The cyclopaedia of practical medicine : comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc. / Edited by John Forbes, Alexander Tweedie, John Conolly.

Date:: 1848

Credit: The cyclopaedia of practical medicine : comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc. / Edited by John Forbes, Alexander Tweedie, John Conolly. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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$taraxacum, and sulphurous mineral waters, as those of Harrogate, are applicable. These last are of known efficacy, and are much to be pre- ferred to the saline mineral waters. In all cases an open state of the bowels is of importance, but much purginsr is generally detrimental. We have great doubt whether any constitutional remedy has a specific action upon the local disease. In France and Germany the dulcamara and viola tricolor have been much used ; but we think that, united with the general treatment, more benefit is derived from the use of the liquor potassae taken a few hours after each meal. A judiciously directed topical treatment is of great importance in the cure of this disease. In sudden and acute attacks a few leeches may be advantacjeously applied near the seat of the com- plaint, especially when this eruption affects fe- males at the critical period of life, although, in these cases, small general blood-lettings are some- times of greater service. In the same state, mild, tepid, demulcent applications are to be frequently used; amongst these the decoction of beans has always enjoyed a great reputation : and as the in- flammatory affection subsides, sulphuretted lotions form the most useful applications. If the disease is not benefited by these means, more stimulating lotions may be had recourse to, but in general they are less useful in this species of acne, and require more circumspection, for they not unfrequently aggravate the complaint. Gentle astringent lotions of alum, combined with a very small quantity of alcohol, are sometimes very useful, and in an in- dolent state of the local disease, the vapour-douche directed to the part affected, has been often found of great service ; the same state also sometimes admits of moderate friction, or resolving applica- tions. It is to these cases that the remedy of Am- brose Pare, a blister applied to the diseased part, deserves consideration, a practice the utility of which has been occasionally verified in the Hos- pital of St. Louis. Nor arc the general principles of surgical treatment to be neglected here ; for when the vari are seated in the follicles, the focus of irritation is removed by evacuating them. Besides these general and local means of treat- ment, the nitro-muriatic foot-bath, in the propor- tion of two ounces of the acid to twelve pints of water, has been very much recommended ; and in many diseases of the skin we have found the greatest benefit from sponging the sound parts of the skin, two or three times every morning, with a lotion consisting of two drachms of nitro-muri- atic acid, and two pints of water. It is also fre- quently of advantage to apply a blister to the arm, or to open an issue as a derivative. 5. ACXE SYPHILITICA. Sijn. Gutta rosacea syphilitica (^Plenck) ; Sy- philide pustuleuse miliare (^Alibert^; Pustules S3'phi]itiques psydracees {^Rayer.') The multifarious forms of cutaneous diseases which have been described as originating in syphi- lis, may fairly be said to have deprived that dis- ease of any specific character, for there is scarcely a morbid appearance presented by the skin which may not, in a modified state, be found amongst syphilitic eruptions. But if any one will take the pains to examine into this matter, he will find, what might reasonably have been expected as be- ing more in accordance with the general laws of pathological phenomena, that though there are certain forms of cutaneous disease essential and peculiar to syphilis, the greater number of those described as syphilitic, depend upon the constitu- tional predisposition of the individual, modified by the syphilitic virus ; and that whilst the influ- ence of this disease impresses upon them a geno- ral character, their particular form depends upon the pathological peculiarity of the individual. Thus, if lichen, lepra, or any other cutaneous dis. ease, makes its appearance in persons tainted with the venereal poison, these diseases, though origi- nating in ordinary causes, will suffer a relative modification. In proof of this, we find that the syphilitic acknowledges the same causes as the other eruptions, being excited by errors of diet, violent exercise, strong mental emotions, &c. It seems, therefore, more natural in a classification founded on external characters, to distribute the syphilitic eruptions in each genera as their exter- nal appearance would require them to be arranged, rather than to confound them together under a class of anomalous eruptions. In this way the general treatment required for this disease may be modi- fied by the peculiar character of each eruption, and the student will be led more naturally to find the place of the eruption in the classification. This is evidently the view which Plenck took of these diseases, and the plan which Willan intend- ed to pursue; but M. Alibert, as faulty in method as correct in description, has formed the venereal eruptions into a class under the name of syphi- lides, and M. Biett, to whom we are so much indebted for a more correct knowledge of many of these diseases, has omitted to correct this error of classification. They who are conversant with diseases of the skin, will find some difficulty in following Mr. Carmichael in arranging these erup- tions under his papular, pustular, phagedenic, and scaly diseases, and will be disposed to doubt whe- ther, under these descriptions, he has been so suc- cessful as to include such as are pecuhar to, or characteristic of, the venereal disease. Under the term gutta rosacea syphilitica, Plenck had marked the acne syphilitica. It corresponds nearly to the disease described by Alibert, under the term syphilide pustuleuse miliare, and, by Biett and Rayer, pustules syphilitiquespsydracees. It is the least common of the syphilitic pustular eruptions, and affects chiefly the face, forehead, neck, and trunk. The pustules of this eruption correspond very neary in form and dimensions to those of acne rosacea; they are round, conical, and acuminated, surrounded with an inflamed areola, and possess the true character of vari, sup- purating only at their apex, and invariably termi- nating in tubercles. They are, however, distin- guished from them by their deep, red, amaranthine, or copper-coloured areola, by their brownish yel- low scab, and by their leaving a small, slightly- depressed cicatrix. A correct delineation of acne syphilitica is still a desideratum in this branch of medicine; but, in general, the nose, cheeks, and forehead present a livid copper colour, as if stain- ed with the lees of wine. In these discoloured patches, pustules appear from time to time, which leave behind them small dark red tubercles, chiefly on the forehead, nose, or adjacent parts of the cheeks. As the pustules succeed each other, they are to be seen mixed together in every stage of their process. With the acne syphilitica may$