla, etc. Camphorated cream or cologne water, locally. Hydroa. Characterized by isolated vesi-cles which tend to recur. Starts as little papules. Itching. Sym-metrical. On face, exterior sur-faces of limbs and genitals. Two or three weeks duration. Potass, iod. Kreasote. Magne-sia carb., etc. Salzburg springs. Hydro-adenitis. Impetigo Ce)NTAGIOSA. Inflammation of perspiratory follicles and adjacent connec- tive tissue, terminating in sup- puration. Bright red, pea-sized SAvellings. Suppurate in a few days. In axilla?, around nipple and on perineum. Has no core. Characterized by one or more discrete vesicles or vesico-pus- tules, generally umbilicated, varying in size from a split pea to a hazel-nut, and followed bv flat, straAV-colored, usually fun- goid crusts. Acute. Contagious. Febrile symptoms. Vesicles grow rapidly and have red areolte. Crusts, straw-colored, flat, and looks as if stuck on. Runs its course in one or two weeks. Most on forehead and cheeks. May extend to mucous membrane. Wake of vaccina- tion. Phos. acid, (axillae). Phos- phorus, (nipple). Nit. acid, (perineum). Gels., or Lappa lo- tion. Tomato poultices. Hot fomentations. Ant. crud. Aconite. Euphor- bium. Tart. emet. Kali bich. Silicea, etc. Soothing applica- tions. White precipitate oint- ment. Well nourished. Intertrigo. Lichen planus. A hypersemic affection. Char- acterized by heat, redness and an abraded surface, with macer- ation of epidermis. From con- tact of two cutaneous surfaces. In fat persons and in infants. Characterized by dull, red, flat topped, angular based, pin- head sized, glazed papules. ('hronic. Runs a papular course. Itching. Symmetrical. Leave melasmic stains. Front of fore- arms and wrists, thighs, abdo- men and leg below the knee. More in Avomen. Disturbance of the trophic neryes of hair papillae, with hypereemia and new tissue formation. Calc. carb. Cham. Graph. Petroleum. Nux. jug., etc. Wash with soap and water. Dust with Lycopodium or Oxide or Zinc, and rice powder. Ant. crud. Ars. alb. Kali bich. Nux. jug., etc. Carbolic acid, Grindelia or H>drocyanic acid dil. wash. Pyrofigneousoil of Juniper. Liberally fed and well hygiened. Lichen simplex. Pempiiigt Characterized by round, solid millet-seed, sized, flesh-colored, or reddish papules. Itching. Distinctly papular course. Outer aspects of forearm, neck and thigh. Characterized by bullae, in groups of three or four, and va- rying in size from a pea to a hickory nut. Mostly chronic. P. Vulgaris on limbs and ankles. Blisters round or oval. Succes- siint., (ulcers). Tinct. of Ben-zoin as preventive. Pityriasis. ( Branny tetter..) Characterized by fine, dry, bran-like scales, seated on slightly reddened, non-infiltrat-ed surface. Slight itching. On scalp, face and trunk. Seated in deep layers of epidermis, and consists in excessive cell prolif-eration. Ars. alb. Fluoric acid. Kali ars., etc. Locally : Infusion of Saponaria bark, or Glycerole of Borax. Prairie itch Acute. Appears in new dis-tricts. May be epidemic. Head-ache, malaise. Slight fever. Vesicles, pin-head or mustard-seed sized. Intense itching. ''Scratch marks."'' Large black-ish scales. Boils. On neck, shoulders, back and outer sur-face of limbs. Rumex crisp. Rhus. tox. Le-dum, etc. Locally : Diluted lye of wood ashes. Hepar sulph. Kali lotion. Prurigo. Psoriasis. (Dry Titter.) Characterized by small pap- ules of same color as skin, ac- companied by intense itching. Skin dry, rough, harsh and thickened. "Scratch marks." Exterior .surfaces of lower ex- tremities mostly. Starts before puberty. Worse in winter. May continue through life. Due to chronic changes in the papil- lary layer. Constitutional disease. Char- acterized by reddish thickened patches, covered with whitish or yellowish white, mother-of-pearl colored scales. Develops rapidly. Elbows and knees mostly. Apt to be symmetrical. Scales are imbricated. Of malarial or traumatic