A manual of the practice of medicine / by Frederick Taylor.

Taylor, Frederick, Sir.

Date:: 1891

Credit: A manual of the practice of medicine / by Frederick Taylor. Source: Wellcome Collection.

869/966 page 849

$obviously the result of the irritation of the body-louse, and 1 shall speak of it when treating of parasites. Prurigo consists originally of minute papules in the skin, which are at first not so much visible as palpable, having the colour of the skin, and only later becoming i)ink and red. They are not collected in groups, but scattered. As they are accompanied by severe itching, they are soon scratched, the heads of the papules are removed, and a small blood-scab is the result. More violent scratching leads to enlargement of the papilkB, thickening and roughening of the skin, the natural furrows are deepened, the surface is covered with mealy scales, the downy hair is destroyed, and when the hand is passed over the skin it feels like a nail-brush or like rough brown paper. Besides the excoriation of the pai^illa?, more extensive scratch-marks, abrasions, and scars may be caused, and other secondary lesions, such as eczematous patches, urticaria, pustules, enlargement of the femoral, axillary, or elbow glands, and finally, more or less deep pigmentation of the skin. The x>cU'ts first affected are the extensor surfaces of the legs and arms, especially the former. The chest, back and front, the abdomen, and gluteal regions are all affected, even a few papules may appear on the face ; but the flexures of the elbow and knee, the axillte, the genitals, the ankles, wrists, i)alms, and soles are always spared. JEtiology.—It is more common in males than in females, and among the poorer classes. Different statements are made as to the influence of cold, but it is certain that winter cold does cause in some people a pruriginous condition, especially of the legs (P. hjjemalis). It commonly begins in infancy, and continues, unless vigorously treated, for the rest of life. Varieties.—P. mitis and P. ferox have been described; they appear to differ only in intensity. Ilebra regarded as a special and incurable form the very intense cases wiiich he saw in Vienna; but there seem to be cases intermediate between those and the milder forms commonly seen in England. Pathology.—The early change is an exudation into and above the papilla of leucocytes or serum, which also infiltrate, and lilt up the epidermis. As to its origin beyond this, little is known, Crocker lays stress on its early symptoms in childhood being urticarial, and regards it, therefore, as primarily a neurosis. Diagnosis.—Very similar conditions are produced by pediculi. These insects should, therefore, be sought for {see Phtheiriasis). Prurigo is, however, distinguished by the age of the patient, the long history of the disease, and the distribution of the lesions. Treatment.—This must consist of the frequent use of warm water, or alkaline baths, and the thorough inunction of soap and emollient ointments. Tar and sulphur preparations are also of value. Whatever method is employed must be continued daily and perseveringly. The following may be used :—Spermaceti oint- ol$

A manual of the practice of medicine / by Frederick Taylor.

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