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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![joct, get rapidly well by attention to cleanliness alone, by the use of baths and fomentations, and the free application of powder to the inflamed parts. [If they are obstinate, some weak metallic wash (as zinei sulph. gr. xii to aq. font, vel rosa) giv) heals them imme- diately.] As to those chronic erythemata that are independent of outward causes, and fiery spots of the face (taches de feu), they often resist every curative means attempted. They have occasionally been successfully treated by the use of baths and steaming, alternated with the local administration of sulphureous vapours; in some cases, too, the cure has appeared to be aided by the use of purgatives. Historical Notices and Cases of Erythema. 225. Erythema has been differently and often imperfectly described in books of pathology. One of its varieties (redness about the margin of the anus), has been signalized as a disease peculiar to childhood; another chronic erythema has been entitled dartre erythemo'ide, thus mixing it up with vesicular and scaly diseases; and a third, erythema diffusum, has been confounded with erysipelas.—Cullen erred when he asserted that erythema was always without concomitant or second- ary fever. By regarding it as the lowest degree of erysipelas, Callisen shows that he was unacquainted with its principal varieties, though they are well described by Willan. Pellagra, which belongs to the order of squamous affections ; and acrodynia, which, in many respects, bears a strong analogy to pellagra; burns and frost-bites, which may appear under the bullous and gangrenous forms; the hydrargyria, whose form is vesicular, have all of late, but improperly, been in- cluded among the erythemata. Cases of the principal varieties of this exanthematous eruption, may be found in various special and periodical publications.1 Case I. Symptomatic Erythema of the buttocks and thighs: cceco colitis. The daughter of M. ****, six months old, at the beginning of Nov., 1824, presented all the symptoms of acute cco-cseolitis or inflammation of the mucous membrane of the caecum and colon: she had frequent liquid, glairy, sour, and at times sanguinolent motions ; pain was evidently excited by pressure along the course of the colon, which was not the case in the districts occupied by the other viscera of the abdomen; the great intestines were distended with flatus which was often expelled; there were fever and loss of appetite: the tongue was nearly natural. At the same time a number of red spots from half an inch to two inches in diameter, of an oval or irregular shape, strongly defined, but not prominent, appeared on the upper parts of the thighs, around the trochanters, and in the inguinal and ischiatic regions. The subcutaneous cellular substance did not participate in Ihe inflammation of the skin.—The symptoms all yielded within twelve days to the application of leeches to the anus, to the use of the warm bath and of emollient cataplasms, to injections of small quantities of decoction of marsh-mallows and of poppy-heads into the rectum, and to the antiphlogistic regimen generally. A month after- wards there was a fresh attack of intestinal inflammation, and a new eruption of these erythematic spots. The same plan of treatment was followed, and with the same success. The inflammatory affection of the great intestine has since recurred at intervals remote in various degrees from each other, and has always been accompanied by symp- tomatic spots of erythema on the hips and thighs; but the plan of treatment indicated, has always proved adequate to put an end to the disorder; and since the month of March, 1825, the child has thriven, and has always enjoyed good health. Case II. Erythema marginatum; patches scattered over the face and surface, of the body: Bronchitis.—I. Bailliot, 26 years of age, of a sanguine temperament and strongly built, entered La Charite on the 13th of Feb., 1827. This patient had been eight days previously 1 Schenck. Obs.med*. rarior. in-fol. lG44,p. 295 (Eryih.of the mammas).—Willan. Reports of the public Dispensary.—Edinburgh Med. and Surg. Journ., Jan. IN 11 (three cases of eryth. tuberculosum).—Journ. des hopitaux, in-fol., annee 2, p. 10 (Eryth. of the lips).—Journ. hebdomad, I. iv. p. 72 (Eryth. ciicinnaties).— Bulletin des sciences med.de Ferussac, t. xiii. p. 232 (intertrigo scrotalis).— Lond. Med. Gnz.. t. xi. p. 37-415 (Irritative eryth.).— Lond. .Med. Gaz., t. i. p. 587 (Sure navel W. Hunter).—Lond. Med. Gaz., t. v. p. 655 (Eruptive rheumatic fever. Cock).