origin. Due to per- version of cell life of the rete. Sulphur. Ars. alb. Ambra. Dioscorea. Dolichos prur. Oleander. Nitric acid, etc. Car- bolic acid or Mezereum lotion. Tar or Sulphur baths. Nutri- tious diet. Ars. alb. Ars. jod. Merc. sol. Muriatic acid. Phos. Sul, etc. Locally: Saponaria bark, or bran baths. Inunctions with Cod-liver or Chaulmoogra oil. Iodide of Sulphur or Chrysoph- anic cerate. Oil of Cade. Bin- iodide of Mercury or white pre- cipitate oint. Green soap treat- ment. Generous diet. Cod- liver oil. 00 Strophulus. (Red-gum). (Tooth-rash). Urticaria. (Nettle-rash). (Hives). Characterized by small, red or white papules, varying in size from a pin's head to a millet seed. On face, neck and arms, mostly. Two forms. Due to congestion about the mouths of sweat follicles. Characterized by sudden de- velopment of wheals, of a whit- ish or reddish color, attended by itching and burning. Wheals are usually round or oval, and finger-nail sized. Come and go suddenly. " Scratch-marks." May be ushered in by febrile symptoms. Caused by dietetic errors, organic uterine disease, and intestinal irritation. Chamomilla. Calcarea carb. Spiranthes. Borax. Ledum. Apis. Cicuta. Sumbul, etc. Apis mel. Berberis. Calcarea carbonica. Cimicifuga. Chloral hydrate. Cina. Copaiva. Con- durango. Ignatia. Kali carb. Natrum. Puis. nig. Robinia. Sulphur, Ustilago, etc. Locally : Vinegar and water, or Chloro- form and cream. Benzoic acid or Carbolic acid lotion. Turkish baths. Remove exciting cause. CO 55 O < < g M CO H « o H M M Zoster. (Shingles). Characterized by groups of split-pea sized vesicles, seated along the course of nerves, and attended by neuralgic pain. Re-sembles eruptive fevers. Be-tween ages of 12 and 24. Runs course in 2 or 3 weeks. Unilat-eral. Often leaves cicatrices. Neuralgia, a sequel. Due to inflammation of sympathetic fibres of ganglia. Rhus toxicodendron. Como-cladia. Graphites. Dulcamara Kalmia. Mercurius. Mezereum. Zincum met. Zincum phos., etc. Galvanic current. Locally: Collodion, or Suonitrate of Bis-muth and starch, dusting pow-der. Chaulmoogra oil, or Can-tharis lotion. Purpura. Characterized by an effusion of red blood globules into the cutis, usually unattended by constitutional disturbance. Spots first bright red, then pur-ple, and change color like a bruise. On legs, mostly. Usual-ly symmetrical. More in aged. Occur in crops. Run a course of 8 or 10 days. May be haem-orrhage from mucous membrane (land-scurvy). There is then constitutional disturbance. Ars. alb. (simple). Sulphuric acid (hemorrhagic). Baptisia. Bryonia. Chloral hydrate. Rhus tox. Phos. Veratrum vir., etc. Hamamelis, locally. Malt foods. Outdoor exercise. Chloasma. (Liver spots). CO s 5 a, o 03 H 03 Pi 5? c Lentigo. (Freckle). « Ph Callositas. j> Ph (Callosity). 55 03 . 5* Claaus. (Corn). S-l o A coloration of the skin, char-acterized by round or OA^al, nick-el-sized or larger, yellowish or brownish patches. On face mostly. More in women than in men. Argent nit. Guarsea. Lauro-cerasus. Petroleum. Sepia, etc. Locally: Merc. cor. lotion, or Muriate of Lime solution. A discoloration of skin, due to deposit of pigment in the rete mucosum, is characterized by round, yellowish, split-pea sized spots. On cheeks and back of hands. Light-complexioned, red-haired people. Kali carb. Sepia. Sulphur, etc. Merc. cor. lotion. Yellowish or whitish, nickel-sized, horny, elevated patches. On hands and feet. Caused by friction. More in men. Graphites (hands). Silicea {feet). A small, usually split-pea sized, flat, horny formation, more or less deeply seated, and Iiainful on pressure. May be hard or soft. Ant. crud. {hard corns). Sulph. (soft corns). Corn plasters (pro-tection). Verat. vir. lotion (if inflamed), etc. Wear easy fitting boots. CO 03 H 5« < k) (h CO 03 W < a Oh O P- 03 H Eh 03 © H M Pi fc 5* fc a © © 5^ Pi © Elephan- tiasis. (Elephant leg.) Frambcesia. (Yaws.) 