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
Licence: Public Domain Mark
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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![come covered with blackish scabs, of no great thickness, which are followed by small ulcerations. A very characteristic general appearance of the countenance, which it would be difficult to de- scribe, attends this complaint. The skin is foul, the features are drawn, and the whole body is emaciated, wan, and, as it were, etiolated ; the countenance is wrinkled, giving the appearance of extreme old age, and a peculiarly diseased odour is exhaled. (^Cazenave et Schedel, Op. cit.) The pustules ot the ecthyma syphiliticum are distinguished from those of the other species by being surrounded by an areola less broad, but of a dark copper or violet colour; by their thicker scabs, furrowed circularly ; by being succeeded by ulcers round and deep, with precipitous edges, and being invariably followed by a depressed in- delible cicatrix, and by being generally attended by some concomitant constitutional symptoms, such as inflammation and superficial ulcerations of the fauces, pains of the bones, sometimes iritis, whilst the history of the case affords the evidence of some primary affection. Mr. Carmichael, who is peculiar in his opinions in limiting the true syphilitic disease to one form of eruption, does not consider the phlyzacious pustules to be of that nature. He considers them as consecutive of a peculiar primary ulcer, which he describes as characterized by a reddish-brown surface, bordering closely on the phagedenic cha- racter, 'having its edges raised and well defined, not excavated, but either on a level with the sur- rounding skin or considerably raised above it, ap- pearing at its commencement in the form of a small pustule, attended with itchiness. According to his observation the secondary eruption is pre- ceded by fever. (^Carmichael on Venereal Dis- eases, 1825.) The view which Mr. Carmichael entertains of this eruption leads him to consider mercury as unnecessary for its cure; he therefore depends upon antimonials, sarsaparilla, and guaiacum for the constitutional remedies ; zinc lotions and rest in the primary affection ; sulphur fumigations, or equal parts of tar and sulphur ointment as the local remedies in the secondary eruption. But as this method of treatment has not met with general sanction, the greatest number of practitioners think it safest to have recourse to the specific cure. This has been already described at length under Acne Sypliiliticum. (See Acxe.) [This form of ecthyma, as well as that which attacks chiefly the legs of old and cachectic per- sons who have lived intemperately, is well treated by the iodides, especially the iodide of iron.] When an infant at the breast is the subject of this eruption, the remedy should be introduced through the system of the nurse, either by admi- nistering to her the liquor ox3inurijtis hydrargyr., or by the friction of mercurial ointment; and if the health of the nurse does not allow of this manner of introducing mercury, the same may be effected by giving the infant the milk of a goat which has been submitted to the friction of mer- curial ointment. These methods have been used lit the Hospital of St. Louis at Paris, and followed with the most complete success. But the mercury, if necessary, may be also directly given to the in- fant ; either small doses of the hydrargyrum cum creta, or minute doses of the oxymuriate of mer- cury in decoction of elm bark or emulsion of bitter almonds, as recommended by Dr. A. T. Thomson. (Bateman's Synopsis, 7th edit.) T. J. Todd. ECZEMA, (from ft-'^fw, effervesco,') is a disease of the skin, characterized at its commencement by the existence of minute vesicles, which are usually closely crowded together, and terminate either in the absorption of their contained fluid, or in its effusion and subsequent concretion into thin scales. It is accompanied with a burning heat and tingling of the inflamed portions of the skin. The disease is not contagious, is usually unattended with fever, and may, for the most part, be traced to some irri- tating cause, either acting directly on the cutaneous surface, or internally through the medium of the constitution. Willan and Bateman, who have always endea- voured to seize on the earliest appearances pre- sented by cutaneous diseases, as being the most constant and characteristic, have placed eczema in their sixth order, vesiculae; whilst Alibert, whose classification is usually founded on the more obvious, though less distinctive, phenomena occur- ing in the advanced period of these affections, a period when several species which were originally dissimilar often become confounded in their exter- nal features, though still unlike as to their even- tual progress, and as to their appropriate modes of cure, has placed it in his order dartre squani' meuse. Thus he has grouped it along with some of the true scaly diseases, and along with some of the papular ones. Struck, however, by the abundant serous secretion by which it is usually moistened, (and which should have led him to a knowledge of its essentially distinct nature, by turning his attention to its primitive vesicular form, the source of this moisture,) he adds the characteristic epithet humide. M. Biett, who, to an intimate acquaintance with the labours of his own countrymen in this department of pathology, adds an extensive know- ledge of the works which have appeared on the subject in England and Germany, usually mani- fests a decided preference for the classification and general views of Willan and Bateman. But in respect to eczema, he thinks these authors have too many subdivisions of the disease, and have spoken in too sweeping a manner of the absence of inflammation around the vesicles, and of fever; as the former almost always exists to a certain extent, and if the local affection occupies much space, some fever usually results. The latter fact, however, we think is very plainly hinted at, if not expressly stated, by Bateman himself. If the cutaneous affection be very severe and extensive, we often also find inflammation of the mucous membranes to coexist. Rayer, a more recent writer, whose views often manifest a somewhat singular coincidence with those which Biett has been in the habit of pub- licly teaching for many years past, emits the same opinion as to the unnecessary subdivision of this affection in the English classification, and pro- poses to substitute a two-fold division, viz. into acute and chronic, as more practical and useful](https://iiif.wellcomecollection.org/image/b21197040_0745.jp2/full/800%2C/0/default.jpg)
