■—mw—mtiiMiai.ti.- ^1 a**** « kKSBB »^, ■Nittni nil iiiii in'i ?$W**^'*t***!v:M1*?'-- ARMY MEDICAL, LIBRARY WASHINGTON Founded 1836 JLNN3X Section. Number ....^_/_>_;_ f° & * Fohm 113o, W. D., S. G. O. 3—10543 (Revised June 13. 1936) NLM005765341 iO, General view of the skin and its appendages-(after Hsitzmann). A HAND-BOOK OF DISEASES OF THE SKIN AND THEIR HOMEOPATHIC TREATMENT. BY JOHN R. KIPPAX, M. D., LL. B., Professor of Principles and Practice of Medicine and Medical Jurisprudence in the Chicago Homceopathic Medical College; Clinical Lecturer and Visiting Physician to Cook County Hospital; Author of Lectures on Fevers, etc. FOURTH EDITION: REVISED AND ENLARGED. CHICAGO. GROSS & DELBRIDGE. 1890. * COP-YKIGHTED BY GROSS & DELBRIDGE, 1890. To ALL PRACTITIONERS AND ■STUDENTS OP HOMOEOPATHS', TRUSTING IT WILL MEET THEIR APPROVAL, THIS VOLUME .is Respectfully Dedicated, PREFACE TO THE FOURTH EDITION". The respectable success of this Hand-Book, as evi- denced by the rapid sale of three large editions justifies the author in allowing a fourth edition of the work to be given to the professional public. Advantage has been taken of the opportunity afforded by the call for another impression to introduce a chapter on diet and hygiene and make such changes in the text as the continued advance in dermatology demands. Chicago, March, 1890. PREFACE TO THE SECOND EDITION. In preparing this edition for the press, the entire- text has been thoroughly and carefully revised. Owing to the unprecedentedly rapid advance in derma- tological science, many portions of the book have been entirely re-written, and much new matter has been added. It is hoped that the work, as revised, will merit a continuance of the favorable recognition extended to the previous edition by the profession. Chicago, November, 1883. PREFACE TO THE FIRST EDITION". The design of the present Hand-book is to furnish such a digest of the essentials of practical derma- tology, as will be serviceable alike to students and practitioners. In preparing the manuscript I have steadily kept one purpose in view, to make it as thorough and practical as possible. To this end con- densation has been more or less necessary, and if at times statements appear too absolute, it must be remembered that conciseness and the limits of the book, prevented any lengthy discussion. The text consists of short general observations ... 237 Xeroderma. See Ichthyosis, ■«, 0 . . . 138 Zcster, o , „ 0 =. . - 23S lu contents. PART THIRD. A Chart of Characteristics, with Diagnostic, The- rapeutic, Dietetic, and Hygienic Hints, . . 243 PART FOURTH. Okthoepic Glossary,........ 280- PART FIFTH. Diet and Hygiene in Diseases of the Skin, . . 285» Index, 290* DISEASES OF THE SKIN. IP^IFLT I. GENERAL OBSERVATIONS. section I. the anatomy and pathology of the skin. The skin is a flexible membrane which invests the body, and joins the mucous surfaces at the various orifices. Its office is to protect the underlying stiuc- turcs from harm, to give shape and symmetry to the human form, to act as a partial respirator, and to perform the important functions of secretion, absorp- licn, and tactile perception. Upon its surface are found numerous elevations, furrows and depressions.. The larger elevations, which take the form of linos or wrinkles, are particularly well defined on the palm of the hand and sole of the foot. The smaller eleva- tions are found upon almost all regions of the body7 and are caused by the prominence of the papillre. The furrows correspond to the larger elevations and lie between them. The minute depressions or pores, r.re the orifices of glandular ducts and of hair-follicles. 17 18 diseases of the skin. Like most tissues of the body the skin is composed of fibres and cells. 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 four kinds, namely, the cells of the rete or stratum malpighii; secondly, those of the stratum granulosum; thirdly, those of the stratum lucidum; and fourthly, those of the stratum corneum. The cells of the stratum malpighii are nucleated, polygonal in form, and rich in protoplasm. TVhen isolated they resemble in outline a chestnut burr, and hence are termed "prickle cells." The cells of the stratum granulosum arc spindle- shaped, have a distinct, clear nucleus, and are ar- ranged in two rows. Those of the stratum lucidum are flattened, indis- tinctly striated, and contain a staff-shaped, or flattened nucleus. They are formed from the cells of the stratum granulosum, and are arranged in three rows. And lastly, those of the stratum corneum, or horny epidermis, are- flattened, have no nucleus, and are usually larger than the other cells. These six elements, the two kinds of fibres, and the four sorts of cells, constitute the main part of the structure of the skin. Anatomically, the skin may be divided into two main lay3i-s, termed respectively the corium and epidermis. Anl again, these two may bo subdivided; the former, into the reticular and papillary layers, and the latter general observations. 19 into the rete malpighii, the stratum granulosum, the stratum lucidum, and the*stratum corneum or horny layer. The corium constitutes the Larger part of the skin, and is made up by the interlacement of elastic fibres and connective tissue. It contains as organs peculiar to the skin, prominently, sebaceous and sweat glands. At the deepest part of this structure, masses of fat globules arc found packed between the fibres of con- nective tissue, constituting the panniculus adiposus, or adipose tissue. The external surface of the corium presents eleva- tions, or nipple-like prolongations, called papillae. These are largest about the female nipple, and corona glandis, and smallest over the general cutaneous sur- face. They present an average of 60,000 to the square inch and ;>.re the scat of the tactile corpuscles of JVIeis- snor. According to their internal structure they may be divided into two kinds, vascular and nervous. The reticular layer is looser in texture than the papillary layer; and the inter-fascicular spaces are well marked. An increase of the connective tissue elements is usually found in keloid, fibroma and scleroderma. And a fatty degeneration occasionally takes place in the new growth which destroys the connective tissue, its in xanthoma. The papilla may at times become enlarged in psoriasis, and the reticular layer may be- come the seat of such parasites as the Guinea worm, the reams scabiei and the pcdiculus. 20 diseases of tiif. skin. Next to the papillary layer of the corium comes the stratum malpighii or rete. The cells of this structure are mainly polyhedral, excepting the lower rows which are fusiform and fill up the interpapular spaces to a level a short distance beyond the apices of the papillae. The deeper layers of this stratum are the abiding places of cutaneous pigment. A hyper-activity of rete cells exists in psoriasis, and epithelioma is supposed to take its departure from this membrane. Beyond the stratum malpighii is the stratum gran- ulosum, which consists of two layers of nucleated,. spindle-shaped cells. It is best seen at the mouths of the hair follicles and near the nails. The stratum lucidum follows it, and is made up of flattened transversely striated cells, arranged in three- rows. And after this comes the stratum corneum or horny epidermis. The deeper cells of the latter stratum are polygonal in shape, while the more superficial are flattened. Its cells are increased in amount in con- gested conditions of the skin, as in psoriasis; in in- flammatory diseases, as in eczema and dermatitis ex- foliativa; and in general hyperplasia, as in elephan- tiasis. They may be congenitally increased as in ichthy-. osis, or become hypertrophicd as in callositas. The cell layers of both the stratum corneum, the stratum lucidum, and the stratum granulosum, mav be elevated along with portions of the rete, by fluid forcing its way up from beneath; and thus they form. general observations. 21 die walls of vesicles as in eczema or herpes on the one hand, or those of bulke, as in pemphigus on the other. The organs of the skin arc: blood vessels,lymphat- ics, muscular fibres, and nerves, sweat glands, seba- ceous glands, and hair follicles; the appendages are, the hair and nails. The large trunks of both arteries and veins are sit- uated in the deeper parts of the subcutaneous tissue, and after supplying the organs form a deep plexus in the deep layers of the corium. Branches from this plexus, ascend to just beneath the papillary layer of the corium, Avhcre they form a superficial plexus. A hyperplasia of these vessels exists in telangiecta- sis. The superficial plexus is mainly affected in psor- iasis, lichen and prurigo. Both plexuses may be im- plicated in eczema. The lymphatics also form plexuses, generally one ■■beneath each plexus of blood vessels, and lymph spaces ure usually present in the corium. They phty an im- portant part in morpheca and are increased, both as to size and number, in elephantiasis. The lymphatic element is also apparent in the glandu- lar swellings of prurigo, and in the enlarged glands at the bac k of the neck in eczema of the scalp in children. The muscular fibres of the skin exist in two forms, s-triated and smooth. The former are found princi- pally in the skin of the face. They arise from the -deeper seated muscles, and pass upwards to terminate in the corium. The latter appear cither as anastomos- ing plexuses running hoi izontall}', as in the scrotum, or 22 diseases of the skin. as fasciculi, as in connection with the glandular appar- atus of the skin. Contractions of the little muscles formed by the aggregation of these fibres, causes the conditions known as cutis anserina or "goose-flesh." Little muscles of the smooth or unstriped variety, called erectores jpili (erectors of the hair), arise from the internal sheath of the hair follicles, pass obliquely upwards around the sebaceous glands, and terminate in the upper part of the corium. They are supposed to erect the hair and to favor the exit of sebum from: the sebaceous glands. The nerves of the skin are surface branches of the- nerve trunks that accompany the larger blood vessels in the subcutaneous tissues. They are composed of both medullated and non-medullated fibres. Tiie medullated fibres terminate as a rule in the Pacinian and tactile corpuscles; while the non-mcdullatcd fibres end as a sub-epithelial plexus in the upper layers of the corium and in the rete mucosum, from which fila- ments ascend between the epithelial cells towards tip- stratum lucidum. The Pacinian corpuscles are small, ovoid bodies,. found in the subcutaneous connective tissues, upon the- nerves of cutaneous supply. They occur in various regions, but arc most numerous in the volar side of the hand and loot. The tactile or touch corpuscles, also called corpus- cles of Mcissner or Wagner, are oval bodies found mostly in the papillae of the corium. They are most GENERAL OBSERVATIONS. 23 numerous upon the last phalanges of the fingers, where they are found in about one of four of the papillae. Vaso-motor and trophic nerves supplying the vascu- lar, muscular and glandular systems, are also found in the skin. The cutaneous nerves, in addition, give to the skin the sense of touch, and are intimately connected with the physiological and pathological changes going on around them. They undergo organic alterations in zoster, leprosy, clermatalgia, and telangiectasis. The siceat or sudoriijarous glands arc small reddish- vellow bodies composed of convoluted tubules situated in the deep parts of the corium, or even in the subcu- taneous adipose tissue. They open on die external surface by means of a narrow efferent duct, which presents an oblique valve-like aperture. They are found in all parts of the body, but are most numerous on the palms and soles. According to careful computation there arc between two and three millions of them in the human body, represent- ing an average of eight miles of perspiratory tubing. By evaporation they tend to regulate the tempera- ture of the body, and ordinarily throw off between one and two pints of fluid daily. They also act as auxiliary to the kidneys, in throwing off excrementi- tious matters. The natural perspiration is generally acid in reaction, and is composed of nearly ninety- eight per cent of water and two per cent of solid, mostly organic, materials. It is normally alkaline in the axilla and between the fingers and toes, and after 24 diseases of the skin. prolonged sweating. It may become variously colored, sis in chromidrosis; or impregnated with organic matters, such as urea, albumen, sugar or bile. The sweat glands may become functionally disor- dered, as in hyperidrosis. They may be primarily affected, as in dy&idrosis, or secondarily disordered as in ichthyosis. The sebaceous or sebiparous glands are small pyriform sacculated organs lodged in the substance of the cor- ium. They are composed of a basement membrane externally, and secreting cells, or their products inter- nally. They are furnished with excretory tubes which open usually in the hair follicles, but occasion- ally upon the cutaneous surface. Generally there are two to each hair, located on opposite sides; at times four or even eight may be found grouped around a single hair-sac. They r.ro to be met with upon all portions of the body, except the palms, soles, dorsum of the third phalanges, and the glans penis. The largest are those of the eyelids, the nose, the lips, the labia externa and the scrotum. The secretion from these glands is of an oily nature, and is known as sebaceous matter or sebum. It contains about fifty per cent of fatty matter, and is perfectly fluid at the ordinary temperature of the body. The office of the sebum is to prevent too rapid evaporation, and to give softness and pliability to the skin and to the hair. The sebaceous glands may be functionally disordered, :as in seborrhcea on the one hand, or as in xeroderma on the other. They may be primarily affected, as in acne, GENERAL OBSERVATIONS. 25 or secondarily diseased, as in elephantiasis and lep- rosy. The hairs arc peculiar modifications of the epider- mis, and consist of shafts and roots. They are ot three classes: (1.) Long and soft hairs, as those of the scalp, pubes, and axillae. (2.) Short hairs, soft as those of the eyebrows, or stiff'as upon the lids. (3.) Fine downy hairs, found upon the face and body and called lanugo. The total number of hairs on the scalp has been 'estimated at from ninety to one hundred and twenty thousand. The cortical portion of the shaft of the hair is made up of firmly adherent, flat horny cells, while the medullary substance consists of a mass of loosely packed epidermal elements. The difference in con- stitution of the cortex and medulla of the hair gives to the structure minuteness, strength and elasticity. A single hair has been known to support a weight of over two ounces; and it is so very elastic that it may stietch almost one-third of its length, yet return to its former measurements. The color of the hair is mostly given to it by the pigment granules that are found stored in the horny find medullary portions. 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 and corium, called the hair follicle. The rate of growth of the hair is about a half inch per month. Hairs grow by the multiplication and pushing outwards of the cells of the bulb lying next 26 diseases of the tKix. to the hair papilla. They may become either hyper- trophied or atrophied, or even texturally changed. The hair follicle is cylindrical in form and is always placed more or less obliquely in the skin. It consists of a body, neck and mouth. The latter is funnel shaped and opens directly upon the surface. The neck is the narrowest part of the tube and is located just. below the level of the papillary layer; while the body, which constitutes the largest part, terminates in a bulbous extremity and contains the hair papilla and the hair bulb. The follicle consists of two parts, an outer, the hair sac, and the inner, the root sheath. The hair sac is made up of three layers, external,, middle and internal. The external layer is the thickest and most impor- tant, and is composed of connective tissue fibres which run parallel with the course of the hair, and join the fibres of the papillary layer of the corium. The mid- dle layer is highly contractile and is made up of trans- verse connective tissue fibres, embedded in a homogen- eous, slightly granular substance. The internal layer is a homogeneous transparent tissue, and is a direct continuation of the basement membrane of the corium.. The hair papilla protrudes into the cavity of the follicle, and consists of connective tissue derived from its middle layer, together with round nuclei and nucleated cells. It is about twice as long as it is broad, and contains arteries, veins and non-medullated GEN ERAL OBSERVATIONS. 27 nerve fibres. The constricted portion of the papilla is the neck and the thicker part the body. The root-sheath consists of two layers: (1.) The external; (2; the internal. The external root-sheath is a continuation of the rete malpighii, which extends into the level of the papilla. It is thinnest at the neck of the follicle, and thickest at the bulb. The internal root-sheath is made up of (a.) an outer or Henle's layer; and (6.) an inner or Huxley's layer. The outer layer is a thin, transparent membrane com- posed of oblong non-nucleated scales which run paral- lel with the shaft of the hair. It commences at the neck of the follicle and terminates at the bulb. The inner layer consists of flattened fusiform nucleated cells containing small refractive granules. As a rule there is only one hair in each follicle, but occasionally two are found to occupy a follicle con- jointly. The nails are horny, elastic, concavo-convex, struc- tures imbedded in the skin upon the dorsum of the distal phalanges. They are composed of altered cutic- ular cells derived from the various strata of the epi- dermis. The posterior portion of the nail, situated beneath the skin, is called the root; and the anterior exposed portion is termed the body. The corium upon which the nail rests and to which it is firmly attached is known as the bed or matrix. The whitish disk, situated just in front of the poste- .28 DISEASES OF THE SKIN. rior groove and due to the diminished transparency of the tissues is called the lunula. Nails grow from their roots as do hairs, and simply slide over the matrix. They grow more rapidly in summer than in winter, and in early age than in adult life. They may become structurally changed, as in onychia. Or they may be primarily affected, hyper- trophicd, as in onychauxis, or secondarily so, as in psoriasis, syphilis and ichthyosis. Or, again, the vege- table parasites may here take up their habitat, giving rise to the condition termed onycho-mycosis. The subcutaneous tissues arc made up of variously sized loose bundles of connective tissue, containing usually an abundance of fat. When the fat cells are arranged in groups to form lobules and lobes, the structure is then called adipose tissue or panniculus adiposus. The beauty of the skin depends upon the activity of its circulation, the shade of the pigment in its rete mu- cosnm, and the depth of its epithelial covering. The shade of pigmentation varies with the color of the hair and eyes. A dark skin generally accompanies dark hair and eyes, while a fair skin is found in people with light hair and blue, hazel or gray eyes. As a rule blondes predominate in temperate and brunettes in tropical climates. SYMPTOMATOLOG y. 29 SECTION II. SYMPTOMATOLOGY. The clinical signs, or symptoms, of disease may be either objective or subjective. Objective symptoms ire those appearances which manifest themselves upon the surface, and aie 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 characters may be roughly outlined as fol- lows: Macules, spots on stains, are circumscribed dis- COLORATIONS OF SKIN. They arc usually of a reddish, yellowish, or brown- ish color; and may be either permanent or evanescent. Small dot-like purpuric macules are calledpelechice. Macules may be cither primary as in lentigo or sec- ondary as in Addison's disease. Sometimes they are physiological in character, as in pregnancy. They are met with in chloasma, naevus, purpura, morplioea, and erythema. Papules or pimples are small acuminated ele- vations OF SKIN VARYING IN SIZE FROM A MILLET SEED TO A SPLIT PEA. They may be either true or false, and are frequently attended Avith itching. They are seen in acne, eczema,. scabies, lichen, prurigo and milium. 30 DISEASES OF THE SKIN. Macules, Papules, Tubercles Vesicles, JBL. Pustules, Bullae, Mfo^ Scabs, ter.-'Pfff=r-f-'^ ,ry change from vesicles or papules. And they termi- nate cither by rupture or by desiccation. They are met with in acne, eczema, impetigo contagiosa and ecthyma. 32 DISEASES OF THE SKLN. Tubercles are small solid flesiuy swellings in the skin, varying in size from a split pea to a hazel nut. They are usually of a reddish color, and arc com- monly situated in the deeper layers of the corium or the subcutaneous connective tissue. They arc seen in acne, tricophytina, sarcoma, fibroma, syphilis and leprosy. Small wens are tubercles. Wheals are red or whitish, transitory elevations of the skin, resembling the sting of the nettle,. and accompanied by tingling or pricking sensa- tions. They are situated in the upper layers of the skin, and are produced by a rapid exudation and tempor- ary incarceration of serum in the- meshess of the corium, due to clonic vascular spasm. They are fugi- tive and capricious in character, and may appear either as elongated oval lines or stripes. They are pathog- nomonic of urticaria. Occasionally they result from insect bites and from medicinal poisoniDg. Scales, are collections of altered cells of the stratum corneum. They are usually whitish or yellowish: in color, and have a shining or glistening aspect. They are ob- served ineczema, pityriasis, psoriasis, ichthyosis,, seboE- rhoea, tricophytina, etc.. SYMPTOMATOLOGY. 33 Excoriations, are superficial solutions of con- tinuity of the skin. They present a variety of forms, and as a rule, heal without leaving scars. They are observed in connec- tion with eczema, scabies, phthiriasis; also in con- sequence of bites of insects; and in all disorders of the skin attended with pruritus. Fissures, are linear solutions of continuity of the skin, situated in the epidermis or corium. They commonly appear about the normal furrows of the skin especially in the vicinity of the articulations. and are usually attended with pain. They occur in eczema, psoriasis, leprosy, and the syphilides. Crusts, are formed by the drying up of discharges. They are yellowish in color when formed by desicca- tion of serum; greenish-yellow when composed of dried pus; and brownish or blackish when they con- tain blood. They are found in eczema, ecthyma, impetigo contagiosa, leprosy, sycosis, seborrhcea, syphilis, etc. Ulcers, are circular solutions of continuity of the skin, usually followed by cicatrices. They are most frequently met with on the lower extremities, and are usually attended with pain. They are the result of previous disease, and occur in lupus vulgaris, leprosy, scrofuloderma, furuncle, etc.. 34 DISEASES OF THE SKIN. Scars or cicatrices, are new formations replac- ing LOST TISSUE. They are usually whitish in color, smooth, and somewhat depressed. They consist of connective tissue elements, and are devoid of hair follicles, papillae or glands. They may follow ulcerative lesions, and are also seen in acne, favus, sycosis and zoster. Of subjective symptoms, sensations of heat, burning and tingling are most common. They are met with in varied degrees in all hyperaemic and inflammatory cutaneous affections. Pain is a general accompaniment of acute inflam- mation, as in zoster, etc. Hyperesthesia or over-sensitiveness 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 conditions. ETIOLOGY. 35 SECTIOX III. ETIOLOGY. The etiology or causes of diseases of the skin may be conveniently considered under two heads: I. In- ternal or constitutional causes. II. External causes. I. The internal causes which are also the most numerous, admit of arrangement and description as follows: 1. Hereditability.—An inheritable state in which diseases or taints may be handed down from parent to child. As striking examples, syphilis, leprosy, psori- asis, and ichthyosis, may be mentioned. 2. -Constitutional Tendencies.—By which is to be understood a disposition either hereditary or acquired, to the development of certain, usually inflammatory, cases under favorable conditions. 3. Organ ic and Functional Diseases of the Internal Organs.—Their name is legion. A few may be cited. Derangement of the alimentary canal, are frequent causes of cutaneous eruptions, notably of eczema, urti- caria and acne. Uterine diseases may complicate or give rise to the same troubles. Disease of the kidney is a common cause, or aggravating condition in eczema. Derangement of the nervous system plays a promi- nent part in a variety of disorders. Venereal excesses lead to herpes, pruritus, and syphilis. And affections of the liver have considerable influence in shaping the •course of a number of cutaneous ailments. 4. Age and Sex are important conditions influen- 3(i DISEASES OF THE SKIN. cing disease. Certain affections are found to appear at stated periods of life, and are peculiar to one or the other sex. The congenital syphilicle appears during the first months of infant life. Ichthyosis manifests itself in the second year. And impetigo contagiosa is in the majority of cases an affection of childhood. Of the parasitic affections, tricophytina, excepting when it attacks the beard, is more common in child- ren, 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 occurrence in males; while- lupus originates in childhood and is more common in females. 5. Certain articles of food, may, under peculiar con ditions become essential factors in the causation of cutaneous eruptions. Of these should be noticed : shell-fish and strawberries as common causes of urti- caria; cracked wheat, graham bread, oat meal and buckwheat, as giving rise to roughness of the skin and pruritus; stimulating drinks, preserved meats, and highly seasoned food, as aggravating influences in eczema, urticaria and acne. 6. Drug Poisoning.—The overdosing with such drugs as Mercury, the Potassium Bromide and Iodide, Quinine and Fowler's solution, Copaiba and Valerian* Chloral and Salicylate of Soda, is frequently produc- tive, i n Old School practice, of cutaneous complications. Notably may be mentioned the eczema mercunale, the urticaria caused by Valerian and Copaiba, the ETIOLOGY. 37 sicne 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 aggra- vated in, or peculiar to cold climates, while others flourish in tropical regions. The majority of cutan- eous disorders are aggravated by cold weather. A few as for instance prickly heat, are peculiar to warm seasons. AVhile certain diseases, such as leprosy, elephantiasis, and pellagra, are almost peculiar to certain countries. As a general rule in any locality, temperature will exert an influence, proportionate to the extremes of heat and cold to which the patient is subjected. 2. Irritants.—AVant of cleanliness is the exciting cause of many skin affections. The tinea fungus riots in dirt, and filth is a condition favorable to the develop- ment of eczema and other cutaneous inflammations. Pruritus is frequently due to the frictional effect of clothing. Traumatism may give rise to excoriations and even infiltrations of the skin. 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, workers in dyes and the wearers of dyed garments, are also frequently the subjects of the same disease. 3. Parasites.—Of these there are many varieties, both aninml and vegetable, each parasite producing its own characteristic contagious lesion, and only requir- ing a favorable soil on which to fructifv and grow. D ~ CD 38 DISEASES OF THE SKIN. 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 way 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 characters 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 the skm, 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 thm 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 surround- ings may modify 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 day lii>"htv admitted from a northern exposure. A white lbdii k the best substitute for sunlight. In difficult or DIAGNOSIS. 39 complex cases, where the unaided eye is unable to solve the problem, a microscope provided with a fifth and half inch objective, may be used with profit. Fig. 3. Skin Grafting Scrssoits. When necessary, as in affections of the beard or scalp,, one or more hairs may be secured for examination by extraction with a pair of epilating forceps, (Fig. 12.) Small slices of other parts to be examined can be easily obtained by the use of the skin-grafting scissors, (Fig. 3.) or, if still thinner sections are needed, the cutisector (Fig. 4.) may be employed. Fig. i. The Cutisector, The temperature of parts, if desired, is readily takem by Seguin's surface thermometer. (Fig. 5.) 40 DISEA>ES OF TliE SKIN. Very material aid in making a diagnosis is fre- quently derived from remembering the locality Fig. 5. seguin's Surface The .mometlr. attacked. The following table, after Fox, gives the main points: The scalp, is the most common seat of seborrhoea, the tineae, eczema, sebaceous cysts, psoriasis and alo- pecia 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 epithelioma. The ears, of eczema. The front of chest, of keloid and tinea versicolor. Under the clavicle, of sudanina. llgion of the nipple, of scabies and Paget's disease. The side of chest, of zoster. The elbows and knees, of psoriasis. The inlerdigils and front oficri^ls, of scabies. Back of the hands, of lichen and eczema. The pedms, of syphilitic. The buttocks inner ankle and toes in children, of scabies. DIAGNOSIS. 41 The dorsum of ]>enis, of scabies. The scrotum, of eczema, psoriasis and chimney* sweepers' cancer. Tlie front of the leg, of dermatitis contusiformis. The hg, if running around or lengtliwise, of zoster. The whole body, of pemphigus foliaceus and derma* titis exfoliativa. And tlie flexures of joints, of eczema and scabies. 