Diseases of the skin : their description, pathology, diagnosis, and treatment / by H. Radcliffe Crocker.

  • Crocker, H. Radcliffe (Henry Radcliffe), 1845-1909.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the skin : their description, pathology, diagnosis, and treatment / by H. Radcliffe Crocker. Source: Wellcome Collection.

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    3° must be led up to with gentleness and tact, after preliminary con- versation has put her at her ease. On first seeing a patient, the sex, apparent age, general confor- mation, complexion, and aspect are noted. Certain questions are then to be asked. How long have you had it ? is the first and most important; it often clears the ground of so much, and will, in many cases, be decisive as to the nature of the disease. Thus, in a wide-spread erythematous eruption, a duration of two or three weeks would at once exclude all the exanthemata for which it might be mistaken ; or, in an infiltration, a duration of several years, with very slow extension, would point to lupus rather than syphilis. The next question is, What was its course ? A large number of eruptions develop in a characteristic way, and alter considerably from their first appearance. This is especially the case in erythema multiforme, in many cases of eczema, in urticaria papulosa, etc. An eruption is also often modified by various circumstances besides time, such as scratching, poulticing, or previous treatment by another practitioner. Then the eruption may come out all at once, as in herpes; or in successive crops, as in pemphigus; or by continuous or inter- mittent spreading, as in pityriasis rubra and in many cases of eczema; or some lesions will be coming and others fading, as in secondary syphilides and hydroa; or again, there may be constant recurrences just when the disease appears to be cured, as occurs commonly in eczema. The third question is, What symptoms, especially as regards itching, fever, etc., attend or preceded the eruption? The fourth question, What is its cause ? has to be answered, as a rule, by the doctor himself, after eliciting from the patient, by question and physical examination, the various external and internal conditions antecedent to the outbreak. A knowledge of general and special etiology is necessary for complete investigation on this point, which would be deferred until the nature of the eruption has been determined. Whether the eruption is only part of a general disorder, or is a disease of the skin itself, will often be decided by the presence and nature of the constitutional symptoms. The physical characters of the eruption must now be examined. The eruption, as a whole, should primarily engage attention, first as regards its distribution and extent. Thus, it may be universal as in pityriasis rubra, pemphigus foliaceus, or lichen ruber; general,