". r ;i40 
 
 F794e 
 1876
 
 TELEPHONE. UPLAND 26 
 
 DR. C. H. WIMPRESS 
 
 OSTEOPATHIC PHYSICIAN 
 
 VCRNON DRIVE 
 r.ON OF STREET RAILWAY UPLAND, CAL.
 
 SKIN 
 
 WITH FORMULAE. 
 
 FOB STUDENTS AND PRACTITIONERS. 
 
 BY 
 
 TILBURY FOX, M.D., F.R.C.P., 
 
 PHYSICIAN TO THE DEPARTMENT FOR SKIN DISEASES IN UNIVERSITY 
 
 COLLEGE HOSPITAL, 
 AUTHOR OF VARIOUS WORKS ON SKIN DISEASES, ETC. 
 
 AND 
 
 T. C. FOX, B.A. (CANTAB.), M.R.C.S. 
 
 PHILADELPHIA: 
 
 HENRY 0. LEA. 
 
 1876.
 
 PRtLADBLPHIA: 
 r. HNS, PRIKTEK. 
 ' <ynp Sirpt
 
 PREFACE. 
 
 THIS little work epitomizes in a short compass 
 the clinical features and the essential points in the 
 treatment of diseases of the skin. 
 
 The book can be easily carried in the pocket 
 an advantage to the student ; and it is believed 
 that it will be of much service to him in the Hos- 
 pital wards and out-patient room, in his early 
 study of dermatology, no less than in his final 
 preparations for the ordinary pass examinations. 
 
 The work is also intended for ready reference 
 by the practitioner in daily practice. It is adapted 
 for this purpose on account of the particular refer- 
 ences made in the text, in the sections on treatment, 
 to particular formulae contained in the third part
 
 IV PREFACE. 
 
 of the book as suitable for use against conditions 
 of disease specialty defined in the text. 
 
 The work, however, in no way supersedes larger 
 works on the subject of skin diseases. 
 
 TILBURY FOX, 
 T. C. FOX. 
 
 14 HARI.EY STREET, CAVENDISH SQUARE, 
 Oct. 1st, 1876.
 
 CONTENTS. 
 
 PART I. 
 
 PAOE 
 
 GENERAL OBSERVATIONS ON SKIN DISEASES ... 1 
 
 SECTION I. 
 
 INDICATIONS FOR THE STUDY OP SKIN DISEASES : 
 
 1. As to the General Character of Skin Eruptions . . 1 
 
 2. As to the Mode of Examining Skin Diseases . . 2 
 
 3. As regards Complications . . . . . 5 
 
 4. As regards Modifications of Eruptions . ' .5 
 
 SECTION II. 
 
 ELEMENTARY LESIONS ......... 7 
 
 SECTION III. 
 
 CLASSIFICATION OR DIAGNOSTIC CHART OF SKIN DISEASES : 
 
 1. Eruptions occurring in Connection with the Acute 
 
 Specific or Zymotic Diseases ..... 12 
 
 2. Eruptions 12 
 
 3. Local Inflammations ....... 13 
 
 4. Hypertrophic and Atrophic Diseases . . . .13 
 
 5. New Formations ....... 14 
 
 6. Haemorrhages . . . . . . . . 14 
 
 7. Neuroses ......... 14 
 
 8. Pigmentary Alterations ...... 14 
 
 9. Parasitic Diseases ....... 14 
 
 10. Diseases of the Glands and Appendqges . . .15 
 
 SECTION IV. 
 
 THE CAUSES OF SKIN DISEASES . 16
 
 VI CONTENTS. 
 
 SECTION V. 
 
 PAUR 
 
 DIAGNOSIS 23 
 
 SECTION VI. 
 TREATMENT (GENERAL PRINCIPLES) 25 
 
 PART II. 
 
 THE DESCRIPTION A.\I> TREATMENT OF SKIN DISKASI- 
 
 Acne .......... 31 
 
 Alopecia or Baldness 33 
 
 Anthrax or Carbuncle 34 
 
 Area, tee Alopecia. 
 
 Atrophia Cutis ........ 35 
 
 Bakers' Itch 36 
 
 Baldness, gee Alopecia. 
 Barbadoes Leg, see Bucnemia. 
 Boils, see Furunculi. 
 
 Bricklayers' Itch 36 
 
 Bucnemia Tropica ........ 36 
 
 Bag-eruption 37 
 
 Cancer, see Epithelioma and Rodent Ulcer. 
 Carbuncle, see Anthrax. 
 Chlonsma, tee Tinea versicolor. 
 
 Comedones 38 
 
 Condylomata . . . 38 
 
 Contagious Impetigo 38 
 
 Dysidrosis 40 
 
 Ecthynitt 41 
 
 Eczema .......... 42 
 
 Elephantiasis ......... 46 
 
 Epithelioma, or Epithelial Cancer 47 
 
 Erythema, or simple redness (hyperaemia) . . .47 
 
 Favus, see Tinea favosa. 
 
 Fibroma .......... 49 
 
 Fish Skin Disease, see Ichthyosis. 
 
 Follicular Hypersemia ....... 50 
 
 Fungi, see Tinea. 
 
 Furunculus 50 
 
 Grocers' Itch 51 
 
 Gutta rosacea, see Acne rosaoea. 
 
 Herpes *..... 52 
 
 Hydroa 53 
 
 Hydroadenitifl ........ 54
 
 CONTENTS. Vll 
 
 
 PAOF. 
 
 Hyperidrosis . 
 Ichthyosis ....... 
 Impetigo ....... 
 Intertrigo, see Erythema. 
 Itch, see Scabies. 
 
 . 54 
 . 55 
 . 56 
 
 Keloid 
 
 . 56 
 
 Kerion, see Tinea kerion. 
 
 
 Lepra ........ 
 Leucoderma ....... 
 
 . 57 
 . 57 
 
 Lichen ..... ... 
 
 . 57 
 
 Lichen urticatus, see Urticaria. 
 
 
 Lupus ...... . . 
 Maculae ....... 
 
 . 60 
 . 61 
 
 Medicinal rashes ...... 
 
 . 62 
 
 Miliaria ........ 
 
 . 62 
 
 Molluscum contagiosuin . 
 Morphcea ....... 
 Nails ........ 
 
 . 63 
 . 63 
 . 64 
 
 Pediculi, see Phthiriasis. 
 
 
 Pemphigus ....... 
 Phthiriasis ....... 
 
 . 66 
 . 67 
 
 Pityriasis ....... 
 Porrigo . . . 
 Prickly Heat, or Lichen Tropicus . 
 Prurigo ....... 
 Pruritus, or Itching .... 
 Psoriasis ..... 
 
 . 68 
 . 69 
 . 69 
 . 69 
 . 70 
 . 73 
 
 Purpura ........ 
 Ringworm, see Tinea. 
 Rodent ulcer ....... 
 
 . 74 
 . 75 
 
 Roseola . . . 
 
 . 75 
 76 
 
 Scabies or Itch ...... 
 
 . 77 
 
 Scabies in Private Practice .... 
 
 . 78 
 
 Scleroderma ....... 
 
 . 81 
 
 Scrof'uloderma ...... 
 
 . 81 
 
 Seborrhoea ....... 
 
 . 82 
 
 Strophulus or Red Gum .... 
 Sudamina ....... 
 
 . 83 
 . 83 
 
 Sycosis ........ 
 Syphilis of the Skin 
 Tinea 
 
 . 84 
 .85 
 . 91 
 
 Urticaria, or Nettlerash .... 
 Vitiligoidea ....... 
 Xanthelnsma . ...... 
 
 . 96 
 . 98 
 . 98 
 
 Xanthelasmoidea ...... 
 
 . 99 
 
 Xerodertna, see Ichthyosis. 
 Zoster, see Herpes. 

 
 viii CONTENTS. 
 
 PART III. 
 
 PAOF. 
 
 CUTANEOUS PHARMACOPEIA 100 
 
 Baths 100 
 
 Fumigation 101 
 
 Caustics 101 
 
 Astringents . . . . '. . . . .102 
 
 Sedatives 103 
 
 Absorbent Powders ....... 107 
 
 Stimulants and Absorbents ...... 107 
 
 Posters Ill 
 
 Mixtures Ill 
 
 Pills 114 
 
 Remedies for Scabies and Phthiriasis . . . .115 
 
 Remedies for Vegetable Parasitic Diseases . . . 116 
 
 Diet in Skin Diseases . ... 118
 
 EPITOME OF SKIN DISEASES. 
 
 PART I. 
 
 GENERAL OBSERVATIONS ON 
 SKIN DISEASES. 
 
 SECTION I. 
 
 INDICATIONS FOR THE STUDY OP SKIN DISEASES. 
 
 IN the successful clinical study and management 
 of skin diseases, there are one or two important con- 
 siderations which should never be lost sight of by 
 the practitioner or the student. 
 
 Firstly, as to the general character of skin erup- 
 tions. There is nothing really special in their 
 pathology. It has been a common remark that the 
 study of skin diseases is bewildering on account, 
 amongst other reasons, of the infinite variety of 
 forms and aspects assumed by eruptions, and the 
 multitudinous names given in consequence. Until 
 lately there certainly was much truth in such a 
 statement, but now researches in cutaneous patho- 
 logy are fast clearing the path to a more correct 
 knowledge of skin affections, whilst difficulties are 
 rapidly vanishing, especial \y by the breaking down 
 of those artificial distinctions which have so multi- 
 1
 
 2 INDICATIONS FOR THE 
 
 plied varieties and terms. It is now manifest that 
 similar morbid processes go on in- the skin and 
 in other parts of the bod 3% Indeed, da\- by day it 
 is becoming more possible to group skin diseases 
 according to their pathological affinities exactly on 
 the same plan as other diseases. This fact in itself 
 testifies abundantly to the clear insight already 
 gained into the subject, and it also explains tin- 
 circumstance that the student of to-day, who is 
 compelled to acquire pathological knowledge in 
 general, discovers that the stucty of skin diseases is 
 rendered comparatively cas3' because of the analogy 
 existing between the facts of general and skin 
 patholog3 r . He does not find himself dealing with 
 strange topics or data, but recognizes familial- 
 appearances, changes, and causes, in morbid action. 
 It is most important then to understand that there 
 is nothing essentially special in cutaneous patho- 
 logical changes as compared with those which occur 
 in other parts. 
 
 Secondly^ as to the mode of examining skin <li.<- 
 eases. In diagnosing a great error is commonly 
 committed by attempting to recognize them from a 
 too partial examination of the phenomena they pre- 
 sent either to the senses of the practitioner or in 
 their histories. Practitioners and students, as the 
 rule, content themselves with diagnosing from sight 
 alone; they make a venture at the diagnosis from the 
 aspect alone, but only to be often signally wrong. 
 Without a correct diagnosis successful treatment
 
 STUDY OP SKIN DISEASES. 3 
 
 cannot be confidently expected, but must be more 
 or less chance work. In some, and indeed many 
 cases, no doubt the nature of the disease can be made 
 out correctly at once from inspection, and that even 
 of a partial kind, inasmuch as the eruption assumes 
 from the outset and preserves throughout its course 
 its typical characters. In other instances, on the 
 contrary, this is difficult or impossible without 
 careful inspection of many parts of the disease in 
 several localities in a given patient, or an inquiry 
 into the previous history of its course ; for many 
 skin diseases are made up of stages, and, at the time 
 of observation, these may vary greatly in different 
 parts, and the tj'pical characters may not be dis- 
 tinctly recognizable or may be masked by accidental 
 concomitants. And further, parts only or stages of 
 different diseases often present a likeness to one 
 another and may convey a very imperfect picture of 
 the disease. To avoid error, then, the diagnosis 
 should be based upon the phenomena or features 
 presented by any given disease as a whole, and not 
 upon any particular portion of that disease. 
 
 It follows, therefore, from what has just been 
 said, that there are two useful rules to be observed 
 in making a diagnosis. The first is this : 
 
 Ail diseased places, or as many as possible, in a 
 patient should be carefully examined, and not one 
 only or one here and there, for the simple reason that 
 the eruption may be at very different stages of devel- 
 opment, and therefore present very diverse aspects 
 in different localities in the same patient.
 
 4 INDICATIONS FOR THE 
 
 The object of this examination is to trace out the 
 origin and course of the disease, ami to link together 
 the various stages into a complete history which 
 will answer in its clinical features to an authorita- 
 tive standard description of the disease whatever it 
 may be. During this examination special attention 
 should be directed to the character of the ne \\e-t 
 developments, and, if there lc none of the kind, 
 to the extending edge of patches which always 
 constitutes the most recently developed parts of the 
 disease, and therefore best portrays the primary 
 lesion. Complications are more likely to be un- 
 ravelled by attention to this point. 
 
 The second rule is this : 
 
 Where the earlier stages in any given case are not 
 recognizable, careful inquiry should be made into 
 the history by interrogation of the patient as to the 
 changes that have occurred before the disease came 
 under observation, with a view to discover its nature. 
 
 Very frequently no fresh developments of the 
 eruption are taking place and no extension of a 
 patch has occurred for some time, the malady 
 having become chronic and indolent and having lost 
 its typical features ; then the only way of making a 
 diagnosis is by observing this second rule. For 
 example, an eczema is characterized mainly by a 
 peculiar discharge, but the discharging stage is 
 frequently over before the case comes under the 
 care of the medical man, and the disease may 
 present a dry and seal}* appearance, and so be
 
 STUDY OP SKIN DISEASES. 5 
 
 mistaken for psoriasis, a fact of not unfrequent 
 occurrence. And again a disease esentially papular 
 may have become inflamed and encrusted, and its 
 true nature may be overlooked, unless the history 
 be carefully inquired into, 
 
 By the observance of these two rules, the elemen- 
 tary lesion and the characters of the different stages 
 of any given disease, are ascertained, and with these 
 the observer should form a picture of the malady, 
 and so make an accurate diagnosis, just as the child 
 with his dissected puzzle puts together the animal 
 or landscape bit by bit, to form the desired whole. 
 
 Thirdly, as regards complications. It should 
 never be forgotten that two or more eruptions may 
 occur together, and their characters be mingled in 
 varying proportions. Examples of this are found 
 in the concurrence of urticaria and eczema, of syphi- 
 litic rash and chloasma, of lichen and urticaria, of 
 ecth}-ma and scabies, of purpura and urticaria, of 
 eczema and scabies or furunculus, and so on. The 
 fact here indicated should never be lost sight of, 
 though, on the other hand, multiformity of eruption 
 is by no means sufficient evidence, yet it is sug- 
 gestive of the coexistence of two or more distinct 
 diseases ; especially if scabies and sj'philis be left 
 out of the question. 
 
 Fourthly, as regards modifications of eruptions. 
 
 There are many influences modifying the aspect and 
 
 general character and behavior of skin diseases, 
 
 that have to be taken into account in dealing with 
 
 1*
 
 6 STUDY OP SKIN DISEASES. 
 
 the treatment. It is necessary for the pli\-i<-i:m 
 not only to recognize any particular kind an<l form 
 of skin eruption, but to appreciate the part played 
 by various concomitant conditions in the individual, 
 such as diathesis, blood state, special causes induc- 
 ing an inflammatory character or leading to unu>u:d 
 pus formation or undue chronicity, and the like. 
 The evil influences of such conditions must be 
 thwarted, so as to pave the way for the proper ac- 
 tion of curative measures directed against the dis- 
 ease as a disease in the abstract. 
 
 A few useful particulars or hints may be intro- 
 duced here. Diseases of the skin are spread or take 
 on an inflammatory character, or the changes in the 
 skin are exaggerated, by exposure to all irritating 
 agencies, heat, cold, scratching, the contact of acrid 
 substances of all kinds, as by the handling of lime, 
 sugar, soda, respectively by bricklayers, grocers, 
 and washerwomen. So, too, an inflammatory aspect 
 is given to eruptions by acridities in the blood, as 
 in gouty or rheumatic subjects, in dyspeptics, and 
 in those in whom the bile acids or retained ellV-to 
 matters are present in undue amount in the blood. 
 Eruptions in strumous subjects are attended In- 
 more or less pus formation unusual to them under 
 other conditions. Undue chronicity is occasioned 
 oftentimes by the existence of nervous or general 
 debility; for nature then lacks the natural recupr- 
 rative power, and cannot exert it in aid of the cure. 
 
 The questions of age, sex, occupation, mode of
 
 ELEMENTARY LESIONS. 7 
 
 life, and the general medical history of the patient, 
 have to be considered, and will be incidentally re- 
 ferred to in other places. Attention to the four 
 indications already discussed will, however, be found 
 of essential importance in the successful study or 
 treatment of a skin disease. It may be observed, 
 however, as regards age, that one essential difference 
 between the cutaneous diseases of young life as 
 compared with those occurring in the middle-aged 
 and old, consists in the fact that the former are 
 often the result of imperfect digestion and assimila- 
 tion, whereas the latter are induced by mal-influences 
 connected with the habits and occupations and wear 
 and tear of adult life, and degeneration of structure 
 in the old, and are modified by a number of func- 
 tional and organic diseases of internal organs, which 
 have not had time nor opportunity to develop in 
 the vounsr. 
 
 SECTION II. 
 
 ELEMENTARY LESIONS. 
 
 The elementary lesions are the types of form and 
 aspect presented by skin eruptions. The student 
 is required to know these at examinations, and a 
 description of them will constitute a general outline 
 of the pathology of the skin. They are nine in 
 number, viz. : Maculae or stains ; redness or hyper- 
 ffiinia ; w heals; papules; vesicles; bullre or blebs ;
 
 8 ELEMENTARY LESIONS. 
 
 pustules; squama; or scales ; and tubercles or large 
 papules. 
 
 Maculae, or Stains may be 
 
 a. Pigmentary in nature when they are due to 
 the presence of altered coloring matter of 
 the blood. The stains may be secondary to 
 other diseases e.g., syphilis ; or physiologi- 
 cal e.g., pregnancy, or associated with 
 certain cachexia; e.g., Addison's disease 
 and leprosj*. The}' may be primary or 
 idiopathic, and are generally left after hy- 
 prrrcmia caused by irritants. 
 
 b. Chemical, as in the case of stains from iodine, 
 silver, bile acids, etc. 
 
 c. Parasitic, due to the presence of fungus ele- 
 ments e. g., tinea versicolor. 
 
 d. Hffitnorrhagic e.g., purpura due to extra- 
 vasated blood. 
 
 Bedness or Hyper semia may be active (arterial) 
 or passive (venous). Active hypera?mia consists 
 of redness removable by pressure. It may be punc- 
 tiform e.g., strophulus; or patchy e.g., roseola; 
 it is often accompanied by swelling from effusion 
 e. g., erythema papulatum; by disordered sensation 
 (pruritis); by slight rise in temperature; it is 
 often followed by desquamation, and occasionally 
 exudation. It is caused by local irritants, by 
 changes in the blood, and by excitation of the 
 nerves. 
 
 Wlieals are raised hyperannic swellings, that
 
 ELEMENTARY LESIONS. 9 
 
 have a palish centre, and rapidly form to as rapidly 
 disappear. They are typically portrayed in the 
 sting of the nettle. It is supposed that they are 
 caused by sudden dilatation of a bunch of capillary 
 vessels and escape of serosity. They are accom- 
 panied by heat and great tingling. Some suppose 
 the vessels beyond the point of dilatation are in a 
 state of spasm. "Wheals are characteristic of urti- 
 caria. 
 
 Papules, or pimples, are little solid raised forma- 
 tions in the skin. They maj" be due to hyperaemia 
 of the papillae forming bright red points e. g., in 
 strophulus ; or may consist of hypenemic, turges- 
 ccut, and erected follicles e. g., lichen tropicus or 
 prickly heat ; or due to deposit of lymph or the 
 like about the walls of the follicles e. g., lichen 
 planus; or are solid lymph formations or cell 
 growths in the derma proper e.g., lichen, prurigo, 
 syphilis ; or may be due to an epithelial collection 
 in the follicles e.g., pityriasis pilaris ; or may be 
 formed by hypertrophy of normal structure e. g., 
 papillary warts. 
 
 Vesicles are upliftings of the cuticle into minute 
 bladders by fluid sweat or serosity; they are 
 solitary or compound. Solitary vesicles may be 
 due to sweat between the strata of the horny 
 layer of the cuticle e. g., sudamina ; if larger 
 (bnllse) by serosity between the horny and mucous 
 layers of the cuticle e.g., pemphigus. All others 
 are compound, and the fluid is collected in loculi
 
 10 ELEMENTARY LESIONS. 
 
 formed by the stretchecl-out cells of the ivle 
 e. g., variola, herpes, erysipelas, blister, eczema. 
 Further, in sudamina, blister, and pemphigus the 
 fluid is sweat or serous; in variola, eczema, and 
 herpes, exudation and pus cells in addition arc 
 present in the rete, in the papillae, and the corium, 
 which also gets thickened if the Inflammation 
 becomes chronic. 
 
 Bullae are simply large vesicles, and their struc- 
 ture the same. In syphilis bulhe may occur, and 
 then the contents become sanious, whilst ulceration 
 is superadded. But usually the bullrc become 
 tense with clear contents, then their contents get 
 opalescent, the bullaj become flaccid and shrivel 
 away, leaving only a red mark, without change in 
 the cutis. 
 
 Pnxtules are elevations of the surface by pus 
 rapidly formed. They are accompanied by more 
 inflammation than vesicles, and by a deeper a flec- 
 tion of the tissues, but the loculi containing pus 
 are similar in structure to those of vesicles. The 
 pustules of ectlryma are large and deep seated, and 
 possess painful indurated bases. 
 
 Squamae or Scales are formed of detached epi- 
 dermic scales. They differ from crusts, which are 
 formed by dried discharge. Scaliness occurs as a 
 secondary consequence in all inflammatory skin 
 diseases ; squama?, particularly as an essential part 
 of squamous inflammation e.y., psoriasis, pityri- 
 asis rubra ; and in hypertrophic conditions.
 
 ELEMENTARY LESIONS. 11 
 
 Tuberculum is a solid fleshy lump in the skin, 
 formed by the growth of new tissue. It is HOMOLO- 
 GOUS e. g , fibroma, keloid, in which the connective 
 tissue is involved; or HETEROLOGOUS e.g., cancer, 
 lupus. 
 
 There are certain " Secondary Changes" deserv- 
 ing of notice. They are 
 
 Crusting, in which crusts form by the drying up 
 of discharge either poured free upon the surface 
 through the inflamed derma e.g., eczema; or 
 from ruptured bullae e.g., rupia; or discharged 
 by an ulcerating surface. They may be due to 
 sebum collected in masses, or to fungus elements 
 e.g., favus. Crusts formed from the escape of 
 serum are thin and bright coloured ; from dried 
 pus, thick and }'ellow ; from dicing of bullfE, as a 
 rule, thin and slightly dark ; from drying of sanious 
 pus from ulcers, thick, dark coloured, and" heaped 
 up ; from collected dried sebum, flat, easily de- 
 tached, and greasy; in favus, pulverulent, honey- 
 combed, and sulphur-yellow. 
 
 Ulcer ation is usually the result of cachectic 
 inflammation, such as the strumous or syphilitic ; 
 or of new growths replacing the normal textures, 
 and themselves softening and decaying, as in lupus 
 and cancer; or it follows the softening of actual 
 outgrowths from the skin, as in fibroma and j^aws. 
 