00 to Chronic disease. Character-ized by great nypertrophy of skin, and subcutaneous connec-tive tissue, usually confined to the lower limbs and genitals. Ushered in bv chill, folloAved by febrile symptoms. Swelling of leg, painfully distended lym-phatics. Due to the filaria san-guinis. In malarial districts and tropical climates. Myristica. Hydrocotyle. An-acardium. Elaeis, etc. Es-march's bandage. Compression of main artery. Excision of sciatic nerve. Hamamelis or Chaulmoogra oil, dressings. Milk diet. Change of climate. An endemic contagious dis-ease. Characterized by var-iously-sized reddish papules, tubercles and tumors, in all stages of development. Start as pin-head-sized points. First resemble a currant, then a rasp berry, and lastly a cherry. Rare-ly occurs twice. Mostly on face and genitals. Endemic in West Indies, etc. The Iodides of Mercury and Potassium. Jatropha lotion. Rosacea. (Copper-nose.) (Wine-nose.) Sclero- derma. (Hide-bound disease.) A chronic disease. Affects more particularly the nose, cheeks and forehead, results from dilatation of the blood- vessels, with increased growth of connective tissue, and is characterized by redness, and a tendency to the development of tubercles and pustules. Three stages: First, passive hyper- aemia, nose cold. Second, min- ute bloodvessels appear. Third, vessels enlarge, skin becomes thickened, papules and tu bercles develop. Disease of middle life._____________ A chronic affection. Charac- terized by hardness and imlas- ticity of integument. Skin lias a yellowish-brown waxy appear- ance. Apt to be symmetrical. Due to stagnation of lymph in the lymph spaces. Arsen. bromide. Agaricus. Bromine. Carbo an. Nux. vom. Petroleum. Rhus rad. etc. Sulphur or Merc. corr. lotions (first stage). Incision of vessels. Faradic current (.sec- ond stage.) Excision of redun- dant tissue, etc. Ant. crud. beris. Elans. Galvanism. Alumina. Ber- Rhus tox., etc. CO s s Oh O 03 Eh 03 W 64 5* W 5^ t-4 6g 55 co o H O h ° H hi < o scleriasis. Onychogry-PHOSIS. An induration of cellular tis-sue, in new-born children. May be congenital or appear during early months of infant life. Stearine-like deposit in the sub-cutaneous tissues. Usually fa-tal. Elaeis guineensis. Characterized by twisted bent nails, which are thickened, and of a yellowish or brownish col-or. Mostly nails of toes and fin-gers. Attacks old people. Graphites and Silicea. 5* a a ph o CO « 3 Oi O H <5 5^ co M H & O C H 5? W O & o H 5> H ■ O 6t) W t> *Z CO o H © Dermatol-YSIS. A hypertrophy of the skin assuming the form of pendulous purse-like folds. Seldom ap-pears before puberty. Runs a chronic course. Bromide of Ammonium. Large folds may be ligatured or excised. Leucoder-ma. (Accjuir d Pie-bald Skin.) Characterized by localized loss of pigment. Patches round or oval, of milk white color. Usually on face, hands, and genitals. Adult life. Progno-sis unfavorable. Sulphide of Arsenicum. Na-trum. Nitric acid. Phosphide of Zinc, etc. Galvanism. Local-ly: Acetic acid for pigmentation around the patch. MORPIlCSA. Characterized by roundish, dirty alabaster-looking patches, circumscribed by lilac-tinted borders, and varying in diame-ter from half an inch to two inches. Course of left supra-orbital nerve most frequent seat. Runs slow course. ^ May recover spontaneously. Phosphorus. Constant gal-vanic current. Well fed. Cod-Liver or Chaulmoogra oil. 00 CI CO w M a pi © 03 b> < hi M < Pi © CO hi H P © O Athofhy of THE NAIL. May be either congenital or ac-quired, and is characterized by deficient growths of nail sub-stance. Nails are brittle and look as if worm-eaten. Have a leaden hue. Silicea. Linear atrophy. Characterized by white or claret colored, depressed, scar-like streaks or spots. Streaks are one or two lines broad by several inches long. Spots vary from pin's head to a pea in size. Mostly on the thighs. Due to cessation of trophic nerve influ-ence