42 DISEASES OF THE SKIN. 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 Derma- tological Association. CLASS 1. Disorders of the Glands.— (1.) Of the sweat glands: Anidrosis. Bromidrosis. Chromidrosis. Hy- peridrosis. Miliaria. Suclamina. (2.) Of the sebaceous glands: Comedo. Cysts. Milium. Molluscum sebaceum. Seborrhoea. CLASS II. Inflammations.—Erythema. Intertrigo. Derma- titis contusiformis. Erysipelas. Pityriasis. Urtica- ria. Acne. Sycosis. Eczema. Dysidrosis. Pernio. Strophulus. Prairie itch. Herpes. Zoster. Hydroa. Pemphigus. Impetigo contagiosa. Ecthyma. Lichen planus. Prurigo. Lichen simplex. Psoriasis. Der- matitis exfoliativa. Anthrax. Furunculus. Hydro- adenitis. CLASS III. Hemorrhages.—(1.) Of connective tissue: Pur- pura. CLASSIFICATION. 43 CLASS IV. Hypertrophies. — (1.) Of pigment: Chloasma. Lentigo. (2.) Of epidermal and papillary layers: Callositas. Cornu cutaneum. Clavus. Ichthyosis. Verruca. Ony- chia. Paronychia. Hirsuties. (3.) Of connective tissue: Elephantiasis. Fram- boesia. Rosacea. Scleriasis. Scleroderma. (4.) Of nail: Onychogryphosis. (5.) Of cutis: Dermatolysis. CLASS v. Atrophies.—(1.) Of pigment: Leucoderma. (2.) Of connective tissue: Morplioea. (3.) Of hair: Alopecia. (4.) Of nail: Atrophy of the nail. (5.) Of cutis: Linear atrophy. CLASS vr. New Groivtlis.—(1.) Of connective tissue: Fibroma > Keloid. Xanthoma. Neuroma. 02.) Of vessels: Naevus. Telangiectasis. Lym- phangioma. (3.) Of granulation tissue: Epithelioma. Leprosy. Lupus erythematosus. Lupus vulgaris. Rhino scle- roma. Sarcoma cutis. Scrofuloderma. Syphilides. CLASS VII. Nuroses.—Amesthcsia. Dermatalgia. Hyperes- thesia. 44 DISEASES OF THE SKIN. CLASS VIII. ) 'arasitic Diseases.—(1.) Vegetable or dermatophy- tic: Tinea favosa. Tinea tricophytina. Tinea versi- color. Alopecia areata. Onycho-mycosis. (2.) Animal or dermatozoic: Elephantiasis. Gui- aiea-worm disease. Mite disease. Phthiriasis. Scabies. desci:l?iion and treatment. 45 PART II. THE DESCRIPTION AND TREATMENT OF SKIN DISEASES. ACNE. Definition.—Acne is an inflammatory disease of the- sebaceous glands, caused by the retention of sebum,. and characterized by the formation of papules, pus- tules and tubercles, which on disappearing may leave cicatrices. Synonyms.—Varus. Ionthus. Stone-pock. Symptomatology.—Acne, from the Greek acme, a point, is, next to eczema, thecommonest disease of the- skin. It may show itself on any part of the body,, except the palms of the hands and soles of the feet,. but generally selects as seats, the face and back. It affects both sexes, and is most common, between the ages of fifteen and foity-five. It occurs mostly in light complexioned young people, at the age of puberty. It is more common at this period of life, because the- hair follicles and sebaceous glands are in a state of physiological hyper-activity, and hence more liable to suffer functional derangement, and to take on diseased states. It may appear either as a separate and inde- pendent affection, or exist as a complication of otlicn follicular diseases. 43 DISEASES OF THE SKIN. The eruption usually manifests itself, in the form of pin head or pea-sized elevations, situated around the glandular orifices, attended by more or less peri-follic- ular and peri-glandular inflammation. The eleva- tions may be either light-red, dull crimson, or viola- ceous in color, and are usually slightly painful and tender. The course of the disease, though at times acute, is usually chronic. When acute, it may run its course in a few d-\ys or weeks, but when chronic it may last for years. Occurring for the most part in early life, it frequently disappears spontaneously as maturity is attained. Varieties.— The two principle varieties of acne are acne vulgaris, and acne indurata. The former vari- ety is most frequently observed in early life, and con- sists of pin-head or split-pea sized, discrete papules, in various degrees of development. The papules and pustules, are seldom surrounded by marked infiltration I nit are generally interspersed with black points (com- edones). The eruption is usually confined to the face and shoulders. The latter variety of acne, acne indurata, may follow sune vulgaris. It occurs oftenest about the twenty- fifth year, and is frequently generalized over the fore- head, cheeks, chin and back of the neck. It consists of split-pea or small chestnut sized papules, tubercles and pustules, situated on reddened, infiltrated and hard- ened bases, frequently presenting the appearance of conical elevations, and often attended with pain. description and treatment. 47 The eruption is usually very chronic, often very indolent, and is apt to be attended with much disfig- urement and scarring. In debilitated states of the system, such as attains in anaemia, chlorosis, marasmus, scrofulosis, and tuber- culosis, a form of the disease, termed cachectic acne, is frequently observed. The eruption appears mostly on the trunk and extremities, and consists of indolent pin-head or bean sized, livid or violaceous, usually soft papulo-pustules, which on disappearing, leave minute cicatrices. An acneiform eruption, to which the name, artifi- cial acne has been applied, is occasionally produced by the constant or over-use of such substances as tar and the salts of bromine and iodine. It usually con- sists of reddish-brown, pin head or pea-sized papules, and differs from true acne, in that it is frequently attended by more or less inflammation of the whole skin, and by the development of pustular and furun- eular lesions. Etiology.—The causes of acne though often obscure, are frequently found in a lowered vitality, commonly associated with functional or organic derangement of the digestive and sexual systems. Acne vulgaris, which is pre-eminently a disease of youth, is frequently attended with either perverted sexual habits, or a poorly regulated sexual hygiene. Menstrual irregularities, and uterine disease frequently play a not unimportant part. \\ hile various topical irritants, such as cosmetics, irritating soaps, frizzes, 48 DISEASES OF THE SKIN. dyed veils, etc., in persons having irritable skin, often produce acne. Acne indurata is oftenest met with during and after adult life. In males it is frequently induced by gas- tric and hepatic derangements, or may be due to ex'-es- sive indulgence in alcoholic liquors. In females it may be caused by gastric trouble, or by ovarian or uterine disease. Morbid anatomy.—In acne vulgaris there is first a retention of the secretion of the sebaceous gland, and the formation of a sebaceous plug, which by blocking up the exsretory duct, acts as a foreign body, and excites inflammatory hyperemia and exudation in and around the hair follicles and glands. If the plug is not removed, pus formation, associated with painful inflammatory induration of the connective tissue about the gland, takes place. In this way the hard tubercles of acne indurata are formed. If the peri- glandular and peri-follicular inflammation is active, both the gland and the follicle maybe destroyed, leav- ing ultimately a visible cicatrix. Diagnosis.—The differential diagnosis of acne is exceedingly simple, if the chief characteristics and history of the disease are borne in mind. The only affections with which it is liable to be confounded are,, a papulo-pustular or tubercular syphilide, rosacea, and eczema in the papular stage. From the papulo-pus- tular syphilide it must be distinguished by its history, by the absence of groupings of eruption and the characteristic crusts^ as-well as of other signs of o-en- description and treatment. 4iJ eral syphilis. From rosacea it may be distinguished by the age of the patient, by absence of itching and burning sensations, and by the color of the pimples, which are pale red or livid in acne, but brighter, and scattered over a more or less reddened patch in rosacea-. In the papular stage of eczema, there is more or less interpapillary infiltration, and a disposition to scaly formation. Treatment.—The treatment is both local and constitu- tional. The diet should be light and unstimulating. Buck- wheat cakes, hot-bread, nuts, cheese, fried substances, exhilarating drinks, and all sweet and rich articles of food should be avoided. In dyspep'.ic patients, a cup of hot water taken a half hour before meals, will often prove beneficial. The external treatment will vary, according to the extent, obstinacy, and stage in which the disease exists. The plugs of sebum should be removed as early as possible. For this purpose a watch-key or what is perhaps pre- ferable, a comedo extractor (Fig. 6) may be used. In Fig. 6. Comedo Extractor. all inflammatory conditions the greatest benefit is ob- tained from five-minute applications of very hot water. two or three times per day. When the pustules are- large and full, the inflammation and congestion is best 50 diseases of the skin. relieved bypassing the point of an acne lance (Fig. 7) into them, and evacuating their contents, and after- wards resorting to the hot water fomentations. In the milder forms, and in all cases after the inflammation and congestion have somewhat subsided, the best results may be obtained from either a resorcin lotion (resorcin one drachm (4.) glycerine one drachm Fig. V. Acne Lance. (4.) aq. aurant. six drachms (24.) alcohol three ounces (90.); or a sulphur wash (sulphur precip. one drachm (4.) glycerine, one drachm (4.) alcohol four drachms (10.), aq. ros. four ounces (128). Finely powdered sulphur, intimately mixed with three or four times its weight of rice flour or of any simple toilet powder, may be freely dusted over the face. In mild forms of acne vulgaris, this prepared sulphur powder may be used in preference to the lotions. In acne indurata, the inflammation and induration are best relieved by freely incising the papules and pustules with the acne lance (Fig. 7), and applying hot fomentations. After the inflammation has some- what subsided, the sulphur lotion referred to above should be employed. In obstinate cases apply nightly, an unguent made of three drachms (12.) of a five per- cent oleate of mercury, and one ounce (32.) of olive oil. The affected parts should be rubbed with a soft nail- brush and warm soap and water, every night before .applying the lotions. description and treatment. 51 In indolent papular acne, associated with comedones the dermal curette (Fig. 9) may be used. Applications of the faradic current every two or three days, and sea salt or sea water (Briggs), baths about twice a week, have occasionally rendered excel- lent service. The soaps that have been found most useful, are notably, sulphur and iodide of sulphur soaps, and the Juniper tar soap. Of internal remedies one of the following may be selected according to the indications: Antimoniumcrudum.—Small, red pimples about the face, and on the right shoulder,stinging Avhen touched. Acne in drunkards, with gastric derangements, severe thirst, and white coated tongue. Antimonium tart.—In obstinate cases with longing for acids, and when there is a decided tendency to pus- tulation. The pustules are thickest on the neck and shoulders, and after discharging leave bluish-red cica- trices. May be used internally and locally. Arsenicum.—In chronic cases when the skin is dry, rough, and dirty looking, and when the eruption is most niaiked on the face and extremities. Cachectic acne. Asimina.—Itching red pimples, appearing first en the left, then on the right side. Pustular acne, with itching in the evening when undressing. Auruni.—Red pimples on the face. Disposition to melancholy. In onanists and syphilitics. After over- dosing with potassium iodide. 52 DISEASES OF THE SKIN. Baryta carb.—In obstinate cases, especially whem the papules or pustules are interspersed with come- dones. Adapted to scrofulous persons and to wine drinkers. Berberis vnlg.—Red, burning, gnawing pimples,. sensitive to pressure, surrounded by red areolae, and. leaving brown stains. Adapted to indurated acne, associated with urinary or hemorrhoidal troubles.. In women with scanty or suppressed menstruation. Belladonna.—Large, bright, red pimples on the face, back, and scapulae, especially in young, full- blooded people. Fine stinging in the tips of the pimples. Worse during menstruation and pregnancy. Bovista.—Large, scattered pimples on the forehead. Hard, red pimples, large as peas, on the chest, worse- from scratching. In delicate women, with thick acrid or corrosive, greenish-yellow leucorrhoea, after the menses. Bromine.—Indurated acne in scrofulous individuals- Aggravated by smoking. Swelling and induration of the glands of the neck. Calcium sulphide.—Painless pimples on the nape of the neck, forehead and chin. Crusty pimples on the face in young people. Swelling and suppuration. of glands. Calcarea carb.—Acne on the face and neck, worse before menstruation. After sexual excesses. Espec- ially in scrofulous persons. Carbo veg.—Pimples on the nape of the neck. Red pimples on the face and chin in young persons- DESCRIPTION AND TREATMENT. 53 Aggravated b}r eating butter or pork. Cachectic acne. Causticum.—Eruption on the face, more felt than seen. Yellow color of the face. Papulous eruption between the eyebrows above the nose. Adapted to dark-haired persons. 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 derange- ment. Cimicifuga.—Acne in women, dependent upon gas- tric ovarian or uterine derangement. Conium mac.—In obstinate, indurated acne occurr- ing on the face. After the suppression of the menses. Adapted to scrofulous persons, and old maids. 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 tem- ple with sore pain. They suppurate and on drying leave nodules. Itching in different parts of the body as if pimples would break out. Graphites—Acne in persons inclined to obesity; particularly females with disposition to delayed men- struation. The skin is very dry, inclined to crack, and easily tends to ulceration. Iodine.—Indurated acne in scrofulous subjects. Adapted to young persons with dark hair and eyes, and rough, dry skin. Kali. bich.—Face covered with a profuse eruption aesemblingacne. When pustules form they resemble 54 DISEASES OF THE SKIN. small-pox pustules. Especially suitable forf.it, light- haired persons. Kali, carb.—Small pimples on the face, chest, and back, with redness and swelling deficient perspiration. Aggravated during suppressed menstruation. In per- sons inclined to pulmonary troubles. Kreasote.—Acne worse after menstruation, or from' getting heated. Dry pimples on the forehead. Greasy pimples on the right check and chin. Ledum.—Red pimply eruption on the face. Small pimples on the root of the nose. In rheumatic persons- and brandy drinkers. Lycopodium.—Red pimples in clusters, between the scapulae and on the nape of the neck. In dyspeptic individuals, inclined to constipation. Mercuriussol.—Indolent bluish-red papules, especi- ally on the lower extremities. Dirty yellow color of: the skin, with glandular swellings. In syphilitic and scrofulous persons. Mezereum.—Single pimples on the thighs. Red pustules with inflamed areolae on the outer side of the extremities. In scrofulous individuals, and in persons. who have already taken mercury. Nabulus serp.—Pimples on the face, about the nose^ upper lip and chin. Natrum mur.—Acne accompanied by seborrhcea,, when associated with scorbutic affections or chlorosis. Nitric acid.—Many small pimples on the forehead* just below the hair. Painful pimples on the chin with hard, red areolae. Skin dry and scaly. Brown-red spots on the skin. After the abuse of mercury. DESCRIPTION AND TREATMENT. 55 Nux juglans.—Variously sized reddish pimples and pustules on the face, chiefly around the mouth. Large painful blood-boils on the shoulders, and in the hepatic region. Adapted to all stages of acne. Nux vom.—Acne with dyspepsia and constipation. After over-use of coffee, liquors or tobacco. In person* of sedentary habits. Phosphoric acid.—Smooth, red pimples with red areolae on the fore arm, 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 the face, neck and shoulders, with peculiar yellow points which neither coalesce nor burst. Frontal headache at night. Adapted to both the simple and indurated forms. Potassium iodide.—Papulous eruption all over, but especially on the face and the shoulders. Painful sen- sitiveness, worse at night. In mercurial and syphilitic affections. Pulsatilla.—Acne in pale, slender individuals. Gas- tric and bilious disorders. Amenorrhoea. Chlorosis., Aggravated by pastry and fat food. Rhus tox.-—Acne in drunkards, rheumatic individu- als, and in persons addicted to sexual excesses. Robini.v.—Hard pimples which take a great while to* suppurate. Great tendency of tumors to become indu- rated. In dyspeptics with sour stomach, worse at night. Nocturnal emissions. Rumex crisp.—Dense ra:;h of small red pimples. 5B diseases of the skin. Eruptions aggravated by wearing flannel. Itching on various parts, worse while undressing. Sabina.—Papular eruptions during pregnancy. Sarsaparilla.—Acne on the nose and face, worse dur- ing the menstrual period. Burning itching eruption. Sepia—Acne on the chin, during pregnancy and nursing. Pimples on the mons veneris, legs and flexures of the joints. Ailments following vaccination and self- abuse. Silicca.—Cachectic acne. Obstinate cases in scrofu- lous persons. Aggravated by wine drinking. Sulphur.—In acne vulgaris with black pores in the face. Red, itching pimples on the nose, lip, around the chin, and on the forearms. Furunculosis. Chronic cases. Sumbul.—Smooth, small, reddish spots on the fore- head. B1;k k pores on the face. Thuja.—Acne on the alae nasi, worse during men- struation, and after excesses of all kinds. Veratrum alb.—Pimples on the right labium iust \efore menstruation. alopecia. Alopecia or simple baldness, is an absence of hair, either partial or general. It is a symptom rather than a disease, and may exist as an accompaniment of a variety of affections. alopecia areata. Definition.—It is a disease of the hair system, characterized by the more or less sudden appearance of variously sized white, bald patches. "DESCRIPTION AND TREATMENT. 57 'Synonyms.—Porrigo decaivans. Tinea decalvaus. Symptomatology.—It starts usually on the scalp, and generally from the parietal protuberances, but occa- sionally it commences in the beard. At times the whole body becomes affected. The disease is fre- quently unilateral, occurs mostly in young people, and is usuallyannounced by the appearance of one or more nickel-si zed, 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 leav- ing a perfectly smooth polished surface, and do not break oil'as in tinea tricophytina. At times little fine lanugo or downy hairs appear on the affected part; these, however, arc seldom more than transients, and soon fall off and disappear. After this manner the disease may run indefinitely. Etiology.—There are probably two varieties of alo- oecia showing a disposition to develop in areas. One variety being contagious and presumably para- sitic; the other often displaying an hereditary predis- position and dependent upon a trophoneurosis or func- tional nerve derangement. Treatment.—The treatment is often parasinoidal, and consists in epilating with a broad-lipped forceps 58 DISEASES OF THE SKIN. (Fig. 12) the marginal hairs, and applying acetic acid,, tincture of cantharides, tincture of iodine, or equal parts of glycerine and tincture of capsicum, to the patch. This treatment is to be followed by an oint- ment of the mercuric bichloride, half to one grain (.03 to .06) to the ounce (32), applied for a fortnight, and changed morning and evening. Cutaneous faradi- zation is often used with advantage in cases of long; standing. The principal internal remedy is Phosphorus, and the next Nairum mur. Others may be indicated for alopecia in general as follows: Aloes.—When the hair comes out in lumps, leaving bald patches. Arsenicum.—When it falls out in circular patches. Calcarea carb.—When the bald spots are on the tempi's. Calcium sulphide.—Bald spots on the head, after headaches. 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 off of hair from eyebrows and pudendum. Kali carb.—Dry hair rapidly falling off* with much dandruff. Mancinclla.—Falling off" of the hair after severe acute diseases. DESCRIPTION AND TREATMENT. 59 Phosphorus.—Falling out in tufts. Phosphoric acid.—Alopecia as a result of debility _ Vinca minor.—The hair falls out in single spots, and, white hair grows there. ANAESTHESIA. Anaesthesia, by which is meant partial or complete insensibility of tlie skin, is encountered in such dis- eases, 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. Definition.—Anidrosis may be defined as a functional disorder of the perspiratory 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, are: iEthusa.—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 per- spiration. Potassium iodide.—The skin is dried up, and rough,. like hog skin. 130 DISEASES OF THE SKIN, ANTHRAX. Definition.—Anthrax is a phlegmonous inflammatKr** of the skin, characterized by necrosis of the cellular tissue, with suppuration, and the discharge of the necrosed masses—called cores—with pus, through cor- responding sieve-like openings. Synonym.—Carbuncle. Symptomatology.—It generally commences with severe burning pains in the part affected, and is accom- panied by more or less fever. As the disease pro- gresses, 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 of cores, form on the surface, and give Jto the part a cribriform appearance. The whole mass, now gradually sloughs away, leaving an ulcer with everted edges, which granulates slowly, and leaves when healed, a permanent, more or less pigmented cicatrix. Anthrax seldom appears before adult life and is oftener met with in men than in women. It appears most frequently on the nape of the neck, shoulders, and the lateial aspects of the hips and thighs. It is usually single, occasionally it is multiple, and not infrequently groups appear in different parts of the body. It is more frequent in winter than in summer, and occasionally displays an opideniic ten- dency. It may run a mild course, or it may be so severe as to terminate fatally. Pyaemia and septi^a^ ;niia are its commonest complications. DESCRIPTION AND TREATMENT. G I) Diagnosis.—Anthrax may be mistaken for erysipe- las or for a collection of boils which have become con- fluent. It differs from erysipelas chiefly in its circum- scribed character, hardness and pain. And it may be distinguished from boils by the more extensive subcu- taneous necrosis, and by the more intense pain and constitutional symptoms. Prognosis.—As anthrax is generally a serious disease the prognosis should be guarded. Treatment.—The diet-should be abundant, nutritious and easily digested, and directed mainly to keeping up the strength of the patient. In debilitated cases, a. jelly made by simmering together equal parts of finely cut mutton, beef and veal may be used. Red wine or brandy and egg, or milk and egg will sometimes prove serviceable. Ventilation is important, especi- ally if the case is severe, and the patient is confined to his bed. Piatt's chlorides, a solution of carbolic acid or of thymol, or some other disinfectant, may be sprinkled upon the bed and about the room, if the car- buncle is large and open or the gangrenous sloughs extensive. 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, hot flax-seed meal poultices, with some antiseptic, such as carbolic acid or thymol, to lessen the risk of septic absorption and to promote the sepa- ration of the sloughs, should be applied. If the sloughing is extensive, charcoal and yeast poultices- 02 DISEASES OF THE SKIN. may be used. After an opening occurs or is made by the knife, the sloughs should be picked out as fast as they loosen, and the ulcer washed once or twice a clay with a weak solution of carbolic acid. Strapping with soap plaster in the early stages has been recommended. xVnd good results have followed the injection of a saturated solution of pure carbolic acid, through the openings into the sloughing tissue, by the aid of an hypodermatic syringe. Of internal remedies, Arsenicum alb. bears the palm. Others may be used according to the indications. Aconite.—As an occasional remedy, when there is much inflammation with high fever. Anthracinum.— Burning pain not relieved by Arsenicum. Cerebral or typhoid symptoms. Evidences of blood poisoning. Apismel.—Continued extension of theerysipelatoid inflammation with stinging burning. Arctium lappa has great reputation. Used both internally and locally. Arsenicum alb.—Large painful and malignant car- buncles. Great prostration. Fixecssive burning, us from hot coals. Better from warm applications. Belladonna.—Bright redness, with throbbing pain. When cerebral complications arise. Erysipelatous inflammation around the carbuncle. Carbo veg.—Dark blackish appearance of the sore, with fetid discharge. DESCRHTION AND TREATMENT. 63 Cinchona.—When the asthenic character of the disease is well marked. Debility from excessive sup- puration. Hyoscyamus.—When there is great restlessness, caused by excessive nervous excitement. Itching around the swelling. In nervous and hysterical indi- viduals. Lachesis.—Bluish purplish looking carbuncles, with evidences of blood poisoning. Nightly burning, oblig- ing one to rise and wash parts in cold water. Cere- bral symptoms. Muriatic acid.—Carbuncles in scorbutic individuals, with ulcers on the gums. Frequent desire to urinate with profuse emission of clear urine. Nitric acid.—AY hen there is a predisposition to anthrax. Phytolacca.—Tendency to carbuncles, especially on the back and behind the eais. Rhus tox.—Great restlessness. Burning itching around the carbuncle, with vertigo. Bloody, or serous, frothy, diarrhoea. Typhoid symptoms. Secale cor.—Carbuncles on the arms. Aggravated by warm applications. Gangrenous tendency. Silicea.—During the process of ulceration, to pro- mote healthy granulation. linear atrophy. Definition.—Linear atrophy of the skin, is charac- terized by white or claret-colored, depressed scar-like streaks or spots. 64 diseases of the skin\ Symptoms.—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 pins-head to a pea or larger. They both present a smooth depressed scar like appear- ance, and may be either white or claret-colored. They usually occur on the pelvis brim, the glutei, and the trochanters, and less frequently on the anterior sur- face of the thighs or the arms. Linear atrophy may occur at all periods of life, runs a chronic course, and seldom affects the general health of the patient. Under the microscope, the papillary layer is found atrophied, and the corium much thinned. It is supposed to be due to the cessation of the trophic nerve influence in localized areas. Treatment.—Cocculus may be given daily to cheek the formation of the claret spots. Graphites or /Sul- phur for the white spots, and Saba\dilla 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. Definition.—Atrophy of the nail maybe either con- genital or acquired, and is characterized by a deficient growth of nail substance. Symptoms*—The nails are usually brittle, thinner than normal, and devoid, of the natural lustre and DESCRIPTION AND TREATMENT. 65' 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. Treatment.—The principal internal remedy for simple atrophy of the nail is Silicea. bakfr's itch. Definition.—Baker's itch is an inflammation of the skin induced by the irritant action of flour. See eczema. baldness. Definition.—See Alopecia. barber's itch. Definition.—See Tinea Tricophytina. BOILS. Definition.—See Furuncle. brick-layer's itch.. Definition.—Bricklayer's itch, is an inflammation of the skin, excited by the irritant action of lime. See Eczema. BROMIDROSIS. Definition.—Bromidrosis is a functional disorder of the sweat glands, characterized by offensive sweat. Synonyms.—Osmidrosis. Offensive sweating. Symptoms.—It may be either general or local. The <6G DISEASES OF THE SKIN. former is usually associated with some constitutional disease. Local bromidrosis is commonly located in the feet, axillae, and genital regions. The hands and feet are frequently cold, and present a bluish appear- ance, due to inactive circulation. Sometimes the dis- order is due to the saturation of long worn socks and boots. The odor varies, being at times almost imper- ceptible, 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 rheuma- tism, "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.—Local bromidrosis is often very diffi- cult of cure. The most thorough cleanliness should be observed. The parts may be washed with plenty of soap—juniper-tar soap is the best—morning and evening, and a piece of lint saturated with a one per .cent, solution of chromic acid, applied at intervals of two weeks. The internal remedy may be selected from the fol- lowing: Artemisia vulg.—Odor of garlic. Baptisia.—Foetid sweat. Frequent sweat from small of the back in all directions. Belladonna.—Sweat on covered parts. It stains the (Clothing and has an empyreumatic smell. DESCRIPTION AND TREATMENT. G7 Bryonia.—Sour or oily sweat night and day. Sweat in short spells, and only on single parts. Cantharis.—Sweating on the genitals. Sweat smells like urine. Carbo veg.—Profuse, putrid or sour sweat. I'oot- sweat, excoriating the toes. Cinchona.—Profuse, sickly smelling sweats. Ex- hausting night-sweats. Colocynth.—Noctural sweat on the head and extrem- ities, smelling like urine, and causing itching of the skin. Conium mac.—Strong, foetid, acrid, irritating sweat. Offensive odor without perspiration. Dulcamara.—Foetid sweat with copious discharge of limpid urine. Offensive night and morning sweat. Graphites.—Sour, offensive, yellow staining sweat. Profuse foot-sweat. Soreness and rawness between the toes after Avalking. Ledum.—Putrid, sour sweat, at night. Itchino- of the body. Lycopodium.—Sweat smelling like onions. Sweat from the least exertion. Nitric acid.—Odor like horse's urine. Nux vom.—Odor of musty straw, night and morn- ing. Petroleum.—Foetid sweat in the axilla. Tender- ness of the feet as if bathed in foul moisture. Tend- ency of skin to fester and ulcerate. Phosphorus.