The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1).

Date:
1845
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Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    phurcti ^i ;ft. lofio.) When stronger irritating remedies are necessary, which is, however, seldom the case, muriate of mercury, in small quantities may be added to the alcoholic lotions. (8. Aquae dest.'llut. Oss.; Alcohol. f.§i.; Hydrargyri chlurid. eorrosiv. gr. vi.ft. lotio.) It sometimes happens, that in old cases of acue simplex, much benefit is derived from exciting an inflammatory state of the eruption. Bateman mentions a lady who con- sidered herself much benefited, after a severe inflammation, and even excoriation of the face, which had been produced by a poultice of bruised parsley. But it is seldom necessary, in this spe- cies of the disease, to have recourse to the remedy of Ambrose Pare, revived by Darwin, who affirms that blistering the whole face, in small portions successively, is the most effectual remedy for the inveterate forms of this acne. The ancients, in the treatment of vari, chiefly relied upon external stimulant applications. These consisted of lotions and liniments, containing vinegar and honey, sometimes combined with an emulsion of bitter almonds, and sometimes with resin, myrrh, turpentine, and other gums, with alum, soap, and Cimolian earth ; or the bruised roots of the lily, cyclamen, and narcissus. But the fruit of the wild vine (labrusca) is the appli- cation which Pliny (Hist. Nut. lib. xxiii. cap. 14,) mentions as most especially useful. 2. Acne Folliculahis, Maggot Pimple. Syn. Acne punctata (Willan) ; 'lovdos (Greco- rum); Varus (Latin); Crinones, Crimones ( Va- riorum Auct.)\ Grutum milium (Tetitonice); Der Gries (Plenck); Punctae mucosa? (Darwin); Grubs (Anglice); Tannes (Gallict). Pustules, having the precise character of vari, are observed to have their seat in the sebaceous follicles ; sometimes originating locally from the accumulation and induration of sebaceous matter, causing their obstruction (emphragma sebaceum); and sometimes symptomatically, from inflamma- tion of the follicles, arising from some disorder of the internal organs. When the vari are produced by the first named cause, the sebaceous matter, by being exposed to the air at the mouths of the fol- licles, assumes a black appearance, and the pus- tules present a black point on their summit, sur- rounded by a very slightly raised border of cuticle. This circumstance, which gives sometimes a par- ticular feature to the disease, afforded Willan the specific character of acne punctata,- but for which as this appearance is far from being constant, and as pustules have their seat in the follicles without presenting it, we have substituted acne follicularis, as better explaining the nature of the affection. A loaded and obstructed state of the sebaceous follicles may exist to a considerable extent, with- out inducing inflammation ; and only very minute hard white tubercles, of the colour and size of millet seeds, are to be observed, from which the sebaceous matter being pressed out through the circular orifice of the follicle, takes a filiform shape, bearing a close resemblance to a maggot. That it really owes its form to the manner in which it is forced through the aperture of the follicle is obvious ; for, if the black spot is ruptured by a fine needle, it will be seen to be a mere deposition of sebaceous matter of a round form. In this state they are commonly known by the name of crinones, worms or grubs. [Recently, it has been found, that these follicles are occupied by a para- VOL. I 7 E sitic insect, (Acarus folliculorum,) which has been found alone or in clusters of several in a single follicle. In the perfectly healthy state of the follicles, they are few in number; but when sebaceous matter, which seems to serve them tor aliment, is allowed to accumulate, they abound. The insect was first observed by M. Simon, of Berlin, and has been since seen and described by Mr. E. Wilson, in his work on Diseases of the Skin.] As the matter accumulates and hardens, it becomes a source of local irritation, and the sebaceous crypts, in consequence of distension, inflame and form pustules, which suppurate im- perfectly. At other times these obstructed follicles remain stationary, without ever passing into the inflammatory state; or the accumulation of the matter goes on increasing until they form con- siderable follicular tubercles, resembling those of molluscum,and sometimes tumours of considerable size, or, occasionally inflaming, assume the ap- pearance of indolent boils. The disposition of the body to the accumula- tion of the sebaceous matter in the follicles of the skin is much dependent upon peculiarity of con- stitution, but is always very intimately connected with a constipated state of the bowels, so that in many individuals the necessity for aperient medi- cine is indicated by the sebaceous follicles appear- ing full or prominent. Besides this origin of follicular vari, they may also be produced directly without any collection of sebaceous matter either by local irritation, in which way some kinds of cosmetics seem to act, or by inflammation of the follicles arising sympto- matically from the irritation of the internal organs, as the bowels or the womb. The follicular may often be seen mixed with the simple vari in this and the other species of acne. Of this complication there is a very accu- rate delineation in Bateman's LXII. plate. For the removal of follicular vari, besides the general treatment of acne simplex, which is also applicable here, it is necessary to empty the folli- cles by mechanical means, either by pressing on both sides of the pustules until the hardened matter is sufficiently elevated to be taken hold of, or by employing a blunt curved forceps for this purpose. But when this state of the follicles exists, to a considerable extent, nothing so effec- tually empties them and clears the skin as the vapour bath, followed by the warm sulphurous bath. Lotions of sulphuret of potass, with or without alcohol, are of great service when the disease is of small extent. When the disease has subsided, and the state of the skin admits of it, general friction with the flesh-brush, a flannel glove, or a coarse towel, is of great use. The internal remedies most suitable in this complaint, are powders of sulphur, magnesia, and rhubarb, with an occasional saline aperient. Dr. Under- wood recommended the use of a solution of car- bonate of potass internally, and Dr. Willan was in the habit of occasionally prescribing the oxy- muriatic acid ; and there can be no doubt that any other medicines which improve the functions of the digestive organs and benefit the general health, have a considerable influence in correcting this unhealthy slate of the skin. It is probably in this way that the following alkaline tonic, recom- mended by Dr. A. T. Thomson, produces its effects i (R Zinci sulpliut. gr. xxiv. : Liquoris
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