in localized areas. Cocculus (claret spots). Sul-phur or Graphites (white spots). Sabadilla (streaks). Cod-liver oil. Fibroma. (Polypus of the Skin.) Characterized by sessile or pe-dunculated outgrowths, from the connective tissue, generally club-shaped, and varying in size from a pea to a large pear. Pain-less. Small ones are soft. The large ones are elastic and fib-rous. Large ones may ulcerate. Cal. ars. Lycop, etc. Remove large tumors by knife elastic ligature or galvano-caustic. Smaller ones disappear under Acid nitrate of Mercury, locally. Keloid. Characterized by one or more flatfish smooth-surfaced tumors, usually upon the site of cicatri-ces. Tumor is made up of a body having numerous prolongations or claws. Size of five-cent piece or larger. Mostly on sternum mammae. Adult life. Negroes. Spontaneous evolution may take place. Fluoric acid. Graph. Nit. acid. Sabina, etc. Galvanism. Xanthoma. Characterized by variously sized golden-yellow, non-indur-ated macules or tubercles. On eyelid and inner canthus. Wom-en mostly. "Chamois-leather" patches. Golden-yellow tuber-cles. Consists of fibrous tissue containing fat granules. Removal of the patch. Njevus. (Port-wine stain.) (Mother's- mark.) Telangiec- tasis. A congenital formation seated in the skin and subcutaneous tis- sue. May be either pigmentary or vascular. Piqmentary are dark cole>red sharply defined spots. When covered with hair they are called " mouse marks." Vascular naevi may be arterial or venous. Redish or purplish col- or. Characterized by circum- scribed vascular cutaneous growths, appearing for the most part durinq adult life. Bright red pin-head or split pea sized. On lace and neck, mav terminate spontaneously, or remain through life. Carbo veg. (piqmentary). Thuja (vascular). Condurango, Calcarea carb., etc. Locally: for pigmentary. Collodion and Merc. cor. paint. For vascular, Electrolysis or the subcutaneous ligature. Same treatment as naevus. Condurago. Epithelk ma. ! (Epithelial cf cer.) W a CO CO a Eh Eh £ 55 c C 03 G •< £ ►J H a fc 53 -< P3 5> 0 fa An affection of middle life. May start either as a flat infil- tration, a wart or other growth. Earliest sign a simple crack, or hard pale dusky lump which sooner or later fissures. Typi- cal ulcer is roundish, split-pea size or larger, has hard sharply defined edges, and secretes a scanty yellow viscid fluid. This form is met with in smokers. Se- lects as seat the lower lip. On the scrotum it is chimney sweeper's cancer. On the upper part of face, rodent ulcers. Second form commences as papules, which grow, and later tend to form red- dish or purplish, walnut-sized aggregations. Sharp pains. Ulcerate. Ulcers have hard, everted, indurated and under- mined edges, secrete an offen- sive pale yellow viscid fluid, and bleed easily. Patient may even- tually die from exhaustion. At- tacks mucous membrane of cheeks preferably. Third form, may develop as wart-like growths or cauliflower excres- ences. Split-pea or hazel-nut sized. Runs course of second form mostly. E. Originates in the endothelium of the lymphat- ics. Thuja. Ars. alb. Conduran- go, and Red-clover, blossom tea. Locally: Arsenical mucil- age. The knife, or the galvano caustic. Leprosy. w a CO cc a Eh CO M Eh s fc 03 © © M H t-1 a fc 55 < 03 > o fa Lupus ery- © thematosus. (Erythematous scrofulide. (Butterfly lu-pus.) A constitutional disease. Characterized by a formation of a new growth, resembling gran-ulation tissue, usually resulting in the destruction of the parts, with anaesthesia and great de-formity. Endemic in some countries. Warm climates. Ma-cular. Tubercular. Anaesthetic. Gradual decline in health. Ma-cular: faint brownish patches or bullae followed by scars and pigmentation, patches are dirty-grey color in center, and brown-ish at periphery. Hyperaesthesia at first, then anaesthesia. On trunk and extensor surfaces of extremities. Tubercular: Dull