—Sweat smelling of sulphur. Sweat mostly en the head, hands and feet. 68 diseases of the skin. Rheum.—Sour smelling sweats. Rhododendron.—Spicy smelling sweat with formi- cation and itching of the skin. Offensive smelling sweat in the axilla. Sepia.—Sweat sour, or like elder blossoms. Offen- sive foot-sweat. During exercise. Silicea.—Offensive foot-sweats, with rawness be- tween the toes. Solanum tub.—AYhen in bed, the sweat has the odor of potatoes. Stannum.—Mouldy, musty, smelling sweat. Staphysagria.—Sweat smelling like rotten eggs. Uterine diseases. Sulphur.—Sweat has a burnt odor. Veratrum alb.—Bitter smelling sweat, staining the linen yellow. CALLOSITAS. Definition.—Callositas consists of an abnormal de- posit of epidermal cells, forming a yellowish or whit- ish, nickel-sized, horny, elevated patch, occurring especially on parts exposed to pressure or friction. Synonyms.—Callus. Callosity. Tylosis. Tyloma. Synvptoms.—It is observed on the hands of mechan- ics 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 in women. Diagnosis.—It differs from clavus or corn in its dif- fuse character, in the absence of pain, and in its involv- ing only the outer portions of the epidermis. DESCRIPTION AND TREATMENT. 69 Treatment.—Occasionally it disappears spontan- eously. If it proves a source of annoyance it may be removed by a knife (Fig. 8) or rasping, otherwise it is advisable not to interfere with it. When the soles become greatly hardened, and are fissured and painful relief can be obtained by wearing constantly, within the stocking, oiled silk cut a little larger than the sole. Graphites and Sill ceo, are respectively the main rem- edies for callosities on the hands and feet. CANCER. The main variety of cancer with which the derma- tologist, strictly speaking, has to deal, is the epithelial. The others belong to the province of the surgeon. See Epithelioma. CARBUNCLE. See anthrax. CHLOASMA. Definition.—Chloasma is a discoloration of the skin, of internal origin, characterized by the formation of round or oval patches, nickel-sized or larger, having a yellowish or brownish color. Synonyms.—Liver spots. Moth. Melanoderma. Symptoms.—It occurs more in women than in men, and is situated chiefly about the face and neck. It usually appears in the form of crescentic patches on the forehead and temples, also about the mouth. In women it is frequently found associated with and ^dependent upon some physiological or pathological 70 DISEASES OF THE SKIN. change in the uterus. In men it sometimes occurs in connection with tuberculosis, and after long-continued malarial diseases. Treatment.—Local applications are of temporary benefit. The one most commonly used is the mercu- ric bichloride lotion of the strength of two grain? (.13) to theounce (32.) of the emulsion of almonds. It may be painted on the parts night and morning. The oleate of copper ointment, prepared by dissolving one drachm (4.) of the salt of oleate of copper in sufficient oleo-palmitic acid to make a soft ointment, is also of service. The internal remedies most useful in chloasma are: Argentum nit.—Slight brown spots on the upper part of the chest and on the hands. Peculiar discol- oration of the skin from bronze color to black. Antimonium crud.—Brown liver-colored spots on both shoulders. Caulophyllum.—In nervous and hysterical women,, and when associated with painful menstruation. Ferrum met.—In chlorotic individuals. Guarana.—Yellow spots on the temples. Liver spots on the arms. Laurocerasus.—Flepatic spots on the face. Lycopodium.—Hepatic spots on the arms. Several brown spots on inner side of both thighs. Nux vom.—Chloasma dependent upon liver derange ment. Petroleum.—Brown spots on the wrists. Yellow- spots on the arms. DESCRIPTION AND TREATMENT,. 71 Sepia.—Yellow streak like a saddle on the nose and cheeks. In pregnant or nervous women. Sulphur.—Hepatic spots on the back and chest. Vellow and brown spots. AYoorari.—This remedy has been used with benefit. CHROMIDROSIS. Definition.—Chromidrosis is a functional disorder of the sweat glands, giving rise to a colored perspira- tion. Synonym.—Colored sweating. Symptoms.—Blue, yellow and red sweat have been observed. It occurs mostly in hypochondriacs and in nervous and hysterical females. The secretion is- usually fitful in character, and may be excited by emo- tional conditions. Treatment.—Nux vom., is the most important rem- edy. CLAVUS. Definition.—Clavus is a small, usually split-pea sized, flat horny formation, more or less deeply seated,. and painful on pressure. Sy n o ny m.—Co r n. Symptoms.—It may be either hard or soft. A hard1 corn is usually located on an outer surface, and a soft corn is generally located between the toes, where the- parts aie kept moist. A corn resembles a callosity when hard, and a wait when soft. It is almost inva- riably due to wrongly fitting coverings for the feet. Treatment.—First of all the patient must consent to 12 DISEASES OF THE SKIN. wear easily fitting shoes or boots. The corn may be gotten rid of by soaking it :n Avarm water or poultic ■ ing it over night, after which the outer layers may be removed with the corn knife (Fig. 8) After continu- ing this treatment for several successive nights, the formation will be softened to such an extent, that u can be removed without pain. Fig. 8. Corn Knife. Repeated dressing of the parts with narrow, short, nicely adjusted strips of Maw's moleskin plaster, after the corn has been thoroughly macerated and the pro- jecting portions removed with the corn knife, are also of service. Flexible or arnicated colloid maybe used as a dress- ing for painful soft corns. Ringed corn plasters often prove valuable aids in protecting the corns. If the corns are inflamed and painful, a veratrum viride or arnica lotion, one part to ten, may be resorted to instead of the poultices. A lotion consisting of one drachm (4.) of salicylic acid, ten grains (.66) of extract of cannabis indica. and one ounce (32.) of collodion, applied with a camel's hair brush once or twice a day has been used with great success in removing corns. Antimonium crudum, is the principal internal -remedy for liardcovns, and Sulphur for the soft variety. DESCRIPTION AND TREATMENT. 73 COMEDO. Definition.—Comedo is a disorder of the sebaceous glands, characterized by small black-topped sebaceous po nts. Synonym.—Acne punctata. Etiology.—Comedo depends largely upon gastro- intestinal or genital irritation. Symptoms.—Comedones, vulgarly styled worms or grubs, are small, hardened plugs of sebnccous matter contained within the cavity and ducts of the glands. They vary in size from a pin-point to a pin-head. The disease shows itself generally on the forehead, cheeks ;and chin. It appears mostly in young people, between the ages of fifteen and twenty-five, and is a frequent accompaniment of acne. In the substance of the mass of retained sebum which may be squeezed out of the gland, a living and innocent grub, first discovered by Henle in 1841, and -called the acarus folliculorum, is frequently, though not always observed. Diagnosis.—It differs from milium in that the seba- ceous 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 mil- let-seed like points. Prorynosis.—If left to itself, comedo rarely runs longer than four or five years. Matrimony is said to hasten its departure. Treatment.—The diet should in the majority of cases he regulated so as to exclude oily and fatty foods and pastry. 74 DISEASES OF THE SKIN. In some cases, however, cod liver oil may be needed. The individual comedos should be squeezed out with a watch key or the comedo extractor (Fig. 6), and a sulphur lotion, composed of sublimed sulphur two drachms (8.) and alcohol one ounce (32.) applied and allowed to remain on all night. The principal internal remedies are Baryta carb.. and Selenium. Others may be indicated as follows: Belladonna.—Comedos in young full-blooded people. Cicuta.—Black spots on 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 free. 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. Definition.—Condylomata are contagious lesions- peculiar to syphilis, and consist of round, oval or oblong, pale or rosy, usually elevated spots, covered with a whitish pellicle. Synonyms.—Mucous patches. Mucous tubercles. Plaques muqueuses. Symptomatology.—They are moist lesions, which may appear at any period of syphilis, but are more common during the early stages. They vary in size DESCRIPTION AND TREATMENT. 75 from a pin's head to a fifty cent piece or larger, and select as seats, notably the niuco-cutaneous surfaces. They are seen mostly about the anus, throat, mouth and genitals, and beneath the mammae, and usually appear upon the skin in connection with the papular syphilide. They are superficial and of a grayish-white color in the mouth, but raised and of a reddish color about the genitals. Their secretion is glairy and intensely con- tagious. rlr the parts clean and dry. If the excrescences are troubloome, excise them with the knife and afterwards apply a mercuric bichloride lotion, strength one to two grains (.066 to0.133) to the ounce (32.) of water. The principal internal remedy is Thuja. Other remedies may be indicated as follows: Cinnabar.—Fan-shaped fig-warts accompanied by tetter. In scrofulous infants and children. Euphrasia.—Fig-warts at the anus. Mercukius cor.—Dry fig-warts, or else fig-warts accompanied by acrid discharges. Soft, flat condylo- mata. Mercurius nit.—Filiform fig-warts. Mercurius precip. ruber.—Fissured condylomata. Mercurius sol.—Conical fig-warts. Small, itching pimples which ulcerate and become incrusted. Mild types. Nitric acid.—Pediculated and pen-shaped, moist condylomata. Fig-warts on the glans. Sabina.—Condylomata attended with itching an< burning. 76 DISEASES OF THE SKIN. Sarsaparilla.—Flat fig-Avarts. Staphysagria.—Cock's comb shaped fig-Avarts. Sulphur.—Soft, spongy fig-Avarts. Thuja.—CaulifloAver excrescences. Condylomata on die penis, vulva and about the anus. Broad, flat condylomata. After iritis, tubercles or Avarty excres- cences on the iris. CORNU CUTANEUM. Definition.—A cutaneous horn is a curved, conical- ridged, usually brownish, corneous eminence, formed of dense, closely compressed columns of epithelia. Synonyms.—Cutaneous horn. Horny excrescence. Symptomatology.—Cutaneous horns commonly de- velop upon the head, but sometimes upon the penis, and other portions of the body. They are usually of small size; occasionally they measure several inches in length. Their growth is attended Avith little or no pain. Treatment.—At times the horn is shed spontaneously, generally it is necessary to excise the entire structure Avith a portion of the skin from Avhich it groAVS. dermatalgia. Definition.—Dermatalgia is an affection of the skin characterized by pain, and is unattended by structural change. Synonym.—Cutaneous neuralgia. Symptomatology.—It attacks principally parts that are covered Avith hair and occurs oftener in women than men. The affected parts are very sensitive to DESCRIPTION AND TREATMENT. 77 external impressions, and the pain may be continuous- or intermittent, slight or severe. It is usually of a burning character, worse at night, and may last a Aveek or longer. Dermatalgia is to be differentiated from pruritus and cutaneous hyperesthesia. Treatment.—The galvanic current, at times affords magic relief. Local application of the rubber bag rilled Avith very hot water is also useful. The following remedies may be compared: Baryta, Bell., Bryonia, Cinchona, Ferrum, Manganum, Nux niosch., Nux vom., Phos. Sepia, Spigelia, Sulph., Veratrum, etc. DERMATITIS CONTUSIFORMIS. Definition.—Dermatitis contusiformis may be defined; as an acute affection, characterized by oval or round purplish nodules, varying from the size of a hickory nut to that of a fist. Sy?iony?n.—Erythema nodosum. Symptomatology.—The attack is generally ushered in by slight febrile disturbance, more or less loss of appetite, malaise, and Avandering rheumatic pains. The nodules are developed suddenly, and appear in crops of rarely less than a dozen in number. They are firm and hard, tender to pressure, and reddish or pur- plish in color as they are first formed, butgroAV darker and softer as they grow older. They develop mostly on the anterior surface of the leg, Avith their long; diameter running lengthwise of the limb. Occasionally 78 DISEASES OF THE SKIN. they appear on the arms and face, and are marked by a dark red periphery. They never suppurate, but dis- appear by absorption, and fade aAvay in color like bruises. They are frequently accompanied by burn- ing pain and considerable constitutional disturbance. The disease is seen mostly in young persons, espec- ially females, and is often associated Avith rheumatism and chorea. It occurs more frequently in spring and fall, seldom lasts longer than two or three Aveeks, and tends to spontaneous recovery. Relapses are apt to take place. Etiology.—Dermatitis contusiformis is supposed to be due to embolism of the cutaneous vessels, and is someAvhat 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. Apis mel.—Inflamed erysipelatous appearance of the nodules. Stinging, burning pains. Relieved by cold dressings. Arnica.—YelloAv,blue, and reddish-blue spots. Pain as if beaten. In lying-in women. Ptele\ trif.—Red spots on the lower extremities, alike in position on both. After an hour or so change to purple color. The spots become dirty yellow, and leave the appearauce of a bruise. Rhus venenata.—Red spots from half an inch to two DESCRIPTION AND TREATMENT. 79 inches in diameter, especially on the legs beloAV the knees, painful and changing color into bluish then greenish yelloAV. DERMATITIS EXFOLIATIVA. Definition.—Dermatitis exfoliativa, may be defined as a disease usually involving the Avhole surface, and characterized by a highly reddened skin, and the abund- ant exfoliation of epidermis in the form of large thin whitish flakes. Synonym,—Pityriasis rubra. Symptomatology.—Dermatitis exfoliativa has been generally described under the name pityriasis rubra, an unfortunate term which is apt to mislead, as the scales are not branny as in ordinary pityriasis, but flake y. It commonly begins in the form of small and red flakey patches Avhich rapidly increase in size, unattended by either thickening of the skin or itching. The flakes vary in size, from a nickle to several centimeters in diameter, and Avhen removed, leave the skin red and shining. Handfuls of these armor-like plates may be shed in twenty-four hours. It is a rare disease, occurs mostly in adult males, 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. Diagnosis.—It is most likely to be confounded with eczema in the squamous stage, psoriasis, pem- phigus foliaceus and lichen ruber. 80 DISEASES OF THE SKIN. Treatment.—Soothing local applications, such as- bran baths or a decoction of walnut leaves folloAved by oily inunctions, and later by oil of white birch, are important aids. The internal treatment should be directed if need be toAvards bringing about a healthy condition of the system. Arsenicum alb. is the principal remedy. Other remedies occasionally indicated are: Arsen- icum iodide, Kali ars., Piper methysticum, Clematis, Graphites, Phosphorus and Sulphur iodide. dermatolysis. Definition—Dermatolysis consists of an hypertrophy of the connective tissue elements of the skin, assuming the form of pendulous or purse-like folds. Synonym.—Cutis pendula. Symptomatology.— It seldom appears before the age of puberty, though occasionally it is congenital. It runs a sIoav course, and may be confined to certain regions or appear on any part of the body. Treatment.—If the folds are large they may be lig- atured and excised. Ammonium bromide has some reputation in arrest- ing the disease. Staphysagria and Carbo animalis may be studied. DYSiDRosrs; Definition.—Dysidrosis may be defined as an inflam- mation of the sweat structures of the hands and feet, and is characterized, by redness and. swelling of the DESCRIPTION AND TREATMENT. 81 parts with distension of the sweat ducts in the form of sago-like points, and the development of bullae. Symptomatology.—It appears more in summer than in Avinter, and attacks symmetrically the sides and palmar surfaces of the fingers, the palms, and some- times the soles of the feet. It selects as its victims the nervously debilitated, and tends to run a definite course of two or three Ave'eks 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 soothing applications, notably alkaline baths to Avhich a little starch has been added, and afterAvard wrapping the parts up in carron oil. Clematis and Natrum sulph., are the most import- ant internal remedies. ECTHYMA. Definition.—Ecthyma is characterized by the devel- opment of large, isolated painful pustules, situated upon hard and inflamed bases, and folloAved by dark- brown crusts, Avhich on falling leave temporary scars. Symptomatology.—The pustules are roundish or oval, flattened, of a yelloAV or yelloAvish-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 fiat dark broAvn crusts, Avhich Avhen removed leave exten- sive excoriations, and resultant temporary scars and pigmentation. Ecthyma may occur at any time of 82 DISEASES OF THE SKIN. life and selects as its victims the badly nourished and cachectic. Scratching often plays an important part in its causation and continuance. The neck, shoul- ders and extremities are its most frequent seats. It is a superficial lesion, and rarely extends beyond the papillary layer. Diagnosis.—It may be confounded Avith eczema and impetigo contagiosa, but is more apt to be mistaken for the large, flat, pustular syphilide. Ecthyma, how- ever, develops mere rapidly, has more heat and pain, and has slight ulceration and broAvnish crusts; Avhile the syphilide has a more or less deep ulcer, Avith abrupt edges, and a blackish crust. Prognosis.—Ecthyma is ahvays curable and displays no disposition to relapse. Treatment.—The patient should be well hygiened and given a good generous diet. The crusts may be removed after soakings Avith oil, and the affected parts dressed Avith a Aveak Avhite precipitate ointment—five (.33) to ten (.66) grains to the ounce (32.) of cosmo- line. After the pustules burst, if the ulcers show but little tendency to heal, a Aveak carbolized Avash may be used. The appropriate internal remedy may be selected from the folloAving: Antimonium crud.—Pustules on the face in fat peo- ple. Yellowish or brownish scabs on the face. De- sire for acids. Arsenicum alb.—Red or Avhite pustules with in- DESCRIPTION AND TREATMENT. 83 tense burning. Painful, black pustules. Thickcrusts leaving well marked scars in cachectic individuals. Belladonna.—Pustules surrounded by a Avhitish areola. Burning and itching with great sensibility to touch. Cicuta.—-Confluent pustules about the face, form- ing yelloAV crusts. Cyclamen.—Pustules on the feet and toes. Croton tig.—Confluent pustules with oozing and burning. Greyish brown crusts on the abdomen. Kali bich.—Pustules all over the body having a small broAvn scab on top. Pustules at the root of the nails, spreading over the hands. Pustules resembling small-pox. In light-haired people. Kreasote.—Large pustules Avith violent itching towards evening. Ulcers on the face and chin. Mercurius.—Suppurating pustules, which either run together discharging an acrid fluid, or Avhich re- main sore, become holloAV, and afterwards raised and cicatrized. Ulcers bleed easily. Nitric acid.—Feeling as of a splinter sticking into the pustules when touching them. Petroleum.—Itching and burning pustules. Great lassitude. Piper nigrum.—Large pustules leaving marks on the face. Rhus tox.—Pustules seated upon a red base, with much itching and burning. Worse at night and in cold and stormy weather. Secale.—Pustules on the arms and legs, with ten- 84 DISEASES OF THE SKIN. dency to gangrene. In cachectic, scraAvny females with rough skin. Silicea.—Ecthymatous pustules all over the bodyr sensitive to contact. Pustules on the back part ot the head. Burning and soreness after scratching. Sulphur.—Dry, thick yellow scabs over the whole , body. Itching pustules on the scalp, painful to the touch. Tartar emet.—Large, round, full burning pustules Avith red areolae, forming in two davs, and leaving deep scars. Thuja.—Suppurating pustules upon the lower ex- tremities. . Cistus and Nux juglans may at times be indicated. eczema. Definition.—Eczema is an acute or chronic, non- contagious inflammation of the skin, characterized by either an erythematous, papular, vesicular or pustular- eruption, or a combination of these, accompanied with burning, itching and more or less infiltration, termin- ating either in discharge with the formation of crusts, or in desquamation. Synonyms.—Salt rheum. Moist tetter. Milk crust. Symptomatology.—Eczema may be either acute or chronic. It may commence abruptly or gradually, and may run its course in a feAV weeks or last for months or years. The acute form is frequently though not ahvays ushered in by more or less febrile disturbance, lassi- tude and loss of appetite, which are soon folloAved br DESCRIPTION AND TREATMENT. 85 tin eruption of one or more reddish patches of variable size, accompanied by heat and burning. In a day or tAvo or at times even in a few hours, little pin points are seen on the reddened surface, and vesicles make their appearance, attended with more or less itching. The vesicles are small and closely aggregated. They are made up mostly of serum, containing a lew leu- cocytes and a little fibrin, and rarely last longer than twenty-four or forty-eight hours. The itching is iioav 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 formed Avhich either rupture spontaneously or from friction. Usually in propor- tion to the amount of leucocytes contained in the effu- sion, the disease will be either decidedly vesicular or decidedly pustular. After rupture the contents of the .pustules dry upon the surface in the form of charac- teristic yellowisli-green scabs. On removal of the scabs or crusts a moist reddened surface becomes visible. This is the second or exudative stage, and may be of indefinite duration. The advancing border of the dis- ease may be marked, either by the formation of neAV papules and vesicles, or by the simple exfoliation of the stratum corneum. This latter phenomenon may be explained by the fact, that succeeding the primary congestion, there is an exudation from the vessels, Avhich may instead of lifting up the layers to form vesicles, ooze through-, and float the corneal layer of cells. 86 DISEASES OF THE SKIN. After a time the exudation lessens, the crusts grow thinner, the effusion ceases, the surface becomes dry, Avhite scales take the place of crusts, and the disease is. in the third stage. Occasionally the skin becomes much infiltrated and thickened, or in more aggravated forms takes on a decided tendency to fissure. If, however, the patches tend to recovery, the scales become finer and more adherent, and the skin gradualhr returns to its natural, condition Avithout a scar. According as the disease is mild or severe, or accom^ paniecl by an amount of pustulation and crusting out of proportion to the extent of the inflammation pres- ent^ has received the names of E. simplex, E. rubrum, and E. i?npeiiginosum. Not infrequently the disease instead of going through its typical course stops short at, or aborts during any one of the stages of development. Thus the eruption may remain erythematous from first to last (E. erythe- malosum). Or the disease may pass rapidly through the condition of hyperemia to the development of small red papules, and then linger (E. papulosum.) Or again the papules may quickly become vesicles (E. vesicidosum); or the inflammation may pass to a pustular form (E. pusiulosum.) Or lastly, the disease may run through all its stages or pass over any one of them, and remain stationary indefinitely in the third stage, (E. squamosum.) Acute eczemas may vary someAvhat in their general, characters, according to their location and the temper- ament of the patient. description and treatment 87 In nervo-bilious subiects they tend to become irri- table, in gouty subjects they are apt to be inflamma- tory, and in scrofulous individuals they run speedily and freely to the formation of pus. AYhen occurring on the scalp—a common seat in infants—the disease passes rapidly through the erythe- matous and vesicular to the pustular stage, and is fol- lowed by the formation of thick greenish-yellow crusts, covering a raAV red and cracked surface. The sero-purulent discharge glues the hairs together and a dense matted crust may be produced. This form may persist for years if neglected, and is seldom attended by much itching. Subcutaneous abscesses and glandular enlargements are not infrequently met Avith in strumous children. On the face the eruption is often symmetrical and may be present in different stages. In adults it tends to linger in the erythematous stage, and usually proves a very stubborn form of the disease. In children, eczema in this locality has been given the title of crusicu lactea. On the eyelids it is frequently very troublesome', and is often confounded Avith inflammation of the Meibomian glands. The margins of the lids are thick- ened and red, and there may be partial or complete loss of the eyelashes. On the nostrils it generally terminates in the forma- tion of a thick scab. On the lips it may be red, seal}' or moist, and is often attended by marked oedema Avith fissures. Ery- 88 diseases of the skin. thematous eczema about the mouth is apt to prove stubborn, and tends to become chronic. On the ears there is generally considerable inflam- mation and swelling. The vesicles may be Avell devel- oped, but proceed to early pustulation. The dis- charge either drips away constantly or dries and forms stalactiform crusts. Small abscesses may at times develop. In the axilla?, enlargement of the axillary glands Avith the formation of abscesses is frequently observed. On the nipples it 5s usually accompanied by severe pruritus and a copious discharge of yellowish or red- dish serum. On the genitals there is commonly considerable attendant heat and redness. Moisture is always a prominent symptom. In females it affects chiefly the labia majora and usually takes the severe form (E. rubrum). Appearing about the anus it leads to the formation of painful itching fissures. 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 through the erythematous and be prolonged in the pustular stage. The flexures of the joints and the clefts of the nates are oftener affected with the severer type (E. rubrum) than other parts of the body. On the hands midfeet it is usually symmetrical, and frequently assumes the fissured form Avith but little exudation and crusting. Local irritants are the most common causes of eczema restricted to the hands and feet. DESCRIPTION and treatment. 89 On the umbilicus it assumes either the severe (E. rub- rum) or pustular (E. impetiginosum) form or is marked by considerable oedema. In young children "scratch marks" are scattered with more or less profusion over the affected surface. Chronic eczemas may either start as primary affec- tions, or Avith acute or sub-acute symptoms, the dis- ease halting 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 Avhenever eczemas take on definite lines of action or show a ten- dency to repeat themselves, and are accompanied by secondary changes. They usually involve a limited surface of the skin; exceptionally they invade the entire surface of the body. They are prone to recur- rent exacerbations of an acute grade, and are generally attended by more or less itching. On the scalp chronic eczema is frequently accom- panied by fulling off* of the hair. Adults of a lympha- tic and scrofulous habit, and especiallv Avomen 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 Avarty thickening of the skin. Squamous or scaly eczema is apt to be attended by itching and the constant shedding of scales. On the cheeks, chin and upper lip it is very intracta- ble. The parts are more infiltrated than in the acute form and may be covered with bran-like scales. Erythematous eczema about the mouth is very rebel- lious. 90 DISEASES OF THE SKIN. On the ears it is very obstinate Avhen it attacks females at the climacteric. Chronic eczema of the auditory canal is not infrequent. The parts are usually moist, thickened and itchy. Not infrequently they ars fissured, especially at the reflection of the auricle from the mastoid process. On the nasal mucous membrane it may form crusts Avhich adhere for years and give rise to annual returns of erysipelas of the face. On the mamma? it may result m the formation of fissures and abscesses. Glycosuria is a common accom- paniment. On the perineum and anus there is always more or less moisture Avith a decided tendency to fissure. On the genitals thickening of the scrotum is apt to take place. Occasionally the penis is affected. Not infrequently there is severe itching. On the hands and feet it sometimes commences by the appearance of fissures which are red and painful, and give forth a viscid secretion which dries into scales. On the legs, especially in old people, it is prone to take on an inflammatory state, Avith a tendency to the formation of ulcers. Infiltration is always a common feature of chronic eczema. Chronic hard patches often occur about the ankles and prove very rebellious. Etiology.—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. DESCRIPTION AND TREATMENT. 91 Like the individual avIio makes a failure in life, eezema usually travels, from head to foot as age advances. 