Volume 1

Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne.

Date:
1906-1909
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    61/576 (page 43)
    menopause. Alcoliol is a frequent canse of tlie stomach catarrh. Rosacea is thus apt to lie a souicwliat complex affection, and its manifestations range through the various degrees of more or less stereotj'ped hypertemia, genendly with the added phases of selwrrhttic catarrh, and secondary infections with pustulation. It may affect the whole flush area of the face or ordj^ certain portions. Some difficulties of diafpiods may arise from late suppiu'ating nodular syphilides localised to the face, and the rare diffuse hypertrophic forms may simulate the leonine aspect of leprosy. Treatment.—As the etiology of acne vulgaris is unsettled, the treatment is to some extent empirical. Internal Treatment.—Whatever the influence of gastro-intestinal or genital disorders, or general states, such as anfcmia and poor initrition with feeble circulation, may be, it is unwise to neglect the correction of any departure from the standard of health. Any defect in this direction should be corrected by appropriate means which we need not consider in detail. There are no specific internal remedies on which we can rely. Arsenic has no great influence. Sulphide of calcium was at one time highly recommended in pustular acne, but is disappointing. Ergot also has its advocates, especially where men- struation is at faiilt. Local treatment is of most imjiortance in the removal of the eruption, and our endeavours nnist be directed (1) to clear away all existing lesions, and (2) to prevent the formation of fresh ones. In patients pursuing their daily avocations the active treatment about to be discussed should be carried out at night, and soothing or cosmetic remedies, such as cold cream or the calamine lotion to which bichloride of mercury may be added, applied in the day- time. The comedones plugging the pilo-seliaceous follicles are the basis upon which so many secondary changes are grafted, and it is there- fore absolutely essential to clear them all away with the contained lanTigo-hairs and organisms. The comedones are extracted by means of the finger-nails, guarded V)y a silk handkerchief, or by a watch-key with bevelled edges, or by one of the numerous comedo-extractors recommended. The extraction is greatly facilitated by loosening the plugs by means of a pricker or needle, and particularly by a preliminary softening of the skin by prolonged steaming, bathing with hot water, or a local water bath effected by means of an impermeable dressing. A vigorous sham- pooing or friction with a towel is desirable. Massage has also been recommended, and Xevins Hyde has devised a massering ball with which he rolls out the plugs. P^xtraction of comedones should be immediately followed by the ajiplica- tion of some disinfectant lotion, or. better still, ointment. Not only is it difficult, however, in many cases to extract all the comedones in this way, but fresh ones continue to form unceasingly. Moreover, we have to deal with the generalised changes in the skin, which Sabouraud ascribes to a parasitic oily seborrha'a, and Unna to a hyperkeratosis. Whether we adopt either of the latter theories or fall Viack on the older view of a jiurely fTuictional disorder, it is found practically that the local application of certain remedies with keratolytic, stimulating, reducing, and disinfectant properties is useful. Soap is constantly interdicted, nevertheless a soa]) treatment, and often a vigorous one, is apt to be most useful. The selection of a soap, and the energy and frequency of its application, must depend on the case and the reaction. The soap may l)e left on all night, or be washed off, and the skin then soothed Viy a bland powder, or be further treated. Sometimes toilet, soda, or castille soaps suffice, but generally a soft potash soap is called for, such as the lin. saponis, or lin. potass, iodidi c. sapone, or Hebra's sp. saponis alkalinus (sap. virid. 3ij., sp. vini rectif. sj.). A sand soap (Auspitz) or milder marble soap (Unna) finds favour with some. Amongst medicated soaps (superfatted (»r alkaline, powder, liquid, or solid) those con- taining sulphur, ichthyol, salicylic acid, naphthol, or bichloride of mercury are useful. The methodical application of these soaps causes a maceration and stimulation of the skin, a moderate exfoliation of the cuticle and lining of the follicles, and helps the disinfection. To assist these processes we can apply, after re- moval of the soap, or at other times, one of the following lotions. The type of the sidphui- lotion is Kunnnerfeld's lotio su/j^/iKris cnm tragacanth :— Sulph. prajcip. .... .ij- Camphor ..... gr. x. Pulv. Tragacanth . . . 7)]- Aqute Calcis et Aqiue Ros;e . aa ^ij. This formula is varied endlessly, chiefly by the substitution of etiier and spirit for the lime and rose-waters, anil glycerine for the tragacanth, or the latter ingredient is omitted. Vlemingkx's solution (quicklime, 5ss. ; sublimed sulphur, gj. : water, 5X. : lioil down in an iron vessel to 3vj., and filter) is too sti'ong, and uuist be well diluted and used carefully. Sid])huratcd potash may be used in the folio-wing formuhe :— Potas. Suljihurat. . . . .j- Tinct. ik'nzoin .... (ilycerine ..... Tjiss. Aqute Rosa' ad . . . . .^iv. Kaposi gives the following ^/rts^t'.s: lac sulplniris, 10; spirits of wine, 10; glycerine, I'ftO: or sulphur, 10: spirit of soft soap, 20; spirit of lavender, 60; balsam of Peru, 1*50; spirit of camphor, 1 ; oil of Bergamot, 5 drops. Unna's