brownish-red tubercles varying in size from a pea to a plum. Mostly on face. Leonine ex-pression. Ulceration. Hydrocotyle. Piper methys-ticum. Calotropis gig. Graph. Sepia. Hura brazil. Guano. Cuprum, etc. Locally: Warm baths and Gurjun oil inunctions. Generous diet. Cod liver or Chaulmoogra oil. Segregation of the lepers. Characterized by one or more usually roundish or oval, varia-bly-sized, reddish patches, cov-ered with fine, thin whitish or grayish fatty adherent scales. Pin-head sized pale red spots on cheeks and nose. Centers mark-ed by greenish comedo-points. Covered with adherent fatty scales. Follicles distended and patulous. Seldom before the 20th year. Extend at periphery. Iodine. Guaraca. Hydroco-tyle. Cistus. Apis, etc. Locally: Saponaria bark or Sulphur baths. Oil of cade. Curette. Good diet. Fresh air and fre-quent bathing. W a CO CO a CO H H O 55 a O 0 H -< (£ A « a 55 55 «i a > $ fa © Lupus vul- garis. (Tubercular scrofulide.) (Wolf.) Rhino- scleroma. A disease of the derma, char- acterized by variously-shaped, pea-sized or larger, yellowish or reddish elevations, which usual- ly terminate in ulceration and cicatrization. Begins as yellow or red solid points, which en- large to form tubercles. May terminate by insensible absorp- tion or ulceration. Puberty. Face and extremities. Crusts after ulceration, are brownish- red and scanty. Cicatrices are shrunken and yellowish. Characterized by irregularly- shaped, sharp bordered, flat swellings, of a normal or dark reddish-brown color, occurring mostly on nose and upper lip. Unattended by pain, but sensi- tive to pressure. Ars. alb. Cistus. Graph. Guaraca. Hydrocotvle. Sta- physagra, etc. Locally : Early stage, Bin-iodide of Mercury oint. Later, Irido - platinum needle dipped in fused Nitrate. Arsenical mucilage. Cosme's paste. Pyrogallicoint. Curette. Nutritious diet. Fresh air. Out- door exercise. Calcarea phos. Guaraca. Rhus rad., etc. Removed by using the irido-platinum points | and Squibb's fused Nitrate. CO a O a © H 55 a CO «0 EH O H ■< a 55 < a © fa o Sarcoma CUTIS. Consists of brownish-red or bluish-red, variously-sized tu-bercles or nodules, attended by a diffused thickening of the skin. A rare and malignant disease. Occurs mostly in adult life. Usually terminates fatally. Calc. phos. Silicea. Condu-rango. Nitric acid, etc. Scrofulo-derma. A strumous disease of the skin, commencing as indolent, painless, livid tubercles, that slowly soften and give place to unhealthy ulcers, with free in-crustation. Mostly on neck and beneath the lower jaw. Oc-casionally on thorax, in axillae and on groins. Calcium sulphide. Calcium iodide. Theridion. Scrofularia, etc. Locally : Iodide of starch paste to ulcers. Generous diet. Out-door exercise. Fresh air. Cod-liver oil. Syphilis. ( yphilis ( f the Skin.) Manifestations of general syphilis on the skin. May be sec-ondary or tertiary. Have a his-tory of syphilitic inoculation. Are of a reddish yellow-brown color. Are polymorphous. Are devoid of pain and itching. Crusts are thick, greenish black. Ulcers are of an ash-gray color, often serpiginous or horse-shoe shaped. Diffused eruptions, generally symmetrical, later ir-regularly distributed. Scales are thin and occur in small cir-cular spots. Are non-inflamma-tory and tend to recur. H a CO a CO M Eh H O a 55 O 0 H © fa o Syphilides. £3" bo E May be herpetic or variceilajorm. Herpet- ic vesicles, are millet-seed or pea-sized, and are seated on coffee-colored base. May be arranged in circles or segments of eircles. They last a week and disappear without scarring. Varicellaform vesicles are about the size of small peas, are surrounded by coppery red areolae, and are; occasionally umbilicated. Form greenish-brown scabs. Leave purplish discolorations. On face mostly. Sixth month after chancre. "• Coffee-with-milk " colored macules, varying in size from a cent-piece to a half- dollar. Oftenest in women. Mostly on neck. Lasts one or two months. Comes between fourth and twelfth month. Three forms: 1st. Millet-seed sized ephemeral dead-grey-colored pustules, which dry and form brownish rough scabs on forehead, angles of mouth and base of nose. 2d. Pin-head or split-pea sized acu- minated pustules, which form brownish scabs, and leave small, white depressed cicatrices. On scalp, face and trunk. 