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 loAver 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 loAver 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-assimilation, is after this manner, a very potent cause. Diseased states of the kidneys or boAvels, and an inactive skin, Avhereby 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, dentition plays an important part. Pregnancy at times occasions an outbreak. Blacksmiths, grocers, bakers, Avasherwomen, and Avorkers in lime, from the irritating nature of their employment, are liable to the types knoAvn as grocer's, bakers's washerwoman's, etc., itch. At times eczema becomes substitutive. And so occa- sionally it may be seen to disappear from the skin in connection with the development of a bronchitis, leucorrhoea, or intestinal catarrh or vice versa. Its disappearance is thus looked upon as a consequence, not a vause of the latter. Of 'ocal causes or those which give rise to artificial '92 DISEASES OF THE SKIN. ■eczema may be mentioned; excessive use of iner*. ary, croton tig., cantharides, mustard, rhus ven. and rhus tox. strong potash soaps, and the contact of aniline dyes and pediculi. An attack may sometimes occur from the injudicious use of Turkish and Russian baths. Eczema is due to faulty innervation, by Avhich cell proliferation and capillary congestion, Avith their con- sequences are produced. The papillary layer is its principal seat and the modus operandi of its develop- ment is as follows : An exudation of serum takes place from the congested vessels, which floats the over- supply of neAV cells, and the two push onto 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. Diagnosis.—The diagnosis of typical eczema presents but little difficulty. It is only in the irregular and imperfectly developed cases that mistakes may arise. In the erythematous stage it may be confounded with erythema, but the subsequent course of the disease soon disperses any doubt. In the papular stage, it at times resembles lichen. Lichen affects particularly the outside of the limbs, and is a decidedly plastic in- flammation, Avhile eczema is a serous one. In the ves- icular stage, eczema, herpes, zoster, and scabies, may bear considerable resemblance. The points of differ- ence are : the vesicles of herpes are larger than those of eczema, and appear mostly on the face and genitals. The eczematous vesicles may be irregularly distributed DESCRIPTION AND TREATMENT. 93" over the body. Eczema is never attended by the neu- ralgic pain of zoster, and the eruption does not follow the course of the nerves. It is seldem accompanied by the intense nightly.itching, so characteristic of scabies. The presence of acari, and the rapid disappearance of the disease under parasiticiclal treatment, Avill at once- decide the question. In the stage of incrustation, it may be mistaken for impetigo contagiosa and tinea favosa. The crusts of impetigo contagiosa, are super- ficial 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 foliaceous variety of pemphigus. Psoriasis never has* a history of discharge, and the scales are silvery Avhite, 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 bullae, and the scales are thick and parch- ment-like. Eczema of the breast differs from "Paget's Disease" in that the latter is an epithelial degenera- tion Avhich frequently ends in cancer. Pustular eczema of the scalp is sometimes mis- taken for syphilis. It differs from the pustular syph- ilide however in the absence of a history of syphilis and of the disgusting odor which ordinarily accom- panies the discharge of the latter. The diagnosis of the principal diseases of the scalp isgiveninthe following table arranged by Morris: ECZEMA. SEBORRHCEA. PSORIASIS. VESICO-PUSTULAR SYPHILIDE. TINEA TONSURANS. FAVUS. 1. Most frequent in children, in the de-bilitated or stru-mous. 2. Often attacks the whole scalp. Ulcers, if any, sup-erficial; crusts thick, yellowish, brittle; pus, epithelium and granular matter. Seited on red, infil-trated, moist, often, excoriated surface, which shades off gradually into heal-thy skin and itches excessively. a. Syphilitic his-tory and phenomena only accidental, if present at all. 4. Distinct eczrma often on other parts of body, on flexor surfaces or behind the ears. 5. Hair heathy, occasionally falling-out ; no parasite. 6. Non-contagious. 1. Usually in ad-ults. 2. Crusts are thin, oily, can be kneaded into masses; consist chiefly, of sebum and epithe iuin on a smooth, oily sur-face ; not, or only slightly, red, and non-excoriated or infiltrated ; itching only slight. 3. Usually no speci-fic phenomena. 4. U s u a 11 y only slight, oily crusting on face near scalp. 5. Hairsoftendrop out. 0. Non-contagious. 1. Most often in healthy persons, rarely in strumous. 2. Eruption usual-ly white, scaly, and silvery; dry from onset and through-out course; red base, only slightly infil-trated, and itching only slight. rs. Usually nospeci-lic history. 4. Well-marked scaly pa'ches, usual-ly present on ex-tensor surfaces of elbows and knees. 5. Hairs only slight-ly affected. 6. Non-contagious. 1. Usually in ad-ults only. 2. In small patches usually; often deep ulcers with sloughy bases. 3. Usually a his-tory of primary syp-hilis, and presence of alopecia, noctur-nal pains, etc. 4. Syphilides. squa-mous, pustular, tu-bercular, etc., with coppery color, usu-ally presentonbody. 5. Hairs fall out freely, and incura-ble alopecia may re-sult. 6. Communicable V*y inoculation. 1. Frequent in children. 2. PatchesusuaUy circular, deficient in hair ; crusts, etc., not i." 3cessarily pre-sent ; itching slight. 4. Ringworm of body (tinea circin-ata) often present. 5. Hairs twisted, thickened, whitish, broken off short, easily extracted ; filled with tricho-phyton tonsurans. 6. Contagious. 1. No special proneness in stru-mous. 2. Round, dry, sul-phur yellow, cup-shaped crusts.pene-trated by dull brittle hairs, with abrupt edges and often ba id patches. 4. Cupped yellow crusts may be found on hairy parts of t he body. 5. Hairs dull, dry, brittle, easily ex-tracted, loaded with achorion Schonleinii 6. Contagious. DESCRIPTION AND TREATMENT. 95 Prognosis.—The prognosis is always good in acute rases, but should be more or less guarded in chronic forms. Eczemas at the mucous outlets are more obstinate than those located elseAvhere. Treatment.—The diet should be regulated so as to bring in as many of the oleaginous principles as pos- sible in place of the nitrogenous. SAveets and starches in excess must be avoided. Pork, fish, seasoned meats, pastry, pickles and stimulating drinks should be strictly forbidden. Cream should enter largely into the diet in children. In adults milk should not be taken as a beverage Avith meals, but alone, on an empty stomach. Mothers nursing eczematous children should abstain from taking ale, beer, Avine or tea. The local treatment consists in first allaying the acute inflammatory symptoms, if any exist. This is best done by the use of bran washes, or emollient poultices of marsh malloAV, boiled starch or linseed meal. In simple eases Avhere there is but little inflamma- tory disturbance, and the discharge is the principal feature, the parts should be dusted Avith buckwheat flour, or with equal parts of starch and zinc oxide. When there is much itching, temporary relief is afforded by the application of cloths wrung out in hot water. As an antipruritic a lotion composed of one drachm (4.) of carbolic acid, one ounce (32.) of glyce- rine, and one pint (512.) of water may prove useful. At times oleates or ointments answer better than 96 DISEASES OF THE SKIN. either lotions or dusting powders, and then the oxide of zinc ointment, the oleate of bismuth ointment or the oleate of tin ointment may be of value. A paste composed of ten grains (.6) of salicylic acid, two drachms (8.) of oxide of zinc, two drachms (8.) of amylum, and four drachms (16.) of white vase- line, is an excellent soothing and protective dressing. In chronic eczema benefit will often follow the use of a glycerine jelly prepared by cautiously boiling one drachm (4.) of gelatine and tAvo drachms (8.) of glycerine in three drachms (12.) of water until they form a transparent mass, and then adding one drachm (4.) of oxide of zinc. When desired for use a sufficient quantity can be liquefied by heating, and painted over the affected skin with a flat stiff brush, forming a thin, flexible, adherent covering. In inveterate cases, oil of white birch may be used in the form of an ointment, one-half (2.) to two drachms (8.) to the ounce (32.) of vaseline. Frequent Avashing of eczema is injurious. In eczema of the legs, considerable benefit may be derived from strapping the parts with Martin's elastic bandage during the day, and applying soothing dress- ings at night. Vulcanized India rubber gloves are of considerable value in eczema of the hands when the- cuticle is thickened and hard.. DESCRIPTION AND TREATMENT. 97 The appropriate internal remedy will usually be one of the following, according to the indications: Aconite.—In the simpler forms of eczema,and when there is much febrile disturbance. Acute cases, Avith stinging and pricking of the skin, in plethoric persons. Alumina.—Hard crusts on the scalp, face and extrem- ities. Gnawing itching, Avorse in the evening, not relieved by scratching. Aggravated on alternate days and from eating new potatoes. Dryness of the skin. Constipation. Ammonium carb.—Eczema in the bends of the extremities. Excoriations between the legs, and about the anus and genitals. Violent itching relieved by scratching. Aggravated by either cold applications or hot poultices. In children. Ammonium mur.—Eczema on the face and across the loins. Intense burning, somewhat relieved by cold applications. Constipation. In fat sluggish individ- uals. Anacardium.—Acute eczema on the face, neck and chest. Intense itching usually aggravated, but occa- sionally relieved by scratching. Redness of the skin Avith eruption of small vesicles. Sensitiveness to draught. Antimonium crud.—Pustular eczema about the face and joints. Painful cracks in the corners of the mouth. Violent itching and burning, better in the open air, Avorse after bathing. Thick, heavy, yelloAV crusts upon the face. Gastric derangement Avith thick white coated tongue. In children avIio groAv fat.. 18 DISEASES OF THE SKIN. Antimonium tart.—Eruptions about the nose and -eyes, neck and shoulders, and back of the ears. Ves- icles surrounded by a red areola. Pustules, as large as ioeas. Itching Avorse in the evening, better in the open air. Eruption leaves bluish-red stains upon the face. Child wants to be carried; cries if touched. Desire for acids; aversion to milk. Rattling cough. Apis mel.—Red and oedematous skin, Avith burning and stinging. Better from cold applications, Avorse after warm applications. Large vesicles. Urine scanty and high colored. Argentum nit.—Eczema on the genitals. Urging to urinate. In children Avho eat too much sweets. Arsenicum alb.—Eczema on the face, legs and geni- tals. Intense burning of the surface. Itching worse during the first hours of sleep. Better from external heat; Avorse from cold or from scratching. Dry scaly eruption Avith parchment-like skin. Falling out of hair in patches. Useful in chronic cases. Arundo maurit.—Eruption on the chest, upper ex- tremities and behind the ears. Intolerable itching, is the principal internal remedy for vesicular 120 DISEASES OF THE SKIN. erysipelas, Bell, for non-vesicular erysipelas, Apis when there is much swelling, and Graphitts or Pul- satilla for wandering erysipelas. Other remedies may bo indicated as follows: Aconite.—In simple erysipelas Avith febrile disturb- ance. Apis.—Erysipelas of the face, and scalp with cedem- 11 tons SAvelling of the eyelids. Stinging burning, pricking pains in the skin. The eruption passes from right to left and is lather pale than deep red. Arnica.—Erysipelas Avith tendency to formation of bullae. Extreme tenderness and painfulness on pressure. Arsenicum.—Erysipelas with gangrenous tendency. Excessive general prostration. Belladonna.—Bright-red non-vesicular SAvelling es- pecially of the right side. Intense fever, the skin imparts a burning sensation to the hand. Brain symp- toms prominent. Tendency of the inflammation to spread in streaks. Borax.—Simple erysipelas of the left side of the face. Sensation as if covered by cobwebs. Bryonia.—Erysipelas around the joints Avith drawing tearing pains increased by motion. Cantharis.—Erysipelas with fine burning stinging pains. Large blisters. The eruption begins on the nose and spreads to the cheeks, more to the right side. •L'rii ary complications. After abuse of Arnica. Cuprum.—Tendency to metastasis to the brain. Violent brain symptoms. Euphorbium.—Erysipelas of the head and face with DESCRIPTION AND TREATMENT. 121 digging, boring and gnawing pains, folloAved when ameliorated by creeping and itching of the part. Con- siderable SAvelling. Small vesicles discharging a vel- lowish fluid. Graphites.—Tendency to repeated attacks, passing from right to left. Erysipelas of the head and face with burning, tingling pains. Swelling and indura- tion of the lymphatics and glands. Hydrastis.—Erysipelas wandering from left side of nose to right over entire face and scalp. Intense pain Avith creeping chills in small of back. Great restless- ness. Urinary suppression. Used both internally and locally. Lachesis.— Erysipelas especially on the Jeft side. The eruption has a purplish, leaden hue. Cerebral symptDins, Avorse from noon until midnight. Delir- ium on closing the eyes. Ledum.—Erysipelas from bites of insects. Nux vom.—Cardialgia. Burning itching all over i;he skin, Avorse in the eArening. Bright red swelling >of the knees and feet Avith intense pain. Phos. acid.—Erysipelas produced by traumatism, where the periosteum is affected. Pulsatilla.—Wandering erysipelas. Erysipelas of the ears. Indigestion after disappearance of eruption. Rhus.—Vesicular erysipelas Avith SAvelling and shin- ing redness. The eruption spreads from left to right. Burning and itching Avorse at night. Extreme rest- lessness. Pain in back and limbs, worse during rest. CEdoma with dark bluish redness of the parts. Typhoid symptoms. 122 DISEASES OF THE SKIN. Sulpb'oT,,—"Migraiojy erysipelas Avith intense itching. Veratrum vir.—Vesicular erysipelas, accompained by high fever and marked cerebral disturbance. Ten- dency to convulsions. FAVUS. Definition.—See Tinea favosa. FIBROMA. Definition.—Fibroma is characterized by sessile or pedunculated outgrowths from the connective tissue,. generally club-shaped, and varying in size from a pea to a large pear. Synonym.—Polypus of the skin. Symptomatology.—The polypi or tumors are as a rule unattended with pain. They may either remain stationary or grow to a considerable size. In consis- tence the smaller are usually soft, and the larger more elastic and fibrous. When large they are apt to take on ulceration. Treatment.—The larger tumors may be removed by the knife, the galvano-caustic, or the elastic ligature. The smaller ones grauually disappear under the local use of the acid nitrate of mercury. The arseniate of calcarea and lycopodium are the pri n- cipal internal remedies. FISH-SKIN DISEASE. Definition.—See Ichthyosis. FRAMBCESIA. Definition.—Framboesia is an endemic contagious DESCRIPTION AND IRE VTMENT I 2'S di.-easc, characterized by variously sized reddish par> ules, tubercles and tumors, in all stages of devticpment. Sytionyms.—Yaws. Endemic verrugas. SympUymatology.—The eruptions start as pin-head sized points and gradually increase in size so as to re- semble in their diflercnt stages of development, first a currant, then a raspberry, and last!}'a cherry. Later on in their course they are apt to break doAvn and ulcerate, pouring out a thin yellowish offensive dis- charge. The disease is almost Avholly confined to tropical climates, and principally met Avith among the colored': races. It rarely occurs twice in the same individual. It attacks mostly the face and genitals, and occasion- ally the upper and loAver extremities. It is endemic in the West Indies and m South America and Africa. Treatment.—Cleanliness, nourishing diet and a avcII regulated hygiene arc highly important. The local treatment consists in using a jatropha lotion having the prepared strength of from one drachm (4.) to Iavo drachms (otassium are the most '■ihcacious internal remedies. FURUNCLE. Definition.—Furuncle is an acute localized inflam- mation of the skin and connective tissue, varying in size; from a small pea to a hickory-nut, having an in- 124 DISEASES OF THE SKIN. duratcd and inflamed base, and usually terminating in suppuration and the formation of a "core". Synonym.—Boil. Symptomatology —The boil commences as a small roundish, infiamed spot, tender to the touch, and sur- rounded by a bright red areola, Avhich changes to purple as the disease advances. It gradually increases in size, becomes more and more sensitive to the touch, and the pain Avhich is usually of a throbbing nature increases in intensity. After running an increasingly painful course of five or six days, the rounded swelling suppurates and throAvs out a central slough called a "core". At times the suppurative stage is scarcely reached, and no core forms. It is then termed a "blind" boil. After the discharge, the pain, redness and inflamma- tory symptoms quickly subside, the patient feels relieved, and unless there are more to folloAV, 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 fol- licles, sebaceous glands or surrounding- cellular tissue. They are usually dependent upon disordered blood- states, or depraved conditions of system, and are some- times epidemic. They are more common at the extremes of life, but may occur at any age. Treatment.—Patients should be Avell hvgiened and given a good wholesome diet. In debilitated states DESCRIPTION AND TREATMENT. 125 the free use of porter may eradicate the tendency to boils. Brewers' yeast, in tablespoonful doses between meals, has the reputation of being a preventive. An ointment composed of hydrarg. oxidi rub. three grains (.2) and lanolin five drachms (20.) sometimes occasions their abortion. When a boil is tense and hard, the best local treatment consists in applying hot, limited flax seed meal or tomato poultices. Poultices should not be continued after the boil opens, as if too long used they rather encourage the formation of new boils. After the boil is fully matured if it has not already opened, it may be incised and the contents evacuated. Gelsemium or lappa cerate is a good after dressing The appropriate internal remedy will usually be one of the following: Absinthium.—Eruption of furuncles over the whole body. ^Ethusa.—Painful boil on the small of the back.. Hepatic derangement. Intolerance of milk. In chil- dren during dentition. Ammonium carb.—Boils on the cheeks and around the ear. In scrofulous children, and in old people. Antimonium crud.—Boils on the perineum. Burn- in «■ pain for some distance around. Gastric derange- ment. Arnica.—Many small boils on the face. Eructations bitter and like rotten eggs. General lassitude. Apis mel.—Boils on the pubis. Burning, stinging pains. Great sensitiveness to touch and pressure. Belladonna.—In early stage, if boil is inflamed and 126 DISEASES OF THE SKIN. painful. Red, hot, shining swelling. Boils on the shoulders every spring. After measles. Bellis per.—Boils beginning as slight pimples, and increasing to large dark colored swellings, with aching pain. Mostly on the neck and loAver jaw. Berberis vulg.—Hastens suppuration in boils, and prevents their recurrence. Bromine.—Boils on the arms and face. In light- haired, blue-eyed persons. Cadmium sulph.—Boils on the nose and buttocks. Calcarea carb.—Boils on the forearms and hands, with lancinating pains. Cramps in the arms. Gland- ular SAVellings. In scrofulous individuals. Calcarea mur.—As a preventive. Calcium sulphide.—When boils mature slowly. Violent throbbing gathering pain. Stinging soreness. After injuries. Carbo animalis.—Boils at the anus. Burning, tear- ing pain. In scrofulous subjects. Cina.—Boils on the head and face in children. Child is very fretful; bores in the nose Avith the fingers. Burning heat of the face Avith glowing redness of the cheeks. Gelsemium.—Large boils on the face and neck. Great muscular prostration. Sleeplessness from nerv- ous irritation. Dizziness and blurred vision. Heat of face and head. Kalmia lat.—Red inflamed spots like incipient boils. Lappa maj.—Boils on the face, eyelids and all over. DESCRIP1ION AND TREATMENT. 127 Ledum.—Boils on the forehead. Itching, pricking tearing pains worse in the evenirg before midnight. After mosquito stings. In drunkards. Lycopodium.—Boils on the nates. Periodical boils. Aggravated by Avarm,Avet poultices. After excessive wine drinking. Manganum.—Small boils. Every injury tends to suppurate. Magnesia mur.—Boils on the nose Avhich suppurate in twenty-four hours. Boils on the false ribs. Men- strual derangements. Diarrhoea in children. Merc. sol.—Boils on the ankles. Coldness of the hands and feet. Fcetid ulcers on the legs, AvithgnaAv- ing itching. Shooting tensive pains, Avorse at night. Natrum carb.—Boils behind the ears. Ulcers on the heel. Burning in the feet Avhen Avalking. Sour eructations. Nitric acid.—Numerous large boils on the scapulae nape of the neck, nates, thighs aid legs. Tensive pains Avorse in the evening and at night. Aggravated by drinking milk. Nitrum.—Boils on the thumb. Nux juglans.—Boils on the right arm. Indurated boils. Blood boils. Violent itching and burning. Nux vom.—Boils on the knees. Gastric derange- ment. Constipation. Phosphoric acid.—Boils in the axillae, and on the nates. Burning, stinging pain. Skin feels sore all over. In young people Avho groAV rapidly. Phytolacca.—Boils on the back. 128 DISEASES OF THE SKIN. . 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. Disposition to boils. Con- stipation. Mai-assimilation. Stramonium.—Boils on the feet. Coldness of the limbs in children. Sulphur.—Boils in the ear. Stinging itching Avitk smarting after scratching; after suppressed menstrua- tion. Disposition to boils. Zincum ox.—Boils on the abdomen, aggravated by use of Avine. Worse before and during menstruation.. Constipation. grocer's itch. Definition.—Grocer's itch is an inflammation of the skin due to the irritant action of sugar. See Eczema.. GUINEA-AVORM DISEASE. Symptomatology.—Guinea-Avorm disease is a com- mon affection in tropical climates, due to the parasite known as the filaria' medinensis. The young worm Avhen quite small bores its Avay into the skin, gener- ally of one of the lower extremities, and there takes up its abode. It remains in a quiescent state in the connective tissue for months, until it attains the length of three or six decimeters. More or less local irrita- tion is by this time caused by its presence, and gen- erally a pointed tumor surmounted by a bleb forms, accompanied by SAvelling and pain, Avhich sooner or later breaks, shoAving the Avorm in situ. There is a& a rule only one avoitii to each tumor.. description and treatment. 129 Treatment.—The treatment consists in removing the Avorm two or three centimeters at a time, care being taken not to break it, and Avinding it around a quill until all is removed. The sore may then be dressed as an ordinary ulcer. Arsenicum alb. or mer- curius may be useful as an internal remedy. herpes. Definition.—Herpes 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. Symptomatology.—The disease is generally preceded by malaise and slight febrile symptoms. A feeling of heat and distress, Avith redness 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 Avhich drop off in a day or two, leaving discolorations Avhich soon disappear. Herpes may occur on any part of the face or genitals, but is commonly encountered about the end of the lips, the prepuce, labia and mons veneris. It tends to recur more on the male genitals than on the female, and is apt to be mistaken for chancroid. It is chiefly excited by cold, and may be sympto- matic, as in the herpetic patches, called "cold sores," that appear on the lip and face in catarrh and pneu- monia, and the crisis of fevers. 130 diseases of the skin. Occasionally it appears about the seventh month & pregnancy in the torn of successive crops of vesicles, beginning upon the extremities and attended Avith excessive itching (II geslalionis). The eruption fre- quently lasts until delivery, and then suddenly disap- pears. Sometimes it re-appears the third day after parturition. At times the disease is characterized by the occur- rence of vesicles in circles about a central one (H. iris). Treatment.—The local treatment consists in the use of camphor cerate, calendula jelly or cologne Avater. The internal remedies are: Aconite.—In the earlier stages Avith catarrhal fever. Agnus castus.—Herpes on the cheeks with gnaAv- ing itching, Avorse from getting Avet. Alnus rubra.—Chronic herpes. Ars. alb.—Red herpetic skin around the mouth, with burning, Avorse from scratching and after mid- night. Herpes iris. Apis mel.—Large confluent vesicles. Burning sling- ing pains. Vesicular eruption on the lips. Cold sores. Aurum mur.—Herpes on the prepuee and vulva. Herpes accompanied by intolerable itching. Bufo.—Herpetic eruption after a cold. Causticum.—Burning vesicles under the prepuce Avhich become suppurating ulcers. Burning vesicles on the face Avhich, Avhen touched, exude a corrosive water, afterward they (\\\ up to a scurf. Calcium sulphide.—Herpes Avhich tends to recur- description and treatment. 131 Herpes on the prepuce, exceedinglv sensitive to the touch. Small ulcers form around the large one. Un- healthy suppurating skin, after mercurial poisoning. Cantharis.—Large, burning painful blisters Avith erysipelatous inflammation of the parts. Burning, tearing ulcerative pains. Worse on the right side. Urinary complications. Clematis.—Itching blisters on the lower lip. Gnaw- ing itching not relieved by scratching. Worse during increasing, better during decreasing moon. Graphites.—Herpes in females with scanty men- struation. Burning blisters on the lower side and tip of the tongue. Dryness of the skin. Hamamelis.—Herpes on the nose. Profuse epis- ttaxis. Helleborus nig.—White vesicles on the lips. Aphthae in the mouth. In scrofulous children. Kali rich.—Herpes after taking cold. Fluent coryza. All the secretions are of a stringy and ropy character. Mercurius sol.—Herpes on the prepuce with a ten- dency to suppuration. Ulcers on the glans. Itching of the genitals. Moschus.—Herpes Avith excessive burning, in hyster- ical subjects. Menstruation too early and too profuse. Natrum mur.—Herpes occurring during fevers. Eruption on the lips and flexures of the joints. Vesi- cles on the tongue. Itching and pricking in the skin. Petroleum.—Herpes on the perineum and genitals. Itching Avorse in the open air. 132 diseases of the skin. Rhus tox.—Herpes upon the hairy parts Avith burn- ing and stinging. Itching worse after scratching. Rheumatic pains Avith great weariness. Sepia.—Herpetic eruptions around the lips. Herpes during pregnancy. Circular form of eruption. Sulphur.—Herpes about the mouth and nose with itching and burning. Itching aggravated by warmth. Hot palms and soles, Sarsaparilla.—Herpes on the prepuce. After abuse of mercury. Upas.—Herpetic eruption on the upper lip, on the left side. iiirsuties. Definition.—Hirsuties is an abnormal development of hair and may be either congenital or acquired. Synonyms.—Polytrichia. Hypertrichosis. Trich- luxis. Augmented hairy growth. Symptomatology.—Congenital hirsuties is a rare deformity, although it is a not uncommon occurrence for infants at birth to display long hairs on hairy parts, which soon fall and arc replaced by shorter hairs. At times the excessive growth covers the Avhole surface as in so-called "hairy men." And again it may be localized to small areas as on moles. Acquired hirsuties occurs mostly in Avomen, upon parts generally covered Avith lanugo or downy hairs, such as the upper lip, chin, cheeks and arms. Occa- sionally in men, this hypertrophy affects the hairs of the scalp or head, Avhich acquire enormous vigor and length. DESCRIPTION AND TREATMENT 133 Hirsuties is more common in dark than in ligh complexioned persons. It in no Avay affects the gen- eral health, and is troublesome only in consequence of the disfigurement it occasions. Etiology.—The causes of hypertrophy of the hairs is enshrouded in mystery. Not uncommonly in women it is associated Avith uterine or ovarian disease. Treatment.—The treatment is principally local, and consists in the destruction of the individual hair folli- cles. This may be accomplished by epilation and the introduction of a straight glover's needle dipped in carbolic acid into each follicle and rotating it several times. Piffard's improved needle holder with lens attachment affords more accurate penetration of the follicle than can be attained by the use of the simple needle. Electrolysis may also be employed with advan- tage. The needle is connected with the negative pole of a galvanic battery—using from six to eight cells— and inserted into the follicle, the circuit is then closed by the patient torching the positive electrode with the hand. In about thirty seconds the follicle will be destroyed Avith the formation of a foam around it, and the hair may be readily removed. Depilatory powders though often used are not to be relied upon. The sulphide of barium depilatory pow- der, prepared by mixing two drachms (8.) of sulphide of barium, three drachms (12.) of oxide of zinc, and three drachms (12.) of amylum,is the best. It may be mixed with Avater and put on as a paste, alloAved to remain five or ten minutes and then scraped off, and the surface anointed Avith cosmoline. 134 DISEASES OF THE SKIN. Lycopodium has been recommended as an internal remedy. HYDEOA. Definition.—Hydroa is a disease characterized by the eruption of isolated vesicles which tend to recur. Symptomatology.—As a skin affection it stands mid- way between herpes and pemphigus, and is mostly a reflex of excited nerve states. It starts as little pap- ules 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 developed, and runs its course in two or three weeks. Treatment.—The Avater of the Salzburg springs,. Austria, has considerable reputation in curing skin, affections, and notably hydroa. Potassium iodide, Kreasote and Magnesia carb are; the principal remedies. HYDRO-ADENITIS. Definition.—Hydro-adenitis is an inflammation of the perspiratory follicles and adjacent connective tissue, ordinarily terminating in suppuration. Symptomatology.—It may occur on any part of the body except the soles of the feet, but is most common in the axillae, around the nipple, and on the perineum. It is usually an acute affection, 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^ DESCRIPTION AND TREATMENT. 