 Excoriation is the exposure of the true skin 
 without its removal, and is due to scratching or 
 rubbing. Its seat is suggestive on the front of
 
 12 CLASSIFICATION, OR DIAGNOSTIC 
 
 the forearms and the thighs of scabies, and about. 
 the clavicles and shoulders of phthiriasis. 
 
 Scars are left I)}- traumatic injuries; caustics; 
 and by certain diseases which ulcerate, such as 
 variola, furunculus and anthrax, pustula maligna, 
 strumous and s3-philitic disease. They signify 
 that the true skin has been removed, and replaced 
 by " cicatricial tissue." 
 
 SECTIOX III. 
 
 CLASSIFICATION, OR DIAGNOSTIC CHART OF 
 SKIN DISEASES. 
 
 The following list, or semi-chart, conveys a good 
 general idea of the various eruptions met with in 
 the skin, and regarded from a clinical point of view. 
 The list comprises: 
 
 1. Eruptions occurring in connection 
 with the acute specific or zymotic dis- 
 eases, including the variolous rash, roseola vario- 
 losa, vaccinia and roseola vaccinia, the rashes of 
 typhus, typhoid, rubeola, rubeola nolha, scarlatina, 
 glanders, and farcy, and dengue. These are impor- 
 tant in reference to the differential diagnosis of 
 skin diseases. 
 
 2. Eruptions, the local vumife&atiaM OF T>IA- 
 TIIETIC STATES, comprising scrofulodermn, or scro- 
 fulous inflammation; xyphilodermata, or syphilitic 
 eruptions ; leproux eruptions ; framboesia or yaws ;
 
 CHART OF SKIN DISEASES. 13 
 
 eruptions occurring in connection with endemic 
 cachexise, such as the Paranghi disease of Ceylon, 
 etc. 
 
 3. Local inflammations, comprising : 
 Erythemalous inflammation ; chief feature hyper- 
 
 ffimia, with or without some slight consequent effu- 
 sion of serosity. 
 
 Erythema, intertrigo, roseola, urticaria. 
 Catarrh a/, characterized by serous effusion into 
 papillary layer, running on to sero-purulent dis- 
 charge and crusting. 
 
 Eczema, impetigo. 
 
 Plastic, essentially papular, due to effusion of 
 plastic lymph into the papillary layer, and sometimes 
 the deeper dermic layer. 
 
 Lichen, prurigo. 
 Bullous, chief feature the development of bullae. 
 
 Herpes, pemphigus, hydroa. 
 Suppuratwe, essential lesion pustules, superficial 
 and painless, or deeply seated and painful. 
 
 Impetigo contagiosa, ecthyma, furunculus. 
 Squamous, characterized by hyperaemia of the 
 derma, and hyperplastic growth of cuticle. 
 Pityriasis rubra, psoriasis. 
 
 4. Hypertrophic and atrophic diseases : 
 A. Hypertrophic. 
 
 Epithelial layers mainly affected. 
 
 Pityriasis, warts, corns, xeroderma, and ich- 
 thyosis. 
 2
 
 14 CLASSIFICATION, OR DIAGNOSTIC 
 
 Connective tissues of the skin specially involved. 
 Keloid, fibroma, morphoea, sclerodermu. 
 
 B. A trophic. 
 
 Senile atrophy, linear atrophy, general mar.-i 
 mus. 
 
 5. New formations, the characteristic being 
 the growth of new tissue made up of granulation 
 cells, or altered and proliferating connective tissue 
 cells. 
 
 Lupus, cancer, rodent ulcer. 
 
 6. Hsemorrhagic (cutaneous), effusion of blood, 
 uninfluenced l>y pressure in points or patches. 
 
 Purpura. 
 
 7. Neuroses, in which the nerves are primarily 
 disordered, and there are no organic changes at the 
 outset. 
 
 Hyperresthesia, anaesthesia, pruritus. 
 
 8. Pigmentary alterations, consisting pri- 
 marily of deposits or alteration of pigment. Pig- 
 mentation, secondary to other diseases, is not in- 
 cluded here. 
 
 Melasma, leucopathia, xanthoderma, etc. 
 
 9. Parasitic diseases, comprising: 
 
 A. Animal. 
 
 Scabies, phthiriasis, eruptions due to gnat 
 bites, fleas, etc. 
 
 B. Vegetable. 
 
 Tinea favosa, tinea tonsurans, tinea circinatn, 
 tinea kerion, tinea versicolor, tinea sycosis, 
 tinea decalvans, onychomycosis.
 
 CHART OF SKIN DISEASES. 15 
 
 10. Diseases of the glands and appendages, 
 
 divisible into : 
 
 A. Diseases of the sweat glands and follicles* as 
 excessive secretion (hyperidrosis) ; dimin- 
 ished secretion (anidrosis) ; altered secretion 
 (chromidrosis, osmidrosis) ; congestive and 
 inflammatory (miliaria, sudamina, lichen tro- 
 picus, strophulus, dysidrosis, hydroadenitis) ; 
 and sweat cysts. 
 
 B. Diseases of the sebaceous glands, as excessive 
 secretion (seborrhoea) ; diminished secretion 
 (asteatodes) ; altered secretion, with or with- 
 out retention (allosteatodes, xanthelasma) ; 
 retention of secretion without inflammation 
 (molluscum, horns) ; slight retention with in- 
 flammation (acne). 
 
 C. Diseases of the hair and hair follicles, as ex- 
 cessive growth (hairy naevi, moles, hirsuties) ; 
 diminished growth, constituting partial or 
 absolute baldness (alopecia) ; textural altera- 
 tion (fragilitas) ; inflammation of the follicles 
 (sycosis). 
 
 D. Diseases of the nails, including: changes 
 occurring in syphilis, lichen ruber, general 
 eczema, psoriasis, pityriasis rubra, and 
 struma ; inflammation of the matrix, as in 
 onyclua; parasitic disease termed onycho- 
 mycosis, caused by the favus parasite or the 
 trichophyton ; hypertrophy, atroph} 7 , and 
 corn of the nail.
 
 16 THE CAUSES OP SKIN DISEASES. 
 
 There are then ten groups of skin diseases viz. : 
 the eruptions of the Acute Specific Diseases ; Local 
 Inflammations; Diathetic Diseases; Hyper- and A- 
 trophic Disease ; New Formations ; Haemorrhagic, 
 Neurotic, and Pigmentary Diseases ; Disorders of 
 the Hair and Glands and their Appendages. Such 
 is the clinical classification that may be given at an 
 examination. Every skin disease must fall into one 
 of these groups, and it soon becomes an easy matter 
 to refer any disease before the observer to its pro- 
 per class 
 
 SECTION IV. 
 
 THE CAUSES OF SKIN DISEASES. 
 
 In the previous section a general summary has 
 been given of the different varieties of skin diseases 
 in the form of a tabular classification. In this 
 section a sketch is furnished of the causes of those 
 diseases, and they may be convenientl}' ranged 
 under two heads : 
 
 1. Those which act from within the system upon 
 the skin, or internal causes. 
 
 2. Those which act from without, or external 
 causes. 
 
 There are some who think that the latter are 
 much more frequently in operation and much more 
 potent than the former, but it is very doubtful it 
 such is reallv the case.
 
 THE CAUSES OP SKIN DISEASES. 17 
 
 A. Internal Causes. Amongst these the most im- 
 portant are: a. Hereditary tendency to a given 
 disease, such as in the case of ichthyosis or psoriasis. 
 It may give rise to a purely local affection, or to a 
 more or less general disease i. e., one involving the 
 skin locally and the general health as well. b. Blood 
 poisoning, or impurification, by special animal 
 or vegetable poisons, inducing specific eruptions, 
 as in the acute specific diseases, sj'philis, or that 
 derived from eating shellfish, etc.; by deficient 
 excretion or the retention of excreta in undue pro- 
 portion, biliary, renal, or intestinal in nature, giving 
 to the blood an acrid character ; by long-continued 
 dyspepsia, either from dietetic errors or otherwise ; 
 by the presence of medicinal substances e. gr., potas- 
 sium bromide, belladonna, or copaiba; by the accu- 
 mulation of lactic or uric acids, as in rheumatism 
 and gout, inducing eruptions and imparting an in- 
 flammatory character to them ; by poverty which 
 depraves the blood and leads to cachexia ; by the 
 imperfect fulfilment by organs of their natural 
 functions, as menstruation, perspiration, and hepatic 
 and renal disturbance, c. Nerve disturbance, which 
 acts in one of four ways. Firstly, by inducing 
 changes in the calibre of the vessels by which the 
 blood supply and fluid transudation is altered, as in 
 the Erythemata. Secondly, lry directly encouraging 
 tissue change, as in herpes and prurigo. Thirdly, 
 by the loss of control over the skin nutrition, which 
 follows from nervous debilit}', allowing morbid 
 2*
 
 18 THE CAUSES OF SKIN DISEASES. 
 
 action of all kinds in the skin to take place more 
 readily. Fourthly, by the transmission of irritation 
 through the reflex function by which eruptions may 
 be excited or aggravated, d. An innate disposition 
 in the skin tissues themselves to take on a diseased 
 condition. This is a point on which special stress is 
 laid. It is pretty certain that many diseases of the 
 skin must originate in a disordered behavior of the 
 very tissues themselves, and do not necessarily de- 
 pend for their cause upon any general mal-nutrition. 
 For instance, cancer is a case in point ; and so also 
 warty growths of all kinds, fibroma, keloid, and even 
 lupus, are other illustrations of the same thing. In 
 some cases there is just an excess of growth, a plus 
 state of the nutrition of the tissue and nothing more; 
 or it may be a minus condition. In other instances it 
 is a perverted nutrition, a deviation in the type of the 
 tissue, as in cutaneous cancer. In fact, Group I V.. 
 and many of the diseases in Group 10 of the clas- 
 sification illustrate this point. It is asserted by 
 most writers that such changes hypertrophy and 
 atrophy are, in reality, merely the consequence of 
 the presence in the blood of a greater or less amount 
 of the pabula of the particular tissues affected. But 
 if these pabula be in excess, which is unproved, the 
 hypertrophy would not occur unless the tissues were 
 disposed to make use of them fully, and, if such a 
 disposition existed in a degree less than that of 
 healthy nutrition, atrophy would result. So that, 
 after all, the " formative capacity" of the tissues
 
 THE CAUSES OP SKIN DISEASES. 19 
 
 themselves is an important element in these plus 
 and minus states of growth, and the explanation 
 given above may be true, for if the tissues them- 
 selves exhibit a tendency to hyperplasia, nature will 
 answer the demand for an increased supply of 
 pabulum. In the case of perverted nutrition (hcte- 
 rologous formation) the changes are explained more 
 readily by a perversion of the "formative capacity" 
 than by altered character of growth, the conse- 
 quence of a supply of a modified kind of pabulum. 
 e. Climacteric or endemic influences induce skin 
 disorder by depraving the nutrition of the body 
 as a whole, as in Elephantiasis Arabum, Framboesia, 
 etc. 
 
 B. External Causes. Some of these influence the 
 general health for evil, and so disorder the skin in- 
 directly; others act directly upon the skin. 
 
 1. Amongst the external causes acting directly 
 upon the skin, the most important are: Scratching, 
 which may excite and always aggravates disease, 
 and may, in contagious cases, spread it from place 
 to place, as in scabies and contagious impetigo. 
 Local irritants of all kinds ex., cold, heat, friction, 
 flannel worn next to the skin, irritants, plasters, 
 fluids, and applications of all kinds; irritating sub- 
 stances, such as lime, sugar, flour, washing soda: pro- 
 ducing bricklayers', bakers', grocers', and washer- 
 women's itch ; unwholesome handicrafts ; dyes, con- 
 tusions, animal and vegetable parasites of all kinds; 
 medicinal applications, and want of care of the skin 
 in the dirty and ill-fed.
 
 20 THE CAUSES OP SKIN DISEASES. 
 
 2. Amongst the external causes that act indi- 
 rectly upon the skin, through their influence upon 
 the general health, ma}' be mentioned: Want of 
 cleanliness, climatic influences, defective clothing, 
 neglect, and the like ; animal poisons inoculated 
 into the skin, etc. 
 
 Clinically, it is of the highest moment to be ac- 
 quainted with the fact that, as a rule, these scvrrid 
 causes not only vary in character, but do not ope- 
 rate in a solitary or individual way. To put it in 
 another way : (1) these influences or agencies are, 
 in reality, divisible into predisposing, exciting, pro- 
 ducing, and intensifying causes ; and further (2) 
 the true cause of the state of any given disease is 
 made up of a number of phenomena or agencies iu 
 combined operation. These are points of great 
 practical importance in reference to the treatment 
 of skin diseases. 
 
 In reference to the first point, it ma} 7 be said 
 that many so-called local causes only predispose, 
 though the}- usually excite, to eruption. For in- 
 stance, take the case of debilitating occupations, 
 which render a man much more liable to be affected 
 by the handling of irritants, or the influence of 
 climate, by which the system generally is dis- 
 ordered with the skin, and the latter so rendered 
 liable to disease. Other causes act as pure \< i- 
 tants, as when there is a predisposition to a disease 
 e.g., eczema, and the local irritant excites it, but 
 probably would not if acting without the existing
 
 THE CAUSES OP SKIN DISEASES. 21 
 
 predisposition. Some, however, are really pro- 
 ducers of disease, as in the case of medical irritants 
 or circulated poisons e. g., malignant pustule or 
 parasites. Others again only aggravate existing 
 disease, as in the case of the wearing of flannel, or 
 exposure, or scratching. 
 
 In reference to the second point, it is indisputable 
 that, in most cases, several agencies or influences 
 external or internal in origin or operation, combine 
 to make up the true cause of a disease, and it is the 
 duty of the physician to recognize the fact and 
 analyze the cause correctly. In fact, in such 
 correct analysis lies the source of all successful 
 dennatological treatment. Diseases of the skin are 
 very different things as portrayed on paper and in 
 the consulting-room from a therapeutical point of 
 view. A disease may answer most perfectly to the 
 t} r pical description, but the remedies ordered for its 
 cure may signally fail, because the analysis of cau- 
 sation is incorrect or incomplete. For diseases are 
 greatly modified as they occur in different subjects, 
 and it is not the uncomplicated type that is to be 
 dealt with in practice, but the disease modified and 
 influenced by the many concomitant conditions of 
 age, constitution, occupation, etc. 
 
 It may be useful to mention a few common com- 
 binations met with clinically, which illustrate the 
 multiform character of the causation of skin 
 diseases, as seen in the consulting-room. In the 
 case of eruptions provoked by local irritants, re-
 
 22 THE CAUSES OP SKIN DISEASES. 
 
 ferred to above, there is very frequently debility 
 present which favors the development of the disease. 
 and which must be got rid of if the eruption is to 
 get well, and if it is to be cured, in the best way. 
 lu fact, the skin of a healthy person will mostly 
 resist the action of many of the local irritants 
 specified, but cannot do so if the subject be weak 
 and debilitated ; so that it is an important point to 
 give tonics, as the rule, in cases of eruptions excited 
 by local irritants. Here there is one simple com- 
 bination of causes, debility and local irritants, in- 
 ducing erythema, eczema, lichen, etc. Other ex- 
 amples readily occur, such as eczema in a gouty 
 subject, modified by neglect and scratching; pso- 
 riasis in a strumous subject in whom the tendency 
 to the disease is hereditary ; erythema in a rheuma- 
 tic subject, in connection with dyspepsia ; eczema 
 occurring in cooks exposed to the irritating in- 
 fluence of the fire, whilst the patient also has a 
 blood current charged with retained excreta, in 
 consequence of inefficient bowel and kidney action ; 
 lupus in a scrofulous subject ; tinea tonsurans in a 
 boy with persistent anaemia and a phthisical ten- 
 dency; pruritus in connection with senile atrophy 
 of the skin, liver derangement, and gout. Other 
 examples might be multiplied almost indefinitely. 
 
 In estimating, therefore, the cause of an}- given 
 cutaneous disease, attention must be paid not only 
 to predisposing and exciting causes, but to coin- 
 cident occurrences and accidental concomitants
 
 DIAGNOSIS. 23 
 
 modifying such disorder ; for it is not in the ab- 
 stract that the disease is to be regarded, but in its 
 entirety, and in all its clinical features and be- 
 haviors. The correct estimation of a disease after 
 this fashion comprises the diagnosis, upon which 
 a few remarks will be made in the next section. 
 
 SECTION V. 
 
 DIAGNOSIS. 
 
 Firstly. In making a diagnosis the observer 
 should apply the rule laid down (Section I.) for 
 examining skin diseases viz., to scrutinize the 
 whole of the eruption, not a part only, and trace 
 carefully its history to discover the nature of its 
 beginning, the character of its stages, if any, and 
 their transitional relationship, and the general 
 course of the eruption up to the time of observa- 
 tion. Secondly. The observer must proceed to 
 determine to which class the disease belongs, 
 according to the principles laid down in the chart 
 in Section III. Is it an eruption of the Acute 
 Specific Diseases? Then the constitutional con- 
 dition will be by far the most pronounced, the 
 patient more or less prostrated, the temperature 
 unusually high, whilst the other pyrexial symptoms 
 will be marked and out of proportion to the mere 
 rash; the access of the malady will have been 
 comparatively sudden, and so on. Is the eruption
 
 24 DIAGNOSIS. 
 
 essentiall}' ery thematous ? It must be one of four 
 conditions viz., erythema, intertrigo, roseola, urti- 
 caria ; and the reader is referred for the features of 
 these to the special description in Part II. Is the 
 disorder accompanied by sero-purulent discharge, 
 by the development of bullae, by pustules, or by 
 squamae alone ? Then the disease is one of those 
 comprised under local inflammations. Is the erup- 
 tion part of a cachexia, or some special diathetic 
 condition present? Then it belongs to Group II. 
 And in a similar way may Hypertrophies or Out- 
 growths of Tissue, Atrophies, New Formations, 
 Hemorrhagic Spots, Neurotic conditions without 
 organic changes, Pigmentai^y alterations, Parasitic 
 diseases, and affections of the Glands, Hair, and 
 Nails, be put under their respective headings. In 
 the case of New Formations, the diagnosis is singu- 
 larly easy. The j-oungest student can readily 
 distinguish the newly-formed fleshy mass of a 
 neoplasm in the skin from the ordinary rapidly 
 formed semi-hyperaemic inflammatory deposit of a 
 similar size; and he knows practically that he has 
 a case of syphiloderma or lupus to deal with. In 
 making a dianosis, the observer must remember to 
 determine whether the disease is or is not com- 
 plicated by another, as evidenced by a mixture of 
 characters, and to thoroughly sift out the nature of 
 any constitutional modifying influences. T/i irdly. 
 An estimate of the immediate or exciting cause of 
 any given eruption is of the first importance in a
 
 TREATMENT. 25 
 
 complete diagnosis. No doubt, when the observer 
 has been able to put the disease before him into 
 its proper class, a pretty correct indication is 
 obtained of its causes, especially as regards Classes 
 1, 2, 4, 5, 6, 9 (Section III.); yet, unfortunately, 
 the difficulty is greater with the eruptions of the 
 commonest occurrence, comprised in Class 3, and 
 with those in Classes 7 and 10 (B and C). Hence 
 the observer must proceed on the lines laid down 
 in Section IV., working out the specific cause, and 
 inquiring into the production of the eruption from 
 within or without. Is the cause an hereditary 
 tendenc}-, the result of blood poisoning, nerve 
 disturbance, a disposition in the tissues themselves 
 to take on a diseased condition, or climatic influ- 
 ence ? Is the cause to be sought in local agencies, 
 as detailed under B (Section IV.) ? And at the 
 same time the observer will bear in mind what has 
 been said about the multiple character of the causes 
 of skin diseases. So the diagnosis will be correctly 
 worked out. The way is now prepared for some 
 remarks on the therapeutics in the following sec- 
 tion. 
 
 SECTION VI. 
 
 TREATMENT (GENERAL PRINCIPLES). 
 
 If, as has been already stated, there is nothing 
 essentially special in the pathological changes that 
 occur in skin diseases, it follows that there can be 
 3
 
 26 TREATMENT. 
 
 little that is absolutely special in the treatment. 
 What differences there are arise from the fact that 
 the skin can be irritated directly, and that the 
 diseased parts become rapidly dry. harsh, cracked, 
 etc., from the constant exposure to the air, so that 
 they need to be kept protected and supple by the 
 use of moistening applications. Otherwise the 
 general principles of therapeutics arc applicable to 
 the case of skin maladies, and it is necessary for 
 the reader to mentally lay linn hold of this fart. 
 
 A correct diagnosis must precede successful 
 treatment. When in accordance with the rules 
 laid down a given disease has been placed in its 
 proper clinical class, and the exciting and other 
 causes discovered, the proper kind of treatment 
 naturally suggests itself. It may be said, indeed, 
 that the ten groups of skin diseases require three 
 main methods of treatment viz., a purely local 
 one, or one almost wholly general, or a mixed kind, 
 partly local and partly general. That is, indeed, 
 saying in other words that skin diseases are made 
 up of those essentially local in nature, those essen- 
 tially general, and those more or less local in their 
 main features, but influenced by general conditions. 
 In the first category may be placed Groups 4, 5, 
 and 9; in the second Groups 1 and 2; and in the 
 third Groups 3, 6, 7, 8, and 10. 
 
 In dealing with the local mischief in Groups 4 
 and 5, absorbent or astringent remedies to promote 
 resolution or removal by caustic or surgical means,
 
 TREATMENT. 27 
 
 constitute the treatment. In Group 9 parasiticides 
 are to be employed to kill the insect or fungus 
 which produces the particular disease present. In 
 dealing with the components of Group 2 for I 
 need not touch on Group 1 specific remedies are 
 used : in scrofuloderma, cod-liver oil ; in syphilis, 
 mercury ; in leprosy and frambo3sia, hygienic meas- 
 ures and so-called " specifics." So far all is clear. 
 When we come to the third or mixed class of 
 cases indicated above, the principles of treatment 
 are more varied. Groups 6, 7, 8, and most of the 
 diseases comprised in 10, are consequent on what 
 may be conveniently termed debility, and the 
 treatment consists of the use of general tonics, etc. 
 It is not necessary to add more about them, as 
 they are amongst the more infrequent of skin 
 maladies. As regards, however, Group 3, the case 
 is different, for the diseases comprised in it con- 
 tain, as will be seen at a glance, almost all the 
 ordinary forms of skin diseases, and it is amongst 
 these the greatest difficulties are met with, owing 
 to the many causes of excitation, aggravation, and 
 modification. Now the diseases comprised in this 
 group are essentially inflammatory ; some run a 
 course of definite duration, as in herpes and roseola, 
 and hence require on\y watching to prevent inter- 
 currcnces, or for the alleviation of special symp- 
 toms and conditions, such as pain or disfigurement. 
 The majority, however, run an indefinite course, 
 and are to be attacked by therapeutic measures,
 
 28 TREATMENT. 
 
 based upon a consideration of the varying com- 
 bination of exciting, aggravating, or modifying 
 agencies. The treatment must be by local and 
 internal remedies. 
 
