The theory and practice of medicine / by Frederick T. Roberts.

  • Frederick Thomas Roberts
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: The theory and practice of medicine / by Frederick T. Roberts. Source: Wellcome Collection.

    1156/1226 (page 1134)
    1131 THEORY AND Fit A CMC li OP MEDICINE. bo attacked by psoriasis, such as the elbows and knees, the buttocks, the scalp, and the extensor aspects of the forearms and legs, but patches may occur also widely over the trunk. Though usually widespread, an isolated patch may exist, which makes the diagnosis more difficult! Psoriasis occurs in both sexes, in all ranks of life, and at any a^e, from childhood upwards. It is extremely rare in infancy, although heredity is somatomes strongly marked. The papules are formed by a primary hyperplasia of the rete, with enlargement of the papilla? and secondary congestion, and increase of imperfectly formed cuticle. The disease is probably due to a peculiar morbid tendency in the skin itself; and although often occurring in apparently healthy subjects, the eruption in predisposed subjects is excited by almost any departure from a state of health, such as gout, struma, dyspepsia, debility from lactation, or pregnancy. The seasons of spring- and autumn seem to favour its out- break, and it is especially prone to recur. The diagnosis of psoriasis has mainly to be made from lichen planus and the scaly syphilides, but the latter will be considered under syphilis. Treatment.—In acute stages of psoriasis, with active congestion of the skin, soothing applications, such as watery compresses, oily appli- cations, or alkaline baths answer best, combined with diuretics and laxatives internally. In ordinary chronic cases the general rule is to carefully sift out any departure from health, should such exist, and correct it; and then to exhibit arsenic, which has a remarkable influence over a great number of cases. This drug should be given in increasing doses, carefully watching its effects, and continued some time after the disappearance of the eruption. Large doses of iodide of potassium have been recommended in the treatment of psoriasis. Recently Byroni Braniwell has demonstrated that dried thyroid extract is of great value. The dose should be 5 grains, gradually increased to 15 or 20 grains a day. The papules may be got rid of by the brisk infriction of various stimulant applications, chosen according to the site involved, the sex and age of the patient, the chronicity of the eruption, and the extent of the disease. It should always be borne in mind that these applications may be absorbed when applied over a large surface. Wo may enumerate, in order of increasing efficacy, mercurial salves, thymol, carbolic acid, naphthol, tar, and chrysarobin or chrysophanic acid. Ichthyol is also employed as a local application in psoriasis. Pityriasis rubra, or gsneral exfoliative dermatitis is a very rare affection, which commences as a reddened scaly patch, and as a rule rapidly involves the whole surface, so that in well-marked eases a striking appearance is produced, for the whole skin is of deep red hue, congested, and covered with large membranous scales, which are cast off in great quantities. The disease is a chronic one, as a rule, (hough occasionally tending to be acute. Patients may quite recover, or the disease may end fatally, and be complicated by remittent fever, albumi- nuria, pulmonary oedema, or marasmus. They are extremely sensitive to cold. Very exceptional cases of lichen ruber, eczema, and pemphigus foliaceus may be universal, and have then to be distinguished from pityriasis rubra. Treatment. — Locally bland emollient preparations arc called for, such as vaseline, lanoline, glycerine of starch, or linimentum ealeis applied after a bath taken lor cleanliness. Internally the general health must be steadily toned up by large doses of quinine, and, where I he disease is not too acute, by arsenic, large doses of iron, and such remedies.