135 abscess is formed Avhich eventually ruptures, and terminates the disease. 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. Phosphoric acid is the internal remedy for hydro- adenitis in the axillae. Phosphorus, Avhen around the nipples, and Nitric acid Avhen on the perineum. HYPERyESTIIESIA. Definition.—Hyperaesthesia, by which is meant an increased sensibility of the skin, is commonly the result of some functional or organic derangement of the nervous system. HYPERIDROSIS. Definition.—Hyperidrosis is a functional disorder of the SAveat glands, characterized by excessive sweat- ing. Synonyms.—Ephidrosis. Excessive SAveating. Symptomatology.—It maybe either general or local,. symmetrical or unilateral. In the general form it occurs quite frequently in connection Avith various febrile disorders, and in such diseases as pneumonia,. rheumatism and tuberculosis. In disturbances 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 136 DISEASES OF THE SKIN. and the old alike, and affects females as well as males. Flat-footed people are especially obnoxious to it. In its causation faulty innervation play an important part. The patient complains of tenderness with more or less burning. The sole and region of the toes, if the foot is the part affected, present a reddish or pinkish appearance. Prognosis.—The prognosis should alAvays 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 zinc oxide and starch or French chalk and starch are often serviceable. In some cases the best results are obtained from foot baths of infusiou of Avhite oak bark. The commonly indicated internal remedies in hyper- idrosis are : Baptisia—In critical sweats. Frequent sweat from the small of the back in all directions. Belladonna.—Sweat on covered parts. Sweat during sleep. Suddenly occurring and suddenly dis- appearing sweat. Bryonia.—Sweat in short spells and only on single parts. Oppressive draAving in the head as the sweat- ing subsides. Calcarea carb.—Sweating from the least exercise. Cold clammy sweat on the legs at night. Foot sweat makes the foot sore. The feet feel cold and damp. DESCRIPIION AND TREATMENT. 137 Chamomilla.—Excessive sweating in Avomen after confinement. Cinchona.—Exhausting night sweats. Partial cold SAveat on the face and all over the body with thirst. Cocculus.—Morning sweat principally on the chest. Conium.—Sweats on falling asleep. Night and morning sweat Avith smarting of the skin. Crocus.—Sweat on the loAver half of the body. Ferrum.—Profuse long lasting SAveat. Clammy debilitating sweat. In anaemic persons. Graphites.—SAveat from the slightest motion. The feet sweat profusely, and there is soreness between the toes after walking. Jaborandi.—Copious sweating and salivation. Pro- fuse secretion from most of the glandular structures of the body. Kali carb.—Sweat mostly on the upper part of the body, especially after eating. Lactic acid.—Profuse inoffensive SAveating of the feet. Nux vom.—Sweat upon the upper half of the body. Sour morning sweat upon the right side. Phosphorus.—Sweat mostly on the head, hands and feet. Profuse night sweat during sleep. Phosphoric acid.—Sweat on the occiput and neck Avith sleepiness and thirst. Polyporus off.—(In five grain doses) for the exces- sive SAveats of consumptives. Pulsatilla.—Left sided SAveat. Sweat only on the face and head. 138 DISEASES OF THE SKIN. Sambucus.—Profuse weakening sweat, especially when awake. Dry heat during sleep. Selenium.—Profuse sweatsinthe arm pits and on the genitals. Sweat stains the linen yelloAv or Avhite, and stiffens it. Sweat on the anterior surface of the body. Sepia.—Sweat on the posterior surface of the body. Offensive foot sweat causing soreness betAvcen the toes. Silieea.—Sweat about the head in large bellied chil- dren. Worse with the change of the moon. Sulphuric acid.—Excessive sweating. Better from drinking wine. Thuja.—Sweat only on uncovered parts. Sup- pressed foot SAveat. Veratrum alb.—Cold, clammy sweat staining the linen yellow. Worse on the forehead. ICHTHYOSIS. Definition.—Ichthyosis is a congenital chronic dis- ease of the skin, characterized by increased groAvtli of the papillary layer Avith dryness, roughness and general scaliness. Synonym.—Fish-skin disease. Symptomatology.— The mildest form of this affection,, occurs in children of two years aud upwards, and pre- sents a dry harsh dirty looking skin, covered Avith a variable amount of furfuraceous scales (Neroderi/,a.) In severer cases, or Avhen further developed the papillae become enlarged, the discoloration groAvs more marked, and the epidermal scales are lozenge- shaped, and arc separated by numerous lines and fis- DESCRIPTION AND TREATMENT. 139 surcs (I. simplex.) In more extreme cases still, the scales form dry, hard, brittle plates of a yellowish or greenish hue, separated by white intervening lines, which mark the natural furroAvs of the skin. ( These plates never overlap one another.) At times the scales become heaped up into black papillary horny projec- tions. To this extreme condition the term ichthyosis hystrix has been applied, from its fancied resemblance to the quills of a porcupine. In ichthyosis the whole surface of the body is usually more or less involved,and the front of the knees espec- ially so. The face and flexures oftheelboAVS and knees, hoAvever, generally escape. There is always attend- ing the disease a characteristic diminution or absence of perspiration. It is apt to be much worse in the Avinter time, so that the face and hands become extensively chapped and painful. Diagnosis.—The diagnosis is generally easy, as pity- riasis is the only disease to Avhich it bears any resem- blance. In pityriasis it should be remembered, the skin is more or less hyperaemic, Avhile in ichthyosis it is not. The scales in pityriasis are "branny" and fall off readily while those of ichthyosis resemble "fish- scales" and are more adherent. Prognosis.—Ichthyosis though very intractable, sel- dom proves fatal. Treatment.—A generous diet should be allowed the patient, and cod liver oil should be a standing order.. After e\rery full bath—the Turkish bath being the 140 DISEASES OF THE SKIN. best—the body should be anointed Avith either olive, chaulmoogra or cod liver oil, well rubbed in. An infusion of quillaya saponaria bark sometimes Works Avell as a local application. Arsenicum iodide is the principal internal remedy. Others may be indicated as folloAvs : Arsenicum iodide.—Dry seal}- skin. Itching and burning. In scrofulous subjects Avith swelling of the lymphatic glands. Clematis.—When there arc fine scales Avith some itching, Avorse Avhen getting Avarm in bed. Rainful SAvelling and induration of the glands. Eruption changes character with the changes of the moon. Graphites.—Skin dry and inclined to crack. Un- healthy skin ; every injury tends to ulceration. Thick and crippled toe nails. Extremities go to sleep. Itching of the genitals. Iodine.—The skin has a brown dingy color. Rav- enous hunger. Swelling and distension of the abdo- men. Emaciation in dark complexioned, scrofulous children. Mercurius.—Dirty, yellow color of the skin. Itch- ing, Avorse at night Avhen warm in bed. Dry, scaly spots. In syphilitic and scrofulous subjects. Natrum carb.—Skin of the Avhole body becomes dry, rough and cracked here and there. Frequent empty or sour eructations. Great prostration. Phosphorus.—Skin is dry and Avrinklcd. Skin of hands is rough and dry. Pains in the chest. Desire for acids and spicy foods. Falling of the hair. Great indisposition. In tall, slender people. description and treatment. 141 Potassium iodide.—Skin dried up. Rough, like hog skin. Sensitive swelling of the thyroid gland. (Edematous infiltration of the tissues. After nier- cury or syphilis. Plumbum.—Dry skin. Absolute lack of perspira- tion. Obstinate constipation. Paralytic Aveakness of the limbs. Thuja.—Dirty gray cadaverous looking skin. Wart- shaped excrescences. Brittle or soft nails. Lymphatic temperament. IMPETIGO CONTAGIOSA. Definition.—Impetigo contagiosa is an acute inflam- matory contagious affection, occurring mostly in children, and characterized by the presence of one or more discrete vesicles or vesico-pustules, generally umbilicated, varying in size from a split pea to a hazel-nut, and folloAved by flat, large straw-colored, usually fungoid, crusts. Symptomatology.—This disease is usually ushered in by a period preceding the eruption, characterized by more or less fe\er and malaise. After tAvo or three days this stage is folloAved by crops of small vesicles, Avhich 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 umbili- cated and contain a lymph-like fluid with granular and subsequently pus cells. Red areolae more or less extensive usuallv surround them. 142 DISEASES of the skin. 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 cheeks, its most usual seat, but quite frequently it extends to the aims and head, and may implicate the mucous membrane of the eyes, mouth and nasal cavity. Impetigo contagiosa was first described by Tilbury Fox in 1s, each bulla running its course in from four to five days. Acute pemphigus is rarely met Avith, excepting in children. It runs its course in from three to six Aveeks, and relapses are prone to occur. Pempliigus foliaceus attacks the body generally, and is often a fatal though rare form of disease. It usually commences by the appearance of a single flaccid bulla on the sternum, and from there spreads over the Avhole surface. The bullae differ from those of pemphigus vulgaris, in that they do not become tense, but remain flaccid 172 DISEASES OF THE SKIN. and dry up to form yellowish parchment-like flake Avhich vary in size from one-third of an inch to two inches. Treatment.—The patient should be placed on a full animal diet, Avith plenty o( 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 are of decided benefit. The continuous bath, as recommended by Hebra, may be resorted to in some cases. Rhus tox., is the principal internal remedy for acute pemphigus vulgaris, and Arsenicum alb., for the chronic form. Thuja is oftenest indicated in the foliaceus variety. Others may be indicated as follows: Ammonium mur.—Blisters the size of peas on the right shoulder with itching. Burning at small spots on the chest. Chilliness especially Avhen walking. Fat body but thin legs. Belladonna.—Painful, Avatery vesicles on the palm of the hand sensitive to the touch. Chill in the even- ing, mostly on the arms, with heat in the head. Causticum.—Large painful blisters on the left side of the chest and neck, which become flattened. Anguish in the chest Avith fever. Involuntary urination Avhen ■sneezing or blowing the nose. Gummi gutti.—May be used when other remedies fail. Phosphoric acid.—Deep hard bullae on the ball of the thumb. Blisters on the balls of the toes. Great DESCRIPTION AND TREATMENT. 173: droAVsiness and apathy. In debilitated individuals.. After sexual excesses. Phosphorus.—Painful hard blisters, full to bursting. Chilliness every evening Avith shivering. Arms and hands become numbi Regurgitation of food. Small Avounds bleed much. 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 or- dinary pin-heads. Raphanus.—Blisters full of water on the breast,. Avithout inflammation redness or pain. Sepia.—Pemphigus on the arms and hands. Heavi- ness of the limbs. Sensitive to cold air. Arthritic pains in the joints. PERNIO. Definition.—Pernio is an inflammation of the skin,. occurring as a secondary effect of cold, and appearing for the most part upon the hands and feet. Synonyms.—Chilblains. Erythema pernio. Symptomatology.—Occasionally pernio attacks the nose and ears, and may appear on any part of the body. It commences after exposure to cold, by slight vesication attended Avith tingling, itching, burning sensations. In mild cases it may terminate in a few days Avith des- quamation, hi severer cases, remissions and exacer- bations are prone to occur and thus prolong the disease for months. The parts are usually left in an irritable state, and are liable to reneAved attacks from the slight- est causes. Any sudden change of temperature, and 174 DISEASES OF THE SKIN. especially a combination of cold and moisture, mi./ reneAv the trouble. In chronic cases the parts become livid or purplish in color, and are more or less swollen and itchy. Ulcers not unfrequently form. Prognosis.—Pernio Avhen it becomes chronic may last for years, disappearing usually in the summer time,but returning again as Avinter approaches. Treatment.—When there is much inflammation a de- coction of marsh mallows, locally, acts Avell. Tamus communis tincture, is recommended as a top- ical remedy for unbroken chilblains. Broken chilblains may be dressed "with either oxide of zinc ointment, or the glycerole of calendula,. liesin ointment is adapted to the ulcers that some- times follow. The gcdvanic current acts favorably in most cases. The tincture of benzoin, painted on the parts once or twice a day, acts as a preventive. The remedies likely to prove beneficial are: Agaricus.—Violent itching, Avorse at night. Burn- ing in the fingers, loAver limbs and toes. Itching, burning and redness of the toes. Muscular twitchings. Arsenicum alb.—Ulcerated chilblains. Red spots on the feet. Violent tearing pains in edges of ulcers Avhen exposed to cold. Relieved by warm applications. Badaiga.—Flesh and integuments sore to the touch. Sensitive to cold air. Belladonna.—Bright red shining swelling, with pulsative pains. Burning in skin Avhen touched. Tingling itclnng, worse at night. DESCRIPTION AND TREATMENT. 175 Cantharis.—Itching and swelling of the fingers. Blisters burning on touch. Burning in the soles of the feet at night in hysteric patients. Tearing and ulcera- tive pains. Citrus vulg.—Itching of the swollen hands and arms. General itching Avhich prevents sleep. Nitric acid.—Itching of the feet. Spreading blisters on the toes. Ulcers Avith stinging and pricking pains as of splinters. Offensive profuse perspiration on the feet, causing soreness. Petroleum.—Broken chilblains with tendency to fester. Heel painfully swollen and red Avitli stitches. Tips of fingers rough, cracked and fissured with stick- ing cutting pain. Unhealthy skin. Primus spinosa.—Itching on tips of fingers as if frozen. Pulsatilla.—Blue red chilblains Avith pricking burn- ing pain, Avorse toward evening. Redness and SAvell- ing of joints Avith stinging pains. Feet feel hot and swollen Avith tensive burning pains. Wandering pains. Rhus tox.—Inflamed chilblains Avith excessive itch- ing. Aching pains in the legs. Worse before storms and from getting Avet. Sulphur.—Thick red chilblains on the fingers which itch severely Avhen Avarm. Predisposition to chil- blains. Urtica dioica.—Has been used both internally and externally with good results. Veratrum air.—Intense painful itching. Chil- blains on the nose. Prickling in the fingers and toes. Used internally and locally. 176> DISEASES OF THE SKIN.. PHTHIRIASIS. Definition.—Phthiriasis is a contagious affection due to the presence of pediculi. Synonyms.—Pediculosis. Morbus pedicularis. Lice disease. Crabs. Symptomatology.—There are three varieties of this> disease, each being the outward demonstration of the ravages of distinct species of pediculi. Thepediculus capitis or head louse, gives rise to the variety knoAvn ha phthiriasis capitis. It may be found dii all parts of the head, but its favorite seat is the oc- cipital region. Numerous OAra or "nits" may be de- posited 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, as imagined, but by inserting their suckers or haustella into the pores of the skin, and so distending them as to frequently cause drops of blood to follow on their AvithdraAval. This irritation together Avith the scratching it induces gives rise to the development of papules,, av hose apices Avhen scratched off, present the blood tipped appear- ance so characteristic of phthiriasis. The pediculus vestimenti, or body louse, has its hab- itat in the clothing, and attacks the body, giving rise to phthiriasis corporis. Its ova are deposited and hatched in the clothing. P. corporis\s mainly a disease of adult years, and is seen mostly in the lower walks of lite. The lesions are multiform, due principally to scratching, ami have: their chief seats on the trunk,, hips and thie'-s.. DESCRIPTION AND TREATMENT. If7 The pediculus pubis or crab louse, usually infests the hair of the pubis, but may wander to other parts. It attacks adults mostly. The pediculi are air-breathing insects and remain wholly upon the external surface. Treatment.—The treatment is mainly local, and consists in the destruction of the parasites and their ova. Phthiriasis capitis responds readily to repeated dusting Avith poAvdered staphysagria. Cocculus indi- cus tincture, often proves serviceable. Ordinary pet- roleum is a most effective application. White precip- itate ointment—ten grains (.6) of white precipitate to the ounce (32.) of cosmoline—is useful Avhen "scratch- marks" prove troublesome. The "nits" may be re- moved by repeated washing Avith carbolized Avater. Phthiriasis corporis is best treated by staphysagria ointment—tAvo drachms (8.) to the ounce (32.)—well rubbed in. The patient's clothing should be thorough- ly boiled or baked, so as to ensure the destruction of Avhatever pediculi may have made it their habitation. For phthiriasis pubis either cocculus indicus tincture, a mercuric bichloride lotion, or a chloroform appli- cation proves an effectual remedy. Internally, Oleander may be given in phthiriasis capitis, and Mercurius in the other varieties if desired. PITYRIASIS. Definition.—Pityriasis is a cutaneous affection char- acterized by fine dry bran-like scales, seated on a slightly reddened non-infiltrated surface. 178 DISEASES OF THE SKIN. Synonym.—Branny tetter. Symptomatology.—It affects mostly the scalp, face and upper part of the body, and seldom or never be- comes 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 accom- panied 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 excessive cell 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. Gly- cerole of borax—two drachms (8.) of borax to one ounce (32.). of glycerine—is frequently of service. Arsenicum alb., is the principal internal remedy. Fluoric acid, Colchicum and Kali arsen., are occa- sionally indicated. PITYRIASIS RUBRA. Definition.—See Dermatitis exfoliativa. PRAIRIE ITCH. Symptomatology.—Prairie itch is an acute inflam- mation of the skin, appearing in neAV districts where it may be for a time endemic. 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 erythematous spots, cov- ered with, small transparent vesicles, varying in size from a pin's head to a mustard seed and situated for DESCRIPTION AND TREATMENT. 179 the most part on the neck, shoulders, back and outer surface of the limbs. An intolerable nightly itching accompanies the eruption, creating an almost irresisti- ble desire to scratch the parts. The scratching oblit- erates the vesicles, and gives rise to scratch marks and to the secretion of an exceedingly acrid irritating fluid, Avhich oftentimes indefinitely prolongs the dis- ease. Large blackish crusts covering suppurating ul- cers are an occasional result. Furuncles quite fre- quently complicate the trouble. Treatment.—Locally, the diluted lye of wood ashes is the best remedy. Internally, Rumex crispus will be oftenest called for. Iilius tox., and Ledum may be studied. prurigo. Definition.—Prurigo is a disease characterized by the development of small papules, of the same color as the skin, accompanied by intense itching. Symptomatology.—It commences by the gradual formation of small, sub-epidermic elevations, Avhich liave a peculiar shot-like feel, and are frequently per- forated by small hairs. These papules are due to chronic inflammatory changes in the papillary layer. Intense itching or pruritus, Avith formication is one of the earliest symptoms and generally continues Avith more or less intensity throughout the entire course of the disease. Hence " scratch marks" are often found complicating the eruption. As the disease progresses the skin becomes thickened and presents a dry, rough, harsh appearance. 180 DISEASES OF THE SKIN'. Prurigo is mainlv an affection of the uoorer classes,. and occurs mostly on the extensor surfaces of the lower extremities, but is frequently found on the fore- arms and trunk. It starts as a rule before pubertyy becomes aggravated during the Avinter months, and is apt to continue through life. It is a rare disease in this country. It differs from phthiriasis with Avhich it has been frequently confounded, in that, pediculi Avhich are the cause of the latter are never present ii* the former. Diagnosis.—It is to be differentiated from papular eczema and urticaria, and from scabies. Prognosis.—The prognosis is always doubtful. 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 carbolic acid, dioscorea, or mezereum lotion may be used. Sulphur is the principal remedy for recent attacks, and Arsenicum iodide for the more chronic forms, Ambra, Arsenicum sulphide, Carbolic acid, Dioscorea, Dolichos pruriens, Mercurius, Nitric acid and Oleander may be studied. PRURITUS. Definition.—Pruritus, or simple itching without any eruption can hardly be called a disease. It is merely a perverted sensation, and is a common accompaniment of a variety of cutaneous affections. When occurring to all appearances independently—as far as any eruption DESCRIPTION AND TREATMENT. 181 b-s concerned—it is even then simply symptomatic of some nerve disturbance, indicative of the circulation of bile or some other foreign material in the blood, or ■else dependent on local excitants. PSORIASIS. Definition.—Psoriasis is a constitutional, non-con- •lagious disease of the skin, characterized by reddish ithickened patches covered Avith Avhitish or yellowish- white mother-of-pearl colored scales. Synonyms.—Lepra vulgaris. Alphos. Dry or scaly tetter. Symptomatology.—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 develop rapidly, so that in a few days they may be as large as a nickel and pre- ^sellt the appearance of drops of mortar. Generally the patches tend to run together as they increase in size, and lose the circular outline that at first charac- terized them. Occasionally the centers of the patches clear up, giving to the disease the appearance of rings. Frequently two rings come in contact with each other at the edges, thus forming the figure 8. At times the ■ circles are incomplete, and as a consequence many lines arc formed. Some Avriters err in speaking of these different stages, as distinct varieties of disease, and so aliude to psoriasis punctata, psoriasis nummularis, psoriasis gvrata, etc. Such, hoAvever, can not be held to be distinct varieties of cutaneous trouble, but are simply stages of one and the same affection. ^182 DISEASES OF THE SKIN. The scales of psoriasis are peculiar and character- istic. They are imbricated, of a silvery Avhite color, and situated on a red and inflamed base. The presence of air in the scales is the supposed cause of their white appearance. The favorite seats of the disease are the tips of the elbows, the fronts of the knees and the head. It may, hoAvever, appear on any part of the cutaneous surface, and is apt to be symmetrical. It is never seen on the mucous membranes or the red mar- gins of the lips, and is but rarely observed on the palms and soles. In gouty individuals the scales are thin, often scanty, attended Avith marked itching, and seated on a very red and congested base, hi strumous subjects, however, the scales are thick, oftentimes heaped up, attended Avith but slight itching, and seated on a less congested base. The involution of the disease is characterized by the diminished elevation of the patch, and the fading of the eruption, Avhich leaves neither staining nor cica- trization. Etioloqy.—The etiology of psoriasis is still obscure. By some it is claimed to be of malarial and by others of traumatic origin. The disease is neither contagious nor hereditary. It occurs alike in both sexes, and very rarely appears before puberty. It prevails more in Avinter than in summer. Next to eczema it is one of the commonest cutaneous diseases of this country. My experience at the dis- pensary, ranks it the fourth in order of frequency. Lang claims to have discovered fungus elements in. DESCRIPTION AND TREATMENT. 183 psoriasis, which he considers the cause of the disease. Morbid anatomy.—It forms principally in the upper layers of the corium and on the apices of the papillae, and is due to a perversion of the cell life of the rete. The scales are made up of masses of cells from the stratum lucidum. Diagnosis.—The diagnosis of psoriasis is generally easy. It may at times be mistaken for eczema, tinea tri- cophytina, lichen planus, lupus erythematosus, pityria- sis, ichthyosis, and the squamous syphilide. Sufficiently characteristic, hoAvever, are the silvery white heaped- up scales, seated on an inflamed cutis which inclines to bleed in pin-point drops on their removal, and the selection of the elboAvs, knees and head as sites. Treatment.—The diet in psoriasis should be a gener- ous one, including oils and fats. The local treatment consists in first removing the scales by means of saponaria or bran baths. Inunc- tions Avith cod liver oil or chaulmoogra oil may then be resorted to, and especially so, if, as occasionally happens, there is considerable attendant inflammation.. In more obstinate cases unless the skin is very irritable- the oil of Avhite birch may be used in the form of an ointment, one drachm (4.) to the ounce (32.) of vas- eline. Marked success has folloAved the use of chry- sarobin paint, prepared by rubbing up one drachm (4.) of chrysarobin, and one drachm (4.) of salicylic acid in one ounce (32.) of liquor gutta-perchae. It may be thinly applied to the affected patches by means of 184 DISEASES OF THE SKIN. a small stiff paint brush. K fifteen per cent, oint- ment of beta naphthol is recommended by Kaposi. especially in the treatment of psoriatic patches upon the face and scalp. It is best to commence the internal treatment with Sulphur. Afterwards one of the following remedies may be given: Ammonium carb.—White pea-sized spots upon the cheek, Avhich continually exfoliate. Skin very sensi- tive to cold. Aversion to being Avashed. Nosebleed when washing the face in the morning. In Aveak nervous individuals. Arsenicum alb.—Skin dry and scaly. Great rest- lessness Avith Aveakness and prostration. Burning itching. Oppression of breathing. Aggravated by eating fruit, ice cream, etc. Arsenicum iodide.—Dry scaly burning itching eruption on various parts. Persistent itching on the back. In obstinate cases. Calcarea carb.—Scurfy spots on the leg. Burning and itching. Skin cracks. Profuse SAveat from the slightest exertion. Large abdomen. Blue eyes, blonde hair, fair skin. Fluoric acid.—Roughness on the forehead like a rough line Avith its convexity upwards. Reddish spots above the eyebrows. Desquamation on the eyebrows. Nails brittle, edges bent in. Hydrocotylc.—Circular spots with slightly raised scaly edges. description and treatment. 185 Iris versicolor.—Irregular psoriatic patches on the knees and elbows, covered with shining scales. Skin fissured and irritable. Gastric and bilious derange- ments. Manganum.—In inveterate cases. Mercurius.—Psoriasis of the hands. Psoriasis in spots all over the body. Scaling oft' and exfoliation of the finger nails. The scalp is painful to the touch. Easy perspiration without relief. In recent cases. Mezereum.—Scurf-like scales on the back, chest, scalp and thighs. Roughness and scaling here and there. Pruritus increased bv scratching or Avhen undressing. Muriatic acid.—Psoriasis of the hands. Great sen- sitiveness to damp Aveather. Natrum ars.—Thin Avhitish scales, which when removed leave the skin slightly reddened. Petroleum.—Skin of the hands cracked and rough. Unhealthy skin. Aversion to the open air. Extreme sensitiveness to slight touch. Falling off of the hair. Phosphorus.—Psoriasis of the arms and hands, and on the knees and elboAvs. Arms and hands become numb. Coldness of the kees at night in bed. Falling ■out of the hair in large bunches. Dry cough with soreness in the chest. Phytolacca.—Surface of the skin shrunken and of a leaden color. Squamous eruption. Rheumatic pains in the extremities. Selenium.—Dry scaly eruption on the palms of the iiands, Avith slight itching. 186 DISEASES OF THE SKIN. Sepia.—Psoriasis on the face. Red roughness of the skin. Falling off of the hair. During pregnancy and nursing. Dark complexioned individuals. Silicea.—Elevated scurfy spots near the coccyx. Small white scales on the face and neck. White spots on the cheeks. Sensation of numbness in the extrem- ities. Brittleness of the naiis. In scrofulous, large bellied children. Imperfect assimilation. Teucrium.—Psoriasis on the index finger of the right hand. PURPURA. Definition.—Purpura may be described as a disease of the skin characterized by an effusion of red blood globules, into the cutis, and the formation of small macules varying from one-twelfth to one-half inch in diameter, usually unattended by constitutional dis- turbance. Synonym.—Purples. Symptomatology.—The spots at the time of their appearance are bright red, but gradually become pur- plish, and subsequently undergo the usual changes of color that are the accompaniments of a bruise. They appear mostly on the legs, and are usually symmetri- cally arranged; they may also shoAV 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. Haemor- rhage from the mucous membrane may at times com- description and treatment. 187 plicate the trouble (landscurvy). It is then apt to be attended by more or less constitutional disturbance. Treatment.—The diet should consist of the most nutritious articles. Malt preparations are useful foods. Outdoor exercise is very beneficial. Locally, hama- melis is one of the best remedies, and Avhen there is much haemorrhage, ice treatment may be resorted to. Simple purpura responds best to Arsenicum alb., and the haemorrhagic form to Sulphuric acid. Other remedies may be indicated as folloAvs: Aconite.