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

  • Taylor, Frederick, Sir.
Date:
1891
Catalogue details

Licence: Public Domain Mark

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

    872/966 page 852
    striking symmetry is observed. Tlie face and scalp are not often attacked, and the palms and soles rarely. The nails are not infrequently involved: they become variously altered, opaque, thickened, pitted, furrowed transversely or immensely thickened, and discoloured. The amount of scale varies in different instances or in the same case at different times. In P. rupioides the scales are heaped into small conical masses, each on its circular base. The eruption is always dry, never moist or scabbing as in eczema. Itching is variable, but not, as a rule, severe. The general health is often perfectly good, or even robust. The disease breaks out spontaneously, often in early childhood, and even if not treated subsides after three or four months, to recur again after a quite uncertain interval. Sometimes the recurrence is twice a year (spring and fall as it is often expressed), or a period of years may intervene. In other cases a slight amount of eruption persists, and extensions take place from time to time. During recovery, pigment stains mark the situation of the patches, especially after the use of arsenic. -astiology—It affects both sexes, and nearly all ages; but it more commonly begins in early life. The only other certain fact in its causation is that it is hereditary; the view that gout and scrofula are causative antecedents has little in favour of it. Pathology.—It is an inflammation of the papilla) and corium, with increase of the rete, downgrowth of the same between the papillae, which appear correspondingly enlarged, and increase of the horny layers. Diagnosis.—In most cases it cannot be mistaken. Patches of dry eczema may resemble it, but the edges are not so sharp and the scales are not so thick and silvery. In i)soriasis of the scalp the scales are often yellow, and look like impetigo crusts; but psoriasis spreads beyond the scalp on to the forehead or neck, and there is always psoriasis of some other part of the body which will be distinctive. These last two points will also serve as between psoriasis and seborrhcea. The features of lichen ruber and x^ityriasis rubra have been sufficiently described. Patches of tinea circinata may look like psoriasis, but their small number, want of symmetry, small scales, and the results of microscopic examination will show their nature. Licpus erythematosus is recognized by its position on the face, the greater thickening of the skin, the sebaceous plugs, and the scars ; and scaly syphilides, by the small size of the lesion, the slight scaliness, the browner colour, and the concomitant symptoms. Treatment.—The best remedy is a combination of internal and external treatment, but one of these alone will suffice in some cases. Internally, arsenic is most frequently successful; it may be given in the usual way—that is, increasing doses of liquor arsenicalis, beginning with 3 or 5 minims, and stopping at 10 or lo minims, always after meals. Other forms in corresx)ond-
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