A theoretical and practical treatise on the diseases of the skin / by P. Rayer.
- Pierre François Olive Rayer
- Date:
- 1845
Licence: Public Domain Mark
Credit: A theoretical and practical treatise on the diseases of the skin / by P. Rayer. 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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![man complication of chronic erythema of the face rank for having united two dis- istind ander the same description, In fact, the thematous affection, whilst rosacea is decidedly i at importance to distinguish, 1>\ means of ■ il examination into the state of the different organs, the idio- frthema of the buttocks, verge of the anus, scrotum, and led l'v fdthiness, from that which often coincides in .-born infants with acute or chronic inllammatory affections of the mucous membranes of the caecum and colon, and which has very ntly the saint' appearance. A like redness about the buttocks and genital organs of the infant has also been mistaken, by superficial mptoms of B syphilitic affection; at the present time such mistakes are, happily, very rare. This variety of erythema, the only one that can be confounded with erysipelas, differs from it by the absence of tumefaction in the subcutaneous cellular membrane. As to the other varieties of erythema, erysipelas is precisely the form of skin disease with which they are least likely to be confounded. Tin1 chaps consequent on eczema, lichen, and syphilitic affections of the yulva, margin of the anus, ears and nipples, and the cracks pro- duced li\ pityriasis or psoriasis of the palms of the hands and soles ol the feet, differ from those observed in the chronic erythemata, by being preceded or accompanied by other elementary and characteristic conditions. Erythema nodosum cannot be confounded with any other variety of exanthema : it differs entirely from roseola by the deep tumefac- tion that characterizes it. It sometimes accompanies attacks of rheumatism. Erythema annulatwm differs from annular herpes by not being surmounted by vesicles. To the erythema lave, some artificial cxanthematic inflammations might with propriety be con- nected. 222. Prognosis.—Acute erythemata, whatever their extent, are not in themselves serious complaints, and their duration does not, gene- rally, exceed two or three weeks. Chronic erythemata, produced and kept up by external causes, get well rapidly under proper treat- ment ; hut the cure of very old erythemata, that have come on with- out any evident physical or chemical cause, is as difficult as it is uncertain. 223. Treatment.— When the varieties of acute erythema are apy- retic, and without complication, they get well of themselves in the space of a week or two. When they are painful or accompanied 1>\ lever, they must he treated by means of emollients, by baths and fomentations of the decoction of althea or of bran, gently warmed or almost cold ; by general bleeding, if the disease extends to the conjunctiva, and if the patient is of a robust constitution or subject to epistaxis. The diet oughf to be cooling; and diluents, such as lemonade, whey, barley-water, &.C, ought to be freely used. The pain and morbid secretion in the intertrigo of children are often diminished by attention to cleanliness, by changing the napkins frequently, and by powdering the inflamed and chapped skin well, alter having bathed and cleansed the parts by means of a muci- laginous fomentation. In adults, when intertrigo am appears to be the effect of riding, or that of the tops of the thigh follows much walking, the skin must be rubbed with tallow softened by heat. When the erythema is pro- duced by pressure or the weight of the body, (eryth. paratrimma ges,) the part must be covered with some soft or soothing r, and the weight of the body and the pressure thrown as much as possible upon other regions. This species of erythema is accompanied by cutaneous or subcutaneous ecchymosis, a two- alteration that is frequently followed by gangrene in patients ed with dothinenteritis, and in elderly persons. To prevent this unfortunate termination, the decoction of bark, solutions of alum, and infusions of oak bark are sometimes had recourse to with The erythema that is produced by the distension of the skin in ■•» Md an ! ' be treated by cold mucilaginous lotions, horizontal position of the limbs, the support of a bandage, and but rarely by the local abstraction of blood, which, however, is some- ; in addition to these, the treatment proper in dropsical complaints must be enforced. The lesions that precede oraccompan) the development of acute erythematous inflammations, present peculiar indications. Genera] blood-letting is always required at the beginning of a rheumatic erup- uve fever; local bleedings from the abdomen or margin <>! the anus, are often useful in cases of gastro-enteritis, or of cseco-colitis in infants at the breast, attacked at the same tune with cry thematic affec- tions of the buttocks and thighs. 224. Chronic erythemata o\ the hands and feet, caused by exter- nal circumstances, are to be met by warm fomentations and bathing, by soothing cataplasms, and sometimes by vapour baths. Liniments, consisting of oil or lard, to which the oxide of zinc, in the propor- tion of an eighth [or a little camphor], is sometimes added, are usual remedies for chapped hands and feet. The affected parts are to he smeared, and a glove or leather sock to be worn night and day, in order to restore to the integuments the softness and pliancy they have lost. Chaps of the nipples are to be treated with mucilaginous fomenta- tions, as decoction of marsh-mallows, poppy-heads, &c, with the addition of a certain quantity of acetate of lead or sulphate of zinc— The nipple is to be kept anointed with any mild unguent, with which, when the pain is very severe, a small quantity of opium may be mixed. [The nitrate of silver in solution, or mixed with sperma- ceti ointment, often proves the best of all remedies in this trouble- some and, at times, serious complaint.] The nipple must be gently washed with tepid water, before the infant is applied, when nursing is not given up entirely. All remedies, however, commonly prove unavailing, unless the mother consents to deprive the child of its milk for some days at least, as, without this measure, the repeated application of the mouth causes so much irritation that the chaps are continually renewed. The mamma? are best depleted by the appli- cation of a proper cupping-glass furnished with a syringe, or by steaming the breasts over hot water. Should we succeed in healing up the excoriations in this way, suckling may be tried again, pro- vided the secretion of milk has not disappeared. Chapping of the nipples may sometimes be prevented by habitu- ating the parts to a certain measure of irritation, by gentle suction, previous to delivery, and keeping them covered with a shield of elastic gum, [bee's-wax or silver. The yellow bee's-wax shield to prevent the pressure of the clothes, the application of the nitrate of silver ointment (gr. iv to gr. viii, to =ss of unguent, cetac. or lard) and the use of the shield and prepared cow's teat, will, in a considera- ble number of cases, do away with the necessity of even suspending suckling for a day, much more of giving it up altogether]. («) Excoriations of the prepuce require the operation for phymosis, when they are owing to the distension and traction of the part during the erection of the penis. Excoriations of the anus require the use of soothing suppositories, hip baths, and bland injections; when the affection is complicated with spasmodic stricture of the rectum, it commonly yields to gela- tinous fomentations or stuping, but is cured more certainly and speedily by the double incision proposed by Boyer. Excoriations of the legs, complicated with oedema and petechia?, are best treated by the horizontal position of the limbs, by the pres- sure of a light bandage, and when the skin is very much inflamed, even by the abstraction of blood locally. Chaps and excoriations of the toes require the feet to be frequently washed, and a piece of soft lint to be interposed twice a day, between the several digits. The superficial excoriations to which new-born children are sub- (a) Small benefit will be derived from topical remedies in this troublesome and often exceedingly painful affection, unless the so frequently associated febrile irritation and derangement of the diges- tive function be removed. This is done by purgatives alternating with magnesia and the alkalies. Of the first, calomel, followed by castor-oil, Epsom salts, or rhubarb and magnesia, with compound powder of jalap, answers a good purpose. When stimulating washes are indicate,], I ]i;ive derived most benefit, in some cases, from the solution of sub-borate of soda in water and alcohol, and in others, from the fluid chloride- of soda of the shops, diluted with equal parts of water.](https://iiif.wellcomecollection.org/image/b21149495_0066.jp2/full/800%2C/0/default.jpg)