—In simple cases Avhen attended by fever. Arnica.—YelloAv, blue and reddish blue spots. In lying-in Avomen. Baptisia.—Livid spots all over the body and limbs, of the size of a three-cent piece. Great languor; desire to lie doAvn. Tired, bruised, sick feeling all over the body. Berberis.—Petechire on the right shoulder or left humerus, back of the hand and Avrist. Bruised pain Avith stiffness and lameness in small of back. Renal or vesical complications. Bryonia.—Haemorrhagic purpura. Aches and pains Avorse from motion. 'Weariness and heaviness in all the limbs. Worse Avhen warm Aveather sets in after cold days. Chloral.—Deep red spots on reddene 1 bases, per- manent under pressure. Haemorrhagic purpura. Lips covered with sordes and dried blood. Great prostra- tion. Cocoa.—Dark spots like ecchymoses under the skin,. ibo DISEASES OF THE SKIN. about the size of a pin's head, on the fingers. May bo used to protect from skin diseases. Hamamelis.—Haemorrhagic purpura. Profuse epis- taxis. Passive, venous haemorrhages. Great lassitude and Aveariness. In old people. Lachesis.—Simple purpura. Blackish-blue spots. Great physical and mental exhaustion. Climacteric troubles. Mercurius.—Bluish-red spots, darker on the margin and lighter in the center. Increase of saliva Avith scorbutic gums. Tongue swollen, shoAving imprints of teeth on margin. Bruised feeling, Avith soreness in all the bones. Phosphorus.—Petechial spots on the skin. Bluish- red spots on the legs. Purple like exanthem over the whole body. Small Avounds bleed much. Rrus tox.—Simple purpura. Dark broAvn spots on inside of ankles. Rheumatism of joints worse dur- ing rest. Patient changes position constantly. Swol- len ankles after sitting too long. Symptoms Avorse ip wet Aveather. Terebinthina.—Haemorrhagic purpura. Intestinal haemorrhages. Haematuria. Great prostration. Veratrum vir.—Simple purpura. Galvanic-ike shocks in the limbs. Rapid pulse; slow respimuon. In plethoric individuals. RING-AVORM. Definition.— See Tricophytina. DESCRIPTION AND TREATMENT. 189' RHINOSCLEROMA. Definition.—Rhinoscleroma is characterized by irregularly shaped, sharp bordered, flat SAvellings of a normal or dark reddish-brown color, occurrino- for the most part on the nose and upper lip. Symptomatology.—Rhinoscleroma is almost unknown- in this country. It Avas first described by Hebra and Kaposi in Is70. It is a disease of adult life, runs a sIoav course, and may remain stationary for years. The tubercles are seldom attended by pain, but are usually extremely sensitive to pressure. Treatment.—When treatment is necessary the tubercles are best removed by the use of the irido- platinum points (Fig. 10) and Squibb's fused nitrate as recommended in Lupus vulgaris. Calcarea phos. Avill probably be the most useful in- ternal remedy. Guaraca, and Rhus rack, may be studied. RODENT ULCER. Definition.—See Epithelioma. ROSACEA. Definition.—Rosacea is a chrDiiic disease, affecting more particularly the nose, cheeks and forehead, result- ing from a dilatation of the blood vessels Avith increased growth of connective tissue, and characterized by red- ness and a tendency to the development of tubercles and pustules. Symptomatology.—Rosacea has three stages. In the* 190 DISEASES OF THE SKIN. -first there is more or less passive hyperoemia of the parts affected. The Avhole diseased surface may be red- dened, or it may be reddened only in spots. 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 in. 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 integu- ment becomes thickened, acne papules and pustules shoAV themselves, the nose becomes Avarm, and the dis- ease passes into the third stage. It may remain in this condition for years, or if the morbid action continues, great thickening and hyper- trophy of the parts, Avith deformity may result. Etiology.—It is mostly a disease of middle life. It attacks both sexes, but males more than females. Any- thing Avhich tends to increase the circulation in the face may produce rosacea. Excessive spirituous indulgence is a prominent cause, as is also functional or organic disease of the uterus or ovaries. Prognosis.—The prognosis is generally favorable if the disease has not passed beyond the first stage. Treatment.—In the first stage a sulphur lotion one (4.) to three drachms (12.) to the ounce (32.) of lav- ender water, may be used Avith benefit. In the second stage the distended blood-vessels should be incised bi-weekly. Gossypium ma}- be used to check the haemorrhage. Good results are obtained from single or multiple punctures of the vessels Avith DESCRIPTION AND TREATMENT. 191 a fine cambric needle attached to the negative pole of a galvanic battery, with from six to ten elements in the circuit. As a last resort, portions of the redundant integu- ment may be excised, or erased Avith the dermal curette (Fig. 9). The internal remedy will usually be one of ths ibl- loAving: Agaricus.—Redness Avith burning heat in the face. Burning itching on the cheeks. In drunkards and after sexual debauches. Antimonium crud.—Red points Avith Avhite dots in the center. Thick Avhite coating on the tongue. Gas- trie derangements. Arsenicum alb.—In long-lasting cases with debility. Rough, dirty looking skin. Burning itching, painful after scratching. Arsenicum bromide.—Violet papules on the nose. Arsenicum iodide.—Redness Avith itching. In scrofu- lous subjects. Belladonna.—Nose red, swollen and shining, Avith small red pimples. Great dryness of the nose. Swell- ing and tension of the upper lip. Parts feel hot to the touch. In plethoric subjects. Bromine.—Pimples on the nose. Soreness under the nose and on margins of nostrils. Swelling of the thyroid gland. In light-haired persons. Calcium sulphide.—When there is a pustular ten- dency. Calcarea phos.—Nose shining like oil. Heartburn with other gastric symptoms after dinner. 192 DISEASES OF THE SKIN. Cannabis.—Large pimples surrounded by red swell- ing. Aggravation in the morning, with burning like fire. Urinary complications. Carbo animalis.—Pimples on the face. Eruption like red spots on the cheeks. Morning nose-bleed pre- ceded by vertigo. Eructations tasting of food eaten. long before. In scrofulous, venous constitutions. Causticum.—Pimples on the nose. Tendency to ulceration. Curare.—Pimples like tubercles On the tip of the nose. Rosacea with varices and bleeding of the cheeks.. Guarea trich.—Rosacea with pains as from excoria- tion when touched. Hyclrocotyle.—Papular eruption on the face. Tick- ling in the nose. Nux juglans.—In strumous subjects. Nux vom.—Rosacea associated Avith dyspepsia and constipation. In drunkards. Opium.—Dusky red bloated appearance. Phosphorus.—Pimples on the face and wing of the nose. Petroleum.—In the second stage. Parts very pain- ful to slight touch. Nausea from riding in a carriage or ship. Rhus rad.—Tip of the nose red and painful, as if it would suppurate. Ruta.—Rosacea. Deep fine stitches in the parts. Aggravated by eating uncooked food. Sulphur.—In chronic cases. DESCRIPTION AND TREATMENT. 193 ROSEOLA. Definition.—See Erythema. RUPIA. Definition.—Rupia may be the result of either the pustular or the bullous syphilide. It consists of thick, greenish or blackish "cockle-shaped" crusts, covering unhealthy punched-out looking ulcers. It is a late and malignant manifestation of syphilis, and is seldom met Avith in private practice. Treatment.—Mercurius bijodat., and Potassium- iodide, are the principal internal remedies. Arsenicum, Berberis aqu., and Nit. acid may be studied. Locally, iodide of starch dressings are serviceable. SALT-RHEUM. Definition.—See Eczema. sarcoma cutis. Definition.—Sarcoma cutis consists of brownish-red, variously sized tubercles or nodules, attended by a dif- fused thickening of the skin. It is a rare and malig- nant disease, occurs mostly in adult life, and usually terminates fatally. SCABIES. Definition.—Scabies is a contagious disease caused by the burrowing of an animal parasite called the acarus scabiei, in the skin, and is characterized by the formation of cuniculi attended Avith intense nightly itching and having as accidental accompaniments, veh- icles, pustules and crusts. 194 DISEASES OF THE SKIN. Synonym.—The itch. Symptomatology.—The first symptom after exposure to the contagion, is usually a more or less extensive local irritation of the skin, attended by the formation of minute inflammatory points or vesicles, and an itching characteristically Avorse at night. On examin- ing the parts carefully at this stage, a burro av or cun- iculus, just beneath the horny layer, may be discovered as a slightly raised, straight or tortuous line, Avith a vesicle at one end, and the itch insect marked by a Avhitish-yelloAv speck, headed off by a dark curved line, at the other. The disease spreads from this point, usually with 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 Avrists, 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 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 acount of the intense itching, "scratch-marks" may 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 characteristic of scabies. The cause of scabies is the acarus scabiei. The dis- DESCRIPTION AND TREATMENT. 195 tea>e arises only from contagion. It may be conveyed from one person to another by hand shaking or by sleeping with one Avho is affected. All are subject to the contagion, Avhether high or low, rich or poor. Men are as a rule oftener affected than Avomen. 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 ele- gant 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 with short spines, Avhich ate directed backwards, and are so arranged as to effectually tfiAvart any attempt at retrogression on 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 with suckers, and four hind leo-s armed with hairs. The tAvo inner hind legs in the male are armed Avith suckers. The organs of genera- tion 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 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 in- sect 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, eommences boring perpendicularly 196 DISEASES OF THE SKIN. through the horny layer and tunnels a place in whicb to lay its eggs. This burrow or tunnel is called a cun- iculus, and may vary from two to several centimeters in length. Here is the little miner's habitat, in Avhich the deposited eggs are usually hatched in about tAvo weeks. The young acari or "brigands" as they are sometimes called, are liberated in the order of their birth, by the gradual Avearing 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 eight to ten days in water, and from two to four clays in vinegar. Diagnosis.—The following are the main diagnostic points of scabies: 1. The presence of cuniculi Avith their contained acari. 2. The seat of the eruption, Avhich is mostly in the interdigits 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, which though continuing through the day is characteristically Avorse at night. 5. The evidences of contagion in the household, other members of the family being affected. 6. The rapid disappearance of all the symptoms un- der parasiticiclal treatment. Prognosis.—The prognosis may usually be con- sidered favorable, provided a correct diagnosis is made, otherwise the disease may last for years. DESCRIPTION AND TREATMENT. 197 Treatment.—Once recognized the disease is speedily cured. A high potency of Sulphur given internally has the reputation of curing scabies, but perhaps the best and most prompt results will be had from well directed local treatment, as the disappearance of the trouble depends on the removal of the cause, or in other Avords, upon the death of the insect. Sulphur ointment—one (4.) to tAvo drachms (8.) to the ounce (32.)—is to be recommended as the best parasiticide. Storax ointment is preferred by some, :as being cheaper and less liable to irritate the skin. (Care must always be taken in using parasiticides not to have them too strong, as the secondary rash is in- variably 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 water bath should be taken. The same programme may be followed on the next and succeeding evenings, or until every trace of itching is gone. In this Avay the majority of cases of itch can be cured in from one to three days. All the clothing of the patient should be carefully boiled or baked before being used. SCLERODERMA. Definition.—Scleroderma is a chronic affection char- acterized by hardness and inelasticity of the integu- ment. 198 DISEASES OF THE SKIN". Synonym.—Hide bound skin. Symptomatology.—-It is a rare disease, and com- monly commences as a circumscribed infiltration of the skin and subcutaneous tissues. As the disease advances, the parts are found to become hard and im- movable, as if frozen or petrified. The skin has gen- erally a yellowish-brown or at times Avaxy appearance. Scleroderma 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 clue to a stagnation of lymph in the lymph spaces. It runs a chronic course, but tends to get well in years. Diagnosis.—The disease bears some resemblance to morplioea, Avith which it is apt to be confounded. Scleroderma, however, is pathologically a hypertro- phy, Avhile morplioea is an atrophy. Treatment.—Galvanism is recommended as having proved beneficial in some cases. As internal remedies, Antimonium crudum, Alumina, Berberis, Elaeis and Rhus tox., may be studied. SCLERIASIS. Definition.—Scleriasis is an induration of the cellu- lar tissue in neAV born children. Symptomatology.—It may be congenital or appear during the first months of infant life. The skin Avhich is at first of a yellowish, brownish or reddish hue,. gradually fades and becomes hard and rigid. The sur- face is generally cold, and more or less oedema is usually present. DESCRIPTION AND TREATMENT. 199 Etiology.—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. Prognosis.—The prognosis is unfavorable, as most children die Avith some affection of the lungs. Treatment.—Elceis guineensis may prove useful as an internal remedy. Hydrocotyle, Phosphorus and Stillingia may be thought of. SCROFULODERMA. Definition.—Scrofuloderma is a strumous disease of the skin, commencing as indolent, painless livid tuber- cles that sloAvly soften and give place to unhealthy ulcers Avith free incrustation. Symptomatology.—It is oftenest encountered on the neck, and beneath the lower jaw, but is frequently met Avith on the thorax, and in the axillae and groins. The cause of this disease is to be found in that peculiar condition of system, Avhich has been termed scrofulosis. Diagnosis.—It is to be differentiated from syphilis, lupus, and epithelioma. Treatment.—Such patients should be alloAved an abundance of fresh air, plenty of outdoor exercise, and a generous diet. Cod liver oil should be one of their standard foods. Locally, the ulcers Avhen formed may be dressed Avith the iodide of starch paste. The Calcium sulphide, is the principal internal remedy. The Calcium iodide, Theridion, and Scrofularia may be compared. 200 DISEASES OF THE SKIN. SEBACEOUS CYST. Definition.—A sebaceous cyst is a Avhitish round or oval tumor of variable size, composed of sebaceous matter enclosed in a sac. Synonym.—Wen. Symptomatology.—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 cheesy, or fluid in character. They are usually painless, run a chronic course, and may end spontan- eously by degeneration of the contents and destruction of the cyst. Treatment.—Excision is the best local remedy. Potassium iodide lx, Baryta carb., and Bromine, have more or less repute in removing cysts, and may be used to prevent their return. SEB0RRH02A. Definition.—Seborrhcea is a functional disorder of the sebaceous glands, characterized by an excessive secretion of sebum. Synonyms.—Steatorrhoea. Sebaceous flux. Symptomatology.—It may appear on any portion of che body, but attacks chiefly the scalp and face. It occurs at all periods of life, is seen more in Avomen than in men, and is either local or general. In the newly-born it is a physiological rather than a pathol- ogical process, and constitutes the vernix caseosa. As a disease it appears either in the form of an oily coat- ing on the skin, or as dirty-white or yelloAv flat scales, DESCRIPTION AND TREATMENT. 201 which are more or less greasy, and slightly adherent (dandruff). Light complexioned people are more subject to the former, and dark complexioned to the latter. When occurring on the scalp, seborrhoea is one of the most frequent causes of baldness; and as a sequel •of variola an oily nose is not uncommon. Diagnosis.—This affection may at times be very easily confounded with eczema. But if it is remem- bered that seborrhoea is always a dry or oily disease, and that eczema has always a history of discharge; and also that the scales of seborrhoea are usually seated on a pale bluish-colored skin, and abundant, Avhile those of eczema are scanty and seated on a red- dened more or less infiltrated surface, the diagnosis Avill not be difficult. Treatment.—-The hygienic influences should be so arranged as to keep the system in the healthiest possi- ble state. All oily scales and crusts should be satur- ated Avith some oily substance, such as olive oil or glycerine, before their removal is attempted. Ten or twelve hours generally suffices to macerate them, so *that they can be readily removed Avith warm soap and water. 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 four drachms (16.) of sapo viridis Avith three drachms (12.) of cologne water. After this treatment one of the simple oils should be applied, otherwise the skin will become dry and harsh. 202 DISEASES OF THE SKIN. Ill mild cases all the local treatment that is neces- sary is an infusion of saponaria bark applied morning and evening. For seboirhoea occurring on the face, a tannin dust- ing powder prepared by mixing from twenty grains (1.3) to one drachm (4.) of tannic acid Avith one ounce (32.) of rice poAvder, has been highly recommended. The most serviceable internal remedies are the fol- lowing: Arsenicum alb. — Smutty brown, mottled skin.. Yellow color of face. Ammonium mur.—Large accumulation of bran- like scales, Avith falling oft' of the hair. Bufo.—Skin greenish, and always looking dirty and oily. Bryonia.—In long lasting cases. Calcarea carb.—Nose shines as from oil. Sebor- rhoea Avith hyperoemia of the scalp and headache. Graphites.—Seborrhoea behind the ears. Iodine.—Firmly adhering scales, which leave the skin red and painful, on removal. Kali carb.—Dry hair rapidly falling off, with much dandruff. Lycopodium.—Seborrhoea on the chin. Mercurius sol.—Seborrhoea of the genitals, accomT panied with hyperaemia. Mezereum.—Excessive formation of smegma. Natrum mur.—Severe itching of the scalp. The hair falls out in masses. Seborrhoea of the face. Plumbum.—The skin of the face shines as if oily, and feels oily„ DESCRIPTION AND TREATMENT. 203' Phosphorus.—Copious 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.—Seborrhoea of the genitals in Avomen. Sulphur.—Dandruff. Thuja.—White scaly dandruff. Hair dry and fal- ling off. Vinca minor.—Seborrhoea on upper lip and base of the nose. shingles. Definition.—See Zoster. STROPHULUS. Definition.—Strophulus is a disease of early life, clue to congestion about the mouths of the SAveat follicles, and is characterized by the appearance of small red or Avhite papules, varying in size from a pin's head to a millet seed. Synonyms.—Red-gum. Tooth rash. Symptomatology.—The face, neck and arms are the usual seats of the eruption, but it may be general in its distribution. There are tAvo forms of the affection. One variety mostly due to over-clothing, appears in infants a lew Aveeksold. In this the eruption reaches its height in two or three days, and then gradually disappears. The other variety is frequently met Avith during the period of dentition, lasts longer than the former variety, and is often associated with gastro- intestinal disturbance. 204 DISEASES OF THE SKIN. Treatment.—The diet should be carefully regulated and all superfluous clothing abandoned. Lancing the. gums is proper only when they are swollen or so tender as to distress the child. Chamomilla is the principal internal remedy. Cal- carea carb. may be called for Avhen there is a chronic acidity. Spiranthes is oftesi indicated. Borax, Ledum, Apis, Cicuta, and Sumbul, may be studied. SUDAMINA. Definition.—Sudamina is a disorder of the SAveat glands, characterized by pin-head sized vesicles formed by the collection of sweat between the layers of the epidermis. Symptomatology.—It is more particularly met with 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 Turkish baths occasionally gives rise to a general attack. Treatment.—Bryonia, Ammonium mur., and Urtica urens, are the most important remedies. SYCOSIS. Definition.—Sycosis is a catarrhal inflammation of the hair follicles of the beard, and is characterized by the formation of papules, tubercles and pustules, at- tended with pain, heat and SAvelling. Synonyms.—Mentagra. Folliculitis pilorum. Symptomatology.—The affection demonstrates itself iby the development of acuminated, more or less in- DESCRIPTION AND TREATMENT. 205; durated, pin-head or split-pea sized pustules immedi- ately around the hairs, containing a thick yellow fluid. More or less pen-follicular inflammation usually ac- companies 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, other- Avise they are generally discrete. The hairs of the affected part are as a rule healthy, and cause pain on extraction (a characteristic). The disease is not con- tagious. Treatment.—Shaving is the first thing to be done,. and it must, if necessary, be kept up daily for months. Hot fomentations should be applied if there is much inflammation. As regards the internal treatment, Tartar emet.,is allowed by common consent to rank first. Other remedies occasionally of service, are: Calcium sulphide.—Many little pimples on the chin, sore Avhen touched. Large sores surrounded by small pustules. (Edematous SAvelling of the parts. Cereus serpentinus.—Pustules on the right upper lip and angle of the mouth, on parts covered by beard. Itching of the parts covered by the beard. Cicuta.—Elevated eruption Avhich causes burning pain when touched. Itching papular eruption on chin. Graphites.—Chin covered with eruption. Hard Avhite pimples on red base. Dry skin; never perspires. Worse on the left side. Kali bich.—Pustules on the right side of the chin, 200 DISEASES OF THE SKIN seattci on reddened bases. In fat, light-haired persons. M: rcuiuus PiiECip. ruber is, next to Tartar emet., one of the most prompt remedies for sycosis. Petroleum.—Papular eruption at the corner of the mouth with sticking pain. Painful pustules on the chin. Sulphur.—Painful pea-sized pimples, Avith red areola. syphilides. Definition.—Syphilides are the manifestations of general syphilis upon the skin. Symptomatology.—They may be divided into tAvo arbitrary groups, viz., the secondary and the tertiary; and possess the following general features: TLcy have a history of syphilitic inoculation. They are of a reddish, yellow-broAvn color, often described as copper-colored. They are polymorphous and elec- tive They are devoid of both pain and itching. The ■crusts are thick, greenish-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 symmetrical. Later the distribution is irregular. The scales occur in small circular spots, and are thinner and feAver in number than in non-syphilitic cases, They are of a non-inflammatory character and are prone to recur. They occur in the ratio of about five per cent, of all cutaneous cases. The secondary syphilides are: 1. Erythematous syphilide.—Tins consists in the DESCRIPTION AND TREATMENT. 207 formation of flat or slightly raised patches, varying in size from a split pea to a tAVO-cent piece. It is the earlie.-t and most frequent cutaneous manifestation of constitutional syphilis, and appears generally at about the sixth Aveek. It often conies 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 white precipitate ointment, ten (.6) to twenty grains (1.3) to the ounce (32.), may be used externally, and Merc, iodat., or Merc, cor., given at the same time internally. 2. Papular syphilide.—This eruption is usually superficial and may either follow 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 usual!}' lasts from three to eight weeks. 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 white border of fine scales. Later they assume a tawny hue, and may be moist, or covered Avith thin, scales. They are usually most marked on the nape of the neck, the flexor sur- faces of the extremities, and on the perineum and gen- itals. 208 DISEASES OF THE SKIN. Treatment.—The five per cent, oleate of mercury is- the best local application. Internally, Potassium iodide and Merc. cor. are the principal remedies. 3. Vesicular syphilide.—This is a rare type of syphilitic eruption, and in the majority of cases, takes the form of herpes. Occasionally it is varicella form. TheAresicles of the /^er/>e^^c manifestation vary in size from a millet seed to a pea, and are seated upon a cop- per colored base. They are arranged either in circles or in segments of circles, usually last about a Aveek, and disappear Avithout scarring. Their first appearance is generally about three weeks after the disappearance of the primary lesion. The vesicles ot the varicellaform eruption are about the size of small peas, are surrounded by a coppery- red areola, and are now and then umbilicated. They may be either isolated or confluent, and are succeeded by greenish-brown scabs which fall off in about two weeks, leaving slowly disappearing purplish discolor- ations. The lesion appears- about the sixth month after chancre, and shoAVS itself mostly about the face.. Treatment.—Merc, cor., Cinnabar, and Merc.jod- atus are three main internal remedies. A Merc. cor. lotion or the oleate of mercury, may be used exter- nally. 4. Pigmentary syphilide.—This consists of "coffee- with-milk" colored macules, varying in size from a eent piece to a half dollar.. It occurs oftenest in women, and appears mostly on the neck, but occasion- ally extends to the body and extremities. It comes DESCRIPTION AND TREATMENT. 209 betAveen the fourth and twelfth month, and lasts one or two months, or longer. Treatment.—Nitric acid is the generally indicated remedy. The Calcium sulphide is sometimes called for. 5. Pustular syphilide.—This may exist in either of three forms: (a.) As small millet-seed sized ephemeral dead- gray colored pustules Avhich dry up and form brownish, rough, scabs, or else linger as slightly ulcerating, veg- etating surfaces. They are apt to appear on the fore- head, 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 pus- tules which form broAvnish colored scabs, and leave small, white, 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 lower extremities. (c.) As ecthymatous umbilicated pustules, which vary in size from a pea, to a hickory nut, and are sur- rounded by a dark areola. These form rough, dark, greenish-brown scabs, and leave slight copper-colored cicatrices, which gradually disappear. Treatment.—Locally, Avhite precipitate ointment may be used. Kali bich. and Merc. nit. are the more common in- ternal remedies. 6. Bullous syphilide.—The eruption is character- 210 DISEASES OF THE SKIN. ized by blebs, Avhich vary in size from a pea to a Aval- nut, and after lasting a variable time, dry up and form dark greenish-brown scabs. It is a rare and late man- ifestation of syphilis, but may occur on the palms and soles of the neAvly-born as a result of inherited disease. Treatment.—Potassium iodide and Syphilinum, are the generally used remedies. 7. Squamous syphilide.—This may develop on the syphilizecl, in the course of other eruptions, or start as a primary condition Avith febrile symptoms, by the formation of small, red, circular blotches, Avhich in a few days become covered with scales. After a feAV Aveeks the scales fall off, leaving dark colored spots, that gradually disappear Avithout cicatrization. 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 limited by the charac- teristic livid areola. 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 Avhen 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 Phytolacca. 8. Tubercular syphilide.—This is a common form DESCRIPTION AND TREATMENT. 211 of secondary syphilis verging on the tertiary. It rarely appears before a year or longer after chancre, and con- sists of circumscribed, dome-shaped, brownish-red ele- vations, Avhich 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 sIoavIv, may last for Aveeks or months, and disappear either by absorption or ulceration. When absorption takes place, small depressed pig- mented spots remain, Avhich cither 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 punchecl-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 Avith the acid nitrate of mercury, and Avhen ulcers form they may be dressed Avith iodide of starch paste. Merc, biniod., and Potassium iodide are the gener- ally indicated remedies. Thuja is adapted to mucous tubercles. The tertiary syphilides are principally Bupiannd the Gummatous syphilide. 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 mul- tiple a.i I grow sIoavIv. They either undergo absorp- 212 DISEASES OF THE SKIN. tion 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 manifesta- tions of hereditary syphilis, as observed in children, differ from those of the acquired form as seen in the syphilized adult. Usually Avithin two 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 and genitals. The skin becomes harsh and dry and assumes a dingy, yelloAvish hue. The face groAvs Avrinkled, and the babe patient appears like a little dried up old man. Sooner or later snuf- fles sets in, the disease extends to the larynx, and the child has a peculiar hoarse cry. About the same time coppery-red mucous patches varying in size from a finger-nail to the palm of the hand, appear on the buttocks, thighs or genitals. Occasionally the hands exfoliate in thin dry scales. After a variable season, dry or moist papules—the moist predominating— make their appearance on the reddened patches. Tu- bercles may form. The matrix of the nail may sup- purate and the nail be shed several times. Excon" DESCRIPTION AND TREATMENT. 