 As regards local remedies, there are three main 
 rules to be observed, viz.: (I) whenever active hy- 
 penemia is present, be the disease what it may, ap- 
 plications of a stimulating nature should not be used, 
 but the treatment should be essentially SOO/////K/, 
 otherwise the inflammatory S3*mptonis will be in- 
 cn-ased, and the disease spread. 
 
 (2) The action upon the skin of an external irri- 
 tant as scratching should IK? prevented, and the 
 air excluded from inflamed or excoriated surfari-s. 
 especial!}- by oil-packing and otherwise. 
 
 (3) Not until the stage of active byperaemia has 
 passed should astringents, stimulating applications. 
 or revulsives be employed. These, and absorbents, 
 are to be reserved for the stages of vascular slug- 
 gishness and inflammatory induration and thicken- 
 ing- 
 
 As regards internal or general remedies, it is pro- 
 posed to indicate below, in as practical and concise 
 a form as possible, the conditions which should be 
 taken into consideration in -framing the treatment 
 of such diseases as erythema, intertrigo, urticaria, 
 eczema, lichen, prurigo, pemphigus, hydroa, ecthy ma, 
 furunculus, pityriasis rubra, and psoriasis; and in- 
 flammatory conditions of the glands and hair folli- 
 cles, as acne, dysidrosis. and sycosis, which are ana-
 
 TREATMENT. 29 
 
 logons to, and only differ in regard to their anatomi- 
 cal seat from, those preceding. This short sketch 
 or chart, inasmuch as it applies to the bulk of skin 
 diseases, should be used regularly in determining 
 the treatment, which must necessarily vary with the 
 different combinations of influencing agencies re- 
 ferred to. These conditions are: 
 
 A Syphilitic Taint which tends to induce indu- 
 ration from the presence of syphilitic tissue ; or ul- 
 ceration, cachexia, and general debility in eczema, 
 psoriasis, pemphigus, ecthyma, acne, and intertrigo, 
 (infants). , 
 
 Constipation which causes dyspepsia, liver torpor 
 and retention of excreta, and occurs in all forms of 
 skin diseases. 
 
 Debility, including anaemia, which retards re- 
 covery from want of recuperative power in the 
 system, all functions sharing in the debility. It is 
 especially operative in furunculus, eczema, pity- 
 riasis ruhra, pemphigus, and ecthyma. 
 
 Diabetes which increases an}' inflammatory con- 
 dition, favors phlegmonous inflammation, and leads 
 to freer development of disease, and to chronicity. 
 Its influence is often seen in eczema, psoriasis, in- 
 tertrigo in adults, furunculus, and anthrax. 
 
 Dyspepsia which induces debility, leads to liver 
 disturbance, impurifies the blood, and increases 
 hypenemia by reflex action, as in acne, eczema, 
 urticaria, and sycosis. 
 
 Errors of Diet which introduce special irritative 
 3*
 
 30 TREATMENT. 
 
 substances into blood, cause dyspepsia, lead to 
 accumulation of nitrogenous matters in system, to 
 liver disorder, etc., and complicate all forms of 
 inflammatory eruptions without exception. 
 
 Gouty and Rheumatic Diatheses which cause 
 accumulation of uric and lactic acids and allied 
 compounds in blood, and give an inflammatory 
 character to disease, as seen in eczema, psoriasis, 
 lichen, ecthyma, sycosis, and urticaria. 
 
 Lack of Hygiene which disposes to torpor of 
 skin, and favors the occurrence of morbid action 
 and disease, as seen in acne and sycosis, eczema, 
 intertrigo, and erythema especially. 
 
 Repression of the special normal el i minatory 
 functions (skin and menstrual), which throws the 
 necessity of compensatory elimination on the 
 skin, which may fail to respond, and so become 
 diseased. In dependent parts this leads to increase 
 of fluid in tissues. It occurs in furunculus, ecthyma, 
 and eczema. 
 
 Retention of Excrela, from kidney, liver, and 
 bowel inactivity, which gives the blood an irritative 
 quality and aggravates hypenemia in all inflam- 
 matory skin diseases. It also leads, in the case of 
 kidney torpor, to increase of watery fluid in tis- 
 sues, as in eczema of the legs. 
 
 Simmons Diathesis which imparts an unusual 
 purulent character to eruptions, and favors the 
 implication of the connective tissues, as in eczema, 
 Psoriasis, acne, and sycosis.
 
 PAET II. 
 
 THE DESCRIPTION" AND TREATMENT 
 OF SKIN" DISEASES. 
 
 Acne is an inflammation of the sebaceous glands, 
 the ducts of the glands, and the upper part of the 
 hair follicles. Mostly resulting from the retention 
 of the sebum (comedo), it attacks chiefly the face 
 and shoulders, and occurs especially about the 
 time of puberty, when the hair follicles are in a 
 state of physiological activity in connection with 
 the free formation of hair, and are in consequence 
 easily disposed to become the seat of disorder. 
 
 The varieties are four in number viz., acne 
 punctata, in which there is simple retention of dis- 
 colored sebum, called comedo, without any inflam- 
 mation, but a certain amount of prominence form- 
 ing a pimple ; acne simplex, in which slight perifol- 
 Hcular inflammation and occasionally suppuration 
 are added to the retention of sebum ; acne indurata, 
 which is marked by considerable inflammatory 
 induration at the base of the spots, and a certain 
 degree of suppuration ; and lastly, acne rosacea, 
 characterized by a bright red color, more or less 
 formation of new connective tissue about, and 
 hypertrophy of the glands, and by its occurrence
 
 32 THE DESCRIPTION AND 
 
 iii middle-aged persons oftentimes the subjrfN >r 
 menstrual disorder. 
 
 The hyperamiia present in acne is especially 
 intensified by dyspepsia, errors of diet, and local 
 irritants. The inflammation, too, is modified by the 
 strumous and syphilitic cachexiae, which conduce 
 to implication of the surrounding cellular tissue 
 and to suppuration in struma, and to induration 
 and ulceration in syphilis. The condition denomi- 
 nated acne rosacca is scarcely a true acne, but con- 
 sists of chronic h\ peraemia of the face, attended by 
 the formation of red papules, due to the effusion of 
 lymph into the papillary layer of the skin. These 
 papules show out from the general reddened surface 
 as minute elevations like non-suppurating acne 
 spots, but they present no central opening. The 
 occasional presence of true acne spots leads to-the 
 inference that the disease is really acne. 
 
 Treatment. The objects in view are firstly, to 
 get rid of concomitant aggravating conditions (see 
 above); secondly, to remove the plugs of sebum 
 from the follicle (in comedo especially) and to lessen 
 the IrypenxMiiia ; thirdly, to restore tone to the 
 vessels and to the general system ; &nd fourthly, to 
 promote the absorption of inflammatory products. 
 In applying these principles, in acne punctata, hot 
 water bathing with friction with mild soap and the 
 use of an alkaline wash (45), or if this fail (07), 
 cautiously used, and tonics, constitute the proper 
 treatment as the rule (see Comedo). In acne
 
 TREATMENT OF SKIN DISEASES. 33 
 
 simplex it is necessary to remove the dyspepsia, if 
 present, by (97) before giving tonics such as (90), 
 (107), or (108), or in anaemic subjects (94). Cod- 
 liver oil must be prescribed for the strumous. 
 Locally the affected parts should be bathed with 
 hot water twice a day, and soothed with (14) or 
 (74) to reduce the hyperaemia, and presently stimu- 
 lated with (64) or (66) diluted. In acne indurata 
 similar internal remedies are required at first ; or 
 if the system be loaded (96) or (98) ; if much indu- 
 ration (85). Locally soothe as in acne simplex, 
 and subsequently remove the induration by the 
 use of (47), (60), or (66); or, if necessary, occa- 
 sionally touch each spot with acid nitrate of 
 mercury. In acne rosacea it is necessary to look 
 to the state of the uterine functions, to remedy 
 coexisting dyspepsia, debility, tippling habits, etc. 
 Internally (95) may be given with advantage; 
 locally (74) may be used, with the occasional 
 application of acid nitrate of mercury to each spot, 
 or (80) may be applied each night. In some cases 
 it is advisable to cut the vessels across with a 
 lancet, and to apply, after the parts have bled, 
 collodion regularly for awhile. In indolent cases 
 of extensive acne rosacea and indurata (65) may 
 be used every night or every other night. 
 
 Alopecia or Baldness may be partial or gene- 
 ral, hereditary or acquired, idiopathic or symp- 
 tomatic. When symptomatic, the baldness is 
 usually a relative one, and it results from the clis-
 
 34 THE DESCRIPTION AND 
 
 torbanee of the nutrition of the part by inflammatory 
 
 diseases e.gr., eczema; or by blood diseases e.g., 
 syphilis ; or by parasites (see Tinea) ; or from de- 
 bilit}^ from other special causes. When idiopathic, 
 it results from atrophy of the affected parts, and 
 failure in the reformation of hair, and then is abso- 
 lute, usually taking the form of circumscribed areas 
 (areata or circumscripla), which gradually extend ; 
 the skin itself is white, less vascular, and less sensi- 
 tive than usual. 
 
 Treatment. In symptomatic cases the treatment 
 of the alopecia is that of the disease which induces 
 it. In the idiopathic forms, where the entire hair 
 is lost, little can be done save by continuous stimu- 
 lation. When more localized, however, good may 
 be effected by applying tincture of iodine daily for 
 two or three weeks, or rubbing in an ointment com- 
 posed of two grains of bichloride of hydrargyrum to 
 one ounce of lard for a fortnight or so, and especially 
 round the edges of the bald patches; then, or when 
 minute downy hairs appear (129), or better (130), 
 ma}' be infricted with perseverance. At the same 
 time appropriate tonics are to be prescribed should 
 there be anosmia or debility. 
 
 Anthrax or Carbuncle is a phlegmonous in- 
 flammation of the skin, with necrosis of the cellular 
 tissue and indolent suppuration, the necrosed tissue 
 forming man}- cores over the surface of the car- 
 buncle, and being discharged, together with pus, 
 through the several corresponding apertures. The
 
 TREATMENT OF SKIN DISEASES. 85 
 
 surrounding parts are brawiry, reddened, and indu- 
 rated, and the vessels plugged. Carbuncles are 
 painful, and exhaust by their irritation and accom- 
 panying discharge. Extensive sloughing and ul- 
 ceration may occur, and even P3 r femic sj-mptoms. 
 Their most common seat is on the back or back of 
 the neck, and they may occur singly or one or two 
 together. The subject of them is usually much de- 
 pressed in health, and often of a diabetic habit. 
 
 Treatment consists in the application, in the early 
 stage, of caustic potash, or the employment of a 
 subcutaneous or other free crucial incision, with 
 subsequent pressure and careful dressing. Inter- 
 nally, the greatest attention should be paid to sus- 
 taining the strength of the patient, by food, medi- 
 cines, or stimulants,, as the case may require. 
 
 Area, see Alopecia. 
 
 Atrophia Cutis may be localized, and is then 
 mostly secondary to the growth and disappearance 
 of neoplasmata, strumous and syphilitic ulceration 
 or degeneration of the skin, as in morphoea ; local 
 inflammatory action, as in the scars left b}' ecthyma, 
 zoster, and variola ; and traumatic lesions. It may 
 be more or less general, and then is a part usually 
 of general senile decaj r ; or congenital, as in some 
 rare cases of xeroderma. The atrophy may be 
 idiopathiC) and then usually takes on the linear 
 form, and is localized to certain parts of the body, 
 and results probably from some defect of innerva- 
 tion.
 
 36 THE DESCRIPTION AND 
 
 Treatment. In the idiopathic form, all that can 
 be done is to afford protection to the part locally. 
 and to give appropriate general tonics internally. 
 
 Bakers' Itch is a term which includes lichen 
 agrius and chronic eczema of the hands. It is in- 
 duced by the irritant action of the flour used by 
 bakers (nee Eczema). 
 
 Treatment Patients are often considerably out 
 of health, and have a loaded system, though they 
 are debilitated. For such (95), or even (96), are to 
 be given, and these may be followed up by tonics, 
 such as (94) or (108). Locally the part may lie- 
 first soothed by (76), or the linimentum calcis, or, 
 if very itchy, by (40) or (42), and afterwards, when 
 the inflammation is subdued, (69) or (78) may be 
 employed. 
 
 Baldness, see Alopecia. 
 
 Barbadoes Leg, see Bucnemia. 
 
 Bricklayers' Itch is similar to bakers' itch, 
 only that it is excited by the irritation of lime. It 
 requires similar treatment to bakers' itch. 
 
 Boils, see Furuniculi. 
 
 Bucnemia Tropica is an hyperplasia of the 
 connective tissues, generally of the lower limb, suc- 
 ceeding to repeated attacks of inflammation of the 
 lymphatics of the limb. As a consequence of the 
 lymphatic obstruction, a greater quantity of lymph 
 is retained in the connective tissue strata of the 
 skin. The disease may attack the scrotum (then 
 called Sarcocele) and penis, as well as the limb, 
 and these separately or at the same time. In some
 
 TREATMENT OP SKIN DISEASES. 37 
 
 cases, the lymphatics are varicose. The cause of 
 the lymphatic inflammation in ordinary elephanti- 
 asis is probably due to residence in damp humid 
 localities, especially such as are tropical or malari- 
 ous. But Chyluria may coexist with the disease, 
 and chyle-like fluid may exude from varicose lym- 
 phatics in the enlarged scrotum ; and as chyluria 
 and chyloderma are associated with the presence of 
 filariae in the lymphatics, it has been asserted by 
 some, that the form of scrotal disease in which 
 chyle-like fluid is formed is only a phase of ordi- 
 nary elephantiasis of the scrotum, and that in ele- 
 phantiasis of the leg or scrotum or other part, the 
 true cause of the lymphatic inflammation is the 
 irritation and obstruction caused by filariae ; but 
 it has not as yet been proved that such is the case. 
 
 Treatment. In the earliest stages, it is that of 
 inflammation of the lymphatics : in the chronic state 
 friction, continuous bandaging, mercurial inunction, 
 and finally ligature of the main artery of the limb, 
 or excision of the part, if the disease is localized in 
 the scrotum, have benefited. 
 
 Bug-eruption. The attacks of bugs is a com- 
 mon cause of skin irritation in children, leading to 
 pruritus and urticaria, conditions which are intensi- 
 fied or appear at night. The bug-bites may often 
 be detected as rosy papules with a central punctum. 
 The remedy is to 'get rid of the bugs from the 
 rooms or beds, whilst the pruritus they induce maj r 
 be relieved by alkaline baths (14), (23), (43). 
 4
 
 38 TIIE DESCRIPTION AND 
 
 Cancer, see Epithclioma and Rodent Ulcer. 
 
 Carbuncle, see Anthrax. 
 
 Chloasma, see. Tinea versicolor. 
 
 Comedones are the small black-topped seba- 
 ceous plugs, or accumulations of sebum, that are 
 found in the early stage of acne punctata. The 
 form of disease in which these occur is called Co- 
 medo. 
 
 Treatment consists in the free use of hot water, 
 and if the skin is irritable, in applying borax or 
 alkaline washes (19), (45), and subsequently when 
 the skin is less irritable, in using tar soap, or soft- 
 soap inunction cautiously, to be followed by (14), 
 to allay irritation, and finally to stimulate the 
 glands to healthy action by such as (B5), (67), or 
 
 Condylomata or "mucous tubercles" are small 
 tumors, generally sessile, with a circular outline 
 and somewhat flattened top, occurring as a part of 
 syphilis. They are usually reddish or brownish in 
 color and spring up on mucous or cutaneous or 
 more often on muco-cutaneous surfaces. They are 
 contagious and liable to suppurate, and contain the 
 peculiar syphilitic tissue in their bases. The treat- 
 ment locally is to keep them constantly clean and 
 dry, and to apply astringents ; or such mercurial 
 preparations as blue ointment, calomel powder, or 
 a lotion of bichloride of mercury (gr. i-ij to 5j of 
 water). 
 
 Contagious Impetigo is a disease quite dis-
 
 TREATMENT OF SKIN DISEASES. 39 
 
 tinct from pustular eczema. Sometimes it is quasi- 
 epidemic, but mostly sporadic. It attacks children 
 only as a rule. The eruption occurs chiefly about 
 the face and head and more uncommonly the hands 
 and body. It may be ushered in by slight pyrexia, 
 and when fully developed consists of vesico-pus- 
 tnles varying in area from a pin's head to a three- 
 penny piece. The spots are usually quite distinct 
 the one from the other, and only run together if 
 they are developed near to one another. They are 
 also superficial i. e., without painful or hard bases 
 as in ecthyma. The scabs that form are light-yel- 
 low in color and look "as if stuck on," and when 
 removed they disclose a red surface. The diseased 
 spots begin as " little watery heads." Each spot 
 runs a definite course of a week or ten days. The 
 isolated and discrete character of the disease may 
 be masked in the face and head, by the excitation 
 of an eczema, or by the running together of the 
 vesico-pustules, either from scratching or, as before 
 stated, by crowding together; but in the latter 
 case the characteristic features seldom fail to pre- 
 sent themselves in the majority of cases in all parts 
 of the eruption in its early stages. The disease is 
 inoculable. 
 
 Treatment. The scabs should be removed by 
 bathing or oiling, when it is only necessary to 
 apply to the part beneath, a weak ammonio-chloride 
 of mercury ointment (gr. v to oj) night and morn- 
 ing, for a few days, and the eruption will generally 
 speedily disappear.
 
 40 THE DESCRIPTION AND 
 
 Dysidrosis is an inflammation of sweat follicles, 
 which we have described as a distinct disease, con- 
 sisting firstly in an excessive secretion of perspira- 
 tion, which however has a difficulty in escaping 
 and is retained, distending the sweat ducts and 
 glands to a greater or less extent. Of course serum 
 is also poured out from the inflamed parts as well, 
 so that the reaction of the fluid discharge is alka- 
 line. It occurs in weakly persons who are the sub- 
 jects of nervous debility, and often in those who 
 readily and profusely perspire. It occurs in winter 
 as well as in summer. If well marked, it may be 
 attended with acute miliaria of the greater part of 
 the body, but the characteristic eruption is seen 
 about the hand. At first the distended sweat fol- 
 licles are seen as small boiled sago grain-like bodies 
 imbedded in the skin of the tips, sides, and bases 
 of the fingers, and more or less over the palm of 
 the hand. As the fluid increases in amount actual 
 vesicles and bullae form, which, however, rarely 
 discharge, but shrivel up ; then the cuticle gets 
 macerated and peels off, exposing a reddened 
 hyperaemic derma, but it never discharges like an 
 eczema, although not unfrequently it is mistaken 
 for it. The rash begins as a distension of, and is a 
 disease of, the sweat follicles. It sometimes lasts 
 a considerable time, until, in fact, the pr.tient re- 
 covers from the debility before mentioned as so 
 often accompanying this disease. 
 
 Treatment. At first diuretics should be given,
 
 TREATMENT OP SKIN DISEASES. 41 
 
 especially in gouty subjects or those in whom the 
 urine is loaded or scanty, to be followed up by 
 suitable tonics, especially quinine and iron. A cool 
 regimen should be adopted, hot drinks avoided, or 
 whatever will increase the perspiration. Locally, 
 if the body generally be affected with miliaria, 
 alkaline baths may be prescribed, but the chief 
 thing is to soothe at the outset by wrapping the 
 parts in some bland or oil}- substance such as 
 carron oil, and subsequently using a slight as- 
 tringent, as (76). In some cases patients affected 
 by dysidrosis are vei'y weak, and in these cases 
 the disease may lapse into a semi-chronic state, 
 and then a long course of tonic treatment must be 
 adopted. 
 
 Ecthyma is characterized by the development 
 of large isolated pustules which have hard and in- 
 flamed bases and are painful. These pustules give 
 rise to unhealthy ulcerations of a greater or less 
 degree, and the crusts that form are large, dark, and 
 firmly adherent. This disease occurs mainly in the 
 badly nourished and cachectic. It may be excited 
 by local irritants; in children especially by scabies; 
 in elderly persons by pediculi. In fact, the majo- 
 rity of cases of ecthyma are secondary to one or 
 the other of these two diseases ; nevertheless the 
 pustules may be excited by scratching alone in the 
 badly nourished. 
 
 Treatment. If the ecthyma is secondary to 
 scabies or phthiriasis, these diseases must first be 
 4*
 
 42 THE DESCRIPTION AND 
 
 treated in the usual way, and then Ionics may !><> 
 administered subsequently, when the ecthyma will 
 disappear. It may be necessary to apply locally 
 (35) or (60) to heal the nlcerations. If the ecthyma 
 be idiopathic it will probably be desirable to give 
 aperients and rectify existing cachexia or debility 
 by good food and tonics, such as (92 , (95), (103) 
 with or without cod-liver oil, applying the local 
 remedies mentioned above. If there be marked ul- 
 ceration the sores may be cleansed by two or three 
 applications of iodide of starch (52) or iodoform, 
 and subsequently dressed with (28), (79), or (81). 
 Eczema is an inflammation of the skin character- 
 ized b} T aero-purulent discharge which stiffens linen 
 and dries into thin, yellow crusts; it is, in fact, a 
 catarrhal inflammation of the skin. It begins by a 
 serous effusion into the papillary layer of the skin. 
 The effused fluid finds its way into the rete, uplifts 
 the cuticle into vesiculation, and escapes free upon 
 the surface, thus constituting the discharge which 
 continues a greater or less time. Coincidently with 
 its escape the fluid, which contains much fibrin, be- 
 comes more or less purulent, and there is a large 
 amount of inflammatory cell-growth in the inter- 
 stices of the stretched-out rete cells and in the tissue 
 of the papillary layer. If the disease becomes 
 chronic the cutis is altered by chronic inflammatory 
 induration to a varying depth. Eczema, therefore, 
 begins as a "serous catarrh," and is followed by sup- 
 puration and inflammatory infiltration into the skin.
 
 TREATMENT OF SKIN DISEASES. 43 
 
 Some think that eczema does not necessarily 
 discharge, but this error probably has arisen 1'rom 
 the fact that many other diseases have been included 
 under the term eczema, such as parasitic eruptions, 
 lichen, and pityriasis. These do not discharge, and 
 hence the statement that eczema is not necessarily 
 accompanied by discharge : but it is important to 
 remember that in true eczema there is always " sero- 
 purulent" fluid effused externally. 
 
 There are three varieties of eczema viz.: (1) 
 E. simplex, which is generally localized to one or 
 two places, and consists at first of crowded vesicles 
 seated on a red base, which, when they rupture, 
 give place to a red discharging and then crusted 
 patch. It is not attended by any marked general 
 disturbance of the system, though perhaps by 
 debility, and is frequently excited l>y local irritants 
 such as heat, cold, scratching, irritant dyes, etc. 
 
 (2) E. rubrum, which is the inflammatory form 
 and is attended by more or less constitutional dis- 
 turbance and by gouty or dyspeptic symptoms. 
 In this form the local inflammatory signs are very 
 marked, that is to say, the parts are hot, swollen, 
 tender, itchy, excoriated, and they discharge and 
 crust. This eruption often attacks the flexure of 
 the joints, especially at the elbows, knees, and axillae. 
 