—Ali- bert. Precis sur les maladies de la peau, t. i. p. 273 (Dartre erythemuide). attacked with the eruption for which he now sought assistance. It was characterized by spots of a red colour, which disappeared on pressure, of an irregular shape, of various sizes, slightly prominent, and not itchy. A certain number of these spots were seen on the forehead and nose; the right eyelid was red and slighty cedematous, the left was only injected in a very small district. Similar patches were observed on the dorsal aspects of the forearms, where they were larger than on the face, and also behind the ears. Their surface looked as if sown over with small white elevations; but on raising the epidermis with the point of a pin, it was seen that there was no fluid effused beneath it. Some of the patches appeared to be sur- mounted by accidental vesicles. The patches were often confluent, others were distinct, and from three-quarters of an inch to an inch in diameter. The chin was covered with solid red lumps, with little tubercles flattened on their summits, in the intervals between which the skin had its natural appearance. Similar elevations, but of less size, occurred in different parts of the cheeks and neck; the cuticle that covered these was shining. One of the lumps of the chin was covered with a yellow crust, produced by the drying of a vesicle. The lips, of unequal redness, seemed marbled; on each conjunctiva, there was a patch of a very vivid red, towards the inner angles of the eyes, which were weeping. On the fore parts of the legs spots were also visible of a less intense degree of redness than those of the face. This erythema first showed itself upon the neck after two days of a violent cough and sense of lassitude. On the third day the patient took to his bed, since which time he has had shivering fits every evening; these continue all night. He complains of headache; the tongue is moist, without any redness of the edges, and is covered by a yellowish fur; he suffers from eructations and constipation, having had but one motion within the last eight days; the pulse is full, a little more frequent than in the healthy state ; mucous rattle at the posterior part of the left lung—(Venesectio ad sxii, mucilaginous lemonade for drink, and low diet prescribed). Feb. 15th.—The blood was found strongly buffed; the patient was sweating profusely: the spots of the eruption were prominent and less red on the face; the cuticle appeared wrinkled on the surface of those behind the ears ; some of the spots on the other parts were also of a less vivid red or livid hue. A few adventitious vesicles were observed full of serum. Feb. 16th.—The spots on the legs have faded; several of those on the face are white and shining, and on the lips they are paler and more collapsed. He complains less of headache, he sleeps better, the fever is diminished, and the expectoration is easy. Lemonade was continued as drink, emollient injections were prescribed, and better diet, broth or soup several times a day was allowed. 17th.— The patches of the forearms are becoming white towards their centres, and form a sort of ring ; those of the right forearm have become con- fluent ; those of the left are a little more extended ; others, as those behind the ears, and on the right upper eyelid, have disappeared, or such as still remain form little islets surrounded by the white or rose- coloured skin; a slight desquamation is taking place about the root of the nose, and behind the left ear. The spots on the legs are shrunk. He sleeps well; the respiration and expectoration are easy, and the appetite has returned. 18.—The redness of the spots declines more and more; their prominence diminishes gradually, especially in the centre; the cedema of the eyelids is no longer visible ; in a word, from this time forwards, the erythematous patches everywhere disap- peared, and were succeeded by a slight desquamation, so that the patient left the hospital perfectly well on the 28th, after a fortnight's confinement. Case III. Several varieties of erythema in the same individual.—M. Dalivot, 21 years of age, entered the hopital Saint Antoine, on the 4th of May, 1830. This young man, strong and well formed by na- ture, had never hitherto suffered from any disease of the skin. Within the last week, however, some red patches had appeared on the face, attended with itching which prevented him from sleeping. The digestive functions having been out of order, leeches had been ap- plied to the epigastrium. On the 5th of May, the face, the upper and fore parts of the chest, and the legs presented an eruption of spots of a livid red colour, raised above the level of the skin, irregularly cir- cumscribed, and not disappearing completely under the pressure of the finger. Some of these were as large as a sixpence, and rounded](https://iiif.wellcomecollection.org/image/b21149495_0067.jp2/full/800%2C/0/default.jpg)