213 Kons and mucous patches are the most common, and at the same time, the most characteristic manifestations of syphilis in the young. Occasionally syphilis is ac- quired by a healthy baby from nursing a Avoman Avith chancre, or through vaccination. This is called In- fantile sypldlis. If the child is born Avith a general •eruption, death is almost inevitable. The bullous syphilide in infants usually manifests itself at birth, and generally results fatally. Treatment.—The Calcium iodide is the principal remedy, and next Mere. viv. Cor allium rub., is adapted to the syphilitic erosions. A five per cent, oleate of mercury inunction is highly recommended. If the simple oleate irritates the skin, equal parts of a ten per cent, oleate and vaseline may be used. One-half of a drachm of the unguent may be used at each appli- cation. TELANGIECTASIS- Definition.—Telangiectasis is characterized by cir- cumscribed, vascular cutaneous groAvths, appearing for the most part during adult life. Synonyms.—Spider naevus. Symptomatology.—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 naevi 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 spontane- ously or remain through life. Treatment.—The treatment is the same as that of aiaevus. 214 DISEASES OF THE SKIN. Condurango is reported as having cured some cases- THE TINEiE. Definition.—" The tineae" is a generic term given to a class of cutaneous affections that owe their origin to vegetable parasites. Symptomatology.—At the Chicago Homoeopathic Hospital 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. Parasites.—The parasites are the Achorion Schon- leinii, the Tricophyton and the Microsporon furfur. They exist in three forms: 1. Conidia or spores, Avhich are made up of an outer and inner enveloping membrane composed of cellulose, enclosing a liquid containing floating granules. They present an average diameter of .006 mm. 2. Mycelia, or thread-like structures, which vary in size and shape from simple, fine, transparent fila- ments, to large, double-contoured tubes. 3. Granules, the nuclear form of the fully developed fungus. They require a high poAver 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 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. DESCRIPTION AND TREATMENT. 215 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 consequently the disease has been running for some time, or has become chronic. If on the other hand sprouting mycelia filled Avith granules,. marked oft* as it were by partitions, and called sporo- phores, are present in large numbers, it may be taken for granted that the fungus growth is active, and that consequently the disease is spreading rapidly, or is in the acute stage. Varieties of Tineoe.—There are three varieties of (< the tinece," due respectively to the ravages com- mitted by the afore-mentioned parasites upon the skin. They are Tinea favosa, Tinea tricophytina and Tinea versicolor. TINEA FAVOSA. Definition.—Tinea favosa is a contagious disease^ characterized by the presence of one or more clustered or scattered variously sized cup-shaped scabs of a sulphur-yellow color, and pierced by a hair. Synonyms.—Favus. Crusted ringAvorm. Honey- combed ringAVorm. Symptomatology.—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 Avhere the vegetable parasite touches the skin, as a slight redness, accompanied by a varying- amount of itching. Scales soon make their appearance 216 DISEASES OF THE SKIN. on the reddened surface and assume the form of pin- head sized crusts. These continue to increase, and the disease spreads, so that at the end of tAvo weeks, the collected mass presents the umbilicated form of the fully developed favus cup. They may iioav remain separated, or coalesce and form yelloAvish-colored, aggregations, having a characteristic honeycomb as- pect. The scabs are peculiarly cup-shaped in appearance, Avith the concavity directed upwards, and vary in size from a split pea to a ten cent piece or even larger. They have a straw or sulphur-yelloAv color, and are as a rule pierced by a hair. A special odor generally attaches to the favus crust: it is that of stale straw, mice or cat's urine. On removing the scab, the skin is seen to present a more or less reddened, hollowed out appearance, cor- responding 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 disease is severe, and the ravages of the parasite are in any way exten- sive, 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 knoAvn as the achorion schonleinii. This fungus Avas named after Schonlein, DKsCRIPTION AND TREATMENT. 217 its discoverer, by Remy. Its history dates back to 1839. Under the microscope it presents the following characteristics: A field studded mostly Avith oval conidia, varied as to size, and mycelia variable as to length and more or less filled with granules. The OA'al fungus has a double envelope, and an average diameter of .034 mm. The mycelia present a pale grayish Avatery appearance, and have an average diameter of .0026 mm. They—the mycelia—are usually abundant, and occasionally as- sume a peculiar grouping Avith the conidia. (I allude to the clustering of four or five of the spores in a i*oav at the end of a mycelial thread.) This is oftener found than many would have us believe, and Avhen present is characteristic of faA'us. Diagnosis.—As regards the diagnosis of tinea favosa, little difficulty is usually experienced. Briefly, the distinguishing points are: The characteristic pea-sized, straAv-colored, cup' shaped, honey-combed crusts. The stale straAv odor. Its prevalence among the poorer classes and children. The presence of the achorion schonleinii, as revealed by the microscope. Its contagiousness. From eczema, for Avhich it is most liable to be mis' taken, it may be distinguished by having no stage of discharge, by having sulphur-yellow instead of green- idi-yelloAv crusts; by its stale straw odor, as con- trasted Avith the nauseous smell of eczema; by being contagious, and eczema not; and by being cured by parasiticides, Avhile eczema avouIcI be aggravated there- bv 218 DISEASES OF THE SKIN, Treatment.—The cardinal point in the treatment,, is either to starve out or kill the parasite. The former may be accomplished by the administration of inter- nal remedies which may so alter the soil as to render it less suitable to the fructification of the plant, and the latter by the use of local applications, called par- asiticides. Before local treatment is commenced, all crusts must be removed and the diseased hairs pulled out. Almond oil, a marsh-malloAv, or mashed turnip poultice, will soften the crusts. The hairs are best removed by a broad-lipped epilation forceps. (Fig. 12). After the scabs and diseased hairs huA'e been Fig 12. Epilatino Forceps. removed, a parasiticide of greater or less strength, depending upon the irritability of the skin and the stubbornness of the parasite, should be applied. A mercuric bichloride lotion—one (.06) to three grains (.19) to the ounce (32.)—acts well. If the fungus has caused considerable irritation, enough over and above the scabbing to occasion a discharge, the oleate of mercury five per cent, will be of service. The positive electrode of a galvanic battery—current of 15 to 20 miliamperes—moistened with the bichloride solution and held on the diseased parts 10 or 15 minutes, causes more rapid penetration of the parasiticide. The internal remedies are: DESCRIPTION AND TREATMENT 219? Agaricus.—Favus with biting itching in the scalp. Crusts sometimes spread to other parts of the body. Sensation as if ice-cold needles Avere piercing the skin. Arsenicum iodide.:—Scalp dry and rough, and cov- ered with dry scales and scabs. Extend to forehead, ♦ace and ears. Intense itching and burning. Bromine.—In children Avith light hair and blue oyes. When the fungus excites considerable irritation 9t tne skin.. Profuse dirty looking, offensive smelling discharge. Crawling beneath the skin of the occiput. Ualcarea- carb.—Thick scabs covering a quantity of thick yellow pus. Large scabs, covering sometimes over one-half the-entire scalp. Burning and itching. Glandular swellings on the neck. In fair, plump children. Dulcamara..—In scrofulous children Avhen the crusts are thick and the hair falls out. Bleeding after scratch- ing. Glandular swellings in the neighborhood of the emotion. Graphites.—Exudation: of clear, glutinous fluid forming moist scabs. Secretion from scratching. Fall- ;,eg out ot" r»air. Skin dry and inclined to crack. Ten- dency to ulceration. Kali carb.—Exudation of moisture after scratch- ing. Sensitiveness to cold. Frequent urination, espec- ially at night. Dryness and falling out of the hair. In old over-treated cases. Lappa major.—Grayish-white, foul smelling crusts. Most of the hair has disappeared. Swelling and sup- puration of the axillary glands. Boils all over the body. 220 DISEASES OF THE SKIN. Lycopodium.—Eruption beginning on the back of the head. When there are several spots, and Avhen the crusts are fetid, thick and bleed wWy, Hunger, but a small quantity of food fills him up. Constipation. Mezereum.—Elevated white chalk-like scabs Avith ichor beneath, breeding vermin. Itching as if the head Avere in an ant's nest. Worse at night. In scrofulous children. Oleander.—Favus on the back part of the head and behind the ears. Biting itching of the scalp as from vermin. Skin sensitive and sore. Phosphorus.—May be used when the follicles ap- pear to have been destroyed, and the scalp left smooth and shiningo Sulphur.—May be necessary to help along the ac- tion of the indicated drug. Ustilago mad.—When there is great moisture, with matting and falling of the hair. Vinca minor.—Offensive, moist eruption with brownish crusts. Abundance of lice on the head. Hair matted together. The hair fails out in single spots and Avhite hairs groAV there. Viola tricoloro—Thick crusts; hair becomes matted; urine smells like cat's urine. Swelling of th- ?crvi- cal glands. Intolerable itching at ni^nt. TINEa TRICOPHYTINA. Definition.—Tinea tricophytina is the variety o* tinea that owes its origin to the tricophytoii. Synonyms—Ringworm. Barber's itcha DESCRIPTION and treatment. 221 Symptomatology.—Under this head are included the diseases commonly described as, tinea tonsurans, tinea circinnata, tinea sycosis, and tinea kerion. The trico- phyton finds its affinity in children of lymphatic tem^ perament, selects as its seat either the scalp or body, and there produces the disease known by the common name, "ringworm." In middle life it frequently at- tacks the beard, Avhere it grows luxuriantly and causes the affection having the vernacular "barber's itch." When the fungus is first planted on the skin, fhe fates being propitious, it demonstrates its presence as does the favus fungus by the appearance of an itchmg erythematous redness, accompanied usually by a crop of evanescent vesicles, Avhich are quickly followed by a scaly formation. If the parasite attacks the scalp, it will be noticed that the hairs covering the patch or patches, gradually become brittle and break off, or are loosened and come out easily. The breaking off of the hairs gives to an old patch, a "stubble-like" appearance, Avhich together Avith a semblance of "goose-skin," due to the promi- nence of the follicles, may be held as characteristic. On the body, where it presents its best developed ringAvorm appearance, tinea tricophytina spreads in a circular fairy-ring-like manner, until it covers an area of a silver dollar or even larger. For, as the skin be- comes accustomed to the presence of the fungus which has already assumed the cellular form in the oldest part of the patch, the central redness gradually fades, Avhile the disease is all the time spreading in the direc- ■222 DISEASES OF THE SKIN. tion of the periphery, Avhere the sprouting mycelia are most active. When the parasite attacks the beard, a slight inflammation is first noticed around one or more hair follicles of the chin, which gradually increases until papules make their appearance. The papules steadily enlarge, so that in about a week's time they may have reached the size of split-peas or hazel-nuts, and have in fact become tubercles. These tubercles are surrounded by a little pus, and pierced by a hair, which loosened by the destructive changes going on around it, ivill, if pulled, come out, causing scarcely per^ ceptible pain. This is an eminently contagious form of tinea tricophytina, and is acquired mostly m ton- sorial parlors, through the carelessness of barbers. AVhen the tricophyton attacks the nails it produces the disease sometimes called onychomycosis. Tinea kerion from the Greek kerion a honeycomb, is the name applied by some writers to a form of this variety of tinea, that is simply the result of a more violent action of the tricophyton, in Avhich the hair follicles become specially inflamed and pour out a viscid mucus, resembling the juice of the mistletoe berry. The tricophyton, from thrix, a hair, and phuton, a plant, was discovered by Gruby in 1844. It Avas after- wards more fully described by Bazin, of Paris, in Itvuation DESCRIPTION AND TREATMENT. 235 irregular from ovarian irritation. During the cli- max is. Veratrum alb.—Nettle-rash about the joints only. Zincum met.—Stinging itching in the skin with nettle-rash eruption after rubbing. Itching rash in hollows of the knees and bends of the elboAvs. After moderate Avine drinking. VERRUCA. Definition.—Verruca may be defined as a hypertro- plued papilla of the skin, covered with a hypertrophic layer of epidermis. Synonym.—Wart. Symptomatology.— Warts may develop as small cir- cumscribed split-pea sized elevations, broad at the base, and of the same color or a little darker than the surrounding skin, or as flat nid broad slightly ele- vated 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. 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 warts sometimes form on the scalp. They someAvhat resemble a crab in appearance, and hence have obtained the vernacular "crab Avarts." Venereal warts are pinkish or reddish vascular vege- tations, and occur for the most part on the genitals, preferably on the penis and labia. They may also form about the mouth and anus, in the axilla and 236 DISEASES OF THE SKIN. betAveen the toes. They are apt to grow very rapidity, 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 Avith gonorrhoea, but are never like the condylomata, a sign of constitutional syphilis. Treatment.—The smaller warts should be removed by the curved scissors, and the larger and more vascular -ones by the curette, ligature or galvano-caustic Avire. Venereal Avarts need the strictest cleanliness. The dry ones may be treated locally by thuja or mercuric bichloride lotion. The moist ones respond best to Ousting with the mercuric chloride. Thuja has great reputation in removing all kinds of Avarts. Moles may be removed by the topical use of the acid nitrate of mercury. The folloAving are the generally indicated remedies for Avarts: Antimonium crud.—Soft smooth Avarts on the neck, arms and hands. Berberis.—Warts the size of millet seeds. Bufo.—Warts on the back of the hands. Calcarea carb.—Small, soft Avarts. Cinnabar.—Warts on the prepuce which bleed Avhen touched. Causticum.—Warts on the nose and eyebrows. Painful Avarts. Dulcamara.—Flat Avarts. Lachesis.—Warts on the thumb. DESCRIPTION AND TREATMENT. 237 Lycopodium.—Pediculated Avarts. M ignesia carb.—May be given two or three grains a day, Avhen other remedies fail. Natrum carb.—Ulcerated Avarts. Nitric acid. Soft Avarts. Warts on the eyelids. Sepia.—Large, hard Avarts. Sulphur.—Hard Avarts. Warts under the eyes. Thuja.—Warts on the fingers. Horny, hard Avarts. It folloAvs Avell after Calcarea. avasheravoman's itch. Definition.—Washerwoman's itch is an inflamma- tion of the skin occurring on the hands in. Avasher- women. See Eczema. XANTHOMA. Definition.—Xanthoma is a connective tissue neAv growth, characterized by the presence of slightly. raised circumscribed " chamois-leathei" patches or golden-yelloAv tubercles. Synonyms.—Xanthelasma. Vitiligoidea. Fibroma lipomatodes. Symptomatology.—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 scini-circular, " chamois-leather" looking patches, unaccompanied by pain. The tubercular form consists. of rounded, golden-yellow tubercles, Aarying in size* 238 diseases of the skin. from a pin's-head to a large pea. This variety is found Jess frequently upon the eyelids than on other parts. In both forms the neAv growth consists of fibrous tissue containing fat granules, and it is to the latter that the disease owes its color. Treatment.—Xanthoma can only be cured by remov- ing the patches. xeroderma. Definition.—See Ichthyosis. ZOSTER. Definition.—Zoster 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. Synonyms.—Herpes zoster. Zona. Shingles. Symptomatology.—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 characters, runs a clearly defined course, and with it the febrile malady disappears. Moreover it rarely attacks the same per- son 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 occurring in the orbital region, it may seriously affect the eye, and is apt to leave behind a severe neu- ralgia. The eruption is usually preceded by a feel i no- of prickling, stinging itching of the parts, which lasts irom twenty-four to forty-eight hours, and abates on DESCRIPTION AND TREATMENT. 239 the appearance of the vesicles. The vesicles are at first filled Avith a clear serum, Avhich soon becomes turbid. They last from eight to ten days, and if not broken, either undergo absorption'or dry up and dis- appear in little brown scales. Zoster occurs most frequently between the ages of twelve and twenty-four, and attacks males more than females. It is a self limited affection and usually runs its course in from one to two Aveeks. Etiology.—Zoster is due to an inflammation of the sympathetic fibres of the ganglia through Avhich the nerves course to the part affected. The eruption in- volves 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. Diagnosis.—The characters of zoster are usually so Avell marked, that it can hardly be mistaken for any other affection. From herpes Avith Avhich it may be confounded, it can be distinguished as follows: Zoster appears but once in a life time, and is gen- erally 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. Neuralgic pains precede the eruption of zoster; herpes has only 240 DISEASES OF THE SKIN. a burning itching. Zoster often leaATes cicatrices and' a troublesome neuralgia; herpes never does. Treatment.—The galvanic current from four to eight cells of a battery of ordinary strength, has been found very beneficial if the pain is sharp, when applied from fifteen to tAventy minutes daily. The local treatment consists in protecting the vesicles and relieving the neuralgic pain. To this end the parts may be painted with collodion, or dusted with the sub-nitrate of bis- muth and starch, equal parts, and a protective bandage applied. Chaulmoogra ol1 will oftentimes prove a very beneficial application. Cantharis lotion has been highly recommended, and will at times be of service. Rhus tox., is the principal internal remedy. Others may be indicated as follows: Aconite.—In the earlier stages, when the neuralgic pain is accompanied by febrile symptoms. Apis.—Burning and stinging pains Avith swelling. Large vesicles, sometimes confluent. Better from cold: applications. Arsenicum alb.—Confluent eruption with intense burning of the blisters. Worse after midnight, and from cold applications. Neuralgia. In debilitated constitutions. Cantharis.—Large blisters, burning when touched. Smarting and stinging. Mostly on the xiirht side. Worse in the open air. Cistus.—Zoster on the back. Neuralgic symptoms. In scrofulous subjects. DESCRIPTION AND TREATMENT. 211 Comocladia.—Zoster on the legs. Rheumatic pains aggravated by rest; relieved by motion. Dulcamara.—Zoster after taking cold from damp air. Moist, suppurating eruption. Glandular swell- ings in neighborhood of eruption. Eruption precedes the menses. Graphites.—Zoster on the left side. Large blisters from the spine to the umbilicus, burning when touched. Worse indoors. Better in the open air. Dry skin, tendency to ulceration. In blonde individuals inclined to obesity. Iris versicolor.—Zoster especially on the right side. Following gastric derangement. Pain in the liver. Neuralgic pains. Kalmia lat.—Facial neuralgia remaining after zos- ter. Worse at night. Palpitation of the heart. Rheu- matic pains. Lachesis.—Zoster during spring and fall. The ves- icles turn dark and are very painful. All symptoms are Avorse after sleep. Mercurius.—Zoster on the right side, extending across the abdomen. Worse at night, from the warmth of the bed. Tendency to suppuration. Easy perspiration Avithout relief. Mezerelai —Zoster in old people. Constant chilli- ness. Neuralgic pains. Worse at 9 p. m. Burning, '-hanging location after scratching. In scrofulous persons. Ranunculus bulb.—Zoster aggravated by change of temperature. Neuralgic sequels. In rheumatic sub- jects. 242 DISEASES OF THE SKIN. Rhus tox.—Burning and stinging pains aggravated by scratching. Small burning vesicles Avith redness of the skin. Confluent vesicles. Worse in cold Aveather. Rheumatic pains during rest. Sleeplessness Avith rest- less tossing about. Zoster brought on by getting Avet, while over-heated. Sempervivium tect.—In obstinate cases. May be used internally and locally. Thuja.—Zoster with eruption only on covered parts. Better from gentle rubbing. In individuals of lymph- atic temperament. Zincum.—Neuralgia following zoster. Pains re- lieved by touching the parts. Worse after dinner and towards evening. Zincum phos.—When other remedies fail. Follow- ing brain-fag in literary persons. ------o------ Note.—In the treatment of skin diseases it should be remembered that the absorption of medicinal sub- stances is hastened under the influence of the positive electrode of a galvanic battery placed upon the skin previously covered with the medicament, and the nega- tive electrode placed at some other point to complete the circuit. The strength of current required is from fifteen to twenty miliamperes. CO PART III.—A Chart oe Characteristics, With Diagnostic, Therapeutic, Dietetic, and Hygienic Hints, DISEASES. definitions and diagnostic teatup.es. therapeutic, dietetic and hygienic hints. ANIDliOSIS. Functional disease of the perspiratory apparatus. Char-acterized by insufficient sxceat. May be either congenital or ac-quired. Functional disorder of sweat glands. Characterized by offen-sive sweat. Most in axillae and feet. General or local. iEthusa, Plumbum, etc. Turkish baths. Free use of water internally and exter-nally. Bromidrosis. (Osmidrosis.) Conium mac, [acrid.) Petro-leum, (axillae). Silicea, (feet). Staphysagria, ( rotten ). Zin-cum, (profuse), ek:. Alum or Carbolic acid lotion and Dia-chylon plaster dressings. Strictest cleanliness. CllROMIDROSIS. 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. S e 1 e n i u m, Sumbul, etc. Remove "grill's1' with comedo extractor. Sul-phur lotion. Matrimony. Ex-clude fatty food. Sebaceous Cyst. (Wen.) Hyperidrosis. <- A o w a Miliaria. O ( Prickly heat.) en « W A « o en Milium. (Skin-stones.) I 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. 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. Disordered action of the sweat glands. Characterized by numer- ous pin-head sized red d e n e d 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 iu women than in men. Potassium iodide. Baryta or Bromine. Excision. Baptisia. Boletus. Calc. carb. Jaborandi. Lactic acid. Sele- nium, etc. Use as little water as possible. 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, andTabacum. Remove by knife. Use Saponaria bark wash. mollusoum Sebaceum. SEBORRHEA. (Sebaceous flux.) Sudamina. Disease of sebaceous glands. Characterized by roundish, pea- sized tumors, umbilicated in the center and of a pinkish white color. Face mostly. In chil- dren. May be semi-epidemic. Tumors contain cheesy matter. Functional disorder of seba- ceous glands. Characterized by excessive secretion of sebum. On face and scalp. More in women than in men. Appearsinthe light complexioned, as an oily coatiiuj; 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. —1 Silicea and Teucrium. Calc. ars. Bromine, etc. In early stage, Acid nitrate of Mercury. locally. If tumors are large use the knife. Bufo. Bryonia. C;ilc. carb. Kali carb. Natrum. Plumbum. liaphanus, 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, Ammonium mur.. and Urtica urens. Look after the general health. Ox CO "A O ►H H < t<>ntig. Graph. .Nux. jug. Oleander. Rous. Sarsap. Sui-phur, etc. Locally — Early; Bran washes, emollient poul-tices, etc. Later: Zinc and starch, Lycopodium orGlyceral tannin. For itching: Diosco-rea, Carbolic acid or Hydro-cyanic acid, lotions or Grindel. cerate (acute cases); pyroligne-ousoilof Juniper(n?n(m inflam-matory cases). Benz. oxide of Zinc oint. or Oleate of Lith-arge. White or red precipitate oint. Cbrysophanic cerate (squamous stage). Sapo viridis (chronic.) Oil of white birch. Aconite. Ars. jodat. Bell. Chel. maj. Chloral hydrate. Lactic acid. Mezereum. Nux. voai. Ustilago, etc. Carbolic acid. Grindeliaor Verat. vir., lotion. Oxide of Zinc or Lyco-podium powder. Erythema. Characterized by macules, papules or tubercles, attended by more or less itchingand burn-ing. Redness disappears under pressure leaves a yellow spot, wiiich 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. CO A O M H < < A M M Furuncle. (Boil.) Herpes. (Fever blister.) Hydroa. Circumscribed inflammation of the skin aud 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. Acute. Characterized b y groups of vesicles, having redden-ed slightly inflamed bases, and situated on jace 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. 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. CO A O H < A M M Hydro-adenitis. Inflammation of perspiratory follicles and adjacent connec-tive tissue, terminating in sup-puration. Bright red, pea-sized swellings. Suppurate in a few days. In axillae, around nipple and on perineum. Has no core. Phos. acid, (axillae). Phos-phorus, (nipple). Nit. acid, (perineum). Gels., or Lappa lo-tion. Tomato poultices. Hot fomentations. Impetigo Contagiosa. 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 by flat, straw-colored, usually fun-goid crusts. Acute. Contagious. Febrile symptoms. Vesicles grow rapidly and have red areolae. 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. Ant. crud. Aconite. EuDhor-bium. Tart. emet. Kali "bich. Silicea, etc. Soothing applica-tions. White precipitate oint-ment. Well nourished. 1 Intertrigo. CO fc O Lichen planus. <\ <\ < ^ fa fc rt M M A hyperaemic 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. Chronic. 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 papilla;, with hyperemia and new tissue formation. Calc. carb. Cham. Graph. Petroleum. Nux. jug., etc. Wash Avith soap and water. Dust with Lycopodium or Oxide of Zinc, and rice powder. Ant. crud. Ars. alb. Kali bich. Nux. jug., etc. Carbolic acid, Grindelia or H>drocyanic acid dil. wash. PyroUgneousoil of Juniper, Liberally fed and well hygiened. Characterized by round, solid millet-seed, sized, flesh-colored, or reddish papules. Itching. Distinctly papular course. Outer aspects of forearm, neck and thigh. Anatherium. Ant. crud. Ars. alb. Bell. Caladium. Krea- sote. Ledum. Nux. jug. Plan- tago maj. Rumex. Sulphur, etc. Locally : Cyanide of Pota- sium, Borax, or Merc, corr., wash. White precipitate or Iodide of Sulphur oint. Glyceral tannin. Rhus tox., (acute). Ars. alb., (chronic). T h u j a, (foliaceus). Causticum. Phos. acid. Ran. bulb., etc. Bran, starch, gela- tine or the continuous bath. Animal diet. Fresh air and plenty of exercise. Characterized by bullae, in groups of three or four, and va- rying in size from a pea to a hickory nut. Mostly chronic. P. Vidgaris on limbs and ankles. Blisters round or oval. Succes- sive crops. P. Foliaceus starts as single flaccid bulla on ster- num. Spreads over whole sur- face. Dry up and form yellow parchment- like flakes. Pernio. (Chilblain.) A £ Pityriasis. < (Branny tetter.) a < fa Prairie itch. Acute. Secondary effect of cold. Appears mostly on hands and feet. Ulcers may form. A winter disease mostly. Agaricu3. Ars. alb. Canth. Citrus vulg. Petroleum. Urtica dioica. Verat. vir., etc. Locally: Decoction ot marshmalloAvs, (inflamed). Tamus com. tinct., (unbroken). Diachylon plaster, Oxide of Zinc oint. or Glycercole of Calendula, (broken). Resin oint., (ulcers). Tinct. of Ben-zoin as preventive. 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. Acute. Appears in new dis-tricts. May be epidemic. Head-ache, malaise. Slight lever. 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 Avood ashes. Hepar sulph. Kali lotion. CO A O hH H < fa A M Prurigo. Psoriasis. (Dry Tetter.) 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 white birch. Biniodide of Mercury or white precipitate oint. Green soap treatment. Generous diet. Cod-liver oil. Strophulus. (Red-gum). (Tooth-rash). 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. Chamomilla. Calcarea carb. Spiranthes. Borax. Ledum. Apis. Cicuta. Sumbul, etc. Urticaria. (Nettle-rash). (Hives). 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. 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. Zoster. (Shingles). Purpura. 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. Characterized by an effusion of red blood globules into the cutis, usually unattended by constitutional disturbance. Spots first bright red, jhen pur- ple, and change color like a bruise. On legs, mostly. Usual- ly symmetrical. More in aged. Occur in crops. Run a course ot 8 or 10 days. May be haem- orrhage from mucous membrane (land-scurvy). There is then constitutional disturbance. Rhus toxicodendron. Como- cladia. Graphites. Dulcamara Kalmia. Mercurius. Mezereum. Zincum met. Zincum phos., etc. Galvanic current. Xiocany: Collodion, or SuDnitrate of Bis- muth and starch, dusting pow- der. Chaulmoogra oil, or Can- tharis lotion. Ars. alb. (simple). Sulphuric acid (hemorrhagic). Baptisia. Bryonia. Chloral hydrate. Rhus tox. Phos. Veratrum vir., etc. Hamamelis, locally. Malt foods. Outdoor exercise. CO fa w fa O H « fa fa a fa a 2 fa fa c CHLOASMA. (Liver spots). A coloration of the skin, char-acterized by round or oval, 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. Lentigo. (Freckle). 