 (3) E. impetiginodes or pustulosum, which is cha- 
 racterized especially by the free formation of pus, 
 free discharge, and free yellow crusting. It is 
 mostly observed in strumous subjects, especially in
 
 44 THE DESCRIPTION AND 
 
 Bach children when badly nourished and the victims 
 of bad hygiene. These varieties occur in different 
 situations on the body. Each variety has its stage 
 of erythema, papnlation, vesiculation, and pustula- 
 tion, and "discharge." These stages have been 
 often made into varieties of eczema, a proceeding 
 at once unphilosophical and unclinical. 
 
 Treatment In E. simplex an}* causes of local 
 irritation are to be removed, and the part protected 
 locally by dusting it over with such as (48 or 49), 
 or (14) may be applied. This should be followed 
 up by (7G); whilst internally quinine and iron (109) 
 is given, since the outbreak or its persistence is 
 very often favored by debility. E. rubrum requires 
 more active treatment. Any gouty tendency must 
 be carefully met by appropriate dietetic and other 
 ivnicdies, all stimulants being at first avoided. The 
 part locally is to be soothed by absorbent powders, 
 or bathing with poppy water, and subsequently 
 dressed with linimentum aqua calcis, or should there 
 be much burning (18), (41), or (74). Sometimes, 
 indeed, all the remedies will fail until a loaded sys- 
 tem has been relieved by aperients or excess of acid 
 generated in the system be corrected, or dyspepsia 
 remedied. When the part affected is less irritable 
 and red (62) or (76) may be employed with tonics, 
 especially arsenic, with alkalies, iron, or quinine 
 (90), (107), (108). If the part become much 
 thickened and indolent, an alterative mercurial 
 course with bark will be found beneficial, at the
 
 TREATMENT OP SKIN DISEASES. 45 
 
 same time that weak mercurial ointments are applied 
 (00), to be followed in the still more chronic cases 
 by blistering, if need be. E. impetiginodes requires 
 the internal use of cod-liver oil, iron, and quinine, 
 with suitable food, and locally the application at 
 the outset of simple oil to free the part from crusts, 
 followed by the linimentum aq. calcis, and then a 
 weak white precipitate ointment, as for instance gr. 
 iij to the sj or (62). 
 
 In addition, certain local varieties are described 
 which it will be desirable perhaps to mention here. 
 E. capitis is almost synorrymous with E. infantile. 
 The child will be found pale, and very likely more 
 or less cachectic. Bad or insufficient food is at the 
 bottom of the majority of such cases, and the 
 remedies required are better food, cod-liver oil, 
 arsenic, and steel wine. Cleanliness and the use 
 locally of the remedies stated to be appropriate for 
 E. impetiginodes must be carried out, for E. infantile 
 and E. capitis take on the characters for the most 
 part of that variety, though occasionally those of 
 E. rubrum. Should there be any difficulty in re- 
 moving the crusts the head or face may be kept 
 soaked in oil until they are loosened and detached. 
 In the adult, E. capitis occurs in the gouty, 
 and requires similar treatment to E. rubrum. 
 E. mammae is frequently excited by scabies. 
 E. nianuum et pedum and E. genitale are ex- 
 amples of E. rubrum. The former is often excited 
 by flour in bakers, by sugar in grocers, and by soda
 
 46 THE DK8CRIPT10N AND 
 
 iii washerwomen. E. fje.nitale is benefited mostly 
 by the use of (74) ; E. manuum by the remedies 
 adapted for E. rubrum ; E.pedum by rest, great 
 cleanliness, and absorbent powders, followed by 
 carbolic lotion, and finally strapping with emplas- 
 trum diachyli. In eczema of the legs, if there be 
 much cedematous infiltration the liberal exhibition 
 of diuretics in conjunction with rest, careful bandag- 
 ing, and the use of (76) or a weak mercurial oint- 
 ment, is all that is needed to effect a cure; though 
 often tonics and good feeding are very useful ad- 
 juncts. Other remedies will be found on reference 
 to the cutaneous pharmacopoeia. 
 
 Elephantiasis. This term is used as a generic 
 one for two distinct diseases: the one is the E. 
 Arabitm, or tropical big leg, or Elephant leg (see 
 Hucnemia) ; the other is the E. Grxcorum, or the 
 true leprosy. E. Greecorum is observed in two 
 chief forms viz., tubercular and the ansest/n-ffi: 
 The tubercular form is known in its full}' developed 
 stage by three sets of symptoms, (a) discoloration 
 of the skin, of a light coffee hue; (b) deposit of a 
 new growth in the skin in the form of dull red 
 tubercles or infiltrations ; and (c) amesthesia of dif- 
 ferent parts, especially the extremities, due to the 
 deposit about the superficial nerve-trunks, of the 
 same new growth as that which invades the skin. 
 The skin deposit is chiefly found about the face and 
 ears, so that the eyebrows, cheeks, forehead, nose, 
 and its aho, being greatly thickened, give the conn-
 
 TREATMENT OF SKIN DISEASES. 47 
 
 tenartce a leonine appearance. In the anaesthetic 
 form the deposit in the skin is not so marked, but 
 anaesthesia is well developed, and eruptions of bulLie 
 which leave behind atrophous spots, and also dull 
 quasi-psoriatic but anesthetic circular spots of 
 eruption are observed. The hands are often dis- 
 torted, and the fingers contracted, so that the hand 
 assumes a claw-like aspect. 
 
 Epithelioma, or Epithelial Cancer. This affec- 
 tion occurs in elderly persons, and attacks by pre- 
 ference the lower lip. It begins as a hard lump, 
 which makes the lip feel swollen and ' ; pouty." 
 This lump soon cracks in the centre from the 
 setting in of ulceration ; and when this takes place 
 the progress of the disease is often very rapid. 
 The ulcer, which is now soon produced, is foul, 
 and its edges everted, indurated, and undermined. 
 The glands under the jaw are enlarged and in- 
 durated. The treatment consists in excision. For 
 the variety denominated Rodent Ulcer (see further 
 on). 
 
 Erythema, or simply redness (hypenemia). 
 Redness may form a part of very many dissimilar 
 diseases, all those, in fact, in which inflammation 
 or active congestion occurs. Reference is here 
 made, however, particularly to erythemata, which 
 in themselves constitute the condition or disease 
 requiring treatment. There are two classes. 
 
 The first group of erythema cases includes all 
 those instances of hyperremia which are excited by
 
 48 THE DESCRIPTION AND 
 
 local irritants of various kinds, as parasites, heat, 
 cold, friction, scratching, flannel, etc., and also coin- 
 prises such as are induced by the rubbing together 
 of two folds of skin (inti-rlriyo), and are accom- 
 panied by a mnciibnn discharge. 
 
 The treatment of these cases consists in removing 
 all local causes of irritation, and simply soothing 
 the part by such remedies as (13), (14), (3G), (74), 
 followed by (10), (39), or (72). In intertrigo (48) 
 and (40) are specially useful; and in some cases it 
 is necessary to give children tonics, particularly 
 steel wine and cod-liver oil. In the intertrigo of 
 old and fat people diuretics and alkalies, followed 
 by tonics and dressing the parts continuously with 
 (13) or (7G), is a good mode of treatment. 
 
 The second group of cases includes the erythe- 
 mata connected with general p3 r rexia, and often 
 with a rheumatic diathesis. There is rather more 
 swelling than in the slighter forms, and a certain 
 amount of effusion, so that the erythema runs on to 
 papulation or the formation of irregular, and some- 
 times large nodular swellings; hence the terms E. 
 population, E. tuberciilalnm, and E. nodosum, and 
 E. mnlliforme, which latter is used by Hebrato in- 
 clude all the forms indicated by the preceding terms. 
 Generally the rashes designated by these terms have 
 a more or less acute onset, ushered in by headache, 
 malaise, and the like symptoms, and then hyperannic 
 blotches appear about the hands, arms, legs, or 
 trunk, and the blotches may get more or less un-
 
 Til EAT ME NT OF SKIN DISEASES. 49 
 
 even or " knotty" from effusion, and a purplish 
 tint quickly develops, especial!}' at the edges of the 
 patches ; and finally the whole thing in a few days 
 fades away with changes of color, like a bruise. 
 E. nodosum occurs about the leg as oblong tuberose 
 swellings about the size of a walnut, or even much 
 larger, with a bluish periphery and quasi boggy 
 feel in the centre. Rheumatic pains accompanj- 
 this forms of erythema. 
 
 The treatment of the members of this second 
 group in the slighter forms consists in giving mild 
 aperient salines, followed by quinine, whilst locally 
 some simple astringent wash, such as (74) or (19), 
 may be applied. In the severer cases it may be 
 necessary to relieve a loaded state of system by (95) 
 or (96), before giving quinine, and locally to use 
 similar measures as in the less severe forms, or apply 
 powders, such as (48) or (49 . 
 
 Favus, see Tinea favosa. 
 
 Fibroma is characterized b}^ the occurrence of 
 outgrowths of fibrous tissue, covered by integument 
 of ordinary aspectand feel. These tumors after a 
 time become pedunculated. Their structure is that 
 of a lax connective tissue, peculiarly rich in cells at 
 certain parts. Sometimes the tumors show a dis- 
 position to ulcerate, and throw up exuberant granu- 
 lations. 
 
 Treatment. If it be important that the tumors 
 should be got rid of, they may be removed by the 
 knife or the ligature. 
 5
 
 50 TFIE DESCRIPTION AND 
 
 Fish Skin Disease, see Jchthyosis. 
 
 Follicular Hypersemia is a common accom- 
 paniment of many diseases, and particularly of those 
 attended by pruritus, for in these it is readily ex- 
 cited by scratching, as in scabies, eczema, and 
 phthiriasis. It gives rise to red papules, which are 
 seen to be seated at the hair follicles in part, and 
 partly to be hypenemic papillae, erroneously said to 
 constitute lichen. The condition demands soothing 
 remedies. 
 
 Fungi. For the names of the several fungi 
 causing parasitic diseases, see Tinea. 
 
 Furunculus. It is scarcely necessary that 
 " boils" should be discussed in any considerable 
 detail in this place. They are usually described as 
 rounded, painful, circumscribed inflammations of 
 the skin, involving the connective tissue, and there- 
 fore more or less deeply seated, with hard, indu- 
 rated, and inflamed bases. Slow suppuration goes 
 on, and the central portion sloughs out, and consti- 
 tutes what is called the "core." In reality the 
 anatomical seat of boils, in the majority of cases, is 
 a hair follicle or the attached sebaceous gland, with 
 more or less participation of the cellular tissue 
 around. In some cases the follicular origin of boils 
 c*imot be made out, hence the division into folli- 
 cular and cellular tissue boils. It is open to ques- 
 tion whether the "core" be always an "exudation," 
 or a gland which has died in consequence of the in- 
 tlainmation. When a boil forms, pain is first felt,
 
 TREATMENT OP SKIN DISEASES. 51 
 
 and then a lump accompanied by tension and red- 
 ness : this enlarges and suppurates. In "cellular 
 tissue boils" gangrene may occur. These are found 
 mostly on the scalp, neck, limbs, and especially the 
 thighs of marasmic adults, and often children. 
 Boils occur in those whose vitality is depressed by 
 defective or depraved living, mal-hygiene, or expo- 
 sure : also in those whose blood current is charged 
 with nitrogenous waste products, and in diabetic 
 patients. An exclusive meat diet, stale or unsound 
 meat, over-fatigue and exercise are other excitants. 
 Local irritants excite their formation, and they may 
 accompany disease in which scratching is freely 
 practised, as in scabies, prurigo, eczema, phthiriasis, 
 etc. Boils may be epidemic, and then occur often- 
 times when erysipelas is rife. 
 
 Treatment. The formulae useful for boils are 
 specially (95), (96), (108), and the mineral acids, 
 internally, and (35), (79), and glycerine of bella- 
 donna externally. Patients with boils should have 
 a carefully regulated diet, and obtain fresh air by 
 change to the seaside or of occupation. Fresh yeast 
 taken in tablespoonful doses three times a day is 
 often very efficacious. In very debilitated persons 
 the free exhibition of red wine or porter may effect 
 the dispersion of the furunculi. Some practitioners 
 find great benefit from the use of carbolic acid, or 
 acid nitrate of mercury to the boils to absorb them. 
 
 Grocers' Itch is similar to Bakers' itch, only 
 that it is caused by the irritant action of sugar.
 
 52 TFIE DESCRIPTION AND 
 
 Gutta rosaeea, see Acne rosneea. 
 
 Herpes is characterized by the occcurrence in 
 circumscribed patches of one or more groups of 
 vesicles, seated upon .an inflamed base. The develop- 
 ment of the disease is attended with smarting and 
 tension, if not acute pain, and pyrexia is often pre- 
 sent. The vesicles are distinct, large, and chambered. 
 They do not burst, but the transparent contents be- 
 come milk}', and they then dry up, forming light 
 crusts that fall in a few days, leaving only a slight 
 reddish stain behind. Each crop of vesicles runs a 
 definite course. Herpes ma}^ be symptomatic or 
 idiopathic. The former kind occurs in the course 
 of febrile disturbances of different kinds ; the latter 
 may be general or local. There is a general form 
 of rare occurrence, beginning by pyrexia, followed 
 by the development of herpes on the skin and the 
 inside of the mouth and throat. The disease lasts 
 ten days or so. The localized form is commonly 
 met with about the lips, prepuce, and the course of 
 one or more intercostal nerves. According to its 
 situation, form, and appearance, so various designa- 
 tions have been applied. Thus, one form is generally 
 known as H. zoster or shinyles, and is made up of 
 several patches or collections of ordinary her|>r<. 
 distributed along the course of a nerve, and uni- 
 lateral in its extent. "When there is a central vesi- 
 cle with a surrounding ring of herpes, and two or 
 more circles of colors like those presented by a 
 fading bruise, the form is called //. m, and is some-
 
 TREATMENT OF SKIN DISEASES. 53 
 
 times seen on the back of the hand. If the disease 
 take simply a circular form, it is often styled H. 
 circinatus. 
 
 Treatment This consists in applying some 
 simple soothing unguent, and exhibiting salines, fol- 
 lowed by quinine if need be. It is necessary in herpes 
 zoster to protect the eruption from rubbing and 
 irritation by dusting with (48), (49), or covering 
 the part with cotton-wool. Sometimes considerable 
 pain and discomfort are left by the eruption, and 
 relief may be given by morphia ointment, opiate 
 poultices, subcutaneous injection, or quinine in large 
 doses. 
 
 Hydroa is a term much misused. It has been 
 applied particularly by English and French writers 
 to Herpes iris, and the bullous eruptions (?) pro- 
 duced by iodide of potassium. It was given by 
 Bazin originally to a disease which stands midway 
 between herpes and pemphigus, and occurs in 
 arthritic (gouty) people, and attacks the cutaneous 
 and mucous surfaces. It lasts two to four weeks, 
 is apt to recur and to become chronic, and appears 
 mostly in the spring. In some cases there are vesi- 
 cles (H. vesiculeux} scattered over the backs of the 
 hands, wrists, and about the knees, and also the 
 mouth, developed out of red papules. In other 
 cases the vesicles are varioliform (H. vaccini- 
 forme) ; in others there are small bullse of different 
 sizes, but none above that of a split pea, these bullae 
 being often grouped. In fact, there are transitional 
 5*
 
 54 THE DESCRIPTION AND 
 
 stages between minute vesicles on a red base and 
 patches of herpes, there being frequently a mixed 
 condition. The treatment consists in defeating 
 the ill effects of M-orry, anxiety, and depression; in 
 regulating the diet, prescribing change of air, and 
 tonics, especially quinine. 
 
 Hydroadenitis is an inflammation of the sweat 
 glands a condition that commences by the appear- 
 ance of small lumpy swellings like blind boils, but 
 which do not suppurate, though remaining some 
 time painful, tender, enlarged, and of a dull red 
 color, like huge acne indnrata spots, only that there 
 is no central pustular point or follicular orifice. 
 
 Treatment. This consists in allaying the local 
 inflammation by ordinary measures, and subse- 
 quently painting with collodion, or stimulating tin- 
 places when indolent with the application of the 
 acid nitrate of mercury; or, should this not suc- 
 ceed, subcutaneous puncture may be employed. 
 
 Hyperidrosis, or excessive sweating, frequently 
 comes under our notice in a variety of diseases. It 
 is said to be a "critical" occurrence in certain fevers 
 at the time of convalescence, and is common as a 
 part of hectic fever. It may be a natural defect, 
 and often occurs about the feet and hands of certain 
 people. 
 
 Treatment. In the class of cases mentioned im- 
 mediately above, a general tonic plan of treatment 
 must be adopted, with the utmost cleanliness, and 
 some such local application as belladonna or alum.
 
 TREATMENT OP SKIN DISEASES. 55 
 
 Should the sweat have macerated the cuticle be- 
 tween the toes and excited an eczema, the parts 
 must be constantly bathed, some absorbent powder 
 used, as (48), (49), and then such as (10), (12), (14), 
 (It), etc. 
 
 Ichthyosis is characterized by the presence on 
 different parts of the body of an incrustation of 
 blackish hue, resembling masses of dried mud caked 
 on the surface. This caking stands out from the 
 level of the skin some two or more lines, and is 
 pretty firmly adherent. It can, however, be broken 
 up into little squarish masses. The incrustation 
 covers a varying extent of surface either on a leg, 
 arm, knee, or shoulder. Beneath the masses the 
 skin is dry and shrivelled ; in some places the pa- 
 pillae are hypertrophied, whilst in others the orifices 
 of the sebaceous glands are very distinct, and into 
 them are fitted little plugs of epithelial and fatty 
 matter projecting from the under surface of the 
 cake. These changes are accompanied by a general 
 cachectic state of the skin, which in the parts not 
 intrusted is dry, harsh, dirty looking, scaly, and 
 not perspiring. The disease is mostly congenital, 
 or it develops soon after birth. The microscope 
 discloses hypertrophy of the skin, the papillae espe- 
 cially being enlarged and elongated and covered 
 with very numerous strata of cuticular scales. The 
 latter, together with sebum, make up the caked 
 masses. A slighter form of the disease in which 
 the surface is dry, harsh, dirty looking, and more
 
 ft 6 THE DESCRIPTION AND 
 
 or less inelastic and scaly, is called xerodermn, but 
 both these conditions are phases of one and the 
 same disease, and often concur. 
 
 Treatment. The disease is incurable. No remedy 
 seems forthcoming which is of any avail against it, 
 though the coincident debility may be remedied. 
 Still patients may be made comparatively comfort- 
 able by bran baths and free oiling of the surface. 
 The caking may be got rid of by wet compresses, 
 alkaline baths, bathing in simple baths, or rubbing 
 in grease or glycerine. 
 
 Impetigo is a pustular eczema, see Eczema. 
 There is a specially contagious variety, see Conta- 
 gious impetigo. 
 
 Intertrigo, see Erythema. 
 
 Itch, see Scabies. 
 
 Keloid is a h\ pertrophic outgrowth of the fibro- 
 cellular tissue of the skin. There are two forms, 
 the idiopalhic and the traumatic, the latter origi- 
 nating in an excessive growth of the tissue of a 
 soar following the use of the surgeon's knife or the 
 applications of acids and the like. In the idiopathic 
 form, a firm, prominent, palish colored nodule ap- 
 pears on the skin and sends out processes, as it 
 were, from its periphery, which by their contraction 
 pucker in the skin around towards the central mass. 
 The contractility of the keloid tissue indeed is cha- 
 racteristic. 
 
 Treatment consists in avoiding all irritation of 
 the keloid growths. If removed they recur.
 
 TREATMENT OF SKIN DISEASES. 57 
 
 Kerion, see Tinea kerion. 
 
 Lepra is an old term for psoriasis, and especi- 
 ally that form which consists of circular rings of 
 disease. 
 
 JLeucoderma signifies "white skin," and con- 
 sists in deficiency of pigment in a part, without any 
 structural alteration whatever. It is a disease ob- 
 served chiefly in those who have resided in tropical 
 climates, and it is probably due to some nerve pare- 
 sis. In private practice it is usually seen affecting 
 the backs of the hands, the neck, and adjacent 
 parts, or the genital organs. 
 
 It often improves greatly, and sometimes disap- 
 pears under the use of general nervine tonics and 
 galvanism of the spine. 
 
 Lichen is characterized by the presence of solid 
 fleshy papules about the size of millet seeds, which 
 preserve their characters as papules throughout 
 their existence, and are accompanied by marked 
 itching. The skin generally, moreover, is usually 
 dry, somewhat thickened, and often of muddy as- 
 pect. The eruption may appear as scattered papules 
 (L. simplex} attacking one or more regions, or even 
 the greater part of the trunk, and more rarely about 
 the extremities: sometimes as groups of papules 
 (L.circumscriptus}. Often the lichen attacks the 
 backs of the hands, and then but secondarily may 
 become inflamed and give out a discharge ( L. agrius). 
 It is in this situation excited by the contact of irri- 
 tants, as sugar and flour, and then bears the name of
 
 58 THE DESCRIPTION AND 
 
 Grocers' or Bakers' itch (vide these). If the papules 
 are seated at the hair follicles, giving the surface a 
 dotted, or even on a small scale a rasp-like appear- 
 ance, the name L.pilaris is given. So called L. liai- 
 </"x is a jn/rpura; that is to sa3 r , there are little 
 haemorrhagic papules formed. In some cases solid 
 red papules of very special features stud various 
 parts of the surface symmetrically, and especially 
 at the front of the forearms, about the flanks, the 
 abdomen, and the hips, etc. These papules attain 
 the size of a large pin's head or more, and are dull 
 red, angular at their bases, flat at top, with a pecu- 
 liar shiny or glazy aspect, and umbilicated-more or 
 less distinctly. At first they are discrete, but they 
 group together into patches by the springing up of 
 new papules between the old. Then the patch be- 
 comes red, infiltrated, and slightly scaly, but dis- 
 tinctly papular at the edge. Dull colored stains are 
 left on the disappearance of patches or papules. The 
 disease is accompanied by a severe burning sensa- 
 tion or itching, and patients attacked are usually 
 much out of health. It is known as L. planits. 
 There is yd a further condition in which the whole 
 surface of the body is generally involved, the pap- 
 ules and patches occupying whole regions, whilst 
 there is also marked hype no mi a, itching, rarely con- 
 siderable marasmus, nervous irritability, and the 
 like symptoms. This severer phase is rare in Kng- 
 land ; it is the L. ruber of Ilebra. This observer 
 I so correctly described a L. scrofulosorum,
 
 TREATMENT OP SKIN DISEASES. 59 
 
 which occurs in those who exhibit decided signs of 
 scrofula. The eruption is made up of groups of 
 little pale papules the size of millet seeds, each 
 having in its centre a little exuvial plug. If the 
 disease is severe, acneiform pustules may develop, 
 interspersed with the papular rash. 
 
 Treatment. Lichen simplex and circumscriptus 
 must be treated as simple inflammations. A loaded 
 s} T stem, pyrexial condition, or debility should be 
 attacked, but alkalies should be exhibited in some 
 form or other. Should the disease not speedily dis- 
 appear a mild mercurial course, or one of Donovan's 
 solution may be given. Locally alkaline and gela- 
 tine baths, with remedies to allay irritation, are 
 needed, as (14), (16), (20), (23), (24),(30),(32\(37), 
 (38), (47). In L. planus the indications, as regards 
 internal treatment, are to improve the tone of the 
 nervous system by rest, change of air, and general 
 tonics, including arsenic, but especially the mineral 
 acids and bitters; to alleviate dyspeptic troubles; 
 to feed up the patient; and lastly, to attempt to 
 diminish, hyperaemia by astringents such as per- 
 chloride of iron. As regards local medication it is 
 needful to allay irritation by gelatine and alkaline 
 baths (la and 16), and by sedatives (23 et .se<?.); to 
 diminish hyperaemia by the use of such remedies as 
 (74), (14); and, finally, to promote the absorption 
 of the papules, especially by vapor baths, and 
 cautiousty emplo}*ed tarry compounds. 
 