3d. Ecthymatous umbilicated pustules. Size, from a pea to a hickory-nut. Have dark areola. Greenish brown scabs, which leave copper-colored cicatrices. Merc. corr. Cin- nabar, and Merc. iodide. Loc ally: Merc. corr. lotion or the Oleate of Mer- cury. Nitric acid or Cal- cium sulphide. Kali bich. and Merc. nit. Locally: White precipitate ointment. Pea to walnut-sized blebs. Dark, greenish-brown scabs. Rare. May occur in the newly- born. Small red circular blotches covered with scales. Leave dark colored spots. Commonly symmetrical. Sixth month after chancre. Circumscribed dome-shaped brownish-red elevations. Split- pea or walnut-sized. On face and back. Leave pigmented spots brownish or blackish scabs covering punched-out-looking ulcers. Figure-of-eight appear- ance of eruption. Potass, iodide, and Syphil- inum. Merc, precip. ruber. Ar- senicum sulphide. Cinna- bar. Sarsaparilla. Merc. corr. Phytolacca, etc. Lo- cally : Reel precipitate oint. Merc, bijodat. and Potass. iod. Thuja (mucous tu- bercles). Locally : Treat the tubercles with Acid Nitrate of Mercury, and dress the ulcers with Iodide of Starch paste. H a CO CO a CO H Eh c 55 a O 0 Ei is Hi H a 55 55 -« M a 0 fa o Syphilides. Appears first as hazel-nut sized hard lumps, situated on head, buttocks, and flexor surfaces of the extremities. Either single or multiple. Undergo absorp- tion or break down, and form deeply-excavated ulcers. A tertiary syphilide. Decline in health. Fissures and chaps about the mouth, anus and genitals. Skin dry harsh and dingy yellowish hue. Face wrinkled. Looks like little dried up old man. Snuffles. Hoarse cry. Coppery-red mucous patches. Dry or moist papules. Tubercles. Bullous syphilde. Excoriations and mucous patch- es most common. Carbo animalis. rango, etc., and for the tubercular. aqu. Bi-c>anide cury. Cistus for syphilitic ulcers. Condu- remedies Berberis of Mer- mercurio- Calcium iodide. Corallium rub. Locally: A five per cent Oleate of Mercury inunction. Dermatalgia. An affection of the skin char- acterized by pain, unattended by structural change. Attacks principally covered parts. More in women than in men. Sensi- tive to external impressions. Pain worse at night, of a burn- ing, boring, or shooting charac- ter. Lasts a week or longer. Baryta carb. Bell. Bry. China. Ferrum. Manganm. Nux mosch. Phos. Sepia. Silicea. Spigelia. Sul., etc. Galvanic current. Tinea fa- vosa. (Fayus.) (Honey-comb Tetter.) O Ei a Tinea tri- < Oh O COPHYTIUA. CO < (Ringworm.) 0 (Barhers Itch.) o M a H a © P* Characterized by pea-sized, straw-colored, cup-shaped, hon-ey-comb crusts. Stale straw odor. Achorion Sehonlienii. Contagious. Poorer classes. Mostly on head, frequently on the trunk. Bromine. Kali carb. Lycop. Mezereum. Phos., etc. Epila-tion. Parasiticides. Hyposul-phite of Soda, Merc, corr., or Sulphurous acid lotion. Chry-sophanic or White precipitate cerate. Characterized by itching ery-thematous redness and crop of vesicles followed by scaly forma-tion. On scalp, hairs become brit-tle and break off. Stubble-like appearance. On body, spreads in fairy-ring-like manner. On head, split-pea or hazel-nut sized papules or tubercles ap-pear. Hairs come out without pain. On nails, called Onycho-Mycosis. Follicles occasionally, pour out viscid mucus resem-bling juice of the mistletoe-berry (Kerion). Contagious. Children of lymphatic temperament. Tricophyton. In youth attacks scalp or body. In adult life the beard. Fungus scales or scabs turn whitish yellow on addition of