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. fa < fa Q co !zj fa < fa . h fa^ fa fa o Callositas. (Callosity). Yellowish or whitish, nickel-sized, horny, elevated patches. On hands and feet. Caused by friction. More in men. Graphites (hands). Silicea (feet). Clavus. (Corn). A small, usually split-pea sized, flat, horny formation, more or less deeply seated, and painful 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 fa fa H < fa \» CO fa fa - -< S fa fa fa M fa fa fa o Ichthyosis. (Fish-skin Oiseuso.) Verruca . (Wart.) A congenital chronic disease, characterized by dryness and roughness. Mildest form in children (Xeroderma). Fur- furaceous scales. In severer cases, papillae enlarged, lozenge- shaped scales, lines and fissures. In worst cases, scales are yel- lowish or greenish. They never overlap. May be heaped up in- to projections. Whole surface more or less involved. An enlarged papilla, variable as to size and shape, covered with an hypertrophic layer of epidermis. S pi it-pea "sized, skin-colored on the hands. Fin- ger-nail sized and brownish on back. Conical thread - like growths on neck, face, and eyelids. Digitated warts on scalp. Venereal warts are pinkish, or reddish vascular vegetations.__________________ Ars. iodat. Aurum. Clema- tis. Kali hyd. Phos. Plumbum. Thuja, etc. Turkish baths, and anointing with either Olive, Chaulmoogra, or Cod-liver oil. Infusion of Saponaria bark. Sapo viridis treatment. Gener- ous diet. Cod liver oil. Calc. carb. Cinnabar. Caust Lycop. Natrum. Thuja, etc Remove smaller warts by scis- sors, and larger ones by ligature or galvano-caustic Avire. For dry ones use Thuja, locally. For moist ones, dust with Proto- Chloride of Mercury. fa . P CO fa CO a H fa o fa > H H fa CJ fa fa fa fc >* fc a O o fa o Elephan- tiasis. (Elephant leg.) FRAMB03SIA. (Taws.) Chronic disease. Character- ized by great nypertrophy of skin, and subcutaneous connec- tive tissue, usually confined to the lower limbs and genitals. Ushered in by chill, followed by febrile symptoms. Swelling of leg, painfully distended lym- phatics. Due to the filaria san- guinis. In malarial districts and tropical climates. 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. Myristica. Hydrocotyle. An- acardium. Elaeis, etc. Es- march's bandage. Compression of main artery. Excision of sciatic nerATe. Hamamelis or Chaulmoogra oil, dressings. Milk diet. Change of climate. The Iodides of Mercury and Potassium. Jatropha lotion. Rosacea. (Copper-nose.) (Wine-nose.) fa CO u fa CO CO fa H O fa fa H >• fa H fa O fa fa a O M o fa Sclero- o derma. (Hide-boand disease.) A chronic disease. Affects more particularly the nose, checks 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 tubercles develop. Disease of middle life. A chronic affection. Charac- terized by hardness and inelas- 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. Elaeis. Galvanism. Alumina. Ber- Rhus tox., etc. CO fa a fa o fa H fa fa fa a > 5 co ?i CO O ^ fa > °S fa fa O SCLERIASIS. An induration of cellular tis-sue, in new-born children. May be congenital or appear during early months of infant life. Stearine-iike deposit in the sub cutaneous tissues. Usually fa-tal. JKlaeis guineensis. Onychogry-PHOSIS. Characterized by twisted bent nails, whicli are thickened, and of a yellowish or brownish col-or. Mostly nails of toes and fin-gers. Attacks old peopK Graphites and Silicea. tr fa H *a ►^ fa o fa"*-CO s a fa o fa H CO M fa a o fa o H fa o fa fa > O fa fa a C CO o b o fa o 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. (Acquired Pie-bald Skin.) Characterized by localized loss of pigment. Patches round or "val, 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. M0RPHO2A. 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 g a 1 -vanic current. Well fed. Cod Liver or Chaulmoogra oil. CO fa fa O < > fa < A fa O CO H a O fa c Atrophy 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. CO a > <■ o fa 0 > > w a CO CO t-H H H >; O fa o o fa o Fibroma. (Polypus of the Skin.) Keloid. Xanthoma. 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. Characterized by one or more flattish 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. 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. Cal. ars. Lycop. etc. Remove large tumors by knife elastic ligature or galvano — caustic. Smaller ones disappear under Acid nitrate of Mercury, locally. Fluoric acid. Graph. Nit. acid. Sabina, etc. Galvanism. Removal of the patch. N.EVUS. (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. Pigmentary are dark colored 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 during adult life. Bright red pin-head or split pea sized. On face and neck, may 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 nsevus. Condurago. Epithelio- ma. (Epithelial can- cer.) 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 groAvths 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. fa . a CO CO a CO H O A fa O 0 £ fa fa fa A < fa > o fa o Lupus ery- thematosus (Erythematous scrofulide. (Butterfly lu- pus.) A constitutional disease. Characterized by 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. 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. 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. Iodine. Guaraca. Hydroco- tyle. Cistus. Apis, etc. Locally: Saponaria bark or Sulphur baths. Oil of white birch. Curette. Good diet. Fresh air and frequent bathing. OS 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. 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. Pyrogallic oint. Curette. Nutritious diet. Fresh air. Out-door exercise. Characterized by irregularly-shaped, sharp bordered, flat SAvellings, of a normal or dark reddish-brown color, occurring mostly on nose and upper lip. Unattended by pain, but sensi-tive to pressure. Calcarea phos. Guaraca. Rhus rad., etc. Removed by using the irido-platinum points and Squibb's fused Nitrate. fa a CO CO a CO H &h £ fe fa O 0 &H ■< £ fa fa a A fc -0 . fa > * fa o Sarcoma cutis. Scrofulo- derma. Syphilides. (Syphilis of the SkinJ 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. 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. 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. Flat split-pea sized or larger, slightly raised patches. Earliest manifestation. No itching. May last for months, significant signs of syphilis attend it. Papules may be acuminated or broad. Are first rose colored, surrounded by white border of scales. Later they have a tawny hue. Most marked on the nape of the neck, flexor surface of extremities, perineum and gen- itals. Appears between third week and fourth month. Lasts from three to eight weeks. Merc, jodat. Merc. corr. Locally: White precipitate ointment. Potas. iod. and Merc. corr. Locally: The 5 per cent, ole- ate of Mercury. Syphilides. May be herveticor varicellatorm. 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. Locally: Merc. corr. lotion or the Oleate of Mer- cury. Nitric acid or Cal- cium sulphide. Kali bich. and Merc. nit. Locally: W h ite precipitate ointment. > H o *J a n > > G H fC co H a -a fa g CO M O H "0 fa a < a o fa o Syphilides. m 3 J3 3 fa 00 3 o a % w u a 3 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. CO a O fa e fa A M fa a CO CO M B fe O M H fa a -< fa o fa o Syphilides. 5 o cS E Q 3 o c a> (. ■o 2 o d M 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. Carbo animalis. Condu-rango, etc., and remedies for the tubercular. Berberis aqu. Bi-c>anide of Mer-cury. Cistus for mercurio-syphilitic ulcers. 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. Calcium iodide. Corallium rub. Locally: A five per cent Oleate of Mercury inunction. CO ►H CO o fa a fa 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 moscli. Phos. Sepia. Silicea. Spigelia. Sul., etc. Galvanic current. 6 M . H CO !* fa a < fa fa o H ■< fa << O fa M fa H 0 CO fa O fa > Tinea fa- vosa. (Favus.) (Honey-comb Tetter.) Tinea tri- cophytina. (Ringworm.) (Barbers Itch.) Characterized by pea-sized, straw-colored, cup-shaped, hon- ey-comb crusts. Stale straAV odor. Achorion Schonleinii. Contagious. Poorer classes. Mostly on head, frequently on the trunk. 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 haze 1-n u t 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 Avhitish yellow on addition of Chloroform. 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. Sepia and Tellurium (Iiing- worm). Merc, precip. ruber. Kali bich. Plantago. Tart. emet. and Cicutu (Barber's Itch). Cocculus Iudicus, ttc. Epila- tion. Shaving every other day. Merc. corr. or Sulphurous acid lotion. Acetic acid or Coster's paint. Chrysophanic Cerate or White precipitate oint. d M • H CO fa a < fa fa CO o M <) a 1=1 u fa fa H a CO < fa fa o -«; fa fa fa p ^ H fa k O fa t> Tinea ver- 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 Jurfur. Next to tricophy- ton in frequency. Feebly con- tagious. Characterized by more or less sudden 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. to d o o H < fa fa a w o GUINEA-WORM DIS-EASE. 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. Elephant-iasis. (Elephant le£.) MlTE DIS-EASE. Due to the filaria sanguinis. See class IV. --- ' - y Due to the leptus initans. "jigger-" Papules, vesicles and pustules. On ankles and legs. South-western states. Along the Mississippi. Mostly in summer. Mild parasiticides. Sulphur ointment. fa < A < Phthiria-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 peliculi de-posited in clothing. Multiform lesions. On trunk, hips and thighs. "Scratch marks." P. pubis. Due to crab louse. In 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. Scabies. (Itch.) Contagious disease due to the aca rus 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 surf a ce of pen is. 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. ORTflOEPIC GLOSSARY. Ac'a-rus (acarus, 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 adjective signifying inflamed. Al-o-pe'ci-a. Baldness. Al-o-peci-a a-re-at'a. See Part II. An-je'mi-a. Deficiency of blood. An-^s-the'sia. Loss of sensibility. 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-ar. See Part II. Ax-il'l^e. Arm-pits. Bac-chi'-a. A synonym of Rosacea. Bleb. A synonym of Bulla. 278 ORTHOEPIC GLOSSARY. 27$ Brom-i-dro'-sis (bromos, a stench). Fetid perspiration. Bul'la. A water-bubble. See Part II. Ca-ciiec'tic (kakos, bad). Pertaining 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 Gyno- cardia odorata. Chil'blain. A synonym of Pernio. Chlo-as'-ma. See Part II. Chlo ro'-sis (chlcn-os, green). Green sickness. Chro-mi-dro'-sis (chroma, color). See Part II. Ci-ca'trix. A scar. Cin'-gulum (a girdle). A synonym of Zoster. Cla'vus (a nail). See Part II. Com'e-do (a glutton). See Part II. Con-dy-lo'ma-ta (kondulos, a tubercle). See Part II. Coni'dia. Fungus spores. Crus'ta lac'tea (milk crust). A term formerly used to- designate Eczema of the face in children. Cu-Nic'ulus (a burrow). Made by the itch insect. Cu-ret'te. A small scoop. Cyst (kustis, a sac). See Part II. Dan'druff. Scurfiness. De-pil'a-to-ry. A remedy which causes the hair to fall off. 2'80 diseases of the skin. Der-ma-tal gi-a (derma, skin, and algos, pain). See Part II. Der-ma-ti'tis. Inflammation of the skin. Der-ma-ti'tis con-tu'si-formis. See Part II. Der-ma-ti'tis ex-fo'li-a-tiva. See Part II. Der-ma-tol'o-gy (derma, skin and logos, discourse). That branch of science which treats of the physiology and pathol- ogy of the skin. Der-ma-to-ly'sis. See Part II. DER-MA-TO-pnY'TON(derma, skin, phuton plant). A vegetable parasite. Der-ma-to-zo'a (derma, skin, and zoon, an animal). Ani- mal parasites. Der'moid. Resembling the skin. Dys-idro'sis (dus, difficult and hydros, sweat). See Part II. Ec-thy'ma. See Part II. Ec'ze-ma (to boil up). See Part II. Ele-phax-ti'a-sis (elephas, an elephant). See Part II. Em'bo-lism. Obstruction of a vessel by a clot. En-dem'ic. Belonging to a particular district. Epn'E-Lis (epi, upon, and helios, the sun). See Part II. E-phem'e-ral. Short lived. Ep-i-dem'ic. Generally prevailing. Epi-theli-o'ma. See Part II. Er-y-sip'e-las. See Part II. Er-y-the'ma (eruthaino, to redden). See Part II. Fa'vus (a honey-comb). A synonym of Tinea favosa. Fibroma (fibra, a fibre). See Part II. Fi-la'ri-a med-i-nen'sis. The Guinea-worm. orthoepic glossary. 281 Fi-la'ri-a san'gui-nis. An animal parasite; the cause of Elephantiasis. Fis'sure (fissura, cleft). See Part I. Frambol'sia, pronounced fram-be'she-a, from framboise a rasp- berry. See Part II. Fun'gus (fungus, a mushroom). Fur-fur-a'ceous. Scaly. Fu'-runc-le (jurunculus, a petty thief). See Part II. Gran'ule. A little grain. Haus'tel-lum. A sucker. Her'pes {herpo, to creep). See Part II. Hir-su'ties. Hir-su'she-es, (hirsutus, hairy). See Part II. Hy'-dro-a (hudcr, water). See Part II. Hy-'dro ad-en-i'tis. See Part II. Hy-per-^e'mia. Excess of blood in any part. Hy-per-.es-the'sia. Over-sensitiveness of the skin. Hy-per-idro'sis (huper, in excess, and hidrosis, sweating.) See Part II. Hy-per-pla'sia. Excessive formation of tissue. Hy-per'tro-phy. Thickening or enlargement. Ich-thy-o'sis (ichthua, the scale of a fish). See Part II. Im-pe-ti'go con-tagio'sa. See Part II. In-crus-ta'tion. The act of forming crusts. In-du-ra'tion. The process of hardening. In-ner-va'tion. The act of giving nervous energy. In-ter-tri'go (inter, between, and tero, to rub.) See Part II. Ke'-loid. Kele, a crab's claw. See Part II. jKe'-rion (kerion, a honey comb). A term formerly applied to 282 diseases of the skin. a modified form of Tinea Tricophytina, when the follicle* become inflamed; and pour out a viscid secretion. La-nu'-go (lana, wool). Downy hairs. Len-ti'go. See Part II. Lep'-ro-sy (lepra). See Part II. Leu-co-der'-ma (leukos, white). See Part II. Li'chen pla'nus. See Part II. Li'chen sim'plex. See Part II. Mac'-ule (a spot). See Sec. 2, Part I. Mic-ro-spo'ron fur'fur (mikros, little, and sporas, seed)- The fungus of Tinea versicolor. Mil i-a'ri-a. See Part II. Mil'ium (a millet seed). See Part II. Mol-lus'cum se-ba'-ceum (mollis, soft). See Part II. Mor'-phosa (morphe, form). See Part II. My-ce'li-a (mukes, fungus). The thread-like structure of & fungus. N^e'vus. A mark or blemish. See Part II. Onychauxis. See Part II. O-nych'i-a (onux, nail). See Part II. On-y-cho-gry-pho'sis. See Part II. On-y-cho-myco'sis. See Part II. Os-midro'sis (osme, ordor). A synonym of Bromidrosis Pap'-ule (dim. of pa'pa, a teat). See Sec. 2, Part I. Far'-a-site (parasitos, a sponger). A term applied to a vege- table or animal that draws its sustenance from another. Par-a-sit'i-cide (anything that kills a parasite). Pe-dic'u-lus. A louse. Pem'phigus (pemphix, a blister.) See Part II. orthoepic glossary. 283. Pe-te'-chi-a (petechio, a flea bite); A red or purple spot.. Phthi-ri'a-sis (phtheir, a louse). See Part II. Pig'ment. Coloring matter. Pit-y-ri'a-sis (piluron, bran). See Part II. Pol-y-mor'phous. Having many forms. Prai'rie itch. See Part II. Pru-ri'go. See Part II. Pru-ri'tus (prurio, to itch). Itching. Pso-ri'a-sis. See Part II. Pur'pu-ra (porphura, purple). See Part II. Pus'tule. See Sec. 2, Part II. Rh ag'-a-des (rhagas, a rent), chaps or excoriations of the skim Rhi no-scle-ro'ma (rhin, the nose, and skleros, to harden) See Part II. Ro-sa'cea, pronounced ro-sa'she-a. See Part II. Ro-se'o-la (dim. of rosa, a rose;. See Part II. Ru'pi-a (rhupos, filth). See Part II. Sar-co'ma cu'tis. See Part II. Sca'bi-es (scabere, to scratch). See Part II. Scler'o-derma (tkleros, hard, derma, skin). See Part II. Scle-ri'a-sis (skleros, hard). See Part II. Scrof'ulo-derma. See Part II. Se-ba'ceous (sebum, suet), fatty. Se-bor-rhe'-a (sebum, grease, and rheo, to flow). See Part IP Se-que'la (sequor, to follow). The consequent of a disease: Spo-rad'ic (speiro, to sow). Occurring singly. Squa'mous (squama, a scale). Scaly. Stroph'u-lus. See Part II. -.284 diseases of the skin. Su-dam'i-na (sudo, to sweat). See Part II. Sy-co'sis (sukon, a fig). See Part II. Syph'i-lide. See Part II. Sy-phil'i-des. Skin diseases arising from syphilis. See Part II. Te-lan-gi-ec'ta-sis. See Part II. Tin'e-a. A moth-worm. See Part II. Tin'e-a fa'vosa. See Part II. Tin'e-a trich-o-phy-ti'na. See Part II. Tin'e-a ver'si-color. See Part II. Tri-chi'a-sis. See Part II. Trich-o-cla'sis. See Part II. Trich-o-phy'ton (thrix, hair, and phuton, plant). The fungus of tinea tricophytina. Troph'ic (trophe, nourishment.) Tu'ber-cle (dim. of tuber, a swelling). See Sec. 2 , Part I. Um-bil'i-cated (umbilicus, the navel). Depressed in the center. Ur-ti-ca'ri-a (urtica, a nettle). See Part II. Var-i-cel'la-form. Resembling varicella. Vis'cid (viscum, bird-lime), gluey, adhesive. Ver-ru'ca. See Part II. Ves'i-cle (dim. of vesica, a bladder). See Sec. 2, Part I, Wheal, pronounced "hweel." See Sec. 2, Part I. Xan-tho'ma (xanthos, yellow). See Part II. Xer-o-der'ma (Xeros, dry). See Part II. Zos'ter (zoster, a belt). See part II. PART V. DIET AND HYGIENE IN DISEASES OF THE SKIN. In the management of skin diseases attention to the matter of food is an item of the utmost importance, as not infrequently a wisely selected diet will accom- plish marked results. Generally the health of the skin is best maintained by a plentiful, digestible,mixed diet, avoiding a predominance of meat and abstaining either partially or altogether from the use of spirit- uous liquors. In dyspeptics it is often advisable not to take animal and vegetable food at the same meal, but to eat animal food at one meal and vegetable food at another. During the summer months the carbo-hydrates— starches, green vegetables and fruits—should be used freely, but in winter time the use of the albuminoids and fatty foods is advisable. Fish may often be used" with advantage in cutaneous troubles in place of meat. Fresh vegetables and whole wheat products are valu-- 285 :286 diseases of the skin. able articles of diet. Tea and coffee if taken should be used only with the greatest moderation. Cocoa made from the nibs is more healthful than either tea or coffee. Milk is a useful and nutritious food, but when used as a beverage by adults it should be taken alone and on an empty stomach. Water should not be taken in excess nor too cold with meals. In reasonable quantities its use as a beverage is beneficial as it di- lutes the intestinal contents and promotes absorption. Between meals fluids may be freely used if desired. Benefit often follows the taking of half a pint of hot water an hour before each meal. It operates as a stim- ulant to the central nervous system and tends to in- crease the secretion of the gastric juice. Fermented liquors, alcohol and tobacco should as a rule be avoided. Acids unless they come from unripe fruit are generally not harmful. Oatmeal often appears to render the skin irritable, and frequently has to be eliminated from the dietary in cutaneous diseases. Patients should be instructed not to eat excessively nor too rapidly, to thoroughly masticate the food and to refrain from over physical or mental labor directly after a substantial meal. As a rule an interval of at least five hours should elapse between meals. Where the patient lives plainly, and the disorder is not speci- ally connected with the digestive system no change need be made in the diet list. Otherwise the follow- ing hints may serve as useful guides: diet and hyuiene. 287 FOODS EASY OF DIGESTION. Meats.—Mutton, venison, chicken or turkey (white meat), squab, partridge, pheasant, grouse, sweet-bread (plainly cooked), fresh fish, haddock, flounder, shad, sole, perch, trout, oysters, raw or stewed (rejecting the hard portion), eggs (soft boiled), beef tea, mutton broth, clam broth. Vegetables and fruits.—Asparagus, beans and peas (young and fresh), cauliflower, squash, oyster-plant (stewed), ripe peaches and pears, apples (baked), summer fruits when perfectly fresh and in season. Bread and farinaceous articles. — Wheat bread (stale), dry and milk toast, steamed crackers, tapioca, rice, arrowroot, sago, maccaroni. Beverages.—Cocoa (from nibs or shells), weak tea Avith slice of lemon (no sugar or cream), toast tea, coffee Avith a beaten raw egg instead of milk, milk, pure water. MODERATELY DIGESTIBLE FOODS. Meats.__Beef, lamb, rabbit, duck, snipe, woodcock, black meat of chicken or turkey, turtle, cod, eggs (scrambled). Vegetables and fruits.—Potatoes (white), beets, turnips, parsnips, lettuce, celery (raw or stewed), spinach, cabbage, water-cress, onions, mushrooms, oranges, grapes, apricots, currants, strawberries, raspberries, 288 diseases of the skin. rhubarb, foreign and cooked fruits, salads of all sorts. Bread and farinaceous articles.—Fresh wheat bread, graham bread (hot and fresh), cracked wheat, hominy,, oatmeal porridge, indian mush, farinaceous puddings, plain cakes, jellies, ice cream. Beverages.—Coffe and tea (strong with sugar and cream), chocolate, lemonade. FOODS DIFFICULT TO DIGEST. Meats.—Pork, veal, goose, sausage, corned beef, dried beef, kidneys, liver, salt meat, salt or smoked fish, mackerel, salmon, eels, herring, halibut, lobster, crabs, clams, shrimps, fried or hard boiled eggs, gravies. Vegetables and fruits.—Cucumbers, radishes, sauer- kraut, pickles, corn, white potatoes (new), sweet pota- toes, nuts, pineapples, blackberries, bananas, raisins, figs, preserves, pickles, pepper, water ices, richly made dishes. Bread and farinaceous articles.—Hot bread, buck- wheat cakes and all hot griddle cakes, muffins, fritters, dumplings, custards, pastry, rich cakes, cheese. Beverages.—Fermented liquors and alcoholic beve- rages Disturbances of the stomach and intestinal canal are often reflected upon the cutaneous surface in the form of erythema, herpes, seborrhcea, eczema or urticaria. Urticaria may accompany jaundice, intermittent fever, diet and hygiene. 289' or disordered menstruation. Pruritus ani is very common in liver derangement. Lichen, anthrax and furuncle are often induced by jaundice. In diabetes* the nails sometimes loosen and fall off. Rosacea fre- quently results from gluttony and intemperance. Acne- may develop from the harmful effect of tobacco, or be. caused by faulty digestion. Patients suffering from eczema should avoid sugar and starchy foods, and take more fatty foods. The diet should be light and unstimulating, yet nutritious. A strickly milk diet or a skim-milk diet may often prove beneficial. Mothers nursing eczematous children should not resort to the use of ale, beer, or wine to in- crease the flow of breast milk, but should use milk or gruel instead. The hygiene and dietetics of skin diseases are close- ly associated. Turkish baths, not too frequently re- peated, are often serviceable in the management of eczema, psoriasis, ichthyosis and in many diseases of the skin resulting from rheumatism or gout. Warm or vapor baths are an excellent means of medication in psoriasis, eczema, lichen, ichthyosis, acne and urti- caria. Massage often proves useful in debilitated states of the system. Exercise (walking, horseback rid- ing, rowing, light gymnastics) is an excellent adjuvant in obstinate cases and should be proportioned to the general strength of the individual. METRIC TABLE. approximate aveights. I Milligram = 0.015 gr. 1 Centigram = 0.154 gr. 1 Decigram = 1.513 grs. I Gram = I 5.432 grs. 4 Grams = 1 fl. drachm. 1 Kilogram = 2£ lbs. avoir. approximate measures of length. 1 Millimeter = 0.039 in. 1 Centimeter = 0.394 in. 1 Decimeter = 3.937 inches. I Meter = 39.37 The United States "nickel" five-cent piece weighs five grams, and is two centimeters in diameter. (Haines.) A meter is about the one ten-millionth part of the earth's polar quadrant. approximate fluid measures. 1 Cubic Centimeter = 15 minims = i fl. drachm. 4 ( ubic Centimeters = 60 minims = I fl. drachm. I Liter == 15,000 minims = I Quart An ordinary back-gammon die is about the size of a cubic centimeter. (Haines.) t29Q INDEX. ACARUS, folliculorum, 73. scabiei, 195. Achorion Schonleinii, 216. Acne, acute, 46. artificial 47. cachectic. 47. chronic, 46. indurata, 48. vulgaris, 47. treatment of 49. Acne lance, 50. Addison's keloid, 166. Adipose tissue, anatomy of, 19. Age, as a predisposing cause 35. Albinism, 152. Alopecia, 56. areata,56. Anaesthesia, 59. Anatomy of the skin, 17. Anidrosis, 59. Animal parasitic affections, 37. Anthrax, 60. treatment of, 61. Anus, eczema of the, 88. Arms, eczema of the, 88. Artificial eruptions, 36. Atrophy, linear, 63. of the nail, 64. BAKER'S itch, 65. Baldness, 65. Barbadoes leg, 109. Barber's itch, 65. Beard, ringworm of the, 220. Bibliography, 289. Birth-mark, 167. Bloodvessels, anatomy of the, i'l. Body louse, 176. Boil, 123. treatment of, 124. Breasts, eczema of the, 8S. Bricklayer's itch, 65. Bromidrosis, 65. Bullse definition of, 31, flALLOSITAS, 68. \J Carbuncle, 69. treatment of, 61. Chart of characteristics, etc., 243-280. Chilblain 173. Chloasma, 69. Chromidrosis, 71. Chronic eczema, 89. Claret stain, 1G7. Classification of skin diseases, 42. Clavus, 71. Cold sores, 129. Comedo, 73. Comedo extractor, 49 Condylomata, 74. 291 S92 INDEX. Corium, anatomy of, 19 Corns, 71. Corn knife, 72. Cornu cutaneum, 76. Corpuscles, tactile, 22. Crab lice, 176. Crabs, 176. Cracks or fissures, definition of 33. Crusts, definition of, 33. Crusta lactea, 84. Cuniculi in scabies, 196. Curette, 159. Cutaneous horns. 76. Cutis, anserina. 22. variegata, 224. Cutisector, 39. Cysts, sebaceous, 200. T\ AN DRUFF, 177,200. JJ Dermatalgia, 76. Dermatitis, contusiformis, 77. exfoliativa, 79. traumatica, 144. Dermatology, definition of, 282 Dermatolysis, 80. Dietetic hints, 285. Dry tetter, 181. Dysidrosis, 80. EARS, eczema of the, 88 Ecthyma, 81. Eczema, 84-108. acute, 84. chronic, 89. definition of, 84. •diagnosis of ,92. diet in, 95. -erythematosum, 86. 'etiology of, 90. impetiginosum, 86. itching of, 85. location of, 87. papillosum, 86. rubrum, 86. squamosum, 86. stages of. 85. treatment of, 95, Elasticity of the hair, 25. Elephantiasis, 108. Ephelis, 110. Epidermis, anatomy of the, 20. Epithelioma, 111. treatment of, 113. Epilating forceps, 218. Erysipelas, 117. treatment of, 119c Erectores pili, 22. Erythema, 114. annulare, 114. iris, 114. gyratum, 114. nodosum, 77. papulatum, 114. tuberculatum, 114. treatment of. 115. Etiology of skin diseases, 35 Excessive sweating, 135. Excoriations, definition of, 33. FAVUS, 215. treatment of, 218. Febrile herpes, 129. Fever sores. 129. Fibroma, 122. Filaria, medinensis, 128. sanguinis, 109. Fish-skin disease, 122. Fissures, definition of, 33. Framboesia, 122. Freckles, 110. Furuncle, 123. treatment of, 124. GIANT urticaria, 227. Glands of the skin, 23. Grocer's itch, 128. Grubs, 73. Guinea-worm disease, 128. HAIR, anatomy of the, 25. elasticity of the, 25. excessive growth of, 132= Hairy mole, 132. INDEX. 293 Harvest mite, eruption from, 165. Head louse, 176. Kerpes; 129. treatment of, 130. Hirsuties, 132. Hive2, 227. Honey-combed ringworm, 215. Hydroa, 131. Hydro-adenitis, 134. Hygienic hints, 213. Hypersesthesia, 135. Hvperidrosis, 135. [CHTHYOSIS, 138/ .L impetigo contagiosa, 141. Infantile, syphilis, 213. Intertrigo, 144. Irido-platinum needle, 162. Itch,193 KELOID, 145. Kerion. 222. King's evil, 199. LAND scurvy, 187. Lentigo, 146. Leontiasis, 147. Lepra, 147. Leptus irritans, 165. Leprosy, 147. Leucoderma, 152. Lice disease, 176. Lichen, planus, 153. simplex, 156. Liver spots, 69. Loss of hair, 56. Lupus, 158-163. erythematosus, 158. exedens, 160. treatment of, 159,161. vulgaris, 160. Lymphatics, anatomy of, 21. MACULES, definition of, 29. Metric table, 288. Microsporon furfur, 225. Miliaria, 163. Milium, 164. Milk crust, 84. Moist tetter, 81. Mite disease, 165. Mole, hairy, 132. pigmentary, 167. Molluscum, contagiosum, 165. sebaceum, 165. Morplioea, 166. Moth patches, 69. Mother's mark, 167. Mucous patches, 74. NAEVUS, 167. Nails, diseases of the, G4, 169. Nerves, anatomy of the, 22. Nettle-rash, 169. Nits of pediculi, 176. ONYCHAUXIS, 169. Onychia, 169. Onychogryphosis, 169. Onycho-mycosis, 170. Orthoepic glossary, 281. Osmidrosis, 65» PACINIAN corpuscles. 22, Papular syphilide, 2OT. Papules, definition of, 29. Parasitic diseases, 193-214. Paronychia, 170. Pediculosis, 176. Pemphigus, 171. Pernio, 173. Phthiriasis, 176. Physiology of the skin, 17= Pityriasis, 177. rubra, 79. versicolor, 224. Porcupine men, 139. Port wine marks, 167. Prairie itch, 178. Prurigo, 179. Pruritus, 180. 294 INDEX. Psoriasis, 181. treatment of, 183. Purpura, 186. Pustules, definition of, 31. EED gum, 203. Removal of superfluous hairs, 133. Rete malpighii, anatomy of, 20. Rhinoscleroma, 189. Ring-worm, 188. Rodent ulcer, 189. Rosacea, 189. Rupia, 193. SALT rheum, 84.193, Sarcoma cutis, 193. Scabies. 193. Scales, definition of, 32. Scars, definition of, 34. Scleroderma, 197. Scleriasis, 198. Scrofuloderma, 199. Scrofulide, erythematous, 158. tubercular, 160. Sebaceous glands, au atomy of, 24. Sebaceous cyst, 200. Seborrhcea, 200. Seguin's surface thermometer, 40. Sex in skin diseases, 35. Shingles, 203. Skin, anatomy of the, 17. Skin grafting scissors. 39. Strophulus, 20;>. Superfluous hairs, 132. Sudamina, 204. Sweat glands, anatomy of the, 23. Sycosis, 204. Svphilides, 206. Syphilide, erythematous, 206. papular, 207. pigmentary, 208. pustular, 209. squamous, 210. tubercular, 210. tertiary, 211. vesicular,208. TACTILE corpuscles, jmat- 1 Dmyof the, 22. Telangiectasis, 213. Tetter, branny, 177. dry, 181. moist, 84. scaly, 181. Thermometer, Seguin's surface,, 40. Tinea, favosa, 215. tricophytina, 220. versicolor, 2'Jl. Tooth-rash, 203. Trchanxifi. 132, Trichiasis, 227. Trichoclasis,227. Tricophyton, descriptionofi the, 222. Tricophytina, 220. Tuuercles, definition of, 32. Tylosis, 68. ULCERS, definition of, 33. rodent, 111. Urticaria, 227. etiology of, 229. treatment of, 229 T7ENEREAL warts, 235, V Verruca, 235. Vesicles, definition of, 31. Vitiligoidea, 237. WASHERWOMAN'S itch- Warts, 235. * Wens, 200. Wheals, definition of, 32. XANTHOMA, 237. Xeroderma, 238.. Y AWS, 122. 70XA,238. L Zoster, £38, etiology of, 239. treatment of, 240. :••;£• ^ NATIONAL ■ 1BR4RV NLM OQ57b53i4 1 • ^ * i NLM005765341