 Lichen urticatus, see Urticaria.
 
 60 THE DESCRIPTION AND 
 
 Lupus is a disease characterized by the forma- 
 tion in the skin of a neoplasm, having minute cha- 
 racters like those of granulation tissue, and taking 
 the form of an infiltration or of tubercles. This 
 neoplasm tends to invade the true skin texture and 
 undergo degeneration, thereby leading to atrophy 
 and scarring. Firstly, the neoplasm may take a 
 diffused form, and L.erythematodes is the term ap- 
 plied to the superficial lupus in which the sebaceous 
 glands seem to be specially involved, and appear as 
 comedo-like spots studding the otherwise reddened 
 and infiltrated diseased surface. It attacks by pre- 
 ference the cheeks of young women on each side of 
 the nose, the two lateral patches being often con- 
 nected after a time by a connecting band of the 
 disease, stretching laterally over the nose from side 
 to side. Similar coexisting patches, leading to 
 atrophy, are observed about the scalp, fingers, and 
 rarely other parts of the body. Secondly, the 
 neoplasm may form distinct tubercular elevations, 
 which are crowded together into a fleshy mass after 
 awhile, and then the name L. tuberculosut^Oi when 
 it does not ulcerate, non-exedens, is given. This 
 form attacks the face and nose by preference. 
 Thirdly, the neoplasm may ulcerate freely, and 
 then the disease is called L.exedens. This attacks 
 chiefly the nose and cheeks. Lupus tissue or tuber- 
 cles are soft and gelatinous-looking, and are mark- 
 edly vascular. It does not tend so much to break 
 down into unhealthy pus as to undergo fatty de-
 
 TREATMENT OF SKIN DISEASES. G I 
 
 generation, and in this respect contrasts with syphi- 
 litic tissue. The local changes in lupus, unlike 
 syphilis again, constitute the whole of the disease. 
 
 Treatment. The essential point is to destroy the 
 new growth by caustics repeatedly applied, but not 
 so as to produce unnecessary cicatrization. Great 
 care is necessary in the application of these remedies, 
 and judgment in the selection of appropriate times 
 and cases. Whenever a lupus is very tender, or 
 shows a tendency to spread rapidly, or becomes 
 hypencmic under slight causes, caustics should not 
 be used : but when the disease is indolent. When 
 the lupus is red, tender, and irritable, it is useful to 
 exclude the air, and paint once or twice a day with 
 liquor plumbi for some time. The caustics most 
 suitable are (5) and (9), and it is best to use them 
 to the edges of the patches in the first instance, and 
 apply a poultice if there is much pain. The caustic 
 may be repeated at intervals till an apparently 
 healthy surface appears, and one that seems inclined 
 to heal. The surface should then be dressed with 
 some simple astringent, as (74) or (35). When 
 lupus patients are out of health, they should take 
 appropriate tonics, iron, especially cod-liver oil, and 
 quinine. The slighter forms of lupus may often be 
 cured by the application of astringents only. 
 
 Maculae. There are four chief forms viz. : 
 
 (1) The pigmentaiy, occurring idiopathically as in 
 
 leucodenna and melanoderma, or symptomatically 
 
 in connection with uterine excitation, and certain 
 
 6
 
 C2 TIIE DESCRIPTION AND 
 
 cachexia?, or after certain eruptions; (2) the para- 
 sitic, as in tinea versicolor; (3) the chemu-al, clue to 
 the use of nitrate of silver; (4) the hflMDOrrhagio, 
 as in purpura (nee the special descriptions of the 
 diseases here named). 
 
 Medicinal rashes. Arsenic is said to excite 
 herpes zoster, and to induce hardness and indura- 
 tion of the palms of the hands; also eczematous 
 inflammation and ugly ulceration when it comes in 
 contact with the skin by means of dyes, as in flower- 
 workers. Iodide of potassium induces acne-like 
 spots and bullae disseminated over the surface. 
 Bromide of potassium excites acne, ecthyma, and 
 inflammation of the sebaceous glands and follicular 
 walls, with retention of an increased formation of 
 sebum. Tar occasions comedo and acne. Copaiba 
 a terribly pruritic, raised, uniform, hyperremic rash, 
 followed rarely by the development of bullae, but 
 more frequently by wheals. Arnica excites eczema, 
 and sulphur a rash like an abortive non-discharging 
 eczema. 
 
 Miliaria is an inflammation of the sweat follicles 
 in connection with disordered sweat function, in fact, 
 sudamina in which there is more than usual hyper- 
 remia. It occurs as an acute, soft, red, pimply, 
 scattered general rash, in pyrexial states, and in 
 hot weather. 
 
 Treatment This consists in the adoption of a 
 cool regimen and the exhibition of some simple
 
 TREATMENT OF SKIN DISEASES. 63 
 
 diuretic, with the use of a weak alkaline or oxide of 
 zinc lotion, as (14) or (19). 
 
 Molluscum contagiosum is a disease in which 
 the sebaceous glands and parts around are enlarged 
 and distended by an excessive quantitj' of sebum, 
 so that sessile, pearly-looking, round, little tumors 
 are produced, which have the peculiarity of an um- 
 bilicatioii in the centre, disclosing the distended 
 opening of the gland duct. They vary in size from 
 a pin's point to a split pea. A white cheesy matter 
 may be squeezed out from the opening, and the sac 
 thus more or less emptied. The face is the chief 
 seat of the disease, and it occurs mainly in children. 
 It is apparently semi-epidemic at times, and appears 
 too to be contagious. 
 
 Treatment When small, the tumors may be 
 touched with acid nitrate of mercury ; when large, 
 the contents should be emptied, and the interi&r of 
 the emptied sac touched with a point of nitrate of 
 silver. 
 
 Morphcea is characterized by the formation in 
 the skin of white, bacony-like, slightly elevated in- 
 durations, that feel firm and look polished, opaque, 
 and dense, and are surrounded by a lilac-colored ring 
 of vessels, more or less distinctly marked. The dis- 
 ease is a fibroid degeneration, and may consist of a 
 small patch the size of a threepenny piece, or of one 
 or more larger ones. The disease may lead to atro- 
 phy of the skin texture, or a resolution may take 
 place without any ill effect being left behind. It is
 
 f,4 THK DESCRIPTION AND 
 
 seen chiefly on the trunk, limbs, and face; in the 
 latter situation some little deformity may result. 
 Sometimes it is conjoined to scleroderma. It attacks 
 particularly weak females. It runs a very indolent 
 course, indeed, and as regards duration, it tends to 
 disappear after a lengthened course of tonics. The 
 disease should not be locally irritated, and local 
 applications do no good. 
 
 Nails are subject to a variety of diseased condi- 
 tions. The clubbing and striation, as an effect of 
 exhausting disease such as phthisis, are well known. 
 They are ill-formed, and rendered opaque and brit- 
 tle, and it may be thickened in psoriasis, pityriasis 
 rubra, lichen planus, and sometimes in ichthyosis. 
 They are likewise stunted, and more or less atro- 
 phied in some cases of syphilis, and idiopathically 
 in those who are weak and out of health. The nail- 
 bedj or matrix, often gets inflamed with pain, heat, 
 swelling, and suppuration, occasioning perhaps the 
 loss of the nail. This is called onychia, and it may 
 be syphilitic, strumous, or erysipelatous in origin. 
 Lastly, the nails may be thickened and rendered 
 brittle, and raised from their bed by the attack of 
 fungi, and then the disease is known as onychomy- 
 
 00818. 
 
 A few words may be added as regards the diag- 
 nosis of these several conditions. In pxoriaxi* 
 of the nails all or most of the nails, of the hands, 
 and perhaps the feet, are affected. They become 
 at first speckled, then opaque, uneven, dull, and
 
 TREATMENT OF SKIN DISEASES. (55 
 
 brittle, and the free edge splits up into several 
 layers. The clue to the nature of the disease is 
 often given by the existence of psoriasis about the 
 bod}', and one method of treatment for the nail 
 and surface disease may be followed out. Onycho- 
 mycosis mostty occurs together with some form of 
 tinea of the head or body. It may arise by a tinea 
 circinata travelling from the finger to the nail, or 
 the nail alone may be affected in those who have 
 been attending to ringworm cases. JSTo psoriasis 
 can be found, moreover, on the body in these cases. 
 The nail becomes opaque and brittle about the base 
 and sides ; then it thickens, is loosened away from 
 its bed, and breaks up into layers. Generally in 
 onycliomycosis and this is a very important point 
 only one nail is affected, and more rarely two, 
 and only exceptionally more than that. The nails 
 of the feet are healthy, or, in other words, onyclio- 
 mycosis only attacks the nails of the hand. When 
 scrapings of the nail are examined, fungus elements 
 will be detected. The treatment consists in soak- 
 ing the nail in a sulphurous acid lotion (one part to 
 three or four of water) constantly, and applying 
 acetic acid every or every other day, but short of 
 producing irritation. Syphilitic disease of the 
 nails may consist in general atrophy or indolent 
 inflammation. In the latter condition the parts at 
 the base of the nail become painful, swollen, and 
 red ; suppuration follows, and unhealthy ulcera- 
 tion with loosening, and perhaps loss of the nail. 
 6*
 
 66 THE DESCRIPTION AND 
 
 Several fingers may be affected at one time. The 
 diagnosis is rendered clear by the concomitance of 
 other evidences of syphilis in the individual. The 
 treatment consists in the application of blackwash 
 externally and anti-syphilitic remedies internally. 
 Onychia, when simple, is known by its acute onset 
 and course, and the entire absence of syphilitic or 
 strumous symptoms. The treatment is that of a 
 sharp local inflammation ; nitrate of lead ointment 
 is highly recommended for the disease. 
 
 Pediculi, see Phthiriasis. 
 
 Pemphigus is known by the occurrence of oval 
 bladders of bulhc, varying in size from a split pea 
 to a pigeon's egg. p]ach bulla contains at first, 
 and is distended by, a semi-transparent fluid ; soon, 
 however, the fluid gets opaque, and the bulla 
 becomes flaccid and dries up, leaving a slight scab, 
 or giving rise to a superficially excoriated surface'. 
 The disease may be acute and pretty general, as in 
 those returned from the tropics, or in unhealthy 
 children. If it occurs in the newly born and about 
 the hands and feet, it is probably syphilitic and one 
 of a series of syphilitic phenomena. Chronic pem- 
 phigus may consist of one bulla (P. solilarii(x), or 
 of many in successive crops, and it lasts an indefi- 
 nite time. A form called P. foliaceux attacks the 
 body generally, beginning in one spot, and gradu- 
 ally invading the body. The bnllae are more or 
 less abortive, and give rise to flaky incrustations 
 covering the surface of the body, and presenting
 
 TREATMENT OF SKIN DISEASES. 67 
 
 the aspect of a crusted eczema, only that bullse are 
 detected. It is a rare form of the disease, and 
 occurs in the debilitated. Sometimes a prurigi- 
 nous rash is found intermingled with the bullre in 
 pemphigus ; and to this condition the term P.pru- 
 riginosus has been applied. 
 
 Treatment. It is held that the remedy for pem- 
 phigus is arsenic. Quinine, in large doses, is useful. 
 Cachectic conditions should be carefully attended to, 
 especially in old people. Locally, soothing applica- 
 tions alone can be used. 
 
 Phthiriasis, formerly called prurigo senilis, is 
 caused by the attack of the pediculus vestimenti. 
 The disease consists in the presence of certain 
 peculiar hsemorrhagie specks, and the phenomena 
 of secondary irritation induced by the pediculi and 
 scratching. It occurs chiefly in the aged, but it 
 also is met with amongst younger persons who are 
 uncleanly. The pediculi attack the regions of the 
 clavicles and neck first of all; and it is there the 
 first evidences of the disease must be traced. The 
 hrcmorrhagic marks are not raised like scratched 
 follicles, nor irregular like excoriations, but round, 
 with a central depression, at the bottom of which is 
 dried blood. The pediculus inserts the proboscis 
 into a pore, which it distends, and as the proboscis 
 is withdrawn the blood wells up to fill the follicle. 
 The irritation and scratching induce the develop- 
 ment of papules, whose apices, when scratched off, 
 become covered by scales of dried blood (prurigi-
 
 68 THE DESCRIPTION AND 
 
 nous, as it is called). This condition, together with 
 ectl^-matous pustules, excoriations from scratching. 
 \v heals, etc., constitute the secondary eruption of 
 phthiriasis. At first the mischief is localized to the 
 neck and shoulders, but presently it spreads over 
 the back, abdomen, buttocks, etc. 
 
 Treatment. It consists in giving warm baths, 
 smearing the skin with some parasiticide, as (114), 
 (115), (124), to keep away the pediculi, and in care- 
 fullj' baking the clothes worn by the patients at a 
 temperature of 220 F. 
 
 Pityriasis consists in an excessive shedding of 
 epithelial scales in the form of brawny desquamation. 
 It may be the result of local irritation or of mal- 
 nutrition. Pityriasis versicolor is a form of ring- 
 worm, and it is described under Tinea. One variety 
 of pityriasis, P. rubra, is a very severe disease. It 
 begins on one part of the body as a red scaly spot, 
 and rapidly spreads, so as to involve the whole sur- 
 face in a very short space of time. The bod}' is 
 intensely red, and covered by lamellar imbricated 
 scales, that are freely exfoliated from day to day. 
 The face is flushed and the scalp even desquamates. 
 It is said to be incurable, but this is certainly not 
 the case. 
 
 Treatment. The slighter forms are relieved by 
 internal tonics and the inunction of oil or some 
 slight astringent. P. rubra must be treated as a 
 disease consisting in general hypcriemia of the skin 
 due to nerve paresis. The patient must be wrapped
 
 TREATMENT OF SKIN DISEASES. (59 
 
 in oil, and quinine and cod-liver oil must he given 
 after the free exhibition of diuretics, to relieve the 
 hypenemic skin. Finally, perchloride of iron will 
 be found very useful as convalescence approaches. 
 
 Porrigo, a term now obsolete, but formerly ap- 
 plied indiscriminately to any crusted eruption or 
 scaly incrustation, especially about the face or head. 
 It included favus, ringworm, eczema, etc 
 
 Prickly Heat, or Lichen Tropicus, occurs in 
 the tropics mostly, but in a milder form in this 
 country, and in the summer. It is seen as a minute, 
 red, very itchy, pimply rash, due to, inflamed sweat 
 follicles. It studs the surface of the body, the limbs, 
 and often the face, and is interspersed with sudamina 
 here and there. The itching is increased by heat, 
 hot liquids, etc. 
 
 Treatment Exhibit diuretics freety: avoid all 
 stimulants: wear light clothing: take light food: 
 use alkaline baths : and smear the surface with 
 whiting made into a thin paste. 
 
 Prurigo must not be confounded with Phthiriasis. 
 It is a rare disease, and is characterized by the 
 development of small, hard, pale or flesh-colored 
 papules, which in their early stage are better felt 
 than seen, accompanied by intolerable itching. 
 The papular rash is primary in prurigo, and not a 
 secondary condition, as in phthiriasis ; nor is it in 
 any way caused by pediculi. The papules are due 
 to chronic inflammatory changes in the papillary 
 layer of the derma, and sometimes the deeper stratum
 
 70 THE DESCRIPTION AND 
 
 of the skin. They occur mostly on the lower liml>s, 
 buttocks, lower part of the abdomen, and outer part 
 of the forearms. The disease is termed P. milts if 
 the papules are small or limited in extent, or the 
 itching, and disease generally, not severe. When 
 the disease is well marked, the papules crowd to- 
 gether in certain situations in patches, especially on 
 the legs : they are felt under the skin before being 
 clearly discernible to the eye, and the itching or 
 disordered sensation termed formication, is like 
 creeping of ants. To this condition the term P. 
 formicans is given. In certain cases where the dis- 
 ease is extensive, and more or less congenital and 
 persistent, it is called P. agria or ferox. Eczema 
 here supervenes or more or less suppuration occurs, 
 with glandular enlargements in the groin, whilst 
 the skin feels thickened and indurated in the chronic 
 stage. In England the severer form is not common. 
 The writers have only met with few cases, and the 
 disease of milder type has occurred in their experi- 
 ence in those exposed to alternate heat and cold 
 in their occupation, and who have become debili- 
 tated. 
 
 Treatment. This should consist in improving the 
 general health, in given arsenic (90 et seq.), or ( 10G), 
 in the employment of vapor and alkaline baths, 
 and the use of sedatives, chiefly ( 23), (30;, (34), 
 (69), (71), (74), as they may best suit. 
 
 Pruritus, or itching, is an accompaniment of 
 most skin diseases, especially eczema, lichen, pru-
 
 TREATMENT OF SKIN DISEASES. 71 
 
 rigo, urticaria, scabies, and phthiriasis. But it may 
 arise in the skin without any eruption, and then it 
 is usually due to the circulation of some acidity, as 
 bile products, urea, uric acid, etc. ; or to some dis- 
 order of the nerves ; or it is excited by some local 
 irritant, as, for instance, about the rectum by asca- 
 rides, about the head and pubis by pediculi, about 
 the body by flannel, friction, or scratching. It 
 must be remembered that the appearance of the 
 skin is always altered by scratching, as it causes 
 follicles and papillae to become hypeneinic and pro- 
 minent; their apices get scratched off, and a drop 
 of blood exudes and dries as a speck. This'pruritic 
 rash is most erroneously termed prurigo (which see). 
 In old people pruritus (senilis) occurs as an hyper- 
 jEsthesia, and consequent on the general atrophy of 
 the skin ; but in such persons the causes mentioned 
 above come readily into play. 
 
 The following hints relative to the more common 
 causes of itching may be found useful. Itching 
 increased at night by the warmth of the bed, with a 
 pimple rash about the front of the arms and the 
 bod}', is suspicious of scabies. Itching in old peo- 
 ple about the shoulders and back, of phthiriasis. 
 At the back of the head in children, of pediculi in 
 the head. Itching, with eruption about the fork of 
 the thigh, of parasitic disease and intertrigo (ex., 
 eczema marginatum). Itching of capricious charac- 
 ter, suddenly coming and going here and there, es- 
 pecially at night, and without visible eruption in the
 
 72 THE DESCRIPTION AND 
 
 d:i yt imc, is suspicious of urticaria. In the winter time 
 especially it is not uncommon for the skin in certain 
 persons to be irritable, particularly towards even- 
 ing, or when the clothes are taken off, and the air 
 obtains access to the skin. The itching in such 
 cases has been termed pruritus hiemalis, or winter 
 pruritus. It occurs in various parts of the body, 
 but more especialty about the thighs and legs. In 
 some cases no eruption can be seen, but in others 
 there is decided turgescence and prominence of the 
 hair follicles, enough in degree perhaps to consti- 
 tute lichen pilaris. The disease is supposed to be 
 "neurotic," but it is probably due to inactivity of 
 the perspiratory function >n the majority of cases: 
 at the same time there is frequently defective excre- 
 tion of nitrogenous matters and bile products. It 
 is not exclusively a winter affection, though most 
 common at that time because of the inactivity of 
 the skin. Scratching, it must be remembered, may 
 excite lichen, eczema, ecthyma, and the like, whereby 
 the primary disorder may be masked. 
 
 Treatment. A number of remedies for itching 
 occurring in connection with particular diseases will 
 be found in formula} (18) to (44), and scattered else- 
 where. Starch, borax, or alkaline baths should be 
 administered when the skin is l^-peraemic or irritnble, 
 and in the early stages of pruritic mischief. In the 
 indolent aspect, or later stages, sulphuret of potas- 
 sium or mineral acid baths are of decided ellieney. 
 As regards internal treatment, this varies with the
 
 TREATMENT OF SKIN DISEASES. 73 
 
 case. Itching due to the circulation of retained ex- 
 creta may be relieved by appropriate aperient and 
 alkaline remedies, whilst nervine tonics will be suit- 
 able for the " neurotic" itching. All parasites and 
 other local irritants must be destroyed or removed 
 (.see 209 el seq.), and flannel especially should not 
 be allowed in contact with the skin in severe pru- 
 ritis. Further information will be gathered from 
 the special descriptions of the several diseases men- 
 tioned here with which itching is associated. 
 
 Psoriasis is a disease characterized by hyper- 
 trophous growth of the epithelial layers of the 
 skin leading to a heaping together of whitish 
 silvery looking masses of scales, which on being 
 removed disclose a hypersemic cutis with papillae, 
 enlarged by engorgement of the vessels. The chief 
 seats of the disease are the elbows, knees, and head, 
 but also the body and limbs generally. The disease 
 is often hereditary. It begins by the development 
 of small spots, P.punctata: these gradually enlarge 
 and look like drops of mortar, hence the terra P. 
 gnttata. Soon many acquire the size of a sixpence 
 or shilling and are generally round, and now the 
 name P. nurnmularis or circinata is given. In 
 some cases large patches are formed by the coales- 
 cence of the spots, so that a great extent of surface 
 is covered ; this is called P. vulgarits. Should 
 patches take on a serpentine form, the term P. 
 gyrata is used, and if the affection is veiy chronic 
 P. inuelerala. Lastly, if the crusting is freer than 
 7
 
 T4 THE DESCRIPTION AND 
 
 usual and assumes a conical shape, the name P. 
 rupioides is applied, the epithelial elements being 
 in this case mixed with pus ; it is dependent on a 
 strumous habit. A common local phase is P. pal- 
 maris, likely to be confounded with syphilitic dis- 
 ease; but the former is generally a part of a more 
 general affection, and it does not begin nor is it 
 limited to the palm of the hand, as is the syphilitic 
 disease as the rule. 
 
 Treatment. In children cod-liver oil, quinine, 
 iron, and arsenic should be given if the scales an- 
 very plentiful and silvery, see (90), (92), ( 1 06), (107), 
 properly proportioned in dose to the age of the 
 patient. Locally alkaline baths may be used with 
 the inunction of oil as long as the hypenemia lasts, 
 and afterwards some mild tar application as (70). 
 In adults, gouty conditions must be rectified. If 
 the skin be very b^'penemic diuretics should be 
 exhibited, and the skin simply soothed b}' alkaline 
 baths and oil inunction. Then arsenic may be givi-n 
 freely, (90 et seq.) and (106 el seq.). Locally at first 
 mild mercurial ointment, (62), (fi3), and lastly 
 tarry preparations, (68), (69), (70), (71), may be 
 used. In no disease is more care needed to unravel 
 the exact combination of conditions conducing to 
 the disease. (See Remarks, Part I., p. 29.) 
 