Chloroform. Sepia and Tellurium {Ring- i worm). Merc, precip. ruber. Kali bich. Plantago. Tart. emet. and Cicuta (Barber's Itch). Cocculus Indicus, etc. Epila-tion. Shaving every other day. Merc. corr. or Sulphurous acid lotion. Acetic acid or Coster's paint. Chrysophanic Cerate or White precipitate oint. to d 1—I Ei CO >< W a < Pi O Eh < 5 rt K o « H a M a o a «i a Ph j Oi <; M M Ei t^- 0 a i> Tinea vek sicolor. (Variegated dandruff.) Alopecia AREATA. Fawn-colored patches accom- panied by itching and desquam- ation. In phthisical patients between ages of twenty and forty. Chest and abdomen. Mapped appearance. Microspo- ron furfur. Next to tricophy- ton in frequency. Feebly con- tagious. Characterized by more eir less sudelen appearance of variously sized white bald patches. Starts on parietal protuberances. Fre- quently unilateral. Oval areas devoid of hair. Spreads rapidly. Smooth polished surface. Fine lanugo. Sepia and Natrum ars Mild parasiticides. Sulphurous acid lotion. Acetic acid baths. Phos. Natrum mur. Fluoric acid. Calcium sulphide. Man- cinella. Phos. acid, etc. Epila- tion of marginal hairs. Acetic acid, tine, of Arnica, Cantharis, or Capsicum applications. Merc. cor. or weak Phosphorus lotion. Guinea-worm dis-ease. Elephant-iasis. (Elephant leg.) Due to the filaria medinensis. Common in tropical climates. Pointed tumors surmounted by blebs. Swelling and pain. Tu-mor breaks, and shows the worm. Remove the worm. Dress sore, as a common ulcer. Due to the filaria sanguinis. See class IV. Mite dis-ease. Due to the leptus irritans. "jigger." Papules, vesicles and pustules. On ankles and legs. South-western states. Along the Mississippi. Mostly in summer. Mild parasiticides. Sulphur ointment. Phtheiria-sis. (Lice disease.) Due to pediculi. Contagious. Three varieties: P. capitis, P corporis, and P. pubis. P. cap-itis. Occipital region. "Nits" in children. •' Scratch marks." P. corporis. Ova or pediculi de-posited m clothing. Multiform lesions. On trunk, hips and thighs. "Scratch marks." P pubis. Due to crab louse. Iii adults mostly. Oleander (P. capitis) and Mer. curious. Locally: Powdered Sta-physagria. Cocculus ind. tinct., White percipitate oint., Merc. corr. lotion or Chloroform appli-cation. Bake the clothing. Contagious disease due to the acarus scabiei. Characterized by cuniculi attended by nightly itch- ing, and formation of papules vesicles and crusts. Occurs mostly in the interdigits and on wrists, in flexures of body, but- tocks and dorsal surface of penis. Seldom above the nipple line. Multiform eruption. Evidences of contagion. Disappears rapid- under parasiticidal treatment. Sulphur. Locally : Sulphur oint. Stor- axoint. Oil of lavender. Balsam of Peru, etc. Bake clothing. PART IV. ORTHOEPIC GLOSSARY. Ac'a-rus (acari, a mite). A genus of minute insects infecting the skin. Ac'a-rus sca-bi-e'i. The itch insect. Ac'ne (acme, top). See Part II. A-cu'min-at'ed (acumen, a point). Pointed. Ag'ri-us (agrios, fierce). An ad- jective signifying inflamed. Al-o-pe'ci-a. Baldness. Al-o-pe'ci-a a-re-at'a. See Part II. An-^e'mi-a. Deficiency of blood. An-^es-the'sia. Loss of sensi- bility. An-i-dro'sis. See Part II. An'-thrax (anthrax, a burning coal). See Part II. A'-rea. An open place. At'ro-phy. Deficient nutrition. At'ro-phy, lin'e-ak. See Part II. Ax-il'l^e. Arm-pits. Bac-chi'-a. A synonym of Ros- acea. Bis in die. Twice a day. Bleb. A synonym of Bulla. Brom-i-dro'-sis (ftromos, a stench). Fetid perspiration. Bul'la. A water-bubble. See Part II. Ca-chec'tic (kakos, bad). Per- taining to a depraved condition of system. Cal:los'i-tas. See Part II. Can'cer (a crab). See Part II. Car'bun-cle (dim. of carbo, coal). A synonym of anthrax. Car'ron oil. A mixture of about equal parts of lime solution and flaxseed oil. Chaul-moo'gra oil. Expressed from the seeds of the Gynocar- dia odorata. Chil'blain. A synonym of Per- nio. Chlo-as'-ma.