 Purpura is characterized by minute extravasa- 
 tions of blood, at first bright red and afterwards 
 indigo color. The size varies from pin points to 
 large specks and blotches, and these even run into
 
 TREATMENT OF SKIN DISEASES. 75 
 
 patches scattered over the surface, especially on the 
 legs. Slight pyrexia accompanies it, and the erup- 
 tion cannot be effaced by pressure. This is P. sim- 
 plex. A more severe form in which haemorrhage 
 takes place more freely into the skin, and from the 
 mucous surfaces, is known as P. haemorrhagica. 
 
 Treatment. The latter condition requires very 
 great care. The former: rest, acids, quinine, per- 
 chloride of iron, turpentine (100), gallic acid, etc. 
 
 Ringworm, see Tinea. 
 
 Rodent ulcer is the least malignant form of 
 cancer. It rarely occurs before the age of fifty, and 
 begins as a solitary, indolent tubercle somewhere in 
 the upper two-thirds of the face. This tubercle 
 after two or three or several years cracks and shows 
 a tendency to ulcerate, the ulcer when formed being 
 bounded by hard sir.uous edges which are not under- 
 mined ; the surface is cleanish and no glands become 
 implicated, nor is there any cachexia. The disease 
 makes very slow progress and is painless. 
 
 Treatment. Free excision at the earliest possible 
 moment with or without the subsequent use of caus- 
 tics. If removed effectually the disease does not 
 return. For caustics, see (3), (4), and (5). 
 
 Roseola is a hypenemia of a rosy hue, either 
 symptomatic, and then part only of certain acute 
 febrile disease, as rheumatism, vaccinia, cholera, etc. . 
 or idiopathic, as seen mostly in children during 
 change of season (R. infantilits), and in connec- 
 tion with slight stomach derangement. It may be
 
 76 THE DESCRIPTION A N T l> 
 
 general and resemble measles, but there are no true 
 catarrhal symptoms; the rash is not crescentic in 
 character, and is more rosy than that of measles. 
 Though it may be distributed more or loss wholly 
 over the body, still it is decidedly patchy in charac- 
 ter. It may occur in rosy circles and rings (It. 
 annulata), especially about the limbs, and in the 
 autumn or summer (R. aitiiimnalis and It. sestiva). 
 
 Treatment. In the idiopathic forms salines and 
 laxatives should be exhibited and some simple oint- 
 ment used. 
 
 Rupia. In this eruption small flattish bulla3 are 
 developed, with at first clearish contents, quickly 
 becoming like a mixture of blood and pus. The 
 bullae dry into dark thick scabs hiding unhealthy 
 ulceration. The crusts increase by additional dis- 
 charge which " dries on" as it were from below as 
 the ulceration increases. They are consequently 
 conical, stratified, dark and adherent, and the 
 "cockle-shaped" crusts are in fact diagnostic of 
 rupia. Should they be moderate in size the disease 
 is termed ft. simplex, if large and prominent, It. 
 prominens ; if the ulceration is excessive and pha- 
 gedsenic, It. escharolica. The disease is always 
 syphilitic. 
 
 Treatment. This should be as for tertiary sy- 
 philis (see 84 et scq.). The ulcers may be cleaned 
 by iodide of starch and dressed with black-wash or 
 (61), (81), (82), (83).
 
 TREATMENT OF SKIN DISEASES. 77 
 
 Scabies or Itch is caused by the burrowing in 
 the skin of an insect called the acarus scabiei. This 
 burrowing excites much itching and some h}<perae- 
 mic rash ; the patient scratches for relief, and so 
 occasions much of the rash that is seen in scabies. 
 Hence scabies consists of an eruption due to the 
 presence of acari in their burrows, together with a 
 secondary rash, the results of the irritation of the 
 skin. The appearance presented l>y the acarus in 
 its burrow, which is characteristic of scabies, is as 
 follows: Where the acarus enters, a vesicle forms, 
 and the animal's course is traced by a slightly raised 
 straight or tortuous line (cuniculus) from one to 
 many lines in length, at the end of which the pre- 
 sence of the imbedded intruder is marked as an 
 opaque spot generall}'. The furrow or cuniculus 
 becomes discolored by dirt, and then has a dark 
 tint with darker dots along its course, probably the 
 excreta of the acarus. Now these furrows are 
 mostly seen in the adult in the interdigits and about 
 the wrists in the earl y stage of the disease, but sub- 
 sequently about the penis at its upper line and other 
 parts of the front of the body. In children the 
 buttocks and feet may alone be the seat of scabies. 
 Of course the furrows lose their characteristic ap- 
 pearance after a good scratching, as they are torn 
 open and the acarus frequently dislodged. If pa- 
 tients are cachectic both the vesicle and the furrow 
 may suppurate, as in so-called pustular scabies. 
 The "secondary rash" consists of hyperamic folli- 
 7*
 
 78 THE DESCRIPTION AND 
 
 cles and papillae forming papules, of ecthymatous 
 pustules excited by scratching, and sometimes of 
 eczema and urticaria. The results of irritation are 
 seen in early scabies in the adult on the front of the 
 forearms and about the wrists ; in chronic scabies 
 on the front of the belly and on the upper part in 
 front and inner surface of the thighs ; in children 
 about the lower limbs, buttocks, and abdomen. 
 Scabies is accompanied by marked itching, which 
 is always worse at night, and several members of 
 a family are often the subjects of attack at the same 
 time. Cuniculi are absolutely diagnostic, but if 
 these cannot be detected, itching at night in persons 
 who have a pimply rash in the interdigits or fore- 
 arms or upper line of the penis is very suspicious, 
 and much more so if several persons in the same 
 family are affected similarly together. 
 
 Scabies in Private Practice. It is impor- 
 tant to remark that scabies often differs very much 
 in aspect, according as it occurs in hospital or in 
 private practice. Amongst the poor, and especially 
 the uncleanly, the burrowings of the acari in the 
 skin are attended with the formation of papules, 
 vesicles, pustules, wheals, etc., in abundance. But 
 amongst the well-to-do, and particularly those who 
 observe great cleanliness, the ordinary results of 
 the irritation produced by the acari may be almost, 
 if not entirely, absent. So that if a student were 
 to be guided by the ordinary descriptions given in 
 books of scabies, he would certainly not be able to
 
 TREATMENT OP SKIN DISEASES. 79 
 
 diagnose the scabies present. The disease would 
 not answer in description to papular, pustular, or 
 vesicular scabies, and yet true scabies might be 
 present. We have seen several cases lately in 
 which patients complained of itching intensified at 
 night in different parts of the body, and in whose 
 skin nothing could be detected but a few cunicnli 
 about the hands or the penis, and an apology for 
 a vesicle here and there. We have seen a multi- 
 tude of acarian furrows about the hands and other 
 parts in a case of scabies, and nothing else. In 
 other cases we have observed just a few very fine, 
 delicate, pale, flesh-colored papules, the result of 
 irritation set up by acari present in the skin, and 
 nothing more, and these, which were lichenous 
 papules, were difficult to make out. In all cases 
 in which a patient complains of itching aggravated 
 at night, even though there be none of the ordinary 
 evidences of scabies present, yet a diligent and 
 active search for cuniculi should be made about 
 the hands and penis. We have known patients 
 treated with powerful internal remedies for " pru- 
 rigo," lichen, and the like for weeks, whilst scabies, 
 which existed, was wholly unsuspected because 
 there were no papules and pustules present. Pa- 
 pules, pustules, and vesicles are indeed accidental 
 accompaniments of scabies, which should be looked 
 upon as consisting essentially of the acari in their 
 furrows (cuniculi) i.e., the real scabies, and the 
 phenomena of irritation (papules, pustules, etc.)
 
 80 THE DESCRIPTION AND 
 
 superadded, which, under certain circumstances, 
 may bu entirely absent. Two or three cases of 
 scabies limited to the penis have recently come 
 under our notice. In all of the cases careful search 
 detected cuniculi. In two, suppurating buboes 
 were produced by the irritation, and the disease 
 was thought to be syphilitic. The diagnosis was 
 rendered easy by the absence of any decided indu- 
 ration about the scabies spots, their vesico-pustular 
 origin, pruritis intensified at night, the presence of 
 cuniculi, and the absence of any concomitant evi- 
 dence of syphilis. 
 
 Treatment. The majority of cases are cured by 
 a free inunction night and morning of (114) or (120) 
 for three nights and mornings. The patient must 
 thoroughly wash himself, and if free from itching 
 on the fourth night may be regarded as well. It is 
 important not to overdo the sulphur inunction, but 
 cease it after a da}' or two, for it often sets up in 
 itself irritation, and the continuance or increase of 
 itching is taken for an aggravation of the disease. 
 After three days' treatment the remedy may be 
 lightly applied to any solitary vesicles that make 
 their appearance. If any parts feel hot and tender 
 (74) should be used to soothe. In chronic scabies 
 it may be necessary to make freer and more potent 
 applications (110 et seq.). Often the free use of 
 storax ointment will be found most effectual ; and 
 so also ointments of iodide of potassium and car- 
 bolic acid.
 
 TREATMENT OF SKIN DISEASES. 81 
 
 Scleroderma is a disease due to hypertrophous 
 growth of the fibro-cellular tissue with infiltration 
 by coagulable fluid. In consequence the skin be- 
 comes first of all stiff, then hard, and then indurated 
 like leather, and it cannot be pinched up or wrinkled. 
 The disease is, as a rule, one of adult ,life; it may 
 come on after exposure, perhaps suddenly and may 
 affect one or more regions, or more or less of the 
 body. It frequently attacks the nape of the neck, 
 or the front of the chest, or a limb. The hardness 
 and induration, which is raised and yellowish look- 
 ing, may take the form of bands, or occur continu- 
 ously over an extensive area. The stiffness pro- 
 duced may interfere with respiration or the move- 
 ments of the face or joints. In some cases it occurs 
 in conjunction with morphoea, or the edge of the 
 sclerodermic band may present the aspect of mor- 
 phoea. 
 
 Treatment. The disease may gradually diminish 
 under general tonics internally, and friction with 
 oil externally, but treatment, as a rule, is not found 
 to be very influential in curing this disorder. 
 
 Scrofuloderma. This disease commences as 
 indolent, painless, livid tubercles that gradually 
 soften up and give place to foul, ragged, unhealthy 
 ulcers with pallid granulations, free secretion, and 
 may be crusting. Occasionally the ulceration is 
 superficial and creeps along the surface. The scro- 
 fulous features will be recognized in this disease
 
 82 THE DESCRIPTION AND 
 
 in the family history, physiognomy, physical condi- 
 tion, glandular complications, etc., in the patient. 
 
 Treatment consists in administering cod-liver oil, 
 iron, quinine, and good food internally, and locally 
 in the application of iodide of starch to cleanse the 
 foul sores, and then some mild astringent; whilst, 
 in the later stages, soap and mercurial plaster is 
 used with iodine fumigation. 
 
 Seborrhoea. This consists in an excessive 
 secretion of sebum. It may be more or less oily, 
 and give rise to a greasy skin (S. oleosa): or it may 
 dry into fatty plates, consisting of dirty white flat 
 scales that feel greasy, and are easily detached, ex- 
 posing a very slightly reddened and non-excoriated 
 skin in which the sebaceous glands are more distinct 
 than usual. This is the common form of seborrhoea, 
 and constitutes what is termed "dandriff" or 
 "scurf" in the head. Thirdly, the fatty secretion 
 may take the form of little plugs distending the 
 orifices of the glands, and then the skin feels harsh 
 like a file (S. cornea). The seats of seborrha-a are 
 especially the scalp and the face. It is liable to be 
 confounded with eczema, but in seborrhoea, although 
 the skin is reddened, there is no breach of surface 
 as is seen when the scaliness and crusting are re- 
 moved. The follicles are seen also to be more patent 
 than usual, and the incrustation is also soft and 
 greasy, and not the result of the drying of "dis- 
 charge." 
 
 Treatment. It is requisite to give tonics and
 
 TREATMENT OF SKIN DISEASES. 83 
 
 arsenic, as (90\ (93), (94), (108) : locally to get off 
 the crusts by oily inunction, and to apply astrin- 
 gents, as (11), (14), (25), (40), (51), (73). 
 
 Strophulus or Red Gum. This term has been 
 applied to many different eruptions, consisting of 
 soft red papules in infants ; in one case, to hyper- 
 semic papillae, in another to hypersemic sweat glands, 
 and again to distended sebaceous glands. So-called 
 strophulus, characterized by bright-red points, 
 seated on the face and arms of children, is, in fact, 
 a hypersemia of the papillae or sweat glands, mostly 
 induced by the child being kept very much wrapped 
 up, and so overheated. S. albidus is the term given 
 to the small pearly-white specks seen about the face 
 of children, and due to distended sebaceous glands. 
 The hypersemic states alluded to above are exagge- 
 rated by any stomach disturbance. 
 
 Treatment. Some mild aperient and ant-acid 
 should be given, with the adoption of a cool regi- 
 men, and the local use of some simple soothing 
 lotion, as (74). 
 
 Sudamina is the term applied to the little 
 vesicles formed by distension of the upper laj-er of 
 the cuticle by sweat. They are apt to occur about 
 the clavicles, neck, or face, but often may be seen in 
 other parts, whenever the skin is stimulated to ac- 
 tivity during the establishment of convalescence 
 from pyrexial attacks, or from keeping the bod}^ 
 too warm. They are especially frequently seen 
 in acute rheumatism. No treatment is required,
 
 84 THE DESCRIPTION AND 
 
 as the vesicles rapidly disappear of their own 
 accord. 
 
 Sycosis signifies inflammation of the hair 
 follicles of the beard and whiskers. It may be 
 caused by a vegetable parasite, and then possesses 
 special features (see Tinea sycosis), or it may arise 
 as an idiopathic inflammation of the follicles, and 
 then is called simply xycosis. In this latter form 
 the disease consists in the development of pustules, 
 pierced by a hair, scattered here and there about 
 the hairy parts of the face. The pustules, which 
 indicate that the whole hair sacs are inflamed, may 
 become more or less indurated at their bases, form- 
 ing qnasi-tubercles. If the inflammation is severe, 
 and the pustules are crowded together, there may 
 be considerable discharge and crusting : the derma 
 and connective tissue textures of the affected part 
 being involved, so that the parts are reddened, hot, 
 swollen, and infiltrated, and the patient may suffer 
 great pain. The disease, however, differs very 
 much in severity. It often occurs in the debilitated, 
 the intemperate, the dyspeptic, and eczematous. It 
 often, too, runs a very chronic course, especially in 
 strumous subjects, and in such cases more or less 
 atrophy and loss of hair may result. 
 
 Treatment. It is generall}' considered that epila- 
 tion rapidly cures the disease, but this is a mistake, 
 and, indeed, the procedure often does harm. It 
 does good if there is much chronic inflammatory 
 thickening involving the deep parts of the follicle
 
 TREATMENT OP SKIN DISEASES. 85 
 
 with suppuration, and should be followed by the 
 use of a weak white precipitate ointment. The dis- 
 ease should be treated as a simple inflammation, 
 locally by hot fomentations and soothing remedies 
 in the early and acute stages ; subsequently by 
 the use of astringents, as (75), followed by weak 
 mercurial ointments ; and lastly, tar or sulphur 
 applications. . Internal treatment consists in the 
 use of aperient tonics, as (95), cod-liver oil and iron 
 when needed, and lastly, a course of Donovan's so- 
 lution where there is much indolent thickening. 
 Where there is much thickening, painting with 
 liquor potassae, followed up with the use of mercu- 
 rial plaster, is often of service, hut the disease must 
 be indolent for this treatment. 
 
 Syphilis of the Skin is met with in connection 
 with hereditary and acquired syphilis. 
 
 Hereditary syphilis is practically nearty synony- 
 mous with congenital or infantile syphilis. This 
 form is uncommon before the end of the second or 
 beginning of the third week, and it is rare after the 
 sixth month ; the usual period of its occurrence is 
 when the child is about three weeks or a month old. 
 No one can mistake the tainted infant ; the general 
 aspect is more or less marasmic ; the child presents 
 a shrivelled, " old man'Mike aspect ; the skin is 
 dirty and muddy, has lost its elasticity, and hangs 
 in loose folds ; it is dry, often exfoliating, and more 
 or less erythematous about the buttocks. The cry 
 of the child is harsh and cracked (characteristic), 
 8
 
 86 THE DESCRIPTION AND 
 
 and "the snuffles, produced by inflammation and 
 u Ice rat ion of the nasal mucous membrane, are pre- 
 sent." The disease is further characterized by the 
 presence of mucous tubercles about the anus or 
 mouth ; fissures at the angles of the mouth ; ulcera- 
 tion of mucous surface ; a high arched palate ; in- 
 flammation of the thy mus gland ; various eruptions 
 over the body, especially about the feet and hands, 
 in the form of erythemata or bulhu ; a subacute 
 onychia is possibly present; and these, together 
 with a family history of sj'philis, are diagnostic. 
 
 With regard, however, to the eruption, it is gene- 
 rally in the form of a dull-red erythema of the 
 hands, feet, and perianal region, with or without 
 tubercular formations ; but it may in cachectic sub- 
 jects consist in ngly ulcerations arising out of tuber- 
 cles, bullae, or pustules. 
 
 The treatment consists in gently mercurializing 
 the child by the use of gray powder or mercurial 
 inunction (a small portion of blue ointment being 
 rubbed into the soles of the feet each night), in 
 keeping up the nutrition of the body by good food, 
 by giving cod-liver oil and chlorate of potash, and, 
 if the child is nursed, in giving the nurse a course 
 of iodide of potassium. 
 
 Acquired syjihilis. When in the adult an erup- 
 tion is due to this cause, there is usually imparted 
 to it a coppery tint, and a more or less circular form ; 
 the general distribution of the eruption is notice- 
 able, and generally there is absence of pain and
 
 TREATMENT OF SKIN DISEASES. 87 
 
 itching; there is a polymorphism about it i. e., 
 papules, tubercles, and ulcers (occasioning loss of 
 substance), etc., occur together ; cachexia, ulcerated 
 throat or tongue, alopecia, nocturnal pains in dif- 
 ferent parts are often concomitants ; and a history 
 of the primary disease may be connected by different 
 links with the present condition by a series of sy- 
 philitic occurrences. 
 
 Syphilodermata may be divided for all practical 
 purposes into three groups ; (a) those that are 
 byperaemic ; (b) those that have deposit (or new 
 tissue formation) as the main feature; and (c) 
 degenerative lesions, the result of suppuration and 
 ulceration of the syphilitic new tissue formed in the 
 skin. 
 
 The following sketch may throw light on this 
 subject. The first effect of the syphilitic poison 
 upon the general system is to give rise to syphilitic 
 fever and transitory hyperseinic lesions, as roseola 
 and erythema. Sufficient time having elapsed for 
 the action of the poison upon the nutrition of the 
 textures, a second period ensues, in which modifi- 
 cations of their normal growth take place that is, 
 new tissue is formed (granulation or syphilitic 
 tissue), and the results appear in the form of 
 papular, tubercular, squamous, and pustular erup- 
 tions, mucous tubercles, gummata, etc. But mean- 
 while the circulating poison has caused the skin 
 glands to inflame (syphilitic acne), and the follicles 
 (syphilitic lichen). These commence also in hy-
 
 88 THE DESCRIPTION AND 
 
 peroemia of the sebaceous glands and follicles, but 
 now not of a transient character, but followed up 
 by infiltration of granular tissue into and about the 
 parts. The nerve-trunks also may become irritated 
 by the poisoned blood, or the deposit about them, 
 and herpes and pemphigus occur as a consequence. 
 A common occurrence is so-called syphilitic palmar 
 psoriasis, which consists in a hard, indurated, 
 cracked, scaly surface, or hard tubercles about the 
 palm of the hand, and in connection with other 
 signs of syphilis. The further stage of syphilis of 
 tin- skin consists in the infiltration by the syphi- 
 litic granulation tissue of the deeper parts, and 
 more extensively than before of the superficial 
 ones, whilst the patient's general health becomes 
 cachectic. Then, in this third stage the syphilitic 
 tissue softens up, suppurates, or ulcerates ; and 
 this latter stage is characterized by degenerative 
 changes in the syphilitic deposit in different parts, 
 as is seen in ulcers, onychia^ etc. 
 
 Treatment. Internally in the papular, tuber- 
 cular, squamous, and pustular syphilides, mercurial 
 treatment is called for, and the bicyanide pill (105) 
 is the best form, and the pill may be given for 
 three or four weeks, or omitted before the gums 
 begin to be affected. See also (84 et seg.) and (104). 
 Iodide of potassium may be given at the same time 
 in increasing doses. In the ulcerating forms, if the 
 patient be well nourished and pretty strong, there 
 is no objection to a mercurial course; but where
 
 TREATMENT OF SKIN DISEASES.. 89 
 
 cachexia is marked, and the patient's condition is 
 one of evident debility, iodide of potassium, with 
 cod-liver oil, or iodide of iron and good food, con- 
 stitute the best treatment. In cachectic, subjects, 
 who are debilitated, restless, and irritable, opium 
 given internally is of much service. In reference 
 to iodide of potassium, it must be borne in mind 
 that its use is beneficial in direct proportion to the 
 duration of the disease; hence when nodes, tuber- 
 cles, caries, and secondary ulcers are present, or 
 when mercury has been fully used or apparently 
 failed, the dose should be gradually increased by 
 three or four grains every few days, until in the 
 case of old-standing and ulcerating syphilis it 
 reaches thirty or forty grains. In most cases the 
 exhibition of the decoction of various woods is 
 advisable ; the compound decoctions of sarza and 
 guaiacum are the best; they keep the skin and 
 bowels acting freely, and thus very materially help 
 the elimination of the poison. 
 
 When a patient 1s under the influence of mercury 
 he should avoid stimulants, cold, and other sources 
 of irritation and catarrh ; the indulgence in stimu- 
 lants, indeed, is a source of infinite harm, and a 
 common cause of aggravation of syphilis of the 
 skin. The diet should be good and nutritious, and 
 the administration of mercury should always be 
 followed up by a course of mineral acids and 
 bitters, or iron and quinine, etc. ; or tonics may be 
 8*
 
 90 THE DESCRIPTION AND 
 
 given simultaneously with the specific remedy, 
 and with a liberal hand if the general health is had. 
 
 Mercurial fumigation, which acts both locally 
 and generally, is in great favor with some practi- 
 tioners. If the skin eruption is extensive it may 
 be employed twice or more a week. 
 
 Locally, the erythematous forms require no 
 special application, but a lotion of oxide of zinc and 
 calamine may be used. Should they be obstinate 
 and leave behind any papules, a white precipitate 
 ointment may be used. The squamous and papular 
 eruptions are relieved by calomel ointment, bichlo- 
 ride lotion, and nitric oxide of mercury ointments. 
 The tubercular and ulcerating forms are those 
 which require special local medication; in the 
 former, the weak nitrate, or nitric oxide of mercury 
 ointments, are those more especially useful, and 
 nitrate of mercury may be cautiously used to de- 
 stroy obstinate indurations ; ulcers may be dressed, 
 if painful, with a solution of watery extract of 
 opium, or be dusted over with calomel, or be stimu- 
 lated with the nitric oxide of mercury ointment, 
 dilute nitric acid, and borax lotions (45), (02), (<'>'!), 
 or treated by the local application of mercurial 
 vapor. Should ulcers be very foul and dirty-look- 
 ing iodide of starch (52) is a good remedy, and when 
 ch'ansed the sore may be dressed by a weak mercu- 
 rial application or astringent wash. Formula) (3), 
 (7), (23), (58), (59), (60), (Gl), (80), (81), (82), 
 (83), may be referred to.
 
 TREATMENT OF SKIN DISEASES. 91 
 
 Tinea is the generic term given to the vegetable 
 parasitic diseases, which are here enumerated : 
 
 1. Tinea favosa or favus, caused by a fungus 
 called achorion Schonleinii. 
 
 2. Tmea to^surans, or ordinary " ringworm" of 
 the scalp, caused by the trichopfiyton tonsurans. 
 
 3. Tinea kerion is a modification of the last, and 
 is caused by the same parasite. 
 
 4. Tinea circinata, or ordinary ringworm of the 
 body, includes Burmese ringworm, Malabar itch, 
 Chinese ringworm, etc, and is caused by the tricho- 
 phyton tonsurans also. 
 
 5. Tinea sycosis or mentagra, or sycosis parasi- 
 tica, is caused by the microsporon mentagraphytes. 
 
 6. Tinea versicolor, or Chloasma, or Pityriasis 
 versicolor, is caused by the microsporon furfur. 
 
 7. Tinea decalvans, or area, or alopecia (one 
 form), is caused by the microsporon Audouini. 
 
 There are two other parasitic diseases which may 
 be mentioned here viz., Mycetoma, or the madura 
 foot or fungus foot of India, caused by the cliionyphe 
 Carteri; and Onychomycosis, or onychia parasitica, 
 alluded to at p. 64. 
 
 Tinea favoso is rare in England. It attacks the 
 young, and is known by the presence of dry, light, 
 sulphur-colored, cup-shaped, umbilicated crusts, 
 made up of fungus elements, and pierced in the 
 centre by a hair from the underlying follicle. 
 These crusts may run together into a confused mass 
 in some cases.
 
 92 THE DESCRIPTION AND 
 
 Treatment. The point is, after getting ofF all the 
 crusts by oil soakage, to destroy the parasite by 
 sulphurous acid lotion, and then epilate bit by bit 
 of the surface, and apply such parasiticides as 121, 
 122, 134, 136, until the microscope shows that the 
 hair is free from fungus. 
 
 Tinea tonsurans is very common, but almost 
 unknown in the adult. It is sometimes epidemic 
 in schools, spreading from child to child by con- 
 tagion. The typical disease consists of circular 
 patches, varying from a sixpence to a five-shilling 
 piece in size or larger, having a slightly raised and 
 scurfy surface, the hairs on which are dry, brittle, 
 lustreless, and broken off close to the scalp. This 
 condition is caused by the fungus attacking the 
 hairs a fact easily shown by soaking a diseased 
 hair in weak potash solution, and then examining 
 it under the microscope ; it will be seen that the 
 hair is invaded to a greater or less degree by the 
 conidia of the triehophyton tonsurans. These 
 conidia, when very numerous, besides crowding 
 around the hair shaft, collect into parcels within, 
 and separate the fibres of the shaft one from another, 
 so that the hair is split up. These short, broken-off, 
 opaque, dull hairs are diagnostic. Tinea tonsurans 
 and tinea circina.la are often observed in the same 
 subject, and, in fact, they are essentially the same, 
 only that one occurs on hairy, the other on non- 
 hairy parts. 
 
 Treatment. If the fungus has not got deeply
 
 TREATMENT OF SKIN DISEASES. 93 
 
 into the follicle, it can readily be destroyed : there- 
 fore the more recent the disease the more easily 
 can it be cured. In very recent cases, two or three 
 applications of the tincture of iodine of double 
 strength, or a blistering, may almost if not quite 
 cure ; this should be followed by the use for awhile 
 of some mild parasiticide, as (121) or (122). The 
 hair should be cut off the scalp for an inch or so 
 around and about the diseased patches. 
 
 In chronic cases, if there are many patches scat- 
 tered over the head, the whole hair should be 
 shaved or cut off close to the scalp ; and, if much 
 diseased, the whole head may be soaked in sulphur- 
 ous acid lotion (125, one part to three or four of 
 water) for a week, to get rid of the disease on the 
 mere surface. Then it is well to epilate over a cer- 
 tain area day by day, subsequently apptying (130) 
 cautiously for seven or eight or more applications 
 at intervals of three or four days. The application 
 will form a cake, and this should be removed by 
 grease or soap in a day or two, or when it begins to 
 "flake off," and before a fresh application is made. 
 Blistering may be used instead. In getting off 
 the caking, a number of diseased hairs come away 
 entangled in the flakes, and this may serve in place 
 of a repetition of epilation. It is no use applying 
 (.136) to the surface whilst the cake is on it, but a 
 clear surface must be obtained about three days or 
 so after an application. It is advisable to continue 
 the applications until the hair begins to grow out in
 
 04 TIIE DESCRIPTION AND 
 
 a natural direction and manner, and then to apply 
 some mild parasiticide, as (128) or (134). In severe 
 cases, epilation must be carried out again and again 
 over tlie patches, and parasiticides must not be dis- 
 continued as long as a single broken-off hair can be 
 detected, or any little dark stub.s are visible, or until 
 the hair grows evenly and well over the surface. 
 The parasiticides that are used are very multitudi- 
 nous; a few suggestions will be found in the Cuta- 
 neous Pharmacopoeia. 
 
 Tinea circinata, or ringworm of the body, is 
 characterized by the occurrence of patches which 
 are red, scaly, and itchy, circular in form, and with 
 a well-defined edge. It begins as a little red scurfy 
 spot which gradually enlarges, and when it has 
 reached a fair size the skin in the central part may 
 be apparently healthy; usually the edge looks red 
 and scaly, the centre generally somewhat paler and 
 less scaly, though covered with a branny de.squania- 
 tion. The edge of the patch may be vesicular, and 
 the disease is evidently inflammatory, though ex- 
 cited by a fungus that spreads equally in all direc- 
 tions, and so produces the circular form. The 
 inflammation falls short of that which occurs in 
 eczema. Any scurfy, red, itchy patch then on the 
 surface of the body should always be examined for 
 fungus elements. The fungus is the same that occa- 
 sions tinea tonsurans, and the two diseases often 
 occur together. 
 
 In hot climates especially, the fungus sometimes
 
 TREATMENT OF SKIN DISEASES. 95 
 
 luxuriates upon the skin, particularly in the myee- 
 lial form, and hence tinea circinata occurs in very 
 large patches, that are very hyperremic at their ex- 
 tending, well-defined edge, but with desquamating 
 and slightly scaly centres. In the fork of the thigh 
 and contiguous parts, patches that have the charac- 
 ters of tinea circinata in an exaggerated form occur, 
 and are characterized particularly by the festooning 
 downwards over the thigh from the groin of a red, 
 scaly, itchy patch, that has a well-defined circular 
 and papular edge. This is the Burmese or Chinese 
 ringworm. 
 
 Treatment. This is always successful. The con- 
 stant use of some such parasiticide as (122), (128), 
 or simple tincture of iodine, or an ointment made 
 of five grains of white precipitate and ten to twentj' 
 of carbolic acid, will always cure the disease. 
 
 Tinea sycosis In this disease, which is very 
 rare in England, unlike non-parasitic sycosis (see 
 Sycosis), the hairs are loosened, rendered brittle, 
 and, in fact, changed as in tinea tonsurans, and the 
 disease is to be treated in a similar manner. 
 
 Tinea versicolor (Pityriasis versicolor or Chlo- 
 asma). This disease consists of fawn-colored 
 patches occurring in the parts covered by flannel, 
 especially the front of the chest and the root of the 
 neck. The patches vary in size, and may dot over 
 the surface or run together so as to cover uniformly 
 a large area. They are raised and itch}', and scales 
 can be scraped from them, which under the micro-
 
 96 THE DESCRIPTION AND 
 
 scope are seen to be invaded by conidia (in heaps) 
 and the mycelial threads (very wavy) of the fungus 
 the microsporon furfur. The disease is some- 
 times mistaken for syphilitic maculae, but the latter 
 are not raised, not itchy, and not scurfy. 
 
 Treatment Apply (127) regularly and for about 
 ten days or so after all appearance of the disease 
 has vanished. 
 
 Tinea kerion is simply tinea tonsurans in which 
 the hair follicles are a good deal inflamed and pour 
 out an albuminous fluid. The special features of 
 the disease are the general prominence of the 
 patch; its perforation with foramina id ext. t he- 
 swollen mouths of the hair follicles; the outpouring 
 of a mucous fluid ; the non-suppuration of the 
 swelling, which, although feeling boggy and ns 
 about to suppurate, should never be opened; and 
 the looseness of the hairs. The disease leaves 
 temporary bald patches behind, and the fungus is 
 observed to have invaded the hairs, as in tinea 
 tonsurans. 
 
 Treatment. Allay the inflammation; cpilate ; 
 and then use some very mild parasiticide, as in 
 ordinary ringworm. 
 
 Tinea decalvans, see Alopecia. 
 
 Urticaria, or Nettlerash The features that 
 attract attention as altogether diagnostic of this 
 affection are first I;/, tin- sudden way in which the 
 erythematous rash appears and disappears, or, in 
 other words, the capriciousness of the eruption ;
 
 TREATMENT OF BKIN DISEASES. 9T 
 
 secondly, the development of "wheals," like those 
 caused by the stings of nettles, in the centre of the 
 red hyperaemic patches. It has differences as it 
 occurs in the adult and child. 
 
 In the adult the wheals are always well marked, 
 and leave no trace of their presence behind when 
 the}" disappear. The urticaria may be acute, gene- 
 rally the result of some dietetic error for instance, 
 the eating of shell-fish or some unwholesome irri- 
 tating food, as potted meats, and there is pyrexia 
 often of a severe character, with even vomiting and 
 prostration. The skin itches dreadfully, and then 
 out comes the wheal eruption. Sometimes the face 
 is attacked and swells enormously, but the erup- 
 tion at once discloses the nature of the case. 
 
 In the child the wheals are not so distinct, and 
 are followed by the development of little fleshy 
 papules hence the term lichen urticatus. These 
 papules become " pruriginous" in proportion as the 
 disease is chronic. 
 
 In both children and adults the disease may be 
 primary and idiopathic, or secondary to some other 
 disease, as scabies and phthiriasis. In the latter 
 there will be a history of antecedent disease of the 
 kind mentioned, and the actual concomitants of the 
 symptoms of these diseases. In the idiopathic form 
 the hyperaemia and wheals exist as the sole disease 
 present. 
 
 Treatment. In the adult in the acute form an 
 emetic may be given if need be, with alkalies, and 
 9
 
 98 THE DESCRIPTION AND 
 
 a slight aperient. Chronic urticaria in the adult is 
 much more troublesome. There is no pyrexia, l>ut 
 constant recurrence of redness and wheals with 
 heat and itching. Assuming the existence of an 
 irritable state of skin, the eruption appears to be 
 kept up by dyspepsia and uterine or liver disorder. 
 Large doses of alkalies internally, followed by (95), 
 and, if desirable, arsenic, with bran and alkaline 
 baths (la and 16), or vapor baths if the skin does 
 not act properly, are beneficial. Such lotions as 
 (18), (23), (26), (27), (30), (31), (33), and many like 
 ones may be used. A similar line of treatment 
 must be adopted for the child in the early stages, 
 though care should be taken to keep the kidneys 
 acting well, and to give cod-liver oil if the health 
 is poor. Locally, soothing remedies arc needed (74) ; 
 but sulphuret of potassium baths in chronic cases 
 are very efficacious. Ointments of storax or calomel 
 and belladonna will be found successful in aiding 
 accompanying pruritus, especially if excited by 
 animal parasites, such as bugs, fleas, lice, etc. 
 
 Vitiligoidea. This is the term applied to the 
 buff-colored patches that form, especially at the inner 
 canthus of the eye, in those who have suffered from 
 chronic liver disorder and have had jaundice. It 
 occurs also about the general surface of the body 
 as yellow or buff nodules. The treatment required 
 is that for hepatic disease. 
 
 Xanthelasma as the term given by Mr. Wilson 
 to Vitiligoidea.
 
 TREATMENT OP SKIN DISEASES. 99 
 
 Xanthelasmoidea is a term given to certain 
 buff-colored patches that appear in a scattered form 
 in young children, resembling Xanthelasma. It is, 
 however, very rare, and has no connection with 
 jaundice. 
 
 Xeroderma, see Ichthyosis. 
 
 Zoster, see Herpes.
 
 PART III. 
 
 CUTANEOUS PHARMACOPOEIA. 
 
 BATHS. 
 
 1. THE quantity of water in a bath is estimated 
 at thirty gallon*, and the temperature of the water 
 should be from 90 to 95 F. 
 
 (a:) Bran and gelatine bath. The quantities to 
 be used are of bran, 2 to 6 ft ; of gelatine, 1 to 3 
 tb ; or of size, 2 to 4 lb. Used in all erythematous 
 and itchy and scaly diseases. 
 
 (6.) An alkaline bath is made with from 3*ij to 3*x 
 of bicarbonate of soda, or 3"iij of borax. It is some- 
 times useful to add to the bicarbonate of soda some 
 bran liquor made by infusing bran in hot water. 
 Used in eczema, psoriasis, urticaria, lichen, and 
 prurigo, where there is much local irritation. 
 
 (c.) An acid bath is made with sj of nitric or 
 muriatic acid or a mixture of the two (3j of each). 
 Used in chronic lichen and prurigo. 
 
 (d.) Sulphurated potash bath has gij to s"iv to 
 each bath. The compound sulphur bath of Startin 
 has 3*ij of sulphur (prrecip.), 5j of hyposulphite of 
 soda, and 353 of dilute sulphuric acid with a pint of
 
 CAUSTICS. 101 
 
 water. Used in itch, chronic eczema, lichen, and 
 psoriasis. 
 
 FUMIGATION. 
 
 2. To administer a medicinal vapor bath, heat is 
 to be applied simultaneously to the drug and a 
 small tray of water, so that steam and the vapor 
 of the drug may arise and surround the patient's 
 body together. The necessary apparatus may be 
 obtained at any instrument-maker's or easily be im- 
 provised. A quarter of an hour should usually 
 suffice for the proper action of the bath. 
 
 For a mercurial bath fifteen to thirty grains of 
 calomel, and for a sulphur bath from one to two 
 ounces of sulphur should be used. 
 
 CAUSTICS. 
 
 3. Calomel, Sijss; bisulphide of mercury, 9ij ; 
 arseuious acid, 3j. Used in lupus, scrofulous ulcers, 
 and syphilis. Dupuytren. 
 
 4. Caustic potash and water in equal parts. Use- 
 ful in liqjus. 
 
 5. Acid nitrate of mercury, made by dissolving 
 3j of mercury in Ij of nitric acid (sp. gr. 1.40). 
 Used in neoplasmata, etc. 
 
 6. Chromic acid, 3j ; water, 3iv. Used for warts, 
 lupus, etc. 
 
 7. Powdered savin; perchloride of mercury; red 
 oxide of mercury, aa 5j- Used for condylomata and 
 warts. Langston Parker. 
 
 9*
 
 102 CUTANEOUS PHARMACOI'(I A. 
 
 8. Carbolic acid, 1 part; alcohol, 1 4 parts. 
 Used in lupus, syphilitic ulcers. 
 
 9. Nitrate of zinc, 1 part ; bread mass, 2 or 3 
 part--. Used in lupus, spread thinly on the part. 
 
 ASTRINGENTS. 
 
 Alum and Zinc. 
 
 10. Alum, gr. xx; sulphate of zinc, gr. x; 
 glycerine, 5j ; rose water, oiv. Used in erythema, 
 interlrigo, eczema. 
 
 Tannic Acid. 
 
 11. Tannic acid, gr. xl ; French vinegar, % ss ; 
 distilled water, 3viiss. Used in seborrhcea 
 Neligan. 
 
 Myrrh and Zinc. 
 
 1 2. Tincture of mj'rrh, gtt. xxx ; zinc oxide, gr. 
 xx ; cold cream, 5J. Used in prurigo, erythema, 
 lichen. Neligan. 
 
 Bismuth and Vaseline. 
 
 13. Trisnitrate of bismuth, 9ij ; lead solution, 
 30 drops ; vaseline, 3j. For intertrigo, eczema, etc. 
 
 Zinc and Glycerine. 
 
 14. Zinc oxide, 3U ; glycerine, 3U 5 lead water, 
 Siss; lime water, svj to 5viij. Used in the secre- 
 tory stage of eczema, in acne, lichen, foul ulcers, 
 impetigo, herpes.
 
 SEDATIVES. 103 
 
 Borax and Glycerine. 
 
 15. Borax, 9j or 3J I glycerine, 5U 5 r ose water, 
 3viij. Used in squanious diseases. 
 
 Acid and Lead. 
 
 10. Dilute hydrochloric or nitric acid, 3ss ; lead 
 acetate, gr. v to x; glycerine, 5iss ; water, 3 V J- 
 Used in eczema and lichen. 
 
 Alum. 
 
 IT. Alum, 5U 5 infusion of roses, .sxx. Used 
 in acne* pityriasis^ and eczema (sine crustis). 
 Cazenave. 
 
 SEDATIVES. 
 
 Soda. 
 
 18. Carbonate of soda, 5ss ; conium juice, j 
 elderflower water, vj. Used in eczema, lichen, 
 urticaria, to allay itching. 
 
 19. Bicarbonate of soda, 3 j 5 glycerine, Jiss ; 
 elderflower water, viss. Used as above and in 
 acne punctata. 
 
 20. Borax, 3ij 5 cherry laurel water, 3j 5 elder- 
 flower water, o^ij. Used in lichen. 
 
 Morphia. 
 
 21. Borax, ^ss; sulphate of morphia, gr. vj ; rose 
 water, sviij. Used in pruritus vulvae. Meigs. 
 
 22. Solution of hydrochlorate of morphia, ^iss ;
 
 104 CUTANEOUS PHARMACOPEIA. 
 
 solution of potash, 5U ; glycerine, sj ; cherry laurel 
 water, sj ; elderflo\vi.>r water, to 3"xij. Used in 
 pruriginous eruption*. 
 
 Hydrocyanic Acid. 
 
 23. Perchloride of mercury, gr. j ; dilute hydro- 
 cyanic acid, 3J 5 emulsion of almonds, 3*vj. Used 
 in itching, lichen, and prurigo. 
 
 24. Dilute hydroc3~anic acid, 5j 5 solution of ace- 
 tate of ammonia, sij; tincture of digitalis, 5'U I 
 rose water, 5\ r . Used in pruritus, prurigo, lichen, 
 urticaria. Thomson. 
 
 25. Dilute hydrocyanic acid, 3ij ; borax, 5j ; rose 
 water, sviij. Used in pruritus of old people. 
 Neligan. 
 
 Cyanide of Potassium. 
 
 26. Cyanide of potassium, gr. vj ; cochineal, gr. j ; 
 cold cream, sj. Used in pruritis, urticaria. 
 Anderson. 
 
 27. Cyanide of potassium, gr. xv; water, sviij. 
 Used in pudendal irritation, lichen, and prurigo. 
 Hardy. (N. B.) Keep it in a dark place. 
 
 Chloroform. 
 
 28. Carbonate of lead, 3 SS 5 chloroform, n^iv ; 
 cold cream, sj. Used in pruritus. 
 
 29. Cyanide of potassium, gr. iv ; chloroform 
 n^viij ; glycerine, 5j 5 white wax ointment, 5 V J- 
 Used in pruritus Neligan.
 
 SEDATIVES. 105 
 
 30. Chloroform, 3j ; glycerine, 5iv. Duparc. 
 
 31. Bichloride of mercury, gr. iss ; chloroform, 
 n^xx ; glycerine, 5*ij 5 rose water, 3*vj. Used in 
 itching, papular, and vesicular diseases, and urti- 
 caria. Burgess. 
 
 Belladonna. 
 
 32. Extract of belladonna, 3*ss; dilute hydro- 
 cyanic acid, s*ss ; glycerine, |j ; water, 3"xiv. Used 
 in papular and phlegmonous affections. Startin. 
 
 Benzole Acid. 
 
 33. Benzoic acid, 40 to 60 grains to 3vj of water. 
 Used in urticaria to allay itching. Ringer. 
 
 Digitalis. 
 
 34. Tincture of digitalis, 3'j to ^iv; glycerine, 
 3"ss; rose water, 3 vj. Used in pruritus of a purely 
 neurotic character. 
 
 Lead. 
 
 35. Carbonate of lead, gr. iv; glycerine, 3J ; sim- 
 ple cerate, j. Used in erythema. 
 
 36. Glycerine, subacetate of lead, and vaseline. 
 Made by Squire, 2T7 Oxford Street. In intertrigo, 
 eczema. 
 
 Acetate of Ammonia. 
 
 37. Solution of acetate of ammonia, 3 ij ; alcohol, 
 ^ss; rose water, ^iv. Used in lichen. Burgess.
 
 106 CUTANEOUS PUARMACOP(EIA. 
 
 Carbolic Acid. 
 
 38. Liquid carbolic acid, ss ; water to Oj. Used 
 to allay itching in chronic eczema or psoriasis. 
 
 Zinc. 
 
 39. Oxide of zinc, 5u ; solution oflead, 5j 5 wine 
 of opium, 5j > PPPy decoction, iv. Used in 
 eczema, herpes, etc. 
 
 40. Oxide of zinc, 5j 5 carbonate of lead, 5j 5 
 spermaceti, j ; olive oil, q. s. To make a soft 
 ointment. Used in seborrhcea, where the skin is 
 inflamed Neumann. 
 
 Camphor. 
 
 41. Camphor, 3 s s; alcohol, q. s. ; oxide of zinc, 
 starch, aa Jj. Used as a powder to allay burning 
 heat of eczema. Anderson. 
 
 42. Camphor, gr. viij ; tincture of conium, 3U 5 
 simple cerate, |j. Neligan. 
 
 43. Camphor, 3ss or 3j ; alcohol, sj ; borax, 3ij ; 
 rose water, sviij. Used in pruritus^ eczema, and 
 the erylhemata. 
 
 44. Sulphate of atropine, gr. j; borax, 5ij ; gly- 
 cerine, 5i'j ; distilled water to sxij. Used to allay 
 pruritus in various diseases where skin is not 
 abraded. 
 
 Borax. 
 
 45. Borax, 9ij ; carbonate of soda, 3j ; gly- 
 cerine, 3iss 5 dilute hydrocyanic acid, n^xxx; dis-
 
 STIMULANTS AND ABSORBENTS. 107 
 
 tilled water, ^vj. Used in vesicular and sebaceous 
 diseases. 
 
 46. Borax, 9ij ; oxide of zinc, 5j I solution of 
 subacetate of lead, 5U 5 lime water, SYJ to ^viij. 
 Used in eczema and herpes. 
 
 47. Borax, 3j to 5ij ; glycerine, 5j ; lard, |j. 
 Used in parasitic diseases, eczema, erythema, inter- 
 trigo, lichen. 
 
 ABSORBENT POWDERS. 
 
 48 (a). Powdered maize, |iv; oxide of zinc, j ; 
 calamine, $ss. Used to excoriated surfaces. 
 
 48 (6). Powdered maize, iv; oxide of zinc, gj 5 
 iris powder, ^ss ; oil of almonds, gtts. x. 
 
 49. The white Fuller's earth, or Cimolite, pre- 
 pared by Taylor, Baker Street. 
 
 STIMULANTS AND ABSORBENTS. 
 
 50. Alcohol, oil-cade, soft soap, aa 5j ; oil of 
 lavender, 5iss. Used in eczema and psoriasis. 
 Anderson. 
 
 51. Soft soap, :|ij 5 spirits of wine, sj ; dissolve, 
 filter, and add spirits of lavender, 5U- Used in 
 seborrhosa. Kalicreme of Hebra. 
 
 Iodide of Starch Paste. (Univ. Coll. Pharm.) 
 
 52. Powdered starch, 1 part ; glycerine, 2 parts ; 
 water, 6 parts : boil together, and when nearly cold 
 add solution of iodine, 1 part. Useful to cleanse and 
 heal foul sores, especially such as are syphilitic.
 
 108 CUTANEOUS PHARMACOPEIA. 
 
 53. Load plaster, 533 ; almond oil, 588 ; hcnzoati-il 
 oxide of zinc ointment, sij. . To be used in eczema 
 as an astringent dressing. 
 
 54. lodoform, gr. xxx-lx ; lard, sj. Used to 
 dress painful burns, ulcers, chancres, and 
 
 Mercurial. 
 
 55. Calomel, 5j J lai'd? 3J- Used in herpes, 
 psoriasis, pruritus vulox. 
 
 56. The oleates of mercuiy, 5 and 10 per cent. 
 Useful in ringworm, syphilis, sycosis, etc. 
 
 57. Green iodide of mercur}', gr. ij to gr. xv ; 
 hu'd, oj- Used in acne. Hardy. 
 
 58. Calomel, 5j ; camphor, 3ss ; spirits of wine, 
 q. s. ; lard, 5j. Used in pruritus of the anal region, 
 and in syphilitic ulceration. 
 
 59. Bicyanide of mercury, gr. v to gr. x; lard, 
 5j. Used for syphilitic tubercles. 
 
 60. Red oxide of mercuiy, finely powdered, and 
 ammoniated mercury, aa gr. vj ; lard, 3j. The 
 " Unguentum mercuriale co." Used in sebaceous, 
 squamous, ulcerous, tubercular, and papular erup- 
 tions. Startin. 
 
 61. Iodine, 3ss ; glj^cerine, ,^ij ; olive oil, siijss; 
 strong mercurial ointment, 3ij. The Linimentum 
 hydrarg. et iodini of Startin. Used in tubercular 
 and cachectic affections. 
 
 62. Ammoniated mercury, gr. xx ; nitrate of 
 mercury ointment, gr. xx ; acetate of lead, gr. x; 
 oxide of zinc, gr. xx ; purified palm oil, sss; fresh
 
 STIMULANTS AND ABSORBENTS. 10'J 
 
 lard, 3ss. Used in eczema of the head, in children 
 especially. 
 
 63. Nitrate of mercury ointment, 5j ; solution of 
 lead, 5i gs > oxide of zinc, 5j ; carbolic acid, gr. v ; 
 fresh lard, j. Used in inflamed or irritable 
 psoriasis. 
 
 Sulphur, 
 
 64. Iodide of sulphur, gr. x to 5j ; lard, 5j Used 
 in acne. 
 
 65. Milk of sulphur, 5ij ; ether, Iss; spirits of 
 wine, 5i'j ; glycerine, 5iij 5 r ose water, svj. To be 
 dabbed on to indolent acne, indurata, or rosacea, 
 allowed to remain a moment or two, and then dried 
 off with linen. 
 
 66. Hypochloride of sulphur, 5U > carbonate of 
 potash, gr. x ; lard, gj ; oil of bitter almonds, gtt. x. 
 Used in acne Wilson. 
 
 67. Sulphur, glycerine, rectified spirits of wine, 
 carbonate of potash, sulphuric ether, equal parts. 
 To be rubbed on to the part affected with comedo 
 with friction. 
 
 Tar. 
 
 68. Tar, alcohol, aa 3j. Used in psoriasis chiefly. 
 
 69. Pyroligneous oil of juniper, 5j to 3j ; mutton 
 suet, 3ss ; -lard, 3j. Used in eczema and psoriasis 
 palmaris, etc. 
 
 70. Tar, 5j 5 camphor, gr. x; lard, 5*. Used in 
 pruritus, and in vesicular and papular diseases. 
 Baume". 
 
 10
 
 110 CUTANEOUS I' II A R M A C O P IE I A . 
 
 71. Detergent solution of tar, 5'j to sj ; glyce- 
 rine, 5ij 5 rose water to sviij. Used in chronic 
 scaly, itchy conditions (dilute hydrocyanic acid may 
 In- added, n^xxx). 
 
 Silver. 
 
 72. Silver nitrate, gr. ij to gr. x ; water, sj. 
 Used in eczema and erythemata. 
 
 Bismuth. 
 
 73. Bismuth nitrate, 5'j ; mercuiy perchloride, 
 gr. x ; spirits of camphor, 3ss ; water, q. s. ad sxvj. 
 Lotio bismuthi nitratis. Used in sebaceous, puslu- 
 lar, and vesicular diseases, and in pifyriasis. Use 
 diluted with 1 to 3 parts water. Startin. 
 
 Zinc. 
 
 74. Oxide of zinc, 5\j > calamine powder, sss ; 
 glycerine, 5'j 5 rose water, svj. Used in eczema, 
 especially where the surface is red and tender. A 
 grain of the perchloride of mercury may be added. 
 
 75. Sulphate of zinc, 5 SS 5 oxide of zinc, 5j; 
 alum, 5 j 5 glycerine, 5'j 5 r ose water to 3vj or 
 more. Used in scaly stages of eczema, indolent in- 
 tertrigo, etc. 
 
 Hebrd's Ung. DiacTiyli. 
 
 76. This is made by boiling together olive oil, 
 3 xv, and litharge, ^iij et 5 v ji to a good consistence, 
 and adding oil of lavender, 5ij- Used in eczema, 
 applied twice a day on linen.
 
 MIXTURES. Ill 
 
 17. Subcarbonate of soda, 3U ; extract of opium, 
 gr. x; slaked lime, 5j 5 lead, ^ij. Used for severe 
 itching in prurigo. Biett. 
 
 78. Nitrate of mercury ointment, 3ij 5 campho- 
 rated oil, glj'cerine, aa *ss. Used in psoriasis. 
 
 PLASTERS. 
 
 79. Camphor, $ss ; black pitch, 5vj ; yellow 
 wax, 5ix ; red oxide of lead, ijij ; olive oil, .51 v. To 
 be melted together till a little burned. Used in 
 boils. (Emplastrum fuscum.) 
 
 80. Mercury, ^iv ; turpentine, 3ij 5 yellow wax, 
 3iij ; lead plaster, oi ss - Used in acne rosacea 
 Neumann. (Emplastrum hydrargyri.) 
 
 81. Mercurial plaster, soap plaster, aa oj- Used 
 for syphilitic papules, tubercles, and indurations 
 generally. 
 
 82. Ammoniated mercury, 3ss; soap plaster, ss. 
 Used in syplnlitic excoriations and ulcerations. 
 Sigmund. 
 
 83. Red oxide of mercury, 3ss ; ammoniated mer- 
 cury, 3 SS I soap plaster, oU- Used in syphilitic 
 cracks and fissures about the hands, indurations, 
 etc. 
 
 MIXTURES. 
 
 84. Perchloride of mercury, gr. T \ to ^ ; dilute 
 hydrochloric acid, gtt. x; water, |j. Take for one 
 dose. 
 
 85. Perchloride of mercury, gr. j ; iodide of po-
 
 112 CUTANEOUS PHARMACOPOEIA. 
 
 tassium, 5U ; water, siij. A dessertspoonful throe 
 times a clay. Used in acne Burgess. 
 
 86. Perchloride of mercury, gr. T J ff ; iodide of po- 
 tassium, gr. v; compound tincture of iodine, n^iij ; 
 water, ^iss. Twice a day. Used in syphilis. 
 
 87. Perchloride of mercury, gr. to ^ ; arscnious 
 acid, gr. ^ to ^ ; water, Jss. For one dose in 
 chronic syphilis. 
 
 88. Iodide of potassium, 3ss Jiij ; sal volatile, 
 5iij ; syrup of orange-peel, 5iv ; water to sviij. A 
 sixth part with half a tumbler of water twice a day. 
 The dose of iodide of potassium may be increased 
 gradually up to gr. xxx if required.. Used in secon- 
 dary and tertiary syphilis. 
 
 89. Iodide of potassium 5 s s and upwards ; po- 
 tass io-tart rate of iron, 3 j 5 syrup, sss; water, s*vj. 
 One-sixth part for a dose in chronic syphilis in 
 anaemic subjects. 
 
 90. Wine of ijron, 3*iss ; simple syrup, sss; 
 Fowler's solution, gtt. xlviij ; distilled water, to 
 S*vj. Dose: a tablespoonful twice or thrice a d;iy. 
 
 91. Fowler's solution, n^lxxx; iodide of potas- 
 sium, gr. xvj ; iodine, gr. iv ; orange-flower w:iU-r, 
 Sij. Dose: a teaspoonful with water three times a 
 day. Used in eczema. Neligan. 
 
 92. Cod-liver oil, 3ij ; yolk of egg, ny ; Fowler's 
 solution, rtLlxiv ; syrup, 3'j 5 distilled water, q. s. 
 ad siv. Dose: one teaspoonful three times a day. 
 Wilson.
 
 MIXTURES. 113 
 
 93. Arscniate of soda, gr. i to ij : distilled water, 
 5\ - iij. Dose: one tablespoonful twice daily. 
 
 94. Hydrochloric solution of arsenic, 3ss ; dilute 
 hydrochloric acid, 5j 5 tincture of the perchloride 
 of iron, 3iss to Jiij 5 water, 3*viij. Dose: a sixth 
 part three times a day. In psoriasis and eczema 
 in anaemic subjects. 
 
 95. Sulphate of magnesia, 5iij ; sulphate of iron, 
 gr. xij ; dilute sulphuric acid, 5ss; infusion of quas- 
 sia, q. s. ad sviij. Dose : one-sixth part twice daily. 
 Used in acne, eczema, impetigo, and ulcerous affec- 
 tions. Quinine may be added if desirable. 
 
 96. Sulphate of magnesia, 5iv; carbonate of 
 magnesia, Jj ; tincture of colchicum, n^xxxvj ; oil 
 of peppermint, n^ij ; water, 3*viij. Dose: a sixth 
 part. Used in crythemata, popular, and acute 
 forms of disease in loaded habits. 
 
 97. Bicarbonate of soda, Jiij; tincture of calumba, 
 5'iij ; sal volatile, 5iij j dilute hydrocyanic acid, 
 n^viij ; syrup of ginger, 5iij I water, 5\-j. Dose: 
 a sixth part an hour before two principal meals. 
 Used in dyspepsia. 
 
 98. Acetate of potash, 3j ; acetic acid, Jss ; 
 spirits of nitrous ether, ,?iss; fluid extract of 
 taraxacum, 3 i]< Dose: a teaspoonful with water 
 before meals. Used in acne indurata Bulkley. 
 
 99. Iodide of sodium, gr. Ix; compound decoction 
 of sarsaparilla, o v HJ- Dose: a sixth part three 
 times a day in obstinate syphilitic eruptions, where 
 iodide of potassium disagrees or fails. 
 
 10*
 
 114 CUTANEOUS P II A R M A C P ( I A . 
 
 100. Turpentine rectified, 5ss to3iss; crensote, 
 n^iij; spirits of rosemary, n\,xl ; water, q. s. ad 
 iv. Dose: two teaspoonfuls every three hours. 
 Used mpurpura. Budd. 
 
 101. Acid tartrate of potash, 5iij ; decoction of 
 broom, gvj. Dose : two tablespoonfuls three times 
 a day. Used as a diuretic and aperient in eczema 
 of the legs with oedema. 
 
 102. Acetate of potash, 3i'j 5 vinegar of squill, 
 5iij ; sweet spirits of nitre, n^xx ; compound 
 decoction of broom, Sviij. Dose: a sixth part 
 thrice a da} r . Used as a diuretic, where the skin is 
 very hypenemic and the urine not freely voided. 
 Digitalis may be added if desired. 
 
 103. Strychnine, gr. ^ 1 ; dilute phosphoric 
 acid, 5'ij ; tincture of orange-peel, 3ss ; infusion of 
 cloves, 3xj. Dose: half an ounce three times a 
 da} r . Used in prurigo and lichen. 
 
 PILLS. 
 
 104. Red iodide of mercury, gr. j to ij ; extract 
 of gentian, 9 ij. Make 12 pills. One pill twice a 
 day. 
 
 105. Bicyanide of mercury, gr. j; quinine, gr. 
 xx ; extract of gentian, gr. xxx. To make 20 pills. 
 One twice a day. Used in ordinary syphilitic 
 eruptions. 
 
 106. Arseniate of soda, gr. ij ; water sufficient to 
 dissolve; guaiacum powder, 5ss ; sulphurated mer- 
 cury, 9j. Mucilage sufficient to make 24" pills.
 
 REMEDIES FOR PHTIIIRIASIS. 115 
 
 One pill two or three times a day. Used in chronic 
 skin diseases. Wilson. 
 
 107. Levigated arsenious acid, gr. v ; powdered 
 acacia, 5 SS j cinnamon powder, 5*0 > glycerine, 
 enough to make 100 pills. (Pil. arsenicalis comp.) 
 Dose : one or two a day. 
 
 108. Arsenious acid, gr. j; quinine, gr. 20-30; 
 dried sulphate of iron or reduced iron, gr. xl-lx ; 
 extract of hop, gr. x ; extract of gentian, q. s. To 
 be well mixed and divided into 20 or 16 pills. One 
 twice a day after a meal.. Used in chronic skin 
 diseases with debility. 
 
 109. Quinine gr. 1 to 2; reduced iron gr. ij ; ex- 
 tract of mix vomica gr. ^ ; extract of chamomile 
 gr. j. To be taken twice or thrice a day. 
 
 REMEDIES FOR SCABIES AND 
 PHTHIRTASIS. 
 
 110. Sulphurated potash, ^vj ; hard soap, fbij ; 
 olive oil, Oij ; oil of thyme, 3ij. Used in scabies 
 and prurigo. 
 
 111. Olive oil, Jij; sulphate of potash, 3xv; 
 sulphate of soda, 3xv; precipitated sulphur, 3x 
 Used in scabies. Mollard. 
 
 112. Sulphur, tar, aa 3vj ; soft soap, lard, aa 
 ^xvj ; chalk, Jiv. Used in scabies. Hebra. 
 
 113. Lard, ij ; sulphur, 3v ; carbonate of 
 potash, water, aa 3ij. Used in scabies. Hardy. 
 
 114. Sublimed sulphur, Jss; ammoniated mer-
 
 11C CUTANEOUS P H A R M A C O P (K I A . 
 
 cury, gr. v; creasote, gtt. iv; olive oil, 5U ; 
 hirtl, oj. Used in scabies. 
 
 115. Olive oil, 3"ss ; lard, 5~ss; powdered 
 
 acre, 5VJ- Soak the stavesacre in hot oil and mix. 
 Used in phthiriasis. 
 
 116. Quicklime, Ibj ; flowers of sulphur, Ibij ; 
 water, Ibxx. Boil until 12tb remain, and then 
 filter. Used in scabies Vlemingk's Solution. 
 
 117. Iodide of potassium ointment is very 
 efficacious in scabies. 
 
 118. Sulphur ointment, 5ij ; oil of chamomile, 
 gtt. xx. Used in scabies. 
 
 119. For phthiriasis the ordinary white precipi- 
 tate ointment of the Pharmacopoeia is as good a 
 remedy as any, diluted from 5 to 10 times. 
 
 120. Liquid storax, 3 j 5 lard, sij. Melt and 
 strain. Used in scabies. Anderson. A little sul- 
 phur may be added if thought desirable. 
 
 REMEDIES FOR VEGETABLE PARASITIC 
 DISEASES. 
 
 121. Perchloride of mercury, gr. x to xx ; elder- 
 flower ointment, oj- Used in the early stages of 
 fovus and tinea tonsurans. 
 
 122. Carbolic acid, 3j 5 glycerine, 333 to 3jj. 
 Used in linea tonsurans. Or the same with rose 
 water, siv, in tinea circinata. 
 
 123. Hyposulphite of soda, 3 iij ; dilute sulphurous 
 acid, 3ss; water, q. s. ad 3"xvj. Used in all forms 
 of parasitic disease. Startin.
 
 REMEDIES FOR PARASITIC DISEASES. 117 
 
 124. Perchloride of mercury, gr. ij toiv; alcohol, 
 5iv ; chloride of ammonium, 5ss ; rose water, q. s. 
 ad 3vj. Used in scabies, phthiriasis, and tinea 
 versicolor. 
 
 125. Saturated solution of sulphurous acid, 1 
 part ; water, 2-4 parts. Used in all the tinese. 
 
 126. Pyroligneous oil of juniper, 5ij to 5iv ; lard, 
 ^iiss. Used in tinea. 
 
 127. Hyposulphite of soda, 5iv; glycerine, -;j ; 
 distilled water, |vj. Used in pruritus vulvas and 
 tinea versicolor. 
 
 128. Ammoniated mercury, gr. yj-xxx ; red oxide 
 of mercury, powdered, gr. vj xxx ; lard, j. Used 
 in all forms of ringworm. Startin. 
 
 129. Strong ammonia liniment, ^ss; castor oil, 
 3ss; spirits of turpentine, purified, ^ss; ammoniated 
 mercury, gr. xv. Brush into the scalp with a hard 
 brush until irritation is set up. For Baldness. 
 
 130. Tincture of cantharides, |j ; distilled vinegar, 
 3iss ; glycerine, 5iss > spirits of rosemary, iss ; 
 rose water, Sviij. To be well sponged into the 
 scalp night and morning. 
 
 131. Blistering fluid, 5j 5 sulphate of zinc, gr. xx ; 
 balsam of Peru, 5iss ; powdered galls, 5U 5 lard, j. 
 For tinea tonsurans. 
 
 132. Subacetate of copper, gr. xxx; birch oil, 
 5iij ; lard, 3j. Same: 
 
 133. Sulphur, tar, tincture of iodine, aa j ; lard, 
 3J. Same. 
 
 134. Carbolic acid, 3j ; sublimed sulphur, 5"j 5
 
 118 CUTANEOUS PHARMACOPEIA. 
 
 tincture of iodine, 5'ij ; vaseline (gclatum petmlci) 
 or lard, 5j- In tinea tonsurans. 
 
 135. Blistering fluid, 5j ; sulphate of copper, 9ij ; 
 powdered galls, 3j ; vaseline, 3j. For ringworm. 
 
 136. Iodine, 3j ij I colorless oil of wood tar, 
 Sj. This preparation is known as " Coster's pa-tr." 
 
 DIET IN SKIN DISEASES. 
 
 There are one or two observations to be made on 
 this subject that may be of use in the management 
 of these diseases. 
 
 Firstly A distinction must be made between 
 the diet of the private and hospital patient. The 
 latter often only requires to be well fed up, and his 
 disease then speedily goes ; the former, on the other 
 hand, often needs to have a check put on the quan- 
 tity and quality of his food. 
 
 Secondly. In children skin diseases may arise 
 directly from defective alimentation, as in the case 
 of eczema; and it is frequently the case that the 
 child, the subject of eczema, intertrigo, or psoriasis, 
 has not a sufficient supply of milk, either from 
 excessive dilution or otherwise. 
 
 Thirdly. The regulation of the diet, setting 
 aside the question of quantity or quality, is as a 
 rule needed not so much to directly influence the 
 skin disease as certain states of the general health ; 
 which modify the particular disease present ; for 
 instance to meet especially dyspeptic, gouty, and 
 rheumatic conditions, but particularly the former.
 
 DIET IN SKIN DISEASES. 119 
 
 In dyspepsia in connection with eczema, acne, 
 psoriasis, or congestion of the face, it is advisable, 
 especially if the urine be very acid, to avoid sugar, 
 tea, coffee, alcoholics, beer, raw vegetable matter, 
 with unripe or uncooked fruit, veal, pork, seasoned 
 dishes, pastry, and the coarser kinds of vegetables, 
 but especiall}' all articles whose use is followed by 
 heat or flushing of the face and by flatulence and the 
 like. Milk, the common meats, a light kind of 
 bread, and some very light wine should be the diet 
 of dyspeptic patients, whose skins are at all in a 
 state of irritation. In very many cases the stomach 
 is at fault at the outset, and a careful regulation of 
 the diet is of the utmost importance as an aid to 
 the other means adopted to correct faults in other 
 parts of the 83- stem. 
 
 In gouty subjects much the same line is to be 
 pursued. As regards stimulants, hock, a good 
 light claret, Moselle even, but not the sparkling, 
 or whisky in Vals water, are the best beverages. 
 
 In strumous subjects, the diet should consist of 
 as much fatty matter as possible. 
 
 Fourthly. In children who suffer from ringworm, 
 it is desirable to give as much fatty matter as possi- 
 ble, by means of milk, cream, eggs, and fat meat if 
 they be got to eat it. 
 
 Fifthly. In syphilis, the greatest care should be 
 taken to avoid anything beyond the most moderate 
 use of stimulants: their abuse in this disease is a 
 source of the greatest aggravation.
 
 120 CUTANEOUS PHARMACOPOEIA. 
 
 Sixthly. In all cases in which the onset or early 
 stage of a skin disease is accompanied by i'ebrilc 
 disturbance, however slight, or in which the disease 
 is very hyperji'inic. stimulants should be avoided, 
 and the plainest and simplest diet ordered. In 
 marked cases of this kind, a milk diet for a while is 
 often found to be very beneficial. 
 
 Seventhly. In some cases in which the skin is 
 hyperremic, this condition is much increased by the 
 ingestion of food, especially if dyspepsia exists, in 
 consequence of the sympathy existing between the 
 stomach and the skin of the part affected. This 
 state of things is especially marked in such discuses 
 as acne, congestion of the face, and non-parasitic 
 sycosis. Stimulants must be avoided, except they 
 be diluted with some alkaline water: the use of a 
 diet appropriate to the dyspepsia must be rigorously 
 enforced. 
 
 Eighthly. It is said that psoriasis requires an 
 ample meat diet ; but the patient must be dieted, 
 and not his disease i. e., the diet should be plain 
 and nutritious, and adapted to the constitutional 
 peculiarities of the individual according to circum- 
 stances. 
 
 Ninthly. In all cases where a skin disease has 
 become chronic, and where there is debility, the 
 patient should be allowed a fall, unstimulating 
 diet. 
 
 THE END.
 
 University of California 
 
 SOUTHERN REGIONAL LIBRARY FACILITY 
 
 405 Hilgard Avenue, Los Angeles, CA 90024-1388 
 
 Return this material to the library 
 
 from which it was borrowed. 
 
 JAN \
 
 
 1876 
 Fox, Tilbury* 
 
 Epitoire of skin diseases. 
 
 MEDICAL SCIENCES LIBRARY 
 
 UNIVERSITY OF CALIFORNIA, IRVINE 
 
 IRVINE, CALIFORNIA 92664
 
 1970 01953 6934